1 
 
POPULAR MEDICINE; 
 
 OR, 
 
 FAMILY ADVISER; 
 
 CONSISTING OF 
 
 OUTLINES 
 
 en 
 
 ANATOMY, PHYSIOLOGT , \M) HYGIENE, 
 
 | M « 11 HINTS Os 
 
 PRACTICE OF PHYSIC, BURGERYi 
 
 DH WOMEN AND CHILDREN, 
 
 ■ 
 I'm SH 1 w- CANN< :» : 
 
 nmo a compam >n \m> iii.im i'kim-ipaui or mamfac- 
 
 I VMM !<•■- | VMIUBS, 
 
 MAM i HHLlV Ml*sl "^AKIfcs « i: ikwiiiikm Al 
 
 i it 11 T< 11 MMENO1N0 
 
 mho CM mi DI< 
 
 
 BY 
 
 i: i m. I). 
 
 •k — 
 
 Rttl | llur|>iUl, A.r.— 
 
 Awiitc.l l»y ievcra 
 
 PHILAINBLPHIAi 
 i.\. !.i LANCHAKD. 
 
 1838. 
 
c 
 
 Entered according to the Act of Congress m the year 1838, by Ca*h 
 
 I lcrk's Office of the Eastern District ofcPennayhrania. 
 
 3: 
 
 / 
 
TO 
 
 JOHN (i I M M E R B, Esq., 
 
 PRINCIPAL OP FRIEND»' HIGH SCHOOL AT UAVERPORD, 
 
 UNDER WHOSE AUSPICES, IN I HABITS OP RE8EAK 1FLEC- 
 
 I, is. i I' mid tl 1 MC DEBT OF 
 
 WERE SYSTEMATIZED, ESTABLISH D. AND || | vILARLE, 
 
 THI8 LITTLI WO* 
 ii 
 RR8PECTFU LL1 DBDII LTED 
 
 HV HI* HBO AND FORMER l'l | 
 
 i 
 
 i A I I UOR. 
 
PREFACE. 
 
 medical pmfiiMMWi has op 
 the publication of ine, and 
 
 Le public, t<> attribute their 
 
 The pr of the present I , bowei 
 
 lull j ma] !>iv- 
 
 .11 knnu in«j- th( nine. 
 
 mcmej . and oouih 
 
 onoeafl 
 promote the umanitj a, on 
 
 band, thai it is ii immun 
 
 praotii i of di 
 
 without em] roducinj 
 
 calculab behalf of 
 
 thai profi ssion the I ave been 
 
 Ins life, nil eh r 01 meanly 
 
 mercenary . opoo 
 
 roletri men u|i to undergo the 
 
 mum of labom for the minimum 
 
 Bu1 it appears to (be author, that the principal i rill 
 
 which h ilted, and ait \\\n-\\ 
 
 I attempts at popular mcdiral in-' :. arc at- 
 
 tribvtable rather to the (Banner in which the robjecl 
 
 \\ iih<»ui wishing torn the meril i 
 
 verai public, be beherea that 
 
 all his pr< tiave passed tOOsHghtlj over inan\ 
 
 matters wki rendered quite intelligible to 
 
VI l»Ri 
 
 persons unacquainted with the science of medicim 
 
 while they have attempted to lay down d: 
 
 the treatment of many states or conditions 
 
 which can only be distinguished wit 
 
 managed with success, by thos 
 
 the moral light to employ the i ■ . but i 
 
 dangerous weapons by 
 
 learning, aided by lone 
 
 experience, tn ventun _ . the 
 
 endeavour h;< 
 
 tioned; — with what 
 
 mine. 
 
 It Form* 
 an u 1 1 
 
 when such advice can 
 time, he is not a 
 eonsii 
 
 consideration i so- 
 
 il. — if hu- 
 
 manity would ; 
 
 wealth and 
 
 id will i 
 and their 
 which / 
 
 lYr 
 to elude 
 Ions, i 
 thus pre 
 
 The gent] 
 whose situal 
 thren in England, will 
 effort 
 
 which is at once anno 
 appears censurable in I 
 serious evils gnra bag 
 regularly educated portion 
 we will pledge ourselves, unh 
 
 would gladly relinquish a share 
 
 emoluments which they now derive from the n 
 
PR I Vllr 
 
 management and complication of cases originally sim- 
 ple, through the folly of empirics, in consideration of 
 .mount of human suffering which would 
 be saved if the domain of quackery were limited, by 
 Eiision i phyai 1 know- 
 
 tile, then, a large and table portion of One 
 
 uinityares semi? 
 
 . in the management of their health, 
 siraUe that th< ' I acquire 
 
 some ki:«>w ledge of the machine upon which they ope- 
 and th< thai they emp] 
 
 important arguments 
 in in. lical information to 
 
 the public in I. Ev< d in our targe cities, — the 
 
 eentr of the population is \o^ 
 
 n. and too prot 
 
 emer < of a kind neigh- 
 
 ■ 
 he m 
 
 warn 
 demanding 
 the 
 
 In the West, — u hi 
 
 iiniinii 
 and in such n ad earth are 
 
 id villa 
 dation 
 
 rom th( 
 ►rtanl period in f nil acute dia 
 
 ins arrii al. 
 difficull On the 
 
 . a family composed of 
 hundred or more individuals. 
 a oin th( 
 
 oi the \ ideni almost exclusively upon 
 
 the.agri ulturisl 
 
Vlll PREFACE. 
 
 cal treatment. It has been truly said that, a little 
 knowledge is a dangerous tiling; but certainly, in the 
 situation just described, the remainder of the couplet 
 is inapplicable. 
 
 Another incalculable advantage which results from 
 the extension of correct medical kn vond 
 
 the limits of the pro which it 
 
 throws in tli 
 bling the public to jui 
 informal ion h the writ* 
 
 arrogance i f those ■.. 
 works, to fx rsu 
 fering from 
 
 or folly, \ et h< - thai tli 
 
 and tne pn I 
 
 -. ml] with 
 
 (loctniM Tl i •. will tt the 
 
 patient, i : 'us firien 
 the practitiom r, an 
 distinguish I 
 
 who ha- 
 of nmiK 
 from Large ci1 
 
 tanong t] 
 present ondert ikini 
 popular medical g\i 
 
 stance that the 
 
 extant, which c 
 
 present state of tin 
 
 arranged in alphi 
 
 which preoluch i 
 
 recollection t^f the mutual 
 
 strovs that system whi< 
 
 memory, facilitate n rin- 
 
 ciples. 
 
 In executing his task. th< 
 
 conscientiously to iueuleat 
 
 I to secure h 
 upon their own parti 
 when other ami more effic 
 while he lias exerted bin 
 form as much condensed as p 
 
PREFAi IX 
 
 uoii he coii- likely to aid the cause of huma- 
 
 nity under i amble circumstam 
 
 Tilt* fo due to the practi- 
 
 tioners of an honourable profession. To those who 
 propose to coin udy of that profession, it 
 
 nay b thai, under the present organization 
 
 our universities and medical i -. the pupil, at the 
 
 moment of entering upon hif rwhelmed 
 
 the (piantr u-ntilic matter forced upon his 
 
 attention by the number and variety of the lectin 
 
 he is called upon to attend. These lectures treat o[ a 
 
 termini if which is 
 
 Unknown to him ; and much iA the value o[ his first 
 
 \x of study is usually lost in obtaining a few gene- 
 ral ideas, laborioi - of 
 more profound, hut. to him. unintelligible learning. 
 ,t in perusing and reflecting upon 
 the contents of tl >f the present 
 
 ark, will communicate, it is confidently believ* 
 Mich broad \ id imp 
 
 physiological, and hygienic bu ill suable 
 
 aim t<» listen with pi. eje to the first 
 
 instruction ; — tic and, to 
 
 man] , almost intolerable portion ^i the 1. I a siu- 
 
 h is n>>w tunc to address the public in 
 
 the design Of the ; work. The 1m -hat 
 
 d individual actually suffering un- 
 
 furse <>f 
 Likely t<» prom health, 
 
 and invigorate and pr the force ^\ Ins oonstttu- 
 
 tioi unquestionably, to recommend a con- 
 
 sultation with some deeenredlj eminent physician. 
 Hut the directions and reasoning 
 better understood bj a patient v. me 
 
 knowledge of the Burst principle a of medicine This 
 knowl* rains! the machi- 
 
 oatiom inder-working empim * bo, that 
 
 has the slightest idea of the structure oft lie most OOm- 
 pli all the WOT would confide the 
 
 i such a delicate machine i<~> the hands 
 n ignorant pretender. 
 
 B 
 
X PREFACE. 
 
 It is not always possible to obtain the 
 ance in due time, and in many situatioi alto- 
 
 gether impracticable to obtain ii at all. There are 
 few medical men who have reached midd with- 
 
 out witnessing much misery and i 
 suiting from the ill-dir f those wh< 
 
 compelled to act on an emergency 
 of a physician. The writer of this t: d ad- 
 
 duce, from personal <•!>• tling in- 
 
 stances of that nature; all < 
 prevented by the p 
 
 small share of the informal tiich he trusts may 
 
 be derived from the following pag< 
 fore, no intelligent man who may not find 
 comfori consulted, and his worn in- 
 
 creased, by studying if 
 gj . hygiene, practical medicim 
 
 To heads of families, principals of 
 lories, seminaries, and 
 
 foreign stations, and tl 
 know ledge is still more import 
 " The Medical Friend/' beii 
 persede the family physician, bul pply 
 
 Ins place, w hen iti:e nd thai 
 
 practical pari of the work dwells chief -easesof 
 
 an acute character, and thai whenchr. nuts 
 
 are mentioned, directions for the management of the 
 ear!i( - have re© the 
 
 after treatment. Thosi liii-li ai 
 
 in their nature, or w Inch d< 
 
 an] stage, ace omitted, or bul lightly touched a] 
 and when such remedies or operations as 
 
 ploj ed only by the profession 
 
 remark, the\ troduced mere! 
 
 tural curiosity o( the reader. When, m the cm 
 
 of a case, the requisite treatment becomes 
 
 or demands superior skill, the subjei I - _- nerallv 
 
 fore-closed by referring thi 
 
 dical advisers. 
 
 The work is divided into two parts ; of winch 
 first is descriptive and theoretical, the second 
 
PR] XI 
 
 I11-; desirable that all who would qualify them- 
 selves for rightly comprehending the practical part 
 should peruse, previously and attentively, the tirst 
 four chapters, which may la* regarded as introduc- 
 tory 
 
 hmcalities have been avoided throughout the 
 nd it ha ideavour of the 
 
 writer to shim whatever pre-euppos - an acquaint- 
 ance with medicine or its collateral branches. The 
 
 impossible an] 
 derabl iil in the nrsl part, and it is 
 
 that the Style will he found as lighl and cnter- 
 
 is with the gravity and imports 
 
 I '!<• mar 
 
 mtaining a very 
 cursory \ id principli 
 
 ti\ nd chapter pr( i more par- 
 
 ticular n< human genera] anatomy » with l)nt 
 
 little that app to the d< partm al ana- 
 
 t"in\ : but, to enliven a [ly considered 
 
 itliarh dr\ 
 ally in 
 
 third cha; 
 
 mal tin mi their aber- 
 
 rati The artificial division 
 
 between : I path* rlj 
 
 adopted in th( been h 
 
 calculated Uthouf 
 
 ould be absurd to an 
 
 . w itlnn thrice the compass 
 oi the volume now offered to I >lic, and slthoujE 
 
 of application, with all the ad\an1a 8S of a 
 
 thorough eleiiientan edncati aid he ne»a ssarv 
 
 omplete the study, the nevertheless cerlain 
 
 era! principles he utained, which maj be 
 
 easily acquired, and which render the information 
 
 presented in the succeeding chapters much more 
 available. The subject is highly interesting in its na- 
 ture, and it is hoped that the will find, in the 
 
 entertainment which il funis l ample remune- 
 
 i tor the lahou nl perm 
 
Xll PREFACE. 
 
 The fourth chapter, on hygiene, or the art of pre- 
 serving health, is by no means the Least imparl 
 portion of the work, and is worthy the attention of 
 every head of a family, or principal of a achooL 
 several subjects of food, clothing, air and moisture, 
 exercise, the errors of and 
 
 matrimony, are discussed under distincl h< ads Many 
 valuable rules for gradually imparting 
 constitution, and for the preservation <>f health ui 
 atmospheric vicissil r in unhealthy Ritual 
 
 will be found in this chapter. 
 
 The second, or practical poi work Lfl 
 
 vided into live chapters, on the fo] 
 jects : surgical accidents and diseases, medical p 
 tice, di» ; women, diseases of chile 
 
 and diseases of adult fi It bai 
 
 remarked, that the arpl ed arrangemenl of 
 
 jects lias not heen adopted in any part of this 
 but all the conveni* h a distribu- 
 
 tion, may be obtained bj n 
 
 index provided for each of the two gn 
 
 this volume. 
 
 An appendix contains a list n\ man . 
 
 medicines and compound prescriptions recommi 
 ed in the work, with the m the 
 
 tatter. It is remarked, thai the mod • 
 
 praclnioners generally employ the smallest nne 
 of remedies, as the most able n led 
 few implements. 1 then, of following th. 
 
 ample of his predec by perplexing the mini 
 
 his readers with a histon of a great mult 
 dicines. the writer has confined his attent 
 Of established reputation, and named in I 
 the work. 
 
 Having thus narrated the contents of the rohu 
 it is proper to mention what portions 
 have been performed by the avowed author 
 part has heen executed by the pi • 96 
 who have aided him in departments to which I 
 have devoted more especial attention, tl 
 have declined the announcement of their nan 
 
PREFACE. X1U 
 
 The author is directly responsible for the whole 
 of the first part of the work, and for all that is 
 strictly surgical in the second part, with the excep- 
 tion of the articles hemorrhoids, hip-joint difi md 
 white swelling, and the surgical section on constitu- 
 tional di 
 
 Tht dicine in modern times has taken 
 
 a ra vnplex in detail, that 
 
 it would be presumptuous in anj one individual, 
 w\i may be liis position, to undertake the pro- 
 
 ductionofa workglancii j rly the whole field 
 
 of the theory and practice of medicine, without the 
 
 of those w hoei 
 tensive than his <>wn in such departments as be I 
 ted by m ai oided by preferen( 
 
 The more cura p ueral the I the m< 
 
 profound is the knowledge required to give value to 
 we pages, and oid the danger of serious en 
 
 for, « ben aumerous 1 aticallv e.\ ; 
 
 and arranged, it ia much i i include tnem within 
 
 definite rules, than when tin nlv in the 
 
 tnemorj of one who writes the results of past sttx 
 reflection, and experii ark 
 
 bas written — I ions, it 
 
 w as thought advisable that the subject of internal dis- 
 should be intrusted to i * hands from 
 
 those which bad been cl with the anatomical, 
 
 physiological, hygienic, and surgical departments. 
 
 The avowed author has addei anal comments 
 
 and incidental r opinions, in the course of 
 
 the Strictl) medical eha; Ins eonnex mn 
 
 with them properly ceased. !!• ta that circum- 
 
 stances induce bis coadjutors to decline the announ< 
 
 ment of their names, and feels that some apolog] 
 
 necessary for the acknowledgment of his own, when 
 
 unattended by theirs The DQOtive nnv be briefly 
 
 stated. 
 
 When a writer presumes to address the public on 
 
 Subjects of high importance, and such as are usually 
 
 regarded as recondite, — especially ifhis subject matter 
 drawn I enera] study and experience, without 
 
XIV PREFACE. 
 
 compilation, or frequent reference to special authori- 
 ties, — the value of his labours depends chiefly upon 
 his opportunities for the acquisition of inform.v 
 and the confidence felt in his mode of employing 
 those opportunities. In otln 
 character and position are m c 
 calculation of the dependence whi' e lldbepli 
 upon his dicta. A book upon ;t BCienl t, un- 
 
 supported by any name Lb, tin 
 with some suspicion ; and, whethi -hen 
 
 appended, be calculate 
 racter, then- is justice in its aimouna men! 
 
 It is true, most of > 
 tained in the follov 
 common pn >f the p 
 
 wanting frequent individual 
 observations, which require a spons 
 c\- of their d< duction, or t] i 
 meat. No par 
 tempted. They will be r< 
 
 who are proficient i such, al< 
 
 the question of their origin is into 
 
 For id the pn >al « ri- 
 
 fcer of the work, has thought i1 incumbent upon bin 
 to attach his name to the volume, althoug 
 is taken with some reh 
 
 are ihose of his tV:i1« ::nt v. wh< un- 
 
 dertaking ; and partly, because it 
 juxtaposition with 
 
 whom to rival, or with whom not 
 
 within the com ins ambition. 
 
 Had the author aimed at reputati might hi 
 
 said much, with justice, in extern] 
 style; hut if he have succeeded in - >ook 
 
 o( real utility, hi which 
 
 may flow from it. 
 
 The book is before the public fall 
 
 by its own merits. All that ifi 
 tmination. 
 
CONTENTS. 
 
 Preface, - - - P:< 
 
 PART Mil- 
 OUTLINES OP an ITOMY, PHI *D ilvcir.M-:, 10 
 
 i II IPTER I. 
 
 HUE] IBfTNARl riON 
 
 17 
 
 CH MM Kit II. 
 nil: HUMAN BODY, - 
 
 . <r udipoae tu*ue, ..... 
 
 I ' aaeoua system, ... - 
 
 .... 
 
 jwular pratcm, anatomy, 
 
 Of the duodenum, - 
 
 Of the liver, ... ... 
 
 Of the small into* 
 
 Of ti. ;ie, ----- 81 
 
 si 
 
 • circulate » • • - • s.M 
 
 irculution, • 80 
 
 -scls, -..-.. go 
 
 lie function of nutrition, ----- 92 
 
 < M' the function of absorption, ----- 93 
 
 < spirution, ------- 
 
 i e apparatus of respiration, ----- 96 
 
 Of secretions, - - - 102 
 
XVI CONTENTS. 
 
 Page 
 
 Of the urinary apparatus, - 103 
 
 Of the urine, - ----- 106 
 
 Of the skin or integument, - - - 107 
 
 Of the nerves, -- - - - - -111 
 
 Of the brain, - ----- 113 
 
 On the duplicature of certain organs, .... 122 
 
 CHAPTER III. 
 
 PHYSIOLOGICAL REMARKS, - - - - 126 
 
 Of assimilation and nutrition, .... 19(5 
 
 Of the reproduction of parts as displayed in the healing of wounds, 133 
 Of symptomatic fever, ..... 
 
 Of irritation and hyper-nutrition, inflammation, physiological, • 147 
 
 Of capillary irritation, ..... 153 
 
 Of nervous irritation, ..... 159 
 
 Of the balance of vital action and re-action, - - - 162 
 
 Of vicarious discharges and transformations of tissues, - - 163 
 
 CHAPTER IV. 
 
 REMARKS ON HYGIENE, - - - - 166 
 
 Offood, - 166 
 
 Of clothing, - - - - - - 188 
 
 Of air and moisture, ...... 
 
 Of exercise, ....... 206 
 
 Of the food and exercise of children, .... 213 
 
 Errors of female school discipline, .... 226 
 
 Of matrimony, ...... ggj 
 
 PART SECOND. 
 
 PRACTICAL DIRECTIONS FOR THE TREATMENT OF 
 MEDICAL AND SURGICAL DISEAfi 
 
 CHAPTER I. 
 
 OF SURGICAL ACCIDENTS AND DISEASES, - 
 Sect. 1. Of wounds and contusions, .... 
 
 Of incised wounds, ..... 
 
 Of incised wounds of the scalp, 
 
 Of incised wounds of the neck and throat. 
 
 Of incised wounds of the chest. 
 
 Of incised wounds of the abdomen, 
 
 Of incised wounds of the joints, 
 
 Of lacerated wounds, .... 954 
 
 Of contused wounds, - - - . . 
 
 Of contusions, ..... 
 
 Of injuries of the head, .... 
 
 Concussion of the brain, 
 Fractures of the skull, 
 
 Of contusions in the cavity of the spine, - - 371 
 
 Of fractures, dislocations/and sprains of the spine, - J71 
 
 Of concussions of the spine, .... 
 
 Of contusions of the chest, .... 
 
CONTENTS. XV11 
 
 Pnge 
 
 Of contusions of the abdomen, ... 275 
 
 Of contusions of the pelvis and perineum, - - 278 
 
 Fractures of thejxdvis, .... 279 
 
 Of contusions or sprains in the joints, - - 281 
 
 Of punctured wounds, - 283 
 
 Sect. 2. On the dilatation of natural passages, and its consequences, 285 
 
 Dilatation of the anus, - 287 
 Of dilated or varicose veins, - 
 Of varicocele, ------ 
 
 Of piles, or hemorrhoids, - 
 
 Of dilatations of the heart and arteries, 
 
 Ofaneuri- - 298 
 
 Of aneurismal varix and varicose aneurism, - - 299 
 
 Of mother-spots, or aneurism from anaatotnofi - 300 
 
 Of hernia, or rupture, - .... 302 
 
 Sect. 3. On deformities from imperfect nutrition of the osseous and 
 
 muscular systems, - - - - -311 
 
 Of curvatures of the spine, ... - 311 
 
 Of club foot, . - - - - 318 
 
 Sect. 4. Of fracture- - 319 
 Fractures of the clavicle, - 
 
 Fractures of the shoulder blade, - - - 323 
 
 Fractures about the shoulder joint, - - - 323 
 Fractures of the arm, - 
 
 Fractures of the elbow joint, - - - - 324 
 Fractures of the fore-arm, .... 
 Fractures of the lower extremities, 
 
 Fractures of the th .... ggg 
 Fractures of the If . .... 
 Fractures of the lingers and • 
 
 Fractures of the lower jaw, - 329 
 
 Of dislocation 1, - - - - 330 
 
 Dislocation of the arm into the arm-pit, - - 331 
 Dislocations of the v. 
 Dislocation of the ankle, with fracture of the fibula. 
 
 Sect. 5. On inflammation and its cooaaonenc 
 External inflammat - 
 
 Terminations of inflammation, 
 
 Treatment of inflammation, .... 335 
 
 titration, - 337 
 Of ulceration, ..... 
 
 Of gangrene, ------ 342 
 
 -Malignant pustule, ..... 342 
 
 Gangrene of old men, ----- 340 
 
 Dry gangrene, ..... 349 
 
 Gangrene from execs- of inflammation, from internal and 
 
 constitutional .... 343 
 
 Gangrene from pressure, - 344 
 
 ^rene from cold, ----- 344 
 
 Gangrene from mechanical injuries, - - - 345 
 
 Terminations of inflammation coupled with collapse, - 340 
 
 Of the sty, ------ 349 
 
 Ulceration of the eye-lashes, - 349 
 
 Foreign substances in the eye, - - - 350 
 
 Inflammation of the eye, - 351 
 
 Ulceration of the cornea, ... - 354 
 
 Films on the eye, ... - - 354 
 
 Foreign bodies in the ear, - 355 
 
 Ear-ache, and suppurations of the ear, - - - 356 
 
 c 
 
XVlll 
 
 CONTENTS. 
 
 Ulcerations of the mouth, .... 356 
 
 Gum-biles, 357 
 
 Suppurations of the urinary passages, - - - 357 
 
 Excoriations about the mucous orifices, - - 359 
 
 Chafing, ...... 359 
 
 Of abscesses, ...... 359 
 
 Run-round, ...... 361 
 
 Whitlow 361 
 
 Nails growing into the flesh, .... 362 
 
 Biles, 363 
 
 Furuncle and carbuncle, .... 364 
 
 Canker, or gangrenous sore mouth of children, - 366 
 
 Burns and scalds, ..... 368 
 
 White swelling, ..... 370 
 
 Hip-joint disease, ..... 371 
 
 Sect. 6. Corns, warts, and moles, .... 373 
 
 Soft corns, ...... 374 
 
 Warts, ...... 375 
 
 Moles, ...... 375 
 
 Sect. 7. Constitutional diseases, .... 376 
 
 Scrofula, ...... 376 
 
 Of cancer, ------ 378 
 
 Venereal dise;. ----- 880 
 
 Scurvy, - - - - : - 801 
 
 CHAPTER III. 
 
 MEDICAL PRACTICE OR TREATMENT OF INTERNAL 
 
 diseases, ........ an 
 
 Sect. 1. Fever, 387 
 
 Intermittent fever, ..... 886 
 
 Continued fever, - . - - - 393 
 
 Bilious remittent fever, .... 400 
 
 Yellow fever, 101 
 
 Petechial or spotted fever, .... 4(iy 
 
 Sect. 2. Eruptive dit ..... 405 
 
 Small-pox, - - - - - .406 
 
 Varioloid, ------ 409 
 
 Chicken-pox, - - - - - -408 
 
 Cow-pox, .--... 410 
 Measles, .--... 
 
 Scarlet fever, ------ 413 
 
 Miliary lever, - ... 415 
 Nettle-rash, - ' - - -11'. 
 
 Prickly heat, or lichen, - - - - 417 
 
 Shingles, ..--.. 417 
 
 Ring-worm, - - - - - - 418 
 
 Itch, - - 418 
 
 Rose-rash, ...... 
 
 Gum-rash, ...... 
 
 Pruriginous rash, - 
 
 Sect. 3. Erysipelatous affections, .... 421 
 
 Poisoned wounds, - - - - - 12"J 
 
 Erysipelas phlegmonodes, or diffused inflammation of the 
 
 cellular tissue, ..... K96 
 
 Inflammation of the veins and absorbents, - - 426 
 
 Sect. 4. Diseases of the respiratorv apparatus, - • H8 
 
 Catarrh, - - - - OB 
 
 Influenza, --..-- 430 
 
CONTENTS, 
 
 XIX 
 
 Pleurisy, 
 
 Lung fever, - 
 
 Consumption, - 
 
 Spitting of blood, 
 
 Pulmonary hemorrhage, 
 
 Asthma, ... 
 
 Angina pectoris, 
 Sect. 5. Diseases of the throat, 
 
 Mumps, - 
 
 Quinsy, - 
 
 Croup, - 
 
 Sect. 6. Diseases of the abdomen, 
 
 Cholera morbus, 
 
 Spasmodic or malignant cholera, 
 
 Diarrhoea, or looseness, 
 
 Dysentery, 
 
 Colic, - 
 
 Painter's colic, 
 
 Liver complaint, 
 
 Inflammation of the kidney, - 
 
 Jaundice, 
 
 Passage of gall stones, 
 
 Worms, 
 Sect. 7. Diseases of fibrous tissue, 
 
 Rheumatism, - 
 
 Gout, .... 
 Sect. 8. Nervous diseases, 
 
 Chorea, or St. Vitus's dance, - 
 
 Shaking palsy, 
 
 Convulsions, - 
 
 Epilepsy, 
 
 Hysteria, ... 
 
 Catalepsy, or trance, - 
 
 Apoplexy, 
 
 Palsy, .... 
 Sect. 9. Prominent symptoms and accidents, 
 
 Dropsy, 
 
 Heart-burn, 
 
 Water-brash, - 
 
 Flatulence, 
 
 Costiveness, - 
 
 Indigestion, or dyspepsia, 
 
 Vomiting, 
 
 Hiccough, 
 
 Cramp, 
 
 Bleeding from the nose, 
 
 Strangury, 
 
 Diabetes, 
 
 Gravel, 
 
 Drowning, 
 
 Death from suspension, 
 
 Page 
 
 431 
 432 
 435 
 439 
 440 
 441 
 443 
 444 
 444 
 444 
 447 
 449 
 449 
 450 
 454 
 457 
 459 
 462 
 464 
 466 
 467 
 468 
 470 
 473 
 473 
 476 
 479 
 479 
 480 
 481 
 481 
 482 
 483 
 484 
 487 
 488 
 488 
 492 
 493 
 493 
 494 
 497 
 502 
 504 
 505 
 507 
 508 
 509 
 509 
 511 
 512 
 
 CHAPTER III. 
 
 DISEASES OF MARRIED WOMEN, 513 
 Of pregnancy, and the position and connexions of the child 
 
 in the womb, .... - 513 
 
 Approach of labour, ----- 518 
 
 Of labour, 520 
 
XX 
 
 CONTENTS. 
 
 Page 
 
 Uterine hemorrhage, - - - - - 526 
 
 Of puerperal convulsions, .... 527 
 
 Inversion of the uterus, .... 539 
 
 Inflammation of the womb, - 531 
 
 Puerperal fever, ..... 532 
 
 Swelled leg, milk leg, or phlegmasia dolens, - - 534 
 
 Puerperal nervousness, mania, and melanchc - 535 
 
 Of palsy of the bladder, .... 537 
 
 Of swelled throat, - 537 
 
 Inflammation and abscess of the mamma, - - 537 
 
 Of inflammation of the nipple, - - . 539 
 
 CHAPTER IV. 
 
 ON DISEASES OF CHILDREN, - - - - .541 
 
 Tongue-tie, --.-.. 
 
 Swelled breasts, ..... 542 
 
 Sore navel, ----.. 
 
 Of the yellow skin and jaundice of infants. . 5 13 
 
 On retension and suppression of urine, 
 
 On painful urination, - 
 
 Incontinence of urine, - 
 
 Excessive urination, urinary consumption, or diabetes, 547 
 
 Sore mouth, thrush, aphthae, - 
 
 Colic, ....... 
 
 Costiveness, ...... 
 
 Vomiting, ...... 555 
 
 Erysipelas, ...... 557 
 
 Dentition, ...... 559 
 
 Worms, ------ 561 
 
 Convulsions, ------ 561 
 
 Dropsy in the brain, - 
 
 Whooping-cough, ----- 5^3 
 
 Inflammation of the tonsils, quinsy, - - • 566 
 
 Cholera infantum, .... - 5^7 
 
 CHAPTER \ 
 
 ON DISEASES OF ADULT FEMALES, 
 
 Appearanco of the menses, 
 
 Chlorosis, or green sickness. - 
 
 Suppression of the menses. 
 
 Obstructed menstruation, 
 
 Painful menstruation, - 
 
 Excessive menstruation, or flooding, 
 
 Final cessation of the mense. 
 
 Leucorrhoea, fluor albus, or whites, 
 
 Pruritis vulva?, 
 
 Falling, or prolapsus of the uterus, 
 
 Retroversion, or fulling of the womb backwards, 
 
 Antiversion of the womb, 
 
 Polypus of the uterus, - 
 
 Cancer of the uterus, - 
 
 Appendix, 
 
 Formulary, 
 
 List of drugs, - 
 
 List of apparatus, 
 
 Index to the first part, - 
 
 Index to part second, - 
 
 Errata, 
 
 574 
 
 576 
 
 580 
 
 596 
 599 
 601 
 607 
 615 
 
CHAPTER I. 
 
 PRELIMINARY REMARKS ON THE ORGANIZATION 
 OF ANIMAL?. 
 
 When we look at the wonderful machine which the Deity 
 has placed upon the earth to preside over his creation — when 
 we consider the beautiful adaptation of its various parts to the 
 purposes for which they are designed — we are struck with awe 
 and admiration, even upon a superficial glance at its beauty 
 and propriety. But when we penetrate beneath the surface, 
 and behold the play of its ten thousand arteries carrying sus- 
 tenance to every part of the system — the veins returning their 
 purple current to the heart and lungs, to be resupplied with 
 the elements of life, — when we observe the lacteals taking up 
 the nutritious particles from the bowels, and conveying them 
 through countless channels to be mingled with the blood — 
 the absorbents removing those parts which are no longer fitted 
 to fulfil their duty, and the glands rejecting them from the 
 body as useless incumbrances, while the vessels again supply 
 their place with fresh materials, — when we reflect, I say, that 
 this most intricate machine is so constantly undergoing waste 
 and repair, that in a very few years it loses every individual 
 atom which formed a part of its original structure, while it 
 still preserves its form and motions unimpaired, we are lost 
 in wonder; not less at the wise ordinations of Nature that re- 
 gulate its operations, than at the audacity of those who dare 
 to interfere with her arrangements, even when disorder is 
 perceived among the wheels and springs of this masterpiece 
 of Divine wisdom and power. 
 
 But Nature governs all her works by a few simple laws ; 
 and when these laws are discovered, the explanation of her 
 most involved phenomena are often brought within the grasp 
 of human reason. By contemplating the fall of an apple, New- 
 ton was enabled to expose the hidden cause of all the move- 
 ments of the heavenly bodies. Now, although we have not 
 arrived at nearly the same simplicity in the study of the sci- 
 ence of life which that philosopher has reached in speculating 
 
 3 
 
18 OUTLINE OF ANATOMY. 
 
 - 
 
 on Natural Philosophy, we have discovered many general 
 principles which shed no inconsiderable light on the other- 
 wise incnm pre flexible operations ofihe human frame in health 
 cnl in disease. Let us, then, proceed to elucidate these prin- 
 ciples, as far as the limits and the object of this work will per- 
 mit.' 
 
 The simplest of .ill animals — which mostly reside in the wa- 
 ter — appear lo be entirely divested of feeling, or voluntary mo- 
 tion ; they have no blood vessels, no nerves, no intestines, no 
 organs; they are composed of a kind of membrane containing 
 'many cells and fibres of different shapes and sizes, filled and 
 surrounded with a peculiar fluid. In structure they are not 
 unlike a sponge, enclosed in a bladder of the same substance, 
 and shaped into different forms according to the species. In 
 composition this membrane does not differ verv widely from 
 the white of an egg when boiled. Such is the picture of the 
 simplest specimens of animal life, and although the labours of 
 recent naturalists have proved the existence of more complex 
 organs in many of the tribes of minute beings, whose existence 
 is scarcely perceptible, except by the aid of powerful micros- 
 copes, there are not wanting many of much larger size, and, 
 therefore, open to accurate observation, in whom the whole 
 body is devoid of any systematic arrangement, other than that 
 which has been just described. 
 
 These animals live by imbibing their sustenance through 
 the skin from the fluid in which they swim, and as they select 
 such particles as are fitted to their wants, they may be said 
 to perform a kind of external digestion. The membrane of 
 which they are composed is supposed to contract when touched, 
 and also, when acted on by light, heat, electricity, and, perhaps, 
 other causes; thus the fluids which it contains are agitated and 
 moved from place to place, so that an imperfect kind of circu- 
 lation is effected without the aid of blood vessels, and all parts 
 of the body are nourished and furnished with the means of 
 growth. If respiration be necessary to these animals, it must 
 be effected by the external surface, and whatever matters re- 
 quire to be ejected from the body are compelled to pass by the 
 same route. This substance, of which they are composed, and 
 which is called cellular membrane, or cellular tissue, seems, 
 therefore, to be capable of fulfilling all the functions of life, as 
 far as they are necessary to the existence of the most simple 
 animals, and, strange as it may appear, even the human em- 
 bryo, when it first becomes visible, and for some time after- 
 Ward, cannot be distinguished from a small mass of cellular tis- 
 sue! Although it is obvious that it must be endowed with life, 
 it contains no vessels nor organs, but resembles a mere piece of 
 animated jelly. 
 
OUTLINE OF AN ATOM V. 19 
 
 When we begin to examine animals more and more ad- 
 vanced in the scale of nature, we rind that those which are de- 
 signed to move about in search of food, instead of having their 
 food brought to them, require to be furnished with organs 
 especially devoted to this purpose. They have muscles: for 
 the occasional, and, as it were, accidental contractions of the 
 cellular tissue are too irregular and uncertain to answer their 
 necessities, and they require an apparatus for locomotion. 
 From the moment that the character of perfect simplicity is 
 thus lost, it seems that mere absorption from the surface is in- 
 sufficient to supply the materials for the different organs, and 
 the animal is supplied with an internal cavity or stomach, and 
 bowels more or less complex in structure, in which food may 
 be enclosed until it can undergo a more careful and deliberate 
 digestion. Still these muscles, of which we have spoken, 
 though they look like fibres of considerable length, are thought, 
 by most, to be in reality composed of globules or particles, 
 ranged in rows in the midst of the cellular tissue, which ties 
 them together in bundles and keeps each particle in its proper 
 place; they are strictly interstitial deposites, rilling the cavities 
 and adhering to the layers of the membrane. 
 
 Now the movements of the muscles would be embarrassed 
 and, perhaps, destroyed, if the liquids which support life were 
 permitted to pervade the whole body, in these, as they do in 
 the simplest animals, which have no well defined organs; the 
 nutritive fluid or blood, is, therefore, generally enclosed in 
 distinct vessels, formed ultimately of the same cellular tissue, 
 but having no communication with its cells. These vessels 
 divide and redivide, carrying the blood to every part of the 
 body, and returning it again to a reservoir, or Heart, which 
 forms the centre of the circulation. 
 
 As every part of the body receives its nourishment from 
 the blood, it is obvious that this fluid is constantly undergoing 
 considerable waste; nature has, therefore, provided a system of 
 vessels which is rather an appendage to the circulatorv ap- 
 paratus than a part of it. These vessels, which physicians 
 call the Lacteals, arise in countless numbers from every part 
 of the bowels. They take up, by some invisible means, such 
 parts of the food as are suited to enter the blood, leaving the 
 rest to be ejected from the body by the natural passages. 
 They pursue a winding course, uniting gradually with each 
 other, and thus becoming larger, as the little streams from a 
 thousand springs are slowly collected first into rivulets, then 
 into brooks, until, at length, they give rise to a noble river* 
 The river of the lacteals into which they are all finally col- 
 lected is, in man, a vessel about as large as a crow-quill, which, 
 running for some distance along the spine, near the back part 
 
^0 OUTLINE OF ANATOMY. 
 
 of the chest, empties its contents into one of the principal veins 
 of the body just before it enters the heart. 
 
 The Heart is a strong hollow muscle, which alternately 
 receives the blood as it flows toward it, and then forces it by 
 a strong contraction through vessels, which go on continually 
 branching until they reach every part of the system, like the 
 limbs and twigs of a great tree. 
 
 The principal trunk and great branches of this class of ves- 
 sels are termed Arteries; the blood is propelled through them 
 chiefly by the direct force of the heart, but they are provided 
 with a coat or envelope of fibres resembling those of muscles, 
 which aid in urging the current more uniformly in proper di- 
 rections, and as the arteries grow smaller, these fibres increase 
 in their relative strength, as the bark of the smaller twigs be- 
 come thicker in proportion, than that of the body of the tree. 
 At length these little arteries become capable of hastening or 
 retarding the flow of blood, and sometimes, perhaps, they check 
 it altogether for a moment. They now change their name, 
 and are called the Capillaries. 
 
 It is through the capillaries that all those particles which are 
 required for the growth and preservation of the body and its 
 several organs, are separated from the blood and placed in 
 their proper stations. The same vessels are supposed by some 
 to take up and mingle with the blood those particles which 
 have done their dutv and are worn out in the service, in order 
 that they may be disposed of, in the manner in which most 
 bodies corporate reward the past services of friends no longer 
 found necessary; that is, by being turned out of doors. In 
 this most thankless duty, however, they are certainly aided by 
 a subsidiary class of vessels called the Absorbent?* which con- 
 vey only colourless fluids collected from all parts of the b 
 Most of these last named vessels, finally empty their contents 
 into the common trunk of the lacteals, and thus into the veins; 
 but some of them reach the same destination by a more direct 
 route. 
 
 This constant addition of nutritive matter to the blood by 
 the lacteals, its distribution to every organ of the animal by the 
 heart and arteries, its separation from the mass of circulation, 
 and its application to the growth and repair of all parts by the 
 capillaries, together with the removal of injured, useless, or de- 
 bilitated particles by the absorbents, are subjects connected with 
 the all-important process of nutrition. 
 
 After the blood has passed the capillaries it falls into ano- 
 ther system of vessels called the Veins, bv which it is returned 
 to the heart. The veins are destitute of the seemingly mus- 
 cular coat of the arteries and capillaries, and although the 
 blood is constantly pushed into them bv the joint action of 
 
OUTLINE OF ANATOMY. 21 
 
 the heart, the arteries, and the capillaries, they are unable to 
 propel it by any effort of their own; they are mere passive 
 conduits. To supply this apparent defect, they are provided 
 with numerous valves, set here and there along their course, 
 which permit the blood to pass toward the heart, but prevent 
 its return in the opposite direction. By the constant motion 
 of the muscles in breathing, walking, coughing-, sneezing, &c, 
 the veins are very frequently Compressed, and their contents 
 urged forward more rapidly; hence the healthfulness of exer- 
 cise and gymnastics, but of this I shall speak more fully in the 
 chapter on Hygiene. All the veins of the body are gradually 
 collected into a few great trunks or canals, which pour their 
 contents into the heart, and those which belong to the general 
 circulation, — that circulation which is destined to supply nutri- 
 ment to the body — form, in the more perfect animals, two great 
 conduits; one coming down from the head and upper extremi- 
 ties, the other coming up from the trunk and inferior ex- 
 tremities. These conduits meet directly end to end, so as to 
 form but one trunk, which opens into the heart by a gap at the 
 side. 
 
 The blood thus returned is of course altered, in the first 
 place, by having parted with a great deal of matter for the 
 repair and growth of the different organs, and secondly, by 
 being loaded with all the useless particles which the absorbents 
 have taken up. In order then that it may be fitted for circu- 
 lating again, it must receive considerable additions and it must 
 cast off considerable impurities. The former are supplied by 
 the lacteals, but the latter process requires a different set of 
 vessels endowed with other powers. 
 
 One of the chief impurities which the blood receives from 
 the absorbents is carbon or charcoal. To rid it of this, a part, 
 and in the more perfect animals, the whole of the blood, is 
 made to pass through an organ where the vessels come almost 
 into contact with the element in which the animal lives, as 
 the water in fishes, and the air in birds and man. Both these 
 elements contain oxygen or vital air, and by some hidden 
 means, the carbon of the blood, being supposed by most to 
 unite with this vital air, escapes through the thin coats of the 
 vessels in the form of carbonic acid gas, the same gas that rises 
 from fermented liquors, soda water, &c. Thus, we see some 
 animals breathing water, and others, air. The former, gene- 
 rally have the breathing organs placed externally; they are 
 termed Branchiae or gills; in the latter, they are situated within 
 the body, and are called Lungs, or lights. The function per- 
 formed by these organs is called respiration 
 
 It is believed by many physiologists that nature, always un~' 
 
22 OUTLINE OF ANATOMY. 
 
 willing to perform any useless labour and anxious to effect as 
 many operations as possible with a very few materials, has so 
 ordered the laws of respiration that it shall preserve the 
 warmth of the animal at the same time that it purities the 
 blood. While the blood is acted upon by the atmosphere in 
 the lungs, or hy the water in the gills, it is supposed to absorb 
 a great quantity of heat, and as it flows towards every part of 
 the body, undergoing a gradual change, it is thought "to throw 
 out this heat, and thus to keep every part at its proper tem- 
 perature. 
 
 The effects of respiration are not sufficient to remove all the 
 impurities of the blood, and, therefore, a number of curious 
 organs, called Glands, are provided, some of which aid in sepa- 
 rating many of these impurities, each gland furnishing its own 
 peculiar fluid, which it pours out either into the bowels or 
 into the skin. The product of many of these glands is made 
 useful for various purposes before it is thrown off from the 
 body; thus the liver, the largest of the glands, forms the bile, 
 which is the natural purgative, producing, when healthy, regu- 
 lar and comfortable stools; and when diseased, occasioning cos- 
 tlveness or bowel complaints: the pancreas and the glands 
 about the mouth pour out the spittle which assists digeNtion. 
 These useful fluids are called Secretions, but those which are 
 ejected, like the urine, without fultilling any important purpose, 
 are called Excretions. 
 
 From what has been said, it is obvious that the motions ne- 
 cessary to main tain life even in very simple animals are nu- 
 merous and complex. The stomach and intestines mu<t re- 
 ceive and digest food; the lacleals must take up the nutritious 
 part of the food and carry it to the blood; the arteries must 
 convey this blood to the different organs; the capillaries must 
 supply the growth and waste of those organs; the absorbents 
 must aid the capillaries in taking away the worn out and use- 
 less parts to mingle them with the blood in the veins; these 
 vessels must convey the blood back to the heart, which must 
 then pass it to the lungs to be deprived of some of its impurities, 
 and to enable it to sustain the heat of the body. In addition 
 to all this, the glands must assist in purifying the hlood, or they 
 must furnish fluids to aid in digestion and other functions, or to 
 purge away those useless remains of the food, which cannot be 
 digested. So many different motions all dependent on each other, 
 would necessarily produce continual confusion, by acting irre- 
 gularly and to cross purposes, if thev had not some common 
 bond of union by which they can mutually inform each other, 
 as it were, of their several wants and actions. This bo: 
 union is furnished bv the nerves. 
 
OUTLINE OF ANATOMY. 23 
 
 In the more simple animals, we find only a few nervous 
 fibres running: in different directions, with here and there lit- 
 tle knots called Ganglions, joining several fibres together. 
 When any impression is made upon one of these fibres, it is 
 instantly communicated to the parts with which it is connect- 
 ed, and" calls them into action. If the fibre is united with 
 others, or with one or more of the little knots just mentioned, 
 they are also called into action, and several different parts are 
 then put in motion at once. Thus when food enters the sto- 
 mach, its nerves receive the impression and cause the capil- 
 laries of that organ to dilate in order to receive the blood 
 required to carry on the process of digestion; they also give 
 notice to the heart, which, if necessary, acts with more force 
 in hastening the circulation, and the capillaries of the skin 
 contract and drive the blood from the surface toward the 
 bowels. This is the cause of the slight chill and consequent 
 fever so often felt during and after a hearty dinner. The ani- 
 mal, however, remains unconscious of all this hurry of business 
 within, and the nerves which are the messengers and agents of 
 the manufactory are called the nerves of organic life. They 
 are altogether independent of the will, and are found in ani- 
 mals supposed to have no brain. 
 
 In beings of a higher order, that are obliged to choose their 
 food with judgment, and to travel far in search of it, other 
 nerves are required to enable them to recognise its presence; 
 these are the nerves of sensation. There must also be a brain 
 to enable the animal to judge of its impressions, and to per- 
 ceive its wants, and another system of nerves is required to 
 pass from the brain to the different muscles, by which the 
 former may direct the motions of the latter; these are the 
 nerves of voluntary motion. All these several systems, though, 
 in some degree, independent, are connected together by the 
 brain and the little knots or ganglions, so that they mutually 
 influence each other. 
 
 Finally, to enclose and protect this multiform and delicate 
 structure, there is a coat of condensed cellular tissue cover- 
 ing the whole body, and called the true skin, over which is 
 spread a thin layer of horny matter called the cuticle or scarf 
 skin. This cuticle is totally insensible, and forms a mere 
 crust which protects the delicate and exquisitely sensitive sur- 
 face of the true skin. The horns, nails, hair, spines, shells, 
 and crusty coverings of various animals, are all classed pro- 
 perly with the cuticle, being either excrescences of, or substi- 
 tutes for, that membrane. 
 
 Each of the parts of an animal that have now been enume- 
 rated may be found even in a common snail, or in the mean- 
 est of the reptiles ; but, as we ascend in the scale of nature. 
 
24 OUTLINE OF ANATOMY. 
 
 every system of organs is observed to become more and more 
 complex in structure, and capable of actions more and more 
 various. 
 
 Man, the most perfect Gf animals, not only requires the 
 whole of this complex apparatus, but his brain also contains 
 systems of nervous fibres, for the exercise of the higher in- 
 stincts, moral feelings, and reasoning faculties. He is at first 
 nothing but a little mass of cellular tissue ; but as the infant in 
 the mother increases in size, one organ is added after another, 
 nearly in the order described, and many of his parts do not 
 reach their full development until he approaches middle life. 
 
 We will now proceed with a hasty review of the several 
 parts and systems which compose the human body, with such 
 notice of their action as our narrow limits will permit, pur- 
 suing the order in which we have already arranged the prin- 
 cipal functions which belong to all animals. 
 
OUTLINE OF ANATOMY. 25 
 
 CHAPTER II. 
 
 STRUCTURE OF THE HUMAN BODY. 
 
 In describing a machine composed of a thousand parts, all 
 so connected that they cannot act separately and independent- 
 ly, but must mutually assist each other in every operation, it 
 is extremely difficult to select a point from which to commence 
 our narrative. We shall he occasionally compelled while de- 
 scribing one organ or one system, to speak of others, that have 
 not been brought before the reader. When treating of the 
 nature of the muscles, for instance, we cannot avoid alluding 
 to the nerves from which they derive their power. But it is 
 hoped that the general view contained in the previous chapter 
 will render the contents of the present sufficiently intelligible. 
 
 OF THE CELLULAR TISSUE. 
 
 If it were possible to remove from the body every thing 
 which gives to each of the different organs its peculiar cha- 
 racter; if we were to take away all the hard parts of the bones, 
 all the red parts of the flesh, all the pulpy parts of the brain 
 and nerves, &c, we should still find the form of the body pre- 
 served. It would then be converted into a simple mass of cel- 
 lular membrane, containing the same cavities which we see in 
 the perfect body; but most of the places from which the par- 
 ticles of the organs had been removed, would be too small for 
 the naked eye to detect them. Now, it has been already 
 mentioned that this membrane appears to form the whole 
 body of the child when it first becomes visible a few weeks 
 after conception. It is, therefore, the foundation of the whole 
 structure of man. Its cavities form his blood vessels; its outer 
 surface is the skin, and its inner surface, the bowels; and all 
 the different organs are made up of matters deposited within 
 its little cells. 
 
 4 
 
26 OUTLINE OF ANATOMY. 
 
 Cellular membrane, when carefully examined, is found to 
 be formed entirely of innumerable little fibres, of every varie- 
 ty of shape and size, running together in every possible di- 
 rection, so as to form a mass very similar to a common sponge, 
 but with intervals extremely small in most places. These fibres, 
 under the microscope, appear to be ultimately composed of glo- 
 bules like those of the muscles, but this subject is still involved 
 in doubt. The marginal fig. I. represents 
 this appearance. In some situations these 
 fibres are narrow, loose, and comparative- 
 ly distant, like the meshes of a net, in 
 others, they are broad and close, so as to 
 form partial cells, which communicate 
 with each other on all sides. The sides 
 of these cells and the meshes of the net- 
 work just mentioned, are prevented from 
 •adhering together by a fluid formed out 
 from the membrane itself, or from the 
 Mood vessels, which keeps them always moist, and when this 
 fluid becomes too great in quantity, in consequence of disease, 
 the patient labours under general dropsy. The swelling of 
 the feet when standing, and their return to the proper shape 
 during the night, so often noticed in weakly persons, furnish 
 a beautiful proof both of the existence of this membrane and 
 of its peculiar structure, which allows the fluid to flow from 
 cell to cell until it settles in the lowest point, 
 
 But if the cellular tissue were every where open and penetra- 
 ble to this extent, it is evident that it could neither confine the 
 blood and other fluids in their proper course, nor could it ef- 
 fectually support the various organs in their correct position. 
 Moreover, where one part is intended to slide over another, as 
 it is the case with the bowels, for instance, which are constantly 
 changing their size and position as the food passes through them, 
 would be very inconvenient to have these parts tied together 
 by close cellular tissue, for this bond would either prevent 
 their proper motives, or it would be continually stretched and 
 torn by them. 
 
 To avoid these difficulties, nature has modified the arrange- 
 ment of the cellular tissue in different parts of the body, in 
 several ways. In some places, the sides of the adjoining cells 
 are united together over a considerable space, so as to form a 
 broad sheet of membrane, through which fluids cannot pass; 
 and these sheets are applied on those parts which are intended 
 to move upon, or glide over each other. Thus, the bowels 
 are covered by such a membrane, which is united to them by 
 loose cellular tissue on one side, but on the other* remains 
 perfectly smooth. After covering each bowel, like an over- 
 
OUTLINE OF ANATOMY. S7 
 
 coat, it passes in a double sheet to the spine, and spreads itself 
 out on each side, so as to form a lining to the whole inside of 
 the abdomen or belly — the cavity in which the bowels are 
 placed. — Oneof these membranes exists ineach of the great cavi- 
 ties of the body; in the head, to facilitate the motion of the brain; 
 in the chest, to allow proper play to the lungs, and in the ab- 
 domen, to hold the intestines in their places without preventing 
 them from receiving and expelling their contents by their pe- 
 culiar movements. 
 
 The same arrangement is noticed on a smaller scale in some 
 other parts of the body, but the three instances just given, are 
 the most important. These membranes are called the Serous 
 Membranes, and the sacs formed by them are called the Ner- 
 vous Cavities. They may be regarded as so many vast cells 
 of the common cellular tissue, not communicating with the 
 neighbouring cells, but completely closed on all sides. As 
 we have compared the cellular membrane, in general, to a 
 sponge, we may now compare the serous membranes to as 
 many wet and empty bladders spread through the substance 
 of the sponge, to which they are glued fast on the outer side. 
 Their chief object is to prevent friction. They are kept al- 
 ways moistened when in health, by a serous fluid very simi- 
 lar to that which is found in the smaller cells, but when this 
 fluid collects in too great quanlity it cannot subside toward 
 the feet as it does in general drops} 7 , but remains shut up in 
 the sac, forming a dropsy of the belly, of the chest, or of the 
 brain, according to the cavity in which the disease is seated. 
 
 Every moveable joint in the body is provided with a simi- 
 lar sac or bladder, which lies between the ends of the different 
 bones, or rather, between the caps of cartilage or grizzle 
 which covers them. The fluid contained in the cavities of 
 the joints differs a little from common serum, and answers 
 the same purpose with the oil used in machinery to prevent 
 friction. 
 
 In many places, where a number of different muscles are 
 frequently called into action at one time, they require to be 
 bound down firmly, to prevent them from getting out of place 
 when the limb or member changes its position. This is ef- 
 fected by another arrangement of the cellular tissue; by which 
 a considerable portion of this spongy matter is compressed 
 into the form of an apron, the cells being nearly or entirely 
 obliterated, and the whole texture of the part rendered firmer 
 by an increase of the number and strength of the fibres, which 
 seem matted together like tangled hair. Membranes of this 
 kind are connected with the general cellular tissue on both 
 sides. When large and broad, they are called Fascix. One of 
 the best marked fascia? in the body, covers and binds down the 
 
OU T -TOMT. 
 
 muscles of the thigh, and, were it not for its presence, the 
 thousand graces of :s or Tagliost would be converted 
 
 into horrible deformity by the muscles, which would start up 
 like cords at every change of the dancers position, until all 
 symmetry would disappear. Some of these fasciae evidently 
 resemble the general cellular tissue, simply condensed to a 
 greater or less degree; almost every muscle, and many of the 
 important blood vessels and nerves are completely surrounded 
 by sheaths of this nature, more or less delicate in structure. 
 The true skin, as we shall see hereafter, is formed in a ve: 
 milar manner, but when membranes of this class are very 
 strong, like those which bind down the tendons of the 
 and hand, they begin to appear more distinctly fibrous, to the 
 naked eye, and in the proper ligaments which bind together 
 the different bones, the cellular character is so completely lost 
 or hidden that considerable care is required to demonstrate 
 its presence. One of the closest and firmest of the membranes 
 formed from the cellular tissue is that which covers the bones, 
 and is called, by anatomists, the periosteum. It is necessary 
 that it should be very strong and close, for, if it were to slide 
 ever so little, in consequence of blows or other injuries, the 
 ▼easels which pass through it to feed the bone beneath, would 
 be torn off, and a part of the bone would be liable to die or 
 mortify, for want of support Yet, even this periosteum, 
 fibrous as it appears to be, is really cellular, and when a bone 
 is broken, we see its cells dilated and enlarged, until the mem- 
 brane becomes soft and pulpy, and ofter. .imes as thick 
 as it is in common, in order that its blood vessels may be al- 
 lowed to enlarge and to make room for the bony matter ne- 
 cessary to mend the fracture. 
 
 To prove the existence of the cellular tissue in the substance 
 of all the different organs, is a task of some difficulty, and al- 
 though it has been demonstrated, again and again, by modern 
 anatomists, neither the limits of this work nor the patience of 
 its uninitiated readers, will warrant us in pursuing the detail. 
 It is hoped, that what has been said, will suffice to give a clear 
 idea of the nature of this fundamental tissue, and whatever 
 additional information is found necessary to our purpose in 
 writing a popular treatise, will be given under other appro- 
 priate heads. 
 
 The cellular membrane is not very liable to disease, except 
 when it contains other matters than those which belong to its 
 own proper texture, and when it is formed into distinct or- 
 gans, such as we shall presently describe. The history of 
 those animals which appear to be entirely composed of it, is 
 so little known that its vital actions can hardly be ascertained 
 by observations made upon them: and in the human body, it 
 
OUTLINE OF ANATOMY. 29 
 
 is so involved and concealed by the operation of other more 
 complex parts, that it is difficult to ascertain its independent 
 agency. It is liable to become diminished or increased in 
 bulk, by the increase or diminution of its contents, and pro- 
 bably, by the absorption or unnatural growth of its own sub- 
 stance also. When it contains other solid substances, as in the 
 muscles or bones, these may be removed by disease, and the 
 part may be reduced to simple cellular tissue, and when in- 
 juries have destroyed a portion of bone, or muscle, the neigh- 
 bouring portions of this tissue are capable of transforming 
 themselves in time, so as to supply the deficiency. When 
 any part of the body is cut away, the wound heals first by the 
 development, or, if necessary, the reproduction of a portion of 
 this tissue, which afterwards receives, more slowly, the pecu- 
 liar character of the part removed. This reproductive power 
 is observed to increase as we descend in the scale of nature, 
 toward animals of more simple structure: thus, lizards and 
 lobsters, when one of their limbs is cut off, renew it in a 
 short time; and among the worms, when cut in half, we some- 
 times see each half forming a perfect animal. In man, how- 
 ever, this power is so limited that some eminent physiologists 
 deny its existence, but the weight of sufficient authority is not 
 wanting to prove the correctness of the views just stated. 
 
 The cellular tissue frequently mortifies, and comes away in 
 large pieces through openings made in the skin, as often hap- 
 pens in the worst forms of erysipelas, but this appears rather 
 to result from its being cut off from its proper supply of nou- 
 rishment, than from any diseased action of its own — and it 
 happens much more readily, where the tissue is soft and com- 
 pressible, than where it is much condensed and firm. 
 
 OF FAT OR ADIPOSE TISSUE. 
 
 Fat is an animal oil, which is secreted in very minute drops, 
 each shut up in a separate cell, composed of membrane so ex- 
 tremely delicate, that its existence is scarcely perceptible. 
 These cells are supposed, by many, to be perfectly closed, 
 but their structure has never been fully demonstrated. Seve- 
 ral drops, with their envelope, are again surrounded by a simi- 
 lar membrane, but a little thicker; a number of these primara- 
 ry groups are again collected under a still firmer covering, 
 and so on, until considerable masses are formed, which are 
 held in place, by the common cellular tissue, in the cavities of 
 which they are placed. 
 
 Most physiologists consider this membrane as distinct from 
 the cellular, and call it the adipose tissue, but their position is 
 hardly sufficiently established 
 
30 OUTLINE OP ANATOMY. 
 
 Masses of fat are always found in particular parts of the 
 cellular tissue, where they sometimes serve the purpose of 
 cushions, as is the case under the skin of the palm of the hand, 
 and sole of the foot. Very often they seem designed to give 
 bulk, freedom, and symmetry, to important parts, which are 
 complex in structure, as in the female breasts, and many other 
 glands. 
 
 But one of the most important uses of the part, is to supply 
 the system v/ith support, when, in consequence of the depri- 
 vation of food, either from loss of appetite, in disease of the 
 bowels, or from hard necessity, the natural supply is cut off. 
 Thus, we find that more bleeding, and a longer continuance of 
 low diet, is generally necessary, when inflammation attacks 
 persons in high keeping, than when it occurs in those who 
 are lean, and have no such reservoir within themselves. 
 Much of the fat is taken up by the absorbents during long 
 sickness, and is conveyed by them into the blood, so as par 
 tially to supply the want of chyle; and this is the chief cause 
 of the " falling away " of the person under such circum- 
 stances. 
 
 The adipose tissue is liable to few diseases, but when it is 
 deposited in too great amount, it is often found in the condensed 
 cellular tissue, where nature never designed that it should 
 appear. It then softens these more solid parts, and produces 
 general weakness, so that very fat persons are rarely healthy. 
 Sometimes it collects in masses, out of its proper place, and 
 forms tumours, which may reach a great size, but they are 
 not dangerous unless they prevent the proper action of the 
 neighbouring parts. They are different from wens, and gene- 
 rally occur in many places at one time, and they should not 
 be meddled with, unless they give considerable inconve- 
 nience; in which case, an experienced surgeon can, at once., 
 determine the propriety of cutting them away. 
 
 OF THE LOCOMOTIVE APPARATUS. 
 
 The locomotive apparatus, or the organs of motion, in man, 
 are composed of two different systems of organs: 1st. The 
 bones, or osseous system, with the Ligaments, which tic the 
 different bones to each other, and assist in forming the joints. 
 2ndly, The muscular system, with the parts accessory to 
 the muscles, called Tendons. 
 
 These organs are not all exclusively employed in moving 
 the animal at will, from place to place, for many of them as- 
 sist in producing internal motions, which are so necessary to 
 life, that they are removed partly, or entirely, from the go- 
 
OUTLINE OF ANATOMY. 31 
 
 vernment of the will. Besides those just enumerated, there 
 are some other structures which aid in effecting or regulating 
 these involuntary motions, and, yet, are not now generally 
 acknowledged to be muscles, although they were formerly 
 ranked as such. I shall speak of each of these systems sepa- 
 rately. 
 
 OF THE BONES, OR OSSEOUS SYSTEM. 
 
 Among the very small and simple animals, whose move- 
 ments are few and of but little extent, there is no skeleton; 
 their muscles are simply attached to a hardened skin, or to 
 each other, so as to draw different parts together; and by thus 
 bending the body, to roll, push, or tumble it about. This ar- 
 rangement we see in many marine and some land worms. 
 
 When we ascend a little in the scale, we come to animals of 
 a more complex shape, and more various powers. They re- 
 quire some firmer support to the muscles, and then we see, 
 either one or more solid external crusts serving, both for bones 
 and a house, as in the shells; or we find the body and limbs 
 enclosed in rings jointed together, so as to form a complete 
 external skeleton, as in insects and crabs. But man could not 
 exist, if constructed on either of these modes; his size, his 
 energies, and his wants, all demand that his body and limbs 
 should be moveable, and possessed of sensation in every part, 
 and he is, therefore, endowed with internal bones. 
 
 When they first become perceptible in the infant, before 
 birth, the bones are all soft and pulpy, being composed — like 
 the rest of the body at a still earlier period — of simple cellular 
 tissue, with its cells filled with a kind of glue: but most of 
 them soon become converted, to all appearance, into cartilage, 
 or gristle, by the deposition of another kind of harder matter 
 along with the gluten in the cells. After a time, we find 
 earthy matter or true bone, thrown down, at first irregularly, 
 in different spots, within what is generally called the carti- 
 lage of each bone. These spots go on continually increasing, 
 and the earthy matter at length becomes so considerable, in 
 amount that the cartilage is no longer visible. The bone is then 
 perfectly formed. This process is not completed in all parts 
 of the skeleton until the child approaches to manhood, and 
 happy indeed is the effect of this arrangement! for the long 
 bones of young persons being partly cartilaginous, may yield 
 to a certain extent without breaking, and before the fifth year, 
 we not unfrequently see the limbs bent to a great extent with- 
 out fracture. Children are so very liable % to falls, that this 
 yielding of the bones very often prevents more serious in- 
 jury, 
 
32 OUTLINE OF ANATOMY. 
 
 Even in the grown man, the cartilaginous part of bone is 
 not entirely removed: only a part of it is taken up by the ab- 
 sorbents, in order to make room for the earthy matter, the 
 particles of which are glued together by the remainder, to 
 which gluing the parts owe all their strength. When a bone 
 is soaked in a strong mineral acid, very nearly all the earthy 
 portion is removed, for it is nothing but a salt of lime; vet 
 the bone retains its shape, being then composed entirely of 
 the remaining cartilage, and it may be bent in all directions 
 without breaking. On the contrary, when the bone is heated 
 for some time in a furnace, very nearly all the soft matter, 
 namely, the cartilage and cellular t: turned out; yet it 
 
 is not changed in form: the phosphate of lime preserves its 
 shape, but the particles adhere they m 
 
 crumbled between the fingers. 
 
 Bone, then, or as it is called by anatomists, tl s tis- 
 
 sue, is composed of the fundamental cellular I cells 
 
 distended, at first, with a glutinous fluid, afterwards with a 
 substance resembling cartil ristle, to which it owes its 
 
 elasticity, and at I Mill later period, a part of this ! 
 moved and replaced by phosphate of lime, which gives it its 
 characteristic hard; 
 
 The precise mode in which the particles of the two diffe- 
 rent depositee just mentioned are arranged in the cellul. 
 sue, M not precisely known; but we will now proceed to 
 mine the structure of the bones when fully formed, as they 
 appear to the naked I 
 
 When you first look at one of the long bones, it seen 
 be formed of a great number of threads or fibres rum 
 by side: but this appearance is deccpt'r. 
 shows 01 that these seeming fibres are constantly runnit | 
 gethcr and dividing in every direction, and that th 
 irregular in size and length as in position. When a similar 
 bone is broken by the hammer, particularly after ii has been 
 long exposed to the air or to fit s off in such a man- 
 
 ner as to induce the belief that it is composed of layers or 
 strata placed one over another; but tlii > 
 
 more careful examination shows that these t. icy have 
 
 been termed by some anatomists, arc com pi tctl with 
 
 the surrounding parts by bony matter, a little less conden 
 and that they have no regularity of form, thickness, or direc- 
 tion. 
 
 The best mode of acquiring a tolerably clear idea of the 
 structure of bone, is to pass a saw, lengthwise, through one ot 
 the principal lon^; bones of some animal, while i 
 We find it composed of a eylim J, en- 
 
 larging and becoming softer as it approaches the 
 
OUTLINE OF ANATOMY. 
 
 33 
 
 form the joints. Each of these long bones is originally com- 
 posed of at least three pieces, the shaft and the two extremi- 
 ties, which do not fully unite until the animal approaches to 
 its full growth. The extremities are composed of a thin outer 
 crust, or covering, which resembles a membrane converted 
 into bone; within, they consist of a great number of small cells 
 and short fibres, as if formed of a portion of common cellular 
 tissue rendered solid and hard in the same manner. The ends 
 of the shafts resemble the extremities very closely; but as we 
 carry our observations toward the middle part, we see the 
 bony cells and fibres growing larger and fewer in number, 
 and the external hard covering, thicker and stronger, until, in 
 the centre of the shaft, we and a large cylinder, generally 
 without any hard cells or divisions, enclosed in a bony case, 
 which, at first sight, appears to contain no cavities within its 
 substance. It seems as if the cellular tissue, which is loose 
 and free in the extremities, were compressed and flattened 
 down in the shaft by the growth of the cavity within, and 
 the resistance of the membrane without, until the cells are 
 nearly obliterated, and the whole mass converted into one 
 solid bony fascia by the cartilaginous and earthy matter 
 thrown down into it by the blood vessels. (I 
 
 If wc n ride of the shaft cross- 
 
 ihlll find that the hard case, just 
 not perfectly solid, but that it 
 infl many small and eloni ities, 
 
 which prove that the original cellular tis- 
 sue is not (l« : and the whole bone 
 may be again reduced to that simple condi- 
 tion by the careful removal of the earthy 
 and cartilaginous particles. The method 
 of pi fact, cannot be described, 
 with propriety, in a popular work. 
 
 All the cavities, whether in the extremi- 
 the central canal, or the hard covering 
 of the shaft, are filled with a still more de- 
 i portion of cellular tissue with its 
 distended by a substance resembling a 
 sofl fit. well known under the common 
 name of / tow. 
 
 The flat bones, such as those of the ribs, 
 fee, and the shoit bones, as those 
 of the spine, i formed in precisely 
 
 the same manner with the extremities of 
 the long bo Those of the head, 
 
 however, have been described by most 
 anatomists as different in their arrange- 
 
34 OUTLINE OF ANATOMY. 
 
 ment — this is a mistake; for the only peculiar circumstance ob- 
 servable in the growth of the bones of the head, is this; 
 the cartilaginous and earthy matters of these bones are thrown 
 down together, so that they are tolerably hard from the first, 
 but the earthy particles are placed, and remain so widely- 
 parted until long after birth that these bones may be consi- 
 derably bent, in children under a year old, without being com- 
 pletely broken. The necessity for this hardness of the bones 
 of the head before birth will be plainly perceived, when we 
 have considered the structure and uses of the skeleton. 
 
 The bones, thus organized, are provided with blood vessels, 
 which are of course accompanied by nerves. They are 
 therefore living organs; but, in a state of health, they have 
 very little sensibility; when they are diseased, however, they 
 are often the seat of excruciating pain. 
 
 The same remark will apply to the membrane containing 
 the marrow. It is a common prejudice, that this marrow is 
 exquisitely painful when touched, as in amputations; but, 
 when healthy, it may be torn or cut almost without the injury 
 being perceived by the patient for, in this respect, it does not 
 differ from the general cellular tissue of which it is a portion. 
 
 The lower parts of the skeleton, such as the small, and most 
 of the flat bones and the extremities of the long bone- 
 much more fully supplied with vessels and nerves, than the 
 shafts of the long bones. For this reason, when inflammation 
 attacks the former parts, it is apt to produce either an abscess 
 or an ulcer, but when it affects the latter, the I more 
 
 frequently a mortification or absolute death of a part of the 
 bone. 
 
 Bach of the bom I nallv by a very fine d< 
 
 membrane, which is called the peri otkum. It appears fibrous, 
 and is not sensible to any great degree when free from 
 ease. It supports and keeps in pis Is and tu 
 
 which enter the bone, and if an; Table portion of it be 
 
 torn oif, the corresponding pert of the bones is extn 
 to die for want of support, particularly if the inj 
 place where the bone is thick and hard in structure. V. 
 inflamed, t lie periosteum may become the seat of intense pain, 
 as those who bave suffered with thf form of felon will 
 
 be willing to acknowh 
 
 In all the moveable joints, we see the extremities of the 
 bones which form them covered with cartilage. The I 
 structure of the cartilages of the joints is not known: 
 seem to be composed of lil 
 
 and they run directly from the extremity of the bone toward 
 the cavity of the joint. One of these cartilag end 
 
 of each bone, and when placed together, they form the I 
 
OUTLINE OF ANATOMY. 35 
 
 or ball and socket, which composes the joint. Their adjoin- 
 ing surfaces are among the smoothest in nature, and they are 
 covered with an extremely delicate and polished membrane, 
 which has been already alluded to when we were speaking of 
 the serous cavities. This membrane contains the synovia, or 
 oil of the joint. The articular cartilages are totally insensible, 
 and their vital and diseased actions are as little known as their 
 structure. Not so the synovial membrane, which, when in- 
 jured and inflamed, becomes the seat of acute pain and serious 
 disease. 
 
 The ligaments are strong, flexible, and generally inelastic 
 bands, which bind together the different bones, and prevent 
 the joints from exceeding the proper bounds of their motions. 
 They are composed of cellular tissue very strongly condensed 
 and strengthened by an interstitial deposite of a fibrous ap- 
 pearance. They differ very widely among themselves, both 
 in form and in the arrangement of their fibres. When in 
 health, they possess no very obvious sensibility; but when 
 they are inflamed or rudely twisted, great pain results; as is 
 seen in sprains of the ankle and other joints. 
 
 In white swellings and some other diseases of the joints, 
 the ligaments become affected very seriously, and the princi- 
 pal reason why we do not more frequently find them diseased 
 is, because they are so sparingly supplied with vessels and 
 nerves — those most potent encouragers of vital energy. When 
 they do become inflamed, the same sluggishness of the vital 
 power renders their recovery slow and difficult; hence, the 
 cause of the long continued soreness which folio 
 sprains, particularly those of the loins from over lifting. When 
 ligaments have once been stretched by any great force, they 
 often continue permanently lengthened, and the patient may 
 then become incurably lame. We see this result most fre- 
 quently, in consequence of sprains of the ankle, and those of 
 the internal ligament of the knee joint. 
 
 The parts thus noticed in a cursory manner, namely, the 
 bones, the articular cartilages, and the ligaments of the joints, 
 compose the skeleton, or frame work of the locomotive appa- 
 ratus; they are the levers and pulleys of the human machine, 
 and it is proper to take a glance at their general arrangement 
 before we pass on to the description of the powers which act 
 upon them, and put them in motion. 
 
36 
 
 OUTLINE OF ANATOMY. 
 
 Fig. 3. 
 
OUTLINE OF ANATOMY 
 
 37 
 
 OF THE SKELETON. 
 
 The skeleton is usually considered as divided into the bones 
 of the heady those of the trunk, and those of the extremities. 
 Of these parts, the trunk may be regarded as the basis, for we 
 find it present in all animals, though many exist without either 
 of the other divisions. The head stands next in importance, 
 for it appears in. many animals who are altogether deprived of 
 extremities properly so called. 
 
 The bones of the trunk, in the adult man, are fifty-three in 
 number. Of these, twenty-four are called vertebrae, and when 
 taken collectively, form the spine or back bone. 
 
 The Spine, is a strong bony column extending along the 
 back part of the trunk, from the lower part of the loins to the 
 head. It is much thicker below, than at the summit, but its 
 bulk varies in different places, in a manner not in strict ac- 
 cordance with any regular law. If viewed in front or rear, 
 the spine appears perfectly straight when at rest; but if exa- 
 mined in profile, or laterally, it presents several strong curva- 
 tures, — sweeping considerably forward in the middle of the 
 neck, and again in the loins, but projecting very much back- 
 ward behind the chest. Each of the twenty-four bones which 
 contribute to form the spine, except the uppermost, has a 
 broad body, of a circular form, (a, fig. 4.) flattened above and 
 below, where it approaches its neighbour. On the back part 
 of this body we find a bridge of bone which extends from 
 one side to the other, enclosing a small ring, (b.) through which 
 the spinal marrow passes, and on the back and sides of this 
 bridge, are several eminences of bone, (c, d.) mostly designed 
 to give a proper attachment to the ligaments and muscles of the 
 spine. 
 
 A DORSAL VERTEBRA VIEWED PERPENDICULARLY. 
 
 Fig. 4. 
 
 a, The flat side of the body of the bone* 
 where it lies in contact with the next 
 bone above. 
 h, The ring- or canal, through which the 
 spinal marrow passes, surrounded by the 
 bridge of bone which spans the back of 
 the body of the vertebra, 
 c, The spinous process which projects 
 obliquely backwards and downwards, 
 and forms one of the long line of bony 
 knobs, which we feel, when the finger is 
 passed down the back. 
 a\ d, Transverse processes. 
 e, c, Articulatory processes. 
 
38 OUTLINE OF ANATOMY. 
 
 One of these projections on each side above the bridge, 
 and one on each side below, (e, e,) is designed to assist in 
 forming the joint between each vertebra and its next neigh- 
 bour, and these joints are differently arranged in different 
 parts of the spine, so as to allow more motion in one place 
 than in another. 
 
 As the head is obliged to move in all directions, a special 
 arrangement is made of the joints between the two uppermost 
 vertebrae and the cranium or bones of the head, properly so 
 called, by which the latter have a pivot-like movement from 
 side to side, so that the face may be turned to a considerable 
 extent without the aid of the vertebrae of the neck, in general. 
 
 That portion of the spine which is found in the neck is 
 likewise capable of considerable motion; for it may be bent 
 backward and forward, or to either side, and it may also be 
 twisted through a portion of a circle, so as greatly to assist in 
 placing the head in any desired position. That portion of the 
 column which lies behind the chest is composed of bones so 
 closely jointed, and so fixed by their connexion with the ribs, 
 and by many projections interlocking with each other, that 
 it is almost immoveable; but that part which supports the 
 loins, though more fixed than the neck, may bend forward or 
 to either side, or it may be rotated to a certain distance — as 
 when we attempt to turn the head completely round without 
 altering the position of the feet. 
 
 If the flat surfaces of the bodies of the vertebrae were in 
 contact, the whole spine would be converted into a solid co- 
 lumn of bone, and of course all motion would be rendered im- 
 possible. To prevent this difficulty nature has interposed be- 
 tween them a thick layer of a substance resembling cartilage, 
 which is flexible and in a slight degree compressible. It is 
 a very curious fact that the weight of the body during the day, 
 while we remain erect, gradually presses these cartilages flat- 
 ter; but in the night, while we are in bed, they slowly return 
 to their original thickness. Now, as each of the twenty-four 
 layers loses and gains its proper width during these diurnal 
 changes, the sum of all these little expansions and contractions 
 produces very obvious effect, and a tall man is found to mea- 
 sure considerably less in height at bed-time than he does in 
 the morning. The cartilages just mentioned, give very great 
 strength to the spine, while they permit the necessary motions 
 of the body, to which each bone contributes its share. This 
 is indeed a most wise arrangement; for if any one joint in the 
 spine were endowed with the power of sudden or extensive 
 motion, the spinal marrow would be liable to continual acci 
 dents, and life would be perpetually endangered; for it is a ge- 
 
OUTLINE OF ANATOMY. 39 
 
 neral principle in mechanics that extensive movements pro- 
 duce feebleness and a greater liability to disorder. 
 
 Besides the cartilages just mentioned, there are many strong 
 ligaments which surround the spine and add greatly to its 
 strength. Among the most important of these, are those which 
 extend from one bone to another, around the bridges at the 
 back of the bodies of the vertebra, and which complete the 
 canal through which passes the spinal marrow. 
 
 But the safety of this most important organ is not confided 
 entirely to the bones, cartilages, and ligaments; for the nume- 
 rous and powerful muscles of the back are so arranged as to 
 give still greater firmness to the column which contains it. 
 
 The individual bones of the spine — of which seven belong to 
 the neck, twelve to the back, and five to the loins — are almost 
 entirely composed of soft cellular structure with no solid or ivo- 
 ry-like tables, so that the jar produced by a blow upon any part 
 of them is not readily felt at a distance, as would be the case 
 if they were more close in their texture. When we consider 
 that, in addition to this, the whole spine and its accessory parts 
 taken collectively, form a complete spring curved in different 
 directions, and that each of the cartilages, separately consi- 
 dered, may be regarded as a springing cushion placed between 
 neighbouring bones, we may form some idea of the care with 
 which we are guarded against injuries by a beneficent Provi- 
 dence. Were it not for this arrangement, a very slight fall 
 upon the feet would inevitably bruise or tear the brain or spi- 
 nal marrow or produce a fracture of the basis of the skull. 
 
 The principal diseases of the spine are irritations, occasion- 
 ing various nervous symptoms; relaxations of the muscles 
 and ligaments, giving rise to curable deformity; and ulcera- 
 tion or mortification of the vertebrae, called caries, producing 
 incurable changes of figure, and often death. These highly 
 important affections will be fully noticed in the proper place. 
 
 The Ribs — Of these bones, little need be said, for every 
 one is acquainted with their general appearance. They are 
 twenty-four in number, twelve on each side. They are each 
 attached to the vertebrae behind, in two places; first, by the 
 extreme ends, called the heads of the ribs, which form joints 
 with the bodies of those bones, and secondly, by little promi- 
 nences, somewhat farther forward, which are connected by li- 
 gaments with bony projections from the sides of the posterior 
 bridges that enclose the spinal marrow. 
 
 The seven uppermost pairs of ribs, thus firmly fixed behind, 
 are connected with the breast bone in front, by means of long 
 cartilages (so called) very closely resembling the ribs in shape, 
 and differing from them only in the deficiency of earthy mat- 
 ter: they are in fact proper bones, which do not ossify com- 
 
40 OUTLINE OF ANATOMY. 
 
 pletely, but remain in a condition very similar to some parts 
 of the extremities in very young children. When broken, 
 they generally unite by throwing out bony matter, and in old 
 age, some of them often become completely ossified. They 
 form regular moveable joints with the breast bone. The re- 
 maining pairs of ribs are called false ribs, because they are not 
 directly connected with the breast bone. The cartilages of 
 all but the two last pairs generally run together, or are con- 
 nected to each other in a somewhat irregular manner, and are 
 finally joined to that of the seventh or last true rib before it 
 reaches the sternum. The two last pairs are merely tipped 
 with a portion of cartilage which is not connected with any 
 other. 
 
 The upper pairs of ribs pass in a direction pretty nearly ho- 
 rizontal, but each succeeding couple becomes more and more 
 oblique as we descend. They are all bound together by mus- 
 cles which pass from the edges of each rib, to the opposite 
 margin of its neighbours above and below, so that if one pair 
 be raised, the others must .follow its movements. They act 
 like a series of hoops of different lengths tied together by 
 cords; but as the lower pairs with their cartilages are much 
 longer and more oblique, than the upper ones, and as they are 
 fastened at nearly equal distances from each other both before 
 and behind, it follows that when moved, they must sweep in 
 larger circles, and thus the lower part of the chest is dilated 
 and contracted to a much greater extent than the upper part 
 during the act of breathing. The seven superior pairs of ribs 
 embrace the chief part of the heart, lungs, and other impor- 
 tant organs, and the five inferior pairs give an attachment to 
 the circular edge of a large thin muscle called the diaphragm 
 or midriff, which divides the cavity of the belly from that 
 of the chest. It will be described more particularly when we 
 speak of the function of respiration. 
 
 The use of the ribs is to protect the organs within the chest, 
 and to assist in drawing in, and expelling the air in breathing. 
 They are composed of loose cellular bone covered by a firm 
 but thin external coat of harder matter. Their diseases do 
 not differ from those of the bones in general. 
 
 The Breast Bone or Sternum, is formed of three pieces 
 joined together by strong ligaments, but in old age they are 
 frequently found united into one. For all practical purposes 
 in the present treatise, these pieces may be regarded as a sin- 
 gle bone somewhat triangular in form, reaching from the throat 
 to the pit of the stomach. It is about two or two and a half 
 inches wide at the top, and tapers to a blunted point at the 
 bottom. Its sides are extremely irregular, being festooned by 
 the jutting out of the surfaces with which the cartilages of the 
 
OUTLINE OF ANATOMY. 41 
 
 ribs are articulated. This bone is of cellular structure, and not 
 unfrequently a portion of it near the centre remains unossified 
 or cartilaginous, so that a dirk or small sword may penetrate 
 it with ease. The lower extremity seldom becomes bony 
 during childhood, and it sometimes remains cartilaginous till 
 late in life. The soft texture and position of this bone, rest- 
 ing as it does on the cartilages of the ribs, as if upon springs, 
 enable it to furnish effectual protection to the lungs and heart, 
 against the effect of falls and blows. It is very rarely frac- 
 tured. The two uppermost angles, receive the inner ends 
 of the collar bones which are there furnished with moveable 
 joints. 
 
 Abscesses within the chest have been known to make their 
 way to the surface through the breast bone, and aneurisms 
 have sometimes occasioned the absorption of a part of it as 
 they do of the ribs. Its other diseases resemble those of the 
 bones in general. 
 
 The Basin or Pelvis is formed in infancy of a considerable 
 number of separate bones; but in middle age, these become 
 united together so as to reduce the number to four. The first 
 of these is a large, light spongy bone of a triangular or pyra- 
 midal shape, very broad and thick at its upper part, and ta- 
 pering nearly to a point below. It is concave in front, and 
 convex behind, and is regarded as a continuation of the spine. 
 This bone is called the Sacrum; and is composed, in infancy, 
 of five parts, each of which resembles a separate vertebra. 
 Attached to the lower end of the sacrum, there is another 
 small bone, which is composed of four pieces during child- 
 hood, and it may be considered as the rudiment of a tail, much 
 as such an acknowledgment may mortify the pride of humanity. 
 In the adult male, the two bones just mentioned sometimes 
 become united into one, which may give rise to considerable 
 inconvenience, as the latter is then subject to the danger of 
 fracture, a very serious accident, in this situation. In the fe- 
 male, this union rarely occurs till late in life, and may occa- 
 sion great difficulty in delivery when the junction takes place 
 too early. The lower bone is called the Os Coccygis, and 
 has a moveable articulation with the sacrum. 
 
42 
 
 OUTLINE OF ANATOMY 
 
 Fig. 5. The Pelvis. The remainder of 
 
 the basin is formed 
 by the share bones, 
 which are so irregu- 
 lar in shape, that it 
 would be improper 
 to attempt to de- 
 scribe them in this 
 work. A glance at 
 the accompanying 
 figure will convey a 
 better idea of their 
 form, than could be 
 communicated by 
 many pages of de- 
 scription. 
 In infancy, these bones are each formed of three separate 
 parts which grow together before manhood arrives. It may 
 be well simply to name them here, without' expecting the 
 reader to remember them, because, if he should ever have oc- 
 casion to refer to other works of a somewhat less popular 
 character, he will often find their names employed as if the 
 original divisions still existed. The front part of the share 
 bone, which extends downward between the bottom of the 
 belly and the groin, is called the Pubis; the lower part, which 
 supports the body when we are sitting down, is the Ischium; 
 and the lateral broad portion with the wings extended up- 
 ward, is the Ilium. 
 
 The upper part of the sacrum projects forwards, and there is 
 a strong ridge or contraction, which encircles the middle of 
 the share bones, which, together with this projection, forms 
 what is called the brim of the pelvis. Above this brim, the 
 share bones are extended into two large wings which are 
 spread outward and upward to a considerable distance, and 
 may be plainly felt by placing the hand above the hip. 
 These bony wings form a part of the sides of the belly, and 
 give a firm attachment to many of its muscles. 
 
 Below the brim, the sacrum and lower part of the share- 
 bones form the greater part of the sides of a large cavity? which, 
 when completed by the muscles and other soft parts, that fill 
 the intervals between the bones, is called the cavity of the 
 pelvis. It contains the bladder and the last intestine, together 
 with all the parts peculiar to the female. Just below the 
 brim of the pelvis and nearly opposite the middle of the share- 
 bone on the outer side, we find a large and deep cup-like ca- 
 vity in which is received the head of the thigh bone where 
 it forms the hip joint. 
 
OUTLINE OF ANATOMY. 
 
 43 
 
 Having now described all the bones of the trunk, namely, 
 the twenty-four vertebrae, the twenty-four ribs, the breast bone, 
 and the four bones of the basin, we here leave the trunk and 
 pass on to the next great division of the bod)*, the head. 
 
 THE HEAD. 
 
 The bones of the head are divided into those of the crani- 
 um and those of the face; the former enclosing the cavity for 
 the reception of the brain, the latter furnishing support to the 
 features, and to the organs of three of the senses — sight, smell, 
 and taste: those of hearing being located in one of the bones 
 of the cranium. 
 
 The cranium is composed of six bones, which are properly 
 its own, and there are two others common to it and to the 
 face. 
 
 The six bones proper to the cranium are for the most 
 part thin, not exceeding one-fourth of an inch in thickness in 
 most persons and places, (fig. 7, -,) and in some situations the 
 light may be distinctly seen through them, when held opposite, 
 to a candle. They surround the whole cavity for the brains ex- 
 cept a small portion of the floor of that cavity, immediately over 
 the nose and the upper part of the throat, which is formed by 
 the two bones common to the cranium and face. The parts of 
 the several bones which form the floor of the cavity are ge- 
 nerally much thicker than those which form its sides, back, 
 and roof; but the partitions between the orbits of the eyes and 
 the brain, and those also which cover the nose are extremely 
 thin and delicate. F'g- 6 - 
 
 These bones are formed 
 within and withoutof very 
 firm hard tables, separated 
 from each other by a lay- 
 er of soft cellular struc- 
 
 ia ""^iryi8 1 tlllc * The inncr ,ab!e re ' 
 
 a rfl ^ww. Wk sembles ivory in close- 
 
 ness, but the outer is more 
 like the middle portions 
 of the long bones in den- 
 sity. In some places, 
 these tables arc widely 
 parted, and the inter- 
 32 vening cellular matter is 
 
 wanting, sothatcavities are formed within the skull, (fig. 7, 7 ,) but 
 they are unlike those of the long bones, for they contain nothing 
 but air. All these cavities communicate either with the nose 
 or throat, and are not developed until the individual approaches 
 
44 
 
 OUTLINE OF ANATOMY. 
 
 4 
 
 the age of puberty. They are designed, like the barrel of an 
 organ, to deepen the tone of the voice. One of the most re- 
 markable of these cavities is formed behind the inner end of 
 the eyebrow; it is familiar to farmers as the part which lodges 
 the worm in sheep; and cases of the same nature have been 
 knOwn to occur in man, (fig. 6, 5 , 5 .) When a severe blow 
 is received over the eyebrow, it is not unusual to see the 
 outer table of the skull broken or crushed into the cavity 
 just mentioned, without any injury of the inner table or to 
 the brain which it covers. 
 
 The cavity of the cranium resembles an egg in shape, the 
 small end presenting toward the forehead, but over the eyes 
 and nose there is a considerable variation from this shape, as 
 if the egg had been broken and somewhat dented inward at 
 that part. Some idea of the dimensions of this cavity may be 
 formed by supposing the head to be divided by a plane pass- 
 ing from the eyebrows through the tubes of both ears to the 
 point of junction between the head and neck behind. All that 
 lays above this plane is the cranium proper, and after deduct- 
 ing the thickness of the bones and soft parts which cover it 
 the remainder is the cavity. It is completely filled with the 
 brain. Fig. 7. 
 
 The bones of the cra- 
 nium in infancy are re- 
 markably thin and deli- 
 cate. They are imper- 
 fectly ossified, and the 
 edges and corners re- 
 main for a time in a mu- 
 cilaginous state, being 
 composed of delicate cel- 
 lular tissue well supplied 
 ■/3with blood vessels, and 
 filling up the space be- 
 tween the internal and 
 external periosteum or 
 membrane which covers 
 the bones. The parts 
 called by mothers the 
 openings of the head, where we feel no bone in young chil- 
 dren, but where the finger perceives the pulsations of the 
 brain through the skin, are in reality portions of the cranium 
 in this primitive or soft state. 
 
 This deficient ossification prevents the different bones of the 
 child's head from coming into absolute contact, and the thin- 
 ness of the edges permits them sometimes actually to slide 
 over each other so as to diminish the size and change the shape 
 of the head, in very difficult labours, without injury to the 
 
 m 
 
 LONGITUDINAL SECTION OF THE HEAD. 
 
OUTLINE OF ANATOMY. 45 
 
 brain. This important provision of nature preserves the ex- 
 istence of thousands at the very onset of life. 
 
 When young children are attacked by dropsy of the brain, 
 these bones, being connected only by soft parts, are stretched 
 asunder by the pressure of the fluid within, and in this way 
 the head becomes enormously enlarged, yet the patient may 
 live; whereas if the same disease should exist to any conside- 
 rable extent after the bones become firmly united, death, from 
 compression of the brain would inevitably follow. 
 
 Even the ossified parts of the young head, although they 
 are never entirely cartilaginous like some other parts of the 
 skeleton, do not contain a very large amount of earthy matter. 
 They continue to be, in some degree, flexible for a few months 
 after birth. This condition of the parts protects the brain 
 from being wounded by many of the unavoidable accidents of 
 childhood; for these soft bones often yield, where, if they were 
 harder, they would break. Even when actually broken, for 
 this sometimes happens, the pieces do not form sharp edges 
 and points as they do at a later period in life, but they rather 
 tear like stiff paper; and even when driven inward, so as to form 
 a star-like depression, the fragments generally preserve some 
 connexion with the rest of the bone: in such cases the brain 
 is pushed before the depressed portions, but the other bones 
 and the softer parts of the head make room for it by allowing 
 themselves to be swelled outward. After a time the pulsa- 
 tions of the brain often succeed in pushing the pieces into their 
 proper place, and little trace of the injury remains. I have 
 seen a case of fractured skull in delivery produced by a de- 
 formity in the mother, and several others in children under 
 the age of one year, in which scarcely any unpleasant conse- 
 quences followed. 
 
 As the child grows older the bones of the head grow thick- 
 er and stronger until they enclose the whole cavity of the cra- 
 nium, being dove-tailed into each other along all their edges 
 in a manner which renders their joinings as strong as their other 
 parts. This kind of articulation is called a suture, (fig. 7, 6 , 6 ,) 
 and a single glance at a skull will enable the reader to perceive 
 how beautifully it is adopted to produce uncommon strength. 
 
 The cranium, when fully formed, is a long case, arched and 
 rounded in every direction, so as to oppose the greatest possible 
 resistance to blows and other injuries, with the least possible 
 expense of material. In those piaces where it is most exposed 
 to accident, as at the back, and the most prominent parts of the 
 sides of the head and forehead, it is thicker, and there is more 
 of the cellular structure interposed between its tables, (fig. 7, 2 .) 
 On the contrary, where the surface retreats a little, or where 
 it is protected by thick muscles, as on the temples, it is very 
 
46 OUTLINE OF ANATOMY. 
 
 thin, and the two tables are almost in contact. Directly over the 
 eye there is a smooth plate of bone which eovers the orbit and 
 forms part of the floor of the cranium on which the brain re- 
 poses. This plate is as thin as writing paper, and so weak 
 that a thrust with a small sword in the eye is considered in- 
 evitably fatal, as the weapon penetrates it and enters the brain 
 with the utmost facility. There is a still more delicate divi- 
 sion between the upper part of the nose and the brain, and the 
 bone is in this place rendered additionally weak by the great 
 number of little holes which pass through it to give passage 
 to the branches of the nerves of smell. The back part of the 
 external bones of the nose lie in contact with this very tender 
 plate, and hence a hard blow on N the root of the nose has been 
 known to produce death by causing a fracture there, and a 
 consequent injury to the brain; an accident which would be 
 much more frequent were it not for the protection given to 
 the part by the solid overhanging ridge of the eyebrows. The 
 internal organ of hearing, on the contrary, is enclosed in a 
 portion of bone extremely hard and thick, which forms the 
 middle of the floor of the cranium, and the greater part of this 
 floor is formed of portions of bone of a very irregular shape 
 and thickness, of a more cellular texture, and penetrated with 
 numerous holes for the passage of many nerves, the exit of the 
 veins, and the entrance of the arteries of the head. A little 
 behind the middle of the floor, we find a very large round hole, 
 about an inch in diameter, (fig. 7, 13 ,) through which the spinal 
 marrow passes from the vertebral canal, already described, into 
 the head, to be connected with the brain. At the sides of this 
 hole we find the two articular prominences by which the head 
 is supported on the first bone of the spine. 
 
 Before leaving the head it will be proper to mention the 
 name and position of the six bones proper to the cranium, as 
 they are frequently met with in popular works. 
 
 The first or frontal bone, (fig. 6, l , and 7, 3 ,) forms the whole 
 forehead, and extends an inch or two above the commencement 
 of the hair. It also furnishes the two thin plates which extend 
 backwards from the brow and cover the orbit of the eye. 
 
 The two parietal bones (fig. 6, 2 , and 7, ',) are nearly rectan- 
 gular, and extend on each side of the middle line of the head, 
 from the back part of the frontal bone to the vertex or crown of 
 the head, and from the middle line just mentioned to about the 
 top of the ear. The centres of these bones are clearly marked 
 by the strong swelling or protuberance usually observed at 
 the back part of the side of the head. 
 
 The two te??ipor a I bones (fig. G, 4 .)are found, one on each side of 
 the head, at its lower part. They have each a broad, thin, wing- 
 like expansion which forms the greater part of the temple, and 
 
OUTLINE OF ANATOMY. 47 
 
 a long, narrow process which is so joined to the cheek-bone as 
 to form a bridge, elevated three-fourths of an inch above the 
 general surface of the skull, which covers and keeps in place 
 one of the principal muscles designed to close the lower upon 
 the upper jaw, (fig. 6, 8 .) They also contain the external open- 
 ing of the ears, and provide that solid mass of bone which forms 
 the middle portion of the floor of the cranium, and encloses 
 the internal parts of the ear. Those pap-like eminences (fig. 7, 
 17 ,) which we feel immediately behind the ears are portions of 
 these bones; they are hollow within, and its cavity communicates 
 with the cavity of the drum of the ear, and also with the throat 
 by means of long fleshy tubes, which are sometimes closed by 
 inflammation, producing a species of deafness. 
 
 The occipital bone, or occiput, forms the back part of the 
 head behind the crown, and a very considerable part of the 
 floor of the cranium, (fig. 6, 3 , and 7, 5 .) It is in this bone that 
 we find the large hole for the passage of the spinal marrow, and 
 the joints which connect the head with the spine. This portion 
 of the occiput is thicker, softer, and more spongy, to assist in 
 protecting the brain from the jar which follows a fall from a 
 height upon the feet. The whole mechanism of the cranium 
 displays a wonderful combination of strength and lightness, 
 and is admirably adapted for the preservation of the all-impor- 
 tant organs which it encloses. 
 
 Of the two bones common to the head and face I need not 
 speak, as in this very hasty anatomical sketch I propose to 
 dwell only upon such points as are useful to the general read- 
 er, avoiding whatever is only intelligible to adepts in medi- 
 cine. They form the middle and part of the front portion of 
 the floor of the cranium. 
 
 The face is composed of thirteen different bones, but it is 
 altogether foreign to our purpose to describe them here. A 
 few remarks on some of those bones will be found in the arti- 
 cles on the diseases and accidents to which they are liable. 
 
 THE EXTREMITIES. 
 
 The superior extremities are each composed of thirty-one 
 bones, the two first of which are the collar bone and shoulder 
 blade. 
 
 The collar bone is long and slender, but it is made of very 
 firm materials, and is almost completely ossified at birth. It 
 is about as thick as the fore finger, and somewhat resembles 
 the letter S in form. It is connected by regular moveable 
 joints, with the breast-bone at its inner extremity, and with 
 the shoulder blade at its outer end. It may be plainly felt 
 
48 OUTLINE OF ANATOMY. 
 
 throughout its whole length, as it forms a salient ridge be- 
 tween the bottom of the neck and the top of the chest. Its 
 principal uses are to keep the shoulder joint at a sufficient dis- 
 tance from the side of the body to facilitate the motions of the 
 arm, and to protect the nerves and blood vessels on the front 
 of the neck from blows and other accidents. 
 
 The shoulder blade is a broad, flat, thin bone, of a triangu- 
 lar shape, which covers a considerable part of the back and 
 side of the chest. Its hinder edge is easily felt, extending near 
 the spine, from the bottom of the neck to near the middle of 
 the back; its upper edge, which is deeply buried, runs in a 
 horizontal direction along the bottom of the neck to the shoul- 
 der joint; and its third edge passes obliquely from this joint 
 to the lowest point of the first. 
 
 Along the back of this bone, not far below the top, the fin- 
 ger perceives a long and very strong ridge which runs from the 
 hinder edge forward, and a little upward to the shoulder joint. 
 This ridge or spine becomes very wide and strong at its outer 
 extremity, where it hangs over the joint and forms the point 
 of the shoulder. At a short distance below this point we find 
 the outer corner of the shoulder blade, and upon it the shal- 
 low cup-like cavity that receives the round head of the bone 
 of the arm, with which bone it forms the shoulder joint. The 
 only firm connexion between the bones of the superior extre- 
 mities and those of the trunk is through the medium of the 
 collar bone, upon which the shoulder blade appears suspend- 
 ed, if we may be allowed the expression, by the extremity of 
 its spine. 
 
 The shoulder blade is every where surrounded, lapped up, 
 and supported by numerous very large muscles, coming from 
 the head, the spine, the ribs, the sternum, or from its own 
 edges and spine; and these muscles have the power of pulling 
 it in every direction, so as to produce the various motions of 
 which the shoulder joint is capable while the arm hangs inac- 
 tive. 
 
 Our remarks upon the bones of the extremities must be ne- 
 cessarily very brief, and I shall therefore confine my attention 
 to a few points of paramount importance, as all details on this 
 subject are connected rather with the practice of surgery than 
 with that of medicine, and are therefore less interesting to the 
 class of readers for whom this work is designed. 
 
 The bone of the arm extends from the shoulder joint to 
 that of the elbow. Its shaft or body is nearly cylindrical, but 
 it becomes considerably larger at its upper extremity where 
 we find a hemispherical eminence on the side next the body, 
 which is covered with an extremely smooth cartilage. The 
 face of this eminence looks inward and upward; it is received 
 
OUTLINE OF ANATOMY. 49 
 
 into the shallow cup. already described as terminating the 
 outer angle of the shoulder blade: thus a regular bail and 
 socket articulation is formed, which permits the arm to be 
 moved to a great extent and in every direction. 
 
 From the shallowness of this joint, the shoulder is very lia- 
 ble to be dislocated, but the projection of the ridge or spine of 
 the shoulder blade prevents the head of the bone from being 
 pressed upward, and it is almost always displaced in the down- 
 ward direction. 
 
 The lower end of the hone of the arm is very much wi- 
 dened laterally, and flattened before and behind. It termi- 
 nates in a rounded scroll or cylinder that looks as if it were a 
 separate piece set crosswise upon the bone. The surface of 
 this scroll is coated with smooth cartilages, and is divided by 
 an elevated ridge which passes round it, causing it to resemble 
 the surface of two pulleys united together. Upon the cartilage 
 covering this scroll the two bones of the forearm work, and 
 the elbow joint thus formed has a perfectly hinge-like character, 
 its only motions being forward and backward. 
 
 The Ulna is the bone of the forearm chiefly concerned in 
 forming the elbow joint. It grasps the scroll-like extremity 
 of the bone of the arm, much in the manner that the hand 
 grasps a large roll of paper, the p;irt corresponding with the 
 palm and fingers being on the hinder side. The ulna does not 
 stop exactly at the joint, but projects a little above it behind, 
 so that when the forearm is fully extended this projection 
 comes in contact with the bone of the arm and prevents the 
 former from bending farther back; it has also a slight eleva- 
 tion on the front side of the ulna, which is partly intended to 
 check in the same manner the too great flexion of the fore- 
 arm. 
 
 The ulna gradually tapers from the elbow to the wrist, 
 where it becomes very slender, and is coated with cartilage 
 so as to form a very small part of the wrist joint. It lies along 
 the inside of the forearm, and terminates at the side of the 
 wrist next the little finger. Its broad connexion with the el- 
 bow joint keeps it so fixed that it cannot turn, and it has only 
 a hinge-like motion at that joint. 
 
 The Radius is the second bone of the forearm, and is chief- 
 ly concerned in forming the wrist joint. Its upper extremity 
 is very slender, and is capped by a tolerably thick ring or 
 wheel of bone much wider than the body of the radius at this 
 place. The upper side of the ring is a little hollowed, and fits 
 on to the outer part of the scroll-like extremity of the bone 
 of the arm in such a manner that it enjoys not only the hinge- 
 like motion in common with the ulna, but also a rotatory mo- 
 tion on its own axis. Not only the upper surface but the edge 
 
 7 
 
50 OUTLINE OF ANATOMY. 
 
 also of this ring is covered with cartilage, and the edge is re- 
 ceived into a smooth notch in the side of the ulna, against 
 which it is confined by ligaments, forming a joint which does 
 not interfere with its rotatory movements. 
 
 At its lower extremity the radius becomes very much en- 
 larged, more especially in breadth, and terminates in a wide 
 and slightly concave surface coated with cartilage, which, with 
 some little assistance from the ulna, forms the upper surface 
 of the wrist joint. On the inner side of this lower extremity 
 of the radius there is a semi-lunar notch which plays over the 
 side of the small rounded end of the ulna, both these parts be- 
 ing covered with cartilage and secured by ligaments. This 
 arrangement, together with that of the joint already described 
 between the upper ends of the same bones, permits the radius 
 to revolve round the lower part of the ulna, carrying the hand 
 with it, so as to present the palm upward or downward at 
 will. 
 
 The Wrist is composed of eight bones, connected together 
 by joints so various and complex as almost to- baflfle descrip- 
 tion. They occupy the space between what is called the wrist 
 joint and the line at which the wristband of a well made shirt 
 terminates upon the hand. Their movements upon each, 
 though slight and almost imperceptible, are all-important in 
 character, and contribute in a great degree to the perfection of 
 that instrument to the possession of which philosophers attri- 
 bute much of the superiority of man over the inferior creation, 
 the master-piece of animal mechanics, the human hand! It 
 would be altogether in vain here to attempt an explanation of 
 movements which even professed anatomists who comprehend 
 them, would find it impossible to describe. 
 
 Taken collectively, and considered as if they were but one, 
 the bones of the wrist form a rounded somewhat circular sweep 
 at their upper edge which is covered with cartilage, and fits 
 into the cavity formed by the lower extremities of the two 
 bones of the forearm. The joint thus formed permits the hand 
 to be bent to a considerable extent backwards, forwards, and 
 inward or toward the little finger, but only very slightly out- 
 ward or toward the thumb. The lower edge of the bones of 
 the wrist is very irregular to accommodate the articulations of 
 the five long slender bones which support the fingers and 
 thumb, and which are plainly felt in the substance of the hand. 
 The wrist is strongly arched on the back, and still more 
 strongly concave toward the palm, which circumstances ren- 
 der it admirably adapted for grasping and holding rounded 
 bodies. 
 
 The long bones that support ihejingers and thumb enjoy 
 no great extent of motion; but that which they do possess is 
 
OUTLINE OF ANATOMY. 51 
 
 of incalculable value. Those of the fore and middle fin- 
 ger are nearly fixed, but that of the thumb enables us to op- 
 pose it to the palm, — a power of such importance that a stiff- 
 ness of the upper joint of this bone destroys perhaps four-fifths 
 of the usefulness of the hand, and as the bones corresponding 
 to the ring, and more especially the little finger, contribute 
 greatly to this opposition, the loss of their motions should be 
 considered a much more serious disaster than the entire de- 
 struction of the middle finger, with its supporter. 
 
 The bones proper to the fingers and thumb, being four- 
 teen in number, are so completely subject to observation that 
 it is unnecessary to speak of their form and motions. There 
 are a few other small bones varying in number in different 
 individuals, which are commonly ranked among the bones of 
 the hand, but they are rather appendages to the muscular sys- 
 tem than to the skeleton, and we shall not notice them. 
 
 The Inferior Extremities are formed on the same general 
 model with the Superior, and it will be sufficient for our pur- 
 pose to notice the principal points of difference without repeat- 
 ing the description of each particular bone. 
 
 The Hip Joint. There is nothing corresponding to the col- 
 lar bone or shoulder blade in the inferior extremities. 
 
 The very deep cup-like cavity for the hip joint, situated 
 near the middle of each of the share-bones, has been already 
 mentioned. Now the head of the thigh-bone which fills that 
 cavity forms a much larger portion of a sphere than the cor- 
 responding part of the bone of the arm, and it is much more 
 deeply and firmly embraced in the joint, like the ball in the 
 socket attached to a surveyor's compass; its motions are there- 
 fore much more limited; it is more difficult to dislocate it, and 
 also to replace it when once thrown out. It is secured not only 
 by a strong capsular ligament, but is likewise furnished with 
 a very powerful cord-like ligament passing from the middle of 
 the ball to the bottom of the socket; the latter must be broken 
 or detached, and the former is almost always torn before it 
 can be put out of place. 
 
 The head of the thigh-bone is not situated directly on the 
 shaft as is that of the bone of the arm, but stands on the end 
 of a neck of considerable length, running from the side of the 
 shaft upward and inward to the joint. In old age this neck 
 becomes shorter and softer, and bends downward till at length 
 it stands nearly at right angles to the shaft of the bone; hence 
 it is very seldom broken in persons under fifty years of age, 
 but much more frequently in very old people. This change 
 is one of the causes of the diminution of stature in advanced 
 life. 
 
 The Knee Joint differs from the elbow in being formed by 
 
52 OUTLINE OF ANATOMY. 
 
 two long bones instead of three. The scroll at the lower ex- 
 tremity of the thigh-bone is indented round the middle by a 
 very deep groove, and seems almost divided into two heads. 
 Each of these apparent heads rests on a shallow depression 
 upon the upper flat surface of the tibia — the bone which forms 
 the shin. This latter is very large and stout; it is swelled 
 out at its upper end until it becomes as wide as the whole knee 
 joint, and thus gives ample support to the body. It has no 
 bony projections, like those of the ulna, to check the too threat 
 flexion or extension of the leg, and this deficiency is chiefly 
 remedied by two strong ligaments crossing each other within 
 the joint, one or other of which is put upon the stretch when 
 the leg is straightened or bent to its utmost extent. 
 
 Besides these and the capsular ligament, the knee has very 
 strong lateral ligaments — particularly on the inside — for the 
 obliquity of the thigh and the straightness of the leg produce 
 a strong tendency in the knee to bend inward under the weight 
 of the body. In heavy lifting, or in violent jumping, the in- 
 ner lateral ligament is sometimes stretched orelongated, and 
 almost incurable lameness results. 
 
 There is yet another small round bone connected with the 
 knee joint, which has no parallel in the superior extremity. 
 This is the Patella, or cap of the knee. It is enveloped in 
 the tendon of the muscles that extend the leu;. This tendon 
 passes over, and around it, to be attached to the shin bom . 
 below the joint. The patella is smooth and covered with car- 
 tilage on its inside, where it is fitted to the groove or pulley 
 of the thigh bone, over which it plays. It protects tiie front 
 of the joint, and acting like a pulley, enables the muscles con- 
 nected with it to act at a considerable mechanical advantage. 
 It may be dislocated in dancing or leaping, but may be gene- 
 rally pushed hack without much difficulty. It is sometimes 
 broken by similar exertions, or by blows, a most unfortunate 
 accident, for the muscles immediately draw the upper frag- 
 ment away from the lower one; they can then be kept in con- 
 tact only by extreme care ami skill, and unsuccessful treat- 
 ment is followed by incurable lameness. In this particular, 
 the patella resembles the projection of the ulna behind the el- 
 bow, which is liable to similar disasters. 
 
 The Tibia, or Shin Bone, is very thick, and shaped like a 
 triangular prism. Its upper and larger end forms all the lower 
 surface of the knee joint and its lower extremity forms nearly 
 the whole of the ankle joint. It has no rotatory motion. 
 
 The Fibula or lesser bone of the leg, is also somewhat tri- 
 angular, but it is very slender and delicate. It is articulated 
 above with the outside of the bulging extremity of the last 
 bone, and below with the side of its lower extremity, by two 
 
OUTLINE OF ANATOMY. 53 
 
 small, nearly flat surfaces. It projects somewhat beyond the 
 lower end of the tibia, and one side of the projection contri- 
 butes to the ankle joint, while the other forms what is com- 
 monly called the outer ankle. It has almost no power of motion. 
 
 The Ankle Joint. That bone of the instep which is inte- 
 rested in the joint has, on its upper surface, an eminence like 
 the half of a solid cylinder set crosswise with regard to the 
 foot, and this is received into a corresponding depression in 
 the bottom of the tibia — thus forming a hinge-like articulation. 
 To strengthen this hinge, the inner part of the tibia sends 
 down a process which faces the corresponding end of the cy- 
 linder, and forms the inner ankle, while the fibula, extended 
 as already described, faces the outer end, and forms the outer 
 ankle. The process of the articular bone of the instep, just 
 mentioned, does not entirely fill the cavity thus formed by the 
 two bones of the leg, so that the foot not only enjoys the plain 
 hinge-like motion, but it may also perform some little rotation, 
 and the sole may be turned considerably inward, or somewhat 
 outward. The former of these motions is increased by a very 
 slight mobility of the fibula, and the latter, by a more complex 
 change of position among the several bones of the instep. To 
 facilitate these various actions, the ligaments of the ankle joint 
 are longer or more relaxed than most others; the stability of 
 our footing depends mainly on the balance of power among 
 the various muscles of the leg, and calls for the co-operation 
 of consciousness and the will; hence, sprains of the ankle oc- 
 cur very frequently to heedless walkers. By long practice, 
 the ligaments of the ankle joint may be stretched so as lo al- 
 low the foot to assume attitudes altogether unnatural, and it is 
 consequently rendered much more liable to injury. The vo- 
 taries of Terpsicore are not aware that they owe much of their 
 pretended grace to an absolute deformity. 
 
 The bones of the Instep, are seven in number, they form, 
 together with the long bones supporting the toes, a very strong 
 arch admirably adapted to sustain the weight of the body, 
 which rests chiefly on the heel and the ball of the great toe. 
 In raising the body on the toes, very great force is required, 
 and in order that the muscles which effect this motion, may 
 act at a considerable mechanical advantage, the bone of the 
 heel is lengthened out, to some distance beyond the ankle 
 joint, and the tendon of those muscles is inserted into its very 
 extremity. 
 
 The toes possess no power of antagonizing each other like 
 the thumb, fingers and palm — hence, their uses and applica- 
 tions are few and simple, but like the different parts of the 
 hand, they vary greatly in importance. The ball of the great 
 toe, as it supports a large share of the weight of the body, 
 
54 OUTLINE OF ANATOMY. 
 
 stands decidedly at the head of the list: when the toes are ex- 
 tensively crushed, so long as this part is preserved, the injury 
 is considered comparatively slight. 
 
 I have now noticed all the parts proper to the skeleton, but 
 there remains one very curious bone, shaped somewhat like a 
 new moon; it is small and delicate, and is composed of a body, 
 two short, and two long horns, the last being generally at- 
 tached to the first by small portions of bone in the cartila- 
 ginous state, which permit some degree of motion. This bone 
 is found at the root of the tongue, following the motions of 
 that organ, and it hangs chiefly suspended on certain muscles 
 of the tongue, the lower jaw, and throat It is only connected 
 with the skeleton by means of a few long and very slender 
 ligaments. 
 
 There are also four minute bones connected each with the 
 ear, but these will be noticed when we consider the sense of 
 hearing. 
 
 The reader has now before him, such a general view of the 
 structure and mechanical arrangement of the tiealthy skeleton 
 as our narrow limits will allow. I will, therefore, close this 
 review of the osseous system with a few remarks upon the 
 changes produced in it by age and disease. 
 
 In old age the cartilaginous layers between the different 
 bones of the spine become thicker and harder, so that the 
 length of the column is considerably diminished, and as this 
 change takes place more rapidly before than behind, the bodies 
 of the vertebrae tilt forward, and produce the characteristic 
 stoop and the rounded back of age. Both these causes tend 
 not only to lessen the stature of the individual, but likewise to 
 limit the extent and facility of motion in the back. 
 
 The ribs are for the same reason approximated toward each 
 other, and some of their cartilages become partly or entirely 
 ossified. This prevents them from moving with their original 
 freedom, and necessarily embarrasses the function of respiration, 
 thus assisting in rendering the action of the heart and arteries 
 slow and sluggish in a manner that will be more particularly 
 noticed hereafter. 
 
 The harder parts of all the bones become still more firm 
 with age, in consequence of the continual deposition of earthy 
 matter within their substance, by which their cells are filled 
 up, and the quantity of their cartilaginous and cellular struc- 
 ture is proportionably diminished. The number of their 
 blood vessels is lessened, and they sometimes become brittle 
 for want of sufficient animal matter to glue the earthy parti- 
 cles firmly together. The softer parts, on the contrary, such 
 as the ends of the long, and the bodies of the short bones, with 
 the cellular structure between the two tables of the skull, he- 
 
OUTLINE OF ANATOMY. 55 
 
 come still softer with age, and yield more or less to the ef- 
 fect of continued pressure, so as to contribute in no small de- 
 gree to the diminution in stature. These changes will at once 
 explain the frequent occurrence and difficult cure of fracture 
 in advanced life. 
 
 The diseases of the osseous system may affect the whole 
 skeleton, or only certain particular bones or their several parts. 
 
 The most remarkable of those of the former class are, first, 
 the brittleness of bone, (fragilitas ossium,) which arises from 
 a deficiency of the animal or cartilaginous matter, and occa- 
 sions fractures from the slightest cause, such as throwing a 
 stone, stepping from a high side walk, &c; secondly, softness 
 of bone, (mollities osseum) caused by an absorption of the 
 earthy matter, even of the most solid parts, permitting the 
 bones to bend and twist by the action of the muscles, until in 
 some cases, the miserable sufferer loses almost all resemblance 
 to humanity. Thirdly, the rickets — a disease somewhat re- 
 sembling the last, but occurring chiefly in children, from a de- 
 ficient secretion of earthy matter. The two first mentioned 
 diseases are almost unknown in this country; the last is also 
 rare, but it will be noticed in the proper place. 
 
 There are many diseases generally called constitutional, 
 which may affect the osseous system to a greater or less ex- 
 tent, without involving the whole skeleton like those men- 
 tioned above. Thus scrofula not only produces those affec- 
 tions of the joints, cartilages and ligaments, which are com- 
 monly confused under the general head of white swellings, 
 but it sometimes attacks even the shafts of the long bones, 
 causing them to become swelled, softened, suid converted into 
 a mass of loose bony net work, filled with a matter like dis- 
 eased marrow. It seems as if the cartilaginous portion was 
 diminished, its place being supplied by a glutinous and an oily 
 matter, and the cells of the bone dilated to a great extent. 
 As the patient recovers, the bone returns nearly to its original 
 state. True cancer when it exists for a long time in the im- 
 mediate neighbourhood of a bone, causes various changes in 
 its structure; its looser parts are softened, and in the long 
 bones, the medullary cavity is enlarged without any change 
 in the external shape of the bone, whilst the hard crust be- 
 comes so thin as sometimes to break with the mere effort to 
 turn in bed, and the periosteum peals off with the greatest fa- 
 cility, in consequence of the obliteration of its blood vessels. 
 Soft cancer, [fungus haematodes,) on the contrary, converts 
 the substance of bone into its own peculiar structure, with a 
 rapidity truly astonishing — paying no respect to its firmest 
 parts, but involving every thing which it touches in one com- 
 mon tumour. The venereal disease does not very commonly 
 
56 OUTLINE OF ANATOMY. 
 
 affect the bone itself, except in a secondary manner by in- 
 juring the periosteum from which it derives its support. Its 
 most common effect upon this membrane is the production of 
 tumours called nodes, which are found in all conditions from 
 a simple swelling to a regular ossification of the membrane. 
 The irritation thus commenced in the periosteum may be con- 
 tinued to the solid substance of the bone, so as to produce all 
 the various phenomena of inflammation of that tissue — or it 
 may so embarrass the circulation in the blood vessels of the 
 membrane, as to cause the death of that part of the bone lying 
 immediately beneath it. 
 
 As most of the diseases just mentioned are very rare, some 
 of them absolutely incurable, and the remainder very difficult 
 to treat, they do not fall within the intention of this work, and 
 are merely noticed here in order to give the reader an idea of 
 the highly vital character of parts commonly considered as 
 mere inanimate levers formed of earthy matter and produced 
 and repaired by the surrounding parts. 
 
 The more strictly local d f bone result from irrita- 
 
 tions or inflammations within the;, ind the most 
 
 important of them will be noticed hereafter, when the reader 
 is better prepared to comprehend their nature. 
 
 OF Till; .Ml 
 
 The muscles are the organs by means of which arc accom- 
 plished all the various perceptible motions going; on in the 
 living body, whether they arc performed voluntarily like those 
 of the feet in walking, or involuntarily, like those of the bow- 
 els in digestion. 
 
 When one of the more perfect animals, such as an ox, a 
 sheep, or a fowl is killed and divided, we find the great 
 of the bodv. with the exception of the brain, bowels, bones, 
 and skin, chiefly composed of two kinds of matter. The 
 is white or colourless, containing here and there masses of tat, 
 and covers ami tills up most of the cavities or interval- 
 the other parts, giving a roundness and finish to the form. 
 This is the cellular tissue already described. The other kind 
 of matter is red, apparently fibrous, and much less yielding. 
 This is commonly called the flesh. It is entirely com; 
 of muscles — so that the terms Jlesh. in general lang 
 muscle, in works on anatomy, are nearly synonymous. 
 
 If we pass our knife through a joint of meat in certain di- 
 rections, we find that we produce a very rough and irregular 
 surface, even when we follow the direction of the groin; but 
 the practised carver, in carving a pig, or poultry, soon learns 
 
OUTLINE OF ANATOMY. 57 
 
 to cut in such a manner as to leave the surface of the different 
 pieces smooth and regular. This is accomplished by follow- 
 ing the course of the natural boundaries between the different 
 muscles so as to divide nothing but the intervening layers of 
 cellular tissue, without disturbing the muscular fibres. Now a 
 little care in discovering and pursuing these boundaries will 
 convince the curious that what we generally take for a uniform 
 mass of flesh is really a collection of many different muscles, 
 some large and some small, each lapped up in a separate sheath 
 or fascia of cellular membrane, connected at both extremities 
 with the parts that it is destined to move, and never attached 
 to the neighbouring muscles except when two or more of 
 these organs are designed to contribute conjointly to some sin- 
 gle operation. 
 
 Each separate muscle is enclosed in a distinct sheath, as I 
 have just mentioned, and the strength and thickness of the 
 envelope varies with the size and position of the enclosed or- 
 gan; its use is to bind down the whole muscle and keep it se- 
 curely in its proper relative position. In some situations a 
 number of muscles together enjoy additional security against 
 misplacement, by being collectively covered by a still stronger 
 and broader fascia, protecting both them and their sheaths. 
 The thigh and the forearm furnish instances of this arrange 
 ment. 
 
 Upon cutting into a muscle thus enclosed, we find it appa- 
 rently composed of a number of large fibres, or bundles of 
 fibres, tied together by a portion of cellular substance more 
 delicate than that which composes the sheath. By careful dis- 
 section we find each of these fibres composed of many others, 
 still smaller and united by membrane still more delicate. In 
 this way we may go on dividing, through several series of 
 compound threads, until we reach the most slender, which is 
 incapable of farther separation, and is called the ultimate or 
 elementary muscular fibre. 
 
 Fig. 8. The elementary muscular fibre is ascertained 
 
 by the best microscopic observations to be formed 
 of a great number of little round globules like 
 those found in the blood, ranged in a straight 
 row, and connected by a very transparent jelly- 
 like matter which enters between them, (see. fig. 
 8.) As to the nature of this matter, anatomists 
 disagree, but it resembles the cellular tissue, and 
 no facts are urged to show that it is not of the 
 same nature. 
 
 The direction of the fibres is very various in 
 the different muscles. In some they run the 
 whole length of the organ, side by side; in 
 S 
 
58 OUTLINE OF ANATOMY. 
 
 others they are arranged like the plume of a pen, and are in- 
 serted into a hard white membrane which divides the muscle 
 lengthwise, &c, but it is unnecessary to dwell upon these pe- 
 culiarities in this hasty sketch of anatomy. 
 
 The motions of the muscles are dependent upon certain 
 nerves which will be described hereafter; one or more nerves 
 being distributed to every muscle, and some of their ramifica- 
 tions being supposed to communicate with each particular fibre. 
 If one of these nerves be divided, the parts to which it is ap- 
 propriated become completely palsied. 
 
 When in health, the muscles are always in a state of ten- 
 sion, so that when they are cut across, the surfaces of the inci- 
 sion are dragged slowly and widely asunder by the retraction 
 of the fibres. This tonic contractile power, as it has been 
 called, is of the highest importance; it assists in strengthening 
 the joints by holding the contiguous bones firmly in contact, 
 for in the articulations capable of extensive and various mo- 
 tions, the ligaments are necessarily so relaxed in order to give 
 freedom to those motions that they are not in themselves a 
 sufficient protection to the joint. This fact is beautifully ex- 
 emplified by the effect of a severe blow upon the great muscle 
 or mass of flesh which covers the upper part of the shoulder. 
 By such an injury the muscle sometimes becomes palsied; it 
 loses its tone and wastes away; the mere weight of the arm then 
 draws the head of the bone away from the joint to the extent 
 of one or more inches. When a bone is dislocated, the neigh- 
 bouring muscles are sometimes violently elongated and at 
 others they are relaxed, according to the increased or dimi- 
 nished length of the limb resulting from the accident, and in 
 either case they adapt themselves to their new position in the 
 course of a few weeks, so as to give the greatest possible com- 
 mand of the member of which the circumstances of the case 
 admit. When an old dislocation attended with elongation of 
 the limb is reduced, some time is required for the muscles to 
 resume their original tension, and the bones are liable to lose 
 their proper position again for want of support; but when the 
 member is shortened, the contracted muscles offer a tremen- 
 dous opposition to the reduction, which, when once effectually 
 accomplished, generally remains secure. 
 
 Both the tonic contraction, and the motions of the muscles 
 are, more or less, dependent for their strength and pi 
 nence, on the nerves — but these organs are much more im- 
 mediately connected with the latter than with the former 
 function, for when the nerve of a muscle is divided, the com- 
 mand of the parts to which it is distributed is almost immedi- 
 ately lost, but its tone declines very gradually and seldom dis- 
 appears completely. 
 
OUTLINE OF ANATOMY. 59 
 
 There appears to be a strong vital attraction between the 
 particles which compose the muscular fibre; for, during life, 
 the muscles will raise with ease a weight that would tear them 
 to pieces if applied after death! 
 
 The motions of the muscles are accomplished by the con- 
 traction of all their fibres, which draws the parts into which 
 their ends are inserted nearer together. This motion is in 
 some muscles entirely dependent upon the will during health; 
 in others it is entirely independent, and in others it may be 
 controlled by the resolution of the individual for a certain 
 time, but at length he is compelled to yield to necessity, or 
 the motion takes place in spite of his opposition. Hence the 
 muscles are divided into the voluntary, the involuntary, and 
 the mixed. The first class includes all those which belong to 
 the extremities and spine; the second, embraces those which 
 enclose the bowels and great blood vessels, giving them their 
 peculiar motions, while the third is composed chiefly of those 
 muscles which contribute directly or indirectly to the act of 
 breathing. Each of these classes of muscles owe their pecu- 
 liar powers to the difference between the several systems of 
 nerves which supply them; but as these systems are all con- 
 nected together so as to influence each other mutually, we 
 sometimes find, in disease and in moments of violent emotion, 
 the muscles of one class taking on the characters of another; 
 thus in all violent passions those of the face, which are ordina- 
 rily voluntary, become completely involuntary. In cholera, all 
 the muscles of locomotion are sometimes affected in a similar 
 manner, and in sudden terror, or in catalepsy, the will is ab- 
 solutely annihilated. These causes which thus revolutionize 
 the powers of whole systems of muscles are, when acting very 
 severely, productive of instantaneous death. This subject, 
 however, is only intelligible to those who have some know- 
 ledge of the nature of the nerves, and we shall not dilate upon 
 it here. 
 
 The Involuntary Muscles are generally hollow, and are de- 
 signed to effect the expulsion of the contents of the bowels or 
 other cavities which they envelop; their fibres are generally 
 short, pale, and very irregular. Their action is such as to 
 compress the cavity which they surround and render it small- 
 er. They have less tone than the voluntary and mixed mus- 
 cles, and yield readily to any distending force that acts slow- 
 ly, recovering their original length very soon after its remo- 
 val; but they often oppose, most powerfully, the attempt to 
 distend them suddenly. One or more layers of this kind of 
 muscle envelops each of the principal organs of circulation and 
 digestion. The heart is almost entirely composed of a vast 
 number of fibres of this class, but redder and more like to 
 
60 OUTLINE OF ANATOMY. 
 
 flesh than most others; the structure and arrangement of these 
 will be noticed hereafter. The stomach is furnished with va- 
 rious layers of a similar nature, but quite pale or yellowish; 
 the fibres run in many directions, interlacing and overlapping 
 each other in various ways. These layers form what is called 
 the middle or muscular coat of the stomach, because it lies out- 
 side of the rough internal or mucous coat that extends through- 
 out the intestines, and within the very smooth serous mem- 
 brane that covers the bowels externally. 
 
 The gullet or oesophagus, and the whole length of the intes- 
 tines below the stomach, are provided with a similar muscu- 
 lar coat, but here the fibres generally run in a circular direc- 
 tion around the gut. Some parts of the passage, however, 
 have an additional layer of fibres running lengthwise over the 
 former, and acting in such a manner as to shorten the bowel 
 at these spots when such a change is required. 
 
 When the intestines are full, these fibres are all stretched 
 to the uttermost, and the mucous coat is comparatively smooth 
 in consequence of the distension; but when Ihey are empty 
 the fibres contract until they nearly obliterate the cavity, and 
 the mucous coat is thrown into wrinkles, or doubled upon it- 
 self. 
 
 When the tone of any of the hollow muscles is lost, either 
 by frequent and undue distention, or by any injury to their 
 nerves, the action of the corresponding organ becomes feeble, 
 its functions are not properly performed, and the contents be- 
 ing retained too long, often become a source of irritation and 
 actual disease. Many cases of dyspepsia originate in such an 
 affection of the stomach, and costiveness of the bowels, fol- 
 lowed sometimes by diarrhoea or purging, frequently results 
 from the same cause. 
 
 In the bladder, when any great obstacle opposes the 
 of urine, it sometimes happens that the fibres are stretched to 
 such an extent as to destroy their tone entirely, and the c 
 would inevitably burst if surgical means were not emp! 
 for the relief of the patient Even after the urine has been 
 artificially evacuated in such cases, the organ regains its pow- 
 ers very slowly, and the efforts of nature cannot be depended 
 upon until it has recovered entirely. 
 
 The most important hollow muscles are the heart, those of 
 the muscular coats of the stomach and bowels, and those of 
 the bladder, the womb, and the organs of generation; each of 
 these different classes of hollow organs will contract and ex- 
 pel its contents when distended to I certain degree, or when 
 the mucous coat is acted upon by certain irritating substances. 
 but it is remarkable that causes which produce strong contrac- 
 tion in certain fibres have no effect upon certain others. Thus 
 
OUTLINE OF ANATOMY. 01 
 
 Ipecacuanha causes the fibres of the lower part of the stomach 
 to contract and close the cavity, while it relaxes those of the 
 upper part, to allow the contents of the organ to be ejected by 
 vomiting. Gamboge, on the contrary, produces an opposite 
 effect by causing an increased rapidity of the natural action 
 by which the stomach propels its contents downwards. Ep- 
 som salts and Rhubarb exert their purgative action pretty 
 equally throughout the whole length of the intestines, while 
 the operation of aloes is very much concentrated on the rec- 
 tum, or lower extremity of the bowels. Healthy urine pro- 
 duces no peculiar effect on the fibres of the bladder, which 
 only begin to contract when they have undergone a certain 
 degree of distention, but the same urine would produce a very 
 different effect upon the bowels if it were received into them, 
 as is proved in some cases of surgical injury. 
 
 The involuntary muscles owe their power to a system of 
 nerves found in all animals a little complicated in structure — 
 even in those that are thought to have no brain or organs of 
 voluntary motion. These are the nerves of organic life. 
 
 The arteries, or vessels destined to convey blood from the 
 heart, are provided with a fibrous coat similar in many respects, 
 both as to appearance and position, to that of the intestines, 
 but many anatomists deny that it is muscular; be this as it 
 may, the function of those fibres bears a very close resem- 
 blance to that of the hollow muscles. The fibres are circular; 
 they have a strong degree of tone, and press firmly upon the 
 blood within; they yield readily to the gradual increase of 
 the circulating fluid, whether it results generally, from high 
 living, or locally, from a determination to the part, as in blush- 
 ing, and inflammation. They strongly resist sudden disten- 
 tion, so that they do not yield to the force of the heart's pul- 
 sations, but remain fixed like solid pipes to allow the blood to 
 circulate regularly in every part. When a bleeding takes 
 place, these fibres slowly contract so as to keep up a constant 
 pressure upon the contents of the vessel by diminishing its 
 size, but if the blood be drawn away very rapidly or to a great 
 extent, they are sometimes unable to contract fast enough, 
 their pressure ceases' and the circulation stops, precisely as the 
 jet of a fire hose would stop after an extensive breach in the 
 conduit that supplies it. This is the cause of fainting, which 
 would always prove fatal if the contraction of the fibres were 
 arrested by the suspension of apparent animation; but fortu- 
 nately such is not the fact; the fibres continue to become 
 shorter and shorter until the pressure on the blood is restored; 
 the vessels then feel the action of the heart, the circulation is 
 re-established, and the patient revives. 
 
 The relative strength of this fibrous coat of the arteries goes 
 
62 OUTLINE OF ANATOMY. 
 
 on increasing as the vessels divide and become smaller. In 
 the larger trunks it seems only designed to adapt the size of 
 the vessel to its contents, but in the capillary branches it proba- 
 bly influences the force of the current of blood, either by aid- 
 ing or counteracting the heart's action; and some say it may 
 even continue that current, under certain circumstances, and 
 in certain parts, without the aid of the heart 
 
 This coat, that answers all the purposes of a muscle, is much 
 under the influence of the nerves, and is supplied with that 
 influence by the nerves of organic life; its action is therefore 
 altogether independent of the will, but may be powerfully af- 
 fected by the mental emotions, like the bowels and other hol- 
 low organs. 
 
 The mixed Muscles, or those which are partly obedient to 
 the will, and partly involuntary, are chiefly concerned in res- 
 piration — a function for which the simplest animals have no 
 peculiar apparatus. Even in man it is neither necessary nor 
 advisable that the mechanical effort of respiration should be 
 going on at all times, because we are occasionally placed in 
 situations where such efforts would inevitably occasion suffo- 
 cation; as, for instance, when the head is plunged into deleteri- 
 ous gases, or when we plunge into the water; and therefore 
 we are kindly provided by nature with the means of check- 
 ing the operation for a certain length of time. But respira- 
 tion is absolutely necessary to the life of a complex animal, 
 and it would be very unsafe to intrust the entire command of 
 such a function to the discretion even of reasoning man. The 
 muscles of respiration are therefore supplied both with n» 
 of organic life and voluntary motion. The former hold the 
 sway on ordinary occasions, but when dancer threatens, the 
 latter soon take the reins, and compel the animal to make the 
 effort to breathe, however reluctant he may be, and they even 
 continue their exertions, when injury to the brain, or the ap- 
 proach of death render him unconscious of his wants. 
 
 The muscles of this class are generally broad, thin, and flat, 
 and are not collected into masses like those of voluntary mo- 
 tion. The most important of them are, first, the Intercos- 
 tal Muscles, a double set placed between the intervals of the 
 ribs, so that there are two between each pair of bones, running 
 from the lower edge of the one to the upper edge of the next, 
 or vice versa. The fibres of these two sets cross each other 
 in their direction, and bind the ribs very firmly together. Bj 
 their contraction they draw those bones nearer together, and 
 as the upper pair of ribs remain nearly stationary, their joint 
 operation elevates each successive pair, in a greater and gi\ 
 degree, thus dilating the cavity of the chest, especially at it> 
 lower part, and causing the air to rush into the lungs. When 
 
OUTLINE OF ANATOMY. 63 
 
 they relax, the ribs return to their former position, in conse- 
 quence of the elasticity of their cartilages and other causes, 
 and the air is expelled again. Secondly, the Diaphragm. This 
 is a broad and thin muscle, commonly called the midriff, which 
 divides the cavity of the chest from that of the belly. Its 
 circumference is attached all around to the lower edges of the 
 ribs and their cartilages, which we can trace so plainly with 
 the hand at the bottom of the chest. Behind, it is attached to 
 the spine. This muscle is so very concave below and convex 
 above, that it may be likened to a basin turned upside down, 
 and the bottom of the basin rises as high as the fourth pair of 
 ribs. The heart and lungs lie upon the upper surface of the 
 diaphragm, and the liver and stomach fill up its cavity. Its 
 fibres run from all parts of the circumference towards its cen- 
 tre, but the whole central part of the diaphragm is composed 
 of a thin white tendon, and the muscular fibres instead of con- 
 verging to the centre are inserted into the edges of this ten- 
 don. 
 
