C/,/;,»^=^ / <7 longitudinal fissure. Inflammation of the Liver. 57 afterward ice over the part. If from other causes, warm emollient and narcotic poultices are better, and antiphlogistics and calomel are dangerous. The bowels should be opened by Epsom salts or calomel and jalap. If* this does not abate the symp- toms in a few days, give a calomel pill of one grain every five hours, or rub a drachm of the strongest mercurial ointment into the side until the gums are found to be a little sore, when the frictions or pills must be discontinued until the mouth is well, and then again resorted to as before. If an abscess points outwardly, apply bread and milk poultices to the tumour, omit the mercury, use wine, bark and a ge nerous diet. As soon as matter is to be felt within it, open it at its lowest and most projecting part with the point of a sharp lancet, and let out its contents very slowly, taking care not to close the w T ound till this is completely effected. The nitric acid in doses of ten or twelve drops, three times a day, gradually increased, and steadily persevered in, will sometimes produce a cure. The mercurial plan, however, is to bo preferred. JAUNDICE. Symptoms. Languor, — loathing of food, — a bitter taste in the mouth, — vomiting, — the skin and eyes of a yellow colour, — the stools clayey, and the urine giv- ing a yellow tinge to rags dipped in it. There is a dull pain in the right side, under the last rib, which is increased by pressure. When the pain is severe, there is fever, — the pulse hard and full, &c. Causes. An interruption to the regular passage of the bile, which is carried into the blood, — bile lie* ing formed in too great quantities. The first is occa- sioned by gall-stones, a diseased liver, &c. Intem- perance is a very common cause, hence tipplers are more subject to it than others. 58 Compendium of Domestic Medicine, Treatment. Place in a warm bath, and allow to remain there some time ; when removed to bed, a grain or two of opium may be given every few hours until the pain is relieved. Bladders partly filled with warm water, or cloths wrung out of hot decoctions of herbs, may also be applied to the seat of the pain. If the stomach be so irritable as not to retain any thing on it, try fomentations and the effervescing mixture, or a blister to the part. As soon as some degree of ease is obtained* by these means, purgatives must be employed, and steadily persevered in; calomel and jalap, or Epsom salts, in the ordinary closes, answer very well. The diet ought to be vegetable, and should the disease have arisen from a neglected inflammation of the liver, it must be treated accordingly. Diaphoretics and resolvents should be given to remove the bile from the blood and the discoloration of the skin; for which acetate and muriate of ammonia,rhubarb, dandelion root, andchelidonium are recommended. Turpentine is particularly good if there be gall- stones or hardening of the liver. (See Inflam- mation of the Liver.) If putrid symptoms show them- selves, meet them with the remedies already directed for such cases. Regular exercise (on horseback, if possible) should never be neglected by persons sub- ject to this disease. * If, however, this cannot be done, and from the pain being very acute at one particular spot, there is reason to suppose that a gall-stone is lodged there, the following remedy may be tried, of which one-fifth or a little less may be taken every morning, drinking freely of chicken broth, flaxseed tea, or barley watei lifter it. Ether three drachms. Spirits of turpentine two drachms. Mix them. Ague Cake. 59 AGUE CAKE. This is the vulgar appellation of an enlarged spleen, and expresses with much brief meaning, the cause of the complaint, as it generally results from ill-treated or obstinate intermittents. It is, however, not productive of much uneasiness, and frequently disappears of itself. The plan of treatment must be governed by the cause: by in- termittents, quinine ; by chlorosis, iron with qui- nine,- by anaemia, quinine with sulphur, auratum, iodide of iron; by syphilis, mercury, &c. INFLAMMATION OF THE INTESTINES. Symptoms. Sharp pain in the bowels which shoots round the navel, and which is increased by pressure, — sudden loss of strength, — vomiting of dark coloured, sometimes excrementitious mat- ter, — costiveness, — small, quick and hard pulse, — high coloured urine. Causes. Strangulated ruptures, — cold, — accu- mulations of hard feces in the bowels, — colic, &o. Distinguish it from colic, by the pain being increased by pressure, whereas in colic it is re- lieved by it. Treatment. Consists in warm narcotic appli- cations to the abdomen; olive oil and laudanum on a thick piece of flannel applied very warm is good ; warm baths, oleaginous drinks and emulsions, as oil of sweet almonds with gum arabic ; strict diet, ipecacuanha and opium in powder, £ gr. each, every 1 or 2 hours, — calomel and opium, castor oil, &c. If there is sweating, then warm baths are contraindicated. 60 Compendium of Domestic Medicine. The diet should consist of small quantities of barley or rice water only. If in the latter stages of the disease, when the inflammation has some- what subsided, an obstinate costiveness be found to resist all the usual remedies, dashing cold water over the abdomen will sometimes succeed, or better still to place ice in a bladder over the abdomen. Remember that this complaint frequently runs its course in a day or two, and that, unless the proper treatment be at once employed, mortification and death will ensue. If a strangulated rupture occa- sion the disease, attempts at reduction must be tried, or operation at once. Great care must be taken in trying to reduce the rupture if it be the cause. It is best to call a physician. CHOLERA MORBUS, OR VOMITING AND PURGING. Symptoms. A violent vomiting and purging of bile, preceded by a pain in the stomach and bowels, —quick, weak and fluttering pulse, — heat, — thirst, — cold sweats, — hiccups, and sometimes death in a few hours. Causes. Exposure to sudden changes of weather, — not wearing flannel, — unripe fruit, — acrid matters of any kind in the bowels, — cold moist air, &c. Treatment. Wash out the stomach and bowels with copious draughts of chamomile tea, barley or chicken water, &c. and inject clysters of the same Cholera Morbus. 61 articles. Bladders or bottles containing hot water, should be applied to the feet, and flannel cloths wrung out of hot spirits, be laid over the stomach. When from the quantity of barley wa'er, &c. that has been taken, it is supposed that the stomach is sufficiently cleared, give one-half grain of powdered opium, and repeat it every few hours as the case may require.- If the powder will not remain in the stomach, give 80 or 90 drops of laudanum, in a table-spoonful of thin starch, by clyster, and pieces of ice on the tongue. Fifty or sixty drops of laudanum in a small quantity of strong mint tea, or the effervescing draught, will frequently succeed in allaying the irritation. If all the^e means fail, apply a blister to the stomach. When the violence of the attack is over, give castor oil or the oil mix- ture, No. 14, to carry off the bile that may remain in the Dowels. To complete the recovery and to guard against a second attack, a complete casing of flannel is requisite, with the use of vegetable bitters and tonics. Persons subject to this disease should be cautious in their diet, and avoid exposure to moist cold air. See Asiatic, or Epidemic Cholera, post, p. 163. DYSENTERY. Symptoms. Fever, — frequent small stools, accom- panied by griping, bearing down pains, the discharge consisting of pure blood or blood and matter, some- times resembling the shreds or washings of raw flesh, — a constant desire to go to stool, — vomiting. Causes. Moist cold air, — unwholesome, putrid * If the weakness be very great, and the spasms so alarming as to cause a fear of the immediate re- sult, the quantity of opium may be increased to 6, 8 or 10 grains at a dose. 62 Compendium of Domestic Medicine. food, — noxious vapours from marshes, ders half filled with warm water over the lower belly, camphor and milk every hour, or No. 23, every three hours, — passing the catheter, — dashing cold water over the thighs and legs, or applying snow or ice to the blad- der, and lastly r the tobacco clyster. INCONTINENCY OF URINE. Symptoms. An involuntary dribbling or flow of urine. Causes. A relaxative or paralytic affection of the bladder, — excessive venereal indulgences, — a dis- eased state of the bladder, — stone in the bladder. Treatment. If it anses from a relaxation or weak- ness of the parts, use the cold bath daily, apply blis- ters between the fundament and the bag, and have recourse to bark and the different tonics, as iron, &c. recommended in indigestion. Twenty or thirty grains of the uva ursi, twice or three times a day, with half a pint of lime water after each dose, may also be tried. If the disease is occasioned by a palsy of the parts, the tincture of Spanish flies may be of service. If a stone in the bladder is the cause, apply to a sur- geon to cut it out. In the mean time, some kind of vessel should be attached to the penis, to receive the urine, in order to prevent it from excoriating the parts. STONE IN THE BLADDER. Symptoms. A frequent desire to make water, which comes away in small quantities at a time, and is often suddenly interrupted, the last drops of it oc- casioning pain in the head of the yard, — riding over a rough road, or any irregular motion, or jolting Stone in the Bladder. 73 causes excruciating pain and bloody urine, accom- panied with a constant desire to go to stool, — itching of the fundament, — a numbness in the thighs, &c. — relraction or drawing up of the testicle. Treatment. Apply to a surgeon. DIABETES, OR AN IMMODERATE FLOW OF URINE. Symptoms. Frequent discharges of large quanti- ties of urine, which is sometimes of a sweet taste, — skin dry, — bowels costive,— appetite voracious, — weakness, and gradual emaciation of the whole body. Causes. A shattered constitution, — immoderate venereal indulgences, — spirituous liquors,— cold, — suppressed perspiration. Treatment. The principal remedy for the cure of this disease, consists in confining the patient to a diet composed exclusively of animal food. Blisters may, also, be applied over the kidneys and kept open with the savine ointment. The prescription No. 24,* has proved eminently successful. The carbonate of ammonia, in doses of 11 or 12 grains three limes a day, is strongly recommended, upon high aulhonty. In addition to these, opium in liberal doses, exercise on horseback, the flesh-brush, and flannel next the skin are not to be neglected. The bowels should be kept open by rhubarb. DROPSY OF THE BELLY. Symptoms. A swelling of the belly, from water contained in it, preceded by a diminution of urine, — dry skin, and oppression at the breast. * Of Dr Ferriar, of Manchester, England. 74 Compendium of Domestic Medicine. Causes. Diseases of various kinds, — intemper- ance, — a dropsical disposition. Distinguish it from tympany by the absence of the rumbling of the intestines, belching, colic, and hollow sound which characterize the latter : From other diseases, by placing one hand on the belly, and gently striking it on the opposite side with the other, when a wavy or tremulous motion will be felt, resembling that occasioned by the agitation of water in a basin. Treatment. One of the most valuable remedies for dropsy is found in the elaterium, (the dried ex- tract) one fourth of a grain of which is a dose. As it is a most active article, it is proper to begin with one sixteenth of a grain daily, which may be cautiously increased to a fourth, or till it is found to exert its fufi powers by bringing away large watery stools. From an ounce to an ounce and a half of cream of tartar, dissolved in water, and taken daily, has frequently succeeded in removing the complaint. As objections are sometimes made to the quantity of this latter arti- cle it is necessary to use in this way, half an ounce of it, with one or two grains of gamboge, every other day, may be substituted for it. Six grains of calomel, with one or two of gamboge, taken twice or three times a week, have cured the disease. Bathing the feet before going to bed, and taking immediately after 20 grains of Dover's powder, by producing copi- ous sweating, has had the same effect. Dropsy is, notwithstanding, a difficult disease to cure. It must be attempted, however, by the use of such articles as we have mentioned, beginning with the first, and if it fail, proceeding to the next and so on. If the swelling increases to such an extent as to be absolutely insupportable, send for a surgeon to draw off the water. At the decline of the disease, the strength must be supported and restored by bark, wine and the tonic plan recommended for indigestion Tympany. 75 TYMPANY. Symptoms. The symptoms of tympany or a col- lection of air either in the intestines themselves, or in the cavity of the belly, are more or less gradual in their approach. When the disease lies within the intestines, it commences with wind in the stomach and bowels, which keeps up a constant rumbling, belching, &c. — colic, — costiveness, — diminution of urine, — want of appetite, &c. When it is in the cavity of the belly and outside the intestines, the swelling is much greater, and very elastic, when it is struck, giving a hollow sound like a drum, — there is no belching, &c. Causes. Weakness of the bowels, — intemperance, — a vegetable diet. . Distinguish it from dropsy, which see. Treatment. If the complaint is within the intes- tines, keep the nozzle of a clyster pipe up the funda- ment, to permit the wind to pass through it, in order to diminish the pressure on the bowels. Warm mint tea, ginger, horse-radish, ether, Cayenne pepper, spices and essential oils, with laxative medicines and clysters, should be freely used, with a moderately tight broad bandage round the belly. If these means do not answer the end, warm and active purges must be resorted to, such as the compound tincture of senna, or jalap, or any of the Nos. 25, 26, or 27. If no relief is obtained and the costiveness continues obsti- nate, apply pounded ice to the belly. Rubbing .1 with turpentine may, also, prove useful It is very apt to terminate in death. GONORRHOEA. Symptoms. A tingling sensation at the end of the penis, which swells, looks red and inflamed, followed 76 Compendium of Domestic Medicine, Dy a discharge of matter that stains the linen, first of a whitish, then of a yellow or green colour, — a scald- ing pain in making water, — involuntary and painful erections. Treatment. There are two kinds of this affection, the mild and the virulent. The first is of so trivial a nature, that plentiful draughts of any soothing liquid, as barley water or flaxseed tea, with a low diet, are sufficient to remove it. The second produces effects more or less violent on different persons, and occa- sionally resists for months, every remedy that can be thought of. If the disease resist the low diet, &c apply to a surgeon, and beware of trusting to the recipes of frie.nds, or of employing their injections. Strictures and other horrid consequences are the most probable results of tampering with this disorder. If at sea, however, you may use an injection composed of five grains of sugar of lead and eight or ten of white vitriol, dissolved in half a pint of soft water. GLEET. Symptoms. The weeping of a thin glairy fluid, like the white of an egg, from the penis, caused by a long continued clap. Treatment.- A gleet is exceedingly difficult to get rid of, and frequently defies every effort that is made for that purpose. It must be attempted, how- ever, by the daily use of the cold bath, and 30 drops of the muriated tincture of iron, taken three times a day, for months, in a glass of the cold infusion of bark. N. B. This complaint if let alone or badly treated is apt to end in an exhausting and incurable disorder. You had better seek the best medical advice within your reach. Involuntary Emissions. 77 INVOLUNTARY EMISSIONS. Symptoms. An involuntary emission of semen during sleep, inducing great emaciation and debility. Causes. Excessive venery, — onanism, — every thing that weakens the seminal vessels. Treatment. Abstain from all sexual indulgence and lascivious ideas or books, — sleep on a hard bed, — use the cold bath daily, with a generous and nourishing diet. Chalybeate water and all the dif- ferent preparations of iron, with the cold infusion of bark and elixir of vitriol, as directed for indigestion, should be freely employed. STRICTURES. Symptoms. A difficulty in passing water, which, instead of flowing in a full stream, either dribbles away, twists like a corkscrew, or splits and forks in two or three directions. They are occasioned by strong injections, — long continued or ill treated clap. The cause, however, is not always to be satisfactorily ascertained. Treatment. Apply to a surgeon : you can do no- thing to rid yourself of the disease but this, — terrible are the consequences of meddling with it yourself. SYPHILIS. Symptoms. Chancres and buboes are among the first symptoms of this dreadful malady, which, if not. checked, goes on to cause an ulcerated throat, nodes, a destruction of the bones and cartilages of the nose, and the palate. The voice is lost, — the hair falls off, —foul spreading ulcers show themselves all over the 78 Compendium of Domestic Medicine. body, the stench of which is insupportable, and be- fore he dies, the miserable victim to it becomes a loathsome mass of corruption. A Chancre at first resembles a pimple, with a little pit or depression containing matter, which soon becomes an ulcer, with an irregular thickened edge, covered with a tough, ash-coloured matter, the basis of which is hard and surrounded by inflammation. It is generally ibnnd on the foreskin or head of the penis. A Bubo is an enlargement of a gland in the groin, beginning in a small hard lump, not bigger than a bean, and increasing to the size of a. hen's egg. A Node is a hard tumour formed on a bone. Treatment. N.B. Apply to a surgeon on the first indication or even suspicion of this most horrible disease, — if taken at an early period, and properly treated, it is soon cured, — but if neglected, or impro- perly attended to, its consequences are too dreadful to be detailed: a lingering death, and a putrescent body, are what you mav expect. Give no confidence to the recipes of friends, but apply to a physician at once. CANCER OF THE PENIS. Symptoms. A small tumour like a wart, upon the head of the penis or foreskin, followed by inflamma- tion and ulceration, which discharges a thin dis- agreeable fluid, — after a time, a cancerous fungus is produced, attended by a most intolerable burning and darting pain. Treatment. Apply at once to a surgeon, who will amputate it. Death is the only alternative. Venereal Warts. 79 VENEREAL WARTS. Crops of these animal mushrooms sometimes spring up round the head of the penis, or on the foreskin. itjlat, they may be destroyed by caustic ; if mounted on a stem or foot-stalk, by tying a piece of thread tightly round it. MERCURIAL DISEASE. This is a complaint whose symptoms nearly re- semble the secondary ones of pox, consisting of blotches on the skin, — pains at night, — ulcers in the mouth, &c. &c. Owing to the liberal use of calomel, it is now a very common disease, which is frequently confounded (even by medical men) with genuine syphilis. Treatment. Abandon every mercurial prepara- tion, — use the decoction of guaiacum and sarsaparilla, — the warm bath, and a mild nourishing diet. If possible, remove to a healthy situation in the country. It is also necessary to take an occasional purgative of the flowers of sulphur or of rhubarb. DROPSY OF THE SCROTUM. Symptoms. A collection of water, which is first perceived at the bottom of the scrotum, increasing in size as it advances upwards, and forming a tumour of the shape of a pear. If examined as directed for dropsy of the abdomen, the wavy motion may be felt, and if a candle be placed behind it, i* becomes partly transparent. Distinguish it from a rupture, by the tumour not 80 Compendium of Domestic Medicine. swelling when the patient coughs, — by the tumour having commenced at the bottom of the scrotum, &c. From a diseased testicle, by its softness, — the natu- ral colour of the skin, — absence of pain, — transpa- rency, &c. &c. Treatment. When it is first discovered, attempt to disperse it, by bathing it frequently with No. 28. The only certain cure is an operation, for which, as there is no pressing danger, apply to a surgeon. ENLARGED SPERMATIC VEIN. Symptoms. A hard knotty and irregular swelling of the vein, which sometimes increases to a large size. When lying down, the swelling diminishes, which distinguishes it from a dropsy of the parts. Treatment. Suspend the testicles, or keep the patient on his back, — apply the lotion No. 28, to the parts, — the cold bath. CANCER OF THE TESTICLE. Symptoms. The testicle is enlarged, — hardened, — craggy and unequal in its surface, — painful on be- ing handled, with irregular pains shooting up the groin, into the back, without any previous injlamma- . tion, disease, or external violence. Treatment. Apply immediately to a surgeon. Castration, and that at an early stage of the disease, is the only remedy that can save life. Be careful, however, to distinguish it from simple swelling of the testicle by inflammation, blows, <&c. Which see Impotency. 81 IMPOTENCY. This is of three kinds. The first arises from an original defect in the organs of generation. The second, from local debility of the parts, brought on by excessive venery, onanism, or some preceding dis- ease : while the third originates from fear, excess of passion, or want of confidence at the moment of coition. The first is incurable. The second must be treated by the general principles and remedies already pointed out for restoring the strength of the system, consisting of the cold bath, preparations of iron, bark, elixir of vitriol, generous diet, exercise, and by steadily avoiding the causes which may have produced it. The remedies for the third, must be sought for, in calm- ing excessive agitation, and acquiring, by habits of intimacy, that confidence they are sure to produce. GOUT Symptoms. Pain in the small joints, generally m the ball of the great toe, — the parts swollen and red, — the attack coming on in the night. Such are the striking symptoms of this disease, and generally the first that are noticed. It is occasionally, however, preceded by all those attendant on indigestion. In the advanced stages chalky lumps are formed in the joints. Causes. A too free use of the good things of this world, — a disposition to it from parents. Distinguish it from rheumatism, by the pain, &c. being in the small joints, &c. Treatment. If the patient be young, vigorous, — having the disease for the first time, give citrate of magnesia, confine him to a low diet, and treat it exactly as an inflammation arising from any other 82 Compendium of Domestic Medicine. cause. To procure sweating, Dover's powder may be taken on going to bed. As soon as the inflam- mation, by tliese means, is reduced, use the cold bath, and take strong exercise on foot, dally, — avoid high seasoned food, feather beds, wine, acids and fermented liquors, for the remainder of your life ! Gout is the child of indolence and intemperance, and to avoid it, the above means must be em- ployed, and steadily persevered in. If, however, the patient is old or infirm, and sub- ject to regular fits of it, he must not be handled so roughly. The most perfect rest should be observed, and the parts lightly covered with fleecy hosieiy, and flannel cloths wetted with the lotion No. 29, made milk-warm. The bowels should be opened with some warm laxative. In a regular fit of the gout, this is all that can be done. The degree of warmth that is applied to the part, must be regulated by the feelings of the patient, who if weak, may use a nour- ishing diet, if strong, a more abstemious one. If from any cause, the disease leaves the extremi- ties and flies to the stomach, apply mustard poultices and blisters to the soles of the feet and ankles, — give jarge doses of ether and laudanum, hot wine, brandy, &c. and endeavour by all such means (including the r ot bath) to send it back again. If the head be the part it is transferred to, and apoplexy is produced by it, take away 15 c. 20 ounce* of blood immediately, and give active purgatives, as 10 or 15 grains of calomel, followed by senna tea, or Epsom salts. If in a tew hours, the patient is not relieved, the head continuing confused and painful, and the pulse full and throbbing, apply cold vine- gar and water constantly to the part. INFLAMMATORY RHEUMATISM. Symptoms. Pain, swelling and inflammation in Inflammatory Rheumatism, 83 some one (or several) of the larger joints. The pain shifting from one part to another, — all the symptoms of fever, — pulse full and hard, — tongue white, — bowels costive and urine high coloured. Causes. Cold, — suppressed perspiration, — wear- ing damp clothes, &c. Treatment. If fever is present, reduce it and the acidity of the urine and system by doses of 5 to 8 grs. of bicarbonate of potash. If consti- pation be present, give a saline purge. After the fever is removed, give 5 grs. of iodide of potas- sium and 10 drops of tr. colchicum 3 times daily, — if much pain is present, add a £ to £ of a grain of sulphate of morphia. If there are pe- riods of intermission in the disease, give large doses of quinine, 20 to 30 grs. in 24 hours. Lemon juice and sugar, half ounce hourly, has been found to be good. If the heart becomes affected, give 5 gr. doses of the iodide of potassium mix- ture with tr. of digitalis, and apply cups over the region. CHRONIC RHEUMATISM. Symptoms. A chronic rheumatism is nothing more than one of long standing. It is unaccom- panied by fever, and makes its attacks on every change of weather, on getting wet, &c, &c. It is frequently caused by inflammatory rheumatism, and sometimes seems to exist as a primary affec- tion. Treatment. I have found no one plan of treat- ment in this species of the disease, so effectual as the following : purge with senna and salts, every other day, — rub the parts well with the liniment No. 30, apply a blister of the parts affected, or paint with tr. of iodine, and on going to bed 30 drops of laudanum, with a tea-spoonful of the tincture of 84 Compendium of Domestic Medicine. guaiacum. It is to be recollected, that this is applica- ble only to chronic cases; if there is fever, &c. it will do much damage. The best safeguard against the complaint is the use of flannel next the skin, winter and summer. HIP-JOINT DISEASE. Symptoms. Excruciating pain in the hip-joint and knee, — the leg becomes first longer, then shorter than its fellow. When lying down the foot rolls outwards, the buttocks appearing flatter than usual, — lameness, — after a while abscesses in various parts of the thigh, — hectic fever, &c. Causes. Scrofula. Treatment. This should be treated carefully and constitutionally; the limb must be kept at rest, and put into a proper machine. Cod liver oil and tonics must be given freely, with all the remedies necessary for the treatment of scrofula. A generous diet of good food, beef and wine, must not only be allowed, but insisted on. Reducing the system by purging or bleeding should never be allowed, as the system of all scrofulous patients should be built up and not reduced if a cure is wished to be arrived at. DROPSY OF THE KNEE JOINT. Symptoms. The joint swells, the skin remaining of a natural colour. By placing the hand on one side of it, and striking it gently on the other, the wavy or fluctuating motion is perceptible, — steady pressure on one side will raise the other above its natural level. Causes. A dropsical disposition, — debility, — rheu- matism, — scrofula, — syphilis. Treatment. Keep a perpetual blister on the joint, Dropsy of the Knee Joint. 85 or make a caustic issue below it, on the inside of the leg, — cold water from the spout of a tea kettle, is a useful application. Camphorated mercurial oint- ment to the knee, and mercury taken internally have sometimes been of service. WHITE SWELLING. Symptoms. Deeply seated pains in the knee, un- attended at first by swelling, which at last comes on with increase of pain. After a while the joint en- larges, — matter is sometimes discharged, — hectic fever follows, and cuts off the patient. Causes. Scrofula, — blows,- — inflammation from any cause. Treatment. If from scrofula, use the general remedies directed for that disease, and apply a blister to the part, which must be kept open by the savine ointment, for months: if from blows, apply the blister as before, keep up the system with tonics, and give a good generous diet. If in spite of these pre- cautions, the disease continues to advance, amputa- tion is the only resource. PIECES OF CARTILAGE IN THE JOINTS. Portions of cartilage are sometimes formed in joints, where they act like any other foreign body of a simi, lar texture. While in the hollows of the part, they five no uneasiness, but as they frequently slip hf« etween the ends of the bones, causing excruciating pain, it is sometimes necessary to cut them out Foi this purpose apply to a surgeon. As all openings into the cavities of the joints are attended with much danger ; unless the pain be insupportable, it is better 86 Compendium of Domestic Medicine. to endure the inconvenience than to run the risk of the operation. SCROFULA, OR KING'S EVIL. Symptoms. Hard and indolent swellings of the glands of the neck, thai when ripe, instead of matter, discharge a whitish curd. It mostly occurs in per- sons of a fair complexion, blue eyes, and delicate make. In bad cases, the joints swell with great pain, — the limbs waste away, — the ligaments and bones are destroyed, when hectic fever soon relieves the patient from his misery. Causes. Inheriting the disease from parents,— moist cold air, — a poor diet, &c. Treatment. Sea-water is a great remedy in scrofula. It is to be used daily as a bath, and a small portion of it taken internally. Made milk- warm, it forms one of the most excellent local applications that we have. Against the enlarge- ment of the glands, paint with tr. of iodine and give iodide of potassium inwardly. The diet should be mild and nourishing. Scrofula is sel- dom, if ever, cured. If the glands become perma- nently enlarged, and by no means can be reduced, then apply to a surgeon for their removal if un- sightly or troublesome. INFLAMED GLANDS. Every gland in the body is subject to inflammation. Whenever one of them is perceived to be in this state, which may be known by the swelling and pain, measures should be taken to reduce it, for fear of its proceeding to what is called scirrhus, and finally to cancer. Leeches, blisters, and all the remedies directed for such purposes, should be actively em- Inflamed Glands. 