 When the diaphragm contracts, the tendon in its centre is 
 pulled downward by its fibres, or, in other words, the basin 
 is rendered shallower, and consequently, the cavity of the 
 chest is then very much enlarged. To fill this enlarged space 
 the air rushes in large quantities into the lungs, and this hap- 
 pens at the same moment that the intercostal muscles contract, 
 all these muscles combine to produce an inspiration. 
 
 But when the basin of the diaphragm is rendered shallow, 
 the liver and stomach, with the other bowels, are pushed 
 downward, the belly is therefore swelled and its muscles are 
 put upon the stretch. The moment the diaphragm relaxes, 
 these last mentioned muscles recover their position, the bow- 
 els, with the liver and stomach are thrust up again, and the 
 air is expelled. This relaxation always occurs at the same 
 moment, both in the diaphragm and the intercostals, and thus 
 is accomplished the act of expiration. 
 
 There are other muscles which contribute to the act of 
 breathing in various ways and under various circumstances, 
 but this view of the mechanism of respiration is sufficient for 
 our present purpose. More will be added when we come to 
 treat of the function of respiration, and the diseases affect- 
 ing it. 
 
 Of the muscles of voluntary motion, I need say but little 
 here, as they were taken for a model when describing the 
 muscles in general, and their appearance and general charac- 
 ters are there described. 
 
 That extremity of a voluntary muscle which is attached to 
 the more fixed parts, is commonly called its origin, and that 
 extremity which is connected with the more moveable parts 
 
64 OUTLINE OF ANATOMY. 
 
 is termed its insertion. When there is ample room allowed 
 for both the origin and insertion of a muscle, and when the 
 form of the part is such that its bulk is not productive of in- 
 convenience or loss of symmetry, the fleshy fibres run the 
 whole distance between the two extremities, and the whole 
 organ consists of one great fleshy belly. This is the case with 
 the great muscle already mentioned, that covers the shoulder 
 joint. It originates from a considerable part of the collar 
 bone before, and a still more considerable part of the spine of 
 the shoulder blade behind. 
 
 Its anterior and posterior fibres run downward and outward, 
 and those that originate from the point of the shoulder, pass 
 directly downward, so that they are all collected together at 
 their lower extremity into a large rough surface upon the out- 
 side of the arm near the middle; and these fibres are fleshy, 
 very nearly from one end to the other. 
 
 But if all the bulky muscles of the arm or leg were similar- 
 ly formed, it is obvious that the shape and use of the limbs 
 would be destroyed, for the thickness of flesh over the joints 
 would then be as great as in the middle of the members. To 
 avoid this difficulty, many of the muscles are terminated, at 
 one or both ends, by white, and very fine cords or membra- 
 nous expansions, called tendons, into which the fleshy fibres 
 terminate. 
 
 As the tendons are vastly stronger, in proportion to their 
 size, than the fleshy bellies of the muscles, they are made to 
 occupy less space and to pass on to their insertion without 
 crowding the neighbouring parts, or destroy ins: the grace and 
 beauty of the person. One of the tendons which furnish the 
 best exemplification of these parts is the Tendon of *hhilles, 
 so named, because the goddess-mother of the Grecian Hero, 
 is supposed to have held him by that part when she plunged 
 him in Styx, to render him invulnerable. It is felt by the 
 fingers as a rounded riband or cord, behind the ankle joint, 
 running from the calf of the leg, to the point of the heel, and 
 in this small cord are inserted all the muscular fibres that com- 
 pose the fleshy calf. By the simplest mechanical calculation, 
 it will be found that when a strong man rises on his toes, lift- 
 ing five hundred weight, this little tendon must endure the 
 tremendous force of one ton and a half, or two tons, yet in 
 bulk, it scarcely equals the little ftftf 
 
 Many of the muscles are provided with tendons at both ex- 
 tremities, and it is to this arrangement that we owe most of 
 the graceful curvatures that render the human form the most 
 exquisite of the beauties of nature. 
 
OUTLINE OF ANATOMY 
 Fig. 8. 
 
 65 
 
 THE ARM WITH THE PRINCIPAL MUSCLE WHICH BENDS THE 
 FORE ARM. 
 
 1. The Wrist Joint. 
 
 2. The insertion of 
 
 the muscle be- 
 low the Elbow. 
 
 3. A weight in the 
 
 hand. 
 
 4. The muscle with 
 
 its two fleshy 
 bellies. 
 
 5. The bone of the 
 
 arm, 
 
 6. The Elbow Joint. 
 
 7. The two tendons 
 
 by which the 
 double muscle 
 originates. 
 
 The Tendons are white, fibrous, and nearly inelastic. They 
 do not differ very widely from the ligaments in structure, and 
 are composed, in reality, of cellular membrane very much con- 
 densed. The fibres are short and variously interlaced. 
 
 Some tendons are round and slender, like that already men- 
 tioned. Most of those of the extremities and spine are of this 
 character. They are often confined in their places by liga- 
 mentous or cartilaginous rings or sheaths, and where they 
 play over each other, or on any hard substance, they are pro- 
 vided with sacks containing synovial fluid like those of the 
 joints, in order to lessen their friction. 
 
 Sometimes we see one of these round tendons passing 
 through a slit in another. This is the case in the hand, where 
 the muscle, which moves the third joint of the fingers, lies 
 below that which moves the second joint. The former sends 
 its long delicate tendons upward, through an opening like a 
 button-hole, in the latter, and thus reaches its destination, 
 without injuring the symmetry of the second joint. On each 
 side of the neck there is a very curious muscle with two 
 fleshy bellies connected by a tendon in the middle. It hangs 
 like a swing from behind the ear to the chin, and it passes in 
 its course, through the body of another muscle, to be attached 
 in the middle to the small detached bone that supports the 
 root of the tongue. One of the muscles of the eye is still 
 more interesting, for its tendon passes over a regular cartila- 
 ginous pulley, fixed to the bony top of the orbit; it is then 
 doubled back so as to roll the eye in a direction exactly con- 
 trary to that in which the muscle contracts. 
 
 There are other tendons, that are broad, thin, and flat, like 
 
 9 
 
66 OUTLINE OF ANATOMY. 
 
 a sheet of paper. Such a one has been already mentioned as 
 forming the centre of the diaphragm or midriff, and several 
 others of still greater extent cover the front of the belly. In 
 tendons of this character, the fibres resemble a regular net 
 work. They are designed to make equal and firm pressure 
 over a wide space, and they are more generally met with in 
 the mixed muscles. 
 
 Some of the round tendons of the extremities send out late- 
 ral expansions which cover and bind down the neighbouring 
 muscles, forming regular fascise of greater or less extent. The 
 great flexer of the elbow provides one of these tendinous fas- 
 ciae to the muscles of the fore arm. 
 
 The Diseases of the Muscles and Tendons are not very 
 numerous; their convulsions and their loss of power in palsy, 
 being generally caused, not by any change in their own sub- 
 stance, but by a derangement in the nerves upon which their 
 action depends. The fleshy parts of the muscles are highly 
 vitalized, but their sensation, when in health, is obscure, and 
 is more nearly allied to soreness than pain. When wounded, 
 the feeling produced resembles that of rheumatism. The 
 tendons are absolutely insensible, unless when twisted. Di- 
 vided muscles unite, like all other parts, by the formation of 
 new cellular membrane between the cut extremities; and this 
 new bond soon takes on an appearance analagous to tendon. 
 It is denied by most, that portions of muscular fibre, when 
 once lost, are ever reproduced in their original form. This 
 we think a mistake, but it is unnecessary to argue the point 
 here. Cancer, Fungus Haematodes, Venereal, &c, some- 
 times produce changes of structure in the muscles, not unlike 
 those noticed in the bones under similar circumstances. 
 
 The tendons have very little vitality, as they contain scarce- 
 ly any blood vessels. When broken or divided, they there- 
 fore unite very slowly, and the manner of their union re- 
 sembles that of a broken. bone. Their extremities swell and 
 become soft, their blood vessels enlarge, and then new matter 
 is formed. This requires much time, and at least four months 
 should be allowed before a broken tendon should be called 
 into strong exertion, although from one to two months is 
 often sufficient for a broken bone. A vastly longer period 
 elapses before the parts return to their original condition. 
 
 Injuries to the tendons were formerly considered very dan- 
 gerous, but this idea is now exploded. The evils dreaded do 
 not arise from the wound of the tendon itself, but from that 
 of the neighbouring parts. Thus, when a broad flat tendon is 
 punctured, the part underneath it may inflame and swell, and 
 the pressure of the unyielding tendon makes that swelling ex- 
 quisitely painful; or, when a round tendon is hurt, where it 
 
OUTLINE OF ANATOMY. 67 
 
 passes through a ligamentous canal, the serous or synovial 
 membrane which lines the canal becomes inflamed, and such 
 inflammations are always serious. Many witloes are of this 
 character. 
 
 The muscles vary in strength and size, more than any other 
 parts, by exercise and use. They may even become so pow- 
 erful as to break the tendons or the bones with which they 
 are connected, as is sometimes seen in leaping and dancing. 
 Convulsions, and more especially lock-jaw, occasionally cause 
 such effects to a horrible extent. 
 
 This peculiar property of the muscles, produces many kinds 
 of deformity, gives the characteristic form to the operations of 
 particular trades, and not unfrequently lays the foundation of 
 consumption and other fatal diseases when exercise is neglect- 
 ed or ill regulated. I shall enlarge upon this very important 
 subject in the chapter on Hygiene. 
 
 By very violent exertion or by severe blows, the muscles 
 interested sometimes lose their power suddenly, never to be 
 regained — hence the excessive folly of the extreme exertion 
 of strength, particularly at an early age. 
 
 OF THE DIGESTIVE APPARATUS. 
 
 When the food has been properly masticated, it descends 
 into the alimentary canal to be subjected to the process of di- 
 gestion. 
 
 The alimentary canal is a muscular tube reaching from the 
 back part of the mouth to the anus, but in its course it so in- 
 volved by turning and doubling upon itself, that if it were 
 stretched out in a direct line, it would be found about six times 
 the length of the body; that is, a man six feet in height, has 
 about thirty-six feet of intestine. 
 
 This canal is essentially composed of two cylinders or coats, 
 connected together by a dense cellular membrane which is 
 also sometimes styled a coat. The inner cylinder or mucous 
 coat is rough, wrinkled, and thrown into numerous folds, as 
 if it were much too large for its envelope; it is supplied with 
 such immensely numerous blood vessels, that when they are 
 minutely injected, they seem in some places to form the whole 
 substance of the membrane. It is very plentifully furnished 
 with nerves from the system of organic life, and is possessed 
 of the highest degree of vital activity and irritability; yet, as 
 its nerves have but a very indirect connexion with the brain, 
 its sensations, in health, are obscure. Hunger and thirst are 
 among the natural sensations of this membrane. At both ex- 
 tremities the mucous coat of the alimentary canal is continuous 
 
68 OUTLINE OF ANATOMY. 
 
 with the true skin that covers the surface of the body, to 
 which it bears so strong an analogy, except in the source from 
 which it derives its nerves, that it may be regarded as a kind 
 of internal skin. At the two points just mentioned, it receives 
 more twigs from the nerves of sensation, and enjoys a higher 
 degree of sensibility. 
 
 The cuticle or scarf skin is continued into the upper extre- 
 mity of the canal, as far as the stomach, but becomes so deli- 
 cate, that it is difficult to detect its presence. In all the in- 
 tervening space between this, and the immediate neighbour- 
 hood of the anus, the cuticle is wanting, and the membrane is 
 protected only by the mucus, which it pours out upon its in- 
 ner surface. When this mucus is removed by inflammation, 
 or by purging in diarrhoea or dysentery, the bowels become 
 liable to severe irritation from slight causes, for they are then 
 reduced to a condition not unlike that of a blistered surface, 
 after the cuticle has been entirely removed; hence, the vast 
 mischief often resulting from the use of very severe medicines 
 in sucji cases, for by violent measures pursued with the inten- 
 tion of " removing impurities," we remove also the natural 
 protection of this extremely delicate surface. This happens 
 the more readily because the peculiar character of the nerves 
 of the bowels prevents them from giving early notice of the 
 danger. 
 
 The mucous coat contains also the smallest branches of mil- 
 lions of the lacteals or little vessels, which imbibe the nutri- 
 tious parts of the food, in order to convey it to the heart, and 
 circulation, as was mentioned in our first hasty sketch of the 
 principal functions of an animal at the commencement of this 
 work. 
 
 The outer cylinder or coat of the alimentary canal is com- 
 posed entirely of the muscular fibres already described, when 
 speaking of the involuntary muscles, with the cellular tissue 
 connecting together those fibres, and the vessels and nerves 
 that supply them. The principal trunks and branches of the 
 vessels and nerves of the mucous membrane penetrate this 
 coat in countless numbers. 
 
 The muscular coat enjoys scarcely any sensibility in health, 
 as it derives its nerves from the system of organic life, but 
 when it is affected by inflammation or spasm, it becomes 
 acutely painful, as we see in cholic and many other diseases. 
 
 The use of this membrane is to thrust the food onward as it 
 undergoes the process of digestion, and this it accomplishes 
 by the successive contraction, first, of its upper fibres, and then 
 of those beyond, in due order, thus forcing the contents be- 
 fore them. When, however, any insurmountable barrier is 
 opposed to the progress of the food, or when the individual 
 
OUTLINE OF ANATOMY. 
 
 69 
 
 has taken a powerful emetic, this action is reversed to a greater 
 or less extent, and the partially digested food is ejected by the 
 mouth* 
 
 Fig. 10. 
 
 A, A. A portion of small intestine. 
 by 6, b, b. Superficial lacteals. 
 
 c, c, c. A portion of mesentery, or that double fold of peritoneum which 
 
 binds the small intestine to the spine. 
 d y d y d. The first range of mesenteric glands, receiving the small branches 
 of the lacteals from the intestine, and transmitting a few larger 
 branches to the second range. 
 C, c, e. The second range of mesenteric glands, collecting the branches 
 of lacteals into still larger trunks. 
 fy f. The receptacle for the chyle and lymph, being a slight enlarge- 
 ment of the thoracic duct at its commencement. 
 g. The thoracic duct. 
 
 h. The aorta or principal artery of the body. 
 i. Lymphatics coming up to the thoracic duct. 
 
70 OUTLINE OF ANATOMY. 
 
 In addition to the two coats just mentioned, all that portion 
 of the canal which is enclosed in the cavity of the abdomen 
 or belly, is covered externally with a smooth serous mem- 
 brane called the peritoneum, to which allusion has been made 
 already. This membrane, after very loosely enveloping the 
 bowels, passes off from the posterior parts of the tube in a 
 double fold, like a towel hanging upon a line, leaving only a 
 narrow strip of the bowel uncovered behind. (Fig. 10. c.) 
 Between these folds the principal vessels of the intestines pass 
 from the great trunks near the spine to their destination, and 
 the lacteals (b.) gradually collecting themselves into a few 
 large branches, pursue their route toward the thoracic duct, into 
 which they are all emptied, that their contents may be con- 
 veyed by that vessel to the great veins, and thus to the heart. 
 
 The double fold of peritoneum coming from the bowels is 
 attached diagonally across the spine, and thus serves to bind 
 the intestines at a proper distance from that column, and to 
 prevent them from getting entangled, while it allows them 
 great freedom to enlarge or contract, or to perform their other 
 necessary motions. The folds are then reflected over the sides 
 of the cavity of the belly, which are thus entirely covered by 
 the peritoneum, so that this smooth membrane is every where 
 placed in contact with itself, and as it is kept constantly moist 
 by its proper serous secretion, all friction between the sides of 
 the belly and the bowels is effectually prevented. The gullet 
 before it passes through the midriff into the abdomen and the last 
 intestine, after it leaves that cavity and enters the pelvis, are 
 the only parts of the canal not covered, wholly or in part, by 
 the peritoneum; it is therefore common to call this membrane 
 the third coat of the bowels; or, if the cellular substance which 
 envelops the mucous and muscular membrane be included un- 
 der the name of the nervous coat, as it is by some, then the 
 peritoneum forms a fourth coat to the intestines. 
 
 The arrangement of the peritoneum is very complex, and 
 furnishes a most wonderful display of the goodness and wis- 
 dom of providence in protecting the important organs which 
 it covers; but it is impossible to describe it in detail without 
 transcending our reasonable limits. Nor is it proper to speak 
 at present of the diseases of the bowels; they are numerous 
 and will be described hereafter. 
 
 OF THE FUNCTION OF DIGESTION. 
 
 The food during mastication is broken into small pieces or 
 it is crushed and mingled with the saliva. This proce.-- - 
 highly important, for if the various aliments were taken 
 
OUTLINE OF ANATOMY. 71 
 
 the stomach in their crude state, they would often prove very- 
 irritating to its delicate surface, and their solidity might ren- 
 der their digestion slow, imperfect, or even impossible. 
 
 The saliva is secreted by a number of small glands situated 
 about the mouth, each of which is provided with a little duct 
 or canal to convey its fluid into that cavity. 
 
 Of these glands the largest are placed beneath the ear and 
 behind and upon the angle of the lower jaw, on each side. 
 Their ducts are seen opening on the inside of the cheek opposite 
 the second great grinding tooth. When the mouth is opened 
 suddenly we often see clear jets of saliva thrown very forcibly 
 into the mouth from the orifices of these ducts. This gland 
 sometimes becomes inflamed, and it is very singular that this 
 affection often prevails epidemically under the common name 
 of the Mumps. It seems to depend on the same general causes 
 with Influenza, and may be considered as a variety of that 
 disease, expending its force chiefly on the salivary organs. 
 The gland is called the parotid, and the inflammation is de- 
 scribed in the books under the title of Cynanche Parotidea. 
 
 Two smaller glands of the same nature lie immediately in- 
 side of the angles of the lower jaw, and discharge themselves 
 by two long and winding ducts terminating on the sides of 
 the bridle of the tongue. They are called the sub-maxillary 
 glands, and when swelled by cold, or in the mumps, they be- 
 come very obvious, and are commonly called kernels. 
 
 Besides these, there are two others — the sub-lingual glands — 
 which we see hanging like a fringe on each side of the bridle 
 of the tongue. They empt}^ their contents through a great 
 number of very small, short ducts, which cannot be detected 
 without close attention. 
 
 The canals of the salivary glands may be obstructed by in- 
 flammation, or by the formation of stones like those of the 
 bladder, and such accidents may be recognised at once by the 
 rapid enlargement of the gland affected, which does not be- 
 come immediately hard, as it always is when inflamed, but 
 continues soft, and yields to the pressure of the finger until 
 the distention is carried very far. Such cases require the 
 prompt assistance of a surgeon. 
 
 When external wounds penetrate these canals, if they are 
 not immediately closed and healed, the constant flow of sali- 
 va often keeps them open, and the fluid, instead of reaching 
 the mouth, is poured out upon the cheek. This is an unfortu- 
 nate accident, and requires the utmost skill to effect a cure. 
 
 The saliva not only has a powerful influence in keeping the 
 particles of food separate from each other, so as to render their 
 passage into the stomach easy and facilitate the action of this 
 
72 
 
 OUTLINE OF ANATOMY. 
 
 organ upon them, but it also assists in dissolving the food, and 
 thus promotes digestion. Any thing, then, that tends to vi- 
 tiate the quality or diminish the quantity of saliva is necessa- 
 rily injurious to health. 
 
 To return to the food and its progress. When it has been 
 properly divided, and mingled and coated with saliva, it is 
 thrust backward by the tongue. The orifice of the windpipe is 
 then closed by its muscles and the curious little cartilage which 
 acts as a lid to that orifice is shut down, so that the food passes 
 safely over it, to the opening of the gullet. When by acci- 
 dent this lid is not closed in time, the food comes in contact 
 with the exquisitely sensitive edge of the wind pipe, pro- 
 ducing a vioient spasmodic closing of the tube, to prevent the 
 passing matter from entering the lungs. 
 
 Fig. 11. 
 
 THE STOMACH. 
 
 A, A. Anterior Surface. R. Enlargement of the lower part. D. Cardiac 
 orifice. F, andC. Principal arteries of the stomach. II. The omentum or caul 
 
OUTLINE OF ANATOMY. 73 
 
 How uncomfortable this accident is, must be well known to 
 all who have had the misfortune to ** swallow a drop the 
 wrong way." 
 
 Once fairly placed in the commencement of the alimentary 
 canal, the food is urged onward by the alternate action of the 
 circular fibres of the muscular coat of the gullet until it is 
 fairly forced into the stomach. 
 
 The Stomach (fig. 11.) is the first great enlargement of the 
 alimentary canal. It is shaped somewhat like a great blad- 
 der, but its upper and lower orifices are near together, but 
 being placed far back toward the spine. 
 
 Its position is such that its course lies nearly cross-wise 
 with regard to the body, so that one of its sides, when the or- 
 gan is full, lies partly in contact with the hollow of the dia- 
 phragm or midriff, and partly with that of the under side of 
 the liver, while the opposite side rests on the intestines. 
 (Fig. 15, o.) The gullet enters it immediately after passing the 
 diaphragm, on the left side of the column of the spine, and 
 the small intestine passes out from it, on the right side of the 
 same column, a little lower down. 
 
 The small arch of the stomach, which rides like a saddle 
 over the bodies of the vertebrae, from one orifice to the other, 
 is very short and is called the lesser curvature; but the great 
 arch sweeps in from the entrance of the gullet far round the 
 left side and the front of the belly, under what we call the pit 
 of the stomach, and so returns to the place of exit for the 
 small intestine, on the right side of the spine: it is very long, 
 and is termed the great curvature. The stomach thus formed 
 and placed, bears considerable resemblance to a retort, with a 
 very short neck, bent until it nearly touches the bottom. 
 The great bulge of the retort lies to the left and in front, the 
 neck to the right and behind; the throat sits over the spine, 
 and the sides approach the horizontal position, the great end 
 being a little the higher. If we conceive the gullet to enter 
 the bottom, and the small intestine to be connected with th 
 neck of the retort, we shall have no bad idea of the form ana 
 position of this important organ. 
 
 The food remains in the stomach a considerable length of 
 time, until it is gradually dissolved and converted into a semi- 
 fluid mass, from which the lacteais can extract the proper 
 nourishment. 
 
 The whole process of digestion is a wonder and a mystery. 
 The food, while the stomach is in a healthy condition, is com- 
 pletely protected against those changes which would take 
 place in the same period of time in the dead body, and all the 
 alterations which it undergoes are the direct effect of actions 
 purely vital, which chemistry can neither imitate nor explain. 
 
 10 
 
74 OUTLINE OP ANATOMY. 
 
 By some unintelligible power, the different articles of food 
 taken, during a meal, are kept wonderfully distinct, and the 
 stomach appears to act chiefly upon one at a time, always se- 
 lecting those first which are most easy of digestion, drawing 
 them towards its surface by some unknown species of attrac- 
 tion. 
 
 It is always the outside of the mass of food that undergoes 
 digestion first, and when this layer is fully prepared, it is passed 
 on into the small intestine, by the regular action of the mus- 
 cular fibres of the stomach, and another layer of food is then 
 attacked and disposed of in the same manner. Whatever is 
 difficult of digestion, whether in consequence of imperfect 
 mastication of the peculiar nature of the substance, remains to 
 the last, and if the powers of the stomach are exhausted, or 
 the food proves very refractory, it becomes a source of irrita- 
 tion and disease Hence, the serious consequences to the 
 health, from the early loss of the teeth, and hence, also, the 
 wide spread prevalence of dyspepsia, from that most vulgar 
 of our national habits, the custom of eating' our meals with 
 disgusting rapidity. 
 
 It is a fact that should never be forgotten, that the stomach 
 loses much of its power of digestion during sleep, so that if 
 suppers be taken immediately before going to bed, the organ 
 is compelled to undergo the irritation resulting from the pre- 
 sence of crude food for many hours together. This out 
 upon nature is never tolerated with impunity; imperfect slum- 
 bers, night-mare, diseases of the heart, sometimes epilepsy, 
 gout, dyspepsia, &c. stand ready to revenge it, and one or 
 other of these ministers of justice is sure to punish the vic- 
 tim of this species of dissipation. When an hour or two in- 
 tervenes between the meal and the repose, the evil is mate- 
 rially lessened, though not entirely removed, for in that time, 
 a surface of digested matter is every where presented to the 
 stomach, and the oppression from the weight of its contents is 
 the only cause of uneasiness. 
 
 It is hardly less injurious to use very active exertion of 
 body or mind immediately after eating. The agitation of 
 the stomach and its contents disturbs the order of digestion 
 and brings portions of crude matter into strong collision with 
 the tender mucous membrane. Moreover there is always a con- 
 centration of vital energy in the stomach during digestion: the 
 blood leaving the surface, which becomes cool and sometimes 
 even chilly, and flying in unusual quantities to the alimen- 
 tary canal. Soon after this the action of the heart is increased 
 and the whole circulation is rendered more vigorous to ena- 
 ble the stomach to effect its purpose. Now when the mus 
 cles, brain, or indeed any other organs are called into strong 
 
OUTLINE OF ANATOMY. 
 
 75 
 
 exertion, they require a similar increase of blood to heighten 
 their powers, and it is wrong to distract the vital energies by 
 calling unnecessarily for their operation in various and distant 
 parts at the same time. (See chapter on Hygiene, tflrt. Food.) 
 The changes that the food undergoes in the stomach have 
 been attributed by most to the operation of a peculiar fluid 
 supposed to be secreted by the vessels on the internal surface 
 of the organ, and commonly known by the title of the gastric 
 liquor. The very existence of this fluid has been denied by 
 some, but it is unnecessary to argue the point in a popular 
 treatise. It is sufficient to remark that the changes just men- 
 tioned consist in the gradual conversion of the whole mass of 
 contents into a semi-fluid substance called chyme, mingled oc- 
 casionally with matters absolutely indigestible, swallowed ne- 
 cessarily or by accident with the food, such as the skins or 
 cuticle of vegetables, cherry stones, pieces of bone, &c. &c. 
 
 Fig. 12. 
 
 SUCTION OF STOMACH. 
 
 A. The extremity of the gullet or oesophagus entering the stomach. 
 
 B. The cavity of the stomach. 
 
 C. The pilorus or outlet of the stomach. 
 
 D. The duodenum. 
 
 The Chyme thus constituted is propelled by the stomach 
 into the first part of the small intestine, commonly called the 
 duodenum, (D.) because its length is about equal to the breadth 
 of twelve fingers. Here the chyme undergoes a kind of second 
 digestion before it is presented to the lacteals to be absorbed. 
 
 The duodenum has been considered by some as a second 
 stomach. It is a narrow gut commencing at the lower orifice 
 of the stomach on the right side of the spine, and passing near- 
 
76 
 
 OUTLINE OF ANATOMY. 
 
 ly horizontally over to the left. At the junction of this intes- 
 tine with the stomach there is a strong band of circular fibres, 
 which close the canal by their contraction, and thus prevent the 
 return of the chyme into the latter organ, (fig. 12. C.) At the other 
 extremity, the duodenum is continuous with the remainder of 
 the small intestine. There are two great glands which pour 
 their secretions into this part of the alimentary canal, and as 
 their agency is all-important to the due performance of the 
 function of digestion it is best to notice them here. 
 
 Fig. 13. 
 
 A. Right lung. 
 
 B. Left lung. 
 
 C. Right ventricle of the 
 
 heart. 
 
 D. Right auricle of the 
 
 heart. 
 
 E. The great vein de- 
 
 scending from the 
 head and upper ex- 
 tremities, called the 
 vena cava. 
 
 F, F. The principal veins 
 
 from the arms coming 
 to join the great 
 vein. 
 
 G, G. Internal jugular veins 
 
 coming from the 
 head. 
 
 H. The great artery of 
 the body called the 
 aorta. 
 
 I. Pulmonary artery. 
 
 K. Diaphragm. 
 L, L. Right and left lobes 
 of the liver. 
 
 M. Round ligament of 
 the liver. 
 
 N. The gall bladder. 
 
 O. Stomach. 
 
 P. Spleen. 
 Q, Q. Situation of the kid- 
 neys behind the in- 
 testines. 
 R, R, R, Small intestines. 
 
 THOIIAC1C AND ABDOMINAL VISCERA. 
 
 The Liver is by far the largest gland of the body, it fills up 
 the principal part of the hollow of the diaphragm on the right 
 side, and extends considerably over to the left of the middle 
 line of the body. Above, it is very convex, but below, it is 
 slightly concave. The hinder edge is very thick and rounded, 
 but the front margin is thin and well defined. The stomach. 
 
OUTLINE OF ANATOMY. 77 
 
 when fully distended, fills up a considerable part of its conca- 
 vity. It is much thicker and more massive on the right side, 
 and gradually becomes attenuated as it approaches the left side 
 of the cavity of the belly, which it never quite reaches, a part 
 of the great end of the stomach being placed between the liver 
 and the latter part. The lower and front edge corresponds 
 very nearly with the margin of the ribs, and seldom passes 
 below that line unless when enlarged by inflammation or long 
 continued fevers. It is divided into several lobes and is kept 
 in place by several double folds of the peritoneum, which co- 
 vers the greater part of its surface, and is then reflected on to 
 the walls of the belly. So great is the weight of this organ, 
 however, that in falls from a great height, it has been known 
 to tear its attachments, and even to crack its own substance, 
 so as to produce speedy death. 
 
 The liver thus placed receives nearly all the blood returned 
 from the bowels toward the heart; the vital current being con- 
 veyed to all parts of its substance by the appropriate vessels, 
 which will be described when we come to consider the sub- 
 ject of the circulation. From this blood is secreted the bile, 
 the peculiar fluid elaborated by this gland, and the bile is re- 
 ceived, immediately on its formation into the minute branches 
 of the gall duct, which are found in every part of the liver. 
 These branches are gradually collected into larger trunks, 
 which are united continually with each other until they all 
 disgorge themselves through one great canal which passes into 
 the duodenum. But in order that this powerful fluid should 
 be reserved in sufficient quantities to answer the demands 
 made upon it under extraordinary circumstances, there is a 
 large reservoir adhering to the concave surface of the liver, 
 which communicates with the duct by a short canal. Into 
 this reservoir the bile flows backward when its presence in 
 the duodenum is not required, (fig. 13. N.) 
 
 The exact duty which the bile performs in the business of 
 digestion is not understood, but it appears necessary that a 
 portion of it should be mingled with the chyme, before the 
 nutritious parts of that mass are prepared to be taken up by 
 the lacteals, to be mingled with the blood. 
 
 Moreover, the bile is the natural purgative, and its presence 
 is highly necessary to quicken the motions of the bow r els in 
 urging forward the useless parts of the food, in order that they 
 may be discharged from the body. When the bile is vitiated 
 in quality, or increased in quantity by disease, it often acts 
 with violence, producing severe and even dangerous purging, 
 and when it is greatly diminished in quantity, obstinate cos- 
 tiveness is the ordinary consequence. 
 
 Healthy bile produces no uneasiness in the duodenum, but 
 
78 OUTLINE OF ANATOMY. 
 
 its presence cannot be tolerated in the stomach. Whenever it 
 finds its way into that organ, it produces vomiting and is im- 
 mediately thrown up. This fact gives rise to a popular error 
 in practice which is productive of vast mischief, particularly in 
 the Western country. I allude to the too free use of emetics 
 under the supposition that the patient is bilious. An emetic 
 reverses the natural action of the stomach, and if severe, it 
 extends its influence to the duodenum. In that case the con- 
 tents of the latter intestine, and of course the bile, if any be 
 present, instead of passing on to the small intestine are re- 
 turned into the stomach, where they occasion terrible uneasi- 
 ness, and the vomiting is continued until all the bile is thrown 
 up. This presence of bile in the discharges is taken by the 
 ignorant observer, for a proof of the correctness of the prac- 
 tice. "See what a quantity of bile he had on his stomach; 
 he needed the emetic badly." Now the reader may be some- 
 what surprised to hear that this very bile was actually brought 
 into the stomach by the very emetic given to evacuate it. If 
 a powerful emetic is given to a man in health/ — as soon as the 
 contents of the stomach are thrown up, bile follows, inevitably, 
 not because it previously existed there, but because the medi- 
 cine has called it there! Emetics are among the most effi- 
 cient means of promoting the secretion of bile, and if that 
 fluid is already too copious, great mischief may result from 
 their action. 
 
 The bile poured into the stomach on such occasions often 
 keeps up the vomiting until the patient dies of exhaustion, or 
 until the over exerted liver loses its power and the secretion 
 stops. In the latter case the patient recovers, with a long con- 
 valescence, a stomach without a tone, and a liver without en- 
 ergy, and too frequently the medicine is lauded for saving him 
 from the desperate situation into which it had reduced him by 
 its own agency! Emetics are valuable remedies in their pro- 
 per place, but let it be remembered that the natural course of 
 the bile is downward. 
 
 The Pancreas is a long, narrow gland placed in contrast 
 with the posterior walls of the belly, behind the peritoneum. 
 It resembles the salivary glands both in its form and in its pe- 
 culiar secretion. Its duct is constructed like that of the liver, 
 except that it has no reservoir attached, and it empties into 
 the duodenum, by an orifice almost in contact with that of the 
 gall duct — indeed, they are sometimes united before they en- 
 ter the intestine. 
 
 The process of digestion is by no means completed in the 
 duodenum, for the food is constantly undergoing changes 
 throughout the whole extent of the alimentary canal. The 
 greater part of the nutritious matter, however, is extracted in 
 
OUTLINE OF ANATOMY. 79 
 
 the duodenum, and by the aid of the bile and pancreatic liquor, 
 it is converted into a milky fluid, called chyle. 
 
 The Chyle, together with the remaining parts of the food 
 pass on into the other portions of the small intestines, where 
 the former is very rapidly absorbed by the open mouths of 
 the lacteals to be carried into the circulation. 
 
 It is a curious fact that however various the quantity of the 
 food taken into the stomach may be, the chyle obtained from 
 it is always of the same nature. Some few substances not pro- 
 perly belonging to this fluid, may enter with it and mingle 
 with the blood, but they are almost immediately thrown out 
 again from the body, either in the urine or in some other ex- 
 cretion, so that the purity of the blood is effectually preserved. 
 
 The small Intestine is divided by surgeons into the jeju- 
 num and the ileum, but this division is arbitrary, and I shall 
 not notice it farther. 
 
 After leaving the duodenum, which terminates on the left 
 side, this intestine is rapidly separated to a distance from the 
 spine, nor does it again approach to the walls of the belly, until 
 its lower end enters the great intestine near the right hip. Al- 
 though its two extremities are separated but a few inches from 
 each other, the tube travels many yards in passing from the 
 one to the other. It winds about and doubles upon itself in 
 every possible direction, until it fills the whole of the middle 
 and lower part of the belly, and even descends some distance 
 into the pelvis or basin when the bladder is empty. Now 
 these folds of intestine would be constantly liable to become 
 entangled and misplaced, were it not for the curious arrange- 
 ment of the double fold of the peritoneum, which after cover- 
 ing the bowels, runs to be connected with the walls of the bel- 
 ly behind, in the manner already described. 
 
 This double fold acts like a ligament, binding the whole 
 length of the small intestine at a proper distance from the 
 spine, without interfering with its necessary motions. 
 
 The hinder part of this duplicative is stretched obliquely 
 across from the upper to the lower end of the gut, adhering 
 strongly to the back of the cavity of the abdomen; but its 
 front edge, where it divides to embrace the intestine is length- 
 ened out like the free margin of a fan, or shirt frill, or a half- 
 opened umbrella, so that it follows all the windings of the ca- 
 nal. 
 
 The mucous coat of the small intestine is not only too large 
 for the muscular cylinder in which it is enclosed — like that of 
 other parts of the alimentary canal — but it is likewise much too 
 long; so that in addition to the longitudinal wrinkles seen in 
 all the bowels, it is also thrown into large, circular folds that 
 hang loosely in the cavity and considerably diminish its di- 
 
80 
 
 OUTLINE OF ANATOMY. 
 
 ameter. These folds are so numerous near the upper extre- 
 mity, that they actually overlap each other as the food passes 
 by them, but near the lower extremity they become smaller 
 and less numerous until they finally disappear. The principal 
 use of these folds or valves, as they have been termed, is to 
 increase the surface in contact with the food, and as the whole 
 mucous coat of this bowel is so covered with little projecting 
 twigs of nerves, and capillary branches of blood vessels and 
 lymphatics, that its surface resembles fine velvet, every part 
 of the digesting mass must necessarily be acted on, and not a 
 drop of the chyle can escape the millions of little mouths al- 
 ways kept open to drink it in: — at least this is the case during 
 health. 
 
 Fig. 14. 
 
 VALVE AT Till: EXD OF THE SMALL INTESTINE. 
 
 a, c. Small intestine, b, b. Large intestine. 
 
 d. A little worm-like appendage of the large intestine. 
 
 By the time the remains of the food have reached the lower 
 extremity of the small intestine, nearly all the nutritious mat- 
 ter has been extracted from it. and it is reduced to a soft mass 
 of faeces and mucus mingled with a little water and other flu- 
 ids. It is then forced into the commencement of the great 
 intestine, which is placed on the right side of the spine near 
 the wing of the share bone. The opening of the small, into 
 the great gut is guarded by a curious valve, formed by an 
 elongation of the coats of the former, which are sloped inward 
 from each side until they leave nothing but a narrow slit, 
 through which the contents may pass downward by pushing 
 the valve open, but if they attempt to return the valve is in- 
 stantly closed, and they are arrested. 
 
OUTLINE OF ANATOMY. 81 
 
 The Great Intestine is many times larger than either the 
 duodenum or the remainder of the small intestine, and it is 
 much less regular in shape, being furnished with several strong 
 longitudinal bands.of fibres which indent it lengthwise, and also 
 with numerous circular contractions intersecting these bands 
 at short intervals, and dividing the whole surface into small 
 squares. In the intervals between the depressions, the intes- 
 tine bulges outward, forming as many little domes in which 
 the faeces accumulate and become moulded into the shape that 
 they generally present when discharged, particularly with cos- 
 tive patients. This part of the alimentary canal is still pro- 
 vided with some absorbent vessels, that take up the fluid por- 
 tions of the contents and gradually harden the fasces; so that 
 when they are long retained in consequence of disease or in 
 old age, they are often discharged with the greatest difficulty. 
 
 That part of the great intestine that lies in the cavity of 
 the abdomen is called the colon, and the lower portion, which 
 passes through the basin to the anus, is termed the rectum. 
 
 The Colon is swelled out, at its commencement, into a large 
 receptacle, called the head of the colon; the small intestine 
 enters it at some distance from the end, and in a direction 
 nearly at right angles to its course. This arrangement assists 
 the valve in preventing the return of the faeces. 
 
 From the lower part of the right flank the colon runs up- 
 ward along the flank, near the spine, until it rises almost to 
 the level of the stomach. It adheres to the right kidney, and 
 continues upward until it comes into contact with the duode- 
 num and the gall bladder. It then suddenly springs in an arch 
 all across the belly, touching the lower side of the liver, and 
 passes immeidately below, or sometimes, in front of the sto- 
 mach, covering and concealing the duodenum. It passes im- 
 mediately along the front walls of the abdomen, and rests on 
 the convolutions of the small intestines. After reaching the 
 left flank, it turns abruptly downwards, adheres to the left kid- 
 ney, and then finishes its course by a kind of double curve to 
 the right again, terminating at the body of the last lumbar ver- 
 tebra, where it is continued into the rectum. 
 
 Thus far the remains of the food, now converted into pro- 
 per faeces, are propelled by the agency of the bowels them- 
 selves, but their final ejection cannot be accomplished in health 
 without the aid of the will. 
 
 The whole digestive apparatus, except the parts about the 
 mouth, the gullet, and the rectum, are placed in a large enclo- 
 sure called the cavity of the abdomen. This cavity is bound- 
 ed above, by the diaphragm, the great muscle of respiration 
 already presented to notice; below by the cavity of the basin, 
 filled in males by the bladder and rectum, but, in females, con- 
 
 11 
 
82 
 
 OUTLINE OF ANATOMY". 
 
 taining also the womb and other organs of generation; behind, 
 by the lumbar portion of the spine; and at the sides and front, 
 by the wings of the share bone, and a number of broad, flat 
 muscles with their tendons — which fill up all the interval be- 
 tween the brim of the pelvis to the lower margin of the ribs, 
 their cartilages, and the breast bone, from the spine, be- 
 hind, to the middle bone of the body before. The whole of 
 this cavity is lined by the smooth delicate serous membrane 
 called the peritoneum, which has been already described, and 
 it is completely filled by the stomach, intestines, and the other 
 bowels, with their nerves, vessels, &c. 
 
 Fig. 15. 
 
 a. The cavity of the chest or thorax. 
 
 b. The cavity of the abdomen. 
 
 c. The line of direction for the dia- 
 
 phragm when relaxed in expira- 
 tion. 
 d. The line of direction for the dia- 
 phragm when contracted in inspi- 
 ration. 
 e,f. The front walls of the chest and ab- 
 domen. 
 The spine, in this figure, is seen in 
 side view, and divided through the 
 middle of the canal for the spinal 
 marro\r. 
 
 \ ; Our limits will not allow us to 
 ; ; dwell on the highly interesting and 
 ! i pcurious arrangement of the diffe- 
 jr rent abdominal muscles: their in- 
 fluence on respiration has been no- 
 ticed above, but on their joint ef- 
 fect in aiding the function of di- 
 gestion, a few words may be add- 
 ed. 
 
 It will be perceived that the 
 greater part of the alimentary ca- 
 nal is enclosed in a cavity, surrounded by broad and strong 
 muscles on every side except toward the pelvis or basin, where 
 it rests upon the bladder and rectum. The former of these 
 organs is only separated from the superincumbent intestines, 
 by a thin layer of peritoneum covering its upper surface and 
 forming the floor of the abdomen. When all the muscles 
 contract together, the bowels are pressed downward by the 
 diaphragm, and they are at the same time forced inward by 
 the muscles surrounding the flank and front of the belly: the 
 only direction in which they or their contents can yield to 
 this pressure, is toward the pelvis, where there is no muscle 
 to oppose them; they, therefore, compress the bladder ant! 
 
 SECTION OFTnORAX AND AHDOMLy. 
 
OUTLINE OF ANATOMY. 83 
 
 turn so as to compel them to evacuate the urine and faeces, and, 
 in this manner, the will of the individual aids the muscular 
 coat of those organs and determines the moment of discharge. 
 
 The same forces operate in producing vomiting, when any 
 obstacle to the natural passage of the food exists; for then the 
 contents of the stomach are pressed upward through the gul- 
 let, the only practicable outlet. The motions of the abdominal 
 muscles in vomiting are commonly spasmodic, and very pow- 
 erful. 
 
 These muscles also contribute greatly to hasten the move- 
 ments of the fibres of the muscular coat by their constant and 
 alternate action in respiration; for varied pressure and agita- 
 tion act as stimulants to a muscle, and promote its contractions: 
 hence the frequency of stools after unusual exercise. 
 
 OF THE CIRCULATION. 
 
 Some very general ideas on the subject of the circulation 
 have been already given in the preceding chapter, and in order 
 to avoid unnecessary repetition, the reader is requested to 
 glance his eye over the outline there given, (p. 20, 21,) and 
 also over the remarks under the head of the involuntary mus- 
 cles, where the fibrous coat of the arteries is mentioned, (p. 
 59, 62.) I shall then consider him familiar with the meaning 
 of the terms artery, vein, capillaries, lacteals, absorbents, 
 fibrous coat, serous coat, &c, and shall employ these terms 
 hereafter without farther definition. 
 
 OF THE CIRCULATING FLUIDS. 
 
 The circulating fluids, like all the solid parts of the body, 
 are supposed to possess vitality, that is, they are compounded 
 in a manner which chemistry cannot explain, and they per- 
 form operations unintelligible to the student of inanimate na- 
 ture. Their peculiar form and character are gradually lost, 
 after the death of the body, when death results from mild 
 causes, and the same changes are observed in them when re- 
 moved from the body in health. In the latter case, if the flu- 
 ids be instantly transferred to the proper vessels of another 
 individual, they retain their vitality and sometimes produce 
 very little disturbance. But some very violent fevers, the worst 
 form of spasmodic cholera, and more especially great shocks 
 of electricity and lightning, affect the circulating fluids as they 
 do the tonicity of the muscles, the cohesion of certain other 
 solids, &c; that is, they suddenly or instantaneously destroy 
 
84 OUTLINE OF ANATOMY. 
 
 all traces of life, not only in the human frame, but in the fluids 
 likewise. 
 
 These facts are sufficient to prove that chyle and blood par- 
 take of the mysterious principle called life, in common with 
 all other portions of the body; although the progress of mo- 
 dern science has displaced the old opinion founded on the let- 
 ter of the Mosaic Law, that the blood is the peculiar seat of 
 the vital principle. 
 
 The first branches of the lacteals are so small that the qual- 
 ities of the chyle that they contain cannot be ascertained with 
 certainty; but when the fluid reaches the thoracic duct, it is 
 white, opaque, devoid of smell, and has a somewhat acid and 
 decidedly sweetish taste. It is composed, like the blood, of 
 solid globules floating in a liquid. When removed from the 
 body, it speedily separates; one part becoming solid like the 
 clot of blood observed in the bowl the day after a bleeding, 
 but wanting the red colour; the other portion serous, like the 
 fluid that surrounds the clot. The solid part of.the chyle seems 
 to possess properties intermediate between those of the serous 
 portion and the clot of the blood, being converted into the lat- 
 ter substance after it enters the circulation. The fluid parts, 
 both of the chyle and the blood are coagulated by heat, like 
 the white of an egg when boiled — and this coagulation seems 
 to constitute one of the principal changes that takes place when 
 the liquid matter of the circulation is deposited, in order to 
 form the white solids of the body, such as simple cellular tis- 
 sue, tendons, ligaments, &.c. 
 
 The chyle contains all the most important elements that are 
 necessary to the formation of the various organs of the ani- 
 mal: these are oxygen, or vital air; chlorine, or the bleaching 
 gas; nitrogen, that portion of the atmosphere which cannot be 
 breathed alone; hydrogen, or inflammable air: carbon, or pure 
 charcoal; phosphorus, the metallic bases of soda and lime; and 
 iron. Potash and magnesia are the only ingredients found in 
 blood that are not enumerated in the list of results from the 
 analysis of chyle, but the absence of these articles cannot be 
 inferred with certainty. The mode in which these elements 
 are combined in the two fluids differ* much more widely. 
 
 The blood is a fluid so familiar to all, that little need be said 
 of its general appearance. It divides, when removed from the 
 vessels, into two portions, the coagulum or clot, and the se- 
 rum. The solid part has a strong red colour, but when broken 
 to pieces and repeatedly washed, it becomes white and fibrous 
 in its appearance, and the colouring matter is transferred to 
 the water. 
 
 In the simplest animals, those which have no muscles, the 
 animal juices, which may be termed their blood, display no dis- 
 
m 
 
 OUTLINE OF ANATOMY. ' 85 
 
 position to separate into a solid and a fluid portion. In those 
 that have muscles of a white colour and sluggish action, like 
 the reptiles, the blood contains the white fibrous matter of the 
 clot, but wants the coloured globules. Even in man those 
 muscles which are kept most constantly in rapid motion have 
 the deepest colour, while those which act slowly and with lit- 
 tle power, like the fibrous coat of the intestines, are compa- 
 ratively pale. Want of proper exercise renders all the mus- 
 cles pale and feeble, and diminishes the size of the clot of 
 blood. 
 
 Hence it is fair to infer that the solid part of the circulating 
 fluids is designed to support the muscular system generally, 
 and that the red matter gives that system its highest degree 
 of strength and activity. The coloured globules of the blood 
 contain also some of the materials necessary to the formation 
 of other parts, and particularly the bones; but they are evi- 
 dently decomposed and deprived of their crimson hue before 
 they enter these parts — while in the muscles their proper cha- 
 racter appears to be in a great degree retained. 
 
 The serum of the blood, contains most of the various ingre- 
 dients necessary to the formation of the white parts of the 
 body, and probably supplies them with nearly all their nou- 
 rishment. The principal ingredients of serum are albumen, 
 or the same substance that forms the white of an egg, and water. 
 When heated, this fluid coagulates and is then reduced to a 
 condition that strongly resembles the matter of many of the 
 white solids, at least so far as its chemical properties are con- 
 cerned. The fluids of all the serous cavities — that thrown out 
 by blisters, and the effusion in dropsy — are of the same charac- 
 ter, and do not differ much from each other. 
 
 The blood that flows from the lungs to the heart, to be 
 driven out again to supply all parts of the body, is of a bright 
 crimson colour; but that which returns from all parts of the 
 body to the heart, that it may be driven into the lungs, is of 
 a dark purple. The chief cause of this difference of colour is 
 the greater amount of charcoal contained in the returning 
 blood, which is supposed to result from the changes that take 
 place in the capillaries, which vessels separate from the mass 
 of circulating fluid much of its other materials and leave an 
 excess of the carbonic matter. This excess is thrown out from 
 the body by the act of respiration, in the form of fixed air or 
 carbonic acid gas, and by the secretion of bile, which contains 
 it in considerable amount. 
 
86 
 
 OUTLINE OF ANATOMY. 
 
 OF THE ROUTE OF CIRCULATION. 
 
 The heart lies on the left side of the chest, where it is en- 
 closed in a bag or sack of serous membrane, adhering to the 
 diaphragm or midriff on its upper surface, and suspended 
 above by its connexions with the great blood vessels as they 
 enter the heart. This sack, after surrounding the heart, is fold- 
 ed inward upon itself so as to cover the external surface of the 
 roots of the great vessels and the heart also, being applied to 
 the organ, in the same manner that*the peritoneum is applied 
 to the bowels and walls of the belly. It contains a little mois- 
 ture at all times, so as to give the organ free play, and to pre- 
 vent friction. When this moisture is much increased, it pro- 
 duces that most fatal disease, the dropsy of the pericardium. 
 
 THE HEART A>"D GIIEAT BLOOD VESSELS. 
 
 1 . The right Auricle, which 
 
 receives the blood from 
 the body in general. 
 
 2. The right Ventricle, which 
 
 drives the blood to the 
 lungs. 
 3 • The left Ventricle, which 
 receives the blood from 
 the lungs. 
 
 4. The left Ventricle, which 
 
 drives the blood to the 
 body in general. 
 
 5. The pulmonary artery 
 
 coming from the right 
 Ventricle. 
 
 6. Its branch which goes to 
 
 the left lung. 
 
 7. Its branch which goes to 
 
 the right lung. 
 
 8. The Aorta, or Great Ar- 
 
 tery going to the body 
 in general, from the left 
 Ventricle. 
 
 9. The descending Great 
 
 Vein, coming from the 
 head and arms to the 
 right Auricle. 
 
 10. The ascending Great 
 
 Vein, from the body and 
 lower limbs. 
 
 11. Apex of the Heart. 
 
 12. 13, 12, 12. Pulmonary- 
 
 veins coming from both 
 lungs to the left Auri- 
 cle. 
 
 13, 14. Arteries supplying the substance of the Heart itself. 
 
 The heart has four cavities; two to receive the blood, and 
 two, much stronger, to propel it. 
 
OUTLINE OP ANATOMY. 87 
 
 The blood collected from the capillaries in all parts of the 
 lungs, flows onward toward the heart, through vessels which 
 are continually uniting and forming larger trunks, until they 
 are finally gathered into four great veins that pour their con- 
 tents into the first cavity of the heart, called the left auricle. 
 As soon as it is full, this auricle contracts and expels it into 
 the second cavity or left ventricle. The walls of this cavity 
 are prodigiously thick and powerful, for they are designed to 
 urge onward the whole mass of the circulating fluid destined 
 for the nourishment of all the organs of the body. This ca- 
 vity communicates with only one blood vessel, the aorta or 
 great artery — into which its contraction forces the blood at 
 each pulsation of the heart. 
 
 The aorta bends in a great curve from the top of the heart 
 to the spine, and gives off several very large branches in its 
 course that pass upward to the arms, neck, and head. It then 
 descends on the left side of the bodies of the vertebras, behind 
 the bowels, until it reaches the neighbourhood of the pelvis, 
 where it divides into two great branches, one of which passes 
 to each of the inferior extremities. In the cavity of the chest 
 it supplies the lungs with small branches for their sustenance, 
 but these little arteries are not at all interested in the respira- 
 tory function, of which we shall presently speak. 
 
 The substance of the heart and the coats of the great vessels, 
 even the aorta itself are furnished with similar branches, upon 
 which they depend for their nutrition. 
 
 In the belly, the aorta gives out many arteries, one or more 
 of which reaches every particular organ in that cavity, and 
 others are distributed through its walls. 
 
 These great branches go on continually dividing and redi- 
 viding, until they become capillary and extend to every part 
 of the body. So numerous and universal are these minute 
 ramifications that some of the older anatomists believed that 
 the human frame consisted entirely of blood vessels; and a few 
 writers of a more modern school uphold opinions somewhat 
 similar. It is in these ultimate branches of the great arterial 
 tree, that the blood undergoes the change in colour that dis- 
 tinguishes the contents of the veins, and it is here also that 
 the particles necessary for the growth and nourishment of the 
 solid organs are separated from the circulation. 
 
 The blood of the capillaries from all parts of the body, sup- 
 plied by the aorta and its branches, returns toward the heart 
 through the veins. These bloodvessels bear less resemblance 
 to the branches or roots of a tree than does the arterial system, 
 for they are connected together more frequently by interme- 
 diate vessels, so that they form a kind of net-work with large 
 meshes, as we may perceive on the back of the hand. As 
 
88 OUTLINE OF ANATOMY. 
 
 they approach the heart, they are gradually merged into larger 
 trunks, which generally accompany the great arteries, and at 
 last they are all collected into two only: — one descending 
 from the head and superior extremities, the other ascending 
 from the lower extremities and pelvis. These are called the 
 venae caves, and they meet at an angle at the heart where they 
 are united end to end. By means of a large opening at the 
 side of the junction of these veins, opposite the angle, they 
 pour their contents into the upper cavity on the right side of 
 the heart, or the right auricle; this, when full, contracts and 
 forces the blood into the lower cavity of the right side of the 
 heart, or right ventricle, which is much thicker and stronger 
 than the auricle. 
 
 By the contraction of the right ventricle, the blood is urged 
 through the pulmonary artery and its branches into every 
 part of the lungs. In the capillaries of the lungs, the blood 
 is subjected to the action of the air. It parts with its carbon, 
 assumes the bright arterial hue, and is rendered fit to renew 
 its course in the circulation, and it is then returned to the left 
 side of the heart through the pulmonary veins, in the manner 
 described at the commencement of this sketch. 
 
 The reader will perceive that the whole left side of the 
 heart, together with the veins that enter it and the artery that 
 leaves it, are designed to receive and transmit red or florid 
 blood, while the blood vessels and cavities belonging to the 
 right side of the heart contain only the dark, or, as it is gene- 
 rally miscalled, the venous blood. Thus we have a complete 
 circulatory system, one half devoted to the functions of nutri- 
 tion and secretion, the other to that of respiration. The op- 
 posite sides of the heart differ so much in sensibility that nei- 
 ther can tolerate the presence of the fluid proper to the other. 
 When the respiration is arrested by disease or suffocation, the 
 blood cannot part with its carbon, but passes into the left au- 
 ricle and ventricle unchanged, and the heart soon ceases to 
 act. 
 
 Each auricle, with its corresponding ventricle, stands then 
 in the centre cf a long canal with countless ramifications, some 
 tending toward it like the roots toward the trunk, and others 
 passing from it like the branches from the trunk of a tree. 
 There are, therefore, two hearts in reality, but in man they 
 are united together and enclosed in one sack; in some animals 
 they are widely separate. We might carry out our compari- 
 son and liken the whole circulation to two trees standing side 
 by side, with their twigs and radical fibres intermingled and 
 united at their extremities. 
 
 The human circulation is therefore single; but the 
 tion of the two hearts into one, has induced anatomists to do- 
 
OUTLINE OF ANATOMY. 89 
 
 scribe it as double. They take the veins of the left and the 
 arteries of the right side together, and call them the pulmona- 
 ry circulatory apparatus, while the arteries of the left, and 
 the veins of the right, are styled the general circulatory ap- 
 paratus. The distinction is too arbitrary, and leads to con- 
 fusion, for neither of these divisions effect a true circulation 
 without the aid of the other. 
 
 Before leaving this subject, two important local modifica- 
 tions must be noticed; the portal vessels and the capillaries. 
 
 OF THE PORTAL VESSELS. 
 
 The blood distributed by the branches of the aorta to the 
 bowels in the abdomen, does not return from the capillaries 
 into the corresponding veins like that furnished to other parts 
 of the body, but is collected into an independent set of ves- 
 sels formed like the veins, but without valves. These vessels 
 are gradually collected into a great trunk called the portal 
 vein, which passes into the liver and there distributes its 
 branches, like an artery, to all parts of the gland. It is the 
 dark venous blood of this vessel that furnishes the bile, the 
 proper secretion of the liver, the uses of which have been al- 
 ready noticed. After the hepatic capillaries have thus accom- 
 plished their purpose they then pour their contents into the 
 proper veins of the liver, to be carried into the vena cava, 
 where they are mingled with the general mass of the circu- 
 lating fluids. 
 
 The portal system, or, as it has been sometimes erroneously 
 called, the portal circle, resembles another tree with its roots 
 and branches, sitting like a parasite upon the nutritious and 
 respiratory system, and destined to effect one isolated, but all- 
 important secretion. This tree has no heart appended to it, 
 and as it commences and terminates in most minute ramifica- 
 tions, the motion of its fluids must be laborious and difficult, 
 depending very much upon the force of the right side of the 
 heart, which continually drives more blood into its radical 
 capillaries, and the alternate pressure of the abdominal mus- 
 cles and diaphragm which squeezes its contents into the liver. 
 
 Now if any cause should drive the blood from the surface 
 of the body toward the deeper seated parts, it is evident that 
 the weakness of this system would cause it to yield readily to 
 the distention, and this fact assists in explaining many symp- 
 toms of congestive fever. Let us take the case of common in- 
 termittent. During the chill, there is an irritation of the 
 bowels which calls the blood strongly toward them. The 
 nerves take the alarm and cause the capillaries of the surface 
 
 12 
 
90 OUTLINE OF ANATOMY. 
 
 to contract, the patient becomes pale and cold and the blood 
 rushes inward. The heart, bowels, lungs, and brain, become 
 oppressed with blood. But, most of all, the portal vessels 
 often become enormously distended, and the current of their 
 blood is embarrassed. The liver, and more especially, the 
 spleen, swell to a great extent, and the bowels being prevented 
 from evacuating their over-loaded vessels into the portal veins, 
 cannot properly exercise their functions. If this slate of things 
 were to prove severe and long continued the patient would 
 die, but the heart soon commences with the tremendous effort 
 to urge the blood onward and equalise the circulation. This 
 produces the fever, and the obstacles to the flow of blood in 
 most parts of the body are overcome; in some places it may 
 prove too rapid, the symptoms of the chill are reversed; the 
 stupor of the brain is succeeded, perhaps, by delirium, or the 
 engorgement of the lungs gives place to inflammation; but the 
 portal vessels are not strong enough to act with corresponding 
 energy, and, although the current recommences its flow, more 
 blood is still received than can pass on with- facility. The 
 liver and spleen continue swelled, the bowels are disordered 
 and the secretion of bile vitiated, until the paroxysm passes off. 
 Even then, these organs may be left in more weakened con- 
 dition than any other parts. If this attack is often repeated, 
 the bowels lose their power, the bile remains constantly de- 
 fective, the liver and spleen become permanently enlarged, 
 and ague cakes, costiveness, dyspepsia, and nervous debility, 
 may render the sufferer miserable to the end of his days. 
 
 This short and very imperfect pathological notice is intro- 
 duced thus out of place, to keep awake the attention of the 
 reader, and to show the absolute necessity of a knowledge of 
 anatomy, in order to qualify a man to judge of disease and its 
 treatment. 
 
 The Spleen is a very large organ lying on the left side of 
 the spine at the back part of the abdomen. It resembles a 
 gland, but furnishes no secretion. It is composed almost en- 
 tirely of blood vessels, (see fig. 17.) and its only known use 
 is to act as a reservoir for the surplus blood of the portal 
 vessels when any diseased or healthy action determines the 
 blood toward the bowels in unusual quantity. 
 
OUTLINE OF ANATOMY. 
 Fig. 17. 
 
 91 
 
 RAMIFICATIONS OF THE SPLENIC ARTERr IN THE SJPLEEN. 
 
 OF THE CAPILLARIES. 
 
 When an artery divides into two branches, it is generally 
 found, that the dimension of the branches, taken collectively, 
 is greater than that of the parent stem; and as all the arteries 
 are divided a great many times before they become capillary, 
 it follows that the caliber of these small vessels must greatly 
 exceed that of the trunk of the vascular tree to which they 
 belong, and this is true with regard to the veins as well as 
 the arteries. Each great division of the circulatory apparatus 
 is therefore compared to a cone, the capillaries forming the 
 
92 OUTLINE OF ANATOMTr 
 
 base, and the principal trunk, where it joins the heart, the 
 apex. Now as the heart propels a given amount of blood at 
 each pulsation, it follows from this arrangement, that the cir- 
 culation becomes very slow by the time it reaches the capilla- 
 ries, and that plenty of time is thus allowed, for the separa- 
 tion of the different secretions and the deposition of the va- 
 rious solids, as the blood passes through these remote conduits. 
 Indeed, the smallest visible capillaries in some animals admit 
 but one globule of blood at a time, so that every particle comes 
 within the influence of that vital power, whatever it may be, 
 which rules over the functions of the several organs. 
 
 The capillaries are not simply continued from the arteries 
 into the veins, but divide and reunite in every direction until 
 they are formed into a complete and very close net work, so 
 that if one branch be clogged or broken, the blood flows on 
 through other channels; and, unless the injury is very exten- 
 sive, no embarrassment of function occurs. 
 
 The coats of these minute vessels are so thin that their 
 structure cannot be examined. It is only inferred from obser- 
 vations on larger arteries. One thing, however, is certain, they 
 may contract or they may yield to dilatation to an astonishing 
 extent. The former power is beautifully proved by the pheno- 
 mena of a chill — when we see a fine florid complexion instant- 
 ly reduced to the extreme of pallor without the loss of a drop 
 of blood. The latter is rendered equally striking, when the 
 enunciation of a name, or word, calls up the tell-tale blood in 
 torrents to the brow of beauty. By this power the capillaries 
 can increase both the amount and the rapidity of circulation 
 in their canals, when any unusual accident demands a concen- 
 tration of vital power in any particular spot. 
 
 There are several functions more or less connected with the 
 circulation, which demand a passing notice here. 
 
 OF THE FUNCTION OF NUTRITION. 
 
 The manner in which the chyle is formed from the food 
 and conveyed into the veins by the lacteals, has been described 
 in the previous section. It enters the right side of the heart, 
 mingled with the blood of the vena cava, from whence it fol- 
 lows the current into the lungs, and is there converted by an 
 unknown process into genuine blood, and forms part of the 
 mass of circulation. Many ingenious theories have been of- 
 fered to explain the manner in which the capillaries deposite 
 the particles that nourish the different organs of the body, but 
 it would be worse than useless to discuss them here. All that 
 is positively known upon the subject is, that no opening 
 
OUTLINE OP ANATOMY. 
 
 93 
 
 terminal mouths can be discovered through which these par- 
 ticles can escape from the vessels. It is probable that they 
 penetrate the coats of the vessels, or rather that they are con- 
 veyed through them by some inherent power of the cellular 
 tissue; for many substances are actually conveyed through such 
 membranes after death, where no openings can exist for the 
 purpose. In the complex animals the presence of the nerves 
 appears to be necessary to the due performance of nutrition, 
 and to the selection of the proper materials for each particular 
 organ. 
 
 OF THE FUNCTION OF ABSORPTION. 
 
 Fig. 18. 
 
 a, a, a, a. Lymphatic vessels proceeding to- 
 ward the thoracic duct. 
 b, b. Lymphatic glands. 
 
 The lymphatics are very small ves- 
 sels, somewhat like veins in structure, 
 conveying toward the heart a colour- 
 less transparent fluid, taken up by their 
 mouths or capillary branches from all 
 parts of the body. These vessels ap- 
 pear knotty from the immense number 
 of valves with which they are provided. 
 They divide and reunite again in the 
 most irregular manner in their course 
 toward the blood vessels. 
 
 The absorbent system is furnished 
 with very numerous glands. Those of 
 the lacteals have been already noticed, 
 and those of the lymphatics are similar 
 in structure. It is supposed that every 
 drop of absorbent matter passes through 
 at least one of these glands before it 
 reaches the circulation, and that it there 
 undergoes some change of structure to 
 prepare it for mingling with the blood. 
 When, as it is thought sometimes to 
 happen, any foreign or deleterious mat- 
 ter is taken up by the absorbents, the 
 gland or glands to which it \8 conveyed 
 are supposed to arrest its progress by 
 taking on inflammation, and thus em- 
 barrass the flow of the lymph until 
 the foreign matter loses its dangerous 
 character, or until the gland swells, suppurates, bursts, and 
 
 LYMPHATICS. 
 
94 OUTLINE OF ANATOMY. 
 
 discharges it from the system. The lymphatic glands, u. 
 fore, have been called the sentinels of the circulation. They 
 are very irregular in their disposition, but are commonly as- 
 sociated in greater numbers about the bends of the principal 
 joints, under and above the collar bone, and about the neck. 
 
 ' In the simple animals, it is certain that the general cellular 
 tissue enjoys the power of absorption, nor is it likely that this 
 tissue loses any of its proper functions in man. There is 
 strong reason to believe that the skin, the mucous membranes, 
 and free cellular membrane absorb certain substances with fa- 
 cility, but in man there are numerous vessels expressly de- 
 signed for a similar operation on a larger scale. They are 
 called the absorbent vessels. They are present in almost all 
 parts of the body, and are arbitrarily divided into two classes, 
 the lacteals, (fig. 18.) which have been already described, and 
 the lymphatics, which differ from the former only in the na- 
 ture of their contents. 
 
 We often see the course of the absorbents rendered very 
 obvious in a peculiar state of inflammation following slight 
 punctures with pins, nails, &c, or the bites of small animals, 
 such as rats, mice, squirrels, &c. 
 
 Such cases are very common when there is prevalent an 
 epidemic tendency to erysipelas. The wound becomes very 
 painful and wears a threatening appearance; red lines are soon 
 observed running along the limb, and when closely examined 
 we feel that they are caused by as many small hard cords, run 
 ning along beneath the skin, and extremely painful when 
 touched. These cords are inflamed absorbents, and their ap- 
 pearance has led to the popular, but mistaken notion, that 
 something poisonous is conveyed into the wound by the instru- 
 ments above named. The symptoms result entirely from the 
 well-known tendency of inflammation to run along the sur- 
 face of any organ that it attacks until it is arrested by some 
 barrier formed by a substance of a different structure and vi- 
 tal action. This barrier, in the case of the absorbents, is 
 formed by the glands. The inflammation generally advances 
 till it reaches a large joint, where it may be quietly arrested, 
 or, if the glands themselves inflame, the flow of lymph may 
 still be checked, the absorbents above the joint may be pro- 
 tected and the glands may suppurate and form a troublesome 
 abscess. If, however, the inflammation passes the first joint, 
 it generally continues in full vigour to the next, and so on, 
 until in some cases it reaches the body, and the patient's life 
 is then in the most imminent danger, either from the extension 
 of the disease to the blood vessels, or from the exhaustion pro- 
 duced by an immense abscess on the side. Several most dis- 
 tinguished professors of anatomy have lost their lives in thi^ 
 
OUTLINE OP ANATOMY. 95 
 
 manner from slight wounds received from the knife in dissect- 
 ing dead bodies. 
 
 If poisons are actually taken up by the absorbents, they 
 rarely display their effects on these vessels themselves, but 
 they may produce symptoms in the glands analagous to those 
 just described. Some poisons, like those of venomous snakes, 
 force their way into the circulation with rapidity, in spite of 
 all the guards, while others reach it very slowly, like those of 
 hydrophobic animals, if indeed there is really any virus pre- 
 sent in such animals; a question that is not positively settled, 
 however probable it may appear. The phenomena that are 
 produced by the bite of the rattlesnake and viper seem to 
 show that their poison is received directly into the blood ves- 
 sels without the intervention of the absorbents, and the same 
 is probably the case with most active poisons. 
 
 The strongest proof of the guardianship of the absorbent 
 glands, is the milder inflammation generally observed in those 
 that are seated in the immediate neighbourhood of cancer, and 
 many diseases of the skin; but the whole subject of absorption 
 is still involved in doubt, and the only fact absolutely ascer- 
 tained is the occasional introduction into the circulation of 
 matter foreign to the blood, through the lacteals, the lympha- 
 tics, and the veins. 
 
 OF RESPIRATION. 
 
 We have already described the general structure of the tho- 
 rax or chest, the cavity principally designed to accommodate 
 the organs of respiration. We have spoken of the curves of 
 the spine interested in the function of breathing; the form and 
 motions of the ribs and intercostal muscles; the position and 
 action of the diaphragm or midriff, and the mechanism of in- 
 halation and exhalation; but it is necessary, before we con- 
 sider the change in the circulating fluids effected by the lungs, 
 to add some farther remarks upon the most essential parts con- 
 cerned in the act of breathing. 
 
 APPARATUS OF RESPIRATION. 
 
 Between the root of the tongue and the upper extremity of 
 the gullet, we find the opening into the canal which conveys 
 the air into the lungs. 
 
 The upper portion of this canal is called the larynx. It 
 forms the hard tumour which we feel when we grasp the upper 
 part of the throat with the fingers; and its most prominent 
 
96 
 
 OUTLINE OF ANATOMY. 
 
 part — much more elevated in the male than in the female — is 
 commonly called Adam's apple. 
 
 Fig. 19. 
 
 Fig. 20. 
 
 GLOTTIS, OR TRACHEA. 
 
 1, 1. Thyroid cartilage. 
 
 2, 2. Greater horns of cartilage. 
 
 3, 3. The vocal cords, or ligaments 
 
 of the orifice of the glottis. 
 4. Orifice of the glottis. 
 5, 5. Arytenoid cartilages, moveable 
 by muscles, and assisting in 
 regulating the voice. 
 6. Cricoid cartilage. 
 
 LARYNX SEEN EXTERXALLT. 
 
 1. The os hyoides, or bone of the root of the tongue. 
 
 2. One of the little horns of this bone. 
 
 3. One of the great horns. 
 
 4. The epiglottis, or cartilage which closes the windpipe in swallowing. 
 
 5. Membrane connecting the os hyoides with the thyroid cartilage. 
 
 6. Thyroid cartilage, or cartilage of Adam's apple. 
 
 7. Cricoid cartilage, forming the base of the larynx. 
 
 8. Part of the windpipe, or trachea. 
 
 The larynx is the organ of the voice. It is chiefly com- 
 posed of five very singular cartilages, covered by nervous 
 membrane, which enclose a large space every where but at 
 their upper end, where the membrane is folded upon itself in 
 
OUTLINE OP ANATOMY. 97 
 
 such a way as to resemble a valve, leaving a very narrow 
 chink for the passage of the air. 
 
 The two smallest of these cartilages are connected by move- 
 able joints to the lowest of the series. They are placed very 
 near each other, at the posterior end of the chink just men- 
 tioned; and two well defined ligaments or cords pass forward 
 from their base to the most prominent part of the larjaix, with- 
 in the folds of the membrane that forms the valve or partition, 
 keeping those folds upon the stretch, and thus determining 
 the size of the orifice. Many small and very delicate mus- 
 cles are connected with these cartilages, and their various ac- 
 tions render the cords just mentioned either tighter or looser, 
 so as to change the size of the opening, and consequently the 
 pitch and body of the voice. 
 
 One of the most curious of these cartilages, is placed just 
 behind the root of the tongue, where it may be seen in some 
 persons by looking into the mouth. Its shape is like that of 
 a leaf standing upright upon its stem. The broad surface an- 
 swering to the upper side of the leaf is directed backward to- 
 ward the spine, the back of the leaf toward the mouth, and 
 the stem is united below to the large cartilage which forms 
 the prominence or apple of the throat. This leaf rises high 
 over the orifice of the larynx, and when we eat or drink it is 
 drawn down over the opening so as to allow the food to slide 
 safely into the gullet. When this cartilage acts imperfectly, 
 either from accident or disease, nature still secures the air pas- 
 sages from being entered by the food; for the moment any 
 thing touches the orifice of the larynx, it is spasmodically 
 closed by its muscles, and a cough almost instantly blows 
 away the offending substance. Nevertheless, small substances, 
 such as coins, cherry stones, &c, do sometimes enter the tra- 
 chea, and it is a curious fact, that the moment they fairly pass 
 the orifice, the spasm ceases, because the continued stoppage 
 of the passage can no longer protect the lungs. 
 
 Below the larynx the air passage takes the name of the tra- 
 chea or windpipe. It is here composed of narrow strips of 
 flattened cartilages, like hoops — that enclose two-thirds of its 
 circumference or more, and are placed almost in contact with 
 each other. The tube is completed by a strong, tough, elas- 
 tic membrane, that continues from ring to ring along the whole 
 length of the windpipe, and fills up the space behind, where 
 the cartilages are deficient. 
 
 The inner surface of the rings, and their connecting mem- 
 brane, is lined by many fibres of a muscular appearance, run- 
 ning in different directions in different places. As little is 
 known of their use, I shall merely mention them. 
 
 The mucous membrane lining the mouth, nose, and gullet 
 
 13 
 
98 OUTLINE OF ANATOMY. 
 
 is continued into the orifice of the trachea, and lines the air 
 passages throughout their whole extent. It is here much 
 smoother than in the alimentary canal, and is deprived of the 
 folds that are seen in the intestines. It soon becomes extreme- 
 ly thin and delicate. 
 
 The windpipe enters the chest and continues to descend 
 near the spine until it reaches the third vertebra of the back, 
 where it divides into two great branches, called the bronchia?, 
 one of which passes to the right, the other to the left side. 
 
 The great blood vessels and nerves going to and from the 
 lungs are associated with these branches, so as to form with 
 them two considerable masses, which are called the roots of 
 the right and left lung. 
 
 The bronchia? are formed in the same manner with the 
 trachea or windpipe; but as soon as they enter the lungs, they 
 go on continually dividing and becoming smaller and thinner, 
 till their very minute ultimate ramifications reach every part 
 of those organs. Their cartilages are less regularly arranged, 
 and after the first divisions of these tubes have taken place, 
 they surround the whole circumferance of the canal. The 
 connecting membrane becomes more and more elastic as it ad- 
 vances, and the mucous coat is at last so extremely attenu- 
 ated that it is scarcely visible. 
 
 Throughout their whole course the bronchia? are attended 
 by the blood vessels, and both at length become capillary. 
 
 At their termination the bronchial ramifications open into 
 the air cells of the lungs, which are little membranous sacks, 
 so small as to be almost invisible, and their coats too thin for 
 a close examination. These cells compose nearly the whole 
 substance of the lungs, and the ultimate capillary blood ves- 
 sels are every where ramified over their surface, thus bring- 
 ing the blood almost into contact with the air that they con- 
 tain. 
 
 Between the air cells there is a little common cellular tis- 
 sue, which connects them together, and forms what is called 
 the substance of the lungs. It is the seat of pneumonia or in- 
 flammation of the lungs, a disease that differs very widely 
 from inflammations of the outer surface of the organ, and also 
 from those of the lining membrane of the bronchia?. There 
 are also numerous small glandular bodies called bronchial 
 glands, of which the use is imperfectly known; they are ge- 
 nerally found near the tubes from which they take their name. 
 The substance of the lungs is nourished by small blood vessels 
 arising from the intercostal or other vessels belonging to the 
 arterial tree of the left side of the heart, and thus the arteries 
 of the right or pulmonary side are left free to perform the sin- 
 
OUTLINE OF ANATOMY. 
 
 gle function of respiration without being embarrassed with 
 the duties of nutrition. 
 
 The lungs, then, are composed, first, of an air-tube with 
 very numerous ramifications, communicating with the atmo- 
 sphere, and kept always open by its cartilaginous rings; se- 
 condly, of air cells for the reception of the atmosphere when 
 inhaled, communicating freely with the air-tube; thirdly, of 
 cellular membrane, interposed between all the various parts; 
 fourthly, of two distinct sets of arteries and veins; one for the 
 nourishment of the organs, derived from the left side of the 
 heart; the other, for effecting the change in the nature of the 
 blood that takes place in respiration, and derived from the 
 right side of the heart. Besides these more bulky parts, 
 there are the bronchial glands, the nerves and the absorbents. 
 
 The lungs, together with the heart and great vessels fill 
 nearly the whole cavity of the chest. When removed from 
 the body, and inflated by air blown into the windpipe, they 
 resemble in form the hoof of an ox, with the hinder part pre- 
 senting forward. When we examine them particularly, we 
 see that they are divided into two separate organs of the same 
 nature, connected together by the first great branches of the 
 windpipe; the right organ being partially subdivided into 
 three lobes, and the left, which is smaller, into two. The heart, 
 with its investing sac, lies in the middle space between the 
 two lungs in front, and the great vessels, the gullet, &c, pass 
 through the same space behind, so that the lungs are not in 
 contact with each other over the greater part of their prox- 
 imate surfaces. 
 
 Fig. 21. 
 
 a. The heart and great 
 vessels. 
 
 b, b. The right and left 
 
 lungs. 
 
 c, c. The diaphragm. 
 
 Each lung is en- 
 veloped in its own 
 proper serous mem- 
 brane, which covers 
 every part of its sur- 
 face, and is reflected 
 from its root, in a 
 
 THE VISCERA OF THE CHEST. 
 
 broad expansion that 
 stretches backward to the spine, and forward to the breast 
 bone, downward to the diaphragm, and upward to the edge 
 of the first rib. From these attachments it is continued over 
 
100 OUTLINE OF ANATOMY. 
 
 all the surface of the side of the chest, so as to form a com- 
 plete sac like the peritoneum, every where in contact with 
 itself, but so smooth and moist as to prevent all friction. 
 These two serous membranes are called the pleurae, their 
 inflammations are well known under the title of pleurisies. 
 
 Each pleura forms, then, a separate cavity, entirely cut off 
 from air or any other fluid than its own secretion, and the 
 two together divide the chest down the middle by a kind of 
 double partition; and, as the heart, closed in the pericardium, 
 lies between the two walls of this partition, the cavity of the 
 chest is divided into three great chambers having no commu- 
 nication with each other; one for the heart and one for each 
 lung. 
 
 OF THE FUNCTION OF RESPIRATION. 
 
 When blood is drawn from a vein, it is at first of a dark 
 purple colour, but after it has been for a short time exposed 
 to the external air, it becomes considerably brighter and re- 
 sembles blood drawn from an artery. This proves that the 
 atmosphere acts chemically upon the fluids of circulation when 
 removed from the body. Again, actual contact is not neces- 
 sary to the production of this change, for it takes place when 
 the blood is enclosed in a thin bladder, and suspended in a 
 draft of air. Now it is by no means certain, that the altered 
 character of the blood, in this experiment, is precisely the 
 same with that known to be effected in the lungs of a healthy 
 man, because a similar change of colour is produced by some 
 other gases besides atmospheric air and its several i 
 dients; yet the change sufficiently proves that chemical a. 
 may act on the contents of a vessel, through its coats, and 
 thus removes the difficulty of accounting for the alteration of 
 the blood in the vessels of the lungs, under the influence of a 
 portion of air which does not come into direct contact with it. 
 
 The blood enters the lungs, charged with a great amount of 
 carbon, which must be removed in order to fit it for the func- 
 tion of nutrition. The air drawn into the air cells, is com- 
 posed of two ingredients, the one, called vital air or oxygen, 
 a gas too stimulating to be breathed with impunity, when pure; 
 the other, called nitrogen, a gas that produces no effect on life, 
 and is merely useful, by diluting the vital air until it is weak 
 enough to be tolerated by the delicate structure of the lungs. 
 Now it is found that when the air is expelled by the lno| 
 is no longer composed simply of oxygen and nitrogen; a con- 
 siderable portion of the former gas is no longer seen, and in 
 its place we find an equal bulk of fixed air or carbonic acid 
 gas, formed by the union of the carbon of the blood with the 
 
OUTLINE OF ANATOMY. 101 
 
 oxygen of the atmosphere. So great is the quantity of this 
 fixed air given off by various animals in respiring, that, long 
 ago, it would have rendered the whole atmosphere unfit for 
 healthy existence, were it not for a most wise provision of 
 nature, that this poison thrown out by animals, should be em- 
 ployed as nutriment by vegetables. Plants absorb the surplus 
 carbonic acid of the atmosphere, and thus contribute to pre- 
 serve its purity. 
 
 So great a degree of condensation takes place when carbon 
 and oxygen unite to form carbonic acid gas, that the bulk of 
 the product is precisely the same with that of the aerial ingre- 
 dient, or in other words, the whole amount of carbon is dis- 
 solved without increasing the bulk of the oxygen with which 
 it combines. It is well known that heat is always given out 
 when the chemical union of two bodies is attended by con- 
 densation, and such is evidently the case here, yet we do not 
 find the heat of the lungs greater than that of other deep- 
 seated parts of the body: what then becomes of the caloric 
 eliminated in respiration? 
 
 We owe the happiest solution of this query to Mr. Craw- 
 ford, who found that the capacity for heat was greater in ar- 
 terial than in venous blood. The surplus heat given out by 
 the oxygen in uniting with the carbon, is therefore instantly 
 absorbed and concealed by the altered circulatory fluid; it 
 travels with it to the left side of the heart, from whence it is 
 distributed to all the nutritive capillaries of the body, and as 
 the blood undergoes the changes in these vessels, that reduce 
 it again to the venous character, its capacity for caloric, is 
 there gradually diminished, and the surplus heat is thus dif- 
 fused so as to produce that equality of temperature observed 
 throughout the body when in health. This theory is so sim- 
 ple and so beautiful that it would be almost a pity to overturn 
 it, but it is not considered as fully established. 
 
 The action of the lungs, is not entirely confined to the eli- 
 mination of the carbon of the blood, and the absorption of ani- 
 mal heat; it likewise contributes in no small degree to the re- 
 moval of the surplus water of the circulatory fluids, for the 
 air enters the lungs when nearly dry, but it always returns 
 loaded with moisture. In this respect it resembles the skin 
 in function, and may be said to aid in effecting a kind of per- 
 spiration. 
 
 Respiration, like all the other animal functions, is not abso- 
 lutely confined to the lungs in man, the gills in fishes, or the 
 branchiae in insects; for the simple animals that are not pro- 
 vided with a vascular circulation, or with any of the organs 
 just mentioned, evidently respire by the surface of the body, 
 
102 OUTLINE OF ANATOMY. 
 
 the only part brought into contact with a fluid containing oxy- 
 gen. It is equally certain that man also respires by the skin, 
 for not only is that superficial membrane constantly pouring 
 out vapour in the form of sensible or insensible perspiration, 
 but carbonic acid gas is also found escaping from it in the 
 same manner, without intermission. The complexity of the 
 human frame, however, renders it impossible for the skin 
 alone to free the whole amount of blood from its excess of 
 carbon, and the peculiar apparatus of respiration is therefore 
 superadded to complete the process. Still, it is well to re- 
 member that the lungs and the skin are designed to aid each 
 other reciprocally, hence, want of cleanliness, continued ex- 
 posure to cold or damp air, improper clothing, and all other 
 causes that tend to disturb the functions of the latter and to 
 check the escape of perspiration, necessarily compel the lungs 
 to perform double duty; they are therefore seriously oppressed 
 by such causes, and these are indeed the foundation of many 
 diseases of the lungs. 
 
 When any of the cavities of the body are ex-posed, or when 
 air is admitted into the common cellular tissue by a wound, 
 the same changes in the blood of the neighbouring vessels 
 takes place to a greater or less extent, or, in other words, we 
 respire by the injured surfaces. This occasions an increased 
 vital activity in the part, and is probably the cause why air 
 has been considered so powerful a stimulant by some writers. 
 The irritating qualities of air have been vastly exaggerated, 
 but the effect just noticed is actually produced, and it is there- 
 fore very well to exclude it from places where nature never 
 designed it to enter. 
 
 OF SECRETIONS. 
 
 We have already spoken of most of the very important se- 
 cretions under the foregoing heads. In treating on Digestion, 
 we mentioned the saliva, the pancreatic liquor, the bile, and 
 the intestinal mucus; under the head of respiration we spoke 
 of the disengagement of carbon and water from the lungs and 
 skin, and of animal heat from the general capillaries; all of 
 which products may be regarded as secretions. 
 
 Secretion, then, is the separation of certain substances from 
 the circulatory fluids by the capillary blood vessels. It takes 
 place in the interior of every organ, producing its growth and 
 renovation. It is seen on the external surface producing per- 
 spiration, on the internal surface in the form of mucus, and in 
 the lungs, effecting the separation of carbon and moisture from 
 
OUTLINE OF ANATOMY. 103 
 
 the blood. In the secretory glands, it elaborates fluids that 
 are generally rendered useful in some way or other before 
 they are ejected from the body. 
 
 There yet remains one of the most important secretions, of 
 which it is necessary to take some notice. I allude to the 
 urine. 
 
 OF THE URINARY APPARATUS. 
 
 The kidneys are two large glands destined to secrete the 
 urine. They are placed, one on each side of the spine, behind 
 the peritoneum, and opposite the two lower vertebrae of the 
 back and the two upper ones of the loins. The right kidney 
 is placed a little lower down than the left, to allow more am- 
 ple room to the liver, which is nearly in contact with it. These 
 organs, therefore, cannot be regarded as part of the contents 
 of the abdomen, and they have no connexion with the portal 
 blood vessels. 
 
 The form of the kidneys is too well known to require any 
 description; for those of the ox and the sheep, which are fre- 
 quently seen on the table of such as are not too fastidious in 
 their taste, convey an idea sufficiently accurate for the non- 
 medical inquirer. 
 
 The outer part of the kidney is so full of minute blood ves- 
 sels that when these are injected with wax, and the animal mat- 
 ter removed from around them by air and acid, they preserve 
 the general form of the organ, and present us with one of the 
 most beautiful anatomical preparations that can be imagined, 
 so much so, indeed, that it is not unusually employed as a 
 mantel ornament by anatomists! 
 
 On the inside of this vascular shell of the kidney we may 
 observe a paler substance, formed into a number of little nip- 
 ple-like eminences, all pointing toward the great fissure in the 
 middle and inner side of the gland. These eminences are 
 chiefly composed of very small vessels, or rather ducts, which 
 are arranged side by side in great numbers, and are designed 
 to convey the urine from the capillaries as it is formed. Each 
 nipple is generally enclosed in a separate membranous funnel 
 which receives the urine from the ducts, collects it, and then 
 pours it into a large membranous sac called the pelvis of the 
 kidney. 
 

 104 
 
 OUTLINE OF ANATOMY. 
 
 Fig. 22. a, a. Cortical substance. 
 
 b, b. The tubular portion, 
 c, c, c, c. The papillae. 
 
 d. The pelvis of the kidney. 
 
 e. The ureter, or duct, carrying 
 the urine to the bladder. 
 
 The pelvis of the kidney is 
 the common receptacle of the 
 urine from all the eminences 
 above described. It occupies the 
 greater part of the fissure of the 
 kidney, and from the side next 
 the spine it sends out a long ca- 
 nal or duct called the ureter, 
 which passes along behind the 
 peritoneum into the pelvis, where 
 it enters the bladder at its lower 
 part The urine flowing con- 
 stantly and without intermission 
 from the kidneys, through the 
 ureters into the bladder, collects 
 in this great reservoir until it is 
 convenient to evacuate it. The loss of this control over the 
 flow of the urine, which sometimes results from surgical in- 
 juries or disease, is one of the greatest evils that can befall hu- 
 manity. 
 
 SECTION OF KIDXEY. 
 
 The bladder, when empty, occupies very 
 
 little 
 
 :pace. 
 
 and 
 
 lies entirely within the pelvis; but when distended with urine, 
 it rises high into the abdomen, always in front of the bowels, 
 which it thrusts out of the way until in extreme cases it has 
 been known to rise even to the pit of the stomach. 
 
 The structure of the bladder resembles that of the hollow 
 bowels so fully described above. It has the internal mucous 
 coat,— but without valves or obvious villosity; — the condensed 
 cellular coat; and the external muscular coat, — over which we 
 find the peritoneum covering the upper end, a small portion 
 of the front, and somewhat more of the posterior side of the 
 bladder; but the extent to which this viscus is covered by the 
 peritoneum depends mainly on the degree of its distention at 
 the moment. The lower part of the bladder is always free 
 from such investment. 
 
 One of the strongest peculiarities of the bladder is the close 
 proximity of the three canals; the two ureters bringing the urine 
 to the reservoir, and the urethra conveying it to the surface: 
 their openings form a small triangle at the lowest part of the 
 organ. 
 
OUTLINE OF ANATOMY 
 
 105 
 
 Fig. 23. 
 
 K, 
 
 K. 
 
 L 
 
 L. 
 
 M, 
 
 ML 
 
 
 N. 
 
 
 O. 
 
 Q 
 
 Q. 
 
 
 R. 
 
 
 S. 
 
 u, 
 
 u. 
 
 
 V. 
 
 
 X. 
 
 A, A. The concave surface of the 
 liver turned up. 
 
 B. A small posterior lobe of the 
 
 liver. 
 
 C. The cleft where the portal 
 
 vein reaches the liver, 
 E, F. The gall bladder. 
 
 G. The pancreas or salivary gland 
 of the abdomen, lying across 
 the spine. 
 H. The spleen. 
 I. The ribs. 
 The kidneys. 
 Renal veins. 
 Ureters, or ducts, leading from 
 
 the kidneys to the bladder. 
 Aorta, or artery of the body. 
 Spermatic arteries. 
 Common iliac arteries. 
 Vena cava, or great vein of the 
 
 body. 
 Spermatic vein of the right side. 
 Common iliac veins. 
 The end of the colon, tied. 
 Commencement of the rec- 
 tum. 
 Y, y. Urinary bladder. 
 
 The Urethra is the membra- 
 nous canal that conveys the 
 urine from the bladder when 
 viscera, of the AiiiwMEN ajtd pelvis— evacuated. It is the seat of se- 
 
 THE STOMACH AND BOWELS BEING RE- 1 •» f..l J* ^„„ 1. i. •* • 
 
 MOYED# veral painful diseases, but it is 
 
 not consistent with our present 
 purpose to mention them here. 
 
 The urinary apparatus gives us an excellent idea o( the 
 structure and arrangement of the excretory ducts in general. 
 At the outer orifice of the urethra, the skin is reverted in- 
 ward, but almost as soon as it enters the canal, it assumes all 
 the characters of mucous membrane. The cuticle continues 
 to cover its surface for some distance, but soon disappears, 
 and the mucous membrane advances alone. When it enters 
 the bladder, it expands so as to line the whole organ, and then 
 proceeds through the little orifices of the ureters, which it fol- 
 lows throughout their whole extent On reaching the pelvis 
 of the kidney it again expands, lines the whole of those cavi- 
 ties, the funnel-shaped sacks, the nipple-like projections, and 
 in all probability, the ultimate urinary ducts likewise, though 
 the extreme minuteness of the last mentioned canals renders 
 their exact structure invisible. Such is the arrangement of 
 all the outlets of the body, whether found on the internal or 
 
 14 
 
I'OS OTTTLIWE OF ANATOMY* 
 
 external surface, whether they open into the bowels or on 
 the skin. Properly speaking, there are no such things as pas- 
 sages from within the substance of the body; for the intega- 
 ments dip into every cavity, and so line and invest it that 
 every part is covered either by the skin or mucous membrane, 
 or some reflection thereof. When a part is exposed to the 
 air it assumes the appearance of true skin, and becomes co- 
 vered with cuticle, whereas, if it is protected at all times from 
 such exposure, it retains or acquires the character of mucous 
 membrane. 
 
 OF THE URINE. 
 
 The Urine, the peculiar fluid secreted by the kidneys, is 
 very different in character in different tribes of animals, and in 
 various individuals. It even changes its properties in the 
 same individual, according to the nature of the diet and the 
 time of day, in health — or, according to the peculiar character 
 of the attack, in disease. 
 
 It is, however, one of the most important agents in the pu- 
 rification of the blood. It removes a very large portion of 
 the superfluous water from the circulation, and this is accom- 
 plished in so short a time after drinking, that many anatomists 
 were formerly deceived into the belief that there existed some 
 route by which water could be conveyed from the stomach ta 
 the bladder more directly than by passing into the blood. la 
 this particular the kidneys seem to aid the functions of the 
 skin, and it is well known that when perspiration flows freely 
 the quantity of urine is diminished, and generally becomes high 
 coloured. On the contrary, when perspiration is checked by 
 any means, without fever, the urine is generally more copious 
 and watery. 
 
 Urine contains a considerable amount of an animal substance 
 peculiar to itself, of which the largest constituent is nitrogen; 
 and it is, therefore, thought that the kidneys are designed to 
 separate from the blood the surplus of that element, which is 
 present in almost all parts of the body, and furnishes one of 
 the strongest distinctions between animal and vegetable mat- 
 ter in general. Most of the peculiar ingredients of the body 
 are occasionally present in the urine, and those which are ca- 
 pable of assuming the solid form, are sometimes known to 
 crystallize in the urinary passages, giving rise to gravel or 
 stone — one of the most painful diseases to which man is sub- 
 ject. Sometimes the stone forms in the pelvis of the kidney, 
 where it may grow and occasion inflammation and absce- 
 it may descend through the ureter, giving rise to most ago- 
 
outline of anatomy. 107 
 
 mzlng pain in its route. If it reaches the bladder it generally 
 remains unnoticed for some time, but as its growth is con- 
 tinual, it finally brings on violent irritation, and all the symp- 
 toms of the disease termed stone in the bladder. Sometimes 
 great numbers of small stones descend the ureters, and from 
 their diminutive size, are washed out of the bladder almost as 
 rapidly as formed, constituting what is commonly called gra- 
 vel. Now and then a piece of gravel unusually large gets 
 clogged or arrested in the urethra, or external passage. The 
 urine is then entirely checked, and prompt assistance is re- 
 quired to save the life of the patient. 
 
 We have now enumerated most of the essential systems 
 and organs of the human body, except a few which are not 
 fitted to appear in a popular work, and before we proceed to 
 mention the connecting bonds which cause this most curious 
 apparatus to act cowrectly and without disorder, it only re- 
 mains for us to add a few words upon the envelope or mantle, 
 which covers and encloses this complex machine, constituting 
 at the same time, the general armour of the system and a dis- 
 tinct organ for the performance of most important functions. 
 
 OP THE SKIN OR INTEGUMENT. 
 
 Fig. 24. 1 . The cuticle or scarf 
 
 skin. 
 
 2. The rete mucosum, 
 or coloured stratum 
 of the skin. 
 
 3. The papillae of the 
 skin, on the surface 
 of the true skin. 
 
 4. The cutis vera or 
 true skin. 
 
 5. The subcutaneous 
 cellular tissue. 
 
 6. Some fibres of cuta- 
 
 neous muscle. 
 
 The Skin or Integument, as we have already noticed in 
 our introductory sketch, is an envelope, enclosing the whole 
 surface of the body, composed of condensed cellular tissue, 
 with a horny and inorganic surface, which it secretes for its 
 own protection. It may be divided into three distinct layers; 
 first, the cutis or true skin; that part which may be converted 
 into leather by tanning; secondly, the rete mucosum, or mu- 
 cous net work; that part which gives the peculiar colour to 
 the races and varieties of mankind; and lastly, the cuticle, or 
 horny covering, which is insensible, inorganic, and seems like 
 a mere dried secretion, designed for the mechanical protection 
 
 gECTlOK or THE SKIJf. 
 
10S OUTLINE OP ANATOMr. 
 
 of the other layers. This division is carried farther by mo- 
 dern anatomists, but it is unnecessary to dwell upon minutia 
 in the present work. 
 
 The Cutis Veru i or True Skin. This is a very strong, 
 lough membrane, composed of the free cellular tissue which 
 forms the general bond of union between the various organs 
 of the body, gradually condensed, and strengthened by firmer 
 fibres. On its inner surface it is loose in texture, and rough, 
 but it soon becomes comparatively hard, without losing its 
 flexibility. It is every where covered with little holes or 
 rings, filled with softer matter, through which the capillary 
 arteries and veins, with the nerves and absorbents of the skin 
 pass and repass to the surface of the layer. 
 
 In some places, this layer is very thick and firm, as on the 
 palms of the hands and the soles of the feet, while in others it 
 is exceedingly thin and delicate, as in the neck and the bend 
 of the different large joints. In parts designed by nature to 
 sustain repeated shocks, the true skin becomes thickened by 
 frequent rough usage, but in those which are protected by 
 their situation, pressure is apt to occasion a thinning and ul- 
 ceration of the membrane. 
 
 The Rete Mucosum or Mucous Net Work. As soon as 
 the nerves and vessels of the skin have passed out through the 
 rings or meshes of the cutis, they display themselves on its 
 exterior surface. The vessels ramify and communicate with 
 each other to a great extent, and their attendant nerves are 
 enlarged and softened so as to become acutely sensitive to 
 every impression. This arrangement produces a great num- 
 ber of little eminences or projections, resembling in some de- 
 gree, the villi of the intestines. They are called the papillae, 
 and are formed of the naked, soft, and expanded terminations 
 of the most minute branches of the nerves of feeling, sur- 
 rounded by a multitude of capillaries, twisted, united, and in- 
 volved with each other in the most complex manner. 
 
 This arrangement is intended to give the greatest quick- 
 ness of sensation to the touch, and wherever great delicacy 
 of feeling is required, the papillae are more numerous and 
 better defined, as at the point of the fore-finger, the tip of the 
 tongue, &c. 
 
 These papillae, or villi, are protected by an extremely deli- 
 cate cellular tissue, filled, and surrounded by a kind of mucous 
 varnish, from which it takes the name of the rete mucosum, 
 or mucous net work. It forms the second, or middle layer of 
 the skin, in which is deposited the colouring matter that gives 
 variety to the complexion. When this colouring matter is 
 entirely absent in the white race, we observe that peculiar 
 transparency of the whole surface which marks the albino; 
 
OtJTLlNE OF ANATOMY. 109 
 
 and it is very remarkable that in such cases the peculiar colour 
 of the eye is also wanting, so that the blood vessels of that 
 organ, like those of the skin, shine through the surface and 
 give the iris a bright red tint, while the hair is rendered 
 snowy white, by the same general cause. A deficiency of 
 this deposite renders the complexion, the eyes, and hair, light, 
 as we observe it in persons of a scrofulous or consumptive 
 constitution, and an excess produces, in like manner, the dark 
 skin, the black eyes, and hair of the brunette. 
 
 The Cuticle or Scarf Skin, appears to be devoid of anima- 
 tion; it contains no blood vessels, no nerves, no cellular tissue, 
 but seems to be a mere incrustation on the surface of the rete 
 mucosum, by which it is thrown out. We see it elevated in 
 blisters, because the inflammation producing them, causes the 
 vessels of the skin to secrete a large quantity of serum in 
 place of the matter fitted to form cuticle. 
 
 The scarf skin is continually worn off by friction, and is as 
 constantly replenished from within. It is divided into little 
 squares or lozenges by numerous wrinkles running in various 
 directions and crossing each other. It is studded with hairs, 
 which are generally found at the intersections of the wrinkles, 
 and on the fingers and toes it is armed with nails. 
 
 It is a popular idea, to the truth of which the older physi- 
 ologists acceded, that the cuticle was perforated by innume- 
 rable holes, called pores, through which the perspiration 
 escapes to the surface; but this idea is now proved to rest upon 
 no solid foundation. The most minute microscopic investi- 
 gations show that there is no breach in the continuity of this 
 mantel: even the hairs, though their roots are found deeply 
 imbedded in the inner membrane of the skin, do not in reality 
 pass through it; for the cuticle is reflected inward around each 
 hair until it reaches the bulb, to which it adheres, and then 
 returns along the hair, with which it is so completely amalga- 
 mated that it is impossible to separate them. 
 
 Pores, then, do not assist in the skin, yet it is certain that 
 sensible and insensible perspiration, gases, &c. pass through 
 it from within, and it is highly probable that some substances 
 enter the system by the same route. This power of transmit- 
 ting gases or fluids, is now known to be common to all organ- 
 ized membranes, whether animal or vegetable, both during 
 the life and after the death of the individual to which they 
 belong; thus, if a piece of bladder, in which there exists no 
 opening, is tied over the mouth of a bottle of spirits, the water 
 of the spirits evaporates and passes through the bladder with 
 rapidity, while the more volatile alcohol is retained much 
 longer, so that the spirits, in time, become stronger; while, on 
 the contrary, if there be no bladder placed over the bottle, 
 
110 ©XTTLINE OF ANATOKT. 
 
 the alcohol will evaporate and leave most of the water he* 
 hind. 
 
 It is not by clogging the pores then, that dirt impedes the 
 flow of perspiration and injures the health, but by covering 
 the cuticle with a kind of varnish which necessarily impedes 
 the, exit of fluids through its substance, in the same manner 
 that a coating of resin prevents the passage of water or vapour 
 through a bladder. 
 
 OF THE FUNCTIONS OF THE SKIN. 
 
 The general function of the skin is to give form, grace, pli- 
 ancy, and afford protection to the surface of the body, as well 
 as to prevent the rapid evaporation of animal juices. The spe- 
 cial functions of the true skin, are to give support to the deli- 
 cate nervous filaments upon which the sense of touch depends, 
 and to furnish a secure foundation for the net work of minute 
 blood vessels that are distributed upon its outer surface, by 
 which the cuticle, nails, hair, and all other appendages are 
 formed, and the perspired matter secreted. The cuticle, as 
 has been already remarked, presents no appearance of organi- 
 zation, and cannot be considered as executing any peculiar 
 function; for in transmitting the perspiration, it probably acts 
 like any other animal membrane. We shall have occasion to 
 speak farther on the subject of the cuticle, under the heads of 
 cleanliness and clothing in the chapter on Hygiene. 
 
 OF THE NERVES. 
 
 All animals of complex organization require some medium 
 of connexion between their different organs, some established 
 government to direct the efforts of the various departments of 
 the system toward a common purpose — the growth, health, and 
 good order of the whole. This bond is furnished by the 
 nerves. 
 
 The Nerves, are small fibres or bundles of fibres passing from 
 one part of the body to another. They generally originate 
 in one or more masses, called nervous centres, and are distri- 
 buted at the other extremity, in minute divisions to all parts 
 of the several organs supplied by them. They are so impor- 
 tant, and their operations are so little understood, that we 
 may be excused for dwelling upon their history at some length. 
 If, by so doing, we should succeed hereafter in persuading our 
 readers that the long train of human ills usually classed under 
 the head of disordered nerves and nervousness are realK 
 
cOTTT&mE OF iLNATOOT. Ill 
 
 *wf©ng '-the most painful, unmanageable, and serious afflictions 
 to which we are subject, if I succeed in eliciting an occa- 
 sional sigh of sympathy for sufferings too generally witnessed 
 with a smile, or a sneer, the cause of humanity will be served 
 and my labour amply rewarded. 
 
 Nervous Matter, or the substance of which the nerves 'is 
 formed, is commonly divided into two kinds. 
 
 The one kind is gray, soft, and not very obviously fibrous, 
 and is found chiefly at the origin of the particular nerves, al- 
 though many anatomists are of opinion, that they are com- 
 posed of this kind of substance at both extremities. The 
 other kind of nervous matter is white, and is invariably ar- 
 ranged in well marked fibres, either separate or collected Ib. 
 tbundles. 
 
 When carefully examined by the mi- 
 croscope, aided by certain chemical mea- 
 sures, both these varieties of matter are 
 found to be ultimately composed of small 
 globules of a peculiar character united to- 
 gether by cellular membrane of extreme 
 delicacy. The globules are irregularly 
 placed in the gray, but are ranged in rows 
 in the white substance; and these rows al- 
 ways remain distinct; never mingling or 
 becoming confused in their course. Suck 
 a -row of nervous globules continued^ 
 without interruption, from the gray substanee in which it ori- 
 ginates to its termination at the surface or in the substance 
 of some organ of the body, constitutes what is called a nerv eus 
 Jilament. 
 
 *& Nerve is a cord composed of a number of nervous fila- 
 ments formed into a bundle, like a skein of silk after it is cut 
 and prepared for the thread-ease. In addition to the very de- 
 licate cellular membrane connecting the globules of which the 
 filaments are composed, each filament is generally found en- 
 veloped in a sheath of stronger cellular tissue, and the whole 
 nerve is also provided with a similar covering of still firmer 
 character. Small blood vessels are observed to enter the 
 nerves, and the ultimate branches are distributed throughout 
 the substance of their connecting membrane, in order to nou- 
 rish and enable them to maintain their functions. The strength 
 of the sheaths surrounding the filaments has induced many 
 anatomists to describe the nerves as collections of tubes filled 
 with nervous matter, but they are really solids composed of 
 the several parts just specified. 
 
 The consistence and colour of Nerves are somewhat diffe- 
 rent, in different parts of the system; their functions are equal- 
 
112 OUTLINE OF ANATOMY, 
 
 Jy various, but the relation between their structure and uses 
 is still among the unfathomed mysteries of nature. 
 
 The proper function of the Nerves is best expressed by the 
 term sensibility, but this word is not used here in its popular 
 acceptation, and we are, therefore, compelled to illustrate, at 
 some length, the extension which must be given to it 
 
 Each individual nerve, or corresponding pair of nerves, 
 has its own kind of sensibility; thus, those of the eye distin- 
 guish light and colours; those of the nose, odours; those of the 
 ear, sounds; some of those of the tongue, flavours; those of the 
 surface, touch; and thus far all is perfectly intelligible. Hut 
 there are other nerves whose powers bear little or no ro 
 blance to what is commonly called sensation. Hunger, thirst, 
 and some other obscure feelings perceived by the nerv 
 the stomach or bowels, are indeed, in some nalagous 
 
 to the five external senses; and, by using the word sensation 
 metaphysically, we may apply it to the feeling of anger, affec- 
 tion, and many other instincts, each of which has its appro- 
 priate set of nerves, forming part of the substance of the brain. 
 How different these characters arc from those of the nerves of 
 voluntary motion, which may be torn or twisted without 
 giving pain to their owner, and perceive nothing but the man- 
 dates of the will which they convey to the muscles, compel- 
 ling them to execute the orders of the mind ! Still m 
 ly removed from our received notions of sensation are the 
 powers of the nerves of involuntary motion, for in health, the 
 mind remains alike unconscious of the impressions made on 
 them, and the actions which they determine; — yet even those 
 nerves receive impressions from various causes, either internal 
 or external, and proceed to the accomplishment of their right- 
 ful duties, as if endowed with a special intelligence, not under 
 the cognizance of the brain; and we can find no better term 
 than sensibility, by which to express their function. 
 
 The connexions of different nerves, take place in two dis- 
 tinct ways, we have already stated, that the filaments arc not 
 obviously combined together in any part of their course, but 
 single threads, or groups of threads, from a bundle or nerve, 
 are continually passing off in various directions to be distri- 
 buted to the organs, or to unite with similar threads from 
 other sources, to form a new nervous trunk. We often ob- 
 serve a number of nerves, thus divided and reunil 
 and again, until they form trunks, each of which contains - 
 filaments from every one of the parent trunks; hence, results 
 a nervous net work called a plexus. Now, these resulting 
 nerves must possess compound functions, for each filament 
 still retains the powers peculiar to its parent trunk, so that if 
 such a trunk be divided or injured, the paitfl supplied by it 
 
OUTLINE OF ANATOMY. 
 
 113 
 
 may be deprived of several powers at once. For instance, 
 each of the great nerves of the extremities originates in the 
 spine by two distinct cords, which soon unite together as do the 
 branches in a plexus; or rather, they are each formed of two 
 nerves, which unite near their origin to form one trunk. If 
 we cut the posterior nerve above the point of union, the cor- 
 responding member loses the sense of feeling; if we divide the 
 anterior nerve in the same manner, the limb loses its capacity 
 for voluntary motion; but if we divide the united trunk, or 
 any of its branches, we instantly deprive the parts supplied by 
 the dissected filaments, of both motion and sensation. 
 
 Fig. 26. 
 
 A. Spinal marrow viewed in front. 
 
 B. A spinal nerve. 
 
 C. Anterior root of a spinal nerve. 
 
 D. Ganglion of the posterior root of a spinal nerve. 
 
 As the nature of this mode of communication is very im- 
 portant in a practical point of view, I will give it one more 
 illustration, at the expense of being compelled to anticipate a 
 few statements belonging properly to other departments of the 
 work. It is known that when any part of the body is injured, 
 and the nerves of that part partake of the injury, the morbid 
 effects of that injury are not confined to the corresponding ex- 
 tremity of those nerves, but that the portions of the brain, 
 spinal marrow or other nervous centres, in which the other 
 extremity of the nerves terminate, are also affected, and this 
 arrangement is indeed indispensable; for, by no other means, 
 could those nervous centres receive instant intelligence of the 
 mischief done, or threatened, so as to call into action the gene- 
 ral powers of the system, to effect the work of defence or re- 
 pair. 
 
 Now if the injured nerve passes into no plexus on its way 
 to the nervous centre, the consequent irritation of the other 
 extremity is of course circumscribed within a small space, 
 
 15 
 
114 OUTLINE OF ANATOMY. 
 
 as when the eye is hurt by too powerful a glare of light, the 
 optic nerve having no connexion in its course wi'h any other 
 except its fellow on the other side, mischief occasional!; 
 suits at the spot where those nerves arise, but not immediately 
 in other parts of the spine or brain. But if the part injured 
 is supplied with nerves from a plexus; the irritation is fre- 
 quently extended to the origins of many or all of the nerves 
 that contribute to form that plexus. Ilence, arise very com- 
 plex symptoms from apparently simple causes, and a host of 
 phenomena too often classed under the vague head of sympa- 
 thy. Let us give one of the most simple examples. 
 
 A man receives a hurt upon the arm or leg. 1 -am, 
 
 for the injured nerves of feeling convey notice of the accident 
 to the brain, but this is not all. The m mo- 
 
 tion are intimately associated with those of feeling, and the 
 former are likewise disturbed by the injury, so that not only 
 is the patient led to avoid all motion of the part by the I 
 cise of the will, but nature, desiring to render assurance doubly 
 sure, deprives him in this way of the power of act 
 rously, in opposition to her dictates. Now, it is not i 
 prising that all the nervous filaments going directly to the 
 wounded spot are so affected that the part becomes painful, 
 and is deprived of motion; but the conservative efforts of na- 
 ture do not stop here. The nerves of each extremity are 
 numerous and leave the spinal marrow at various places, but 
 they are all associated and combined together by means of 
 plexuses; so that in severe injuries to any of their branch* I 
 the various trunks take cognizance of the accident through the 
 agency of their associated filaments, and thus the sensibility 
 and motive power of the whole member become disturb* 
 as to secure a desire or a necessity for keeping the whole 
 limb as much at rest as possible; thus indicating the first and 
 most important prescription in every case of local d 
 injury. 
 
 The train of effects is by no means finished at this point, 
 but we are not yet prepared to pursue it farther. Knough 
 has been said to prove the importance of this first mode of 
 communication between the nerves, and to point out the man- 
 ner in which nature herself guides the man of science in the 
 study of symptoms and the application of remedies, let! 
 him scarce any other duty than to second and support he: 
 ertions. 
 
 The other mode in which various nerves are associated, is 
 by ganglions, which are small masses of nervous matter. 
 terspersed with very loose cellular tissue, and sometimes with 
 animal oil or fat. These ganglions seem to answer the pur- 
 pose of little brains dispersed throughout the bodv, and hold- 
 
OUTLINE OF ANATOMY. 115 
 
 ing jurisdiction over the operations of certain parts of the sys- 
 tem. They possess no consciousness, at least in man. Many 
 of the inferior animals have no other general nervous centres 
 than a few associated ganglions, and display so little intelli- 
 gence, that they are supposed hy many, to be entirely devoid 
 of consciousness or will, we have already stated that these 
 animals are supplied exclusively by the nervous system of or- 
 ganic life. As we ascend in the scale of nature, we meet with 
 animals still devoid of a proper head, but provided with one 
 ganglion much larger than the others, to which they are all 
 subservient. These animals have consciousness, will, and 
 powers of voluntary motion. Their great ganglion has been 
 dignified with the title of Brain, but its intimate structure has 
 never been discovered. 
 
 Led on by the analogy between the functions of this great 
 ganglion, and the human brain, many physiologists have re- 
 garded the latter as a ganglion also — but the progress of mo- 
 dern anatomy has demonstrated the fact that the human brain 
 is in reality composed of a number of systems of nerves per- 
 forming various offices, and differing in function only, from 
 the nerves of sensation, motion and organic life. The reason 
 why this arrangement escaped detection for so many ages, 
 was, that the nerves of the brain are not generally collected 
 in bundles; nor are they invested, like the others, in distinct 
 sheaths. They are spread out, so as to form a kind of nervous 
 membrane, which is crowded into the head, like a crumpled 
 handkerchief, and nothing but the most delicate dissection can 
 unravel the confusion. In young children who have dropsy 
 of the brain, the head sometimes increases enormously in size, 
 and this nervous membrane becomes unfolded to a great ex- 
 tent by the water accumulated within it. The child often re- 
 tains its faculties for a long time, and, after death, the structure 
 above described, is very obvious. 
 
 The greater part of the ganglions, properly so called, belong 
 to the nerves of organic life. They are connected together 
 by nervous bands, so that they mutually influence each other. 
 All the nervous fibres from the viscera, or bowels, and those 
 that preside over the circulation, pass 'directly or indirectly, 
 into one or other of these ganglions, and the fibres which en- 
 ter the ganglion in this manner, often exceed in number those 
 which connect with its fellows. 
 
116 
 
 OUTLINE OF ANATOMY 
 Fig. 27. 
 
 a>a. A portion of intestine. 
 b, b. Part of the aorta or great artery. 
 
 c, c. Nerves of the intestine, following the course of the branches of the 
 artery. 
 
 The connexions of the ganglions of organic life with the 
 nerves of sensation and voluntary motion through the medium 
 of the spinal marrow of which we shall presently speak, in 
 man, are numerous; even the eye is not entirely unconnected 
 with them, and they are slightly associated by two routes 
 with the nerves of the brain itself. 
 
 These ganglions have the power of rendering the m 
 which centre in them independent, to a greater or less extent, 
 of all other parts of the system; but when acted upon by 
 powerful causes, they may produce strong impressions upon 
 the nerves of motion or sensation, and even on the brain. 
 Disease of these latter organs may also occasion morbid ac- 
 tions in the ganglions and their nerves, under certain circum- 
 stances; thus proving the universal connexion of the various 
 parts of the system with each other. Let us illustrate these 
 facts by examples. 
 
 Slight irritations of the intestines often give rise to diarrho?a 
 or to that disturbance of the circulation which is commonly 
 called internal fever, while the mind of the patient continues 
 clear, and he attends to his business without feeling any pain 
 or material uneasiness. In this case the danger is not immi- 
 
OUTLINE OF ANATOMY. 117 
 
 nent. Information as to what is going on is conveyed, so to 
 speak, to the ganglions, and nature intrusts the care of the 
 case to them, without alarming the brain and other nerves, 
 because their assistance is not required, and it is unnecessary 
 that the patient should be conscious of the mischief going on 
 within him. If the brain were troubled with messages upon 
 every little accident that occurs in the bowels, the man could 
 hardly digest his dinner in peace! 
 
 When the irritation is much more severe or extensive, its 
 effect extends beyond the ganglions, through the medium of 
 their connexions with other parts of the nervous system. Thus, 
 in spasmodic colic, the brain becomes perfectly conscious of 
 the mischief, and the patient suffers so intensely, that he in- 
 stantly seeks the relief which is so promptly necessary. In 
 spasmodic cholera, which is accompanied by universal irrita- 
 tion of the intestines, violent cramps of the voluntary muscles 
 take place; and in many cases of fever resulting from inflam- 
 mations of the lining membrane of the stomach or bowels, all 
 the functions both of the mind and body become impaired. Some 
 of the exemplifications of this law are very curious. Thus, an 
 injury to the spine, often occasions palpitation of the heart, 
 and diseases of the heart sometimes occasion all the symptoms 
 of irritation of the spine: a chronic disorder of the stomach 
 may produce total blindness; and the constant motion of sur- 
 rounding bodies occasions vomiting or sea sickness, by the 
 impression on the eye! With very delicate patients, in fevers, 
 the motion of a rocking-chair in a sick room may endanger 
 life! It is hardly necessary to adduce any more facts in or- 
 der to show that diseases may prove highly dangerous in some 
 cases before producing serious symptoms, and that the real seat 
 of a disease is often widely removed from the part apparently 
 most affected. 
 
 The spinal marrow, of which we have already spoken, is a 
 long mass of nervous matter, like the brain in many respects, 
 which fills the greater part of the canal in the spine or back 
 bone. It seems to be the centre of the nerves of motion and 
 feeling, most of which pass off from it in pains through little 
 holes between the several bones of the spine. These holes are 
 much larger than the nerves, and are filled by soft cellular tis- 
 sue, &c, which prevents the latter from being crushed or in- 
 jured by the necessary motions of the bones; but in certain 
 accidents, and in some diseases which occasion a thickening of 
 the soft parts, they are pressed upon, and of course palsied. 
 When the spinal marrow itself is firmly pressed upon, all those 
 parts which are supplied with nerves originating below the 
 injury are more or less completely deprived of motion and 
 sen.s-i'Inn: and if the iniurv tnlrpa place high up on the back or 
 
118 OUTLINE OF ANATOMY. 
 
 in'the neck, the nerves of organic life are disturbed in their 
 operations to such an extent that the patient must die. If the 
 injury is too slight to produce complete palsy, it not anfre- 
 quently produces irregular convulsions. When only a part of 
 the thickness of the spinal marrow is injured, there may be 
 a loss of sensation without loss of motion, and vice versa. 
 
 Among the lower order of animals which have a regular 
 skeleton, such as the reptiles, the spinal marrow is very large 
 in proportion to the whole mass of nervous matter, because 
 their brains are remarkably small, being suitably adapted to the 
 slender intelligence, or rather instinct, which is sufficient for 
 their wants; but as we ascend in the scale of nature toward 
 animals of more complex organization, we find the brain con- 
 stantly enlarging its proportions and complexity, until the spi- 
 nal marrow becomes a subordinate part of the nervous system. 
 
 OF THE BRAIN. 
 
 This grand and all-important organ, to the perfection of 
 which man owes his high ascendency among the works of 
 God, appears, at first, in the most imperfect animals that pos- 
 sess it, as a mere excrescence or knob on the upper end of the 
 spinal marrow; but becoming continually more and more in- 
 volved, as the complexity of the animal, and the multitude of 
 his necessities increases, until, in the lord of the creation it 
 constitutes one of the most occult and difficult studies which 
 the mind of man has attempted to grasp. Even the mere ar- 
 rangement of its parts has escaped for ages the acuteness and 
 the untiring industry of professed anatomists, and vain would 
 be the endeavour to explain to the general reader, even the 
 little now known of its structure and functions. A few broad 
 and bold outlines, such as are absolutely necessary to the com- 
 pletion of this anatomical view, are all that can be attempted 
 here. 
 
 When the bony case which contains the brain is laid open, 
 we find it lined, throughout its whole extent, by a strong, 
 thick, pearly, fibrous membrane, which even extends itself 
 into the spinal canal containing the marrow. This membrane 
 adheres strongly to the bones over which it passes, and a- 
 in supplying them with blood vessels. It answers the pur- 
 poses of an internal periosteum, but as its adhesions are not 
 so firm as those of that membrane when the top of the skull 
 is raised, it is torn loose from the bone, and continues to co- 
 ver and conceal the brain. It is called, by anatomists, the 
 Dura Mater, and is regarded as the outer membrane of the 
 brain. 
 
OUTLINE OF ANATOMY. 119 
 
 The inside of the dura mater is lined by another membrane 
 so exceedingly thin and delicate that its existence is difficult 
 to prove, except in certain stages of disease, on which account 
 it is called the arachnoid or spider web membrane. It is re- 
 flected from the dura mater so as to cover also the whole sur- 
 face of the mass of brain, but without descending into all the 
 inequalities of its surface. It enters some of the great fissures 
 of the brain, and lines, also, certain cavities within the substance 
 of the organ. 
 
 This is a proper serous membrane, like the pleura in the 
 chest, and the peritoneum in the abdomen, and answers the 
 same purpose, namely, the prevention of friction from the mo- 
 tions of the brain. It is also liable to the same diseases, such 
 as violent inflammation and dropsy. 
 
 Immediately beneath the arachnoid, we find another mem- 
 brane much stronger than that just mentioned, but weaker 
 than the dura mater. This is the pia mater, or proper mem- 
 brane of the brain, which contains all the blood vessels which 
 go into and return from the substance of the organ. It dips 
 into all the inequalities of the surface, and lines the cavities 
 of the brain, lying under the arachnoid. The violent inflam- 
 mations of the head, attended with severe fever and delirium, 
 or phrensy, are generally seated in these membranes, and not 
 in the substance of the brain as is commonly supposed. 
 
 After the removal of the membranes, the brain itself comes 
 into view. It is a soft mass of gray and white pulpy matter, 
 looking, at first, like a long intestine crowded together upon 
 itself; but the convolutions, as they are called, are not com- 
 plete: the fissures that separate them are shallow, and below 
 them is found the central white mass of the brain, upon which 
 these convolutions are based. 
 
 If the brain be carefully lifted from the head, we shall find 
 it almost divided into two portions, the one small, and marked 
 by very narrow convolutions, lying underneath the hinder 
 part of the other, which is many times larger, and is covered 
 by much broader convolutions. 
 
 The first of these portions is called the cerebellum, or little 
 brain. It appears before the other portion in the order of for- 
 mation, and is found in considerable perfection in animals that 
 possess scarcely a trace of the larger and more important por- 
 tion of the brain. 
 
 The cerebellum is so intimately connected with the upper 
 extremity of the spinal marrow, that the former has been re- 
 garded by some physiologists as an excrescence upon, or pro- 
 duction of, the latter. A great number of nervous fibres from 
 the spinal marrow pass into the cerebellum, and are displayed 
 through its substance, terminating in its convolutions. These 
 
120 OUTLINE OF ANATOMY. 
 
 fibres constitute nearly the whole mass of the white or central 
 part of the organ. The reader will not be surprised, then, to 
 hear that the cerebellum exerts a very powerful influence over 
 the functions of sensation and motion, which are the proper 
 functions of the spinal marrow, and the nerves which form 
 it. But as these functions are performed by animals in which 
 the cerebellum can hardly be detected, such as the least per- 
 fect reptiles, it follows that this portion of the brain must ex- 
 ercise some office peculiar to itself. Physiological experiments, 
 and the history of disease, sufficiently show that it assists in 
 keeping the power of locomotion under the influence of the 
 will, and that it is the seat of the instinct which tends to the 
 continuation of the species. 
 
 The larger portion of the brain, already mentioned, is called 
 the cerebrum, and is the seat of the higher intelligences. It 
 is divided by three deep indentations on it's sides and base, 
 and another running lengthwise along its middle line, into six 
 lobes, ranged in order, by pairs, and called the posterior, mid- 
 dle, and anterior lobes. These parts, instead of being simple 
 in character, and all designed to contribute to one purpose, as 
 was formerly supposed, are now known to be composed of a 
 multitude of parts which defy description in a popular work, 
 each designed to fulfil the ends of its own creation. Among 
 the lower orders of the vertebrated animals, the first parts which 
 appear are those that form the back part and the base of the 
 cerebrum, which are supposed by phrenologists to be the seats 
 of those instincts which are necessary to self-defence, the pro- 
 tection of offspring, the procuring of suitable food, &c; and 
 it is a most curious fact, that the order in which the develop- 
 ment of these several parts is observed to take place, u 
 ascend in the scale of creation, corresponds astonishingly with 
 the habits of the several animals examined. The same remark 
 is true with regard to the order of their growth in man as he 
 advances from infancy to age, changing the form of his brain 
 according to the nature of his necessities, and his relations, and 
 duties in life. 
 
 It is only among the more perfect vertebrated animals that 
 we find the middle and anterior lobes of the cerebrum in a 
 state of considerable development; and the superior portions 
 of these lobes are brought to perfection in man alone. 
 
 According to the doctrines of the phrenologists, the back 
 part of the posterior lobes of the brain is the seat of those in- 
 stincts which are necessary to the protection of the offspring 
 during the helplessness of infancy; the lower part of the mid- 
 dle lobes is the seat of those propensities which are absolutely 
 necessary to self-defence, self-support, and the pursuit of ] 
 namely, the disposition to combat and destroy. 
 
OUTLINE OF ANATOMY. 121 
 
 Thus far, the doctrines of phrenology which have produced 
 so much discussion of latter years, may be regarded as fully 
 established; the evidence is too powerful to be resisted, as 
 " he who runs may read." The order in which these portions 
 of the brain are developed, both in ascending the scale of ani- 
 mated nature, and in the growth of the human embryo; their 
 comparative bulk in various animals, answering precisely to 
 the habits of those animals; their actual size in the different 
 sexes and individuals of the same species, corresponding with 
 their different duties and shades of character; the history of 
 insanity and idiotcy; and the influence of education and habit 
 on the form of the head, prove, beyond a doubt, the correct- 
 ness of the doctrine. But the functions of the other portions 
 of the brain, which are either peculiar to man, or are possessed 
 by him in common with but few other animals, are not so 
 easily determined. 
 
 As this is no suitable place for discussing in detail the pe- 
 culiar views of Drs. Gall and Spurzheim, I shall merely re- 
 mark that according to the doctrines of these philosophers the 
 anterior lobes of the cerebrum are the scat of those organs 
 which the mind employs in perceiving the relations and pro- 
 perties of external things, and in reflecting and reasoning upon 
 them; while the upper portions of the middle lobes are chief- 
 ly occupied by the organs of the moral sentiments and feel- 
 ings. 
 
 In offering this extremely imperfect sketch of the ground- 
 work of a much debated science, I do not design to express 
 any opinion, on the manner in which the principles of that 
 science have been carried out in detail, but the few facts which 
 have been stated possess a degree of importance in practice 
 which would have rendered their omission improper; for they 
 illustrate some beautiful positions in hygiene and the treat- 
 ment of disease, as will be seen in the sequel. 
 
 The reader must not suppose, however, that the whole mass 
 of the cerebrum is devoted to the independent and internal 
 actions of the mind. Presiding over, influencing, or deter- 
 mining, as this organ does, the purposes and effects of nearly 
 all the actions performed by the body and its several parts, it 
 necessarily requires a complex apparatus to connect it with 
 the other portions of the nervous system; no inconsiderable 
 part of this apparatus is contained within its substance, and 
 tends to increase its bulk. Like the cerebellum, it receives 
 from the spinal marrow a great number of fibres which spread 
 themselves out and pass on to the convolutions in a similar 
 manner. Other fibres, originating in the convolutions, run in 
 the opposite direction until they are lost in the spinal marrow. 
 From the basis of the brain, the nerves of smell, sight, and 
 
 16 
 
122 OUTLINE OF ANATOMY. 
 
 hearing appear to pass off, as do also those nerves which give 
 sensation and motion to the head and face; and the system of 
 organic nerves, is also connected with the brain in a manner 
 too complex to be here described. Thus the cerebrum is close- 
 ly associated with all parts of the animal economy, and the 
 mind, enthroned like a spider in the centre of his web, feels 
 the impulse of every impression made even on the remotest 
 confines of its dominion. 
 
 ON THE DUPLTCATURE OF CERTAIN ORGAN 
 
 It is a singular fact, that the organs most essential to the 
 mere existence of an animal; — those, I mean, which are found 
 in all, or nearly all animals, however simple; those which act 
 in a manner independent of the will, and without the indivi- 
 dual being conscious of their action — are, for the most part, 
 very irregular in form, and single. Thus, man has but one 
 stomach; and in those animals which are provided with more, 
 the different stomachs do not resemble each other, nor do they 
 fulfil the same purposes in the economy of the system: they 
 are, therefore, to be regarded rather as different organs mis- 
 called by the same name, than as duplicates of the same Ol 
 This is true with regard to the ox, and other ruminating ani- 
 mals which have several cavities commonly called stomachs. 
 In nearly all animals, there is but one intestinal canal, — the 
 exceptions to this rule being found only in a few species of 
 marine shell-fish. Man has but one heart, the two sides of 
 which do not resemble each other; his principal blood vessels 
 are single, and, if many of the main corresponding branches 
 passing to or from the opposite sides of the body resemble 
 each other in position, this results rather from the necessary ef- 
 fect of the form of the parts through which they pass, than from 
 their being formed by nature on the same model. Moreover, 
 the resemblance is never very strict, and the distribution of 
 the minute branches becomes exceedingly irregular and un- 
 certain. Parts of this single, or irregular character are called 
 the organs of vegetative or organic life. They fulfil the pur- 
 poses of digestion, nutrition, respiration. &c. — functions with- 
 out which no animal, however simple, can exist. These parts 
 of the body are governed, more immediately, by the iu 
 of organic life, which have been noticed alreadv. 
 
 But, on the contrary, those parts of the more perfect ani- 
 mals, which place them in connexion with surrounding t! 
 which are under the government of the will, or contribul 
 the perfection of the external senses, are always arranged in 
 pairs; the organs being almost exactly similar on the opposite 
 
OUTLINE OF ANATOMY. 123 
 
 sides of the body. Thus, man has two arms, and two legs, si- 
 milar, each to each. All the organs of his external senses are, 
 in like manner, double, even to the nose, which, though appa- 
 rently single, is composed of two nostrils, alike, or very near- 
 ly alike, in all respects. These duplicate parts are called the 
 organs of animal life, and are under the government of the 
 nerves of animal life, or, as it is sometimes called, the life of 
 relation. 
 
 There are other parts of the body, of a mixed character, 
 being partly under the influence of the will, and partly inde- 
 pendent of it, such as the ribs and muscles of respiration, &c; 
 and these parts, though double, are less symmetrical and more 
 subject to variety of form, than those which appertain exclu- 
 sively to the life of relation. 
 
 All parts of the brain are double; hence, the organs of 
 thought and of instinct are precisely alike on both sides of the 
 head, excepting in cases of individual or hereditary disease, and 
 if a portion of one side of the brain be injured or removed, it 
 is possible for the other side to execute all the mental opera- 
 tions; as a man may continue, after the destruction of one eye, 
 to see accurately with the other. But as a man sees but one 
 image of an object, although that object is painted on the re- 
 tina of each of his eyes, so his mind performs but one opera- 
 tion at a time, although both sides of the brain may be called 
 into action. Now, in order that the opposite portions of the 
 brain may always act in concert, and thus prevent confusion, 
 there are several bundles of nervous fibres within its substance 
 that pass from one side to the other, connecting the corre- 
 sponding parts with each other, and answering no other pur- 
 pose than to produce this consentaneous action. These con- 
 nexions are called the commissures of the brain. It is proba- 
 bly in part owing to a similar connexion known to exist be- 
 tween the optic nerves, that we see but one image with both 
 eyes, and that when only one eye is injured, both are so very 
 liable to inflame at the same time. 
 
 It would verge perhaps on the ridiculous, if we were to car- 
 ry our analogy farther, and conclude that because the eyes 
 perceive two images of the same object in squinting, that cer- 
 tain instances of mental obliquity might be accounted for, 
 upon the same principle; but, jesting aside, there are certain 
 mental phenomena displayed occasionally in disease, that ren- 
 der it at least probable that the two sides of the brain are ca- 
 pable, under certain circumstances, of acting independently, 
 and in a manner different from each other. The writer of 
 these pages formerly had the pleasure of a personal acquaint- 
 ance with a lady whose case, at one time, attracted very ge- 
 
124 OUTLINE OF ANATOMY. 
 
 neral attention, having been made public by the late Dr. Mit- 
 chell, of New York. 
 
 ' She became subject to convulsions, after having arrived at 
 mature age, and after the first attack had passed over, she was 
 found completely ignorant even of the alphabet, and it became 
 necessary to teach her like a child. Her progress, however, 
 was very rapid, and she soon acquired the command of lan- 
 guage, but her memory of past events was so completely lost, 
 that she read her bible with all the zest of novelty, and was 
 exposed to danger on several occasions, from her want of 
 knowledge of the habits of animals, and the properties of 
 things, with which she had been familiar from infancy.* Her 
 fits returned at long and increasing intervals, and after each 
 attack she remembered every thing that she had known at 
 the time of the preceding paroxysm, but was totally uncon- 
 scious of any occurrence that took place during the last inter- 
 val. Thus she appeared to possess two sets of ideas, which 
 intermitted with each other, and so complete were these changes, 
 that she might almost be said to have two individualities! 
 When in one condition, she was always seriously inclined, 
 somewhat taciturn, and disposed to melancholy; in the other, 
 she was loquacious, was lively, wrote poetry, was given to 
 reparte, and read novels with avidity. In both states, she 
 was decidedly intelligent, and became accomplished, without 
 displaying any traits that would have led a stranger to suspect 
 aberration of mind. 
 
 Many cases of this character are on record, and some of 
 them are too well authenticated to admit of doubt. 
 
 It is not pretended that these instances furnish positive 
 proof of the occasional independent action of the two sides of 
 the brain, for they may be explained, though not so simply. 
 upon other principles. They are noticed here, as strongly il- 
 lustrative of the complexity and mysterious character of that 
 machine, with which ignorance and empiricism have the au- 
 dacity to tamper so often and so rashly. 
 
 There is one circumstance connected with the duplicate 
 character of the brain, which it is highly important to men- 
 tion. 
 
 The fibres which have been already described, as connect- 
 ing the cerebrum with the spinal marrow, run across each 
 other near the place where they join the latter organ, so that 
 those which pass to or from the left side of the cerebrum, go 
 
 * She once seized a large rattlesnake by the tail, as it was entering a hole in 
 the ground, and owed her life to the strength of her intended prey and the 
 slipperiness of its integuments. 
 
OUTLINE OP ANATOMY. 125 
 
 to the right side of the spinal marrow, while those on the 
 right side of the former are connected with the left side of the 
 latter. This arrangement accounts for the remarkable fact 
 that, in fractures, or other severe injuries on one side of the 
 head which produce palsy or convulsions, these symptoms 
 generally occur on the opposite side of the body. When 
 palsy, or convulsions are confined to the same side with the 
 injury, it is rendered probable, (though perhaps not certain,) 
 that the cerebellum, or some of the parts near the summit of 
 the spinal marrow are wounded, and that the cerebrum has 
 escaped. 
 
 Here we will leave the subject of anatomy, after having com- 
 pleted such an outline as is fitted to amuse and instruct the 
 general reader. We may find it necessary, as we advance in 
 the work, to give some farther details with regard to particu- 
 lar organs; but when this is the case, the anatomical descrip- 
 tions will be found prefixed to the chapters, or sections, 
 which treat of the diseases of those organs. 
 
126 PHYSIOLOGICAL REMARKS. 
 
 CHAPTER III. 
 
 PHYSIOLOGICAL REMARKS. 
 
 If it be difficult to convey to the general reader any thing 
 like a complete notion of the structure of the human body, it is 
 still more difficult to communicate a knowledge of its various 
 actions. Hence, if we have been compelled to be v 
 ral in our anatomical remarks, we are under still stronger com- 
 pulsion to limit our range in the field of Physiology* Pur- 
 suing, then, the plan of teaching already adopted in this work, 
 we shall confine ourselves to the consideration of such points 
 only, as are both necessary to our future design, and intelligi- 
 ble to unprofessional readers; beginning with the most simple 
 ideas, and gradually enlarging the field of view as we ascend 
 to more complex operations. 
 
 Physiology is the science of life, and treats of the operations 
 and actions performed by living bodies when in a state of 
 health. It has been customary to give a different name to the 
 science that treats of the same actions when in a state of dis- 
 ease, which is called Pathology: but these branches are as in- 
 timately connected with each other as is the art of making a 
 watch, with the art of keeping it in order. However conve- 
 nient such a division of the subject may be for those whose 
 lives are spent in the prosecution of such studies, it is too ar- 
 tificial for our present purposes, and we shall disregard the 
 distinction in the few remarks which follow. 
 
 OF ASSIMILATION AND NUTRITION. 
 
 In the section of the last chapter, some idea of the me- 
 chanical process of nutrition was attempted to be given, but 
 nothing was said of the power by which an animal bod 
 lects, from the food taken into the stomach, or from the me- 
 dium by which it is surrounded, such particles onlv, as are 
 necessary to support the body, or the various organs which it 
 
PHYSIOLOGICAL REMARKS. 127 
 
 contains, while it rejects those particles which are noxious or 
 useless. Of this power we propose to speak at present. 
 
 We have already spoken of that singular property by which 
 animal membranes, such as strips of bladder, mucous membrane, 
 &c, are enabled to pass certain fluids through their substance 
 in preference to other fluids; and it has been shown that the 
 substances thus transmitted, are not always those which escape 
 most rapidly when exposed to the air, or left in a vessel un- 
 confined. The experiments of Dutrochet, Farraday, Mitchell, 
 Rodgers, and others, have proved that the same power exists 
 in all animal, and probably, in all organized membranes after 
 death, and a multitude of facts in the physiological history of 
 man and animals, might be adduced to show that similar ope- 
 rations are constantly taking place in the living body. 
 
 But there is a still more curious and important truth con- 
 nected with this subject. The same membrane will transmit 
 one substance with facility in one direction, while another 
 can only pass with freedom in the opposite direction! 
 
 Now, although both living and dead matter possesses this 
 power, there are many circumstances in the history of disease 
 and death, which prove that the vital principle exerts a con- 
 trolling influence over its displays. Thus, the colouring mat- 
 ter of the bile appears to be retained entirely in the gall blad- 
 der during health, and in bodies examined a few hours after 
 accidental death, we generally find the outside of that recep- 
 tacle of a natural colour with an unstained pearly surface; but 
 in persons who have been destroyed by hepatic complaints, 
 and those who have been dead for a considerable time, this 
 surface, together with the neighbouring bowels, are often 
 found deeply imbued with the yellow or brown colour of 
 the bile. Many other facts of a similar nature might be 
 mentioned, but it is suflicient for our present purpose to men- 
 tion one of them, which comes continually under the observa- 
 tion of every anatomist. It has been mentioned, in the appro- 
 priate section, that the cuticle, (see page 107,) which covers the 
 whole external surface of the body, is altogether divested of 
 openings or passages, and that the belief in the existence of 
 pores in the skin, is an error. This belief has resulted from 
 the appearance of the membrane, where its lines or grooves 
 intersect each other, and where the hairs are implanted. The 
 inference, that passages exist, drawn from seeing the skin be- 
 dewed with large and scattered drops of sweat, is equally 
 unfounded, for this appearance is at once explained by the 
 power of which we have been speaking, as resident in all ani- 
 mal membranes. It is now no longer doubtful that the skin 
 transmits outwardly through its substance not only the va- 
 pour of the insensible perspiration, but the fluid which bathes 
 
128 PHYSIOLOGICAL REMARKS. 
 
 the whole surface during violent exertion, or exposure to the 
 heats of summer, together with the salts well known to be 
 contained in this secretion. It is also known that the same 
 skin is capable of transmitting, inwardly, certain substances 
 which are applied upon its outer side, and this is done, with- 
 out the aid of any vessels, by a vital power residing in the 
 membrane itself, altogether different from capillary attraction, 
 or that power by which unorganized and spongy bodies im- 
 bibe a fluid which is placed in contact with them. That this 
 property of membrane is a vital and not a mechanical one, is 
 proved by the fact that it is diminished or arrested in certain 
 stages of disease, as, for instance, in the hot stage of certain 
 fevers, when the supply of blood to the surface is even greater 
 than usual — while it is increased a hundred fold in other mala- 
 dies, such as malignant cholera, when the external circulation 
 is almost destroyed! The very recent experiments of Dr. 
 Rodgers on this subject, {American Journal of Medical 
 Sciences, August, 1836,) appear like the dawning of a new 
 morning over the darkest regions of Physiol . 
 
 Now, although the mucous membranes of the alimentary 
 canal are believed to be deprived of cuticle throughout nearly 
 their whole extent, yet it does not follow that the extremities 
 of the lacteals, or other vessels, which take up the nutritious 
 particles of the food from the surface of these membranes, are 
 open, or that they ever reach quite to the cavity of the bowels. 
 Anatomists have never demonstrated the existence of any con- 
 nexion between the vessels and the surface, in any part of the 
 body, although our coloured injections of the blood vessels 
 are often carried to such a degree of minuteness that the fluid 
 employed flows into the intestines and fills them, — leaving the 
 colouring matter behind, in the vessels. But this result, as 
 well as the secretions of the bowels, and the absorption of the 
 nourishment of the system, may all be accounted for on the 
 principle already laid down; by which living membranes trans- 
 mit through their own substance, in opposite directions, the 
 various substances which nature designs to employ in, or re- 
 ject from the system. 
 
 Among the simplest animals, which are not provided with 
 nerves or blood vessels, and in which, if they have cavities, 
 the inner and outer surfaces are apparently alike, the whole 
 process of assimilation appears to be perfected by the external 
 membrane or tissue, without any other aid; but in the complex 
 animals and man, though the inherent powers of the tissue 
 still remain, the process of assimilation cannot be completed in 
 this simple manner. The chyle taken up by the lymphatics, 
 is not blood, though it is evidently an organized fluid: it must 
 pass through the lungs before it becomes fitted to nourish the 
 
PHYSIOLOGICAL REMARKS. 129 
 
 system. The lungs in man, then, assist in this process. The 
 blood is not muscle, though the fibres of muscles are formed 
 from the materials which are supplied from the blood by se- 
 cretion, and the same remark is true of all the various organs 
 of which the body is composed, and consequently, the process 
 of secretion is but a particular form of assimilation. 
 
 The same arguments which show that the reception of nou- 
 rishment into the system is, in all probability, the transmitting 
 power of the membranes — and chiefly, of the mucous mem- 
 branes — tend with equal force to prove that the secretion of 
 the materials of the different organs, or, in other words, orga- 
 nic nutrition, is also the result of the same power. The ves- 
 sels which supply the several organs of the body have never 
 been proved to terminate with open mouths, nor has it been 
 shown that they are porous — and although many medical doc- 
 trines have been based upon the supposition that they are con- 
 structed with one or other of these species of orifices — the 
 idea is purely hypothetical. It amounts to no more than a 
 guess, or if supported by seeming facts, these are the result 
 of microscopic observations of a very questionable character. 
 On the other hand, the doctrine which attributes the nutrition 
 of the organs to the transmitting power of the membranes 
 which form the coats of the vessels, and enclose the particles 
 of the organs and tissues, (see page 126,) stands upon facts of 
 greater weight, because they can be observed on a greater 
 scale. 
 
 In the present state of our knowledge, then, it is more cor- 
 rect to consider the first and last steps of nujrition, as well as 
 the formation of secretions as phenomena, characteristic of the 
 vital organization of tissues, and not produced, as is still gene- 
 rally believed, by the blood vessels themselves. 
 
 These remarks may appear to contradict the opinion de- 
 fended in the first chapter of this work, where it is urged that 
 the cellular tissue is the fundamental tissue, by which all parts 
 of the body are formed, and in which their particles are depo- 
 sited; for, it will be asked, if there is but one fundamental 
 membrane in the body, and if all the other tissues are composed 
 of this, and certain matters thrown down into its cells; and if 
 it be true that absorption and secretion are the result of a pro- 
 perty inherent in the membrane, how can it happen that all 
 parts of the body do not absorb and secrete in the same man- 
 ner? The answer is a plain one. The interstitial deposites 
 do certainly modify the vital powers of the organs or com- 
 pound tissues into the formation of which they enter. They 
 are new agents in the vital chemistry of the parts; and it would 
 be as unreasonable to suppose that cellular tissue complicated 
 with bone or muscular matter, would produce precisely the 
 
 17 
 
130 PHYSIOLOGICAL REMARKS. 
 
 same action with cellular tissue in a free state, as to suppose 
 that sulphuric acid combined with lime or potash, would act 
 in' the same manner with sulphuric acid when in its pure or 
 isolated condition. The experiments of Dr. Rodgers suffi- 
 ciently prove that, the transmitting powers of the peritoneum, 
 the mucous membrane, the substance of the liver, and the 
 bladder are widely different from each other, while they are 
 sufficiently energetic to effect the decomposition of metallic 
 salts even after the tissues have lost their vitality! When it 
 is recollected, in addition to these facts, that in the more com- 
 plex animals, the nerves exert an important influence in modi- 
 fying, according to circumstances, the vital properties of the 
 parts to which they are distributed, it cannot appear surprising 
 that we should witness such various effects in different por- 
 tions of the body, from the operations of assimilation and nu- 
 trition. 
 
 But, in the former chapters of this work we have spoken 
 of the capillaries as active agents in the two intimatelv 
 ciatcd processes just mentioned; and this may lead the reader 
 to tax us with inconsistency, in Attributing such extensive 
 powers to the tissues themselves. Let us, then, explain the 
 agency of the blood vessels, in the support of the principal 
 functions of organic life. 
 
 The blood vessels are the conduits which convey the fluids 
 that have undergone that process of assimilation which fits 
 them for nourishing the several organs of the body, to the 
 parts where they are required. They also convev those mat- 
 ters which have ceased to be useful, to the different apparatus 
 designed to discharge them from the system. The capillaries, 
 by means of their strong fibrous coats* and their capability of 
 dilating or contracting extensively, determine, in great d< g 
 the quantity of blood directed to any particular part, and the 
 rapidity of its motion when there. So lon^ as a part remains 
 healthy, it is a general rule that the greater the amount of 
 blood which passes through it in a given time, the more active 
 are its functions; but the reverse of this is often observed in 
 disease, for the excessive and rapid supply of blood will some- 
 times arrest the functions, as has been remarked of the skin in 
 the hot stage of some fevers, and an extreme slowness of the 
 circulation sometimes appears to favour certain secretions: 
 which fact, as we have already mentioned, may be observed 
 in the skin and mucous membranes during the malignant cho- 
 lera. The power of the capillaries in regulating the circula- 
 tion, is much influenced by the nerves, which thus exert an 
 indirect influence over the processes of assimilation and nutri- 
 tion not less important than their direct eflect on the vital pro- 
 perties of the tissues. 
 
PHYSIOLOGICAL REMARKS. 131 
 
 But the nerves themselves depend upon the capillaries for 
 the preservation of their own functions. If they are supplied 
 freely with blood, they act with energy, and under other cir- 
 cumstances they generally become debilitated, and nutrition 
 is carried on with greater or less facility, according to the con- 
 dition of the nerves of the part. 
 
 Again, if the quality of the blood be vitiated, as it may be 
 by improper diet and other causes, both the nerves and the 
 other tissues must suffer for the want of their proper stimulus, 
 and the materials for their support, and assimilation and nutri- 
 tion must necessarily become disordered. 
 
 It appears, then, that the processed of assimilation and nu- 
 trition, the most important functions of the animal organiza- 
 tion, depend upon four principal circumstances: — 1st, the con- 
 dition of the membrane; 2d, the proper composition of the 
 blood; 3d, the action of the blood vessels — and4lh, the influ- 
 ence of the nerves. The disorder of either of these circum- 
 stances is sufficient to induce disease; and as they are all by 
 nature mutually dependent on each other, it follows that nei- 
 ther of them can be disturbed without affecting all the others. 
 It is often impossible to determine where the first link in the 
 chain of morbid action is located; and it is sometimes equally 
 difficult to discover the starting point in the train of causes 
 which produce disease. Witness the history of epidemics and 
 hereditary affections, — the former resulting from some wide- 
 spreading physical influence, perhaps — like the secret agents 
 which engender cholera and influenza — co-extensive with the 
 whole globe: the latter, consequent upon the misfortunes, and 
 it may be, the crimes of our progenitors! 
 
 It has been customary for the unprofessional public to smile 
 at the science of medicine, because its teachers and distin- 
 guished fellows have differed widely from each other in their 
 theoretical opinions; but it should be remembered that short 
 of the dogmas of revealed religion, there are no indisputable 
 truths but those of well demonstrated mathematical proposi- 
 tions. 
 
 The doctrine of gravitation, by means of which the science 
 of mechanics has been brought to its present high perfection, 
 is founded upon a mere hypothesis — a word of eleven letters 
 used to express what none can comprehend! Eclipses were 
 calculated long before the days of Newton by those who 
 thought the sun moved while the earth stood still, and whose 
 descendants now believe the world to be a plane! 
 
 No one will pretend that the theories of Newton have not 
 been of incalculable advantage in the application of science to 
 the practical affairs of life; yet they do not explain the first 
 cause of any planetary movement — and already the progress 
 of the chemistry of imponderable fluids begins to threaten the 
 
132 PHYSIOLOGICAL REMARKS. 
 
 foundations of his system. Its just conclusions, indeed, can- 
 not be overthrown, for they rest upon innumerable observa- 
 tions. Just so, the various medical theories which have chased 
 each other rapidly into oblivion from the times of Hippocrates 
 to those of Broussais — though all are partial and imperfect — 
 have tended, each in turn, to advance the science and give 
 birth to ideas more and more important and correct.* They 
 are like so many steps or terraces upon the mountain of science, 
 whose summit, illuminated by the clear rays of truth, is wise- 
 ly placed above the region of the clouds, unattainable in this 
 state of existence. 
 
 The chief cause of the diversity of medical theories has 
 been the habit of attributing the phenomena of the disease 1o a 
 disorder in only one or two of the four circumstances enume- 
 rated as influencing the processes of assimilation and nutrition, 
 to the neglect of the others. Thus, the solidists accounted 
 for all morbid actions by attributing them to changes in the 
 condition of the tissues, forgetful of the obvious fact that those 
 very changes are the result of previous disease, and, therefore, 
 cannot be regarded as a safe starting point in medical reason- 
 ings, though they furnish satisfactory explanations of many 
 important symptoms. 
 
 The humoratisis, on the contrary, referred every thing to 
 the condition of the fluids, unmindful of the fact that these 
 very fluids are formed by the action of the solids upon exter- 
 nal matter. The followers of Cullen directed their attention 
 chiefly to the condition of the capillaries and the nerves, to 
 the exclusion of the blood and the other tissues. Waving the 
 less detailed doctrines of Brown and Rush, the theory of 
 Broussais carries generalization to a greater extent than any 
 of its predecessors; but it was scarcely matured, before many 
 facts were accumulated which could not be embraced within 
 its limits! 
 
 In the midst of all these revolutions of opinion, the science 
 has been steadily advancing, and continually arranging in sys- 
 tematic manner, a larger and larger circle of facts. We are 
 
 • We must refuse this praise to some of those wild dreams which now agi- 
 tate the public mind— such as that German doctrine which teaches that the 
 half is greater than the whole! and that the best mode of rendering a disease 
 better is to make it a little worse.'— the still less rational position of those who 
 hold, that because mineral medicines are sometimes poisonous, we should con- 
 fine our treatment to the use of vegetables and "herbs;' which are often much 
 more poisonous!— and the opinions of those who think that " life is fire.'"— and, 
 like the Ghebers of old, worship its personifications in cayenne pepper and the 
 hot bath! These may be classed with the fancies of Paracelsus, when that 
 great reformer "drew upon his imagination for his fads." These doctrines 
 are intangible, and the medical profession has no pecuniary interest in opposing 
 their ascendency, for they certainly do not diminish its emoluments. 
 
PHYSIOLOGICAL REMARKS. 133 
 
 still far from the comprehension of first causes in Physiology; 
 but those who tax the profession with empyricism, in conse- 
 quence of the apparent contradiction between contending opi- 
 nions on medical theory, betray a partiality and narrowness 
 of judgment. All the doctrines noticed are true to a certain 
 extent, and all have contributed their share in promoting the 
 application of truth to practice. Even when they sink beneath 
 the scythe of Time, their influence continues to add strength 
 to those which rise upon their ruins, as the decaying tree gives 
 richness to the soil from which the stem of its successor draws 
 its nutriment. 
 
 As the processes of assimilation and nutrition, viewed in 
 the very extensive sense which we have given them, include, 
 directly or indirectly, all the Oligemic functions of an animal, 
 their disorders embrace the whole field of morbid action, or 
 disease, so far as it results from the operation of external causes. 
 The nature of life itself, and of the nervous influence, like gra- 
 vitation, chemical reaction, and all other first causes in philo- 
 sophy, is placed beyond the limits of our knowledge, and 
 though there is much in the history of epidemics and heredi- 
 tary disease, which tends to prove that these causes themselves 
 are altered in their action by changes in the organization of 
 the individual, or by atmospheric influences, it is at present in 
 vain to argue upon the modifications of disease which proba- 
 bly result from these alterations. In this department of our 
 science, the duty of the physician is now, and in all probabi- 
 lity will for ages continue to be the accurate observation and 
 careful record of isolated facts. 
 
 OF THE REPRODUCTION OF PARTS, AS DISPLAYED IN 
 THE HEALING OF WOUNDS. 
 
 The mechanism of nutrition in the first production of the 
 human body, is a subject involved in extreme obscurity and 
 difficulty; nor is it at all adapted to the character of a popular 
 work. But, in the history of the healing of wounds, we are 
 able to perceive, more clearly, the mode in which nature pro- 
 duces the several organs of the body, by means of close obser- 
 vation on her mode of operating in the reproduction of parts 
 of the body which have been divided or removed by acci- 
 dent. 
 
 When a clean cut has been made by a sharp instrument, in 
 a part which contains no very large blood vessels, it is ob- 
 served that the nerves of the part are stimulated; or, in other 
 words, the patient suffers pain, if the wound occur in any or- 
 gan supplied with nerves of sensation. Very soon after this 
 
134 PHYSIOLOGICAL REMARKS. 
 
 moment, the capillary vessels of the part are found enlarged, 
 and more blood is admitted into the neighbourhood of the in- 
 jury than is usually found there. This proves that the circu- 
 lar or muscular fibres of the capillaries have been relaxed, and 
 that the vessels are increased in size. As an inevitable conse- 
 quence, the colour of the part is heightened, and so long as 
 the process is consistent with health, the functions of the part 
 are increased in rapidity, its hue approaches to that of arterial 
 blood, its sensibility is increased, its temperature is elevated 
 above the customary standard, and the part is in some degree 
 swelled or enlarged. This condition has been erroneously 
 designated by a term which is invariably associated with the 
 idea of local disease. This term is inflammation. 
 
 Inflammation is described to be a state of any particular part 
 of the body, characterized by an increase of heat, redness, 
 swelling, (i. e. fulness,) and pain, (i. e. sensibility.) A better 
 description of high health could hardly be given! If we com- 
 pare the young child with the adult man, we find him distin- 
 guished by a comparatively greater amount of heat, redness, 
 fulness, and sensibility! — that is, he labours under universal 
 inflammation! If we were to examine the fcetus before 
 birth, it would be found possessed of these same characteris- 
 tics in a still greater degree, if the term sensibility be extend- 
 ed to the perceptions of the nerves of organic life! After a 
 hearty meal it is well known that the heat, redness, fulness, 
 and sensibility of the stomach are decidedly increased — and 
 this increase is carried so far that symptoms analogous to a 
 slight chill and fever are the natural consequence. In the 
 terms of the definition, then, it would be perfectly logical to 
 say that, after dinner, a man labours under inflammation of 
 the stomach — a very serious disease called gastritis by phy- 
 sicians! 
 
 The very close analogy between the healthful operations of 
 the body in restoring wounded parts, and the phenomena of 
 actions universally acknowledged to be morbid, has led many 
 professional writers to the adoption of the term ''healthy inflam- 
 mation" to signify the former class of vital effects. But the 
 employment of the same name to designate states, both of 
 health and disease, is calculated to produce endless and inex- 
 tricable confusion in the minds of those who seek information 
 in the science without the means and leisure to become pro- 
 found. I shall, therefore, reject the term inflammation in the 
 present work, while speaking of the healthful process by which 
 parts are reproduced, reserving it as a title for certain* morbid 
 trains of symptoms which will be described hereafter. 
 
 In perfectly simple cuts, occurring in healthy individuals, 
 the process of restoration is exceedingly easy, provided the 
 
PHYSIOLOGICAL REMARKS. 135 
 
 <5«t surfaces be kept accurately in contact with each other by- 
 mechanical means. The vital actions of the part being ren^ 
 dered more active in the manner already described, the wound- 
 ed cellular tissue pours out a glutinous fluid analogous in ap- 
 pearance to that which fills the cells of the foetus at a very 
 early stage of growth, and that which is found in the structure 
 of the simplest animals. This fluid gradually hardens, bind- 
 ing the cut surfaces together, until, in a few hours, it becomes 
 a part of the cellular tissue, and soon afterwards, minute 
 branches of blood vessels from the neighbouring trunks are 
 found to have penetrated it in all directions, so as to consti- 
 tute it regularly a portion of the living body. If the health 
 and constitution of the patient be good, this process is effected 
 promptly, and without accident. Hence the extreme folly of 
 those nostrums which are so often administered in "fresh 
 cuts," and which are so exceedingly prone to produce the very 
 mischief they are applied to prevent. Afresh cut requires 
 no other precaution, after the bieeding is checked and the 
 wound cleaned, except that its edges should be kept in con- 
 tact as nearly as possible, and the external air excluded as 
 completely as convenience will permit. If the patient be very 
 weak, or unusually excited, the part may become diseased and 
 may then require other treatment; but these conditions will 
 be considered hereafter. 
 
 When a compound organ, such as a bone, muscle, or nerve, 
 is divided by the cutting weapon, the union is effected in the 
 same manner; but a very long time elapses, after the union is 
 effected by the cellular tissue, before the peculiar intestitial 
 deposites which form the organ are thrown out in such a man- 
 ner as to restore its proper functions. In a muscular part, this 
 result is not completed for many weeks; in a bone, it occu- 
 pies some months; and in a nerve, several years elapse before 
 it is entirely finished. Even the brain itself has been known 
 to unite in this manner after a wound; but this effect is ac- 
 complished with so much difficulty, that the number of in- 
 stances on record are very few. It would appear, therefore, 
 that the later an organ is produced, in ascending the scale of 
 nature, the more difficult is its reproduction. Man, like a 
 zoophyte, can renew a portion of cellular tissue with ease, but 
 as this tissue forms nearly the whole organization of the lat- 
 ter, if it be cut in half, each piece forms itself into a perfect 
 animal; while in man, the complexity of the organs renders 
 their renewal difficult long after the union of the tissue in 
 which they are imbedded. 
 
 If the wound inflicted should occasion a loss of any portion 
 of the solid substance of the part on which it is inflicted, na- 
 ture apparently pursues a very different course in effecting a 
 
136 PHYSIOLOGICAL REMARKS. 
 
 cure, but it is in reality the same in principle. In this case, 
 the sides of the wound cannot be kept in contact by mechani- 
 cal means, but continue gaping, and more or less exposed to 
 the external air. If the wound be small and the part remain 
 entirely uncovered, the glutinous fluid which has been already 
 mentioned, gradually fills the vacancy, and often rises far 
 above it, becoming dried by the air, and converted into a scab, 
 beneath which the union makes regular progress without any 
 change in the secretions of the part. This mode of cure by 
 scabbing is often the best which can be accomplished by the 
 surgeon, who should encourage it whenever circumstances 
 permit. The greatest inconvenience attendant upon it results 
 from the hardness of the scab and its disposition to contract, 
 so as to irritate the surrounding parts; but this can be gene- 
 rally relieved by touching it with oil, or by frequent bathing. 
 
 But when the wound is large, or when it is dressed, from 
 the first, with an ointment, it will not form a scab; and the 
 surface of the cellular tissue of the wound secretes a new mem- 
 branous covering, probably formed by the glutinous exudation 
 already mentioned. This membrane soon becomes organized 
 and begins to secrete matter, or pus, which keeps the wound 
 continually moist, and prevents the irritation which would 
 otherwise inevitably result from the drying effect of the air. 
 
 While the pus is forming and flowing from the wound, the 
 membrane and the surrounding parts are becoming continual- 
 ly more and more vascular, until the wound is rendered in- 
 tensely red; and, in the mean time, the cells of the cellular tis- 
 sue are distended with an increased serous or other deposite, 
 so that they swell up more and more, and the whole surface is 
 covered with little conical eminences, resembling flesh, called 
 granulations, which shoot from all points toward the centre 
 of the wound and the surface of the skin, and wherever the 
 sides or summits of these eminences come in contact with 
 each other, they unite and close that part of the wound, thrust- 
 ing up before them the membrane which secretes the pus, un- 
 til at length it is raised nearly to the level of the skin. The 
 membrane then becomes thickened; a great deal of fibrous mat- 
 ter is deposited in it, the secretion of pus ceases, the heat and 
 redness decline gradually, and it dries, — assuming the charac- 
 ters of an irregular skin. The wound is then said to be healed 
 or cicatrized. 
 
 After this is accomplished, the absorbents remove the unu- 
 sual deposites of fluids from the cellular tissue, and also from 
 the substance of the scar, which contracts powerfully, but al- 
 ways remains irregular in form, and more liable to disease 
 than the original structure. With this contraction and absorp- 
 tion, the swelling disappears, and the cure is complete. 
 
PHYSIOLOGICAL REMARKS. 137 
 
 This process is always much slower when more solid parts 
 are wounded, for then it is often necessary that the absorbents 
 should take away the interstitial deposites of the organ before 
 the cellular tissue can be left free to swell and form granula- 
 tions to close the wound, — or, the neighbouring tissues must 
 enlarge to a greater extent, and pour into their cells matters 
 not designed by nature to appear in such situations. This dif- 
 ficulty is remarkably evident in cases of compound fractures, 
 where an external wound communicates with the cavity of a 
 broken bone. 
 
 Internal wounds heal in the same manner with external 
 ones, but the process is then concealed from view. When the 
 wound is simple, and the parts around it are not too much 
 weakened by the accident to pursue a healthy course, the 
 blood which fills up the intervals between its sides, and pre- 
 vents them from closing, it is generally absorbed, and finally 
 disappears so as to permit the sides to unite without the for- 
 mation of any pus: but if the quantity of blood be very great, 
 it becomes altered in character, and irritates the wound to such 
 a degree that pus is secreted, and the case converted into an 
 abscess. 
 
 Even after this, the fluid may be absorbed by degrees, and 
 the wound may heal by internal granulations, but far more 
 frequently, nature converts it into an external wound, by an 
 absorption of that side of the abscess which happens to lie 
 next the surface, sometimes, even while granulations are ac- 
 tually growing on the deeper side; and the abscess at length 
 makes its way through the skin, pours out its contents, and 
 heals in the manner already described. 
 
 It is not by any means necessary that a part should be posi- 
 tively wounded, in order that all the phenomena of heat, 
 redness, swelling and pain should make their appearance, and 
 that the part affected should undergo something like a repro- 
 duction. Let us suppose, for instance, that a mechanical in- 
 jury has been inflicted by a blow without a wound. The part 
 takes on the same kind of action; there is more blood sent to- 
 ward the part than usual, its sensibility is increased, &c; and 
 if any particles or atoms are rendered unfit for service by the 
 injury, they are taken up into the absorbents, and others are 
 deposited in their place, from the capillaries, without the oc- 
 currence of a rupture. 
 
 If the injury be still slighter, the same symptoms occur, but 
 they are evanescent. No change of structure takes place in 
 the part, but its functions are for the moment increased in ac- 
 tivity, and then every thing returns to its natural condition, as 
 from a false alarm. 
 
 None of these phenomena are inconsistent with health. They 
 
 18 
 
138 PHYSIOLOGICAL REMARKS. 
 
 do not constitute disease, but are mere exemplifications of the 
 process of nutrition, by which the body was originally formed, 
 and by which its waste and injuries must be repaired. When 
 any disturbance takes place in the order or degree in which 
 these symptoms appear, then indeed we have disease, and 
 among the most important of these disturbances we may class 
 inflammation^ which will be treated of hereafter. 
 
 OF SYMPTOMATIC FEVER. 
 
 Even where a local injury has been slight, it produces, 
 through the medium of the nerves, effects upon the nervous 
 centre most closely connected with the part. An increase of 
 vital energy, and a larger supply of blood being indispensable 
 for the repair of the injured organ, the heart is called into un- 
 usual activity, and the circulation is hurried, the capillaries 
 give passage to more blood in a given time, the animal heat 
 is increased, and all the vital functions are carried on with un- 
 usual vigour for a time, while the irritated point still holds the 
 ascendant over other parts of the system in vital activity. Af- 
 ter a short time, however, this unusual energy declines, from 
 the exhaustion of the over-wrought organs, or the subsidence 
 of the local irritation. 
 
 It matters not whether the part injured be internal or exter- 
 nal, nor whether the mischief be produced by a mechanical 
 cause, by a change in the quality of the circulating fluids, or 
 by some momentary derangement in the action of the nerves 
 of the part, occasioning an irritation there: the same train of 
 Symptoms occurs under all these circumstances, and gives us 
 an example of the mildest form of Reaction or Symptomatic 
 Fever. Still, the condition of the part, and that of the system 
 in general, is such that nature requires no aid from art, and 
 the patient can scarcely be regarded as having passed the bar- 
 riers of health. 
 
 But let the injury be a little more severe, and then disease, 
 either local or general, or both, is fairly established. The part 
 affected is weakened to such a degree, either by the direct ef- 
 fects of the cause of injury, or by exhaustion from the excess 
 of its own action, that its vessels are no longer capable of bear- 
 ing up against the force of the general circulation: and al- 
 though they may still permit an unusual quantity of blood to 
 flow through them, this is accomplished by their passive en- 
 largement, and they no longer react properly upon their con- 
 tents. The current of the blood becomes less rapid, the vessels 
 are more and more stretched and weakened, the colour be- 
 comes deeper or more purple, and at length the fluids may he 
 
PHYSIOLOGICAL REMARKS. 139 
 
 reduced almost to a state of stagnation. In the mean while, pre- 
 parations for the removal and reproduction of the injured part 
 may still he carried on, though laboriously and imperfectly, be- 
 cause of its unhealthy condition. This is a picture of local in- 
 flammation. 
 
 Two important consequences generally follow from this state 
 of things. 1st. The overloaded vessels, unable to propel their 
 contents, commonly relieve themselves by effusion; that is, they 
 pour out, either on the surface or within the substance of the 
 part, the serum of the blood, as in blisters, — or pus, as in ab- 
 scess. 2d. The distention of the vessels becomes itself a source 
 of irritation to surrounding parts, and thus extends the injury 
 and the disease: — while nature, on the other hand, in patients 
 of healthy constitutions, as constantly endeavours to arrest the 
 progress by causing an adhesion of the cells of the cellular tis- 
 sue all around the inflamed parts, so as to isolate them from 
 the rest of the body; and when this purpose fails, the conse- 
 quences are often dreadful. 
 
 These facts explain the appearance so commonly noticed in 
 most local inflammations that are not cured in their earlier 
 stages — appearances often beautifully exemplified in a common 
 bile. The centre of the tumour is found soft and compressi- 
 ble, being converted into a regular abscess. The parts imme- 
 diately around the cyst containing the pus are of a dark pur- 
 ple colour, from the stagnation of the blood in the vessels; — 
 the rest of the swelling is of a bright red hue, and its tempe- 
 rature is elevated far above the natural standard — while round 
 the margin, the cells of the cellular tissue are obliterated by 
 adhesion, and the spreading of the inflammation is prevented. 
 
 The reader has now received some idea of the purely local 
 effects of injuries when not carried to such an extent as to de- 
 stroy the energies of the part, and produce its immediate or 
 very speedy death by gangrene or mortification. But there 
 are a series of consecutive consequences which require more 
 especial notice, and by a proper explanation of these we shall 
 best convey some idea of the nature of that extensive disease 
 which causes directly or indirectly a large majority of all the 
 deaths which load the bills of mortality — fever — a word on 
 which innumerable volumes have been written, and innume- 
 rable lectures delivered, causing violent altercations both in 
 and out of the profession. It does not admit of a simple defi- 
 nition, but must be understood from its general history. 
 
 When a local injury is both severe and extensive, the im- 
 pression upon the nervous system, in general, is such that its 
 energies are depressed on the instant; for no organ or sys- 
 tem in the body can endure an exceedingly powerful impres- 
 sion without temporary depression from the overwhelming 
 
140 PHYSIOLOGICAL REMARKS. 
 
 demands made upon it. In consequence of this depression, the 
 patient is rendered languid. The hlood leaves the surface of 
 the body and retires to the vital organs in the interior, embar- 
 rassing them by its quantity. The heart shares in the general 
 depression, and struggles feebly to continue the circulation. 
 If this state of things be carried very far, the patient is said to 
 be in collapse. 
 
 More or less disposition to collapse is observable in the 
 commencement of nearly every case of fever, and if carried 
 beyond a certain point, the vital organs are paralyzed, and the 
 patient generally dies in a few hours — as often happens in the 
 Asiatic cholera, and sometimes in malignant intermittent fe- 
 vers; — but otherwise, it seldom continues long. The nerves 
 appear to be accumulating power during this short period of 
 repose; and, before long, reaction, or symptomatic fever, makes 
 its appearance. The heart acts with continually increasing 
 energy, driving the blood in a very rapid torrent through the 
 arteries. 
 
 Still, the injured part itself, demands and receives the great- 
 est supply of nervous energy and the largest amount of blood, 
 for it is there that nature is compelled to resist or repair the 
 threatened mischief. This part, already weakened to a degree 
 which makes the pressure of even a healthy circulation dan- 
 gerous to its integrity, suffers incalculably more under this 
 violent reaction of the system. Hence the necessity of de- 
 pleting measures, such as bleeding, cold effusions, &c, in cases 
 of high inflammatory fever in its first stage. 
 
 But it is a law of the animal economy, as we have had occa- 
 sion to mention in the earlier part of the work, that whenever 
 an organ is called upon for unusual exertion, it afterwards 
 sinks into a state of exhaustion; or its vital powers are dimi- 
 nished. This state of things, as it appears in the injured part, 
 has been already pointed out, but its influence on the system, 
 generally, remains to be explained. 
 
 When the principal blood vessels, and the heart itself be- 
 come fatigued to a certain degree, the paroxysm of fever de- 
 clines: but if the local irritation continues the same, or when 
 it gradually increases in violence, the heart and vessels, after 
 a temporary and partial rest, are stimulated to renew their ef- 
 forts, and this alternation may be continued from day to day, 
 while the patient improves, or becomes worse, in proportion 
 to the relative length and intensity of the remissions and ex- 
 acerbations. Here, then, we have explained the phenomena 
 of a remittent fever, and indeed, all fevers are more or less 
 remittent. 
 
 It has been stated that in order to produce reaction, or 
 symptomatic fever, it is necessary that the local irritation 
 
PHYSIOLOGICAL REMARKS. 141 
 
 should be of sufficient extent and severity. Now, the part af- 
 fected with inflammation is liable to the same alternations of 
 increased excitement and exhaustion that mark the progress 
 of a general fever; for inflammation is but a kind of local fe- 
 ver, and of course it is subject to its remissions. When the 
 remission of the local symptoms is so complete that the irrita- 
 tion falls below that standard of violence which is necessary 
 to produce reaction, the symptomatic fever must cease; but it 
 will be renewed again as soon as the local exacerbation reaches 
 the requisite degree of intensity. It is obvious, that, under 
 such circumstances, we should have an intermittent fever. 
 
 All the three forms of fever, or types, namely, the conti- 
 nued, the remittent, and the intermittent, are occasionally seen 
 as consequences of simple mechanical injuries, and the reign- 
 ing doctrine of the day, (the Broussaisan,) attributes, very 
 correctly, all fevers to some local irritation. It was formerly 
 customary with nosologists, (that is, those who divide diseases 
 into orders, genera, and species, like objects of Natural His- 
 tory,) to range fevers under two distinct orders, the idiopa- 
 thic, or self-created, and the symptomatic, or consecutive fe- 
 vers. 
 
 This distinction is now very generally discarded, and we 
 think with perfect propriety; for in the train of symptoms 
 which mark the approach and the attack of fever, there is al- 
 ways found some local inflammation, or some irritation of suf- 
 ficient extent or violence, to deserve that name; and this local 
 affection invariably precedes the reaction. It is rarely possi- 
 ble, in the present state of our knowledge, to penetrate farther 
 back than this primary local affection in studying the history 
 of fevers, and it is therefore styled the cause, or the proxi- 
 mate cause of fever. In that sense we shall employ these 
 terms in our future remarks in the progress of this work. 
 
 The proximate cause of fever is generally the result of some 
 accident, such as a blow or fall, improper diet, exposures to 
 changes of climate, an irregularity in the functions of some 
 nerve produced by some known or unknown causes, the ab- 
 sorption and introduction into the circulation of some poison, 
 the inhalation of noxious vapours, &c. &c. These are called 
 exciting causes. 
 
 There are peculiarities of certain individuals, the result of 
 accident, hereditary tendencies, &c, which prevent them from 
 experiencing the same effect which most persons suffer from 
 the action of the same causes of disease. These peculiarities 
 are commonly styled constitutional, and are designated among 
 medical men by the terms temperament , diathesis, idiosyn- 
 cracy, &c, — hard names that we shall not even attempt to ex- 
 plain, — for this work is not intended for those who wish to 
 
142 PHYSIOLOGICAL REMARKS. 
 
 study the science in all its elaborate details. Again, there are 
 certain atmospheric or other occult influences which modify 
 the character of fevers in different places, years, and seasons. 
 Thus, the same imprudence in eating, which in one year pro- 
 duces a bilious fever, shall, in another, bring on a yellow fe- 
 ver; in a third, malignant cholera; in a fourth, a spotted fe- 
 ver, &c. &c. Causes of this description are entitled predis- 
 posing causes. 
 
 The same changes produced in the characters of fever by 
 the various predisposing causes, are equally obvious in the his- 
 tory of local inflammations. Thus, an amputated limb shall 
 recover without difficulty, and very promptly at the Pennsyl- 
 vania Hospital, in Philadelphia, while at St. Thomas's, in Lon- 
 don, it shall bring on an erysipelas of the member; and at the 
 Hotel Dieu, in Paris, the patient shall die of abscess of the 
 lungs — though all the individuals subjected to'these operations 
 may resemble each other in apparent health, and be subjected 
 to a plan of treatment alike in every instance. Nay, more, — 
 in a succeeding year, the order of these results in the different 
 institutions mentioned, may be entirely reversed. 
 
 So far we have been treating of fever in its simplest form, 
 but it is now time to mention other results and trains of symp- 
 toms which may render the disease extremely complex and 
 difficult to be understood. In explanation of our meaning, it 
 is, perhaps, most proper to select an example from among those 
 of the most involved character. We will select the case of an 
 irritation in the intestines. A patient predisposed to abdomi- 
 nal disease, either in consequence of some personal peculiari- 
 ty, or the epidemic tendency of the season, shall be guilty of 
 an imprudent exposure, or an irregularity of diet. An irrita- 
 tion shall occur in consequence of this conduct in some part 
 of the small intestines. These organs are supplied by the 
 nerves of organic life, and consequently the brain takes no no- 
 tice of what passes there until the mischief becomes severe. 
 The part affected, perhaps previously weakened by the epide- 
 mic or other tendency, or by ill-regulated habits, is unable to 
 resist the vigour of the general circulation, bearing with unu- 
 sual energy upon this particular spot, in consequence of the 
 urgent necessity of repairing, with the utmost speed, the inju- 
 ries inflicted upon such important organs. The part inflames; 
 the heart is called into undue action, and the functions of the 
 intestines are embarrassed or overwhelmed. Still, the exist- 
 ing condition of things is not as plainly perceivable as it is 
 when external parts are injured, for the general circulation is 
 less obviously disturbed when the disease is confined to or- 
 gans of which the vessels appertain to the portal system, (sec 
 page 89 7 ) which is compared, in our earlier pages, to a para- 
 
PHYSIOLOGICAL REMARKS. 143 
 
 sitic plant, than when it affects, directly, the great arterial tree. 
 The concentration of the vital powers upon the internal or- 
 gans, resulting from their excessive irritation, render the ex- 
 ternal parts and other organs comparatively languid, and there 
 is established a low, irregular fever, very different from that 
 which characterizes external injuries. The countenance, and 
 the skin in general, do not exhibit the strong marks of fulness 
 that occur in ordinary fevers; for the blood is mainly direct- 
 ed to the viscera, and the natural impression that the disease 
 results from general debility, is often impressed upon other 
 minds than those of the uninitiated. The unresisted accumu- 
 lation of blood in the bowels, soon produces an embarrassment 
 of the circulation, and the vessels soon endeavour to relieve 
 themselves by pouring out increased and vitiated secretions 
 internally, even while the external surface is hot and dry, and 
 the insensible perspiration is checked. The patient becomes 
 affected with a dysenteric discharge. 
 
 The impression made upon the nerves of the part by this 
 extreme and increasing irritation is conveyed to the great 
 nervous centres of animal life, and all the most important func- 
 tions are necessarily disturbed by this consecutive result. The 
 several ganglions may be called on for a degree of exertion 
 inconsistent with their healthful action, and each of these may 
 become a new centre of irritation, calling for additional exer- 
 tions on the part of the heart and great vessels, already debi- 
 litated by previous demands. If the disease advances, the ir- 
 ritation at length radiates from the ganglions to the spinal 
 marrow, and the nerves of animal life become involved in the 
 disease. Muscular power and the external senses are then 
 embarrassed, and the general disturbance is at last continued to 
 the brain itself, — low, muttering delirium comes on; the or- 
 gans of respiration become affected; twitchings of the tendons, 
 a ghastly countenance, spasms and insensibility make their 
 appearance, and unless the superior powers of the constitution, 
 with the aid of high professional skill and tact, enable the pa- 
 tient to conquer the disease, he dies! In the mean while, 
 though every symptom seems to mark the presence of debili- 
 ty, the inflammation cf the part of the small intestines which 
 causes this long train of evils, goes on continually increasing, 
 even to mortification, and the several centres toward which 
 the irritation has been radiated — themselves, in turn, inflame; 
 so that, instead of a single local injury, we have to contend 
 with many, all of which are important and dangerous to life. 
 
 The professional reader would at once perceive, in the fore- 
 going picture, the likeness of a disease formerly ranked among 
 the most purely idiopathic fevers, but now well known to ori- 
 
144 PHYSIOLOGICAL REMARKS. 
 
 ginate in an inflammation of certain little glands upon the mu- 
 cous membrane of the small intestines! 
 
 This disposition displayed by irritations, to radiate by means 
 of the nervous connexions existing between different parts, 
 explain a host of singular effects observed in the history of 
 disease, — Such, for instance, as the following: — A blow on the 
 head will sometimes occasion an abscess of the liver, and an 
 inflammation of the liver will produce disease of the brain. 
 A disturbance of the bowels will give rise to an eruptive dis- 
 ease of the skin, and an eruption on the skin will produce an 
 injurious influence on digestion. Some irritations of the small 
 intestines give rise to cramps of the extremities, and a broken 
 limb is a very common cause of little scattered abscesses in 
 the lungs. In the midst of all these endless complications, 
 how absurd appear the pretences of those innocent empyrics 
 who unhesitatingly attack diseases of which they cannot com- 
 prehend the seat, by means of remedies of which they neither 
 know the nature or the action! 
 
 The general debility noticed in the more severe and com- 
 plicated fevers, is not entirely the result of exhaustion of the 
 system from over action: it frequently appears from the first 
 moment of the attack, and is produced by the concentration 
 of vital energy in the irritated parts, which does not leave 
 enough for the proper supply of the other organs. But it is 
 well known that the mere extent of surface affected by an ir- 
 ritation, has quite as much influence as its severity in deter- 
 mining its physiological effects; for a very slight scald over 
 the whole surface of the skin will kill; while a "hand or a foot 
 may be burned to cinders in a furnace without endangering 
 the life of the owner. The two facts just noticed enable us to 
 employ, advantageously in medical practice, certain powerful- 
 ly stimulating applications to healthy parts in order to lessen 
 the intensity of violent morbid actions in other portions of the 
 body. This is called treatment by counter irritation. Let 
 us take an example: — A patient, with a strong determination 
 of blood to the head, growing, perhaps, out of over application 
 of the mind. He has a severe headach and confusion of ideas, 
 with some disorder of the stomach produced consecutively, 
 and complains of nausea, vertigo, noises in the head, and an 
 extreme sensibility of the eye and ear. His physician orders 
 him large mustard plasters to the wrists and ankles, and con- 
 tinues them until considerable irritation is produced. The 
 head is relieved, and in the following manner: — The injury 
 inflicted by the remedy is mild in grade, but covers a consi- 
 derable surface. It does not endanger the integrity of the 
 part, yet it calls off a great deal of vital energv from the svs- 
 
PHYSIOLOGICAL REMARKS. 145 
 
 tern in general, and the diseased organ, which in the case de- 
 lineated, is the brain, shares in the diminution until, perhaps, 
 its over excitement is reduced to the standard of health, and 
 it is permitted to recover its energies and powers of resistance 
 before nature has accomplished the cure of the inflammation 
 caused by the mustard. 
 
 Drastic purgatives and other internal remedies of a highly 
 stimulating character, are often employed in fevers and local 
 inflammations, upon this principle of counter irritation; and 
 there are cases in which the happiest results may follow such 
 a course; but this mode of treatment has been carried much 
 too far by the practitioners of the last age. 
 
 There are two important precautions which should always 
 be observed in practising by counter-irritation. 1st. Strong 
 stimulants should never be administered or applied during the 
 height of reaction in fevers, because their direct effect in in- 
 flicting a new injury increases the violence of reaction, and 
 must necessarily render the subsequent exhaustion more se- 
 vere. If used at all in fevers, they should be employed during 
 the remissions or intermissions. An exception to this rule 
 exists in certain cases of low or typhoid fevers of long stand- 
 ing, — when dire necessity compels us un willingly to support 
 the sinking energies of nature at all hazards. But in these 
 cases, the end in view is general stimulation, and not counter- 
 irritation. 2d. Strong Stimulants, applied externally, should 
 uever be carried to such an extent as to cause severe pain in 
 cases of disease of the head, for the radiation of the irritation 
 caused by the remedy to the other extremity of the nerves of 
 the part may produce an inflammation, or an increase of the 
 functional embarrassment in the brain! 
 
 The reader will now perceive that any local injury of con- 
 siderable extent, and of sufficient intensity to produce a mor- 
 bid change in the actions of the injured part, must generally 
 produce a reaction of the circulation; or, in other words, a fe- 
 ver. On the other hand, every case of fever commences in 
 some local irritation, which, in most instances, gives rise to 
 other irritations in distant parts. The first of these affections, 
 which has been already defined to be the cause or proximate 
 cause of the attack, is called the primary irritation; the others 
 are styled secondary or symptomatic. But it is a singular fact 
 that the primary and secondary affections mutually act on each 
 other in most cases, so that when either of them is exacerbated 
 or relieved in any degree, the other shares in this change of 
 intensity. Thus, if primary irritation of the stomach occasions 
 the symptoms of mental excitement which was described on 
 the last page, and the patient should venture to increase the 
 disorder of the head, by applying his mind to serious thought, 
 
 19 
 
146 PHYSIOLOGICAL REMARKS. 
 
 his stomach would inevitably be rendered worse; and if a blow 
 on the head should produce an inflammation of the liver, an 
 active course of depletory treatment, addressed to the latter, 
 would materially lessen the danger of the brain. This explains 
 the reason why so much of our practice in medicine is direct- 
 ed to the mitigation of symptoms, instead of the destruction of 
 the cause of the disease. 
 
 The removal of the proximate cause of a disease does not 
 always produce a cure; for, on many occasions, the former is 
 successfully combatted by the power of nature, while the se- 
 condary irritations perpetuate the disease. Thus, an irritation 
 of the spine may produce disease of the heart, and the latter 
 may destroy life long after the former has yielded to remedial 
 measures. 
 
 When the symptomatic irritation is much more intense than 
 the primary one, it sometimes acts as a natural counter-irritant, 
 and the latter suddenly and entirely disappears, the former 
 having called off all the surplus vital energy to itself. This is 
 an instance of what is called, by physicans, Metastasis. 
 
 Metastasis generally takes place from parts of lesser to those 
 of greater consequence in the economy; and as the affection 
 is of much more pressing importance than its cause, it is often 
 proper to endeavour to reproduce the original affection by 
 means of appropriate remedies; and if we succeed, the secon- 
 dary irritation commonly subsides as suddenly as it appeared! 
 I remember the case of a lad who laboured under a disgusting 
 disease of the scalp, which disappeared by metastasis, on five 
 or six occasions, always producing furious insanity. The mad- 
 ness resisted every species of treatment until the eruption was 
 reproduced, when he became rational immediately. Such ac- 
 cidents as this are common in most of the eruptive diseases, 
 when they are arrested by improper exposures, or too energetic 
 local treatment: — the eruption declines, and some vital organ 
 becomes the seat of a dangerous and often fatal inflammation. 
 To such cases of metastasis, produced by external causes, the 
 term revulsion has been applied, though it is frequently em- 
 ployed in a more extended sense. 
 
 There is reason to believe that in most cases of revulsion, 
 there exists a previous radiated irritation in the spot to which 
 the disease is translated, but that this is mild, and masked, as 
 it were, by the more obvious external affection. When the 
 latter is suppressed too suddenly, it is easy to comprehend 
 that the vital energy previously concentrated upon it, may not 
 become regularly and safely diffused through the system; but 
 may be suddenly directed upon the previously weakened in- 
 ternal organ, in such a manner as to produce the singular phe- 
 nomena of metastasis. 
 
PHYSIOLOGICAL REMARKS. 147 
 
 The number of instances of serious disease, occasioned by 
 the principle on which metastasis depends, is much greater 
 than might be supposed at first sight; for it includes not only 
 the revulsions of which we have been speaking, but all the 
 evils following the sudden arrest of habitual discharges — such 
 as apoplexy from the cure of piles, abscess of the lungs from 
 the healing of fistula, convulsions and inflammation of the bow- 
 els from exposure in young females, &c. : in all which cases 
 it is desirable, under ordinary circumstances, to renew the ori- 
 ginal affection, the suppression of which has caused the mis- 
 chief; and where this cannot be done, it is often advisable to 
 imitate nature, by establishing a similar local disease in some 
 more convenient place, as is often done by means of issues, 
 setons, moxa, and tartar emetic plasters. 
 
 OF IRRITATION AND HYPERNUTRITIOX. 
 
 I have now described, in a general way, both the primary 
 and secondary effects of the function of nutrition, as displayed 
 in the reproduction of parts, and have shown how disease in- 
 evitably follows the over-strained efforts of nature to produce 
 a cure of injuries, whether the causes be internal or external. 
 Let us now pass to the consideration of some of the conse- 
 quences of increased vital activity in particular parts, when 
 no apparent injury has been inflicted; consequences resulting 
 from some inexplicable changes in the action of the tissues 
 themselves, but probably produced by irregularities in the 
 nervous influence, which, when properly balanced, preserves 
 that mutual relation of parts so necessary to the proper sup- 
 port and sustenance of all the various organs of an animal so 
 complex in structure as is man. 
 
 Under the operation of certain stimulants, and especially 
 under the natural stimulus of exercise, any part or organ of 
 the body may have its functions increased; and even its struc- 
 tural development is hastened by the continued action of such 
 causes. The growth of muscles, under such circumstances, 
 has been already mentioned, and this subject will claim addi- 
 tional attention in the chapter on Hygiene. To quote ano- 
 ther and more curious example of the operation of this law, it 
 may be mentioned that habits of thought and study not only 
 strengthen the powers of the mind, but actually enlarge the 
 brain. This state of things is perfectly consistent with health, 
 though occasionally, when carried very far, it produces peculi- 
 arities verging on, and predisposing to, disease. Thus the 
 constant employment of certain muscles produces those pecu- 
 liarities of person, or slight deformities which characterize the 
 
 _ 
 
14S PHYSIOLOGICAL REMARKS. 
 
 operatives in particular trades; and the habitual cultivation of 
 certain instincts, moral feelings, or intellectual faculties, may 
 occasion ungovernable passions, morbid feelings, or eccentri- 
 cities of character. 
 
 It is still more curious that the same plan of counter irrita- 
 tion, which was spoken of in the last section, as a mode of treat- 
 ing fevers or inflammations, may be usefully employed in cor- 
 recting the undue effects of the functional exercise of particu- 
 lar organs. Thus, the prescription of powerful and continued 
 muscular exertion corrects the ill consequences of laborious 
 study, and an application to the solution of mathematical stu- 
 dy, has been known to cure muscular spasms! 
 • But there are numerous changes of structure of a decidedly 
 morbid character, yet somewhat of the same, nature with those 
 just pointed out. These are called instances of hypernutrition, 
 and are marked by an undue growth of the part affected, of 
 such extent, as to embarrass some of its functions. This growth 
 is the result of a chronic or habitual increase of the vital ener- 
 gy of the part, to a degree inconsistent with health; but not 
 distinctly marked by those changes in colour, temperature, 
 and sensibility, which distinguish the process by which inju- 
 ries are repaired, nor by those symptoms of fever that present 
 themselves during the reaction consequent upon such inju- 
 ries. 
 
 Hypernutrition almost invariably consists in an increase of 
 the interstitial deposites of the tissue interested, and rarely 
 leads to any great addition to the cellular or primitive tissue. 
 It is considered as a result of one of the lightest shades of or- 
 ganic irritation, which latter term we shall not attempt to 
 explain at full length; for it is extremely difficult to say in 
 what acceptation it is received by the profession at larg< 
 various and, apparently, inconsistent are the phenomena attri- 
 buted by different theorists, to this very general term. In 
 few words, it may be defined to be a morbid increase of vitali- 
 ty in some particular organ, tissue, or system, not sufficient in 
 degree or extent to constitute an inflammation. 
 
 As the principal effect of hypernutrition is the unnatural in- 
 crease of the interstitial matter distending the cells of the cel- 
 lular membrane in the different compound tissues, it may be 
 fairly said to include the unnatural increase of the serum which 
 lubricates the cells of the free or general cellular tissue itself, 
 and also the serous cavities, whenever this accumulation is the 
 result of increased vitality in the part. 
 
 Dropsy, whether general or local, is commonly a conse- 
 quence either of a merely mechanical obstacle to the free cir- 
 culation of the blood, or of a similar difficulty caused bv a 
 change in structure in some highly important organ, — the 
 
PHYSIOLOGICAL REMARKS. 149 
 
 dropsy being, in fact, a symptom of some other much more 
 serious accident, or disease; and until the latter is removed it 
 is in vain to attempt the cure of the former. 
 
 It may seem strange that we should rank dropsy among the 
 diseases of increased action, when it is so universally consi- 
 dered as a mark of debility; but it does not follow by any 
 means, because a particular portion of the body is acting with 
 undue force, that the system in general should be found in 
 a similar condition. The reverse of this is more frequent- 
 ly the case, and general debility often acts as an exciting cause 
 of local activity. The functions of the free cellular tissue, and 
 of those parts which are most liberally supplied with this tis- 
 sue, appear to increase as the powers of animal life decline, and 
 they continue in certain instances even after the death of the 
 individual! As persons decline in life, or become weakened 
 by disease, the more dependent portions of the body begin to 
 display a tendency to dropsical effusion, and the extent of this 
 disposition increases as the powers of the system diminish. 
 Perspiration is one of the last lingering operations of life, and 
 even after the body has been laid in its final receptacle, the 
 hair and the nails may continue to grow! It would seem that 
 those portions of the most complex animals which resemble 
 in structure the bodies of the simplest animalcules possess 
 some power analagous to that by which the latter preserve 
 their vitality when dried and laid aside for years! 
 
 But the cellular tissue is the seat of numerous other changes 
 of structure more obviously the result of hypernutrition, com- 
 plicated, perhaps, with some change in the nervous balance of 
 the part, by which the operations of the tissue are modified, 
 and the deposites altered in character from that of serous ef- 
 fusion. One of the most usual examples of this is found in 
 the formation of cavities or sacks distended with fatty, gase- 
 ous, or gelatinous matter, and constituting tumours which go 
 on increasing until removed by the knife or remedied by other 
 measures. The changes appear to be effected without calling 
 the capillary blood vessels into any undue action; and may 
 even be arrested and removed by measures which increase the 
 degree of irritation in the part, and promote the rapidity of 
 capillary circulation. Thus, if the cavity of a gelatinous cel- 
 lular tumour be laid open with a knife, and its contents be 
 evacuated, it becomes so much excited by the injury, that its 
 cavity is often obliterated by adhesion, and its peculiar secre- 
 tion disappears. Again, if a wen be repeatedly rubbed every 
 day with a saturated solution of common salt, it will frequent- 
 ly inflame, become gangrenous and slough away, through nu- 
 merous little holes in the skin; and the disease will be found 
 perfectly cured. 
 
150 PHYSIOLOGICAL REMARKS. 
 
 Among the parts of the body which are more purely cellu- 
 lar in their structure — the skin, is peculiarly liable to hyper- 
 nutrition. It is seen, generally, in elephantiasis, and locally, 
 in corns and various excrescences. The causes of the latter 
 tumours are often purely mechanical. 
 
 In the locomotive apparatus, such consequences of irritation 
 are less frequent, but they are seen occasionally in the knotty 
 enlargements of tendons produced by local pressure, and in 
 the nodes and other swellings of the bones. 
 
 Hypernutrition of the hollow viscera, is not at all uncom- 
 mon. It is seen in the heart, from spinal irritation; in the sto- 
 mach, from over-eating; and still more commonly from the 
 habit of taking inordinate quantities of fluid; and in the blad- 
 der, from obstructions to the discharge of urine in stricture, 
 gravel, (fee. 
 
 In compound organs, such as the bones, for Instance, the ex- 
 cess of nutrition may be confined to any one of the several in- 
 gredients of which those organs are composed. Thus, in some 
 cases the quantity of animal matter is increased, and the bones 
 become so soft as to bend under the action of the superincum- 
 bent weight of the body, constituting what is called mollities 
 ossium, and giving rise, in childhood, to bandy-legs, and even 
 elub-feet. In other cases, the quantity of earthy matter is 
 thrown down in undue amount, and the bones are rendered so 
 brittle as to break under slight muscular exertions, consti- 
 tuting the disease termed fragilitas ossium. It is often diffi- 
 cult to determine whether these changes result from an in- 
 creased supply of one ingredient, or a diminished secretion of 
 the others; and it is sometimes of great importance to distin- 
 guish between these two conditions, for, in the former, there 
 is always an undue degree of vital activity in the part affected, 
 while, in the latter, the cause of the change of structure is 
 more frequently an irritation in some distant organ or system 
 which calls off the vital power in another direction, and thus 
 induces a symptomatic and secondary debility of that part. 
 Under circumstances so opposite in character, it is obvious 
 that very different courses of treatment may be required. 
 
 In the foregoing remarks, we have considered hypernutri- 
 tion as the result of modifications in the transmitting power of 
 the tissues, to which, in a previous section, the function of nu- 
 trition has been attributed. But it is obvious that the condi- 
 tion of the vessels, and the circulating fluids, must exert an 
 important influence upon the effects of irritation in producing 
 these alterations of structure, as upon them depends the quan- 
 tity and quality of the material furnished to the parts inte- 
 rested. 
 
 It is also obvious that the action of the nerves is equallv 
 
PHYSIOLOGICAL REMARKS. 151 
 
 engaged in the process; for, independently of the control over 
 the operations of the tissues, exercised directly by these con- 
 necting wires of the animal machine, (see page 130,) the mu- 
 tual association between the nervous energy and vascular ac- 
 tivity is so intimate and constant, that it is impossible for either 
 to be increased or diminished without a corresponding altera- 
 tion in the other. It is impossible, however, to prosecute this 
 subject farther on the present occasion. 
 
 The application of general principles to the treatment of dis- 
 eases resulting from hypernutrition, is by no means difficult. 
 The remedies are of two classes. 1st. Those addressed to the 
 part affected; and 2d. Those intended to act on distant parts, 
 or upon the system generally. Among the former class we 
 may place mechanical pressure at the head of the list, when- 
 ever it is applicable. This remedy acts by diminishing the 
 quantity of the circulating fluid supplied to the part; it resists 
 the deposition of new matter, and it encourages the absorption 
 of the surplus particles which have resulted from the disease. 
 In all these ways it tends directly to remove the evil. Pres- 
 sure also benumbs the sensibility of the nerves, and thus les- 
 sens the vital activity. Unfortunately, this remedy is applica- 
 ble only in cases of external disease; and when these are cha- 
 racterized by a high state of nervous excitement, the pressure 
 cannot be tolerated. 
 
 Next in order, we may rank absolute rest of the part, by 
 which we mean not only mechanical rest, but also, rest of the 
 functiojis of the part. Suppose the eye or ear, for instance, 
 to be the seat of an organic irritation, tending to produce a 
 hypernutrition of any portion of the organ, it is just as neces- 
 sary to prevent the patient from exposure to light or sound, 
 and to cause him to avoid the exercises of leaping or running, 
 so as to agitate the fluids and quicken the circulation; for, 
 whatever induces the exercise of an organ has a tendency to 
 increase its vital activity, and especially its nutrition. 
 
 Cold applications, and other sedatives, are also among the 
 very important remedies; but, as these always induce a reac- 
 tion, unless their application is continued for a considerable 
 time, it is productive of more injury than benefit to use them 
 partially or timidly. Their action is very similar to that of 
 pressure, and their applicability is even more extensive. 
 
 Local depletion follows next. The action of cups and 
 leeches is this. They remove from the blood vessels in the 
 neighbourhood of the part, a portion of their surplus supply of 
 blood, and, at the same time, they diminish the whole amount 
 of the circulating fluid,— but the wounds and the iritation di- 
 rectly resulting from the bites of the leeches, or the blades of 
 the scarificator, determine an additional flow of blood toward 
 
152 PHYSIOLOGICAL REMARKS. 
 
 the part. If the quantity abstracted be large, the local ner- 
 vous excitement is lessened, the morbid sensibility of the 
 nerves is relieved, and the capillaries are allowed time to re- 
 tract and recover their energies; but, if it be small, the effects 
 of the additional irritation, produced by the remedy, may 
 more than counterbalance the benefit derived from it, and the 
 disease may be rendered worse, instead of better. As hyper- 
 nutrition is commonly the result of chronic and tedious affec- 
 tions, local depletion cannot be carried so far in complaints of 
 this nature as it can in cases of decided and severe inflamma- 
 tion, and it is therefore less frequently applicable in the for- 
 mer than in the latter class of morbid actions. Yet it is fre- 
 quently employed with a happy effect. 
 
 Stimulating applications are rarely proper, because their 
 immediate effect is to concentrate additional vital force in the 
 parts to which they are applied. But it is found that the results 
 of irregular hypernutrition possess a less perfect organization, 
 and are less capable of resisting destructive agents than the 
 healthy portions of the body. Stimulating applications are, 
 therefore, occasionally useful in producing inflammation in the 
 newly formed parts; by which means they are actually destroyed 
 and caused to slough away, as is frequently the case with su- 
 perficial wens and fatty tumours, particularly such as are so 
 frequently observed upon the head, in persons who have passed 
 middle life. This is a mode of treatment, employed more in 
 condescension to the fears of the patient, than to the proper 
 laws of the science, for the remedy is quite as painful, and cer- 
 tainly more dangerous than the knife, when the latter is pro- 
 perly employed. 
 
 The action of the two last mentioned remedies will explain 
 to the popular reader a fact which puzzles many; namely, that 
 two different plans of treatment, diametrically opposed to each 
 other, may sometimes prove equally successful in the cure of 
 the same disease! 
 
 The general remedies which are applicable in cases of hy- 
 pernutrition, may be again subdivided into evacuunts, coun- 
 ter-irritants, and tonics. The former are employed when 
 the patient is in high health or plethoric. They act on the 
 disease by diminishing the force and quantity of the circula- 
 tion; and some of them, like the drastic purgatives, may ulso 
 prove advantageous by counter-irritation. 
 
 The regular counter-irritants, such as issues, setons, moxa, 
 blisters, &c, are frequently serviceable in the manner already 
 pointed out in the section on fever. They must be employed 
 mildly and for a long period of time, to produce much advan- 
 tage in cases of hypernutrition. 
 
 Tonics are used in many cases where the disease occurs in 
 
PHYSIOLOGICAL REMARKS. 153 
 
 persons of weakly or exhausted constitutions, and it is quite 
 possible for this condition to be produced by the disease itself, 
 notwithstanding the slight degree of irritation commonly ob- 
 served in such cases; for, when the organ affected is a vital 
 one, the embarrassment of its functions alone, may cause a ge- 
 neral disturbance sufficient to sap the energies of the whole 
 system. This is proved by the history of many instances of 
 hypertrophy of the heart and liver. The mode in which to- 
 nics act beneficially is this: they strengthen and elevate the 
 tone of all parts of the body so as to restore them to their na- 
 tural energy. In accomplishing this purpose, they undoubtedly 
 tend to stimulate the seat of the morbid irritation, in common 
 with all other parts; but the increase of vital action, and the 
 regulation of the balance of excitement in the organs, general- 
 ly, lends still more powerfully to depress that morbid irrita- 
 tion by calling the vital powers into play in other quarters. 
 
 Besides the classes of medicines already noticed, there are 
 several other agents employed in practice with very great 
 effect, but of which the mode of action does not admit an 
 easy explanation. They are principally prescribed in those 
 forms of hypernutrition which appear in the bones, glands, and 
 other complex organs, and in those which are the result of 
 what are ordinarily called specific diseases. These remedies 
 have a most powerful action in promoting absorption, but how, 
 we know not. Among them we may notice calomel, and 
 arsenic, in glandular swellings and the nodes of bones and pe- 
 riosteum; colchicum in gout, and iodine in tumours, of almost 
 every description. 
 
 OF CAPILLARY IRRITATION— INFLAMMATION. 
 
 Having dismissed the subject of irritation, as displayed in 
 modifications of the transmitting power of the tissues, it is pro- 
 per to follow up the inquiry by speaking of the effects of irri- 
 tation on the capillary circulation; but so much has been al- 
 ready advanced on the subject, in the section on mechanical 
 injuries, that our task will be a light one. 
 
 It has been seen that the first object of nature, on the occur- 
 rence of an injury, or an undue excitement of a part, is the re- 
 pair of the part. To accomplish this end, she directs toward 
 the part an increased amount of nervous energy, and enlarges 
 the capillaries to facilitate the freedom of circulation in the 
 injured spot. She goes still farther when the case is a grave 
 one, for she enlarges all the principal arteries going toward 
 the injury, contracts all those leading to a distance from it, 
 
 20 
 
154 PHYSIOLOGICAL REMARKS. 
 
 and then calls the heart into violent action to increase the ra- 
 pidity of the flow of blood. 
 
 The term irritation has been so constantly applied in very 
 recent times, to this peculiar condition of an injured part, that 
 the idea of irritation is inseparably, though unfortunately, as- 
 sociated with the idea of an increased capillary circulation; — 
 one of many effects being thus substituted for a cause; — and 
 the whole group of associated phenomena involved in the 
 healthful operation of repairing injuries has been set down as 
 a disease! Hence all the interminable attempts to define the 
 words irritation and inflammation, and the long shelf-loads 
 of volumes written on the vexed question, whether the latter 
 is a disease of excitement or debility! 
 
 The term capillary irritation, simply considered, ought to 
 be confined to the designation of that condition of the capilla- 
 ries which attends upon the sanitive operations of nature in 
 removing injured, and in restoring lost parts.' When the 
 parts become exhausted by such efforts, and no longer capable 
 of resisting properly the impulse of the blood, so that the very 
 attempts at cure become a source of disease, the condition of 
 things is changed, and the terms should be changed also. 
 
 The reader will now be able to comprehend the motive 
 which induces us to discard the word irritation in the sense in 
 which it is employed by the founder of the popular medical 
 doctrine of the day, and to employ, instead thereof, the word 
 inflammation, confining the meaning of the latter to condi- 
 tions which are decidedly morbid. 
 
 Much of what we have to remark upon the subject of in- 
 flammation has been given to the reader in the section on the 
 reproduction of parts, and in that upon reaction. All that we 
 propose at present, is to recall to mind the fact that the diffe- 
 rent parts concerned in an inflammatory action may be in very 
 
 * Much has been written, and some ill feeling- has been displayed bv physi- 
 ologists, on the question of the primary effects of irritants on the capillaries; 
 some asserting that they contract, others, that they dilate them. And the con- 
 tending parties regulate their ideas of the active or the passive nature of inflam- 
 mation accordingly. Now this is really illogical. Inflammation is not a direct, 
 but a consecutive effect of the application of irritants. Some irritants do cer- 
 tainly contract parts— as the astringents,- others as certainly expand them— as 
 heat,- and both, alike, occasion inflammation, though neither of these changes 
 just noticed constitute the disease. Two things are certain— inflammation is 
 always attended with enlargement of the capillaries, and enlargement of the ca- 
 pillaries is always attended with relaxation of the arched fibres of the middle 
 coat. This is no proof that inflammation is a state of increased, or that it is a 
 result of diminished action. The relaxation may be, like many other similar 
 phenomena, a mere result of a natural consent of parts consistent with either 
 theory. If these facts had been duly considered by phvsiologists, a deal of ink 
 and paper would have been saved. 
 
PHYSIOLOGICAL REMARKS. 155 
 
 different conditions, requiring the application of various and 
 opposite remedies. This is done in order to show the fallacy 
 of the idea entertained by many followers of Broussais, that 
 the local application of stimulants to internal parts in a state 
 of inflammation, or as they term it, irritation, is always im- 
 proper. This conclusion they would hardly attempt to defend 
 to the fullest extent in theory, but it is obviously the princi- 
 ple on which they practise in fevers 
 
 Let us take the case of a common bile, in a state approaching 
 to maturity, — a case which has been described already in a 
 previous section. The walls of the centre of the tumour are 
 purple, engorged, and display marked feebleness of action. 
 The circulation is here very inactive, or it is completely ar- 
 rested; and the sensibility of the part is diminished. Apply 
 stimulants to this part, and you will hasten the opening of the 
 abscess; nor will even the use of powerful caustics occasion 
 material pain, or heighten, in the slightest degree, the violence 
 of the disease. The middle of the tumour is often in a state 
 of high irritation, occasioning increased deposition, and hard- 
 ening, analogous to a rapid hypernutrition. Stimulants would 
 here be highly improper, and an active depletion may be, 
 sometimes, very serviceable. Around the outside of the tu- 
 mour the healthful process of adhesion, or the preliminary 
 steps of the function of reproduction, are going on regularly, 
 and should not be disturbed. Generally, reaction is aiding the 
 proper progress of the case, or, from defects of constitution, the 
 action of the heart may be too violent, or too feeble, for the 
 purpose — and the general treatment must be varied according 
 to these circumstances. 
 
 The mere extent of an inflammation may determine the pro- 
 priety of using or avoiding stimulants in the treatment. Let 
 us choose an example from the history of an accident familiar 
 to all. A man shall burn his finger severely, and one of his 
 elderly advisers who has heard that spirits of turpentine is 
 u good for a burn," shall apply this formidable article to the 
 finger: — the patient will soon be convinced by bitter experi- 
 ence that the doctrine is incorrect! But hasty conclusions are 
 seldom safe. Another patient shall fall into a hatter's caldron, 
 and the whole of his lower extremities shall be deeply and 
 terribly scalded. Pale, and shivering in collapse, he is car- 
 ried to an hospital, and the surgeon shall envelop his limbs in 
 an ointment composed of lard and spirits of turpentine. Af- 
 ter a tedious confinement, the patient may recover, telling me, 
 "the sovereignest thing on earth, was turpentine" for an ex- 
 tensive burn!* 
 
 * I was once present when a little black boy was brought into the Pennsyl- 
 vania Hospital in a violent frenzy. He had burned his eyes while playing- with 
 
156 PHTSIOLOGICAL REMARKS. 
 
 If we apply the same reasonings to the treatment of internal 
 injuries, which habitually govern us in the treatment of exter- 
 nal complaints, (which is indeed the only philosophical plan 
 of procedure,) we shall find the use of stimulants in fever, 
 when properly applied, quite as reasonable as that of turpen- 
 tine in burns. 
 
 Let us suppose a patient to be attacked with that species of 
 inflammation in the intestinal glands which gives rise to ty- 
 phus fever. If we give the patient wine in the early stages 
 of this complaint, we do exceedingly wrong under all ordina- 
 ry circumstances, for the inflammation is of small extent. True 
 we do not give pain to the patient, for the nerves of the part 
 affected are those of organic life. The old-fashioned plan of 
 stimulating in typhus, has slain more men than Samson! Yet 
 when, in the after progress of the disease, the radiating irrita- 
 tions have extended the inflammatory action to many other 
 organs, and when the powers of the system sink beneath the 
 unequal struggle, wine may prove not only useful but essen- 
 tial to the life of the patient! 
 
 But let us now choose a case of a different character. A 
 patient appears in the first stage of malignant cholera. The 
 whole surface of thirty-six feet of intestine are in a state of 
 sudden and high irritation! He is in profound collapse, and 
 the superficial circulation is totally arrested! The case resem- 
 bles that of the extensive scald. Give him largely of brandy 
 and opium, and he may recover. Treat him on an opposite 
 system, and he dies! 
 
 How ridiculous, then, is that system which prescribes for the 
 name of a disease, while it neglects the state of that disease! 
 Even in cholera, of which we have just spoken, if stimulants 
 were given in every case, the most serious evils would follow, 
 particularly in temperate climates, where the sudden and pro- 
 found collapse which marks its access in tropical countries is 
 very rarely witnessed. 
 
 The treatment of inflammation should be governed by the 
 same principles, and requires the use of the same classes of 
 agents that have been recommended under the head of hyper- 
 nutrition, except that pressure is more rarely applicable; but 
 it is requisite to use the remedies with more energy and de- 
 cision. 
 
 Before leaving the subject of inflammation, it is necessary to 
 say a few words of engorgement', — an affection of the capillary 
 
 powder; and his mother, by the advice of a neighbour, had filled them with 
 spirits of turpentine. " The Doctor told her it ivas very good for a burn."' Bv 
 the aid of five stout men, the boy was held down on the counter until his eyes 
 ■were well washed with a strong syringe and water! Strange to say — the "or- 
 gans were uninjured! 
 
PHYSIOLOGICAL REMARKS. 157 
 
 vessels often confounded with inflammation, and producing, in 
 many instances, analogous results, though possessing a very 
 opposite character. 
 
 The word engorgement has been employed quite as vaguely 
 as the other terms which we have had occasion to define. By 
 many, it is made to include a fulness of the vessels resulting from 
 a determination of blood toward an inflamed or highly irritated 
 point; while others have extended its signification to the dis- 
 tention observed in the vessels of a part previously weakened 
 by inflammation; but these appearances are properly a por- 
 tion of the train of consequences produced by capillary irrita- 
 tion. 
 
 The term engorgement should be restricted in its applica- 
 tion to a condition often the very reverse of this, in which 
 the distention results from causes resident, not in the part af- 
 fected, but a distance therefrom. 
 
 The causes of engorgement are purely mechanical; for in- 
 stance, a tight garter is habitually worn above the knee, where 
 there is but one bone in the limb, and where all the veins of 
 the leg are compressed by the ligature. The circulation in 
 the arteries is less embarrassed by slight forces, and the blood 
 continues to flow through them into the parts beyond the gar- 
 ter, with much more facility than it can return by the veins. 
 The latter vessels, and finally the' capillary arteries also, are 
 consequently distended, and a retarded circulation is esta- 
 blished. The vessels being unable to discharge their burden, 
 nature attempts their relief by calling into play the transmit- 
 ting power of the tissues, and the more fluid parts of the blood 
 are thrown out into the cells of the cellular tissue in the form 
 of serum; the feet swell, and the patient labours under oedema 
 or local dropsy. The distended vessels would be unable long 
 to continue the circulation against such difficulties, unless their 
 strength were increased, and nature soon endeavours to accom- 
 plish this purpose by causing a hypernutrition of the coats of 
 the veins which become greatly thickened, while they are at 
 the same time elongated and twisted; and the patients present 
 the diseased appearance called varicose veins. But altered or- 
 gans can never act with as much regularity and propriety as 
 healthy ones, and, after some time, the thickening of the coats 
 as well as the stagnation of the blood in the veins, interferes 
 with the necessary nutrition of the surrounding parts, which 
 soon become incapable of carrying on their vital functions for 
 want of sustenance. The absorbents continue to take up the 
 particles which are thus rendered useless, while few or none 
 are deposited in their place, and the weakened parts disappear, 
 leaving an irregular hole or sore. Nature still struggles to re- 
 store this loss; but the process of reproduction cannot be sue- 
 
158 PHYSIOLOGICAL REMARKS. 
 
 cessfully carried on with injured tools and an imperfect sup- 
 ply of bad materials, and the patient then labours under an 
 ulcer of the leg, which it is often almost impossible to cure! 
 
 The same results very frequently follow the simple pressure 
 of the columivof blood, in persons of unusual height, who are 
 obliged to be much upon their feet; and it is rare to see a man 
 of fifty, measuring six feet or upwards, whose veins about the 
 ankles are not in some degree varicose. The swelling of the 
 feet so often observed in women during the latter months of 
 pregnancy, is produced in the same way, by the pressure of 
 the womb upon the veins of the pelvis; and many other sin- 
 gular affections in various parts of the body result from simi- 
 lar causes. If the mechanical obstruction take place in the 
 heart, the patient will often suffer from general dropsy, for, in 
 that case the engorgement is general. 
 
 There is another set of engorgements of a much more se- 
 vere, but often transient character. The application of cold, 
 or any other direct sedative* to the whole surface of the 
 body, occasioning a contraction of its capillaries, drives in- 
 ward a large portion of the circulating mass; and if the veins 
 of any internal organ are previously weakened, that organ be- 
 comes engorged. Certain vital obstructions in the capillaries 
 of the liver, are very common causes of engorgement of the 
 portal circle; and if these obstructions are frequently renewed 
 for a long time, all the consequences of varicosity, such as 
 dropsy, thickening of vascular parts and ulceration may occur 
 within the abdomen. This is witnessed in the liver and spleen 
 in old cases of neglected intermittent fever. 
 
 The proper treatment of engorgement is very obvious. 1st 
 When the disease affects external parts, mechanical contri- 
 vances must be made to support the veins, and all mechanical 
 obstructions to a free circulation must be carefully removed. 
 2d. The distention of the vessels may sometimes be relieved 
 by local blood-letting frequently repeated, and by promoting 
 the natural secretions of the part. If the portal circle be the 
 seat of the disease, leeching the verge of the anus may be 
 made to act directly in relieving the vessels of the abdomen, 
 which are not provided with valves, — a course of treatment 
 plainly pointed out by nature, which often effects a cure by re- 
 peated attacks of piles. This remedy may be aided by saline 
 purgatives, upon an obvious principle. 3d. Counter-irritants, 
 of the milder and more durable cast, are often useful in divert- 
 
 * With all due deference to the opinions of certain physiologists, we hold 
 few positions to be more absurd than that which attributes the contraction of 
 the circular capillary fibres to an increase of action in the part. The whole his- 
 tory of disease most plainly proves that precisely as the nervous energy de- 
 clines, the capillaries contract. 
 
PHYSIOLOGICAL REMARKS. 159 
 
 ing the force of the general circulation from the diseased 
 part. 
 
 OF NERVOUS IRRITATION. 
 
 The nature of the nervous influence is so little understood 
 that it will not be surprising to the reader to hear that the 
 characters of nervous diseases are among the most difficult of 
 medical studies. Indeed but little is yet known of them. 
 
 In the few remarks that will be made on this subject, the 
 term nervous fluid will be freely employed, not because the 
 nerves are vessels containing any liquid in their cavities, for 
 they are solid, and have no cavities; nor because they convey 
 from place to place any occult, imponderable fluid like heat, 
 light, or electricity; for, though such a fluid is very probably 
 secreted and conducted by the nerves, the fact remains to be 
 proved. We employ the term, therefore, merely because the 
 phenomena of nervous action can be more intelligibly ex- 
 plained upon the hypothesis that it is dependent upon the mo- 
 tions of a fluid than upon any other supposition. 
 
 It has been stated that the power of the nerves and the ful- 
 ness of the capillaries were mutually dependent on each other; 
 but it must not be supposed that the influence of the nervous 
 system is always lessened by the abstraction of blood, or in- 
 creased by the habit of over-eating and plethora. The very 
 reverse of this is often the case. As the more important vas- 
 cular organs become the seat of undue determinations of blood, 
 simply by over-bleeding or starvation, so the nervous centres 
 become the seat of increased excitement from the general de- 
 bility of the system; for it is rather the relative than the ac- 
 tual strength of any part that determines its influence on the 
 vital operations of the animal. 
 
 It seems to be a law of the animal economy that there should 
 be a perfect balance of power throughout the nervous system 
 when in health and at rest; but that the moment we commence 
 to move, or are subjected to any local excitement of the nerves, 
 the nervous fluid is directed more especially to the organ used 
 or irritated, leaving the remainder of the body relatively defi- 
 cient in nervous energy. 
 
 When it is recollected, in addition to the facts just noticed, 
 that any cause which throws an unusual amount of blood into 
 the capillaries about any particular portion of the body, has a 
 tendency in the first instance to heighten the nervous power, 
 it will be at once perceived that all the several classes of re- 
 medies which are recommended in capillary irritation are 
 equally applicable in nervous irritation ; and that the method 
 
160 PHYSIOLOGICAL REMARKS. 
 
 of treatment, by counter-irritation, is peculiarly adapted to the 
 management of the latter class of diseases. 
 
 But, besides these various agents, there are others which 
 appear to possess peculiar powers in increasing or allaying 
 nervous excitability. Among the most important of which 
 are the stimulating antispasmodics, which act as counter-irri- 
 tants, and the narcotics, or opiates, which act as direct seda- 
 tives on the nervous system after the excitement of the ca- 
 pillaries, which they generally produce in the first instance, 
 has passed away. A few words added, on the order of phe- 
 nomena produced by different degrees of nervous excitement, 
 and we will pass to other subjects. 
 
 The immediate consequences of an impression made by a 
 stimulant acting on a nerve, are an increased tendency of blood 
 to the part, and the other preliminary steps which mark the 
 commencement of an attempt at reproduction. There is also 
 an acute and peculiar pain, if the nerve be a part of the sys- 
 tem of sensation. The irritation commonly radiates without 
 delay to both extremities of the nerve, that is, to the surface 
 or organ in which it terminates, and to the nearest nervous 
 centre with which it is connected. Hence arises a train of 
 sympathetic affections, which have been sufficiently described 
 already, and a series of functional disturbances in the organ or 
 surface just mentioned, their character varying with the in- 
 tensity of the irritation. It is to the last named symptoms 
 that the attention of the reader is especially called at present. 
 
 In slight cases, the functional derangement consists in a 
 simple increase of activity in the natural operations of the part. 
 Thus, if the nerve be a cutaneous one, the skin of the part be- 
 comes redder and warmer than natural, and its sensibility is 
 increased while the moisture of the part on which it termi- 
 nates, instead of being checked, is rendered rather more re- 
 markable. If it be an intestinal nerve, or one distributed to 
 any part of the mucous membrane, an increased secretion of 
 mucus takes place, or the patient is affected with symptoms 
 simulating a catarrh; if it be a muscular branch, twitchings, or 
 unusual motions are produced; if a nerve of the heart, palpi- 
 tations ensue; if of the kidneys, the urine flows in greater 
 quantity, &c. If the case be somewhat more severe, instead 
 of a simple increase of the natural functions, we often observe 
 those functions materially altered in character. For instance, 
 in a mucous membrane the mucus is exchanged for pus; in a 
 suppurating wound, the pus is replaced by a thin and highly 
 irritating sanies; and in a muscle, the mere occasional twitch- 
 ing is converted into a strong spasm, placing the organ entire- 
 ly beyond the control of the will. The frequent repetition or 
 the long continuance of this grade of irritation, sooner or later 
 
PHYSIOLOGICAL REMARKS. 161 
 
 produces a change of structure in the part or organ supplied 
 by the nerve. 
 
 If the grade of the affection be very intense, the effect is re- 
 versed, and the part is completely paralyzed. According to 
 the organ subjected to the change, the urine ceases to flow, or 
 the bladder to contract, the muscles become palsied, or the 
 bowels remain obstinately bound, refusing to answer to the 
 action of any purgative. And if this state continue for any 
 great length of time, the patient must die, or the part will 
 dwindle away for the want of use, leaving little but the cellu- 
 lar tissue which originally formed it, to mark the spot which 
 it previously occupied. 
 
 Irritations of the nervous centres are the more important, 
 the greater is the extent of the vital operations over which 
 they preside; and when they are grave in character, the issue 
 is generally mortal. 
 
 The brain, that proud distinction of the more complex ani- 
 mals which raises them so infinitely above the semi-vegetable 
 existence of the simpler tribes forming the lower links of the 
 animal scale, is rather a combination of centres, than a single 
 centre of nervous energy; and some very curious proofs of 
 this fact are presented in the history of its diseased actions. 
 
 Portions of the brain have been lost by fractures of the skull 
 in falls, and by sabre-cuts in battle — and even musket bullets 
 have penetrated it without destroying life! yet, as a general 
 rule, all very serious injuries of this mass of nervous matter 
 are considered fatal. The danger is greater the nearer it ap- 
 proaches to the junction of the spinal marrow at the base of 
 the brain, for that is the spot toward which all the nerves of 
 animal life, whether internal or external to the brain, appear 
 to tend. 
 
 Injuries of the upper and anterior portions of the brain ap- 
 pear to be much less serious in their immediate consequences, 
 than those of the posterior and lower portions, provided the 
 nature of the mischief is not such as to occasion extensive ir- 
 ritation, or general pressure on the brain; and this fact is beau- 
 tifully consistent with the theoretical views of the phrenolo- 
 gists. For the upper and anterior parts of the organ are the 
 supposed seals of the moral and intellectual faculties, while 
 the lower and posterior portions are the known residence of 
 many of the more important instincts, and also exerts a very 
 direct influence over other vital operations than those of the 
 mind: and it is much easier for an animal to subsist without 
 intelligence or sentiment, than he can without instinctuous de- 
 sires! But all parts of the brain are too important to be long 
 subjected to undue exercise, or irritation, without producing 
 serious alterations in the balance of the system, and the vital 
 
 21 
 
162 PHYSIOLOGICAL REMARKS. 
 
 functions generally, and hence the reciprocity between the 
 health of the body and the head has become proverbial. 
 
 By far the most curious circumstance in connexion with the 
 history of the cerebral irritations, is the possibility of treating 
 them by means of mental counter-irritation — a subject which 
 deserves much more attention than it has yet received from 
 the profession; and one which will form, before long, the phi- 
 losophical basis of the moral treatment of insanity, as it has 
 already shed new light on the theory cf education! Much 
 observation has convinced us that the best possible counter- 
 check to the morbid excitement of the physical passions of 
 man, is a close application to the study of mathematics or na- 
 tural history! And, on the other hand, the over-strained powers 
 of the reasoning faculties are best restored by those relaxations 
 and amusements which actively employ the muscles, the senses, 
 and the affections, thus exciting the nervous fibres of the pos- 
 terior and lower portions of the brain. 
 
 ON THE BALANCE OF VITAL ACTION AND REACTION. 
 
 We have already spoken of the fact that an excitation of 
 any one portion of the nervous system produces a diminution 
 of the supply of nervous fluid in other parts; but there is one 
 circumstance connected with this subject that requires some 
 farther notice. 
 
 Whenever an irritation is produced in any given spot, its 
 vital energies are, for a time, increased, while those of the rest 
 of the system are relatively diminished; but, after a certain 
 time the part becomes exhausted by its unwonted exertion, 
 and the scales are turned. The system becomes relatively 
 more vigorous than the part affected. The same causes being 
 continued in action, the part soon resumes its powers and 
 again takes the ascendant under the reaction of the general 
 system. In this manner a continued vibration is kept up be- 
 tween the local affection and the rest of the body, becoming 
 greater, or less violent, according to the comparative severity 
 of the disturbing cause, and the resisting force of the consti- 
 tution: This gives to the disease the appearance of periodi- 
 city, so generally observed, and goes far to explain the limit- 
 ed duration of fevers, their remissions and intermissions, cri- 
 tical days, types, &c; matters far too abstruse to be considered 
 in a popular work. 
 
 It follows, from the remarks contained in the last paragraph, 
 that the treatment required at different periods in the progress 
 of any attack of disease, may be very various, and that quite 
 as much depends on the proper time for the exhibition, a? 
 
PHYSIOLOGICAL REMARKS. 163 
 
 upon the nature of the remedy. A bleeding that may be 
 very serviceable at three o'clock in the afternoon, may be 
 very improper at ten in the morning, but may be absolutely 
 demanded in the evening of the succeeding day! How inju- 
 rious, then, is the custom of physicians in large capitals, who 
 always send for a bleeder to open a vein! In the majority of 
 cases this is well enough; but the physician should never be 
 without his lancet, and should employ it personally on grave 
 occasions, so as to retain, at least, the facility of habit, and a 
 practical knowledge of the use of the instrument. It is a cu- 
 rious fact that some physicians, in extensive practice, who 
 would set, or even amputate a limb, if suddenly called on duty, 
 are yet afraid to open a vein! so complete is their habitual 
 dependence on others! 
 
 OF VICARIOUS DISCHARGES AND TRANSFORMATION OF 
 
 TISSUES. 
 
 There are some curious proofs of the influence of the nerves 
 over the action of the tissues, and some that tend equally to 
 establish the fundamental principle laid down in the first chap- 
 ter of this work; namely, that the cellular tissue is the basis 
 and original agent in the construction of all other tissues and 
 organs. I allude to the cases of healthy or diseased action, in 
 which one portion takes upon itself the duties and functions of 
 another portion. 
 
 If, in females, the menstrual discharge be checked, it not 
 unfrequently happens that the lungs supply the deficiency by 
 throwing out blood, an accident which often excites extreme 
 alarm when there is little danger. In like manner, the skin has 
 been known to discharge urinous matter, when the secretions 
 of the kidneys have been arrested by disease. In fractures and 
 wounds of all the more solid organs, when there is any dis- 
 placement of the injured surfaces, nature does not content her- 
 self with simply reuniting the dissevered parts, but hastens 
 her operations, and renders assurance doubly sure, by calling 
 on all the neighbouring tissues to supply a portion of the new 
 matter, such as bone, ligament, &c, in order that the injury 
 may be repaired as soon as possible. — As the object of these 
 changes of function is evidently the promotion of health under 
 circumstances in which it cannot be preserved by ordinary 
 means, they are called vicarious discharges, or vicarious ac- 
 tions: but we see similar alteration of structure frequently oc- 
 curring in situations where, instead of relieving or perfecting 
 the system, they oppress or injure it. Thus, all parts of the 
 body — not even excepting the brain itself — have been occa- 
 
164 PHYSIOLOGICAL REMARKS. 
 
 sionally seen converted into bone! and, under the influence of 
 morbid causes, it seems as if the cellular tissue was furnished 
 by the nervous influence, with power to create any compound 
 tissue, or peculiar organic structure, not only where it should 
 be, but, also, ivhere it should not be! 
 
 When such transformation of tissue occurs, it is, in general, 
 extremely difficult to discover either the cause of the change, 
 or the remedy for its occurrence. When the misplaced pro- 
 duct is soft, and capable of compression, pressure sometimes 
 occasions its reabsorption; but when it is decidedly hard, as 
 in ossifications, it is commonly impossible to effect a cure un- 
 less the part affected can be removed by the knife. Even this 
 last resort must frequently fail; for, if the action of the free 
 cellular tissue is so seriously altered in one particular spot, 
 experience teaches us that the disease is extremely prone to 
 reappear in other places, after the removal of .the part at first 
 affected. 
 
 It is unnecessary to bestow further attention upon those de- 
 generations of tissue which result from the absorption of the in- 
 terstitial deposites of compound tissues; for these have been 
 sufficiently noticed in the earlier part of this work: but the 
 morbid alterations observed in disease are not confined to the 
 misplacement or destruction of the various organic products 
 commonly observed in the body; other, and altogether diffe- 
 rent matters are occasionally deposited in the cells of the cel- 
 lular tissue, having no affinity with any ordinary animal pro- 
 duct Of this nature are the tuberculous matter peculiar to 
 scrofula and consumption, the constituents of cancerous and 
 certain fungous tumours, &c &c. Their extreme obstinacy, 
 and, generally incurable character, are mainly attributable to 
 our ignorance of the method in which they are produced. 
 
 In common with all newly formed or misplaced parts, these 
 diseased deposites possess less power of vital resistance than 
 the original structure; and, in many cases, their presence be- 
 comes a source of irritation to the surrounding parts, and ul- 
 ceration of the most alarming and intractable character is a 
 frequent consequence. 
 
 Our object, in the present and preceding chapters, has been 
 to give the reader some idea of the mode in which reasoning 
 and scientific observations may be employed in pursuing the 
 study and practice of medicine. The very hasty glance which 
 has been taken, is sufficient, it is hoped, to show the fallacy of 
 the popular notion that almost any one, whatever be the nature 
 of his education, is capable of becoming acquainted with this 
 most occult branch of human learning; and the equally un- 
 founded opinion that the patient "surely knows his own con- 
 stitution better than any body else/" Let any candid man 
 
PHYSIOLOGICAL" REMARKS. 165 
 
 examine the complex nature of many of the problems which 
 have been rapidly stated in the preceding pages, and he will 
 be able to judge of the justice of the boasted powers of empy- 
 rical and ignorant pretenders to skill, and how far the venders 
 of universal medicines, are entitled to the confidence of the 
 public. It will be well, also, if he should modestly inquire of 
 himself how far he may safely venture on applying the practical 
 directions, which it is the chief object of this work to place at 
 his command, at times, and in situations which admit of a refe- 
 rence to persons of superior information on medical topics. 
 
 What has been stated may enable him to comprehend the 
 action and the propriety of many remedial measures hereafter 
 advocated; but he will find very numerous prescriptions, the 
 operation and philosophy of which, he will fail to compre- 
 hend, and which could not be explained to the uninitiated. 
 
166 REMARKS ON HYGIENE. 
 
 CHAPTER IV. 
 REMARKS ON HYGIENE. 
 
 Hygiene, or the art of preserving health, as it is usually- 
 termed, is, in reality, an important and extensive science; but 
 it would be inconsistent both with the limits and the objects 
 of this work, to attempt any thing more than a passing notice 
 of the more valuable practical deductions drawn from its doc- 
 trines and established by experience. It forms no part of our 
 design to appear learned; we are only anxious to be useful. 
 
 In fartherance of this view, the remarks contained in this 
 section will be divided into five principal sections, on food, 
 raiment, air, exercise, and the management of the health of 
 children. Under each head will be given such practical di- 
 rections as are most likely to be serviceable in the every day- 
 business of life. 
 
 OF FOOD. 
 
 Man, is evidently constructed with a view to the mastica- 
 tion both of animal and vegetable substances; and, according- 
 ly, some of his teeth are constructed like the grinders of the 
 graminivorous animals, while others resemble those of beasts 
 of prey. 
 
 At various eras in the annals of history, certain nations and 
 sectaries, influenced by false religion, or equally spurious be- 
 nevolence, have contended against the propriety of subsisting 
 upon animal food. In our own day, we observe the influ- 
 ence of this prejudice, nationally, in the worshippers of Brah- 
 ma, and on a narrower scale, in the monomaniacal conduct of 
 certain advocates of a most humane and reasonable doctrine — 
 the ultra-temperance reformers! 
 
 It is not in the structure of the teeth alone that we perceive 
 the truth of the position that Providence designed both the 
 beast of the field, and the herb of the garden for the support 
 
REMARKS ON HYGIENE. 167 
 
 and sustenance of man! His internal organization is equally- 
 constructed with direct reference to this double purpose! His 
 length of small intestine involved upon itself, and the several 
 enlargements and toriuous course of his great intestine, are 
 evidently contrived upon the model of the herbivorous tribes, 
 while his single and simple stomach, so different from those 
 of the ruminating animals, is clearly designed for the less la- 
 borious process of digesting meals. 
 
 Until, then, it can be proved to demonstration, that modern 
 theorists are wiser in iheir knowledge of physiology, than He 
 who gave laws to the science, and constructed the master- 
 piece of nature, it is ridiculous 1o argue upon the question 
 which has been so much debated by a few enthusiasts! 
 
 E/en those who act upon 1he doctrine that animal food is 
 unnecessary to man, and therefore to be avoided on the prin- 
 ciples of benevolence, would find but liltle encouragement 
 from an actual comparison of the relative developments of 
 those nations who abstain from it, and those who use it freely. 
 The former are invariably weaker and less vigorous, and their 
 longevity is less remarkable than the latter. 
 
 But it is much more difficult, perhaps impossible, to deter- 
 mine the relative proportion of animal and vegetable food 
 which will be found most conducive to health. This propor- 
 tion will be found to vary much with the climate and the 
 temperature of the season. In tropical countries, the abun- 
 dance of fruits and vegetables which burden the table through- 
 out the year, points out, in the clearest manner, that nature 
 designed the inhabitants of these regions to subsist chiefly 
 upon plants; or, if we state the proposition in different terms, 
 the constitution of man, in these situations, is habitually 
 adapted to such food. In polar regions, on the contrary, 
 scarce a trace of vegetable life remains, and the scattered po- 
 pulation subsists almost exclusively upon animal food. Neither 
 of these extremes is found consistent with the highest per- 
 fectibility; and it is probably owing, in a great degree, to the 
 proper balance between the quantity of nutriment obtained 
 from the two great kingdoms of organic life, that the people 
 of temperate latitudes have ruled the world from time imme- 
 morial, and are likely to perpetuate their power to the end of 
 time. 
 
 Next in importance to the nature of the food taken, is the 
 mode in which it is prepared for reception into the stomach. 
 Man has been called, emphatically, a cooking animal, but it 
 may well be questioned, whether he has gained any great ad- 
 vantage by the cultivation of the culinary art. It is true that 
 by the aid of fire, he appropriates to his use many substances 
 which are either indigestible or poisonous in their natural 
 
168 REMARKS ON HYGIENE. 
 
 state; but his bill of fare would have been very considerable, 
 even if all such articles had been excluded. Be this as it may, 
 hereditary habit has not only rendered cooking necessary to 
 health, but even the peculiar modes of dressing employed by 
 different nations and tribes have become essential to their com- 
 fort; and many of the races may be distinguished by their 
 food and tastes, almost as readily as by their physiognomy. 
 To show how far the system adapts itself to peculiarities of 
 habit in regard to food, it is sufficient to mention that a conti- 
 nental European soon becomes dyspeptic when he is boarding 
 at the best of English tables; and the insular traveller is liable 
 to the same evil on the Continent, until long familiar with the 
 luxury of a Parisian kitchen. A curious example of the same 
 nature, which comes home to the bosom of an American is 
 this: — It is said that it is far more disgusting to a Parisian 
 belle to sit at the same table with a dish of Indian corn, than 
 for the unpractised school-boy of six years, to discuss a plate 
 of olives! 
 
 If it is impossible to lay down strict rules of diet, which 
 will be generally applicable to the residents of different coun- 
 tries and climates, it is equally so to establish such a code for 
 persons of various ages, and diverse ranks and occupations. 
 The sturdy labourer in the fresh air of the harvest field, would 
 starve upon the rich viands of the citizen, while the latter 
 would be altogether incapable of digesting the stubborn mate- 
 rial in which the latter takes delight! 
 
 The student, whose muscular system is but slenderly exer- 
 cised, and whose vital energies are chiefly concentrated in the 
 brain, cannot tolerate the use of any considerable amount of 
 animal food, without which, the operative would sink at his 
 daily task. We have been absolutely shocked, on more than 
 one occasion, when some delicate girl, whose fibres have been 
 debilitated, and whose viscera have been enervated by the 
 early mismanagement of nursing, and the neglect of physical 
 education, has been rudely chidden in our presence, because 
 she turned with loathing from the steaming of roast beef, or 
 the doughy luxury of apple-dumplings! Her censor, perhaps, 
 some florid, overgrown, though well-meaning tyrant of sixty, 
 who has been permitted to resist the shocks of all manner of 
 exposures, and, it may be, dissipations, to serve as a monu- 
 ment of the prodigious power of nature in the occasional con- 
 struction of invulnerable constitutions! " Have done with these 
 girlish whimsies! eat it at once! It never disagrees with me, 
 and I have used it these forty years!" cries the incensed and 
 insensate "head of the house," and the unfortunate victim of 
 "good education" retires from the table in tears, with a 
 stomach additionally irritated by the want of proper suste- 
 nance. 
 
REMARKS ON HYGIENE. 169 
 
 There will be ample occasion, in the after part of this chap- 
 ter to enlarge upon this species of domestic oppression, parti- 
 cularly when speaking of boarding school mismanagement. 
 
 The quantity of food required by an individual in health 
 varies with the amount of exercise taken, and the term exer- 
 cise is here employed not only to express muscular exertion, 
 but must be extended much more widely, so as to include the 
 operations of all the organs, both of organic and animal life. 
 Digestion is itself an exercise of the stomach; perspiration, an 
 exercise of the skin; thought, of the brain, &c. Now the 
 more an organ is employed, so long as it is not exhausted by 
 over exertion, the more rapid and considerable are its internal 
 changes; or, in other words, the more vigorous is the display 
 of the function of nutrition in the part; and, hence, the more 
 considerable is the amount of food required. In fact, the appe- 
 tite may be regarded, in one point of view, as a kind of gradu- 
 ated measure by which we should always regulate the quanti- 
 ty and frequency of our meals: and it is often the only test 
 by which we can ascertain when exercise is promoting the 
 health, and when it is injuring the constitution. So long as 
 the appetite improves under gymnastic training, the nutrition 
 of the body goes on with increased vigour: but the moment 
 that any important part begins to suffer from exhaustion, the 
 appetite declines. This circumstance will be more fully no- 
 ticed in a future section. 
 
 Of Mastication. The proper attention being given to the 
 selection and preparation of food, the next thing that claims 
 the attention of the student of Hygiene, is mastication. This 
 process is absolutely necessary to reduce solid nutriment to a 
 condition in which the stomach can act upon it with facility. 
 Hence the infinite importance of the preservation of the teeth, 
 the much neglected organs by means of which this reduction 
 is accomplished. It is true that persons accustomed to labori- 
 ous exertion, and especially those whose avocations, like those 
 of the agriculturist, are pursued in the open air, may bolt their 
 dinner in a few moments with comparative impunity; not so 
 the delicate and sedentary! The national habit of rapid eat- 
 ing, which is so universally observed in our country, un- 
 less in the most refined circles of society, cannot be too se- 
 verely censured. The ridicule cast upon us by foreigners on 
 this account, though often intended to injure, has been of con- 
 siderable advantage; and it may be confidently hoped that the 
 day is not far distant when the mass of our fellow citizens will 
 learn to enjoy their meals according to the custom of other ci- 
 vilized people. The inquiry is very frequently made, why 
 has dyspepsia become so much more general of late years than 
 it formerly was? There are probably many reasons, but of 
 
170 REMARKS ON HYGIENE. 
 
 these the strongest is unquestionably the habit of rapid eating. 
 Perhaps it may be denied that our immediate ancestors were 
 less addicted to this practice than ourselves, but supposing that 
 facts may be adduced to establish this point, (which, however, 
 we have not been led to believe by our researches,) the argu- 
 ment would still hold good; for the habits of the greater por- 
 tion of the community have been totally changed since the 
 days of our grandfathers. Then, the lad of eighteen was not 
 considered a man, but might be seen on holy-day afternoons 
 trundling his hoop, flying his kite, or playing at fives or wicket 
 on the commons like a romping boy! His father was in the 
 habit of taking daily exercise in the open air; for cities were 
 small, the manufacturing population did not exist, and the 
 merchant did not disdain to assist in packing his own goods; 
 for the division of labour was not then carried, as now, to a 
 high degree of perfection; time was not so valuable, nor were 
 rail-roads ever at command to convey the traveller from 
 place to place in luxurious idleness, unconscious of the motion. 
 In those days, even the medical student commenced the study 
 of his profession by pounding continually with the heavy pes- 
 tle in the enormous iron mortar to advertise the passenger that 
 there resided a disciple of Esculapius! Well might our grand- 
 fathers digest the half masticated dinner with less injury than 
 we can! Even the habits of the weaker sex have undergone 
 a similar revolution. Many a reader will remember the big 
 spinning-wheel which hummed him to sleep in childhood, 
 when one of the greatest recommendations to matrimony, even 
 with the most fashionable of the sisterhood, was for the belle 
 of the day to display on Sundays a gown of her own manufac- 
 ture! Now, the progress of machinery has banished the wheel 
 not only from the chamber of the metropolitan lady, but even 
 from the garret of the farmer's wife! and we have been con- 
 vinced by actual observation, that during this and other changes 
 in domestic habits, dyspepsia has increased to an astonishing 
 extent among the women of agricultural districts; and how 
 could it prove otherwise when the cheese-press and the churn 
 are exchanged for Scott and the piano; while apple-dumplings 
 and tough pastry are demolished in double the weight and 
 with thrice the velocity ! 
 
 The injury resulting from rapid eating is not confined to the 
 mere result of imperfect mastication; for it is well known that 
 the cravings of hunger are satisfied by a much smaller quanti- 
 ty of food, when sufficient time is allowed to each meal, than 
 when the business of the table is hurried through in a few mi- 
 nutes; and this fact, in connexion with the prevalence of the 
 vulgar custom on which we have been animadverting, goes far 
 to explain the frequency of plethora, headaches, habitual cos- 
 
REMARKS ON HYGIENE. 171 
 
 tiveness, and chronic hepatic disease in females and studious 
 men. Some may be surprised to hear costiveness attributed 
 to over eating; and indeed this affection, in the cases referred 
 to, appears to depend quite as much on the want of exercise, 
 as upon the errors of the table; for moderate agitation pro- 
 motes the evacuations and the activity of all the actions of or- 
 ganic life, although severe jolting, such as we experience in a 
 stage-coach on a rough road, diminishes their activity: — yet, 
 excess in eating, by destroying the tone of the stomach, by 
 calling upon it for unusual exertions, prolongs the stay of the 
 food in that organ, and prevents it, at the same time, from un- 
 dergoing the changes which fit it for passing through the ali- 
 mentary canal with promptitude, and thus it becomes, not only 
 an additional cause of costiveness, but a fertile source of intes- 
 tinal and sympathetic irritations. 
 
 There is a mutual relationship between the condition of the 
 stomach and the teeth, which is so intimate that if either be 
 seriously affected the other is sure to suffer — and thus the ha- 
 bit of rapid eating has a tendency to destroy the teeth, and 
 is one of the principal causes of the proverbial prevalence of 
 decay in the teeth on this side of the Atlantic. 
 
 Use of Saliva in Mastication, It is not only by occasion- 
 ing a mechanical division, and a crushing of solid aliments that 
 mastication promotes the process of digestion; for it also se- 
 cures the complete admixture of the food with the saliva, — a 
 fluid which undoubtedly serves a double purpose in aiding na- 
 ture in this most important operation. Though it is extreme- 
 ly probable that a peculiar liquid secreted by the stomach it- 
 self, is chiefly concerned in dissolving the food and convert- 
 ing it into chyme, yet there is every reason to believe that 
 the saliva also contributes essentially to the solution. At all 
 events, any disease which diminishes or vitiates the secretion 
 of saliva, invariably produces a very serious disturbance of di- 
 gestion, and every habit which occasions a useless expendi- 
 ture of spittle gives rise to the same kind of mischief. Dis- 
 eases of the pancreas, which organ, as has been already stated 
 in the physiological chapter, is a kind of internal salivary 
 gland, are frequently attended by results in many respects si- 
 milar, but not perfectly identical. The reason of this is easily 
 explained. The pancreas pours its secretion into the duode- 
 num or commencement of the small intestine, and the food 
 must pass from the stomach, which is the first and most im- 
 portant digestive organ, before it can be submitted to the ac- 
 tion of the pancreatic liquor. This fluid, therefore, cannot 
 properly supply the place of the saliva; for, in the absence of 
 the latter, the mischief is done before the remedy is applied. 
 Irritations of the pancreas react primarily on the small intes- 
 
172 REMARKS ON HYGIENE. 
 
 tines, while those of the salivary glands react upon the sto- 
 mach. 
 
 -Though the intestinal canal is lubricated plentifully by its 
 own mucus, under all ordinary circumstances, it requires some 
 assistance in giving a free passage to solid aliments, which 
 would inevitably carry away the mucus, and come into con- 
 tact with the delicate surface beneath, if these substances were 
 not previously coated and intermingled with some other ad- 
 hesive and diffusible fluid, calculated to prevent friction. This 
 fluid is found in the saliva, which lubricates the whole surface 
 of the passing mass, and prevents all irritations of the surfaces 
 beneath. To the action of this fluid the reptiles owe the power 
 which they possess, of swallowing with facility substances of 
 greater diameter than that of their own body, as we frequent- 
 ly observe in the snakes. 
 
 The use of tobacco and its injurious effect on the constitu- 
 tion may be mainly explained upon the principles which have 
 now been laid down. This drug is a native of our climate, 
 and it is natural that it should be held in more general appro- 
 bation amongst us than in most foreign countries; and hence 
 it becomes the more important that we should point out the 
 evils which follow its employment. 
 
 In all its various forms, tobacco acts as a narcotic, and les- 
 sens the nervous activity of the individual, especially in the 
 parts to which it is directly applied; but, like all other articles 
 of the same class, except, perhaps, prussic acid, and one or 
 two others, it stimulates before it lulls. In the stimulating 
 stage of its action, the sensations which are produced by it in 
 persons who use it habitually, are highly pleasurable, and the 
 secretions of the surface and surrounding glands are for a time 
 increased. Even the exhaustion which succeeds this hyper- 
 excitement is often agreeable, especially to persons of warm 
 temper; but there is always an ulterior period of lassitude and 
 depression, like that which follows the use of alcoholic stimu- 
 li, and requiring a repetition of the dose for its relief. Unfor- 
 tunately, tobacco is a poison to which the human system adapts 
 itself with astonishing facility — though so horrible in its ef- 
 fects when employed in any considerable quantity at first! 
 But let none deceive himself into the belief that this adapta- 
 tion is perfect, and that he can employ his favourite weed 
 with impunity or benefitT The mischiefs resulting from in- 
 dulgence, though latent, are not the less certain. The use of 
 tobacco by snuffing is, perhaps, the most exhilarating and 
 harmless mode of employing it; but even in that form it soon 
 renders the mucous surfaces of the nose and throat drv and 
 harsh, and places them in a condition which increases their 
 liability to ulceration, while it destroys the delicacv of the 
 
REMARKS ON HYGIENE. 173 
 
 sense of smell, and changes the tone and quality of the voice 
 in a manner destructive of all eloquence! 
 
 There are occasions on which snuff, hy provoking spasmo- 
 dic sneezing, may prove serviceable in disease: there are 
 others in which there would be great danger of determining 
 an apoplexy from the same cause. In persons who are unused 
 to snuff, it may produce some benefit in chronic inflammation 
 of the eye, and in temporary deafness from catarrh; for the 
 effects of most substances applied to the mucous surface of the 
 nose, are extended to the eye and ear, — the external mem- 
 brane of the former, and the internal lining of the latter or- 
 gan, being formed by extensions of the nasal mucous mem- 
 brane. For the same reason, it is probable that the long-con- 
 tinued habit of snuffing, may occasion an imperfection of hear- 
 ing, and an enlargement of the blood vessels of the eye; ef- 
 fects which we think we have frequently witnessed in snuff 
 takers who have passed middle life. 
 
 The extent of mucous surface, impressed by the use of snuff, 
 is less considerable than that which is acted on by smoking or 
 chewing tobacco, and it is less closely associated by sympathy 
 with the stomach, while it stands in even closer relation with 
 the brain. Stimulating powders are therefore employed in 
 many cases to relieve obstinate headaches, and although they 
 can scarcely be classed among the very active remedies, their 
 effects have sometimes proved advantageous. Snuff may be 
 occasionally serviceable upon a like principle, but it acts most 
 powerfully in a manner the reverse of the stimulating powders, 
 though producing, in the end, the same result. The latter act 
 as counter-irritants, calling off the nervous power from the 
 brain to the olfactory nerves; the former diminishes the sensi- 
 bility of the olfactories, and this sedative impression is extend- 
 ed to the brain. But it appears that most substances taken 
 into the nose or mouth produce their characteristic effects most 
 decidedly on the fifth pair of nerves, which are intimately 
 connected with, and necessary to the perfection of all the 
 senses alike; so that if any minute branch of these nerves be 
 injured, it is quite possible for the taste, smell, hearing, or 
 sight to be seriously affected by the accident. Disorders of 
 this kind are occasionally witnessed after the extraction of 
 teeth; and the dentist is sometimes censured harshly for an 
 unavoidable result, — fortunately, the evil is almost never per- 
 manent. It is chiefly by virtue of this action on the fifth pair 
 of nerves that tobacco sometimes proves serviceable in tic do- 
 loureux, neuralgia of the head, tooth, and earache, &c, when 
 these complaints are chronic, or of long continuance; but it 
 does not follow that the occasional success attending the use 
 of this poison, will justify us in considering it the best article 
 
174 REMARKS ON HYGIENE. 
 
 in the treatment of such cases:— still less defensible is the po- 
 sition that the habit of using tobacco is proper with a view of 
 preventing a tendency to such attacks — for it would be just 
 as reasonable to advocate the chewing of opium, because that 
 drug relieves pain in certain cases of local injury to which all 
 men are liable! It is plain, then, that tobacco, like all other 
 poisons, is occasionally valuable as a medicine, but that, by 
 employing it habitually, except under very peculiar circum- 
 stances, we injure our constitutions and deprive ourselves of 
 the advantage of the present effect of the remedy when it is 
 imperiously demanded. 
 
 Smoking and chewing both act much more powerfully on 
 the digestive functions, than taking snuff; but there are consi- 
 derable differences in their mode of action. In smoking, tobac- 
 co acts upon a much wider surface, though in a milder man- 
 ner. It is impossible to avoid the frequent inhalation of the 
 fumes of the common cigar into the lungs; those of the pipe 
 are still more liable to enter the air passages; and the hookah* 
 is expressly intended for inhalation. The latter instrument 
 displays, in the strongest light, the extreme susceptibility of 
 the lungs to the action of vapours thus introduced, and the ra- 
 pidity with which the whole system may be acted on through 
 this route. The Hindoos commingle spices with their tobacco, 
 and dilute it with conserves, and then inhale until the lungs 
 are completely filled with smoke. Novices in the use of 
 the hookah are often intoxicated in a few minutes by the prac- 
 tice. From this it follows that the influence of smoking is dif- 
 fused more generally over the whole system, and that the sto- 
 mach suffers indirectly. Smoking, by its action on the lungs, 
 occasions obstinate thirst, and general debility. The former 
 result leads to the employment of immoderate draughts of 
 fluid, and the latter incites us to the use of stimulating food 
 and drink: thus, dyspepsia and intemperance are the ordinary 
 consequences of habitual smoking. Chewing, on the contrary, 
 produces a more intense effect upon a smaller surface. Its ac- 
 tion on the kindred senses of taste and smell is very powerful, 
 and the stomach immediately sympathizes with the mouth. 
 The flow of saliva is also rendered unhealthy, and increased 
 in quantity. If ejected from the mouth, ihe digestion suffers 
 from the absence of the fluid in dissolving the food, — an evil 
 which cannot be prevented by substituting water, or stimu- 
 lating liquors: it it be swallowed, it enters the, stomach com- 
 bined with a virulent poison, which, however its effects mav 
 be diminished by habit, can never be rendered innoxious. To 
 prove how terribly deleterious is this article so common! v 
 
 • The East Indian pipe. 
 
REMARKS ON HYGIENE. 175 
 
 employed by our fellow-citizens, it is only necessary to men- 
 tion the fact that death by vomiting has been known to follow 
 the application of two leaves of moistened tobacco to the wrists 
 of a delicate patient! We sometimes employ injections of to- 
 bacco to produce general relaxation in certain surgical acci- 
 dents, but the remedy is so dangerous that it is recommended 
 with extreme caution, and its prescription by any other than 
 experienced men should be discountenanced by every one 
 who has a proper respect for human life; yet it is not unusu- 
 ally administered by quacks and ignorant nurses, even in chil- 
 dren! 
 
 The quantity of food taken into the stomach is a matter 
 scarcely less important than its quality. When excess is car- 
 ried to a very great extent, the mere mechanical effect of dis- 
 tention on the circulation is sufficient to produce serious effects 
 in many cases. The abdomen being called upon to give en- 
 trance to a much larger amount of contents than it is in the 
 habit of accommodating, the abdominal muscles cannot relax 
 sufficiently to give it room, and the enlargement of the sto- 
 mach on the one hand, with the resistance of the muscles on 
 the other, press the blood mechanically out of the vessels of 
 the intestines and the portal system. Consequently, the other 
 blood vessels and the heart arc oppressed and overloaded, — 
 the skin becomes florid or purple, — the pulse laborious and 
 slow, — the ideas confused, and the whole system is rendered 
 uncomfortable and inactive, until the food has been in part di- 
 gested and absorbed, and the muscles of the abdomen gradu- 
 ally dilated. This state of things is highly dangerous, and ac- 
 counts for the frequent occurrence of apoplexy immediately 
 after a hearty dinner or supper. 
 
 The continued habit of over-eating in this manner, produces 
 a gradually increasing permanent distention of the stomach, 
 and destroys the tone of its fibres, so that in time they cannot 
 produce sufficient pressure upon the contents to promote di- 
 gestion, and it is only when the stomach is well filled that this 
 process can be carried on with activity — consequently, a por- 
 tion of food remains too long in the cavity after every meal, 
 and becomes a source of irritation and dyspeptic symptoms. 
 
 If the distention from over-eating is produced rapidly, it 
 generally excites nausea, and the offending matter is often 
 thrown up by vomiting, by the same process which we ob- 
 serve in the evacuation of all the other hollow organs. 
 
 The remarks just given explain the ill effects of the me- 
 chanical embarrassment of the stomach, but it is also liable to 
 debility or disease from an undue exercise of its physiological 
 functions. When highly spiced, or strongly stimulating arti- 
 cles are employed in considerable amount, the powers of the 
 
176 REMARKS ON HYGIENE. 
 
 organ are taxed to the uttermost, in order to effect the process 
 of digestion with the greatest rapidity. This higher excite- 
 ment is followed by an equivalent loss of energy which does 
 not pass off until the stomach again requires the exercise of 
 the digestive function, when it is called into unusual exertion 
 with exhausted powers; and, consequently, it performs its of- 
 fice imperfectly, and soon becomes incapable of maintaining 
 the proper equilibrium with other parts of the system, which 
 is necessary to the preservation of health. Though the debi- 
 lity occasioned by the last mentioned cause does not affect the 
 muscular coat of the stomach in the same manner with mecha- 
 nical distending forces, it is nevertheless a most fruitful source 
 of dyspepsia. 
 
 It is laid down as a law by many, that we should always 
 leave the table with an appetite, if we desire to promote our 
 health: but this is by no means necessary, for it is quite suffi- 
 cient that we should avoid decided over-distention, and all un- 
 due stimulation of the stomach. 
 
 As a general rule, children require vastly more food in pro- 
 portion to their size than adults, and the requisite quantity 
 •continues to decrease with advancing age, and for the best of 
 reasons: — the vital operations, and the rapidity of the changes 
 ^effected by nutrition, become much less marked as we grow 
 older, and the waste of the system being thus rendered less 
 considerable, a smaller quantity of food is required to resup- 
 ply it. 
 
 The reverse of this appears to be the case with regard to 
 the stimulating qualities of the food. The advance of age is 
 attended by a loss of excitability in all the nerves chiefly from 
 habitual excitement, and a consequent decline in the vigour 
 of the organic functions. The vital powers are then frequent- 
 ly invigorated by the moderate use of diffusible stimuli, and 
 highly seasoned food — so that some of the very causes of dys- 
 pepsia in early life may be classed among its preventives at a 
 later period. 
 
 Of drink, little need be added after the remarks on solid 
 food, which have been already offered. The same principles 
 with regard to distention and stimulation, hold good in refe- 
 rence to fluids, but it may be well to impress upon the reader 
 a fact which has received too little attention from medi- 
 cal men and teachers of Hygiene; namely, that the drinking 
 of immoderate quantities, even of pure water, is among the 
 frequent causes of debility of stomach and disturbed digestion, 
 thus paving the way for ill health or serious disease. In a na- 
 tural condition of the organ, all reasonable quantities of fluid 
 are very speedily taken up by the absorbents, carried into the 
 circulation, and, if not required, thrown out by the kidneys 
 
REMARKS ON HYGIENE. 177 
 
 and by perspiration: but when the quantity taken is sufficient 
 to produce a full distention of the stomach, its fibres become 
 habitually relaxed, and the fluid will then lay for hours in the 
 cavity, and its presence there may be recognised by its regur- 
 gitation whenever the body is much agitated by running, leap^ 
 ing, riding, or any sudden motion. The way for the encroach- 
 ment of disease in after life, is often laid in early childhood, 
 by the habit of drinking too much water at a time, and it is 
 well for all persons having the slightest tendency to dyspepsia 
 to guard against this habit. When the weather, or any other 
 cause provokes excessive perspiration, or when the quantity 
 of urine discharged is very great, more water is required to 
 supply the drain; but it should be taken, not in large draughts, 
 but In small quantities, frequently repeated. It is, however, 
 much better to employ such measures as are calculated to di- 
 minish the drain, rather than to increase the supply. 
 
 We shall enlarge upon this subject in speaking of the effects 
 of stimulating drinks. 
 
 The use of Stimulating Drinks has given rise to so much 
 discussion of late years, that it would be wrong to treat the 
 subject with neglect in a work like the present. The incalcu- 
 lable evils following the abuse of such articles have produced 
 a popular action and a state of public feeling on this subject, 
 which, like most excitements, have outstripped the bounds of 
 reason, and while effecting vast alleviation of the misery flow- 
 ing from intemperance, have occasioned a reaction unfavoura- 
 ble to the calm discussion of the question. Not contented with 
 the condemnation of the alcoholic liquors, the free blood of 
 the generous vine, and the fermented juices of the fruits and 
 grains, some advocates of temperance have carried the war 
 much farther and reprobated the use of tea and coffee, mustard, 
 pepper, and vinegar! These are all stimulants, they allege; 
 and total abstinence from stimulants is the only protection 
 against the insidious approach of habits of intemperance! We 
 have here ample proof of the ridiculous extent to which theo- 
 rists may be carried who neglect to define their terms, and also 
 of the necessity for the diffusion of a little more physiological 
 knowledge among the mass of the community! The student 
 of the philosophy of life well knows that nearly all articles 
 which sustain the human body and support animal life are sti- 
 mulants, and those who have noticed what has been stated 
 in the preceding chapter, under the head of counter-irritants, 
 must have perceived that the application of a stimulant to one 
 part of the body is often among the most certain means of di- 
 minishing the energy of some other part. A partial or one- 
 sided view of these facts formed, indeed, the foundation of one 
 of the most lauded medical theories of former times, whicji 
 
 23 
 
178 REMARKS ON HYGIENE. 
 
 taught that " life is a forced state," and that the action of sti- 
 mulants not only supported, but actually constituted life! It 
 is -certain that without the use of stimulants life cannot be sus- 
 tained, and the only remaining question is, what particular sti- 
 mulants are healthful, and what are dangerous. 
 
 Alcohol in its pure state is a rapid poison, which acts pow- 
 erfully on the tissues with which it comes in contact. Taken into- 
 the stomaeh> it probably alters the texture of the mucous coat, 
 and whether it can then be absorbed into the circulation has 
 not been ascertained. All that is known is that it will occa- 
 sion death. 
 
 Alcohol diluted is a slow poison, and like most other arti- 
 cles of the same class, may occasionally prove useful in main- 
 taining health or curing disease;, but an habitual resort to any 
 of the liquors containing this article, whether the quantity taker* 
 be large or small, invariably injures the health, though from 
 the slowness of the approach of its ill consequences, they fre- 
 quently escape notice, and when perceived, are often attributed 
 to other causes. Diluted alcohol does not change the charac- 
 ter of the surfaces on which it is applied, as the pure spirit 
 does; and it is therefore freely absorbed, and enters the circu- 
 lation, extending its influence to every blood vessel in the 
 body. Of course, as this fluid contains no nourishment, and 
 is altogether foreign to the blood, it is speedily thrown off from 
 the system with some of the secretions; but it is a curious cir- 
 cumstance that very slight differences in the purity of alcoho- 
 lic liquors occasion an unaccountable diversity in their effects, 
 Thus, alcohol diluted with pure water, brandy, gin, whisky, 
 &c. y though alike in all respects except in the presence or ab- 
 sence of a little vegetable matter, — which is sometimes sa 
 small in amount as to be scarcely appreciable by weight, — pro- 
 duce impressions on the system of widely dissimilar character. 
 For instance: — the alcohol, simply diluted, generally acts as a 
 purgative, and is probably absorbed with difficulty, as its ef- 
 fects on the brain are confined pretty much to a pleasurable 
 sensation, evidently resulting from a simply nervous or sym- 
 pathetic impression, like the first enlivening effect of Cham- 
 pagne. This peculiarity has induced us to employ half an 
 ounce of the pure alcohol diluted with a gill of water, as a 
 mild laxative in certain cases of extreme debility, and although 
 we would be far from warranting its use by persons not of the 
 profession, yet it might be proper to call the attention of me- 
 dical men to the subject, as the spirit in this simple state has 
 never been employed in general practice. Gin, on the contra- 
 ry, which can scarcely be distinguished from simple diluted 
 alcohol, except by the presence of a mere trace of a volatile ve- 
 getable oil, is taken into the circulation with more rapidity 
 than any other liquor, and is cast out with equal speed: but 
 
REMARKS ON HYGIENE. 179 
 
 it does not act as a purgative, except in a few rare instances, 
 its chief operation being on the kidneys, which it siimulates 
 to an increased flow of urine. The intoxication resulting; from 
 gin, is therefore prompt, but evanescent. 
 
 The diuretic properties of gin give this liquor a preference 
 over all other spirituous liquors in certain cases of dropsical 
 effusion. 
 
 Whisky, which can scarcely be distinguished from gin by 
 its chemical properties, differs from it in producing a more 
 permanent effect, and in provoking more free perspiration. It 
 also acts strongly on the kidneys. When taken hot and mixed 
 with molasses ajid some other articles, as is often done by di- 
 rection of elderly ladies who are fond of domestic medical 
 practice, its diaphoretic powers may sometimes prove highly 
 serviceable at particular moments in the progress of catarrh, 
 and even in some cases of intermittent fever, before the coming 
 on of the chill; but it is a dangerous remedy, and under popu- 
 lar guidance, probably destroys more than it relieves! 
 
 Brandy, as it is commonly employed, is coloured with a 
 considerable amount of vegetable matter, and it is probably 
 owing to this circumstance that it acts so differently, in some 
 respects, from the liquors already enumerated. It has a ten- 
 dency in most persons, and under most circumstances, rather 
 to check than to promote perspiration, and sometimes even re- 
 strains the secretion of urine! As it readily enters the circu- 
 lation, and is thrown off from it with difficulty, its effects are 
 much more permanent than those of other liquors, particularly 
 •on the nervous system; and for this reason it is one of the 
 most unwholesome products of the still for the inhabitants of 
 cold or temperate climates, and in dry situations: but, like 
 most other noxious agents, it has its useful applications: — it is 
 the best of the diffusible stimulants, where such stimulants are 
 positively demanded among the old residents in swampy dis- 
 tricts within the tropics. Fortunately, the regular alternation 
 of the seasons in other regions prevents that constant exhaus- 
 tion from perspiration and the undue rapidity of all the vital 
 actions which characterize life in equatorial countries; and our 
 remarks upon the use of brandy cannot, therefore, be quoted 
 in defence of its abuse. If brandy, or any other alcoholic li- 
 quor be freely employed by the unacclimated in climates like 
 that of Bengal, Batavia, &c, the danger of almost immediate 
 death is rendered extremely great, so much so that it has been 
 said that more than one half of all the foreigners settling in 
 Calcutta and its vicinity die before the expiration of the first 
 year, and chiefly in consequence of indiscretion in employing 
 stimulant drinks which the custom of the country continual- 
 ly places before them! Yet how ridiculous is the attempt to 
 
180 REMARKS ON HYGIENE. 
 
 reason on this subject, like a quack upon his panacea, and to 
 force all mankind to follow an intemperate temperate faith, 
 until they become capable of living on bread and water! If 
 the old residents in India were deprived of their brandy or 
 other stimulus, the mortality among them would probably be 
 raised to the same standard; 
 
 It will be questioned, very naturally, by the advocates of 
 temperance, how the remarks just mentioned can be rendered 
 consistent with the position previously taken, that the habitu- 
 al use of such liquors proved invariably injurious? the answer 
 is a simple, though a curious one. The climates in which al- 
 cohol becomes almost indispensable to life, are precisely those 
 in which it is impossible to preserve the health for a long time 
 by any measures. In Bengal, for instance, so universal is the 
 prevalence of chronic liver complaint, that the lowest mercan- 
 tile officer of the British East India Company is permitted to 
 be absent from the country without the loss of salary, at least 
 six months in every period of five years, in order to recover 
 some little energy to resist the ceaseless sapping of the heat 
 and miasmatic vapours of that interminable swamp! Yet even 
 with every precaution, it is almost impossible to avoid hepatic 
 disease for five years consecutively. The late celebrated mis- 
 sionary chief, the Rev. M. Carey, was said to be the only man 
 of the pure European race who ever continued in good health 
 for ten years in Bengal! The cause of this wide-spreading 
 affliction is beautifully laid down by Johnson in his work on 
 tropical climates. The long-continued heats, unrelieved by 
 frost at any season of the year, produce a constant Interac- 
 tion on the skin. The perspiration is poured out almost un- 
 ceasingly, and in immoderate quantities; the skin becomes 
 debilitated, while it still continues under the action of power- 
 ful exciting causes, and the liver suffers sympathetically; for 
 it is found that all general impressions upon the skin, have 
 also a strong action on the liver. Extreme general exhaustion 
 and debility are the natural consequences of the immoderate 
 flow of perspiration; and the European residents of such coun- 
 tries as Bengal are thereby enervated to such a degree that 
 they become incapable of sudden or powerful exertion: — their 
 very voices are generally low and whispering, and their enun- 
 ciation so slow that they are often understood with difficultv! 
 Such debility is exceedingly dangerous, as it renders the >vs- 
 tem peculiarly liable to disease from trivial causes. Diffusible 
 stimuli are so necessary to elevate the exhausted powers, that 
 even the curries, and the hot spices which Providence has 
 planted in those countries, — certainly not without design. — 
 prove insufficient to arouse and support the vital energies With- 
 out the aid of alcoholic liquors, and of these, the Im 
 
REMARKS ON HYGIENE. 181 
 
 brandy, because it acts more favourably on tbe skin, and rather 
 tends to diminish than to increase the perspiration. Yet let 
 it be remembered that the necessity for the employment of 
 such a poison grows out of the previous habits and hereditary 
 peculiarities of those who are foreign to the countr} T : — the in- 
 digenous races of men require no such support, and are really 
 the more healthy for that precept of their religion which pro- 
 hibits the employment of strong drink! 
 
 The propriety of using stimulus after long residence in hot 
 and damp countries, is proved by the fact that even ladies in 
 India will often take a daily allowance of brandy and water 
 sufficient to intoxicate a resident in temperate climates, yet so 
 far is the custom from establishing a love of drink, that the 
 moment a resident leaves the country and breathes the fiee, 
 mild air of the ocean, he ceases to call for his brandy, often 
 without being aware that he has changed his habits! The ne- 
 cessity exists no longer, and the desire ceases; so that if he 
 become intemperate, it is only after another apprenticeship to 
 the bowl ! 
 
 It is easy, by a little reflection on the remarks just made> 
 to trace the few cases in which the use of spirituous drinks may 
 become proper in persons in health not resident in hot and 
 damp situations. 
 
 When those who have passed middle life, find themselves 
 extremely debilitated in consequence of the gradual decline of 
 the vital powers so constantly observed as we advance in age, 
 rendered more remarkable, perhaps, by previous habits of dis- 
 sipation or precocious luxury, it may be advisable to resort 
 occasionally to some diffusible stimulus calculated to give tem- 
 porary energy to the functions of life, if an undue determina- 
 tion of excitement to any particular organ threatens the de- 
 struction of the balance of health* When great exposures to 
 cold, or the depressing effects of miasmatic vapours, or impure 
 air, have brought on extreme weakness or chilliness, a little 
 gin or whisky may prove highly serviceable in hastening 
 the reaction and increasing the excitement of the surface; but 
 it must be remembered, that it is only after the exposure that 
 the rule applies, for no point in Hygiene is better established 
 than the fact that the use of stimulants before or during the 
 exposure to cold, tends to lessen the power of vital resistance. 
 Nor should it be forgotten that the remedy is here employed 
 medicinally , and not as an article of diet. 
 