87 ployed, among which tr. iodine and a good diet must not be neglected. SCIRRHUS. Symptoms. A hard tumour, unequal on its sur- face, and not very sensible, giving but little or no pain on being handled. Treatment. Apply to a surgeon without loss 01 time for fear of a cancer. CANCER. Symptoms. A tumour, differing from the preced- ing one by being surrounded with enlarged veins. It is, also, more painful, the skin being sometimes discoloured and puckered. The whole tumour is particularly heavy, and at last breaks into a malignant ulcer or sore, whose edges are raised, ragged, un- even, and curl over like the leaves of a flower, — white streaks or bands cross it from the centre to the circumference. Acute and darting pains accompany Doth this and the preceding stage of the disease. Treatment. There is but one remedy that can be depended on for the cure of this painful and in- veterate complaint, and even that should be resorted to early, in order to ensure success. All the diseased parts must be cut out. Arsenic, corrosive sublimate, phosphate of iron, and a thousand other articles, have been recommended, both externally and internally, but without any effectual advantage. To relieve the {)ain, opium may be taken in large doses. A very ow diet (such as is barely sufficient to support life) of milk and vegetables, will produce the same effect. The sore should be defended from the air, by some mild ointment. Powdered chalk, scraped carrots, 88 Compendium of Domestic Medicine, fresh hemlock leaves, and powdered charcoal, may be used for the same purpose. GOITRE. Symptoms. A tumour in the fore-part of the throat seated in a gland close to the projection called " Adam's apple." Causes. These are not ascertained. They are supposed to consist of some peculiarities in the water of those places where it is common. Treatment. Goitre is incurable. When taken at the very beginning of the complaint, however, and in young persons, it is said to have been dispersed by a course of mercury, joined to frictions of the part with strong mercurial ointment. FAINTING. Causes. Sudden and violent emotions of the mind, — bleeding, — diseases of the heart and its great vessels. Treatment. Lay the person on the back, and raise the feet, then open the doors and windows, and sprinkle cold water in the face. Smelling salts may be held to the nose. apoplexy:. Symptoms. Falling without sense or motion, — profound sleep, — face livid or flushed, — eyes wide open or half closed, and immovable, — breathing low labouring and irregular. Causes. A rushing of blood to the head, excessive fat in persons with a short neck, — gluttony, — violent Apoplexy. 89 exercise, — intense heat, — anger, — hearty meat sup- pers, — blows on the head, — intoxication, &c. &c Treatment. If the pulse remain full, — the face flushed, &c. take away twenty ounces or more of blood on the spot, remove the cravat, unbutton the shirt collar, and place the patient in bed, with the head and shoulders a little elevated. The windows and doors must be thrown open, and no more persons than are necessary, be allowed to remain in the room. The head is to be shaved and cupped, a blister ap- plied to the back of the neck and the head, and mus- tard poultices to the feet. An active purgative* should always be administered, as soon as the patient is bled, and its operation assisted by repeated clysters. If by these means, the breathing is not easier, and the pulse softer, bleed again, and again. If however, the patient is old and infirm, and the attack has come on more gradually, if the pulse ia weak, and the face pale, do not bleed, but give immediately a warm purgative, apply the blisters, &c. If it arises from swallowing vegetable poisons, give an active emetic, as 30 grains of white vitriol, and act as directed in cases of similar accidents. In this second kind of apoplexy, stimulants, as hartshorn to the nose, &c may be used ; in the first, they are very injurious, and should never be employed. STROKE OF THE SUN. This proceeds from exposure to the sun's rays, and exhibits the same symptoms as apoplexy, commencing with vertigo, loss of sight, ringing in the ears, &c. and must be treated by large and repeated bleedings, and in every other respect as directed for apoplexy. * If the patient cannot swallow pills, try liquids; if neither, have recourse to a strong purgative clyster 90 Compendium of Domestic Medicine. EPILEPSY. Symptoms. A fit, in which the patient falls to tne ground in a convulsion, — the eyes are distorted and turned up, — hands clenched, — foaming at the mouth, — convulsions, — the whole ending in a deep sleep. Causes. Sudden fright, — anger, — injuries done to the nerves, — unknown. Treatment. Keep the patient from hurting him- self, by holding his hands, legs, and particularly his head, which he is apt to dash violently against the ground or surrounding objects. A piece of soft wood should be placed between his teeth, to prevent his tongue from being bitten. This is, in general, all that can be done during the fit. Give twenty gr. doses of bromide of potassium three times daily. CATALEPSY. Symptoms. A sudden suspension of the action of the senses, and of volition, the body and limbs preserving the position given them, while the action of the heart and lungs continues. Treatment. Electricity, cold douches, chloro- form inhalation, and irritation of the skin during the spasm. In the intervals, if from intermittents, quinine, if from cold, warm and sulphur baths, if from hysteria or catamenia difficulties, anemia, &o. f use the general remedies recommended therefor. Palsy. 91 PALSY. Symptoms. A partial or complete loss of the powers of motion, and the sensibility of particular parts of the body, — the pulse soft and slow. Causes. Apoplexy, — pressure on the nerves, from blows, wounds, &o. — the fumes of lead, mercury, &g. Treatment. The treatment must be according to the cause. By the idiopathic and pure nervous palsy, attention must be called to the spinal column as the seat of the disease, for which nux vomica, zinc, stramonium, steel baths, cold baths, and moxas down the column, are of service. Magnetism down the back, from the back of the head to the end of the back-bone, is often of use. It is well always in the use of electricity to begin with a weak current. The continual electrical stream upon the limb has produced cures. After the misuse of mercury or mercurial preparations a palsy of the limbs takes place, for which opium or morphium is recom- mended j also electrical baths. If occasioned by pressure on a nerve or by the misuse of too strong coffee, tea, or tobacco, the cause must be removed. TETANUS, OR CRAMP. There are several very long and very learned names affixed to this disease. When it is confined to the muscles of the neck and jaws, locked-jaw is the common and expressive term for it. The affec- tion, however, is always the same, requires similar treatment, and consists in an involuntary contraction and stiffening of a part of the muscles, the senses remaining perfect 92 Compendium of Domestic Medicine. LOCKED-JAW. Symptoms. A stiffness in the back of tne neck, which renders it first painful, and at last impossible to turn the head round, — difficulty in swallowing, — pain in the breast shooting to the back, — the lower jaw becomes stiff, and gradually closes. Causes. Wounds, — robust habit of body, — local irritation of a nerve. Treatment. If the disease is supposed to arise from a wounded nerve, or from an injury done to tendinous parts, by a pointed instrument* enlarge the wound with a sharp lancet, or penknife, and pour laudanum or turpentine into it, as directed for similar accidents. Blood-letting in this disease has been en- tirely given up in modern times, instead of which it has been found that to chloroform the patient was best. This being done, give 2 or 3 grains of opium at once, and repeat it every two hours, increasing the dose, according to the violence of the symptoms and the effects produced by it, without regarding the quantity that has been taken. Cases are on record, where 66 grains (a drachm) of solid opium have been taken at once, and with the happiest effect. This, however, is a large dose, and should never be ventured on. but under the most desperate and alarming circum- stances. Active purging with castor oil and senna tea, must not be omitted, and if the power of swal- lowing be lost, laudanum, &c. must be given in clys- ters. Drawing a tooth, is generally recommended by physicians in those cases where the jaws are firmly closed, for the purpose of transmitting medi- cines and food to the stomach. This has always ap- peared to me every way calculated tu increase the evil. If no opening exists between the teeth, access to the bowels can always be obtained by clysters, and in this way nourishment and remedies may be * As by running a needle into the foot, &c. DISTRIBUTION OF THE FACIAL NERVE AND OF THE BRANCHES OF THE CERVICAL PLEXUS. 1, The facial nerve at its emergence from the stylo mastoid foramen. 2, temporal branches communicating with (3) the frontal branches of the fifth or trifacial nerve. 4, infra-orbital branches, communicating with (5) the infra orbital branches of the fifth nerve. 6, maxillary branches communicating with (7) the mental branch of the fifth nerve. 8, cervico-facial branches. 9, the spinal accessory nerve giving off a brauch to the trapezius muscle's. Locked-Jaw. 93 injected. It is always proper, however, when the disease is perceived to be coining on, to place two small pieces of soft wood between the grinders of the upper and lower jaw, one on each side, so that they may be kept asunder. Madeira wine, in doses of a wine-glassful every hour, continued for several days, and combined with the internal use of mercury and the warm bath, has been found of great service. Cold water dashed freely over the patient, every two or three hours, may likewise be tried. After every affusion, he should be well wiped, and put into a warm bed, when a large dose of laudanum in warm Madeira wine, should be given, and the parts rubbed with the liniment No. 31. The tobacco clyster* has sometimes succeeded when every thing else has failed. During the relaxation which it occasions, opium, wine, &c. must be freely administered. Blistering the whole length of the spine, and caustic issues on its sides, as nearly on a line with the parts affected as possible, are strongly recommended. PAINFUL AFFECTION OF THE NERVES OF THE FACE. This disease also called tic-doloureux, neuralgia, &c. is of very rare occurrence. As it is, however, sometimes met with, it is proper to notice it. Symptoms. A very severe pain darting in particu- lar directions, not lasting more than a second, but * Although a valuable addition to our means of cure, the tobacco clyster is not to be employed lightly, or on common occasions. It should always be re- served to the last moment, never using it until every thing else has failed. The prostration of the system, and other alarming symptoms it sometimes causes, render this caution necessary. 94 Compendium of Domestic Medicine. very rapidly repeated, and excited by the slightest touch, — during the intervals, there is no pain what- ever. There is no inflammation or swelling of the cheek, as in toothach, nor does the pain seem so deeply seated. Treatment. Blisters, leeches, mercurial oint- ment, opium and Fowler's solution of arsenic, with many other remedies of the same class, have been ali recommended and used for the cure of this most painful of all the affections to which the human body is subject. Where the pain is so excessive as not to be borne, two grains or two grains and a half of the extract of belladonna, may be taken every three hours. When the pain is somewhat relieved, this quantity must be diminished. Sulphate of qui- nine in large doses has often been found' a most excellent remedy, particularly if combined with morphium and aconite. If this fails, apply to a skilful surgeon, who will divide the nerve. ANGINA PECTORIS. Symptoms. An acute pain at the lower end of the breast bone, shooting into the left arm, — great diffi- culty of breathing, — anxiety, — palpitation of the heart, — a feeling of suffocation. It usually comes on while ascending a hill, or going up stairs. Causes. The vessels of the heart being turned into bone, — an accumulation of blood in the heart and its vessels. Treatment. During the fit, let the patient in- hale sulphuric ether. If fainting, dash cold water in his face. Should this not rouse him in a few minutes, apply a blister to the chest. Strips of linen, moistened with the solution below,* applied several * Tartar emetic, one drachm. Spirits of camphor half an ounce Boiling water, one pint. Mix. Angina Pectoris. 95 times a day to the breast bone, for a month, are said to have effected complete cures. They act by pro- ducing a crop of pimples, on the appearance of which, the disease declines. Persons subject to this complaint, should avoid all fermentable food, and excess in eating or drinking, taking care to live quietly, and to keep the bowels open. Saline purgatives, followed by opium, to lessen the spasm, with the warm bath, and a per- petual blister or plaster of the tartar emetic ointment to the chest, are perhaps the best remedies that can be employed. DANCE OF ST VITUS. Symptoms. Irregular and convulsive motions of the limbs and head, generally of the arm and leg of one side only. It varies, however, in different per- sons, and is frequently counterfeited by beggars. Causes. Weakness of the nerves, — worms, — poi- sons, — fright, &c. Treatment. The daily use of the cold bath, with the Peruvian bark, has often succeeded in curing the complaint in young subjects. In addition to these, any of the preparations of iron, No. 41, combined with large doses of musk, opium, camphor, &c. may be tried. Active and long continued purging sometimes produces the happiest results. SCARLET FEVER. Symptoms. Chills, — heat, — thirst, — headach, — the skin is marked with large red or scarlet patches, which at last unite, disappearing in a few days in a kind of branny scurf, — sore throat. Causes. A particular contagion. §6 Compendium of Domestic Medicine. Distinguish it from measles, by the spots coming out on the second day of the fever (in measles they seldom appear until the fourth day); by their colour, which is that of a boiled lobster, whereas in measles it is of a dark red. Treatment. An emetic (ipecacuanha) should be given on the first appearance of the disease, to be followed by a dose of salts, then give ten to twenty grains bisulphite of soda every two hours. If the pulse is full and strong, the head aches, and the heat great, and no eruption, sponge cold water over the body very freely and frequently. There is no disease in which the advantage of cold affusion is more striking. In order to reap the full benefit of it, however, it must be freely employed, that is, as often as the heat, and then brought down on the front of the leg, to which it is secured by circular turns. In this way the bro- ken pieces will be kept in contact, and in the course of a month or six weeks will be united. Fractures of the foot, toes, &c. are to be treated like those of the hand and fingers. OF DISLOCATIONS. The signs by which a dislocation may be known, have been already mentioned. It is well to recollect that the sooner the attempt is made to reduce it, the easier it will be done. The strength of one man, properly applied at the moment of the accident, will often succeed in restoring the head of a bone to its place, which in a few days would have required the combined efforts of men and pulleys. If after several trials with the best apparatus that can be mustered, you find you cannot succeed, make the patient drink strong hot toddy, of brandy or other spirits, until he is very drunk. In this way, owing to the relaxed state of the muscles, a very slight force will often be sufficient, where a very great one has been previ- ously used without effect. If any objections are made to this proceeding, or if the patient will not consent to it, having your ap- paratus (which is presently to be mentioned) all ready, let him inhale chloroform or ether until com pletely under its influence ; the instant this happen? apply your extending and counter-extending forces A.nother important rule is, to vary the direction of the extending force A slight pull in one way, will 140 Compendium of Domestic Medicine. often effect what has been in vain attempted by great force in another. OF THE LOWER JAW. This accident, which is occasioned by blows, or yawning, is known by an inability to shut the mouth, and the projection of the chin. To reduce it, seat the patient in a chair with his head supported bv the breast of an assistant, who stands behind him. Your chumbs being covered with leather, are then to be pushed between the jaws, as far back as possible, while with the fingers, outside, you grasp the bone, which is to be pressed downwards at the same time that the chin is raised. If this is properly done, the bone will be found moving, when the chin is to be pushed backwards, and the thumbs slipped between the jaws and the cheeks. If this is not done, they will be bitten by the sudden snap of the teeth as they come together. The jaws should be kept closed by a bandage for a few days, and the patient live upon soup. OF THE COLLAR BONE This bone is rarely dislocated. Shoula it occur, apply the bandages, &c. directed for a fracture of the same part. OF THE SHOULDER. Dislocation of the shoulder is the most common of all accidents of the kind. It is very easily known by the deformity of the joint, and the head of the bone being found in some unnatural position. To reduce it, seat the patient in a chair, place one hand on the prominent part of the shoulder blade, ju&l above the spoT where tne head of the bone should be. while with the other you grasp the arm above the elbow and puli it outwards. Should this not succeed, lay the patient on the ground, place your heel in his arm-pit, and steadily Dislocations. 141 and forcibly extend the arm, by grasping it at the wrist. The same thing may be tried in various posi- tions, as placing yourself on the ground with him ; laying him on a low bed, while you are stauding near the foot of it, &c. If this fails, pass a strong band over the shoulder, carry it across the breast, give the ends to assistants, or fasten them to a staple in the wall ; the middle of a strong band or folded towel is now to be laid on the arm above the elbow, and secured there by numerous turns of a bandage. The two ends of the towel be- ing then given to assistants, or connected with a pulley, a steady, continued and forcible extension is to be made, while with your hands you endeavour to push the head of the bone into its place. OF THE ELBOW. If the patient has fallen on his hands, or holds nis arm bent at the elbow, and every endeavour to straighten it gives \im pain, it is dislocated back- wards. Seat him in a chair, let one person grasp the arm near the shoulder, and another the wrist, and forcibly extend it, while you interlock the fingers of both hands just above the elbow, and pull it back- wards, remembering that under f hose circumstances, whatever degree of force is required, should be ap- plied in this direction. The elbow is sometimes dislocated sideways or laterally. To reduce it, make extension by pulling at the wrist, while some one secures the arm above, then push the bone into its place, either inwards or outwards, as may be required. After the reduction of a dislocated elbow, keep the joint at perfect rest for five or six days, and then move it gently. If in- flammation comes on, apply ice bladder, &c. &c OF THE WRIST, FINGERS, &C Dislocations of the wrist, fingers and thumb, are readily perceived on examination; they are all to bo 142 Compendium of Domestic Medicine. reduced by forcibly extending the lower extremity of the part, and pushing the bones into their place. If necessary, small bands may be secured to the fin- gers by a narrow bandage, to facilitate the extension. These accidents should be attended to without delay for if neglected for a little time, they become it remediable. OF THE THIGH. Notwithstanding the hip joint is the strongest one in the body, it is sometimes dislocated. When this accident occurs, which may be readily ascertained by comparing the limb with its fellow, &c. send foi a surgeon as soon as possible. OF THE KNEE-CAP. When this little bone is dislocated, it is evident on the slightest glance. To reduce it, lay the patient on his back, straighten the leg, lift it up to a right angle with his body, and in that position push the bone back to its place. The knee should be kept at rest for a few days. OF THE LEG Procure a surgeon as quickly as possible. OF THE FOOT. The foot is seldom dislocated. Should it happen, however, let one person secure the leg, and another draw the foot, while you push the bone in the con- trary way to that in which it was forced out. The part is then to be covered with compresses dipped in lead water, and a splint appi ed on each side of the leg that reaches below the foot A cedents of this nature are always dangerous, an mat can be done to remedy them consists in the speedy reduc- tion of the bone, keeping the parts at rest, and subduing inflammation by cold, low diet, &q. &c. Compound Accidents. 14S OF COMPOUND ACCIDENTS. Having spoken of the treatment to be pursued for a bruise, wound, fracture and dislocation, as happen- ing singly, it remains to state what is to be done when they are united. We will suppose that a man has been violently thrown from a carriage. On examination, a w T ound is found in his thigh bleeding profusely, his ankle is out of joint with a wound communicating w T ith its cavity, and the leg broken. In the first place stop the bleeding from the wound in the thigh; reduce the dislocation next; drawine edges of the wounds together with sticking plaster: and procure a surgeon as quickly as possible. If, insf? 4 ^ of a wound, fracture and dislocation, thero is a concussion or compression of the bram, a lislocati^n and fracture, attend to the concussion first, the dislocation next, and the fracture the last OF AMPUTATION. This operation should never be attempted except by a surgeon. If a limb be nearly severed from the body by ac- cident, and hang merely by a slip of skin or muscle, it may be divided with a sharp knife. OF SUSPENDED ANIMATION FROM DROWNING. The common methods of rolling the body of a drowned person on a barrel, or holding it up "by the 144 Compendium of Domestic Medicine. heels, &e. are full of danger, and should never be permitted. If a spark of life should happen to re- main, this violence would extinguish it for ever.* As soon, therefore, as the body is found, convey it as gently as possible to the nearest house, strip it of the wet clothes, dry it well, and place it on a bed be- tween warm blankets, on the right side, with the head elevated by pillows. Every part is now to be well rubbed with flannels dipped in warm brandy, or spirits of any kind, while a warming pan, hot bricks, or bottles or bladders filled with warm water, are applied to the stomach, back, and soles of the feet. Daring these operations a certain number of the as- sistants (no more persons are to be allowed in the room than are absolutely necessary) should try to inflate the lungs, by blowing through the nozzle of a common bellows, or a pipe of any kind, placed in one nostril, while the other with the mouth is kept closed. An assistant standing at the head of the body should take hold of the arms at the wrists, and raise the arms up to the head, and then throw them forward on the chest, thus dilating and con- tracting the thorax, making artificial respiration. All these operations, particularly rubbing the body and trying to inflate the lungs, should be continued for six or eight hours, and when the patient has come to himself \ small quantities of warm wine, wine- whey, brandy and water, &c. may be given to him, from time to time Should the accident occur in winter, and the body feel cold, as if frozen; previously to applying warmth, rub it well with snow, ice, or very cold water. Above all things remember that perseverance for many hours in the remedies pointed out, may give * The seal of the Humane Society beautifully ex- presses this fact. It represents a little boy blowing a coal, the motto ('*£ I mistake not> " a spark may re- Suspended Animation. 145 you the unspeakable pleasure of" restoring a fellow creature to life. FROM COLD. Take the body into a room, the doors and windows of which are open, and where there is no fire, and rub it with snow* or cold water. After a while, fric- tions with flannels and hot spirits are to be used, as in the preceding case, and warmth very gradually ap plied. The lungs are 10 be inflated as directed in cases of drowning, and when the patient i& able to sw-allow, warm wine, &c. may be given in small quantities. If a limb is frosl-bitten, the cold applications shoulc 1 be continued longer, and w T armth be more gradually applied than when the whole body is frozen. Care should be taken to handle the parts carefully, so as not to break off the ear, tip of the nose, &c. FROM HANGING. The remedies for this accident are the same as in drowning, with the addition of taking away a small quantity of blood, by cupping glasses, from the neck, or by opening the jugular vein. FROM FOUL AIR. Throw open the doors and windows, or take in* patient into the open air, and seat him, undressed, well wrapped in a blanket, in a chair, leaning a little to the right side, place his feet or whole body in a bath, and sprinkle his stomach with cold vinegar 01 w T ater, and rub it immediately with flannels dipped in oil. Clysters of vinegar and water are to be in- * If this can be procured in plenty, the patient, with the exception of his face, which should be left out, may be completely covered with it to the thick- ness of two feet. K 146 Compendium of Domestic Medicine. jected, and when animation returns, continue tho frictions, and give warm mint tea, &c. OF SWALLOWING POISONS. The first thing to be done when a person is dis- covered to have swallowed poison is, to ascertain what it is he has taken : the next, to be speedy in resorting to its appropriate remedies. If any one of these cannot be had, try some other without loss of time. Oil of Vitriol, — Aqua Fortis, — Spirits of Sea SalU — Oxalic Acid. Symptoms. A burning heat in the mouth, throat and stomach, — stinking breath, — an inclination to vomit, or vomiting of various matters mixed with blood, — hiccups, — costiveness or stools more or less bloody, — pain in the belly, so great that the weight of a sheet cannot be borne, — burning thirst, — diffi- culty of breathing,— suppression of urine, &c. Remedies. — Mix an ounce of calcined magnesia with a pint of water, and give a glassful every two minutes. If it is not at hand, use flaxseed tea, rice water, or water alone in large quantities, until the former can be procured. If it cannot be obtained, dissolve an ounce of soap in a pint of water, and take a glassfiu every two minutes; chalk or whiting may also be taken by the mouth, and clysters of milk be frequently injected. If the patient will not vomit, put him in the warm bath, bleed him freely, and apply leeches and blisters over the parts pained. If the cramps and convulsions continue, give him a cup of common tea, with an ounce of sugar, forty drops of Hoffman's anodyne and fifteen or twenty of lauda- num every quarter of an hour- No nourishment but Sioallowing Poisons. 147 sweetened rice water is to be taken for several days- In these cases never give tartar emetic, ipecacuanha, or tickle the throat with a feather; they only increase the evil. ALKALIES. Caustic Potash, — Caustic Soda, — Volatile Alkali. Symptoms. These substances occasion the same effects as acids, producing dreadful convulsions. Remedies. Take two table spoonsful of vinegai or lime juice in a glass of water at once, follow it up by drinking large quantities of sugar and water. Pursue the same treatment as in poisons from acids. mercury. Corrosive Sublimate, — Red Precipitate, — Vermilion. Symptoms. Constrict' on and great pain in the throat, stomach and bowels, — vomiting of various matters mixed with blood, — unquenchable thirst, — difficulty of urine, — convulsions. Remedies. Mix the white- of a dozen or fifteen eggs with two pints of cold water, and give a glassful every two minutes, with as much milk as can be swallowed, and large doses of ipecacuanha. If aftei the egg mixture is all taken, the vomiting does not stop, repeat the dose, with the addition of more water. Leeches, the warm bath, blisters, &c. are to be used to reduce the pain and inflammation, as be fore directed. Symptoms. These are the same as produced by the mercurial poisons. Remedies. Give large quantities of cold sugar and water, until a plentiful vomiting is induced, to assist which, ipecacuanha* may be taken in considerable * To render it more active, ten groin? of sulphate of zinc may be added to it. 148 Compendium of Domestic Medicine. doses at the same time;* barley, rice water, flaxseed tea, milk, &c. should afterwards be employed. Oil is never to be used in this case until the symptoms have considerably abated, or the poison has been ejected. COPPER. The symptoms occasioned by swallowing verdigris* are nearly the same as those of the mercurial poisons. The great remedy is large quantities of sweetened water. In addition to this, use all the means recom- mended for corrosive sublimate, &c. ANTIMONY. Antimonial Wine, — Tartar Emetic, — Butter of An- timony, fyc. Symptoms. Excessive vomiting, — pain and cramp in the stomach, — convulsions, &c. Remedies. Encourage the vomiting by sugar and water, and if after a while it does not stop, give a grain of opium in a glass of the sweetened water, every fifteen minutes. To relieve the pain, apply leeches to the stomach, throat or parts affected. SALTS OF TIN. Give as much milk as can be got down, and if it is not at hand, use large quantities of cold water to in- duce vomiting. If the symptoms do not abate, pursue the plan directed for acids. SALTS OF BISMUTH, GOLD AND ZINC. Pursue the plan recommended for arsenic. LUNAR CAUSTIC Dissolve two table spoonsful of common table sa 1 !, m two pints of water; a few glasses of this will in- * Equal parts of lime water and sugared water may also be used. Swallowing Poisons. 149 duce vomiting If not relieved, drink flaxseed tea, apply leeches, &c. as for acids. SALT-PETRE. Pursue the plan recommended for arsenic omitting the lime water. SAL AMMONIAC. Symptoms. Vomiting, — pain in the belly, — a stiff- ness of the whole body, — convulsions. Remedies. Introduce your finger or a feather into the throat to induce vomiting, and give plenty of sweetened water. To relieve the convulsions give the tea, laudanum, &c. as for acids, or the laudanum alone, and to ease the pain in the belly, apply leeches, &c. LIVER OF SULPHUR. Symptoms. They resemble those caused by salt- petre. Remedies. Two table spoonsful of vinegar in a glass of water, are to be frequently taken until vomit- ing is brought on, after which, have recourse tc leeches, blisters, &c. PHOSPHORUS. The symptoms and remedies are the same as by poison from acids. SPANISH flies. Symptoms. Great pain in the stomach, with obsti- nate and painful erections, accompanied by a diffi- culty or suppression of urine, or if any is passed, it is bloody, — a horror of swallowing liquids, — frightful convulsions. Remedies. Make the patient swallow as much sweet oil as he can possibly get down. Milk anc. sugared water are also to be freely used. In addition 150 Compendium of Domestic Medicine. to the plan recommended for acids, solutions of gum arable, or flaxseed tea, are to be injected into the bladder. If no vomiting is induced, put him in the warm bath, continue the sweetened water, and rub his thighs and legs with two ounces of warm oil, in which a quarter of an ounce of camphor has been dissolved. Eight or ten grains of camphor may be mixed with the yolk of an egg and taken internally. If there is acute pain in the bladder, apply leeches over it POWDERED GLASS. Stuff the patient with thick rice pudding, bread, potatoes or any other vegetable, then give him five grains of tartar emetic to vomit him, after which, use milk freely, clysters and fomentations to the belly with the warm bath ; leeches, &c. are not to be neg- lected. Sugar of Lead, — Extract of Saturn, — White Lead — Litharge, — Minium. Symptoms. A sweet astringent taste in the mouth, — constriction of the throat, — pain in the stomach, — bloody vomiting, &c. Remedies. Dissolve a handful of Epsom or Glau- ber salts in a pint of water and give it at once; when it has vomited him, use sweetened water. If the symptoms continue, act as directed for acids. OPIUM, OR LAUDANUM. Symptoms. Stupor, — an insurmountable inclina- tion to sleep, — delirium, — convulsions, &c. Remedies. Endeavour to excite vomiting by six grains of tartar emetic, or four grains of blue, or thirty of white vitriol. Thrust a feather down the throat for the same purpose. Never give vinegar or other acids, until the poison is altogether or nearly evacu- ated. After this has taken place, a wine glassful of Swa'fowing Poisons. 15.1 lemon juice and water may be taken every five minutes, along with a cup of very strong coffee. The coffee, &c. are to be continued until the drowsiness is gone off) which, if it continues, and resembles that of apoplexy, must be relieved by bleeding. The patient is to be forcibly kept in constant motion. MUSHROOMS. Remedies. Give the patient immediately, three grains of tartar emetic, twenty-five or thirty of ipe- cacuanha, and an ounce of salts, dissolved in a glass of water, one third to be taken every fifteen minutes until he vomits freely. Then purge with castor oil. If there is great pain in the belly, app^ leeches, blis- ters, &c. TOBACCO, HEMLOCK, NIGHT-SHADE, SPURRED RYE. Remedies. An emetic as directed for opium. If the poison has been swallowed some time, purge with castor oil. After vomiting and purging, if the patient seems drowsy, bleed him, and give vinegar and water. POISONOUS fish. Remedies. An emetic. If it has been eaten some time, give castor oil by the mouth and clyster. After these have operated, twenty drops of ether may be taken on a lump of sugar ; vinegar and water as be- fore mentioned. FOREIGN BODIES IN THE THROAT. Persons are frequently in danger of suffocation from fish bones, pins, &c. which stick in the throat. The moment an accident of this kind occurs, desire the patient to be perfectly still, open his mouth and look into it. If you can see the obstruction, endea- vour to seize it with your finger and thumb, or a long 152 Compendium of Domestic Medicine. slender pair of pincers. If it cannot be got up, or is not of a nature to do any injury in the stomach, push it down with the handle of a spoon or a flexible round piece of whale-bone, the end of w 7 hich is neatly ^vered with a roll of linen, or any thing that may be ai nand.* If you can neither get it up nor down, place six grains of tartar emelic in the patient's mouth. As it dissolves, it will make him excessively sick, and in consequence of the relaxation, the bone, or what- ever it may be, will descend into the stomach or be ejected from the mouth. If a pin, button, or other metallic or pointed body has been swallowed (or pushed into the stomach) make the patient eat plentifully of thick rice pudding, and endeavour to prevent him from going to stool for at least twelve hours. OF BURNS AND SCALDS. There are three kinds of remedies employed in ac- cidents of this nature. Cooling applications, such as pounded ice, — snow, — vinegar, — cold water, — lead- water, &c. Stimulants, as warm spirits of turpen- tine, — brandy, or any ardent spirits, and carded or raw cotton. Any one of these articles that happens to be nearest at hand, may be tried, although the preference is due to the turpentine or spirits, which being made as hot as the patient can bear it, is to be applied to all the burned surface (so as not to touch the adjoining sound skin) until some common basilicon ointment can be thinned with spirits of turpentine, to the consistence of cream, in which state it is to be spread on a linen rag and laid over the part, taking care, as before, not to let it touch the sound skin. * The small end of a common riding whip answers very well. Burns and Scalds. 153 If, however, (the rule is general) this plan causes great pain and inflammation, it must be abandoned, and one of the others be resorted to, as the pounded joe, which can be readily applied in a bladder. Equal parts of lime water and linseed oil well mixed, forms one of the most soothing of all applications. Should much fevsr prevail, it is to be reduced by- bleeding, purging, &c. but if on the contrary, the sys- *em seems to sink, wine, bark, &c. must be employed. OF MORTIFICATION. From what has already been stated, it is evident that in treating wounds, &c. as well as diseases, one great and important indication is to repress excessive inflammation, which, if allowed to proceed to a cer- tain point, sometimes produces mortification or the death of the parts. Whenever, therefore, from the violence of the fever, heat, pain, redness and swelling, you are fear- ful of its ending in this way, apply ice bags or cloths dipped in cold water over the part. If, how- ever, the fever and pain suddenly cease, if the part which before was red, swollen and hard, becomes purple and soft, abandon at once all reducing mea- sures, apply warmth over the whole of the parts, and give wine, porter, bark, one else fails. 156 Compendium of Domestic Medicine. CHAPTER IV. Prescriptions referred to in the preceding pages. No. 1. Saline Mixture. R.* Salts of Tartar, 1 drachm, — Water, 4 ounces, — Essence of Peppermint, 3 drops. When the salt is dissolved, add very gradu- ally lemon juice or vinegar, 1 ounce, or till the titervesccnce ceases. To be taKen every hour. No. 2. R. Sulphate of Quinine, 13 grains, — Gum Arabic powdered, 1 drachm, — Loaf Sugar, J an ounce, — Water, 6 ounces, — Essence of Peppermint, 5 drops. A table spoonful every hour, shaking the bottle well before it is poured out. No. 3. R. Calomel, 6 grains, — Antimonial Pow ders, 3 grains. To be taken every three hours. No. 4. Effervescing Mixture. R. Salt of Tartar, 20 grains, — Water, 2 ounces, — Essence of Pepper- mint, 2 drops. When the salt is dissolved, add a table spoonful of lemon juice, or good vinegar, and swallow it immediately. No. 5. K Chalk Mixture, 4 ounces, — Tincture of Kino, 1 drachm, — Lavender Compound, 1 drachm, — Laudanum, 31) drops. A table spoonful every two or three hours, as may be required. No. 6. R. Cayenne Pepper, 6 ounces, — Common Salt, 4 drachms, — Boiling Water, \\ pints,— Boiling Vinegar, \\ pints. Let it remain in a close vessel for an hour, then strain it through a fine linen cloth. * R. stands for Recipe or " Take." The weights ased in these Prescriptions are troy or apothecary's —not avoirdupois weight. Prescriptions. 157 Take a table spoonful every hour or two, according lo circumstances. No. 7. R. Musk, 1 drachm, — Gum Arabic pow- dered, 1 drachm, — Loaf Sugar, 1 drachm, — Water, 6 ounces. Rub up tne musk with th^ sugar, then add the gum and pour on the water veiy gradually, so as to incorporate the whole. Take a table spoonful every two hours. No. 8. R. Camphor, 30 grains, — Almonds blanch- ed, 2 drachms, — Loaf Sugar, 1 J drachms, — Pepper- mint Water, 6 ounces. Moisten the camphor with a few drops of spirits of wine, and reduce it to powder. The almonds and sugar having been beat to a paste, add the camphor, and pour on the water gradually, rubbing the whole well together. Take a table spoonful every two or three hours. No. 9. R. Sugar of Lead, 5 grains, — White Vit- riol, 2 grains, — Laudanum, 2 drachms, — Rose Water, 6 ounces. Or, Wine of Opium, ^ an ounce, — Wa- ter, 2 ounces. Or, Alum, \ a drachm, — Rose Wa- ter, 6 ounces. To bathe the eye frequently. No. 10. R. Barley Water, \ a pint, — Vinegar, \\ ounces. Or, Alum, 1 drachm, — Rice Water, lj pints, — Honey, 1 ounce. Or, Vinegar, 2 ounces, — Water, 1 pint. To gargle the throat. No. 11. R. Barley or Rice Water, J a pint, — Tincture of Myrrh, \ an ounce, — Muriatic Acid, \ a drachm. Or, Sharp Vinegar, 1 ounce. Gargle the throat frequently. No. 12. Wine or Vinegar wliey. R. Place a sauce pan containing a pint of new milk, on the fire, and while it is boiling add one gill of white w T ine ox half the quantity of good vinegar. As soon as the milk is turned, take it -off) strain the whey through a cloth and sweeten it to your taste. No. 13. R. Paregoric, \ an ounce, — Syrup oi Squills, 1 ounce, — Antimonial Wine, 2 drachms,— Water, 6 ounces. Take two tea spoonsful every fif teen minutes, until the cough is relieved. No. 14. R. The White of 1 Egg,— Castor Oil, 2 158 Compendium of Domestic Medicine. ounces, — Lavender Compound, 2 drachms, — Sugar, J an ounce, — Water, 4 ounces. Incorporate the oil and the white of the egg, by shaking in a bottle, then add the water containing the sugar and lavender. Half may be taken at once, and the other half in a few hours, or a table spoonful hourly until it operates. No. 15. R. Chalk Mixture, 4 ounces, — Tincture of Kino, 1 drachm, — Cinnamon Water, 2 ounces, — Laudanum, \ a drachm. A table spoonful every two hours, or oftener if necessary. No. 16. R. Tincture of Catechu, 2 ounces. Take two tea spoonsful in a little port w 7 ine, every hour, or oftener if required. No. 17. R. Extract of Logwood, 20 grains, — Cin- namon Water, 2 ounces, — Tincture of Kino, 1 drachm, — Su^ar, 2 drachms. To be taken at once. Not 18. R. Prepared Chalk, 2 drachms,— Loaf Sugar, 1 drachm. Rub them well together, and add gradually of mucilage of Gum Arabic, 1 ounce, — Water, 6 ounces, — Lavender Compound, 2 drachms, — Laudanum, 30 drops. A table spoonful every hour or oftener if necessary. No. 19. R- Calomel, 10 grains, — Jalap, 12 grains, — Opium, 1 \ grains, — Tartar Emetic, \ a grain, — Oil of Aniseed, 1 drop. Make the whole into a mass with conserve of roses, and divide it into five or six pills, all of which are to be taken at once. No. 20. R. Socotrine Aloes, 1 ounce, — Liquorice, 2 ounces, — Coriander Seeds, \ an ounce. Digest the aloes arrl liquorice in 1 pint of brandy for a week, shaking 'he bottle frequently, and add half a pint of a very sirong decoction of Carolina Pink Root. Dose, two table spoonsful every morning, fasting. No. 21. R. Powder of the root of the Male Fern, 1 drachm. This is to be taken in molasses early in the morning, and for two days in succession, to be followed with some very active purgative. No. 22. R. Powder of Tin, 1 drachm, — Molasses as much as will envelope it. Repeat the dose morning and evening for three days, and then take some active Prescriptions. 159 purgative. Or, Bark of the fresh root of Pride of China, 5 ounces , — Water, 2 pints. Boil it in a close vessel to one pin.. Dose, a table spoonful every two hours till it operates. Or, Bark of the Cabbage- tree, 1 ounce, — Water, 2 pints. Boil lo one pint and strain. Dose, a wine glassful or about two ounces. ]N o. 23. R. Mucilage of Gum Arabic, 1 j ounces, — Olive Oil, 2 drachms. Mix them well, and add Ether i drachm, — Laudanum, 20 drops. Take at once. No. 24. R. Peruvian Bark, 20 grains, — Uva Ursi 20 grains. — Opium, J a grain. Make a powder, to be taken three times a day with lime water. No. 25. R. Compound Tincture of Senna, 1 ounce — Compound Tincture of Jalap, 2 drachms. No. 26. R. Calomel, 10 grains, — Jalap, 15 grains, — Oil of Aniseed, 2 drops. To be taken in molasses. No. 27. R. Compound Tincture of Senna, 1 ounce, — Wine of Aloes, 2 ounces, — Simple Syrup, 1 ounce, — Water, 4 ounces, — Oil of Mint, 2 drops. A tabic spoonful from time to time, as may be necessary. No. 28. R. Muriate of Ammonia, J an ounce, — Vinegar, 2 ounces, — Proof Spirits, 3 ounces, — Water, 3 ounces. Mix them for a wash. No. 29. Scudamore's Lotion for Gout. R. Alcohol, 3 ounces, — Camphor Mixture, 9 ounces. Render the whole milk warm, by adding boiling water. No. 30. R. Water of Ammonia, 2 drachms, — Olive Oil, 1 h ounces, — Laudanum, j an ounce. Shake well. No. 31. R. Opium in fine powder, 2\ drachms, — Soap Liniment, 2 ounces, — Spirits of Camphor, 2 ounces. Pour the liniment gradually on the opium rub well together, and add the spirits of camphor. No. 32. R. Sulphate of Quinine, 8 grains, — Syrup of Rhubarb, 2 J ounces, — Orange flower Water, 2^ ounces, — Sulphuric Ether, 10 drops. No. 33. R. Muriated Tincture of Tron, 2 ounces. Take twenty drops three times a day, in a wine glass of the cold infusion of bark. Or, Extract of Bark 1 drachm. — Extract of Gentian, 1 drachm,— Greer Vitrioi, J a drachm. — Myrrh, 1 drachm,— Oil of Ani- 160 Compendium of Domestic Medicine. seed, 10 drops, — Simple Syrup sufficient to make the whole into a mass, to be divided into sixty pills, of which take three twice a day. Or, Rust of Iron, 1 drachm,— Conserve of Roses, as much as will make a mass, to be divided into sixty pills, of which take two, three times a day. No. 34. R. Calomel, \ a drachm, — Tartar Emetic, 15 grains, — Opium, \ a drachm. Add syrup sufficient to form a smooth mass, and divide it into sixty pills. Yeast Poultice. R. Into an infusion of malt or beer, stir as much oatmeal as will make it of a proper thickness, and then add a few spoonsful of yeast. Charcoal Poultice. R. To half a pound of common rye mush, add two table spoonsful of finely powdered fresh made charcoal, and stir them well together. Rye Meal Poultice. R. This is made precisely like rye mush, care being taken to have it very smooth. Emollient Clyster. R. Thin Starch, 1 pint, — Mo- lasses, 1 wine glassful. Or, Molasses, and Sweet Oil, each 1 wine glassful,— Warm Barley Water, 1 pint. Or, Flaxseed Tea, 1 pint, — Milk, J a pint Anodyne Clyster. R. This is formed by adding 40 50, 60, or more drops of laudanum (as occasion may require) to the Emollient Clyster. Purgative Clyster. R. Table Salt and Brown Sugar, each a table spoonful, add half a gill of Mo- lasses, and rub them well together. While you are stirring them, gradually pour in two ounces of Castor Oil, and a pint of warm Water. Tobacco Clyster. R. Infuse 1 dracnm of Tobacco in a pint of boiling water for ten minutes. The one naif to be injected first, and if this will not produce the wished for effect in half an hour, throw up the remainder. Hartshorne^ decoction of Spanish Flies in Spirits of Turpentine. R. Spanish Flies bruised, 1 ounce, — Spirits of Turpentine, \ a pint. Boil for three hours and strain. PART SECOND EPIDEMIC CHOLERA: CAUSES, PREVENTION, SYMPTOMS AND TREATMENT OF EPIDEMIC CHOLERA. DYSPEPSIA, OR INDIGESTION: CAUSES, PREVENTION, SYMPTOMS AND TREATMENT OF DYSPEPSIA, OR INDIGESTION. S1CK-HEADACH: CAUSES, CURE AND PREVENTION OF SICK-HEADACH. THE TEETH; STRUCTURE, FORMATION, DISEASES AND TREATMENT OF THE HUMAN TEETH. 161 ASIATIC, OR EPIDEMIC CHOLERA. As an epidemic, Cholera first made its appearance in Bengal during the month of August 1817. Since that period it has continued to prevail, with scarcely any intermission, up to the present time, spreading itself over nearly the whole of India and the rest of Asia, over a part of Africa, and over a considerable portion of Europe. In 1832 it broke out in the Canadas", and visited successively nearly all the larger cities of the United States. By this terrible epidemic, provinces have been ravaged, and districts depopulated ; entire garrisons have been destroyed, and victorious armies arrested in their triumphant progress. Under every point of view Epidemic Cholera claims the attention of every individual, and of every community. Though attended with the most violent symptoms, extremely rapid in its progress, and in relation to the real cause by which it is pro- duced, shrouded in the most impenetrable mystery; yet there are few diseases an attack of which can be so readily and certainly guarded against — while no one is so completely under the control of medicine during its first stages 163 164 Compendium of Domestic Medicine Cholera, like all other epidemics, is evidently dependent upon a morbid change in the condition of the atmosphere. What is the actual nature of this change it is impossible to ascertain. By some it is referred to irregularities in the electrical slate of the air ; others have presumed that the air be- comes loaded with poisonous effluvia emitted from the earth; while others restrict its cause to a change in the sensible properties of the atmosphere, in other words, to unusual coldness, heat, moisture or dryness — or to rapid and sudden transitions in these particu- lars. It is certain, that in most places where the cholera has appeared, it has been preceded or accom- panied by violent storms or earthquakes, or by sea- sons unusually disturbed. That the disease is in no degree contagious, that it is not capable of being communicated from the sick to the well, is now established by so many posi- tive facts, that it appears unnecessary to enter here into an examination of this point. Its non-contagious- ness is proved by the disease appearing, at the same time, at points far distant from each other ; while in situations intermediate between these not a single case will occur. Physicians, nurses, and attendants upon the sick, are not more affected by the disease than other classes of persons, nor even in as great a proportion; and individuals who were in hos- pitals with other diseases, and were seized with cholera, did not communicate the disease to the other patients in their immediate vicinity. Predisposing and Exciting Causes. 1st. A vitiated and damp state of the atmosphere. Cholera has always prevailed most extensively and produced the greatest ravages, in those situations ordi- narily the most unhealthy, particularly in the vicinity Asiatic, or Epide?nic Cholera. 165 of low, wet, and marshy districts — along the low, muddy banks of rivers; in crowded towns and villa- ges, and in the hovels of the poor, where a proper ventilation is neglected, and in which all kinds oi filth are allowed to accumulate. 2d. A constitution broken down by misery, vice, intemperance or fatigue. In every place where Cholera has made its appearance, the great majority of those attacked have been individuals of the lowest classes of the community; those living in the depths of vice and misery ; the habitually intemperate ; those who were constantly exposed to fatigue, and to the inclemencies of the weather; and those who, from extreme poverty, are obliged to subsist on unwhole- some food, or such as is deficient in nutriment. But few persons in easy circumstances and of temperate lives have been attacked ; and in those few, the oc- currence of the disease could very generally be traced either to fatigue, to exposure to wet or damp or to the night air, to fear and anxiety, to improper food, as that which is too stimulating, difficult of digestion or flatulent, to fasting too long, to a consti- tution broken down by disease or a state of conva- lescency particularly from stomachic and bowel complaints, to the use of impure water, of cold and iced fluids or of iced creams when the body is in a state of fatigue, or overheated. to indulgence in acid drinks, or those which readily become sour in the stomach, as the weaker wines, table beer, cider, &c, to the imprudent use of medicine, especially emetics and purgatives, or to prolonged watchfulness PREVENTION. To avoid Cholera, therefore, an individual must live temperately on plain, nutritive food, simply cooked. He must avoid rich, high-seasoned soups and sauces, all made dishes and pastry ; of salted provisions he must partake in great moderation, 166 Compendium of Domestic Medicine, salted, dried, and smoked fish he must abstain from, as also pork, geese, ducks, crabs, lobsters, and the like. He must avoid all flatulent vegetables, as cabbages, radishes, green corn, dried peas and beans or those difficult of digestion, as mashed potatoes, cucumbers melons, mushrooms, pickles, &c. and likewise all unripe, decayed, or very acid fruit. He must give up entirely the use of ardent spirits, bran- died wines, &c. as ordinary drinks : indeed, as a general rule, pure water should be his sole beverage. Active regular exercise in a free pure air, not carried so far as to induce fatigue ; regular and sufficient sleep; the avoidance of crowded assemblies, of the night air, of wet or damp, or extreme heat, or of ex- posure to cold, without due precaution, are other means essential to be observed, in order to escape an attack of Cholera. Personal cleanliness, and all the other means cal- culated to insure the due performance of the functions of the skin, are likewise all important preventives; hence the use of the warm bath daily, or sponging the entire surface with tepid water, followed by brisk frictions, morning and evening, and a flannel or thick cotton garment next the skin, should never be neg- lected- The possession of that species of moral courage which is intimately connected with a well informed mind ; a reliance upon the goodness and superin- tending providence of the Supreme Being; and a consciousness of having fulfilled, to the utmost of our abilities, our religious as well as social duties (which, while they prompt us to avoid danger by the use of all practicable and rational means, pre- vent all unnecessary terror and alarm when the evil is present), have a powerful influence in guard- ing the system against disease during the prevalence of every epidemic. The necessity of comfortable, clean and well ven- tilated dwellings, situated in a dry, elevated and otherwise healthy situation, must be sufficiently Asiatic, or Epidemic Cholera. 167 evident to all. When, however, an individual is under the necessity of residing in a low, damp, unhealthy situation, much may still be done to pre- vent disease, by a proper attention to ventilation, during fine weather; by strict cleanliness; by closing th? doors and shutters before night fall ; by occupy ing the upper rooms of the house, and, in very damp weather, by fires in the apartments where the family pass the day, and in the bed-chamber. SYMPTOMS. Epidemic Cholera, in regard to its symptoms, may be divided into four stages or periods. 1. The Stage of Diarrhcea. This stage is usually accompanied with griping pains in the stomach and bowels; by a sense of lassi- tude ; rumbling of wind in the bowels; frequently, pain and giddiness of the head, and dull pains in the knees and loins. The pulse is various; the tongue is coated with a thin white or yellowish mucus, or thickly furred in the centre and red at the edges. The appe- tite is diminished ; and the thirst increased. There are often shooting pains or stitches through the calves 01 the legs. The foregoing symptoms are most usually attended with nausea, with frequent watery dis- charges from the bowels, or with a constant inclina- tion to go to stool without any evacuation taking place, or with only a thin mucous discharge some- times streaked with blood. This stage may last for several days before the symptoms of the ensuing stage are developed; in many cases the symptoms of the latter appear in a few hours. The occurrence of the second and subsequent stages depends greatly upon the constitution and habits of the patient, as well as upon the circumstance of his having, or not. resorted to proper medical aid. In the debilitated and especially the intemperate, the discharges from 168 Compendium of Domestic Medicine. the bowels are not unfrequently from the first very copious, of the appearance of whey, and giving rise to a sense of extreme exhaustion, of faintness or even fainting In such cases, in a very few hours, cramps, vomiting and collapse are apt to come on ; any im- prudence in eating or drinking, improper exposure, &c. will also accelerate the occurrence of the second and subsequent stages of the disease 2. The Stage of Spasm. This stage is characterized by violent pains of the stomach and bowels occurring at intervals ; by pain of the head and back ; by almost incessant vomiting and purging of a rice-water fluid ; by inordinate thirst and violent spasms, particularly of the muscles of the ex- tremities. The skin still remains warm, but is bathed with perspiration, and has a peculiar doughy feel; the tongue presents nearly the same appearance as in the first stage; the temperature of the hands and feet is reduced ; the pulse is often full and of some firmness ; in other cases it is very compressible ; or again, it is small and contracted. The mental faculties are un- impaired; the countenance is expressive of great suffering or distress. In this stage the secretion of urine is often diminished in quantity or entirely sus- pended. 3. The Stage of Commencing Collapse. In this stage the skin is cold, livid and covered with a profuse clammy perspiration ; the tongue is also cold and livid; and the extremities corrugated as if they had been soaked in water; there are frequent cramps of the extremities; the eyes are si ink, the features contracted; there is constant purging, occasionally accompanied with vomiting ; there is pain of the stomach, a small, feeble and depressed pulse, and a complete suppress- ion of the urinary secretion. The mental faculties are still unimpaired. Often considerable heat is felt over the stomach. Great thirst and a constant desire for cool air are almost invariably present. Asiatic, or Epidemic Cholera. 169 4. The Stage of Confirmed Collapse. This stage is marked by icy coldness, and a deep blue or purple hue of the skin, tongue and inside of the mouth ; the extremities are corrugated ; the whole sur- face is covered with a profuse cold perspiration, which seems to exude in large drops from the pores of the skin. No pulsation can be detected in any of the su- perficial arteries, and the action of the heart is slow and feeble. Involuntary watery discharges flow from the bowels. The voice is low, husky, and almost extinct. The body exhales a peculiar and very dis- agreeable odour. There is a short quick respiration, with heaving of the chest. The patient complains of a burning heat in the region of the stomach, and craves without intermission cold water and fresh air; he is extremely restless, or doses with half open eyelids, the pupils of the eyes being rolled very much up wards. Until the very end, the mental faculties continue unimpaired. TREATMENT. The treatment of Cholera differs according to the stage of the disease. 1. In the first stage, w 7 hen the patient is young and robust, the skin dry, the pulse frequent and hard, and the griping pains in the bowels constant or severe; a large mustard; plaster over the abdomen, and another on the back, will be found of great service* Bathing the feet in warm water, also the applica- tion of frictions to the whole of the lower extrem- ities, or mustard poultices to the ankles, will also be decidedly beneficial. When the diarrhoea is but trifling, a dose of cam- phor with a few drops of laudanum should be given, and repeated if necessary. If the discharges from the bowels are very co- pious, and of a thin, watery and unnatural appear- ance, a pill of camphor, rhei and opium, repeated at 170 Compendium of Domestic Medicine, proper intervals, will often be found very speedily to arrest these discharges, and after a time to pro- cure the evacuation of a very dark, viscid and offensive matter, followed by natural stools. When the griping and constant inclination to stool are peculiarly troublesome, place lumps of ice continually on the tongue, and an injection of thin starch, olive oil and opium will often remove very speedily the disease. The warm bath is a remedy well adapted to this stage when properly managed. Attention to diet and clothing is all-important. The patient should be confined exclusively to gum or rice water taken cold and in small quantities at a time; even after the symptoms of the disease have disappeared, the diet should consist for sev- eral days of well boiled oat meal gruel, thickened milk, or crackers boiled in milk. A very slight impropriety in diet will often bring back the very worst symptoms of the complaint, and render a cure impossible. 2. When Cholera has reached its second stage, there is not a moment to be lost — the least delay on the part of the patient, or timidity in the prac- titioner will be followed by the most fatal conse- quences. Give the patient every five minutes, a dose of the following anodyne and cordial tinc- ture: Take of aromatic spirits of ammonia, lau- danum, chloroform and spirits of camphor 1£ fluid drachms, creosote 8 drops, oil of cinnamon 2 drops, alcohol enough to make 1 oz. of the tinc- ture. Put a tea-spoonful of this in a wine-glass of ice water, and give one tea spoonful of the so- lution every five minutes until the patient decid- edly improves, then lengthen the intervals of doses till the symptoms all abate. This treat- ment, the result of much experience during the Asiatic, or Epidemic Cholera. 