 In our own country, or rather in the northern part of it, the 
 heats of summer are not continued for a sufficient length of 
 time to induce the necessity of employing the same regimen 
 which is required between the tropics, and it is found by con- 
 stant and ample experience, that even the labourers in the bar- 
 
182 REMARKS ON HYGIENE. 
 
 vest field accomplish a greater amount of labour, and endure 
 with impunity much longer exposure to the intense heat of 
 the sun when denied the use of alcoholic liquors, than when 
 indulged in them ; and the only occasion on which they are 
 available in assisting labour, is when an individual is called 
 upon by dire necessity to perform services for a short time 
 only, but which exceed his natural ability. For such a pur- 
 pose, when the task is to be accomplished in a very short time, 
 the distilled liquors are perhaps the best stimuli ; but when 
 the exertion is to be continued for some hours, the malt li- 
 quors are decidedly preferable. Unfortunate necessity alone, 
 can furnish an apology for such trials, and although by the aid 
 of the stimulation, the work may be completed without any 
 seeming difficulty, the individual invariably suffers, subsequent- 
 ly, all the evils of a state of exhaustion proportionate to the de- 
 gree of over-exertion, and the effect of the beverage. Repeat- 
 ed attempts of this nature prove inevitably ruinous to the 
 health. 
 
 We have now attempted to point out the few cases in which 
 alcoholic liquors may be considered admissible as articles of 
 regimen. It is unnecessary to dwell particularly on the man- 
 ner in which they gradually undermine the health when ha- 
 bitually employed, that matter having been explained in our 
 remarks on the action of highly seasoned solid food; but it 
 may be well to mention that the liver is seriously affected in 
 almost every case of even the moderate, but habitual use of 
 spirits. It is also remarkable that the brain often becomes 
 hardened in consistence, and performs its office much more 
 sluggishly under the operation of the same causes. It is by 
 no means necessary that the habit should be carried even to 
 occasional inebriation, in order that these changes should 
 take place; they are not uncommonly met with in persons 
 who have always enjoyed the character of temperate men. 
 
 As it forms no part of our intention in the present essay to 
 produce a connected treatise on Hygiene, we shall here close 
 our remarks on drink, without taking especial notice of the 
 various fermented liquors; for the knowledge of their various 
 qualities, and the numerous poisonous substanees and hetero- 
 geneous mixtures with which they are adulterated, or by which 
 they are imitated, is now industriously circulated by those dis- 
 ciples of temperance whose peculiar notions on some subjects 
 we have been compelled to combat, but whose labours have 
 been of incalculable value to the public, as none are more hap- 
 py to acknowledge than ourselves, for none have had more 
 ample testimony of the fact. The subject of mineral waters 
 is also avoided, because that portion of society who are able 
 to resort to the springs, very readily and cheaply obtain in 
 
REMARKS ON HYGIENE. 1S3 
 
 other popular treatises, much fuller information as to their na- 
 ture and uses than could possibly be compressed within the 
 space allotted to the Hygienic portion of this work. 
 
 OF CLOTHING AND CLEANLINESS. 
 
 The subjects of clothing and cleanliness are so intimately 
 connected in some respects in their relation to Hygiene, that 
 it is deemed better to include them both in the same section, 
 than to devote a distinct section to the remarks on baths, as is 
 usually done in works of a similar character. 
 
 It is obvious that man requires, in most countries, the aid of 
 artificial covering to protect him against the vicissitudes of the 
 weather; and although, in some tropical districts, this protec- 
 tion is nearly or entirely neglected by the natives, yet the 
 delicate skin of the white race requires to be secured from the 
 scorching heat of the sun at the equator, no less than to be 
 sheltered from the cold in other and more rigorous latitudes. 
 Many generations would probably pass away, before the action 
 of that wonderful law of the animal economy which adapts the 
 constitution of man to almost all varieties of circumstances 
 could bring about those changes which would permit the Euro- 
 pean to endure the exposures known to be harmless to the 
 African. Many nations, it is true, expose particular portions 
 of the person which others religiously cover, and hence arise 
 a variety of opinions, both as to the propriety and expediency 
 of particular costumes. " The more you expose a child to the 
 air, and the lighter the dress he wears, the more vigorous and 
 hardy you make him," says some theorist in education. " Let 
 him run about without shoes or stockings, and dabble in the 
 wet as much as he pleases — the dirtier the better! Children 
 thrive in the dirt!" The rough sons of certain agricultural 
 districts, where this advice is followed to the letter, even for a 
 longer period than during the age of childhood, seems indeed to 
 furnish abundant evidence in its favour; but if we inquire more 
 particularly into the history of families in these sections of 
 country, we shall be startled at. the sacrifice of human life 
 which has been incurred in effecting this physical induration. 
 We shall find that nearly all the feeble and delicate are killed 
 off by the experiment within the first two or three years; 
 leaving none but those on whom nature has bestowed the har- 
 diest constitutions to be subjected to the discipline above re- 
 commended! It is true, indeed, that a Scottish Highlander in 
 his kilts, will undergo with impunity exposures which would 
 probably prove fatal to almost any of his neighbours of the 
 lowlands, but it must be recollected that hereditary habit re- 
 
184 REMARKS ON HYGIENE. 
 
 organizes human nature, and there has been little in the social 
 position of the Highlander to do away with the physical pe- 
 culiarities which he derives from his savage ancestors, among 
 wnom exposure continued a necessity until the laws of life 
 rendered it innoxious. 
 
 Another sect would teach us that it is wisest to be armed at 
 all points against the variations of the seasons; that every por- 
 tion of the body which admits of it should be well and warm- 
 ly clad, until we are compelled to live in an artificial hot cli- 
 mate of our own creation! but it would be well to remind 
 these advocates of excessive caution, that the Romans constant- 
 ly exposed the neck, and we are not informed that these hardy 
 conquerors of the world were particularly subject to anginose 
 affections. In our own day, the fashionable belle provides us 
 with a far more important illustration. Her half clad feet and 
 chest, her bare neck and shoulders, are alternately subjected 
 to the heat of the ball-room, and the chill air of the theatre; 
 and her dress — in its very structure illy-fitted to protect the 
 person — is invariably composed of the thinnest materials which 
 can be tolerated, in order that comfort, safety, and principle 
 may be immolated on the altar of taste! It is true that these fol- 
 lies are not indulged with impunity, as the weekly bills of 
 mortality amply testify, but that they are not universally fatal 
 to the feeble frames and enervated constitutions of these hyper- 
 refined creations of artificial society is quite sufficient to prove 
 that the system of extreme caution in dress advocated and prac- 
 tised by many, is not by any means essential to health: nay, 
 it is even injurious, for constant protection against vicissitudes 
 of temperature, climate, and accidents is altogether impossible; 
 and the fact that undue warmth strongly predisposes the indivi- 
 dual to taking cold from trivial causes, is established beyond 
 dispute by the observation of those who reside in tropical 
 countries. In Bengal, during the month preceding the rainy 
 season, when the thermometer ranges constantly and very gra- 
 dually between 85 and 105 degrees of Fahrenheit, it is exceed- 
 ingly common for severe catarrhs to result merely from the 
 waving of the hot air by the punkah, or large fan, which forms 
 part of the furniture of every saloon! If, then, we accustom 
 any part of our persons to an undue degree of warmth or co- 
 vering,* we lay ourselves open to additional danger from tri- 
 vial accidents. 
 
 * It is a common error to suppose that the presence or absence of even the 
 slighter tissues, is a matter of indifference in dress. Let a lady remove her 
 gauze veil, or a gentleman shave his favourites, when about to face a keen 
 north-wester, and the result will fully convince the party that neither gauze 
 nor hair can be despised with impunity. Slight irregularities in the clothing 
 of the feet are often the causes of much more serious disasters, than those of 
 
REMARKS ON HYGIENE. 1S5 
 
 In order to ascertain what medium in dress is just and pro- 
 per in particular places and for particular persons, it is neces- 
 sary to consider what parts of the body most require protec- 
 tion in all persons; and what peculiarities of the sexes require 
 corresponding cautions with regard to other parts. The first 
 of these questions alone requires attention here. 
 
 1st. What parts of the body most require protection in 
 all persons? The same general laws which have been noticed 
 in the preceding chapters are equally applicable in this depart- 
 ment of Hygiene. As those organs of animals which appear 
 first in ascending the animal scale are always the most impor- 
 tant, because they are those most essential to the growth and 
 existence of the animal, so they require the most perfect pro- 
 tection; for a disorder in their operations must necessarily dis- 
 turb the whole system more certainly and seriously than a 
 similar irregularity in any other parts. The abdomen is 
 formed long before any other cavity, and within its walls is 
 concentrated nearly all the apparatus of vegetative or organic 
 life, (see p. 186.) Here, then, is the part which requires the 
 most careful protection, for here is found the fundamental or- 
 ganization on which the building and repair of the whole body 
 depend! But this protection is more necessary in early life 
 and in advanced age, than during the intervening period, for 
 the following reasons, 
 
 Ineaily life, all the vegetative or merely organic operations 
 of the animal are carried on with energy and rapidity, because 
 the building is then about being constructed, while in middle 
 life, the process of assimilation is only required for repairs. 
 Those portions of the apparatus which arc most constantly 
 employed, are of course most liable to get out of order, and 
 should therefore receive the most careful attention. On the 
 contrary, in old age, the same parts become sluggish, and the 
 demands made upon them are comparatively few; but at the 
 same time, their internal organization Ls rendered imperfect 
 by the deposition of an unusual number of particles within 
 their substance, producing that species of induration of which 
 we have spoken in a former chapter, as one of the characteris- 
 tics of age in all parts of the body. It follows from these 
 facts that, although the abdominal organs become less suscep- 
 tible of impressions in advanced life, their powers of vital re- 
 sistance are also diminished; and it is found by actual obser- 
 vation, that more is lost in point of safety, by the latter, than 
 is gained by the former alteration. 
 
 more apparent consequence; for nature, like man, though prepared for great 
 occasions, often seems negligent of trifles! and it is safer to run barefooted in 
 the snow, than to change boots for shoes during cold or damp weather. 
 
 24 
 
1S6 REMARKS ON HYGIENE. 
 
 The reader will now comprehend our reasons for recom- 
 mending that the abdomen should be better protected by cloth- 
 ing than the rest of the person, especially during the periods 
 of'childhood and old age. 
 
 There is one all-important law, which is not generally laid 
 down by writers on Hygiene, and that it is desirable to impress 
 as strongly as possible. *fl partial covering of any cavity, 
 is much more dangerous than an entire exposure. Although 
 it is highly proper that flannel should be worn next the skin 
 in all cold countries and seasons, yet we well know that many 
 individuals neglect the precaution with impunity. Now we 
 venture the assertion, without the dread of contradiction, that 
 no man can make use of a short flannel shirt that does not en- 
 tirely enclose the lower part of the abdomen, or a shirt which 
 occasionally rides up to the level of the top of the pelvis, with- 
 out suffering severely, and often dangerously, from this partial 
 covering. If young, he will be subject to attacks of inflam- 
 mation of the bowels, diarrhoea, incontinence of urine, or 
 strangury, for which he is totally unable to account; — and if 
 old, he will be liable to similar paroxysms of rheumatism, in- 
 flammations of the kidney, or other evils equally inexplica- 
 ble. 
 
 There can be no doubt that the employment of such gar- 
 ments as those just mentioned, and the neglect of the princi- 
 ple that partial exposures are dangerous, are frequent causes 
 of the loss of human life! and it would be difficult to adduce 
 a more beautiful proof of the vast importance of Hygienic de- 
 tails, apparently trivial, and scarce worthy of notice. 
 
 In order that the reader should be made fully acquainted 
 with the principle on which clothing should be employed in 
 protecting cavities from the effects of cold, it will be well to 
 mention that the direct effect of cold on the contents of the ca- 
 vities is rarely experienced in an alarming degree: it occurs 
 only in cases of an approach to freezing; and is of course fatal, 
 if long continued. The more important influence is an indi- 
 rect one. The cold producing a contraction of the capillaries 
 of the surface, and a corresponding diminution of nervous en- 
 ergy in the skin, it follows that the amount of circulation and 
 nervous action in the internal parts must be proportionally in- 
 creased. Hence, a greater liability to diseased action! The 
 truth of this explanation is beautifully proved by reversing the 
 proposition. Let the stomach be occupied by digestion, or 
 let the lungs or intestines be irritated by any of the usual 
 causes of disease, and immediately the surface becomes chilled, 
 no matter what the temperature of the surrounding air may 
 be. In the first mentioned instance, the blood was driven 
 from the circumference to the centre, and is best recalled by 
 
REMARKS ON HYGIENE. 1S7 
 
 external applications; while in the last it is enticed from the 
 surface, for the purpose of repairing internal injury, and is 
 more readily replaced by remedies addressed to those parts 
 which are irritated, than by any external treatment. When 
 a man is chilled by exposure, the fire will warm him, but in 
 the chill of an intermittent, a dose of forty drops of laudanum 
 will often restore the heat of the surface in a few minutes, 
 when all the blankets in the world would fail! 
 
 The chief object of clothing is to prevent this determination 
 of blood to the internal parts during slight exposures: hence, 
 the importance of protecting not only the abdomen, but the 
 feet also, (distant as they are from the scene of action,) when 
 we desire to shield the bowels against the effects of atmosphe- 
 ric changes; but on this point we shall speak hereafter. 
 
 As we ascend the scale of nature, after passing in review 
 those animals which are provided with but one internal cavi- 
 ty, which generally contains alike the organs of digestion and 
 respiration, we begin to observe a second cavity forming itself 
 by the growth of a partition across the abdomen, converting 
 it into two distinct chambers, of which the lower is the abdo- 
 men proper, and contains all the organs of digestion, and the 
 upper is the thorax or chest, which, in man, contains the heart 
 and lungs. 
 
 It is generally supposed that the lungs require more careful 
 protection than even the abdominal viscera, but a moment's re- 
 flection will at once convince us to the contrary. Nature, 
 whose laws are unerring, guides us on all questions of this 
 kind. She has separated the abdomen more completely from all 
 direct connexion with external things, and it is only at long in- 
 tervals and for short periods, that any crude extraneous sub- 
 stance is permitted to act upon the stomach, — the other parts 
 of the canal (in health,) being free from all contact with un- 
 digested matter. On the contrary, the lungs are at all times and 
 unceasingly in contact with the atmospheric air and the thou- 
 sand impurities which it contains: they are liable to great and 
 sudden changes of temperature in the surrounding medium, 
 acting upon them both internally and externally; for the walls 
 of the chest are in many places thinner, and every where less 
 loaded with subcutaneous fat than those of the abdomen. 
 Moreover, though the assertion may prove startling to some, 
 it is not the less true that morbid changes of structure in the 
 alimentary organs are vastly more important and dangerous 
 than those of the lungs! The latter, indeed, are often known 
 to become impervious in more than half their extent, and yet 
 life may be continued for years! Still stronger proofs of a 
 similar character might be adduced; but enough has been said 
 
1SS REMARKS ON HYGIENE. 
 
 to show that the protection of the chest by clothing, though 
 of incalculable importance, is of somewhat less consequence 
 than that of the abdomen. The latter should therefore be 
 somewhat more warmly clad than the former, and in this re- 
 spect the dress of females is somewhat more rational than the 
 male attire. 
 
 Partial exposure of the chest is of course liable to the same 
 objections which have been already urged against that of the 
 abdomen; and it should be remembered that the lungs rise be- 
 hind the clavicles, above what is commonly considered the 
 cavity of the chest, and encroach a little on the base of the 
 neck. The dress should always protect this part in cold wea- 
 ther, if we desire to regulate it on philosophical principles; — 
 but the rigid laws of fashion interfere to prevent a proper sys- 
 tem in both the sexes. The ridiculous cravat, invented to 
 conceal a deformity! and the equally absurd padded stock are 
 used to convert the neck and throat into a furnace, and the 
 unreasonable temperature is adroitly made to cease at either 
 end, precisely where it would be most excusable to employ it; 
 namely, near the tonsils above, and about the collar bones below! 
 In women, on the contrary, fashion not only exposes the base 
 of the neck, but also the upper part of the chest. Fortunate- 
 ly, the natural tendency of such habits to run into extremes, 
 bids fair, ere long, to render this partial exposure a complete 
 one! It will then become comparatively innoxious! 
 
 The next great cavity of the body is that of the head, but 
 rhis appears much later in ascending the scale of nature, than 
 those previously mentioned. It also requires much less care, 
 — for if we except the climates distinguished by the extremes 
 of heat and cold, both of which render a head-dress absolutely 
 necessary; the head adapts itself with great facility to any de- 
 gree of exposure. It is only requisite to avoid rendering the 
 head susceptible to slight impressions by too great warmth in 
 the apparel, and to shun unusual currents of air, such as the 
 waving of the punkah, which has been already mentioned as 
 a cause of catarrh in tropical countries. 
 
 In proceeding to the consideration of the principles which 
 should determine our mode of dressing the extremities, the 
 first point of -importance which strikes us is the feeble powers 
 of the inferior, when compared with the superior extremities. 
 The pressure of a long column of blood on the vessels of the 
 legs, and the embarrassment of the circulation from that cause, 
 together with the greater distance from the centre of circu- 
 lation, render the vital operations in the feet peculiarly slow; 
 while the sympathies awakened by impressions on the feet 
 are even more extended and important than those which arise 
 
REMARKS ON HYGIENE. 189 
 
 from exposures of the superior extremities; consequently, it 
 is necessary to clothe the feet more warmly than the arms, 
 and a neglect of this law is often productive of great danger. 
 
 Having now dismissed the question of the parts of the body 
 which most require protection from exposure, it is proper to 
 consider the nature of the substances to be employed in cloth- 
 ing. 
 
 The properties requiring the greatest degree of attention in 
 the selection of tissues or other materials for clothes are, 1st. 
 The degree in which the material is capable of conducting 
 heat. 2nd The nature of its action on the skin. 3rd. Its po- 
 rosity or power of imbibing or transmitting insensible perspi- 
 ration; and 4th. Its colour and the character of its surface. 
 The articles employed in dress are so various that it would be 
 impossible for us to consider them in detail, and in the re- 
 marks which follow, we shall confine our attention chiefly to 
 the qualities of dresses composed of linen, cotton, silk, wool, 
 or leather, as this list includes most of the materials in com- 
 mon use. 
 
 1st. On the conducting power of the materials. — It is very 
 easy to lest the conducting power of any tissue or other arti- 
 cle intended to be used as a garment, by the impression which 
 it produces upon the sense of touch. Take a number of strips 
 of different substances, and place them together in an apart- 
 ment, until they all acquire the same temperature with the 
 surrounding air. Then let each of these strips be applied, in 
 succession, to the back of the hand, and it will be found that 
 some of them will feel quite cold, others lukewarm, and others 
 positively warm. Now these articles being all really of the 
 same temperature, the apparent difference results entirely from 
 the fact that some of them carry off the animal heat with more 
 facility than the air, and therefore diminish the warmth of the 
 surface, while others, on the contrary, have less conducting 
 power than air, and thus confine the animal heat until it accu- 
 mulates on the surface. 
 
 Linen is the coldest of all the articles commonly employed 
 in clothing, and is infinitely more comfortable to the skin than 
 any other tissue in warm weather, and in tropical climates; 
 but this quality renders it highly dangerous when used with- 
 out caution, and without sufficient clothing to envelop it. In 
 situations, and at seasons when the temperature of the air is 
 nearly uniform, or free from sudden changes, it is both safe 
 and delightful for those who are not under the necessity of 
 using severe exertion, and are therefore able to avoid being 
 thrown into sudden perspiration. In the middle and southern 
 parts of the United States it is a proper dress for sedentary 
 and idle persons, during the months of June and July, and 
 
190 REMARKS ON HYGIENE. 
 
 during a part of August; but in the spring and fall, when the 
 mornings and evenings are cool and the middle of the day in- 
 tensely hot, it becomes improper; for the changes of the at- 
 mosphere produce their action on the constitution almost in- 
 stantaneously when the body is clothed in linen; and though 
 many persons in the vigour of life employ the linen shirt 
 with impunity at all seasons, their experience furnishes no 
 evidence of the propriety of such a habit, in delicate persons, 
 or those susceptible of strong impressions from without. Even 
 those who have been long accustomed to this mode of dress- 
 ing generally find themselves compelled to employ flannel in 
 winter, and cotton in the spring and fall, before they have 
 passed the meridian of life; and the principle adopted by some 
 parents and masters; namely; that thin garments and linen 
 next the skin, in cool weather, are among the best means of 
 "hardening children" deserves to be represented as a mur- 
 derous principle! 
 
 On all tropical coasts, and in the neighbourhood of moun- 
 tain ranges, where the sea-breeze or the cold air of the heights 
 rushes in, after sunset, to constringe every fibre after the relax- 
 ation of the day, the use of linen next the skin should always 
 be avoided; and the workman in the harvest-field who comes 
 in from his labour, bathed in profuse perspiration, to set himself 
 in the strong draught between the kitchen door and the great 
 fire-place, while demolishing his cold collation of pie, milk, 
 and cider, — might almost as reasonably circulate between an 
 oven and an ice-house, as to encase his broad chest in linen 
 while exposed to such sudden transitions of temperature! 
 
 In passing these strictures upon a favourite and truly de- 
 lightful species of attire, we would not be understood to offer 
 any objection against the luxury of linen sheets; articles with 
 out the aid of which hot weather is indeed a misery! Long ere 
 we retire, the occupations of the day are over, and the heat of 
 our bodies, as well as the activity of our minds, is tempered 
 down gradually, so that in most situations there is no danger 
 of any violent change of temperature for many hours; and if 
 any thing of the kind is anticipated, it is easy to protect the 
 person b}^ other external covering much more completely than 
 can be done during the day, when the European style of dress 
 is employed. The momentary shock on leaping into bed, and 
 the continued comfort attending the use of linen sheets, is in- 
 deed decidedly healthful; and the abdomen and thorax, which 
 require the greatest degree of protection, are secured against 
 the direct effects of this mimic cold bath, while the whole body 
 is invigorated by the re-action it produces. 
 
 Next in order as an immediate application to the skin, we 
 may rank the cotton cloths. Cotton is decidedly a bad con- 
 
REMARKS ON HYGIENE. 191 
 
 ductor of heat, although it is less remarkable in this respect 
 than silk or woollen. Though more irritating to the skin than 
 the former, it is bland when compared with the latter, and fur- 
 nishes us with the best defence against the diurnal and other 
 slight changes of temperature of hot seasons and climates. 
 Not sufficiently warm for safety in winter, it is at all other 
 times the best material for garments worn next the skin under 
 circumstances which render the use of linen improper. 
 
 A peculiar property of cotton pointed out by Johnson in his 
 work on tropical climates, is of so much practical importance, 
 that it requires particular notice. A fresh cotton shirt excites 
 perspiration in a remarkable degree, and becomes speedily 
 wetted with the discharge. This does not render the wearer 
 subject to a sudden chill on exposure, as is the case when linen 
 is worn; but if the shirt be frequently changed, this constant 
 drain from the skin soon reduces the strength, and increases 
 the liability to disease. To avoid this inconvenience, which 
 becomes serious in hot countries, it is best not to change the 
 shirt daily, but to dry the garment during the night, and con- 
 tinue to wear it for two or three days before washing. When 
 once saturated with perspiration it proves much less liable to 
 the objection just stated, and we have often noticed, on long 
 pedestrian excursions, that a march of forty miles in a clay was 
 performed with much less fatigue with a cotton shirt worn on 
 the previous day, than with one fresh from the laundress. 
 
 Cotton hosiery is very commonly worn in this country during 
 the summer, and by many females during the winter also. 
 The latter practice is inexcusable, and is the source of incal- 
 culable mischief and destruction of life. If appearances must 
 be consulted, in preference alike to comfort and safety, it is at 
 least desirable that stockings of light woollen should be worn 
 beneath the cotton. 
 
 Pedestrians, soldiers, and all persons accustomed to walking 
 or standing during long periods should invariably employ 
 woollen hose, even in the hottest weather; as a neglect of this 
 precaution is very destructive to the feet. 
 
 Silk is at once a bad conductor of heat, and an exceedingly 
 agreeable application to the skin. The perfect roundness and 
 smoothness of the thread prevents it from creating the slight- 
 est irritation, but the same properties enable the air to circu- 
 late very freely through the pores of silken tissues, and in a 
 strong breeze the wind meets with less resistance than it does 
 from either linen, cotton, or woollen. The open fabrics 
 of silk which are used for hosiery, shirting, &c, when used 
 alone, furnish, therefore, but slender protection against expo- 
 sures; but when covered by other garments which arrest the 
 circulation of air between the threads, they become very warm 
 
192 REMARKS ON HYGIENE. 
 
 articles of attire. Silk, therefore, is among the best articles to 
 place next the skin, as an under-dress, in moderately cold 
 weather; but when worn loose, or as an outer covering, it is 
 very cool, and fit only for the warm seasons and climates. It 
 enjoys an advantage over all the other materials which have 
 been enumerated, in the freedom with which it permits the 
 exit of the insensible, and the evaporation of the sensibl-e per- 
 spiration; and it is also remarkably exempt from that power 
 of imbibing and retaining animal effluvia, which often renders 
 clothing unhealthy, or make it a vehicle for the transmission 
 of contageous diseases. 
 
 Woollens, and especially flannel, are invaluable as articles 
 of dress, and the range of their usefulness is much more ex- 
 tensive than is generally supposed. When used next the skin, 
 they combine a sufficient power of retaining the animal heat, 
 with a freedom in transmitting the insensible perspiration, and 
 a mechanical action on the skin which preserves just sufficient 
 glow and excitement to heighten without exhausting the vital 
 energy of the surface. These properties render them of infi- 
 nite value in cold and damp countries, where the vital power 
 of the skin is continually depressed by the atmospheric influ- 
 ence. 
 
 But the usefulness of flannels is by no means confined to 
 the colder climates; it constitutes the best over-dress for pro- 
 tecting the person from the slight but dangerous vicissitudes 
 of temperature in tropical countries. Being prepared of all 
 degrees of fineness, it may be made into garments, loose, light, 
 flowing, and airy — proving vastly more comfortable, even in 
 the extreme of hot weather, than any other species of cloth, 
 while at the same time it protects the wearer more perfectly 
 against the ill effects of sudden draughts of air, the sea breeze, 
 morning mists, &c, those fertile sources of disease between 
 the tropics. 
 
 Of the skins of animals employed in dress, little need be 
 said, for except as coverings for the hands and feet, articles 
 of this character are now seldom used; still it is proper to no- 
 tice the buck-skin shirt and drawers, and what are termed the 
 medicated hare-skins for protecting the front of the chest. 
 
 Buck-skin is by far the warmest article which can be worn 
 next the skin, and in the extremes of cold weather it is per- 
 fectly delightful to the wearer. With a shirt and drawers 
 well made, and covering the person completely from the mid- 
 dle of the neck to the ankles, the wearer may fearlessly de\\ 
 the most intense cold of our winters. It is customary to line 
 garments of buck-skin with silk in order to prevent immedi- 
 ate contact between the skin and the garment; but this is al- 
 together unnecessary, and by no means convenient,— for the 
 
REMARKS ON HYGIENE. 193 
 
 silk gives way very soon, while the buck-skin seems almost 
 incapable of wear. The transmission of the insensible per- 
 spiration is also more easy when it has only to pass through 
 one homogeneous layer, than when several thicknesses of dif- 
 ferent materials are applied. When buck-skin is worn for an 
 inner garment, it should not be frequently changed, as it will 
 not bear repeated washing without becoming altered in tex- 
 ture, and as it preserves the surface more free from all acci- 
 dental impurities from without, it may be worn for an entire 
 month without any breach of personal propriety. Almost any 
 degree of exposure during the winters of the temperate zone, 
 may be borne with impunity by those who are clad in buck- 
 skin; but the utmost caution is necessary in relinquishing its 
 use on the approach of warm weather, as the sudden change 
 from such garments to any of those in more general use is ex- 
 tremely severe; and it is best to employ very stout flannel, or 
 the thickest Canton flannel for an under-dress during some 
 weeks in the spring of the year, when buck-skin has been used 
 through the cold season. 
 
 Under the name of medicated hare-skin, an article of dress 
 of great value has been recently introduced. It is simply the 
 skin of some species of the rabbit tribe, (the white varieties 
 being commonly preferred,) tanned without removing the fur. 
 The pretended medication is merely a trap to secure the po- 
 pularity of the article by calling in the aid of a little mystery ! 
 It is worn on the breast, with the fur next the skin, and is an 
 admirable protection to those who are in the habit of leaving 
 the upper part of the chest ill-guarded. To women who can- 
 not or will not employ buck-skin, it acts as a delightful and 
 efficient preventive against catarrhs, and materially retards the 
 advance of consumption. The wearer should be careful to se- 
 lect a skin large enough to cover the whole front of the chest, 
 for if it be too narrow, it rather increases than diminishes the 
 danger of exposure. The medicated hare-skin is usually sold 
 by the druggists. 
 
 Within the last few years, the various tissues coated with 
 the varnish of India Rubber which have been introduced into 
 the system of the toilet, have attracted much attention, and it 
 becomes requisite for us to notice the peculiarities of this spe- 
 cies of dress. 
 
 The principal peculiarity of caouchouc is its total incapacity 
 for transmitting the sensible or insensible perspiration, and 
 the parallel power which it naturally possesses of cutting off en- 
 tirely the access of moisture to the person from without. Pre- 
 pared as this article was originally, when designed to be em- 
 ployed as an article of dress, the solvents of a spirituous or 
 -ethereal character employed in its application, rendered it a 
 
 25 
 
194 REMARKS ON HYGIENE. 
 
 stimulant, of great activity; and, waving the disagreeable odour 
 which the solvent elicited, it became decidedly objectionable 
 as an application to the skin. But numerous improvements 
 have been recently made in the manufacture of India Rubber 
 cloth, and the process is conducted by means of rollers without 
 the aid of any solvent; the inconvenience resulting from the bad 
 odour is thus completely obviated. Yet, notwithstanding these 
 improvements, it is improper to use the article as an under- 
 dress, for even when made into sheets, the caouchouc is found 
 to act so powerfully upon the skin, that a decided eruption is 
 goon produced wherever it remains long in contact. This pro- 
 perty, which prohibits its employment in health, bids fair to 
 render it a very valuable remedy in chronic pains, rheuma- 
 tism, &c; for it acts as a slow, but powerful counter-irritant 
 or revulsive. 
 
 Even as an external dress, the India Rubber should not be 
 worn on ordinary occasions; for, being impervious to all mois- 
 ture, a few hours are sufficient to render the other clothing 
 damp and clammy with the precipitated effluvia of the person, 
 which is not permitted to escape by evaporation. But, on all 
 occasions when we are compelled to remain for a time ex- 
 posed to unusual moisture, such as the mists of the morning 
 and evening in cool weather, or when compelled to wade in 
 the water, as in fishing or hunting, we can find no more per- 
 fect protection than a partial or complete over-dress of India 
 Rubber cloth. 
 
 Having now completed a rapid review of the parts of the 
 body which most require protection, and the character of the 
 various kinds of material generally employed for dressing, we 
 will close the present section with a few general remarks on 
 the application of the principles laid down — for to descend 
 into particulars, would be impossible within any reasonable 
 limits. 
 
 Children, and old persons, require much warmer apparel 
 than persons in middle life. 
 
 Exposures to sudden changes of temperature are dangerous 
 every where; but cold, or even an air merely chilly, when 
 combined with much moisture, is vastly more dangerous than 
 when the atmosphere is dry. 
 
 Slight changes of temperature are much more dangerous in 
 tropical climates, and in summer, than in winter, and in colder 
 regions. 
 
 Exposure about sun-set, and before sun-rise, ought to be 
 avoided by the delicate with more caution than is requisite 
 during the day time or late at night; — and when any febrile 
 epidemic is prevalent, this rule should be observed by all. 
 
 Undue warmth of covering at night, in hot weather, is pe- 
 
REMARKS ON HYGIENE. 195 
 
 culiarly enervating, for it is then that the system is in the best 
 condition for enduring, without danger, a moderate and invi- 
 gorating temperature. But when the nights are subject to sud- 
 den changes, as they always are in tiie neighbourhood of moun- 
 tains, it is proper that thin blanketing or some other wool- 
 len covering should be used above the sheets, and a ne- 
 glect of this precaution has cost the lives of many invalids in 
 situations otherwise well calculated to restore their health. 
 
 In extremely cold weather, the covering of the night re- 
 quires to be much warmer than that of the day. 
 
 Warm clothing to the feet and lower extremities generally 
 is one of the best of all preservatives against the ill effect of 
 sudden exposure. 
 
 With the foregoing general rules once fairly impressed on 
 the mind, the regulation of the dress in various situations and 
 in persons of different constitutions, may be left with safety 
 to the intelligence of the individual most interested. 
 
 Of Cleanliness. — We have spoken of the ill effects of cloth- 
 ing which, like India Rubber, is impervious to the sensible 
 and insensible perspiration, but there is another mode in which 
 the same arrest or retardation of the discharges of the skin is 
 much more frequently effected. Uncleanliness. — Let not the 
 fair or the fastidious reader be shocked by the allusion ! Doubt- 
 lessly all those who move in the middle or higher walks will 
 indignantly exclaim against a lecture upon a subject which it 
 is deemed an insult to suppose neglected! We do not desire 
 to offend, but our duty calls upon us to proceed. Of the ac- 
 tual accumulation of what is called dirt upon the surface of 
 the body, little need be said; all but a few peculiar theorists 
 on the training of children, to whose opinion we have alrea- 
 dy replied, are well aware that neglect on this point is both un- 
 healthy and disgusting: but it may be well to mention, in 
 passing, that the scrofulous and pulmonary diseases of the in- 
 digent and the slave, are rendered vastly more numerous by 
 this neglect. The introduction of the public baths of the Ro- 
 mans would prove a noble charity at the north, and a matter 
 of serious economy to the southern planter. 
 
 Let us pass to a subject less generally understood! — In the 
 chapters on Anatomy and Physiology, the cuticle or scarf-skin 
 has been described as an envelope not endued with vitality — 
 a mere crust depending on the surface, and capable of trans- 
 mitting moisture or other matters very slowl- It was de- 
 scribed as thick and massive on parts designed to bear pres- 
 sure, but peculiarly thin and delicate in certain places. Now 
 it is perfectly well known to physicians that where the cuticle 
 ifc thinnest, there the sensible and insensible perspiration flow 
 most readily; there substances applied to the surface are most 
 
196 REMARKS ON HYGIENE. 
 
 rapidly absorbed into the body; and there also external agents 
 act most promptly upon the nervous system. On the inside- 
 of .the arms and thighs mercurial ointment salivates soonest; 
 on the back of the hand, the forehead, arm-pit, and groin, ex- 
 ercise first calls out the flood of perspiration, and blistering 
 plasters raise the most speedy vesication. Every thing, then 7 
 that tends to increase unduly the quantity of cuticle, disturbs 
 the freedom of the skin in the performance of its active func- 
 tions. The most important functions of the skin are the tran- 
 spiration of moisture, &c, which removes unnecessary sub- 
 stances from the circulation; and absorption, which assists. in 
 changing the qualities of the blood, and, under certain circum- 
 stances, appears to contribute even to the nutrition of the body. 
 If the transpiration be checked by the excess of cuticle, the 
 lungs and kidneys, (the two other organs which separate the 
 mass of the surplus fluids from the system,) are called upon 
 for greatly increased exertions, and are consequently rendered 
 much more liable to disease. 
 
 The human cuticle is not a permanent covering, but an in- 
 crustation of horny matter continually produced by the true 
 skin, and intended to be as continually worn away by fric- 
 tion; but if protected from accidents by clothing, and its con- 
 dition neglected, it is not worn away with sufficient rapidity, 
 from most parts of the person; — on the contrary, it accumu- 
 lates until the insensible perspiration penetrates it with diffi- 
 culty, and the health is injured. To illustrate my meaning 
 more fully, let us suppose a person remarkably careful of the 
 appearance of face, hands, and nails, and prodigal of soap, 
 whose weekly ablutions of the whole person are never neglect- 
 ed, but who employs a soft towel, and considers the principal 
 object to be accomplished by wiping, to be the removal of 
 moisture. Take this individual when fresh from the bath and 
 "clean," — rub him down well with a coarse towel, particu- 
 larly on the back, the shoulders, the front, and the inside of 
 the limbs, — then plunge both patient and towel into a fresh 
 bath, and the water will be instantly rendered turbid or milky 
 with the flocculi of scarf-skin, the most unhealthful of all dirt, 
 washed from the surface of this fastidious personage! 
 
 It is of the utmost importance, especially with the delicate 
 and sedentary, that a rough towel or the flesh-brush should be 
 employed in bathing, and that it should be thoroughly applied 
 to all parts of the person. This is even more conducive to 
 cleanliness, good health, and spirits, than the most liberal use 
 of soap. 
 
 At certain periods of the year, quadrupeds shed their hair; 
 snakes, their skin; deer, their horns; and birds, their feathers; 
 — mam also, sheds his coat in summer! It may be seen peal- 
 
REMARKS ON HYGIENE. 197 
 
 ing off in flakes from the forehead, the cheeks, and the backs 
 of the hands. The season of this quasi moulting, is that at 
 which such ablutions as are here described become most ne- 
 cessary. 
 
 Without entering at any length upon the subject of baths, 
 we will here close the section with a strong expression of dis- 
 sent from the opinion of those who approve of bathing soon 
 after a meal. At such times, the cold bath does injury by 
 driving too great a quantity of blood toward the bowels, and 
 the hot-bath is equally hurtful by drawing too much of the 
 circulating fluid to the surface; and thus both alike disturb di- 
 gestion, the former by oppressing, and the latter by debili- 
 tating the stomach. 
 
 OF AIR AND MOISTURE. 
 
 The reader is already sufficiently well acquainted with the 
 importance of the lungs in the animal economy, and will be 
 fully prepared to appreciate the importance of every thing 
 which relates to the quality of the air admitted into those ex- 
 tensive organs. 
 
 As presenting a vast absorbing surface, possessed of the 
 highest possible degree of vascularity and vitality, the cavity 
 of the lungs must be open to the most rapid action of poison- 
 ous substances, when they find admittance with the air neces- 
 sary to the support of life. It is true that most of the gaseous 
 or fluid substances which would produce rapid death by their 
 presence in the lungs, are, when concentrated, refused admis- 
 sion, because their presence in the throat occasions an instan- 
 taneous spasm which closes the glottis, or opening of the la- 
 rynx, (see p. 96,) and death, if it occurs, is caused by suffo- 
 cation before the noxious article finds its way to the lungs. 
 Thus, if a man fall into a brewer's vat when filled with strong 
 carbonic acid gas, or if he fall into the water and is drowned^ 
 he dies before much of the gas has penetrated the larynx, and 
 before any of the water has flowed into the lungs. It is only 
 after death that the air passages become in a considerable de- 
 gree filled by the foreign fluid. On the contrary, when poi- 
 sonous gases are mixed with a considerable portion of atmo- 
 spheric air, they find a much more ready access to the lungs, 
 and consequently produce their peculiar effects upon the con- 
 stitution. Some poisons, such as the fumes of ether, do not 
 occasion spasm, and find entrance in a much more concen- 
 trated shape. 
 
 If a person immersed in water, or in any of the gases which 
 close the glottis, be drawn from that situation before or very 
 
19S REMARKS ON HYGIENE. 
 
 soon after the spasm has been relaxed by the approach of 
 death, there is always a reasonable hope of restoring the sus- 
 pended animation, and if the patient recover at all, the health 
 is seldom seriously injured. The cases resemble the effects 
 of hanging, in most respects, except in the absence of the me- 
 chanical mischief done by the rope. When, on the contrary, 
 the immersion has taken place in a diluted mixture of a nox- 
 ious gas with atmospheric air, serious disease or death may 
 follow after a considerable interval of time, even when the 
 suspension of animation has been by no means complete. 
 Among fatal accidents of this nature within the memory of 
 the writer, are several in which the fumes of burning straw, 
 the damp of wells, mixtures of air and carbonic acid, &c, have 
 occasioned death, when the motion of the heart, occasional res- 
 piration, and sometimes even traces of consciousness, have 
 continued throughout the whole period of exposure to the poi- 
 son, and afterwards. The strongest of these cases was that of 
 an unfortunate fellow-student, who died in a few weeks from 
 the effects of chlorine gas, which he had imprudently inhaled 
 in testing the smell of the fluid in the lecture-room. After an 
 approach to fainting for a few moments, this gentleman rose 
 and left the room, to which he never returned! If the admix- 
 ture of considerable quantities of impurity with the air we 
 breathe is thus capable of producing terrible effects, it stands 
 to reason that even portions more minute, such as it is impos- 
 sible to avoid, must exert considerable influence upon the 
 health; and if farther proof be required of the extreme suscep- 
 tibility of the lungs to impressions from without, it is only 
 necessary to refer to the intoxicating effects of the hookah, 
 and the dreadful mischief which frequently follows the silly 
 practice of inhaling the fumes of ether. 
 
 These remarks are made, to aw r aken the attention of the 
 reader to the influence of minute peculiarities in the character 
 of the atmospheric medium in which we are placed; but their 
 practical application must be directed in a great degree by the 
 good sense of the reader; for it is utterly impossible to exa- 
 mine in detail the various dangers to which we are constantly 
 exposed in regard (o the properties of the air we breathe, and 
 the mode in which we may guard against them. In the pre- 
 sent work our remarks on this subject will be chiefly confined 
 to some peculiarities in the physiological effects of air, result- 
 ing from states of temperature, moisture, and elevation; dwell- 
 ing chiefly on such as have relation to the location, ventilation, 
 and domestic arrangements of dwelling-houses- 
 
 From the days of Hippocrates, the father of medicine, down 
 to very recent times, the prevalence of epidemics has been at- 
 tributed to the action of poisonous effluvia contained in the air, 
 
REMARKS ON HYGIENE. 199 
 
 and supposed to be derived from the decomposition of vegeta- 
 ble and animal matter, and the emanations from the bodies of 
 the sick. These effluvia have been termed miasmata, and 
 each peculiar epidemic has been considered the result of its 
 own especial miasm. The progress of Physiology, and espe- 
 cially the increased knowledge of nervous stimuli, and the ad- 
 vance of electro-magnetism, have shaken the foundations of 
 this theory, or rather hypothesis, of miasm. The attempt is 
 seldom made by medical philosophers of the present day to 
 account for the varieties of fevers and other epidemic diseases, 
 on the supposition that each variety is produced by a peculiar 
 miasm; for it is now commonly conceded that the rapid and 
 general epidemics owe their origin to causes more remote than 
 any mere adulterations of the air. The term " telluric influ- 
 ence" has of late been extensively employed to express this 
 remote predisposing cause of disease, which seems, at intervals, 
 to modify the nervous action or vital power of the whole ani- 
 mate creation, and enables the same exciting causes to pro- 
 duce various effects at different times; but this term is really 
 a mere name for what we do not understand; and like all other 
 words substituted for things, has done considerable mischief. 
 Some theorists now contend that no peculiar effluvia are ne- 
 cessary to the production of fevers, and that the only circum- 
 stances connected with the condition of the air which exert 
 any material influence in exciting such diseases, are tempera- 
 ture and moisture! But granting all the vast importance of 
 these circumstances, the whole history of endemic diseases, 
 or those appearing regularly or constantly in certain situations, 
 should demonstrate in a manner quite satisfactory to the minds 
 of philosophical inquirers, that, independently of all epidemic 
 changes, and all varieties of temperature and moisture, there 
 are vitiations of the air, resulting from animal and vegetable 
 decomposition, fully capable of producing febrile disease. Mi- 
 asms thus engendered may be blown about by the winds, and 
 may thus do mischief at a distance from the place of their for- 
 mation; they may be elevated to the upper regions by the 
 heat of the sun, and precipitated by the coolness and dews of 
 evening. Truly, these miasmatic exhalations will not explain 
 the differences between epidemics or the mode in which they 
 are extended — for these diseases often spread in the face of 
 the wind, and in a manner which cannot be explained by any 
 known atmospheric revolution. But miasmata are not the 
 less certain causes of disease, because they do not determine 
 the nature of the disease which they generate. They make 
 the patient sick, and leave it to the peculiarities of climate and 
 location, or the nature of the reigning epidemic to determine 
 the character of that sickness. The same miasm which in 
 
200 REMARKS ON HYGIENE. 
 
 one place excites an intermittent fever, shall, in another, pre- 
 voke a dysentery! That which in one year brings on a yel- 
 low fever, may, in another, give rise to Asiatic cholera! 
 
 It follows, then, that the location and ventilation of a resi- 
 dence is a matter of the utmost importance to the health of 
 the occupants, and that after the temperature and the degree 
 of moisture are duly regulated, it is proper to guard against 
 miasms with the greatest care. 
 
 The effluvia generated by vegetable decomposition are be- 
 lieved to be readily precipitated by moisture; hence the dews 
 of the morning and evening, the mists of the spring, and more 
 especially the autumns, and the first showers of the rainy sea- 
 son in tropical climates, are rendered peculiarly dangerous to 
 health, because they apply, both to the skin and to the surface 
 of the lungs, a watery vapour charged with miasmatic exha- 
 lations. By following the diurnal variations of temperature, 
 we shall at once perceive the reason why exposures in the 
 middle of the day and late at night are so much less hurtful 
 than those to which we are subjected during the morning and 
 evening hours. At night, in most situations, the free mois- 
 ture of the air, together with the miasm, is chiefly precipitated 
 upon the ground, so that we walk over the prostrate enemy. 
 At mid-day, on the contrary, the unhealthy effluvia are imme- 
 diately heated and rarefied by the sun's rays, so that they as- 
 cend, with the air, into an elevated region, leaving us to walk 
 in safety under a canopy of disease! 
 
 Our country contains many valleys which are proverbial for 
 their unhealthiness. The traveller should never pass these 
 districts until the sun has illuminated, for a few minutes, the 
 whole extent of the plain, or, in other words, until the curtain 
 of poisoned air has been lifted from the low grounds by the 
 warmth of day. If compelled to pass the night in such a re- 
 gion, he should at least retreat to shelter before the sun has 
 set, and protect himself by artificial means against the dangers 
 to which he is exposed by nature. 
 
 It appears probable, (to speak in the most cautious manner,) 
 that vegetation — which, in its decay, produces by far the great- 
 est amount of miasm — when vigorous, subsists upon and de- 
 stroys it. This result is no doubt in a great degree owing to 
 the action of the roots in absorbing the elements of decayed 
 plants beneath the soil, but it is at least equally certain that 
 the stems and leaves of living vegetables inhale the same ef- 
 fluvia to an incalculable extent. Our American forests are al- 
 most universally remarkable for their healthiness in their pri- 
 mitive state. The most noxious portion of the gases elimi- 
 nated from the dead leaves is immediately absorbed by their 
 living successors. The tree, the vine, the shrub — even the 
 
REMARKS ON HYGIENE. 201 
 
 grave festoons of moss, and the humbler lichens and mush- 
 rooms, all contribute to preserve the fitness of these gloomy 
 wilds for the residence of savage or adventurous men. But 
 when the sturdy settler grapples with the Majesty of nature 
 in these, her chosen haunts, deeply does she revenge the de- 
 secration of her altars! The green robe has scarcely fallen 
 from the girdled tree ere the demon of disease is busy with 
 his victims. The summer sun plays fiereely on the damp 
 soil, in whose bosom the elements of destruction have slept 
 innoxiously for ages. They rise, and the unthinking farmer 
 whose first effort destroys all vestages of tree or plant around 
 his log hut or his boarded cabin, lies wholly at their mercy! 
 The pale planter of the low grounds goes shuddering to his 
 labour with yellow cheek and watery eye. The more vigo- 
 rous woodsman of the height sinks under the slow sapping of 
 •hepatic diseases, from which his very cattle cannot escape!* 
 and the denizen of the nascent city of the south-west, falls sud- 
 denly beneath the terrible plague of the tropics, — the dreaded 
 yellow fever! But these evils are, in most situations, merely 
 temporary. In a few years a large proportion of the destruet- 
 able vegetable matter in the soil is dissipated. Sometimes, 
 though, alas! too rarely in our country, a few young trees are 
 planted round the dwelling, and finally, the harvest, the cul- 
 tivated garden, and the fields of grass supply the place of the 
 primeval forest and destroy the remaining miasm, as it is 
 formed. The offended dignity of nature is appeased, and Hy- 
 giea reigns once more over a hardy yeomanry, whose dames 
 and daughters display the roses of their well rounded cheeks, 
 glowing through the nut-brown tint of health! 
 
 Almost the only places in which the evil influence of mi- 
 asmatic exhalations resist more permanently the effect of those 
 causes which have just been pointed out, are the broad and 
 rich bottoms of those rivers which periodically overflow their 
 banks, increasing the fertility of the earth at the expense of 
 the health and life of the cultivator. In such situations the 
 depth of the soil renders it incapable of exhaustion, and 
 the annual addition of destructible matter exceeds the de- 
 mands of the most vigorous vegitation. Here, then, the 
 sources of disease are continually exerting their energies, and 
 ages may prove necessary to paralyze their power. The 
 strongest natural examples of this character, in our country, 
 
 * During a residence of a year in north-western Pennsylvania, the writer was 
 astonished to find ample verification of a fact mentioned to him by an intelli- 
 gent settler, namely, that all the cattle of the district, though thriving in ap- 
 pearance, were affected by softening, abscess, or worms in the liver. He exa- 
 mined many oxen destined for the table, and found them invariably in the con- 
 dition described. 
 
 26 
 
202 REMARKS ON HYGIENE. 
 
 are seen in the low lands of the Ohio and Mississippi; — the 
 most remarkable artificial instances may be found in the rice 
 plantations of the South. 
 
 On a smaller scale, a certain degree of permanence is given 
 to the unhealthiness of districts by the vicinity of extensive 
 swamps in which the water is occasionally raised by unusual 
 rains, the existence of considerable flats on the margin of fresh 
 water estuaries, and even the construction of mildams in level 
 countries. The description o^ the artificial means by which 
 these evils may be counteracted is foreign to the purpose of 
 this work, but it is right to mention that for several years af- 
 ter the draining or embankment of such tracts, the unhealthi- 
 ness of the surrounding country is generally increased by the di- 
 rect action of the sun on the remains of vegetation; though the 
 ultimate benefit far outweighs this temporary ill consequence. 
 
 Even after the entire clearing of a district of country, thouglv 
 the excessive miasmata may be no longer generated, the more 
 fertile portions still give rise to poisonous effluvia — insufficient, 
 perhaps, to engender disease under ordinary circumstances, — 
 but powerful enough to produce very serious consequences 
 when epidemics prevail in the neighbourhood. Effects of this 
 character are so frequently observed, that it might almost be 
 established as a general rule that the ?nore fertile the soil, the 
 more sickly is the district; although by an apparent contra- 
 diction, the vigour of vegetation is the chief protection of hu- 
 man life in such situations! The settler should remember 
 that " bane and antidote are both before him" and the ap- 
 plication of philosophical principles to the selection of a suita- 
 ble residence is every where important. 
 
 The first point to be considered in the location of a dwel- 
 ling-house, is its elevation. It should always be placed as high 
 above the level of the neighbouring water-courses as circum- 
 stances will permit. By this precaution we secure ourselves,. 
 in a considerable degree, against the influence of miasm in 
 its most concentrated form, and that in which it acts at the 
 greatest advantage; namely; when held in solution by the moist 
 exhalations or diurnal mists of the low grounds. It is a 
 fact well known in tropical and swampy countries, such as 
 the Dutch East India settlements and the delta of the Gan- 
 ges, that the second story of a house is vastly more healthy as 
 a residence than the lower rooms; and there are two situa- 
 tions in temperate climates, in which attention to this circum- 
 stance might prevent much misery and loss of life. 1st. In 
 the country; when houses are built on low or inundated lands 
 where endemic fevers prevail, there is not only a greater 
 chance of escaping an attack when the family is located on the 
 second floor, but the disease,, if it should appear, is often much 
 
REMARKS ON HYGIENE. 203 
 
 more manageable in the upper rooms. 2d. In cities, where 
 the diseases of childhood — and especially the cholera infantum, 
 that terrible scourge of infants which often yields immediate- 
 ly to the influence of country air, when all other measures 
 fail, — these diseases, I say, are often cured in the second story 
 of a dwelling, in cases in which such a result could not possi- 
 bly occur if the little patients were confined below. The only 
 exception to this rule is found in houses with thin and unpro- 
 tected roofs, such as are usually found in America, where do- 
 mestic architecture is neither adapted to the climate of the 
 torrid, nor to that of the frigid zone, though our climate, in 
 most places, presents alternately the extremes of both! The 
 upper story is too frequently placed under the immediate in- 
 fluence of the heat of the roof in summer, when the direct rays 
 of the sun convert it into an oven, the heat of which is scarce- 
 ly tempered by the interposition of a low and ill ventilated 
 attic or loft. We have had occasion to witness, in several 
 cases, the occurrence of the most severe and rapid fevers of 
 hot climates, produced artificially in temperate districts, by the 
 increase of temperature resulting from this obvious and gross 
 error in the construction of buildings. The genuine malig- 
 nant cholera, the concealed abscess of the liver, the inveterate 
 bloody dysentery, the spontaneous lock-jaw, &c, complaints 
 familiar to those who have practised in Batavia and Calcutta, 
 have been observed, from time to time, in the ill-constructed 
 buildings about the brick-ponds in the environs of Philadel- 
 phia; but we have never met with cases of this character, ex- 
 cept during the prevalence of epidemics, or in patients who 
 are lodged within the direct influence of a heated-roof.* 
 
 Having laid down a general rule with regard to the import- 
 ance of an elevated site for dwellings, the next point of inte- 
 rest is the form of the ground plot, and the nature of the soil 
 on which the building, the garden, &c, are located. Every 
 precaution should be observed in avoiding the presence of un- 
 due dampness, on the accumulation of decaying vegetable mat- 
 
 * It is really astonishing 1 that the evil effects of the usual arrangement of the 
 roofs of dwelling-houses have been so generally overlooked! The remedy is 
 very simple. A few orifices beneath the eves to admit the external air between 
 the shingles and the ceiling or floor of the loft, together with a couple of co- 
 vered ventilators on the ridge of the roof, would at once establish a continued 
 current of air in warm weather, and the surplus heat would thus be conveyed 
 away by an apparatus put in motion by itself. This plan could be prevented 
 from producing any inconvenience in colder weather, by simply closing the ven- 
 tilators; and, in the dead of winter, the orifices beneath the eves might also be 
 plugged up if necessary, and thus the residents would be possessed of ready 
 means for moderating both the heat of summer and the cold of winter, in the 
 ■upper stories of their dwellings. 
 
204 REMARKS ON HYGIENE. 
 
 ter in the immediate vicinity of the house. The ground should 
 be naturally drained, as far as is consistent with fertility. Nei- 
 th'er stagnant ponds, nor water-courses subject to irregular 
 floods, should be near, and the foundations of the building 
 should be decidedly higher than any neighbouring water level. 
 Unfortunate necessity can alone excuse the location of a house 
 upon a substratum of clay, and such a site can never be ren- 
 dered healthful but by artificial draining, — a plan far too ex- 
 pensive for general adoption in agricultural districts, unless 
 the clay should be found to overlay a stratum of gravel. 
 
 There are many wide tracts of fertile country where this 
 rule cannot be observed, as the geological structure of the 
 neighbouring rocks converts these districts into what are com- 
 monly styled basins, and draining is then rendered extremely 
 difficult or absolutely impossible. 
 
 The form of the neighbouring heights; and the prevalent 
 course of the vernal and autumnal winds should always be con- 
 sulted in the selection of a residence.- 
 
 East of the Allegheny range of mountains the breezes of the 
 spring and autumn are generally from the south and west; con- 
 sequently, it is much safer to reside on the south and west mar- 
 gins of water-courses and swamps, than to be located to the 
 north and east of them; for, in the former case, the miasms arc 
 blown away from the dwelling, while in the latter, they are 
 continually directed towards it. 
 
 In many places, the heights which border upon rivers and 
 low grounds, are arranged in such a manner as to arrest the 
 souther!}' breezes, with the miasms which accompanv them, 
 and give them a northern direction along the intervening gul- 
 lies, often concentrating the miasms and inundating narrow 
 tracts of land in more elevated, and apparently healthful posi- 
 tions, far removed from the source of the poisonous effluvia. 
 The heights above Fairmount produce this effect in a verv ob- 
 vious manner; the miasms of the neck below Philadelphia are 
 driven by the south wind up the Schuylkill, and striking against 
 the hills just mentioned, are driven across the ridge between 
 the Schuylkill and the Delaware, in a direction almost at right 
 angles to the wind, often carrying disease over a narrow belt 
 of highland, while the inhabitants of all the surrounding coun- 
 try are in the enjoyment of comparative health. Such situa- 
 tions should be carefully avoided by settlers when circum- 
 stances allow them a chance of selection. 
 
 One of the greatest protections against the ill effects of mi- 
 asm is a row of young and vigorous trees, near the dwelling, 
 which should always be planted at the distance of a few hun- 
 dred feet on the side next the principal source of the poison. 
 
REMARKS ON HYGIENE. 205 
 
 With a few remarks on certain means of regulating Lhe tem- 
 perature and moisture of dwellings, which appear not well un- 
 derstood amongst us, we will close the present section. 
 
 In England every little cottage is surrounded wilh verdure, 
 The honey-suckle, the eglantine, and the clematis intwine 
 their brandies around the door-way and form festoons above 
 every window, while the ivy covers the blank wall with the 
 best of all protections against the rays of a basking sun. How 
 barren and cheerless in comparison is the aspect of those un- 
 meaning piles of logs, boards or bricks, so often in our land 
 miscalled a home! But taste and beauty are not the chief re- 
 commendation of this species of ornament. Waving the in- 
 estimable moral advantages of cheerfulness, and that expansion 
 of heart, which a fondness for the gems of Flora invariably 
 bestows, the horticulture of cottages is a subject of great hy- 
 gienic importance. A dense mass of foliage covering the walls 
 of a building in summer, reduces the excessive heat within 
 doors, and equalises the temperature of the day and the night. 
 In this manner it lessens the risks of disease, and renders an 
 attack less dangerous. The ivy, so commonly employed in 
 Europe, where families remain fixed in one situation for many 
 generations, is a plant of very slow growth, and entirely unfit- 
 ted for the wants of our restless and ever-changing country- 
 men. It is also liable to another serious objection, — that of 
 rendering walls damp, and destroying our shingle roofs. But 
 nature has given us a vine which grows in great profusion in 
 all our forests, most admirably adapted to the purpose of pro- 
 tecting houses, whether built of bricks or wood. It is the 
 common creeper, (ampilopsis amerieana,) often mistaken for 
 the poison vine, from which it differs in having five leaflets, 
 instead of three, upon each footstalk, and in adhering to sur- 
 faces by means of long tendrils with terminal suckers, instead 
 of bundless of short roots shooting directly from the stem. 
 
 This plant will often cover the entire side of the largest 
 houses in four or live years, it turns much of the rain, and im- 
 bibes the atmospheric moisture, rendering the wall peculiarly 
 dry. It will not adhere to the painted eves nor to the frames 
 of windows, from which its long branches sweep downwards, 
 forming graceful festoons and curtains. The general intro- 
 duction of this plant would add vastly to the beauty, but still 
 more to the health of the country. 
 
 The manner in which too much moisture in the air pro- 
 motes disease, has been sufficiently described already, and it 
 is in the mornings and evenings, during the moderate weather 
 of the spring and fall, when miasms are most rife, that the 
 moisture of the air is greatest. 
 
 Those periods, then, require the most careful attention to 
 
20G REMARKS ON HYGIENE. 
 
 be paid to the artificial temperature of dwellings. When air 
 is heated it unites with a larger portion of moisture, rendering 
 it comparatively innoxious. Hence, whenever the tempera- 
 ture of the mornings and evenings becomes suddenly dimi- 
 nished, fires should be lighted in the sitting room, and the 
 members of the family should be removed as much as possi- 
 ble from all exposure, from sunset until ten o'clock, and from 
 daylight until after the morning meal. 
 
 By strict attention to the details pointed out in this section, 
 particular families have escaped for years the encroachments 
 of miasmatic disease, though resident in the midst of districts 
 suffering under the most terrible endemics. Instances have 
 been witnessed among the fens of Italy, the fogs of Holland, 
 and the fertile bottoms of our own sea-like rivers. 
 
 OF EXERCISE. 
 
 The advantages which flow from exercise are so universally- 
 advocated in town and country, palace and hovel, that it seems 
 almost a work of supererogation to speak of them here. A 
 little inquiry, however, will convince the observer that much 
 as healthful exercise is praised it is but little understood. If 
 we attempt to advise a dyspeptic shoemaker that he stands in 
 need of free exercise to remove his disease, he will probably 
 display his well developed arms and broad shoulders, and ne- 
 glecting his slender or dropsical legs, and his sallow or swelled 
 countenance, will triumphantly prove your ignorance by in- 
 forming you that he works from morning till night, and re- 
 tires to bed exhausted with fatigue! In many, this will ex- 
 cite a smile, but it is easy to quote examples of the same kind 
 of reasoning in those whose wealth and opportunities should 
 teach them better. The merchant's salesman, whose daily du- 
 ties call for continued physical exertion, in superintending if 
 not immediately executing the removal of packages and goods 
 from place to place, considers himself exempt from all charge 
 of neglecting exercise, forgetful of the fact that free air is ne- 
 cessary to the revivication of the blood, which is driven in a 
 rapid current through the veins whenever we use exertion, 
 but which cannot supply the force or vital energy required to 
 render exercise serviceable, without a constant and increased 
 supply of the purest air. By the neglect of this supply, exer- 
 cise instead of increasing the energy of the system, is convert- 
 ed into a mere means of useless exhaustion. Equally irra- 
 tional is the practice of many well-meaning parents, (some- 
 times countenanced by the physician,) of confining the exer- 
 cises of their daughters to the duties of a household, — under 
 
REMARKS ON HYGIENE. 20 7 
 
 improper notions of cultivating domesticity. How often, in- 
 deed, do we see poor, pale, etiolated girls, with swelled feet, 
 haggard looks, and attenuated extremities, but with broad, 
 round shoulders, unduly developed by making beds and scrub- 
 bing furniture, yet deprived of the breath of Heaven and the 
 cheerfulness of society, under the idea that woman's duties 
 should be centred in her home, and that exercise and free- 
 dom from improper exposures are the best securities against 
 the loss of health and the deterioration of morals! Annually 
 are numerous victims among the wealthy and the lovely sa- 
 crificed to this preposterous application of laws in themselves 
 correct! 
 
 Exercise, to be serviceable, must be taken in the open air, 
 and it should never be carried so far as to produce exhaus- 
 tion. 
 
 Those exertions which call for the action of particular sets 
 of muscles, if long continued without change, invariably tend 
 to produce deformity. From this cause result those peculiari- 
 ties of form which characterize particular trades — and it should 
 not be forgotten that these peculiarities are invariably marks 
 of irregular nutrition, and consequently increase the liability 
 to certain diseases. Almost every trade has some besetting 
 affection which attacks its followers more frequently than other 
 men. 
 
 In order, then, that muscular activity, (to which the term 
 exercise is commonly restricted,) should be made conducive 
 to health, it is necessary that all the muscles should be em- 
 ployed so frequently as to give each set its proper develop- 
 ment and to preserve the balance of the system. Deformities 
 resulting from the undue or deficient exercise of particular 
 muscles are almost always curable by systematic exertion — 
 but so little are the principles upon which exercise should be 
 regulated, understood by the mass of society, and even by those 
 physicians who seldom encounter surgical cases, that most of 
 the popular modes of attempting the correction of such evils, 
 have a decided tendency to increase them. Thus, if a girl be 
 round-shouldered, or given to stooping, owing to debility of 
 the muscles of the back, or too great development of those on 
 the front of the chest, her parents apply corsets or braces, 
 which by supporting the head and shoulders artificially, pro- 
 duce still greater weakness of the back for want of use; she 
 is then, perhaps, directed to scrub furniture to invigorate her 
 constitution, by which means the anterior muscles are ren- 
 dered still stronger, so that the deformity is rapidly increased 
 by two different processes, both instituted for its cure! The 
 only rational remedy for stooping is the frequent application 
 of a force which tends to draw or thrust the shoulders or head 
 
208 REMARKS ON HYGIENE. 
 
 still farther forward; for the necessary resistance to this force 
 will always increase the tone and size of the weakened mus- 
 cles; and the only precautions necessary in employing this 
 principle in all cases where there exists no serious disease of 
 the bones, are, 1st. to avoid fatiguing the weakened muscles 
 by continuing their action too long, for this will cause a loss 
 of power; and secondly, to allow sufficient rest between the 
 exercises. This latter precaution requires one word of com- 
 ment. It is not during the actual exertion of any organ that 
 its strength is increased — but stimulation produced by the ex- 
 ertion notifies the system, (if we may be permitted this personi- 
 fication) that additional nutrition is necessary in that part to 
 enable it to meet the demands upon it, which, having been 
 made once and again, are likely to be repeated frequently. 
 
 A horse, or a man, on a long journey, actually loses flesh; 
 but the journey once completed, and rest wil-h a liberal diet 
 allowed, he rapidly increases in strength and size.* It Is 
 during the rest which follows exercise, that the muscles be- 
 come enlarged and strengthened. It has been alread] 
 plained in a former chapter, that no part can retain its ener- 
 gies if constantly exerted; or, in other words, if acted upon by 
 a constant force. Hence, excessive may be occasion- 
 
 ally employed with advantage in certain surgical cases where 
 the exhaustion of a muscle becomes desirable; but this subject 
 is placed beyond the domain of Hygiene.t 
 
 In the foregoing remarks the reader will find the elements 
 of the theory of gymnastics, but it would be folly to attempt 
 to describe the applications of this much neglected art, within 
 the limits of such a work as the present. The knowledge and 
 intelligence of the mo V accomplished surgeon may often be 
 employed in determining the proper course oi for 
 
 unusual cases, and with a degree of benefit for which no mo- 
 ney can compensate; for the management of such cases often 
 requires an extent and accuracy of anatomical and p! 
 cal research which can only be effected by professional men 
 of the highest qualifications. But the common good sense of 
 mankind will enable all to apply the principles laid down, to 
 the every-day business of life, and to that good sense we will 
 now commit the subject, after a few remarks upon the folly 
 of those who oppose some of the most useful con- 
 
 sequence of the evils following their abuse. 
 
 There are certain sectarians, and many conscientious indi- 
 
 * This idea, carried out by the physiologist, would probably explain the whole 
 theory of habit, and in conjunction with the influence of hereditary pec i 
 ties, would go far to explain the apparent varieties of most of the races of man- 
 kind. 
 
 j- Surgeons will perceive that extension in luxations acts on this principle. 
 
REMARKS ON HYGIENE. 209 
 
 viduals who exclaim against particular amusements on account 
 of the evils to which they are supposed to lead, — though those 
 evils have no direct connexion whatever with these sports. 
 "Late hours and suppers are in the highest degree injurious. 
 Dancing leads to late hours and suppers, — therefore, dancing 
 is in the highest degree injurious." Such is the logic by 
 which the most innocent pastimes are frequently attacked, but 
 when such things are regarded with the calm eye of reason, 
 there will be found no connexion between dancing and dis- 
 sipation — fencing and ferocity — boxing and blackguardism, 
 other than that which is presented by their initial letters! 
 The time occupied in the acquisition of these accomplishments, 
 the supposed waste of which induces many worthy people to 
 oppose them, is in reality well spent, for it is occupied in re- 
 ducing to a science the proper exercise of most of the muscles 
 of the body. These arts are among the most important means 
 of health, muscular vigour, grace, and accuracy of movement; 
 and the practice of them, rightly regulated, conduces alike to 
 the powers and safety of the sailor and the hunter on the 
 one hand, and to the skill and delicacy of touch of the artist 
 and the operating surgeon on the other. The public health 
 would be incalculably promoted by the foundation of well or- 
 ganized gymnasia in every considerable school and town; — 
 and even on large plantations the trifling expense attending 
 the necessary fixtures would be amply compensated by the 
 increased productiveness of labour, and the cheerfulness of 
 servants. This last position may seem strange to many, for 
 the fatiguing labours of the plough or the scythe might natu- 
 rally be supposed to destroy all zest for unnecessary exertion 
 on the part of the agricultural labourer; but the slightest ob- 
 servation of the habits of the farmer's boy will convince us 
 that athletic exercises are sought with avidity even as a relax- 
 ation from the severe discipline of the harvest field! and the 
 reason is obvious. Running, leaping, the games of prison bars, 
 wicket, fives, &c, call into action all those muscles which are 
 unemployed in ordinary agricultural labour; thus acting as an 
 actual relief to the exhausted organs according to the laws of 
 counter-irritation, and preventing, also, the deformity which 
 inevitably results from ill-regulated labour. 
 
 The influence of voluntary exercise upon the mind, and the 
 physiological reaction of the mind upon the body, render 
 these sports infinitely more conducive to health, than the ef- 
 forts which are made in the simple discharge of duty; so that 
 in choosing an operative in business, it is one of the best of 
 rules to select the youth who plays best, for he will be found 
 almost always to work best! His occasional truantship will 
 
 27 
 
210 REMARKS ON HYGIENE. 
 
 be more than compensated by his greater availability while 
 on duty. 
 
 'Muscular exercise, as a counter-irritant, now requires a pass- 
 ing notice. It is in this capacity that it acts as an antidote to 
 dyspepsia. The increase of nutrition, and, consequently, of 
 vital energy in so large a portion of the body as the muscular 
 system, must necessarily tend to lessen very materially the 
 undue excitement of any internal organ, such as the stomach 
 in dyspepsia, but it is a mistaken notion that those who lead 
 an active life are entirely protected from this distressing af- 
 fection. Dyspepsia is often, if not generally, a consequence 
 of habitual debility from the over-exercise of the stomach, and 
 it is unreasonable to suppose that the evil can be entirely re- 
 moved b}- bodily activity, while the stomach is still subjected 
 to the original causes of the disease. Exercise to any great 
 extent may even occasion an increase of dyspepsia in certain 
 extreme cases, for it tends directly to draw olF from the inter- 
 nal organs a portion of the vital force already deficient in the 
 stomach, it should therefore be used with caution, and its ef- 
 fects should be carefully watched. 
 
 One of the most beautiful effects of exercise as a counter-ir- 
 ritant, is witnessed in the systematic management of many af- 
 fections of the mind, which, though often distressing, do not 
 surpass the bounds of health; but its proper application to such 
 complaints receives very little consideration, even from phy- 
 sicians. The over-exertion of any set of mental faculties pro- 
 duces in the part of the brain in which the organs of these fa- 
 culties are seated a condition parallel to that of the stomach in 
 dyspepsia, and one curable according to the same laws.* 
 
 Men of literary professions are constantly liable to the ill 
 effects of such partial exertions of mind: and dissipated men 
 are subject to even more serious dangers from the undue cul- 
 tivation of the instinctive feelings. In the former, the mind 
 is directly threatened, and in the latter, the bodily powers are 
 overthrown by nervous derangements which frequently pro- 
 duce the most terrible s;loom and distress, followed sometimes 
 by convulsions and a gradual loss of intellect. 
 
 There arc two modes of exercise by which counter-irrita- 
 tion may be produced in a manner highly serviceable in these 
 local affections of the interior of the brain and cerebellum. 
 First; — by employing other portions of the brain while those 
 which are over-exerted are allowed to remain at rest, we di- 
 
 * Here, as in several other places, we use the language of the phrenolc 
 because, whatever may be thought of their doctrine, it is now universally g 
 "ed that their terminology conveys the clearest 
 
 observed by students of the physical operations of the human mind. 
 
REMARKS ON HYGIENE. 211 
 
 Vert the vital forces from the diseased to healthy organs. 
 Thus, the study of natural history constitutes one of the best 
 remedies for threatened insanity or deep gloom in poets and 
 metaphysicians: that of mathematics alleviates the distress re- 
 sulting from wounded feelings or illicit indulgences. Se- 
 condly; — by exercising all the muscles we expend a large 
 portion of the nervous energy, and thus temporarily diminish 
 the functional action of the whole brain, while we more per- 
 manently enlarge one of the principal systems of the organs, 
 and restore the balance of nature by calling forces from the 
 head toward the extremities. We have seen hereditary insa- 
 nity held in check for many years by such measures, rightly 
 directed; and we have repeatedly cured the established habits 
 growing out of the tyranny of the most engrossing passions 
 by the same process. Exercise, then, not only improves 
 health, in the common acceptation of the word, but the feel- 
 ings and the morals also, a healthy condition of which is abso- 
 lutely essential to the comfort of the individual. To neglect 
 the physical means of cultivating the moral relations of life is 
 to outrage the rights of society; and consequently, a neglect 
 of systematic exercise may become an offence against religious 
 duty! We commend this subject to the reflections of those 
 who are the appointed guardians of public virtue. 
 
 It is unnecessary to enlarge upon the subject of exercise in 
 other organs and systems, for the same principles which arc 
 applicable in the case of the muscles are equally so in that of 
 any other organ, whether its function be mental or mechani- 
 cal. 
 
 Entire rest of any part allows its power to be lost for want 
 of use; regular employment strengthens it and renders it larger; 
 too great exercise may occasion undue development, and sub- 
 ject the part to disease. Still greater degrees of exertion pro- 
 duce, first, irritation, then debility, then a temporary or total 
 destruction of power. The exercise of one set of organs calls off 
 excitement from all others, and too great development of one 
 set occasions a dangerous destruction of the balance of the sys- 
 tem. After having carefully perused the remarks contained 
 in the chapter on Physiology, these hygienic laws will be en- 
 tirely intelligible to the reader. We can but indicate them 
 here, leaving their application to himself. 
 
 The title of passive exercises has been given to those recrea- 
 tions in which the body is agitated by any foreign force, inde- 
 pendent of any exertion on the part of the individual. Of this 
 class, we may enumerate, in the order of their activity, swing- 
 ing, the see-saw, sailing, carriage-riding, riding on horseback, 
 and jolting in wagons. The slight influence of these exercises 
 
212 REMARKS ON HYGIENE. 
 
 upon the muscular system being thrown out of the question, 
 their results depend mainly upon their influence on the circu- 
 lation. And this is one of the most beautiful mechanical prob- 
 lems involved in physiological reasonings. 
 
 Whenever the body ascends, the fluids in the blood-vessels 
 .at first attempt to lag behind because of their inertia, and the 
 veins and capillaries of the lower portions of the body are con- 
 sequently distended, until the whole mass of fluids acquires the 
 general movement. Then, the moment the upward motion 
 ceases and the body begins to descend, the circulation becomes 
 more rapid by the contraction of the elastic vessels, relieved 
 as they are at once from the inertia of the blood contained 
 within them. Descending with the body until it reaches its 
 lowest depression, the blood continues to flow toward the 
 heart, not only by the natural force of the circulation during 
 rest, but by the continued elastic contraction of the distended 
 vessels; but, at the same time, it acquires its share of the ge- 
 neral descending movement of the whole body; and when the 
 latter begins suddenly to ascend again, the blood still endea- 
 vours to fall, until it is checked with a jerk by the coats of 
 the distended vessels, and the reaction of these not only occa- 
 sions a full and complete dilatation of the last ramification of the 
 capillaries, but produces a sudden jet toward the heart, fol- 
 lowed by a rapid current in the same direction. The heart, 
 thus filled with more facility than under ordinary circum- 
 stances, contracts more speedily, and the pulse becomes quick- 
 ened. If the passive exercise be carried too far, palpitation may 
 be produced; and if any particular part be excessively weak- 
 ened — or if any one organ be affected with irritation," inflam- 
 mation, or their consequences — this quickened circulation, so 
 general in its influence upon the whole system, may conside- 
 rably increase the danger of local disease, and must b 
 verned with prudence and caution in cases of patients debili- 
 tated by long-continued illness. But with this circumspec- 
 tion, how incalculably beneficial are the results of passive ex- 
 ercises during long and tedious convalescence! How vastlv 
 do they reduce the dangers of relapse, or that utter destruction 
 of theenergies of the system which so frequently supervenes 
 •upon it! Even in health, these amusements give energy to 
 all the animal powers, and fortify us against the encroachments 
 of disease. They should be encouraged by all, but especially 
 by children. They are the proper exercises of the circulation. 
 The results of a sea-voyage, and of many childish sports, both 
 upon the health and temper, are at once explained on the prin- 
 ciples just laid down. 
 
 .Under the head of deformities, and that of women within 
 
REMARKS ON HYGIENE. 213 
 
 the month, will be found some precautions with regard to ex- 
 ercise under peculiar circumstances — and with these remarks 
 we submit the subject to the good sense of the reader. 
 
 ON THE FOOD AND EXERCISE OF CHILDREN. 
 
 Very few persons are aware of the thousand ills to which 
 we are subjected, during life, by the misplaced kindness of pa- 
 rents, or the carelessness or inhumanity of those who should 
 be the guardians of our infancy. 
 
 The mismanagement of food alone, in childhood, lays the 
 foundation of long-continued sufferings, or seriously diminishes 
 the comforts of a large portion of the human family, and we 
 should be guilty of great neglect if we were to pass this sub- 
 ject unnoticed; especially as it is one upon which the princi- 
 ples of physiology, applied by the aid of a little common sense, 
 are capable of shedding the clearest light. 
 
 Milk is designed by nature for the nourishment of the 
 young of all the more perfect animals during the first stage of 
 their independent existence. Now it is well known to every 
 housewife, that the internal membrane of the stomach of an 
 animal, even when dried and made into rennet, will convert 
 milk from a fluid into a solid substance, which, when allowed 
 to remain for a considerable time undisturbed, becomes more 
 and more tenacious by contracting, like the coagulum of blood, 
 and forces out its more fluid particles in the form of whey, 
 while the remainder becomes more and more analogous to 
 cheese. This last substance, when fully formed, is well known 
 to be peculiarly difficult of digestion, and can only be tolerated 
 by the human stomach after having undergone thorough mas- 
 tication. The fate of one whose stomach should be complete- 
 ly filled with a solid mass of cheese might be easily foretold. 
 It would be inevitable death from the same cause which is 
 known to destroy life when large quantities of fluid blood are 
 taken into the stomach and allowed to coagulate there. Yet 
 this coagulation actually takes place whenever milk enters the 
 stomach of a living animal, and the same tendency to form a 
 mass of cheese immediately displays itself. If the quantity 
 taken were large, and it were possible for the function of di- 
 gestion to lie dormant for forty-eight hours, under such cir- 
 cumstances, there would be serious danger of death from the 
 inability of the stomach to act effectively upon the tough sub- 
 stance within it. Fortunately, nature has secured to this most 
 important organ of organic life, the power of acting immediate- 
 ly, and for a long time consecutively, upon any digestible ma- 
 
214 REMARKS ON HYGIENE. 
 
 terial; yet here, as in every other part of the system, alter- 
 nation of rest and exercise are indispensably necessary. 
 
 We find that the free use of milk unmixed with other edi- 
 ble matter, can be tolerated by very few adults, except those 
 who lead a laborious life in the free air, and whose stomachs 
 are thereby endowed with enormous powers of digestion.* 
 The reason of this must now be obvious to the reader. Though 
 not absolutely indigestible, milk is exceedingly difficult of di- 
 gestion in a grown animal; it remains a long time upon the 
 stomach, the centre of the coagulum continually growing 
 firmer and firmer until, toward the conclusion of its solution, 
 it resists most pertinaciously, and the stomach becomes ex- 
 hausted, and often permanently weakened by the effort to di- 
 gest it. 
 
 But, it will be asked, how then can milk furnish the only 
 proper diet, and the most healthful nutriment of early child- 
 hood? Plainly for three good reasons. The stomach of an infant 
 possesses much less coagulating power, and the central por- 
 tions of the quantity taken remain much longer in a fluid con- 
 dition than they do in grown persons. In proof of this, it i< 
 only necessary to state the fact, that infants often discharge 
 fluid milk from the stomach hours after it has been taken, but 
 adults, when affected with vomiting, expel it perfectly coagu- 
 lated, even in a few minutes after drinking it. The idull 
 nerally takes a considerable quantity at a draught, and forms 
 one great coagulum at once; the infant, on the contrary, im- 
 bibes it slowly, and produces partial coagulation of small de- 
 tached portions which are much more manageable. Nature 
 even corrects the errors of appetite in the infant, for if an un- 
 due quantity of milk be taken suddenly, as is often the case 
 when the bottle is employed, the child" soon afterwards ejects 
 the surplus in a fluid state, and relieves the stomach of the in- 
 jurious load. The occurrence of this species of vomiting is 
 justly regarded by nurses as a sign of health; it is seen 
 frequently in those infants whose stomachs are in the most 
 vigorous condition, but, I believe, never occurs in the adult. 
 Lastly; digestion, like all the other organic functions, is car- 
 ried on much more rapidly in infancy "than in adult age, and 
 
 * As milk furnishes an admirable diet, when properly managed, in some few 
 cases of dyspepsia, and in many pulmonary affections," it mav be well to men- 
 tion in ibis place a very singular fact. If to a quantity of milk we 
 small quantity of farinaceous mutter, (say a tea-spoonful of flour to the gallon 
 of milk,) and if the mixture be then heated to the boiling point and again suf- 
 fered to cool, it will be found deprived of those propertied which render it nox- 
 ious to the adult stomach. It may then be taken freelv by those who dare not 
 partake Of milk in its natural state. The whey, when 
 be a healthful beverage at all ages. 
 
REMARKS ON HYGIENE. 215 
 
 the coagula, or rather flocculi, in the stomachs of the former 
 are finally removed long before they have had time to contract 
 sufficient firmness to offer resistance to the natural actions of 
 the organ. 
 
 The change in the functions and powers of the stomach, as 
 the infant advances in age. is gradual, and a corresponding 
 change is effected in its natural nutriment. The mother's 
 milk, during the first few months, possesses very different pro- 
 perties from those which it assumes toward the end of the year, 
 being, at first, much less perfectly coagulable, and containing 
 a much larger proportion of whey. Hence, one of the chief rea- 
 sons of the comparative superiority of development displayed 
 by children raised by the mother over those who depend upon 
 a wet-nurse, the latter class of assistants being generally chosen 
 from among those who have lost their own children, or have 
 been compelled to relinquish the care of them after several 
 months from the period of birth. Hence, also, the still greater 
 evils resulting from the use of the bottle in rearing young chil- 
 dren; — the milk of the cow being much less perfectly adapted 
 to the wants of the infantile stomach at any period, than is that 
 of the human breast. 
 
 Between those periods in which milk, as an article of diet, 
 is to be considered healthful in the one and injurious in the 
 other, there is a time at which a change in the habits of the 
 infant becomes necessary to the preservation of its health, and 
 the neglect of this important moment is a fertile source of 
 early death or permanently debilitated constitution. This re- 
 mark brings us to the subject of weaning. 
 
 Weaning should take place about that epoch in the life of 
 the infant at which the stomach has become so far changed in 
 function that it begins to coagulate milk speedily and com- 
 pletely, and when the masticatory apparatus is sufficiently 
 complete to fit it for acting upon solid food. This period, no 
 doubt, varies greatly with the temperature of the climate and 
 local position. Among the Samoedes and other extreme north- 
 ern tribes who, from motives of pure charity, inter the infant 
 with the dead mother that they may not see it perish by star- 
 vation, the development of the human body is long protract- 
 ed. The women are said to be rarely marriageable before they 
 reach the age of twenty-five years, and it is reasonable to con- 
 clude that the earlier progress of the infantile functions is in 
 like manner retarded; hence the practice of suckling children 
 for several years, which prevails from necessity in those in- 
 hospitable climes bordering upon polar regions, may there bo 
 found consistent with the health of these unhappy people. 
 
 Far different is the state of things within the tropics. There, 
 women are often marriageable at 10, 11, or 12 years of age. 
 
21G REMARKS ON HYGIENE. 
 
 and the physical and mental development of the infant is pro- 
 portionally rapid; consequently, the proper time for weaning 
 is considerably earlier than in temperate countries. The 
 United States comprise a vast range of climate, and the law 
 which would prove correct in Maine could not be safely fol- 
 lowed in Mississippi. 
 
 It is both impossible and unnecessary to designate any pre- 
 cise period at which the weaning of an infant is imperatively de- 
 manded, but it is easy to establish extreme limits beyond which 
 it is highly imprudent to transgress. In the middle states these 
 limits may be placed at 9 and 15 months from birth. If cir- 
 cumstances oblige us to remove the child from the breast at at* 
 earlier moment, the consequences are always troublesome and 
 often serious; and if the mother continue to nourish the child 
 beyond the latter period, the effect upon the stomach is al- 
 ways injurious, though the consequences, in' such cases, are 
 very rarely attributed to the real cause. The false tenderness 
 which induces some parents to neglect the weaning of chil- 
 dren until eighteen months or two years, is altogether inex- 
 cusable, and the intelligent physician must condemn, even 
 while he pities the motives which occasion similar practices 
 to a much greater extent among the poorer class of society. 
 There exists, however, one prevalent opinion which demands 
 farther notice. It is generally thought that the dangers of the 
 second summer are much enhanced* by premature weaning, 
 and that sickness or general debility of the infant interdicts 
 the attempt to change so entirely its natural habits. "I can- 
 not wean my child, noio" says some affectionate mother of a 
 child twelve or fourteen months old in May. u It is so feeble, 
 and it has to go through its second summer! If it were to die, 
 I should never forgive myself! Oh dear! — Doctor, I cannot 
 take from it its natural food I" Now, as it is acknowledged 
 to be improper to wean in very warm weather, because the 
 extreme excitability of the young fibres at such times renders 
 the slightest irregularity dangerous, the unfortunate infant to 
 whom allusion has just been made, is condemned to the breast 
 until the succeeding October at least; that is, until it reaches 
 the age of seventeen or nineteen months. In this case, the 
 anxious mother is correct in her principles, but she strap _ 
 misapplies them in practice. The milk which constituted the 
 "natural food" of the child, when under the year, becomes 
 unnatural food when it passes that epoch, and the feeble in- 
 fant, compelled to combat all the ills of the second summer 
 with but slender powers of resistance, is forced, by mistaken 
 kindness, to admit daily into its stomach quantities of a fluid 
 which becomes daily more and more difficult of digestion \ 
 The consequences of this mistake are in a high degree serious, 
 
REMARKS ON HYGIENE. 217 
 
 and there can be little doubt that the proverbial mortality of 
 childhood is much increased by it. In our climate the age of 
 twelve months is, as a general rule, the best period for wean- 
 ing. If a child be eleven months old at the end of the month 
 of May, it should be deprived of the breast about that time, 
 rather than that it should be subjected to the evils resulting 
 from the continuance of its previous habits to the age of six- 
 teen months, when the weather would again become favoura- 
 ble to the undertaking. But if only nine months old, or less, 
 at that time, it is better to delay the weaning until the suc- 
 ceeding October. 
 
 Though the proper period for weaning varies in different 
 countries, nature has furnished us, in the dentition of the in- 
 fant, with an unerring guide not only in chosing the moment 
 for this operation, but also in regulating the after habits of the 
 child as it increases in size and strength; and it is a matter of 
 astonishment that this circumstance should be so seldom 
 touched upon by hygienic writers. Every reader is doubt- 
 less aware that the human jaw is provided with three dis- 
 tinct groups of teeth for the purpose of masticating the different 
 kinds of food employed by omnivorous animals, but it may not 
 be so generally known that naturalists are able to determine 
 the kind of food requisite for any quadruped by the simple ex^ 
 animation of the teeth, without previous knowledge of its ha- 
 bits. Now, it is not only true that nature provides nothing in 
 vain, but it is equally indisputable that she provides nothing 
 out of its proper time and place, so long as her efforts are un- 
 influenced by accident or indiscretion. The few quadrupeds 
 which, like the infant, are unprovided with teeth, are not de- 
 signed to subsist upon solid food, or at least upon that which 
 requires mastication; and the whole analogy of nature bears 
 us out in deciding that until the teeth are grown no solid food 
 should be taken by the infant. The date of the appearance of 
 the temporary teeth varies regularly with the climate, and ir-r 
 regularly from accidental circumstances; the latter varieties 
 may be considered as errors of development, and in those whq 
 present them the rules of diet derived from the condition of 
 the teeth cannot be strictly applied. 
 
 The incisors of the lower jaw generally make their appear- 
 ance about the sixth or seventh month. Those of the upper 
 jaw appear soon afterwards. They acquire about the tenth or 
 twelth month sufficient size to be decidedly useful, and nature 
 certainly never designed that they should remain unemployed. 
 The occasional employment of cow's milk, somewhat diluted 
 and sweetened, and mixed with such farinaceous solids as are 
 easily divided by the incisors, now becomes proper as a pre- 
 
 28 
 
218 REMARKS ON HYGIENE. 
 
 paration for weaning. The use of bread, mashed potatoes, 
 and other vegetable food, should be gradually introduced. 
 
 ,The next teeth which make their appearance in the usual 
 order are two of the small grinders, a kind of teeth peculiar 
 to those animals which subsist upon vegetables, and fitted for 
 grinding many of the more solid articles which the incisors 
 can only divide. Some few weeks after these, the canine or 
 eye teeth, as they are commonly called, make their appear- 
 ance, and are soon followed by another pair of grinders. 
 
 The canine teeth are peculiar to animals which subsist on 
 meats;, they are designed for .tearing, and their complete de- 
 velopment marks the time when it is proper for the child to 
 commence the use of solid animal food. In our climate, this 
 takes place about the end of the second year; for although the 
 canine teeth appear much earlier, they do not reach their full 
 size and strength for several months. 
 
 This great change in the habits of the infant should not be 
 made suddenly, but with considerable caution, particularly if 
 the constitution be weak. 
 
 The use of spices, wine, and all kinds of stimulants should 
 be rigorously interdicted until after the child has reached ma- 
 ture age, even by those parents who are unwilling to practise 
 the precepts given in the earlier part of this chapter. The 
 cruel and abominable practice of inundating the delicate and 
 highly susceptible stomachs of infants with such stimulants as 
 wine, whisky, and beer — a practice far more common among 
 the poor, and in agricultural districts, than would be generally 
 credited, — should be suppressed by penal enactments. When 
 followed in ignorance, it is a mark of stupidity, — when re- 
 sorted to by the intelligent, it proves the utter want of prin- 
 ciple. I will not abuse the ear of good sense in proof of the 
 justness of these violent expressions! 
 
 There are two errors of diet almost universal among chil- 
 dren, which demand notice in this place. First; the abuse of 
 cakes and doughy articles; and secondly, the use of undue 
 quantities of drink. 
 
 Cakes which crackle under the teeth, and which, therefore, 
 admit of complete mastication, if made of good materials, and 
 not over-burdened with sugar, molasses, or injurious chemical 
 substances, may be used in moderation with propriety. But 
 how is it to be expected that the stomach can tolerate with 
 impunity the constant stuffing of pasty masses of soft ginger 
 or queen-cake, pie-crust, and buckwheat dough with which 
 mothers, grand-mothers, and aunts continually oppress their 
 little favourites, until they are weighed down bv their false 
 kindness? These substances — often rendered absolutely poi- 
 
REMARKS ON HYGIENE. 219 
 
 sonous by the employment of bad flour and chemical correc- 
 tives — act in the same manner with coagula of milk and blood, 
 and it is unnecessary to dilate upon the consequences; they 
 have been already pointed out under the head of weaning. 
 The robust, who use much exercise, may not suffer obviously 
 from such diet, but it is not only injurious, but no doubt fatal 
 in many cases, among those of feeble health or sedentary ha- 
 bits. In those who are subjected to the modern system of 
 long sessions at school, the intellect itself seriously suffers by 
 such habits in eating, and the blame attached to the preceptor 
 for the deficient progress of the student, is often chargeable 
 upon the parents who continually labour to vitiate the proper- 
 ties of the soil designed for cultivation. 
 
 The immoderate use of d rinks (even that of plain water) 
 to which children are very much inclined, is a serious injury 
 to the stomach, and may be considered one of the most fre- 
 quent causes of the dyspepsia which appears later in life. The 
 evil results from the distention produced by the fluid. When 
 a much larger quantity is taken than the wants of the system 
 demand, a considerable portion is apt to remain for hours un- 
 absolved, and the constant repetition of this state of things 
 soon destroys the tone of the stomach., and prevents it from 
 contracting completely and firmly when empty. The blood- 
 vessels are then relieved from the natural pressure which they 
 should occasionally suffer; they become permanently enlarged 
 and relaxed, and incapable of executing their functions with 
 promptitude. In this condition of the stomach, after a hearty 
 draft of water, the regurgitation of the fluid in the relaxed ca- 
 vity may be distinctly heard on any sudden motion of the 
 body. The evils following the habit of diet of which we have 
 just spoken, are difficult to cure; but the best mode of treat- 
 ment consists in the free use of table-salt, which powerfully 
 constringes the stomach, and is not unfrequently very service- 
 able in the simplest forms of d} T spepsia. 
 
 In childhood, food is required more frequently than in later 
 life; and the attempt to confine a boy of less than eight years, 
 rigorously to three meals a day, is exceedingly injurious. 
 Children should eat often and a little at a time; nor should 
 they ever commence the labours or amusements of the day 
 without taking something, even though it be but a biscuit or 
 a crust of bread. 
 
 On the subject of exercise, sleep, and clothing in children, 
 we need not enlarge, for the principles which should govern 
 in these matters have been already stated. But we cannot too 
 strongly condemn the employment of a few popular adages, 
 the practical application of which goes far to render the com- 
 mencement of life miserable, to thwart the ends of existence, 
 
220 REMARKS ON HYGIENE. 
 
 and in some instances to vitiate the moral tone. Parents may 
 smile, but 
 
 "These little things are great to little men." 
 
 11 Hold up your head and look like a gentleman." How 
 often are poor little creatures condemned to suffer through 
 long hours of restraint, in the vain endeavour to cheat the 
 world by seeming what, the Creator never designed them to 
 be, — arresting the development of their muscles and laying 
 the foundation for debility and disease! The phrase should 
 unquestionably read, — Toss up your heels and behave like a 
 child! 
 
 u Little children were made to be seen, and not heard!" 
 What thinking individual is ignorant that childhood is the 
 season for the acquisition of facts, which, to be valuable, must 
 be explained by their seniors, and that the reception of false 
 impressions then, is ruinous to the good government of after- 
 life? What an admirable opportunity for the formation of a 
 correct moral Code, is enjoyed by the child of six or seven 
 years, when seated by the fireside or in a corner of the room, 
 during a political discussion over the dining-table, — compelled 
 to sit still and reflect without inquiry, while the conversation 
 is rendered perfectly free by the assertion of the host, — "Oh! 
 never mind him! He's too young to understand!" Reason 
 declares that " Little children were made to be noisy and ask 
 questions" and religion demands that they should be grati- 
 fied! 
 
 ERRORS OF FEMALE SCHOOL DISCIPLIN 
 
 Great evils result to the fairer portion of creation from cer- 
 tain infringements upon the laws of Hygiene during the later 
 periods of adolescence, — infringements unfortunately most fre*- 
 quent among those who most strongly insist upon what they 
 consider to be the refinement of female education. These er- 
 rors are observed too often in the domestic circle, but as they 
 occur much more generally in schools, we have preferred to 
 mention them under this caption. 
 
 So much has been already said of the causes of deformity 
 from inactivity of the muscles of the back, that it is unneces- 
 sary to allude any farther to the ill effects of corseting, par- 
 ticularly before the full development of the figure; but it is 
 proper to mention that unless the use of seats with comforta- 
 ble backs be substituted for the present absurd benches em- 
 ployed in schools, a loose corset may prove of great service 
 in preventing the exhaustion resulting from continued exer- 
 
REMARKS ON HYGIENE. 221 
 
 tion in the vain attempt to preserve an upright attitude for 
 hours together, by furnishing an occasional support to the per- 
 son when it yields to the necessity of rest; but a light corset 
 is ruinous, because, by giving a permanent mechanical sup- 
 port, it destroys all chance of the necessary occasional exer- 
 cise. Certainly it is desirable that the attitudes of students 
 should be as easy as possible while the mind is closely en- 
 gaged, and common chairs in confusion would be infinitely 
 better calculated for school service than the stitF, orderly 
 benches now in general use. But it seems to be adopted as 
 an axiom in our system of education, that physical uncomfor*- 
 tableness is a strong incitive to the mental efforts of children! 
 The parents of Lady Jane Grey pinched her and twisted her 
 ears while studying, to fit her for a throne! The system 
 brought the lovely sufferer to a scaffold! Just so, we have 
 seen the modern student tormented, to fit him for distinction 
 by means, which, in the strife and struggle of after life, have 
 landed him in an alms-house! 
 
 The long sessions now so general in schools, ought to be 
 decidedly condemned; and in cities, where ample play-grounds 
 cannot be provided for females, a separate room for the ruder 
 amusements should always be provided within the building. 
 No session should be extended beyond one hour and a half, 
 without an interlude of half an hour; and in exercises on that 
 most trying of seats — the music stool — the lessons should be 
 much shorter, and the intervals much longer. Calisthenic ex- 
 ercises (female gymnastics) should be universally encouraged, 
 and among the most important of the games tending to cor- 
 rect the vices of form and habit resulting from school disci- 
 pline, we would expressly recommend battledore, and jump- 
 ing the rope. For farther practical hints on this subject, see 
 the article spine in the second part of this work. 
 
 The next subject of importance, which claims our attention, 
 is the necessary protection against cold and exposure to damp 
 in school girls who are approaching the most critical period 
 of adolescence. The regulations of seminaries are made for 
 the government of the many, and, like all human laws, must 
 press unequally upon the few, for laws cannot be rendered 
 perfect. The dress of boarding-schools, though somewhat 
 more rational than that observed in general society, is still so 
 badly regulated in the case of young girls, as to be productive 
 of incalculable evil; and, were the task not absolutely hope- 
 less, we should feel inclined to decry the use of thin shoes 
 and stockings; but there are other still more important expo- 
 sures which must not be passed unnoticed. The fatal opinion 
 -that children are hardened by exposure, is very popular among 
 the principals of female schools, who, being generally men, 
 
222 REMARKS ON HYGIENE. 
 
 and therefore ignorant of the peculiar precautions necessary 
 for the protection of those of the other sex, neglect such mat- 
 ters in the construction of rules of government. Their lite- 
 rary assistants are commonly unmarried females, often not 
 much advanced in age; and it is not to be expected — both on 
 this ground, and, also, because the relative position imposes 
 restraint, or endangers the destruction of discipline — that these 
 teachers can be confided in by the pupils, as their confidential 
 advisers on subjects of peculiar delicacy. 
 
 The housekeeper is, too frequently, eitber the wife of the 
 principal or some one chosen from the ruder walks of life, and 
 unacquainted with, or forgetful of the wants of the refined, the 
 delicate, or the young. If the wife — her near connexion with 
 the head of the establishment causes it to be frequently 
 esteemed dangerous to trust her, lest punishment or loss of 
 confidence should follow the acknowledgment of trilling in- 
 discretions; and thus distrust and concealment too generally 
 become habitual among the students. If, on the contrary, a 
 housekeeper be a woman of little education or moderate in- 
 tellect, she can neither win upon nor understand the feelings 
 of those who are of a more refined class than herself, nor can 
 she become the adviser of those who commonly exceed her 
 in knowledge, and not unfrequently io e.rj)erience also, if we 
 apply that much abused word to observation coupled with re- 
 flection. There is, then, a necessity for some one, in every 
 well conducted female boarding-school, who should stand in 
 the relation of a mother and intelligent nurse to the children, 
 not only in sickness, but in health. She should be the inti- 
 mate of their hours of amusement; she should be freed from 
 the duty of ever imposing tasks upon them. Her control 
 should be absolute over the wardrobe and the toilet; and her 
 authority paramount to the established regulations of the 
 school on all exceptionable cases of diet and regimen. Her veto 
 should even annul the edicts of the master in cases where she 
 thinks rewards or punishments incompatible with health; but 
 she should have no power, herself, to punish or reward, or her 
 feelings would inevitably overthrow her usefulness. 
 
 To such a character, and to parents in general, we would 
 •suggest the following hints. 
 
 A girl approaching to her period of full development, or 
 one who has passed that period, should never be permitted to 
 expose herself to cold at critical times. We will name but 
 two of the applications of this rule, the neglect of each of 
 which has proved the ruin of the health of many, and the death 
 of some lovely beings under our own immediate cognizance. 
 It is customary, at most boarding-schools, for the children in- 
 discriminately to wash in the morning in open sheds, or in 
 
REMARKS ON HYGIENE. 223 
 
 bleak pump-houses, which are intensely cold in winter, and 
 perpetually clamp and chilled by evaporation in summer. There 
 are particular moments when this exposure is extremely dan- 
 gerous to females, and it is exceedingly improper to intrust 
 the observance of the requisite caution on these occasions to 
 the judgment of children or the foresight of young or igno- 
 rant assistants. Moreover, there are, in every school, some 
 individuals of delicate constitution to whom such exposures 
 are, at all times, highly injurious. 
 
 Humanity requires that the rigid rules necessary for gene- 
 ral government should give way under such circumstances, 
 and the occasional appearance of partiality in yielding peculiar 
 privileges to the few, is no valid plea for avoiding the proper 
 arrangement at the expense of personal cruelty. 
 
 Among the modes of punishment not unfrequently adopted 
 at schools, is confinement to a seat in a cold room or gallery 
 during a stated time, in the intervals between the sessions. 
 Whether this outrageous abuse of power is ever practised in 
 seminaries for females we know not; but having suffered se- 
 verely ourselves, and having witnessed much suffering, and 
 one death from this punishment in a boarding-school for boys, 
 — of high character, and governed by men undoubtedly con- 
 scientious and esteemed intelligent, — we deem a caution on 
 this subject necessary, not knowing to what extent the inde- 
 fensible custom may prevail. 
 
 Another more popular mode of domestic or scholastic pu- 
 nishment consists in confining the offender in a room, either 
 depriving her of a meal, or restricting her to bread and water, 
 according to the supposed enormity of the offence committed. 
 Solitary reflection and compulsory idleness are the worst of in- 
 flictions upon a child, consistent with physical health, and, 
 rightly managed, furnish the best means of taming the un- 
 governed will — but the irregularity of meals, and the depri- 
 vation of nutritious diet, rapidly destroys the tone of the sto- 
 mach at any age, and are by far most injurious in childhood. 
 The consequences are the more to be dreaded, because they 
 seldom attract attention until the cause is forgotten. 
 
 The absurdities practised in seminaries, with regard to diet, 
 are so numerous that we cannot pretend even to attempt a ca- 
 talogue of them, but it is hoped that the remarks contained in 
 a previous section will attract attention to the subject, and 
 lead to the removal of much of the evil, the existence of 
 which can only be attributed to the want of any attempt to 
 regulate such matters by the plain laws of common sense. 
 We cannot avoid, however, a notice of two ludicrous cases in 
 point drawn from the vivid recollections of boyhood. 
 
224 REMARKS ON HYGIENE. 
 
 Suddenly removed from a course of sedentary study in a 
 capital city, with a constitution somewhat enfeebled by the 
 want of powerful exercise, free air, and sunshine; but robust 
 and rather remarkable for muscular development among city 
 children, — w r e were placed, at the age of ten years, within the 
 halls of one of the most carefully regulated boarding-schools 
 in the country. Our appetite was keen, for we had ridden 
 many miles — our dinner was plain, but good — and we did to- 
 lerable justice to the soup and meat, but for the dessert, we re- 
 ceived, like all our companions, great aud small, older or 
 younger, an enormous segment of a most enormous pie! say 
 six inches for I he cord of the arc, and ten or twelve for the 
 radius, geometrically speaking. Our lusty associates caused 
 their several portions to disappear with alarming rapidity, — 
 and by the time we had nibbled off some six inches of the 
 acute angled extremity of our own — the meal was ended!! — 
 We rose to depart, but one of the scholars whose turn it was 
 to act as a kind of steward to our form, arrested us with the 
 information that it was held a breach of decorum to leave any 
 thing remaining on the plate ; and that it was therefore neces- 
 sary that the pie should be demolished! Horror-struck, we ex- 
 claimed that the feat was utterly impossible, and an appeal 
 was made to the preceptor at the head of the table. But the 
 law was imperative; and after a few tears and some no very 
 agreeable thoughts of home, we made our charge most man- 
 fully. Again, and again, the absolute nausea of repletion 
 checked our progress; but there stood the vicegerent, (the pa- 
 tience of the teacher being exhausted,) whose only answer to 
 all expostulation was "You must eat it! — Master Amos says 
 so!" Never shall we forget the sufferings of that terrible din- 
 ner! But there is an end to all things. After three hours 
 of strenuous exertion the monstrous load disappeared, the lat- 
 ter portions literally moistened with our tears. Fortunately, 
 the pastry was vilely simple in composition, or we had not 
 lived to tell the agonies of home-sickr.ess and heart-broken 
 misery endured, when, after losing an entire afternoon session 
 in the school-room, we e-caped from the dining-room to the 
 play-grounds and seated ourselves, with aching masticatory 
 apparatus, and unbuttoned jacket to witness the gambols in 
 which we could not share! Supper we could not dream of — 
 though, as it was a rule of the school that all who were not on 
 the sick-list should be present at the table, and though this 
 rule was authoritatively announced by the preceptor, our bit- 
 ter tears, and the plea of our recent arrival at last obtained for 
 us a dispensation. Next morning we made a confidant of an 
 older scholar, and consulted him as to the means of evading 
 
REMARKS ON HYGIENE. 225 
 
 such horrible inflictions in future. " Nothing easier," he re- 
 plied, " when you've got more than you want, slyly pocket it, 
 and when you come up, throw it away!" 
 
 By the aid of this innocent manoeuvre, we were enabled to 
 get along in tolerable comfort, until the gradual distention 
 of our stomach, and the vigour produced by romping games 
 in the free air of the country, enabled us to dismiss one of 
 those fearful pieces of pie with great satisfaction; but at that 
 school was laid the foundation of a dyspepsia from which we 
 are never likely to recover! 
 
 Another scene at the same school resulted from the attempt 
 of the teachers to compel an unfortunate youth to partake of 
 the usual nightly fare of mush and milk. He had a peculiar 
 idiosyncracy which made it impossible to retain the article 
 upon his stomach. His finesse in concealing his absence from 
 the supper-table, or in getting his neighbours to relieve him 
 of the disagreeable duty of eating that which he loathed, at 
 length failed in protecting him. The laws prescribed not only- 
 presence at the table, but active co-operation in the demolition 
 oi mush and milk! Compulsory process was issued, and the 
 unfortunate lad was placed under guard, and allowed nothing 
 at his subsequent meals but the identical bowl of this homely 
 material at first refused, until cured of his contumacy, which 
 was attributed, in spite of his asseverations to the contrary, to 
 a fondness for luxury or a contempt for the table. Breakfast and 
 dinner passed untasted; but the prisoner had many friends: 
 when supper appeared, and the word of attack was given, the 
 teachers were astonished at the universal silence which per- 
 vaded the dining-hall. 
 
 The children had made common cause with the sufferer, 
 and philosophically refused to cat their meal, unless he was sup- 
 plied with more palatable food. The dignity of the teachers 
 was compromised and the whole school, with one exception, 
 went supperless to bed. The hard law which bore upon the 
 obstinate individual was not relaxed, and all the rebellious 
 were condemned to be deprived of their occasional luxuries 
 until they returned to obedience, and mush and milk! On 
 the next evening only six generous fellows, undauntedly lost 
 their suppers in defence of principle; and these were locked 
 up in a room employed as a species of prison for delinquents, 
 with their porringers before them to yield or die. Three days 
 passed by, yet still the urchins looked as hale and vigorous as 
 ever, — the untouched mush and milk had grown dry and 
 mouldy! The teachers found themselves in a ridiculous po- 
 sition, and were compelled to yield to necessity by permitting 
 the cause of all this turmoil his free choice between mush 
 and milk, and a supperless night! Long, anxiously, and in 
 
 29 
 
22G REMARKS ON HYGIENE. 
 
 vain did the preceptors seek the cause of these camelion-like 
 powers of their pupils! Twenty-four years have passed since 
 we figured in these scenes, and will now venture to hint that 
 they were supported hy the ingenious petty larceny of their 
 fellow pupils. The modus operandi we forbear to mention, 
 in charity to future victims of oppression. 
 
 One of the ornaments of the profession will smile to see this 
 little story, in which he was the principal actor; but he will 
 coincide with me in the opinion that the dietetic system of 
 this extremely well regulated school was not very philosophi- 
 cally adapted either to the physical comfort or moral well-be- 
 ing of the pupils. 
 
 We will here close our remarks upon school discipline, in 
 the hope that our hints may lead not only preceptors but pa- 
 rents to reflect upon the real importance of many little details 
 relating to education which it is impossible to notice in this 
 work. 
 
 OF MATRIM' 
 
 We come now to a very important subject, upon which our 
 previous remarks on physiology anil h; should hai 
 
 practical bearing, and it is intended to devote a :• s to 
 
 their application, to an important epoch in the career of the 
 fairest portion of the creation, WOM itined 
 
 to be the bosom friend of man, and the medium through which 
 the race is to be perpetuated. We ti 
 
 cused by them from any disposition to invade their peculiar 
 privileges, if we venture, as their philosophizing frien 
 mark out the course proper for them to pursue in order to at- 
 tain the great end of their 
 
 Given as a help meet for man, it becomes woman to j 
 obedience to those laws which tend to the improvement of 
 the race. 
 
 From what has been said in the pi part of this work, 
 
 it will be remembered that the d< :it of the ho 
 
 successive, that one organ after another comes into play. Thus, 
 at the very earliest observable period, human c is mere- 
 
 ly vegetative, without volition, sensation, or motion; as the 
 muscles become developed motion is effect 
 system is expanded sensation is experienced, and after : 
 reached another degree of development volition is man 
 After birth, the animal and organic life gradually acquire force, 
 till they, in concert with the cerebral mass, become consoli- 
 dated, and intellectual manifestations occur. By degrees the 
 being expands, the strength increases, anil, as a common rule 
 in this country, at about the age of foul -;imcs 
 
REMARKS ON HYGIENE. 227 
 
 the capacity of reproducing the race. Still, however, this sea- 
 son is premature for the health}' performance of this function. 
 Early marriages are to be deprecated, as they materially in- 
 fluence the health and well-being of the offspring; this is evi- 
 dent, not only in mankind but in inferior animals. Let all 
 the organs of the system be kept in a healthy condition, — let 
 them acquire firmness, with their functions unimpaired by 
 improper use, and, under circumstances otherwise favoura- 
 ble, we may readily calculate upon the most happy result of 
 a judicious marriage — a family of healthy children. 
 
 The exact period at which the body becomes fully expand- 
 ed is not readily fixed, being much influenced by the original 
 constitution, the physical and moral education, as well as the 
 climate, habits of life, &e. While in the tropical regions, the sys- 
 tem is as it were forced into a rapid development, and females 
 not unfrequently become mothers at 9 or 10 years of age, in 
 the colder regions women are not prepared for this function till 
 at a much more advanced period. The ancient Germans, who 
 were remarkable for their bodily and intellectual vigour, were 
 very exemplary in their moral habits, and never married till 
 they were 24 or 2Z years old. 
 
 All other circumstances being favourable, we might, perhaps, 
 consider that from l! le, and 23 to 
 
 2S for the male, would be the proper period for marriage in 
 this country. 
 
 It is the result of observatir mtering upon 
 
 the arena of matrimonial duty at the '22 years, 
 
 may become mothers e a family in the course of the 
 
 next fifteen years as those who position at the ear- 
 
 lier age of 14, 1 5 or 1 provided both are placed under 
 
 equally favourable circumstances, while the former will proba- 
 bly find them- hausted by tlit change, and enjoy all 
 the pleasure of being surrounded by a more vigorous offspring. 
 
 In large cities where free air and sufficient muscular exer- 
 cise are not easily obtained, precocious marriages are produc- 
 tive of much evil, causing not only diminished vigour, and 
 short life in the father, blighted health and tarnished beauty, 
 as well as premature decline of life, in the mother, but also 
 debility of body, predisposition to diseases, such as scrofula, 
 rickets, and consumption, together with imbecility of mind, 
 or even fatuity of intellect in the children. In healthy dis- 
 tricts of open country, where the calm pursuits of agricultural 
 life do not much interfere with the dictates of nature, less 
 inconvenience will probably result from a slight anticipation 
 of the time we have intimated as commonly the best for ef- 
 fecting the new relation. In newly settled countries marriage 
 contracts are often determined by the ability of the husband 
 
228 REMARKS ON HYGIENE. 
 
 to purchase a small tract of land, in the labour of clearing 
 which his young wife will often aid, till called therefrom by 
 the imperious duty of fostering her offspring, which in the 
 course of a very lew years often become numerous, and gene- 
 rally attain to great vigour of body and mind. 
 
 Those who, in order to escape the fatiguing duties of a ma- 
 trimonial life, and continual anxiety from the care of young 
 children, resolve not to wed themselves to such a charge, and 
 thus aspire to sail lightly along the tide of life, should remem- 
 ber that while they fail to fulfil one of the objects of their ex- 
 istence they are in general more short-lived than those who, 
 having rightly cultivated and exercised their organic functions, 
 are sometimes remarkable for their longevity. Hufeland tells 
 us that all those who have attained to a great age were mar- 
 ried even more than once, and generally at a late period of 
 life; and that there is no instance of a bachelor attaining a great 
 age. There are some striking instances of advanced life where 
 marriage was often repeated. Thomas Parr, of England, who 
 lived 152 years, was married several limes; De Longvillc, 
 of France, lived 110 years and married 10 wives; the writer 
 has seen Andrew Wallace, a Scotchman by birth, though ac- 
 tively engaged in the revolution of this country, which lie had 
 adopted as his own, moving with pretty firm step, in the 
 streets of Philadelphia at the age of 10G. We believe he had 
 been married several ti 
 
 Not only is it important in our estimation that the persons 
 who become candidates for marriage should have attained a full 
 development of their organs, but, in order to the happiest result, 
 both parties should be possessed of health and a good consti- 
 tution; for it is possible that the organs may be brought up to 
 their full development without their having acquired that 
 firmness and stability which cannot be easiiy deranged by the 
 changes which occur in the progress of the function of repro- 
 duction. It is true that we occasionally meet with children 
 apparently very robust, though born of feeble parents: these 
 exceptions, if properly watched, will be found to fall within 
 the rule; for sooner or later we witness in most of them the 
 premature decay of the rosy cheeks, marasmus, phthisis, or 
 other manifestations of a scrofulous diathesis. If these chil- 
 dren should attain to manhood, and in their turn become pa- 
 rents, what is to be expected other than a rapid degeneration 
 of the race? 
 
 It is well known that the diseases of parents are often visit- 
 ed upon the children or the children's children through seve- 
 ral succeeding or alternate generations, and unless great care 
 is exercised in their moral or physical culture, whole families 
 decline from the bodily and mental vigour for which they 
 
REMARKS ON HYGIENE. 229 
 
 were once remarkable, until they either sink into obscurity 
 or become pests to society. This observation will apply to the 
 intellectual as well as the physical condition, and as a vicious 
 predisposition in either may be developed in afterlife, though 
 the early years may have been passed in apparent good health 
 both bodily and mental, parents are bound to investigate the 
 morbid hereditary tendencies of their offspring before they 
 encourage their intermarriage with those who display similar 
 tendencies. We may, perhaps, be permitted, owing to the 
 importance of this subject, to introduce the strong language of 
 Dr. Reid on this matter. "Nothing can be more obvious, 
 than that one who is aware of a decided bias in his own per- 
 son towards mental derangement, should shun the chance of 
 extending and of perpetuating without any assignable limit 
 the ravages of so dreadful a calamity. No rites, however 
 holy, can, under such circumstances, consecrate the conjugal 
 union. In a case like this, marriage itself is a transgression 
 of morality. A man who is so situated, in incurring the risk 
 of becoming a parent, involves himself in a crime which may 
 not improbably project its lengthened shadow, — a shadow, too, 
 which widens in proportion as it advances, — over the intellect 
 and the happiness of an indefinite succession of beings." It 
 becomes our duty, then, to comply with the duty of averting 
 or mitigating these evils by judicious and well selected mar- 
 riages, and a properly directed physical education. In this 
 way we may do much in arresting the transmission of heredi- 
 tary bias: and by invigorating the general system we render 
 it less susceptible to exciting causes, and strengthen those parts 
 which may be liable to diseased action. Experience has taught 
 the necessity, in some of the old countries, of avoiding these 
 evils as far as possible, and it is said, particularly in Europe, 
 that in the higher ranks of society, before the marriage con- 
 tract is signed, inquiry is frequently made whether either of 
 the parties are liable to any disease by hereditary* descent, the 
 gout, however, appears to be excepted; this being a disease to 
 which the royal family is incident, or being an evidence of 
 the good living of the family, may possibly be considered a 
 mark of distinction instead of an evil! Marriages have been 
 frequently broken off, even at a late period, when it was dis- 
 covered on the side of either party, that scrofula, consumption, 
 or madness had existed, or was actually existing in any mem- 
 ber of the family. 
 
 The efforts which have been made within a few years past 
 to destroy the vice of intoxication, so common in this coun- 
 try, have been already commented upon in the early pages of 
 this chapter. This practice, as well as general dissipation, 
 should be strongly deprecated by females, who should never 
 
230 REMARKS ON HYGIENE. 
 
 unite themselves to a man addicted to either of these habits; 
 and we agree with a late luminous writer on this matter, that 
 they shoul I be protected by legal divorce if the husband should 
 acquire the former habit after marriage. Constant or frequent 
 excitation by intoxicating drinks impairs the intellect; general 
 dissipation acts most powerfully in enervating the strength of 
 the body; and not only does the woman suffer all the horrors 
 which attend such indulgences in her husband, but her off- 
 spring too frequently inherit feeble constitutions. 
 
 There is no other form in which the curse falls either so 
 commonly or so terribly upon the evil-doer, as when his 
 crimes impair the moral or physical sanity of his children. It 
 seems cruel to deny to the repentant the solace of domestic 
 enjoyment, — often the only means of restoring them perma- 
 nently to society and usefulness, — to present and eternal wel- 
 fare; but we owe it to our readers, as a duty, "to stale that it 
 is not by example alone that the son of a drunkard is so often 
 led to resort to intoxicating drinks, and that the child of the 
 libertine flics to the haunts of vice, or dies prematurely in 
 his innocence from the results of bodily inherited with 
 
 his paternity! Inherited, did I say? Too often the victim falls 
 before the parent, who, perhaps, has lot Hen the suf- 
 
 ferings entailed upon him- youthful indiscretions" 
 
 and dreams not that lie winged ihe arrow that leaves him de- 
 solate ! Habits, like i . are of; litary! The 
 stronger sex pursue, with unrelenting cruelty, the slig 
 errors of the weaker. By w! an of 
 the world attempt to oppo :i justice 
 to take her course, we utter a .lion to those fair 
 beings whose rights are so feebly protected, even in the most 
 civilized societies ! lie may be amiable and good-heartt 
 the common opinion of mankind. Even aft ling upon 
 the crushed hearts of others whose wcalv is pro- 
 tection, he may be held magnanimous and noble. Perfect 
 may he be as Crickto .. mtiful even as Antinous. 
 
 Yet beware! If you would not resemble the pale statue of 
 immortal Grief in her vain strife to shield the last sad relic 
 of her lovely ones — the childless mother circled by her dead ! 
 Then shun that most mistaken thought, so often uttered by 
 the fondest of your sex and the worst of ours, " The re- 
 formed rake is the best of husbands."' 
 
 While we have thus furnished to the female some points of 
 importance to her in placing herself in a position to perform 
 the part she is to act in life, we must not pass over, without 
 proper notice, the qualifications necessary for her to possess, be- 
 fore she should enter upon this interesting and important sphere 
 of duty. In proportion to the value she sets upon her own 
 
REMARKS ON HYGIENE. 231 
 
 health, and the gratification she would feel in finding herself, 
 at a proper period of life, surrounded by a group of healthy 
 children whose physical and mental powers she would be the 
 happy agent in expanding, let her not pass over lightly, or con- 
 ceal any physical disability which might make marriage fatal to 
 herself, or give evidence that by such concealment she had 
 been dishonest to the man who entered into this relation with 
 her. The existence of cancerous affections, or a known predis- 
 position to them, should always be considered by her an ob- 
 jection to matrimony. There are also certain physical con- 
 ditions of her system which render her liable to more than 
 ordinary suffering from parturition, if this process take place 
 for the first time at a late period of life: and a woman be- 
 coming a mother at this time will also be liable to be de- 
 prived of the pleasure of seeing her children settled in life 
 before she is herself obliged to leave the world, even by the 
 common contingencies of age. We would therefore suggest, 
 that those who have deferred this ceremony till beyond the 
 thirty-fifth year, had better wait till they have passed the 
 period of becoming mothers. 
 
 We will now close this subject, and with it the chapter on 
 Hygiene, with a single remark upon the means by which he- 
 reditary tendencies may be eradicated, or rendered weaker in 
 families, by judicious intermarriag 
 
 It is well known that, as a general rule, the offspring par- 
 takes of the peculiarities of both the parents. Now heredi- 
 tary diseases are, for the most part, the result of either a 
 deficient or an undue development of some particular organ 
 or system; and by marriage with one whose natural tenden- 
 cies are the reverse of our own, we may neutralize the 
 diseased disposition of both parents in the constitution of the 
 offspring. Thus, a female of lymphatic temperament, who is 
 obviously predisposed to cancerous affections, may intermarry 
 with a man whose circulatory apparatus is unduly developed, 
 and who is threatened with hemorrhagic or apoplectic dis- 
 ease. In this case the probability of the occurrence of cancer 
 or hemorrhage among the descendants would be much less 
 considerable than if the parties had formed a connexion among 
 those more closely resembling themselves respectively. An- 
 other instance of the same kind of compensation is observed 
 when a powerful and athletic individual, whose mind is per- 
 haps less vigorous than his person, intermarries with a scrofu- 
 lous or consumptive female, whose talents are precocious and 
 whose genius preys upon the corporeal energies. Unfortu- 
 nately, this mode of correcting idiosyncrasies is not entirely 
 effective; for once in a few generations, some individual of the 
 race, impressed with the peculiarities of his progenitor, almost 
 
232 REMARKS ON HYGIENE. 
 
 always appears, and sinks a victim to the demon who haunted 
 the parents! Yet, sufficient good results from the considera- 
 tion of physiological principles in matrimonial arrangements, 
 to render the advice of a medical philosopher highly impor- 
 tant on many occasions. 
 
 In our land, where the free play of the heart is more gene- 
 rally consulted in love affairs than in any other, it may seem 
 almost hopeless to lay down any rules on such a subject; and 
 far be it from us to desire to roughen the " way of true love" 
 by any unnecessary checks! Nature, were not her dictates 
 thwarted by the errors of false education and by ridiculous 
 conventional arrangements, would regulate these matters even 
 better than the doctor, — for it is a singular fact that attach- 
 ments of a serious character are much more frequently formed 
 between dissimilar individuals, than between those who 
 strongly resemble each other; the strange likeness so often 
 observed between husband and wife, when they have been 
 long married, being an acquired one from similarity of pur- 
 suits and position, and not an original one from primitive 
 conformation: — it is physiognomical, from community of feel- 
 ing, — not structural, from constitutional identity. 
 
 But even with us the progress of luxury, refinement, folly, 
 and vice, is rapidly introducing customs at variance with na- 
 ture. Matrimony has become, and will continue a matter of 
 over-legislation — and our hints may be useful to those who 
 do not consider beauty as paramount to duty, and wealth 
 more estimable than health. 
 
PART II. 
 
 PRACTICAL, DIRECTIONS 
 
 FOR 
 
 THE TREATMENT 
 
 MEDICAL AND SURGICAL CASES. 
 
 30 
 
PART II, 
 
 CHAPTER I. 
 
 OF SURGICAL ACCIDENTS AND DISEASES. 
 
 In the present chapter it is proposed to speak of the mode 
 of treating accidents and external diseases, so far as they can 
 be safely managed, when the advice of medical men is not at- 
 tainable. 
 
 It has been customary, in most popular treatises on medi- 
 cine, to arrange the subjects alphabetically for convenience in 
 reference, but the author deems it more proper to preserve 
 more strictly the mutual connexions between the various af- 
 fections which fall under the notice of the practitioner, because 
 facts are always better understood and retained more readily 
 in the memory, when viewed in their relation to other facts 
 which are similar in character, causes, and results. The sub- 
 ject of this chapter will therefore be divided into numerous 
 sections, commencing with those injuries which are purely ac- 
 cidental, then treating of local inflammations and their conse- 
 quences, and concluding with some of those affections com- 
 monly ranked with surgical diseases, and usually termed con- 
 stitutional and specific. 
 
 SECTION I. 
 
 OF WOUNDS AND CONTUSIONS. 
 
 A contusion or bruize is but an internal wound, or a wound 
 which does not communicate with the external air, for al- 
 
 
236 OF INCISED WOUNDS. 
 
 though some bruises are not apparently attended with the tear- 
 ing or separating of the flesh or other soft parts, the effusion 
 of blood from the vessels, which occasions the black and blue 
 colour of such parts, proves that many of the capillaries at 
 least, are really torn — for this reason we class these two kinds 
 of accidents together. 
 
 Of Incised Wounds, or such as are made with a sharp cut- 
 ting instrument. 
 
 Wounds of this class are always attended with rapid bleed- 
 ing, and if the quantity of flowing blood be considerable, this 
 discharge demands immediate attention. The dark red colour 
 of the venous blood is generally very easily distinguished from 
 the bright scarlet of that which springs from an artery. The 
 former always flows in a steady stream, while the latter is 
 thrown out by fits and starts; each jet of which, when large ves- 
 sels are divided, often flies many feet from the wound and cor- 
 responds with one bound of the pulse. When the arteries are 
 very small, this jerking motion of the blood is scarcely per- 
 ceptible, but in such cases there is rarely much occasion to de- 
 termine the character of the vessel. Bleeding from the veins 
 is seldom attended with great danger, and is easily stopped by 
 pressure on the orifice of the vessel or near the side of the 
 wound. The bleeding from veins almost always appears 
 chiefly on the side of the wound farthest from the heart, but 
 that from arteries, except in wounds about the joints, usually 
 springs from the side next the heart. 
 
 Modes of stopping the Bleedijig. If the discharge of blood 
 be small in quantity, it generally stops, in a little lime, without 
 the assistance of the surgeon; but in all cases, except in wounds 
 from glass or china, it is right to cheek it by pressing the edges 
 of the wound firmly together and keeping them so by proper 
 dressings. If the wound be on the forearm, hand, leg or foot, 
 the bleeding is much retarded by placing the limb in the most 
 elevated position, (that is, above the body.) and supporting it 
 there. If the wound cannot be closed, it is often proper to 
 fill it with lint, which, by coagulating the blood, prevents its 
 further escape; and if this fail, some lint may be dipped in a 
 strong solution of alum, and then stuffed into the wound; 
 but this mode of treatment is altogether inadmissible, unless 
 the injury be of such a character that the wound cannot be or 
 ought not to be healed immediately. There are many more 
 powerful remedies for these slight hemorrhages, of which the 
 most formidable is the actual cautery, or burning with a hot 
 iron; but the attempt to use these without competent surgical 
 advice would be extremely improper and dangerous. 
 
 When the amount of bleeding is more considerable it is 
 often necessary to take up the arteries, and if their mouths 
 
ARREST OF THE BLEEDING. 237 
 
 are distinctly seen on separating the edges of the wound, 
 they may be safely seized by a pair of small pincers or a de- 
 licate hook, and tied lightly with a ligature composed of two 
 or three strands of waxed sewing silk, slightly twisted. The 
 arteries in such cases are recognised by the jet of blood that 
 shoots from them at every pulsation, and care must be taken 
 to confine the noose of the ligature as closely as possible to the 
 artery alone, for fear of including some of the little branches 
 of the nerves which are often found close in the neighbourhood 
 of these vessels. This little operation can rarely be attempted 
 by those who have no surgical education, but it may be useful, 
 wilder certain circumstances, for all to be acquainted with it. 
 
 If the wound be located on either of the extremities, — until 
 proper medical assistance can be obtained, it is easy to com- 
 mand the hemorrhage by means of a tourniquet, an instrument 
 which will be presently described. 
 
 If a very large artery be wounded, such as the principal blood 
 vessels of the neck, the arm, or the thigh, it is almost impossible 
 for any one unacquainted with surgery to retard, even for a mo- 
 ment, the fate of the patient, unless the tourniquet can be em- 
 ployed. The bleeding, in such cases, is tremendous, and 
 threatens rapid dissolution. 
 
 The Tourniquet is an instrument intended to apply and 
 tighten a ligature about a limb, near to the body, in such a 
 manner as to compress all the blood vessels of the limb so as 
 to arrest completely any hemorrhage which may occur in any 
 part of it. This is the instrument employed by operators, to 
 prevent bleeding while they amputate a limb. It cannot be 
 employed for many hours together without destroying the vi- 
 tality of the member, and is, therefore, only a temporary re- 
 medy. It must be placed, in all cases, between the wound 
 and the limb — and should always be applied on some part of 
 the limb which contains but one bone, for in the leg or fore- 
 arm the vessels between the bones would continue the circu- 
 lation in spite of the tourniquet. Thus, in wounds of the hand 
 or forearm, it is usually fixed about the middle of the arm, and 
 in those of the leg or foot, on the middle of the thigh. The 
 instrument as employed by surgeons, is too costly to be found 
 in families, but the field tourniquet, which is a simple strap 
 with a peculiar pad and buckle, might be used with propriety 
 on large plantations: it is designed for military surgery, and 
 is sold by all the instrument makers. The best substitute for 
 sudden emergencies is the following. Tie a silk handkerchief, 
 folded diagonally, till it is about two inches wide, loosely 
 round the limb where the tourniquet is required, so that the 
 knot, which must be very secure, may bear as nearly as pos- 
 sible over the route of the principal artery of the limb which 
 
23S OF INCISED WOUNDS. 
 
 is a little in front of the middle of the inner side of the thigh 
 or arm. Now take a short stick, (six inches of the end of a 
 brush-handle will answer the purpose,) and thrusting it under 
 the handkerchief, on the outside of the limb, twist it till the 
 bleeding stops. If time permit, it is best to place a flat com- 
 press of linen or muslin beneath the stick, to keep the hand- 
 kerchief from pinching the skin; and if the operator knows 
 exactly the route of the artery, it is also advisable to place a 
 small roll of muslin beneath the knot. By a general know- 
 ledge of this mode of treatment, the life of many a patient 
 may be saved until surgical aid can be procured from a dis- 
 tance of twenty miles. No matter how severe the wound 
 may be, if the bleeding threatens the life of the patient, the 
 tourniquet should be instantly applied by the most intelligent 
 by-stander who possesses sufficient nerve for the purpose. 
 
 Wounds beyond the reach of the Tourniquet. When 
 wounds of large arteries take place so high on the thigh or 
 arm that there is no room for a tourniquet between the wound 
 and the hip or shoulder, death generally takes place very ra- 
 pidly, unless aid be afforded by an intelligent and prompt 
 assistant. The finger placed on the groin near its inner side, 
 feels a strong pulse beating just where the main artery of the 
 limb passes over the edge of the pubic bone, (see anatomy 
 of the pelvis,) and just at this spot, the end of the thumb 
 pressed strongly on the bone cuts off the greater part of the 
 circulation by closing the artery, and very much lessens, if it 
 does not entirely cheek the hemorrhage. The great artery of 
 the arm winds round and over the first rib, behind the clavi- 
 cle or collar bone, (see skeleton,) and by pressing the thumb 
 strongly down behind the latter, its pulse may be felt. Pres- 
 sure in this place stops a bleeding from the large arteries of 
 the shoulder or arm-pit, but it is an extremely painful mea- 
 sure. 
 
 By such means as have been just described, the life of a pa- 
 tient may be preserved for half an hour while a surgeon is 
 called, and the instruments prepared for a" serious operation. 
 But the position of the artery in these two situations should 
 be ascertained before the accident, by those who wish to be 
 prepared for usefulness on momentous occasions. When the 
 wound is bleeding, it is generally too late for the novice to at- 
 tempt a successful exploration. The uninitiated operator must 
 husband his strength and suppress his feelings! This kind of 
 pressure cannot be long preserved without extreme exhaus- 
 tion. We have several times had valuable lives suspended 
 upon the last joint of our thumb, and ice never perspired more 
 freely! 
 
 In wounds in which large arteries are divided on one side 
 
UNION BY THE FIRST INTENTION. .239 
 
 of the neck, and only on one side, life may be preserved for 
 a few minutes, provided there is room enough for pressure 
 with the thumb between the clavicle and the lower edge of 
 the wound. The carotid artery may be stopped by pressing 
 the thumb backwards between the outside of the wind-pipe 
 and the front edge of that large muscle which winds round 
 the side of the neck from the breast-bone to the long projec- 
 tion immediately behind the ear. Along this space the pulse 
 of the artery is very plainly felt. When large arteries on 
 both sides of the neck are wounded, no one but an accom- 
 plished surgeon can be of any use, and even he can rarely 
 save the patient; for stopping both carotids at the same time 
 would in itself occasion death, by nearly cutting off the circu- 
 lation in the brain: the two small cervical arteries, which alone 
 could carry blood to the interior of the head under such cir- 
 cumstances, are, in all probability, unable to maintain the 
 functions of so large and important an organ even for an hour. 
 When one carotid, or its principal branches are cut, life can- 
 not be preserved many minutes without a surgical operation, 
 for the connexions between the vessels on the two sides of 
 the neck are so frequent and so large, that the patient soon 
 dies from the loss of the blood flowing through the branches 
 of the uninjured carotid. 
 
 In wounds of the body which do not penetrate the cavities, 
 it is generally impossible to stop the bleeding from large arte- 
 ries by any other means than by tying the arteries, or by stuff- 
 ing the wound with lint and placing a firm bandage over the 
 compress. When the last method succeeds, it is very impro- 
 per to remove the lint or dress the wound, without advice, in 
 less than forty-eight hours. Even then, if the lint adheres 
 firmly, or the wound is covered with a coagulum of blood, it 
 is wrong to disturb it, until nature herself loosens it. Lint 
 should never be used in cuts unless under necessity, for it de- 
 stroys the chance of healing the wound immediately. In all 
 incised wounds, heat or ablutions with warm water promote 
 bleeding, while cold tends to lessen it. 
 
 He who studies the foregoing directions will be prepared 
 to render all the assistance in checking hemorrhage from in- 
 cised wounds which can be safely undertaken by those who 
 are not of the profession. 
 