171 visitation of the cholera in 1849, 1850, and 1854, has been found very successful. The limbs of the patient should then be rubbed well with some stimulating liniment : these fric- tions are to be followed by mustard poultices to the ankles, wrists, thighs and arms. In this stage, particularly at its very commencement, bathing the feet in hot water will frequently be followed by a very good effect. Internally the patient should take iced water in small portions at a time ; or when this is immediately rejected by the stomach, a tea-spoonful of powdered ice may be given every fifteen minutes. After the stomach has become calm and is capable of re- taining medicine, the pill of camphor and opium, as directed in the first si age, should be given, and repeated every two, three or four hours according to circumstances. By this treatment, in a very short period, the vomit- ing and spasms will be suspended, and the inordi- nate discharges from the bowels arrested. In many cases a dose of castor oil will now bring away copious stools of a very dark and extremely offensive nature, after which the bowels will return to their natural condition. It is all important in this stage to prevent the patient from drinking too much; which, in conse- quence of his inordinate thirst, he will be very apt to do unless carefully watched. The warm and vapour baths do no good, but rather harm in the se- cond stage of Cholera ; and ihe most pernicious effects will in general result, if recourse be had to stimu- lants, or to inordinate doses of opium or lauda- num. Occasionally it will be found that there is a ten- dency in this stage to an overloaded stale of the vessels of the brain, indicated by drowsiness, dilated pupil, and a dark flushed appearance of the coun- tenance ; here, cups to the temples or back of the 172 Compendium of Domestic Medicine. neck, with cold applications to the scalp, should never be neglected. 3. When Cholera has reached its third stage, to save the life of the patient will demand great cir- cumspection, judgment, and decision on the part of the physician and attendants. The entire sur- face of the patient should be diligently rubbed either with the hand, or a flannel cloth, wet with a liniment composed of equal parts of spirits of turpentine and a solution of pure ammonia : after the frictions, large mustard poultiees should be applied to the arms, wrists, thighs and ankles; and the feet should be enveloped in bags filled with warm bran or sand, and the whole body covered with a blanket. By the treatment just detailed, the reduction of the symptoms is produced gradually : first there is a cessation of the profuse perspiration ; the fea- tures then become more natural, the corrugation of the extremities disappears, and finally the livid colour of the skin is removed and the natural tem- perature of this part is restored. Throughout the third stage of Cholera the pa- tient should be supplied, at short intervals, with small quantities of powdered ice or of iced water. Even greater caution than in the second stage, will be required to prevent him from indulging his inordinate thirst ; to guard him against the use of stimulants, and the too free administration of opiates. In the early period of this stage all kinds of food are to be abstained from : when conva lesoence has been established, the same remarks in regard to diet will apply as were made in refer- ence to the first stage. Asiatic, or Epidemic Cholera. 173 4. When the period of confirmed collapse has arrived, little hopes of recovery need be enter- tained. The patient should be carefully rubbed over the whole body with ice, then dried and wrapped in dry blankets outside of which bags filled with warm bran or bottles of hot water may be applied, and internally give champagne and ice, or rum and Selters water, or one gr. camphor every £ hour, or spirits of hartshorn one drachm in 6 oz. sugar water, a table-spoonful every % to £ hour. Also rub the body with spirits of mustard, and for the cramps in the calves of the legs rub them with chloroform and camphor spirits. As soon as reaction takes place and has been fully established, the treatment should be con- ducted as in the other stages. In the period of reaction let the patient sleep and perspire freely, and continue giving him Selters water and ice. To arrest the discharges from the bowels, give £ gr. calomel every 3 hours with or without opium ; if vomiting should take place, give small doses of morphium 1-15 gr., — and a mustard plaster over the stomach; if there is a tendency of con- gestion to the head, apply cold iced cloths or leeches. After recovery, the patient must natu- rally be very careful for a long time with his diet. 174 Compendium of Domestic Medicine, DYSPEPSIA, OR INDIGESTION. There are few complaints more prevalent, parti- cularly among sedentary mechanics and artizans, students and professional men generally, as well as among the indolent and luxurious inhabitants of all large and wealthy cities, than those which have their origin in the stomach and the other organs con- cerned in digestion. The stomach and intestinal canal, parts of a most delicate structure and possessed of an exquisite sensibility, are not only hourly subject to injury from improper food and drinks, or an excess- ive indulgence of the appetite in a diet, which, if taken in moderation, would be altogether whole- some ; but, by the close sympathy which exists be- tween these and all the other organs, they quickly participate in the diseases of other and remote parts. Whether it be the brain, the lungs or the skin which Buffers, the stomach cannot remain long in health. Hence, Indigestion is an attendant upon nearly every malady, both acute and chronic, to which the human body is liable. The symptoms of pain and uneasi- ness in the region of the stomach are often indeed the first which direct the attention of the patient to his real condition. On the other hand, the extensive sympathies of the stomach cause the diseases which may originate primarily in the latter to be extended quickly to the liver, bowels, brain, skin and lungs Dyspepsia, or Indigestion. 175 It is this that renders indigestion so complicated and protean a disease— differing in its phenomena accord- ing to the period that it has existed and the constitu- tion, age and sex of the patient in whom it occurs. The causes of Dyspepsia are of two classes. First, those which affect primarily the stomach; and se- condly, those which disorder first some other organ, the stomach being affected secondarily or by sym pathy. Of the causes which affect directly the stomach, the principal are errors in eating and drinking Overfeeding, the use of too rich and stimulating food, of articles difficult of digestion, as fried meats, made dishes, gravies, clams, lobsters, fried oysters, rich soups, fresh bread,- and pastry of all kinds; late and heavy suppers, eating rapidly without properly chewing the food, the excessive use of strong tea and coffee, the use of flatulent and indigestible vegeta- bles and fruits, as cabbage, green corn, pickles, cucumbers, melons and the like, and the abuse of spices, are so many causes of injury to the digestive organs, and which, sooner or later, give rise to the train of symptoms characteristic of Dyspepsia. Ex- ercise immediately after eating, or intense occupation or violent excitement of the mind, if constantly or repeatedly indulged in, by impeding the change of the food into chyme, and allowing it to ferment or become acrid, will always, sooner or later, induce Dyspepsia. All drinks excepting water, used as ordinary beverage, whether fermentea or distilled, malt, vinous or spirituous, disorder the digestive or- gans, and give rise to the very worst kinds of dyspepsia. The tippler as well as the drunkard are almost invariably dyspeptic. Even lemonade, if drank in too great quantities or too frequently, will disorder invariably the stomach. Smoking, chewing 176 Compendium of Domestic Medicine. and even constant snuffing, very generally produce Dyspepsia, as well by the waste and vitiation of the saliva, as by the narcotic or depressing effect which the tobacco produces upon the nervous system gene- rally, or immediately upon the stomach. When, by any of these causes, the coats of the stomach are rendered morbidly irritable and its vital powers are impaired, the use of even the ordinary articles of food will be a sufficient stimulus to increase the disease, and dev elope the more aggravated phe- nomena of Dyspepsia. A cause of Indigestion which acts primarily upon the stomach and bowels, of not unfrequent occurrence, though but little suspected, is the imprudent or immoderate use of various medicines. Any indiscretion — whether it consist in excessive in- dulgence infood r an occasional debauch or a too heavy supper — will give rise to certain symptoms termed in popular language bilious. Now the most prudent course would be abstinence for a day or two with the plentiful use of some bland diluent. But instead of this, resource is had to an emetic, to a dose of calomel or anti-bilious pills, followed perhaps by chamomile tea, or some aromatic tincture or stomachic bitter, or perchance a daily glass of brandy and water ; and the slight irritation which exists in the stomach is in this manner not only aggravated but rendered permanent, and Dyspepsia ensues. Of the causes which act indirectly upon the stomach in the production of Dyspepsia, the principal are, the want of sufficient active exercise; exposure to a damp, vitiated and confined atmosphere ; seden- tary and constrained positions of the body long in dulged in ; close application or anxiety of the mind, together with all the exciting and depressing passions ; late rising and prolongation of the occupations or amusements of the day during the greater part of the night; want of cleanliness, or rather inattention to the state of the skin; frequent vicissitudes of the weather; cold and damp; and a neglect to obey the Dyspepsia, or Indigestion. 177 regular calls of nature for the evacuation of the bowels — excessive indulgence in venereal pleasures and various unnatural practices. In casting the eye over the above list of causes, the reason will be readily understood wfny Dyspepsia is of so frequent occurrence among nearly all the classes which compose the population of a large city. The sedentary artizan confined for the greater part of the day and night to a small, close, and often dirty and crow T ded workshop, his body bent constantly over his task, while his mind perhaps is harass- ed by the anxious thoughts occasioned by the wants of a numerous family immersed in poverty, or the painful reflections to which a view of his own folly m|y have given birth — The slave of luxury or of pleasure, whose whole existence is spent in listless apathy or in a round of dissipation, who consumes the night amid scenes of riot or of folly, and the morning in unrefreshing slumbers or in entire in- dolence — The industrious mechanic and shop-keep- er, whose minds are absorbed by the cares of exis- tence and their bodies imprisoned within the narrow confines of their respective shops — The enterprising -nerchant, the ambitious student, the aspiring poli- tician, the man of letters and the members of the various professions, who, in addition to their seden- tary habits, have a thousand causes to vex and agitate their minds, and too often add to these, errors in diet and indulgence in intoxicating drinks — Finally, the numerous slaves of vice and sensuality pro- duced by the folly, and nurtured by the wealth of every prosperous and crowded city : These all con stitute so many victims to Indigestion, as well as to numerous other diseases. Those most exempt from diseases of the stomach are individuals of temperate habils and contented minds, whose inclinations or whose occupations carry them abroad into the open air and impose a necessity for active and regular bodily exercise. The empiovments most friendly to health of stomach M ' 178 Compendium of Domestic Medicine. and of the body generally, are those of the farmer, and the gardener, who at the same time adhere to regular hours and sober habits, and are removed at once from the deteriorated and unwholesome atmos- phere and follies of the city, and the thousand sources of care audi anxiety to which its inhabitants are daily subjected. SYMPTOMS. The symptoms of Dyspepsia are very numerous and diversified — they differ according as the disease is confined to the stomach and bowels, or has ex- tended to the liver, the brain, the skin, the lungs and other organs. The phenomena by which the disease is most usually accompanied, are a sense of disten- sion or oppression after eating, acrid or sour eructa- tions, flatulence with frequent belching of wind, impaired appetite, vitiated taste, increased thirst, constipation and uneasiness of the bow T els, sometimes looseness, coated tongue especially in the morning, loss of strength, disinclination to exercise, and a general feeling of depression and indescribable weariness. When the bowels are moved, the stools are unnatural, being either green, black or very light. Nausea, headach, vertigo and dimness of vision are very generally experienced, and sometimes bilious vomiting; a burning sensation at the pit of the stomach is not unfrequent; sometimes the patient experiences a violent pain of the stomach which ter- minates by a copious discharge, by the mouth, of an insipid or perhaps intensely acid, colourless fluid of a glairy consistency. Palpitation of the heart likewise often attends ; with pain in the pit of the stomach or towards the right side, sallowness of complexion, depression of spirits and irritability of temper. The patient is sleepless at night and drowsy during the day, or his slumbers are disturbed by the most frightful or distressing dreams. Sometimes the body is Dyspepsia, or Indigestion. 179 extremely emaciated, at others it appears fat or rather bloated. The whole of the foregoing symptoms are not, however, present in every case of Dyspepsia ; but under whatever form, and from whatever cause the disease has originated, there is always a conside- rable degree of general languor and debility, and a great susceptibility to atmospherical vicissitudes; exercise, or exertion of any kind soon fatigues; the pulse is weak or morbidly excited, the sleep disturbed, the limbs, especially the feet are cold, or rendered so by slight causes ; and a sense of distension and oppression, acid eructations, flatulence, nausea, head- ach, irregular bowels, pain in the pit of the sto- mach, sallowness of the complexion and dryness of the skin are pretty constantly present. Frequently there is a good deal of feverish heat, with flushing of the face, dryness of the mouth, thick coated state of the tongue, pain on pressure at the pit of the stomach, weakness of the knees, wandering pains of the limbs and body, and a dry scurfy state of the whole surface. In the more aggravated forms of Dyspepsia there is often constant violent pain in the stomach; frequent vomiting of dark matter, the utmost debility and emaciation of body, and extreme despondency of mind. In others there are cough and expectoration, hectic fever, night sweats, and a wasting diarrhoea. Frequent and dangerous mistakes are often made in relation to the seat and real nature of the disease giving rise to the symptoms of Dyspepsia. The bitter taste in the mouth, nausea, bilious stools and sallow complexion, have led many to ascribe them to a disease of the biliary organ — hence it is not unfre- quent to hear dyspeptic patieots complain of being bilious or of suffering from liver complaint. But though in very many cases the biliary secretion is disordered, yet for the most part this is a secon- dary and sympathetic affection, dependent upon the irritation or disease seated in the stomach and upper portion of the intestines, and quickly disappears upon 180 Compendium of Domestic Medicine. the removal of the latter The practice resorted to under ihe supposition of bilious derangement being the chief cause of the symptoms, is highly pernicious, very generally aggravating and complicating the primary disease. Emetics, frequent doses of calomel and other purgatives, and the various irritating reme- dies so generally employed, always do more or less injury to the already diseased stomach. Other patients, paying attention solely to the sense of exhaustion, the disinclination to exertion, the want of appetite and the sallowness of the complexion, believe the whole of the symptoms under which they labour to be the result of pure debility. Tonics, stimulants, wine, brandy and porter with rich nour- ishing food are resorted to, but without the least good effect. The disease proceeds onwards even more rapidly than before, and the mistaken patient becomes daily more and more weak. The remedies he has taken have acted like oil thrown upon fire : instead of removing the debility of the system they have merely increased the irritation of the stomach, and secondarily of the other organs. By others again the symptoms of Dyspepsia are supposed to be nervous; and valerian, ether, musk, assafoetida and bark are profusely administered to relieve them, by strengthening, as it is presumed, the nervous system. It is very certain that many of the symptoms from which dyspeptics very commonly 8ufler depend upon an affection of the nervous system; but the treatment usually resorted to, in order to remove such, affection, is altogether impro- per, it keeps up and aggravates the disease of the stomach by which the nervous affection has been produced. PREVENTION. The prevention of stomachic diseases, including Dyspepsia, will depend upon a cautious avoidance of ALIMENTARY CANAL. a, oesophagus ; b, stomach ; c, cardiac orifice ; d. pylorus: c, small intestine ; /, biliary duct ; g, pancreatic duct ; h, ascending rcolon; »', transverse colon ;,;, descending colon; /.-, rectum. Dyspepsia, or Indigestion. 181 their remote and exciting causes. Let an individual live upon plain wholesome food, cooked in the simplest manner and eaten in moderation. Let him drink nothing but water, and allow to his meals a sufficient space of time, so that he need not eat with haste, and swallow his food without properly chewing it. Let him shun crowded, ill ventilated apartments, and take a sufficient amount of active exercise in the open air daily. Let him retire to rest at an early hour at night, and rise from his bed with the sun. Let him make no use of tobacco in any form. Let him cultivate an even, contented and cheerful frame of mind, and shun as much as possible every source of engrossing care, and of deep depressing emotions. ' Living wisely," as an old writer justly expresses it, " rather in the shade, than risking his happiness upon the smiles and the whims of fickle men ;" let him fly from dissipation, folly and vice of every kind, and he will seldom be troubled with Dyspepsia. TREATMENT. The first and most important point in the treat- ment of Dyspepsia is to relinquish whatever cause has laid the foundation for or given rise to the complaint, and which continues to aggravate it. This will of itself often be sufficient, especially in its early stages, to remove entirely the disease. If the patient leads a fashionable life, it will be neces- sary for him to forsake at once the haunts and habits of dissipation; to leave the crowded city, to shun luxurious tables, rich wines, strong drinks and late suppers ; to renounce his indolence and late hours ; and to return to a simple and rational mode of living. He must seek pure air, engage in active regular ex- ercise and in pleasing out-door occupations, retire and rise early, make use of a simple moderate diet, and court the society of a few cheerful and intelligent friends. The plodding student must in a great mea- 182 Compendium of Domestic Medicine. sure lay aside his books, and extinguish his midnight lamp ; the fagging tradesman and merchant will find it indispensably necessary to seek daily, active exer- cise in a pure air; the tippler and the drunkard must give up their potations. In short all dyspeptics must exercise for several hours each day out of doors ; they must rise early and take a sufficiency of sleep during the night; they must seek cheerful conversation; and carefully and constantly observe a moderate, plain and wholesome diet. Among the articles from which the individual labouring under Indigestion must entirely abstain are to be included all species of very fat, salted, dried, smoked or fried animal food ; veal in almost any form, rich soups and sauces, spices, pickles, cucumbers, all flatulent vegetables, particularly cab- bage, mashed potatoes, melons, unripe fruit, also sau- sages, fish, particularly salted fish and that which is fried, fresh bread, hot toast, pastry, fried oysters, crabs and lobsters, animal jellies, tea, coffee, malt liquors, wine, ardent spirits, and tobacco whether in snuffing, chewing or smoking. The dyspeptic should never take so much food at one meal as to cause a feeling of fulness or distension in the stomach; and, except under very particular circumstances, he should confine himself to three meals a day ; the last one to be taken at least two hours before going to bed, and to be very light. The best common beverage for a dyspeptic is pure water, or toast and water. It is a common but very erroneous opinion, that persons with impaired appetites and feeble powers of digestion ought to eat little at a time and often. Such a practice is altogether injurious. By taking food in small portions almost constantly, no time is allowed for the proper digestion of that previously eaten, and the stomach is in this way kept in a constant state of activity and of irritation. In- stead of gaining strength, it becomes more enfeeb- led. As a general rule, subject to very few ex Dyspepsia, or Indigestion. 183 ceptions, no food should be taken in the intervals of the meals. Riding on horseback is a highly beneficial exercise for those labouring under Indigestion; it gives a mo- tion to the abdominal organs, which is communicated by no other kind of exercise. Daily walking in the open air must not however be neglected. A combi- nation of these two species of exercise is preferable to either alone; for riding chiefly exercises the abdominal viscera, and walking the limbs and thora- cic organs. Exercise should never be taken imme- diately after a meal, nor carried to the extent of inducing undue fatigue. The feet, chest and abdomen of dyspeptics should be especially guarded from cold. If there is consi- derable torpor of the skin and a feeling of chilliness from slight reductions of temperature, flannel should be worn next the skin, during at least ihe colder and more changeable months of the year. Woollen stockings and a flannel roller around the abdomen are always important articles of dress to the dyspep- tic. At night, the bed clothes should not be' more than are sufficient to keep the body comfortably warm, and a mattrass is always preferable to a feather bed. The following are the principal symptoms which seem to demand relief in Dyspepsia. 1. Costiveness. There are few points of greater importance in the management of Dyspepsia than the proper regu- lation of the bowels. They ought to be fully eva- cuated once in the twenty-four hours. To do this, the habit of soliciting a discharge at a regular period of the day by the natural efforts will often suc- ceed. Habitual costiveness in those inclined to indigestion is often caused by neglecting the calls of nature. If this have not the desired effect, a diet composed of laxative vegetables, as well-boiled sphv 184 Compendium of Domestic Medicine. nage, boiled turnips squeezed perfectly dry, well- boiled oat-meal gruel, chicken or veal broth, or some of the summer fruits, perfectly ripe, eaten raw or after being cooked, will very generally produce a free state of the bowels. Let it be recollected that although the articles of food just enumerated maybe highly improper for the ordinary use of the dyspeptic, yet taken occasionally, merely with a reference to their laxative effects, no harm but much good will result from them. Bran bread or crackers, used con- stantly, will often remove costiveness. If costi veness still continue in conjunction with regular active ex- ercise and early rising, frictions over the whole of the abdomen night and morning should be resorted to. The practice of shampooing, rendered some time since very popular in this city by the announcements and publication of Mr Halsted, will not unfrequently succeed in causing regular evacuations by stool, and obviate the necessity of resorting to medicine. This practice will be detailed hereafter. The use of the warm bath should never be neglected. When me- dicines are demanded, they should be of the most gentle kind and not too long persisted in. A combi nation of magnesia, rhubarb and small portions of ipecacuanha is a very excellent purgative in dyspep- tic cases; so are the seidlitz powders, if not too often repeated. A pill composed of the blue mass, soap, myrrh and ipecacuanha, will be in many cases pro- ductive of the best effects The utmost care must be observed, however, not to produce active purging or any considerable irritation of the bowels, in attempting to relieve costiveness — whatever remedy is used, its effects are merely temporary; a regular state of the bowels can be obtained permanently in no other way than by a proper diet and regimen, in addition to the other means calculated to restore to the digestive organs their healthy tone and functions. Dyspepsia, or Indigestion. 185 2. Flatulence. To remove this unpleasant and troublesome symp torn, strict attention must be paid to diet. Food m any degree irritating, acid or fermentable must be abstained from. Active exercise must be taken in the open air, and frictions over the stomach re- peated several times a day. As a palliative, a glass of water in which a few grains of the bi- carbonate of soda have been dissolved, or perhaps what is better with the addition of a few drops of aqua ammoniae, will often be found useful. There is danger however of increasing the irritation of the stomach when this is too often repeated. The cause of flatulence is the disordered state of the digestive organs ; when this is remedied the former will cease. We must caution the dyspeptic against the too cus- tomary practice of resorting in cases of flatulence to mint water and various aromatic tinctures, brandy and water, and similar stimulants : from such remedies the most mischievous effects are to be apprehended. 3. Violent Pain of the Stomach and Bowels. In some cases of Dyspepsia the paroxysms of pain are so intense that for their immediate relief opium must be resorted to ; the best form for its administration will be in the form of a powder composed of one grain of opium or one third of a grain of sulphate of morphia with ten grains of magnesia and one of ipecacuanha. The relief obtained in this way, however, is only temporary; and to repeat too frequently the remedy will be productive of mischief. The calm resulting from opiates in Dyspepsia very often leads to their habitual use; but this never fails to aggravate the disease and render its cure more difficult, if not im- possible. Ten grains of pepsin with three grains of the subnitrate or carbonate of bismuth, taken before each meal, will be found of very great 186 Compendium of Domestic Medicine. ■ 1 » benefit in these cases. In very many cases the pain of the stomach will be removed by warm fomentations over the abdomen, and by cups to the region of the stomach or along the spine. 4. Nausea and Vomiting. Nausea and vomiting are often distressing symp toms in cases of Dyspepsia. To relieve them, cold toast water, or a draught of soda water taken in a state of effervescence, will very commonly be found useful remedies, in conjunction with a proper atten- tion to diet. When the vomiting is very distressing, a blister should be applied over the pit of the sto mach. 5. Constant Soreness and Pain of the Stomach. Soreness of the stomach, great tenderness under pressure, or constant pain in that organ, is frequently present in protracted cases of Dyspepsia. It is some- times accompanied with burning of the soles of the feet and palms of the hands, or dryness and heat of the entire surface. In these cases the use of all solid food must be abandoned, the patient being con- lined solely to toast water or gum arabic tea ; ice bladders or cloths dipped in cold spring water and wrung out, should be applied without delay over the stomach, and repeated if the symptoms be not removed the first time, or if they recur subsequently. The patient should not in such cases make use of any very active exercise. The pain and tenderness alluded to depend upon a greater or less degree of inflammation seated in the lining membrane of the stomach and upper intestine; which, unless it be promptly removed, may produce a degree of disor anization in these important organs from which re covery can scarcely be hoped for. 7 6 CHYLE- VESSELS OF THE MESENTERY. 1, aorta; 2, thoracic canal ; 3, lymphatics ; 4, radicles of the chyle-vessels ; 5, intestine ; 6, mesentery ; 7. lymphatic vessels. Dyspepsia, or Indigestion, 187 GENERAL REMEDIES. We have next to consider some general remedies demanded for the cure of Dyspepsia. 1. The Warm Bath and Frictions. So intimately connected are the stomach and skin, that one of these parts can scarcely ever be involved in disease without the other suffering likewise. It is important therefore, in all cases of Indigestion, to promote the health of the external covering of the body — by exciting it to a regular discharge of its functions. This is best effected by the use of the warm bath and by frictions. When properly used, these means seldom fail to prove highly refreshing, to remove many of the symptoms most distressing to the patient, while they aid greatly in bringing back the digestive organs to a healthy condition. From ninety to ninety-six degrees is the best range of heat of the bath for the use of dyspeptics ; and the proper time for resorting to it is in the morning, between breakfast and dinner. The patient may repeat the bath three or four times a week, and remain in it from fifteen to thirty minutes, according to his feel- ings, which ought to be comfortable on coming out of the water. A gentle walk or ride should follow the use of the bath whenever the weather is favour- able. When the warm bath cannot be conveniently procured, or when it fails in producing a beneficial effect, which will seldom however be the case, tepid sponging may be substituted. That is, the whole surface of the body is to be sponged regularly every morning with tepid water, or salt and water; the pa- tient immediately afterwards rubbing himself per- fectly dry with a coarse towel. This is a very refreshing and beneficial practice, and one which Sir Astley Cooper considers to have very materially 188 Compendium of Domestic Medicine. contributed to ensure the excellent health which he so long enjoyed. He uniformly resorted to it imme- diately on rising from his bed. Frictions over the surface with a towel or flesh brush without sponging may also be resorted to with the best effects in the evening, or just before retiring to bed. This is a very effectual means for producing sound and re- freshing sleep, and causes the patient to awake in the morning with renewed strength and vigour. 2. Mr Halsted's Method. On principles similar to those on which the warm bath and frictions act, in removing Dyspepsia, is to be explained the practice of Mr Halsted, which he recommends as a specific in this disease. The plan of treatment to which we allude is commenced by applying over the anterior part of the abdomen an emollient poultice or cloths wrung out of warm water, and repeating these until the abdominal muscles become perfectly flaccid. The patient being placed in such a situation, either standing or sitting, as shall most completely relax those muscles, the hand of an assistant is to be insinuated deep into the soft parts, in such a manner as that ihe bowels shall rest in some measure upon the open palm. Then by a quick but gentle motion these parts are to be pushed upwards towards the stomach, and in this manner agitated daily or oftener until an evident change for the better is produced, when the fre- quency of its employment is to be gradually dimin- ished. This is by no means anew plan; it differs but little from that recommended and employed by admiral Henry in 1787. This latter directs the patient whilst in bed, by means of a bone rounded at the end in each hand, to knead the bowels as much as possible, particularly about the navel, causing, " the two in- struments to meet among the bowels as much as they can be forced to do." Dyspepsia, or Indigestion. 189 From frictions and the warm bath diligently per- severed in, all the good effects resulting from the practice just described will be obtained, and with less trouble to the patient and less danger of doing mischief when the stomach or bowels are morbidly tender or inflamed. 3. Mineral Waters. The use of the natural mineral waters has been recommended in cases of Dyspepsia, and instances are related of marvellous cures effected by their agency. The water, impregnated with saline or mineral substances, of many of the natural springs, will, no doubt be found of advantage in some of the forms of stomachic disease, both inwardly and as a bath. But we are persuaded that the good effect frequently ascribed to these waters is dependent equally upon the journey ; the agreeable occupation of the mind ; the pure air and daily exercise at the spring, and the breaking up for a time the ordinary bodily and mental occupations — the absence, for a season, from the fatigue and anxious cares to which the individual had been previously subjected. In the same manner a sea voyage will often effect a complete cure. 4. Tonics and Bitters. We forbear to enumerate the numerous tonics — mineral and vegetable, the bitters and arc matics that have been at different periods, and are still by many writers, recommended for the cure of Dyspepsia. Un less aided by the treatment already laid down they can do no possible good ; with it they are seldom if ever needed. They have in fact produced more injury by far than benefit — by being resorted to at an im- proper period of the disease, or continued for too long a period. A light bitter or some simple tonic may, towards the termination of the disease, add tone to 190 Compendium of Domestic Medicine. the stomach, but by no means so certainly or effectu- ally as will a proper diet, regular exercise, pure air, cheerful employments, and the disuse of the vari- ous injurious agents usually introduced into the stomach. CONCLUSION. We may remark, in concluding, that the plan of treatment we have laid down must be persevered in for a considerable length of time before any effectual relief is to be expected : stomachic diseases of any standing cannot be removed in a few days. It is im- portant also that the treatment be uniformly perse- vered in, until the cure is eflected and the func- tions of the stomach are completely re-established. It will not do to adhere to the rules laid down for a week or two, and then commit an act of folly or of dissipation, returning afterwards in hope of benefit to a temporary course of prudence and of temperance. Such conduct is more than madness — nothing but disappointment can result from it. Dyspeptics, from the desponding state of mind under which they most commonly labour, and an erroneous and exaggerated opinion of the nature of their dis- ease, of its extent and danger; as well as from their want of patience to pursue a long uninterrupted series of gentle remedies, and the false estimate very generally made by the public of the efficacy of diet and regimen unaided by some potent medicine inter- nally administered ; render themselves the willing dupes of every needy and impudent empiric. Tempo- rary relief is often obtained from the pills and panacea of the latter ; but the disease, nevertheless, becomes more deeply rooted, and the unfortunate patient for a moment's ease is made to suffer for life. The dys- peptic should always view T the empiric as one of his greatest enemies — the one most to be dreaded. SICK-HEADACHE. This disease is the result of our advanced state of civilization, the increase of wealth and enjoy ments in the power of most people in this country, and of the luxurious and enervating habits in which those in easy circumstances indulge. It is unknown among the natives of our forests, or among those of the frontier inhabitants whose necessities oblige them to live in a manner the reverse of that com- mon among the inhabitants of the Atlantic states, and particularly the residents of our large cities and towns, among whom the complaint very generally prevails. Some of their habits are indeed of a na- ture directly calculated to lay the foundation of the complaint; but the vigour of their constitutions and daily exposure to pure air, aided by constant exer- cisej are more than sufficient to countervail their bad effects. The stomach is the seat and throne of this disease, and affects the head by means of that sympathetic connexion which it holds with it and every organ of the human body. High living, over-eating, late hours, disposition to acidity in the stomach, partial mastication or long continued use of food of difficult digestion, suppers, indolence, relaxing habus, and the presence of bile in the stomach, are the general remote causes. Our remedies therefore must be 191 192 Compendium of Domestic Medicine. directed to the stomach, and the restoration of its nervous functions, the impaired state of which occa- sions the agony endured by those who labour under the complaint. The desirable change however must be efFected by slow degrees; for the stomach gives way slowly, and the means of cure must be gradu- ally applied. The length of time required to re- establish the tone of the nerves of the stomach, will vary in different persons in proportion to the violence of the disease, the fidelity with which the sufferer follows the advice given, and the susceptibility of the stomach to the impression of the remedies, and food prescribed: the object of their exhibition how- ever will be obtained sooner or later. SYMPTOMS. An attack of the disease most commonly forms in the course of the night, and on awaking, a pain is felt in some part of the head, but generally over one or both eyes. More or less languor attends it, with a diminished or total disrelish for food, and great sensibility to light. , After continuing for one or two days, and even longer, if no remedy be taken, a nausea sometimes succeeds, which finally ends in vomiting, or this may easily be excited by a draught or two of warm water: in either case, relief is soon obtained from the more acute symptoms, and sleep follows — though a distressing soreness and confusion of the head succeed, which gradually go off, and health is restored. In some cases the pain in the head is preceded by a dulness and heaviness of the eyes, and confusion of the brain, which finally ter- minate in the fixed pain. Cold feet sometimes pre- cede an attack, and constitute the first symptoms of its approach. Sick-Headach. 193 MEDICINES. In commencing a regular plan for restoring the tone of the nerves of the stomach, a laxative ought to be the first remedy; as rhubarb, of which twenty, thirty, or thirty-five grains, in powder, may be taken early in the morning in syrup, or in the form of pills of a convenient size made with the same material, or, which is preferable, with castile soap, on account of its purgative power. Its activity may be quick- ened, and the object of its exhibition promoted, by the addition of one or two grains of aloes, if no objection to it exist, arising from its effect on the rectum, or from its harsh operation on the stomach or bowels. During the operation of the medicine, several tea cups of thin gruel made of oat meal or corn meal, to which so much salt has been added as to be perceptible, should be taken. The breakfast after this prescription, and through the treatment, may consist of a cup or two of weak souchong tea, with a soft boiled egg, weak coffee, water in which chocolate nut-shells have been boiled, or prepared cocoa, with a slice of dry stale bread. The dinner must be of the lightest kind, of any of the articles hereafter specified. In southern constitutions, an attack of the disease is generally brought on by the presence of bile in the stomach, the removal of which is therefore indis- pensably requisite previous to taking any medicine to relieve the headach, or to the commencement of any regular system of prevention of the disease. An emetic of ipecacuanha, in this case, will be absolutely necessary, of which fifteen, twenty, or twenty-five grains (according to ease or difficulty of being oper- ated on by it) may be taken in half a wine-glass of water. Two vegetable anti-bilious pills will insure its full operation, and the complete removal of the offending cause. The emetic may be worked off by N 194 Compendium of Domestic Medicine, a tea cup or two of weak chamomile tea, taken at intervals, after the medicine has operated two or three times. The evening is the most suitable time to take the emetic, after the operation of which sound and refreshing sleep most commonly follows In case the medicine does not operate on. the bowels once or twice, the dose of rhubarb and aloes be- fore mentioned, or twenty or twenty-five grains of jalap or rhubarb, with four or five of calomel (if the bowels are difficult to move), may be taken the following morning or night, and worked off by gruel of corn or oatmeal. Nausea from the calomel is in general prevented by the addition of a few drops of essence of peppermint, or a tea spoonful of compound spirit of lavender. If it come on, it may be relieved by a few spoonsful of a watery infusion of cinnamoi. or ginger, or by a little mint water. No fear neec. be entertained of the proportion of calomel prescribed affecting the mouth (unless the system be uncom- monly sensible to its effects), for the quantity added to the jalap and rhubarb insures its passage through the stomach and bowels— whereas a smaller dose might not be removed, and would then touch the mouth; at the worst its effects will only be temporary. This important preliminary being settled, the pa- tient must commence with the following medicine Prepared rust of iron, 1 drachm (60 grains), Columbo root, fresh powdered, 2 drachms, Orange peel, 3 drachms. Mix and divide into twenty papers: one to be taken morning and evening, in a small quantity of jelly or syrup, and washed down with a wine-glassful of cold water. After taking the above medicine for four weeks, rhubarb, recently pow 7 dered, may be substituted for the columbo, and if it be desired to render it more grateful, cinnamon may be added to the whole. If the dose be inconveniently large, the number of papers may be increased to thirty. After another month's use of this new prescription, the bitters may Sic k-Headach. 195 De omitted for four or five weeks, and the prepared rust of iron used alone. The occasional presence of bile or acid in the stomach, an occurrence that is easily known by the invalid, must be removed, by some anti-bilious pills for the bile : and for the acid, by twenty or thirty grains of magnesia, or dried subcarbonate of soda in the dose of from ten to twenty grains, in pills made with castile soap, three or four of which may be taken in a day. We have known Fowler's mineral solution given with great benefit in this disease: and our confidence in its powers, induces us to recommend it in violent cases. When taking it, the patient is not to drink cold water, or take cold. The dose may be from three to five or ten drops at the utmost, in half a wine glass of water, early in the morning, for an adult. If nausea be produced, it may be taken when going to bed, or one or two hours after a meal. The addition of a tea-spoonful of compound spirits of lavender (where this medicine has not previously been added) renders 't more agreeable, and prevents nausea. It must be discontinued, for a short time, when swelling in the face, or a sense of fulness in the eyes, is perceived. After the return of a fit, it may be again commenced. If nausea, or griping follow its use, the dose must be lessened. A tea-spoonful of common salt, dissolved in half a pint of water, and taken frequently in the course of the day, has afforded temporary benefit in a few cases; but we do not recommend it, by reason oi its uncertainty. The use of cider, as a remedy in this disease, was long since highly extolled by Dr N. D wight of Con- necticut: but we are convinced that the relief ob- tained by it must be only temporary; and we have known many, too many instances of ruinous attach ment to strong drink, from early morning doses of tincture of Peruvian bark, and the infusion of other 196 Compendium of Domestic Medicine. vegetable tonics in Port wine, to prevent or cure fever and ague, dyspepsia, or complaints called ner- vous, to permit us to sanction the use of even cider for Sick-headach. As bread constitutes so large a portion of our daily aliment, and forms a most important item in the articles by which a cure of this distressing com- plaint is to be effected, it demands the first notice. Bread should be light, and none other must be touched. There is no excuse admissible for heavy bread. If corn bread be used, it should be eaten in the form of thin, crisp cakes. I cannot conceive a more injurious article of diet, to a weak stomach, than the hot corn bread of the southern states. No wheaten bread should be eaten, unless twenty-four hours old. Economy and health unite in proscribing fresh bread as an article of diet: for, however palat- able, it is highly injurious to the stomach, and tries its powers more than almost any other of the causes of disease. During the years of youth, when the natural vigour is daily deriving cm accession of strength, — or, in constitutions enjoying greater pow- ers of the stomach than are absolutely required for the purposes of digestion, fresh bread may be eaten with impunity for years ; but I will venture to assert, that every meal m which it is taken, will detract some little from the powers of that organ, and that, in time, it will show its effects. As an attachment and relish for bread one day old is acquired in a short time, the sooner the former is left off the bet- ter; indeed a cure must not be expected, so long as the use of fresh bread is indulged in. Irfcases of severe affliction from the disease, and where a disposition to acidity prevails in the stomach, it is advisable to lay aside raised bread altogether, and to srbstitute shipbread or crackers, or rice boiled Sick-ffeadach, 197 dry. Where the teeth have failed, biscuits may be soaked in cold water, a short time before they are wanted. Bread made from unbolted wheaten flour, commonly called bran bread, is to be preferred to while bread. That species of animal food which has been found to agree best with the invalid should be eaten, and none else. Wild meats, being more tender, and more easily digested than the flesh of domestic ani- mals must be taken advantage of whenever occasion will permit. Our markets annually furnish, in the proper seasons, abundance of venison, which, of all our meats, is the most proper for those afflicted with a weak stomach, or Sick-headach. Game of all kinds, and rabbits, afford an ample variety of tender food. Beef is an article upon which we can subsist longer without disrelish, than almost any other. The part of the sirloin, containing the tenderloin, should be preferred ; though other parts, provided they are tender and juicy, may be eaten. Good mutton may be a standing dish. If either be roasted, the over done outside parts are to be avoided, being difficult of digestion. Beeves' tongues, salted and smoked and corned beef, are equally proper, and even medi- cinal, owing to the stimulus of the salt used to cure them. In general, corned beef is not half boiled by American cooks. Slow, steady boiling, for several hours, is requisite, to render that article sufficiently tender for a deranged stomach. Rapid boiling occa- sions a waste of fuel, dissipates with the steam the volatile and savoury particles of the meat, and thus renders the article less good and palatable The water in which meat is boiled, should be kept just at the boiling point. The same rule holds in regard to soup. The lean part of a white fat fillet of veal may be occasionally eaten. The knuckle of veal must never De touched, being very difficult of digestion. Of shell-fish, crabs and oysters are the only spe- cies allowable. The latter should always be accom- 198 Compendium of Domestic Medicine. panied with a due proportion of bread or biscuit, to compel mastication, and prevent over-eating. Lob- sters are inadmissible. There can be no objection to trout, rock (streaked bass), black-fish, sea-bass, sheepshead, perch, flound- ers, and whiting. Boiled fish are generally found more easy of digestion, than when otherwise pre- pared. The use of other fish must be regulated by the effects produced on the individual eating them. Soft boiled eggs, poultry, and ham well boiled, may properly constitute a part of the dinner of an invalid. Pork, unless young, and fed on corn and milk, is too strong; and in any case, the lean part only should be eaten Meat pies are ruinous to the stomach of all subject to Sick-headach. But whatever may be the article of animal food that constitutes the material of dinner, the following rules ought to be constantly observed : 1. If ihe meat be not salted, it should be kept as long as possible before it is cooked, that it may be tender. 2. Whether roasted, boiled or stewed, meat ought to be done until tender. French cooks pay much more attention to this point than those of America or England. 3. Simplicity in diet is essential to those subject to Sick-headach. The weak stomach revolts at the task of overcoming the difficulty of digesting a din- ner composed of numerous ingredients, and either rejects them, or labours to do the hard duty thus imposed. It may succeed, after a time, though every such exertion tends infallibly to increase the disease in question. The dinner ought to consist of one dish of animal food, and one or tw-o of vegetables, besides bread ; for the stomach is less strained to extraordinary activ- ity, than when several different articles are eaten. Besides, some articles, apparently of the same nature, do not agree when mixed, and maj' do harm by creat- ing a disturbance in the stomach, the quiet of which Sick-HeadacTi. 199 it is important to preserve. The principle of this harmony of aliments applies almost with equal force to vegetables, among which we see agreements and disagreements, almost as great as those we remark in the mixture of two articles of animal food, or of fish and flesh. There are few articles upon which we can live so long without tiring, as beef, potatoes, and rice. These are so innocent, and so well adapt- ed to give tone to the stomach, that they ought to constitute the diet of such as are labouring under a Sick-headach, as long as they can be procured, or taken without disrelish. Much of their excellence, however, depends upon their cooking. Tt is essen- tial that the potatoes be mealy, and that the rice be boiled dry : as this article agrees with most persons, • every invalid is urged to use it as steadily as possi- ble. Green peas, carrots, parsnips, and small homi- ny, may occasionally be substituted. 4. Slow and complete mastication of food is indis- pensable. The pleasure, moreover, of eating, is very much increased thereby ; because the organs of taste are more forcibly impressed than when the food is a shorter time retained on them, by imperfect mastication. Another advantage of slow eating is, '•hat, the stomach being gradually distended, there is less danger of its being overloaded, and it is less sensibly affected by the subsequent relaxation, than if the food be hastily swallowed. When slowly and fully comminuted, the food is also more equally ex- posed to the action of the saliva and gastric liquor, which are designed by nature to dissolve it. The digestion of food is thus promoted. Long intervals between meals render the adoption of this practice very difficult ; for the keenness of the sensation of hunger involuntarily forces us to eat quickly. The invalid should, therefore, never permit that sensation to proceed further than to cause a relish for food which should consequently be taken as often as is requisite, without reference to the regular hours of the family meals. Various articles can always be at 200 Compendium of Domestic Medicine. hand. But, on the contrary, unappeased hunger ia not less injurious, than adding to the load in the stomach before the previous meal has been digested. The inevitable consequence of this repletion is, that digestion is disturbed, the organ is unduly roused to overaction, and, in the end, evinces the loss of vigour, by the occasional derangement of its nerves, and the production of the distressing sympathetic affection of the pain of the head. The effects of such indiscretion are often shown several days after it has been com- mitted ; but most commonly the next day. 5. Moderation in diet must always be attended to. The stomach may be injured, by being over- loaded with simple food, as certainly, though not so speedily, as by other food of improper quality. The invalid should leave off eating, the moment the first distention of the stomach is perceived. Slow masti- cation favours satiety, without inducing undue dis- tention. The dinner should consist principally of vegetables. Most persons in the United States eat much more animal food than is necessary for or con- sistent wilh health. The rule with respect to butter shall be short. A more innocent article of food is not to be found than pure fresh butter, nor a more injurious one than strong butter The former may, therefore, be safely taken in moderation, provided it be found not to dis- agree with the stomach. This point can easily be settled by the invalid. Many physicians, without consistency or reflection, cry out against fresh butter as noxious, and yet will prescribe repeated doses of castor-oil, without once inquiring whether it is not, as it often is, offensive from rancidity. The most innocent mode of using butter is to spread it cold on bread twelve hours old, or on biscuit previously soaked. Soups of every kind are highly injurious to those troubled with Sick-headach, and ought therefore to be avoided. They suddenly distend the stomach without giving tone, and, in the way usually made, CARTILAGES OF LARYNX AND EPIGLOTTIS, AND UPPER RINGS OF TRACHEA, SEEN FROM BEHIND. (Taken from Todd and Bowman.) a, arytenoid cartilages, b, superior cornua of thyroid cartilage, c, its inferior cornua. d, posterior surface of cricoid. /, epiglottis, with its perforations, h. its left inferior tubercle, i, upper margin of thyroid, t, trachea. Sick-Headach. 201 are injurious, from the grease they contain, and which, from the heat they are subjected to, are much disposed to create acidity. The best gravy of all roasted meat is its own liquor. An invalid's stomach is better without any. The ranced fried liquid fat, passing under the name of gravy, is ruinous to the stomach of those subject to Sick-headach. Vinegar pickles must be shunned. They are injurious from the indigestible nature of the solid article, and from the acid used in their pre- servation. But mustard and horseradish may be safely eaten ; they are gently stimulating ; and in an habitual colic, arising from gout, the latter has been eaten at all hours, with the most marked benefit. Vegetable acids of all kinds, and fruits, are highly injurious. Some of the latter may be more particu- larly hurtful, on account of the difficult digestion of their skins. Cherries in one case, and apples in another, excited severe attacks of the disease. It will be observed that we have said nothing about desserts. We proscribe them all. There can, indeed, be no objection to plain puddings made of rice, bread, biscuit or potatoes, provided the butter in them is not found to disagree with the stomach, and provided they are eaten sparingly, and after a moderate dinner. Calves-feet jelly, without wine, is equally innocent, and may be taken to the extent of a glass with safety. A plain apple pie, with well baked and very light crust, may also be occasionally eaten, with the same caution as to quantity : but we hold up both hands against rich pastry, and a variety of rich puddings which the ingenuity of cooks have invented to please the palate at the expense of health. They are death to a stomach subject to the derange- ment of nerves producing Sick-headach. The invalid is better without any dessert ; for granting that the articles are in themselves innocent, yet they may be injurious by their bulk, and by disagreeing with those constituting the substantial part of the dinner. Besides the stomach acts with most vigour wnen 202 Compendium of Domestic Medicine. employed in digesting the fewest articles; and, therefore, it is wrong to try its powers by undue ex- ertion, or even to risk its derangement by a mixture of food. If any argument be necessary to urge the adoption of this simple diet, and to reconcile those subject to Sick-headach or dyspepsia, to the depri- vation of their usual supposed comforts, let it be re- membered, that the more steadily they submit to the discipline recommended, the sooner the object of it will be attained. Let them also reflect, that in ex- changing temporary sensual gratification, and conse- quent suffering, for the habits and food that will, in a short time, prove as agreeable as those they have relinquished, they will also acquire light pleasant feelings, elasticity and serenity of mind, and all those sensations arising from the permanent enjoyment of good health, and freedom from pain ; and above all, for uninterrupted capacity to discharge the duties which their various situations in life may demand. They must, however, bear in mind that a return to old practices will unquestionably, sooner or later cause a return of their complaints. We can assure .hem, however, that they will, in a short time, become reconciled to the rational mode of life recommended, and that they will not only afterwards pursue it from choice, but advise others to adopt it. Tea and coffee must be taken in great moderation. In place of them, for breakfast, the articles noted in page 193, or a small portion of some of the varieties of animal food mentioned at page 197, may be sub- stituted ; with the addition of sound bottled claret, if the acid of this wine should be found not to disa- gree with the stomach. The claret must be diluted with water. In the evening a cup of souchong may be taken with safety ; but it would be better to omit it, and to take a few oysters, or a soft boiled egg or tw T o, an hour at least before bed time. Regular sup- pers must be wholly laid aside. Invalids should avoid dinner and supper parties, r or they thereby escape the inducement to transgress Sick-Headach. 203 Ihe rules proscribed for their cure, the importunities and remarks upon their forbearance from the thought- less and inconsiderate, and the reflections which may prove mortifying to them from seeing others, either in high health, or who set bad health at defiance, eating freely of what they call the good things be- fore them. DRINKS. Let every one afflicted with the Sick-headach be assured of the fact, of the superiority of water as a diluent, and throw aside wine, spirit, and malt liquors. [n the winter, if the coldness of the water should prove disagreeable, or give pain when taken, these effects may be prevented by pouring boiling water on toasted bread or biscuit, and permitting the tem- perature of the water to descend to a degree that may be found pleasant. It may then be taken at meals, or at any other time in the course of the day when required. This toast infusion is far preferable, and more palatable, than that made by infusing a hot toast in cold water. Those who are not blessed with water naturally pure, should, if possible, use distilled water; the benefit of which the late and experienced Dr Heberden, of London, thought might be as great in many chronic complaints of the sto- mach and bowels, as the most famous mineral walers are in other disorders. Dr Lamb says he was cured of a Sick-headach by the use of distilled water, and that he was informed of the same complaint having been relieved in others by using it. particularly by a gentleman more than sixty years of age. The same author relates several cases of the decided good effects of distilled water in various chronic com- plaints, as cancer, gout, obstirate cutaneous erup- tions, &C. Dr Adair also adds several facts of its me- dicinal powers. If distilled water be used, the first gallon that comes over should be thrown away- For 204 Compendium of Domestic Medicine, want of it, the water may be boiled ; and, in both cases, it should be put. into an upright churn, with- out a cover, and agitated for some time, to impreg- nate it with the air which it loses by either operation and, for want of which, it has a vapid and peculiar taste. In places where the water is obviously im- pure, or bad tasted, it ought to be passed through a filtering stone, or, which is better, a filtering appara- tus The water drinker will find, after a short trial, that he will never want the luxury of an appetite; that the sensibility of the organs of taste is increased, and that he will thereby add to the pleasure of eating. But. it must be remembered, that a cardinal point in the cure of all diseases of debility in the stomach, or of derangements in its functions, is to take no more drink at meals than is sufficient to promote the solu- tion of the food in its natural solvents, and its passage out of the stomach. Haifa pint, or a little more, is enough. The operation of the good effects of the tender modes of cooking, in France, is prevented by the large draughts taken by the people of that country at dinner: and indigestion is known to be a prevail- ing disease among them. During the day thirst must be assuaged, either by plain water, or water impreg- nated with carbonic acid, the method of doing which is now generally known. Where acidity prevails in the stomach, ten or fifteen grains of the supercar- bonates of soda or of potash, should be added to each glass without syrup. Half a tumbler is enough for one draught. More would cause uneasy disten- tion of the stomach. This drink, taken daily, has, in one case, suspended a severe Sick-headach for several months. The alkali may be dissolved in a wine-glass of milk, and pure water taken after it, if aerated water cannot be procured. The tonic effects of malt liquors on the human body, when not contra-indicated by some circum- stance, would naturally lead those not acquainted with them, to expect that they would be highly be- Sick-Headach. 