 Mode by which Nature effects the cure of incised Wounds. 
 There are two modes by which nature heals incised wounds. 
 The first of these is called healing by the first intention, and 
 can only take place when the sides of the wound can be kept 
 nearly or quite in contact, and when the bleeding can be 
 stopped without much handling. 
 
 Soon after the wound is made, the blood vessels around the 
 
240 OF INCISED WOUNDS. 
 
 cut throw out a kind of glutinous secretion, which adheres to 
 both surfaces of the incision; and when the edges are kept 
 close, rapidly grows harder and more adhesive, filling all the 
 little intervals of the wound, and binding the sides together. 
 In twenty-four, or forty-eight hours, this secretion becomes 
 pretty solid, and new communications are formed in it, between 
 the blood vessels on the opposite surfaces. A few days, or 
 weeks, according to the extent of the injury, render the new- 
 formed bond as firm or firmer than the original structure. 
 Such is the simple manner in which wounds unite when no 
 large arteries are wounded, when no unnecessary washing or 
 handling is resorted to, when the parts are kept together and 
 at rest, and when no nostrums or stimulating applications are 
 applied "to hasten the healing." 
 
 A little coagulated blood between the lips of a wound will 
 not prevent this kind of union, if the orifice be well protected 
 from the air, and the lips pretty strongly pressed against it, 
 for it is generally absorbed before the glutinous fluid loses its 
 character. Even larger coagula are often left under deep flaps 
 in some incised wounds, where they are be} 7 ond reach, and 
 the parts healing rapidly over them, they may give no trou- 
 ble. If there should be a small cavity at the bottom of a large 
 wound where the sides cannot be kept in contact, (as when a 
 muscle is divided and its fibres retract,) it is better that it 
 should continue to be filled with blood than with any thing 
 else, as this fluid is less irritating than any other. But it is an 
 important general rule that the bleeding should be stopped 
 and all coagula removed before attempting the first dressing 
 of an incised wound, as the neglect of this rule very often oc- 
 casions an abscess or an ulcer; for blood, when long in contact 
 with the air, becomes highly irritating, and in many persons 
 it is difficult for the absorbents to remove a large coagulum, 
 even when a wound has healed over it. 
 
 If the edges of an incised wound cannot be brought quite 
 together, if the bleeding vessels require time in taking them 
 up or stopping them, if balsams or other stimulating applica- 
 tions are applied, as is often foolishly done under the idea that 
 these nostrums are "good for fresh cuts," or, lastly, if the bad 
 state of the constitution bring on inflammation in the wound, 
 — then the union by the first intention will often fail to be ac- 
 complished, and the injury must recover by what is called 
 union by the second intention. Still it is of great importance, 
 except when the wound is inflamed, to keep it as nearly closed 
 as possible by the dressings, in order that the cure may be as 
 rapid as possible, and that some part of the cut may unite im- 
 mediately, so as to diminish the labour of nature. 
 
 In union by the second intention. The vessels pour out 
 
UNION BY THE SECOND INTENTION. 241 
 
 the same glutinous fluid that has just been mentioned ; but this, 
 instead of binding the sides of the wound together, appears to 
 become converted into a kind of new membrane, covering the 
 whole surface, and soon taking on the characters and functions 
 of a living organ. In a few hours this membrane itself begins 
 to form a new secretion, differing in character from any thing 
 seen in the sound and healthy body. This secretion is called 
 pus, or more commonly matter, and is too well known to 
 need any description. Beneath this [me and perfectly trans- 
 parent membrane, the capillaries enlarge themselves, and, per- 
 haps, increase in number until the surface, when washed or 
 cleansed, appeal's as red as if it were composed entirely of 
 translucent blood vessels. These capillaries not only supply 
 the new membrane wilh the fluid necessary to furnish the pus 
 which bathes the wound, but they also deposite a kind of glu- 
 tinous matter in the cells of the cellular tissue all around the 
 cut, causing it to swell up. and gradually fill the cavity of the 
 wound with a multitude of little conical eminences called gra- 
 nulations, which look like flesh, but. are really composed of 
 cellular membrane coloured by innumerable little blood ves- 
 sels. Wherever these granulations come together, whether 
 in consequence of their own growth or the dressings of the 
 surgeon, they soon unite, and the secretion of pus ceases in 
 that spot. At length the constant growth of the granulations 
 fills up the whole cavity nearly or quite to the level of the sur- 
 rounding surface, and then the new membrane gradually dries 
 and takes on a character somewhat like that of the skin, the 
 change commencing at the edges, and tending toward the cen- 
 tre. This is called the cicatrization of the wound. 
 
 After the cicatrization of the wound, the absorbents soon 
 take up the glutinous matter secreted in the cellular tissue, to 
 form the granulations; and the new scar with the parts beneath 
 begin to contract with great force, drawing together the ori- 
 ginal sides of the divided parts. It is this strong contraction, 
 which cannot be prevented, that produces the terrible defor- 
 mity from wounds or other injuries, when large portions of 
 skin have been entirely destroyed, as we sec in burns. 
 
 Such is the history of union by the second intention in in- 
 cised wounds, when the patient's constitution is healthy, and 
 the case not tampered with by ignorant pretenders; but many 
 trivial causes may interrupt the process. If the discharge of 
 the pus be prevented by closing the wound too tightly, it col- 
 lects within, and its pressure not only prevents the granulations 
 from forming, but causes the cavity to enlarge like an ab- 
 scess. If inflammation attack the part, or if the wound be 
 left so much exposed that the air causes the pus to become 
 sour or bad, the granulations do not fill up the cavity, but it 
 
 31 
 
242 TREATMENT 
 
 degenerates into an nicer. In certain states of the constitu- 
 tion or conditions of the part, the granulations are rendered 
 large and weak, rising up beyond the surface of the skin, and 
 forming what is commonly called proiul flesh: over this the 
 wound either refuses to heal, or, if it unite at all. continues ex- 
 ceedingly liable to re-opening from slight injuri 
 
 After these remarks, the reader is prepared to understand 
 the treatment of incised wounds. 
 
 Treatment. — The Weeding being stopped, the next thing 
 required is to secure the union by the first intention of the 
 whole wound, or as large a part of it as possible. All that is 
 required in dressing for this purpose is to close the wound and 
 keep it closed, — and the following are the proper measures. 
 
 The suture or stitching. It is a very popular prejudice 
 that large wounds generally require to be sewed up. A good 
 surgeon very rarely uses a stitch, except in wounds of the 
 eyelids, nose, lips, or ears, when it is impossible to use stick- 
 ing plaster, or bandages so as to close the wound. It occa- 
 sionally happens, however, that a cut is made many inches in 
 length, and in an angular or very irregular direction, so that 
 it cannot be closed throughout its whole length without a su- 
 ture, and we may then place one or two stitches at the angles 
 with advantage: but these should only be regarded as as 
 ants to the sticking plaster or bandage, and the attempt to sew 
 up the whole length of a wound of any ordinary dimensions, 
 or even to close a part of it by a regular seam is justly regard- 
 ed as horribly bad surgery. Each stitch must be separate, 
 and should be taken in the following manner. 
 
 Take one, two or three threads of sewing silk (the unco- 
 loured is best.) about six inches long, and well waxed; pass 
 this ligature through the eye of a darning needle, if no curved 
 surgeon's needle be at hand — giving preference to the com- 
 mon Dutch needle, if possible, for these arc much less likely 
 to break than those made of steel. Pass the needle through 
 the skin, from one side of the wound, directing it from with- 
 in outward, so as to pierce the skin about half an inch from 
 the cut, unless it be in a very delicate part, like the eyelid — 
 taking care to include the whole thickness of the skin, which 
 varies from the eighth to the half of an inch indifferent places. 
 Having drawn the ligature through until its middle lies in the 
 wound, detach the needle entirely, and thread it with the 
 other end of the ligature: then beginning in the wound below 
 the skin, bring it out in the same manner on the opposite side. 
 The stitch is then complete, and it only remains to tie the 
 ends of the ligature, either in a single knot, or in the sliding 
 noose, usually called a booby's knot The stitches should ne- 
 ver be tied tighter than is barely sufficient to cause the edges 
 
OF INCISED WOUNDS. 243 
 
 of the wound to touch each other gently, and all strain should 
 be taken off by supporting the rest of the wound by strips of 
 sticking plaster or the bandage. If the parts become swelled 
 or inflamed, the stitches must be cut immediately, and as soon 
 as the part adheres sufficiently to need them no longer, they 
 should be divided and drawn out. Clumsy operators and 
 those who have not received a regular medical education make 
 much more use of the suture than those who are experienced. 
 The writer of these pages, in treating some hundreds of cases, 
 including many wounds of the eyelids, nose, lip, tongue, and 
 ear, has never had occasion to employ a stitch, except in three 
 instances. 
 
 Adhesive strips, or pieces of sticking plaster, are by far the 
 most important means for closing incised wounds. Although 
 their use is so well known that it is unnecessary to explain 
 what is meant by them, there are some precautions in apply- 
 ing them which require notice. It is best to make them as 
 broad as convenience will permit, provided the wound be not 
 exceedingly short, or seated on a very irregular part. They 
 should be not less than six or seven inches in length for large 
 wounds of the body or extremities, and as long as possible for 
 those of the face, hands, feet, <S:e. They ought never to be ap- 
 plied lengthwise to the wound, but should cross its course in the 
 way best calculated to keep the sides together. We must never 
 permit them to cover the whole wound, for it is necessary to 
 allow short intervals between the strips in large wounds, and 
 the ends of the cut should never be quite covered, however 
 small it may be, in order that blood or pus, if any occur, may 
 escape without parting the sides of the wound. A strip of 
 adhesive plaster should never be permitted to encircle the 
 whole limb, for its pressure would then tend to embarrass the 
 circulation by acting like a ligature and preventing the return 
 of the blood through the veins. In wounds running length- 
 wise of the fingers, it is absolutely necessary to employ strips 
 which would pass several times round the part ; but the difficul- 
 ty can be generally conquered by winding the strip in a spiral 
 direction, so as to allow the capillary circulation to be conti- 
 nued round the intervals between the turns. 
 
 When any of the blood vessels of the wound have been tied 
 to prevent bleeding, one end of the ligature is always cut off 
 close to the knot, and the other must be left long enough to 
 project from the wound, in order that the ligature may be 
 drawn out when it has separated from the end of the vessel, 
 an occurrence which takes place in from three days to as many 
 weeks, according to circumstances. These ends of the ligatures 
 most be permitted to pass freely through the intervals between 
 
244 TREATMENT 
 
 the adhesive strips, and, if possible, it is best to bring them 
 out at one angle of the wound, preferring the lowest angle, in 
 order that the pus which always forms along the track of the 
 ligature may flow out most easily. 
 
 When the wound is fairly closed by the adhesive strips, a 
 small piece of soft rag or patent lint covered with simple oint- 
 ment, should be laid over the whole, taking care not to cover 
 a great deal of the surrounding skin or the ends of any of the 
 strips with the salve, as this loosens the sticking plaster and 
 irritates the surface. This ointment prevents the discharges 
 from the wound from becoming dry, and rendering the neces- 
 sary removals of the dressings painful to the patient. 
 
 The first dressing should never be removed in less than for- 
 ty-eight hours without strong necessity, or the commencing 
 adhesions will be torn, and the wound re-opened. In taking 
 off the sticking plaster, we should always begin at both ends 
 and pull the strips by doubling them back and drawing toward 
 the wound. Tf the parts be covered by long hairs they should 
 be well shaved before applying the plaster, and if the strips 
 in coming off adhere to the small hairs, these should be cut 
 with a sharp knife as we proceed. All the rg after the 
 
 first should be repeated every twenty-four hours in warm wea- 
 ther, and at least every forty-eight hours in winter. 
 
 Bandages. Whenever an incised wound is situated on a 
 moveable part — such as the neighbourhood of the joints — and 
 whenever the cut is very deep or extensive, it is apt to 
 or to be dragged open on every attempt at motion. It is then 
 highly important not to trust the closing of the wound entire- 
 ly to the adhesive strips, but we should support the part with 
 a bandage, and confine it in a state of absolute rest. Thus a 
 deep cut across the front of the arm would be opened at 
 every attempt to straighten the forearm, and it is nece-- 
 to keep the arm in a sling in order to prevent this accident, 
 and if a deep cut lengthwise of the arm shows a tendency to 
 gap, it is proper to confine the whole arm in a spiral bandage, 
 such as surgeons call a roller, in order to assist the ad he; 
 strips by pressing the edges together. 
 
 Whenever we employ rollers on either of the extremities, 
 it is proper to begin at the fingers or toes, where the ban g 
 should always be tightest, and to continue it gradually up the 
 limb until we have passed the wound and its dressings. This 
 is done to prevent the pressure of the roller from acting like 
 a ligature and embarrassing the circulation in the veins below 
 it. More will be learned by seeing a roller once properlv 
 applied by an accomplished surgeon, than by many pages of 
 description; and all that we can now offer the reader on this 
 subject is. 1st, never to employ a bandage o( more than 
 
OF INCISED WOUNDS. 245 
 
 and a half fingers' breadth for the arm, or three fingers' breadth 
 for the leg; 2d. to use for all their rollers the common domestic 
 bleached, but unglazed muslin, at from 10 to 15 cents per 
 yard; 3rd, never to sew separate strips together to make a band- 
 age, if this can be avoided; 4th, always to make the turns of the 
 roller overlap well; and lastly, never to allow the bandage to 
 be creased or rumpled where it touches the skin. 
 
 Splints. In all wounds running crosswise on the fingers 
 or in certain places about the larger joints, it is always ad vise- 
 able and often absolutely necessary to resort to other measures 
 than the adhesive strips and bandage in order to control the 
 motions of the neighbouring joints, and secure the wound 
 from being torn open inadvertently. For this purpose we 
 employ splints, or strips of some firm substance, to extend 
 along the limb, generally from its extremity to the joint next 
 above the wound. These are bound on by means of a roller 
 passed round both the limb and the splint* 
 
 There are a great many different kinds of splints employed 
 by surgeons, but only two varieties can be employed in do- 
 mestic practice with any propriety. These arc the paste- 
 board splints, and the wooden splints. 
 
 Paste-board splints arc best made of the thickest book- 
 binder's board, or — if great strength be required — of two of 
 these boards strongly glued together. The splint being cut to 
 the required length and breadth, by means of a strong jack- 
 knife, is to be dipped into, or passed through boiling water for 
 a few seconds only, until it will bend in any direction without 
 breaking; but it must not be soaked so as to make it very soft. 
 It is then placed on the limb and secured by a pretty tight 
 roller, which causes it to assume the form of the parts on 
 which it presses, and in a few hours it becomes permanently 
 moulded to that form by drying. 
 
 JToodcn splints should be made of panel white pine, ce- 
 dar, or ash, the two former being preferable in most cases, be- 
 cause they arc so readily cut by a pen knife. The wooden 
 splints which are required in all wounds of the extremities 
 except perhaps those of the thigh, are best made of a smooth 
 common shingle, plained down until reduced to one half, or 
 one third the thickness of the butt: a splint of any shape can be 
 cut out from this with a pen-knife in a few moments, and the 
 edges and angles being rounded off it is ready for use. Seve- 
 ral shingles thus prepared should always be ready in case of 
 accident, in every large establishment, and on all considera- 
 ble plantations. 
 
 Before a splint is finally applied, it should always be lined 
 with tow or cotton, and if of wood, this lining should be bound 
 on to it by a bandage or piece of smooth muslin. We shall 
 
246 OF INCISED WOUNDS BY GLASS. 
 
 speak further on the subject of splints in mentioning the in- 
 cised wound of particular parts. 
 
 Of incised wounds by glass. It is very important to men- 
 tion that cuts made by glass form an exception to the general 
 rule in the treatment of incised wounds. It is almost impos- 
 sible to tell when we have removed the last fragments of such- 
 a transparent substance, and if the wound should heal, as ifc 
 may often be made to do, over a piece of glass concealed be- 
 neath the skin, the consequences are often very troublesome, 
 and sometimes dangerous. For this reason glass wounds 
 should never be united by the first intention, but should be 
 dressed for at least two days with a plain bread and milk poul- 
 tice, introducing a little common lint between the edges of 
 the wound before applying the poultice, if the cut be deep and 
 narrow. Afterwards the wound will unite by the second in- 
 tention, and the granulations, as they rise, will thrust out any 
 portions of glass remaining in the cavity. 
 
 If we fail in causing the union of the whole of an incised 
 wound by the first intention, we can almost always succeed 
 with the greater part of it; and very little variation in the 
 treatment is commonly required to effect the union of the re- 
 mainder by the second intention. The same care continues 
 to be necessary in keeping the wound closed as accurately as 
 is convenient by adhesive strips, bandages, or splints. Stitches 
 are generally cut away, when incised wounds begin to throw 
 out pus, or suppurate; but this should not be done if removing, 
 the stitch will put the parts upon the stretch, or cause the 
 wound to gap very much. Greater care is now required to 
 avoid allowing the collection of matter within the wound by in- 
 terposing any obstacle to its escape. For this reason theadlu 
 strips should be wide apart, and the end or angle of the wound 
 which is calculated to drain it most completely should be 
 made constantly dependent by fixing the limb or part in a 
 proper position. If the wound be very large, and the dis- 
 charge very great, the patient may require confinement to his 
 bed to secure this position. More care is necessary in band- 
 aging in these cases, and little compresses by the side of the 
 wound may be often serviceable in keeping the deepest parts 
 of the cut in contact. The simple ointment should cover a 
 wider space in these cases, than in those which do not suppu- 
 rate, to protect the pus in the wound from the action of the 
 air. 
 
 When inflammation comes on, if the orifice be wide, the 
 wound becomes an ulcer; if narrow, an abscess or fistila; 
 for the treatment of which, see the proper heads. 
 
 Healing of incised wounds by scabbing. We sometime.- 
 see slight incised wounds which do not gap much, and which 
 
OF INCISED WOUNDS OF THE SCALP. 247 
 
 have remained undressed for some hours, covered either by a 
 little scab composed of an excess of the glutinous fluid em- 
 ployed by nature in healing wounds, or of coagulated blood, 
 which after filling the cut has just covered the orifice and be- 
 come dried there. Under such scabs the wounds generally 
 heal slowly but surely, and if we attempt to remove them, 
 particularly if the skin of the part be thick, as on the joints of 
 the fingers, the palm of the hand, the sole of the foot, &c, we 
 are apt to give cause to troublesome fissures or narrow sores, 
 which it is sometimes very difficult to cure. It is best to 
 leave these cases entirely to nature, or to rest content with 
 merely oiling the scab a little when its contraction causes pain 
 and irritation. In a week or two the crust falls off, leaving 
 the parts well. 
 
 Balsams, &c. A great many nostrums, such as the red oil, 
 spirits of turpentine, various balsams, &c, are strongly recom- 
 mended as excellent for fresh cuts! It is useless even to name 
 these articles, for although some of them may prove servicea- 
 ble in bruises, contused wounds, and punctured wounds at cer- 
 tain times, and under certain circumstances, the application of 
 any remedy to the interior of a "fresh cut" is utterly absurd 
 and ridiculous! — it inevitably interferes with the first great 
 object of nature, — the union by the first intention. 
 
 We will now proceed to speak of some peculiarities of treat- 
 ment required by incised wounds of particular parts. 
 
 Incised wounds of the scalp. Most wounds of the scalp 
 are made with instruments or bodies much duller than those 
 which produce incised wounds in other parts; but the power 
 of the scalp to adhere by the first intention, exceeds by great 
 difference, that of any other part of the body; and even when 
 this part is torn or lacerated by falls or other accidents, the in- 
 jury should always be treated like an incised wound. 
 
 I have seen nearly half the scalp of the top and left side of 
 the head, a large portion of the skin of half the forehead, the 
 external angle of the left eye and the whole of the left temple 
 torn up, turned back, and covered with chips, dirt, and brick 
 dust, in consequence of the head being caught in falling be- 
 tween the hub of a cart-wheel and a high pile of boards, yet, 
 when washed and replaced, the whole united by the first inten- 
 tion, except the parts about the corner of the eye, and one spot 
 on the temple where it was necessary to tie an artery, and 
 where the ligature prevented the immediate healing. The 
 connexion between the loose flap and the head was formed 
 just above and behind the ear, and did not exceed three inches 
 in length; — yet the scar left on the forehead and temple does 
 not appreciably diminish the remarkable beauty of the young 
 man who was thus horribly injured. 
 
248 OF INCISED WOUNDS OF THE NECK. 
 
 In wounds of the scalp, unless they extend to the temple, 
 where there is a thick muscle covering the bone and one large, 
 though not very important artery, the cases requiring ligatures 
 are exceedingly rare, for all bleeding is easily checked by 
 pressure with a compress and bandage. Stitches are never ne- 
 cessary, and sometimes prove highly dangerous. 
 
 After removing every trace of dirt or other foreign matter 
 by washing with a sponge and milk-warm water, the next 
 thing to be done is to shave the head well and freely for se- 
 veral inches round the wound. The edges being drawn to- 
 gether by the adhesive strips, and the simple ointment applied, 
 the whole dressing should be kept in place by a large hand- 
 kerchief applied as the French do in making their common 
 head-dress, or by a close-fitting night-cap. If any little ab- 
 scesses should form under a flap of scalp while the rest of the 
 flap is uniting, they should be opened early with a thumb- 
 lancet. 
 
 Incised wounds of the neck and throat. Those wounds of 
 the neck which neither wound a large artery nor open the 
 wind-pipe, arc not generally difficult to treat. If they run across 
 the front or side of the neck, they never require stitches; but 
 to aid the sticking plaster in keeping them from gaping it is 
 best to fix the head in a night-cap and tie it in such a manner 
 as to draw the head downward toward the wound. When 
 long wounds run lengthwise of the neck, it is wrong to apply 
 adhesive strips too tightly, for fear of embarrassing the circu- 
 lation of the head; but the skin of the neck is so loose that we 
 can always close a wound of this kind without making them 
 tight. No bandage should ever be applied all round the neck; 
 but if a salve be wanting over the strips, it must be kept in 
 place by other strips crossed over the dress; 
 
 When large blood vessels are wounded, none but the ablest 
 surgeon can be of any use unless for a few moments, and in 
 the manner pointed out at the commencement of this section. 
 
 When the wind-pipe is opened extensively, the patient can- 
 not breathe except through the wound, which gapes horribly, 
 and the voice is destroyed. Many small blood vessels are di- 
 vided, and if the wound be accurately closed, the blood is apt 
 to flow into the lungs and strangle the patient. For this rea- 
 son the suture must never be employed to close the skin in 
 front of the wind-pipe, which should be left very slightly open 
 for a drain. Stitches may be occasionally serviceable at the 
 corners of the wound by contracting its extent, and practised 
 surgeons sometimes venture to draw the ends of the wind-pipe 
 itself together by stitches passed through the cartilages of that 
 tube; but the only mode of keeping the edges of the wound so 
 near together in front as to give a fair chance of an early cure. 
 
OF INCISED WOUNDS OF THE CHEST. 24i* 
 
 is by bringing and confining the head as far forward as possi- 
 ble by means of a cap with strings attached to a band passed 
 round the chest, and in order to prevent the introduction of 
 dust with the breath, the wound must be covered with fine 
 gauze. Of course no individual unconnected with the medi- 
 cal profession would have the madness to attempt the treat- 
 ment of a wound of this character, except when compelled to 
 do so by dire necessity. 
 
 Incised IVounds of the Chest. If these wounds are not deep 
 enough to reach the cavity of the chest, they require no pecu- 
 liar treatment. If they do open the cavity, the lungs on the 
 corresponding side instantly collapse, half the chest becomes 
 filled with air, and the patient breathes with great difficulty 
 by the other side of the chest only. Blood often flows inter- 
 nally, and inflammation of the pleura and the lungs are the in- 
 evitable consequence. There is frequently a rushing of air in 
 and out of the wound with every effort to breathe, and if the 
 lungs themselves are wounded, there is generally a cough and 
 6pitting of blood. After closing the wound by adhesive strips, 
 it is necessary to be very careful to prevent any danger from 
 the wound being forced open and the dressings being drawn 
 into the chest by the rush of air in breathing; so that if the 
 lungs be not wounded it is generally best to cover the strips 
 with a large piece of fine linen, the centre of which should be 
 spread with simple ointment, and the whole secured by a very 
 broad bandage round the chest, to which the edges of the linen 
 may be pinned or stitched securely. A surgeon should then 
 be procured as soon as possible. 
 
 If the bleeding be very great, flowing out more freely when 
 the patient performs the act of expiration, the wound should 
 be covered with a thick firm compress bound on in such 3. 
 manner as to arrest the flow entirely until the surgeon arrives, 
 and the patient should repose on the side next the wound. 
 
 In those cases of wounds of the lungs which bleed with ra- 
 pidity, the lancet must be used without scruple; the most abso- 
 lute rest and freedom from excitement both of mind and body 
 are requisite; and the diet as well as the general treatment 
 must be such as to reduce the patient as rapidly and as low as 
 possible, until the hemorrhage is checked and the violence of 
 inflammation is over. After this, the management of such 
 wounds requires great skill, and depends too much upon the 
 peculiarities of individual constitutions to fall under any gene- 
 ral rules. Deformity of the chest, chronic pain, and perma- 
 nent difficulty of breathing are common results of the most 
 successful treatment, and these cases always display a fearful 
 contest between death, the powers of nature, and the resources 
 of ^rt. If pieces of clothing, dressings, or large quantities of 
 
 ?>2 
 
250 OF INCISED WOUNDS OF THE ABDOMEN. 
 
 blood find their way into the cavity of the pleura, trouble- 
 some abscesses, fistulas, and other accidents, sometimes re- 
 quiring severe surgical operations, and putting life to risk long 
 after the patient rises from his bed, are often among the ulti- 
 mate consequences of these formidable injuries. 
 
 Incised Wounds of the Mdomen. In healthy constitu- 
 tions, superficial wounds of the abdomen are, for the most 
 part, of little consequence. Unless they occur near the rim 
 of the belly, they can scarcely occasion very troublesome 
 bleeding, as there are but two very important arteries on the 
 whole anterior surface. If these wounds be deep enough to 
 divide any of the muscles or tendinous expansions, there is 
 danger of hernia or rupture occurring sooner or later at the 
 spot where the cut is made; and hence, after accurately closing 
 the wound by adhesive strips, we should apply a pretty thick 
 compress of folded muslin over the dressings, and bind it ra- 
 ther firmly by means of a bandage, to prevent the bowels from 
 thrusting the perineum into the wound. This compress should 
 be worn for some weeks after the parts have healed, in order 
 that they may acquire as much firmness as possible, and the 
 bowels must be kept free by fluid diet and medicine. 
 
 Even if the cavity of the abdomen be opened — unless the 
 opening be extensive or the bowels be wounded — the case 
 need not necessarily prove serious. The wound should be 
 closed as quickly as possible, and if it unite by the first inten- 
 tion, no farther difficulty need be expected, except from the 
 tendency to hernia, which must be guarded against by the 
 means already pointed out. The best diet is rye mush and 
 molasses, and the best purgative is oil; but small doses, occa- 
 sionally, are all that can be required, for two evacuations per 
 day are as much as should be permitted. 
 
 If the cavity of the abdomen be extensively opened, with- 
 out a wound of the intestines, these instantly start out at the 
 wound, and soon swell to such a degree as to make it very 
 difficult, if not impossible, to return thrm. If a surgeon can- 
 not be obtained immediately — as in country situations and on 
 extensive plantations — this is one of the cases in which an in- 
 telligent man of great nerve and prudence may save life by 
 offering timely aid. The bowels may be handled with a fine 
 and very soft towel, damped in water at about, or a very little 
 above, blood heat; and if any foreign matter adhere to them, 
 it may be washed off with a soft sponge,* properly prepared 
 by the apothecary. 
 
 These wounds always require stitches, and these must be 
 passed deeply, and brought out at least half an inch from the 
 
 * Common sponge must never be used, a* it always contain* impir 
 
OE INCISED WOUNDS OF THE ABDOMEN. 251 
 
 wound on each side. They should never pass quite down to 
 the cavity of the abdomen, unless applied by a surgeon, but 
 they may include a portion of muscle with perfect propriety, 
 if there be any in the way. The bowels being held aside by 
 an assistant, the operator takes a stitch about an inch from one 
 corner of the wound, and ties it: he then proceeds in the same 
 manner at the other corner; and, after reducing as large a part 
 of the protruded bowels as possible, he continues applying 
 stitches alternately on each side, at distances of an inch, re- 
 ducing a portion of the remaining bowel after forming each 
 knot, until the whole mass is nearly secured within the abdo- 
 men. If any portions of bowel show a disposition to protrude 
 between the stitches, these must be carefully reduced before 
 applying the long strips of sticking plaster, which should fill 
 up all the intervals of the suture. A broad piece of lint, spread 
 with simple ointment or lard, over the whole, completes the 
 dressing, for no bandage should be employed. 
 
 During both the dressing of the wound and the after-treat- 
 ment, till the wound heals, the patient should lie on his back, 
 with his hips and shoulders raised by pillows, so as to relax 
 the abdominal muscles as much as possible; he must not be 
 permitted to rise from his bed on any account, and his evacu- 
 ations must be received in a bed-pan. 
 
 Strict, low diet should be enjoined; and if the intestines 
 be not wounded, the patient may drink freely. Purgative 
 medicines, by mouth, ought not to be given, for fear of ex- 
 citing the abdominal muscles, but the bowels may be kept 
 open by laxative injections. 
 
 Even if we fail in uniting by the first intention incised 
 wounds of the abdomen which open the cavity without 
 wounding the intestines, nature generally effects adhesions on 
 all sides, between the bowels and the internal edges of the 
 wound, so as to prevent the inflammation from extending to 
 the whole cavity; and the wound may then heal by the second 
 intention without danger. But these adhesions are sometimes 
 imperfectly formed, and then the inflammation spreads. When 
 this is the case, the patient must be most freely bled, and eve- 
 ry thing must be done to avoid the slightest irritation of the 
 bowels. This disposition to general inflammation of the ab- 
 domen may be perceived by the increased heat of Ihe belly, 
 an increasing tenderness when touched, obstinate costiveness, 
 sickness of stomach, vomiting, and hiccough. When the two 
 latter symptoms occur, the patient is in extreme danger, and 
 will rarely recover. 
 
 When the bowels are protruded in large incised wounds, 
 and one of them is found to be wounded, the treatment de- 
 fends much on the extent of the wound in the intestine. If 
 
252 OF INCISED WOUNDS OF THE JOINTS. 
 
 this does riot extend more than one-fourth round the bowel, 
 it may sometimes be stitched to the side of the wound, and 
 the remainder of the cut may be closed and treated in the 
 usual way, leaving the feces to escape for a time, until, by 
 bandage and compress, the opening can be healed over, and 
 the natural route re-established. If the wound divide the half 
 or the whole circumference of the intestine, the two divided 
 ends must be drawn out completely to the surfaces of the bel- 
 ly, and there secured, while the attempt is made to heal the 
 rest of the incision. This leads to the establishment of an 
 artificial anus, and reduces the patient to a condition which 
 would be much worse than death, were it not that the advance 
 of surgery has furnished us with two modes of operating by 
 which some of these cases may be ultimately cured. 
 
 What has been said on wounds of the intestines, is merely 
 intended to convey general information to the-reader, and (he 
 author has no idea that any one not connected with the pro- 
 fession, will have the folly to tamper with cases of this terri- 
 ble nature. 
 
 Incised ^Founds of the Joints. It is of the utmost im- 
 portance that those wounds which lay open a joint should be 
 closed as speedily as possible, for if the orifice should gap for 
 a few minutes only, a general inflammation of the whole joint 
 is almost sure to follow. This is an extremely troublesome, 
 and — if the joint be a large one, such as the ankle, knee, or el- 
 bow — a highly dangerous accident; for the symptomatic fever 
 always runs very high, and the discharges of pus, mingled 
 with the natural secretion of the joints, exhaust the strength 
 of the patient. If he escape the violence of the fever, and 
 bear up under the exhaustion, he is still liable to sink 
 from the formation of small abscesses in the lungs or liver; 
 and, if this danger also passes by, he almost invariably reco- 
 vers with a stiff limb, which, if its position during the reco- 
 very be left to chance, is often an incumbrance during the re- 
 mainder of life. 
 
 The orifice in cases of this kind should be closed as accu- 
 rately as possible, and should be held so by adhesive strips. 
 If a surgeon be not immediately at hand, this should be cer- 
 tainly done without waiting for the arrival of one. The ad- 
 hesive strips having been adjusted, there will be generally an 
 oozing of some blood between them. A light compress of 
 muslin or lint, without ointment, should be bandaged over the 
 cut, and the blood soaking into and beneath this compress, will 
 coagulate over the incision so as to exclude the air. This- 
 compress should not be disturbed for several days, unless 
 by a professional adviser, but the bandage may be removed 
 from time to time, if necessary. It is absolutely nece?r 
 
OF INCISED WOUNDS OF THE JOINTS. 253 
 
 that the part should be preserved in a state of perfect rest, for 
 the letfst motion of the joint may be attended with the most 
 serious consequences; and it is therefore proper to apply a 
 long splint in all such cases, so that the patient may be de- 
 prived of the power of moving the limb even during sleep. 
 
 When any symptoms of tenderness or inflammation appear, 
 leeches must be freely applied, and the first appearance of fe- 
 ver should be met by the liberal use of the lancet, saline pur- 
 gatives, and strict, low diet. 
 
 If we fail in accomplishing the cure by the first intention, 
 the joint will soon become violently inflamed; the synovia, or 
 the fluid which fills the cavity, flows freely, mingled with the 
 pus from the wound. The dressings must then be thrown 
 aside : and a bread and milk poultice, changed twice a day, be- 
 comes the best local application; but in these formidable cases 
 the life of the patient depends for the most part upon prompt 
 and vigorous general treatment, varied from time to time, ac- 
 cording to the peculiar constitution and condition of the indi- 
 vidual. It would be worse than folly to lay down rules for 
 their treatment in a popular work, and the highest accessible 
 surgical talents must be called in requisition. 
 
 We will now conclude our remarks upon incised wounds, 
 with some important directions in relation to superficial 
 wounds in the neighbourhood of joints, and the position in 
 which the limb should be kept in order to prevent the mo- 
 tions of the part from putting the cut on the stretch. 
 
 In all wounds about the arm-pit or shoulder, after the dress- 
 ings are completed, the arm should be bound lightly to the 
 side by three or four turns of a broad bandage, and the fore- 
 arm should be carried in a sling. A sling is equally necessa- 
 ry in all cross cuts about the front of the elbow; but when a 
 long or deep wound takes place across the back of the elbow, 
 the arm should be kept perfectly straight, by a wooden splint 
 extending from the ends of the fingers, and this splint should* 
 not be relinquished until the parts have been healed for some 
 days. In similar cuts about the wrist or the back of the hand, 
 the splint should extend from the middle of the fore-arm to 
 the ends of the fingers. It is even proper to apply a little 
 splint in cuts on the back of the ringers, especially if they 
 cross either of the joints, for these injuries often become ex- 
 tremely troublesome where motion is not entirely prevented. 
 If one finger only be wounded, a narrow splint, running from 
 the middle of the palm to its extremity, will be sufficient 
 for all purposes, and will be found much less annoying tharr 
 a larger one; but, if several fingers are hurt, the whole hand- 
 should be confined upon a splint, 
 
254 OF LACERATED WOUNDS. 
 
 Wounds of the groin require that the patient should be con- 
 fined on his back in bed, with his body raised nearly to a half 
 sitting position by pillows; and most incised wounds of the 
 leg and foot may be treated by placing the limb in a straight 
 posture, and ordering the patient to keep it so: splints are very 
 rarely necessary. 
 
 Wounds of the heel made with the axe are not uncommon, 
 and require especial notice. This part contains a most pow- 
 erful and important tendon, called the tendon of Achilles, from 
 the old Homeric legend in relation to that hero. All the large 
 muscles which extend the foot and enable us to rise on the 
 toe are attached to the principal bone of the heel by means 
 of this tendon; and if it be divided, the upper part of it is 
 very soon drawn up far away from the inferior part. If it 
 unite in this situation, the new bond of union always remains 
 weak and extensible, so that the command of the foot is in a 
 great degree lost. 
 
 If the tendon be completely divided, the advice of a sur- 
 geon is absolutely necessary to prevent incurable lameness; 
 but if it be only partially severed, the chances are much bet- 
 ter. In either case, the best domestic treatment consists in 
 bending the leg at right angles with the thigh, and binding 
 upon the foot a splint cut into the form of the sole of a shoe, 
 but with an extremity projection; six or seven inches behind 
 the heel, on the under surface of which extremity should be 
 tied the end of a broad piece of roller, [bandage.) about a 
 yard, or a yard and half in length. This roller is intended to 
 be thrown smoothly over the back part of the leg and round the 
 front of the thigh, being then returned, to be tied at the place 
 of its commencement. It thus keeps the foot strongly extended, 
 with the toes pointing downward, without interfering with the 
 dressing of the wound, and without embarrassing the circula- 
 tion, as it would do if the bandage were made to pass all round 
 the limb, instead of merely pressing upon its posterior part. 
 After the splint is applied, the knee should be bent, the wound 
 dressed, and the patient confined in bed, with the limb in this 
 flexed position, which should never be changed during the 
 treatment. The foot should not be put to the ground for six 
 weeks at least, and no force in walking should be exerted for 
 three months after the accident. 
 
 Of Lacerated Wounds, or such as are made by instruments 
 which tear. 
 
 The principal difference between the condition of a lace- 
 rated and an incised wound, consists in the perfectly healthy 
 condition of the edges in the latter, and their injured state in 
 the former accident. The parts about the immediate neigh- 
 
OF LACERATED WOUNDS. 255 
 
 bourhood of a lacerated wound are not divided nicely in the 
 precise direction of the instrument which makes them, but 
 are torn off, sometimes on one side, and sometimes on the 
 other. They, therefore, present rather a multiplicity of frac- 
 tures of particular fibres than a clear cut. These fibres are, 
 therefore, found in a debilitated condition, and illy calculated 
 to resist the force of the general circulation which is natural- 
 ly increased for the purpose of supplying the repairs for the 
 lost and injured parts. The energy of the vital operations 
 going on in these weakened parts is greater than they can 
 bear consistently with health, and they are, therefore, ex- 
 tremely liable to become inflamed. Of course, then, there is 
 much less chance of union by the first intention in lacerated, 
 than there is in incised wounds, but this chance is much 
 greater in some places than in others. A complex organ or 
 tissue, like the skin or a muscle, unites with great difficulty, 
 because the injury done by the tearing instrument is greater 
 in proportion to the strength of the fibres, and the power of 
 healing is less in proportion to the amount of interstitial mat- 
 ter included in the cellular tissue of the part. — (See Sect, on 
 the Reproduction of Parts, p. 133.) In such situations, then, 
 inflammation almost invariably follows a lacerated wound, and 
 it is only after the subsidence of this inflammation that the 
 edges of the wound are able to unite even by the second in- 
 tention. In the soft, pasty, free cellular tissue intervening be- 
 tween the different organs, it matters very little in what di- 
 rection a wound takes place, and comparatively slight mischief 
 is done by laceration. Such parts often unite by the first in- 
 tention, so as very much to diminish the extent of the wound 
 and the danger of exhaustion to the patient while all the other 
 portions are suppurating freely. 
 
 Few parts are so extensively or seriously injured by lace- 
 ration as the blood vessels; and hence follows a consequence 
 of great importance. 
 
 When blood comes into contact with dead or very debili- 
 tated animal matter, it has a strong tendency to coagulate, and 
 when it reaches the torn and collapsed vessels around a lace- 
 rated wound, it generally undergoes this change, so as to clog 
 and shut up their open mouths. Lacerated wounds, there- 
 fore, seldom bleed much, unless the larger blood vessels are 
 opened. 
 
 These wounds also produce a much more powerful impres- 
 sion on the system in general than those which are made with 
 cutting instruments; for when they are at all severe, the pa- 
 tient sinks immediately into a more or less complete collapse: 
 the general circulation is rendered extremely feeble, and hence 
 there is little or no bleeding for some time, even when the 
 
256 OF LACERATED WOUNDS. 
 
 largest vessels are involved. It is only after the patient has 
 recovered from the collapse, or, in other words, after the re- 
 action has come on, that the danger from loss of blood be- 
 comes imminent. The hemorrhage which then occurs is 
 called secondary hemorrhage, and happens much more fre- 
 quently in lacerated than in incised wounds. The arm, with 
 the shoulder blade and collar bone, have been known to be 
 dragged off by a machine, without producing bleeding! 
 
 Two consequences follow from this injury to the blood ves- 
 sels and the collapse of the system in lacerated wounds: 1st, 
 It is unnecessary in most cases to tie the arteries; and when, 
 from the large size of the vessels ruptured, or the occurrence 
 of secondary hemorrhage, we are compelled to do so, the ar- 
 tery wounded, or the main trunk which supplies the bleeding 
 branches, must be taken up at a distance from the wound; for, 
 if tied very near the lacerated parts, the ligature would ulce- 
 rate out, and the hemorrhage might return during the absence 
 of all competent assistance. Of course this operation can only 
 be performed by a regular surgeon, and all that can be done 
 by others is, in cases of great emergency, to plug the wound 
 with lint if it do not communicate with any internal cavity, 
 and to apply compresses and a bandage to check the flow of 
 blood. 
 
 In deep lacerated wounds, involving the large muscles, 
 however they may gap, it is generally better to depend upon 
 placing the part in the position best calculated to relax those 
 muscles and approximate the sides of the wound, than to at- 
 tempt to draw the edges together by stitches, which produce 
 great irritation when they are carried deep, and are extremely 
 apt to cut their way out through the bruised parts. Unprac- 
 tised surgeons sometimes employ modifications of the suture 
 with advantage in such cases, but unprofessional assistants can- 
 not do so with any safety. When adhesive strips and regular 
 bandaging can be employed in promoting the close of the 
 wound, they should be resorted to: but this is seldom the case 
 when the injury is extensive. The best mode of dressing 
 small lacerated wounds, is to place directly upon them, or 
 over the adhesive strips, a plaster of simple cerate, (see In- 
 dex — Salves,) spread upon muslin or patent lint, so applied 
 as not to cover a great deal of the surrounding skin. If the 
 wound be large and gaping, a light, mild, warm bread and 
 milk poultice, mixed with a little oil, should be applied, and 
 regularly changed once a day in winter or twice a day in sum- 
 mer, until granulations begin to fill the bottom of the wound. 
 If the poultice be changed less frequently, it will either be- 
 come hard and dry, or sour; and in either case it will act as 
 a powerful irritant. In wounds of any considerable diqo 
 
OF LACERATED WOUNDS. 257 
 
 sions if they become inflamed, hot and dry round the edges, 
 the poultice should be employed, without regard to the pre- 
 sence or absence of granulations: but in this condition of the 
 parts, the poultice should be cold, prepared without oil, and 
 more frequently changed. If the redness show any disposi- 
 tion to spread generally and widely over the surrounding sur- 
 face, there is danger of the occurrence of erj^sipelas, and the 
 case requires a different course of treatment, as will be noticed 
 hereafter. 
 
 In all cases, it is of the utmost importance that the wounded 
 part should be kept at perfect rest. 
 
 A very good mode of treating lacerated wounds of the leg, 
 is to place the patient on his back, with the limb on a pillow 
 laid in a long narrow box, protected by a piece of oiled silk 
 or muslin, or an India rubber cloth, and then covered with 
 bran. The bran can be washed away with a little soap and 
 water, and renewed at any moment. If the wound be small, 
 the bran will often form a crust over it, beneath which it 
 will heal kindly without the aid of any other dressing. 
 
 When, in an incised wound, the granulations have nearly 
 filled the cavity, and begin to rise in places a little above the 
 surface, they sometimes form proud flesh, and require the ap- 
 plication of a gentle astringent to give them firmness. A wash 
 formed of the decoction of oak-bark or a little plain or burnt 
 alum in powder, dusted on every day or two, will answer 
 this purpose in most cases; but if the granulations be unusu- 
 ally hard or very exuberant, it is well to touch the whole sur- 
 face occasionally with lunar caustic; and if the skin around the 
 wound appear extremely delicate and moist, with a disposition 
 to throw off the cuticle before the new fine skin beneath is 
 perfectly formed, then dusting with finely powdered chalk or 
 carbonate of zinc will hasten the completion of the cure. 
 
 Lacerated wounds of the chest, if they open the cavity, are 
 almost certainly fatal, and little can be done for them but to 
 exclude foreign substances by light dressings guarded by fine 
 gauze. 
 
 Lacerated wounds of the abdomen are not necessarily fatal. 
 When large enough to require the suture, it should be em- 
 ployed whenever the condition of the parts will admit of its 
 use. The stitches should be carried as deeply as possible 
 without entering the cavity, through muscle or fascia, but avoid- 
 ing the peritoneum, and they should be brought out at least 
 an inch from the edge of the laceration. In other respects, they 
 are to be treated like the wounds already mentioned. The for- 
 midable character of these accidents is sufficient to guaranty 
 that their management will not be undertaken by incompetent 
 hands. 
 
258 OF LACERATED WOUNDS. 
 
 Lacerated wounds of the joints, and especially those of the 
 ankle joint, may be sometimes treated on a plan widely diffe- 
 rent, and with the happiest results. These accidents are often 
 attended by displacements of the bone, and the dislocation 
 must be reduced, or the portion of bone thrust through the 
 skin removed, (which latter operation can be performed by a 
 surgeon only,) before any attempt is made to close the wound. 
 If, then, there be an oozing of blood from the torn surfaces, 
 without a dangerous hemorrhage, the limb must be placed in 
 the position best calculated to relax the edges; and if the form 
 of the wound be such that a bandage properly applied will not 
 close it completely or nearly so, some strips of adhesive plas- 
 ter may be employed. If the nature of the accident precludes 
 the possible introduction of any foreign substance, such as dirt, 
 chips, &c. into the wound, the larger coagula of blood should 
 be removed with the finger, but the part should not be washed. 
 Stitches should not be employed. The wound being closed 
 as accurately as possible, by the position of the limb, with or 
 without the aid of adhesive strips, the operator applies two or 
 three folds of patent lint over the whole seat of the injury. 
 Then, if the form of the part require it, a compress of muslin 
 is placed upon the lint, and the whole is enclosed in a proper 
 bandage,accurately but not tightly applied. The patient must be 
 strictly^ confined to his bed, and all motion of the joint pre- 
 vented. If the knee, ankle or foot be the seat of the injury, 
 the limb should be covered with bran over the dressings in 
 the manner already described. In this mode of treatment the 
 dressings are matted together by coagulated blood, which ad- 
 heres strongly to the torn edges and the surrounding skin, be- 
 coming too hard and dry to putrefy. Beneath this covering 
 the wound heals like an internal laceration without suppuration. 
 
 The bandage should not be removed to examine the d; 
 ings unless inflammation or fever appear, or unless there be 
 signs of moisture perceptible, showing the escape of a fluid 
 discharge from the wound. When such symptoms demand 
 our interference, we apply a very moist bread and milk poul- 
 tice without oil, over the dressings, after removing or cutting 
 off so much of the bandage as is not adherent to the lint and 
 compress. A few repetitions of the poultice will bring off the 
 whole mass of covering, and the wound must then be treated 
 on the plan recommended under the head of incised wounds 
 of the joints when they cannot be united by the first inten- 
 tion, (p. 252.) 
 
 When inflammation of a joint from a wound is once esta- 
 blished, the use of the joint is almost always lost, and the pa- 
 tient, if he recover at all, is usually confined for many months, 
 and rises with an enfeebled or broken constitution.' In bad 
 
OP CONTUSED WOUNDS. 259 
 
 lacerated wounds of joints, therefore, the question of the pro- 
 priety of amputating the limb is always started. In the deci- 
 sion of this question between the imminent risk of life or the 
 permanent loss of health on the one hand, and the creation of 
 a deformity on the other; involving also, in both cases, a con- 
 siderable degree of disablement, — both the patient and the sur- 
 geon are solemnly bound, to consider well the station, means 
 of livelihood, social responsibilities, general health, and age 
 of the sufferer. A poor or married man may be compelled to 
 lose a leg to preserve which a rich or single man may afford 
 to run great risk of life. A man of family is bound in honour to 
 ensure his safety at the expense of a deformity, the conse- 
 quences of which to the youth of high prospects or an unmar- 
 ried female, may be worse than death. A man of indepen- 
 dent estate may sacrifice a right arm where his humbler neigh- 
 bour must run into any degree of danger rather than fall upon 
 the world's cold charity. As a general rule, American sur- 
 geons amputate too little, from a feeling of false pride in ac- 
 complishing the difficult. 
 
 Of Contused Wounds. In wounds of this class the parts 
 around the injury arc much more extensively and deeply ia* 
 jured than in either of the preceding varieties. Indeed the 
 external wound is often of very little consequence in compa- 
 rison with the bruise and its effects. The latter will be de- 
 scribed under the head of contusions, and the former will re- 
 quire but short notice here. 
 
 The edges of the wound in these accidents are generally de- 
 bilitated to such a degree that they are incapable of resisting 
 the impulse of the circulation, quickened as it is by the acci- 
 dent as soon as reaction is established. 
 
 It therefore commonly fol.lows, either that the edges mor- 
 tify and come off, or, that they are removed by the absorbents, 
 as being no longer fit for restoration to health. Thus, generally, 
 the wound is enlarged in the first instance, before granulation 
 begins or any attempt is made toward healing. 
 
 It follows, of course, that union by the first intention is out 
 of the question, and it is no longer an object to close the wound 
 in the first instance either by suture, adhesive strips, or the 
 methodical bandage. When the injury is not very extensive, 
 it is adviseable to apply poultices from the first; but as these 
 applications are peculiarly debilitating in their effects, and 
 must necessarily extend much beyond the limits of the wound 
 itself, it becomes improper to use them when the surrounding 
 parts are severely and extensively bruised, for fear of endan- 
 gering a wide-spread mortification or a considerable ulcera- 
 tion. In such cases, it is best to dress the wound itself with 
 a mild or gently stimulating ointment, such as simple cerate or 
 
260 or CONTUSIONS. 
 
 basilicon, (see Index, Salves.) leaving the neighbouring surface 
 free for the application of other remedies which its condition 
 may require. When the mortification of the edges threatens 
 to be extensive, when the constitution of the patient is feeble, 
 and there is danger of a progressive gangrene, the stimulating 
 poultices, such as the yeast poultice, become valuable reme- 
 dies. 
 
 Poultices should not be employed too long in the treatment 
 of contused wounds; for, after the granulations have been once 
 fully formed, they are extremely apt to become flabby or form 
 proud flesh, if kept too moist and warm by the dressing?. 
 When a contused wound is long in healing it is proper to con- 
 sider and treat it as an ulcer, and we will refer to the section 
 on ulcers for further particulars. If proud flesh should make 
 its appearance, it may be repressed by the means prescribed 
 under the last head. 
 
 Or Contusions. A contusion or bruise is an internal wound 
 or rupture. It needs no external dressings to protect it from 
 the action of the air, for it is always covered by the skin, if 
 not by other tissues. When a contusion recovers in the sim- 
 plest way, the blood which is always poured out from some of 
 the smaller blood-vessels, is gradually changed in colour, from 
 the dark purple or black of the fresh coagulation, through the 
 tints of blue, green, yellow and brown, so well known to all. 
 These changes result from the action of the absorbents, which 
 take up the colouring matter of the blood more rapidly than 
 the solid parts. As the coagulum disappears by absorption, 
 the torn parts again come into contact and unite; but as the 
 serum of the blood is always separated during the act of co- 
 agulation, this serum, carrying with it a portion of colouring 
 matter, flows out and spreads in the surrounding cellular tis- 
 sue; often settling by its weight into parts at some distance 
 from the seat of the injury; as we see in the lower evelid after 
 bruises on the forehead. The serum is often more slowly ab- 
 sorbed than the solid coagulum, so that we frequentl v observe a 
 ring of many colours round a bruise which has apparentlv re- 
 covered: but I have never known the serum to give rise to 
 any material trouble. 
 
 When the quantity of blood effused is much more conside- 
 rable, and the part in which it is contained is profoundly in- 
 jured by the accident, or when the constitution of the patient 
 is in bad condition, the coagulum sometimes degenerates or 
 becomes putrid before the debilitated absorbents can remove 
 it. This leads to the formation of an abscess which, when it 
 bursts or is opened, often gives rise to an ill-conditioned ulcer, 
 difficult to cure. As a general rule, when a considerable n 
 of blood is poured out near the surface of the body, and after 
 
OV CONTUSIONS. 261 
 
 remaining hard, like a firm coagulum,for a considerable time, 
 becomes quite soft and fluid, so as to convince us that it has 
 been dissolved — it is best to open and evacuate the cavity 
 by passing a thumb lancet very obliquely into it: the attempt 
 may then be made to close the orifice by an adhesive strip, 
 and the whole cavity by a compress of lint and a light ban- 
 dage; but if, as generally happens, inflammation appears ©r is 
 increased after the dressing, it must be immediately removed, 
 a proper poultice substituted, and the treatment managed as 
 in other cases of abscess. (See Index.) Collections of blood im- 
 mediately beneath the cuticle, occasioned by bruises, are usu- 
 ally termed blood-blisters. In these the effused fluid generally 
 remains fluid or very soon becomes altered, probably by the 
 action of the air through the very thin pellicle which covers 
 them. They scarcely ever disappear by absorption, though 
 seated directly on one of the most powerful absorbing surfaces 
 in the body; and if they are opened directly, they become ex- 
 tremely painful and produce severe inflammation or ulcera- 
 tion. It is best to allow blood-blisters to remain untouched 
 for several days, after which their contents may be evacuated 
 by passing a pin or needle for some distance under the neigh- 
 bouring cuticle before permitting it to enter the blister. In 
 this way the free admission of air is prevented, and the pain 
 and irritation avoided. 
 
 When the quantity of blood effused in a contusion is very 
 great, a curious result often follows, which is apt to produce 
 great alarm in the patient and his friends. The air which al- 
 ways escapes from blood as it contracts after coagulation, is 
 forced out in such quantities as to distend the cellular tissue 
 for some distance around the seat of the injury. The part 
 then crackles under the pressure of the finger, and as the dark 
 colour often strengthens the deception, it is supposed that gan- 
 grene or mortification is about to take place. 
 
 Though the presence of this air endangers the decomposi- 
 tion of the blood, which would inevitably occasion a seri- 
 ous or destructive abscess, yet it is often absorbed without dif- 
 ficulty in a few days, leaving the coagulum to be removed 
 more slowly; and the patient then recovers, sometimes with 
 very few troublesome symptoms, even when the appearances 
 are, at first, very much against him. 
 
 Another cause of alarm in severe and extensive bruises, is the 
 appearance, over the injured surface, of small blisters filled with 
 a bloody serum, precisely similar to those which are so often ob- 
 served when an inflammation is on the point of ending in mor- 
 tification. But when these collections precede, instead of fol- 
 lowing the commencement of inflammation, they are not a very 
 
262 CONTUSIONS IN CAVITIES. 
 
 certain indication of danger, although they prove the injury 
 to be both deep and severe. 
 
 In very severe bruises, when the patient is thrown into col- 
 lapse by the accident, it is sometimes adviseable to bring on a 
 re-action by giving the patient a glass of wine, or some other 
 gentle stimulant; but the use of the lancet, which is almost al- 
 ways recommended by the ignorant under such circumstances, 
 is extremely improper, and occasions the death or the sacri- 
 fice of the constitutions of many. Except in some cases of 
 injuries of the head, no one should be bled after a severe acci- 
 dent until the pulse has risen and fever is about to appear. 
 Then, indeed, it is often proper to bleed freely and fearlessly. 
 
 When the inflammation which usually follows a bruise has 
 passed away, leaving the parts in a condition so debilitated 
 that the absorbents are unable to take up the remains of the 
 effused blood and serum, we may often accelerate recovery by 
 bathing or dressing the part with some stimulating application, 
 such as diluted brandy, spirit of hartshorn, camphor, &c. 
 
 When bruises occur in parts remarkable for the number 
 and development of the nerves of sensation, such as the ends 
 of the fingers and toes, the pain produced by the accident is 
 very severe, and often intolerable. It is right in these cases 
 to dress the contusion with rags or a very loose bandage com- 
 pletely wet with laudanum; or if the contusion be too exten- 
 sive for this mode of treatment, a milk-warm poultice of hops 
 and vinegar should be applied. When the pain in these ner- 
 vous parts results from inflammation, which often comes on 
 some hours or days after the accident, the treatment must be 
 different. Laudanum is then too stimulating, but the solution 
 of opium in water may be mixed with the plain bread and 
 milk poultice which forms the best local application. In 
 bruises and crushes of the fingers and toes, the distressing 
 wakefulness occasioned by this inflammatory pain may be re- 
 lieved at once by a dose of antimonial wine, just sufficient to 
 produce nausea without vomiting. Laudanum, even when 
 given internally, increases the severity of the complaint. 
 
 Contusions in the great cavities of the body are more com- 
 plex and dangerous in their nature than those which are located 
 on the extremities: they are also much more difficult to distin- 
 guish and comprehend. 
 
 There are two distinct modes in which contusions may oc- 
 cur in the viscera of the great cavities. 1st. The pressure or 
 blow of an external body may crush the bony walls or com- 
 press the flexible covering of a cavity in Mich a manner as to 
 injure the viscera or bowels which it contains: or, 2nd. In 
 falls from a height, when the body is suddenly arrested, the 
 larger and heavier viscera, such as the liver, spleen, brair 
 
INJURIES OF THE HEAD. 263 
 
 experience a violent jolt, and may be most severely bruised, 
 or even torn from their connexions by their own weight, (mo- 
 mentum,) so as to occasion death without any signs of exter- 
 nal injury. 
 
 Severe contusions of the great cavities are much more seri- 
 ous in their consequences than similar injuries occurring ex- 
 ternally; because the free action of the organs enclosed in these 
 cavities is necessary to life. A blow which temporarily disa- 
 bles a voluntary muscle produces little mischief, because the 
 patient may very well remain at rest until the muscle gradu- 
 ally recovers its power; but when the function (the peculiar 
 power of action) of any important internal organ is arrested in 
 consequence of the application of a mechanical force, death 
 often follows long before sufficient time has been allowed for 
 the organ to recover its tone. 
 
 After these remarks the reader will be able to perceive the 
 necessity of a few comments upon contusions of each of the 
 great cavities. 
 
 Of Injuries of the Head. External contusions of the scalp, 
 when unaccompanied by open wounds, are not of much im- 
 portance, except sometimes in children. In early life, it oc- 
 casionally happens that blood iseffused immediately under the 
 skin of the scalp, and when the cavity which contains it is 
 opened either by nature or art, the part becomes the seat of 
 a small abscess which proves very difficult to treat. The best 
 practice in such cases is to lay open the whole cavity by two or 
 more free incisions, apply a bread and milk poultice, and leave 
 the abscess to fill itself with granulations from the bottom. A 
 neglect of this course sometimes occasions troublesome or even 
 dangerous disease of the bones. 
 
 The special importance of contusions of the head results 
 mainly from the injuries sustained by the brain or principal 
 nerves. These vary in degree and character, so as to demand 
 especial notice. 
 
 One of the most simple and common injuries of the head 
 results from the unwarrantable and cruel practice of boxing 
 the ears, as a punishment for children. Its consequences are 
 often distressing in the highest degree, and not unfrequently 
 prove fatal to the intellect or life of the sufferer. Even when 
 the blows are lightly struck, the air is forced with great vio- 
 lence upon the drum of the ear, and when that membrane 
 escapes a rupture destructive to hearing, — an accident which has 
 repeatedly happened! — the delicate, and exquisitely suscepti- 
 ble nerves of the interior of the ear are compressed to such 
 a degree as to give rise to terrible irritation of their other ex- 
 tremities in the brain. Severe headach is the lightest of the 
 evil consequences of this savage treatment, and, if the punish- 
 
264 INJURIES OF THE HEAD. 
 
 ment be frequently inflicted, fatuity or extreme dulness of 
 mind and temper are a very common result! But even these 
 are trifling, in comparison with other effects by no means in- 
 frequent. Epilepsy, inflammation of the brain, and sudden 
 death, may and do follow such inflictions, and it is not always 
 that the author of the cruelty becomes aware of his or her own 
 agency in the business; for the fatal affections but rarely ap- 
 pear until some weeks or even months have elapsed. If the 
 argument of brute force be really necessary, which, in well re- 
 gulated families is very seldom the case, for the love of mercy 
 and humanity let it be the argumentum a posteriori! 
 
 The next accident in violence which claims attention is sim- 
 ple concussion of the brain, or stunning. When the head is 
 forcibly struck or suddenly arrested in a fall, the weight of the 
 brain causes it to press forcibly against that side of the scull 
 which receives the blow; and an injury more or less severe 
 results from the violent but momentary compression of this 
 most important organ. In the mildest form of the accident, 
 the jar produces a peculiar bewilderment of mind, followed 
 almost instantly by a sensation of terror, which passes off in a 
 few moments, leaving the patient in health. Concussion, in 
 this degree, scarce ever gives rise to any important conse- 
 quences, and is generally even less dangerous than a smart box 
 on the ear. Hence, in the falls of young children, if the child 
 cry freely at the moment of the blow, or very soon after- 
 wards, we may generally regard the accident as unattended 
 with danger. 
 
 When the blow is somewhat more severe, all consciousness 
 is lost; the surface of the body becomes pale, a general col- 
 lapse is produced, and it is some time before the patient reco- 
 vers the command of his senses. If the pupil of the eve be 
 examined at this time, it will be found in a large majority of 
 cases either of its natural size or somewhat enlarged, but very 
 slightly susceptible of the action of light; that is, it does not 
 dilate and contract freely when the lids are alternately closed 
 and opened again. 
 
 The limbs are generally found completely relaxed in sim- 
 ple concussions which are not very severe, but in more grave 
 accidents of this class they are often found in a state of spas- 
 modic stiffness, and the pupil may then appear considerably 
 contracted. 
 
 This last condition is more threatening, for it proves that 
 the jar has been strongly felt at the origin of the nerves and 
 the attachment of the spinal marrow, while the contraction of 
 the pupil shows the existence of a local irritation coupled with 
 the weakness produced by the shock. 
 
 When a patient is recovering from an accident of this cha- 
 
OF CONCUSSION OF THE BRAIN. Z&5 
 
 ?acter he usually complains of considerable nausea, and dis- 
 tressing vomiting is a common symptom in bad cases. 
 
 In a few minutes or hours, the symptoms of collapse gradu- 
 ally wear ofl', leaving in most instances no trace of the injury, 
 other than a general feeling of weakness, lassitude of mind, 
 and perhaps a head-ache more or less severe. Fever some- 
 times, but rarely appears with the approach of reaction. But 
 the dangers which follow a concussion are by no means con- 
 fined to the few days immediately succeeding the accident. 
 There is always more or less danger of inflammation of the 
 substance of the brain from the irritation produced by the 
 shock, and this most dangerous affection makes its approach 
 very slowly and insidiously. The first symptom which usu- 
 ally marks its approach is a dull, deep-seated, heavy pain in 
 the head, succeeded by a slight chill or repeated rigors, which 
 soon give rise to an obscure feverishness and a marked tenden- 
 cy of blood to the head, first observed from one to two weeks 
 after the accident. If the progress of the disease be not 
 checked by vigorous treatment, the patient soon begins to dis- 
 play a sluggishness of speech and ideas, with an increasing 
 disposition to sleep; but Jittle pain is experienced, because the 
 substance of the brain, though the judge of all sensations, pos- 
 sesses, in itself, no sensibility whatever. After a time the 
 sleep, or rather, drowsiness of the patient is disturbed by low 
 muttering delirium; and when abscess of the brain results, the 
 commencement of this stage of the complaint is marked in 
 most cases by a peculiar form of convulsion. The patient 
 starts up suddenly in bed; his countenance expresses great 
 anxiety and distress, he turns his head, tosses his arms wild- 
 ly about for a few moments, and then sinks back on his pil- 
 low. These paroxysms are repeated perhaps every two or 
 three hours, but are not attended by a total loss of conscious- 
 ness. I have never known a case of recovery after this form 
 of convulsion appeared. The patient soon sinks into stupor, 
 and dies in three or four days at farthest. 
 
 The treatment of concussion of the brain is simple and 
 obvious. In the mildest form of the accident, a few hours' rest 
 and a few days of moderate caution against errors of diet and 
 excitement of mind will render the patient secure from dan- 
 ger. 
 
 In the cases marked by temporary loss of consciousness, 
 more care is necessary, and when vomiting occurs the utmost 
 attention should be paid to the condition of the patient. No- 
 thing can be done with safety by unprofessional attendants 
 until consciousness returns, and bleeding during the first mo- 
 ments of the shock would be utter madness in simple concus- 
 sion. As the senses return, the sickness of stomach may be 
 
 34 
 
266 TREATMENT OF CONCUSSION. 
 
 checked, if necessary, by giving a little peppermint, or by a 
 wine-glassful of a strong infusion of Horsemint, (monarda 
 punctata) made with boiling water in an earthen vessel, and 
 then suffered to cool, or by the application of a spice plaster* to 
 the pit of the stomach. 
 
 The patient should be confined to his bed, in a darkened 
 room. His mind should be kept free from all excitement. All 
 loud sounds, and every thing calculated to excite his senses 
 should be prevented, and all persons but his necessary attend- 
 ants and nearest female relations excluded. This caution 
 should be continued until the patient has recovered entirely 
 from the apparent effects of the blow, which in grave acci- 
 dents may be protracted for several days. 
 
 Costiveness is a common symptom in severe concussions, 
 and it is proper to remove it by active purging; for the coun- 
 ter-irritation produced by such measures, tends to relieve the 
 head from direct irritation. If no professional assistance can 
 be procured, the following prescription may be hazarded — 
 Take of Powdered Rhubarb 8 grains. 
 Powdered Aloes 2 grains. 
 
 Calomel 4 grains. 
 
 Mix these with a few drops of water, and make the mass 
 into four pills, of which two may be given immediately, and 
 the remainder in two hours. 
 
 When the urgency of the case requires it, this treatment 
 may be repeated for two or three days in succession; but for 
 delicate females the dose must be diminished to one half. 
 
 If fever should come on upon the appearance of reaction, it 
 is proper to abstract a little blood from the arm, and to use 
 cooling drinks, and a gentle saline purgative, such as Epsom 
 salts in divided doses; or the Seidlitz powder. 
 
 The diet of a patient who has suffered under a concussion of the 
 brain should be quite low for the first few days, and it is import- 
 ant that all irregularities or excess be carefully avoided for two 
 or three weeks; for until the lapse of that interval, there is al- 
 ways some danger of an excess of inflammation of the brain: 
 and this danger is much increased by the indulgence of the 
 appetite. 
 
 Inflammation of the membranes of the brain is a very rare 
 consequence of the class of accidents of which we are speak- 
 ing. When it does occur, it is marked by violent fever and a 
 phrensied delirium, very different from that which characterizes 
 
 ♦ Take of cloves and cinnamon, passed through a coffee mill, of each a heap- 
 ing tea spoonful; of black pepper about the half of that quantity. Mix these, and 
 and an equal quantity of flour. Make the mixture into a paste with brandy or 
 whisky; spread it upon a piece of muslin 8 inches square, and lay it on the pit 
 of the stomach. 
 
OF COMPRESSION OF THE BRAIN. 267 
 
 the inflammation of the substance of the brain. The appro- 
 priate treatment will be found under the proper head in the 
 medical portion of this work. 
 
 Of Compression of the Br ain. Next in point of importance 
 to the simple concussion of the brain, comes the accident 
 usually termed compression of the brain. 
 
 This is always the result of a contused wound of the sub- 
 stance of the organ, and may occur from either of these causes: 
 1st, The rupture of a blood vessel from over distention, which 
 causes Apoplexy or Palsy, subjects discussed in the medical de- 
 partment of this work. 2nd. Fracture of the skull, which pro- 
 duces this result only in certain instances, and will be, therefore, 
 considered in the sequel of this article. 3d. Falls or blows, in 
 which the brain is compressed against its bony case with such 
 force as not only to bruise, but even to tear its substance, in 
 such a manner as to cause bleeding from one or more blood 
 vessels of considerable size. In this case, the blood, having no 
 means of egress from the bony cavity which contains the brain, 
 necessarily presses upon its substance more and more, as it is 
 forced out of the vessels by the power of the heart and arte- 
 ries. 
 
 Our present remarks refer to accidents of the third class, 
 chiefly. 
 
 The collapse of the system which is produced by an injury 
 as serious as that of which we are speaking, always diminishes 
 the force of the circulation, and generally, but not always, 
 prevents the rapid effusion of the blood over the brain. The 
 first symptoms in most cases are therefore those of simple con- 
 cussion, and the signs of compression appear, and go on rapid- 
 ly increasing after the patient has showed some signs of re- 
 turning consciousness. When the ruptured blood vessels pour 
 out their contents freely from the first, the marks of compres- 
 sion and concussion are so confused that it is often impossible 
 for the most practised surgeon to pronounce upon the real na- 
 ture of the case, and the treatment being equally difficult, it 
 would be folly to pursue the subject here. 
 
 The peculiar marks of compression are the strong dilatation 
 of the pupil, and a deep stertorous or snoring respiration, to- 
 gether with a partial or total loss of consciousness, and a par- 
 tial or complete inability to move the limbs. In the simplest 
 cases, the muscles are perfectly relaxed or palsied, spasms ap- 
 pearing only when the injury has produced an irritation of 
 some or all of the nerves of motion. In a few words, the patient 
 appears apoplectic. 
 
 When a patient subjected to a severe fall or blow upon the 
 head, has laboured for some time under the symptoms of con- 
 
26S FRACTURES OP THE SKULL. 
 
 cussion as already described, — when he has afterwards reco- 
 vered his consciousness in part, or completely, and the signs 
 just mentioned as characteristic of compression begin decidedly 
 to approach (particularly if the colour of the face be height- 
 ened,) the nature of the case cannot be considered doubtful. 
 
 Under such circumstances the treatment required is very 
 obvious. The returning energy of the circulation must be 
 kept down by the lancet, and all obvious re-action rendered 
 impossible by the loss of blood. Physicians of skill, and those 
 only, can venture upon bleeding in those still more alarming 
 cases in which there is reason to suspect an active hemorrhage 
 in the brain, while the system still labours in profound col- 
 lapse. These are the exceptions of cases to which we have for- 
 merly alluded, as warranting the use of the lancet almost im- 
 mediately after a severe accident. 
 
 The recovery in cases of compression without fracture is 
 slow and tedious. The patient, in a large majority of cases, 
 remains subject for a long time to symptoms of palsy, and the 
 loss of power is sometimes rendered permanent. 
 
 It is unnecessary to dwell any longer upon the general treat- 
 ment of compression, for, as it is always attended with more 
 or less concussion and contusion of the brain, the danger of 
 subsequent inflammation and abscess are as great as in the ac- 
 cidents previously described, and in addition to the early use 
 of the lancet, the other remedies and precautions mentioned 
 under the previous head must be employed. 
 
 Of Fractures of the Skull. A simple fracture of the 
 skull unattended with depression, concussion or compression 
 of the brain, is not always an accident of much importance. 
 The broken edges in such cases cannot be dragged out of their 
 proper position by the muscles attached to them, but lay quietly 
 in their places, and the wound requires no peculiar treatment, 
 recovering as readily as a flesh wound, only that it requires a 
 little more time. It is therefore usual among surgeons to con- 
 sider fractures of the skull, not among fractures in general, but 
 in connexion with Injuries of the Brain. 
 
 There are two accidents occasionally resulting from very 
 simple fractures of the skull which do not directly involve the 
 brain; the one, fatal — the other, highly dangerous. 
 
 The first of these is seen when the crevice or fissure runs 
 across the track of some tolerably large blood vessel enclosed 
 entirely within the bone, when this vessel is torn, and when 
 the blood, finding no free passage externally, flows within the 
 cranium and produces compression of the brain. 
 
 This accident is most frequent in fractures from blows on 
 
FHACTURES OF THE SKULL. 269 
 
 the temple, — when the middle artery of the dura mater or in- 
 ternal periosteum of the head is apt to be torn, — and in frac- 
 tures of the base of the skull, from smart falls on the feet with 
 the knees in the extended position — when there is danger of 
 rupturing the jugular vein, as it enters the cavity of the head 
 through a hole in the bone toward which the fissure in most 
 cases directs itself. 
 
 The treatment in such cases is obvious. If symptoms of 
 compression come on gradually after a blow on the head, and 
 the route of a fracture can be ascertained by the finger, espe- 
 cially if it pass toward the front of the temple, we should make 
 a free incision down to the bone, with a knife, as nearly as 
 may be across that part of the track which corresponds with 
 the pi incipal blood vessel known to be enclosed in the bone on 
 that part of the head which is the seat of the injury. In this 
 manner we may sometimes save life by giving an outlet to the 
 accumulating blood. Surgeons may do much more in some 
 cases, for they may apply the trephine, and after removing a por- 
 tion of the bone, may remove part of the blood already effused, 
 and, if necessary, plug the artery. This treatment is of course 
 inapplicable when the jugular vein is injured, for this vessel 
 lies far beyond the reach of the knife. 
 
 The second accident to which we have alluded, is the oc- 
 currence of Epilepsy from the following cause: — 
 
 When a narrow fracture of the skull unites, the bond of union 
 is generally bony; and in this case it is always irregular, oc- 
 cupying more space than the healthy bone. This tumour 
 causes a slight pressure on the brain within, and becomes a 
 source of slow or chronic irritation, accompanied by a deter- 
 mination of blood to the head whenever the patient labours 
 under unusual bodily or mental excitement. This often pro- 
 duces an Epilepsy, the attacks of which complaint may be ren- 
 dered less frequent, but cannot be cured by the general regu- 
 lation of diet and medicine laid down in the Medical Depart- 
 ment of this work. A severe and dangerous operation has 
 been practised for the relief of such cases, and, in some in- 
 stances, with success. A portion of the bone over the origi- 
 nal fracture, and including the tumour, has been removed by 
 the trephine. The loss of so large a piece of the skull prevents 
 the orifice from being again closed by bone; but a strong 
 fibrous membrane is formed in its place; and, being flexible, 
 this prevents the brain from suffering by pressure. 
 
 The dangers of this operation are so great, and the number 
 of cases in which it has yet been tried, so small, that its pro- 
 priety under any circumstances is still considered question- 
 able. 
 
 Fractures of the skull attended by depression are gene- 
 
270 FRACTURES OF THE SKULL. 
 
 rally productive of the most serious consequences; but the 
 rule is not without its exceptions. 
 
 'At the time of birth, or in the earlier years of infancy, it is 
 not very uncommon for children to meet with accidents such 
 as are now under consideration. A portion of the skull may 
 be deeply indented, and symptoms of compression of the 
 brain may or may not be presented; but the bones being but 
 partially ossified, and not completely connected together at 
 their edges, the fragments are soon raised nearly to their na- 
 tural position by the pulsations of the brain, and the head, as 
 ossification advances takes a form accommodated to the slight 
 change of position in its contents. It is seldom necessary to 
 do more than put the child upon a slender supply of milk 
 gruel or panada, (according to its age,) to keep the bowels 
 open, to apply gentle cold to the head, and to avoid all ex- 
 posures and causes of excitement; such as light, loud talking, 
 dandling, and rocking in the cradle, for two or three days. 
 If surgical aid be required, none but the most able assistance 
 can be of any advantage. 
 
 When similar accidents occur in grown children, or adults, 
 if the amount of depression be slight, no symptoms of com- 
 pression may appear, and it has been decided pretty generally 
 among surgeons, that under such circumstances it is improper 
 to cut down upon the bone, or to attempt to remove any frag- 
 ment by the trephine, because, by so doing, we convert a sim- 
 ple into a compound fracture. We think that the propriety 
 of this rule depends on the form of fracture. There are many 
 cases of this kind in which the trephine ought to be applied, 
 but it is unnecessary to point them out in a popular work. 
 If the accident itself has produced a wound which lays bare 
 the fracture, then, indeed, it is always proper to extend the 
 cut, if necessary, in order fully to determine the nature of the 
 case. 
 
 Fractures of the skull occurring to adults or well grown 
 children, when attended with depression, but not with alarm- 
 ing symptoms, if they be left to nature, too frequently occa- 
 sion subsequent epilepsy, or severe nervous disorders, which 
 render life a burden. 
 
 In fractures with depression attended with serious symp- 
 toms, the effects produced are precisely the same with those 
 already described under the head of depression — except that 
 they reach their height, in most cases, at the moment of the 
 accident, instead of coming on gradually, as they do in c 
 of pressure from hemorrhage. The cause being the diminu- 
 tion of the size of the cavity containing the brain by the crush- 
 ing in of its solid walls, the effect can be removed only by re- 
 storing or raising these walls to their proper place by means 
 
OF CONTUSIONS IN THE CAVITY OF THE SPINE. 271 
 
 of a metallic lever; and in order to give this lever an entrance 
 beneath the edge of the depressed fragments, it is generally- 
 necessary to cut out a piece, often from the sound part of the 
 skull, by means of a peculiar circular saw. This constitutes 
 what is commonly called the operation of trepanning. Of 
 course, the whole subject is strictly professional, and is intro- 
 duced in this popular work merely to gratify the curiosity of 
 the reader. 
 
 When fracture of the skull is complicated with a rupture of 
 the membranes of the brain, or a loss of part of its substance, 
 the danger is always very imminent; but it is a mistaken no- 
 tion that such cases are inevitably mortal. It is never too 
 late to apply to high surgical authority in injuries of the 
 head. 
 
 The treatment of these accidents is rendered more difficult 
 and complex by the infinite varieties in the form and position 
 of the fragments, which in addition to simple compression 
 sometimes give rise to internal bleeding, or wounds and con- 
 tusions of the substance of the brain, and sometimes to mere 
 irritation of the membranes, from the irregularities of surface 
 presented by the fracture. It would be impossible to give 
 the popular reader any idea of the mode of distinguishing 
 these complications, or the remedies for their relief. The 
 whole subject is one of extreme difficulty, and with the few 
 remarks here given, we will close our observations on injuries 
 of the head. 
 
 Of Contusions in the Cavity of the Spine. Though 
 small, the cavity of the spine is of the utmost importance, in 
 consequence of the nature of its contents. The spinal mar- 
 row and the origins of nearly all great nerves of sensation and 
 motion are located within it. It is liable, like the head, to a 
 variety of accidents producing concussion, compression, and ir- 
 ritation of its contents. The thickness and loose texture of the 
 vertebrae or bones of the spine, and their mobility upon each 
 other, render them less liable to injury from falls and blows, 
 and they are additionally protected by the thick and strong- 
 muscles which surround them; but this immunity is partly 
 compensated by their liability to sprains and dislocations, in 
 consequence of the number of regular joints formed between 
 them. 
 
 Injuries of the spine are scarcely less important than those 
 of the brain, and a wound or severe contusion of the spinal 
 marrow almost always ends sooner or later, in death. 
 
 Fractures of the Transverse and Spinous Procession or 
 projecting parts of the vertebrae, sometimes occur without any 
 serious injury, and all that is necessary in the treatment of 
 such cases is to keep the patient in the most comfortable atti- 
 
272 "FRACTURES OF THE BODIES, &C. 
 
 tude for four or five weeks, and to employ the usual measures 
 to prevent or reduce inflammation in the commencement of 
 the case, (see Inflammation) and to pursue the regimen 
 proper in fractures generally, at a later period (see Frac- 
 tures.) When the muscles attached to the broken processes 
 do not of themselves preserve the fragments in a proper posi- 
 tion, no mechanical measures can accomplish the purpose, be- 
 cause the fragments are too deeply embedded in the flesh to 
 be acted on by such means, and they, therefore, unite in an 
 unnatural or deformed position; but this is rarely a matter of 
 much consequence. 
 
 Fractures of the Bodies, or Lateral Arches of the Vertc- 
 brae, and sudden Dislocations, almost inevitably occasion 
 permanent compression of the spinal marrow or principal 
 nerves. In all such cases the parts of the body below the 
 seat of the injury are incurably palsied, and there is scarcely a 
 shadow of chance for the life of the patient. If the injury be 
 located low down in the lumbar region, life may be protract- 
 ed for some months — if in the middle of the dorsal region, 
 several weeks may elapse before the fatal termination — if in 
 the lower part of the neck — the period is limited to a few 
 hours or days; but when the dislocation or fracture occurs 
 near the upper extremity of the neck, the death of the patient 
 follows in a manner nearly or absolutely instantaneous, pre- 
 cisely as an animal dies who has been pithed. 
 
 The reason of the variety in the time of death from inju- 
 ries of the spine is this. The numerous connexions between 
 the great nerves of motion and sensation which originate from 
 the spine in the manner described in the anatomical part of 
 this work, are connected by a regular series of branches with 
 the sympathetic system and the nerves of organic life — any 
 injury, therefore, which seriously impairs the integrity of the 
 spinal marrow, produces a powerful impression upon the vital 
 powers of the internal organs, and as the most important of 
 the vital organs are seated high up in the body, while the 
 palsy and disturbance from injuries of the spine is confined to 
 parts below the injury, it follows that the higher the seat of 
 the mischief, the more speedy is the death. 
 
 It is altogether useless to give any information on the sub- 
 ject of the local treatment of fractures of the body or lateral 
 arches of the spine. Some very severe surgical operations 
 may be occasionally warranted for the relief of these accidents, 
 but the friends, nurses, or assistants can do little beyond 
 placing the patient at perfect rest in a convenient attitude. 
 One precaution may, indeed, prolong the life of a patient. It 
 will be mentioned under the head of concussions of the spine. 
 
 Contusions of the Muscles and other soft parts about the 
 
CONCUSSIONS OP THE SPINE. 273 
 
 Spine, and Sprains of the Vertebrae, which latter are proper 
 contusions of the ligaments of the articulations, are treated on 
 pretty much the same principles with similar injuries of other 
 parts. They are, however, peculiarly prone to produce se- 
 vere and long continued pain resembling rheumatism, which 
 it is extremely difficult to remove. After the immediate ap- 
 plication of cold or warm ablutions to the part, according to 
 the constitution and sensations of the patient, if inflammation 
 runs high, the diet should be vigorous, and leeches should be 
 very freely applied. When the inflammation disappears, sti- 
 mulating embrocations, such as the soap or volatile linaments 
 (see Index,) are often highly useful. The best mode of re- 
 lieving the chronic pains, which often continue for months or 
 years, is by the application of plaster of Burgundy pitch, or 
 hemlock, or, what is far better when obtainable, the sheet India 
 rubber bound over the part for several weeks together. During 
 the whole inflammatory stage, and for some time after, the 
 strictest rest must be maintained, and strong muscular efforts, 
 particularly in lifting, should be prohibited until all traces of 
 the injury have disappeared. 
 
 Concussions of the Spine from falls or blows, generally 
 produce great weakness, and sometimes complete paralysis of 
 the parts below the seat of the injury. These effects are, for 
 the most part, evanescent, and require no other treatment than 
 rest. 
 
 A few hours would usually be sufficient to restore the pa- 
 tient, were it not that the bladder very often becomes para- 
 lyzed at first, and it then offers no effective resistance to the 
 accumulation of urine, which it has no power to discharge, if 
 not prevented by artificial means. The distention goes on in- 
 creasing until the fibres of the organ are stretched beyond the 
 point at which they lose their power of contraction, even 
 after the nervous energy returns; and if this state of things be 
 permitted to continue, the bladder will burst and the patient 
 must die. It is highly necessary, then, that the condition of 
 the urinary discharge should be narrowly watched, and as 
 often as twelve hours pass without an evacuation, the catheter 
 must be introduced. This is the more necessary as the blad- 
 der is benumbed by the concussion, and does not become the 
 seat of pain or much uneasiness; so that, in many cases, if the 
 surgeon do not inquire into its condition, the patient may 
 not become aware of the difficulty until after the organ is 
 ruptured! By applying the catheter twice a-day for three or 
 four days, we commonly succeed in restoring the tone of the 
 bladder. 
 
 There is one circumstance, in connexion with this matter, 
 which deserves especial attention. It sometimes happens that, 
 
 35 
 
274 OF CONTUSIONS IN THE CHEST. 
 
 the bladder, after being distended to a degree which com- 
 pletely paralyzes it, discharges a portion of urine from time 
 to time, by the mere pressure of the abdominal muscles. This 
 may deceive the friends of the patient and lead to fatal ne- 
 glect. In such cases, the abdomen will be found swollen and 
 tense, with a hard, rounded, internal tumour extending from 
 the brim of the pelvis nearly or quite to the navel, which 
 does not disappear even after the imperfect discharges just 
 mentioned. Unless this condition be relieved by the cathe- 
 ter, the bladder may be rendered incapable of recovering its 
 tone for months, or even permanently, and incontinence of 
 urine is the terrible result. 
 
 This affection of the bladder occurs also in most cases of 
 fracture or dislocation of the spine, and the same effects are 
 produced upon the rectum; or, if the injury be high up upon 
 the back, the whole of the intestines are rerrdered torpid or 
 paralytic. These results, (incurable in cases of fracture or 
 sudden dislocation) are among the most important causes of 
 death in injuries of the spine below the middle of the back. 
 It is hardly necessary to dilate any farther upon the treat- 
 ment in a popular work; for the aid of the surgeon will al- 
 ways be sought when obtainable, and we have said all that can 
 be trusted with safety in the hands of the uninitiated. 
 
 Of Contusions in the Chest. The bony frame of the chest 
 is at the same time so strong and so elastic, that internal con- 
 tusions from falls and blows are much more rare than might 
 be supposed. The lightness and mobility of all the organs in 
 this cavity except the heart, together with the peculiar elastic 
 membranous supports, the flexible floor of the diaphragm, and 
 the bed of air furnished by the lungs to the latter viscus — all 
 tend to protect the chest against the consequences of violence. 
 Yet there are many causes which do occasion contusions with- 
 in the chest, a severe blow directly over the heart might possi- 
 bly produce a bruise of that organ, and a similar impression 
 on the sternum or breast bone has been known to give rise to 
 an abscess within the front of the chest. 
 
 But contusions of the interior of the chest are rarely caused 
 by any other accidents than dislocations or fractures of the 
 ribs or their cartilages. When the fragments in such cases 
 are driven inward, the pleura first, and then the lungs are apt 
 to suffer. 
 
 We have already spoken of wounds of the lungs, such as 
 result from their puncture by a sharp, projecting portion of a 
 broken rib, (see Wounds of the Chest.) The milder injuries 
 occasioned by an angular projection, or an overlapping of the 
 fragments are seldom extensive, because the lungs yield so 
 readily to pressure. 
 
OP CONTUSIONS IN THE ABDOMEN. 275 
 
 But the great danger in all cases of contusions of the chest 
 is active inflammation, either of the pleura or the lungs. The 
 former kind of inflammation, when confined entirely to the 
 serous membrane, rarely occasions much pain; while in the 
 latter, the suffering is often intense: but these two affections 
 are generally confused together by unprofessional persons, and 
 often by medical men themselves. Both, when severe, are 
 attended with high fever, and independently of the treatment 
 of the fracture or dislocation, from which they may have 
 arisen, their treatment consists chiefly in repose, rigorous diet, 
 the avoidance of all stimuli, perfect quietude, and the free use 
 of the lancet, when the constitution of the patient will warrant 
 it. The various organs of the chest being seated close to the 
 centre of circulation, and provided with innumerable blood 
 vessels of unusual size, their inflammation from mechanical 
 injuries require more active depletion than those of almost 
 any other part of the body. 
 
 A very powerful remedy in lessening inflammation of the 
 chest, is the tartar emetic, given in divided doses, so as to pro- 
 duce decided sickness or nausea; but the history of the inter- 
 nal treatment of this affection belongs, more properly, to the 
 medical department of this work, where it will be found under 
 the headsof pleurisy and inflammationof thelungs. Cold drinks, 
 such as ice water or lemonade, in small quantities, are highly 
 useful; but the external application of cold water, so useful in 
 many forms of inflammation, is generally improper, because 
 it tends to drive the blood inward toward the seat of the in- 
 jury. When fever runs high, cold applications to the fore- 
 head, face, wrists, and ankles are useful, and are much more 
 safe in inflammations of the chest produced by contusions, 
 than in those which arise from internal causes. 
 
 Of Contusions in the Abdomen. Of the very large, im- 
 portant, and heavy organs contained in the abdomen, many 
 are liable to severe contusion or even laceration from internal 
 forces which leave no mark on the soft and flexible walls of 
 this cavity. These accidents are generally fatal, though re- 
 coveries sometimes take place even under the most unfavour- 
 able circumstances. 
 
 All such accidents produce most serious depression of the 
 system, and the patient rarely recovers from the collapse. 
 When reaction comes on, the case becomes one of a purely 
 internal character, and the treatment being medical rather 
 than surgical, the reader is referred for information on the 
 subject to the appropriate heads in the medical portion of this 
 work. The immediate effects of these accidents are all that 
 interest us here. 
 
 The Liver and Spleen are suspended upon strong liga- 
 
27G OP CONTUSIONS OF THE LIVER, &C. 
 
 mentous or membranous connexions, which cannot yield to any 
 considerable extent. Their weight is so great that their sub- 
 stance may be crushed, or they may be torn in part from their 
 connexions, by their own acquired momentum or descending 
 force, when the body is suddenly arrested in falls from a great 
 height. The liver may be torn or contused by a blow which 
 strongly compresses the walls of the abdomen near the short 
 ribs, and bends the edge of the liver upon itself. The spleen 
 itself is not altogether beyond the reach of a blow on the 
 loins. 
 
 The first and greatest danger of these accidents is internal 
 hemorrhage, the next, inflammation and abscess. The col- 
 lapse is always profound, and as it is extremely difficult, if 
 not impossible to determine precisely the nature or extent of 
 the accident, the only direction which can be given to the un- 
 professional attendant, is to place the patient fn a state of re- 
 pose, and trust solely to the powers of nature, until reaction 
 occurs, when the case must be treated with decision and firm- 
 ness, in the manner prescribed for inflammations and abscess 
 of the liver, in the medical portion of this work. 
 
 The Kidneys are very rarely contused by blows; but in- 
 stances have occurred in which they have been bruised and 
 even ruptured, by blows on the loins from falls, or received 
 in fighting. In such cases, the treatment required is similar 
 to that prescribed under the head of Nephritia or Inflamma- 
 tion of the Kidney, in the medical department. The nature 
 of the mischief is easily determined by the severe and pecu- 
 liar pain felt in the small of the back, which is only relieved 
 by rendering the back perfectly straight, or by bowing the 
 body very far forward. 
 
 It is not uncommon for the kidney to suffer severely in 
 those terrible accidents, which happen so frequently from the 
 caving in of banks of earth; but the mischief done to the ab- 
 domen in general, in these cases, often renders the injury of 
 the kidney a matter of secondary importance. 
 
 Bloivs on or near the Stomach often produce instantaneous 
 death, probably by the injury done to some of the most im- 
 portant portions of the nervous system «f organic life. 
 
 Blows received lower down upon the Abdomen are strong- 
 ly resisted by the abdominal muscles; and the plastic:' 
 semifluidity of the great mass of intestines with their con- 
 tents, tends to neutralize the effect of the force, bv distributing 
 it equally over the whole cavity. Injuries from such cause's 
 are, therefore, less serious than might be expected, unless the 
 force applied be very violent, as in kicks from horses, and in 
 partial inhumation under falling banks. 
 
 All serious contusions of the abdomen are attended with ex- 
 
OP BLOWS ON THE ABDOMEN. 277 
 
 treme depression. The pulse, if perceptible, is small, weak, and 
 generally frequent; the countenance pale and dejected, with a 
 peculiar expression of pain about the face; and it is remarkable 
 that these symptoms of collapse may be attended with active 
 and severe inflammation of the whole cavity of the peritone- 
 um, which the debility and the absence of pain on pressure 
 would lead the inexperienced to believe impossible. I have 
 seen death following; in twelve hours after a contusion of the 
 abdomen produced by a kick from a horse; yet, in this case, 
 extensive adhesion and effusions of lymph, and purulent mat- 
 ter were found on examination in the abdomen. The patient 
 did not complain of severe pain, nor was the pulse at the wrist 
 perceptible at any time after the accident. 
 
 When a person has received a severe contusion of the abdo- 
 men from the pressure of a heavy weight, Gr the impulsion of 
 any large body, the bladder is very generally found in a state 
 of temporary paralysis, even when no injury has been inflicted 
 on the spine. One of the first things demanding attention in 
 these cases is, therefore, the introduction of the catheter, if 
 the bladder be not effectually evacuated within twelve hours 
 after the accident — and the instrument must be employed at 
 least once every day until the organ recovers its tone. 
 
 In every instance of- injury of the abdomen, a surgeon will 
 be consulted, of course, if professional aid can be obtained. 
 When this is impracticable, the greatest care of the attendants 
 should be to do as little as possible. The case is generally 
 safest in the hands of nature, until fever comes on, when it 
 must be met by the lancet, cooling drinks and a rigorous diet. 
 
 One caution should be always observed from the first. The 
 quantity of food or drink admitted into the stomach at any 
 one time must be very small, as any effort at vomiting pro- 
 duces a very unfavourable effect. If, as sometimes happens, 
 vomiting be produced by the accident, it is right to adminis- 
 ter occasionally a little lavender compound, strong mint tea, 
 the camphor julep, or some other of the many popular reme- 
 dies for sickness; but this must be done with great care, lest 
 by their stimulating effect, these remedies should increase in- 
 ternal inflammation. Obstinate vomiting will not unfrequently 
 yield to the application of a spice plaster to the pit of the sto- 
 mach. In cases of extreme depression, when it seems abso- 
 lutely necessary to sustain the patient by some stimulus, it may 
 be proper to give a table-spoonful of the terebinthinic mix- 
 ture every hour or two. 
 
 The best way of making this mixture for such a purpose^ 
 is as follows: 
 
 Place in an eight-ounce vial, 
 
 Pure Spirits of Turpentine, 1 drachm. 
 
278 OF CONTUSIONS OF THE PERINEUM. 
 
 Oil of Peppermint, 2 drops. 
 
 The whites of two eggs. 
 
 Shake these well together, and then add, by little and little, 
 six ounces of sweetened water; agitating the mixture frequent- 
 ly, and always shaking the vial before giving a dose. 
 
 A patient who has been subjected to an accident of this cha- 
 racter, should be kept in bed and at rest until his energies have 
 been in a great degree recovered, and all danger of inflamma- 
 tion has passed away. Several weeks are sometimes necessary 
 for this purpose; and even for a longer period, strict caution 
 in regulating the food and drink of the patient is highly ne- 
 cessary; for the abdominal organs, weakened by the accident, 
 should not have their functions called into play unnecessarily 
 until they have enjoyed a long repose. 
 
 Of Contusions of the Pelvis and Perineum. Among the 
 most serious consequences of contusions of the perineum, is 
 the injury done to the urinary organs by these accidents, and 
 the subject thus becomes connected with contusions of the ca- 
 vity of the pelvis. 
 
 The most common causes of such injuries are falls upon the 
 rail of a fence, the edge of a cart wheel, or some similar nar- 
 row body when the legs are expanded so that the blow is re- 
 ceived directly on the perineum, or soft parts between the 
 buttocks. 
 
 The irritation resulting from these injuries is very great, and 
 the consequent inflammation and fever, severe. But the more 
 immediate result will claim our chief attention. The urethra, 
 or canal by which the urine is discharged, almost invariably 
 suffers a severe spasmodic contraction, a contusion which de- 
 stroys its powers for a time, or an actual laceration. In all 
 these cases the flow of urine is arrested, and the bladder be- 
 comes permanently and dangerously distended. After a cer- 
 tain length of time, the urine may begin to dribble away bv 
 drops, or it may be discharged frequently and in small quan- 
 tities by the will, but without effectually relieving the bladder. 
 When a laceration of the urethra has taken place, more or less 
 discharge of blood, or bloody urine occurs, and in some rare 
 instances, the blood regurgitates, or flows back into the blad- 
 der so as to fill that organ with a solid coagulum, thus com- 
 pletely clogging the outlet. This last occurrence has been 
 held a fatal one by many surgeons; but if a catheter can be 
 introduced fairly into the bladder, as has been done by practi- 
 tioners of superior skill or remarkable good fortune, the case 
 is not peculiarly difficult. A portion of the coagulum may be 
 washed away by injecting warm water through" the catheter, 
 
OF FRACTURES OF THE PELVIS. 279 
 
 and then removing it again by the suction 1 of the syringe; af- 
 ter which, the urine itself will rapidly dissolve the coagulum. 
 
 As the condition of the parts renders the introduction of a 
 catheter, in contusions of the peritoneum attended with sup- 
 pression of urine, a very critical, although a necessary step, 
 the operation should never be attempted except by a practical 
 surgeon, and the aid of such a one should be immediately 
 sought. If the instrument cannot be introduced, it may be- 
 come necessary to tap the bladder. 
 
 When spasmodic stricture occurs, which may be known by 
 acute pain in the part, and by violent straining, it is improper 
 to apply cold: however severe the consequent inflammation 
 may be, warm fomentations arc productive of much more re- 
 lief. One of the best applications is a warm poultice of hops 
 or chamomile. When there is no spasm, cold may be usefully 
 employed, as in other inflammations. If there be laceration 
 of the urethra, an abscess and mortification of the loose cellu- 
 lar tissue about the perineum, terminating in fistula, will almost 
 invariably follow, unless prevented by the most consummate 
 skill. 
 
 It is right to combat the inflammation consequent upon 
 contusions of the perineum, by the most vigorous measures in 
 the first instance, if the severity of the injury have not pro- 
 duced a collapse; for if the first few hours be lost, the rapidity 
 of the changes in a part so remarkable for active vitality, ren- 
 ders the formation of an abscess almost certain. The free use 
 of leeches and the lancet, are highly necessary in attempting 
 to arrest the inflammation; but if a tendency to form matter 
 be perceived, it should be encouraged by the application of 
 emollient poultices; and the abscess, when formed, should be 
 opened by an early and free incision. 
 
 Fractures of the Pelvis. — These accidents are generally 
 fatal, but they owe their fatality less to the injury done to the 
 bones than to the contusion of the soft parts within the pelvis, 
 or the rupture of the urethra, and are, therefore, properly 
 considered in this place. 
 
 The most common causes of these fractures of the pelvis 
 are the falling of banks of earth/ or the passage of heavy ve- 
 hicles over the part. Sometimes the wing, or upper part of 
 the ilium (see p. 42,) is broken; and I have known a patient 
 to recover from a fracture of this kind almost without an un- 
 pleasant symptom. Sometimes the fracture runs into the 
 socket, of the head of the thigh bone; then all motions of the 
 corresponding member are terribly painful, if not rendered 
 impossible; and if the patient recover, it is generally at the 
 expense of permanent lameness. Much more frequently, the 
 bones of the pelvis give way in front and at the sides of the 
 
280 OP FRACTURES OF THE PELVIS. 
 
 perineum; and, as these parts are deeply imbedded, and give 
 attachment to powerful muscles, it is impossible to contrive 
 any mechanical apparatus capable of retaining the fragments 
 in their proper places. They are almost sure to wound or 
 bruise the urethra, bringing on obstinate retention of urine; 
 and such cases have invariably terminated fatally. 
 
 So severe an injury as a fracture of the pelvis is commonly 
 attended by a profound collapse of the system, and some days 
 usually elapse before inflammatory symptoms or fever begin 
 to appear. The existence of the fracture is known by the in- 
 ability of the patient to assume a sitting posture; by extreme 
 difficulty and pain when the lower extremity is moved, al- 
 though, when measured, it is found to retain its natural lei 
 and by a dull grating, perceptible by the feeling of the pa- 
 tient, if not by the ear of the surgeon or attendant. 
 
 The only precautions which can be taken, with safety, 
 the unprofessional attendants, to promote the safety of the pa- 
 tient, in fractures of the pelvis, until surgical aid can be ob- 
 tained, are tin 
 
 The utmost care should be used in c g the patient, 
 
 from the place where the accident happens i hamber. 
 
 The horizontal position should be | 
 
 the body supported by two as- who' 
 
 should face each other, crossing and interlocking their hi 
 first, beneath the shoulders of the patient, and then behind 
 his buttocks. Another assistant should take charge of each 
 lower extremity, placing one hand behind the thigh, a little 
 below its middle, and the other beneath the calf of the 
 These four assistants should walk sideways in carrying the 
 person. A fifth assistant should follow, holding in charge the 
 head of the patient All hurry should be avoid* hour 
 
 or two of time are not very important in such cases; and none 
 of the above details should be neglected unless by necessity. 
 
 When arrived at the chamber, the patient should not be 
 put to bed until he has been undressed, and, in i \ this 
 
 purpose, it is extremely improper to attempt the removal of 
 coat, waistcoat, or pantaloons entire. A plain bench, board, 
 settee, or long table should be chosen, and covered with a 
 narrow mattress, or blanketing many times folded. On I 
 after turning up the tail of the coat, the patient should be 
 gently laid upon his back. One sleeve of his coat being ripped, 
 or cut, from the wrist to the shoulder strap, the latter 
 and the collar cut through, or ripped from the facing, the g 
 ment is readily removed by gently raising the shoulders and 
 passing to the opposite side, without disturbing tin 
 The shoulder-strap of the waistcoat being cut, ami the collar 
 detached, it may be removed in the same manner. N 
 
OF CONTUSIONS OR SPRAINS IN THE JOINTS. 281 
 
 having taken off the suspenders, let the waistband of the pan- 
 taloons be divided on each side, and rip down the outer seams, 
 by the pockets, to the middle of the thigh, or farther. The 
 back part of the pantaloons may now be doubled backward, 
 and gently drawn down beneath the pelvis; but we should 
 never attempt to pull it down by taking hold of the legs, in 
 the common way, as this will produce terrible pain in most 
 eases. The difficulty is now chiefly over; but, if the stock- 
 ings require removal, or if, before undressing, it be necessary 
 to withdraw boots, the knee must be firmly grasped by an as- 
 sistant during the operation. 
 
 The bed being properly prepared, (it should be a fracture 
 bed, see Index,) a long, soft, roller towel, or folded muslin 
 sheet, is laid across that part of the bed where the pelvis is 
 intended to lie, and just high enough to avoid the danger of 
 becoming soiled by the evacuations. The patient being lifted 
 in the same manner as at first, is then placed on his back, in 
 a proper position in bed. If, on trial, it be found that he ex- 
 periences some relief by being slightly turned to one or the 
 other side, this may be permitted; and if the ends of the towel 
 be now brought forward and firmly and smoothly pinned, it 
 will be seen that the pain is either decidedly increased or 
 somewhat relieved by the pressure: accordingly, it should 
 be continued or laid aside. 
 
 This and strict repose are all that can be prescribed for the 
 relief of the fracture, separately considered, by unprofessional 
 hands, under any circumstances. The treatment of the ac- 
 companying injuries within the pelvis, or in the perineum, 
 must be conducted on the plan already laid down for contu- 
 sions of those par 
 
 \\ e have been very particular in our remarks on the mode 
 of handling the patient, not only because it is of the utmost 
 importance in the rare cases of which we are treating, but, 
 also, because parts of the same process are requisite in the 
 management of several other injuries of more frequent occur- 
 rence; and the reader will have occasion to refer to these re- 
 marks hereafter. 
 
 Of Contusions or Sprains in the Joints. — The nature 
 of these accidents is so well understood that it seems scarce- 
 ly necessary to describe it. But there are some circum- 
 stances, however, which are deserving of notice. In every 
 severe sprain there exists an internal wound, more or less 
 extensive; and, consequently, we frequently observe extra- 
 vasations to a considerable amount, which often continue to 
 require treatment after the inflammatory symptoms have dis- 
 appeared. 
 
 36 
 
2S2 OF CONTUSIONS OR SPRAINS IN THE JOI> 
 
 In accidents of this character the ligaments of the joints are? 
 more or less lacerated, torn from their connexions, or vio- 
 lently stretched. It is found that a ligament which has un- 
 dergone a great deal of extension, recovers its tone and con- 
 tracts to its original dimensions with extreme slowness: the 
 joint therefore remains weak for many months, and frequently 
 requires a mechanical support for its protection. 
 
 The first objects in the treatment of sprains, are the relief of 
 the violent pain produced by the stretching or twisting of the 
 ligaments, and the diminution of the danger of severe inflam- 
 mation by preparatory measures. The excess of pain beii. j 
 itself, an active agent in producing inflammation, the rem 
 adapted to one of these purposes are generally equally appli- 
 cable to the other. In patients with healthy constitutions, 
 when neither threatened with the rheumatism nor consump- 
 tion, a running stream of cold water furnishes means oi 
 fecting both designs In a most speedy and effectual manner. 
 This remedy, of course, is inapplicable to sprains of the hip, 
 shoulder, or spine; but in those of the knee, ankle, elbow and 
 wrist it is attended with the happiest cflccts. The full stream 
 of a pump or hydrant falling upon the injured part increases 
 the pain, in the first instance, sometimes to a deg i ecly 
 
 tolerable, but if the application be continued, the part becomes 
 benumbed, and the pain soon ceases. In from ten minutes 
 to half an hour, according to circumstances, this eilect is pro- 
 duced. This application should be made as speedily as pos- 
 sible after the accident, and must not be arrested until the 
 sensibility of the part is much diminished, or it will pro- 
 duce injury rather than benefit. 
 
 In sprains of the thigh, shoulder and spine, rags wet with 
 cold lead water may be substituted, and should be frequent! v 
 changed until the heat of the part is reduced. 
 
 In patients subject to consumptive disease, or rheumatism, 
 and fearful of the application of cold, we may ofien g 
 great relief, by pouring on the part a stream of moderately 
 warm water, after which the part may be enveloped in a ban- 
 dage thoroughly imbued with laudanum. These precautions 
 being taken, the patient is seated with the injured part in ai. 
 vated position; or, if ill bed, it must be supported by pill 
 The most absolute rest ol^ the limb must be strictly enjoined 
 upon the patient. "When inflammation has become established, 
 the most rigorous local treatment is proper. The diet should 
 be low; and. if fever appears, some blood maj 
 arm to advantage. This course should be continued until 
 inflammation has in a great degree subsided. Repeated let 
 and the constant use of cold ablutions will be beneficial du- 
 ring the inflammatory After the lapse of li\ 
 
OF PUNCTURED WOUNDS. 2S3 
 
 days, some change of treatment is required; the vital energies 
 of the part have heen exhausted, the ligaments have lost their 
 tone, and the ahsorbents can no longer take up the extravasated 
 blood with freedom. Gentle stimulants will now give vigour, 
 and hasten the cure. Bathing with one of the following ar- 
 ticles, which are arranged in the order of their energy of ac- 
 tion, will generally be found advisable as the case advances.* 
 Warm vinegar, warm brandy or whisky, the soap liniment, 
 camphorated spirit, volatile liniment, spirits of hartshorn, 
 spirits of turpentine, decoction of cantharides. As a general 
 rule, the deeper the joint, the more powerful is the application 
 required in the chronic stage. Sprains of the spine, parti- 
 cularly, which endure for a long time, are sometimes much 
 benefited by frictions with the decoction of cantharides in 
 spirits of turpentine. In persons subject to rheumatism, the 
 injured joint is exceedingly liable to attack during the chronic 
 stage of the sprain. The terrible suffering which results, is best 
 relieved by poultices of hops and vinegar, or by the applica- 
 tion of plasters composed of two or three drachms of some 
 strong narcotic, such as the extract of belladonna, hellebore, 
 or stramonium, mixed with half an ounce of lard. During the 
 chronic stage, the patient should gradually return to his usual 
 habits of diet, and the injured joint may be carefully subjected 
 first to passive, then to active motions, to prevent permanent 
 lameness. These exercises should not, however, I)' 4 carried 
 to such an extent as to give the patient pain. When the 
 joint continues feeble for a long time, it is best to embrace it 
 firmly in an elastic flannel bandage; or, if necessary, com- 
 plete support may be given by means of a proper splint. In 
 very bad cases, months may elapse, before the extravasated 
 blood is totally absorbed; and a much longer time may fre- 
 quently elapse, before the distended ligaments recover their 
 tone, and restore the joint to its primitive strength. A severe 
 sprain is a more serious accident than a fracture, and should 
 never be ignorantly trifled with, or neglected. 
 
 Of Punctured Wounds. — It has been customary to treat 
 distinctly of those wounds which are made by long narrow 
 instruments, but which do not penetrate cavities, under the 
 head of punctured wounds. The peculiarities of wounds of 
 this character have been very much exaggerated, and the 
 measures taken to prevent evil consequences from them are 
 often productive of serious mischief. 
 
 If a narrow and deep puncture inflame, the swelling of its 
 
 * Those articles which stand last on this list, are only serviceable in old and 
 severe cases. They are rarely useful within a month after the accident; and 
 as most sprains recover in less than a month, they seldom come into play. When 
 med too early, they are very injurious. 
 
284 OF PUNCTURED WOUNDS. 
 
 walls occasions very painful pressure on the nerves of the 
 part; and if, as often happens, the instrument have penetrated 
 a fascia, or tendinous expansion — (see Index,) — the inflamma- 
 tion, and the consequent pressure of the parts beneath against 
 the unyielding fascia may be spread over a wide surface, and 
 produce not only extreme agony, but serious danger to life, 
 even when the extent of the original wound is inconsidera- 
 ble. Nothing can be more irrational than the popular mode 
 of treating accidents of this character, which consists in soak- 
 ing the wound w r ith spirits of turpentine or strong lie, for fear 
 of lock-jaw. That there are no cases of punctured wounds 
 in the palm of the hand or the sole of the foot, id which be- 
 nefit may result from strongly stimulating applications made at 
 a proper time and more proper manner, I will not pretend to 
 say; but this is certain; — in nine cases of ten, the practice will 
 be attended with most unfortunate consequences, and it would 
 be extremely silly for any one unacquainted with surgery to 
 judge what cases would prove exceptions to the general rule. 
 
 Punctured wounds occurring in warm weather, and t 
 cially such as are located in the foot or hand, require careful 
 watching and surgical advice; but the only safe course for the 
 domestic adviser, when a surgeon cannot be procured, is as 
 follows. 
 
 Immediately on the occurrence of the accident, we should 
 order a plain poultice of bread and milk; to which may be 
 added, when the wound is extremely painful, about U 
 of opium to a tea-cupful of poultice. The opium should only 
 be employed at the first dressing, and for the relief of the ner- 
 vous pain; for after inflammation has become established, the 
 pain will be increased instead of being lessened by such an 
 application. 
 
 The poultice should be changed at least once, daily, until 
 the violence of the inflammation is over. If swelling extend 
 rapidly over the mrrounding surface, and the intense throb- 
 bing pain lead to the supposition that beneath 
 which the inflamed parts are firmly bound down has been 
 wounded, the skilful surgeon will generally make a free inci- 
 sion through the wound and the fascia, thus converting the 
 punctured into a simple incised wound. 
 
 The part, which has received the wound, should be main- 
 tained constantly in an elevated position, until the inflamma- 
 tion has subsided. If the arm — it should be carried in a sling: 
 if the leg — it may be supported by one or more pillows in bed, 
 and upon an extra chair during the da v. These wounds 
 scarcely ever heal by the first intention, but rarely occasion 
 much suppuration, unless they produce a d< 
 When the amount of discharge begins to decline, or when the 
 
DILATATION OF NATURAL PASSAGES. 2S5 
 
 \ 
 
 parts about the orifice appear much weakened, the poultice 
 should be omitted, and a dressing of simple cerate with a 
 loose bandage, applied in its place. The most perfect repose 
 of the limb is often of absolute necessity in deep punctured 
 wounds of the extremities, and suitable splints are then re- 
 sorted to. 
 
 When a punctured wound remains many days but little al- 
 tered in appearance, and instead of pouring out healthy pus, 
 yields scarcely any discharge, and presents a gaping orifice, 
 lined with a ragged ash-coloured membrane, there is danger 
 of some serious disturbance of the general health, predisposing 
 to nervous spasms or lock-jaw. These are the circumstances 
 which demand the application of local stimulants to the 
 wound, but we do not deem it prudent to prescribe any par* 
 ticular plan of local treatment in a popular work. All that 
 can be safely done by the domestic practitioner, when surgi- 
 cal advice cannot possibly be procured, is to keep the patient 
 on ■ very mild though somewhat nutritious diet, giving ten 
 or fifteen drops of Elixir of Vitriol in a tumbler two-thirds 
 full of water, repeating the dose twice or thrice every dav. 
 The bowels should be kept open, one or two free discharges 
 per diem being secured, if necessary, by mild purgatives. 
 For children under I of age, a Seidlitz powder or a 
 
 small dose of Epsom salts will answer the purpose; but for 
 adults, it is better to employ some combination containing a 
 portion of calomel. Bight grains of rhubarb, and three 
 grains of calomel, formed into three pills, or taken in powder, 
 with molasses or brown sugar, will be found a safe and elli- 
 cient dose, and will usually leave its impression on the bowels 
 for three or four days, before it becomes necessary to repeat 
 the prescription. 
 
 For some remarks upon poisoned wounds, and the compli- 
 cation of wounds with certain troublesome forms of inflamma- 
 tion, the reader is referred to the medical portion of this 
 work, where the subject of Erysipelas if treated of — that cu- 
 taneous disease being somewhat closely associated with many 
 accidents following the iniliction of wounds. 
 
 SECTION II. 
 
 On the Dilatation of Natural Passages, and Us Con- 
 sequenccs. 
 
 Next to the actual wounds of parts, it is natural to consider 
 their stretching or permanent distention: several accidents of 
 this description may be properly discussed in a popular work; 
 
DILATATION OF NATURAL PA 
 
 but, before entering on the separate classes of these acci- 
 dents, it is necessary to premise some general remarks. 
 . The hollow viscera, the blood vessels, and other canals of 
 the human body, are all intended to contain certain soli' 
 fluids, varying in quantity from time to time, and they are all 
 furnished with a coat of muscular or other contractile fibres, 
 which adapt their dimensions to the quantity of their con- 
 tents, as has been described in the anatomical chapter of this 
 work. But this power of adaptation has its limits. If n< 
 or quite all the contents be excluded for a length of time, the 
 diameter of the canal is continually lessened, not only by the 
 increasing contraction of the fibres, which cannot be carried 
 very far in all cases, but also, by an interstitial absorption, which 
 gradually renders the coats thinner and shortens the 6 
 J f all contents be absolutely excluded, and the continue"! 
 elusion be consistent with life, there exists no limit to this 
 absorption, until the portion of the rendered 
 
 i totally i revious I 
 
 enee remaining, cord of dense cellular tissue, 
 
 resembling a delicate roiio at. 
 
 If, on the contrary! the i <>f a natural canal be fre- 
 
 quently or for considerable periods, increased beyond all 
 proper or customary amou .'lies perman< 
 
 dilated, and the fil g to their 
 
 natural dimension-. We have spoken of th 
 ring to the bladder, in the Phj . apter, and to the 
 
 stomach, in tin- hygienic section on food: our busi- 
 
 ness is with other effects of similar causes. 
 
 This dilatation, far from being generally productive of thin- 
 its of the canali is usually attended with much 
 thickening and increased Btrength, which is the result 
 hyper-nutrition, by means h nature attempts forcibly 
 
 to resist t he distending power. T 
 
 are often found thus enlarged to the th'u one-fourth of 
 
 an inch; thearter Halation, or in aneurism, which 
 
 is a somewhat compli rionally found 
 
 with walls much thicker. The abdomil I and tendons, 
 
 in old hernia, not unfrequently present us with a section 
 measuring ten times the natural amount. 
 
 But if the distending force 1 . and the com 
 
 of the canal be continually on the i 
 
 action constant, (as in aneurism, where the | the heart 
 
 perpetually tends to press more blood into the tumour) the 
 powers of nature are at last exhausted, the hyper-nutrition 
 >, and this occurs sooner in just proportion to the im- 
 portance of the organ affected. When this state of thin— - 
 established, the increasing press the conto 
 
 a rapid absorption of the walls oi the canal, particularly . 
 
DILATATION OF THE AM'S. 287 
 
 weakest part, and the cavity bursts sooner or later, unless the 
 death of the patient prevent the issue. 
 
 We have clearly indicated, in the foregoing remarks, the 
 nature of the accidents spoken of, and the principal morbid 
 changes caused by them. The most rational plan of treatment 
 is plainly deducible from the same remarks. It consists in 
 evacuating, as far as possible, the contents of the canal, and in 
 permanently preventing their .nidation in improper 
 
 quantities; leaving the natural operation of a well known law 
 of physio! feet the gradual reduction of the passage by 
 
 interstitial absorption. Other measures than these are required 
 only where the functions of t!. elude the applica- 
 
 tion of mechanical contrivances or operation- mor- 
 
 bid w< of the p u>e of dilata- 
 
 tion under the action of its ordinary functions; and in i 
 
 complicated with d Dal superindu 
 
 existing with the dilatation. The last named class is by no means 
 a slender one, and some in- complications will 
 
 be mentioned in the | I ction. 
 
 Dilatation qf the-Jlntu* This affection results chiefly from 
 the habit of costivem - the frequent of large 
 
 it it is much promoted by all which 
 
 tend to produce relaxation of the part and fulness of the 
 morrhoidal vessels: an st important are seden- 
 
 tary habits, luxurious living, and uncleanlii 
 
 The ill disa- 
 
 ted with fecal mat- 
 Ontinually bathes the part; the patient controls his dis- 
 
 eharges with difficulty, wh ed with the slightest . : 
 
 of the bowels; the inu 1 becomes 
 
 thickened and disi a dull, ! 
 
 pain in the part, and sometime 
 
 One in the muscles which close the 
 anus, prevents tbem from yielding the proper mechanical sup- 
 port to the hemorrhoid . which are (he principal blood 
 the part; and ti. tome cnl I 
 and varicose, sometimes pouring out blood into the surrouud- 
 ellular tissue, where it forms little sacs, which, becoming 
 surrounded by walls thickened by hyper-nutrition, form those 
 rery troublesome tumours called pilta. Pil therefore, 
 both a cause and a consequence of dilatation of the anus. 
 
 Another very annoying accident, often caused by this dila- 
 tation, is prolapsus of the anus, a> it is commonly called. This 
 consists, usually, of a falling down or thrusting out uf the mu- 
 cous membrane alone, which projects more and more at each 
 stool, until it becomes altered in structure, and is. at length, re- 
 turned with difficulty. Sometimes, however, it is the whole 
 
288 DILATATION OF THE ANUS. 
 
 thickness of the intestine which descends, being doubled within 
 itself, like the finger of a glove; and the case is then much more 
 serious. 
 
 In the treatment of dilatation of the anus, mechanical inge- 
 nuity is of no avail ; the parts are beyond the reach of any com- 
 pressing force, except that of their own muscles. The first 
 object is to remove the cause, namely, the occasional passage 
 of hardened fasces in large masses. To effect this, it is neces- 
 sary to correct the diet by the avoidance of rich food, wines, 
 and much spice, in order to lessen the disposition to costive- 
 ness; and then, to employ such measures as tend directly to 
 keep the bowels open. Gentle purgatives and laxatives, such 
 as the Seidlitz powder, Epsoi. ;istor oil, rhubarb, <x.e. 
 
 may be required occasionally; but it would be extremely im- 
 proper to depend exclusively upon medicines, in cases requir- 
 ing a long continued course of treatment. There are many 
 articles of diet, of an opening quality, and these should be the 
 main dependence of the patient. Among the best of then 
 such articles as admit of the use of sweet oil, which should be 
 employed freely, and such tl I with in :nush 
 
 and molasses act very powerfully in keeping the bowels open, 
 and form favourite remedy with the late Dr. Ph\ 
 
 The bowels being duly regulated, the next object is to in- 
 K the tone of the sphincters; anil this is best accompli 
 by cold ablutions and I The proper mode of apply- 
 
 ing cold is by means of a stream of cold water bearin^ 
 rectly on the part. In some of our large cities this is l 
 managed, by standing in a bath tub, beneath a hydrant, and 
 allowing the water to flow upon the anus; but the apothec 
 have always on Bale, a large syringe for self-injection, which, 
 by throwing its stream perpendicularly upward, is admirably 
 adapted to the treatment of diseases of the anus by cold w 
 This remedy • g contraction of the coats of the blood 
 
 Is, expelling one cause of distention, while it produces an 
 increased tone in the sphincters, thus diminishing the diame- 
 ter of the canal. The ell. omote the re- 
 gular action of the 1> -hen the external 
 sphincter of the anus, which, contrary to the common opinion 
 of anatomists, is a voluntary muscle; anil an i: I f its 
 strength by exercise, has an important influence on the dimen- 
 sions oi' the anus. The exerci>es which tend most powerfully 
 to effect this purpose* are dancing, running, leaping, and jump- 
 ing the rope. These are not only useful in producing a dimi- 
 nution in the canal, but they also tend, by increasing the tonic 
 
 -ire of the muscles, to remove piles, when alreadv I 
 ing, and, by promoting cleanliness and relieving irritatit : 
 check the disagreeable mucous dischai "g 
 
DILATATION UF THE ANUS. 2S9 
 
 When the habitual moisture of the part gives rise to very 
 
 troublesome itching or painful excoriation, the greatest relief 
 is obtained by introducing into the rectum a very small sup- 
 pository of tallow or suet before going to stool, and by keep- 
 ing the orifice constantly dusted lightly with prepared chalk 
 or the carbonate of zinc, during the intervals between the daily 
 use of the cold water. 
 
 Although piles are spoken of as one of the consequences of 
 this form of dilatation, yet these tumours are so important, and 
 arc produced in so many other ways, that it is much better to 
 treat of them in another place. 
 
 The prolapsus ani, or coming down of the anus, is not al- 
 ways attended by the dilatation of the canal, for it may be pro- 
 duced by severe straining at stool at any lime, particularly in 
 children; and it may occur as a symptom of certain other dis- 
 eases; but this be the most proper place to notice it. 
 The accident may be recognised by the formation of a soft red 
 tumour all around the anus, at every stool. This, at first, re- 
 tires of its own accord in most cases, immediately after the 
 close of the evacuation; but as it continually increases in size 
 by repeated descents, it soon requires the aid of the lingers to 
 replace it. After a time, its bulk becoi. great that 
 this is difficult, and in some sadly neglected ^possible. 
 The prolapsed part soon becomes subject to inilamma- 
 . which thicken it permanently, weakening the patient 
 by a perpetual discharge of nutter, and rendering reduction 
 extremely difficult and painful. Sometime! the tumour be- 
 comes strangulated by the sphincter muscles: the pain is then 
 horrible, all die arc arrested anil, unless relieved, the 
 lie; but some instances have occurred in which 
 the protruded part has mortified and (alien off in time to 
 life, without any surgical operation. In old cases, the pro- 
 traded part, even when of enormo as been known tu 
 remain down for years without preventing the evacuations; 
 and the mucous membrane, in these cases, becomes gradually 
 converted into skin! 
 
 To reduce a bad prolapsus an i,wc should commence by pouring 
 freely over the part cold or tepid water, according to the condi- 
 tion of the constitution and the degree of inflammation in the tu- 
 mour. The patient is then to be placed on his back in bed, with his 
 buttocks drawn down nearly to the foot, his shoulders and but- 
 tocks well raised by cushions, and his heels drawn up to his 
 thighs, An operator with smooth hands, well greased with 
 lard, places himself at the foot of the bed, and presses the tu- 
 mour gently upwards, with the palm of one or both hands, ac- 
 cording to the size of the swelling, for a considerable time. This 
 pressure is designed slowly to empty the blood vessels, and 
 
 37 
 
290 OF VARICOSE VEINS. 
 
 thus diminish the projecting mass. The assistant then conti- 
 nues the pressure with the fingers of both hands, while, with 
 both his thumbs, he gradually and slowly thrusts the central 
 portions of the tumour from without inwards toward the lit- 
 tle depression which marks the extremity of the canal of the 
 gut. Thus, those portions which descend last are reduced 
 first; for it is folly to attempt to return the whole ma- 
 once. When the reduction is apparently complete, the fore- 
 finger of the right hand, well oiled, should be introduced as 
 high as the middle of the third joint, to place the last folds en- 
 tirely clear of the canal of the anus; and the patient being 
 directed to avoid all straining, the finger is to be withdrawn 
 very slowly, by turning it gently, first in one direction and 
 then in the other. 
 
 If the case be very painful, and the patient strong, he may 
 lose blood from the arm pretty freely before the operation. 
 If the inflammation be very great, and the tumour appear 
 likely to prove very obstinate, small leeches may be plenti- 
 fully applied before the cold. In bad cases occurring in adults, 
 forty drops of laudanum may be given fifteen minutes before 
 the employment of pressure. 
 
 The reduction being completed, and the patient made com- 
 fortable in bed, if no laudanum have been given previously, the 
 dose just mentioned should be now administered, to check 
 any call to stool for a day or two; and the food allowed should 
 consist of gruel, exclusively, for some d BT which, the 
 
 rules of diet laid down lor cases of dilatation must be ob- 
 served. 
 
 Mr. Gooch invented a peculiar truss, to prevent the protru- 
 sion between the stools which is apt to occur spontaneously 
 in very bad cases o{ dilatation of the anus. This instrument is 
 noticed in the American Cyclopaedia of Practical Medicine, 
 Art. Anus. By referring any intelligent surgeon's instrument 
 maker to this work, with a note of the height, and the mea- 
 sure of the circuit of the pelvis, the patient may obtain the 
 machine to order at any time. 
 
 The above directions are all which can be given with any 
 safety, to the best informed domestic practitioner. For the 
 relief or cure of even the worst cases of prolapsus ani in which 
 the above described measures fail, mar . but sue 
 
 ful surgical operations may be performed; but these require 
 high skill, and the very description of them would be unin- 
 telligible to most of our read* 
 
 Of Dilated, or V arian t Perns. — The eficet of the weight 
 of the column of blood in distending and rem! -cased 
 
 the veins of the lower extremities, particularly in tall men, 
 the effects of tight garters in produei: 
 
OF VARICOSE VEINS. 291 
 
 the similar influence of the pressure of the womb in pregnant 
 women, together with a notice of the local dropsies, or swell- 
 ings, of the legs which are consequent to this embarrassment 
 of the circulation, have all been mentioned in the first part of 
 this work. (See Circulatory Apparatus.) 
 
 When varicose veins are bad, the whole of the affected limb 
 appears as if enveloped beneath the skin by innumerable large, 
 blue worms, while the skin itself presents multitudes of redder 
 tortuous lines, which might be mistaken for their infant pro- 
 geny. These are the dilated veins, with their coats enor- 
 mously thickened by hypernutrition, or morbid nutrition. 
 Along their route we observe, every here and there, a hard 
 knot, or tumour; this is a valve, morbidly altered in texture, 
 and rendered useless by the disease. The circulation through 
 these enlarged canals is slow and difficult, so that the blood 
 actually coagulates in places along the sides of the vi- 
 and, notwithstanding the increased nutrition of the co 
 the veins, and the serous deposits in the cellular tissue which 
 often enlarge the whole member prodigiously, the general nu- 
 trition of the limb is rendered extremely feeble and ineffi- 
 cient; the muscles losing their colour and strength rapidly. 
 After a time, it often happens that nutrition ceases altogether 
 in places, and these parts being removed by the absorbents, 
 extensive ulcers, which are nearly or quite incurable in their 
 nature, are created. We may heal them again and again 
 in some i—UneOS, but the moment the patient quits his bed 
 and attempts his usual avocation they tie alniusl sine to recur. 
 Our only resource is the partial relief of the varicose condi- 
 tion of the veins h\ surgical measures, for a complete cure of 
 this affection we hold to be impossible* 
 
 It would be a reasonable inference that, as the pressure of 
 the incumbent column of blo«n| is the principal cause of vari- 
 cose veins, the recumbent position would be the best during 
 the treatment. But, it is found that the removal of the accus- 
 tomed and natural pressure from the veins soon produces a 
 loss of tone which causes them to yield to distention the mo- 
 ment that pressure is restored. Although the vessels when 
 in health soon regain their power, becoming even stronger 
 in consequence of the previous repose, yet, when diseased, 
 the immediate mischief resulting from the subsequent disten- 
 tion outweighs the benefit of the repose. It is best, therefore, 
 when treating varicose veins, or the ulcers which they produce, 
 by means of remedies which admit of such course, that the 
 patient should be permitted to rise, or even to walk about 
 during the day. All advantages actually gained under such 
 'urcumstances may probably prove somewhat permanent 
 
 The most powerful, while it is the safest measure for the re- 
 
292 OF VARICOSE VEINS. 
 
 lief of varicose veins, is pressure. This is effected by means 
 of bandages, or adhesive strips. The latter are objectionable, 
 because they irritate the skin, and provoke ulceration. 
 
 In applying a bandage for this purpose it is absolutely ne- 
 cessary that the roller should commence at the very toes, 
 where its pressure should be greatest, and that it should press 
 regularly and smoothly on every part of the limb, up to the 
 summit of the enlarged veins. It is improper that the pres- 
 sure should he very firm at any point; for strong compre 
 continued for any considerable length of time invariably 
 weakens the capillaries so as to occasion at least a temporary 
 enlargement on the removal of the bandage. We think there 
 is even an advantage gained by removing the pressure daily 
 for an hour or two, to accustom the to the force of the 
 
 circulation while the patient is in a recumbent position. 
 
 Practised surgeons generally prefer domestic muslin for 
 making their ban.. B f the hands of the skilful, it 
 
 is applied with gi racy and security -light ir- 
 
 regularities in such a bandage arc often productive of the 
 must serious irritation in consequence of the unyielding cha- 
 racter of the material, it is unsafe in unprofessional bands. A 
 much better article for domestic practice is the common 
 flannel, which is elastic, and slight irregularities in the appli- 
 cation arc, therefore! less important. 
 
 This pressure by bandage must be kept up for many weeks 
 in order to produce any beneficial change in the coats of the 
 veins, and even then, as the principal cause of the disease, 
 namely, the pressure of the column of blood, cannot be 
 moved, there is a very strong probability that the disease will, 
 ere long, return in full force. To prevent this, it is customary 
 to wear a laced stocking of woollen netting or buckskin, which 
 will permanently assist the vessels in supporting the weight 
 of the blood. 
 
 When var'w 1 arc complicated with ulcers of the 
 
 . the latter require a local treatment that will not ink: 
 with the application of the bandage. It is usual, and] 
 lievc, proper to draw the l the ulcers slro; g 
 
 ther by long and broad strips of adhefl iter, until the 
 
 size of the sores is much diminished, or until a diffused 
 ness of the skin and an eruption round the atripi tam- 
 
 ing that the skin is intolerant of the plaster. Over the adhe- 
 sive strips, or if these be not employed, immediately on the 
 sore, we lav a piece of muslin or patent lint spread with sim- 
 ple cerate or basilicon ointment j enough 
 the ulcer. On this, again, we place a thin com; >me- 
 what larger dimensions, and then pi *PPty lne l Vi 
 bandages, The ulcers should be washc 
 
OF VARIOCELE. 
 
 and water every time the dressing is removed] and if the 
 
 ointments be found, after a time, to disagree with them, their 
 surface may be dusted with powdered chalk or the carbonate 
 of zinc, for two or three days; alter which the ointments may 
 be reapplied. 
 
 The attempt is sometimes made to etlect a cure of varicose 
 veins by means of a surgical operation, and partial success is 
 occasionally obtained. Nearly all the superficial veins of the 
 lower extremity are first collected into a few great (rank 
 the inner side of the thigh; and these, again, are finally united 
 into one. The operation of which we are speaking consists 
 in cutting out about half an inch of this single trunk, or of the 
 two or three which immediately form hat when the 
 
 wound is healed, the route of circulation through these veins 
 may he ai blood CO flow through 
 
 deeper channels. It is found that nature, begins to contract 
 the dilated canals as soon as the amount of circulating fluid 
 and the direct pn the whole column of blood have 
 
 been diminished by the operation. 
 
 kocde. — This difl exceedingly common. It 
 
 consists in a varicose condition of the veins of the spermatic, 
 cord; and it ifl narkable that, in nine : ten, the 
 
 left testicle only is effected. The complaint gives rise to a 
 dull, heavy pain or uneasiness about tl. . 1 in had 
 
 . the gland 10 often diminished in size. When varicocele 
 occurs, as it very often n of the i 
 
 moral habits, it will be generally found to disappear sponta- 
 neously after marriage. 
 
 The disease is frequently mistaken for hernia, and this error 
 von been committed by regular medical practitioi 
 though such an extremity of care! ifl hardly credible. 
 
 The deep blue of the enlflu is seen through the .skin 
 
 in sou . and the wormy or knotty and tangled feeling 
 
 of the tumour when rolled between the thumb and finger, 
 are signs sufficient to enable the patient himself to distinguish 
 between this and every other alfection of similar parts. r J nere 
 are, it is true, certain complicated i which it is not 
 
 quite so eas eive the true character of the complaint; but 
 
 these are rare; — they cannot be judged of by the unprofession- 
 al, and, therefore, need not be here described. 
 
 1 ne proper means for the cure of varicocele are simple, 
 and readily practised. Cold bathing, and the local applica- 
 tion of a stream of cold water, are very important measures; 
 and it is advisable, also, to avoid a habit of costiveness, which 
 tends very strongly to increase the disease. General ami free 
 exercise in the open air is highly serviceable, but the remedy 
 on which our main dependence should be placed is a proper 
 
294 OF HEMORRHOIDS OR PILES. 
 
 suspensory bandage, an article on sale at all apothecaries* 
 shops. Unfortunately, however, most of these bandages are 
 miserably mal-constructed. They are made non-elastic in the 
 body-band and thigh straps, which should yield, in order to 
 render the patient comfortable, and elastic in the sac which 
 contains the testicles, where all yielding in the material inter- 
 feres with the special design of the apparatus. These defects 
 are remedied in the best suspensory for varicocele which we 
 have seen. It is contrived by Dr. Heber Chase, of whose 
 trusses we shall have occasion, presently, to speak, and is sold 
 by his agent, Samuel Sheppard, druggist, South Ninth Street, 
 Philadelphia. No doubt it will become generally known and 
 diffused in a short time. 
 
 Some empirics, and certain ignorant inventors or venders 
 of trusses for hernia, have the folly publicly to advertise their 
 instruments for the cure of varicocele; and we have seen ad- 
 vertisements of this character seemingly backed by the fa- 
 vourable opinions of men high in the profession. We can 
 scarcely believe these signatures to be genuine; but, be thi> 
 may, it is our duty to caution those who suffer under the dis- 
 ease against the cupidity of any one who would sell such an 
 instrument for such a purpose* A truss may. and often does, 
 give rise to varicocele, and its application while the disease 
 exists invariably renders it worse. We have no patience with 
 the grossness of these deceptions, having witnessed so much, 
 and such frequent suffering consequent upon them. 
 