205 neficial i-n the present complaint: but they are inju- rious, from containing more or less free acid, and must, therefore, be avoided: Attention to the state of the bowels is of essential importance in this disease. Costiveness not only dis- poses to its origination, but increases the disposition to frequent attacks of it. The bowels must, there- fore, be constantly kept open by the use of occasional doses of medicine, when necessity may require it. The Congress Spring water, at Saratoga, is the best laxative ibr the purpose; for it is the peculiar pro- perty of this admirable water not to weaken like other purgatives. Three tumblers full, taken early in the morning, are enough at a time. When drank on the spot, a tumbler of the Flatrock water, which is a pure chalybeate, may be taken in the afternoon. Where the Congress water cannot be procured, rhu- barb may be substituted, and, to prevent it giving pain, three or four drops of the essence of pepper- mint may be added to the dose ; or about thirty grains of the root may be cut up and chewed; the effects, when thus used, will be more slow and natural than when a full dose in powder is taken, If there be an aversion to this excellent medicine, castor-oil may be substituted. Spinage, when in season, simply prepared, and slightly seasoned, should be eaten at dinner, when constipation comes on. Where acidity prevails in the stomach, half a drachm to a drachm of calcined magnesia should be taken in milk. It would certainly conduce to the promotion cf the vigour of the body, or, at least, prevent the increase of muscular relaxation, if enervating feather beds were laid aside, and mattrasses of hair, or southern moss, substituted. In summer, a feather bed is an absurdity. Even in winter, a short time will recon- cile the most delicate to mattrasses, when they will invariably be preferred to feather beds. In cold weather, a blanket may be put between the sheet and the mattrass. 206 Compendium of Domestic Medicine. EXERCISE. Exercise is an essential remedy in the cure of the Sick-headach. But under the word exercise, so much is comprehended, that it is necessary to enter into detail respecting it. No species of bodily motion, no variety of the species of exercise commonly used, will have the desired effect, unless under proper regula- tions, and in conjunction with a due observance of the whole system of conduct laid down in the pre- sent set of directions. It is only one of the means prescribed, and may be defeateu by, or even interfere with the rest that are essential, by being improperly used, or by inattention to other directions. The ex- ercise must be in the open air, and occasionally be- fore breakfast. If taken in the house, it fatigues without effecting any change in the system. Riding on horseback, on account of the agitation of the in- ternal viscera, is, of all species of exorcise, the most proper; and should be constantly taken, every morn- ing, when the weather will permit. A long journey is much preferable to daily short rides at home, on account of the exhilarating and medicinal effects of the continued change of scene and of air on the system. Occasional stops should be made, and exer- cise on foot taken. Exercise, however, alone, will not cure or prevent the disease, which is known to affect persons of the most active dispositions, and possessing considerable muscular vigour. If it be not convenient to take a long journey, daily rides at home, or walking exercise, may be substituted. Some business, or object of investiga- tion, ought always to be had in view when exercise is taken, as a visit to a friend, the local topography or geology, mineralogy or botany of the country, &c. &c. To this must be added gentle frictions from right to left, on the side, and region of the stomach and bowels, with the flesh-brush or flannel, for fifteen Sick-Headach. 207 minutes, every morning before rising, and after meals The benefit of this remedy, though slow, is certain CHANGE OF AIR. A powerful remedy, in the cure of this disease, is a change of air. The influence of the air of a place, in the production of diseases, is evident from a variety of facts; and the prevention and cure of them obtained by a temporary change of air, or permanent removal of residence, is no less indis- putable. A striking effect of the change of air in the Sick- headach, occurred in a citizen of Philadelphia, who, from his sixteenth year, had been subject thereto, and in whom, until he had passed his fortieth year, it annually increased in force and frequency, so as to render his life miserable. A few years since he re- moved from the small and confined house, in which he had lived for many years, to one of larger size, having a spacious garden; and the consequence was, that, in the course of two years his headach became much less frequent, and his general health improved. OTHER CAUTIONS. Diseased teeth frequently excite this disease. In the commencement of a cure, therefore, all stumps that give occasional pain, and all hollow teeth not to be rendered useful by plugging, should be extracted Slight decays in other teeth must be cut out, and the cavities plugged. Early hours are essential to the cure of the com- plaint. This refers to bed-time and rising, and the invalid should make it a point never to indulge in the unsound sleep that is apt to follow lying in bed in the morning, after being awake some time. The languor induced by a long continued recumbent pos- 208 Compendium of Domestic Medicine. ture of the body, promotes that torpor of the diges- tive organs which contributes to the origination of the disease, and its continuance. A headach almost in- variably ensues from such practice, with the loss of that refreshing sensation arising from the sound re- pose of the preceding night. Cold feet frequently excite the disease. Care must be taken, therefore, to guard the feet from cold and wet, by cork-soled or Indian rubber overshoes, which are now made with great neatness, and by wearing warm stockings. Flannel socks should also be worn in winter when going to bed, and may be pulled offin the course of the night, when the warmth of the body has become equally diffused. No one subject to Sick-headach should sleep with a fire in the chamber; for the diminution of tempe- rature that often takes place in the course of the night, from the fire going out, or from a change in the weather, disposes the system to catarrh, and every such indisposition retards the cure of the dis- ease. This remark does not apply to Canada, or the eastern states, where the severity of the cold renders the preservation of an uniform temperature in the whole house, during winter, an object of unceasing attention; nor to those who have the means of keep- ing up a regular heat in their chambers during the night. The thermometer should not be permitted to rise above sixty degrees. The proper practice is, to have a fire kindled, early in the morning, in a sheet- iron stove, which heats quickly, or to dress in an adjoining room, where there is a fire. Bed-curtains should not be used. If the system feel exhausted by the duties of the morning, and require repose after dinner, to recover its energies, sleep for half an hour may be indulged in, to great advantage, with the body in an erect Sick-Headach. 209 position, or nearly so. A recumbent posture should never be adopted, if a cure be hoped for. The prac- tice, while in perfect health, of regularly going to bed after dinner, for an hour or more, is productive of the most enervating effects, and should never be adopted, by young persons who are desirous to pre- serve or acquire firm muscles, good complexions, or strong nerves. No one who values the preservation of a vigorous state of the surface, or wishes to prevent the gradual diminution of its tone, should ever permit a warming pan to enter the bed. In cases of natural delicacy of constitution, a flannel gown may be used to sleep in. One of the surest methods to invigorate the skin, and to prevent a disposition to take cold, is to rub some part of the body every morning, on rising, with a coarse towel dippecl in cold water. The refreshing sensation arising from this practice is so great, that no one who tries it will deprive himself of the grati- fication. The well known sympathy between the surface and the stomach, authorises a belief that the practice would prove a powerful auxiliary to the system recommended for the cure of the sick- headach. The passions of the mind must be kept under with especial care. Every mental irritation will add strength to the disease, and retard the wholesome operation of the remedies prescribed for its cure. The common effect of giving way to fretting, peevish- ness, or resentment, is an attack of the complaint. A determination should be made to overcome this disposition. One effect of the system of diet recom- mended for the cure of the complaint, is a happy re- volution in the temper, from great irritability to phi- losophic endurance of the little evils of life, and the power of self-command. The mind and the corpo- real functions are intimately connected and mutually act and react on each other. Every source of do- mestic irritation should, if possible, be avoided. The troubles of life affect the digestive organs very sen O 210 Compendium of Domestic Medicine. sibly, and operate with increased force when they are joined to improper food, or other remote causes of the disease. TREATMENT OF AN ATTACK OF THE COMPLAINT. If the disease announce its approach, which it sometimes does, by certain premonitory signs, as heaviness of the eyes, or confusion of the head, no time ought to be lost in arresting its progress. If the prevalence of an acid or of bile in the stomach be known, attention must be paid to their removal. If the first be present, twenty or thirty grains of calcined magnesia, or ten or fifteen grains of super- carbonate of soda or of potash, may be taken in a tumbler of artificial mineral water; and if this cannot be procured, they may be mixed with new milk or gum-arabic water: to both, the addition of orgeat, syrup of sugar, or of ginger, all render the draught more agreeable, Bile is to be removed by a brisk purge of com- pound podophyllin pills ; after which, if relief be not obtained, fifteen, twenty, or thirty drops of laudanum may be taken in half a wine-glassful of water, with the addition of a tea-spoonful of com- pound spirit of lavender, and sleep encouraged by retiring to bed in a dark room. If, on awaking, the pain in the head should not have disappeared, its removal will be promoted by the person remaining in bed, and repeating the dose. It is better, how- ever, to take enough at first, to insure a sound sleep for several hours; after which it commonly happens that no symptom of the disease remains, except a slight confusion of the head, arising from the effects of the laudanum: but this will disappear in a short time, by taking a cup of clear strong coffee, without sugar or cream. In this way relief from the present symptoms will Sick-Headach. 211 ne certain ; and by repeating the foregoing process a few times when the attack returns, it will be shortened, and the habit of the disease be broken and by due care to avoid the causes that excite it and the use of the medicines, diet and regimen re- commended, its return may be prevented. 212 Compendium of Domestic Medicine. THE TEETH. It is intended in the following treatise, 1. To give, in as few words as possible, a clear description of the structure and formation of the Teeth; and to bring to view those circumstances con- nected with their growth, with which it is important for every individual to be acquainted. 2. To give a brief sketch of the most common dis- eases to which the Teeth are liable; together with such directions, relative to their treatment and pre- servation, as shall enable the reader to take the necessary care of his own Teeth; and, if a parent, to pay proper attention to the Teeth of his children. The reader is aware that the diseases of children are not embraced in the plan of this Compendium of Do- mestic Medicine; but the author, in treating of the Teeth, has found it impossible to avoid some notice of the subject — unless at the hazard of omit- ting much that is interesting and instructive to those to w T hom this work is professedly addressed. 3. To guard against the injurious practice of igno- rant operators ; and to remove some of those popular prejudices which prevent many from adopting the only treatment calculated to diminish the liability to disease in these useful and important organs. A, the separate human teeth as they occur in the half jaw of the adult. B, the human teeth in situ in the upper jaw. a, a, incisors. 6, b, canine, c, c, premolars. d, d, true molars. The Teeth. 213 STRUCTURE, NUMBER, FORM AND ARTICULA- TION OF THE TEETH. In order to render the description of the Teeth, and of their diseases, as clear and comprehensive as poss- ible, anatomists have considered a Tooth as divided into three parts or sections ; first, the body or crown ; second, the neck ; and third, the root or fang. The whole of that part of a Tooth which is gene- rally exposed to view, when the gums are in a healthy state, is called the crown. The part which is immediately embraced by the gums, and to which they are united, is called the neck. The third section, or fang, is all that part which is found buried in the socket, when the bony process, of which the socket is formed, is in a perfect state. The hard or bony structure of the Teeth is described as consisting of two substances; one of a dense bony nature, much harder than that of any of the other bones, and of which are formed all the internal, parts of the crowns, the whole of the necks, and also the fangs of the Teeth. The enamel, or external cover- ing, is the other hard substance, which, however, forms only a part of the crown. It is of a peculiar nature, possessing a hardness and density exceeding that of any other substance in the whole body, and covers the crowns of all the teeth, but is seldom in any part more than a line in thickness. It is thickest, at those parts which are most exposed to use ; and thinnest, at those nearest the gums. The Teeth, like the other bones, are hollow, having a cavity in their crowns, corresponding, in form, to the external part of the tooth, and a canal in each fang, extending from this cavity, 'and terminating by a small opening in the point of the fang. These cavi- ties, however, are not, as is commonly supposed, for the lodgement of marrow, as in the other bones, but to give place to blood vessels and nerves, on which 214 Compendium^ of Domestic Medicine. the Teeth depend for their nourishment and sensi- bility. The dimensions of these cavities are found to vary, according to the degree of perfection attained in the formation of the Teeth ; being greatest in those which are very young, and becoming gradually smaller, till their formation is completed. In the Teeth of adults, they become still less, as the individual ad- vances in years, so that in those of very aged persons, these natural cavities are often found to be entirely closed, or filled by solid bone. Of the two sets of Teeth with which the human jaws are successively furnished, the first are called the temporary, infant, or Milk-Teeth ; and the second, the permanent or adult Teeth. There is most com- monly a difference in the number which composes these two sets, the first containing twenty, and the second thirty-two. The number in the second set is often found to vary, being in some greater, and in others less : but this variation seldom occurs in the first set. Both sets are divided into classes. In the first set there are, in each jaw, 1. Four front Teeth (Incisores), two on each side. 2. Two eye Teeth, or canine Teeth (Cuspidati), one on each side. 3. Four grinders, or double Teeth (Molares), two on each side. The front, and canine Teeth are succeeded, in the permanent set, by Teeth of the same denomination ; but the grinders of the first set are followed in the second, by Four double- pointed Teeth, or small grinders (Bi- cuspides). In addition to which there are in this set, a fourth class, viz. Six large grinders, or double Teeth (Molares), three on each side ; the last of which, on each side, is called wisdom-tooth. The Teeth of both sets, or those of the same class The Teeth. 215 in both, bear a strong resemblance to each -other ; so that, in many instances, at the period of shedding, the teeth of one set have been mistaken and extracted for those of the other. The roots of all the front and canine teeth, in both sets, are single, and generally straight and tapering ; and those in the upper jaw are commonly the longest The fangs of the small grinders (bicuspides) are flatted and thin, often a little crooked and tapering, and generally some of them forked at their extremi- ties. All the double Teeth (molares) in both sets have, in the under jaw, two fangs, and in the upper one, three ; two of these being fixed towards the outer edge of the jaw, and the other towards the roof of the mouth or palate. In many instances, however, the grinders of the upper jaw have ibur, or even five, fangs ; and those of the under jaw, three. And on the contrary, some of these Teeth, which are gene- rally designed by nature to have two or three fangs, are found with but one. The Teeth are connected with the jaws by the means of sockets, which are formed to receive and fit each particular fang, and by intermediate mem- branes, which serve at once for linings to the sockets, and coverings to the fangs; so that the roots of the Teeth are not immediately articulated or joined to the bony sockets, but are united by these membranes. The sockets which receive the Teeth are formed of thin plates or processes of soft spongy bone, which, while they embrace the fangs of the Teeth, serve as a support to the gums. These plates of bone, which are called alveolar processes, are produced, and in- creased, with the formation and advancement of the Teeth; and there is such a mutual dependence of the teeth and these processes on each other, that a Tooth is no sooner removed, than a wasting of the process commences, and all traces of a socket soon disappear. And on the contrary, when this dissolution and ab- sorption of the processes are first effected, as is often the case in consequence of disease, the Teeth irame 216 Compendium of Domestic Medicine. diately become loose and painful, and the patient is almost constantly afflicted till they are wholly re- moved. Thus it appears, that where there are no Teeth, there can be no alveolar processes, and where the alveolar processes are destroyed, the Teeth can no longer be preserved. These bony sides of the sockets are covered, like the rest of the jaw, by a thick strong membrane, called periosteum, which contributes greatly to support and strengthen them. The gums are next spread over this periosteal covering; and these again are in- vested by a very delicate membrane, which is con- tinued over the lips, tongue and throat, and is indeed the immediate lining of the mouth. All these soft parts, which cover the sockets of the Teeth, are so intimately united by the intermixture of their fibres and vessels, that they cannot be distinctly separated by the knife, and appear, on dissection, like one uni- form and homogeneous substance. These parts, and the membranes which connect the teeth with their sockets, serve for the transmission of innumerable small vessels, which go to nourish the jaws and teeth. Vessels and nerves of conside- rable size enter the jaws, and pass in channels at the deepest part of the sockets, where they supply the fangs of all the teeth with small branches; and in this way the cavities of the teeth are furnished with arteries, veins, and nerves, that enter at the fangs by the small openings in them, which have been men- tioned above. In order to illustrate the doscriptions which have been or may be given, the following print has been drawn and engraved. It consists of a representation of the bones of the face, in which the first and second sets of teeth are so exposed as to show their relative situation in both jaws, as found in a child of six or deven years of age. The preparation from which the drawing was taken had all the flesh removed, and the outer plate of the alveolar processes sawed and cut away in The Teeth. 217 such a manner as to bring to view the fangs of the temporary teeth, and the crowns of the permanent set which were beneath them. Explanation. a. a. a. Three front Teeth of the first set, the other had been shed. b b. The canine or eye Teeth of the first set c. c. c. c. The double Teeth or grinders of the first set, their fangs being partly absorbed. 1. 1. 1. 1. The crowns of the front Teeth of the permanent set, one of which, in the under jaw, is fully advanced, and is in the place of a temporary tooth which has been shed. 218 Compendium of Domestic Medicine. 2. 2. The crowns of the permanent, canine or eye. Teeth. 3. 3. 3. 3. The crowns of the double-pointed Teeth, or small grinders of the permanent set. 4. 4. The first large grinder or doufae tooth of the permanent set in each jaw, the fangs of which are not fully formed. It is owing to the early appear- ance of these Teeth beyond the temporary grinders, that many persons are deceived, and suppose they have never shed all their double Teeth. 5. 5. The crown of the second large grinder, or double tooth of the permanent set, in each jaw, still deep in ils socket, the formation of its fangs not having commenced. The subject was too young to allow of exhibiting the rudiments of the wisdom Teeth, or third large grinders. These are formed still farther back than the others. FORMATION OF THE TEETH. 1. Formation of the Milk Teeth. When the rudiments of the Teeth are first disco verable, they are small gelatinous or pulpy bodies, enveloped in thin membranous sacks, and arranged in a sort of excavation or groove in the jaw, which at this time is but imperfectly formed. Bony fibres then shoot across this groove, and separate it into iistinct cells, each of which contains its proper pulp, or embrvo tooth, invested in its membrane. At the time of birth, the formation of the temporary Teeth has generally so far advanced, that the pulps have attained their full size, and ossification has extended over their surfaces in such a manner as to form complete bony shells of the size and figure of the crowns of the Teeth ; and the pulp of the first per- manent grinder, on each side of both jaws, has ac- quired a considerable magnitude. After this the The Teeth. 219 pulps begin to elongate, in order to form the fangs, and the process of ossification is continued for the same purpose till they are completed. While this process is going on at the roots, another is progressing at the crowns, by which an earthy substance is deposited on their surfaces, and gradu- ally formed into that highly polished and beautiful covering, called the enamel. And while these changes are taking place, the Teeth are gradually rising, the alveolar processes which are to support them are increasing in height, and the membranous envelopes are dissolved and taken up by innumerable absorbing vessels, and car- ried into the mass of blood, having effected the pur- pose for which they were formed. After this, the gums, or those parts of them which are situated im- mediately over the Teeth, are also absorbed, and the advancing Teeth are allowed to rise into view. The age at which the Teeth begin to appear, is usually that from the sixth to the eighth month; sometimes earlier, and often much later. They ge- nerally advance in pairs, and in the following order: 1. The two central front Teeth of the under jaw, which are soon followed by the corresponding ones in the upper jaw. 2. The two next front Teeth, or lateral incisoresof the under jaw, which are succeeded by the corres- ponding upper ones. 3. The smallest double Teeth, first in the under, and then in the upper jaw. 4. The under canine Teeth, which are followed by the upper ones, called the eye Teeth. 5. The largest double Teeth. These also appear in the same order, with respect to the jaws, first in the under, and then in the upper one. They often pass through the gums at about the same time that the canine Teeth do, and sometimes before them. At other times, the canine Teeth precede even the smaller grinders in their advancement. Though this is the order in which these Teeth 220 Compendium of Domestic Medicine. generally appear, various circumstances produce the greatest irregularity in this process. The time which is occupied for their advancement varies much, though it is usually a period of about eighteen months, or two years. 2. Formation of the Permanent Teeth. The formation of the second set of Teeth, is one of the most curious and interesting processes which is effected in the development of any part of the human frame. While the temporary Teeth are forming, and soon after ossification has commenced on their pulps, the rudiments of the permanent set may be discovered. They are connected with the membranous coverings of the temporary Teeth, and are contained in the same sockets with them. When the first set advance to their destined situation, this connexion is not de- stroyed, but the permanent Teeth are left deep in the jaw, and bony partitions are formed between the sockets of the two sets. At a certain period after the crowns of the permanent Teeth are formed, the partitions of bone, which separate them from the sockets of the other set, are absorbed, and they gradu- ally rise and occupy the space thus formed. To give place to these Teeth, the fangs of the temporary set are then absorbed ; and in this way their crowns are finally deprived of all support, except a slight attach- ment to the gums, and are often removed by the ordinary pressure of the tongue against them. SHEDDING THE TEETH. The provision of nature for exchanging the two sets of Teeth, is as much calculated to excite our admiration, as the process by which they are formed. And there is no period at which the Teeth of children require more, if so much, attention and care. The Teeth. 221 If the fangs of the temporary Teeth be slowly ab- sorbed, the permanent Teeth will generally come forward so as to appear as soon as the corresponding ones of the preceding set are shed; and in a majority of cases, without doubt, the whole process is per- formed by nature with such perfect regularity, that the interference of art would be at best but useless. In some cases, it would be detrimental to the forming and rising Teeth ; and in others, injudicious and cruel, from the unnecessary infliction of pain. Yet there are so many cases in which irregularity and deform- ity, with their usual consequences of disease and suffering, are produced, by the manner in which the permanent Teeth are allowed to advance, that it is highly important that all parents should be acquaint- ed with the situation of the two sets of Teeth in rela- tion to each other, and with the changes which take place within the period of the second dentition. See plate, ante page 217. For it is only by their know- ledge of these, that they can be enabled to judge correctly when it is proper for them to interfere in removing the temporary teeth, and when it may be expedient or necessary to apply for the advice and aid of an experienced and judicious dentist, to pre- vent the evils w T hich often result from neglect or ignorance. If the permanent Teeth are discovered to be emerging from the jaw in such a manner that their position will be improper and injurious, or if they are inclined to any irregularity arising from the dispro- portionate growth of the Teeth and jaws, much may be done to prevent it by a seasonable removal of the temporary Teeth; but this should not be done by any who are ignorant of their liability to do mischief by taking the wrong Teeth, or by extracting them too early, or by removing loose Teeth only, when there may be the greatest necessity for extracting such as are perfectly tight, and in which the process of ab- sorption has hardly commenced. It is a very common opinion that the first Teeth 222 Compendium of Domestic Medicine. have no roots, and that they may therefore be ex tracted without injury, at any period. But nothing can be more incorrect; for the Teeth of a child have longer and larger roots, in proportion to the size of their crowns, than th* Teeth of an adult; and their connexion with the forming Teeth of the second set, at an early period, is such, that if they be extracted too soon, the violence done to the tender Teeth be- neath them may be so great as to prevent their for- mation from being completed, and they may never appear. Another prevailing opinion is, that the temporary Teeth should always be extracted as soon as they are discovered to be loose; and though this may generally be done without any bad effects, it is not so necessary as has been supposed, and in most in- stances is a useless interference ; and exposes children to suffer both fear and pain, which might as well be avoided ; for the looseness of these Teeth, as has already been shown, is occasioned by the absorption of their fangs ; and there can be no surer evidence than this, that nature is doing her own work in due season, and needs not the aid of art to expedite it, or render it more perfect. It is not by removing Teeth which are loose, but those which are firm, and have their fangs nearly or quite entire, that any advantage is obtained which will favour the regular advancement of the perma- nent set. The best advice, therefore, that can be given on this subject, to parents, and those who have the care of children, is to examine the Teeth fre- quently, about the usual period of shedding (the sixth or seventh year); and if any of the second set begin to make their appearance, or there is an evi- dent swelling of the gums at the part where any of them are expected to appear, a sufficient number of the first Teeth should be extracted to allow a suffi- cient degree of room for the second, which are com- ng forward. From what has been stated, however, it will rea- The Teeth. 