 Very numerous surgical operations, and many of them of 
 the severest character, have been performed for the cure of 
 varicocele; but it is much to be feared that great pain, perma- 
 nent evil, and sometimes death, are unnecessarily incurred in 
 this manner. There may be occasional cases of varicocele 
 warranting the use of the knife, but the dif in a vast 
 
 majority of cases, more readily and effectually relieved by 
 measures prescribed above. Varicocele is a source of much 
 inconvenience, and sometimes occasions disgusting deformity; 
 but it is not a dangerous disease, and we should be careful how 
 we institute a dangerous treatment for its relief. 
 
 Of Piles, or Hemorrhoids. — The word pile has been ap- 
 plied to so great a variety of tumours about the anus, differing 
 more widely in their cause and character than in their appro- 
 priate treatment, that it seems necessary to include them all 
 under one general head, in a popular work: and as the two 
 most common and troublesome forms of disease result from 
 dilatations of the venous system, this seems the proper place 
 to introduce the whole subject. 
 
 The term hemorrhoids, or piles, is applied to at least t 1 
 kinds of tumours, situated about the anus, which it i< very im- 
 
OF HEMORRHOIDS OR PILES. 295 
 
 portant to discriminate from each other. The first of these 
 consists of an enlargement, or dilatation of the veins of the 
 part. These hemorrhoidal varices are of a dark bluish colour, 
 soft and elastic to the touch, somewhat resembling ripe grapes: 
 when compressed by the finger, they are diminished, but re- 
 turn to their former state as soon as the pressure is removed. 
 These tumours can be traced far up into the rectum. Their 
 shape is different from that of other piles; they are broader at 
 the base, and rounder. Sometimes they are found distributed 
 in clusters. It is principally this kind of tumour from which 
 proceed the severe bleedings by which the disease is some- 
 times rendered formidable and dangerous. These tumours 
 do not often, like the other varieties comprehended under the 
 same name, admit of excision. 
 
 The second and most frequent kind of hemorrhoidal tu- 
 mours is first seen in the form of small fleshy tubercles, ge- 
 nerally of a brownish or pale red colour. They may be situ- 
 ated either within the rectum, or about the edge of the anus. 
 In the latter case, they are pale, elastic, and have a spongy feel. 
 Their surface is smooth, and their appearance semitransparcnt 
 Sometimes the anus is completely encompassed by the tumours, 
 but more generally they appear on one or both sides, leaving 
 an interval. In either case, the shining and smooth membrane 
 which covers them appears to be continuous with the lining 
 of the lower portion of the bowel, and to possess in a degree 
 the same character. They are often found to contain a cen- 
 tral cavity filled with fluid or coagulated blood, which appears 
 to have entered through the minute vessels. The cavity does 
 not usually exceed the size of a pea; but is sometimes large 
 enough to contain several drachms of blood. Frequently the 
 whole substance of the tumour is infiltrated with bluod, con- 
 tained in canals which have lost their original connexions with 
 the veins, and when this is discharged, by design or accident, 
 it collapses and becomes like a loose fold of skin. These piles 
 often subside spontaneously. When such piles have for some 
 time been subjected to the pressure of the sphincter from 
 above, and of external substances from below, they become 
 harder and more permanent, and form a source of almost con- 
 stant irritation, preventing the patient either from walking or 
 sitting, and causing by their presence an urgency and pressing 
 down, which often occasions actual prolapse of the bowel. This 
 last condition of the hemorrhoidal tumour which has been just 
 described, is commonly called the blind piles, and is found ex- 
 clusively about the verge of the anus; but closely connected with 
 blind piles, and apparently dependent upon an extension of the 
 same morbid actions, arc the caruncular piles or hemorrhoidal 
 excrescences, which are of a more indolent character, and often 
 
2i)C> OF HEMORRHOIDS OR PILES. 
 
 continue when the cause which produced them has ceased to 
 operate. These caruncles are soft and compressible, of a red 
 colour, and frequently attached by a narrow neck to the sur- 
 face of the perineum. 
 
 The third production to which the name of piles is com- 
 monly but perhaps improperly applied, is more decidedly of a 
 warty character than that just described, is found at a greater 
 distance from the anus, and appears to depend on a different 
 cause, as it has no apparent connexion with the veins. It is 
 easily removed by excision, and requires no farther notice. 
 
 The remote causes which produce the two first mentioned 
 forms of piles, are to a considerable extent identical, and are 
 numerous. We have already mentioned the effects of dilata- 
 tion of the anus in producing them, and we may now mention 
 as a frequent cause, a condition precisely the reverse: in 
 lav action of the bowels, arising from I inued eostivc- 
 
 ness in individuals of rather rigid fibre. In th< ■ I the 
 
 rectum itself, and the abdominal muscles which act upon it, 
 arc thrown into the most powerful contractions in order to ex- 
 pel the hardened feces, while the sphincter remains unyield- 
 ing and refuses to act in concert. Hence, on every expulsion, 
 the mucous membrane of the rectum and the v con- 
 
 tains arc caught and detained, and some of the veins strangu- 
 lated by the forcible construct ion of the muscle. This 
 gular action of the intestines is also liable to take place v. 
 any fixed cause of irritation or annoyaiu •• nt in or about 
 
 the bladder. Thus, the presence of Stone within the cavity of 
 the latter organ, or an enlargement of the pi id which 
 
 surrounds its neck, may become a cause of] 
 them if already present Enlargement of the liver, or a i 
 of pregnancy, by causing pressure on the veins of the p< 
 may likewise become a cause of the affection, especially in the 
 varicose form. 
 
 We have already intimated that it is the first of the abort 
 rietiea of hemorrhoidal affection which h d the name of 
 
 bleeding piles. It does not always happen, however, that when 
 the walls of the varicose tumour give \ I ual bleeding 
 
 follows. Sometimes the blood accumulates in the neighbour- 
 ing cellular membrane; and the tumour, in place of diminish- 
 ing, is very greatly increased. In most cases the whole inte- 
 gument yields, ami the bloo forth very profusely. 
 peated accidents of this kind will produc ihaostion 
 even endanger life, and where this is no* the debility 
 consequent on the excessive depletion may bring on dro 
 A less direct, but still serious danger from the blec 
 that by repetition they will become I habit of the 
 tern, which cannot be checked without injuru 
 
OP HEMORRHOIDAL PILES. 297 
 
 Many of the remedies usually employed to arrest hemorrhage, 
 such as cold, pressure, powdered alum, &c, may be employed 
 io these cases, when the bleeding points are accessible; but as 
 the vessels cannot be tied in most cases, and as patients often 
 bleed internally, a surgeon must be called in case of difficulty. 
 Local astringents, with low diet and attention to the regularity 
 of the evacuations, will generally prevent the return of the 
 bleeding. 
 
 In the management of piles generally, however, the regula- 
 tion of the bowels forms one of the most important means, 
 and one which in ils application is found most difficult. The 
 employment of powerful cathartics, instead of diminish- 
 ing, will have a direct tendency to aggravate the affection. 
 If possible, daily evacuations are to be procured by dieting 
 merely, whir it effected by the free use of articles 
 
 •d with oil or molasses. Where this cannot be done, the 
 mildest laxatives must be employed. Sulphur has enjoyed 
 the credit of being a specific in this disease; a reputation which 
 it owes mainly to its power of gently exciting the peristaltic 
 action, and perhaps partly to the fact, that, being insoluble, it 
 descends in substance to th< portion of the intestine and 
 
 expends its force there. 
 
 When the tumours arc highly irritable and inflamed, the 
 treatment is that of local inflammation generally, modified by 
 the particular situation of the part. I should first be 
 
 applied, and the bleeding ence the parts may then be 
 
 ting OV< ;iour of warm water or the in- 
 
 fusion of hops, poppiee,4ic. If the irritation be not thus sub- 
 dued, a poultice will be found to afford decided relief. The 
 tenesmus and straining with which this state is often accom- 
 panied, and which make an ftp to that of dysentery, 
 will generally icr the introduction of some mild sup- 
 pository, as recommended in that i When, by means 
 these, the irritability is subdued, somewhat harsher mea- 
 Diay be resorted to for the dispersion of the tumours 
 themselves. Cold astringent injections and washes, the pow- 
 der of galls or catechu, and the dried juice of the garden ce- 
 lendine (chelidonium ?najus) ointments, made of the same 
 articles, piaster of Paris or fuller's earth, reduced to a paste, 
 and the lunar caustic in substance or solution, have been found 
 useful; but the latter can only be employed safely by profes- 
 sional hands. Frequently, however, all these means fall short 
 of the end desired, which is the removal of the source of annoy- 
 ance, and then the aid of the surgeon must be called in, to re- 
 move the tumour by the ligature or the knife. The choice 
 between these must be regulated by the circumstances of 
 each particular case. The former is the most painful and te- 
 
 3S 
 
298 OF ANEURISM. 
 
 dious mode, the latter is in some cases followed by trouble- 
 some bleeding. The size and form of the tumours, the mode 
 of their attachment, and the general habit of the patient, will 
 be kept in mind by the surgeon in forming a decision. 
 
 Dilatations oj the Heart and Arteries. In our rather ar- 
 bitrary arrangement of subjects, which by most surgical wri- 
 ters are not arranged at all, we can find no better place than 
 this for the introduction of aneurisms and other enlargements 
 of the arterial system. 
 
 Enlargement of the heart is generally if not always the re- 
 sult of some serious constitutional disease, and is any thing 
 but accidental in character. Among the most common causes 
 are rheumatism and disease of the spine. The subject is in- 
 troduced here in order to remove the vulgar impression that 
 diseases, or at least changes of structure, in this important 
 organ are necessarily fatal. The heart may be greatly en- 
 larged, yet under a judicious treatment and regimen, the pa- 
 tient may so far recover as to enjoy general good health to 
 the end of a long life. 
 
 The heart after dilatation may even recover its original 
 dimensions, like any other dilated canal. 
 
 The disease may be recognised by the violent action of 
 the heart; by the frequency of palpitations; by the pul« 
 the heart being felt over parts of the chest where they are 
 not generally perceived; and by a kind of I r rushing 
 
 sound striking upon the ear, when held near to or in contact 
 with the chest. This sound has been compared to the blast 
 of a bellows, and one very similar is heard in large aneur 
 and in hardening of the valves of the heart, as well as in di- 
 latation. 
 
 The treatment of dilatation of the heart must necessarily 
 consist mainly in removing the cause; be it di :)ine, 
 
 rheumatism, or any other disturbance to the nervous pou 
 the organ; but much may be done in some cases, in arn - 
 the progress or effecting the removal of the enlargement, 
 by lessening the force and frequency of the pulse and the 
 quantity of the circu'ati: ends are accom- 
 
 plished by means oi rest, freedom from excitement, the 
 ful use of the lancet, strictly D sod mild diet, and the 
 
 administration of digitalis — a reroi i singular in- 
 
 fluence over the pulse, but unsafe in other than professional 
 hands. 
 
 Aneurisms are large, pulsating, bloody tumours oc 
 by the enlargement or partial ruptu 
 be folly to attempt any particular description of lli - 
 tions, upon which dozens of volumes have been 
 
OF VARICOSE ANEURISM. %99 
 
 fice it to state that the coats of the vessel where the enlarge- 
 ment occurs are, by some cause or accident, diseased or weak- 
 ened to such a degree that they are no longer able to resist 
 the force of the blood as propelled by the heart; and they 
 yield to the consequent distention until they resemble a thick 
 bladder or sac, filled with blood, which goes on continually 
 increasing, unless checked by treatment or by nature, until it 
 bursts, and the patient dies. It seems to be a general law of 
 these enlargements, that the hvpernutrition or thickening of 
 the coats, which is often carried to a great extent, is never suf- 
 ficient by itself to check the disease; but nature aids this thick- 
 ening powerfully f by lining the whole cavity of the aneurism, 
 when it ifl large, with layer after layer of firm coagulum; un- 
 til, in son iry small portion of the cavity contains 
 circulating blood. In a few rare instances, these coagula 
 have been known to stop the extremity of the artery where 
 it enters the tumour; and the disease has been thus spontane- 
 ously cured. Where in aneurism if situated in some internal 
 part entirely beyond the reach of the surgeon, if it has not 
 advanced too far, there is always a little hope that the precau- 
 tions and treatment recommended for enlargements of the 
 heart, may prolong life, under tolerably comfortable circum- 
 stances, lor many years. 
 
 When the aneurism is accessible, as when it is in the neck, 
 on the head, in the arm-pit, groin, or extremities, the 
 should he placed at once in the hands of an able surgeon. The 
 requisite operation consists in tying ted artery between 
 
 the heart and the tumour, by which means the admission of blood 
 through the regular route if , and the contents of tin.' tu- 
 
 mour stagnate and coagula: ) form a barrier against its 
 
 access in other directions. The wails of the aneurism then 
 display the tendency to contract which is common to all ca- 
 nals when no longer employe'!. 
 
 If the patient live long enough, the whole of the coagula 
 may be absorbed, and the cavity may become obliterated. Of 
 late years, it has been found that aneurisms which lie beyond 
 the reach of the knife may be sometimes effectually cured by 
 tying the vessels which lead out of them, instead of seeking 
 those which lead into them. The blood then stagnates and 
 coagulates^;' want of an outlet, as in the former case , for want 
 of supply. 
 
 tlucnrismal ttarix and varicose aneurism are terms used 
 by surgeons to express certain accidents which sometimes oc- 
 cur in the operation of bleeding from the elbow. The lancet 
 is made to plunge entirely through the vein, and into the ar- 
 tery; thus establishing an unnatural communication between 
 the vessels; which may be either direct, from one to the other, 
 or indirect, through a sac formed by effused blood in the eel- 
 
300 OF MOTHER-SPOTS. 
 
 lular tissue between the artery and vein; both these vessels- 
 cpmmunicating freely with the sac. 
 
 This accident is certainly a great misfortune, not only to the 
 patient, but also to the operator, for the latter is generally ru- 
 ined in reputation: a consequence which is not always just; for 
 the accident may occur to the most skilful bleeder, when it is 
 absolutely necessary to apply the lancet to a vein which lies 
 immediately over an artery. In most cases, however, the oc- 
 currence is due to an unusual distribution of the artery of the 
 arm, which the operator has the carelessness not to perceive. 
 The fact that the artery is wounded, may be known by the blood 
 flowing in jets instead of a stead}- stream, and by its very bright 
 colour. Some individuals in very high fevers bleed di: 
 from the veins by jets, but the blood is then of a darker 
 colour. When this accident occurs, the hemorrhage ii 
 strained with some difficulty by the ban ernal 
 
 orifice generally closes, leaving the blood escaping from the 
 artery to flow back by the vein; which latter vessel becomes 
 gradually dilated from the elbow to the shoulder, fornr 
 large pulsating tumour at the site of the wound, and communi- 
 cating a pecui lion of thrilling along the whole route 
 of the vein. The use of the arm is commonly lost. 
 
 A severe and often tedious surgical operation furnishes the 
 only means of relief in this affection. 
 
 Mother-spots, ilncurisms from anax/omosh. We often ob- 
 serve on the persons of young infants, a few red lines branch- 
 ing out from a common centre or interlacing with each c 
 which have been compared by nurses to spi 
 blackberries, crabs, &c, according to certain superstitious 
 judices existing among the vulgar. Though marks somewhat 
 similar may be occasioned by mere slight discoloration* of the 
 skin, yet a vast majority of them arc formed bv cnla: . 
 of capillary vessels; and although a few verv small >; 
 may be found to remain permanently, during life, without pro- 
 ducing material inconvenient . ptions it 
 will be found that the disease extends itself to all the surround- 
 ing capillaries, which soon form a slightly pulsating tunn 
 a bright red or bluish colour, supplied with bio 
 multitude of small arteries which enter it or 
 tumour soon penetrates deeply below the skin, and ad me til 
 intersects much larger blood vessels. Its growth is, in i 
 cases, rather slow, and in others extremely rapid; but, sooner 
 or later, the surface ulcerates, the vessels open, and 
 hemorrhagesoccurfrom time to time until thepatie 
 is exhausted, and if nothing is done to prevent the pi 
 the disease, he dies. These tumours may occur on almost any 
 part of the body. The scalp, , the breast, the 1 
 and the extremities may all be affected; and sometime 
 
OP MOTHER-SPOTS. 301 
 
 tumours occur In the same patient. Some of the most rapid 
 and fatal ones are found on the inside of the under lip; where 
 they arc generally of a blue colour, and roll the lip outward 
 toward the chin. Sometimes, but rarely, the disease com- 
 mences after the patient has arrived at maturity: it is common- 
 ly a disease of childhood, and is generally congenital. 
 
 It is of the utmost importance that the best surgical advice 
 should be sought immediately in cases of this nature, as a little 
 delay may place the disease even beyond the reach of the knife; 
 no matter how young and tender the patient may be, if the 
 tumour display any tendency to increase in size, it must be 
 taken in hand at once. Sometimes, when the tumour is seated 
 on the scalp, the breast bone, or any other very firm part, it 
 may be cured by methodical j with a compress and 
 
 bandage; especially if the patie years of age. The 
 
 contents of the enlarge-' ' being expressed and prevented 
 
 from returning, the vessels become permanently contracted, 
 and the tumour shrivels up and disappears. In other * 
 there are no remedies but the knife or ligature. When the 
 knife is employed, the hemorrhage is tremendous during the 
 cutting, and, if the tumour be large, the life of the patient is 
 threatened. The bleeding arteries are so numerous that it is 
 impossible to tie them as we proceed, as is done in most ope- 
 rations; but the blood ) flow chiefly from the side of 
 the cut next the tumour; for i< markablc fact thai, in 
 most cases, the moment the excision of the tumour is com- 
 pleted the hemorrhage , and there often 
 remain but fc requiring the ligature. The operation 
 should therefore be performed with rapidity. 
 
 The dangers of the knife may be avoided in some cases oc- 
 curring in young children, by a method which, we believe, is 
 claimed by Dr. John Khea 15arton,of Philadelphia. 'I 1 wo hare- 
 lip pins may be plunged in opposite directions beneath the base 
 of the tumour, and left projecting at each end, above the skin. 
 A strong ligature being twisted around the four extremities of 
 the pins, must then be drawn tight enough to arrest the circu- 
 lation in the tumour. If the swelling be very large, this liga- 
 ture may require to be re-tightened a little from time to time, 
 and in a few days, the tumour will fall off. The only objec- 
 tions to this mode of treatment arc, first; that the action of the 
 ligature upon the skin is sometimes, though not always, very 
 painful; and secondly, that it is often difficult to pass the pins 
 entirely beneath the base of the tumour and to bring them 
 again to the surface. The first of these objections is at once 
 outweighed by the security of the operation, when it is prac 
 ticablc; but the second will compel the surgeon to avoid this 
 method in cases of the nature just mentioned; for the conse- 
 
302 OF HERNIA. 
 
 quences of removing a portion only, by means of the ligature, 
 might prove not merely dangerous, but even fatal. The pa- 
 tient might bleed to death from the remains of the tumour, 
 after the ligature has ulcerated off. 
 
 Hernia or Rupture. This dangerous and very common 
 disease deserves especial notice in a popular work; because, 
 even in this country, where it is supposed to be much less 
 common than in some parts of Europe, it probably affects 
 every eighth or tenth individual. 
 
 The walls of the abdomen, where they are formed of ten- 
 dons, are provided with certain passages designed to transmit 
 blood vessels or other parts. Th< ^es are not posi- 
 
 tively open canals, for the coats of the vessels which they 
 transmit are connected with the walls of the passages all around, 
 by a loose and extensible cellular tissue. The pressure of the 
 abdominal muscles upon the bowels, in jumping, lifting, sud- 
 den falls, and all violent exertions of the body, sometimes force 
 a portion of some bowel outward through the pas This 
 
 accident constitutes hernia or rupture. The bowel al ■•■ 
 thrusts before it the peritoneal lining of the abdomen, in the 
 form of a sac, within which the bowel lies. The sac tears 
 away the loose cellular tissue of the passage, and stretches 
 tendinous fibres which surround its outlet. The whole hernia 
 then enlarges into a soft or doughy tumour, according to the 
 nature of its contents, lying beneath the skin and superficial 
 fascia. For some months after the first Appearance of this tu- 
 mour, its contents often return into the abdomen when the pa- 
 tient lies down, and it then disappears entirely. Bui 
 exertion, when standing, tends to force more bowel into the 
 it will soon require some effort with the hands of the patient or 
 an assistant to restore the protruded bowel to the proper 
 ty. This operation is called taxis: and, after t!. uion, 
 
 the hernia is said to be reduced. Hie sac soon forms adhe- 
 sions with the surrounding parts in its new situation, and can- 
 not be returned; it is then said to be irreducible; but this alone, 
 does not prevent the restoration of the bowel. In old i 
 the sac is found to undergo, together with the cellular I 
 and fascia which cover it, those changes produced by hyper- 
 nutrition described at the head of this section, (p. 2S6.) until it is 
 sometimes so thickened as to form a very inconvenient tumour, 
 even without its contents. The bowels now form adhesions 
 to the sac, in some cases, so that they cannot be returned into 
 the abdomen. The patient is then said to labour under I 
 ducible hernia. At all su n from the first occurrence 
 
 of the accident, a portion of bowel is liable to be forced down, 
 so large as to»occasion the tendinous orifice of the canal to bind 
 the protruded parts like a cord : causing them to inflame and 
 
 
OF HERNIA. 
 
 303 
 
 swell; and if the parts are not reduced, this inflammation so 
 increases the firmness of the stricture, that the circulation is 
 arrested, and the bowel becomes mortified. When this stric- 
 ture occurs, the hernia is said to be strangulated. 
 
 The accompanying drawing (fig. 28,) will give the reader a 
 tolerably accurate idea of the several positions in which her- 
 nia usually appears. The figure represents the abdomen and 
 thighs of a man with the skin on one side chiefly dissected off 
 to show the abdominal tendons, and the situation of the prin- 
 cipal canals. 
 
 Fig. 28. 
 
 a, b, represents 
 the inguinal canal, 
 left for the passage 
 of the spermatic 
 cord, which is 
 marked out by two 
 dotted lines, and is 
 afterwards seen de- 
 scending into the 
 scrotum. The cord, 
 while in the canal, 
 and the canal itself, 
 are covered by the 
 thick tendon of one 
 of the great mus- 
 cles of the abdo- 
 men, and, over that, 
 by a fascia, cellular 
 membrane and skin. 
 a, marks a littledot- 
 ted circle which is 
 called the internal abdominal ring. This is formed in a fas- 
 cia which coven the peritoneum, beneath the abdominal mus- 
 cles and tendons. It is the internal orifice of the canal, b, is 
 the external abdominal ring, which is formed by a parting of 
 the fibres of the tendon of the great muscle which covers the 
 canal, and is situated just at the bony edge of the pelvis, g. 
 It is the external outlet of the canal, and lies beneath the su- 
 perficial fascia, cellular membrane, and skin. These parts are 
 the most common locations of hernia in men. Sometimes the 
 bowel presses the sac of peritoneum through the internal 
 ring, «, into the canal. The accident is then called common 
 inguinal hernia. It may happen that the bowel, following 
 the route of the canal, does not reach the external ring, so as 
 •to rise in front of the tendon. It is then termed concealed 
 
JUi OF HERNIA. 
 
 inguinal hernia. Sometimes the bowel, covered by the pe- 
 ritoneum, bursts up directly through the internal fascia, by 
 tearing it, and escapes at once through the internal ril 
 without passing through the canal at all. This case is called 
 ventro-inguinal hernia. In old cases of common inguinal her- 
 nia, the bowel enlarges both rings: drawing the upper one 
 down until they nearly correspond, and the canal is destroyed 
 or rendered perpendicular to the surface. This accident is 
 called direct hernia. In any of these forms, the progress of 
 the disease may cause such an elongation of the sac as will 
 permit the bowel to fall into the scrotum, which, at last, may 
 become so much dilated as to hang nearly to the knee and con- 
 tain the greater part of the contents of the abdomen. Incre- 
 dible as it appears, even the liver, the spleen, the bladder, and 
 the womb, have been occasionally found in hen. 
 
 The line, g, e,f % rcj, he folded edge-of the great 
 
 don which marks the upper boundary of t! 
 be felt stretching from near the pubis to the ; i ominent 
 
 point of the side of the pelvis. Just below . marks the 
 
 spot where the tumour generally appears in femoral hernia; 
 said to be the most common \ I women. The canal 
 
 by which this hernia ei that which g to the 
 
 great blood v< "he se- 
 
 phena vein plunging down to t vein of the thigh be- 
 
 neath, and will give a tolerable idea of the position of 1 
 nal, which lies high up under the fold of tendon g % e.f. — d, de- 
 signates the umbilicus; where the v to and coming 
 from the after-birth, enter and pass out of the foe- 
 tus before birth. The parts around the scar formed by the 
 Killing o(T of the * er quite so firmly pre 
 tendon as those at a 1! t distance; and hence this 
 becomes the seat of a kind of hernia called umbiiiea 
 which is more common in women than in men. 
 
 By kick . tunds, and other acci me- 
 
 times by the growth o( fatty tumours between the fibres, the 
 tendons may be torn or pat 1 the bo . protrude 
 
 at almost any point on the 
 
 do men, constituting ventral hernia. These, and certain in:. 
 varieties which are very rare, require h cal skill, and 
 
 need not be described in a popular work. 
 
 Symptoms and com of strangulation, h 
 
 hernial patient i^ constant); tion, 
 
 and every one who labours under strangulated hernia 
 considerable danger of death, — the symptom 
 extent, the treatment, should be known to al!. 
 occurrence, strangulation is generally mistaken for colic; 
 pt in the severity of the pain at the ring, the \ 
 
.SYMPTOMS AND CONSEQUENCES OF STKANGULATION. 305 
 
 symptoms, for some time, scarcely differ from those of a very 
 bad colic. Almost invariably, there is one loose discharge from 
 the bowels near the moment of strangulation; it is even vio- 
 lent and copious, in some instances; and occasionally, but very 
 rarely, a second follows very soon after. This seems asto- 
 nishing; as, in most strangulated hernia}, the whole calibre of 
 some part of the intestine is so tightly grasped by the ring, 
 that nothing can possibly pass: but in fact, these evacuations 
 come exclusively from the part of the alimentary canal below 
 the stricture; and this portion once evacuated, all farther pas- 
 sages are impossible until the strangulation is relieved. The 
 exceptions to this rule are exceedingly rare; for even when 
 the tight ring embraces only a portion of the calibre of a large 
 gut, or when it grasps the caul or omentum without any por- 
 tion of the intestinal canal, the extreme irritation produced, 
 almost always occasions a spasmodic stricture of some part of 
 the gut, which completely closes its passage; and the spasm 
 will continue, if the omentum be not reduced, until the pa- 
 tient dies. Still there are some exceptions. I have known a 
 large piece of omentum, strangulated in the common inguinal 
 hernia of a young female, to mortify and be thrown out by ab- 
 scess, while the patient continued to have daily discharges, 
 though suffering severely with colic pains. 
 
 Soon after ti gulation occurs, the hernial tumour be- 
 
 comes tender to the touch, and commences to swell, severe 
 pains ire usually felt both at the scat of stricture and about 
 the umbilicus, the latter being often more distinctly paroxys- 
 mal. As the case advances, it* left to run it <•, the tu- 
 mour increases in 1. purple, and 
 livid, while its tenderness becomes continually more marked, 
 and is extended to the abdomen, so that the patient can scarcely 
 bear to be touched on any pari of its surface. Contempora- 
 neously with these local changes, the countenance assumes 
 first an anxious, then a haggard expression; the pulse rises 
 and becomes very frequent, then diminishes in volume and 
 becomes gradually more and more feeble and fluttering; while 
 tomach is affected in succession with nausea, vomiting, 
 hiccough, and finally the discharge by mouth, of fecal matter. 
 
 In protracted eases; — those for instance which have continued 
 from four to eight days; — it is usual for the symptoms, when at 
 their point of greatest severity, to cease suddenly and entirely 
 without any return of the bowel, leaving the patient calm and 
 {vec from pain. This flattering condition of things is the im- 
 mediate precursor of death. It marks the moment when the 
 mass of intestines inflamed by the accident sink into a state 
 of mortification. 
 
 39 
 
306 OPERATION FOR HERNIA. 
 
 It has been alrtady remarked that when nothing but omen- 
 tum is embraced in the stricture, the contents of the sac may 
 mortify and come away without destroying the patient. The 
 same thing may happen even when the sac contains mortified 
 intestine, provided the stricture be relieved and the dead bow- 
 el laid open in time by a surgical operation. When thifl 
 suit takes place, all feces are discharged by the wound, and 
 the patient is said to labour under artificial anus: 
 
 The continuance of life under such circumstances dep 
 mainly upon the spot where the intestine is laid open. If 
 there be length enough above this spot to allow the absorbents 
 or lacteals to take up the greater part of the nourishment con- 
 tained in the food, the patient lives; but if the opening be much 
 nearer the stomach, he dies of gradual starvation! The con- 
 dition of a patient with artificial anus would be such as to ren- 
 der life undesirable, were it not that means have been d 
 
 ■! to enable the surgeon to re-establish the route of the in- 
 testine by creating a lateral passage from one extremity of the 
 intestine, at the wound, into the o! inity. i 
 
 first accomplished by DOT distinguished countryman, the 
 Dr. Physic k, snd h ^swasrcL 
 
 est triumphs of the art. The late M. Dupuytren, of I 
 Dicu, soon afterwards contrived another method of operating 
 for the same purpose; hut a Dr. Lotz, a country practitioner 
 residing in one of the interior counties of Pen. . has, 
 
 by a very happy thought, succeeded in contriving 
 fully employing an instrument wh more 
 
 usefulness than the plans of either of i: surgeons just 
 
 mentioned. Some very ran- esses of artificial I 
 ble without an operation with the knife; but a description of 
 them would detain us too long. The domestic practitioner 
 can do nothing with - 
 
 On the removal rtf stran gula tion by the knij ope- 
 
 ration for hernia, as it is called, consists in making a lor. _ 
 cision through th mmencing an inch or two above the 
 
 neck of the sac, and c\tcr.< lal inches below the neck, 
 
 along the front perl of the tumour. The cellular membrane, 
 and any layers of hich may chance to lie over the sac 
 
 after it has escaped through the tendinous canal, are then di- 
 vided to somewhat less extent; and, the sac being laid bare. 
 some surgeons lay it open and i I 
 
 ing which others - ua/, both pa 
 
 arc right, and merely rtai t: but the 
 
 argument belongs exclusively to I . and mu> 
 
 be opened here. 
 
 The sac being laid bare or open, — may be. the - 
 
OPERATION FOR HERNIA. 307 
 
 geon then thrusts his fore-finger into the tendinous canal as 
 for M the edge of the stricture which binds the bowel and neck 
 of the sac. Then, taking; a narrow, blunt-pointed knife, he 
 lays it flat along the finger, and pushes it past the stricture — 
 entirely into the abdomen if necessary; — and, having entered 
 far enough, he turns the edge up, and divides a few fibres of the 
 strictm in jj; tendon or fascia, in swell a direction as to endanger 
 least the neighbouring arteries. The bowel is then easily re- 
 duced. This is an operation which, varied according to the 
 kind of hernia, has excited more dispute and discussion in the 
 profession khan its importance d md in 
 
 ninety-nine cases in the hiw ned by a tole- 
 
 rable anatomist who has not been i">» much confused by reed" 
 
 ! complexity where no eompi its, li is not at 
 
 ail dai in its own nature, of ad- 
 
 Di between the 1 . PO old and firm as 
 
 to prevent a pi from distinguishing between them. 
 
 true that in opening the tee, the knife has been known 
 to burst into a mortified in! but the sooner Mich an ac- 
 
 cident happens, ii cmn happen^ the better for the patient. 
 
 Ac to find on record a case of death from the 
 simple effect of the operation for strangulated hernia; yet it is 
 not entirely without its ten ung practitioners; for there 
 
 A formidable accidents which occasionally happen 
 during or after ti lion, to which all are alike liable 
 
 ikilfal or d op- 
 
 portunity | n to ruin a 1 g by s 
 
 _ of the >houlder; and the public should be upon its guard 
 ich interested pi which are nut wholly un- 
 
 known even in t;, .1 of professions, 
 
 It will i er makii Jit of an operation 
 
 lered among, the most da. \ how it happens that so 
 
 a portion of the p ited upon, die within a few 
 
 iformanccl The Though the 
 
 operation for hernia is not dangerous, yet the complete- stran- 
 gulation of a bowel even fur a tew boil eedingly dan- 
 Lnding law of the profession that the knife 
 should not be employed until all other reasonable means of re- 
 duction b tried and failed. The operation is scarcely 
 ever performed in less than twelve hours after strangulation; 
 seldom, in less than twenty-four hours; and not very un fre- 
 quently, at still later period*. The j^easonuljle measure* to 
 which the bowel is subjected during these intervals, will be 
 clear to the reader after our remarks on reduction. They are 
 such that if the stricture be not pretty nearly complete, they 
 must restore the bowel; and the patient almost always reco- 
 
308 DEDUCTION OF HERNIA BY TAXIS. 
 
 vers, if this be effected in a very few hours: though even the 
 partial pinching, in more protracted cases, sometimes brings on 
 inflammation and death after reduction. Now it is clear that 
 the cases operated on at twelve, twenty-four, thirty-six hours, 
 &c, are generally cases of nearly complete, and sometime 
 quite complete strangulation of twelve, twenty-four, &c. hours* 
 duration. It is impossible that a complete strangulation, (i. e. 
 one which arrests the circulation,) could continue for even six 
 hours without producing the destruction of the life of the 
 el. It is even very singular that a nearly perfect stricture 
 should exist twelve hours or longer, without producii 
 least a fatal inflammation of the strictured part. The reader 
 may now judge how little the operation has to do with the 
 death which so often follows. 
 
 Dozens of lives have been and still continue to be sacrificed 
 by the delay of this operation, from idle fears, which might 
 be saved by a little more promptitude in performing it. 
 
 Treatment of strangulation Inj tau ction. The 
 
 moment strangulation occurs, a good surgeon should be sent 
 for, if possible; but as this is not always the case, not a mo- 
 ment should be lot (I iends, in attempt- 
 ing reduction before the arrival of I The pal 
 should undress, and lie on his back in bed. The affected part 
 should be thoroughly shaved. If the hernia be not extremely 
 large, and old or irreducible in its character, the following 
 course should be pursued. The head and shoulders, as well as 
 the pelvis, should be strongly i The thighs 
 should be completely bent, and the heels drawn up high in bed. 
 If the hernia should be located in the groin, the thigh on the 
 affected side should be most elevated, and should also be car- 
 ried a little across its fellow. The patient should now 
 dily endeavour to return the bowel by the D which he 
 may have found generally - I in his own ease. Tl 
 efforts may be continued for half an hour; when, if ineffectual, 
 and if no surgeon have been procured, other B 
 be pursued by a highly intelligent assistant. The patient, if 
 vigorous, may be freely bled from the arm, and the cl 
 local applications may be made. When ice cannot be procured, 
 the powder of muriate of ammonia thrown into water, may be 
 used, to produce intense cold. Whatever article is employed, it 
 should bo done faithfully: the only precaution i 
 avoid the actual freezing of the tumour. While this cold is 
 being applied, it is sometimes useful to place one or two heavy 
 smoothing irons upon the hernia; lor we have repeatedly 
 the reduction happily effected under the steady pressu: 
 such instruments, without the aid of ha: ouioe 
 
RETENTION OF IIEUNIA BY TRUSSES. 309 
 
 the cold for full half an hour, the patient or assistant should 
 again attempt the reduction. If still unsuccessful, the cold 
 should be continued; and if there be much disposition to in- 
 flammation about the part, leeches may be applied over or 
 round the neck of the sac. A powerful injection of senna 
 tea and salts, will sometimes do essential service by calling 
 strongly into play the peristaltic action of the lower part of 
 the alimentary canal; and the smallest escape of feces from 
 the strictured bowel will often pave the way for the reduction 
 of large and obstinately strictured hernia:. The taxis should 
 be renewed every half hour; and great care must be taken to 
 act steadily, regularly, and patiently, covering as much as pos- 
 sible of the tumour with the hands, and avoiding any severe 
 i|)on one spot. The kneading, punching, ami violent 
 thrusting frequently resorted to by I and inexperienced 
 
 practitioti' \tremely da: tg nd may deploy th< 
 
 tienteven after the reduction it accomplished With apparent suc- 
 The direction of the pressure may be changed a little from 
 side to side to advantage, and requires to be varied with the 
 kind of hernia, and its route of escape* Details on this sub- 
 ject cannot be given here, but we would J advise I 
 director of a large manufactory, mining concern, or planta- 
 tion, as well as every preceptor of a boarding school, to make 
 himself somewhat acquainted with the anatomy of the ingui- 
 nal femoral canals, in order to become more capable of 
 
 dness to those under his control, o the 
 
 ting room, with a small fee to th r. would put 
 
 him in possession of the desired information. We might con- 
 tinue the subject of redaction through much -pace, 
 tC mention the very numerous ten ■ommend- 
 edj ami occasionally i mployed, by various practitioners; but it 
 is believed that the directions already given, are all that can 
 be at once safely and usefully followed by the domestic prac- 
 titioner. 
 
 It may be well, however, to remark that strangulation in 
 very old or irreducible hernia?, is less frequently attended with 
 fatal consequences. Spontaneous reduction not unfrcquently 
 
 place in large old hernia: alter strangulation has e\ 
 for several days. Where- the local inflammation in ti 
 is not vci . in addition to measures in aid of texts, 
 
 as recommended above, the best effects often result from giving 
 an active purge of oil or senna; remedies which might be very 
 dangerous in more recent 
 
 Retention <>f hernia by trusses — Radical cure. The truss, 
 and its use in retaining the bowel in hernia, are too well known 
 to require particular description, lint the proper construe- 
 
310 RADICAL CURE OF HERNIA BY TRl 
 
 tion of trusses has been shamefully neglected, until recently,, 
 by the profession; being thrown entirely into the hands of in- 
 strument-makers and pretenders, whose continual changes, and 
 improvements, — so called, — have rendered it difficult to num- 
 ber the modifications: yet until within the last three or four 
 years, no instrument had been invented equal in usefulness to 
 the old-fashioned common truss invented before any of them. 
 None of the trusses invented before the year 1S34, were en- 
 tirely dependable in retaining even the common inguinal her- 
 nia completely and permanently. The bowel would occasion- 
 ally descend, in defiance of the care of the patient, and the 
 truss itself became a source of danger by its action on the 
 bowel. Humanity is indebted to Dr. Hebe: of Phila- 
 
 delphia, for the invention of a complete series of trusses adapted 
 to each variety of hernia, and all the complications of several 
 varieties occurring in the same individual; whi.ch instruments, 
 after they are once properly adjusted, are capable of retaining 
 the bowel with absolute certainty, under all the exertions re- 
 quired even by laborious prol 
 
 But this ii not all — It is found that this certainty and per- 
 fection of retention enables the pt i.ature to contract 
 the passage in the mam ribed at I of this sec- 
 tion, (p. 285,) so that after the tru^> has been worn from nine to 
 eighteen months, the patient generally finds himself radically 
 cured. Wc believe that this result will take place in no: 
 than nine-tenths of the cases occurring in persons under fifty 
 years of age, and in ■ fair proportion of cases later in life. 
 
 One of the principal operativ as of Philadelphia, re- 
 
 marks that the number of cases of strangulated hernia h. 
 minished astonishingly since the introduction of these instru- 
 ments. 
 
 Unfortunately, they positively require to be adjusted and 
 applied in the first instance, by | on who has taken the 
 
 pains to study their use and construction — and as such a 
 one is not always procurable, it will be frequently i 
 to resort, temporarily, to other com :i recom- 
 
 mend none better than a broad, firm bandage round the b 
 and a thick compress over the navel, in umbilical hernia; the 
 old-fashioned common truss in inguinal hernia: and in femo- 
 ral hernia, wc scarcely know what to recommend. A 
 of a number of ordinary trusses may perhaps enable the pa- 
 tient to seize upon one which may support the bowel tole- 
 rably well, but no instrument expressly applicable to 
 form of the disease was even in use prior to the inventu 
 Or. Chase's femoral truss. This inventor published ■ 
 on the radical cure of Hernia by Instruments in 
 
CURVATURES OF THE SPINE. 311 
 
 replete with information designed for the use of patients and 
 popular inquirers, to whose attention we would strongly re- 
 commend it. 
 
 SECTION III. 
 
 On Deformities from Imperfect Nutrition of the Osseous 
 and Muscular System* 
 
 Under this head wo may treat of two classes of affections 
 which demand some notice in a popular woik: namely, curva- 
 tures of the spine, and club-f< 
 
 Of curcu tu res of t lie spine. These deformities occur from 
 a great variety of C*U8e8, of which a considerable class are 
 connected with an exceedingly depraved condition of the con- 
 stitution, sometimes scrofulous, sometimes cancerous, some- 
 times syphilitic, &c. These difl -lerally result 
 from accidental weakness or unfavourable circumstances sur- 
 rounding the individual ; occasionally, from hereditary peculi- 
 arities of the race ; as in the case of the Cretins; and now 
 and then, they plainly fall upon the innocent child, as the bit- 
 terest of all tl - of Providence upon the errors of the 
 parent. The grave easel to which we allude are Chose which 
 produce serious alterations of structure in the bones of the 
 ■pine, and sometimes the entire destruction of the bodies of 
 some of the vertebras. Such cases generally occur in 
 childhood; though they ate sometimes produced by accidents 
 at an advanced age, in perSOUS of SCTOfuIo llty habit 
 This character is recognisable at once, by the severity of the 
 inflammatory and febrile symptoms which mark the com- 
 mencement of the deformity, and recur frequently during its 
 continuance. 
 
 Every thing in the treatment of these terrible affections, 
 must be made to depend upon the skill and faithfulness of a 
 superior surgeon; for madness only could induce the tamper- 
 ing of unprofessional hands with cases of such a character. 
 Unfortunately, but very few, even among American surgeons, 
 have given particular attention to this subject — partly on ac- 
 count of the rarity of the disease in this country, and partly 
 because most of the cases occur among those whose extreme 
 poverty reduces them to an absolute dependence upon politi- 
 cal, or governmental charity; which, boastful as it always is, 
 but seldom furnishes the means for a long and expensive 
 course of treatment in a chronic disease. Our hospitals, which 
 are mostly private charities, reject these protracted cases very 
 
312 CURVATURES OF THE SPINE. 
 
 properly; because they would occupy a portion of a limited 
 space to a disadvantage, and exhaust contracted funds which 
 would effect much more good in curing acute and rapid dis- 
 eases. 
 
 The practitioner, being thus cut off from the experience 
 which might be obtained from the treatment of masses of 
 cases in hospitals and alms-houses, necessarily approaches the 
 few scattered patients of a richer order, in his private practice, 
 without the necessary lights. 
 
 Unfortunately, the indisposition of the profession to grapple 
 with these more serious diseases of the spine, has induced a 
 neglect, also, of those vastly more numerous and milder curva- 
 tures which result simply from relaxation of the ligaments, 
 and deficient tonicity of the spinal muscles. 
 
 Of late years, a few practitioners of real merit have given 
 much attention to this subject, and the public faith in empi- 
 rics and pretenders begins to be on the decline. But the ap- 
 paratus which is useful, if not essential, to the proper treat- 
 ment of these deformities, when considerably advanced, is 
 complex, anil too expensive for the means of private families 
 and general practitioners. In Europe, such cases are referred 
 to privc institutions called X; — and although an 
 
 unreasonable and groundless pride, too commonly lead- 
 aspiring surgeon in this country to avoid confining his atten- 
 tion to the treatment of any one special 
 under the erroneous idea that such a course is calculated to 
 lessen his professional respectability, yet we arc not without 
 hopes of seeing Philadelphia provided with a respcetab!- 
 ihopedic Institution. Till then, let us lay down the rules 
 which may be safely followed by parents an<; 
 10g the progress, or in removing the appearand | de- 
 
 formities. 
 
 Curvatures of t lie spine from relaxed ligaments and weak 
 muscles, usually occur in your, _ I approaching Lhe _ 
 
 of puberty, and thi number than 
 
 boys. The rich and luxurious are most liable to such curva- 
 tures, but they are seen in many oi the children of the poor. 
 It is observed that, in a vast majority of cases, the left shoulder 
 hangs lower than the right; and in females, the dress habitual- 
 ly slips from the former. This is the circumstance which 
 first calls attention to the deformity; but it is by no no 
 the first in the order of morbid changes. The criminal indul- 
 gence of fondness for cakes, sweetmeats, and rich ; 
 young and rapidly growing girls, deprives them of their appe- 
 tite for animal food, which furnishes the most powerful nou- 
 rishment to the muscular system. The otions enter- 
 tained among the wealthy, with regard to propriety and e\ 
 
CURVATURES OF THE SPINE. 313 
 
 rum m female children, cut them off from almost every 
 opportunity of giving; active exercise to the muscles, and 
 ■especially to those of the back, which, therefore, rapidly lose 
 their tone, as will all organs when habitually unemployed. As 
 if these sources of mischief were not sufficient to render the 
 sex sufficiently delicate, or, to speak more correctly, crippled. 
 Fashion comes in to the rescue, with her stays and corsets, to 
 improve God's image according to her ideas of beauty and 
 symmetry. Bound up in steel or hickory, whalebone, and 
 firm cloth, the unfortunate spinal muscles have so little chance 
 of employment, that too frequently they become shrunken, 
 pale, flabby, and dropsical; the same results being also extend- 
 ed to the ligaments. There then remains scarcely any sup- 
 port to the spine; which, being a long narrow column com- 
 posed of twenty-four distinct parts, must bend in some direc- 
 tion, if unsupported by mechanical contrivances, the moment 
 the body ! - perpendicularity, as it must do even in 
 
 taking a single step. 
 
 The mal-arrangement of habits and attitudes at school, are 
 admirably adapted to give the greatest possible effect to these 
 causes of deformity. Indeed, it seems to be held essential to 
 the proper worship of the Divinity, and the successful prose- 
 cution of learning, that the body should be subjected to phy- 
 sical torture, to promote the due exercise of the mind — wit- 
 ness the perpendicular walls ol" pews, the backless bene! 
 lecture rooms, and the isolated stools of our seminaries. The 
 human spine cannot he held erect, except by a continued mus- 
 cular effort, and no spinal muscle will endure half an hour 
 of conslant exertion, without becoming completely exhausted: 
 when weakened in the manner above described, it cannot 
 act for ten minutes without n If the feeble victim of 
 
 spinal curvature should attempt to relieve herself by reclining, 
 during the long and unreasonable sessions of the schools, — her 
 seal being unprovided with back or arms, and her right hand 
 almost constantly employed with her book or papers, — she 
 can only accomplish her purpose by leaning with her left 
 elbow upon the desk; and the constant resort to this practice 
 increases the deformity of spine, by weakening still more the 
 muscles which support the left shoulder, and by producing a 
 twisting of the vertebrae, which complicates the curvatures. 
 The ill effects of this attitude have been so frequently men- 
 tioned in popular works and lectures, that preceptors general- 
 ly endeavour to prevent their pupils from assuming it — 
 
 " Don't lean on your desk, Miss ■ ! sit up straight, and 
 
 hold your shoulders back, or you will grow crooked!" — Such 
 is the usual order; now look to the consequences! The up- 
 right position of the spine being altogether insupportable for 
 
 10 
 
314 CURVATURES OF THE SPINE. 
 
 more than a few moments, the child endeavours to relieve 
 herself by bearing her weight upon one hip; and, as in most 
 persons, the right upper extremity, and the left lower extre- 
 mity are naturally stronger than their fellows, it is usually 
 upon the left hip that the patient sits. This attitude com- 
 pels the child to incline her body toward the left side, to 1 
 about the proper equilibrium. The weight of the whole up- 
 per part of the person then bears upon the inclined lumbar ver- 
 tebrae, which are much more moveable than those of the back, 
 though they suffer less pressure: consequently, as the weak 
 and tired muscles soon cease to give any effective support, the 
 former bones tend continually more and more to the left, un- 
 til the ligaments which connect them are put upon the stretch, 
 and the balance of the person is again destroyed by the weight 
 of the head and chest. This o ic sufferer to turn the 
 
 upper part of the person to the right, by voluntary effort* to 
 recover the equipoise. The two or three lower lumbar verte- 
 brae preserving their inclination to the left, the remainder are 
 now brought back toward the middle line; and the lower dor- 
 sal vertebrae, being compelled to partake in the same change 
 of position, the le rmed into a bow, 
 
 with its convexity looking to the left. When the patient re- 
 clines in bed. the bones, for some time after the commence- 
 ment of the case, slowly resume their natural position; but 
 the daily repetition of the same causes continually incr 
 the deformity, until the weight of the head and should' 
 thrown too far to the right, and continual efforts are made to 
 restore the balance by carrying them again to the left. 1 
 the firmly knit dorsal arc forced gradually to j 
 
 to these efforts by the extension of their ligaments, and the 
 spine of the hack of the chest is formed into one great bow, 
 with its convexity turned to the right. This occasions the 
 left shoulder to droop, ind - the right one very promi- 
 
 nent. The ribs on the latter side are separated from each 
 other, while those on the former arc made to approach more 
 nearly together. A repetition of the same pro- 
 
 duces a similar bending of the spine of the neck, in the oppo- 
 site direction, corresponding with that in the lumbar n z 
 
 Such is the history of the formation of the most coir,: 
 form of lateral curvature of the spine — a deformity exist i : g 
 greater or less in nearly two-thirds of the ft 
 
 refined life. At the commencement the patient can render the 
 spine straight for a few mome most immediately the 
 
 body falls, and the curves are reproduced. When the deformity 
 continues slight until the patient has reached mat;, 
 it generally remains stationary ever aflerw. 
 
 The curva* described being once commci\ 
 
CUBVATURES OF THE SPINE. 315 
 
 evident that the weight of the body must act as a constant 
 force, tending to increase their convexity; and that the irregu-r 
 Jar action of the weakened and displaced muscles, must fre- 
 quently assist in producing the same evil. From this con- 
 stant increase of curvature there results, in certain bad cases, 
 a series of changes of a formidable, and sometimes highly 
 dangerous character. The ribs on the side corresponding 
 with the convexity of the dorsal portion of the spine, are se- 
 parated more and more widely from each other, while those 
 corresponding with the concavity, are made to touch, or even 
 overlap each other; sometimes they even become united by 
 bone. The bodies of the vertebras become wedge-shaped bv 
 their pressure upon each other, and the position of the 1 
 bone is seriously changed. The consequences of these various 
 change* of form, acting on I i i and the health, need 
 
 not be dwelt upon; but fortunately, so long as the suspension 
 of the body on the arm-. nsion by the shoulders 
 
 and feet, produces any visible diminution of the curves or 
 lengthening of the body, the case remains, in a great degree, 
 or wholly curable — and if the attack have not been preceded 
 by fever or much local pain in the spine, a great deal of good 
 may be done by the domestic practitioner, in the absence of 
 more scientific ad\ 
 
 —The indications to be fulfilled in the domestic 
 management of these . Brat, I the whole 
 
 omlly, to 
 the bulk and strength of the muscles of the spine bv 
 . local applications and repc 
 
 I ried to such an extent as to produce 
 exhaustion. The debility of the patient will of; r her 
 
 table of (Talking any considerable distance; and the pas- 
 f riding, with the more active amusements of 
 bathing and swimming, if ladies may be supposed to swim in 
 America as they do in Europe, are among the most beneficial 
 efforts. The patient should never be permitted to sit, with- 
 iilicient supports on every side, to be used when desired. 
 A cushioned and armed rocking chair, with a sloping back, (not 
 concave longitudinally.) is most convenient on ordinary oc- 
 casions, ami a similar chair without rockers, while pursuing 
 studies. As the time spent in the study and the carriage cannot 
 be employed in exercising usefully the muscles of the spine, it 
 is best that they should then be kept in as perfect repose as pos- 
 sible; and this is best effected by a well made corset, calcu- 
 lated to support the figure as nearly in the natural position 
 as possible. 
 
 The use of tonics must be managed with some caution, and 
 
316 CURVATURES OF THE SPINE. 
 
 whenever febrile symptoms appear during their employment, 
 they must be omitted for a time. The prescription which we 
 have found most generally efficacious, is as follows: — Direct 
 the patient to take a dose of five drops of the muriated tinc- 
 ture of iron, in a wine-glass half full of water, on the morn- 
 ing and evening of alternate days; and on the intermediate 
 days, let her take a wine-glassful of a mild infusion of gentian, 
 columbo, or quassia, on an empty stomach, twenty minutes 
 or more before each meal. If the remedies occasion costive- 
 ness, this may he corrected by an occasional Seidlitz powder. 
 The muriated tincture of iron appears to have a peculiar e 
 in giving firmness and colour to muscular fibre. 
 
 The diet best calculated to increase the bulk and tone of 
 the muscular system, is one composed chiefly of the flesh of 
 full grown animals; such as beef, venison, wild ^nme, mutton,. 
 fltc., but especially beef. The meat is I 
 on the gridiron, and dl I plainly and 
 
 of the patient will allow. Some have, unlbrtui. 
 dislike to beef, and it is nc< avoid pi 
 
 IDg patients to partake of what is decidedly disagreeable ei- 
 ther in kind or quantity. Pork is inadmissable in all forms. 
 
 Local applications to increase the tonicity of the spinal 
 muscles, often produce very important effect* 
 in the morning and after retiring for the night, th ould 
 
 be well rubbed from end to end with a flesh brush; for which 
 may be substituted, every three or four days, frictions with a 
 rough towel, wet with a saturated warm brine: care being 
 taken to dry the back perfectly, after the operation, and to l 
 the patient strictly against cold. Extending the application 
 of the flesh brush in a more gentle manner to the rest of the 
 surface is often very beneficial. 
 
 But the most important and difficult part of the treatment 
 is the graduated i mil repose of the spinal mu* 
 
 The use of an organ without over-tasking its actual power, in- 
 creases iis strength ai. itiguing an ( 
 quentlv, we weaken it. The incn _h. and actual 
 growth of an organ, under . do not take place during 
 the exertion, but afterwards; and they arc much promok 
 absolute repose in the intervals of exertion. 
 
 The exercise of the spinal muscles, while the weight of the 
 person is pressing down on the spinal column in a stale of con- 
 siderable curvature, is calculated to increase the c id re- 
 pose, however absolute, in the upright position, is also calcu- 
 lated to increase the evil. Such are the principles which should 
 guide us in our practice. 
 
 Let a suitable dry garret or chamber be - where a 
 
 fire may be lighted when required. Into one of tin 
 
CURVATURES OF THE SPINE. 317 
 
 beams of the ceiling, secure very firmly an iron staple, from 
 which suspend a rope terminating in a ring or eye, a little 
 above the height of the palm of the patient's hands when held 
 up as high as possible while standing on tip-toe. In this ring, 
 secure crosswise a round wooden slick, two feet six inches 
 long and one inch thick. Cover both ends of this stick with 
 buckskin. On the floor immediately under the suspended 
 rope, place a light stepping block, nine inches square and four 
 inches thick. The apparatus is then ready for use. 
 
 in hour after bre tl every evening, 
 
 two hours after dinner, the young lady. u I, should 
 
 step upon the block, and seizil Slick with her 
 
 the block a tew inches to one side with 
 .villi her toes upon th The exercises 
 
 it, at first, part or the whole of the weight 
 
 of the body by the arms, according to the strength of the pa- 
 tient. This is done at once by simply bending the k 
 The weight of the pelvis ami lower limbs then acts as an ex- 
 tending force, and strai I and lumbar curvatures 
 of the spine. At first, the debility of the patient will often 
 put a stop to i :i in half a minute; but when I 
 tomed to the l will be able to continue it for I: i 
 ten minutes at a time. When the arms and anl 
 the lb fled with the tip of the to 
 
 itient m pari of her 
 
 t upon the c When sufficiently rested, the 
 
 1, but it must never be carried so 
 s to lead to j . ie. 
 
 r the patient has acquire I h sufficient to support 
 
 ight f«>r some moments, without touching the 
 
 floor with her ml co- 
 
 ly throwing the pelvis and 
 limbs backward and forward, and also from side to side, all the 
 l of the back of the spine will be called into active ex- 
 ertion in a manner calculated to increase their power, while 
 the curvatures are undergoing an actual extension. These cx- 
 s may be continued longer and longer from week to week, 
 and must be pursued steadily 1 1 months, before much 
 
 permanent benefit can be expected. 
 
 The moment the exercise is finished, the patient should be 
 conveyed to bed; a good feather bed, not too thick, and laid 
 on a well tightened sacking, being preferable to a mattress. 
 1 'here she should repose upon her back for one or two hours, 
 according to her degree of feebleness. The corset may then 
 be applied, and she may be permitted to rise. 
 
 When the patient has so far recovered by the general and 
 local treatment above recommended, that the curvature of the 
 
318 HAE1T OF STRAINING. 
 
 back is but slightly perceptible, she may take part to adran~ 
 tage in active exercises and amusements without suspension, 
 and among the most useful of these are the plays of battle- 
 door and shuttle-cock, and the graces. The former should 
 be played chiefly with the left hand. Dancing, jumping the 
 rope, and the oft prescribed but highly injurious exertions 
 of waxing furniture, and making beds, should be scrupulously 
 avoided until the increased age of the patient assures us that 
 the existing condition of the spine has become permanent. 
 Nearly all cases of the kind under consideration are curable 
 if undertaken before the age of seventeen, and most of them, 
 if bad, remain nearly unchangeable after the age of twenty. 
 
 Before quitting entirely the subject of curvature of the spine, 
 it is right to mention that it is very common, for both young; 
 ladies and young gentlemen, to contract a habit of bending the 
 head and shoulders habitually forward, until tire back becomes 
 arched, the shoulders rounded, and the head has a confirmed 
 stoop. This exceedingly ungraceful defect is often i 
 worse by the means used to eun tiff collars, and Mi- 
 
 nerva braces; which, by relaxing the muscles of the back, cause 
 the spine to be much more arched, the moment they are re- 
 moved. This defect of figun J corrected by fitting to the 
 head a cap with a long cord attached to its front margin, which 
 may be passed over a pulley attached to the door or mantel- 
 piece at about the height of the pat freight I 
 veral pounds being fixed at its extremity, the patient, while sit- 
 ting or standing, amuses himself in drawing the weight up and 
 down, by causing his head alternately to advance toward, and 
 retreat from the pulley. Another method consists in wearing 
 a cap or calash with a padded crown, ami reclining repea: 
 everyday, for as long a time as possible, with the back of the 
 head against the wall anil the feet thrust forward one. two, or 
 three feet upon the floor, according to the strength of the pa- 
 tient. This inclined position o( the person causes the weight of 
 the body to rest upon the back of the head and feet alone, ami 
 the extending muscles of the spine must exert themselves pow- 
 erfully to prevent the patient from sinking toward the floor, 
 which exercise rapidly increases the!; h. Rov 
 working with the cross-cut saw. climbing hand over hand, 
 are athletic occupations well calculated to cure the most obsti- 
 nate stoop. 
 
 Of Club-foot. We shall say but a few words on this | 
 ject, for it is doubtful whether any degree of ingenuity in the 
 domestic practitioner will enable him to be useful in the treat- 
 ment of the deformity. Vet as most cases are curable if taken 
 in hand before the children are five years old. It would be wrong 
 to let the occasion pass without impressing 00 parents tlu 
 
OF FRACTURES. 319 
 
 cessity of seeking good surgical advice in time; cautioning them, 
 at the same time, against the boasts of mere instrument ma- 
 kers and empirics. 
 
 In club-loot, the bones of the leg are sometimes defective 
 in form, one or the other being too short at the point, or they 
 are dislocated from each other before birth, the outer ankle 
 bone (fibular malleolus) sliding behind the great bone of the 
 leg, (tibia.) These accidents sometimes give rise to the com- 
 mencement of club-feet, but in many cases the ankle joint, 
 properly so called, is very little disturbed, and the chief amount 
 of change takes place by the twisting and overturning of the 
 bone of the heel, and a revolution among the bones forming the 
 articulation which rims across the instep. In most cases, the 
 outer edge of the foot tends to rest on the ground; the instep 
 looks outwards and the sole inward, while the toes are drawn 
 upward; and, in many instances, their backs may be laid, by the 
 hand of the nurse, straight up along the leg! Sometimes, but 
 very rarely, the deformity is in the opposite direction, and the 
 foot rests upon its inner edge. Again, not unfrequently. the 
 heel is drawn forcibly upward, and the toes pointed downward 
 so that the patient walks on the latter, and the former can ne- 
 ver approach the ground. 
 
 Now as scarcely any two cai in the nature and ex- 
 
 tent of the deformity, which frequently extends even to the 
 knee and hip joints, it follows that the forces required to re- 
 store the bones to their places must be almot ioua in di- 
 rection as the • in number; hence it would be folly to 
 place the treatment in unprofessional hands; but as nearly i 
 case is curable if taken in time, it would be criminal to Buffer 
 the deformity to be neglected, even during the first months of 
 infancy, when surgical advice is accessible. 
 
 section iv. 
 
 Of Fractures. 
 
 Our remarks on fractures must necessarily be general; for in 
 a small portion only of these accidents can an unprofessional 
 person safely undertake the treatment, even in the absence of 
 a surgeon; yet, as there are many ways in which such as 
 ants may be useful in promoting the welfare of the patient 
 when no surgeon can be obtained, some little history of frac- 
 tures, and a few special directions for the management of 
 such accidents, are deemed proper in this place. 
 
 It is a very popular prejudice that much depends, in frac- 
 tures, upon the first setting of the bones; and it is not uncom- 
 
320 or FRACTURES. 
 
 mon when one practitioner has wound himself into the care 
 of a case belonging originally to some younger but better in- 
 formed surgeon; (adishonourable trick which we have seen more 
 than once performed in country practice by those who, like a 
 certain venerable friend of ours, have founded forty years of 
 lucrative practice on no better diploma than an old title deed 
 of land, written in Latin, and on parchment in olden times;) it 
 is not uncommon, we say, under such circumstances, for the em- 
 piric to charge deformity arising from his own want of skill to 
 the careless setting of the regular practitioner at the commence- 
 ment. Now be it known that extreme accuracy of the first, 
 ay! and the second, and third settings of a fracture, (for most 
 cases require many re-settings.) is a matter of comparatively 
 little importance! In fractures near a joint, indeed, great care 
 and accuracy may be required at the very first; for the swell- 
 ing produced by the accident is very apt to destroy all after- 
 chance of action until too late : but these cases form a vcry 
 small minority among fractures, nine-tenths of which proba- 
 bly occur somewhere near the middle of a long bone. 
 
 Let us not be misunderstood — It is of the utmost import- 
 ance, in fractures of the extremities, that we should brin_ 
 limb to its full length as soon >le after the accident, 
 
 and keep it so; for every hour of overlapping between the : 
 ments permits of a more and more obstinate contraction of 
 the muscles, which always struggle to shorten the limb, 
 oppose the correct setting. The overlapping, if permitted to 
 continue for some days, produi all the surround- 
 
 ing parts, preparatory toe fleeting a union of the fragmei 
 their false position; and when those fragment! arc alterv 
 drawn nearer to their proper pi - arc rend 
 
 useless, and new or.es are demandc the cure of a frac- 
 
 ture is always a serious tax on the powers of the system, and 
 this needless additional taxation of these powers endangers the 
 production of a weak bond of union, or a false joint. But if 
 the limb be of a full length, a little sliding of a fragment 
 to the right or left, or even a considerable angular de- 
 formity at the seat of fracture, is of scarce any importance 
 until after the expiration of two weeks. The whole of this 
 period is occupied by nature in swelling and developing the 
 periosteum for many inches above and below the fraetur 
 distending its cells with effused fluids, to permit its little 
 sels to expand freely and carry red blood; in filling the cells 
 of the surrounding cellular tissue and expanding Is in 
 
 the same manner; in absorbing the medullary matter from 
 flie ends of the fragments, the colouring matter from the 
 coagllla formed by the accident; and in forming little canals 
 through the latter, to permit of the growth of cellular tissue 
 
FRACTURES OF THE CLAVICLE. 321 
 
 to act on their interior. After all this is done, say from the 
 end of the second to the middle of the third week, the blood 
 vessels begin to fill the cells of all this mass of prepared tis- 
 sue, first with a substance resembling cartilage, and then with 
 bony matter. It now becomes truly important to set the 
 limb with accuracy, and to keep it perfectly motionless until 
 firmly united. In about five or six weeks in young, healthy, 
 and sanguine patients, and in from nine to twelve, in old, 
 phlegmatic, or intemperate people, a broken bone will he found 
 firmly united by new bone thrown massively and irregularly 
 around the fragments; but for several months longer, this new 
 bone is capable of being re-absorbed, so as to allow the limb 
 to become deformed by use, if the patient be attacked with 
 severe erysipelas of the limb, or a typhus or other low fever, 
 or if he indulge in a series of complete drunken fits. This fact 
 is mentioned to shield the reputation of surgeons whose pa- 
 tients have found their limbs crooked some weeks after the 
 attendant has pronounced them well; and also, to caution drunk- 
 ards; to induce patients attacked with erysipelas within six 
 weeks after recovering from a fracture of a lower extremity, 
 to retire immediately to bed; and to persuade these, and fever 
 patients, not to rise on becoming convalescent, without calling 
 for an examination of the state of the limb. The perfect and 
 final union of a fracture requires from one to two years; and 
 when it is accomplished, all the unnecessary parts of the rude 
 mass which formed the first bond of union will be found to 
 have been removed by the absorbents. 
 
 The description of the progress of union which has just 
 been given, is adapted to the history of cases occurring in 
 adults. In children, the stages are always much more rapid. 
 
 We shall now proceed to give some very short directions 
 for the DM nt of particular fractures occurring on the 
 
 road, at sea, on distant plantations, or in other situations 
 where surgical assistance is unattainable for many days. 
 These directions are merely temporary, and are designed to 
 procure the patient as much freedom from pain, and security 
 from deformity, as can be obtained fey simple contrivances 
 every where at hand, and applied by persons without surgi- 
 cal knowledge. 
 
 These plans, though many of them are vastly inferior to 
 those employed by surgeons, are yet sufficient to prevent 
 much evil; and, in many cases, they may even effect very to- 
 lerable cures. 
 
 Fracture of the Clavkle. — A fracture of the clavicle or 
 collar bone, permits the shoulder to approach the side. As this 
 change will relax the muscles which support the shoulder, it 
 
 11 
 
322 FRACTURES OF THE CLAVICLE. 
 
 is allowed to fall an inch or two, and as the base of the 
 shoulder blade cannot retreat far, the arm is rolled forward 
 upon the breast. The indications of cure arc, to keep the 
 shoulder far enough from the side, and on a level with its 
 fellow. To effect this, take a block of the lightest dry white 
 pine or cedar, and trim it into a wedge, four inches broad, one 
 and a half thick at its upper part, tapering nearly to an 
 edge below, and long enough to reach from the arm-pit to 
 within two inches of the prominence of the elbow joint. 
 This block should have all its edges and corners smoothly 
 rounded, and should then be thickly wrapped up in linen or 
 muslin, the whole being suspended on two very broad tapes, 
 or pieces of bandage, secured near the middle of the narrow 
 sides of the wedge. Now make a kind of stall or short - 
 for the elbow, of brown hollands, or other firm tissue. Let 
 this rise about three inches behind the elbow, and run about 
 four inches along the fore arm, when bent at right angles with 
 the arm. Two wide bandages, each about lhre<? quarters of a 
 yard long, are to be firmly sewed ; one to the back part of 
 the sling on the side next the body, a little above the point of 
 the sling which receives the elbow; the other, in front, to the 
 edge of the sling which corresponds with the outer side of the 
 elbow joint. To apply the apparatus, proceed as fol! 
 Seat the patient on a stool, or chair, without a back. Let an 
 intelligent assistant raise the arm of the injured side directly 
 outwards from the body, till it is nearly horizontal; and, p! 
 one hand under the arm, a few inches below the axil! 
 him raise the shoulder considerably above its usual level, 
 when standing at ease. The operator now places the thick 
 end of the covered wedge as high as possible in the arm-pit, 
 with its slope running perpendicularly down the side. 
 
 The tapes which support the wedge are then carried up. 
 the one before, and the other behind the chest, to the sound 
 shoulder, where they arc carefully tied over a strong com 
 of linen or muslin, which protects the skin from creases. The 
 arm is now brought down to the ride, over the middle of the 
 wedge, which presses the shoulder outward. The sling being 
 now fitted on to the elbow, and a little cotton, fine tow, or Max 
 being interposed, the bandages are secured tightly over the 
 opposite shoulder, in the same manner as those of the w 
 This supports the shoulder it the required height To render 
 all secure, fold a soft long towel, in the direction of its breadth, 
 till it is six or eight inches wide; pass it firmly and cv 
 round the chest, over the lower part of the arm. aod all the 
 dressings; stitch or pin it tight in front, and secure its upper 
 edge to the edges of the wedge cover, and to each of the sling- 
 hands. The hand may be supported in a common handker- 
 
FRACTURES OF THE SHOULDER AND ARM. 323 
 
 chief sling, but should not be brought close round in front of 
 the chest, or the circulation in the arm will be arrested. 
 
 This rude treatment will not prevent all such deformity as 
 might be important to the appearance of a young girl; but it 
 will secure a safe, strong, and not unsightly cure in a man 
 who is not particularly fastidious about good looks, or when 
 placed beyond the reach of surgical aid. 
 
 Fractures of the shoulder blade. These are rare, but 
 sometimes occur in heavy falls and in partial inhumation un- 
 der fallen banks. The unprofessional practitioner can do very 
 little for their relief. Their existence may be known cither 
 by the irregularity of the fragments of the bone as the finger 
 traces their outlines beneath the skin, or by a grating of the 
 fragment upon each other, when different parts of the bone 
 are pressed upon by the palm of the hand. \i surgical aid 
 cannot be obtained, it is proper to bind the arm lightly to the 
 side, and leave the case to nature. In some cases the patient 
 will recover without loss of power or appearance; in others, 
 there will remain considerable deformity, and serious limita- 
 tion of some of the motions of the arm. 
 
 Fractures about the shoulder joint. Accidents of this 
 character are numerous, often very obscure, and require the 
 highest surgical skill for their treatment. When, unfortu- 
 nately, it is impossible to obtain such aid, we can do no other 
 than secure the arm at rest in the easiest position; but the use 
 of the limb, to a \c\y serious extent, will generally be lost. 
 
 Fractures Qf the arm. These are known by an angularity 
 or unnatural flexibility of the bone, somewhere between the 
 elbow and shoulder, and by the grating of the fragments when 
 the arm is moved. In the absence of a surgeon, much good 
 may be done by the following plan, when pursued by an intel- 
 ligent person accustomed to bandaging. Make a flat com- 
 press of linen or muslin simply folded, three inches wide, half 
 an inch thick, and long enough to reach from the arm-pit to 
 near the point of the elbow ; — secure this to the side by two 
 short bandages, stitched to its edges and tied over the opposite 
 shoulder, and steady it by a turn or two of abroad bandage round 
 the chest and compress, allowing the latter to incline a very lit- 
 tle forward as it descends. Then, with a penknife, prepare three 
 narrow strips of thin, well planed cedar shingle, each from an 
 inch to an inch and a half wide. Make one of them long 
 enough to pass from the back of the shoulder joint to the tip 
 of the elbow, along the back of the arm; one, to extend from 
 the outside or point of the shoulder to within an inch of the 
 external prominence of the elbow; and the third, from the 
 front of the ball of the shoulder to just above the bend of the 
 elbow. Let each of these pieces be well lined with tow, on 
 
324 FRACTURES OP THE ELBOW JOINT- 
 
 the side next the arm, and enveloped in muslin. Now let the 
 operator take a muslin or red flannel bandage, of about two and 
 a half fingers' breadth, and eight or ten yards long, and begin- 
 ning at the base of the fingers, envelop the whole limb even- 
 ly and smoothly to the elbow. Then, — giving the hand to an 
 assistant, with directions to hold the forearm at right angles 
 to the arm, while he presses the elbow strongly and steadily 
 downward, so as to stretch the broken bone to its full length, — 
 the operator, still holding the remains of the roller, sees th.it 
 the bone of the arm is rendered straight. He next continues 
 the bandage evenly up to the shoulder; and, applying the three 
 covered splints in their proper position, he places them in 
 charge of another assistant, while he brings the bandage down 
 again, so as to surround splints, arm, and all, to near the elbow. 
 The arm is now brought to the side, lying smoothly along the 
 compress, and the whole is secured to the chest by several 
 turns of broad bandage passed round the body and limb. The 
 forearm is supported in a common sling. 
 
 Of course, no person alt. unaccustomed to appl 
 
 rollers, and making what are called reverted turns, ran under- 
 take this treatment; hut a f. -w leSBOfU D 
 
 useful degree of knowledge of this art. and all who are at the 
 head of establishments ought to acquire it. though vn 
 sorry to confess that medical graduates of uni\ i loaot 
 
 very generally obtain it. till they In for some 
 
 years as surgeons. Sea captains acquis* it by Looki 
 hospitals; and we hav decent cures of frac- 
 
 tured arms performed by such novices at sea. 
 
 Fractures of the pit — None of these <an he success- 
 
 fully treated by a domestic practitioner; hut \n I. 
 cannot be obtained lor several days, the use of the limb may 
 be lost or preserved by the choice of an attitude; and a 
 on this subject is necessary. When the tip of tl. . (the 
 
 piece which projects behind the joint.) is broken olf, it is 1: 
 diatcly drawn up behind the arm, where it I ird lump 
 
 some little distance above the joint: while the finger will sink 
 into the cavity o( the joint behind, in a manner wholly unnatu- 
 ral. It is absolutely necessary that, in this case, the elbow should 
 be kept constantly and fully extended even before th- 
 is obtained. Let a long piece oi thin white pine or cedar, two 
 inches and a half in width, and well rounded at the 
 so cut as to extend from near the shoulder to the wrisfl : line it 
 well with low, bound on with a bandage or piece of muslin, and 
 padded thickly at the middle and the extreme lower end. to 
 till the inequalities of the limb. Bind this gently along the 
 whole length o( the front of the aim and forearm, 
 vender the elbow immoveable; and so let it continue till the 
 
FRACTURES OF THE FOREARM. 325 
 
 In all fractures of the elbow joint in which the tip retains 
 its integrity, the arm should be carried quietly in a sling until 
 assistance can be obtained. If left, by necessity, to nature, 
 these cases almost always result in the loss of much of the 
 motion of the joint. 
 
 Fractures of the forearm. — Whether one or both the bones 
 of the forearm be broken, the treatment may be the same. 
 The accident is known by an unusual deformity somewhere 
 between the elbow and wrist; (which deformity is slight 
 when but one bone is broken high up in the fleshy part of the 
 limb;) by the inability of the patient to turn the hand; and by 
 the pain and grating occasioned when the examiner attempts 
 to turn it for him. 
 
 To treat a fracture of the forearm, take two splints cut 
 from a planed cedar shingle; one of them, long enough to reach 
 from the bend of the elbow, when the arm is flexed at right 
 angles, to the t i j > of the middle finger and a little beyond it; 
 the otii. i. extending along the back of the forearm, from the 
 elbow joint to the wrist joint. Let the part of the long splint 
 which covers the palm of the hand, be as wide as the palm 
 exclusive of the thumb. Trim oil' the sides of the splint a lit- 
 tle at the wrist, SO as to render it not a great deal wider than 
 the small pari oftbe arm. From the u rist towards the elbow, it 
 should gradually in< little in width, and should correspond 
 
 exa< tlv in form with the short splint These splints are to be 
 covered with tow on the side next the limb; and from near" the 
 wrist to near the elbow, the tow is to be thickly padded along 
 the middle of the splint, but more slightly toward the I 
 The tow is to be securely bound to the splints by bandages. A 
 roller of two and a hall fingers 1 breadth, and five yards long, 
 being provided, every thing is ready. The operator requests 
 
 an assistant to stand behind the patient's arm, and clasp his 
 hand in front of the limb, just above the elbow. He then 
 grasps the hand; and. while the assistant gives the necessary 
 resistance, ho Btretches the forearm, while at right angles with 
 the arm, and places it in a position as natural as possible, 
 with the palm of the hand looking upward and a little inward. 
 lie then applies the long splint, and bandages the hand flat 
 upon the broad part, but leaves the thumb free. Having 
 reached the wrist with the bandage, he applies the short 
 splint also; and, continuing the roller over both splints to the 
 elbow, ho secures the bandage, and orders the forearm to be 
 carried in a common sling. Prom five to six weeks is about 
 the time required for the use of splints, in fractures of the 
 upper extremities. 
 
 Fractures of the loxcer extremities. — The precautions in un- 
 dressing and iifting the patient, laid down in the sub-section on 
 
320 FRACTURE5 OP THE THIGH. 
 
 contusions of the perineum and fractures of the pelvis, (p. 220) 
 are in great degree necessary in cases of fracture of the 
 thigh. There is no difficulty, it is true, in getting off the 
 upper garments; but the boots or shoes, the stockings, and 
 one limb of the pantaloons must be sacrificed at once, rather 
 than that much pain or rough motion of the fractured limb 
 should be produced. A hand-barrow, or a plain broad board 
 carried on cross-sticks, by four or six men, is a much better 
 mode of conveyance for such accidents, than the settee so 
 commonly employed. As in injuries of the pelvis, so in those 
 of the inferior extremities, the undressing of the hould 
 
 be completed before he is placed on hi> bed. In all fractures 
 requiring to be treated in the recumbent position, a matl 
 is preferable to a feather bed. During the lifting of t 
 tieot into the barrow, or into the bed, one individual should 
 retain exclusive charge of the injured limb. 
 
 Fractures of tki thigh. — It is -not to b 
 tic practitioner will he able to « ure of fi thigh, 
 
 without considerable deformity - will 
 
 occur, where no o; i. it is w 
 
 state a rude method by which the useitiln< i 
 least, ma] ired. Let a malti and let it 
 
 be placed on a strong bi with a light 
 
 wooden floor. Place the Ii upon 
 
 on this. .1 roller towel, and. i: 
 
 large pieces of buckskin. Place th e of but k 
 
 carefully over the perineum, and between the scrotum 
 thigh upon the injured side. Place the middle of the t. 
 smoothly folded until about three inches broad, dii 
 tween the folds of the buckskin on the perineum; an 
 one end of the towed behind th .bile 
 
 the other is brought up iu front of the pelvb 
 near the arm-pit on the injured side. Now take a stout j 
 of window cord or clothes line, and securing one end to the 
 two loops o( the towel near the- -trm-j.'. Other be- 
 
 hind the shoulder and up to the head o[ the bed. where it must 
 be very firmly secured to the head r the upper cross 
 
 piece of the bedstead, in Buch a manner i 
 the surface of the bed. This fixes the .rt of th 
 
 tient's thigh. 
 
 Next, let a stout block of inch white or yellow pine bo nailed 
 to the bottom cross-piece oi the bedstead, opposite t! 
 the injured limb, and let it be lo 
 
 two below the cross-piece, and so far ;wo\ ■ be level 
 
 with the middle of the hollow of ih« 
 the mattress. The upper end of this block 
 like a swallow's tail. 
 
FRACTURES OF THE LEO. 327 
 
 The operator now folds a silk pocket handkerchief, diago- 
 nally, until it is about two and a half inches wide in the mid- 
 dle. The centre of this, should be applied to the back of the 
 ankle, the two tails brought forward and crossed on the top of 
 the instep, and then carried downward on each side ot the foot 
 to about five inches below (he sole, where they are tied firmly 
 in a hard knot. The unexpended ends of the handkerchief 
 are then secured to a piece of stout cord, one or two feet long. 
 The operator is now ready for setting the limb, which he does 
 by grasping the ankle with both hands, and stretching the 
 limb firmly, slowly, and regularly, until it appei . iy, or 
 
 quite of the full length. An assistant j rd at- 
 
 tached to the handkerchief over the notch in the foot- block, 
 and, by tightening it from time to time, i ecu res all that the 
 opera s. When the extension h d a- far 
 
 as desirable, the cord is tied round the projecting bottom of 
 the block, and the operator proceeds to support the foot by 
 pillows at the sides, or some other contrivance to prevent the 
 from turning tin- broken limb outward bv their weight 
 To prevent the bed-clothes from touching the limb, lie takes 
 three keg-hoops, cuts them in half, and, making a double se- 
 micircular arch of each, by tying the corresponding halves 
 together, crosswise, he pla< - athwart the 
 
 limb, beneath tin.' clothing. The limb should be measured 
 frequently from the front point ot' the share- bone to the point 
 outer ankle : and whenever the limb is found I 
 
 k tension bhould be I, and the cord lightened. It 
 
 i< best to place the second piece of buckskin between the 
 handkerchief and the loot, to prevent ulceration, which it 
 to occur during extension, which must continue live- w< eks. 
 
 — Little can he done towards setting a 
 fractured leg, bv any but the best surgical anatomists, when 
 is much displacement among the fragments; but, for- 
 tunately, iu a great number ol there is very little dis- 
 | uent. 'J 'he treatment is then very simple, and the domes- 
 tic practitioner may imitate the surgeon very cl< - 
 
 Take a planed inch board, loni: enough to reach from six: 
 inches above the knee to three inches below the heel. Make 
 it ten inches wide at the top. and seven at the bottom. On the 
 bottom, nail a foot-piece, standing Up at right angles, or inclined 
 a very little downward by a bevel. Let this foot-piece be five 
 inches wide, bv ten inches high, with a semicircular top. Now 
 make two lateral splints, as long as the back-board already 
 
 ibed, and let them be six inches wide at the bottom, eight 
 inches wule at the top, and one inch thick. Along one mar- 
 gin of each of these lateral splints, and along both margins of 
 
328 FRACTURES OF THE FINGERS AND TOES. 
 
 the bottom board, bore four spike gimlet holes, at equal dis- 
 tances. With eight pieces of stout tape, tie the lateral splints 
 to the bottom board, so as to allow them to move as on hi: 
 (which latter are, of course, preferable, when obtainable,) and 
 we have a very decent fracture box for broken legs. To em- 
 ploy the apparatus, lay a soft, thin feather pillow on the box, 
 with the lateral splints expanded, and over this, if you have 
 one, a cloth of oiled silk or India rubber. Then, the limb 
 having been previously extended, the foot brought into a 
 natural position, and all great irregularity in the line of the 
 shin bone removed, the operator carefully lifts the limb with his 
 two hands, while an assistant { fi ;u lure-box and pil- 
 
 low beneath it. The leg being laid carefully on the pillow, 
 after it has been a little hollowed out at 1 and calf, the 
 
 lateral splints are turned up, and three or four broad t 
 doubled, being passed under the whole fracture box, arc tied 
 at one side, so as to produce moderate pressure on the leg. 
 The limb is then covered with bran thrown down on th 
 low, and the dressing i 
 
 without other dressings, when the limb i- slightly < 
 or has received small wounda at the time of the accident It 
 usually crusts with the blood and fluids over rock Inch 
 
 get well rapidly beneath ; but, if suppuration 
 off most kindly with Castile soap and warm water, and - 
 
 newed in a moment. Bran is even the 
 
 the strips and salves used in large wounds; and r the 
 
 poultices, in bad compound fractures. It absorl - 
 
 fluids, preserves cleanliness, and excludes the fly. We have 
 
 seen it applied directly, with the happk 
 
 face of the worst lacerated wounds. 
 
 Fractures of the Finger* and Toes, — When tin-- parti arc 
 crushed by weights, poultices as well . rally 
 
 necessary; but, whether in simple or complicated lVaetm 
 the hand, it i< best to bifid the whole hand to a splii I 
 to the form of the edges of the palm and lin_ 
 thumb, and extended as high ;b the museu! 
 arm. to check the motion of the wrist When the thumb is 
 broken, we use a little splint, which I e ball of the 
 
 thumb, and. becoming rapidly narrower as it appro 
 first joint, extends to the end oi the last joint 
 flexion. It is bound on by a very narrow strip of ban 
 which, after enveloping the thumb, makes two or three turns 
 round the wrist, and is finally secured hv a pin over the ball 
 of the thumb. 
 
 The toes are very rarely subject to simple fractures. When 
 such accidents occur, we treat them by m ' splint to 
 
FRACTURES OF THE LOWER JAW. 329 
 
 the sole of the foot, with suitable compresses and bandage, pro- 
 hibiting the foot from being put to the ground for at least four 
 weeks. 
 
 Fractures of the lower Jaw. — The uninitiated can do nothing 
 with these troublesome accidents, except to support the chin 
 by a handkerchief tied over the head, securing it by another 
 passed round the temples, and feeding the patient entirely 
 on broths and gruels till a surgeon can be obtained. 
 
 Before quitting entirely the subject of fractures, a few ge- 
 neral remarks must be made. The diet of a patient with frac- 
 ture, for the first week, should be low; but there can be no 
 greater mistake than the continuance <if low diet for a longer 
 !>eriod, without argent necessity. The labour of uniting a 
 broken bone, when once commenced, i- one : and na- 
 
 ture require* the support of a generous diet, from the end of 
 the first to that of the sixth week. A pretty free use of good 
 porter or ale, daring this period, is not at all amiss, when there 
 exist no constitutional objections to it. A neiilect of this rule 
 we believe to be the most common cause of imperfect unions 
 and false joint i illy in the public alms-houses of the 
 
 country, and in those of some cities, where public charity is 
 | < I on an exceed ing ly economical 
 
 An adult patient, who has had a fracture of the inferior ex- 
 tremities, may relinquish his splints in live or six weeks, and 
 may be subjected to frictions and passive motions of the limb 
 to remove stillness; but he should not be permitted to rise, with- 
 out the permission of a surgeon, till the completion of eight 
 weeks. A boy of twel\ ma? throw off Ins >[>lints a week 
 
 earlier, and may rise in six w< < kft 
 
 An adult who has had a fracture of a Superior extremity, 
 may throw the apparatus aside in live weeks, and a boy of 
 twelve years in four. The former may apply the limb to light 
 in six, and the latter in five weeks. 
 
 The bug Confinement on the back, in fractures of the lower 
 extremities, render it accessary to guard against ulcerations of 
 the back and buttocks from constant pressure, in weakly peo- 
 ple. By changing the point of support with down or air pil- 
 lows, this terrible evil, when threatened, may be prevented. 
 Bvefl when surgeons are in attendance, it is safest for the 
 friends to look after this matter occasionally, especially in fe- 
 males. The use of the bed-pan, an absolute necessity when 
 common beds are used, is often extremely annoying and pain- 
 ful. Beds which remove this difficulty by very simple ma- 
 chinery, have been invented by Drs. B. II. Coates, and Caspar 
 Wistar. They are in use in hospitals, and the wealthy at a 
 distance may be put in the wav of obtaining them to order by 
 
 12 
 
330 OF DISLOCA'li' 
 
 addressing Mr. Samuel Sheppard, druggist, South Ninth Street, 
 Philadelphia. I believe that they are no where kept on sale. 
 
 Of Dislocations in general. When the extremity of a bone is 
 thrown out of the eavity which is intended to contain it, it is 
 said to be dislocated, or put out. This accident, when sudden, 
 is always attended with a laceration of some of the ligaments, 
 and a severe stretching of others. Portions of the edges of 
 the bony cavity of the joint are often torn oirby the ligaments. 
 Some of the muscles attached to the dislocated bone are re- 
 laxed, and others are violently elongated. If the bone remain 
 out of place for any length of time, the relaxed muscles con- 
 tract and hold it almost immoveably in its new position. The 
 torn ligaments soon unite with surrounding parts, so that in old 
 dislocations they must be re-torn before the bone can be re- 
 placed. After some weeks or monl f the old 
 joint begins to be tilled up with bone and cartilage, whi 
 edges are absorbed and rounded oil*. In ' time, the 
 distorted muscles become slowl to their new po- 
 sitions; their functions are partly . ! nature com- 
 mences the formation of a rude new joint, by throwing out an 
 irregular cup of new bene round tl 
 
 changes Bhow the ne< tude in reducing dislo- 
 
 cations as speedily as possible; K. lour of dcla 
 
 pidly increases the resistance: 
 of those pretenders, called bon 
 
 dislocations of several years' standing; or, in other v 
 undertake to restore the bone to a eavity w i long 
 
 ceased to exist ! But the gullibility of the public is without 
 end; and the only reward of the professional man who 
 tures to denounce the ignorance of ; -host 
 
 blunders swell his recei he pitiful chai pur- 
 
 pose and selfishness! The deaths and miseries occasioned by 
 these pretenders are buried in oblivion, while the few appa- 
 rently brilliant sue _ eons have 
 failed" are bruited about with all manner of • K I 
 it must be confessed there is reason to fear that the opportu- 
 nity for some of t: i furnished by the culpable 
 habit of certain excellent medical practitioners, whose want of 
 advantages and exclusive pursuits have rendered them 
 rant of the first principles oi ibit of taking 
 charge of surgical cases: — which are thus removed from the 
 notice of those whose professional studies tit them for such un- 
 dertakings. It is time that the pul . that to 
 profound medical scholar or teacher and a m 
 practitioner, though it by no means .ends in no cl. 
 to prove a capacity for treating the most simple dislocatk : 
 other surgical cas 
 
DISLOCATIONS OP THE ARM OR SHOULDER. 331 
 
 There are, we believe, but three kinds of dislocation in 
 which the domestic practitioner can make himself useful. Of 
 these we will speak. 
 
 Dislocation of the arm into the armpit. When, after a fall, 
 or blow on the shoulder, the arm is found fixed at an angle of 
 thirty or forty degrees with the side of the body ; when the 
 patient has lost nearly all command of its motions, but when 
 an assistant can move the elbow backward or forward a few 
 inches, with great pain to the patient: when the elbow can 
 he lifted directly outward from the body, without much pain, 
 till the arm is nearly horizontal, but cannot possibly be made 
 to approach the side, the mere attempt producing intense suf- 
 y\ when the point of the shoulder stands out sharp and 
 clearly marked, and the round muscular prominence immedi- 
 ately below it is flattened, so that the linger, when pressed 
 inward immediately below the point of the shoulder, seems to 
 sink into a kind of cavity; and when we can feel, in the arm- 
 pit, a large, round, bonv lump, which has no business there; 
 we know that the arm is dislocated downward into the arm- 
 pit. 
 
 If, in such a case, a surgeon cannot be procured within two 
 hours, an intelligent assistant can, and ought, to attempt the 
 reduction without delay; and, by following these directions, 
 he may almost a! ceed with very slight effort. 
 
 Let the patient lie flat upon his back on the floor, with his 
 head supported by a pillow. The operator then seats himself 
 also on the floor, clo>e by the side of the hip of the patient, 
 on the injured side. Extending the h j he patient he 
 
 then places the sharp outside vx\^ of his foot between the side 
 of the body and the bony lump formed by the head of the 
 bone in the arm-pit. The sole of the foot looks outward, and 
 forms an inclined plane for the head of the bone to slide over, 
 while the instep presses the patient's side. The operator now 
 grasps the wrist of the injured arm, and, drawing it obliquely 
 downward, while carried as far outward from the side as the 
 natural position of the limb after the accident shows to be 
 necessary, he applies a long, regular, gradually increasing 
 force, until he feels the limb begin to elongate a little. As 
 soon as this is perceived, and while the extending force is 
 fully maintained, he makes a gentle attempt to carry the arm 
 toward the side. If successful, the head of the bone will sud- 
 denly fly into its place with a snap; if he fail, the extension 
 must be continued and increased; and, after a time, the at- 
 tempt to bring the arm to the side must be repeated. Suc- 
 cess generally follows in five or ten minutes. The force re- 
 quired is often exceedingly slight; but it is sometimes very 
 considerable, and it is, therefore, best that the operator should 
 
332 DISLOCATIONS OF THE WRIST AXD ANKLE. 
 
 be a rather powerful man, and capable of continuing a consi- 
 derable amount of extending force for many minutes together. 
 There are several other forms of dislocation of the arm; but 
 none of them are manageable except by surgeons. They are 
 rare; and we have no wish to induce rashness to meddle with 
 such cases, by communicating a partial knowledge of the sub- 
 ject. ' 
 
 Dislocations of the Wrist. — These accidents occur in va- 
 rious directions, and may be either complete or partial. Their 
 nature is too obvious, when they occur, to admit of any doubt 
 even on the minds of those who know nothing of surgery; and 
 when the best aid is not obtainable within an hour or two. it 
 is right to attempt the reduction, which is rendered vastly more 
 difficult after swelling and inflammation have supervened. 
 
 One law will apply to the mode of reduction, in all the va- 
 rieties. Let the surgeon grasp the forearm, above the wrist, 
 firmly, with one hand, while with the other he seizes tlv 
 located hand. Let him then make gradually increasing and 
 very steady extension, in the direction in which the fi 
 point in each particular case, and when the hand evioN 
 begins to yield to the extension, gradually, and without force, 
 it may be brought into its proper position. 
 
 Dislocation of the tflnkle, with Fracture of the Fibu! 
 This common accident sometimes happens from turnii i 
 the side of the foot, and somei lows, or ] 
 
 sure on the outside of the leg. It may be known by a want 
 of firmness in the bone immediately above the external ankle, 
 which feels as if beaten in, and by the undue ease with which 
 the sole of the foot can be made to look outward to an impro- 
 per extent. The best treatment for this accident, when a sur- 
 geon cannot be procured, is that prescribed for fractured leg, 
 with but slight modifications. There is no difficulty, whate- 
 ver, in replacing the foot; but the muscles have a constant 
 tendency, though not a forcible one. to tilt it outward again. 
 To check this; place the limb on the pillow, in the common 
 fracture box described under the head of fractures of Um 
 use the feathers in the pillow, or the bran, or a folded towel 
 between the pillow and box, to make a kind of compress 
 which shall press the outer edge of the foot inward, and turn 
 the sole of the foot in the same direction, slightly. The part 
 of the pillow pressing on the inner ankle should be, alse. 
 ported by a compress placed between it and the box. while 
 the part opposite the outside of the limb, for three inches 
 above the external ankle, should have the feathers shaken 
 from it, so as to press as lightly as possible. This attitude 
 being preserved until the fracture unites, will secure the ankle 
 
EXTERNAL INFLAMMATION. 333 
 
 joint against serious loss of power, though it will probably re- 
 main a little weakened. 
 
 Wlienevera limb has been dislocated and reduced, it should 
 be confined in a motionless position for two or three weeks, 
 in order that the torn ligaments may re-unite; and if this be 
 neglected, the displacement is extremely apt to recur. 
 
 We have now given all the advice we dare venture to give 
 the uninitiated, in relation to dislocations. In all cases except 
 those above mentioned it will be safest to let the case rest for 
 surgical advice, however tardy, rather than to increase the 
 danger to life or limb by awkward efforts. A perfectly sim- 
 ple and manageable dislocation may, by a little ignorant tam- 
 pering, be rendered almost, or quite irreducible, to the infinite 
 torture of the patient. 
 
 section v. 
 On Inflammation and its Consequences. 
 
 It is so utterly impossible to lay down any course of treat- 
 ment in inflammations and their consequences which will not 
 be liable to exceptions too numerous to be specified, that it 
 becomes most important that even the domestic practitioner 
 should take a broad view of the subject, and possess himself 
 of certain general principles, before he ventures to study the 
 special directions given in this section. His general know- 
 ledge and practical good sense must often be permitted to 
 modify even his application of those directions. I must, 
 therefore, beg the reader who has read the preceding chap- 
 ters of this work to recur, with serious attention, to the sec- 
 tions on the Reproduction of Parts, (p. 133,) Symptomatic 
 Fever, (p. 13S,) Irritation, or Hypernutrition, (p. 147.) and In- 
 flammation, (p. 153,) in the Physiological chapter. This he 
 should do before he commences the study of the present 
 section. 
 
 External Inflammations, (in which, alone, with their 
 consequences, the surgeon is interested,) whenever they are 
 somewhat considerable or severe, yet not sufficiently violent 
 to produce collapse of the system, present us with at least three 
 deviations from the ordinary actions of health. The inflamed 
 part itself, — in a state of actual disease, with its vessels weak- 
 ened, and rendered incapable of resisting the force of the cir- 
 culation, — contains more blood, and circulates, at first, a larger 
 amount of this fluid than natural. The nerves of the part are 
 
334 TERMINATIONS OF IXFLAMMATIOX. 
 
 rendered painfully susceptible of all impressions by this in- 
 creased supply, and even the distention of the part becomes 
 a source of pain. The activity of some of the functions of the 
 vessels is even increased by their development, and the ani- 
 mal heat is, for a time, elevated even above the height neces- 
 sary for the most rapid reproduction of parts. The heat, red- 
 ness, swelling, and pain are, therefore, carried beyond the 
 standard of health. Nature takes the alarm lest this excc^ 
 condition should unfit the part for the exercise of its func- 
 tions; and she immediately prepares for its destruction and 
 replacement, should the severity of the injury render this neces- 
 sary. The centre of inflammation is every where surrounded 
 by blood vessels in the highest state of activ itinating 
 
 the cellular tissue with lymph, and drawing a line of circum- 
 vallation around the disease, which, even should it prove un- 
 necessary, is still a sanative attempt To support this activity, 
 and to prepare for all chat rteries leading to 
 
 the part become gradually dilated, and the heart 
 make additional efforts to increase the supply of blood ; or, 
 in other words, symptomatic fevt r is indue 
 
 It is very probable that, when the human 
 and the vigour of I I by luxe 
 
 vice, this process usually terminated without Q the 
 
 best cure of which the nature o\ the case admitted, A: 
 savage tribes, — none of which, however, can !»<■ consklen 
 approximating very nearly in pi nditioo t" the race 
 
 in its primitive state, — the history ot inilammai tions 
 
 seems to lend some colour to this hv 
 
 But, in these degenerate day*, man has become artificially 
 modified to such an extent that the "vis ir.edicatrix nat 
 itself must be ridden with curb and lash, or it will ii 
 overleap all reasonable bounds. 
 
 Before speaking of the treatment, let us take a view of the 
 several terminations of inflammation, as the] died. 
 
 These are in reality but ti . and 
 
 mortification; but nearly all >■. Ihere to the folio 
 
 list; vie. Resolution, effut pur a t ie n , ulceration, and 
 
 ga?i^rejie or mortification* 
 
 When all the symptoms of inflammation gradually decline 
 and disappear, naturally or under the action of remedies 
 no signs in the part of the pre-, 
 to terminate by resolution. 
 
 When, from longer continuance, the distension so far e: 
 bles the vessels that they become unable enli \pel their 
 
 undue contents by the natural route, they frequently transmit a 
 portion of the more fluid parts through their coats into tin 
 
TREATMENT OF INFLAMMATION. 335 
 
 rounding cellular tissue, in the form of clear or bloody serum ; 
 and the inflammation is then said to terminate by effusion. 
 
 The title of termination by effusion is also given to that 
 process by which blood vessels, irritated to a high degree of 
 activity, secrete lymph or other matters in the interstices of the 
 capillaries, so as to form a tumour or callosity more or less per- 
 manent; but this result is directly connected with hyper or 
 morbid nutrition, or with the reproductive power of nature, 
 and is not, strictly speaking, a consequence of inflammation : 
 it is very frequently witnessed in enlarged glands. Termina- 
 tion by effusion, then, is but a modification of that by resolu- 
 tion; for the effused fluid, if the disease terminate at all, soon 
 disappears by absorption, leaving no trace behind. 
 
 When the injury done to the vessels in the centre of the in- 
 flammation is so great that they are gradually unfitted for ful- 
 filling their part in the system, and are irrecoverably altered, 
 begin to undergo a process of absorption to make way 
 for the formation of new pan-. A cavity is thus formed, which 
 is always lined with a new membrane, and the new blood ves- 
 f this membrane secrete pus or matter, which continually 
 dilates the sac, filling up the space I the inflamed and 
 
 M parts are absorbed. Thus is formed an abscess; and as 
 cretion of the pus rapidly relieves the inflammation where 
 it is mildest, it gradually subsides and is said to terminate by 
 suppuration. 
 
 Inflammations of mucoid metimes those of 
 
 vin when diverted of its cuticle, terminate by suppuration 
 without loss of substa: 
 
 When the same condition of parts that has just been noticed, 
 occurs immediately upon the surface, or when l iperfi- 
 
 cial ibseesfl bursts < Eternally before the inflammation subsides, 
 ire have an open sore instead of a cavity, and the inflamma- 
 tion is said to terminate by ulceration: but as such ulceration 
 is uniformly attended with the secretion of pus, this obviously 
 constitutes a mere variety of the termination by suppuration. 
 
 When the violence of the inflammation is so great as to de- 
 stroy suddenly the vitality of the part, before absorption can 
 begin to remove it, it is said to terminate by gangrene or mor- 
 tification. 
 
 Treatment. The great object in the treatment of inflam- 
 mation is, if possible, to bring about a resolution; and the 
 means are various. 
 
 1st. All external and mechanical sources of local irrita- 
 tion should be removed. When the inflammation affects the 
 skin, the atmospheric air itself becomes a source of irritation, 
 by increasing the vitality of the blood; and hence, we often 
 guard the part by covering it with flour, or cerate; as, in ery- 
 
336 TREATMENT OF INFLAMMATION. 
 
 sipelas; or with mucillage; as, in inflammation of the eye. Mo- 
 tion is a powerful mechanical irritant; hence all inflamed parts 
 should be kept strictly at rest. Often, the pressure of the skin 
 or a fascia' acts mechanically to produce intense irritation in 
 the inflamed parts beneath; hence we divide these bands freely 
 by the knife; as, in laying open a whitlow, or the capsule of a 
 swelled gland. 
 
 Sometimes the inflammation attacks delicate soft parts inter- 
 laced with rigid tendinous fibres, and we are obliged to divide 
 the swelling in various directions, or even to destroy it totally 
 with vegetable caustic; as we often do in carbuncle. 
 
 2nd. Means should be used to cause the vessels to con- 
 tract, and drive the blood from lite part: but the ?7iean$ 
 should be sedative. Cold, and certain astringents are the re- 
 medies chiefly employed for this purpose. Cold water, ice 
 water, water cooled by dissolving in it the muriate of ammo- 
 nia, and lead water, which is a cold solution of the acetate of 
 lead, are generally employed, and one or the other is a desi- 
 rable application in almost every commencing inflammation of 
 moderate extent. To be effective, cold must be applied con- 
 stantly till the heat of the part is reduced below the natural 
 standard. If the part cannot be immersed in the refrigerating 
 fluid, or the latter allowed to fall in a steady stream upon it, 
 we must use rags thoroughly wet, and very frequently changed 
 till the cflect is produced. 
 
 3rd. Pain, which is a gnat I • may be occa- 
 
 sionally checked to advantage by nan < -. Thus we use 
 wet with laudanum, even in anticipation of inflammation, in 
 severe contusions of nervous parts; as in a mashed finger. In 
 certain extensive inflammations, the watery solution of opium 
 is exceedingly useful; as. in wide spread erysipelas of any other 
 parts than the head and face. In severe injuries to ligamen- 
 tous parts, occurring to feeble or delicate patients, a hop poul- 
 tice has a happy eflect on this principle: as, in some sprains 
 of the ankle. 
 
 4th. 77k- quantity qfbiood in the attire blood vessels around the 
 inflamed part, should be directly and indirectly diminished. 
 is done indirectly by cold applications, and directly by the 
 employment of leecb 
 
 5th. The force of the heat:' . and the quantity of the ge- 
 
 neral circulating fluid, should lh lessened. ThlJ • 
 low diet, purgatives, diuretics, diaphoretics, and all measures 
 calculated to increase the secretions in other parts: and, still 
 more directly, when the condition of the patient will permit, 
 by bleeding from the arm. 
 
 6 th. he may often do ynueh ?ochI by drazcing off the surpiu 
 tality of the inflamed part by counter :nd the undue sup- 
 
TREATMENT OF ABSCESSES. 337 
 
 ply of blood by calling it to distant parts. The first is often ef- 
 fected by issues and seatons to the back of the neck, in inflam- 
 mations of the eye and ear, and the latter by dry and wet cup- 
 ping, and by blisters, in deep-seated inflammations. 
 
 7th. When the general force of circulation is sufficiently reduced, 
 either by the debility induced by very extensive inflammations or by 
 artificial depletion, ice may give relief by causing effusion directly 
 from the neighbourhood of the injlamed vessels. Though this is 
 usually effected by powerful stimulants, the relief following 
 the subsequent effusion, more than counterbalances the tempo- 
 rary increase of the disease from the previous irritation. On 
 this principle we use blisters over inflamed glands, and directly 
 upon surfaces affected with erysipelas. 
 
 When an inflammation shows a disposition to terminate by 
 effusion, the circumstance almost invariably marks a complete 
 crisis in the disease; and, with some caution in keeping the 
 force of the general circulation down to the natural standard, 
 the case may be left pretty much to nature. 
 
 When the effusion is considerable, and does not appear dis- 
 posed to yield readily to absorption after the inflammation 
 has subsided, it is sometimes advisable to hasten its retreat by 
 moderate pressure with a bandage, or by bathing the part with 
 brandy, or whisky and water. This condition is frequently 
 noticed in the skin after erysipelas. 
 
 When it is ascertained that inflammation will not terminate 
 by resolution, but is running on to suppuration, (a condition 
 easily known by a throbbing pain in the tumour, by the swell- 
 ing beginning to approach the surface at some particular point 
 with more rapidity than usual, and ui last, by a discoloration of 
 the skin over this point,) a change becomes necessary in the 
 plan of treatment. It is still an object to lessen the severity 
 of the inflammation, and the activity of the circulation around 
 the inflamed part, in order to prevent the undue extension of 
 the abscess; but it is also desirable to hasten the suppuration, 
 and to bring it as soon as possible to the surface or within 
 reach of the lancet. 
 
 To effect this, while we continue for a time the use of low 
 diet and gentle purgatives, we apply a warm bread and milk 
 poultice, changed twice a day, to the centre of the inflamma- 
 tion; and as soon as we can perceive a fluctuation, or the mo- 
 tion of a wave of matter when tapping the sides or top of the 
 tumour with the tips of the two fore-fingers, we plunge in a 
 lancet and evacuate the matter. The local treatment is then 
 regulated precisely as that for uniting wounds by the second 
 intention. 
 
 When the abscess is very large, and the discharge profuse, or 
 when the patient has been greatly debilitated bv other causes* 
 
 I ■" 
 
338 TREATMENT OF SPREADING ULCERS. 
 
 » there is a great tendency to sink; and the strength must be 
 
 supported by a generous and highly nutritious diet, sometimes 
 with the addition of porter or wine, the use of bitter tonics, 
 and the mineral acids; such as ten drops of the elixir of vi- 
 triol, (aromatic sulphuric acid.) three drops of nitric or mu- 
 riatic acid, or five drops of the muriated tincture of iron, to 
 be taken twice or thrice a day, in half a tumblerful, or more, 
 of water. Soaking the feet every night in the nitro-muriatic 
 bath, (see Index,) is often extremely serviceable. This sin- 
 gular remedy frequently produces a salivation, but without 
 shock to the constitution, or that danger of taking cold which 
 attends mercurial ptyalism. 
 
 When inflammation terminates, or endeavours to termi- 
 nate in ulceration, the ulcer may be found in either of four 
 conditions, dependent on the state of the surrounding parts: — 
 and here we exclude the varicose ulcer, which has been treat- 
 ed of elsewhere. — In one condition, the inflammation subsides 
 entirely as soon as the ulcer has reached its greatest dimen- 
 sions under the action of the bread and milk poultice, which 
 is used here, as in the abscess, to promote the rapidity of the 
 necessary changes. The ease is then analagous to a simple 
 wound with loss of substance, and will recover under similar 
 treatment This is what most sin "g ve termed healthy 
 
 ulcer. It is formed by disease, and is then not healthy: it be- 
 comes healthy when the inflammation ceases, and is then, pro- 
 perly speaking, no longer an ulcer. 
 
 In another condition, not distinguished by any particular 
 name among BUI the inflammation, instead ol 
 
 ceeding in effecting a termination when the ulcer ij 
 seems to propagate Itself all around, from the ulcer as a cen- 
 tre; the latter enlarging continually, as the inflammation de- 
 stroys the fitness of the neighbouring parts to fulfil their func- 
 tions. The burrowing and phagedenic utcers of sui 'g 
 belong to this i metimcs the inflammation travels 
 
 superficially, and the parts beneath the destructive operation 
 retaining their healthy powers, the ulcer may heal from the 
 centre, even while it enlarges round the circumference : as 
 we see in Rtipia and other aflections of t 1 -:>mc of a 
 
 scrofulous, and others of a syphilitic character. This condi- 
 tion marks the absence, or the imperfection of the proc> 
 .which the reproductive power ol' the system end 
 arrest the progress o( inflammation: and it clearly ind 
 a bad state of the general health. It is found that. • 
 tensive and rapid, these ulcerations require, for their cm 
 solute rest of the whole person, moderate, but not too i 
 diet, and regular purgation; a fe^ of calomel 
 
 occasionally added to the saline or other cathartics empl 
 
TREATMENT OF IRRITABLE ULCERS. 339 
 
 The mineral acids, as prescribed in excessive suppurations, 
 are also highly serviceable. Locally, the application of cold 
 seems to be interdicted, and the simple bread and milk poul- 
 tice proves inefficient. I have found a poultice composed 
 one half of the crumb of bread, and the other of coarsely 
 broken leaves of cicuta, (co?iiu??i macalutum,) prepared with 
 milk in the usual way, the most powerful of all local measures 
 in the treatment of the burrowing and phagedenic ulcers. 
 Notwithstanding the rapid advance of the habit of treating 
 syphilis without mercury, I still invariably endeavour to pro- 
 duce and maintain a slight copper taste in the mouth, by 
 means of pills of one grain of calomel, in every case of rapid 
 and deep ulceration, apparently of syphilitic origin. Cases 
 that resist every thing till this impression is produced, will 
 often get well immediately after, under the use of cicuta. In 
 rupia and some other similar exulcerations of the skin, the 
 pure extract of cicuta, made into an ointment with a very 
 little lard, will often effect great relief; but proper rupia is a 
 most unmanageable affection. Calomel given to touch the 
 mouth is inadmissible in these cutaneous cases; but calomel in 
 the form of an ointment, applied directly to the sore, is often 
 useful. We might dilate upon the thousand remedies which 
 occasionally cure slight, and ill-defined ulcerations of the 
 skin; but the extreme difficulty of distinguishing the very nu- 
 merous varieties of these atfections, must for ever keep them 
 within the province of a select circle of professional men, who 
 pay particular attention to diseases of the skin. 
 
 In a third condition, the parts around the ulcer arc relieved 
 of the activity of inflammation; but the blood vessels, instead 
 of returning to a healthy state, seem to undergo some unknown 
 change of action which keeps up an excessive excitability of 
 the nerves of the part The ulcer is extremely painful; some- 
 times constantly, and sometimes periodically; and its edge is 
 j liar or jagged. The granulations often form with great 
 rapidity, and nearly fill the sore; when suddenly, and without 
 apparent cause, they totally disappear, leaving the sore as bad 
 as ever. The discharge is seldom of pure pus, but more ge- 
 nerally an irritating and thin ichor. These ulcers occur most 
 frequently in the neighbourhood of moveable joints, and par- 
 ticularly in that of the ankle: they are the irritable ulcers of 
 surgical writers. The most absolute rest of the neighbouring 
 joints, and of the part affected, must be secured; and, if neces- 
 sary, this must be done by splints of carved wood, moulded 
 tin, or wet book-binders' board, bound on the limb, and allowed 
 to dry there. The ulcer must be dressed with narcotic poul- 
 tices, of which the best are those prepared with bread and 
 milk mingled with cicuta, (conium macidatum,) Jamestown 
 
340 TREATMENT OF INDOLENT ULCERS. 
 
 weed, {datura stramonium,) and opium; and, in some cases, 
 the poultice of boiled hops and vinegar will prove serviceable. 
 The dressings must be light, for the part will not tolerate 
 much pressure; and as no one article agrees with it for many 
 days together, the poultices may be alternated with ea-ch 
 other, and with plasters of simple cerate, or of this ointment 
 mixed with about one-eighth of its bulk of sugar of lead. 
 Surgeons sometimes relieve the most obstinate of these ulcers, 
 by burning off the whole surface with vegetable caustic, ( 
 tic potass,) and dressing with the bread and milk poultice, 
 until the slough is separated. The new sore thus created 
 sometimes resembles a healthy wound, and heals without dif- 
 ficulty. 
 
 In the fourth and last condition, the edges of the ulcer are 
 thick and rounded; the whole sore is surrounded by a callo- 
 sity, which appears to embarrass the restorative powei - 
 though the absorbents had failed in removing all the parts which 
 are rendered incapable of perform in 5 their proper duties by 
 the inflammation, and had saddled them, weak as they are, 
 with a task of reproduction, of which they are incapable. 
 The discharge is sometimes purulent, sometimes watery, and 
 sometimes almost imperceptible. At one time, there will be 
 no visible granulations; at another, the sore will be filled with 
 such as are large, rounded, pale, anil flabby; instead of small, 
 conical, bright red, and firm. In some cases, on the contra- 
 ry, the bottom of the ulcer is covered with small, pale granu- 
 lations of very slow growth, and almost cartilaginous hardness. 
 The cavity is generally deep, and the edges overhangi: _. — 
 Such ulcers are most common on the 1 I, and 
 
 arc the indolent ulcers of surgical writers. 
 
 These ulcers require the emplovment of . to pro- 
 
 mote the absorption of the callosities «>r d< bicfa sur- 
 
 round them, and assist in rendering them indok at 
 is best applied by means of long and broad 
 
 plaster, drawn tightly across the sore, and supported by a 
 well applied bandage and compress. They shook] he chai 
 
 or tightened, once every other day, at farthest; and if an] 
 dancy to erysipelas appear on the neighbouring skin, the 
 strips must be omitted, and the Iv d compress relied 
 
 upon solely. Poultices, or any other moist applications, con- 
 tinued for many days together, are very injurious: and the 
 local applications require to he stimulating. Among :! 
 ointments may be mentioned, basilicoo ointment, liouland's 
 cerate, red precipitate ointment, white precipitate ointment, 
 and tar ointment. These must he chanced from time to time; 
 for no one application will continue to do good for many 
 consecutively. Great cleanliness should be i and the 
 
HEALING OF ULCERS. 341 
 
 part should be well washed with Castile soap, water and 
 sponge, before each dressing. Sometimes the ulcer will not 
 tolerate unctuous applications of any kind, but shows a dispo- 
 sition to become irritable under their use. Mucilaginous or 
 astringent washes must then be substituted. Of these, some 
 of the best arc, decoction of slippery-elm bark, decoction of 
 oak bark, and solutions of the sulphates of iron or copper in 
 the proportion of fifteen or twenty grains to the ounce of 
 water. 
 
 When the bottom of the ulcer is entirely without granula- 
 tions, perhaps little can Ik- gained by any additional stimula- 
 tion; but when filled with such as are loose and flabby, if the 
 astringent washes do not alter their character, it is best to 
 dust them every two or three day* with red mercurial pre- 
 cipitate, or with a little burnt alum. This last article i^ a 
 very mild caustic, when applied to new-formed parts, and a 
 powerful astringent under all circumstances. It is prepared 
 by placing a lump of common alum on an iron shovel, and 
 placing it over the lire. It melts in its own water of crystal- 
 lization, and the heat must be continued until this water boils 
 off; and the remaining fioerj powdered, is the burnt 
 
 alum used bv suiL r < <»ns. When the sore contains the little. pale, 
 cartilaginous granulation! above mentioned, some still more 
 i i ul applications are required; and the best of these is 
 the mild mineral caustic, (lunar caustic or nitrate of silver) 
 which may he freely applied to the whole BUrfece, and re- 
 ; d, ifneo I days in succession. Surgeons some- 
 
 tinx - resort to still more powerful measure -. and rut away the 
 thickened edges with the knife, or burn them off, together with the 
 
 bottom <it" the ulcer, hv means <>\ the strong vegetable caustic. 
 Ulceration in general is a modification ot the termination of in- 
 flammation by suppuration. 
 
 When an ulcer of any class has been regularly filled by 
 granulations, these sometimes become exuberant instead of 
 healing over; and they then rise into what is called proud Jiesh. 
 This must be repressed by the free application of Peruvian 
 bark, burnt alum or lunar caustic, according to the obsti- 
 of the growth; but in using the two last named articles, 
 care must be taken to prevent their touching any part which 
 has pot risen above the natural height of the surface, or any 
 part upon which the thin, white, or glossy membrane which 
 forms new skin, has begun to appear. 
 
 Instead of the thin membrane which marks the proper pro- 
 cess of healing, we sometimes observe the surface partly co- 
 vered with a thicker, opaque, white, spongy looking film, 
 which often separates in flakes, from time to time, and shows 
 no disposition to dry. Whenever this is the case, the ulcer 
 
342 MALIGNANT PUSTULE GANGRENE OF AGE- 
 
 should be covered with the dry dust of chalk, or, what is better, 
 the carbonate of zinc, over which we may lav a simple rag of 
 muslin. 
 
 Indolent ulcers, with a surface constantly moistened 1 
 iluid thinner than pus, but which are not painful, will often 
 recover under a constant covering of the dust of chalk, or un- 
 der a dressing of simple dry lint; and 1 have known some of 
 the most obstinate to be happil; d in their condition by 
 
 being left uncovered, .and entirely I to the stimulant 
 
 and drying effects of air for twenty- ether. 
 
 When an ulcer shows a disposition to form ;i scab, tin- should 
 never be disturbed unless pus collect beneath, or unless the 
 hardness and contraction of the scab prove very irritatu 
 the surrounding parts. In either of th< it may I 
 
 parated by one or two bread and milk poulti 
 
 Though inflammation i^ said to terminate in >e or 
 
 mortification, the mortification often - the imlammation. 
 
 This is the case in the malignant pustule, ill ; old 
 
 men, and the dry gangrene from e iting br< ad which 
 spurred i j ot 
 
 The malignant p ttett tl is b ran e; but is begtnnii - 
 
 appear in this country. It » contracted in the si 
 ner, by carving or opening th< of diseased cattle'. It 
 
 begins by a small spot of mortification, occurring somewhere 
 on the extremities, (generally the upper.) without pain or 
 warning. It spreads very rapidly, and soon becoi rcled 
 
 with a ring o( horribly painful inflammation. But oi 
 is known for it, and it will certainly prove fatal if tin 
 be not applied very promptly. The whole pustule witl. 
 inflamed ring around it must be entirely ed with 
 
 table caustic, or the white hot iron; and the part should 
 be dressed with bread and milk poultiee until the CSC bar I 
 away; alter which it is treated as a simple uleer. 
 
 The gangrene of old m invariably in the I 
 
 advances up the leg, and involves the whole thi \ the 
 
 member. It is supposed to be caused by the Oflsification of the 
 smaller arteries. Life may be supported till ass 
 kained, by generous diet, keeping the bow< a\*\ mod- 
 
 ly administering wines and cordials. Amputation is th< 
 medy: but this cannot be attempted until the pi the 
 
 disease is arrested, and nature att< 
 then; the large arteries are closed 
 
 beyond the mortification; so that the operation must be per- 
 formed high up; and the chance of l»oth 
 on account o( the debility of the patient, ami the fiequ 
 with which the ossification is found extended to all the -mallei 
 vessels of the limb, or, perhaps, the whole b 
 
GANGRENE FROM INTERNAL CAUSES. 343 
 
 The rare and curious disease, called dry gangrene, occurs in 
 persons of all ages. It begins at the finders or toes of one or 
 more limbs, ailects the whole thickness of the member, and is 
 progi The part dies and shrivels, without producing 
 
 much smell. The principal blood vessels are closed iar above 
 the termination of the gangrene. Amputation is necessary, 
 with the same precautions as in the last named disease ; and 
 the chance of success is very slight, for nearly similar reasons. 
 
 Gangrene from excess of inflammation occasioned bij internal 
 and cxmttitutional com* s, may extend to the whole thickness of a 
 member, or be comparatively superficial. In the former case, 
 amputation will be n< ; in the latter, it can seldom 
 
 be required. This form of gangrene ifl progressive : and 
 the V4 nd its limits Amputation is. there- 
 
 fore, liable to the restrictions and risks mentioned in speaking 
 of tin- ae of old persons, and the dry gangrene; but in 
 
 this form, when the line of demarkation between the living 
 and the dead parts is once dearly marked, the chances of 
 succe astly greater, unless the patient be reduced by 
 
 disease to an extreme degree of feeblea 
 
 In the treatment of the form of gangrene under considera- 
 tion, indcpcndentlv of the | for the relief of the 
 general disease which causes the inflammation, and in addition 
 to the usual measures tor maintaining the strength of the pa- 
 tient and retions in good condition, as laid 
 down under the head of suppuration, w<_ have local measures 
 for arresting the progr es s of th< ae, which are of little 
 avail in the preceding varieties. The most powerful of these 
 is a blister, applied all around the line where the mortification 
 This practice was strongly inculcated by the late 
 celebrated Dr. Phytick. Its action obviously results from the 
 relief given to the capillaries in the immediate neighbourhood 
 of the gangrene, by the effusion caused by the blister. 
 
 A great variety of poultices have been recommended in the 
 treatment of gangrene; and some of them. the fer- 
 
 menting and charcoal poultices, have been regarded as almost 
 specilic in their action by many. But, excepting that it is 
 proper to apply gentle stimulants to the weakened vessels im- 
 mediatelv in contact with the dead matter, and that it is agree- 
 able to check the fetid odour of the decaying parts as much 
 as possible, there appears no very valid reason for modifying 
 a poultice merely on account of the neighbourhood of dead 
 matter. The charcoal poultices are dirty, and the fermenting 
 ones are troublesome and very disagreeable. We would there- 
 fore recommend, in domestic practice, a simple bread and 
 milk poultice, when the extent of the disease is small, and a 
 poultice of Indian meal and water, dusted over with powdered 
 
o44 GANGRENE FROM PRESSURE AND COLD. 
 
 Peruvian bark, when it is great. If the cinchona be not pro- 
 curable, prepare the poultice with a decoction of tanner's 
 bark, or the bark of the dog-wood,* (cormts fiorida or ceracea.} 
 To remove the terrible foetor, the dead part of the limb may 
 be wrapped in cloths wet with pyroliimeous acid, and sur- 
 rounded with coarsely powdered fresh charcoal, these appli- 
 cations being frequently renewed. 
 
 The probability of recovery in cases not requiring amputa- 
 tion, depends very much upon the strength of the patient, and 
 his ability to bear the exhaustion of a terrible discbarge during 
 the whole time of the separation of the dead matter and the 
 healing of the cavity left by its decadency. To increase the 
 chances, the tonic measures and diet directed in case of 
 fuse suppurations from abscesses should be carried as far as 
 the general condition of the patient will warrant. 
 
 (fangrtnt from pressure, that dreadful aflliction of the 
 bed-ridden, is progressive only so far as the can* il pr gri ■ 
 and its extension i be moment that the | 
 
 moVed. There is no reason to believe that the blood vessels 
 are clogged with coagvb for any distal) 
 of the gangrene. The nsoal seats of this kind* of [ e are 
 
 the sacrum, the nates, the hips, the harks and points of the 
 shoulders, and — in mismanaged fractures of the leg or thigh — 
 the parts over the tendon of the h 
 the perineum. The preventive trcatm 
 
 frequently the points of pressure, (except in lure, 
 
 where the pressure must be smoothly applied, and made mo- 
 derate in degree,) by means o( down cos! 
 changes of position, and. in hospitals, 
 Fomentations with cold brandy, or wbil to fortify the 
 
 part; and, after gangrene has occurred, they hasten the - 
 
 ration of the sloughs. The best poultice, in sir! - one 
 
 of plain bread and milk; or. if the general debility be 
 great, a little hark may he added. 
 
 Gangram from CM — Thh d principally in the 
 
 ears, nose. lips, chin, and extremities. It alVects the whole 
 thickness of the part attacked, and generally requires amputa- 
 tion, to prevent the irregular cicatrix resulting from a natural 
 separation of the parts. It is very rarely ve, and il 
 
 ver so to any great extent. There is no reason br believing that 
 the circulation in the vessoh ia embarrassed far beyond the 
 limit of mortification. The line oi demarkation between the 
 
 • We mean the tree called dog-wood in the middle states. The name i» a 
 dangerous one, for it is applied very differently in different places; and we ire 
 told that it is used at the north to signify the "most poisonous of the sumacs, 
 the rhus yernix ! 
 
GANGRENE FROM MECHANICAL INJURIES. 345 
 
 dead and living parts is readily, and, in most instances, speedily 
 formed. In these cases amputation is, therefore, beset with 
 none of those dangers which attend it in most of the preceding 
 varieties. The prospect of cure, under the proper general 
 treatment, is good; for the patients most subject to these acci- 
 dents are men of vigorous and hardy constitutions. We have 
 known of more than one instance of natural cure, without am- 
 putation, after the loss of both feet, where professional aid 
 could not be obtained, and where even the diet was ill adapted 
 to support the patient under an exhausting discharge of pus. 
 
 Gangrene fi\ mical Injuries. — When the mortification 
 
 occurs from tfa - of inflammation produced by mechani- 
 
 cal injuries, the injuries are generally much more extensive 
 than the mortification; and for this reason alone, the gangrene 
 jucntly progressive. The uniform ill ellects of amputa- 
 tion in some of the preceding varieties, has induced many sur- 
 to proscribe the attempt to amputate before a clear line 
 of demarcation is trac absorbents, between the dead 
 
 and hiving matter: or, at all events before the progress of the 
 mortification is arrested. Hundreds of lives have been sacri- 
 ficed to the < on and sympathetic mischief resulting 
 from severe injuries, during tip' delay occasioned by this ill- 
 founded opinion. We cannot allow even this opportunity to 
 past without stepping aside, for a moment, from our legitimate 
 track, to point out sore of the erroneous character of 
 the rule to those practitioners wh ion removes them 
 from the opportunity of widely extended surgical observation. 
 
 Traumatic gangrene, (the technical title of the present va- 
 ) t!iou'_ r h frequently pi . when un- 
 
 comp rosly injured at the time of 
 
 nt. The emban of the circulation from co- 
 
 agulation never appeal- sphere much more extended 
 
 than the limits of toe injury. The principal causes of morti- 
 fication, or ulceration of the slump, and consequent death, after 
 amputation in other forms of gangrene, are either the vitia- 
 tion of the constitution by previous disease, or the morbid con- 
 dition of the part involved in the operation produced by simi- 
 lar causes. Now, in traumatic gangrene, the constitution is 
 usually sound, until the health is undermined by the conse- 
 quences of the injury itself; and, especially, by the irritation 
 produced by the morbid condition of the parts; which are so 
 altered by the accident and the subsequent inflammation, as to 
 be liable to fall under the progress of the gangrene. So much 
 for the dangers dependent on the general condition of the 
 health. As it regards the state of the part operated upon, no 
 surgeon in a sound state of mind, professionally speaking, would 
 attempt to pass his knife through parts seriouslv altered from 
 
 -11 
 
34(i INJURIES PRODUCING COLLAPSE. 
 
 health. He goes above the injury; or, at least, above the se- 
 vere impression which it has made ; and there operates upon 
 parts nearly, or entirely, in a sane condition. The causes of 
 disaster, in amputations during the progress of other 
 grenes, are therefore absent in the commencement of trau- 
 matic gangrene; and we are confident that the risks of an 
 ulceration or mortification of the stump, as well as the danger of 
 phlebitis, or metastatic abscesses, — the usual causes of death. — 
 are much greater when we wait for the line of demarkation, 
 than when we operate as soon as possible after the full 
 blishment of reaction. 
 
 Cases occurring in persons previously affected with serious 
 ill health, are of course exceptions to this law, and one other 
 caution seems advisable here. A livid appearance of the 
 skin, and the formation of collections of bloody scrum beneath 
 the cuticle, after bad fractures and contu-i- • proof of 
 
 gangrene; for we frequently tee thai state of tbingi on the 
 surface of limbs, in which the si:_ r ns of circulation beyond the 
 injury arc plain and obvioi: with- 
 
 out another unpl mptOBL 
 
 In traumati' - not to require or ad- 
 
 mit of amputation, the it should be similar to that 
 
 scribed in gangrene from excess of inflammation produced by 
 internal caua 
 
 Termination* of inflammation coupled with colhr f -.--\\ 
 completed our remarks upon the terminal ntlamma- 
 
 tions of moderate extent, it ■ time to add a few wordi upon 
 those which arc 10 genera] fti to produce collapse. The 
 frequent of these accident :lt from burns and 
 
 scalds, which may therefore be taken as the tvju ; tl 
 there arc others of similar character occasioned ! 
 both internal and external. 
 
 The condition of things immediately foil 
 of this description, is widely dii m that p it the 
 
 commencement of tion. The vu\ exu nt and mi; 
 
 of vessels injured, renders it impossible that the rapid:; 
 circulation should be materia 11 v increased it for the 
 
 whole mass o( circulating thud is insufficient to keen up a 
 swift current through so many dilated Teasels, whil- 
 ing a sufficient supply to the other i ad the b 
 
 rally. This impossibility is rendered more \ natu- 
 
 ral consequence of all extreme 
 
 one which has been already described in the chaptc r on pi 
 logy. This is the concentration of the vital energies upon the 
 organs most essential to life, which pr 
 
 ment of the blood vessels of the brain, b nacb. and ihe 
 
 portal system generally : thus removing a 
 
INJURIES PRODUCING COLLAPSE. 347 
 
 other parts of the body, oppressing and checking the action of 
 the heart, and leaving the surface, where uninjured, pale and 
 contracted. 
 
 In this condition, the inflamed part is indeed reddened, but 
 the colour is not the florid hue of lesser inflammations, but 
 wears a purple, dark, or venous aspect. The temperature 
 is not materially increased, and is often found even below the 
 natural standard ; for the main source of animal heat is cut otK 
 For the same reason, — (he tardiness of circulation, — the sensi- 
 bility of the superficial nerves is diminished, instead of being 
 increased. But little positive pain is felt, and although there 
 is sometimes a terrible burning or tingling sensation, yet, in a 
 majority of cases, the patient complains of nothing but 
 cold, and trembles like one in the chill of an ague. It is curi- 
 ous that the extent of a superficial injury is much more effect- 
 ive in producing collapse than its severity. I have seen many 
 of the muscles of both noyed by hot sand poured out 
 
 from a bursted brick kiln, yet the patient suffered no collapse, 
 and lived for many weeks; and again, 1 have seen a man who 
 had been completely surrounded by high pressure steam, im- 
 mediately on its escape, in profound collapse and violent chill, 
 though the scald had not raised a blister on any part of his 
 
 Ja.* An individual but slightly burned over more than 
 lalf hi- surface, almost al. j while one who has been 
 
 rely burned over but one-third of bis person, stands 
 drer chance of re< 
 
 In thf state above described, it i< evident that the applica- 
 tion of cold would be extremely improper. It diminishes still 
 farther, the alrea< enl vitality of the surface, and in- 
 
 - thf determination of b of life al- 
 
 ready oppressed with I id. We have seen a surgeon 
 
 wild enough to direct cold effusions on one of the most exten- 
 ttded with collapse; but almost immediate death 
 ived the correctness of the doctor's theory ! Equally 
 idle, to use no har>hcr term, would be the attempt to employ 
 local depletion, or low diet, in cases of this character. In 
 \' tv had accidents of this nature, the labour of reparation, if 
 attempted, keeps the system constantly depressed. The reac- 
 tion is imperfect, and when fever occurs, it is of a low type, 
 and attended with great danger of inflammation of internal 
 organs. 
 
 The general treatment throughout the case must be of the 
 tonic and stimulating character, to support the patient's 
 strength, and equalise the circulation; care being taken to 
 
 " It is a remarkable fact that steam, on its first escape from very high pres- 
 sure, does not scald. The farther the subject is removed from the orifice, the 
 more serious is the effect of the heat. 
 
348 INJURIES PRODUCING COLLATE. 
 
 keep up the natural secretions by suitable purgatives, such as 
 eight or ten grains of rhubarb, occasionally combined with 
 five of calomel, and the terebinthinic mixture given in ihe 
 dose of a table-spoonful every three or four hours. The sti- 
 mulants given should be of a nature to act on the skin. The 
 camphor julep and wine whey, are among the best. If there 
 be great restlessness and vigilance, an occasional dose of a 
 tea-spoonful of Hoffman's anodyne, will . «t relief. 
 
 Acidity of stomach may be checked by ten grains of carbo- 
 nate of soda, dissolved in a wine-glassful of water. Sick 
 of stomach may be relieved by the spice piaster, with cold mint 
 tea, or the horse-mint tea, {monarda punctata ;) and thirst, by 
 lemonade, cremor tartar water, and ice. When suppuration 
 is extensively established, great benefit frequently follows the 
 use of the decoction and tincture of bark, or the best wine 
 bitters. 
 
 The local treatment must also be stimulating. The appli- 
 cation universally employed, in the first instance, in very 
 extensive burns and scalds, is the Kentish ointment: a mixture 
 of lard and spirit of turpentine: which, far from giving pain, 
 is peculiarly soothing in its effects. 
 
 The above directions are intended for the treatment of 
 in which free reaction never becomes established. 
 When the pulse rises, and the swelling, heat, and pain of the 
 part increase, the proper treatment should be cautiously and 
 slowly approximated to that prescribed in inflammations of 
 more moderate extent. 
 
 These injuries very rarely terminate in resolution; and then, 
 only in cases of the mildest character. When the mischief 
 is more severe, the cuticle is lost over part, or the whole of 
 the burned or scalded surface, and the most troublesome ul- 
 cerations of the true skin are almost sure to follow. When 
 •still more the true skin itself is destroyed, often toge- 
 
 ther with deeper seated parts. We bave tben. actual and in- 
 stantaneous mortification, preceding the inflammation; but the 
 gangrene never shows sition to ictly 
 
 local. The ulcers are now proportionally more unmanagea- 
 ble, and are followed by terrible contractions of the cical 
 when healed, often producing dreadful deformities, and some- 
 times destroying the use of the neighbouring joints. 1 
 deformities are not always incurable — surgery has manv re- 
 sources for their relief, in the way of serious, painful, and 
 protracted operations; but very few surgeons in this country 
 have as yet been willing to attempt much in tl. i The 
 
 subject, however, attracts more and more attention d; 
 
 Having completed our somewhat ample remai k lam- 
 
 ination, in general, we must trust mainly to the intelligence 
 
ULCERATION OF THE EYE-LASHES. 349 
 
 of the reader, in applying the principles and directions to par- 
 ticular cases. Our remarks en certain peculiar inflammato- 
 ry affections will be few, brief, and confined chiefly to those 
 points in which the nature or treatment of the disease differs 
 from that laid down in the preceding portion of this section. 
 
 Of the Sty. This is an inflammation on the edge of the 
 eye-lid, surrounded by much hardening, and often inducing 
 inflammation of the front membrane or conjunctiva of the eye, 
 and consequent intolerance of light Sties are often vqvv te- 
 dious and painful, and there is apt to be a succession of them. 
 
 The sty is occasioned by a clogging of the outlet of one of 
 the little glands, which furnish* > or gummy matter to 
 
 the edge of the eyelid. The secretion then collects and forms 
 a little sac, which inflames, but rarely if ever suppurates freely. 
 Sometimes it may be much benefited by the application of 
 a leech or two, after which the eyelid may be rubbed with 
 Goulard's cerate; and if the interior of the eye be inflamed, it 
 should be relieved by frequently dropping into it a single 
 drop of a solution of the pith of sassafras, made by shaking 
 four or five inches of pretty thick pith, or a proportionate quan- 
 tity of that which is liner, in a four or six ounce vial full of 
 pure water. To drop this, let the patient place his fore finger 
 over the mouth of the vial, and looking directly up to the 
 ceiling, let him bring the etlge of the vial close to his open 
 eye: by raising his linger a little from the mouth, and then 
 dosing it again immediately, in this position, a single drop 
 will fall directly on the ball of the eye. When there is any dis- 
 position to point, or form a yellow spot on the edge of the 
 eyelid, it should be picked open with the point of a needle, 
 and the yellow crust which soon forms on the spot, should be 
 kept soft by very frequently washing the gently closed eye- 
 lids with warm water and plenty of Indian meal. A disposi- 
 tion to form a succession i may often be checked by 
 wetting the palm of the hand with brandy or whisky, and 
 subjecting the open eye, every day, to the fumes alone, by 
 holding the wet hand over it. 
 
 Ulceration of the eye-lushes. There is a troublesome 
 scurfy or scaly ulceration of the edge of the lid which destroys 
 the eye-lashes, after surrounding the base of each hair with a 
 kind of honey-comb crust. 
 
 To relieve this, prick away all the scabs carefully with the 
 point of a needle; and then with the back of the point of a 
 penknife, spread a little citron ointment, mixed with its own 
 bulk of lard, over the ulcerated surface, pushing it very care- 
 fully between the hairs, f)ut avoiding all contact between the 
 eye and the salve. In half an hour, wash it off with Castile 
 
350 FOREIGN SUBSTANCES IN THE EYE. 
 
 soapsuds on a soft rag — and repeat the application every 
 morning;. 
 
 Foreign substances in the Eye. Particles of dust, saw dust, 
 sand, the grit from grindstones, &c, are very frequently caught 
 between the eye-ball and lids, where they give intense pain, 
 and if not immediately washed out by the flood of tears which 
 they create, they produce excessive and sudden inflammation. 
 They must be removed as soon as possible. If of a dark co- 
 lour, and above a microscopic size, they may always be 
 by raising the upper or d» the lower lid, drawing it 
 
 off at the same time from the ball by means of the la 
 directing the eye to be rolled in various directions. After a 
 few trials, we almost always see the offensive particle-, 
 can readily remove them, either by blowing with the breath, 
 or scooping them up with the eye of a silver probe or bodkin, 
 or one handle of a delicate pair of ladies' 1 I— in The 
 bears the contact of these smooth solid substances perfectly 
 well; and if gently used, they in whatever. As 
 
 soon as the particle is .a drop of the solution of pith 
 
 of s;i- iould be dropped into I it should be 
 
 covered with a handki r a few hours. When the mote 
 
 cannot be me may be slippc . 
 
 tween the upper lid and the ball, and the lids closed. The 
 stone will immediately commence travelling round 
 pushing the mote from pin . till the I 
 
 approaches the opening, ami is washed out b) tb< The 
 
 stone may he left in th- an hour: as it pj » un- 
 
 pleasant sensation. Every family should he 
 veral of these useful little i, which are told 1 ■;. 
 
 apothecaries. They are the opercula or mouth-] mall 
 
 marine shells, worn very Bmoolh I 
 on the beach in certain countries. They ihould be 
 clean, and preserved from the con! 
 
 vinegar or lemon juice will du pail them. Their 
 
 motion in the eye nod by that of the ball and lida 
 
 they do not drop out the moment t 1 
 be pressed out by a slight touch o\ tin 
 
 Sometimes pieces ( .t iron. BO BtlDH 
 hie. are driven forcibly into the membranes, or even into the 
 cavities of the eye. In the lat 
 
 cuated in consequence of the - the wound, the iron is 
 
 absorbed by the fluids, generally without producing ma: 
 inconvenience: hut when the particles stick in the outer mem- 
 branes, they give intolerable pain. 1 I this 
 kind happen to turners, machinists, and bla 
 ways require (he aid of a surgeon. Fortuoatelj 1 aid 
 
INFLAMMATION OF THE EYE. 351 
 
 is almost always promptly attainable in the neighbourhood of 
 the establishments of these artisans. 
 
 But 1 have frequently seen milder cases in distant country 
 situations, where domestic relief is often the only dependence 
 for many hours. On attempting to work rusty and neglected 
 iron pump-handles, the axles of grind-stones, and the chains of 
 well-buckets, we frequently see thick showers of fine sharp 
 particles of rust shot off in all directions with great force by 
 the friction. This is the general cause of the accident on dis- 
 tant /arms, and it is very rarely understood. When, after 
 standing near either of the domestic machines just men- 
 tioned, while in action, a patient suddenly complains of great 
 pain in the eye, an inability to keep it open, and a profuse 
 flow of tears, we should at once examine the organ with ex- 
 treme care: and if a minute speck of a black or brown colour 
 n in the clear or white part of the eye. which does not 
 move upon being gently touched with the point of the finger, 
 we arc sure of < ur case. A person with linn nerves, a steady 
 hand, and a tolerably delicate touch, may safely pick away 
 tin; mote with the point of a I die, provided it be not 
 
 Obviously sunk beneath the surface. In this case, he must use 
 freely the solution of pith of 1 • and leave the treat- 
 
 ment to a sin -.on, be his arrival late or early: for, by attempt- 
 ing too much, the eye might ho evacuated 
 
 As soon as the point of tin- needle has obviously removed 
 
 any portion of the mote, the operator may bo assured that the 
 
 whole is dislodged] even though a brown <>r dark spot remain. 
 Motes of this kind are hard, and do not come away piece-meal : 
 and they always produce an appearance which may prove a 
 source of dan ror, if the fact he overlooked. They 
 
 communicate to the tissues all around them a stain of their 
 own colour, which often continues (or weeks alter the cause is 
 removed. The consequences of attempting to pick away this 
 stain need not be pointed out. 
 
 frnfiamnuUion if (lie Eye, The human eye is an organ so ex- 
 tremely complex, that it is subject to a very great variety of 
 diseases, some of them destructive to the organ itself, and others 
 even to the life of the patient. It is, therefore, with fear and 
 trembling that we attempt to address ourselves to unprofes- 
 sional cars upon this critical subject. But after having seen 
 the eye tilled with powdered alum, when in a high state of 
 inflammation, — with sand, to grind oil a film mechanically, — 
 with spirits of turpentine, to relieve a burn, &c, we cannot 
 but feel that the few remarks we are conscientiously warrant- 
 ed in making, may be productive of more good than harm. 
 
 Acute inflammations of the eye, when at all severe, are 
 commonly attended with violent reaction. The fever is gene- 
 
352 INFLAMMATION OF THE EYE. 
 
 rally open and high, and the case requires the most vigorous 
 general, as well as local treatment. 
 
 'The lancet should be freely used when the constitution of 
 the patient will bear it, and in those terrible inflammations of 
 hot and sandy countries, sometimes, though rarely witnessed 
 in other situations, which produce suppuration in the course 
 of a few hours, it is often advantageous to bleed, even to faint- 
 ing. The diet should be as strict as possible, and both eyes 
 should be positively protected from light. Saline purgatives 
 should be given freely and frequently, as the patient's strength 
 will bear it. 
 
 When the iris is inflamed, the state of the organ may be 
 known by the formation of a well defined, narrow red 
 round the circumference of the clear part of th red- 
 
 ness evidently shining from deeper parts, through the white 
 membrane in that place, where it is thin;) by a reddish, dt 
 or unnaturally mottled appearance of the coloured membrane 
 of the eye; by an unusual smallness, immobility, and, some- 
 times, irregularity of the pupil; by pain d< <1 in the 
 ball of th mveryintJ -ation of con- 
 striction and pain across the front of the forehead, above the 
 eye-brows. In this state of things, the mouth must be touched 
 with mercury, as rapidly as possibl a pill of half 
 a grain of calomel and the fourth of a grain of opium, four or 
 six times a day, while the general treatment above described 
 is pushed with vigour; omitting all purgatives, for fear of re- 
 tarding the action of the mercury. The moment the gums 
 appear a little sore, and the quantity of saliva begins to be in- 
 creased, the mercury must be intermitted; ami, if the saliva- 
 tion threaten to run high, a gargle of borax and sage tea, and 
 a purge o( sulphur and cremor tartar should be given. The 
 operation should be followed by the occasional exhibition of 
 a mercurial pill whenever the salivation appears likely to 
 cease; so as to keep up a gentle action on the mouthfor seve- 
 ral days. This is almost the only hope of safety in iri 
 
 In inflammations of the front membrane of the eye. which 
 arc much more common, the whole surface of the inside of 
 the lids and the white part of the ball arc generally reddened. 
 The litis are swelled and puffy, the eye watery, and the e< _ 
 of the lids, in mild cases, are generally agglutinated in the 
 morning. There is intolerance of light, but not so mark* 
 it is in iritis. The pain is commonly superficial, and is of the 
 smarting and burning kind. The general treatment being 
 carried on as vigorously as the violence and rapidity of the 
 case seem to require, the best local mcasur 
 the infusion of the pith of sassafras and weak lead water. Cold 
 applied to the lids gives great relief. 
 
INFLAMMATION OF THE EYE, 353 
 
 In bad and rapid cases, the swelling becomes very great; the 
 external membrane of the eye becomes thickened and granu- 
 lated, rising up until the clear part looks as if seated at the 
 bottom of a blood-red cup, and the thickened membrane some- 
 times actually protrudes from the lids. In this condition the 
 eye pours out an enormous quantity of pus. If the disease 
 continues unchecked, the external lining of the clear part be- 
 comes cloudy and opaque, or even red. This produces a film 
 which seldom disappears entirely, and often produces incura- 
 ble blindness. These cases occur, occasionally, in all places, 
 and at all ages; but they are most frequent among children in 
 temperate, and adults in tropical climates. 
 
 In addition to the general treatment already laid down, the 
 author of these pages introduced into the practice of the Penn- 
 sylvania Hospital, in 1819, a plan of local treatment, formida- 
 ble in appearance, but perfectly safe, even in popular hands, 
 under the circumstances described, and one which has never 
 failed, in his hands, to conquer the disease. It consists in ap- 
 plying three or four American leeches directly to the ball of 
 each affected eye, avoiding the clear part. When the leeches 
 are two-thirds full, cut oil' a quarter, or half an inch of their 
 tails with a very sharp knife, razor, or pair of scizzors, dis- 
 turbing them as little as possible by the operation. They will 
 then continue to suck for a long time, evacuating themselves 
 it as they fill. l( their pertinacity exceed the bounds of 
 patience, they may be made to fall off quickly by touching 
 their backs with a little dry table salt. This operation never 
 produces any evil consequence, though the unpractised ope- 
 rator is often extremely alarmed, next day, to find the whole 
 surface of the eye of one bright red hue, in which no vessels 
 can be discovered! This appearance is occasioned by an ef- 
 fusion of blood from the leech bites, poured out beneath the 
 membrane, which is nearly transparent, even when inflamed. 
 It is of no consequence whatever, and disappears in a few 
 clays by absorption, sometimes passing through the various 
 shades of colour usually seen in bruises. After the operation, 
 the eye should be covered with a light, cold bread and milk 
 poultice, containing a little sugar of lead. This practice, with 
 the exception of the mutilation of the leech, has been since 
 introduced, extensively practised, and publicly advocated by 
 a distinguished surgeon of Dublin. To show the safety of the 
 leech, as an application to the ball of the eye under such 
 unfavourable circumstances that none but a surgeon could 
 safely presume to employ it, I will mention that in one case 
 of violent iritis threatening the destruction of both eyes long 
 before salivation could be induced, I ventured, as a forlorn 
 hope, to apply three very large leeches directly to the red 
 
 45 
 
354 ULCERATIONS AND FILMS 01 THE EVE. 
 
 ring already described, where they bit entirely through the 
 white coat of the eye, and drew the blood directly from the 
 vessels supplying the iris. Strange lo say; though the pupils 
 were contracted to the size of the heads of large pins, and 
 nearly square, while the iris wore all the appearances of im- 
 pending disorganization; the relief of the attack, under this 
 treatment, proved both immediate and complete. 
 
 Ulceration of the Cornea. — This alTection is noticed chiefly 
 to warn the domestic adviser to seek surgical advice as quickly 
 as it appears. In this affection, the eye is very intolerant of 
 light, and watery; and, on examination, we perceive, on some 
 part of the clear portion of the eye, a small, rounded, or ir- 
 regular depression; and two or three well marked n 
 are seen meandering from some point of the white of th< 
 across the field of the clear part, toward this depression. The 
 danger of loss of sight is imminent; and, although surgeons 
 possess many resources for the Bi f the 
 
 case, yet all that can safely be done by unprofessional fr. 
 is, to relieve pain by the use of the solution of pith ot 
 or well filtered watery solution of opiu;. lode all I 
 
 and, by practising, in moderation, the means of general d< 
 tion laid down at the head of this article, to delay the pro- 
 gress of the case until aid can be obtained. 
 
 Films on the Eye. — The disease called pterygium by 
 gcons is very common, and only occasionally I jble. 
 
 It then appears as a triangular opaque membi lied with 
 
 many long red \\ larp point slowly creeping 
 
 on to the clear part of the eye, generally from the inner side, 
 and crowned with a little brown lump at i Its 
 
 growth is not inflammatory; but it frequently bee 
 flamed with cold. Astringent -. such as sulpha) 
 
 copper, three grains; sulphate of zinc, (bur 
 of lead, six grains to the ounce of watt , 
 it to shrink and disappear, for a time; but, if they give U 
 ness to the eye, they must be omitted. When this affection 
 encroaches permanently upon the sight, we perform, for its 
 relief, certain surgical operations, neither painful nor dai 
 ous; but troublesome, and of rather tloubllV 
 
 Opacity of the cornea, or clear part of t ; d those 
 
 films which arise from purulent ophthaln. 
 entirely beyond the reach of i } but time itself often 
 
 does much in tho- e not utterly hopeless; and 
 
 we seriously recommend the reader not to endeavour to i 
 the change by art, unless by the adviv ikilful: 
 
 but, by all means, let him >hun the absurdil 
 quackery, and the false pretences of itinerant oculiJ 
 these, what little sight remains, is almost sure lo be lost. 
 
FOREIGN BODIES IX THE EAR. 355 
 
 Nearly all the chronic affections of the eye, including rheu- 
 matic and scrofulous inflammation, will endure to wait until 
 the best advice can be obtained: the deeper seated inflamma- 
 tions are beyond any popular assistance, except such as may 
 result from the rational application of the general principles 
 laid down in the commencement of this section, and we have 
 now said quite as much of diseases of the eye as we can say 
 conscientiously in a work designed for families. 
 
 Foreign bodies in the Ear. Insects occasionally make their 
 way into the external ear, particularly in children, when lying 
 on the grass. They sometimes produce horrible torture by 
 irritating the drum of the ear, and parents are troubled to 
 know how to dislodge them. No process is more simple. — 
 Let the child recline with the opposite ear upon a pillow, 
 and fill the affected one with sweet oil. There is no insect 
 that will not perish, or make good its retreat, when this me- 
 thod is pursued. 
 
 Solid substances are frequently pushed into the ear by chil- 
 dren; where, if large, they sometimes occasion much inflam- 
 mation, and become firmly wedged by the swelling. Great 
 danger of destruction to the drum and small bones of the ear, 
 results from awkward attempts at removing such substances, 
 by which they are driven still deeper into the canal. If the 
 foreign body have any visible projecting point, of which a 
 firm hold can be taken, this may be seized by forceps or pin- 
 cers, and the body removed directly; but when the substance 
 is rounded, or formed with many faces, or extremely smooth 
 and cylindrical, it is very wrong even to attempt its removal 
 by any such means. Cherry stones, apple seeds, common 
 nets, bugle beads, and pieces of red coral, furnish 
 main i point. If we attempt to seize them in front, 
 
 instantly Blip farther in, and endanger the drum. We 
 must get behind them and hook them out, always proceeding 
 with great caution. Sudden and severe pain warns us when 
 we touch the drum of the ear, and then all considerable pres- 
 sure in the inward direction must cease. When the foreign 
 body is small in proportion to the size of the canal, it may 
 generally be removed by means of the little steel ear-picker 
 on the handle of the common pocket tweezers; but, when 
 larger, the eye of a fine bodkin or silver probe should be 
 gently curved and inserted beyond the body to draw it for- 
 ward. A few drops of sweet oil, previously dropped into the 
 ear, will much facilitate the operation. When a large glass 
 bead, with eighteen or more polished faces, is forced into the 
 ear, — an accident which we have seen rendered fatal to hear- 
 ing by mismanagement, — the only sure mode of extraction is 
 to pass a very fine hook through the eye of the bead, and 
 
356 INFLAMMATION OF THE EAR. 
 
 catch a purchase upon its farther end. A fine darning needle* 
 with its temper entirely destroyed by the candle, and curved 
 at a right angle as closely as possible to the extremity of the 
 eye, furnishes the best extemporaneous instrument for such 
 extraction. 
 
 Ear-ache and suppurations of the Ear. The diseases of 
 the ear are intricate and little known, and it would be idle to 
 dilate on them here; but a few words may prove useful in al- 
 leviating pain. 
 
 There are media of nervous communication between the 
 teeth and the ear, through the distribution of the fifth pair of 
 nerves. When, therefore, we find a settled, obstinate pain in 
 the ear, either constant or irregularly paroxysmal, without ob- 
 vious cause, without much detriment to hearing, or any swell- 
 ing or purulent discharges, we should examine the condition 
 of the teeth and gums, and remove all sources of irritation in 
 that quarter. 
 
 Swellings and suppurations of the lining membrane of the 
 ear generally result from cold. Ti. be either internal 
 
 or external to the drum; but, in either case, the severe throb- 
 bing pain is best relieved by warmth; anil one of the best 
 modes of applying warmth is as follows: — Take a root of the 
 garden garlic, and roast it pretty thoroughly; then separate 
 the cloves; and after syringing or washing the ear with I 
 tile soap, or milk and water, made pretty warm, heat one of 
 the cloves, and taking a little piece th a large 
 
 knot on one extremity and a needle at the ot - the 
 
 thread through the clove, from the great tou -mall end, 
 
 and draw the knot just within the surface: then introduce the 
 clove into the ear. large end foremost, and as warm as it can 
 well be borne, leaving the end of the string dependent Change 
 this application every few hoi | the ear, if i 
 
 sary. 
 
 Frequently in children, and sometimes in adults, ulcerations 
 occur in the external ear, and these may even occasion dis- 
 eases of the bone, pieces of which are often discharged from 
 the sores; ami sometimes the affection has been known to 
 prove fatal by reaching the brain. The dil 
 cases are fetid, and the dil m indication of con- 
 
 stitutional ill health. All that can be done by the domes- 
 tic practitioner, is to keep the ear as clean as p 
 ringing; to relieve pain by the garlic cloves, when violent 
 inflammations occur: ami to attend to the condition of the 
 bowels and general health. Free air, and tolerably good diet, 
 are generally required, when there is no threatening of disease 
 of the brain. 
 
 llccrations of the Mouth. There are several forms of 
 
, GUM-BILES — URINARY SUPPURATIONS. 357 
 
 small ulcerations of the mouth which give great inconvenience, 
 but rarely lead to a consultation with a physician, except in 
 large cities, or in cases of more serious disease in which these 
 ulcers appear merely as a symptom. They are seen on the 
 edges of the tongue, the gums, and the inside of the lips or 
 cheek. They are small, irregular, superficial, often numerous, 
 very painful, sometimes surrounded with many enlarged ves- 
 sels and a small ring of bright red hue. Their suiface is co- 
 vered with a closely adherent white coat or spurious mem- 
 brane. Some of these are herpetic, others are aphthous. 
 They often prove obstinate, because they are caused by a bad 
 condition of the bowels. 
 
 They may be seen, occasionally, at all the other mucous 
 orifices of the body, and even on the brown areola round the 
 female nipple. 
 
 The favourite applications to these ulcers, are borax, and 
 salt-petre applied solid or in solution; but the treatment 
 which we have found most generally successful, is the satu- 
 rated solution of sulphate of copper* The sore should not be 
 left under the impression of this agent for more than five mi- 
 nutes, when the mouth should be well rinsed with cold water. 
 The application should be repeated every day or two. It fre- 
 quently happens that these sores, when situated on the cheeks 
 or lips, are rendered much more painful by their pre 
 upon the teeth, or by the irritating effect of impurities about 
 the gums. This may be at once relieved by roasting a fig, 
 splitting it in half, and applying the soft side of one piece 
 next the sore. 
 
 (1 inn-biles. The causes and nature of these affections are 
 too well known to need description. They are sometimes 
 very large, and tend to break externally. They should be 
 brought forward as fist ai >le by means of the hot fig 
 
 poultice just described; and if large, should be opened early 
 by the lancet, always on the inside of the mouth; for, if they 
 burst or arc punctured externally, extremely disagreeable de- 
 formity always results. As soon as they recover, any decayed 
 fangs which may be likely to reproduce them should be ex- 
 tracted; but it is generally unadvisable to perform such opera- 
 tions during the continuance of the inflammation. 
 
 Suppurations of the urinary ])ussu<r CS , Besides the dis- 
 charges of matter from the male and female urinary passages, 
 originating in immoral habits, there are others equally profuse, 
 which arc occasioned by cold, chemical irritations, poisons 
 taken internally, and other causes. "We have seen them se- 
 veral times, in carefully guarded girls under ten years of age, 
 and in boys even before the age of five years. It is, there- 
 fore, incumbent upon the medical or domestic practitioner to 
 
358 URINARY SUPPURATION. 
 
 be extremely guarded in founding suspicions of moral impro- 
 priety upon such slender grounds. 
 
 Whatever be the cause of the discharge, the symptoms and 
 proper treatment are nearly the same. There is a period, 
 lasting from three days to two weeks, during which inflam- 
 mation runs very high, with extreme scalding in urination, 
 and often intense pain, particularly at ni^ht. On the subsi- 
 dence of these violent symptoms, the discharge of pus often 
 becomes even more profuse, though the scalding and pain 
 may have been almost relieved. After several weeks or 
 months, if the case be neglected, the discharge ch.v 
 dually to a pale, and almost colourlo early 
 
 incapable of cure, and exceedingly exhausting to the patient 
 
 During the highly inflamm ^e, the general treat- 
 
 ment of severe inflammation, which has been already described, 
 should be employe'!, led local injections used after every urina- 
 tion. The best inject ion I are made of the pith of sassafras for 
 males, and the slippery elm bark for females. If great pain be 
 Suffered at night, apply I large bread and milk poultice, with 
 opium, or one of Imps and vim 1 diluted with w 
 
 From thirty i<> sixty dropi <>f nitre, in half a 
 
 wine-glassful of water at bed-tim< . soothing. 
 
 When the inflammation hai _ ', a little 
 
 water may be added to the inj id when the pain 
 
 and scalding an- very considerably diminished, we may begin 
 to use an injection of sulphate of copper in the proportion of 
 half a grain to the? ounce of the solution of the pith of sassa- 
 fras. This injection produces much smartii I 
 increase of the purulent discharge, soon followed by i 
 diminution. The strength of the injection may be increased 
 every three days, at the rate of half a grain of the sulphate to 
 the ounce, until the difl be cheeked, or the strength be 
 
 five grains to the ounce, which must not be exceeded. The 
 arresi of the disci fated by the first in- 
 
 jection, ami in Other rases, not for several v. \ - <lden 
 
 arrest by too powerful a solution at first, may occasion \ 
 serious consequences; such as swell) e in the male and 
 
 peritoneal inflammation in th< - ngle 
 
 caution to omit the astringent injection for ;>. I, : the 
 
 inflammation be found decidedly ir. - by it an hour after 
 the application, the practice above described will be found 
 perfectly safe, if strictly followed. Once, or. at most, twice a 
 day. we may use the sulphate of copper; but the plain muci- 
 laginous injections may he employed as often as thev are 
 found agreeable. Some person- id of the stimu- 
 
 lating balsams, internally exhibited; but we have seldom seen 
 much benefit derived from them. 
 
EXCORIATIONS — ABSCESSES. 359 
 
 Excoriations about the ??iucous orifices, occasioning swell- 
 ings of the neighbouring glands. All the mucous orifices 
 of the body are liable to two forms of superficial ulcer or ex- 
 coriation: one beginning with a little watery blister, which 
 bursts and leaves a shallow sore, soon acquiring a hard- 
 ened base; and the other commencing generally with a very 
 small pustule, and covering itself with a soft scab. Both forms 
 ry apt to occasion swellings of the neighbouring glands, 
 which, if neglected, will sometimes suppurate, when they 
 must be opened and treated as abscesses; but this termination 
 must be prevented, if possible. The ulcers should be washed 
 every morning with a saturated solution of sulphate of cop- 
 per, to be removed by clear water, without friction, in about 
 five minutes; and after the part has been dried, it should be 
 covered with the powder of carbonate of zinc, renewed as 
 often as it becomes moistened by the discharge. When the 
 ulcers begin to contract, the sulphate of copper may be omit- 
 ted; but should they spread or multiply Sgatn, it should be 
 renewed. 
 
 When the glands begin to swell, the patient should be put 
 on a low diet] and bled, if neees>arv. He should also take a 
 gentle saline purgative daily; such as the SeidlitZ powders. If 
 •ell rapidly, let leeches be freely applied OVCF 
 them. If still unchecked, and no signs of threatened suppura- 
 tion appear, apply a blister over them. When the hardness 
 of the glands continues long after the ulcerations which caused 
 their enlargement are cured, a plaster composed of ointment 
 of while precipitate, one ounce — camphor in fine powder, 
 one drachm — and muriate of ammonia powdered, one scru- 
 ple — will very much promote their absorption. 
 
 Chafing in the creases of the folds of the groin and other 
 parts. To this very troublesome affection, fat persons and 
 children are peculiarly subject. It is a transformation of skin 
 into mucous membrane, from the exclusion of air and the con- 
 stant action of moisture, and is at once cured by keeping the 
 part covered with dry pearl powder or carbonate of zinc, 
 washed off and renewed twice a day with cold water. The 
 powder allows the air to penetrate the fold, and keeps the part 
 dry; thus restoring the skin to its natural structure. 
 
 Chafing from friction. This source of annoyance is too 
 well understood to need description. It is best relieved by 
 coating the part well with sweet oil, or unsalted lard, and then 
 allowing cold water to ilow over it. The interposition of a 
 little lint or a piece of silk between tie inject to attri- 
 
 tion, will prevent the renewal of the evil. 
 
 Of Abscesses. For the general principles which regulate 
 the treatment of abscesses, we refer to the pages on inflam- 
 
300 ABSCESSES. 
 
 mation terminating in suppuration. Our present intention is 
 to offer a very few remarks on opening and dressing these af- 
 fections. 
 
 When an inflammatory tumour has commenced the forma- 
 tion of pus, the occurrence is known by a change in the cha- 
 racter of the pain, which becomes throbbing and compara- 
 tively dull; (we must except from this rule inflammations of 
 the hand and foot, which generally throb from the first;) by 
 the summit of the tumour assuming an unusual prominence, 
 and a faint attempt at a conical form: by a perceptible de- 
 crease of hardness in the centre; and, after a time, by the 
 fluctuation of the pus when the swelling is tapped with the 
 finger. 
 
 The disposition to point or open externally is known 
 decidedly conical prominence, and by a change in the colour 
 of the skin, from white, to red or brown. It is rarely pi 
 to allow al of their own accord; for natut 
 
 most always effects the Dill kwardly and imperfectly. 
 
 The thumb la the instrument commonly employed in 
 
 opening them; bilt in timid j re the matter ap- 
 
 ues very near tie infill, the 
 
 spring times preferable. In very large ab- 
 
 staining quarts «>f matt cially wl 
 
 occur in patients much debilitated by the dif 
 safest to evacuate the COOU - low- 
 
 ing the punctures to heal in the inter\ e by 
 
 passing the thumb lancet very obliquely through the true 
 skin, before raising its heel ami plu larly into 
 
 the cavity; so that the internal and ea i not 
 
 correspond, ami the skin is ive to be clo- 
 
 the desired amount of matter h 
 
 cuation of the whole of these large collections some" 
 causes the patient to sink: and thi lion of air into the 
 
 cavil;. - the pus afterwards S . rendering it irri- 
 
 tating, and bringing tion of the exten- 
 
 sive sore. But, in all al ctent, the puncl 
 
 should be direct, and the ei 
 
 As soon as it is completed, a small portion of lint shouk 
 gently inserted into the orifice to prevent it from el 
 the first intention, and then bread and milk poultices should 
 he applied for one or two days. The lint c with 
 
 the first dressing, and need not be renewed. If there be much 
 inflammation about the abscess, the poultices may be conti- 
 nued; but if not, it is commonly best to apply some : 
 ointment, such as the simple cerate, to tl 
 ty, while we use a bandage, with or without moderate l 
 press to keep the :>ides of the al much in con- 
 
RUN-ROUND WHITLOW. 361 
 
 tact as possible, without interrupting the free exit of the pus 
 as it is formed. 
 
 In large abscesses, it is sometimes convenient to sur- 
 round the dressings with bran to absorb the pus, and keep off 
 the fly. 
 
 Large collections of matter sometimes form without ob- 
 vious inflammation at the spot where they appear. These are 
 most frequently seen on the back or thigh, or about the anus. 
 They must never be tampered with by the domestic practi- 
 tioner, as both their cause and 'place of commencement are 
 generally beyond his cognizance, and the attempt to open 
 them often hastens the death of the patient. They may be 
 connected with dil the spine or liver, though pointing 
 
 on the shoulder or thig 
 
 Jiiui-ruiDul. This is a disease of the fingers and toes. We 
 frequently see an inflammation running round the sides and 
 of a nail, commonly caused by paring too closely the 
 fold of the cuticle found in that situation, or by tearing down 
 a shaving of the edge of the nail. The inflammation produces 
 B ring or semicircle of redness, and a very considerable de- 
 gree of swelling, attended with extreme soreness and consi- 
 derable pain. Suppuration speedily supervenes, and the pus 
 is located between the external cuticle and the duplicative of 
 that membrane which is reflected inward toward the root of 
 :il. It is easily t lie skin from the 
 
 nail, or dividing ti of the fold, where the matter shows 
 
 itself plainly through the cuticle. It is well to apply a poul- 
 "' two Of three days bo a run-round of this kind, but it 
 should then be omitted. All the loose cuticle should be care- 
 fully pared off with a delicate pair of 5 anil the 
 face will then be found moist, covered with an imperfect cu- 
 ticle, and studded with minute ulcerations. If the old cuticle 
 be suffered to remain, the soi< ,11 be very protracted; 
 but, when removed, if it do not yield in a few days to the 
 use of simple cerate, it may be cured by dusting it with dry 
 carbonate of zinc. 
 
 Whitlow* This is a much more formidable and terribly pain- 
 ful disease of the lingers and toes. It sometimes occurs with- 
 out obvious cause, and is apt to attack several digits in St* 
 sion. It may be brought on by a bruise, by pricking with a 
 needle, by biting or cutting the nails to the quick. The in- 
 flammation may be seated either immediately beneath the 
 thick, hard akin of the last joint, beneath the firm, tendinous fas- 
 cia, or beneath the periosteum of the same part These three po- 
 sitions constitute three varieties of whitlow; the severity of 
 the symptoms, and the seriousness of the case, being propor- 
 
 16 
 
3G2 NAILS GROWING INTO THE FLESH. 
 
 tionate to the depth of the seat of the disease. The pain, in 
 all the cases, is very great, and also the febrile reaction. The 
 patient is generally deprived of all sleep until the suppuration 
 has made some advance. In the deeper varieties, the pain is 
 but slightly if at all assuaged by the suppuration until the mat- 
 ter is evacuated. 
 
 It is vain to attempt to cure a whitlow by resolution; and 
 the local treatment should be such as to promote the formation 
 of pus as quickly as possible, by means of warm bread and 
 milk poultice, with which a little laudanum may be mixed by 
 way of trying if it will give any relief to the pain, though, 
 in most cases, it increases it. The general treatment should 
 be active. Purges of Epsom salts, the lancet, strict low diet 
 and repose, should be positively insisted upon. The on! 
 medy which we have ever known to procur . uring the 
 
 height of the attack, is tartar emetic or the antimonial wine, 
 given in sufficient dose at bed time to produce decided nausea 
 without vomiting. To effect this, give the patient twenty drops 
 of antimonial wine every ten or fifteen minutes, till the re- 
 quisite nausea is produced. 
 
 The moment there is reason to believe that matter ha* 
 formed, we relieve the patient at once by a very painful, but 
 highly necessary proceeding, lo which no patient who knows 
 the instantaneous relief which follows, will, for a moment, 
 object. With a very sharp knife we divide, at one stroke, 
 the whole inflammatory tumour completely from end to end, 
 and to a depth equal to that of the disease. In the first vari- 
 ety, we cut halfway to the bone; in the second, nearly down 
 to it; and in the third, we cut firmly upon it. The pus is 
 thus evacuated, and the case advances rapidly toward cure, 
 under the use of the bread and milk poultice. From this 
 moment there is rarely much pain, except when the hard 
 edges of the thick cuticle press upon the swelled parts be- 
 neath, which IS commonly the case in the first variety. 
 
 The cuticle becomes detached from the parts beneath in 
 mass, far and wide round the tumour, and should be cut away 
 with a pair of scissors as fast as it is detached. The third va- 
 riety is often very tedious; for the bone, or a part of it, fre- 
 quently dies, and is long in being separated from the living 
 periosteum. 
 
 Affections similar to whitlow are occasionaliv seen on other 
 joints of the lingers, in the palm ol the hand, and even on the 
 fore-arm; but great care and correct anatomical knowledge 
 are necessary in opening abscesses in these positions, and the 
 cases should be left entirely to surgeons, unless there is the 
 most urgent necessity for interfere 
 
 Nails groivi fig into the flesh. This is a popular misnomer 
 
BILES. 363 
 
 — for the deformity of the nail almost always originates in 
 disease of the membrane near the commencement of the last 
 joint of the digit, which secretes it. The pressure of the shoe 
 or grasping with the hand then renders the edge of the nail a 
 cause of irritation; but it is rather the soft parts which grow 
 on to the nail, than the nail which grows into the soft parts. 
 
 By prying up the edge of the nail, and placing cotton under 
 it, so as to keep off the soft parts, and by cutting the middle 
 of the nail thin, so as to make it flexible, we may give tempo- 
 rary relief; but we know of no ellectual remedy except the 
 application of lunar caustic to the whole sore surface, and re- 
 peating the application once a week, if necessary, until the 
 soft parts recede from the nail. The first application is gene- 
 rally attended with considerable pain, but the succeeding ones, 
 when required, give much less inconvenience. This remedy 
 is generally successful. Poultices are employed for a couple 
 of days after each application of caustic, and simple cerate 
 during the remainder of the intervals. 
 
 Biles. — These troublesome and painful, but by no means 
 dangerous visiters, are generally, though not always, accom- 
 panied by florid health, and may then be regarded as a proof 
 of its excess. Those who are subject to a succession of them 
 should avoid salt provisions, stimulants, and spices. If adults, 
 they should purge themselves pretty freely with Epsom salts 
 ev^vy other day for a week; if children, with sulphur and 
 cremor tartar. All stimulant drinks and spices are injurious, 
 and the appetite for meat should be sparingly indulged. 
 
 A bile is an inflammation of the subcutaneous cellular tissue, 
 (see Anatomy — skin,) leaving the skin in health, and is com- 
 pletely limited in extent by the healthy capillaries around it, 
 which completely agglutinate, or close, the surrounding cells. 
 The inflammation of the centre of the tumour is almost always 
 \ ere as to cause the mortification of the cellular tissue, 
 which forms what is called the core of the bile, and the ab- 
 scess cannot possibly recover till this core is discharged; hence 
 the advantage of opening a bile freely with a lancet, which 
 gives a free exit to the dead matter, when detached, instead 
 of trusting to the slow process of nature in destroying the skin 
 by ulceration, which terminates in the formation of one or 
 more small orifices, giving a free escape to the pus, but often 
 retaining the core for a long time. Indeed, we are often 
 compelled to enlarge the natural orifice with the knife, before 
 the dead matter can be removed. 
 
 A gently stimulating salve, such as the basilicon ointment, 
 or a mixture of mutton suet and resin, is the most common 
 application to biles, in all stages; but, when at all convenient, 
 the bread and milk poultice is preferable, until the matter is 
 
3o4 FURUNCLE — CARBUNCLE. 
 
 evacuated, and for two days afterwards. The stimulating 
 plaster then provokes less discharge than the poultice, and 
 promotes the cure. 
 
 Furuncle and Carbuncle. — Furuncle is an inflammatory 
 tumour, resembling a very small bile in a state of intense ir- 
 ritation, and exquisitely painful. It is not sealed beneath the 
 true skin, but in its very substance, and consists in an inflam- 
 mation of all the soft parts contained in one or more of the 
 minute, tendinous or fibrous rings which form the outer sub- 
 stance of the true skin, each of which gives passage to the 
 delicate extremity of a nerve of sensation, and its accompany- 
 ing blood vessels. The effect of the rigid rings acting upon 
 such parts, when swelled by inflammation, must be obvious to 
 all. The irritation is raised to the greatest possible height, 
 and the swelling increases, until the soft parts, with the ner- 
 vous pulp, are strangulated by the fibres, and mortify. Hence 
 the intense pain and the febrile reaction which -attend the dis- 
 ease. 
 
 The best and least painful mode of treating this affectii 
 to divide the tumour at once, with a sharp knife, and then to 
 dress it with poultices; but. if the patient refuse to submit to 
 this, it must, be treated like a common bile. 
 
 Carbuncle differs from furuncle, in being a progressive in- 
 flammation. Located in the same a, it affects i 
 more of the tendinous rings; and the intensity of the irrita- 
 tion continually eatiscs additional numbers to be added to 
 those already involved, while a wide and spreading purple 
 ring of hardening surrounds this central disease, and [ 
 the way for its increase. The base of the tumour tfl 
 hard and deep, involving the subcutaneous cello! 
 down to the surfaec of the mttf f in- 
 tense agony, an imperfect suppuration comes on, and, flowing 
 into the few unclosed cells of the cellular I 
 tumour peculiarly quaggy or doughy. In the mean time, the 
 centre of the tumour mortifies, and numerous little ulcerations 
 on the skin give partial exit to the ill-conditioned pus. The 
 tendinous rings ol the skin partake in the mortification, be- 
 cause their vascular support is entirely cut off by the destruc- 
 tion of the soft parts around them; and the 
 widely and deeply. During this process, unfortunately, the 
 pain and irritation are not new parts around the 
 circumference o( the dead skin are continually taking on the 
 same kind of inflammation, and propagating the 
 
 This complaint is peculiar to per>ens w! 
 are weakened by disease, luxurious habits of living, or intem- 
 perance. It is one of the most painful affections with which 
 humanity is afflicted, and very frequently terminates fatally. 
 
CARBUNCLE. 305 
 
 The proper general treatment varies with the condition of the 
 patient. Sometimes the lancet will be applicable in persons 
 not too far advanced in age, or broken down in health ; but 
 the symptomatic fever is of a low type, threatening the 
 brain and its membranes especially, and scarcely less power- 
 fully the stomach. After the disease has made some progress, 
 it is very generally necessary to support the strength of the pa- 
 tient by wine whey, wine, bark, and other tonics and stimu- 
 lants; but these should be employed with caution. Mustard 
 plasters to the feet and wrists, and other means of counter-ir- 
 ritation, when the brain is threatened, have been too much 
 neglected. The spice plaster, mint lea, and alkaline medi- 
 cines, such n» extra-soda-water, or doses of ten grains of super 
 carbonate of soda, will often give relief to sickness of sto- 
 mach, and the sweet spirits of nitre does good by promoting 
 the tendency to the skin. If there be no acidity of stomach, 
 or vomiting, cremor tartar water, sweetened, will be useful in 
 allaying thirst, and promoting the flow of urine. 
 
 As the first local application, a plain bread and milk poul- 
 tice is best. When the suppuration has advanced, and orifices 
 appear, Peruvian bark may be added; and when the mortifica- 
 tion is at its height, the charcoal poultice is advisable. But 
 the disease is terrible, and the local treatment should be vi- 
 gorous. There are two methods of relief which will frequently 
 save life, if the patient have the nerve to bear, and the prac- 
 titioner courage to undertake them. The French method 
 consists in dividing the tumour by the knife, in at least two, 
 but if large, in live or six directions; this relieves in considera- 
 ble degree, the tension anil strangulation which cause the 
 violence and spreading of the inflammation and gangrene; but 
 as the incisions cannot reach all the affected rings of the cutis, 
 the relief, though great, is partial. There is no advantage in 
 dividing more than the entire thickness of the true skin; and 
 for this purposej the cuts should be about half an inch in t/epth. 
 
 A much more philosophical, and really less painful method, 
 though it has a terrible sound, is that of (lie late J)r. Physick. 
 Me recommends the destruction of the entire thickness of the 
 skin over a wide space in the centre o( the tumour with the 
 :ihle caustic; which requires to be wet at the end of the 
 stick, and to be robbed for some time over the surface. This 
 destrovs all the strangulating and strangulated parts at once, 
 and with them, the chief cause of pain and irritation. An an- 
 thrax or carbuncle sometimes readies a diameter of six or 
 eight inch 
 
 When the sloughs separate, the surfaces of the fascia; or 
 muscles beneath, will often be found completely denuded, the 
 enormous ulcer which remains, will be usually in an irritable 
 
366 GANGRENOUS SORE MOUTH. 
 
 or indolent condition, requiring appropriate treatment; and the 
 scars are^sometimes a cause of much deformity and inconve- 
 nience. The strength of the patient must be supported during 
 recovery, by a generous diet and free air, as the discharges 
 are long protracted and exhausting. 
 
 Canker or Gangrenous Sore Mouth of Children. This 
 terribly fatal affection is not uncommon in swamp? di>t 
 and occasionally appears epidemically on a much wider sphere. 
 Its chief victims are children from the ages ofeig nths 
 
 to ten years, and it is confined almost exclush elf t » th 
 constitutions have been shocked or debilit | .receding 
 
 disease; especially by intermittent or scarl* I 
 
 The disease appears, at first, as a redness and inflammation 
 along the edges of the gums, — commonly on the incisor teeth 
 of the lower jaw; and it runs pretty rapidly from tooth to 
 tooth. A slight discharge of fetid pus may soon be per- 
 ceived along the inflamed line, and an evident ulceration soon 
 succeeds. 
 
 The inflammation speedily attacks the periosteum of the 
 sockets of the teeth, loosening first one and then another, and 
 extending also to the periosteum of the jaw. The discharge 
 becomes daily more profuse and fetid, and, in a few d 
 the gums generally begin lo swell. 
 
 At thi> lie of simple debility with which the 
 
 patient had been previously all- d for a febrile 
 
 condition, of a low or sinking character; the tongue is thickly 
 furred in man] Jims anil throat are loaded with 
 
 foul and often adhesive matter. 
 
 The child is now unable to pursue his sports or studies, 
 though, until this period, the c apt to escape 
 
 tion, unless the mortality prevalent around them baa 
 the attention of the friends. This < ; for 
 
 the diseSM advances from this point with fearful rapidity. 
 One or both cheek! . and the inflammation runs 
 
 high. Spots of mortification appear, usually, on the gums, 
 sometimes on the inside of the cheek, or v y in the 
 
 throat. The gang treads in every direction without 
 
 check, — involving, in a few daj rtion of the gums, 
 
 or perhaps the whole thickness of the cheek. It pa] 
 spect to the bone of the j ig not only the teeth 
 
 and their sockets, but, where life endui\ - 
 portion of the bone. 
 
 The child is sickened and diarrhoea follows, from the quan- 
 tity of fetid discharge unavoidably swallowed: and exhaustion 
 and death soon close the scene. 
 
 This disease was found most terribly mortal from the time 
 at which it was first described by Mr. Pearson, until the | 
 
GANGRENOUS SORE MOUTH. 367 
 
 ers of sulphate of copper, as a remedy, were developed by 
 Dr. B. H. Coates, at the Children's Asylum at Philadelphia. 
 It is now manageable by severe measures in a large majority 
 of cases; but after the appearance of mortification, it will prove 
 almost certainly fatal, unless treated by fearless and expe- 
 rienced practitioners. 
 
 The support of the patient's strength, and the general treat- 
 ment, may be regulated according to the directions laid down 
 for excessive suppurations; the mineral acids being highly 
 serviceable as tonics. In addition to this, it is proper to give 
 about half an ounce of sweet oil, and two grains of calomel, 
 daily, when the bowels are disordered by the foul discharges. 
 But the general treatment is of no avail whatever, if the local 
 remedies be not most faithfully applied. The directions for 
 the local treatment are these: — 
 
 The moment that the disease is recognised, every tooth 
 must be carefully examined, and if found in the slightest de- 
 gree loose, with the gum in a suspicious condition, it must be 
 immediately extracted without wasting a thought on the mere 
 loss of appearance. This done, a solution of the sulphate of 
 copper, perfectly saturated, (for a weaker solution is of little 
 value) must be provided. A small slender stick, or piece of 
 whalebone, armed at its extremity with a soft, piece of rag, 
 must be dipped into the solution; and, after being thoroughly 
 soaked, the rag must be rubbed freely and firmly over every 
 part of the ulcerated surface, being made to penetrate to the 
 bottom of the socket of every extracted tooth, and between 
 the gum and the bone of all those which remain within the 
 range of the disease. This will occasion some pain, and a 
 little bleeding; but the question is one of life or death, and 
 these inconveniences are trilling. Care must be used to 
 rinse the mouth, after the operation, with sage tea or some 
 other mild gargle, and if possible, to prevent the child from 
 swallowing any portion of the solution, which is a powerful 
 and somewhat dangerous emetic. 
 
 The application should be repeated every day until the pro- 
 gress of the disease is arrested, and the discharges have as- 
 sumed a more natural appearance. The success of the treat- 
 ment depends mainly on the care with which the solution is 
 made to touch every point of the diseased surface; and it ap- 
 pears to be chiefly on account of the necessity of this contact, 
 that after mortification occurs, the case is generally incurable. 
 The dead surface then prevents the wash from reaching the 
 diseased parts beneath, unless these are soaked through with 
 the solution, or the sloughs are pared away or divided by 
 means of the knife: — alternatives which can be employed only 
 by surgeons. 
 
368 BURNS AND SCALDS. 
 
 The skilful practitioner does not despair of even these des- 
 perate cases, which are inevitably fatal in popular hands; for 
 cures have occurred after the mortification of the entire thick- 
 ness of the cheek. The author himself once had occasion, 
 after the partial recovery of such a case, to remove the whole 
 of the upper jaw bones, except the portions supporting the 
 sockets of the two last molar teeth on the ri^ht side, and the 
 last molar, on the left. Not only the palatine, but even the 
 orbital processes came away, yet the patient recovered! 
 
 Fresh air and cleanliness are as important in this disease as 
 in any febrile complaint; and a change of residence should be 
 made, if practicable, when the location where it occurs is cold 
 or damp. 
 
 Bum* and Scalds. 1 laving already spoken of the effect and 
 general treatment of very extensive burns or hen pro- 
 
 ductive of colhpv | only remain! for us to j 
 
 some succinct directions for the local treatment of these inju- 
 ries. 
 
 There is littl a burn and a scald. 
 
 that i 
 
 moisture, while in the former, wh< they 
 
 are often hardened or i - by the action of the heat. 
 
 In every burn or scrdd unattended by collapse, the I 
 
 i most powerful stimulant, giog the 
 
 blood in the distended capillaries to a hig 
 
 At all event-. :e to the air certaink it in- 
 
 erease of the pain, and heightens m teviolen 
 
 inflammation. To plunge the part into, or to bathe it freely 
 with colli water, is almost an instinctive, and an apparently ra- 
 tional impulse; but it is foil iically, that water is also a 
 stimulant to the surface, under such eireir 
 
 'ban the air. The co! tefal, but the inju- 
 
 rious chemical or physiological action of the accent by m< 
 of which it is applied, far on' A 
 
 burn, should never be touched with < > bile un- 
 
 protected. H ig the i: rt with | ight 
 
 pellicle of unctuous matter, not in a ra; . much of 
 
 evil influence o( the air, and that of the v. | and 
 
 the latter may then be employe! as a re' - lera- 
 
 ble benefit in certain eases. We shall speak hereetefir of 
 unexplained effect o\' cotton, — an article often cm; 
 not on empirical, at least on hypothetical principles, but one 
 of which the astonishing good ion- 
 
 able. These remarks premised, the n -land 
 
 the reasOnab our practical directions. 
 
 In very small burns, it is found that the a 
 potato furnish the most decidedly dclig 
 
BURNS AND SCALDS. 369 
 
 lions; but, unless the part be previously touched with good 
 sweet oil, fresh, unsalted lard or butter, goose grease — or, if 
 nothing better be accessible, pure spermaceti oil, the effects of 
 the potato will be very transient, and the intervals between 
 the renewals of the cold scrapings, (which must be very fre- 
 quent,) extremely painful. 
 
 If no potato be at hand, let the part be oiled, and then held 
 for a long time in cold water. Treated in this way, the seve- 
 rity of the pain will subside in from twenty minutes to two 
 or three hours. After which, if the burn be deep, cold bread 
 and milk poultices, well covered with good oil, form the best 
 dressing. 
 
 In all large burns or scalds, unattended with collapse, the 
 first question is — Has the cuticle been extensively broken? 
 If not, then let the part be instantly enveloped in carded cot- 
 ton, which should bo kept at hand in every family, in case of 
 accident. If there be a delay of more than twenty minutes 
 in this application, it will be of little service; and if delayed 
 for an hour, it will prove decidedly injurious. 
 
 When the article cannot be procured in time, let the parts 
 be well oiled; and if not too ex inconvenient- 
 
 ly situated for immersion, the case may then be treated with 
 the cold water: but we hi Ml any benefit result 
 
 from simply bathing the parts with wa1 
 
 When the situation or extent of the burn precludes the use 
 of this remedy, it should be dressed with the ointment o( 
 lime water in Dtl, in the manner which II pre- 
 
 sently describe. 
 
 In burns and scalds with extensive rupture of the cuticle, 
 we cannot with any propriety apply the cotton in the first in- 
 stance; but after a complete oiling of the part, if the time 
 d after the accident be not too considerable, it may be 
 employed to much advantage. The benefit derived from the 
 application of cotton appears to be limited to about twenty- 
 lour hours: it may then be d carefully* and a dressing 
 applied, consisting of patent lint, linen, or muslin, well coated 
 with lime water and sweet oil. These ingredients may be 
 mixed in equal parts, or with an excess of the former, by 
 shaking them together in a wide-mouthed vial or decanter. 
 They form a kind of white paste, very soft, and extremely 
 agreeable in its effects. 
 
 This dressing should be renewed two, three, or four times 
 
 a day, until a new cuticle begins to form, or until suppuration 
 
 is established over the surface. When the latter termination 
 
 takes place, the case is to be treated as a simple ulcer. (See 
 
 18.) 
 
 If the burn be deep and so as to harden and render 
 
 17 
 
370 WHITE SWELLING. 
 
 crisp any part of the skin, this must mortify and slouch awny. 
 In such cases, it is best to omit the ointment in about forty- 
 eight hours, and then, to use poultices until the sloughs - 
 rate: after which the case may be treated as an ulcer. 
 
 Burns are extremely apt to give rise to redundant granula- 
 tion, or proud flesh; and when this cannot be held in check, 
 by the means already laid down for the purpose, (p. 341) the 
 tar ointment will be found a valuable remedy. The Kentish 
 ointment should never he employed in burns unattended with 
 collapse; but when the ulcers which remain become dec! 
 ly indolent, — which rarely happens, — bathing the parts wiih 
 brandy is sometimes highly serviceable. 
 
 The reaction, and symptomatic fever produced by burns or 
 scalds of moderate . should be treated like the same af- 
 
 fections in other inflammations, and \ 
 
 ha U Sting suppurations which are very apt to occur, render 
 highly ii' the precautions laid down- under the appro- 
 
 priate head. (p. 337.) 
 
 The cicatrices of b : I disposition 
 
 to contract and produce deforn iich cannot be wholly 
 
 prevented; bat great care should be employed in placing the 
 injured parts in the n :al and useful p id in 
 
 •:ing the: Where 
 
 surgeons cannot be obtained, something may be done in this 
 . even by the intelligent who are not of the profession. 
 For the treatment of burns and •roductivc of coll 
 
 we refer to our remarks contained under the head of Inflam- 
 matton* coupled with coUqpt . I ■;.) 
 
 White Swelling. — The term white swelling implies the 
 enlargement of a joint without dislocation. In 
 inclu< tty wide 
 
 which we shall briefly consider under Ulifl 
 white swelling of the knee joint; the most I . perhaps, 
 
 and the most alarming of all the affections of joints whi 
 sume ■ chronic cl m most fi con- 
 
 sists in an inflammation of the synovial membrane; the 
 consequences oi which are in and altt - vtion 
 
 from its internal surface, effusion of lymph into the jo 
 times a change of structure in the membra: Ouch 
 
 it is converted into a grist! UlStOD 
 
 of lymph into the common cellular membrane. The carti- 
 lage, and even the bones, may be eonsecuti 
 sometimes the inflammation, commencing in I 
 tends itself from them to the softer pel 
 
 White swelling is often connected with a scrofulous 
 the system. In this case, it is much more I - 
 cult to cure, and the cancellated structure of the bone is the 
 
HIP-JOINT DISEASE. 371 
 
 primary seat of the affection. This form appears most fre- 
 quently in children, while that which commences in the sy- 
 novial membrane rarely occurs in young subjects. When in- 
 flammation of the synovial membrane subsides spontaneously, 
 the fluid is absorbed. In some instances, the joint regains its 
 figure and power of motion; but in others, it remains perma- 
 nently stiffened, and swollen; leaving the patient liable to a 
 recurrence of the inflammatory action on exposure to cold, 
 and other local causes. It should not be forgotten that white 
 swelling, though it arise in many of its forms from constitu- 
 tional causes, may be induced by accident in those who are- 
 predisposed to it; so that, if after exposure to cold, a contu- 
 sion or painful swelling occur in the knee joint, and the 
 swelling long outlast the pain, the case must be immediately 
 submitted to the inspection of a surgeon. 
 
 Of the treatment of white swelling we shall say but little; 
 as it require! consummate skill and long experience. One 
 remark, however, will not be misplaced. In the primary 
 stage of all affections of the joints which threaten to become 
 chronic, absolute rest is of the utmost importance. Not only 
 should the patient be restrained from using the hip joint at 
 all, but the horizontal position and perfect quietude must be 
 resolutely maintained. The proper general treatment will be 
 fully noticed under the head of scrofula, when the local dis- 
 18 connected with a scrofulous habit. 
 
 Hip-joint Disease. This disease bears considerable resem- 
 blance 10 its nature to white .swelling; and, like it, is some- 
 limes, but not always, connected with a scrofulous constitu- 
 tion. The complaint is moat frequently seen in children un- 
 der the age of fourteen; but no sex or condition is exempt 
 from its attacks: and the number of adults and even of old men 
 affected with it is considerable. 
 
 The approach of hip disease is much more insidious than 
 that of white swelling, and its primary symptoms are often 
 overlooked or mistaken. The first circumstance to be noticed 
 light limping. The child, for example, in ascending a 
 ilight of stairs, will advance the sound leg and draw the other 
 up to it, without attempting to put this one forward in its turn. 
 In walking on a level, the affected limb is either dragged 
 along upon the floor, or the weight is thrown for the moment 
 upon the toes only. In the last case there is an appearance 
 of shortening; in the first, of lengthening of the limb. Both 
 appearances, however, are deceptive. No variation in the 
 length of the limb occurs until a late stage of the complaint, 
 when extensive changes have taken place within the cavity of 
 the joint. The symptom now alluded to arises from the effort 
 made to avoid calling into play the muscles of the affected 
 
'j~fZ IIIP-JOINT DISEASE. 
 
 limb, qs is done in natural walking. When these appearances 
 are noticed, immediate attention must be directed to the sus- 
 pected hip. If it be really the seat of the disease, the usual 
 .depression or dimple between the hip and the nates will be 
 found effaced, and its place supplied by an observable pro- 
 tuberance in most commenci:._ 
 
 The seat of the pain at the t> _ g of the disease, is un- 
 
 certain, and of itself offers no suiTicient evidence of the true 
 state of things. Sometimes it shoos down from the hip to 
 the knee; sometimes it is referred exclusively to the latter 
 part; sometimes to the foot; and sometimes it shifts from 
 place to place, without remaining long fixed in any one spot. 
 Sooner or later, however, and often from the beginning, a 
 fixed pain is experienced in the part above referred to, imme- 
 diately behind the hip itself. From the first, moreover, if we 
 make • either before or behind the hip, we produce 
 
 an Ul >;ition, sometimes amounting to acute pain. 
 
 othf : - the eoai 'here 
 
 s often, . ly period, an emaciation of the af- 
 
 nd the correspon 
 
 toms 
 of th 
 to ro 
 
 : ima- 
 rv Btage of ihe du 
 IDg will accompli>h more than I 
 lame and painful issi nth. 
 
 The p: make pro- 
 
 cess fori i 
 
 rj mp- 
 The 
 
 This i 
 
 fatal termination. l r 
 
 dence of I 
 
 articular 
 
 located 0] 
 
 shortened : and a >nsequei 
 
 the union beU 
 
 : the 
 bone acquires a degree of mobility in it 
 
 Itappe i 1. That 
 
 commences with f the 
 
 socket being generally 
 the head of the thigh bone. "J. The ale 
 
 hones, which become- . An abscess forms in the 
 
 joint, which il mem 1 
 
corxs. 373 
 
 and the capsular ligament, generallv bursting on the thigh. 4. 
 In the progress of the disease, all the soft parts about the joint 
 become involved, forming a common confused mass. A distinc- 
 tion, likewise stated on good authority, is, that in cases of a 
 scrofulous character, the primary seat of disease is the bone 
 itself. 
 
 It is of the utmost importance, that the domestic observer 
 in this disease, should seek the best surgical aid without de- 
 lay; contenting himself, until it is obtained, by enjoining the 
 most absolute rest in the horizontal position. 
 
 SECTION VI. 
 
 Corns, JVarts, and Moles. 
 
 We have deemed it unnecessary to dwell upon the charac- 
 ter or treatment of particular tumours and excrescences re- 
 sulting from hyper-nutrition, morbid nutrition, or the transfor- 
 mation of complaints of these classes admit of 
 
 sufficient delay to allow the patient to procure medical advice, 
 
 and but t< can properly form the subject of domestic 
 
 treatment under any circuit • p. 151,) but it would 
 
 be srn entirely unnoticed the thre ■ forms of hyper- 
 
 nutrition which stand ai the head efthii 
 
 Cams. It has been stated, in the anatomical chapter of 
 
 this work, that the nails, fa productions of the cu- 
 
 : or. at 1 able that horny membrane. 1 tarns are 
 
 nothing else than unusual growths of the cuticle, caused by 
 habitual p| upon prominent portions of the body. They 
 
 joints of the toes, where they are 
 of tight booti or shoes; but they do not 
 diner from th< es not unfrequently noticed on the in- 
 
 step, heel, hip, elbow, or knee, when either of these parts is 
 subjected to long-continued pressure. Their com seems 
 
 iate between that ol ordinary cuticle and that 
 of the nails: though, after a time, it becomes analogous to the 
 
 latti 
 
 These excrescences arc themselves incapable of inflamma- 
 tion; but they often occasion great suffering when they inflame 
 the p ind them by their pressure. They sometime 
 
 come surrounded by a little abscess, and are then cast off or 
 cured. 
 
 The proper treatment of con: simple, — and, if faith- 
 
 fully attended to, — almost certain! 1 -iul. Let the part 
 
 be well soaked in warm water; then with a sharp penknife, 
 
374 eoiixs. 
 
 pare away the summit of the excrescence until it is level with 
 
 the sound skin or a little depressed below it. In the next j 
 
 provide some buckskin well coated with good adbesi 
 
 tor. Take a circular piece of this, about thi 
 
 in diameter as the corn, and cut a hole in its centre, a little 
 
 larger than the base of the corn. The ; 
 
 around the excrescence; which o 
 
 so that nothing can pi i*. Tn 
 
 moved, the di a disappears, li 
 
 rapidly for a time, let it he frequently retric : the 
 
 plaster reappli 
 
 When corns occur betwt en tl ften imp 
 
 surround I hem, and it i< then 
 
 of the buck-skin between the poioi 
 them permanently apart;— bat, let it b 
 that the appli< 
 tends to inert 
 
 Under the foregoing ly and ju 
 
 applied, we behev< that • 
 
 the junction 
 
 skin i- perpetually fold i un- 
 
 common t<> ol 
 
 with a thin and red ; 
 
 no slight resemblam 
 
 rOUghly soaked, and ihen eut I 
 
 affection has been CSJI< .." but a 
 
 iated or i 
 in its natnn . The thi 
 stilts from the simple imbil 
 
 andthe thin, red surfa< in. tram: 
 
 moisture, and the 
 the n 
 fetid • 
 
 ful : it i> sometime 
 the fold of the 10 
 
 In the treatment 
 
 as in as in tine corns; but inert 
 
 here, in applj 
 
 sure is not among the The mas1 
 
 tuaJ mode of euro La to keep tl wash tht 
 
 thoroughly with Castile soap ami water, twi i then 
 
 to dust the part well with the powder 
 and io place a piece of soft patent lint on thedjscsw - 
 Cleanliness, and some dry! material occasion- 
 
 ally applied are necessary, permanently, 
 
 renee of the disease; — an accident alwaj • from 
 
 the constancy o( the cause. 
 
WARTS AND MOLES. 375 
 
 Warts. These are horny productions rooted in the true 
 skin, and not in the cuticle. They are at first enclosed in a 
 distinct sac, and it is the front part only which is afterwards 
 removed; so that the excrescence seems to be always seated 
 in a cup of membrane by which it is secreted. This mem- 
 brane must be destroyed, or its functional action changed, be- 
 fore the disease can be cured. When seated, as it usually is, 
 on the palm of the hand, a wart often appears closely con- 
 nected with the fascia or tendinous sheaths of these parts, with 
 which the true skin lies in close contact. A vascular produc- 
 tion of the membrane forming the cup sometimes penetrates 
 far into the body of the wart, and bleeding may then be pro- 
 duced by very >lij;ht injuries of the part. On the extremity 
 of the back of a fil wart will sometimes adhere firmly 
 
 i to the periosteum. 
 
 It is dangerous to tamper with excrescences of this charac- 
 ipecially when seated on the face; as an injury accident- 
 ally indicted is apt to produce troublesome ulceration; and, on 
 the face, even cancer may be engendered thereby. 
 
 Fumigation with hot water, or with hot infusions of aro- 
 matic plants, placed in a metallic vessel, and the steamcol- 
 lectcd by an inverted funnel, will sometimes remove warts. 
 The Steam from a decoction of the root of the narrow-leaved 
 dock, has the reputation of superior virtues, we know not 
 on what ground. The juice of the Garden eelendine, and 
 vinegar used as i wash, occasionally succeed. 
 
 Lunar causti • jiiently used to produce an absorption 
 
 of tin - . but it is a rather dangerous remedy. 
 
 If the dread of the knife induce the patient to refuse the best 
 mode of operating, which conaU lovingthe wart and its 
 
 membranous base by cutting, the entire destruction of these 
 parts by mes caustic, which acts deeply and 
 
 effectively i may be admissible. 
 
 Unless there is in the location of the wart, some good rea- 
 son why it should be removed, it is wisest to leave the case to 
 nature; ami spontaneous cures will not unfrequently occur. 
 
 )le*. These are small tumours, often adhering by a narrow- 
 neck, and composed of the same substance with the true skin, 
 from which they arc derived. These productions are seldom 
 a source of material uneasiness, but they sometimes disfigure 
 the person, and at other-, give 1 "ise to inconvenience in sitting, 
 or lying in certain attitudes. The mole should then be re- 
 moved, either by a single clip with a pair of sharp scissors 
 carried quite down to the base of the production, or, if the 
 connections be wide, by a circular cut with the scalpel or bis- 
 toury. The latter operation is the exclusive province of the- 
 surgeon, but the former may be safely performed by a friend. 
 
376 SCROFULA. 
 
 If there be trouble in stopping the bleeding, or if a very small 
 portion of the diseased substance have escaped the scissors, it 
 is well to touch the cut lightly with lunar caustic. Some per- 
 sons, through dread of cutting instruments, prefer the ligature 
 for removing moles; but this method seldom accomplishes the 
 purpose so completely, and is decidedly more painful than 
 that for which it is substituted. 
 
 SECTION VII. 
 
 Constitutional dia< 
 
 Scrofula. — Which U called also the K . tfl a constitu- 
 
 tional disease, manifesting itself principally by 
 of the absorbent glands, which terminate in imj uppu- 
 
 ration. The d . but 
 
 not coiil;: 
 
 known means, from an I individual, 
 
 subject- are children from tin 
 it has been i 
 tion which enables it 
 obvioi 
 
 tioned a florid countei 
 
 fulness of the upper lip, extt I thin the blue- 
 
 eyes, light hall auch 
 
 depended on; for some of 
 country, occur in 
 
 All the cir id to produ< - 
 
 predisposing i . an unheahn 
 
 mosphere, imj 
 
 i rded in this light Where th 
 disease will of) ir independently 
 
 tary influence ; u r . and all 
 
 iniliu 
 
 will generally escape. For the production of scrofula, t!. 
 fore, there seem to be requisil 
 tendency, and secondly, the million i 
 agent, to call it into action. 
 
 The following description will convey 
 of the disease, h usually commences wkh a so 
 one of the lymphatic glandi nerallv. in children, about 
 
 the ear or net k. The covering OJ 
 thickened, and the whole mass 
 which may be compared to that of leatlu inges 
 
SCROFULA. 377 
 
 into a character of elasticity, and even of fluctuation, while a 
 firm circumscribed margin can be felt around the base of the 
 tumour. The skin is slightly red. If an incision be made at 
 this time, no matter, or a very little only, will be evacuated; 
 but the wound remains open, exhibiting a slough or core 
 within, between which and the skin a probe can be passed 
 for a considerable distance. At a later period, however, the 
 tumour lo ! astic character, becomes soft and flaccid, 
 
 and iluctuates freely: the skin assumes a light purple colour, 
 and small veins may be traced on its surface. It soon grows 
 thinner and darker, bursts, and di I a thin fluid like 
 
 mixed with some portion of curd-like substance. The 
 aperture enlarges as the tumour subsides, and the sore 
 sumes the character of ao ulcer, with a smooth, hard, tumid 
 margin, of a purple colour. Its surface is light red; and the 
 ire pale and unhealthy. The discharge is thin, 
 and mixed iv. with curdy flakes. A \ hen the ulcer has 
 
 continued for some time, it begins slowly to heal, the discharge 
 ,v diminishing and becoming thicker. An elevated scab, 
 of a dirty white or yellowish colour, is next formed. This 
 continuca for some time: then falls oil", and leaves the place 
 covered with a purple scar. Some, scrofulous 
 
 after bursting, sinus, the mouth of which assumo the 
 
 appearance of a scrofulot while th of the 
 
 sinus con tin i 
 
 The parts which are most frequently affected with scrofula, 
 
 10 the lymphatic .md perhaps the skin, are the 
 
 ■poogy extremities of the bones and the joints. In scrofulous 
 
 SUOJe :!ar to those in the glands appear in va- 
 
 parts of the body. Finally, the glands of the mesentery 
 
 are often found, in scrofulous subjects, to be universally en- 
 
 1 and diseased; a circuit. which, more than any 
 
 olher, determines the claim of the - j a constitutional 
 
 character. 
 
 In this country, the prevalence of scrofula is, for the most 
 part, confined to the southern states, where it is very common 
 among the blacks, and to a considerable extent among the 
 emigrants from Europe. Cases of it, often of severe charac- 
 ter, are always to be found among the neglected children of 
 the poorer classes in all the principal cities. 
 
 As scrofula illy a disease of debility, and the pre- 
 
 disposition to it is rendered active by all external causes 
 which go to impair the constitution; so both in its prevention 
 and its cure, those means are to he adopted, which have an 
 opposite tendency. If possible, the air of the city should be 
 exchanged for that of the country; that of swampy districts* 
 for drier situations; unwholesome food, for that of better qua- 
 
 L8 
 
378 CANCER, 
 
 lity, and the clothing, state of the skin, and regularity of 
 the bowels should be most carefully attended to. Salt water 
 bathing has been recommended as a tonic, peculiarly suited to 
 these cases. In employing salt water, however, we must 
 carefully attend to the power of the system to react under the 
 chill. As respects internal remedies, the tonic bitters have 
 sometimes had the reputation of benefiting the complaint; at 
 others, mild alteratives, as the sarsaparilla; and again, alkaline 
 medicine; but at present, nothing seems to be so much relied 
 on as the iodine, the virtues of which in reducing glandular 
 tumours under certain circumstances are undeniable. 
 
 In tumours which have not advanced to suppuration, and 
 which are external, frictions with an ointment of iodine are 
 used locally; but in internal tumours and scrofulous ulcera- 
 tions, some of the fluid preparations, internally exhibited, are 
 generally preferred. 
 
 Of Cancer. Cancer generally commences in a hard, well 
 defined, heavy, and sometimes knotty tumour, beginning in the 
 secreting glands, but often propagated to other parts, and ter- 
 minating in an ulcer with thick margins and a fetid discharge. 
 
 A predisposition to cancer is unquestionably hereditary ; but 
 with what peculiarities of structure this predisposition is con- 
 nected, or by what external signs it may be known, is mere 
 matter of conjecture. 
 
 Cancer is not contagious; and the experiment of communi- 
 cating the disease by inoculation has always failed. Jt is most 
 frequent in women; and the object of its primary atta< 
 most generally the female breast. Unmarried women after 
 the age of forty are most liable to cancer ; and, next to these, 
 mothers who have not suckled. Next in the order of frequen- 
 cy, come married women who have reached the period 01 
 above referred to. When cancer occurs in men, it i- chiefly 
 in the lips or on the face, where it is commonly caused by the 
 irritation of a peculiar kind of wart. 
 
 The accidental or occasional causes which develope the con- 
 stitutional tendency to cancer, are numerous. Among them 
 may be mentioned various kinds of external injury: pre-€J 
 ing tumours, accidentally irritated ; severe eruptive disc, 
 and the time of life. 
 
 Cancer in the breast usually commences with a small indo- 
 lent tumour, which for some weeks, months, or even years, at- 
 tracts little attention. After a longer or shorter period this 
 tumour is affected with itching, which is soon exchanged for a 
 pricking or lancinating pain, often very intense, and generally 
 shooting in the direction of neighbouring glands. A 
 burning, and a livid discoloration of the skin appear still later 
 in the case. When these symptoms are united, i: row 
 
CANCER. 379 
 
 character of the disease may be considered as manifest, but 
 previously it is usually termed scirrhus. Hardened bands are 
 now formed in the integuments, which become puckered ; and 
 the nipple, gradually retracted, sometimes wholly disappears. 
 At this period the tumour approaches the skin, and feels knotty 
 to the finger, while varicose veins usually begin to show them- 
 selves on its surface. Sooner or later the integuments give 
 way in places, and a small quantity of fluid mixed with blood 
 is discharged. The ulcer rapidly enlarges till a considerable 
 cavity is exposed, from which issues a most offensive discharge. 
 At this period, granulations sometimes form; but they are loose, 
 soft, and unhealthy, and seldom extend over the whole surface 
 of the sore. Whatever appearances of a tendency to heal the 
 ulcer may assume from time to time, no real progress is made ; 
 its ravages extend until the whole gland is involved, and the 
 weight, pain, and fcetor of the tumour render life a burden. 
 Even under these appalling circumstances, however, existence 
 is sometimes wonderfully protracted ; and during years of suf- 
 fering, the vital powers continue their bootless struggle. 
 
 When cancer attacks the uterus, it is known by lancinating 
 pains in this organ shooting through the region of the pelvis ; 
 and there is, after a time, a mixed, unhealthy discharge, having 
 the peculiar odour which belongs to the disease. Occurring 
 in the stomach, cancer is obscure, and during life is seldom 
 more than suspected. There are acute and burning pain at 
 the pit of the stomach, tenderness on pressure, nausea and re- 
 jection of food; but these symptoms do not enable us certainly 
 to discriminate between this disease and many others. 
 
 Cancer of the lip usually commences with a slight fissure, 
 or crack, which being irritated by injudicious applications, 
 takes on a malignant Yorm. On the tongue, the disease first 
 manifests itself in a small wart near the tip. Both this and 
 the last form are easily removed by operation, and they rarely 
 return. On the cheek and nose cancer is usually preceded 
 by a wart, which, when not subjected to irritation, may remain 
 harmless for life. 
 
 Cancer of the breast, in its early stage, admits of relief from 
 leeching, lead water washes, and the constant application of 
 sheet lead to the surface of the tumour. At a later period, 
 when the ulcerative form is fully developed, the application of 
 arsenic has been much resorted to ; and this substance forms 
 the basis of most of the cancer plasters in common use. It is 
 a violent and dangerous caustic. Among internal remedies, 
 the most lauded, perhaps, for a time, was the hemlock, (conium 
 maculatum, cicuta) but it is found that though this remedy may 
 operate for a few days like a charm, the benefit then sud- 
 denly ceases, and an increased dose is required, of which the 
 
380 VENEREAL DISEASES. 
 
 effects prove equally transient. Externally, a poultice of 
 cicuta sometimes gives great temporary relief. In fine, it is 
 generally conceded, that there is no cure for cancer, and that 
 the sooner the diseased gland is removed, after its true condi- 
 tion has been satisfactorily ascertained, the better. If 
 operation be delayed, the disease almost invariably extent 
 self to the axillary or other neighbouring glands, which are 
 removed with difficulty, and if suffered to remain, will cer- 
 tainly reproduce the disease. 
 
 Cancers of the skin rarely return after operations, but those 
 of other parts are extremely prone to do so; partly, bc< 
 surgeons arc too frequently indisposed to extend their O] 
 tions far enough ; partly, because the operations are . 
 deferred too long; but still more frequently because tb 
 instead of being merely local, is the result of a constitutional 
 peculiarity. 
 
 Venerea . — V\"omen of uncleanly babi: r to* 
 
 have the live organs constant!; 
 
 acute intlammati' led with more or less acrid 
 
 rge; and in t] ::i to be capable of communi- 
 
 cating to I : >rms 
 
 of inflammato: 
 and appears i 
 
 inflamed red hue 
 
 opens at a point. I 
 
 portion of limpid virus. The chancre show 
 puce. • of the urethra. It 
 
 on the third or fourth day after coition, more commo: 
 ever, a A later; and someti 
 
 Instead of chancrei 
 which may extend over col :cc. 
 
 The second eflfi - coition is a tumour in the 
 
 groin, generally commencing in one or I the lymp 
 
 glands, enlar . 
 
 to Mippi;: 
 
 reached a coi ainal tu- 
 
 mours remain 
 
 considerable period. r ap- 
 
 pears indepen nerally < 
 
 dered as a coi 
 
 tion of its peculiar secretion. the inflamn. 
 
 often extends to the spermatic cord, causing 
 larged and tender, and likewise to the t< which be< 
 
 swollen. 
 
 The third affection which oral 
 
 cause already mentioned, is an inflammation of the 
 surface of the urethra, at first recognised by a burni 
 
VENEREAL DISEASES. 381 
 
 tion in passing the urine, and soon afterward by a discharge of 
 mucus, and then of yellow coloured pus from (he passage. 
 The scalding usually subsides in a few days, and the discharge 
 may be diminished almost to nothing, under proper manage- 
 ment. This change may occur, even without treatment, in 
 from eight to twenty days; but the discharge frequently changes 
 its consistence, becoming thin, chronic, and continuing, with 
 ional intermissions, for months, and even years. This dis- 
 ease i -able of producing a sympathetic affection of the 
 testicles, like that mentioned afa upervening on bubo. 
 
 These forms of disease may occur separately or together; 
 and, as we id, the IV often in a condition to com- 
 
 municate one or all, according to the condition of the recipient, 
 and oilier circumstances have led some physicians to 
 the conclusion that the cause which produces these diifercnt 
 affections is one and the same, and that the effect is merely 
 modified by peculiarities of constitution in the individual af- 
 fected. Perhaps the more genera] opinion however is, that 
 they arc not produced by a single poison; that the first two con- 
 stitute one disease termed syphilis, of which the bubo and 
 chancre are alike symptoms, while the third — gonorrhea — is a 
 distinct affection emanating from its own peculiar poison, and 
 elf only. 
 
 Th i iv symptoms of syphilis, which constitute a most 
 
 important feature of til nimence with soreness and 
 
 ul< erative inflammation of the tonsils, uvula, palate and tongue; 
 by which the yoii e i^ rendered hoarse, and the swallowing 
 structed. The ul< tut the throat arc foul and rough, 
 
 having an excavated centre covered with a white or gray 
 slough, and surrounded with a hard, elevated, and deeply red 
 ;a. The skin is attacked with an eruption, not of strictly 
 uniform character, but illy attended with copper co- 
 
 loured spots, which at first fall in svuv( or scales, and after- 
 wards form sc a l)^; these often degenerate into ulcers, which 
 prove foul, offensive and obstinate. With the advance of the 
 disease, pains are felt shooting through the limbs, and the in- 
 vesting membrane of the bones becomes inflamed and swelled, 
 forming what arc termed nodes, especially observable where 
 the bones approach near the skin. The small hones of the pa- 
 late and nostrils next begin to participate in the disease, and 
 are gradually eroded; the voice becomes nasal and imperfect, 
 and the form of the nose is lost. These secondary symptoms 
 often supervene upon syphilis, but never follow simple gonor- 
 rhoea, unless improperly treated by mercury. 
 
 The old or Hunterian school, which taught the identity of 
 all the forms of venereal disease, taught also that an actual 
 specific virus was present, in the matter of venereal sores, and 
 
382 VENEREAL DISEASES. 
 
 of gonorrheal discharge, which, being absorbed into the 
 tern, give rise to the secondary symptoms; — that this virus 
 could never be entirely eradicated by natural effort; — but 
 -that mercury possesses a peculiar affinity for the venereal 
 virus, combines with it, and renders it inert, which no other 
 known substance is capable of doing. These opinions are 
 now almost universally discredited. In fact, experience has 
 shown, that secondary symptoms, instead of being peculiar to 
 cases left to nature, supervene quite as frequently on those 
 cases in which mercury has been largely employed; and it is 
 generally conceded that the venereal disease, in all its forms, 
 is capable of spontaneous cure. Nay, so great has been the 
 change of opinion on these subjects, that some of the 
 forms in which the secondary disease shows itself, the affec- 
 tions of the bones for example, are, by many, believed to be 
 themselves of mercurial origin, and to be developed by the 
 treatment, rather than the disease. 
 
 One of the most interesting, and obscure questions relative 
 to this dia that of i! which regulate its pro; 
 
 tion. It is the general opinion, that the actual contact of the 
 matter of chancre, or of gonon quired to produce the 
 
 KMind individual. 
 
 It would appear, therefore, that a husband can communi- 
 cate cither disease to his wife, only so long as the local symp- 
 toms continue; and that an individual, while still sufl 
 under constitutional symptoms supposed to be syphilitic in 
 character, may be justified in marrying. But though this 
 proposition may be strictly true a> mmunica- 
 
 tion of these Bpecific - in their primary form, < 
 
 riencc abundantly shows, that, from a system affected with 
 secondary symptoms. mptoms, or other 
 
 them may be communicai seems to be proved be; 
 
 a doubt, that a mother I with the secondary symptoms 
 
 only, may communicate them to her infant; that an inf.i 
 affected may nda- 
 
 ry symptoms, either consequent to prii r re- 
 
 ceived from a diseased infant, may again communicate them 
 to another infant; — the peculiar organs in which the primary 
 disease shows' itself, remaining mean while unaffected; — 
 that a father who labours under secondary symptoms, though 
 he may not communicate them to his ici/c 
 ever be blessed with a healthy child. 
 
 Treatment. Opinions are still divided on the question, 
 whether mercury is to be regarded as in an] Rtfic 
 
 in syphilis. The idea, that the disease is incurable without 
 mercury is now abandoned ; but this retm H consi- 
 
 dered as one of great value, and, in the majority of cases, will 
 
VENEREAL DISEASES. 383 
 
 probably continue to be resorted to. In chancre, a slight mer- 
 curial course will cause the ulcer to assume a healthy charac- 
 ter, and to granulate kindly; and in bubo it will often prevent 
 the tumour from suppurating. Whether the remedy acts 
 specifically or by counter-irritation is unimportant. It is ge- 
 nerally conceded that cures effected by this method are more 
 rapid than when no mercury is employed. In the latter case, 
 it is necessary to subject the patient to severe restrictions in 
 regard to diet, rest, fee., which are attended with far more 
 inconvenience than results from the employment of mercu- 
 rials when judiciously conducted. Salivation should never 
 be intentionally produced; for a slight swelling of the gums, 
 and factor of the breath, are sufficient indications that the spe- 
 cific action has taken place; and this action may be cautiously 
 maintained until there Ifl observed a decided tendency to 
 rapid improvement, which usually happens in from two to 
 six days; the effecta being more rapid on chancre than on 
 bubo. Longer than this we would never continue the action 
 of mercury. In the local treatment of chancre it often happens 
 that nothing is requisite but to keep the ulcer clean, either by 
 simple lotions, or by solutions of the astringent salts; as alum, 
 sugar of lead, white vitriol, &c. In addition to this, some 
 ointment must be employed, the choice of which may be regu- 
 lated by the principles laid down in the sub-section on ulcers, 
 (p. 33S.) The ointment, or simple powder of the red precipi- 
 tate of mercury, is a favourite application, when the ulcer is 
 covered with an adherent gray matter, and the carrot poul- 
 tice is generally employed in the phagedenic or burrowing 
 form of the disease; but here we much prefer the cicuta poul- 
 tice. 
 
 At the commencement of bubo, the ol in other inci- 
 
 pient to proem ;: itn. For this purpose, as 
 
 for the cure of chancre, abundance of mercury was formerly 
 thought the only means; but it was rubbed liberally into the 
 affected groin, in the form of ointment, under the erroneous 
 impression that the mercury would pass through the gland. 
 The same practice is still continued, and with much effect, in 
 promoting a rapid absorption of the tumour. (See sub-section 
 ^nations of mucous orifices, (p. 359.) 
 
 When pus appears to have formed, the softening of the 
 tumour must be encouraged by the application of a common 
 poultice ; this may indeed be applied in every stage. When 
 the matter approaches the surface, the abscess should be 
 opened, early and freely, to prevent the formation of indolent 
 and thin flaps, which often require to be burned off with caus- 
 tic, before the cavity can be healed. It happens not unfre- 
 quentlv. that a bubo becomes indolent, and refuses either to 
 
384 scurvy. 
 
 advance or recede. To open a sore of this description would 
 be imprudent. In this state of the parts, blistering is often 
 very useful, and the ointment of white precipitate, or the blue 
 'butter, with one drachm of powdered camphor, and one scru- 
 ple of powdered muriate of ammonia, will be found an t_.\< cl- 
 ient application. For our views on the treatment of gonor- 
 rhoea, we refer to the sub-section on termination of inflammation 
 in suppuration, (p. 31 
 
 Scurvy. — Ti; ial symptom of scurvy is an effusion of 
 
 blood from the superficial blood vessels, and i ranee in 
 
 spots, resembling what arc called blood blisters, man 
 under the cuticle. This, however, and th : debility 
 
 which accompanies it, are common to two di huh dif- 
 
 fering both in the i inces under which they arise and in 
 
 the character of their a land scurvy 
 
 and sea Bcurvj . mel with at 
 
 every period of life, but principally affects persons of v 
 and delicate constitution. It i 
 
 and pains in the limbs, to which 
 shivering, nausea and von 
 
 monk appears first on lb • the 
 
 thigh, arm, and trunk. 
 
 are numerous on the inside of the □ rticularh 
 
 the gums, tonsils, and lips. It i^ from these that the 
 bleeding generally occurs; but as the di Mood 
 
 flows also from the nostrils, lung 
 all these parts are found, on examination ai: 
 with spots, similar to those which show then . the mu- 
 
 cous surface of the mouth. It is : 
 by the absence of spoo - .. tin- gin. 
 tiniruished from sea scurvy. 
 
 The taih(», both remote and immediate, are obse 
 among the former are mentioned, on l'. 
 impure air, and anxiety ; on i 
 ranee. The 
 
 of the si pulse and 
 
 dence of exhaustion ; sometimes, in full, 
 which have the appearance of requiring 
 sometimes the general health 
 This confusion of cai 
 rare instances which are met with at 
 
 many years since, when ti, . the 
 
 larger European cities, th, 
 similar to those which produce 
 
 The ravages o( sea-scurvy forme 
 est obstacle to the prosecution of v. 
 prevention, one o( the greatest triumpl I and 
 
scurvy. 385 
 
 science, from the time of the celebrated expedition of Vasco 
 de Gama, in which fifty-six men were lost by this then un- 
 known malady, to that of Ca plain Cook's voyage in the Reso- 
 lution, this disease constituted one of the most serious evils 
 attending maritime adventures. 
 
 So late, in fact, as 1741 , the fleet under the command of Cap- 
 tain, afterward Lord Anson, lost half the crews in the space 
 of six months from the time of leaving England. 
 
 Some parts of the description of this disease have been an- 
 ticipated, in speaking of purpura. There is the same weak- 
 ness and inactivity, with pale, bloated complexion, and a swell- 
 ing of the lower extremities. If the gums are examined, they 
 will be found spongy, disposed to bleed, and frequently swol- 
 len to an enormous extent, and seem as if in a state of decay, 
 while the teeth are loosened in their sockets. 
 
 The skin is generally smooth, shining, and covered with bluish 
 or livid spots, not rising above the surface; and these often coa- 
 lesce, so as to form large blotches. Wherever ulcerations have 
 existed, they break out again, and discharge a thin offensive 
 fluid mixed with blood. A soft, spongy, putrid clot soon forms 
 on their surface, which is with diiiiculty removed, and when 
 removed, quickly forms again, followed by a fungous excres- 
 cence, which has the appearance of liver. When this has 
 been extirpated by the knife or caustic, it is reproduced in a 
 few hours. In the last stage of the disease, blood is discharged 
 from the intestines, and even from the bladder: and the debi- 
 lity is so great that tin -t motion will produce fainting 
 and even death. Yet during the whole course, the sense of 
 pain is ^ I i ^ 1 1 L or wanting; and the spirits often so far outrun 
 the physical power, that the patient, if roused by the stimulus 
 of hope or fear, will often attempt a violent exertion, and 
 perish in the very act. 
 
 The proximate cause usually assigned for the symptoms of 
 scurvy, is a putrescent state o(^ the blood ; but the remote cause 
 is unquestionably the exclusive employment of salted animal 
 food. We say exclusive: for it appears that the free use of 
 (rc^\\ acescent vegetables, or of vegetable acids in any form, 
 will counteract the influence of the salted provision, and ena- 
 ble the stomach to form chyme of laudable character. In 
 long voyages, during which fresh vegetables cannot be de- 
 pended on, scurvy may be effectually prevented by providing 
 an ample supply of citric acid or lemon juice. This was one 
 of the improvements suggested by Captain Cook, to whom, more 
 than to anv other individual, belongs the praise of having dis- 
 covered the means of resisting this formidable enemy. This, 
 however, was not the only improvement which this skilful na- 
 vigator introduced into the dietetic regulations of a voyage. 
 
 49 
 
386 scurvy. 
 
 The quality of the food and water, the clothing and personal 
 cleanliness of the men, and the ventilation of the vessel, were 
 all objects of his attention ; and such was the success of his be- 
 nevolent exertions, that he was enabled to fulfil his celebrated 
 voyage of three years and eighteen days, with a company of 
 one hundred and eighteen men, in all latitudes from 52 c North, 
 to 71° South, with the loss of but one individual from disease, 
 and that one, a man who was apparently consumptive when 
 he commenced the voyage. The example thus given has been 
 worthily followed up 6ince his time. At the present day sea- 
 scurvy is, in the navies of civilized nations, a rare disease. In 
 our own vessels, private and public, it is effectually prevented, 
 by allowing the crews a sufficient proportion of vegetable food 
 and vinegar, by improved means of preserving water free from 
 impurity, and, on long voyages, by furnishing lemon juice, 
 which is still acknowledged to be preferable as a preventive 
 to any other article. The great efforts which have been made 
 of late years to promote cfeanKniM ain ; en, to discou- 
 
 rage the me of ardent spirits, and to substitute therefor the 
 more innocent stimulus of tea or coffee, have undoubtedly con- 
 tributed, among their other good effects, to the diminution of 
 this repulsive and dangerous disease. 
 
CHAPTER III. 
 
 MEDICAL PRACTICE, OR TREATMENT OF INTER 
 NAL DISEASES. 
 
 True to our original intention in offering this work to the 
 public, we shall avoid all those arts by which the composers 
 of treatises on domestic medicine, have endeavoured to encou- 
 rage the credulous in the belief, that, by a few hours' study, 
 and an occasional reference to a book, they could supersede 
 the necessity of advice from those whose lives and observa- 
 tion are devoted exclusively to the study of disease. We shall 
 endeavour to engross, in the present chapter, such information 
 only, as may be safely and advantageously communicated to 
 the intelligent who are not of the profession, in order to ena- 
 ble them to save human life and suffering where higher as- 
 sistance is inaccessible or unobtainable in time, without en- 
 couraging that rashness which induces the empiric, and cer- 
 tain ignorant professional sectaries, to rush into fearful respon- 
 sibilities, unnecessarily or criminally. We ardently hope 
 that the result of our labours will be such as to leave us 
 chargeable with no follies committed in the sick room under 
 the sanction of our authority. 
 
 section I. 
 Fever. 
 
 The symptom essential to fever, is an altered condition of 
 the nervous system, in consequence of which, the sensations 
 of heat and cold no longer correspond to their usual causes; 
 in which cold is felt, notwithstanding the presence of a warm 
 atmosphere and abundant clothing, or heat notwithstanding 
 their absence. Together with this, there is usually a rapid 
 pulse, headach, and nausea. Fever, in this sense, accompanies, 
 or is ■ symptom of, various other diseases, particularly inflam- 
 
388 INTERMITTENT FEVER. 
 
 mations; but the term fever, or general fever, is applied to a 
 state in which the febrile action is dependent on no external 
 or visible local disease. 
 
 Intermittent Fever. — A regular paroxysm of intermittent 
 fever consists of three stages; and may be thus described. 
 The patient first exhibits evidence of languor and debility, 
 unwillingness to move, and a disposition to yawn en motion, 
 as if aroused from sleep. At this period, the extremities, if 
 examined, will be found cooler than usual, though as yet no 
 change in temperature is obvious to himself. Presently the 
 chill commences, invading the hick and then the- rot uf the 
 body, with a progress which is felt and described as crec 
 or crawling. The state of chill, when perfect, is marked by 
 a sense of extreme cold, which demands instant augmentation 
 of all the usual appliances for warmth. possible 
 
 approach to a fire, and additional clothing, or the protec 
 of a bed; by all which, ho it little reliei 
 
 the same time, there is a tremor or shivering, usually more 
 violent than the impression of external cold proc! \\ on 
 
 the moat Susceptible, being wholly beyond the control of the 
 sufferer. At this time, however, if the skin be felt with the 
 hand, it will be found warmer than usual, notwithstanding the 
 chilliness of the sensation. I lain time, the sense of 
 
 cold begii, tit, and occasional hot fl ;.ced. 
 
 This state of things it. ic approach of the second - 
 
 By degrees, the m and that of unnatural 
 
 heat ensues, the heat of surface as manifi the touch 
 
 continuing undiminished or i; _. With this chai 
 
 heightening of colour is deveh r many parts, and 
 
 •tally in the (ace, which becomes of a bri let. The 
 
 heat and led: :iore and more marked for a time, 
 
 the skin continuii it declining in hars 
 
 the third to all 
 
 the symptoms. The I ady becomes cool, the 
 
 countenance I all things return, 
 
 for the most part, to their natUl 
 
 There are many other appeal iliar 
 
 to each, or common to all the s which 
 
 it will he proper here to notice. In the cold stage, the 
 is frequent, small, and often irregular; ihe breal \ious 
 
 and sighing, sometimes attended with cough. In the hot 
 stage, the pulse becomes regular, hard, and full, and increases 
 in these qualities, till the 9 
 
 piration becomes more full and free, but continues frequent 
 and anxious. In the sweating Stage, the pulse bece. 
 and less frequent, returning :ly to its natural ! 
 
 the anxiety and difficulty of breathing arc remc 
 
INTERMITTENT FEVER. 389 
 
 The appetite, of course, disappears from the commencement 
 till the conclusion of a paroxysm, and, in general, an ahsolute 
 aversion to food takes its place. Together with this, there is 
 often sickness at the stomach, and vomiting of a bilious mat- 
 ter: this may occur either in the cold or hot stage, but is most 
 common in the former. Thirst and dryness of the mouth 
 and throat continue during the whole paroxysm, but abate as 
 the sweat flows freely. And, lastly, headach, attended with a 
 peculiar throbbing in the temples, together with pain in the 
 back, and often in the limbs, must be enumerated among the 
 symptoms of a paroxysm of fever. 
 
 The interval between the paroxysms of an intermittent, is 
 a period of comparative health: and the time which elapses 
 between the commencement of successive paroxysms is that 
 which determines the type of the disease. If this period is 
 twenty-four hours, the fever is termed quotidian or daily; if 
 forty-eight, so that the second paroxysm occurs on the third 
 day, counting from the first, inclusive, it is a tertian; if seven- 
 ty-two hours, a quartan. Regular intervals are rarely pro- 
 tracted beyond this period. 
 
 It may happen that a fever consists only of a single parox- 
 ysm, terminating entirely in the first sweating stage. When 
 this result occurs by art, it does not prevent the disease from 
 being ranked as intermittent. Hut a lever having essentially 
 but one paroxysm, has been termed ephemeral. An epidemic 
 of this ephemeral character once prevailed in England, and 
 was called the sweating sicki; 
 
 It is foreign to our purpose to enter into the much disputed 
 question of the immediate cause or intimate nature of lever. 
 As respects the remote OT external causes of intermittent, they 
 are now generally allowed to be marsh miasmata; that is, the 
 exhalations arising from vegetable substances, partially im- 
 mersed in a moist soil, and acted upon by the rays of a hot 
 sun; although it frequently happens that febrile miasma ap- 
 pears to be generated independently of this precise combina- 
 tion of causes. Very many of the rivers in our middle and 
 western states, on the margins of which springs a luxurious 
 tation, especially if their banks are low, and periodically 
 inundated, are favourite haunts of the affection. But there 
 are facts in regard to the salubrity or unhealthincss of river 
 situations, which are difficult to reconcile with any precise 
 theory ; and our own Schuylkill furnishes an example of a river 
 flowing on quietly from year to year in the same channel, 
 and nourishing the same vegetation on its borders, yet in the 
 course of a few years completely changing its character, so 
 that spots in its vicinity once sought for most desirable and 
 delightful retirement, have come to be avoided as if infested 
 
390 INTERMITTENT FEVER* 
 
 by pestilence. We have dilated on this subject in the chap- 
 ter on Hygiene. 
 
 It is worthy of remark, however, that intermittent fever is 
 sometimes generated in very limited localities, from causes, 
 which, though strictly analogous to thoM which induce its 
 action on a large scale, may be easily overlooked or misun- 
 derstood. Jn fact, cases occasionally occur among children or 
 peculiarly susceptible subjects, even ill the midst of populous 
 cities, and where the drainage is apparently perfect. They 
 are usually found in very Confined situations, and especially in 
 cellars, and can he explained only by admitting the presence of 
 a local malaria in such situations, from the vegetable remains 
 which are allowed to accumulate, and the moisture with 
 which they an: iurround< <l. 
 
 The treatment of intermittent fever divid. naturally 
 
 into, first, the raanag< tiring the parox\ 
 
 condly, that proper during the interval Ai reapecui the 
 former, it a toe obviotli dure 
 
 is to obtain n means of the ge. The ob- 
 
 ject of ait, then, Would seem to be to accelerate as mu 
 
 ale the aceeai of Ihii in otbei to shorten 
 
 the cold lit; for, when the not lit is once induced, t; 
 ing b seldom long in following it. To accomplish this object, 
 besides indulging the inclination of the patient for warmth ex- 
 ternally, we supply him lai th warm diluent drinki 
 hot barley water, flax-seed ioi ige or balm 
 unless the stomach be irritable. These aiti to diliuse 
 warmth through the system, and, if retained on the stomach, 
 are presently carried oil' by perspiration. El D P Im D I '• ctcd 
 by vomiting, they are not always injurious, for 
 a tendency to the BUriai e« II at, spintll 
 punch, &c., acl injuriously, by rendering the hoi e of 
 much more intensity than it would othe i be, and 
 thus cause tinned tha nation. Laudanum and i 
 phor are frequently employed to shorten the cold it _* 
 first is liable io th n already u:_ nous 
 articles. Camphor is what is termed a di: and, 
 therefore, well suited to effect the purpose. A tea-apooni 
 paragoric tincture, which combines the virtues of opium and 
 camphor, may be often given With goo 
 
 mencement of the cold stage of an intermittent, combined with 
 the sudorifica above alluded to. When much headach is 
 sent from the commencement, and particularly if the patient 
 be troubled by ineffectual retchings without vomiti 
 highly proper to give an emetic of a grain oi' antimony with 
 twenty of ipecacuanha. At the end of -five ort 1 
 
 minutes the dose may be repeated, if no cmesis be prodi; 
 
INTERMITTENT FEVER. 391 
 
 Warm water should he taken freely to promote the operation-. 
 This dose is proper for an adulr. 
 
 But the most important consideration in intermittent fever 
 is, how to prevent the return of a paroxysm. For this purpose, 
 the Peruvian bark, or its preparations, have been employed al- 
 most exclusively, from the time when their virtues became 
 known to the civilized world. 
 
 In what way or by what law of the system, (he cinchona 
 produces its etlects, it is difficult to say. The general charac- 
 ter of bark, is that of a tonic; and in this view it is generally 
 prescribed for debility, more particularly for the debility inci- 
 dent to, and consequent on fever. The fact that the parox- 
 ysms of fever are arrested by the administration of a few 
 grains of bark, is among the best authenticated, as well as 
 most remarkable in medical science. This property, we may 
 add, is not confined to the Peruvian bark; other bitter barks, 
 woods, &c, such as cascarilla, gentian, quassia, and chamomile, 
 likewise possess it: but their virtues are seldom appealed to 
 except as matter of curiosity. A modern improved method, 
 by which the use of the hark in substance, has been super- 
 seded, is to extract the bitter principle, or quinine, in the Ibrm 
 of a sulphate. This beautiful salt, which is now manufactured 
 in great abundance, in Europe and in this country, has taken 
 the place, almost wholly, of the old forms in which bark was 
 administered. In exhibiting it, the hot rule is to commence 
 its use immediately after the slow of the paroxysm, and con- 
 tinue it at intervals of one hour in quotidian, two hours in ter- 
 tian, and three in quartan airue. In order to secuie a proper 
 condition of the lyatem for the exhibition of the tonic, it is es- 
 sential in son.' i exhibit lome cathartic medicine, if the 
 evacuations are not spontaneously regular. 
 
 If the case be a protracted one, the liver and spleen almost 
 invariably become diseased : ami this itate is generally accom- 
 panied by a jaundiced hue of the eye. It is then proper to 
 have two doses of five grains of calomel taken at bed-time on 
 successive evenings, followed by a little oil, or salts, in the morn- 
 ing, if the calomel does not operate by nine o'clock : this should 
 be done before exhibiting the tonic. 
 
 When, under the use of quinine or bark, the paroxysms do 
 not cease, but occur at longer intervals, we are gaining ground, 
 and may calculate on success with a little delay. When, on 
 the contrary, the intervals grow shorter, we are losing ground, 
 and may feel assured that some additional treatment is neces- 
 sary to moderate the violence of the hot stage. The saline 
 draught and the neutral mixture, if there be sickness, and the 
 sweet spirits of nitre given in the dose of thirty drops every 
 half hour, will often accomplish the purpose: they should be 
 
392 INTERMITTENT FEVER. 
 
 aided by cold drinks and affusions, or even by the lancet, 
 the pulse is very high, the skin very hot and dry, and tl 
 roxysm long. Sometimes ihe inter ndered in 
 
 feet by the continuance of -an obscure, 
 through the sue.) finer it age and the interval a hould 
 
 not be given, under these circun til the intern, 
 
 is rendered complete; which may b 
 
 or two di ilomcl, ai xhibition, 
 
 during the interval, of an imV v e root, in 
 
 the proportion of one ounce to the pint of hot water, a wine- 
 glassful i" be taken, cold, . the interval and 
 the sweating stag 
 
 Tli< od bark are p 
 
 tplicabie by tli«* addition of mi 
 
 tions of sulphate nd opium. The two foil 
 
 jority of chilli 
 portion of th< 
 rode* 
 
 scription ■ intend* d for those who 
 
 the form i i pills, — the second, tin a dis- 
 
 t for that I sdninistratj 
 
 1. T i Sulphate of nnii 
 
 Bulph ii. 
 
 Minn in j ii. 
 
 Gum Arabic in powder 
 
 Mak 
 
 divide the no isi into 
 
 IX>^ :>iil. 
 
 9, Ti Sni 
 
 Sulphate o( cop] ii. 
 
 Put them in phial, \\. ounces of 
 
 water, and shake them a 
 Then a 
 
 F.lixir of vitriol, 
 i.lanum. 
 Shako the phial again, and then till it with v 
 Do>e — a table spoonful 
 
 The medicine, given 
 of the interval, should be continued till bed-time on tin 
 on which the chill is missed tor the first timo, and this day 
 should be noted. 
 
 There is a strong tendency, in an mum :iich has 
 
 been checked, to return on the seventh, fourteenth. or tw« 
 
CONTINUED FEVER. 303 
 
 first day: to prevent this disaster, a dose of one or the other of 
 the above prescriptions should be taken in the morning, at noon, 
 and at night, on each of the days here named, counting from 
 the day on which the paroxysm first failed to appear; viz. the 
 sixth, seventh, thirteenth, fourteenth, twentieth, and twenty- 
 first days. By faithfully following this direction, the patient 
 will verv rarely experience another attack, for at least six 
 months; which is ,t< long an indemnity as can be reasonably 
 asked by those who continue to reside in an infected district. 
 
 Although quinine may be almost with certainty depended 
 on for remedying an attack of intermittent fever, and the sys- 
 tem remains secure for a time, continued exposure to the 
 same malaria will again induce it, and even removal to a 
 more salubrious climate is not always a safeguard. The indi- 
 vidual who has frequently suffered, sometimes retains a re- 
 markable susceptibility to the disease for years, and even for 
 a whole lire. In such individuals, simple exposure to cold 
 will often be sufficient to induce an attack. For awhile, 
 these relapses are cured with the same ease as the first attack; 
 but after some time the quinine seems to lose its effect. Un- 
 der these circumstances, the Fowler's Solution, an arsenical 
 preparation, has been found a valuable substitute. It is em- 
 ployed in dosei of ten drops, taken at intervals; but it is an 
 Article altogether too dangerous for domestic ill 
 
 Continued \ paroxysm of intermittent, as above 
 
 described, may be considered ; or model of all febrile 
 
 <>ns, to which all bear more or less of resemblance. But 
 there i« a large class of fever* in which the regular sequence 
 
 .upturns which belongs to the intermittent fails to be ob- 
 
 •!. The aci« Btially with chill, which is 
 
 succeeded by a sensation of heat. Pain in the head and back, 
 
 if appetite, thirst and . are also present. But 
 
 tier wholly from regular intermittent in the fol- 
 lowing circumstances. The commencing chill is less vio- 
 lent, and often not attended with absolute rigour or shaking; 
 the hot stage, when fully formed, may continue with little 
 change in the degree of heat for many hours or even days; 
 and there is no regular termination by sweat. The natural 
 state of the functions, instead of being restored at the expi- 
 ration of six, eight, or ten hours, oftentimes does not return 
 for as many weeks; but once restored, the whole force of the 
 morbific action is exhausted, and there remains no tendency 
 to a new paroxysm. Such is the general character of continued 
 fevers. But as under this class are embraced diseases of very 
 different character, it will be better at once to separate them; 
 
 ring for distinct notice the bilious, remittent, or yellow 
 fever, as likewise the petechial or spotted fever, and the ma- 
 
 oil 
 
394 CONTINUED FEVER. 
 
 lignant typhus, all which arc diseases of very fatal tendency, 
 and considering at present the common inflammatory or con- 
 tinued fever, together with the mild typhus or slow fever, 
 which is the form into which the former passes when pro- 
 tracted naturally. 
 
 The commencing symptoms of continued fever have been 
 described. Its approach is insidious, and generally the stage 
 of chill has already been succeeded by heat before it attracts 
 notice. Then the patient is found with Hushed face, suffused 
 eyes, hot skin, quick, hard pulse, tongue loaded with secre- 
 tion, thirsty, very restless, and in the I -;htly 
 delirious, yet without other pain than that referred to the 
 head, and an achil lion in the back and limbs. The 
 disease is seldom allowed to make progress without interfe- 
 rence, for experience fully proved the utility of at- 
 tempting to arrest it, and so clearly pointed out the means of 
 so doing, that these means are probably tin rted 
 to. The relief urgently demanded at this period, is to be 
 gained in a very large proportion of cases by the simp! 
 hibitlOD of an emetic; in a smaller number by the 
 
 medy, preceded by bleeding; and a still smaller, perhaps] 
 bleeding alone. The latter is most ial when it pro- 
 
 duces free perspiration and excites vomiting, which it not un- 
 frequently docs. The rejection of the contents of the 
 
 inach, followed by a free d of bile, g 
 
 to the head, and oily to at 
 
 and break up the fever. Should the latter not ha; 
 patient obtains after some hours a remission of the^symptoms, 
 the pulse becoming slower and softer, the skin more cool, 
 countenance brighter, thil mind clear and tranquil. 
 
 These favourable changes, when transitory only, arc most 
 usually remarked in the early pari 
 
 ning an aggravation again taki- When this alternation 
 
 has continued for a lew days, one of two things tsk 
 Either gradual improvement occurs with tl. ap- 
 
 petite, l natural coolness ol the >kin, the restoration of the 
 strength, &c, or the fever cha: v i • The return of 
 
 daily febrile action ceases to be I . or becofl 
 
 slight. The pulse sometimes falls below its natural standard 
 to sixty, or even fifty beats per minute. The body is pale and 
 cool; but, on any exertion, a sudden flush will be noticed in 
 the cheeks, especially in children, which subsides when the 
 occasion which produced it is piimod The disposition to 
 speak, or even to reply to questions. The adult 
 
 answers after a moment's hesitation, and in a d: g :onc; 
 
 the child speaks in whispers. Little attention is given u 
 rounding objects: the sight, hearing 
 
CONTINUED FEVER. 3&5 
 
 certained, smell and sense of feeling are benumbed; the eyes, 
 when examined, have a staring expression, as if scarcely af- 
 fected by light, and the pupils will be observed unnaturally 
 dilated. The balls are often suffused with tears. There is no 
 thirst, and little appetite, though scarcely an aversion to food, 
 for small quantities are willingly taken, especially by chil- 
 dren. The alvine discharges become slow and sluggish. From 
 this state the patient may and often does recover, after a te- 
 dious confinement of eight, ten, twelve, or sometimes twenty 
 weeks, with extreme emaciation, and almost total loss of 
 strength. If fatal, death usually takes place in the third or 
 fourth week, though such a termination may occur at any 
 time. Among the symptoms of a graver character than those 
 above mentioned, are what is called coma, and delirium; the 
 former being a deep, heavy, protracted sleep, from which the 
 patient is roused with some difficult}-; the latter evinced by 
 a low muttering of incoherent sentences, and a half-dreaming 
 state, during which the most singular phenomena are occa- 
 sionally noticed almost to the last. The attention can be re- 
 called, with some effort, to what is passing around. Recovery 
 in protracted cases is sometimes followed by wild insanity, 
 which, however, is almost always curable in the course of a 
 few months. 
 
 Such is a sketch of the mild typhus or slow nervous fever 
 of our own country, a disease most observed, perhaps, in our 
 northern and middle states, but known very well to practi- 
 tioners at the west and south. Its medical treatment belongs, 
 of necessity, exclusively to the profession ; and there is less 
 occasion for opening the subject here, because the slow and 
 gradual progress of the symptoms affords ample time and op- 
 portunity to obtain medical advice. 
 
 But to that important part of the direction of these cases 
 which falls under the denomination of nursing, attendance, and 
 general management, we wish to call especial attention. 
 These subjects are too often overlooked or neglected in prac- 
 tice, for the very reason that their practical application re- 
 quires that patience, firmness, self-command and perseverance, 
 which, though among the best, are among the rarest qualities 
 of our nature. 
 
 Clean ti/wss may be justly ranked as first in importance 
 among the duties of a sick-room. Between the indolence 
 which avoids all avoidable trouble; the indulgence which can- 
 not bear to inflict immediate inconvenience for the sake of 
 subsequent benefit, and the fear which shuns the responsibility 
 of any decided measure, even the necessity of neatness is too 
 often lost sight of; and, among those who should both know 
 and do better, negligences are permitted which the parties 
 
396 CONTINUED FEVER. 
 
 concerned would blush to see exposed. We do not hesitate to 
 lay it down as a general rule, that there is no state or stage 
 of fever, in which the exposed part of the person may not be 
 claily washed, the linen about the person daily changed, and 
 the bed daily made. Even in cases of extreme debility I 
 things may be done, so as to afford far more permanent com- 
 fort to the sufferer than the temporary inconvenience caused, 
 provided the process be managed with g ■ and discre- 
 
 tion. For the mere purp< 
 
 may be employed ; but there is a refn lueuce in the 
 
 application of cold water to the fac< ring 
 
 the heat of continued fever, which is sometimes indescribable, 
 and which is not attended with any subsequent il The 
 
 skin for a time is relieved of its burning sensation and dn 
 becoming soft, moist, and natural in temperature, and this ef- 
 fect will often continue for a considerable time. The mouth 
 and teeth should not he neglected at an;. .nd as IOC 
 
 his strength will permit, tli I should be encouraged to 
 
 attend to them for I. - of the 
 
 sick-room, the nee .oris 
 
 likely to become offensive, little need be - - the 
 
 nuisances, however, which are apt to collect in room, 
 
 and to which too much indnL are the 
 
 boxes, papers, &c, the contents of which are hut partially 
 consumed. Let them be banished without hesitation, as soon 
 as their i> •ntinucd. 
 
 Temperature and ventilation. Patients almost always know 
 when the bed-clothing is insufficient, or the room too cold; but 
 the due caution to prevent the body from being too much co- 
 \cied, or the room over-heat- 
 
 Attendants should be exceedingly attentive- on this point, 
 complaint on the part o( the ; should be prevented by 
 
 anticipation. Ventilation rtant at all 
 
 though more difficult to i In comfort in 
 
 winter than in summer, it may be managed at all I 
 The air can be suffered to gain admittance from a door. i: 
 from a window, in the course of 
 
 time to dissipate any noxious effluvia. A w indow op< 
 downward at a distance of fifteen or twenty feet from the bed, 
 is almost always available for this pur;> 
 
 The subject of administering food and drink is. - the 
 
 source of perplexity to many well-mear: 
 though perfectly satisfied thai the natural good 
 
 guide in regard to this matter in health, cannot 
 suaded that this is equally the case in disease. To a j 
 tent, however, Mich is the fact. During the early | 
 while active symptoms arc present, th 
 
CONTINUED FEVER. 397 
 
 food is not only absent, but an absolute aversion to it is gene- 
 rally present. Liquids are sought for with great avidity, and 
 the purest and simplest water is the most agreeable. As the 
 ardour of the fever subsides, the desire for drink, especially for 
 cold liquid, is lessened, and often some warm slightly nutritious 
 beverage as tea, gruel, arrow root, &c, is found very palatable. 
 As the fever still farther abates, and the previously coated 
 tongue clears, the appetite for solids returns, though the desire 
 is generally found to be easily appeased. In the protracted 
 cases which we have attempted above to describe, there is 
 rather a willingness than an absolute desire to eat, rather a 
 of emptiness than appetite, and indulgence, while it gives 
 little pleasure, is yet found to relieve an uneasy sensation. 
 
 For the most part, we apprehend, these promptings of nature 
 may be depended on, provided we are careful to exhibit only 
 the milder articles of food in small quantities frequently re- 
 peated. Some exceptions or limitations to the rule occur in 
 children, in persons greatly advanced in life, in those whose 
 minds arc enfeebled by long illness, in patients who sutler from 
 habitual indigestion, and in persons prone to habitual excess. 
 To lay down precise rules for the management of each of these 
 s of patients, would require an elaborate essay, and the 
 consideration of many topics which do not enter into our plan. 
 By the exercise of sound discretion serious errors may be 
 avoided, and even n . when not too work out their 
 
 own remedies. The folio wi ins, however, the result, 
 
 of some observation in this may not be found useless. 
 
 Persons of mature ai^e and of sound mind, may be indulged- 
 in simple water at any time, to any extent they desire, if not 
 affected with obstinate vomiting. Children and childish per- 
 sons may be limited in regard to the quantity, but not as to 
 the frequency of the indulgence. The same may be said with 
 more confidence of the simple infusions, as toast-water, balm 
 &C, because, being somewhat repulsive in taste, they are 
 not likely to be taken in excess, even by the most thoughtless. 
 
 To children, as soon as the desire for solid food returns, it is 
 perfectly safe to allow a dry biscuit, which requires some ac- 
 tion of the teeth to put it in a condition to be swallowed, and 
 the very trouble the indulgence costs is the best safeguard 
 against exce 
 
 ■ patient of any age should be urged to eat, nor should the 
 nutritious liquids above referred to, the gruel, &c, be insisted 
 on, unless by express order of a physician. Many persons are 
 averse to these preparations, and want no food till they are 
 able to return to their ordinary repast of tea or coffee and 
 toast, or even till they can indulge in some light animal nourish- 
 ment. 
 
398 CONTINUED FEVER. 
 
 When an experiment in diet which is regarded as doubtful 
 is to be tried, let the trial be made in the early part of the day. 
 An article not thought of till the hour of dinner is passed, if it 
 require any preparation, had better be deferred till next day. 
 This rule is peculiarly important during the first few da- 
 convalescence, while there is still a tendency to febrile action 
 towards evening. To take this period for an indulgence in 
 itself allowed to be of questionable character, is obviously in- 
 consistent with wholesome discretion. 
 
 No rule can be given in regard to these cravings which are 
 felt by conval< for such i 
 
 dried beef, pickled oysters, &c. 'I lication sought in 
 
 these caa of the taste rather than the appetite, a: 
 
 taste is all that is needed. We have heard an anecdote of a 
 distinguished practitioner, who, in reply to an importunate re- 
 
 ofa patient, that she might be indulged in rid 
 tainlv. my, dear, a tea-spoonfall three times a da] 
 any thing need be feared, it' tl. but small en< 
 
 Although pti *.ment in 
 
 department, we deem 006 subject, — I .lvinc 
 
 discharges in fever. — tOO important to pass 01 
 The - still fre- 
 
 quent It may be ohviafc :lation of 
 
 diet, such as will he noticed under the head of ; or 
 
 by administering one of the cathartics in common use, 
 quantity just sufficient to effect 
 solicitude felt on thai subject by alt 
 
 Carried to e\i eflB, and leads to an i ncc with 
 
 the natural t< ndencies and demand) Of L The 
 
 y obviously is to appropriate \ hly the nutri- 
 
 ment which enters the stomach, ery small 
 
 residuum, and that in a state not very favourable to 
 
 taneous expulsion. If a too 
 
 it will probably become a source o( irritation: but 
 evacuation be unduly urged, the d is not propers 
 
 fected, and the benefit of the nutriment i~ lost. 
 
 Other inconveniences of will be con- 
 
 sidered h rve that, 
 
 in convalesce] r. only the mildea i kmM 
 
 be employed. Generally speaking, the use oi >ome mild 
 charine or sub-acid firu wed prunes or tamarind, will be 
 
 sufficient; or, if any proper medicinal article l little 
 
 confection of senna, the rhubarb pill, or a tea-spoonful I 
 in emulsion, may be substituted 
 
 On one subject connected with the management of 
 room, we must be excused for speaking KHM sev<. 
 
CONTINUED FEVER. 399 
 
 We allude to the admission of unnecessary or improper at- 
 tendants and visiters into the apartment. Not only in fevers, 
 but in the whole range of nervous affections, even when mild, 
 it is of the utmost importance to prevent all unnecessary ex- 
 citement of the senses or the mind of the patient. The room 
 should be darkened, to relieve the eye, and a heavy tread, or a 
 creaking shoe should never be tolerated. In severe cases, and 
 particularly those attended with giddiness or great irritability 
 of stomach, the mere presence or absence of a continued mo- 
 notonous sound or an unvarying motion, such as the oscilla- 
 tion of a rocking-chair, will sometimes determine, as we know 
 by actual experience, the result of life or death! A nurse 
 who argues and disputes with others, in the presence of a pa- 
 tient, should be immediately dismissed. A practitioner who 
 so far forgets the duties of his station, as to raise his voice, or 
 indulge his temper, or annoy the patient with disagreeable and 
 irrelevant conversation, or alarm him by appearing after in- 
 dulgence in dissipation, whatever be his talent or standing, 
 should be tolerated only when no more reasonable or credita- 
 ble assistance can be possibly obtained. 
 
 Religious services in the sick room should be very short 
 and very quiet. Singing, and especially singing in concert, 
 is very reprehensibla A clergyman who knows the true du- 
 >>[' his calling, and prefer! the true service of his Master, 
 to tin ie of petty influence or the gratification of a silly 
 
 vanity, will always consider the advice of the medical atten- 
 dant, both with regard to the time and duration ofhifl 
 and lie should slso recollect that, either from respect or policy, 
 the practitioner generally avoids carrying his expressed cau- 
 tions on such subjects to the extent which justice to the pa- 
 tient demands. 
 
 Hut what shall to the kind friends whose anxiety 
 
 for the patient induce them to insist on admittance? The face 
 of a friend is often more serviceable than medicine, more in- 
 vigorating than wine! but the faces of a dozen, are worse than 
 intoxication. 
 
 Independently of the noise and excitement produced, the 
 mere presence of numbers poisons the very air which the sick 
 man breathes, and renders even the healthy liable to contract 
 disease. This habit of crowding a sick room is chiefly no- 
 ticed among the vulgar, and is often tolerated by anxious 
 friends, for fear of giving offence; but let it be remembered 
 that none but the weak and prejudiced can be offended at be- 
 ing deprived of the power to injure those whom they profess 
 to love; and where health is at stake, the value of such friend- 
 ship is a negative quantity* 
 
 There are two pests of the sick room with which we have 
 
400 BILIOUS REMITTENT AND YELLOW FEVER. 
 
 no patience. They are of both sexes, but of totally distinct 
 species, — though too frequently, both are relations of tht pa- 
 tient. 
 
 The first — mild, kind, and prompted by the best of mo- 
 tives — is a soothing and low voice, which flows, however, with 
 an almost ceaseless current, inquires into all the feeln ig 
 the patient and all the directions of the physician: 
 former to be of good cheer and trust in Providence, hoping 
 
 that every thing is for the best; but states th, , 
 
 and Mrs. 13 , and little C . all laboured under just such 
 
 symptoms — that the first was saved from Death's door by good 
 
 Dr. D , under a totally different course of treatment — that 
 
 the second seemed to be doing well for a long time under the 
 attending physician, but died unexpectedly on the twentieth 
 
 day ! and that poor little C recovered directly under tl. 
 
 of Cayenne pepper and the hot bath! The kind friend If 
 the apartment with ti. cc that the patient looks 
 ill. but exhorts him to be of i:ood cheer and hope for the 
 quietly breathing in the ear of the nurse or \\ ife, — u My dear! 
 It's a very b.. not better call in Dr. 1) r" 
 
 The other annoyance is of an opposite character — Ko 
 Strong, active, and either blustering .inc. accordi 
 
 the lex — totally incognizant ol and incredulous of de- 
 
 bility. — it inters the chamber with a hurried or a heavy t 
 If of the masculine variety, it Itl the patient in a 
 
 tone, in something like the followi — u Come! come! 
 
 This will never do! l! You would be well 
 
 enough if you would but think so. and throw your medicines 
 out of the window. Nurse! you n Ser your pal 
 
 spirits to sink. I have cone through as much trouble and expo- 
 sure as any one. in my time: but I ncv 
 
 never sick I day in my life. This all conies of over indul- 
 gence and him' ihould ride out and take the air, 
 and call your friends about you. and you would be well direct- 
 ly. Here, Nurse! 1 have brought him a bottle of win- 
 mind the doctor and h'\< 01 > 1 had nothing to do this 
 evening, 1 thought 1 would just step over and sit an hour with 
 him to keep up his spirit- 
 
 We have Buffered less than many from the folly of tl 
 friend/// homicides, having made it through life a principle 
 of action always to cause their immediate ejectment, or to ab- 
 dicate ourselves — but having witness deniable suffering 
 from such proceedings, and hoping that a few mav be startled 
 by these true pictures, into something like a ratior. 
 of conduct, we have sketched them from the memor\ 
 rner years. 
 
 BiHom Remittent, and Fellow Fever, \> it ia notour 
 
YELLOW FEVER. 401 
 
 design to enter into the treatment of fevers, except so far as 
 to secure the patient against loss of time, when the physician 
 is not immediately accessible, it is less important for us to go 
 into any examination of the arguments for and against the 
 identity of the bilious remittent, and yellow fevers. After 
 simply announcing our faith in the fact that all fevers are 
 symptomatic of local inflammation, or irritation in certain 
 parts, either internal or external, and that its varieties depend 
 upon the peculiar organs thus affected, we have only to state 
 our inability to discover any difference in the seats of the two 
 forms of fever just mentioned, in order to convince the reader 
 that we regard them as differing only in intensity. 
 
 The bilious remittent is but a somewhat more complicated 
 variety of the common remittent, which we have described 
 under the title of continued fever. Its peculiarities consist 
 chiefly in a more serious implication of the liver, giving rise 
 to mure obstinate constipation, or to a diarrhoea caused by 
 vitiated bile, and a yellow or jaundiced hue of the skin; alto, 
 a greater irritability of stomach, which is apt to occasion vio- 
 lent vomiting, which becomes, in some cases, almost uncon- 
 trollable. 
 
 The treatment recommended in the commencement of con- 
 tinued fever, generally, is applicable here; but there is even 
 stronger necessity for early medical advice; for the disease, it 
 left to itself, is much less prone to fall into the low and pro- 
 tracted state, and more liable to I rapidly fatal termination. 
 As advice is not alwa\ ble, it may be proper to state, 
 
 that the treatment laid down for yellow lover is applicable to 
 bilious remittent, when moderately employed; and that, in 
 certain situations, the latter, when epi> - often nearly 
 
 as fatal aa the former; into which it finally merges itself at 
 certain points on our western wa* 
 
 Yellow Fever has been said to be a disease of comparative- 
 ly recent origin. The first distinct account of its appearance 
 given at Barbadoea in the year 16 17. It occurred at Bos- 
 ton in 169 J. Its first appearance in Europe is referred to 
 . when it broke out in Lisbon. After some years it de- 
 clined in severity, but recurred with new violence about 1793, 
 and since that year has raged with varying intensity in the 
 south of Europe, the tropical part of Asia, and the West In- 
 It has long been a summer epidemic of New Orleans, 
 Charleston, S. ('.. &c, and was repeatedly destructive in the 
 city of Philadelphia in 1768, 1793, 1797, 1798, 1799. It 
 showed itself more mildly in 1802, 1S05, and 1820. New 
 York has also suffered several times. Among the local causes 
 which produce it, one of the most active, undoubtedly, is the 
 effluvia of decaving vegetable matter; but these are insufficient 
 
 51 
 
402 YELLOW FEVER. 
 
 without the epidemic tendency; it has been generally believed 
 to have been imported, and then propagated by contagion in 
 our northern cities. But this is a subject which we will not 
 discuss at present, farther than to state, that the belief in its 
 importation and contagiousness increases in just proportion to 
 the distance to which we retire from those countries where 
 the disease is best known and understood. It is termed yel- 
 low fever, from the tinge assumed by the skin of persons af- 
 fected; black vomit, from the peculiar matter rejected from 
 the stomach; and, sometimes, palludal or marsh fever, from its 
 local origin. The peculiar symptoms by which it is (i 
 guished from other continued fevers, arc the following: — The 
 chill is slight, never amounting to absolute shivering, b' 
 ne rally accompanied with fain' of the stomach 
 
 exists from the first, and the retching increases with the dis- 
 tter vomited is yellow, on the second 
 or third day, it becon . ami towards the inina- 
 
 tion, black or of I lour ami resembling cofiec-grounds 
 
 in consistence. The yellow colour of the skin, which is by 
 no means peculiar to ' loped on the 
 
 third or fourth day, in ck, and I .d thence 
 
 extends to th» the body, which, in fatal cases, becomes 
 
 yellow throughout The urine, when observed, is of a dark 
 saffron colour. The ti irst covered with a moist. 
 
 low ish white coat, then Incomes drier and more discoloured, 
 and finally quite black. The time required for the i 
 reach its fatal termination . :i some instances, 
 
 not exceeding twenty-four hours, in which I How 
 
 colour of the skin is much leu jly marked. When it 
 
 runs to four or live da] such 
 
 as would lead an inexperienced person to anticipate reco\ 
 and often the spirits and - .ours 
 
 before death. When the peculiar vomiting] above mentioned, 
 has once taken place, the diaeasa almost ilwayi prove! fatal. 
 
 From the very various opinions rcspe trcatme 
 
 yellow fever, it is not easy to select rul to general 
 
 As in the mildet g tnent 
 
 will be (oi\m.\ sueees>ful. BO in ti. -hare 
 
 the disgrai lure. In the last, however, the general re- 
 
 sult o( experience i be, that aco; • 
 
 ■ bleeding carried to the extent ss, is 
 
 more likely than any other remedy a favourable im- 
 
 pression at the outset, to relieve thi hcadaeh. the pulse, 
 
 and check the vomiting. The blood should be drawn in an 
 ered or sitting posture, and in ■ rail stream, 
 faintness is the sooner induced, and the advai the 
 
 bleeding gained with the 
 
PETECHIAL OR SPOTTED FEVER. 403 
 
 The effect of the blood-letting in reducing the system, is to be 
 immediately followed up by a powerful cathartic; an ounce of 
 Epsom, or an ounce and a half of Rochelle salts, for example, 
 which must be repeated every four hours till full operation is 
 produced. Should this active treatment succeed in controlling 
 the primary symptoms, in arresting the vomiting, for exam- 
 ple, and relieving the headach, the subsequent management of 
 the case is simple. Ventilation and cold affusion, to diminish 
 burning heat of skin, must be employed during the remainder 
 of the fever, and bark and wine during the period of conva- 
 lescence. 
 
 U the salts be rejected, or if the vomiting be severe, a spice 
 plaster should be applied, and lime water and milk — one table- 
 spoonful of each — may be given every five ibr ten minutes, and the 
 moment the retching is lulled, a dose of ten grains of calomel in 
 our country, or twenty in a tropical climate, should be adminis- 
 tered, in a small portion of molasses or honey, — cold lemonade 
 by the half wine-glass at a time may be fearlessly given, after 
 this for three or four hours, when, if the stomach be composed, 
 and the thirst great, cold drinks should be taken freely. When 
 calomel is given in purgative doses, not immoderate in quan- 
 tity, the dread of cold after it is in a great degree a prejudice. 
 To secure the operation of the purgative without disturbing 
 the stomach, ; f BntOffl salts may be dissolved in a gill 
 
 and halt iv hour. Having 
 
 diminished the pul- d the temperature by 
 
 cold effusions, composed th id allowed our purga- 
 
 tive time ' hours are sufficient 
 
 for this,) all our attention should he given to the production of 
 perspiration in mi hut when ti. ry threat- 
 
 ening, and the epidemic rapidly fatal, this course should be 
 coupled with the; attempt t<> touch the mouth with mercury. 
 For the former panose, the followii. may be employed 
 
 alternately, or in buc< ceording to the degree 
 
 of vascular reaction and the ability of the stomach to bear 
 The saline draught given every hour; sweet spirits of 
 nitre, forty drops every two hours, in a little water: the infu- 
 sion n( Virginia snake root, a wine-glassful every two hours ; 
 and. if there be little tendency to the head remaining, the Do- 
 powder, ten grains every three hours. The two latter ar- 
 ticles alternated every hour and a half, with some warm tea in 
 the interval, act very powerfully. The mercurial course cannot 
 be attempted by the domestic practitioner under any circum- 
 stances with safety. 
 
 Petechial or Spotted Fever derives its name from the ap- 
 pearance which it exhibits of dark coloured spots upon the 
 skin, caused by the extravasation of blood beneath the cuticle. 
 
404 PETECHIAL OR SPOTTED FEVER. 
 
 As described by European authors, it is a malignant typhus, a 
 variety of the putrid typhus, camp, or jail fever, a disease of 
 which we have fortunately little experience in this coi 
 and of which we shall only remark, that it exhibits in a 
 vated form all the symptoms which we have enumcrai< 
 belonging to our own protracted nervous fever. A peculiar 
 form of spotted fever, however, has been repeatedly epidemic 
 in this country, particularly in the eastern the 
 
 descriptions of eye-witnesses, it seems to be one of direct pr. 
 t-ion, without any preceding stage of excitement. Jt 
 fact, a striking resemblance to malignant ch 
 that many very intelligent observers bare maintnii 
 with that disease. An eminent physician of New England de- 
 scribes it as a nervous fever, in which I 
 
 ing, the torpid or forming dthatof. tend- 
 
 ed together, attended \\ ah pain in th- 
 
 roxysms o . and, for i cool 
 
 skin, a slow pulse, and 
 techial eniptii i ipilla- 
 
 ., delirium, palpitation, numbness, and in»usccpt: 
 to the action of ordinary rubefacient! and bl id sulking 
 
 after evacuations, are much more con.:. < ther 
 
 febrile disease." thor admits that cold:. 
 
 numl - and pui union to both 
 
 i 
 very decidedly from other fe brili ic other ! 
 
 it is said that it is only in i ases, 
 
 that i cholera ii it. Ord -esof 
 
 sinking typhus so much res Me common i . that 
 
 without a previous at during 
 
 a paroxysm of oi iroely discern the 
 
 difference. u In it jthor air 
 
 quoted, " I have seen it destroy life within I 
 attack, and within one hour ■ ttdenl f.imn; 
 
 sufficiently apprehensive to send for a 
 
 tended with vomiting and diarrhcra; in Ol case 
 
 of cholera. Othei 
 
 iso slight as not to require the patient'- bed. It \ 
 
 equally with respect to its duration. I 
 up within a few hours from 
 
 tinues five or seven days; at other times, . ly when it is 
 
 complicated with common typhus, and often when it is only a 
 mild disease, it is protracted two. thl 
 
 occasionally two or three months. Dr. Miner, in \. K. Jour. 
 vii. k 2'3. The long protracted o 
 
 tinction between this form of dn 1 cholera : but wh 
 
 is recollected that collapse in the latter is often folk 
 
SMALL-POX. w 405 
 
 stage of reaction in which the disease answers very nearly the 
 character oflow typhus, the distinction will appear less marked. 
 The most essential difference between the two diseases is, per- 
 the circumstance, that in sinking typhus, the brain is the 
 chief seat of derangement, while in cholera it is the stomach. 
 H J 11 general,' 1 . Miner, " there is greater weight of dis- 
 
 ease in the brain, and coma or delirium is much more frequent 
 in sinking typhus than in cholera." J)r. M. tells us that the 
 application of blisters to the head relieved the cerebral symp- 
 toms; but in the general treatment of this form of typhus, 
 nothing but the most active stimulants would answer. On the 
 commencement of the attack, heat was applied to the surface 
 by means of hot bricks of hot water, etc., while lau- 
 
 danum, alcohol, the essentia] oils, and hot liquids were the in- 
 ternal remedies. Neither emetics, cathartics, nor depletion of 
 any kind was employed from the time when the character of 
 the disease came to be fully understood. Treated on these 
 principles, the fever w rally relieved at the outset, and 
 
 convalescence was manifest in the course of six or eight 
 
 SECTION' u. 
 
 uses. 
 