223 dily be seen, that when the temporary Teeth have become very loose and troublesome, they may be extracted indiscriminately, and by any person; but when they remain firm, and the Teeth of the second set are coming forward in such a manner as to lap over each other, or appear in a double row, it is of the utmost importance to remove them, whether the process of absorption has commenced at their fangs or not, in order to give room, and restore regularity to the rising Teeth. It should be remembered, with regard to the exami- nation of the jaws and Teeth at the time of shedding, that all the Teeth which are to succeed the first set. if they come forward too soon, or before the tempo- rary Teeth become loose, will be discovered behind them, or on the inner side of the jaw, excepting the eye Teeth, or cuspidati, which will be found advanc- ing on the outer side of the jaw. It sometimes hap- pens, also, that when the temporary grinders have been very early removed, the bicuspides, or small grinders, of the second set, make their appearance on the outer part of the jaw, next the cheek. This is most common with the upper ones. All cases of great irregularity (which may gene- rally be discovered before the teeth have risen far above the gums, and often as soon as they appear) should without delay be placed under the care of an experienced dentist; for the limited knowledge which parents usually obtain, from the few cases which come under their observation, is not sufficient to en- able them to judge what is proper to be done, with that degree of correctness which the nature of the subject requires. THE FIRST DENTITION. The age at which the first Teeth begin to appear, varies very much in different children. This is caused by various constitutional peculiarities ; some* 224 Compendium of Domestic Medicine. times it depends on the general vigour of the system when there is no predisposition to disease of any kind. It may likewise depend on the influence of various morbid principles which have been inherited from the parent, or on that of diseases produced by various external causes. Children of the most robust constitutions do not always begin to cut their teeth earlier, or get through this process in a shorter time, than many others that are of a more sickly and feeble habit ; yet the former are much less liable than the latter to suffer from the pains and diseases to which children are exposed during the period of dentition. The common expression of cutting the teeth, has arisen from an opinion, that the growing teeth make a passage for themselves through the gums by lace- ration ; which certainly is not the case. As the teeth rise, a waste or absorption of the gums takes place, in order to let them pass through. This is often effected so easily as not to occasion any symptoms of pain or uneasiness. The absorption of the gums, to make way for the teeth, is as certain an effect of na- ture as the growth of the Teeth. In many cases, how ever, the rapid advancement of the Teeth, and the changes which must necessarily take place to produce it, produce also much disturbance about the jaws, and in the system generally. The gums appear swollen and inflamed, there is an increased flow of saliva, the infant is restless, cries, and frequently puts its hands to its mouth. From the effects of local inflammation and nervous sympathy, the whole body may become dangerously affected; in such cases the most sudden and happy effects have been pro duced by lancing the gums. This operation is a very simple, but not an unimportant one, as will be seen in our remarks (subsequently) on the mode of performing the operation. It is often attended with the most unexampled benefit to the child, and should never be neglected when required. Whatever contributes to promote the healthfu' operations of nature, will make Teething easy; such The Teeth. 225 as frequent bathing in warm or cold water, according to circumstances, friction of the body and limbs, good air, exercise, and wholesome food ; and above all, a cool and open habit of body. The gums should be rubbed with the finger, and the child should be al- lowed the use of its own fingers in its mouth. The idea that a child's sucking its fingers will prevent their growth, is a prejudice without foundation in truth. The old and erroneous opinion, that the Teeth, as they grow 7 , cut their way mechanically through the gums, first suggested the idea of assisting them in their protrusion, by the friction and pressure of hard substances; and hence arose the cruel and hazardous practice of scratching the gums through with the finger nail, or with pieces of hard loaf sugar, a prac- tice which has loo often been the cause of severe local and general suffering, if not of death, from the inflammation, fever, and spasms, which it has contribu- ted to excite. Hence also the use of the coral and other hard smooth substances given children to bite ; which are most dangerous instruments put into the hands of children to destroy themselves; for as the Teeth rise, and become slightly elevated above the edges of their sockets, those hard substances press and bruise the gum between them and the sharp points, or edge of the tooth underneath : inflammation and its consequences undoubtedly follow ; and in this way, we are fully persuaded, the lives of thousands of children are lost. The second dentition, or protrusion of the perma- nent Teeth, is seldom the cause of any suffering, ex- cept w T hen the last grinders, or wisdom-teeth as they are called, are passing through the gum, being at the same time situated farther back than usual, and in such a manner as to present their pointed surfaces towards the cheek; in which case, the motion of the jaw in mastication, occasions such a degree of press- ure on the gums and surrounding parts, as to produce much irritation, often a considerable degree of in- 226 Compendium of Domestic Medicine. flammation about the jaw, and even ulceration. These circumstances sometimes render it necessary to extract these teeth, though in most cases they may be preserved, and the troublesome complaints re- moved by cutting away a small portion of the inflamed gum over the teeth, or by other timely and judicious treatment. DISEASES ATTENDING DIFFICULT DENTITION. In infancy, every part of the system is highly sus- ceptible of morbid impressions, and one set of organs readily becomes diseased through sympathy with another. Among the diseases to which children, while teething, are liable, are, general irritation, or fever of an inflammatory kind, eruptions on the skin, diar- rhoea, dysentery, cholera, inflammatory affections of the lungs and throat, swelling of the glands about the throat and neck, spasmodic affections of the limbs, and often convulsions of the whole frame. What has commonly been called the fever of teething children, makes its appearance several times in the course of the period occupied for cutting the teeth; often commencing very suddenly, and marked by a dulness and heaviness of the eyes, rnu- sual heat of the skin, quickened respiration, coated tongue, loss of appetite, and restlessness. When these cases occur, it will be proper for the parent or nurse to administer some mild emen>, or gentle cathartic medicine, and place the little patient for about ten minutes in a warm bath, as high as the waist. But if these do not give relief, and remove the principal symptoms of the complaint, no delay should be allowed in calling medical assistance. The doubtful aid of inexperience should no longer be trusted. When there is an eruption, which has become in any degree troublesome, the parts should be carefullv The Teeth. 227 washed once or twice a day with castile soap suds, or warm milk and water, and covered with hair powder, or dry wheat flour; or smeared with olive oil, and covered with lint. No medicated ointment applied with a view to dry up, or scatter the erup- tion, should be used, or can be used with safety, without previous medical advice. The bowels of infants, while they are Teething, are not unfrequently affected in such a manner as to produce the most alarming consequences in a very short time. Sometimes, however, they remain in a diseased state for several weeks; the child at the same time continuing lively and playful, with a good appetite ; so that the sympathetic affection of these parts appears to be but a salutary effort of nature, to relieve the system from other and more serious diffi- culties, or to prevent their occurrence. The very common practice, both of mothers and nurses, of dosing infants that are suffering under diarrhoea or dysentery, with paregoric, anise, burnt brandy, and sugar, and various astringent prepara- tions, cannot be too seriously condemned. It is a practice which but too often serves to drive to a fatal close, a disease which, if it had been treated by a skilful hand, or even left to the kind efforts of nature, might have been conducted to a happy termination. Concerning most of the other diseases which have been enumerated, few parents possess a sufficient degree of knowledge of them, to be enabled to de- termine what is best to be done; and, indeed, the anxious concern which most parents feel for their suffering offspring, generally unfits them, more than any other circumstance, for a calm and deliberate exercise of their judgment. Delay in giving the attention which is often re- quired by children, when they begin to suffer from teething, is a fault of too common occurrence, and of too inexcusable a nature, to be passed wholly unno- ticed. The various maladies which attend the age of infant dentition, should not be suffered to prev on 228 Compendium of Domestic Medicine. the constitution, while the too often fallacious hope is cherished, that all will be well when the child has finished cutting its teeth; for, changes are not unfrequently produced in the system, which effect a lasting injury, and prevent the enjoyment of perfect health through the remainder of life. It may be asked, does the cutting of the milk-teeth require the aid of the dentist? Certainly not; it is generally a benign operation ; but there are cases in which maternal solicitude has need of counsel; and the physician as dentist, or the dentist who is a phy- sician, in this case, will show what is requisite to be done. In almost every complaint attending diffici It den- tition, the operation of dividing the gums with a lancet over the rising Teeth, is of very great import- ance, and cannot be too strongly recommended ; for, in many instances, it prevents the necessity of em- ploying any other remedy, and often exceeds all others in efficacy. In cases of great inflammation about the gums, attended with fever, the operation is often followed by the sudden cessation of pain, and the mitigation of every symptom of irritation ; in diseases of the bowels, by the perfect removal of the most distressing symptoms, and a speedy return of the healthy action of the parts; and in spasms of the limbs, and general convulsions, by the imme- diate interruption of the paroxysms, and a prevention of their recurrence. Its salutary effects are so power- ful and decisive, that in all painful cases of dentition marked by evident swelling and inflammation of the gums, it should be performed without delay. The prejudices which still exist against the opera- tion, greatly prevent the extension of its usefulness ; but it is one which is perfectly simple and safe, when performed by any one acquainted with the anatomy of the infant jaw, and the relative situation of the two sets of Teeth. The accidents which have been kn^ wn to follow it, are among the common fruits ol ignorance and presumption It is so far from being The Teeth. 229 painful or cruel, as is by many supposed, that infants, which a moment before were writhing and crying with pain, are sometimes known to laugh in the face of the operator before he has finished the incision ; so sudden, and so great, is the relief which they ex- perience. DISEASES OF THE TEETH. The diseases to which the Teeth are subject, attack them in various ways, and present very differ- ent appearances. In some instances, owing to the peculiar nature of the disease, or the constitution of the Teeth, they are destroyed without causing any considerable degree of suffering, or giving rise to any disease of the surrounding parts; in others, not only the Teeth are affected in the most troublesome and painful manner, but the diseases originating in them, are extended to the gums, palate, tongue and other parts of the mouth, producing fungous and fleshy tumours about the gums and cheeks, deep- seated abscesses, and caries or rottenness of the bones. The Teeth, owing to their particular nature and situation, are subject to some diseases which are peculiar to them, and to others which are of a cha- racter very similar to that of the diseases w T hich affect other bones. They are also, like most of the other bones, liable to fracture, dislocation and other accidents. Hence it must be evident, that in some instances, they will require a peculiar treatment, while in others the same surgical principles must be adopted, which are observed in the treatment of dis- eases and accidents of the other bones. 230 Compendium of Domestic Medicine. Caries or Rottenness* The first disease to be mentioned, and that which is by far the most common, is caries, or rottenness of the Teeth. This commences in different parts of the Teeth, and is produced by several causes. It some- times commences in the internal part of the crown, and gradually extends till much of this portion of the tooth is destroyed. The enamel is rendered thin by the progress of the disease within, and finally breaks by a very slight r ressure. fn other cases, its first effects are discovered on the enamel, which is dis- coloured, and becomes of a black or brown appear- ance ; its substance is decomposed, and in many cases it cleaves from the bony portion of the tooth, by which the progress of decay is for a long time arrest- ed ; but more frequently, when suitable means are not adopted to prevent it, it soon extends from the enamel to the softer and more sensibly organized parts of the tooth. In all cases, black and uneven cavities are pro- duced, which serve to give lodgement to particles of food; and these, mixing with the fluids of the mouth, readily undergo a putrefactive process, and hasten the destruction of the Teeth. By the progress of caries, also, the principal nerves, which supply the natural cavity in the tooth, become exposed not only to sud Jen changes of temperature, but to pressure from mastication, to the irritating contact of the tooth-brush, tooth-pick and other sud- stances; and hence, pain and inflammation are pro- duced, and the extraction of the tooth very commonly becomes the only means of preventing continued suffering. Cause? of Caries. — This affection of the Teeth is the consequence either of internal constitutional causes, or of those which are external and adventi- tious, and very commonly of both. Caries of the Teeth and even that of a peculiar character has The Teeth. 231 been so often traced through whole families, from one generation to another; that this disease must be considered hereditary, as much as any to which the human system is liable. In numberless cases, caries appears to be the effect of some serious disease with which the individual had been afflicted while the Teeth were in the early stages of formation. With regard to the local or external causes, they are most commonly found to be collections of earthy and other foul substances, which have been suffered to form and collect about the Teeth, and also the use of inju- rious tooth-powders and washes. Treatment of Caries. — Although some Teeth are so constituted as to possess but little durability, and after the destroying power of caries once begins to operate on them, they go on rapidly to decay, in spite of all the aid which science and skill can afford; still, there are comparatively but few instances in which seasonable and judicious treatment will not arrest the progress of disease ; and even render Teeth serviceable for many years, which, if neglected, would soon be entirely destroyed. In the treatment of carious Teeth, it is of the utmost service to remove, by means of suitable in- struments, the whole of the decayed portion in all cases, leaving at the same time as much of the sound part of the tooth as possible, if this be not done, little, if any service is rendered by any operation ; and the Teeth go on to decay in the same manner after it has been performed as before. The surface of the tooth, where the decayed part is removed, should be left perfectly smooth, and if excavated, only in such a degree, that by the proper use of the tooth-brush, the lodgement of particles of food and other substances may be wholly prevented. Another mode of treating caries, and which most effectually prevents its increase, is that of filling the excavation, which has been formed by disease, with pure gold, or some olher metallic substance. This operation, when properly performed, will generally 232 Compendium of Domestic Medicine. preserve the Teeth from ten to twenty, and some times even thirty years, in a sound and serviceable state; while at the same time it prevents all those unpleasant and painful occurrences to which a ca- rious and hollow tooth is constantly exposed. The author has witnessed the salutary effects of this practice, in cases w T here the Teeth had been filled with gold, for twenty and thirty years. In operations of his own, teeth have stood the test of twelve years without any apparent alteration; and cases are recorded, in which the gold has preserved teeth in a perfectly sound and useful state, for a period of forty years. When by caries the natural cavity is laid open, and the principal nerves are exposed, the tooth often becomes too tender to bear the pressure occasioned by mastication, or the sudden changes of tempera- ture, and it becomes painful from the slightest causes After the disease has proceeded thus far, the Teeth may often be saved by filling them with gold, the nerves which supply the natural cavity first being destroyed. This the patient may do gradually, by carefully cleansing the cavity of the tooth of every thing which may be lodged in it, and applying a little lint soaked in some essential oil, as that of cloves or cajeput, which, if renewed two or three times a day, will, in a short time, have the desired effect. The nerves of such teeth are also sometimes destroyed by the dentist, in a more expeditious manner, by the use of strong mineral acids, or by instruments designed for this purpose. Although, from the time of the earliest writers on diseases of the Teeth, the operations of sawing and filing those which are carious have been recom mended and practised, they are seldom of service, are often injurious, and, in most instances, to say the best of mem, are ineffectual and useless. The par- ticular objections to them will be noticed in some subsequent remarks on these operations The Teeth. 233 Diseases of the Fangs of the Teeth. The disease, which has just been described, is ^ne which has its seat in the crow T n and neck of a tooth ; its progress being almost invariably arrested when it reaches the fang. But there are other diseases which attack this part, and which, though they do not so commonly occur, are not less destructive in their effects than caries. Cases of enlargement of the fangs, owing to an ac- cumulation of bony matter on various parts of them, are not uncommon, by which, not merely a single tooth is sacrificed, but one after another is lost, till, in some cases, the patient is deprived of the whole set, by this formidable and destructive disease. It commences with a dull pain in one side of the jaw, which at times appears to be fixed in some particular tooth. Soon after the Teeth which have been most painful are found to be loose, and the gums and alveolar processes are gradually destroyed or ab- sorbed, leaving the fangs without covering or sup- port; the teeth are thus rendered useless, and too troublesome to be borne, and must be extracted. A disease similar to one which affects the other oones, and which has been called dry gangrene, sometimes fixes on The Teeth. It commences in the natural cavity of the tooth; the lining membrane and vessels connected with it are destroyed, and the crown of the tooth, before there is much pain, as- sumes a dark blue appearance. A degree of inflam- mation next commences in the articulating mem- brane which connects the fangs with their sockets* the gums acquire a dark red hue, are soft, and easily made to bleed. Matter is then formed about the roots of the tooth, and is discharged by smaii open- ings produced in the gums by the disease; and in this way the connexion of the tooth with the socket and the gums is destroyed, and the loss of it becomes inevitable. 234 Compendium of Domestic Medicine, These diseases, with others of a similar nature, extend in some cases to the bones of the face, so that abscesses and caries of the jaw are often connected with them, particularly as consequences of neglect or improper treatment. The causes of these diseases, though for the most part obscure, are sometimes to be traced to a connec- tion with some constitutional affection, or to blows, falls and various accidents. In the early stage of these diseases, or when they are first discovered by the patient, extraordinary care should be taken to brush and cleanse the Teeth and gums, which should be done two or three times daily. Benefit will also be found from the use of an astringent lotion, of tincture of Peruvian bark and rose water, in equal quantities, or a decoction of marsh rosemary, in the proportion of one ounce of the dried root to a pint of water. When these dis- eases have so far advanced, as to become serious and painful, the patient must not expect to combat them with advantage, unaided by the advice and particular direction of an experienced surgeon, o dentist. And it is of importance that those who may suffer from complaints of the above description, should be cautioned against confiding in the advice of ignorant persons — mere tooth-drawers, and quacks. The former will generally affirm that nothing is to be done but to extract the Teeth, while the latter will be ever ready to apply their infallible nostrums accompanied with a profusion of promises to cure all complaints, even those which they are sometimes pleased to call cancers of the mouth. Toothach Writers on the subject, have generally mentioned this complaint as a particular disease; whereas, a moment's reflection will show us that it is only a common symptom of disease. Pain in the Teeth or toothach, is an almost invariable attendant on The Teeth. 235 all the diseases which have been mentioned, and the mode of removing it varies with that of treating the different diseases of which it is a symptom. If it be induced by the exposure of the more sensible part of a tooth, as in case of caries, filling the cavity with gold, or the other methods of defending the nerves from the air, or destroying them, as mentioned above, will be sufficient to remove it. If it arise from in- flammation about the root of the tooth, the same means should be used to subdue it, as in other local inflammations; and hence, in such cases, we find that cold water, or vinegar, cold meal-poultices, or strong irritating tinctures to the face, and a full dose of Glauber or Rochelle salts, are the most effectual in removing the pain. The too common practice of holding hot stimulating substances in the mouth, serves but to prolong the suffering. A momentary relief only is obtained, while the tongue and cheeks are smarting with each renewal of the medicine, but no permanent ease is experienced, till, by long suf- fering, fasting and watching, the patient becomes exhausted, and the paroxysm terminates in sleep. Very severe and almost unexampled suffering is sometimes caused by certain nervous pains to which the Teeth are liable, not only when they are ca- rious, or otherwise diseased, but even when sound. These, however, are generally sympathetic, and may be traced to some change in the habit or circum- stances of the system, particularly those to which the female constitution is liable, or to some disor- dered nerve, or other local difficulty. Toothach from rheumatism, though rare, if th6 Teeth are all sound, is very apt to occur when any of them are diseased ; and the pain is not then con fined to the diseased Teeth only, but often extends jo the sound ones, and even from the Teeth of one side of the jaw to those of the other. Toothach is also a common attendant on a dis- ordered state of the stomach and other digestive organs ; and the suffering in these cases is generally 236 Compendium of Domestic Medicine. even more severe than when produced by othei causes, and is much less likely to be removed by any application made to the face or teeth only. When toothach is merely symptomatic of disease, or derangement in some other part or organ, it will most commonly yield to those remedies which are calculated to remove the original complaint. If, therefore, it be in consequence of nervous pains about the face, or ear, use some strong irritating tincture, as that of camphor, Cayenne pepper, or flies, or the volatile liniment, applied externally; giving at the same time a moderate dose of lauda- num, and repeating it if required. Ii it be attendant on a sudden attack of rheumatism, it will often be wholly removed by a full dose of volatile tincture of guaiacum, a warm bath. If derangement of the ordinary functions of the stomach and bowels induce it, an emetic, or a dose of some active cathartic medicine will in general procure relief. These internal remedies, however (as well as most others of a very active nature, which are applicable to the abovementioned cases), should, as much as possible, be administered under the direction of a physician, in order to guard against error, in judging of the nature of the case, and in the choice of medi- cines most suitable. Tartar, or Scurvy of the Teeth. This is a troublesome, and often a very destruc- tive complaint, and one which does much injury to the Teeth, even before those who suffer from it are aware of any danger. It does not originate from any particular state oi the teeth alone, or from a disor- dered state of the gums and alveolar processes, as many are led to suppose; but is owing to an accu- mulation of earthy matter deposited from the saliva. With some individuals, it collects much faster than with others; so that, whereas one will have hid The Teeth. 237 teeth completely encrusted with it in a few weeks, if the proper means be not daily used to prevent it, another will pass a long life without any care of his teeth, and tartar will not collect on them at all ; so much does ils formation depend on the natural, or constitutional state of the fluids of the mouth. The tartar is seen on some teeth of a black or greenish colour, and very hard ; on others, brown or yellow, and not so firm in its consistency; but in all cases it is productive of incalculable injury to the Teeth, gums and alveolar processes. When it is first deposited on the Teeth, it is soft, and may be easily removed with a tooth-brush; but if suffered to remain, it soon acquires a stony hardness, and gra- dually increases in thickness about the necks of the Teeth ; the gums become irritated and inflamed by it, the sockets are next destroyed, and the Teeth, being left without support, are often pushed out by the ordinary pressure of the tongue and lips. Tartar will in some cases collect to so great a degree on the Teeth of children as to produce a separation of portions of ihe jaw; and not only bring away the temporary teeth, but destroy those of the second set, which are beneath them. From this, and what has been before stated concerning the bad effects of tartar on the Teeth, it will readily be per- ceived how important it is to arrest the progress of so mischievous a complaint, m its earliest stage. With regard to the treatment of these cases, if the tartar has been suffered to become so hard as to require much force to remove it, the operation should be carefully performed, and without injuring the enamel, as is sometimes done, by the use of acids and files, practices which cannot be too severely cen- sured. The Teeth should be perfectly cleared of this foreign matter by sharp, cutting instruments, of a suitable form to effect the object without wounding and lacerating the gums. For the purpose of pre- venting the tartar from collecting again (or indeed from forming in the first place), and for restoring the 238 Compendium of Domestic Medicine. gums to a healthy state, nothing more is requisite, generally, than the daily use of a stiff brush, and some suitable dentifrice (post page 245), or the as- tringent washes mentioned ante page 234. Many persons are in the habit of suffering their teeth to go without, any efforts of their own for keep- ing them in order, and apply at stated periods to a dentist, to have the tartar removed from them; and this they do, no doubt, from the persuasion that it is all that is requisite for preserving them. But it may be important to state, for the information of those who are thus deceived, that the repeated collections of tartar, and frequent operations, do an injury to the Teeth which is not to be repaired by any sub- sequent care. The gums and alveolar processes are driven from them, they are deprived prematurely of that defence and support which these parts are de- signed to give, and are often lost many years before they would be, were a due degree of care bestowed on them. DISEASES OF THE ALVEOLAR PROCESSES. The alveolar processes commonly share in the dis- eases which affect the fangs of the Teeth ; but cases in which they are primarily diseased are very rare. A complaint which is most frequently met with in them, is a gradual decay, or wasting of the bony substance, attended with a certain degree of inflam- mation of the contiguous parts. A little pain, or uneasiness and swelling of the gums, are first expe- rienced ; the bone or process after this is very rapidly absorbed ; the affected teeth become loose, and ap- pear to be thrust forwards and out of their sockets, so that they are much longer than the rest. These cases, and particularly such as extend to the sockets of many or all of the Teeth, appear often to be caused by, or dependent on, a rheumatic or gouty affection of the whole system In the early The Teeth. 239 stage of the disease the patient should take extraor- dinary care in brushing and cleaning The Teeth daily; and he may also use with advantage, the astringent washes recommended in the preceding chapter; by which, the progress of the disease will be much retarded, and the suffering greatly diminished. Preternatural enlargements of the alveolar pro- cess, or bony tumours, are sometimes found to arise on the jaws. They may readily be distinguished from those of a different nature, by their being much harder, and immovably fixed to the bone. They are not to be dissipated by any application made to the part, or by any internal remedy; and all attempts to do it, are, at best, but useless, and for the most part hazardous. In these cases, as in all others, the interference of quacks cannot be too scrupulously avoided, and the advice of an experienced surgeon should be seasonably obtained. Tumours of this kind do indeed increase very slowly, and if season- ably removed, are seldom injurious in their conse- quences. The fatal effects which they have some- times been known to produce, have been in con- sequence of deferring too long a safe and simple operation. Caries of the alveolar process is a common occur- rence, but it generally arises from some disease which has commenced in the Teeth, and from va- rious accidents to which these processes are liable in common with other parts. The patient has little to do for himself in these cases ; they for the most part require surgical aid, and to be treated according to genera] surgical principles 240 Compendium of Domestic Medicine. DISEASES OP THE GUMS. Inflammation and Sponginess of the Gums. This is the most common disease to which the gums are liable, and which, indiscriminately with that state of the Teeth which is produced by the accumulation of tartar, is often called scurvy. The effects of this disease are, a swelling of the gums, with a dark red, unhealthy appearance, great ten- derness, and liability to bleed. In very bad cases the gums are surprisingly thickened, and rise nearly to the tops of the Teeth. If the gums are suffered to remain for a length of time under the effects of this disease, the sockets of the Teeth are destroyed by absorption and ulceration, and the Teeth them- selves drop out. The ordinary causes of the disease are, collections of tartar on the Teeth, long neglect of brushing the Teeth and gums, even when there is no tartar formed, the use of mercury, and a scorbutic state of the whole system. In order to prevent the ravages which this disease soon makes, if neglected, the gums should be brushed two or three times a day with the astringent washes which have been mentioned above. Powders, con- taining Peruvian bark, are often recommended ; in the worst cases, however, and particularly in those whieh have been caused by the use of mercury, which renders the gums very irritable, no powders should be used ; but alternate mild and astringent lotions, such as warm water, or milk and water, fol- lowed by the application of a decoction of rosemary root, or hyson tea, the tincture of Peruvian bark, or a solution of alum, in the proportion of one drachm to a gill of water. If the inflammation and swelling of the gums bet produced by the accumulation of tartar, which is the The Teeth, 241 most usual cause, this substance should be imme diately removed. Gum-Boils. Small abscesses of the gums often appear over the roots of the Teeth, which are commonly called gum- boils. They do not, however, originate in the gum. but are produced by disease in parts beneath, most commonly by ulceration at the fang of a carious tooth. After matter is formed at this part, the inflammation is extended to the gum, and the process of ulceration is continued till the matter is discharged. After gum-boils have been thus produced, they often re-appear from very trifling causes, till a per- manent abscess is formed, from which matter is daily discharged. Although with some individuals these may remain for several months, or even years, with- out producing any serious consequences, particularly if the constitution be perfectly healthy; yet the inju- ries which sometimes result from them show, in a manner too painful and troublesome to be forgotten, that they deserve early and particular attention. It is important in all cases to open these abscesses with a lancet, to allow the matter to be discharged as soon as il is evidently formed; and when a permanent cure is not to be obtained, except by extracting dis- eased Teeth or stumps, this operation should be per- formed without delay. The operations which are required in the treat- ment of these cases, if attended to in season, are most, of them too slight to be feared, and all of them much less painful than the extraction of a bad tooth Tumours of the Gums. Preternatural enlargements of the gums are not uncommon. They proceed from various causes, but generally from diseased Teeth; and are seldom to be cured till these are extracted. Q 242 Compendium of Domestic Medicine. Tumours of the gums are either of a soft spongy texture, or of a more firm and fleshy nature, some- times nearly of the consistence of cartilage. All of them expose the patient to other and more serious evils, by causing a disease of the jaw, more or less extensive. The hard, fleshy, or cartilaginous tu- mours are not so common as those of the opposite nature; but their consequences are much more to be dreaded, if they are not early extirpated. They are sometimes found to be connected with a pre-existing disease of the jaws and Teeth, and at others, arise without any discoverable cause. In all these cases the speedy removal of the tumour (by the use of caustics, the ligature, or the knife) is the only plan of treatment on which we can reasonably depend for success. In some instances, however, the lace- ration produced by extracting Teeth which were enveloped in such tumours, has proved an effectual remedy. CLEANING THE TEETH. Highly important as this operation is to every in- dividual, there are too many who neglect it; and, ■simple as is the process, there are many who, from habit, prejudice, or want of correct information, fail o{ performing it in a proper manner. As soon as the crowns of the first four permanent incisors, or front Teeth, have fully advanced through the gums, children should be provided with a suita- ble tooth-brush, and be taught the use of it. There are but few persons, whose Teeth do not require a considerable degree of care to keep them in a heal- thy and sound slate, and more particularly to protect them from the rapid and injurious effects of caries, after they have become affected with this disease. For many, the daily use of the brush and cold water is all that is required to keep the Teeth in perfect order ; but most commonly, to effect this purpose, the The Teeth. 243 use of dentifrice of some sort is found to be indis- pensable. With regard to the use of a brush, a moderately stiff one should be employed ; for a brush may be too soft to be of any service, or so hard as to irritate firm and healthy gums. The Teeth should be brush- ed both morning and evening, but more particu- larly in the morning, as the causes which favour the accumulation of tartar operate most powerfully during the hours of sleep. Brushing them once a day, however, if it be done faithfully, is preferable to many hasty and imperfect attempts to clean them. Merely to pass the brush a few times hastily over the teeth, is of little service ; five minutes or more should be diligently spent in performing this opera- tion. It is also a very useful practice, to brush the Teeth always after eating, particularly if they are very uneven, or affected with caries. The idea that the enamel of the Teeth can be in- jured by brushing, is as false and ridiculous as it would be to suppose that the palms of the hands may be worn out by moderate labour. The brush should not only be passed from side to side of the mouth, on the outer surfaces of the Teeth, but on the inner parts of them, next the tongue and roof of the mouth ; also upwards and downwards, from the gums of one jaw to those of the other When the Teeth have been seasonably attended to in the manner above directed, the necessity for using dentifrice or tooth- powder, is very much diminished, if not wholly su- perseded ; and there will be no case in which the use of it will be required oftener than once or twice a week. It should be remembered that it is not by merely spreading the powder over the surfaces of the Teeth with the brush, and then rinsing it off, that it is to have its proper effect; but by faithfully rub- bing it for several minutes on all parts of the Teeth which are exposed to the action of the brush, taking care afterwards to remove every particle of it by the use of the brush and water, because, if left to lodge 244 Compendium of Domestic Medicine. about the Teeth and gums, it aids the formation of tartar. The water may be used cold or warm, as can best be borne, but cold is preferable. Care should be taken in providing tooth-powder that it do not contain any substance that will act either chemically or mechanically on the Teeth, to injure them. Emery, pumice stone, and various acids are not unfrequently detected in those denti- frices and washes for the Teeth and gums, which are advertised as infallible in rendering the Teeth sur- prisingly white, dissolving and removing tartar, pre- venting decay, toothach, fyc. fyc. These may im- prove the appearance of the Teeth for a day, but in many instances ruin them for ever. Many persons, ignorant and unsuspicious of any evil consequences, are induced to use acids, some- times concentrated lemon juice, but more generally diluted vitriol, because they give the Teeth at once a beautiful white appearance. But few, however, have done this, without having to lament a most serious injury, or the total loss of their Teeth ; for in a short time, they become of a dead chalky white, soon turn dark coloured, and be- gin to decay and crumble to pieces, leaving the fangs in their sockets, more generally exposed to pain and inflammation, than if the crowns had been destroyed by any other cause. These baneful effects of acids cannot be too strongly impressed on the mind of every one ; for they are so often used by the unwary, even at the present day, that scarcely a week passes, in which the writer has not an opportunity of wit- nessing some new case of the evils sustained by the pernicious practice of cleaning the teeth with an acid lotion of dentifrice. We present to our readers the following recipe for a tooth-powder, which we can conscientiously recom- mend, for keeping the Teeth clean and rendering them white. It is perfectly harmless; and few per- sons will find it necessary to use it oftener than three times a week. Although a little used every morn- The Teeth. 245 ing will be found beneficial. Any one can have it manufactured by a druggist from the subjoined recipe : — Powdered Orris Root, A ounces, Prepared Chalk, 4 ounces, Powdered Cinnamon, £ ounce, Bicarbonate of Soda, £ drachm, Oil of Rose, 2 drops. — Mix. In order lo cleanse and preserve artificial Teeth, the above directions should be carefully observed. It is necessary to add, however, that these Teeth require more frequent attention than natural ones, and that they should always be cleaned with a soft brush, and the mouth be rinsed thoroughly at least three times a day, particularly after eating. If they are well made and well set, they will bear this treat- ment; and will appear better and last longer in con- sequence of it. OPERATIONS ON THE TEETH. The remarks which I shall offer under this head are not made with a view to describe particularly the various operations which are required in the treatment of diseases of the Teeih, but rather to no- tice some circumstances connected with a few of the most common of them, which it is important should be more generally understood. Extraction of the Temporary Teeth, when Diseased The temporary, or first Teeth, become often very soon diseased, and require an operation, that of plugging, extraction, or the removal of tartar. The importance of the latter will be seen by adverting to the observations on scurvy, ante page 237. With regard to extracting the temporary Teeth, it should be remembered, that a child ou^ht not to be depri- red of them without duo consideration. If at the 246 Compendium of Domestic Medicine. age of four or five years, the front, or even the ca- nine Teeth, become carious, as they often do, they may be extracted; but much better it would be to have them properly filled, and if, at this early pe- riod, the double Teeth are found to be decayed and painful, it will be advisable to defer extracting them as long as is consistent with safety, and at the same time to employ all suitable means to allay the pain, and to have the Tooth or Teeth cleaned from the decay and filled with gold. If there be inflammation and swelling of the jaw and face produced, the removal of the affected teeth should be no longer delayed; as deep abscesses, which break externally through the cheek, are not unfrequently the consequence; and ulceration, when it takes place, and exists for any considerable time about these teeth, is known even to injure the per manent ones which are forming beneath them. Lancing, or Cutting the Gums, at the time of Teething. The salutary effects of this operation were noticed in the remarks on Diseases of Dentition (ante page 226); and they will be very generally perceived, when it is performed at a suitable time, and in a proper manner. It should never be done, excepting when there is evident swelling of the gums over the expected teeth, attended with undoubted signs of inflammation. These, however, should be ascer- tained by the surgeon, and not by the parents or nurses. Ineffectual and repeated operations will then be prevented ; and it will only be requisite that the lancet should be used by some one familiar with the anatomy of the infant jaw, and with the relative situation of the two sets of Teeth at this period. As this treatise may occasionally fall into the hands of physicians, it may not, perhaps, be wholly unim- portant, that we should address to them, a few obser- vations on the above mentioned operation. Nothing, but an essential difference in performing The Teeth. 247 die operation, could have given nse to the very op- posite opinions, which have been, and still are, entertained by physicians with regard to its utility For, while many are fully convinced of its beneficial effects, some consider it as altogether useless, and others condemn it as injurious. When it is considered advisable to cut the gums, it should be done with a common broad-edged gum- lancet, and the incision made immediately over the Teeth which are about to appear, but over no others. The gum should not merely be scarified^ but cut entirely through, as also the investing or capsular membranes, till the lancet is felt to grate against the enamelled surface of the Tooth. Should the edge of the lancet be placed a little too far towards the inner part of the jaw, particularly in cutting for the front and canine Teeth, although we may divide tho gum, and feel that the edge of the instrument is re sisted by bone, it will probably be no other than the internal plate or transverse portions of the alveolar processes, and the objects of the operation will not be obtained. Some relief may be produced for a little while by the bleeding, but more frequently, the irritation of the gums will be increased. Besides, by making the incision in this manner, there is dan- ger of dividing or injuring the membranous and vascular connexion between the first and second sets of Teeth, and thereby injuring or destroying the permanent ones entirely. Therefore, in order to prevent any injurious consequences, as well as to render the operation most serviceable, the incision should be made towards the external plate of the alveolar processes, so as to avoid the connecting membranes and sacks of the permanent teeth, par- ticularly those of the incisores and cuspidati. Those of the bicuspides are more easily avoided, on account of the flat and broad surfaces of the temporary grin ders. 248 Compendium of Domestic Medicine. Filing or Sawing the Teeth. This operation is often performed with a view to remove the black and defective parts of carious teeth, and to separate them in such a manner that the excavation formed by the disease may be more exposed to the action of the tooth-brush ; but in a majority of cases these purposes cannot be effected either by saws or files, the operation will therefore he unavailing, and the hopes of the patient disap- pointed. The particular objections to the use of these in- struments are : 1. That they do not remove the whole of the decay- ed parts of the Teeth; and it is a fact sufficiently evi- dent to common observation, that the disease of caries is often communicated from one tooth to ano- ther by contact; and it is equally true that while any of the defective part of a tooth is suffered to re- main, the liability of that tooth to decay is much greater than if this part were entirely removed. 2. That in all cases, the effect of sawing or filing is to deprive the Teeth, unnecessarily, of a great portion of their sound enamel, particularly when these operations are performed on the front teeth. 3. That the crowns of the Teeth being broader than their fangs, they often crowd together in such a manner, that, by the repeated operations of filing to keep them separated, one quarter and sometimes one third of each tooth is sacrificed, by the use of these improper instruments. 4. That separating sound teeth with the file or saw (or indeed with any other instrument) is a practice for which there can be no reasonable apol- ogy. The idea that they may be too close, and injure each other by lateral pressure, is altogether errone- ous ; and there are no just grounds for the belief, that, by this operation, they may be prevented from de saying. The Teeth. 249 To these objections we may add, that filing the Teeth always gives them a square and artificial ap- pearance, and is one of the most disagreeable, and often painful, operations that is performed on them to many persons, even worse than that of extraction As a substitute for files and saws, it is now recom- mended to use, in the operations for caries, small crooked knives, and other cutting instruments, which are liable to none of the above objections, and which enable the operator to effect the first, and also the most important objects in the treatment of this dis- Filling Teeth with Gold or other Metals. This operation, which is called plugging the Teeth, is performed for the purpose of rendering teeth which have begun to decay more lasting and serviceable; and when it is seasonably and properly performed, it is effectual in preserving them for many years, very commonly from ten to twenty, and in some cases even forty years. There are often cases in which the diseased tooth will not bear the pressure which is required to fill it properly with gold; and then an amalgam of mercury and tin may be used in its stead. It ia therefore best, in all cases where it is practicable, to use pure gold, which is too hard to be worn away by the ordinary process of mastication, and which will not be ehanged in its properties, or corroded, by any article of diet or medicine, ex- cepting mereury, when its use is long continued. 250 Compendium of Domestic Medicine. Scaling the Teeth, or the Removal of Tartar. Although every person may prevent the accumu lation of tartar upon his teeth, by the means pointed out in the preceding pages, and may even remove i after it has acquired a very considerable degree of firmness ; yet it is very often allowed to collect for so great a length of time, and to become so hard, that an operation under the hands of the dentist is the only remedy. The doubts that are by some enter- tained concerning the necessity or usefulness of re- moving the tartar, originate in an imperfect know- ledge of the nature of the case, and from accounts of injurious treatment by ignorant operators. The effects which have followed the use of acids and files, to dissolve and remove this substance, have not failed 1o destroy the confidence of those who have ever submitted to such impositions. The operation, if skilfully performed, is simple, and seldom painful ; and will always be of service while the Teeth retain a sufficient degree of attach- ment to their sockets to make them worth preserving. ft should be performed in the manner which has been directed at page 237; and the mode of treat- ment there prescribed for preventing the necessity of its repetition, will, if adopted, always be effectual. Extracting Teeth. There is probably no surgical operation which is not of a very serious or dangerous nature, that is so much dreaded as the extraction of teeth. Yet it is not always so much the fear of pain, provided the tooth be well extracted, as that of having it broken, the jaw fractured, or the instrument slip or break in the operation. These are accidents, however, which seldom happen in the practice of a skilful operator; The Teeth. 251 but are generally attributable to ignorance or care- lessness. There are, indeed, circumstances some- times connected with every kind of surgical operation which increase the difficulty of performing it, and which are not in all cases to be foreseen ; yet they are extremely rare, and when they do occur, if science and skill be engaged, unfavourable results are often prevented. The accidents above mentioned do indeed too often happen; and they must continue to occur, while the operation is entrusted to persons merely because they have strength enough to extract a tooth, and presumption enough to undertake it. Many are willing to believe a man sufficiently skilled in this operation, because he can make the instru- ments with which it is performed ; but who would employ a person to remove a wen, amputate a finger, or open a vein, because he could manufacture a knife or a lancet ? An idea is erroneously entertained, by many, that the instruments which are in common use for ex- tracting teeth are imperfect; but ihis is not the case On the contrary, the Key, the Forceps, the Hook, and the Graver, or what has been improperly called the Punch, though simple instruments, are all very per- fect in their construction ; and, in their present im- proved form, are calculated to separate a tooth from its socket with as much safety and dispatch, and with as little pain, as are consistent with the nature of the operation. Much time has been expended, and great ingenuity exerted, to produce an instrument for extracting the double teeth in a. perpendicular direction; but every contrivance of this sort has been calculated to ope- rate by making pressure on one or more of the Teeth next that which is to be drawn. This circumstance has shown such instruments to be in a great degree useless, on account of the frequent unsoundness or looseness of the Teeth on which the required press- ure must be made, or the defective state of the tooth 252 Compendium of Domestic Medicine. to be extracted. Besides, these instruments are un« avoidably large, and sometimes so complicated, that their application is inconvenient, and the operation necessarily slow and painful. ARTIFICIAL TEETH. The early loss of the natural teeth y which is often occasioned by disease, or by various accidents, and the pain and inconvenience which many individuals thereby experience, may be greatly diminished by the use of artificial teeth, provided they are well made and judiciously set. Artificial teeth have been in use for many years, and have been formed of various animal and min- eral substances, such as human and animal teeth, ivory, bone, &q. These have, however, given way in the present day or more modern times to the porcelain teeth, composed of mineral substances, the manufacture of which has been brought to such a high state of perfection that it requires no small degree of acuteness of observation to distinguish them from extremely natural teeth. And they may now be set so firmly as to be very useful, both in eating and speaking, as well as ornamental. Artificial teeth may be set from one to any num- ber required. They may be secured by wooden pivots to the fangs or roots of decayed teeth which are left in the jaw, or to the remaining natural teeth by clasps around them, or be fas- tened to a plate of rubber, silver, gold, or plati- num, which is held in the mouth by suction ; and they may be set generally without giving any pain or uneasiness. INDEX. Abdomen, Dropsy of, 73 Abscess, 116 Psoas, 117 Accidents, 122 Compound, 143 Affection of Nerves of Face, 93 Ague Cake, 59 Amputation, 143 Aneurism, 111 Angina Pectoris, 94 Anodyne Clyster, 160 Apoplexy, 88 Artificial Teeth, 252 Asiatic Cholera, 163 Asthma, 47 Bladder, Inflammation of, 70 Stone in the, 72 Brain, Compression of, 125 Concussion of, 124 Inflammation of, 37 Beds for Travellers, 19 Bleeding, 154 from the Nose, 41 Piles, 116 Bilious Fever, 30 Blind Piles, 116 Bites of Dogs, &c, 130 Blindness, Night, 40 Boils, 114 Bougies, 155 Blood, Spitting of, 49 Vomiting of, 56 Blotched Face, 106 Bubo, 78 Burns, 152 Cancer, 87 of Lip, 42 of Penis, 78 of Testicle, 80 of Tongue, 43 Catarrh, 47 Chancre, 78 Cramp in the Stomach, 53 Cartilage in the Joints, 85 Carbuncle, 114 Carious Ulcer, 121 Catalepsy, 90 Catheters, 154 Charcoal Poultice, 168 Cramp, 91, Chest, Dropsy of, 51 Cleaning the Teeth, 242 Chicken Pox, 100 Contents, 5 Colds, 47 Consumption, 49 Cholera Morbus, 60 Colic, 64 Painter's, 65 Chronic Rheumatism, 83 Cholera, 163 Compression of Brain, 124 Concussion " " 125 Contusion, 123 Contused Wounds, 129 Compound Accidents, 143 Cow Pox, 100 Dance of St. Vitus, 95 Diarrhoea, 63 Diabetes, 73 Difficulty of Urine, 70 Dimness' of Sight, 39 Diphtheria, 45 Diseases of Alveolar Pro- cesses, 238 Gums, 240 Dislocations, 139 Lower Jaw, 140 Collar-bone, 140 Shoulder, 140 Elbow, 141 Wrist, &c, 141 Thigh, 142 Knee-cap, 142 Leg, 142 Foot, 142 Division of Diseases, 23 Drowning, 143 Dropsy of the Abdomen, 73 Chest, 51 Knee-joint, 84 Dropsy of the Scrotum, 79 Dyspepsia, 174 Dysentery, 61 Ear, Inflammation of, 40 Eye, " " 38 253 254 INDEX. Effervescing Mixture, 156 Emissions, Involuntary, 77 Encysted Tumours, 113 Emollient Clyster, 160 Enlargement of Uvula, 43 Enlarged Spleen, 59 Spermatic Vein, 80 Epilepsy, 90 Erysipelas, 96 Mercurial, 98 Extracting Teeth, 250 Fainting, 88 Flannel, 17 Face, A flection of Nerves of, 93 Fractures, Arm, 135 Collar Bone, 135 Foot, 138 Fore-arm, 136 Knee-cap, 137 Lower Jaw, 134 Leg, 138 Nose, 134 Kibs, 136 Thigh, 137 Wrist, 136 Felons, 115 Fever, 26 and Ague, 28 Bilious, 30 Hectic, 36 Intermittent, 28 Low Nervous, 32 Putrid, 34 Remittent, 30 Simple Inflammatory, 27 Scarlet, 95 Typhus, 32 Fleshy Tumours, 112 Fistula, 118 Fits, 90 Foreign Bodies in Throat, 151 Fungous Ulcers, 119 Ganglion, 113 Glands, Inflamed, 86 Gravel, 68 General Rule, 15 Gleet, 76 Goitre, 88 Gonorrhoea, 75 Gout, 81 Uum Boils, 241 Hartshorne's Decoction, 160 Headache, 38 Sick, 191 Heartburn, 54 Heart, Palpitation of, 50 Hectic Fever, 36 Herpes, 103 Hiccough, 53 Hints to Travellers, 17 Invalids, 21 Hip-joint Disease, 84 Introduction, 15 Indigestion, 54 Inflamed Glands, 86 Ulcer, 119 Inflammatory Fever, 27 Rheumatism, 82 Sore Throat, 44 Inflammation of Brain, 37 Bladder, 70 Ear, 40 Eye, 38 Intestines, 59 Kidneys, 68 Liver, 56 Stomach, 52 Influenza, 47 Intermittent Fever, 28 Impotency, 81 Incontinence of Urine, 72 Incised Wounds, 127 Indolent Ulcer, 120 Intestines, Inflammation of, 59 Involuntary Emissions, 77 Irreducible Ruptures, 109 Itch, 103 Jaundice, 57 Joints, Cartilage in, 85 Kidneys, Inflammation of, 68 King's Evil, 86 Knee-joint, Dropsy of, 84 Lancing the Gums, 246 Lip, Cancer of, 42 Liver, Inflammation of, 56 Locked-jaw, 92 Low Nervous Fever, 32 Measles, 99 Mercurial Disease, 79 INDEX. 255 Mercurial Erysipelas, 98 Ulcers of the Mouth, 42 Medicines for Travellers, 18 ' Mortification,' 153 Mouth,Mercurial Ulcers of, 42 Nettle-rash, 105 Night-Blindness, 40 Node, 78 Nose, Bleeding from, 41 Painter's Colic, 65 Palpitation of Heart, 50 Palsy, 91 Preface, 3 Penis, Cancer of, 78 Pleurisy, 48 Prescriptions, 156 Piles, 115 Blind, 116 Bleeding, 116 Pimples on the Tongue, 42 Poisoning by Acids, 146 Alkalies, 147 Antimony, 148 Arsenic, 147 Bismuth, 148 Copper, 148 Lead, 150 Liver of Sulphur, 149 Lunar Caustic, 148 Mercury, 147 Mushrooms, 151 Opium, 150 Phosphorus, 149 Powdered Glass, 150 Poisonous Fish, 151 Salts of Tin, 148 Saltpetre, 149 Sal- Ammoniac, 149 Spanish Flies, 149 Tobacco, 151 Polypus, 41 Poultice, Charcoal, 160 Yeast, 160 Rye Meal, 160 Psoas Abscess, 117 Pulse, The, 25 Putrid Fever, 34 Sore Throat, 45 Punctured Wounds, 129 Purgative Clyster, 160 Rash, Nettle, 105 Remittent Fever, 30 Reducible Ruptures, 108 Rheumatism, Inflammatory, Chronic, 83 Ringworm. The, 105 Round, 67 ' Rules, General, 15 for Invalids, 21 Ruptures, 108 Irreducible, 109 Reducible, 108 Strangulated, 109 Rye-meal Poultice, 160 Saline Mixture, 156 Scalds, 152 Scald Head, 104 Scaling the Teeth, 250 Scarlet Fever, 95 Small Pox, 101 Strangulated Rupture, 109 Sprains, 124 Spermatic Vein, Enlarged, 80 Spleen, Enlarged, 59 Steatomatous Tumours, 112 Swelling of Tonsils, 44 White, 85 Sick-headache, 191 Symptoms, 192 Medicines, 193 Diet, 196 Drinks, 203 Exercise, 206 Change of Air, 207 Other Cautions, 207 Sight, Dimness of, 39 Simple Inflammatory Fever, 27 Scirrhus, 87 Stings of Bees, &c, 131 Spitting of Blood, 49 Strictures, 77 in the Throat, 46 St. Anthony's Fire, 95 St. Vitus' Dance, 95 Scorbutic Ulcer, 121 Scrofula, 86 Scrofulous Ulcer, 121 Scrotum, Dropsy of, 79 Scudamore's Lotion, 159 Scurvv, 106 Sloughing Ulcer, 120 Stone in the Bladder, 72 256 INDEX. Stomach, Cramp in the, 53 Inflammation of, 52 Sun-stroke, 89 Suppression of Urine, 71 Suspended Animation, 143 from Cold, 145 Drowning, 143 Foul Air, 145 Hanging, 145 Syphilis, 77 Tape-worm, The, 67 Tartar of the Teeth, 236 Travellers, Beds for, 19 Cold, 20 Flannel, 17 Hints to, 17 Medicines, 18 Night Air, 20 Towels and Soap, 19 Water, 19 Teeth, The, 212 Caries of the, 230 Diseases of the, 229 Formation, 218 First Dentition, 223 Shedding the, 220 Structure of the, 213 Testicle, Cancer of, 80 Tetanus, 91 Throat, Inflammatory Sore, 44 Putrid Sore, 45 Strictures in, 46 Tohacco Clyster, 160 Tooth-ache, 234 Tongue, Cancers on, 43 Pimples on, 42 Ulcers on, 42 Tonsils, Swelling of, 44 Tumours, 108 Encysted, 113 Fleshy, 112 Steatomatous, Tympany, 75 Typhus Fever, 32 Ulcers, 119 Fungous, 119 Indolent, 120 Inflamed, 119 Mercurial, of Mouth, 42 " " Tongue, 42 Scorbutic, 121 Scrofulous, 121 Sloughing, 120 Venereal, 121 Urine, Difficulty of, 70 Incontinence of, 72 Immoderate flow of, 73 Suppression of, 71 Uvula, Enlargement of, 43 Venereal Ulcers, 121 Warts, 79 Vinegar Whey, 157 Vomiting of Blood, 56 and Purging, 60 Wine Whey, 157 Whitlow, 115 White Swelling, 85 Worms, 66 White Thread, 67 Wounds, 125 Contused, 129 Incised, 127 Punctured, 129 Poisoned, 130 of the Abdomen, 132 Chest, 132 Ear, 131 Joints, 133 Limbs, &c, 131 Scalp, 131 Tendons, 133 Throat, 132 Yeast Poultice, 160 THE END. 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