 -Having gone through the consideration of gene- 
 ral or simple fevers to a few very remarkable 
 n which, aftef a continued fever of some hours, or 
 . an eruption is thrown out upon the skin, which forms at 
 once the leading characteristic of the allection. and by the pro- 
 of which the disease is limited. Such is the case with 
 small-pox. This disease commences with many of the symp- 
 toms of ordinary fever, chill followed by heat, pains in the 
 head and loins, extending to the extremities, restlessness, thirst. 
 These usually commence at night, and undergo some remis- 
 sion during the day, to be renewed with increased intensity at 
 its close. There is often a severe burning sensation in the 
 stomach, and a soreness of throat, attended with considerable 
 degree of hoarseness. At this time a peculiar odour fre- 
 quently arises from the skin of adults, and from the breath of 
 children, which is perfectly evident to every one on entering 
 the room. The eyes are red and shining, and are often suf- 
 fused with tears, while the membrane of the mouth and the 
 gums appear fuller than natural. Bleeding from the nose is 
 
40G SMALL-POX. 
 
 not unusual in children. In subjects of a full habit and san- 
 guine temperament, especially women and children, a rose-co- 
 loured rash sometimes precedes the eruption, comi n the 
 face, and thence passing to the trunk arid extremities. It some- 
 times shows itself as early ai the secoi d day, bul n rally 
 later, and appears so much like measle-, that even experienced 
 persons have been deceived. On the third day. it i> not un- 
 common for children to have an attack of com The 
 •eruption itself usually appears late on the third. or on the 
 morning of the fourth day. about eight] I the com- 
 mencement of the (e\ar. It i< teen first on the nose and 
 extends to the face and bead, and afterwardi m\ neck, 
 chest, trunk, arms and legs. It commences in the form of 
 small red circular which, at ant mm h i 
 lered, multiply rapidly, and in the course ol two or lb 
 iDTade the whole f ftheskia, 1 into the 
 mouth, and to the internal membrane <•: 
 appearance of the eruption, th 
 
 the head, hack, and loins and the increased h much 
 
 diminished, an nd or 
 
 third dav of tin little 
 
 limpid or wal tip, an illy pass into 
 
 their second or V« n which 
 
 or hemispheric bladder, tilled with 
 this, as well as the uent changes, foil 
 
 order of the eruption, ft ward. Ii 
 
 the vesicles flatten at the top, so as to present a e prcs- 
 
 sion at the centre. This change, how 
 
 marked upon the lace, the 
 their rounded form much longer. 
 
 full size, the parts around tin in swell jnd redden, and tl 
 such an extent in the lace, that the features Can with diff: 
 be recognised On the sixth i the eruj 
 
 its form unci' K>ther i 
 
 smooth ami semi-transparent 
 
 whitish. The opacity increases, and the colour .ill it 
 
 reaches that of straw or cream. A mail speck nowi 
 the centre ^( each vesicle, which spit ada till 
 surface. Mean while the l tilled 
 
 with matter resembling pass. which is called the 
 
 maturation of the panted with an ii 
 
 fever, marked by chills, heat, beadach, thirst, and some- 
 torpor and delirium. Thii is a period o\ dai 1 1 the 
 eighth or ninth day oi the eruption, the fourth or drviiiL' stage 
 commences, ^omo of the pustules break, and dssohai 
 matter, which crusts upon the surface: in othus. the crusting 
 goes on internally; but all are converted into sol; 
 
SMALL-POX. 407 
 
 brown, and dry masses, which gradually fall off. During this 
 process, the secondary fever declines, and the redness which 
 surrounded the pustules, fades and disappears. Each pimple 
 requires from twelve to fifteen days to complete its course. 
 The whole period from the commencement of the fever to the 
 disappearance of the scabs from the extremities is, therefore, 
 from eighteen to twenty-one days. The scars left by the 
 scabs, are first red, but soon change to purple, and at length 
 either disappear entirely, or sinking deeper, become perma- 
 nent pits. 
 
 In the above description of the progress of small-pox, we 
 have principally had in view the distinct form of the erup- 
 tion. The conlluent form differs mainly in the following par- 
 ticulars. 1. The previous fever is much moi . assuming 
 a typhus form, often with delirium, and sometimes terminating 
 fatally. 2. The eruption often appear! on the second day of 
 fevew and always earlier than in the di>crete form. 3. It shows 
 itself nearly at the same moment in every part of the body. 
 1. When the pimples become vesicular, they increase rapidly 
 in breadth, and, wherever numerous, tend to coalesce and run 
 together. This character, which gives its name to the variety 
 of the dim Ined throughout; and when the drying 
 process occurs, the face is covered with a continuous scab, 
 which falls off in large n ■>. The vesicles, where dis- 
 tin< t, never rise into a spherical form, like those of distinct 
 small-pox. but are tlat and irregular in outline. (>. Suppura- 
 tion t rfectly, and the fluid 
 never acquires the deep yellow tinge, and thick consistence, 
 which i-s observed in the distinct form. 7. The secondary 
 ,.ii< at the eleventh day j and is accom- 
 panied bv the secretion of an extremely viscid saliva, which is 
 difficulty. This is the period of greatest 
 i. Torpor and delirium frequently supervene, and the 
 patient di 'tic. 
 
 The present treatment of small-pox, displays perhaps one of 
 -t of the improvements of modern medicine. It was 
 thought necessary, in order to prevent the repulsion of the 
 eruption from the surface, and throw out the morbid virus 
 more fully, to guard the patient from all access of fresh air, to 
 keep his body loaded with clothing, and to supply him plenti- 
 fully with hot and stimulating potions. The mortality under 
 this system of management was dreadful; being about one out 
 of four among adults, and one out of seven among infants. At 
 present, the opposite system is pursued. Abundant ventilation 
 is allowed; the patient is permitted just such clothing as is 
 comfortable, and drinks his water or lemonade at any tempe- 
 rature which suits him. The other treatment consists mainly 
 
408 SMALL-POX. 
 
 in the due regulation of the bowels, in protecting the eye?, in 
 controlling the fever at the outset, and guarding against ex- 
 haustion in the later stage. 
 
 Aperient medicines are not often needed for the first ot 
 these purposes, and sometimes a few drops'of laudanum may- 
 even be demanded to check diarrhoea. The second object is 
 effected by keeping the room moderately darkened. The third 
 purpose, — that of reducing the fever, — is effected by the ordi- 
 nary depictive measures, which have been considered undc _ 
 neral fever. As respects the fourth, it is certain, that son 
 mulus, as that of wine or porter, is sometimes required about the 
 15th day of the disease, when the secondary fever has assumed 
 a decidedly sinking character. The necessity for this treat- 
 ment is pointed out by a weak and failing pulse, dry dark 
 on teeth, and low mutt _ lirium. The 
 amount of alcohol which can be borne under these circum- 
 stances, without causing headach or intoxication, 
 prisingly greet It is someti: the com- 
 
 the d ■Pply ■ blister to the to relieve 
 
 cough; ami I be done without regard to the eruption 
 
 on the part. '1 'he hardened mucus and half separa 
 which impede thi - of the throat ami nostrils, mi - 
 
 patiently remov* d by syringing or otru i - they produce 
 
 constant annoyance and are a terio Station. 
 
 Small-; i communicable to un- 
 
 protected individuals by contact with, or a near approach to, 
 a diseased patient. 
 
 Within what limits the activity of the contagion is confined, 
 has not 1) taincd. It is probable that i 
 
 hie of communicating the 
 
 before the eruption appears. 1 that the mat- 
 
 ter of eontagion will remain for a loni; time attached to the 
 body ami bed-clothes which h 
 
 sick. unless washed ami exposed to ml that the;,' 
 
 ments, if not duly ventilated ami i in. for a 
 
 considerable period, s -ease. 
 
 Persons visiting patients with small 
 
 mav convey the disease in their persons or clot: 
 
 v isceptibility to small-pa mi- 
 
 versal; hut those who el g I unproli 
 
 may suffer at another. 
 
 It has been maintained by very high authorities, that t 
 who have had a regular attack of small- osed 
 
 to the contagion in any way. with entire impur. 
 now fully disproved; and. unhappily, il - 
 thai a second attack, under - 
 than the first; for the case I idividual 
 
VARIOLOID CHICKEN-POX. 409 
 
 has recovered from the first, fallen victim to the second at- 
 tack! This, however, is extremely rare. The cases of a se- 
 cond attack, milder than the first, are more numerous, but still 
 to be regarded as remarkable exceptions to a general rule. 
 
 Inoculated small-pox is rarely seen in this country, as the 
 practice of vaccination has almost wholly superseded true ino- 
 culation. As the latter operation is now considered wholly 
 unwarrantable, we shall avoid all allusion to its results. 
 
 The term varioloid disease is now applied to small-pox erup- 
 tion, as it appears in those who have previously had either the 
 natural or inoculated disease, or who have been vaccinated. As 
 neither of these occurrences can be depended on with abso- 
 lute certainty to modify the character of a subsequent spon- 
 taneous eruption, it ifl evident that varioloid must, in its se- 
 verest form, be undistinguishable from small-pox; but as in 
 the large majority of cases it is a much milder affection, it is 
 proper to give it a peculiar name. The following are the 
 points in which varioloid usually differs from genuine small- 
 pox. 1. The precursory symptoms are less violent and of 
 shorter duration; and the whole course of the eruption is more 
 promptly completed. 2. The pocks are less regular in the 
 order of their appearance and in their distribution. 3. Vario- 
 loid is not attended with secondary fever, or salivation; the 
 swelling of the surface is inconsiderable or wanting, and the 
 whole train of symptoms comparatively mild. 
 
 Chicken-pox. A disease resembling in its essential parti- 
 culars that which is now known to us as chicken-pox, has ex- 
 isted, and been described ever since the dark ages; yet it is 
 still disputed, whether the affection be distinct, or merely a 
 variety of small pox, modified either by the constitution of 
 the individual, or by the circumstance of a previous infection. 
 The latter opinion has been ably maintained by two eminent 
 European professors; but the former view is adopted by the 
 great majority of medical authorities of the present day, and 
 the arguments in its favour seem decidedly to preponderate. 
 Chicken-pox has often prevailed, epidemically, over extensive 
 portions of this country, without any material variation from 
 a standard form, and without ever assuming the peculiar symp- 
 tom of variolous disease. When observed, side by side, with 
 small-pox in our cities, there is seldom any difficulty in dis- 
 tinguishing them. The following description of the course 
 of the disease, and the remarks which follow, will, we hope, 
 place this important distinction in a clear light. 
 
 Chicken-pox is sometimes, but not always, preceded by dis- 
 tinct precursive fever, of the same general character with that 
 which has been described, as announcing the approach of 
 small-pox. On the third dav, the eruption appears in the 
 
 *52 
 
410 cow-pox. 
 
 form of small inflamed spots, commonly showing themselves, 
 first, on the back and breast. These spots have little promi- 
 nence, are of a pale red hue, and exhibit smooth and shining 
 surfaces. In a few hours, a minute vesicle may be seen rising 
 up in their centre, with a whitish, transparent, and extremely 
 thin covering. On the second day of the eruption, the 
 cles increase, and occupy nearly the whole of the inflamed 
 spots, so as to resemble little bladders of fluid situated on 
 narrow inflamed bases. Their form is irregular. They easily 
 give way under pressure, and communicate to the finger a soft, 
 elastic sensation, like pressure on a wet spo: _ mctured, 
 
 the vesicles collapse and fall to the level of the skin. On the 
 third day, the fluid becomes turbid, and by the fourth, many 
 of the V( reak and form ( • contents of the 
 
 others condensing and hardening within them. On the fifth 
 day, most of I eir little pellicles 
 
 collapsing, adhere to the* skin beneath, so as to confine a little 
 fluid in the tubular ring which remains. The drying process 
 On rapidly, and by the sixth day, all th con- 
 
 con- 
 tract into 8 tenth 
 separate and a single piece, but in small 
 ments, leaving ory traces in the skin. 'Die febrile 
 symptoms, if any have been developed, decline on the second 
 • f the eruption, and do not again recur. 
 
 re, is equally distinguished from small- 
 pox and varioloid. 
 
 Cuu'-jjf.r. The iccine disease and cow-pox, both 
 
 refer. II known, to the original source from which the 
 
 infection cine 
 
 matter has ever been obtained from the cow in this con 
 and it has been found exlremt ly ilitlicult to procure it from 
 the animal, even in those ; .and where it irai 
 
 observed by. Whether bj . ous trat,^ 
 
 sions it i ring the last fif 
 
 has lost any thing of its prop! question not 
 
 easily answered; but th ghl of opinion is decidedly a^ 
 
 this view. The time required by the i compk 
 
 course, and the successive appearai 
 
 as can be ascertained, still the same as at the introduction of 
 the disease, Though the anticipations entertained ot 
 as affording a certain immuniu .all-pox, appear not to 
 
 be fully realized, the exceptie: the ca> 
 
 varioloid disease, which do not endanger life, are too r„ 
 be regarded as very important. 
 
 It is fully established, that vaccination is as s 
 against small-pox, as this discr- n cither of its fa 
 
VACCINATION. 411 
 
 Indeed, the results of strict investigation within a few years 
 go to show, that the degree of protection is even greater. In 
 regard to the other much agitated question, whether the effect 
 of vaccination is permanent upon those on whom it is prac- 
 tised, or whether, after a certain number of years, the suscep- 
 tibility to small-pox returns, a difference of opinion still pre- 
 vails. 
 
 Experience seems to justify the idea, that in certain consti- 
 tutions, a second vaccination will afford an immunity, which 
 the first had failed to confer; but whether this depends on an 
 originally unexhausted susceptibility, or is the effect of lime, 
 it is not ( A large majority of the attempts at re- 
 
 vaccination, which have been made, have failed in producing 
 any specific effect; the puncture has exhibited .slight inflamma- 
 tion for a few days, and then has entirely healed. This result has 
 been manifested as clearly after an interval of thirty years, as 
 at any shorter period. The idea, therefore, that the effect 
 uniformly dies at the end of seven years, or any other definite 
 period, seems wholly unsupported. On the other hand, in 
 where revaccination appears to succeed, it may often be 
 suspected that the progress of the former vaccination was im- 
 perfect; a suspicion, for which the careless manner in which 
 the operation is frequently performed affords abundant grounds. 
 The strongest array of facts, in favor of revaccination, which 
 is known to us, is contained in the Medico-Chirurgical Journal, 
 for January, 18.34. [( that .statement be correct, it is conclu- 
 sive in regard to the propriety of performing the operation 
 under circumstances of peculiar exposure. 
 
 The vaccine disease may be communicated either from a 
 fresh vesicle during its progress, or by means of the dry crust 
 which falls off, when the process is completed. The latter 
 method is bv far the be*t for the domestic operation. 
 
 The scab or crust, should be carefully preserved in waxed 
 cloth, and when used, a small portion of it should be crushed 
 or cut down to the state of fine powder, with the heel of a 
 thumb lancet, then mixed with a drop of water, and rubbed 
 into a paste. The surest mode of communicating the disease 
 is this. With the heel of the thumb lancet, chafe the cuticle 
 on the middle of the outside of the arm, till it is reddened over 
 a space of half an inch. Then spread a portion of the paste 
 upon the centre of this space. Then, with the point of the 
 lancet, make half a dozen light scratches, close together, 
 through the paste, and just deep enough to give a trace of 
 blood, without causing a drop to flow; spread the remaining 
 paste over the scratches, and let it dry there. About the third 
 or fourth day, the germ of the future vesicle can be traced in 
 an extremely minute pimple, scarcely prominent above the 
 
412 MEASLES. 
 
 surface of the skin. On the fifth or sixth day, a little fluid is 
 effused. On the seventh or eighth, the vesicle is perfect, with 
 the upper surface depressed or cupped, and a red margin of a 
 few lines in diameter. On the ninth and tenth, this margin 
 spreads, the part becomes swollen, tense, and painful, the axil- 
 lary glands are enlarged, and some restlessness and other evi- 
 dences of general irritation are present. At this time, a rash, 
 more or less general, often shows itself, principally observable 
 on the chest and neck, and resembling that already described 
 as appearing in small-pox. The v< - - con- 
 
 cave surface, becomes flat, or convex, e size, and the 
 
 contained fluid becomes opaque and viscid. On the eleventh 
 and twelfth days, the areola begins to fade, sometimes from the 
 external margin, but generally from an intermediate circ 
 as to form a whiter zone, which can often be dm 
 many hours. The swelling now rapidly diminishes, and the 
 vesicle gradually dries. In the course of three or four days, 
 the latter m converted ii b, which hardens becomes 
 
 more and more p I distinct lrorn the surroui 
 
 skin, and from tl h to the twenty-fourth dt 
 
 either rubbed off I violence, or falls off of itself. 
 
 The i B ;|ar: and anv 
 
 material aberration, other than a mere delay in the first ap- 
 pearance of the v. i!t doubtful. Vaccina- 
 tion should never be performed during bad health, or the pro- 
 a of another eruption. 
 
 Mea$Ut, — This diseai bably always received bv con- 
 
 tagion, that is. bj the touch, or n ach of some one 
 
 already suffering under it. Measles n more common in winter 
 and spring, than in summer and autumn; more frequent in 
 children than in adults, but bj 
 
 eumstnn or of Bl nuine measles seldom 
 
 occurs more than once during life, and w hen judiciouslv bn 
 is not often fatal. 
 
 The commencing symptoms of mcmlm. which arc devel. 
 from ten to fourteen (\a\ 
 about the nostrils, with - 
 cough, and. in general, the app 
 
 set of a catarrh. The pre! -also indicated by 
 
 the usual hot. dry skin, headach, tfc : the 
 
 fourth day of fever, the eruption makes its appearand 
 in deep-red, distinct pimples, which tainter and D 
 
 confused as the disease advances, and collect in patches of 
 irregular form, with intervals of i 
 The febrile symptoms are not relieved, and - 
 gravated. on the appearance of the rash. The headach 
 fever abate in the morning to be renewed at night* and the 
 
SCARLET FEVER. 413 
 
 hoarseness, cough, &c, continue without much abatement, as 
 long as the eruption lasts. This begins to subside on the third 
 or fourth day from its appearance ; the redness diminishing, 
 and the skin assuming a mealy appearance, while scales are 
 thrown off in the form of a fine dust. At this period, in 
 favourable cases, the other symptoms subside; but sometimes 
 the eyes continue tender and inflamed, and sometimes the 
 cough remains. When the disease has been particularly 
 severe* a torpid, lethargic state sometimes supervenes on the 
 subsidence of the eruption: this is common also to scarlet 
 fever, and will be noticed under that head. 
 
 Active medical treatment is not usually required in measles. 
 The eyes should be protected from the light; some laxative 
 medicine administered; and the relief of the catarrh promoted 
 by giving plenty of barley water and gruel, until the appe- 
 tite returns. The body should be protected and the skin 
 shielded from currents of air. The temperature of the drinks 
 is not very important. The cough and difficulty of breathing 
 may often be relieved by exposing the head, well covered, to 
 the steam of warm water or of vinegar. U the cough be severe, 
 and accompanied with pain, more active measures must be re- 
 sorted to under the guidance of a physician. A moderate 
 looseness occurring toward the close of the disease, is a source 
 of relief, and must not be rashly interfered with. 
 
 At the outset, measles are sometimes liable to be confound- 
 ed with scarlet fever; but it is to be remembered, that in the 
 last disease there is no sneezing, and no watering or swelling 
 about the eyes, which in measles are always present. 
 
 Scarlet Fever. For many years past, this disease has been 
 regarded through most of the United States as the most dan- 
 gerous and formidable affection of childhood. Where not 
 immediately destructive to life, scarlet fever often prostrates 
 the nervous power of the system, and lays the foundation for 
 permanent debility. 
 
 According to the views of many medical writers, scarlet 
 fever and malignant sore throat, both often epidemic, and both 
 specific, are yet to be regarded as distinct diseases; although 
 it is allowed, that the latter is generally accompanied with a 
 scarlet rash. For practical purposes, it is best to consider 
 them as one and the same; keeping it in mind, that as scarlet 
 fever, peculiarly so called, may occur, and even prevail epi- 
 demically, without sore throat, so may the latter appear, ac- 
 companied with a scarcely perceptible efflorescence. 
 
 Scarlet fever, when epidemic, does not seem to be depen- 
 dent for its production on contagion alone. When, however, 
 this source can be traced, it appears to take effect in about 
 
414 SCARLET FEVER. 
 
 three or four days. The eruption, which is nearly simulta- 
 neous with the fever, consists at first of minute red points, 
 soon confounded in a general blush, which extends itself over 
 the whole surface, but is chieBy manifest on the face and 
 breast. The colour of this blush is a bright scarlet, not seen 
 in measles, nor in any other disease. On close examination, 
 the small points of the skin will still be found inflamed, and 
 slightly prominent; but the roughness thus produced has not 
 the coarseness felt in measles. The appearance of a full and 
 extensive efflorescence is a favourable sign; for the fuller the 
 eruption, the milder will be the febrile symptoms, and the 
 affection of the throat. The approach of the latter, which 
 may occur as soon, or even sooner than the rash, is marked 
 by a difficulty of swallowing, and sense of soreness. On exa- 
 mination, the tonsils, and the neighbouring parts of the pas- 
 sage are found swollen, and intensely red,' and, in a short 
 time, patches of a white or ashy colour are observed, which 
 indicate that ulceration of the mucous membrane has ah 
 taken place. As the swelling and ulceration incre: * 
 attempt to swallow is attended with much *j and fre- 
 
 quently liquids taken into the mouth arc forced into the nos- 
 trils. During this state of the part- differs no per- 
 manent diminution and little n j the thirst is extreme, 
 the skin hot, hcadach intense, the sleep broken by dreaming, 
 Starlings, and twitchingi of the limbs; and not unfreqm 
 delirium is present. Mean while the eruption, perhaps, after 
 fading and reappearing, finally On the sixth or se- 
 venth day of the fever, the whitish sloughs are loosened and 
 thrown off, the ulcers heal, with relief to all the symptoms, 
 and, in favourable cases, ti terminates from the - 
 to the ninth day. When it is otherwise, death may take 
 place from the violence of the fever at an early period, or the 
 fever may pass into a typhoid th a sei mp- 
 toms nearly resembling those which have been described 
 under the head o\ continued fever, and which may run on for 
 six or eight weeks, though usually with eventual recove: 
 
 Scarlet fever is more frequent in children than adults, and, 
 among the latter, in women than in men. [ti 1 and 
 
 danger, however, both augment wit gene- 
 
 ral, but once during life; but instances of a second attack are 
 said to be more frequent than in : this sui 
 
 however, testimony is not uniform. Dr. Lilian, of London, 
 saw 2000 cases, only two of which were known to be of this 
 character. 
 
 In treating this disease, as its absolute arrest, by any means, 
 is not to be expected, three objects are to be kep- 1 
 
MILIARY FEVER. 415 
 
 To moderate the violence of the febrile action ; 2. To subdue 
 those symptoms which immediately threaten life; 3. To coun- 
 teract debility. 
 
 For the first purpose, the principal agent which has been re- 
 lied upon is cold, applied externally to the surface by sponging 
 and bathing, and internally by the use of iced water and ice it- 
 self. It has been even proposed to plunge the whole body, during 
 the full development of the eruption, into cold water, and thus 
 reduce at once the temperature of the surface: a violence 
 scarcely to be justified by any circumstances whatever. Other 
 means of moderating the fever are offered by the administra- 
 tion of the neutral salts, and especially of nitre, which, when 
 swallowed in substance in small portions, is thought to pro- 
 duce a beneficial local action on the throat itself. The second 
 object is to be answered, in cases where the inflammation and 
 swelling are excessive, by general bleeding, and the abstraction 
 of blood from the neck by leeches. The third is perhaps the 
 most important, as the stage of debility soon arrives, and the 
 condition of the system which accompanies it must be prompt- 
 ly met. As soon then as the active fever subsides, if a state 
 of languor, prostration, and debility succeed; if the tongue re- 
 main loaded, the bowels torpid, and the spirits depressed: espe- 
 cially if the ulcers refuse to heal and assume a foul and un- 
 healthy aspect, no time is to be lost; bark, wine, and the acids 
 must be given internally, gargles of the same character em- 
 ployed for the throat, and every means resorted to, for pre- 
 venting irritation of the digestive system, and supplying it 
 with mild nourishment. The typhoid state, to which we have 
 alluded as a sequel common to this disease and to measles, is 
 peculiarly protracted and obstinate in children. Sometimes 
 such a degree of debility is induced that the articulation is 
 wholly lost, the limbs are perfectly paralyzed, and the mental 
 powers prostrated. In this state it is through the stomach, an 
 organ only a little less weakened than the others, that these 
 are to be slowly re-established. The patience, perseverance, 
 and care, necessary for the task, can only be realized by one 
 to whom the charge has been committed. From day to day 
 the same discouragements are renewed, and it is only after 
 weeks of patient and assiduous labour that hope seems to 
 dawn, and the efforts of affection and duty once more promise 
 to be crowned with success. 
 
 Miliary Fever or Sweat Ervption. The name of this 
 disease sufficiently explains its origin. It occurs in persons 
 of loose fibre and indolent habits, who have been keeping up 
 a profuse discharge from the skin for several days by lying in 
 bed in warm apartments, and covered with too much clothing. 
 Women are more liable to it than men, and it occurs very fre- 
 
416 NETTLE-RASH. 
 
 quently in child-bed — when the system is already weakened, 
 and the constant use of warm diluent drinks often increase 
 the excessive sweating. 
 
 It usually appears in minute red points much like those seen 
 in the commencement of measles, being most numerous on 
 whatever part of the body has been kept warmest. The sweat 
 which accompanies it is frequently of offensive odour; it is 
 principally troublesome by itching and tingling, and is at- 
 tended with thirst, heat of skin, and often a coated and foul 
 tongue. The period of its duration depends on (he continu- 
 ance of the causes which produced it. If external heat and 
 internal stimulants be continued, lest the eruption should be 
 driven in, the latter may be kept up indefinitely; but if the 
 clothing be diminished, the surface exposed in a reasonable 
 measure to the air, hot drinks avoided, and the surface sponged 
 occasionally with cool water, particularly if to these means be 
 added a gentle saline cathartic, the disease subsides in a few 
 days. 
 
 A form of this complaint, better entitled to the appellation 
 of erupt i \ is mentioned by authors as occasionally epi- 
 
 demic. The fever pn j about tl.. 
 
 the disease runs on, with variable remissions, for seven, four- 
 teen, or even twenty-one days, and usually terminates in a na- 
 tural sweat. It hti lometii < d fatal. 
 
 Nettle-ra.sh. — Nettle-rash is characterized by the appear- 
 ance of wheals, or bl florid elevations of the skin, 
 accompanied with itching and tingling, appearing sur 
 in different parts, and fading Sbd reviving very irregularly. 
 Its most frequent remote cause is the presence in the stomach 
 of food, either poisonous in itself, or disagreeing with the 
 constitution of the patient. Such are cucun >hrooms, 
 crabs, shrimps, herring, muscles, some kinds of honey, mack- 
 erel, and oysters at particular - iwberriei 
 have been known to produce it, and, much more frequently, 
 fresh pot s ome of the mineral substances, as 
 also copaiba and pnissic aeid, have the same power in some 
 
 It sometimes occurs as an en, J in by a re- 
 
 gular chill, and the eruptii If on the second day. 
 
 In the dyspeptic form of the affection, the removal of tl 
 fending matter usually affords relief; though sometimes it con- 
 tinues obstinate for several days. In the febrile variety little 
 medical treatment is needed. A cooling aperient may be 
 given, and vinegar or brandy may be applied to the skin for 
 the relief of the itching. In sonu j been 
 
 found necessary; and in others, a few grains of super-carbo- 
 nate of soda are found very useful occasionally. The disease 
 
PRICKLY HEAT, OR LICHEN SHINGLES. 417 
 
 appears to become chronic in certain cases; but these will be 
 found to depend upon some continued error of diet, which 
 corrected, the eruption will disappear. 
 
 Prickly Heal or Lichen is a disease caused by intense and 
 long continued heat; but it may be excited by the same causes 
 which produce the nettle-rash, when the system is prepared 
 for it. It is one of the most annoying plagues of a tropical 
 climate. The general character of the disease is that of "a 
 diffuse eruption, with red pimples, and a troublesome sense of 
 tingling or pricking." There is more or less general irrita- 
 tion, and sometimes a little fever at the commencement. In 
 its milder form, it first appears with distinct red papillae about 
 the cheeks and chin, or on the arms, with little inflammation 
 around their base. In the course of three or four days, the 
 eruption spreads over the neck, body, and lower extremities, 
 producing an unpleasant sensation of itching, often aggravated 
 at meals and during the night. In a week or ten days, the co- 
 lour of the eruption fades, and the cuticle separates in scurf. 
 This is the common form; but we find that from external heat, 
 and sometimes from internal disorder, a vivid rash is often 
 thrown out, consisting principally of deep red pimples, occa- 
 sionally degenerating into wheals like those of the nettle rash, 
 which remain for a considerable time, unless the atmospheric 
 or other causes are removed. For the relief of the itching 
 and burning sensation attendant on prickly heat, which in tro- 
 pical countries are often absolutely intolerable, the best appli- 
 cations are brandy and cold water; the latter requiring some 
 caution when the patient is perspiring. 
 
 The slightest stimulant either in food or drink, will often 
 diive the new-comer in Bengal, from the dinner table to the 
 bath, much to the amusement of the company. 
 
 We have even seen life endangered in Calcutta, by the ex- 
 cessive irritation in Lichen, which sometimes renders the 
 whole surface of the person thick and hard, like some leprous 
 affections; but this state always results from gross indulgence 
 in food or drink, and soon moderates on its discontinuance. 
 
 Shingles are sometimes, but not generally, preceded by some 
 constitutional affection, as sickness and headach. The first 
 local symptoms perceived, are itching and tingling in some 
 part of the trunk, which, when examined, is found to be stud- 
 ded with small red patches of an irregular shape, at a little dis- 
 tance from each other, on each of which numerous minute 
 elevations are seen clustering together. These are easily per- 
 ceived to be vesicular in their character. In the course of 
 twenty-four hours they enlarge to the size of small pearls, per- 
 fectly transparent, and containing a limpid fluid. The clusters 
 are of various diameters, from one or two and even three 
 
 53 
 
418 RINGWORM — ITCH. 
 
 inches, and are surrounded by a narrow red margin. For three 
 or four days, other clusters continue to arise with considerable 
 regularity, nearly in a line with the first, extending always 
 Cowards the spine atone extremity, and toward the breast-bone 
 or median line of the belly at the oilier, till they form a half 
 circle. Sometimes the disease nearly, but never entirely 
 circles the neck, arm or knee. Instances of its takii 
 tudinal direction, are very rare. In five or - . the fluid 
 
 of the rest ume a pearl-like colour and becomes W 
 
 purulent. If the inflammation be unu ■ •re, it 
 
 D6 actually converted into pus. Between the second 
 fourth days, some of the w 
 charge a limpid fluid The cu -hod, and the 
 
 ■ tin bid fluid. Others shrink Dp 
 
 transi A in- 
 flamed surface. 
 
 The causes of t es are r ood, 
 
 it shows Usell <>r the I at of 
 
 autumn, and freqv >a un- 
 
 wholi some diet, and other causes <-i debility. As respects i 
 
 little i 
 
 Ringworm is an afli ngles in som- 
 
 I, but is much llightei , 
 
 circular, — \\h- 
 
 the margin of the ■ 
 
 and disposed to peel off in bl A single circular 
 
 patch often runs throw eeks; 
 
 but a nev i up in ourhood, and so on iu 
 
 sin cession for an indi I 
 
 s as solutions 
 of lead, white vitii re in use, as is 
 
 wise, laudanum, diluted with an equal or larger quantity of 
 wal« 
 
 Ink, which - (her 
 
 by its arid or Iu gen Its do 
 
 not answer, but ■ es an immediate cure. 
 
 Attention to e!ea: ! the 
 
 spots may be washed to any extent with soap and m 
 Ringworm has sometii 1 to be c 
 
 account is now b tance in w 
 
 affected with the disease, communicated it in a tx>arding-»c 
 SO that fourteen out o! en pu| ih y at- 
 
 tacked. 
 
 77k- tich haa aflammat 
 
 without fever, consisting g a serous 
 
 fluid, which may appeal but are I 
 
ITCH — ROSE RASH. 419 
 
 principally in the flexures of the joints, and between the fin- 
 gers and toes." In the severer cases, and later stages of the 
 «'i flection, the vesicles degenerate into pustules, containing a 
 yellow matter, and these, sometimes coalescing, form irregular 
 and unsightly blotches. Itch may spontaneously arise from 
 filthy and negligent habits; but it is usually received by conta- 
 gion. Adults take the disease less readily, and when contracted 
 by them, it remains dormant for a longer time. 
 
 Itch, at its first appearance, is sometimes difficult to distin- 
 guish from other eruptions; but when it has become confirmed, 
 the coexistence of the pimple, the vesicle, the pustule, and 
 the scab, the absence of fever, the close aggregation of the 
 eruption in the particular parts already mentioned, and the 
 circumstances under which it shows itself, are sufficient to 
 determine its nature. 
 
 Many intelligent writers assert, that the proximate cause of 
 itch is a peculiar insect, which is often found in the pustules; 
 but the necessary connexion between the disease and the ani- 
 mal is not sufficiently supported by evidence. 
 
 When itch has continued for a long time, and extended it- 
 self to the surface, generally, its sudden removal by treatment 
 has been said to produce internal disease, and even mental de- 
 rangement. But, as a general rule, no hesitation should be 
 felt in curing it by the speediest possible method; for it is 
 never known to cease spontaneously. In the treatment, va- 
 applications have been employed with nearly equal sue- 
 since it seems sufficient to induce a new action in the 
 part by some active stimulus. Thus sulphur, zinc, mercury, 
 lum t tobacco, and tar, can each boast of its cures, 
 and preparations, dependent on one or more of them for their 
 virtu. t different times, enjoyed the reputation of spe- 
 
 cifies. The common mode of employing sulphur, is to pre- 
 pare an ointment of this article with lard, and rub it well into 
 the affected parts, for two or three successive nights, before a 
 warm lire; after which the skin must be thoroughly washed, 
 usual to administer the sulphur, internally, in slightly 
 laxative doses; — an innocent treatment, and one which may 
 prevent a repulsion of the disease from the skin. A neater 
 mode of employing the same stimulant, is the use of a sulphur 
 bath, the patient being enclosed in a box, so that his face only 
 is exposed to the external air, and the fumes of the sulphur 
 being admitted from below. Other ointments and lotions for 
 the itch are in common use; but it is needless to describe 
 them. 
 
 The rose rash appears in a blush, similar to that which 
 belongs to the specific febrile eruptions. It has been mistaken, 
 
420 GUM RASH — PRURIGINOTS RASH. 
 
 in fact, for scarlet fever, from which it differs in this circunv 
 stance, that the redness is removed by slight pressure, and re- 
 turns at once over the whole part pressed upon, when the 
 pressure is removed; whereas, in scarlet fei return of 
 
 redness is more gradual, and extends from the circumference 
 toward the centre. The resemblance, however, is such that 
 children have been supposed to have scarlet 
 times in succession; an error, which attention to the above 
 mentioned circumstance, and to the slightness of the general 
 affection, will be sufficient to prevent. R fre- 
 
 quently occurs daring the first dentition, especially v 
 acid is present in the stomach, and it d th the re- 
 
 moval of the irritation by which it was occn> In adults, 
 
 y occur during the heat of summer, somewhat in the 
 manner of lichen, and run a 1 | three or four 
 
 . then dtsapp ontaneously. It sometimes I 
 
 tn annular or ring like form, with a wh in the centre. 
 
 ill, but l • dilate to the dia- 
 
 i of htlf an i 
 
 The gum rath ii i baraetari ivid minute 
 
 pimp! kly set upon a surface of a I colour. 
 
 Sometinv 'he pimples are whitish, and hence the 
 
 distinction ofwhil 1 gum. -case, in one of its 
 
 i If in in t thin two or three daj 
 
 birth. In another, it appears like th- >ing; 
 
 and again, occasionally :i ovcr-hcati: . _ 
 
 or disturbs nee of the stomach. W. -rash 
 
 is always Attended with considerable itching, and is aggra- 
 1 by excess in clothing and warmth. 
 
 itching, and 
 
 nn eruption of pimples nearly of the colour of t! i hich 
 
 concrete into bJsel t, the 
 
 ; and it is frequently imi mcleanly 
 
 habits, conjoined with reoiden imp, unhealt: 
 
 . and 
 the itching is incf lien clothing, 
 
 &c. Prom scratching, "rition, the pimples sometimes 
 
 degenerate into small ich keep up 
 
 indefinite period, ami may resemble A f the 
 
 itch. 
 
 There are numerous, we might almost say numberless, other 
 cutaneous diseases, upon f e could OCCU] 
 
 ble space; but, are for the most | with 
 
 difficulty} as they are often extremely unmanage.. . more 
 
 especially, because none o( th- 
 treatment, we prefer omitting them in a p 
 
ERYSIPELAS. 421 
 
 signed merely to assist the intelligent "who are not of the pro- 
 fession in their endeavours to be safely serviceable, and not to 
 supply the place of the physician when accessible. 
 
 , \Y r e will now pass to the consideration of some very serious 
 affections, a few of which properly belong to the eruptive fe- 
 vers; but which we have thrown into a separate section in or- 
 der to preserve their connexion with some othei diseases , with 
 which they are often involved in intimate complication. 
 
 x in. 
 
 Erysipelatous Affections. 
 
 ysipelai is an eruptive fever of a typhoid character, oc- 
 curring more frequently in persons in advanced life, or those 
 of debilitated constitutions, but confined to no age or condi- 
 tion. It often breaks out, as a limited epidemic, in hospitals, 
 jails, &C 
 
 Its approach is insidious, the preceding fevi-r being often 
 
 lllght Sometim is chill, succeeded by heat, and 
 
 itpanied by drowsiness and even by delirium. On 
 the third and fourth day I redness shows itself in some part 
 of the person. At first, this is not very distinct, and the line 
 which separates it from the surrounding parts not very well 
 marked; but ii gradually spreads in all directions, and as it ad- 
 vances, becomes more prominent, and its outline more per- 
 fectly defined. When it attacks the face, the nostrils become 
 Swollen, tense, and painful, and the eyelids so much enlarged, 
 as often entirely to obstruct the sight. In the majority of 
 cases, perhaps only one side is affected; and then the bounda- 
 ry may be traced along tbe ridge of the nose, bisecting the 
 
 the chin, and the scalp. The distortion of the features, 
 
 idly of the mouth, is among the most striking appear- 
 On examination with the hand, the morbid action is 
 found to involve at least the whole thickness of the true skin, 
 to which it imparts an unnatural hardness and a peculiar fleshy 
 feel. At first, slight pressure causes the colour to disappear, 
 which returns when this is removed. The parts first attacked, 
 and the others in succession, begin to form blisters in irregu- 
 lar patches on the second or third day. The fluid effused is 
 yellowish or livid, and oozes out through small crevices. On 
 parts where blisters do not appear, the skin usually dries into 
 line scales, like those seen at the close of measles. The in- 
 flammation and accompanying fever usually continue from eight 
 
422 POISONED WOUNDS. 
 
 to twelve clays. During this time, however, the eruption trails 
 along gradually and successively over different parts, so that 
 the process in a given part is completed in somewhat less time: 
 at length the disposition to spread nd the disease sub- 
 
 sides. The signs which indicate danger in this disease are the 
 continuance or renewal of the delirium, and the occurrence of 
 coma or torpidity from which the patient is with difficulty 
 roused. These, however, do not necessarily indicate a fatal 
 termination; for persons in advanced life often exhibit both 
 delirium and coma for mil 
 
 The treatment must vary with the condition of the patient. 
 If he be accustomed to drinking or improper food, if nausea 
 and dyspeptic hetdsch be | particularly if accompanied 
 
 with i the mouth, an emetic is proper, and should 
 
 not be withheld l> ir of tendency to the head. One or 
 
 two cooling and moderate >metimes needed; 
 
 but, iu general, ill very active evacuations are improper. 
 When there il n Itration, the decoction of Peruvian 
 
 bark. ition of quinine, may be given in such quantities 
 
 as the h will bear. \.l Eternal applications, great re- 
 
 \>y dusting the part with meal, and 
 
 ntly have a happy effect. The 
 lution of opium, so usefol . »f other parts, 
 
 is inadmissible in that of the face. The mucilaginous washes 
 seldom benefi have always found the much 
 
 lauded unctuous prep Iccidcdly injurious. In t 
 
 pelas which is advancing unli rapidity slong 
 its J" I by a narrow blister ap- 
 
 plied surround the limb, over the line where the in- 
 
 flammation term i i 
 
 The erysipelas of infants is i peculiar disease, which 
 
 show - ithin B few I ;rth; 
 
 in fact, it IS someti l I tal. It commences ordinarily 
 
 about the navel, and in its | lower part of 
 
 the sbdomen, the hip, uion fol- 
 
 i of the parts; but in in- 
 fants at the period just alluded to. the disease may prove fatal 
 without reaching either of the- 
 
 1 iOCsl I from wounds may occur on any part of the 
 
 body, but most frequently follows on wounds of the scalp, and 
 then assumes much of the character of general erysipelas, as 
 already given. 
 
 toned Wo*nd$, — Erysip i, urn- 
 
 stances, is connected directly with tl 
 and not with the local injury on which it fa 
 grafted ; but in poisoned WOU1 
 toms depending 00 the poison itself is introdu • 
 
POISONED WOUNDS. 423 
 
 of specific virus introduced by inoculation do, indeed, engen- 
 der diseases wholly different from erysipelas; but, at present, 
 our attention is due to poisoned wounds, from which diffused 
 inflammation of an erysipelatous character usually results. 
 
 The most familiar instances of poisoned wounds, arc those 
 inflicted by insects, such as the wasp, the hornet, the bee, the 
 musquito, the field-spider, Sic. All these have the power of 
 inserting into the wound some peculiar fluid, capable of pro- 
 ducing a specific effect. In the bee, this poison lies in a small 
 bladder, situated at the base of the sting. When the bladder 
 has been removed, the wound produces no more effect than a 
 simple puncture. The poison flows from the vehicle through 
 the sting, which is tubular, at the moment when it is inserted; 
 and the mechanism in all other venomous animals is nearly 
 the same. Generally, a sting by any of the smaller insects 
 produces an inflammatory swelling, which subsides of itself; 
 but this i' 1 part, depends on the location of the wound. If the 
 eye be stung, for example. wrv serious consequences may 
 ensue. In constitutions of peculiar susceptibility, almost any 
 of these stings may produce danger, and even death; in- 
 stances being on record of the latter result, from the bites of 
 spiders, and the -tin-j^ of wasps and musquitoes. Death has 
 followed m iev< es within half an hour after the infliction 
 
 of stings bv 8U)gl< 
 
 The treatment most Btrongly recommended is, first, if the 
 be in the wound, carefully to cut oil' the poison vesicle 
 from: then to extract the former; Dext to immerse the 
 part in wry cold water, and Lastly to cover it with cloths 
 soaked in lead-watl r, or rub it with oil, |><>|>py juice, or brine. 
 If the inflammation i- i . local and general 
 
 bleeding must ployed. We believe, at last, that the 
 
 best local application i* the childish one of coin wet mud. 
 
 The most severe' poisoned wounds are inflicted by the sco- 
 lopendra, the scorpion, the viper, the cobra di capello, and 
 the rattle-snake The mechanism by which the wound is in- 
 flicted, is much alike in all. The tooth itself is perforated by 
 a cavity through which the venom flows. The bite or sting 
 of these animals is followed by local pain, swelling, redness, 
 and a rapid disorganization and effusion of the blood. These 
 effects extend to the whole limb, and not unfrequently to the 
 trunk of the body also. After a time, the pain abates, the 
 part becomes soft and cold, and mortification supervenes. 
 The general symptoms, in these severe cases, are prostration, 
 anxiety, difficulty of breathing, and profuse sweats. 
 
 In the advanced stages the skin is cold; the pulsation of the 
 heart scarcely perceptible; the stomach incapable of retaining 
 liquid; and delirium soon supervenes. The bites of venomous 
 
424 POISONED WOUNDS. 
 
 snakes, however, are very unequal in their consequences, their 
 malignancy being greatly influenced by the state of the poi- 
 son vesicle at the time, the part bitten, the constitution of the 
 sufferer, the season, &c: many persons escape with trifling 
 inconvenience, while, in others, death may take place in a few 
 hours. 
 
 In the treatment of the bites of poisonous reptiles, a great 
 variety of nostrums have been recommended. Absoi 
 magi, . the bruised leaves of several of our indige- 
 
 nous vegetables, certain roots used to deceive the \ 
 those arch rogues the snake-catcher . have 
 
 highly extolled ai the bite of the rattle-snake 
 
 and cobra di eapcllo. 
 
 We li ivc apenl n iich time in - tion of the claims 
 
 of these articles on the theatre of their employment, and are 
 firmly convinced of their Do ibtlessly the 
 
 claima of the I plant which I .tl'y obtained high 
 
 fame on South A mtiican authority. Will 
 founded, but we have not witness! 
 
 about the wound, arc mot lible rem 
 
 sorption o ling of the poison is so rapid, ti 
 
 be il i icyond i 
 
 of the remedy in w minutes, ami the means for sale* 
 
 rforming the operations | r ob- 
 
 tainable so soon. 
 
 The popular method of applj Mind tho 
 
 limb aOO?e the swelling) i* at war will: e\ - i y principle of good 
 
 surgery and common directions will I 
 
 from tlie well trie gent American n 
 
 men, and illy thrown on the hi>tory of ab- 
 sorption. 
 
 Dr. Caspar Pennock, of Philadelphia, has discovered that 
 
 wire on a partieulaj ttly firm to i 
 
 the circulation in the ; tually delays the absorption of 
 
 a poison until the prest ; and, in the wounds 
 
 under consideration, it is well known that the blood vi 
 
 which have fell the full action of the 
 
 OUt tlu 4 vitiated blood from the 
 
 it to flow into the cellular tissue through tl ll ' 
 
 seen the arm-pit full ol of a 
 
 rattle-snake on the point of the , — and the groin in the 
 
 same situation, from I ^reat toe. 
 
 When a patient, then, is bitten at a 
 let him instantly seek a pebble or a hard chi 
 able size to make pressure on an inch o: 
 the wound, and let him bind it exactly on the part, with great 
 
ERYSIPELAS PHLEGMONODES. 425 
 
 tightness, with his handkerchief or the sleeve of his shirt, 
 twisted, if necessary, with a stick, as directed in the remarks 
 on the tourniquet in the section on incised wounds. If bitten 
 on the finger or toe, let him arrest the circulation at once by 
 ligature. Time will then be allowed for farther action. 
 
 No woodsman or traveller should be found without his tin 
 or glass flask for drink, and his means for making a fire. If 
 the former happen to contain a little whisky, it will be for- 
 tunate. 
 
 The next step is to light a fire, and heat the flask with a 
 little liquor or water in it till the fluid boils. Then, quickly 
 removing the pebble or chip, let the flask be emptied at once, 
 but without agitation, and, while full of steam, invent it with 
 its narrow neck over the wound. As it cools, it produces 
 powerful suction, and the greater part of the poison, together 
 with much of the vitiated blood, will be drawn into the flask. 
 This plan will be found inapplicable in wounds of the lingers 
 and toes; and here some good might be done by suction with 
 the mouth, if the teeth and gums of the operator be in per- 
 fect order; but we would prefer amputation above the liga- 
 ture, to the dangers of such an experiment. 
 
 We firmly believe that suction and amputation are the only 
 local resources in these accidents. The former does not re- 
 move the poison entirely, and the system has still a struggle 
 to go through, but one in which it always conquers, if the 
 ;ion be rightly performed. If the means of suction 
 are not obtainable on the spot, the patient must depend on 
 ne till he arrives at a house. The rattle-snake 
 bite is rarely fatal to stout adults, except in very warm wea- 
 ther, and the stings of scolopendrai and scorpions seldom ter- 
 minate in death. 
 
 The general treatment of these accidents should be such as 
 is adapted to typhoid fever, combined with that of erysi- 
 pelas. 
 
 Erysipelas Phlegmojiodcs, or Diffused Inflammation of 
 the Cellular Tissue. When erysipelas becomes epidemic, 
 there is a strong tendency in all wounds and local injuries, 
 whether caused by operations or accidents, to take on a pecu- 
 liar form of the disease which is not confined to the skin, but 
 extends deeply into the cellular tissue of the limb or part af- 
 fected, involving, in many cases, even the fasciae, and al- 
 lowing nothing to escape, except the principal vessels, the 
 nerves with their sheaths, and the muscles. This inflamma- 
 tion commences at the wound, pursues the usual course of ery- 
 sipelas, so far as the skin is concerned, and is attended with a 
 typhoid fever, in which the symptoms in the head are much 
 
 54 
 
 
426 INFLAMED VEINS AND ABSORBENTS. 
 
 less marked than In erysipelas of the face, delirium seldom 
 appearing until toward the last, in fatal cases. 
 
 The cellular membrane, in the mean time, passes on to sup- 
 jxiration, without much pain, and as nature makes no attempt 
 to circumscribe the pus, or form a regular abscess, except, 
 perhaps, an imperfect and inefficient one whenever the dis- 
 ease in its regular progress approaches any one of the princi- 
 pal joints, the matter flows unrestrained through the cells of 
 the cellular tissue, which soon mortifies most extensively, 
 causing the part to feel doughy, or like a quagmire. The 
 skin, retaining its vitality, ulcerates into rounded orifices here 
 and there, to give exit to the pus and the sloughs of the cellu- 
 lar tissue, which may often be pulled out in masses like wet 
 tow many inches in length! After a time, if the pus be care- 
 fully pressed out, we may often look down through these 
 holes upon the muscles and great blood vessels of the limb, 
 dissected clean by the mortification of the tissue! Yet even 
 this horrible disease, when properly and carefully treated, 
 will generally yield to medicine; and the patient then reco- 
 vers without permanent deformity — the cellular tissue being 
 regenerated ! 
 
 Surgeons have it in their power to limit very much the 
 progress and danger of this disease, by making long incisions 
 through the skin at the time that the pus begins to form, but few 
 patients will submit to the remedy. When necessary, the holes 
 in the skin should be freely enlarged, to give exit to the pus 
 and sloughs, and as the spreading of the matter is the chief 
 cause of the mortification, great care should be taken to fix the 
 part in such a position as to drain off the fluids, and to apply 
 light bandages above and below the inflamed portion of the 
 skin, to prevent the pus from percolating farther. In other 
 respects, the local treatment resembles that of common erysi- 
 pelas; the watery solution of opium being one of the best ap- 
 plications, and poultices of all kinds being inadmissible. 
 
 The general treatment is similar to that required in typhoid 
 fever, and exhausting discharges of pus; but an occasional ad- 
 dition of five grains of calomel will be found highly servicea- 
 ble in correcting torpidity of the liver, which is almost always 
 present. The violence of the disease is generally over, in 
 from fourteen to eighteen days, but the discharge and debility 
 may last for months. 
 
 Inflammation of the J~cins ami Absorbents. After b! 
 punctures, burns, bleeding, pricks from the knife in dissection, 
 &c. on the upper extremities, wc sometimes see considerable 
 erysipelatous inflammation about the wound, followed, in a 
 few days, by burning pain extending to the elbow or arm-pit 
 — and long red lines running from near the wound tow 
 
INFLAMED VEINS AND ABSORBENTS. .427 
 
 the same parts. If the disease continue, the glands of the arm- 
 pit swell and become extremely sore; and when the red lines, 
 which are thickened, hard, inflamed, and exquisitely tender, 
 have reached the elbow, or, if commencing there, the shoulder, 
 a violent and most dangerous irritative fever supervenes. At 
 each joint reached by the inflammation, which is chiefly 
 seated in the absorbent vessels or the veins, diffuse inflamma- 
 tion of the cellular membrane and more or less erysipelas ap- 
 pear. An attempt is then made to arrest the disease by the 
 formation of an abscess; but this is rarely effected except at 
 the arm-pit. The abscess, if formed, is not limited; and after 
 passing the shoulder the pus is seldom checked in percolating 
 the cellular tissue, till it reaches the middle line of the body — 
 as in common erj^sipelas. 
 
 The great object in the local treatment of these often terri- 
 ble cases, is to bring about resolution, and prevent the forma- 
 tion of pus. Of course, no unprofessional man would have 
 the rashness to tamper with a disease of this character which 
 frequently terminates mortally in from five to fourteen days, 
 unless in situations where it is quite impossible to obtain me- 
 dical advice. To meet such exigencies, however, we will 
 venture upon a few remarks. 
 
 If the patient be not too much debilitated by intemperance 
 or previous disease, the lancet may be used, with caution, at 
 the onset of the fever. A bread and milk poultice, dusted 
 with opium, must be applied immediately to the wounds. If 
 leeches be procurable, they may be employed freely over the 
 inflamed lines, carefully avoiding the neighbourhood of the 
 erysipelatous blush about the joints. If cold applications be 
 agreeable, use them to the same parts with the same caution. 
 After these measures, and such general treatment as is adapted 
 to continued fever, (see the appropriate subsection,) have, in 
 some degree, diminished the pain, apply a blister over the 
 termination of the red lines, including the bend of the neigh- 
 bouring joint. If, notwithstanding these efforts, there is evi- 
 dence of erysipelatous inflammation of the arm-pit and side, 
 and a threatening of abscess there — the case will probably 
 terminate mortally, in the absence of an experienced surgeon. 
 If the patient survive till pus is fairly formed, open the ab- 
 scess early and freely, and endeavour to prevent the subsi- 
 dence of the pus toward the hip, or back, by compresses or 
 suitable bandaging. At this stage, the fever is decidedly ty- 
 phoid, and the exhaustion from the enormous discharge is 
 terrible. We cannot do better than refer the reader to the 
 latter part of the subsection on continued fever, and on the ter- 
 mination of inflammation in suppuration, for the little light 
 which can be thrown upon the general treatment in addressing 
 those who are not of the profession. 
 
428 CATABRH. 
 
 SECTION IV. 
 
 Diseases of the Respiratory Apparatus. 
 
 Catarrh. The symptoms of a common cold are too well known 
 to require any description. Its usual causes are a sudden 
 change of temperature, partial exposure to strong dr 
 air, or to a cool and damp atmo- at it often makes its at- 
 
 tack without obvious reason. In its nature it is a mild d< 
 of inflammation, generally commencing in the mucous mem- 
 brane of the nose, and ivities, and gradually 
 extending through the mm be larynx, and often to the 
 whole length of the ail Its tendency is to produce 
 superficial fffiltlMH, or an cretion of 
 the natural mucus. When confined chiefly to the larynx, 
 
 I scarcely sufficient to pro- 
 duce much febrile reaction; but when tl or a coi 
 rable part of the air pas>agcs are involved, it makes up b 
 tent for its deficiency ta violence, and tfr ea y m p t o m a n V 
 often quite severe. 
 
 Still, in ttarrfa m ?ery rarely 
 
 becoming so, only in i nee of its forth 
 
 any latent tendency to other Beiioc ons, such as con- 
 
 sumption, scrofula. 
 
 In one form catarrh becomes epidemic, an- imc, 
 
 of influenza. I progre ss ef the I 
 
 ral great infiu ant doom i 
 
 i< B matter of great interest, but our limits compel us to omit it: 
 suffice it ' 
 rapid to be caused by conti -1 both its 
 
 r; ■ 
 
 the impossibilit D attack 
 
 care, disprove its de| • icric 
 
 lure or moisture. Though these 
 nary causes o\ catarrh m 
 its \ iolence, the source oi infliH 
 terious agents which probably produce all ll, 
 domic disease. Influenza probablj than 
 
 the plague, though secretly; for it calls into action all lurking 
 tendencies to consumption, scrofula, and other chronic diseases* 
 and while apparently immolating lew victims itself, it obviously 
 swells the bills of mortality through the ag asea, 
 
 tor one or two years al 
 
 There is a peculiar form . rh, the obstii 
 
 o( which depends upon a dysj 
 
TREATMENT OP CATARRH. 429 
 
 It yields only to the remedies appropriate in that complaint. 
 There is also another, peculiar to elderly people, being an ha- 
 bitual cough, accompanied with loose expectoration, occasional 
 hoarseness, and increased secretion in the nose and fauces. 
 This, it is considered dangerous to cure, but it is much relieved 
 by a course of stimulating treatment, the reverse of that which 
 is employed in a common cold. 
 
 In common catarrh, active or severe remedies are seldom 
 needed. It is a common impression that a hot beverage taken 
 at the outset of a cold, aided by rest in a warm bed, will bring 
 on perspiration, and cure the cold. In all mild cases, the first 
 of these effects will generally follow, and as no evil can result 
 from the trial when there is scarcely any fever, the plan appears 
 worthy of a trial. It is indeed natural to suppose that as sup- 
 pressed perspiration often causes the disease, restored perspira- 
 tion should relieve it; and the rule is found true to a certain ex- 
 tent. If the first intimation of approaching catarrh — the first 
 tickling sensation in the nostrils — were to be met by increased 
 protection of the person, a draught of hot mint, or other mild 
 tea, or even a brisk walk, the disease might be successfully 
 combated in many cases. But nature is not to be interrupted 
 in her processes at all times, or under all circumstances; and, 
 having adopted a particular mode of counteracting a morbid im- 
 on, she cannot be expected to abandon this, at an advanced 
 stage, for one offered by art. Hence, our sudorifics often fail 
 in producing the defiled ellect. In respect to the more simple 
 articles employed in this way, being always harmless, their 
 failure need not be dread 
 
 But of the stimulating compounds prepared with brandy, 
 or other alcoholic ingredients, this is far from being true. 
 They may not only fail in curing, but may aggravate the malady. 
 
 Hot lemonade, or some simple infusion, therefore, will be 
 found a far safer remedy. There is reason to doubt whether 
 the production of a sweat depends very materially on the heat 
 of the beverage. When the body is well protected externally, 
 cold drinks excite the surface as readily, and, when there is 
 much fever, more readily than such as are warm. In the far 
 west, where the processes of the healing art are conducted 
 somewhat summarily, we have been told that it is common to 
 cure a cold by covering the body with buffalo-skins, placing 
 the feet opposite a good fire, and causing the patient to drink 
 cold water. There is much good sense in the plan, and it can 
 hardly fail to prove salutary. One of the best and most 
 powerful sudorifics, after fever has supervened in bad colds, is 
 a weak, hot infusion of bone-set (Eupatorium perfoliatum.) A 
 full pint should be drank at bed-time, and as hot as possible. 
 
430 INFLUENZA. 
 
 There is, usually, even in cases of a mild character, a per- 
 ceptible aggravation of the symptoms toward evening, marked 
 by a slight creeping and chilliness, which sufficiently indicates 
 the propriety of caution in regard to exposure at that period of 
 the day. If the fever run hi^h, the depletory com- 
 
 mended in the commencement of the continued fever, come into 
 play, and as a febrifuge, ten drops of antimonial wine, with 
 thirty drops of sweel of nitre, ma; 
 
 two hours. Inflammations of toe throat, wbi supervene, 
 
 may be treated like other inflammation! wh< 
 sired, but cold application- iina- 
 
 lions of In fla mm>> 
 
 Parents oft. er it necessary to keep their children at 
 
 home from school and play (it ma; r inclina- 
 
 nation) f< too trivial to uention, and 
 
 which are rather aggravat ved by t! ;tion. 
 
 : 
 
 ficial, as w< li m an 
 
 atmosphere heated and dried by a glou of anthracite 
 
 coal. 
 
 Ini inflammation 
 
 of t Ik , all tin* a sex- 
 
 the subs! 
 in addition to t h« and 
 
 Wheezing, .1 rapid pu 
 
 headach. Tin - usually r« gular ^me- 
 
 times asaumes an ir intermittent type In 1 
 
 ticular epidemics, many \ sank int<> collapi 
 
 w boors : and the disea* 
 cramp, most painful cough, « 1 num. 
 
 But, m fact, the 1 lemk, like all o4 
 
 rably al 
 times very mortal anion:: the robust; but if the 1 cate 
 
 succumb, it i- - ases 
 
 < ni:< ndered bj the complaint \\ 
 pe with a lighter par 
 
 Aj the nature of tOH 
 
 men catarrh, and a lung fever, the application oi a li;t!> 
 cretion ami intelligence, to the practical 
 
 these heads, will - ,ule in ti 
 
 than any mlcs which could be given & 
 
 For the relief of cough in the rrh.when 
 
 mild, any of the lozenges which taudaausn or 
 
 opium in the crude state, may , the 
 
 chronic forms and la t .. when 1 
 
 lozenges and the brown mixture are useful. In the catarrh 
 
PLEURISY. 431 
 
 of old men, the following expectorant mixture has been found 
 to give much ease. 
 
 Gum ammoniac, - one drachm, 
 
 Gum Arabic, .... half an ounce, 
 
 Antimonial wine, - one drachm, 
 
 Hartshorne's acetic tincture of opium, one drachm, 
 
 Pure water, six ounces. 
 
 Rub these ingredients together in a mortar, until they form 
 a milky mixture. 
 
 Dose. — A table spoonful three times a day. The sirup of 
 squills, in table spoonful doses, occasionally, b also serviceable 
 in protracted cases among adults; but we think it increases 
 the susceptibility to disease of the throat in voung persons. 
 
 wrisy. — An attack of pleurisy is marked by acute pain in 
 some part of the chest, most generally referred to that part of the 
 side which corresponds to the sixth or seventh rib, about mid- 
 way of its length. The pain is sometimes heavy and dull, 
 some: tt< ■; but always aggravated by a full breath, 
 
 which, therefore, the sufferer mot carefully avoids. When a 
 full breath is taken, it induces cough, which, for the most 
 is short and dry. The ordinary breathing is unaccompanied 
 with or pain, at least, until the distention of the 
 
 chest arrives at a certain point. The pulse is hard and fre- 
 quent, but the other symptoms of lever are not generally very 
 strongly marked. 
 
 It is certain that a disease attended with these symptoms 
 often exist-, and is relieved promptly by a full bleeding, or 
 finds spontaneous reli nallv in sweating; and it is 
 
 dingly probable, if not quite certain, that the seat of 
 i these cases, is the pleura or investing membrane of 
 That we have not more direct evidence on this 
 point, arises from the fact, that these symptoms admit of 
 lief, and rarely prove fatal, unless accompanied by 
 others which mark affections of the substance of the lungs. 
 Doubt has been thrown on this subject by the circumstance, 
 that when lung fever, which have never exhibited these 
 
 symptoms of pleurisy, have proved fatal, the pleura has been 
 found, on examination, to participate in the disease. Effusion 
 into the cavity has been discovered, and in many instances 
 the two sides which form the cavity have been found adhe- 
 rent. How can we reconcile this process, which seems to 
 imply a high degree of inflammation, with the absence of the 
 violent and acute pain and the other symptoms above de- 
 scribed I Many plausible answers might be given to this. 
 
432 LUNG FEVER. 
 
 query; but the question not being of practical importance, we 
 shall not discuss it. The distinction between pleurisy and 
 lung fever is sufficiently obvious; but it is much more difficult 
 to decide, whether the pain in full respiration, the hard pulse, 
 and the short dry cough, may not be owing to a c;\ 
 rior to the pleura itself, and situated in the intercostal and 
 pectoral muscles; in other words, whether they may not be 
 rheumatic in their character. In I, the presence or 
 
 absence of other rheumatic symptoms, as pain in the move- 
 ments of the arm and shoulder, will help to deride the ques- 
 tion; and there is a peculiar p eition in which, if the pain be 
 muscular, the patient will be likely to complain: viz. stand- 
 ing upright on the foot of the a. the other 
 bent ami n the toes. This position bra< 'hole 
 side, and tests the soundness even <>i the intercostal row 
 
 Alter all. this distincti d.uv i 1 1 • | 
 
 in a rheumatic inilammat". 
 
 with acute pleurisy , the to appropriate to acute plug 
 
 would be demanded. 
 \\ < li.i\ e already said, that in l 
 may often 1m- prompt]) relieve .. without 
 
 any additional n Died) li is i this 
 
 source is not i follow up its • lister ami 
 
 an active catbart - in he 
 
 added. 
 
 Lung Fever. The- r are acute pain in the 
 
 breast, with lassitude, and . accompanied 
 
 ally with chill, ami, sooner or later, with pain o: ten- 
 
 sion and weight upon the part. The chill is followed by _ 
 heat, ami presently an acute and pungent pain SttSI 
 pari of the chest, more frequently the middle of one Bide, 
 tending to the collar-hone, and > the shoulder. The 
 
 breathing becomes frequent and short, with a hard, oft rep. 
 
 and painful cough, and an c\ ion of frothy or viscid cha- 
 
 racter, becoming tinged with hlood or baring this appearance 
 from the first, sometimes, however, grei 
 
 in seme - wholly wanting. The indication from 
 
 the pulse is uncertain: sometimes this is hard, full, frequent; 
 sometimes frequent he metimes not g the na- 
 
 tural standard, or eve: intermittent. 
 
 The action o( the heart d often accompanied with 
 
 a sense o( heat ami horning. The countenance is flushed, some- 
 what tumid, ami the li; ! d livid; hut sometimes tin 
 general paleness and a contracted arking a collapse. 
 There is often an sbundant and viscid sweat about the 
 neck, and breast, while other parts of the body continue hot 
 
LUNG FEVER. 433 
 
 and dry. The thirst is intense, with dryness of the tongue 
 and throat, and difficulty in the act of swallowing. Answers 
 to questions are uttered with hesitation, and with frequent in^ 
 terruptions. In regard to position, that on the affected side is 
 generally- preferred; but sometimes, the only posture which is 
 at all tolerable is that on the back, with the head and shoul- 
 ders elevated. 
 
 The symptoms heretofore enumerated may be considered 
 as common to all well marked cases: there are others which 
 belong only to the most severe, and may be considered as in- 
 dicating a fatal termination. Such are, extreme redness and 
 prominence of the eyes; swelling of the tongue; stupor or de- 
 lirium. With these, in fatal cases, the usual precursors of 
 death are manifested in about seven or ten days. 
 
 A favourable termination is brought about in different ways. 
 Sometimes bleeding takes place from the nose, by which, with- 
 out other apparent evacuation, effectual relief is obtained. More 
 generally, the secreting surfaces of the lungs themselves pour 
 forth an increased quantity of matter, varying from the tough 
 glairy character of the ordinary catarrhal sputa, to the con- 
 sistence of true pus. Most frequently, these two kinds of 
 discharge are mixed, the mucus serving as a tenacious ve- 
 hicle in which the purulent matter is enclosed. The tinge 
 of blood in the sputa often alarms the patient or his friends; 
 but it is merely an effort of the small vessels on the surface 
 of the pulmonary passages to relieve themselves of distention 
 by pouring forth their contents. By this expectoration, the 
 difficulty of breathing and pain are relieved, and the violence 
 of the fever diminished. Sometimes it happens that no con^ 
 Biderable discharge takes place from the lungs; but, in place 
 of this, there occurs on the seventh, ninth, or twelfth day, 
 a profuse perspiration, pouring from the whole surface; while 
 the urine deposites a copious pus-like sediment. Sometimes, 
 again, without either expectoration or sweat, the disease has 
 been dissipated by unclouded urine, secreted in uncommon 
 quantity, amounting in some instances to 12 pints in a day! 
 
 Another direction is often given to the progress of pneumo- 
 nia, by the formation of an abscess in the substance of the lungs. 
 Why this should happen in a part communicating by so many 
 passages with a natural outlet is not easy to say. The abscess 
 thus formed may either discharge itself into the cavity of the 
 pleura, forming an empyema, or it may open into the air pas- 
 sages, and thus be expectorated. The occurrence of empyema 
 has sometimes been detected during life, and the matter dis- 
 charged by puncture. In some rare cases the opening has 
 taken place spontaneously. When the abscess forms a com- 
 
 55 
 
434 LUNG FEVER. 
 
 munication with the air cells, a large amount of pus is at once 
 discharged by cough. The subsequent history of these cases 
 varies according to the strength of the constitution, the I 
 ence of any tendency to consumption, and other circumst.i 
 When recovery takes place, the discharge gradually lessens in 
 quantity, and becomes of thinner consistence, ihe abscess gra- 
 dually healing and contracting. When the system want 
 gour to effect this result, t continues, hectic fever 
 
 is developed, and the disease 101 jlmo- 
 
 nary consumption. 
 
 AJ; the first onset of the disease the lancet is indicated, par- 
 ticularly if the combination ot nptoms with the 
 pleurisy afford j that the pleura participati 
 the inflammation. Where this in in 
 the chest and difficulty of bren 1 considerable, the pulse 
 full and hard, and the 
 
 pain in Ihe head, blood should be drawn from the arm to a 
 sufficient f to these 
 
 symptoms. If lb 
 
 to ;i surface of Ito it will b ucly 
 
 after the bleeding 
 
 the 1 1. .ches for an adult 
 
 , and in proportion U>v a L If 
 
 in the co.: »r four hours, ac . id be 
 
 manil 1 particularly n emetic 
 
 may be admit for it is 1 :non that 
 
 pneumonia is dej. ...pru- 
 
 dence and irregularity . com- 
 
 bined with late I. 
 
 most frequent 
 
 BD under othi 2 condition of the stomach 
 
 demanding an rom the \ 
 
 darting pain in the I . accompanied by nausea. 
 
 The employment of em 
 vantage. It is one of I igon 
 decided perspiration, and . which 
 the d ng argu- 
 ment in f imitati; it. 
 
 The principal rei 1 be relied on 
 
 at the outset oi ti. ! the 
 
 application of blisters to the c: \hen 
 
 employed at all. should alw ould 
 
 be resorted to, only when, after dach coi 
 
 other evidence is afforded . a bilious 
 
 state o( the system; and the bill n the 
 
 pain in thest ami soreness In n likl or ab- 
 sent. 
 
CONSUMPTION. 435 
 
 After the first 48 hours of the disease have elapsed, the pros- 
 pect of terminating it by any immediately debilitating action 
 on the system will be so far diminished, and the powers of th-o 
 frame so much exhausted, as in general, to forbid the use of 
 remedies in this view. The object now is to favour expecto- 
 ration from the passages of the lungs: for this purpose, various 
 articles have been recommended under the name of direct ex- 
 pectorants. Of these the most efficacious, if, indeed, any of 
 them can be depended on, is undoubtedly the squill. But a 
 class of medicines which have been much more relied on for 
 this purpose, are those which produce more or less nausea or 
 inclination to vomit. The vast amount of secretion from the 
 lungs which precedes and follows the action of an emetic, is 
 matter of familiar observation; and this observation has been 
 turned to account by giving to patients under lung fever small 
 doses of antimony or ipecacuanha, enough to produce sickness 
 without provoking actual discharge from the stomach. Em- 
 ployed with discretion, this class of remedies will do good; 
 but they arc too uncertain in their operation to be -the subjects 
 of specific rules, and too powerful to be safely trusted in the 
 hands of the inexperienced. To those, therefore, who, with- 
 out regular medical education, are obliged to treat this stage of 
 pulmonary inflammation, we can offer no better advice tjian to 
 regulate the external circumstances of the patient on principles 
 !y laid down under the head of fever; to give warm di- 
 luent drinks prepared with barley, gum Arabic, slippery elm, 
 &c, to apply a blister, should local pain or soreness recur, and 
 to alleviate the annoyance suffered from cough at night by an- 
 or opiate < ombining squills, ipecacuanha, 
 
 and opium, in the proportion of a grain of the first two, and 
 half this quantity of the third, in powder or pill, a prepara- 
 tion is formed which is at once expectorant, diaphoretic, and 
 anodyne, and which will generally relieve, for three or four 
 hours, that tedious and hacking cough, the occurrence of which, 
 during the hours of sleep, is among the most troublesome at- 
 tendants on the disease. 
 
 The serious objections to opiates are, that the sleep they pro- 
 . if much fever be present, is not refreshing, and that their 
 action is not favourable to the due performance of digestion, 
 and the regularity of the evacuations. The first objection is 
 met, in some degree, by combining the opium as above men- 
 tioned; and sometimes more successfully, by substituting for it 
 a fifth part of the same quantity of the morphia. The second 
 evil must bo obviated by a judicious employment of aperient 
 medicines. 
 
 Consumption. We have above noticed the manner in 
 which common inflammation of the lungs appears to termi- 
 
438 COXSUMPTION. 
 
 nate in consumption. Probably, in most cases of pneumonia^ 
 which take this course, there must have existed, previously to 
 the occurrence of the disease, the peculiar structural derange- 
 ment which predisposes to phthisis, which consists in the pre- 
 sence of certain soft, yellowish bodies, called tubercles, or of 
 a grayish substance, which is capable of assuming the same 
 general character. It appears that in every fatal case of true 
 phthisis which has been examined after death, one or both of 
 these appearances has been found. 
 
 A great proportion of the cases of consumption develope 
 themselves without severe inflammatory symptoms, and ar- 
 rive at full maturity almost without the subject of them 
 pecting that he has had any serious disease. The commencing 
 symptom is a slight and short cough, which soon becomes ha- 
 bitual; but which is so little remarked by the patient, that, if 
 asked the question, he will unconsciously deny having any 
 COUgh wi In answer to more particular inqi. 
 
 1 knowledges that he has had a slight cold, but bei 
 
 himself to be wholly rid of it at present It may be obsc i 
 however, by a little careful attention, that the breathing is 
 easily hurried by motion, that there is some emaciation, and 
 a diminished disposition to any fort T may 
 
 continue fur a year or two. w ithout any other complaint on 
 the part of th< , than thai ■ ore liable to take cold 
 
 than formerly, and that cold produces cough. Th< 
 vations may still prove temporary; relief may be procured, 
 no alarm or SI ocrienccd. It is often ol how- 
 
 ever, lint on some of these occasions, the cough is troublesome 
 on the patient's lying down at night, and continues longer 
 than in ordinary catarrh. 
 
 The cough, thus incrcasi: [ nitting. is often unattend- 
 
 ed, for a long time, by any expectoration whatever. But when, 
 at length, it heroines mon ttended with the 
 
 raising o\' phlegm from the hi cially in the morning. 
 
 The discharge by d< p ppearancc, becoming 
 
 more abundant, less transparent, and, at length, yellow or 
 greenish; finally assuming a purulent, or. as the popular term 
 is. corrupted appearani neither at this, nor any other 
 
 time, does the matter thrown up, resemble pure unmixed 
 More or less mucus, or viscid white phlegm, is mixed with 
 it, and seems absolutely requisite, in order to enable the mus- 
 cles concerned in the act of coughing to effect the expectora- 
 tion. 
 
 these changes advance, the breathing becomes more dif- 
 ficult than before, ami the emaciation and weakness incr 
 Many of the natural secretions are now checked; and fern 
 particnlarlyi perceive a cha 
 
CONSUMPTION. 437 
 
 the effect of tlpe pulmonary disease, though often regarded by 
 themselves as the cause of the cough. 
 
 Up to this period, the pulse may not have been materially 
 affected; but feverish symptoms now begin to manifest them- 
 selves by the occurrence of a slight chill, or, at least, a feeling 
 of chilliness toward evening. This is the commencement of 
 hectic fever. It is soon found that the fever observes its regu- 
 lar periods, and that two paroxysms occur in the course of 
 every twenty-four hours, with equally well marked, though 
 somewhat different symptoms. The morning fever comes on 
 about noon, the patient at this time experiencing rather heat 
 than chill, with a flush in the cheek, which, as the disease ad- 
 vances, becomes one of its most striking characters. Some 
 remission then follows; but in the evening, another paroxysm 
 •succeeds, in which the cold stage is decidedly predominant, 
 so that the patient always requires an increase of clothing. 
 This chill is followed, particularly towards the termination of 
 the disease, by very abundant sweats, which, however, are 
 never accompanied, and rarely preceded, by any sensation of 
 warmth. These night sweats, as they are called, form ano- 
 ther of the prominent marks of consumption. They increase 
 in amount with the advance of the disease, and become very 
 profuse toward the termination of fatal cases. In the progress 
 of the affection, pain in one or other side is felt and becomes 
 nearly constant: this is aggravated by cough, and in particu- 
 lar positions of the body. Spitting of blood is another symp- 
 tom, which always shows itself in the course of the disease, 
 though it does not always attend its commencement. As the 
 case approaches a fatal result, the tongue is observed to be- 
 come peculiarly clean, red, and shining; the eyes assume a 
 pearly lustre, and the feet swell. Still later, the mouth be- 
 comes affected with aphthous eruption; and an obstinate loose- 
 ness of the bowels, which rapidly exhausts the strength, makes 
 its appearance. 
 
 It is not the mere existence of tubercles in the lungs that 
 constitutes consumption; for these have been found after death, 
 in a large number of cases, in persons who have died of other 
 diseases. It is, in fact, the morbid development, the inflam- 
 mation and suppuration of the tubercle, which gives rise to 
 consumption. Two objects, therefore, present themselves as 
 practically important: first, to ascertain the existence of tuber- 
 cle, and secondly, to guard against its development in phthi- 
 sis. Of the hereditary transmission of consumption, no doubt 
 is now entertained; and in examining the lungs of children 
 born of consumptive parents, tuberculous formations have, 
 almost always, been observed. Again, tubercles are common 
 in scrofulous subjects; that is, in persons who, when children-. 
 
438 CONSUMPTION. 
 
 were remarkable for a florid complexion, thick upper lip, and 
 a tendency to swelling of the glands of the neck. But al- 
 though these appearances. and others, which might he men- 
 tioned, may inspire a suspicion of the existence of tubercular 
 matter, they do not justifj ry decided measure to pre- 
 
 vent its development. It would he desirable that pe; 
 evidently predisposed to the : the in- 
 
 fluences of a climate, in which theezciti consump- 
 
 tion are rare or wanti Lly cannot he done 
 
 in the great proportion of ea>cs, the i 
 
 will he to avoid dden atmospheric 
 
 changes which are calculated to induce i 'i be re- 
 
 el in ind -. and cautious diffi- 
 
 cult it is for one enjoy ing apparent i follow such rales, 
 
 we need scarcely h injunction! 
 
 idom. in 
 pain in tl 
 
 it, that t! 
 of his condition. From this time. of minor rem 
 
 are prop ch with i 
 
 good luce the inflammatory 
 
 the irritation; opium is 
 given to quii ilomel to 
 
 alter * intimon; >ecto- 
 
 pro- 
 duce momen*. 
 
 all arc in turn abando 
 the inconveni 
 till, at lei 
 and quid 
 
 ire for consumption. 
 tain it is, that pro- 
 
 purulenl »tion, 
 
 and I 
 shown t 1 
 eurred in which the ul been 
 
 found ci( 
 
 Were it pra< >r the lungs to enjoy for a * 
 
 that repose which is p. i ased 
 
 structure, the process of Ik m of 
 
 an abscess, would be comp i this 
 
 is impossible, the next 
 der the task * , > is 
 
 This will depend mainly on t the q' 
 
 of the air breathed, and the quality of the hloo 
 
 on. The latter is principally dependent on the qoalit 
 
 food taken, and hence one 
 
SPITTING OF BLOOD. 439. 
 
 ed, and nutritious diet. It is partly in this view that the ex- 
 clusive use of milk as an article of diet has been proposed, 
 and the result in many instances has been exceedingly favour- 
 able to the plan. 
 
 The regulation of atmospheric influence is at once the most 
 important, and the most difficult part of the management of 
 consumption. Changes from heat to cold, from dryness to 
 moisture, and often the reverse, arc found to aggravate the in- 
 flammatory action and increase cough. Hence the leading ob- 
 ject of the sufferer and his friends is to place him beyond the 
 reach of these changes, and render the medium which he in- 
 hales as uniform as possible. This, among us, is sufficiently 
 difficult to effect at all seasons; but in our winter and spring 
 months it becomes peculiarly so. One of two modes of pro- 
 ceeding must be adopted. First — To create and maintain an ar- 
 tificial temperature by means of lire, preventing as much as pos- 
 sible all unnecessary draughts of air; and, secondly, to seek a cli- 
 mate where the winter is so mild as toadmit of constantexposure 
 without danger. The first plan is so difficult and expensive, 
 that it almost always fails. The success of the second expe- 
 dient seems to depend on the stage of the disease at which it 
 is adopted. Those who have resolution, at the first develop- 
 ment of the characteristic expectoration and fever, to bid fare- 
 well to country and to friends, and submit to the inconveni- 
 ence of temporary exile, will, if judicious in their choice, al- 
 most always find relief; while those who wait till the re- 
 sources of treatment at home are exhausted, till cough, ex- 
 pectoration, and night sweats have reduced their strength to 
 the lowest ebb — till three-fourths of the lungs arc disorganized, 
 and the remainder scarcely adequate to the performance of 
 their functions, wjll too surely find that they have sacrificed 
 the comforts of home without the prospect of an equivalent, 
 and have turned their back on friends and kindred, only to 
 find a grave in a foreign land. 
 
 Spitting of Blood, When blood comes from the throat into 
 the mouth, and is thence spit out, it is a question of great in- 
 terest to determine, whether it proceeds from the posterior nos- 
 trils, the throat itself, the stomach, or the lungs. The first 
 < ase is easily distinguished, by the facility with which the pa- 
 tient can cause the blood to appear by blowing the nose. The 
 second is not likely to happen, unless preceded by some ob- 
 vious disease or inflammation of the part, and the question is 
 easily determined, by ocular inspection. The signs of distinc- 
 tion between bleeding from the stomach, and that from the 
 lun^s, are, firstly. The former is usually raised by vomiting, and 
 the latter by coughing. This test is not quite certain; for vo- 
 miting is usually attended by some cough, though the cough 
 
440 I'ULMOXARY HEMORRHAGE. 
 
 by which blood is raised, is unlikely to be attended with vo- 
 miting. Secondly, the blood, when it comes from the stomach, 
 is usually in larger quantity than when from the lungs. Third- 
 ly, the blood from the lungs is usually florid, and mixed only 
 with a little froth and phlegm ; while that from I tch is 
 
 darker, and combined generally with other substances peculiar 
 to that organ. Fourthly, vomiting of bloc likely to 
 
 happen, unless preceded by some mark f the sto- 
 
 mach, and bleeding from the lui 
 and other trouble about the With 1 
 
 it is not easy to make an unwilling mistal 
 remarks, though mostly ap| to both affections, will be 
 
 especially applied to bleeding from the lungs, which 
 (he more common and important 
 Pulmonary ht morrha^ 
 
 ; 
 them is ( -soon 
 
 as discovered. In 
 Dtrasted with 
 
 extent, ihould 
 
 by d iiiptoius «.i raacular fulness. 
 
 In active 1. ih a full bounding 
 
 pulse fhtthingt, sense I 
 
 bleed at the outset, until the pulse b I. and th 
 
 ing is rendered m It the d 
 
 under tin it, it nm as passive, and the 
 
 astringent ren \ l 
 
 is to be placed in the vegetal) 
 the most trustworl Jam and - 
 
 mked with popular n ranch 
 
 more employed than these, and one which in ac- 
 
 tive hemorrhage, without preliminary blo<Hl-lett. 
 salt. This hai the 
 
 services of a ; 
 
 UOIM cannot be fully i I I, but iu mar 
 
 duces nausea, on which its .dent. 
 
 It may be taken as rapidly Bi possible, in the dose 
 
 spoonful or more re| 
 or li\ i 
 
 vourite remedy for hen .1 in- 
 
 sed excitement, is the I It possess- .rious 
 
 property of reducing the free, 
 
 lient be kept, while under its influence, in a recumbent postal 
 at least, without any chanj Lion. It I 
 
 its effect by acting primarily on Um 
 
 and is an article to be employe 
 
 however, on hemorrhage, s 
 
ASTHMA. 441 
 
 even when the seat of the bleeding is at a great distance from 
 the centre of the circulation. From fifteen to twenty-five drops 
 of the tincture may be given to an adult, every two hours. 
 
 In speaking of hemorrhage from the lungs, we have had in 
 view a real discharge of florid blood in some amount, and not 
 the mere coloured sputa which appear under a variety of 
 circumstances. To these coloured sputa, as appearing in pneu- 
 monia and phthisis, sometimes as a favourable sign, allusion 
 has been already made. 
 
 Astkmahaa been well described as "a difficulty of breathing, 
 recurring in paroxysms after intervals of comparative good 
 health, and for the most part unaccompanied with fever." 
 Airain, asthma has been said to be " a disorder of the respira- 
 tory organs, characterized by remittent dyspnoea, the attacks 
 of wh ; ch genera II J return in the night, attended by circum- 
 stances which are noticed more or less in all cases where 
 there is some obstacle to the mechanism of respiration." The 
 last is not exact as a definition, but it is valuable as referring 
 to some points, which ought to be kept in view in attempting 
 to gain a distinct notion of this singular disease. 
 
 A paroxysm of asthma usually occurs during the soundest 
 sleep, generally from midnight to two or three in the morning. 
 The sleeper is awakened, after some: struggling and convulsive 
 movement*, with a sense of impending suffocation, and of most 
 painful constriction across tin: chest, which feels as if bound 
 with cords, lb- is compelled immediately to sit erect, and in 
 osition labours for breath in the most distressing anxiety. 
 Frequently he flies to the window, where he sits or lean^ so as to 
 inhale the air with lorn, regardless of any ex- 
 
 The breathing, mean while, is accompanied with a 
 uit wheezing, the extremities are cold, the face pale or 
 livid, the eves staring, the heart palpitates, the pulse is weak 
 and irregular. After these symptoms have continued for some 
 time, cough occurs, with an cilbrt at expectoration. The mat- 
 ter raised is sometimes merely a little frothy mucus; at other 
 times mere viscid and heavy sputa, perhaps mixed with a little 
 blood. In the last case, the expectoration usually proves criti- 
 cal, and is followed by relief. The ordinary duration of a pa- 
 im is from one to three hours. The frequency of attack 
 varies, but a paroxysm like that above described, has been 
 known to recur nightly for seven weeks together. 
 
 Few diseases have given rise to more discussion with regard 
 to their cause and nature, than that now under consideration. 
 We will express our views on the subject, with all modesty, in 
 a few words. 
 
 The proximate cause of asthma appears to be a want of the 
 proper change of the blood in the lungs, from the venous to 
 
 50 
 
442 CAUSES OF ASTHMA. 
 
 the arterial character, producing a demand for an increased 
 supply of the purest air, which, during the paroxysm, is 
 prevented from effecting its full purpose by some obstacle to the 
 process of decarbonization, (see Function of L n,) either 
 
 mechanical or nervous. Hence embarrassment of the left side 
 of the heart, to which the blood is not sufficiently stimu!. 
 to produce regular aciion. This disturbance of the circul. 
 necessarily produces engorgement of the lungs, and hence the 
 hurried respiration and sense of suffocation, which mark the 
 attack. The exciting arc all those m« 
 
 physiological agents which produce dii ition 
 
 directly, by limiting the supply of air. or indirec: ard- 
 
 i DLC the proper cl in the 1 
 
 v. Ik n the air is pi i 
 
 and much lata complete; it also lessens, probably in c> 
 quence of ibis, the rapidity of circulation 
 
 r in one I 
 and t 
 
 . one of 
 causes of asthma. Propsyc/tl a, ossific 
 
 nf anthracite, 
 burned in ill-con- 
 structed I: .uses of a 
 diminished supply 
 asthma. Chi' .ml warm at: 
 
 sudden cold, the chilly s 
 
 meat of the I 
 
 humoral asthma. Wl pul- 
 
 monary i 
 
 the blood, is an <\ spasmodic asthma. 
 
 Enlargement of the a i ml what is called emphynen \ 
 
 of the lun. 
 
 attendant on - a ex- 
 
 citing cause of all the forn 
 
 Occasional attat <usccpti- 
 
 ble temperament, but in nod health, fi 
 causes. Asthl 
 
 duced by the sli^h : in others, by that 
 
 o[' musk. w bay, i 
 
 n o\ ncr\ on- il the un- 
 
 folding of a cambric handi . at any hustle 
 
 or hurry among her ai Jit of 
 
 air h : and its 
 
 ment may be perfectly ventilated, in 
 spasmodic character, • 
 
 opium eaters, when i f their as* 
 
 ittack comes on a nd unless 
 
AXGIVA PECTORIS. 443 
 
 supplied with opium, the patient expires in the course of a few 
 hours. In the cases above described, the term nervous or spas- 
 modic asthma is justly applicable. 
 
 In a large proportion of the cases in which the disease is 
 habitual, the resort to fresh air and free exposure seems to give 
 the only relief which the circumstances allow. The pheno- 
 mena of the tit, and the state of the lungs on which it imme- 
 diately depends, would appear to point out the expediency of 
 diminishing the furce of the circulation: but the more powerful 
 agents we possess fur this purpose, such as blood-letting, nau- 
 seants, &c, do more injury by diminishing the muscular 
 force on which the maintenance of the respiration depends, 
 than good by lessening the force with which the blood is 
 thrown upon the lungs. Nauseants, however, arc occasionally 
 resorted to, and in full habits, when the attack is violent, and 
 threatens actual danger from suffocation, bleeding is decidedly 
 proper. The latter can scarcely happen, except in the early 
 attacks of robust subjects; for when the habit is formed, the 
 fit is seldom fatal. Inhaling the fumes of tobacco, or the 
 ei of the thorn apple, {datura stramonium) is a favourite 
 remedy with some. The latter is a powerful narcotic, and, 
 when smoked, produces temporary nausea with general re- 
 laxation and reduction of the pulse. But it is a danger- 
 ous plant. A strong tincture of lobelia, taken in the dose of 
 fifteen drops at the commencement of a paroxysm, has also 
 
 found to ailbrd relief; but this is also a dangerous 
 article. 
 
 The disease, now generally known by this 
 name, has on! distinctly described within a few years. 
 
 Its first attack often occurs in taking exercise after a full meaJ. 
 The patient experiences severe pain in the front of the breast, 
 extending towards one shoulder, more frequently the left, and 
 shooting downward towards the arm and hand. The pain is 
 such as immediately to check his progress, and induce him, if 
 walking against the wind, to turn round and rest. After a few mi- 
 nutes it subsides; but recurs again from time to time, the attacks 
 lasting longer, and being accompanied with a sense of approach- 
 ing suffocation. When once habitual, it is excited by the 
 
 st muscular effort. Even coughing will bring on a parox- 
 ysm. In this way the disease may continue many years, the 
 patient, during the intervals, being apparently in possession of 
 tolerable health. So capricious, however, do the paroxysms 
 
 ;e, that the dread of their approach is never absent. 
 Every imprudence in diet, exercise, exposure to change of 
 temperature and undue effort, is sedulously avoided ; purges, 
 tonics, mercurial blisters, bathing, and the host of uncertain 
 remedies usually brought to bear on incurable disease, are 
 
444 MUMPS. — eUIVST. 
 
 tried in succession, but to little purpose. The - )mc- 
 
 times, but rarely, - usly. More gem rail 
 
 attacks recur with continually in . until, at 
 
 length, in a paroxysm of unusual severity, overcome by pain, 
 and struggling in all the agony of suffocation, the pal 
 breathes hi- last la most of those who have'died of ai 
 pectoris, more or less of structural of the heart 
 
 been traced, although the appearand 
 have not exhibited un\ uniformity. The 
 
 frequent changes noticed li 
 
 \ ftlves, a thickening < 'ii <<l lh< 
 
 Sometimes b morbid appearand - 
 
 organs remote from the beast, and in oiln-r instances no or- 
 ganic change u h If the natui 
 
 the disease be thai d uni- 
 
 form nor 
 
 riooally afforded by emetics, son i; and in 
 
 the inten • with da 
 
 N 1 
 I of Iht Throat. 
 
 Mumps, This inflammation of the parotid 
 
 gland, li ii a hard, painful swelling, not extremely tender, 
 appearing irid and 
 
 the angle of the jaw, i m rious g<. rtorb- 
 
 ance, or p l much frver in its ling 
 
 increases till the thin! 
 clines. The I 
 to run its i v 
 
 the d 
 where it is ra 
 
 demicallj . 
 affords n • 
 
 Quinsy. Of tl. mt quinsy, or ulc 
 
 lion of th 
 
 : for though il 
 of inflammation occurs h the scarlet rash, 
 
 vet the principles of ti 
 nation, are equally SO w :. n it 
 Passing over this, therefor. .11. under tin :ead. 
 
QUINSY. 443 
 
 -consider only quinsy, properly so called, in which the inflam- 
 mation tends, for the most part, to a phlegmonous or suppura- 
 tive character. 
 
 It commences generally without previous fever. The ex- 
 citing cause is cold applied to any part of the surface, and par- 
 ticularly to the neck when in a state of perspiration. At first, 
 a sense of uneasiness is felt in the throat, which soon amounts 
 to decided soreness, aggravated by every movement of those 
 muscles which perforin the act of swallowing. On examina- 
 tion, the tongue is found to be covered with white fur; the 
 whole surface of the fauces is of a deep scarlet hue, and one 
 or both tonsils >o swelled, as to fill up, in whole or in part, the 
 interval which ordinarily exists between them and the uvula. 
 The examination, necessary to ascertain the condition of the 
 throat can be easily made, when the patient, sitting opposite the 
 light, opens the mouth as widely as possible, and draws the 
 air slowly in. During this last effort, the tongue is necessarily 
 depressed, and a view of the diseased parts is obtained. If 
 tin- expedient does not succeed, the tongue may be depressed 
 by means of a spoon, or any article resembling it in form. As 
 the swelling increases, the enlarged gland encroaches upon the 
 uvula, pushes it toward the opposite side, and renders the rela- 
 tion of the parts more difficult to discover: the difficulty of 
 swallowing becomes extreme, and liquids, on which the attempt 
 at deglutition is made, are forced into the nostrils. In extreme 
 . breathing is also embarrassed : the voice, which in all cases 
 is obscured, b nearly inaudible, and the countenance 
 
 evidenci & In Ihis state of thing-, from 
 
 the vicinity of the inflamed parts to the angle of the jaw, it 
 often becomes difficult to separate the teeth to any extent. The 
 natural relief i- d by the bursting of the tonsil, and the dis- 
 
 charge of the contained matter, which happens from the fourth 
 to the eighth day. It does not always happen, however, that 
 the tonsil suppurate-, even when the disease is left to itself. 
 lution may take place on the second, third, or fourth day, 
 but if the symptoms have gone on actively beyond this time, 
 suppuration may he deemed almost inevitable. When one ton- 
 sil has broken, it is very common for the other to take on the 
 same action, but the disturbance of the system is generally less 
 with the second suppuration than with the fust. 
 
 No disease more easily becomes a habit of the system than 
 quinsy, and it will then recur on the slightest exposure, or 
 in a manner wholly unaccountable. Though a most distress- 
 ing disease, it is rarely fatal. 
 
 In directing the treatment, regard must be had to the proba- 
 bility of termination by suppuration. In many cases this must 
 matter of conjecture; but if the outset of the inflamma- 
 
446 QUINSY. ' 
 
 tion be peculiarly severe, if the di-ease be epidemic, and has 
 been found in the great majority of instances to terminate in 
 this manner, or if the patient have been liable to suppuration in 
 former attacks, the chance of effecting resolution is small, 
 we should encourage the suppuration. In doubtful 
 same course will be advisable, for the follow The 
 
 class of remedies which promote suppuration, cause in general 
 less pain, and induce lei qaent debility, than those which 
 
 have resolution for their object: and while we have lilt* 
 deuce that the former throw ai le in the way 
 
 of resolution where tin B tendency to it, we have 
 
 son to believe that the latter impede the 
 retard the result which the] I ipable oi 
 
 vulsive measures should therefore be < uiion, 
 
 and not continued when their inefli fairly 
 
 shown. These remedi 
 tics, purgatives, blistei i 
 
 gargles ii ritory, that lit) d on 
 
 them, pared 
 
 by diluting go 'i' with an equal quantity . and 
 
 adding ho I irritant! throat, the. 
 
 moat popular i- 
 
 cd the pn *l"l. T 
 
 tended to acl as ta other inflamo !ood- 
 
 lettiog has sometia 
 
 ly to the tonsil or by scarifying the part with a lancet, i 
 
 measures, though highly efl 
 
 use. I y applied to the n< 
 
 and there are tew situationi in wh 
 
 effectual. Lastly, general bleeding 
 
 derable extent in cases win il the 
 
 diseai 'de to r< 
 
 the operation, Iter decw 
 
 increase of febrile symptoms, which endentl 
 
 arrest 
 
 The means of promoting support 
 simple. Tlu \ . for the i . in the inl 
 
 pour from boiling water Of Vinegar, aim aoui- 
 
 ticea to the throat. When the matt . and tl. 
 
 - not readily bun ielf, it may I .1 by the 
 
 lancet ; but sometimes the g 
 
 the patient from opening the mouth sufficiently to render pos- 
 sible the artificial opening. In i 
 ened, it may he I to administer an 
 
 the agitation that if 
 
 In impending suffocation from i both 
 
croup. 447 
 
 glands, in the commencement of the case, free and often re- 
 peated bleeding is sometimes our only resource. 
 
 Croup. The seat of croup is principally, though not solely, 
 the trachea, a quantity of lymph being thrown out upon the in- 
 ner or mucous membrane of this passage, which, hardening, 
 forms a false membrane, and rendering the passage narrow, 
 obstructs the breathing. Croup is most frequent in children, 
 from the first to the fourth year, and plump, fat subjects are 
 more likely to be affected, than those of spare habit The 
 disease occurs at all seasons, but especially at times when 
 changes of weather are frequent. The decisive symptom, the 
 shrill sound produced by the passage of the air through the wind- 
 pipe, which, once heard, can never be forgotten, developes itself 
 a few hours after the first embarrassment in breathing is per- 
 ceived. If this sign be absent, the case can hardly be regarded as 
 croup, though the term is often misapplied. Other marks of 
 the disease are a hoarse sonorous breathing, and a husky cough, 
 sometimes wholly dry, but, at others, attended with expecto- 
 ration of a purulent matter, in which may be detected frag- 
 ments of the membranous formation above named. The voice 
 is sometimes, but not always filtered. On examining the throat, 
 it will be found of a deep red colour, and in the struggles of 
 the child, a large quantity of pus will often be thrown up on 
 the tongue. The disease, whether it terminates favourably or 
 otherwise, is of short duration, often only a lew hours elapsing 
 before relief is obtained, or death terminates the case. When 
 the crins i- favourable, portions of the false membrane are some- 
 times expectorated, but in other instances the sputa offer no- 
 thing peculiar, in the most dangerous stage or degree of the 
 ere is often to be remarked a mottled complexion, or 
 a circumscribed llu>h in the cheeks. The pulse is small and 
 quick, the eyes prominent and blood-shot, the pupils dilated. Vio- 
 lent tossing alternates with lethargy according, to the difficulty of 
 breathing. The immediate cause of death is either actual suf- 
 focation, or the exhaustion incident to the rapid breathing, the 
 laborious action of the heart, and the imperfect supply of air. 
 Frequentlv, some hours before a fatal termination, the little suf- 
 ferer falls into a state of torpidity, and death is met with sur- 
 prising tranquillity. 
 
 In treating croup, the remedies principally relied on, are 
 bleeding, emetics, and calomel. Bleeding is employed, not only 
 with the view of relieving inflammation, but likewise to 
 diminish the engorgement of the lun^s. Emetics, also, apart 
 from their general effect, tend powerfully to effect a dislodg- 
 ment of the peculiar secretion within the throat. Calomel has 
 enjoyed a large share of confidence in croup; but it should 
 never be employed by the unprofessional assistant. 
 
44S cboup. 
 
 In domestic practice, where medical advice cannot be in- 
 stantly obtained, no time should be lost in waiting. Let the 
 little patient be bled very freely at the commencement of the 
 imethiog in the constitution of the child render 
 bleeding decidedly improper. ', i a child of three 
 
 years or u 
 
 if necessary, in half an hour. Ifttl j do not 
 
 duce vomiting, double its quantity or frequenc 
 be very mild. \ omiti . and. it" it appear not 
 
 in three hours, the warm bath romote it. 
 
 The pur| iceomplished \\ i ! 1 1 extreme difficulty, but 
 
 when free emi n, the patient, with ordinal 
 
 warm d 
 and the i 
 a l< ■• .. 
 
 diminished. All 
 
 avoi ■!■ 
 
 long it will ... 
 
 essentiall 
 wine in ' 
 
 sirup, i^ a vi i\ in at and safe A 
 
 single . . 
 
 b both safe and 
 The croup of adults, 
 that aboi 
 
 itself principally in th 
 
 brok d the 
 
 other p 11 re or 
 
 i the th: ; the 
 
 attack, accompank d with 
 hut with little or no cough. The in flam 
 
 ; lymph, ami then to be 
 
 ed in the larynx and wind 
 difficult breathing, an: 
 
 with tin- h mark croup in 
 
 dren. Another differ that the 
 
 Mimes the character of a im 
 
 therefore, is seldom mixed with any solid n it consists 
 
 principally of mucus or phlegm, md sometii 
 disease is commonly fatal under any mode of treatment. It 
 was probably this iat terminated ikl A'asb- 
 
 ington. 
 
CHOLERA MORBUS. 449 
 
 SECTION VI. 
 
 Diseases of the Abdomen. 
 
 Cholera Morbus or bilious cholera consists essentially in the 
 vomiting and purging of bile. This may commence as a 
 sequel of ordinary vomiting, when the contents of the stomach 
 have been discharged, but its irritability continues; or it may 
 occur spontaneously without any known cause of irritation 
 being present in the system. In cither form cholera is espe- 
 cially the disease of a hot climate, and never developes. itself in 
 our own, except during the summer, or early in autumn. 
 
 The remote cause of cholera, therefore, is heat applied to 
 the skin; and the immediate eflect of this application is gene- 
 rally supposed to be stimulation of the liver, and increased 
 secretion of acrid bile; but it may with equal reason be sup- 
 posed, that the immediate effect of the ovef-excitement of the 
 skin is to produce irritability of stomach and nausea, and that, 
 this cll'cct once produced, the secretion of bile follows as a con- 
 rice. Cold, or arrested perspiration, following exposure to 
 extreme and long continued heat, is among the most frequent 
 exciting causes of the disea 
 
 Tiie attack of cholera is generally sudden, the patient being 
 roused from uneasy tleep or suddenly alarmed during the day 
 by extreme nausea, and at once obliged to evacuate the stomach. 
 In some cases, pain, acid eructations, and a sense of lassitude 
 usher in the attack, in the order of events, the purging may 
 precede the vomiting, but the reverse is usually the case. The 
 matters rejected are, first, the undigested remains of food, if 
 any, then bilious matter more or less mixed with mucus,' and 
 then purer bile, varying from its characteristic yellow to a 
 green, brown, or black hue. The dejections either continue to 
 be bilious or change to a peculiar half watery discharge, 
 which has been compared to the washing of fresh meat. 
 
 Spasms, fust in the abdomen, and afterward in the extremi- 
 ties, are a frequent symptom, and under the combined influ- 
 ence of these causes, the strength is soon exhausted. If the 
 case be violent, collapse succeeds, and death may follow in a 
 few hours, unless the restorative power of nature, or the in- 
 terference of art afford some relief. 
 
 The stomach is the primary and principal seat of this dis- 
 . and to this organ must the treatment be especially acl- 
 
 57 
 
450 CHOLERA. 
 
 dressed; for if, by any means, its irritability can be relieved, 
 the management of the bowels will cause little trouble. 
 When the disease is seen at its commencement, it will be of- 
 ten sufficient to enjoin abstinence from those large draughts of 
 water, which the thirst incident to the disease induces the 
 patient to demand, but which are rejected as soon as taken, 
 and to direct small quantities of warm aromatic infusions, 
 such as those of mint, balm, chamomile, or horse-mint. But 
 when the vomiting has continued for several hours; when the 
 patience and strength of the subject are spent, and the more 
 serious symptoms begin to manifest themselves, there is no 
 longer any room for this inert treatment The arrest of the 
 vomiting is urgently demanded, and must be effected at all 
 hazards. Opium, camphor, and alcohol, have each a peculiar 
 control over the stomach; and a combination of the three, 
 which is offered by the paregoric tincture in common use, 
 will, in a lar^c proportion of I found efficacious. Aj 
 
 subsidiary means, a cataplasm of mustard to the stomach and 
 the feet, a spi r to the pit of the stomach, and the use 
 
 of small quantities of iced water, or solid ice. are strongly in- 
 dicated. With tl g of the vomiting, the intestinal dis- 
 charge* usually cease also; and so complete is the change, that 
 it ia often found i to administer a cathartic soon after 
 the arrest of the disease; for which reason we prefer giving 
 a dose of ins of calomel, as soon as the vomiting is 
 lulled for half an hour, in every severe case. 
 
 Spasmodic or Malignant Cholera, though familiarly 
 known in India, from time immemorial, has attracted atten- 
 tion in Europe and this country only within seven or eight 
 years; but. as genuine cases of this disease were occasionally 
 met with in this country prior to the epidemic attack, as 
 others are still showing ti, - in our large cities, and as 
 
 it has once or twice threatened to become epidemic a second 
 time, in certain sections of the country, a parsing notice of it 
 cannot be supcrlh:- 
 
 Spasmodic is distinguished from common cholera, by the 
 degree o( its violence and fatality; by the nature of th 
 charges; and by \ in which the nervou- 
 
 tern is affected. In place of the bilious vomiting and pui i 
 by which the latter is distinguished, the ^ov marked at 
 
 its onset by a profuse discharge in both directions of a colour- 
 less fluid, in which not a particle of bile can be traced, and 
 which, from its peculiar appearance, has been compared to rice 
 water. The cramp, which in the common cholera is an oc- 
 casional concomitant only, and comes on some hours after 
 the attack, is here among the earliest and m nit symp- 
 
CHOLERA. 451 
 
 toms. The spasms, commencing in the muscles of the belly, at- 
 tack in succession those of the thigh, legs, and feet, and after- 
 wards those of the chest, arms, and hands. These cramps 
 are fixed contractions of the body of the muscle, which is 
 gathered into a hard knot with excruciating pain. In the 
 course of a minute or two this relaxes; but it again returns or 
 is transferred to others; so that the sufferer scarcely enjoys an 
 instant of entire freedom. Sometimes the vomiting takes 
 precedence, as in common cholera; but often the purging 
 ushers in the attack, anil in some of the more rapidly fatal 
 cases, it is the only evacuation. 
 
 The collapse which sometimes occurs in the common cho- 
 lera, as an immediate precursor of a fatal termination, is often 
 the primary stage of the spasmodic disease. So sudden is its 
 onset, that the patient is sometimes struck down, as if by 
 lightning; passing at once from full health, to a state which 
 may be compared to a living death. 
 
 The collapse of cholera is so profound, that all the functions 
 of organic life appear to be nearly suspended. The action of 
 the heart is feeble and irregular; the pulse cannot be felt; and, 
 if a vein be opened, it is with the greatest difficulty that a 
 few drops of blood are obtained. Spontaneous vomiting or 
 purging may not be present; but if any liquid is swallowed, it 
 is often immediately rejected. The whole surface presents a 
 peculiar blue colour, and the hands and feet, when examined, 
 are found shrivelled, yet damp, like leather, after immersion 
 in water. t The extremities are chilled and the eyes sunk; the 
 tongue is cold to the touch; and a profuse cold sweat pours 
 from the whole surface. Spasms are among the regular symp- 
 toms of this stage, becoming less severe, in most instances, as 
 it advances; but although they often cease for some time be- 
 fore death, they not unfrequently continue even for an hour 
 after life has departed. 
 
 The voice is a peculiar, husky, or hoarse, but feeble whis- 
 per, and the perfect self-possession with which the patient re- 
 plies to questions in regard to his condition, coupled with the 
 sepulchral tone in which the answers are conveyed, serves 
 more than any other circumstance, to augment the horror of 
 the scene. So complete has been the collapse, in some instances, 
 that the vomiting, purging, and spasms, were all absent, and 
 the whole duration of the disease has varied from a few mi- 
 nutes to a few hours. We have seen death occur, in one case, 
 within five minutes after the attack, and in several others, with- 
 in an hour. Even in Paris and New York, individuals were 
 seized in the street, with retching, vertigo, &c, and before 
 they could be conveyed to an hospital, or any medical aid pro- 
 cured, were found to have expired. 
 
452 CHOLERA. 
 
 Even where ihe patient rallies from the state of collapse, 
 the final result is not always favourable. A febrile stage, re- 
 sembling typhus fever, often ensues, with loaded tongue, cool 
 s-kin, torpor without sleep, and sometimes wilh delirium. 
 This may terminate fatally, at the end of eight, ten, or twelve 
 clays. 
 
 Like all other epidemies, cholera has been most fatal at its 
 commencement, and as it progressed has become more ma- 
 nageable; probably, because the most susceptible subjects were 
 the first objects of attack, and the epidemic influence was more 
 slowly exerted upon those who, by their constitution and ha- 
 bits, were best calculated to oner effectual resistance. Thus, 
 the persons first seized have generally been the inhabitants of 
 unhealthy locations, persons of irregular habits, and those al- 
 ready suffering under disease. When these have been swept 
 off in great numbers, another class become affected, among 
 whom nil these predisposing causes are either absent, or i 
 in an inferior degree. Whatever mode of treatment, there- 
 fore, may have happened to be in vogue, during the prevalence 
 of a mild epidemic, or when I one lias expended its 
 
 force, obtains credit for the time: and hence, the numerous 
 and contradictory plans of managing the disease which have 
 been advanced with equal confidence. 
 
 Without attempting even to enumerate these plans, we shall 
 offer such remarks on the treatmei n to us best fitted 
 
 for the guidance of the domestic practitioner, when medical 
 assistance cannot be obtained: remarks founded on considera- 
 ble acquaintance with the disease, acquired in more than one 
 hemisphere. 
 
 When cholera is ushered in by premonitory symptoms of 
 diarrhoea, accompanied by occasional sinking spells, some li- 
 vidity of the lips and nails, and frequently, wandering neural- 
 gic pains, it is of the utmost importance to check these symp- 
 toms at once, and this may often be cfiectcd by very simple 
 means: a little lavender compound, taken occasionally, and 
 followed by half a tea-spoonful of paregoric elixir — or a table- 
 spoonful of the camphor julep, (though the preventive powers 
 of camphor have been most ridiculously, if not criminally 
 aggerated,) or a draught of strong mint tea, with a total avoid- 
 ance of all food, except arrow root, the gruels, or panada, will 
 generally succeed in twelve hours. Irritants are more to be 
 dreaded than simple stimulants, and notwithstanding the low 
 diet, a glass of good port-wine sangaree may be taken at din- 
 ner time, by those accustomed to wine. If these remedies 
 fail in cheeking the diarrhoea, or if this discharge be very pro- 
 fuse, the following much more powerful prescription will 
 rarely fail. 
 
C HOLER Aw 453 
 
 Take of, Prepared chalk, 2 drachms. 
 
 Powdered gum Arabic, 2 drachms. 
 Pure water, 5 ounces. 
 
 Mix them thoroughly in a mortar, and then 
 Add, Laudanum, 2 drachms. 
 
 Tincture of Kino, J an ounce. 
 
 Dose — a table-spoonful every two or three hours. 
 
 When the attack comes on, notwithstanding all our efforts, 
 the practice must be much more energetic. If the vomiting 
 be, as it almost always is, a prominent symptom, it may some- 
 times be checked by giving a table-spoonful of common salt, 
 dissolved in a tumbler of water — half to be given at once, and 
 the remainder, if the vomiting continue unabated, in thirty 
 minutes. A small injection of some stimulant tea, such as 
 the horse-mint, (monarda punctata,) if accessible, or the com- 
 mon garden mint, with two drachms of laudanum, will some- 
 times aid in checking the vomiting. 
 
 The moment that the efforts of the stomach are lulled, or if 
 this result cannot be effected in an hour, then without regard- 
 to the discharges, give fifteen grains of calomel, mixed with 
 just enough molasses to enable the patient to swallow it. 
 
 From the first, let hot bricks, or bottles of water, be applied 
 to the extremities and the stomach, and if possible, have a light 
 muslin bag or pillow case filled with hot bran, as a substitute 
 for the bottles or bricks applied to the abdomen, which are 
 managed with difficulty on account of their weight and form. 
 Dry heat is greatly preferable to steam or moist applications. 
 Administer also, a tea-spoonful of lavender compound, with an 
 equal portion of paregoric elixir, every hour; let the patient 
 chew slowly small pieces of ice, or if this be unobtainable, let 
 him take frequently half a wine-glassful of the coldest water 
 to relieve the urgent thirst ; and endeavour to relieve the mus- 
 cular spasms by strong pressure with the hand, as they occur. 
 
 When the patient shows a disposition to sink into collapse, 
 mustard plasters should be freely applied to the wrists and an- 
 kles, and when the collapse is confirmed, a large one should be 
 placed on the abdomen, over which warmth should be con- 
 tinued. 
 
 In mature collapse, the internal medicines should be omitted, 
 and in their place a table-spoonful of brandy or old whisky, 
 with not more than an equal quantity of water, and ten drops 
 of laudanum, should be given every half hour. Five grains 
 of calomel every twelve hours may also be continued through- 
 out the case. 
 
 On the cessation of the discharges in the collapse, the lau- 
 danum should be omitted, but the brandy continued; and when 
 the cramps disappear, the heat applied to the surface should 
 
454 DIARRHffiA. 
 
 be moderated. On the first signs of low, muttering delirium, 
 which, we believe, never occur until after the final arrest of 
 the discharges, the course of treatment should be changed, and 
 that adapted to typhoid fever substituted for it. 
 
 In those cases of instantaneous or very sudden collapse which 
 are almost peculiar to tropical climates, wherein the pulse at 
 the wrist is imperceptible at the moment of attack or within 
 fifteen minutes thereafter — wherein, if fatal, death follows in 
 from twenty minutes to twelve hours, and if the patient sur- 
 vive twenty-four hours, he is considered safe, — the collapse 
 must be treated with still greater promptitude. A towel, dipped 
 in boiling water, and very slightly cooled by evaporation, should 
 be thrown on the surface of the abdomen as quickly as possi- 
 ble. It will seldom create a redness there ! A drachm of lau- 
 danum should then be given, followed in ten minutes by a gill 
 of brandy slightly diluted. The doses of brandy and laudanum 
 above prescribed for the milder cases, may then be doablcd, 
 and continued till the pulse return^. A dose of twenty grains 
 of calomel may be given at any convenient and early moment, 
 and dry heat and mustard plasters liberally employed. 
 
 Recovery from these cam, where it occurs, i* usually \ 
 rapid, and we have seen in several instances the sufferer, at- 
 tenuated and with a loosened skin, still unretracted from the 
 enormous loss of matter by the discharges, yet pursuing his 
 usual avocations on the day succeeding the attack ! Indeed, in 
 contradiction to received opinion, we believe that the morta- 
 lity among the cases of sudden collapse, when the practitioner 
 can reach the patient before death, will be found less com 
 rable under fearless treatment, than in more protract 
 
 Of course, these directions are intended for adults when the 
 disease is epidemic, severe, and at its height, — and must be ren- 
 dered proportionally more mild in young sons, seat! 
 cases, more moderate epidemics, and the decline of even the 
 severest. 
 
 Diarrhoea or looseness consists in an increased frequent J 
 the discharges from the bowels, the matter | Idom va- 
 
 rying from its usual character, except in becoming more loose 
 and watery. Each evacuation is immediately preceded by 
 griping pain, which is relieved by the discharge itself, and 
 not return, except with the succeeding sjtooL T1k i rally 
 
 moderate, not extreme thirst: the appetite impaired, but not 
 wanting; some tenderness is discovered on pi 
 the bowels, and an unusual accumulation of fluid can be ; 
 ceived within their cavity. This dis d by external 
 
 influences of less activity, but of the same character, as those 
 which produce cholera: but it is more frequent in summer, and 
 especially in autumn, when the alternate action of heat and 
 
DIARRHCEA. 455 
 
 cold is aided by the abuse of fruits and crude vegetables. A 
 slight increase of evacuations, produced by indulging somewhat 
 freely in ripe fruit, is not to be regarded as a disease; but a 
 very moderate disorder of this kind, when combined with the 
 influence of atmospheric changes, or operating on an unusually 
 irritable constitution, may give rise to diarrhoea; and hence, 
 excesses which may be practised at one time with impunity, 
 will, at another, produce serious results. 
 
 Diarrhoea, induced by exposure merely, may be regarded 
 without impropriety, as a catarrhal affection ; and we have al- 
 ready remarked, that among the modes in which catarrh of the 
 lungs finds a natural termination, the transfer of the increased 
 secretion to the alimentary canal is by no means the most unu- 
 sual. Others, among less frequent causes, are certain affections 
 of mind, as anger, disgust, and especially fear. In some per- 
 sons, certain articles of diet, not generally injurious, will al- 
 ways produce it. It is a very common attendant on the pro- 
 cess of teething. 
 
 The increased secretion from the coats of the intestines has 
 undoubtedly a tendency to relieve pre-existing irritation, and 
 therefore should not be too suddenly checked. On the contra- 
 ry, it is often advisable to promote it, at the commencement, 
 by some mild cathartic. For this end, a spoonful of oil answers 
 perfectly well, or, perhaps still better, a few grains of rhubarb, 
 which generally has an astringent after its cathartic operation. 
 The effects of laxatives are somewhat various. Sometimes the 
 discharges seem to be merely increased in quantity by them, 
 without any change of character. More frequently, however, 
 they check the disease until after the operation of the medi- 
 cine, and this is especially the case when a slow cathartic, such 
 as rhubarb, is exhibited. Sometimes the action of this last ar- 
 ticle, even in its common dose, is simply astringent, and the dis- 
 ease disappears, upon its administration, as if by charm. Even 
 when the cathartic increases the discharge without changing 
 its character, the disorder may cease spontaneously under pro- 
 per regulation of the diet. Should it not do so, a grain of 
 opium or twenty drops of laudanum may be given at night, 
 and the cathartic repeated in the morning, if the diarrhoea 
 continue. Even when the discharges are delayed by the ca- 
 thartic, an opiate may be given, but is not often needed. The 
 principal benefit of opium seems to be a check to the discharge 
 of the secretion for a few hours, which prevents the necessity 
 of rising during the night. Taken prematurely, and followed 
 up as is sometimes recommended after every discharge, it often 
 does unquestionable harm. 
 
 The more general but all-important means of controlling di- 
 arrhoea, are to be fround in rest, attention to the clothing, and 
 
456 DIARRHCEA. 
 
 regulation of diet. Bodily exercise must be avoided ; a rule 
 difficult to follow, while the disease is only felt as an oc- 
 casional inconvenience, but one which is absolutely indispensa- 
 ble. The skin should be protected by sufficient clothing, of a 
 character to afford security against sudden chills; for which 
 purpose flannel is the best of tissues. The diet should consist 
 almost exclusively of the milder vegetables. The morning and 
 the evening meal must consist of tea, or the shells of cocoa, or 
 boiled milk with bread. Rice, sago, tapioca, or the simplest 
 meat broth should form the dinner, and it is better to take it 
 at short intervals than as a regular meal. 
 
 Even after the disease appears to be checked, it is absolute- 
 ly necessary to continue these precautions; for an imprudent 
 exposure to the night air, a fatiguing walk, or a dinner, will 
 often undo the labour and care of a week, or perhaps convert 
 the disorder, from the manageable form in which we have 
 hitherto considered it, into a true dysentery. 
 
 In addition to the above, which is the common acute diar- 
 rhoea, various forms of chronic discharges from the bowels are 
 mentioned by authors, to which it will be sufficient to make 
 very cursory allusions. One of termed while looseness, 
 
 from the milk ranee of the dejections, which resemble 
 
 lime-water. It occurs chiefly in persons in whom the functions 
 of the liver have been much impaired by residence in a warm 
 climate. It sometimes succeeds the bilious fever of our south- 
 ern states, or is the effect of the combined action of external 
 heat, and a stimulating diet. Though not rapidly fatal, it is 
 cured with difficulty, and by repeated attacks finally exh 
 the system. 
 
 There is a disease called Uentery, in which the food pat 
 through the bowels unchanged. Its proximate can 
 creased irritability in the muscular system of the stomach and 
 bowels, independently of the influence of cold, or any peculi- 
 arly irritating quality in the food itself. The food is not. 
 diarrhoea, urged through the intestines because it is indi_ 
 ble; but it is undi the state of the intes! 
 
 does not allow time for the nutritive juices to be absorbed. In 
 (fibular looser* m the mucous membrane, pre- 
 
 serving a tube-like form, are thrown off. — The dischar_ 
 masses of fat. which are recorded in collections of medical cu- 
 riosities, need only be mentioned. The common form of • 
 nic diarrhoea, is serous or watery, and results frequently from 
 the neglect of the acute form, which is allowed to become a 
 habit of the system. The diarrhoea incident to the lat 
 of consumption, and which always aceelera: tal termi- 
 
 nation is ascertained to depend on inflammation and ul 
 tion of the intestinal tube. The treatment of none oi the>L 
 rieties should be attempted by the domestic practitioner. 
 
DYSENTERY. 457 
 
 Dysentery. The characteristic symptom of dysentery, is an 
 earnest desire to evacuate the bowels, followed by severe 
 straining efforts, which expel a little of the mucus that natu- 
 rally covers the surface of the intestine. This generally re- 
 sembles a mass of jelly, is often mixed with blood, but always 
 unmixed with any of the natural bilious discharge from the 
 canal. This evacuation relieves the pain for the moment, but 
 after no long interval, the same desire returns, and is followed 
 by the same result. If, mean while, the true fecal matter is ex- 
 pelled at all, it appears in small, dry masses, which appear to have 
 been retained for an unusual period. Continued fever, which 
 is increased towards evening, accompanies the disease, and, 
 with the increase of fever, the local symptoms are also aggra- 
 vated. As the disease advances, the true mucous character of 
 the stool is exchanged for one having rather the appearance 
 of matter from an ulcer or open sore. The termination is va- 
 rious. Sometimes recovery is effected by a single remedial 
 measure, sometimes after three or four days of treatment, and 
 sometimes at the end of many weeks. When the disease is 
 epidemic, and of severe character, the patient often dies with 
 extensive inflammation; and, if neglected, the disease fre- 
 quently passes into a chronic form. 
 
 The slimy and bloody discharges in this disease, are un- 
 doubtedly dependent on inflammation of the mucous membrane 
 lining the bowels; but in what manner is the absence of the 
 natural feces to be explained 1 By some, this has been attri- 
 buted to a spasm or stricture of the large intestine, at its upper 
 part, by which the feces are supposed to be mechanically pre- 
 vented from descending; an explanation attended with some 
 difficulties, and which we shall not stop to examine. 
 
 The tenesmus, or straining in dysentery, is one of its most 
 striking symptoms, and shows how completely independent of 
 anv solid matter in the intestine, is the desire for evacuation. 
 
 A tea-spoonful of semi-fluid matter arouses the activity of the 
 part when in this irritable state, even more than actual disten- 
 tion when the bowel is in health. This tenesmus, when the 
 disease has continued for some days, becomes the cause of 
 much pain and faintness, and at a later stage causes serious in- 
 convenience, especially in children, by occasioning a protrusion 
 '*- f the mucous membrane or bowel itself. 
 TVv^-o treatment of dysentery in its incipient stage, the only 
 one Winch we propose to consider, is simple. If evidently 
 the result of excess, if accompanied with nausea or other 
 symptoms of deranged stomach, or if simply attended with 
 (ever and headach, an emetic will be highly proper; but this 
 remedy is absolutely inadmissible when the disease prevails 
 
 58 
 
458 DYSENTERY. 
 
 as an epidemic. In these visitations the rules of ordinary ex- 
 perience cease to guide us, and it is often found necessary to* 
 omit remedies which, on general principles, seem decidedly 
 called for. In ordinary cases the effect of an emetic, given 
 at the invasion of this disease, is highly salutary, and often 
 succeeds in arresting its progress. This may happen in va- 
 rious ways. In the first place, there is a stronger sympathy 
 between the stomach and the rectum and colon, than between 
 any intermediate portions of the canal; and whoever has at- 
 tended a chronic disease of the lower bowels, must have ob- 
 served that there is no other cause by which this disease is ag- 
 gravated so quickly and certainly, as by the presence of undi- 
 gested aliment in the stomach, and that there are often no 
 means of relieving an attack so certain as that of emptying 
 this organ. In persons predisposed to dysentery, it is fre- 
 quently found to recur immediately on committing an im- 
 prudence in diet, and before the irritating cause can have 
 passed beyond the stomach itself. Secondly, an emetic is 
 often the most complete of all cathartics; producing evacua- 
 tions in both directions, changing the whole secretion of the 
 canal, and converting the existing affection into an artificial 
 and very manageable form of cholera. Thirdly, an emetic 
 is one of the most powerful sudorifics; and when the disease 
 lias arisen, as often happens, from suppressed perspiration, this 
 affords a direct means of restoring the suspended action. In- 
 deed, we know of no single remedy so likely, when adminis- 
 tered at the very outset of the disease, to effect a complete 
 cure; but where the case has been suffered to run on un- 
 checked to the second or third day, we cannot recommend 
 this mode of treatment with the same confidence. Bleeding, 
 which is sometimes necessary, can only be employed safely 
 with limitations which it belongs to the experienced practi- 
 tioner to estimate. The remaining remedies are a cathartic 
 and an opiate. Which of these shall enjoy precedence of the 
 other, is a question often settled by convenience alone. If, for 
 example, we wish to afford immediate repose, which is often de- 
 sirable at night, fifteen grains of Dover's powder may be given 
 at once, and even repeated in four or five hours, if the morbid 
 evacuations recur. Opium, given in this way. does not inter- 
 fere with the subsequent operation of a cathartic. Its effect 
 istodiminish increased sensibility, and moderate the augmented 
 action. Its influence in both these respects is more likely tu 
 be directed to the rectum, where both these derangement- 
 ist, than to the intestines above, which are already in a s 
 of torpor. Hence we usually find that for some hours after 
 an opiate, although the canal may be still unrelieved, the irre - 
 
colic. 459 
 
 •gular action is suspended. As a general rule, however, a mild 
 aperient will be first administered. We cannot agree with 
 those practitioners, however intelligent and respectable, who 
 deny the expediency of giving cathartics at all, and advise 
 that enemata alone should be trusted to for the removal of 
 accumulations. This remedy is, however, a useful auxiliary 
 in removing hardened feces, and is useful in other ways, if 
 it be given in such quantity and of such temperature as to 
 produce free perspiration, whrch it may easily be made to do. 
 
 Among the collateral sources of benefit in dysentery may 
 be mentioned external Warmth, which is as much needed and 
 better borne in this disease than in cholera. Mucilaginous 
 drinks, such as flaxseed tea, barley and gum water, mucilage 
 of slippery elm bark, and of the pumpkin seed, are grateful, 
 and do much good by lubricating the surface of the canal. 
 The use of blisters to the bowels in the early stage is seldom 
 needed; that of warm fomentations is highly advisable. The 
 excoriation about the lower passage is a source of great an- 
 noyance, and is best relieved by the application of unsalted 
 lard. Another troublesome, but necessary precaution in chil- 
 dren, is to oblige them, from an early period, to allow the eva- 
 cuations to pass from them in a recumbent posture. This 
 will much diminish the straining. The last two directions 
 belong to the treatment of the disease, if protracted; but they 
 are addressed to the nurse rather than the practitioner, and 
 may therefore be pardoned. 
 
 The after treatment of dysentery, and the management of 
 'the dreadful varieties of this disease often seen in hot climates 
 and during certain epidemic attacks in temperate countries, 
 are subjects on which we dare not give instructions to the po- 
 pular reader; for the employment of the formidable measures 
 necessary in some of these cases might prove, in his hands, 
 more dangerous than the disease. 
 
 Colic. An intermittent, griping pain in the belly, princi- 
 pally about the navel, forms the general and leading symptom 
 of colic. It is often met with as a concomitant of some of the 
 affections elsewhere noticed, as of surfeit, flatulence, costive- 
 ness, &c. Viewed as a distinct disease, however, it embraces 
 a frequent and important class of cases, to which the sudden- 
 -ness of the attack, the severity of the pain, and the necessity 
 of prompt and efficient measures, impart peculiar interest. 
 
 We have said that the pain in colic was intermittent. The 
 intervals, however, are of much less duration than in diarrhoea, 
 and the disease is unaccompanied by discharges downward. 
 The navel is generally retracted during the pains. There is 
 vomiting, sometimes of undigested food, sometimes of bile; 
 
460 colic. 
 
 and in the very severe cases called iliac passion, the contents 
 of the bowels themselves are thrown up. 
 
 The causes of colic are. among others, the application of 
 cold to the body when heated, long continued costiveness, the 
 abuse of emetic and cathartic medicines, imprudence in diet, 
 under the influence of mercurial or other medicines; opium- 
 eating, the use of crude and indigestible vegetables, and excess 
 in eating. The immediate cause is constriction of the bowels. 
 
 The objects in treating colic are, to remove the offending 
 cause, to relieve pain, and to procure an evacuation from the 
 canal. An emetic is often advisable, even if we are not per- 
 fectly certain of the presence of offending matter in the sto- 
 mach. When there is nausea, sense of oppression, and head- 
 ach, and no spontaneous vomiting has occurred, the necessity 
 of an emetic may be regarded as unquestionable. When spon- 
 taneous vomiting has occurred, but the nausea and headach 
 continue, the same remedy will probably bring away bile, and 
 afford ultimate, though not very prompt relief. Jn these cases 
 we suppose an offending matter to have been present; but 
 even though the stomacli may have been empty from the com- 
 mencement, an emetic may still be of service by producing an 
 increased flow of Ule, and favouring the evacuation of the 
 bowels. On the other hand, this remedy is decidedly objec- 
 tionable when the action of the intestines is inverted, and a 
 vomiting of feces is present ; when the pain is extreme and 
 demands instant relief; when vomiting has produced general 
 exhaustion or collapse. Of the first of these cases, which is 
 termed iliac passion, and constitutes the most dangerous form 
 of the disease, we shall speak hereafter. 
 
 For the relief of pain, the most powerful remedial memos 
 possess, are blood-letting and opiates. Where active symp- 
 toms must be checked at all hazards, there is no remedy, the 
 effect of which follows so immediately as that of bleeding In 
 live minutes, it may often be made to produce fainting: in 
 which state, for the moment at least, relief is certain. " An- 
 other advantage of bleeding is, that it favours other evacua- 
 tions. If employed when the stomach is full, unless this o 
 is peculiarly debilitated, it produces vomiting. It also pro- 
 motes evacuation in the opposite direction, as is proved by the 
 patient being often compelled, even in the severest cases of 
 colic, to go to stool before the arm can be bandaged. It is the 
 most powerful of all anti-spasimxlies, and also favours sweat- 
 ing. Bleeding, therefore, in emergencies, is the most valuable 
 remedy we possess. It is interdicted, like emetics, when con- 
 tinued vomiting has produced much exhaustion. Opium i* a 
 valuable medicine in colic, and frequently acts most satisfacto- 
 rily in relieving both pain and spasm. It is particularly de- 
 
colic. 461 
 
 manded when an active bleeding has reduced the vigour of the 
 circulation, and when nothing remains but an obscure sense of 
 pain with a feeling of debility. 
 
 In the form of laudanum, or paregoric elixir, it often serves to 
 relieve the vomiting, with which each return of the pain is 
 sometimes followed. The last object is still more certainly 
 efFected by opiate injections, consisting of some warm mucila- 
 ginous liquid containing from twenty to thirty drops of the 
 laudanum. The use of opium has been objected to, as tending 
 to produce constipation, and thus to interfere with the subse- 
 quent operation of purgatives; but though opium tends to check 
 the natural evacuations, yet this effect does not seem to be 
 proportional to the dose; and after very considerable quantities 
 have been given for the relief of pain or spasm, it is- not found 
 that cathartics act with much less force than before; some- 
 times, indeed, they act even more readily, for cathartics taken by 
 mouth will not usually operate, until the pain and the irritability of 
 the stomach are subdued. Cathartics, given by way of clyster, 
 in any stage of the complaint, are often highly serviceable. In 
 some of the most obstinate and protracted cases of constipation 
 in colic, relief has been obtained by the gradual introduction 
 into the rectum of large quantities of warm fluid, from four to 
 five pints, for example, either uncombined, or with the addi- 
 tion of some oily ingredient. It is doubtful whether this remedy 
 reaches the actual seat of obstruction ; but the general relaxa- 
 tion of the whole system, evinced as it is by profuse perspira- 
 tion, is sufficient, in itself* to explain the result. This simple 
 expedient deserves to be tried, in every case where serious 
 difficulty is met with in effecting evacuations. Among cathar^ 
 tics, the most proper in this disease are those which are most 
 likely to be retained by the stomach; and this is especially the 
 case with those which can be given in a liquid form, and pos- 
 sess a certain aromatic flavour. Even before the morbid irri- 
 tability of stomach is wholly controlled, small quantities of some 
 compound infusion, like that of senna, given at intervals and 
 steadily persevered in, will often restore the bowels to their 
 appropriate functions. 
 
 Among the less powerful auxiliary means, employed in this 
 disease, are fomentations and blisters. The continued appli- 
 cation of heat and moisture, will be found to afford very con- 
 siderable relief, in many instances. External irritants, such 
 as rubefacients and blisters, are not deserving of so much con- 
 fidence. They require much time, and, when they fail, in- 
 crease the suffering of the patient. 
 
 The form of colic, termed ileus or iliac passion, is distin- 
 guished by the inverted action of the intestinal canal, through- 
 out nearly its whole course; so that apparently fecal matter 
 
462 painter's colic. 
 
 -is actually forced upwards, and rejected from the mouth. 
 The pain in this disease is severe, and the danger imminent. 
 It is extremely difficult to determine the condition of the in- 
 testine during life. After the termination of fatal cases, one 
 portion of intestine is sometimes found to have descended 
 into and become enclosed by another; and, in some instances, 
 nooses or knots have been formed by the bowels; the encir- 
 cling portion being even drawn so tight as to produce stran- 
 gulation, followed by gangrene. Our remarks on the treat- 
 ment of this form of colic, are designed merely to prevent 
 the domestic practitioner from doing mischief, by employing 
 certain remedies useful in common colic, but fatal in ileus — 
 it would be folly in the unprofessional to undertake any de- 
 cided responsibility in the management of the latter, except, 
 perhaps, to employ a few very obvious precautions. This 
 disease almost always baffles the wisest, and. nature may be 
 more safely depended upon than the blind efforts of the igno- 
 Tant. 
 
 Blood-letting, fomentations, and injections are. at least, as 
 decidedly indicated in this form as in the preceding. Vomit- 
 ing is of course forbidden, and cathartics are generally ren- 
 dered useless by the irritability of the stomach. Calomel, in 
 conjunction with opium, and sometimes one or the other se- 
 parately, have been known to check the vomiting, and then 
 cathartics have proved effectual. Beyond this, the rase must 
 be left to nature or the physician. 
 
 Painter's Colic. This form of colic is distinguished from 
 every other, partly by its cause, which is the absorption of 
 lead into the system, and partly by certain peculiarities in its 
 progress, which we shall proceed to notice. The pain is 
 usually seated, from the beginning to the end of the attack, in 
 The pit of the stomach: from this point, it passes upwards into 
 the arms, and downward to the navel, back, loins, and lower 
 portion of the abdomen; sometimes extending to the thighs 
 and legs. Along with this pain there is great external sore- 
 ness, so that the patient is scarcely able to bear the slightest 
 pressure. The bowels are firmly bound from the commence- 
 ment of the disease. Nausea and retching begin on the se- 
 cond or third day, and are followed by vomiting of slimy and 
 bilious matter. As the pain increaa attacks of retch- 
 
 ing and vomiting become more frequent and severe, and con- 
 tinue till a favourable change occurs. Toward the close of 
 the disease, the feet sometimes assume a red and swollen ap- 
 pearance. The first symptom of a favourable change is often 
 profuse sweats, accompanied by a rash. The pain now be- 
 comes more tolerable; the patient feels an earnest desire to 
 evacuate the bowels, and, on making the attempt, succeeds in 
 
painter's colic. 463 
 
 passing away some masses of hardened matter, of a rounded 
 form and perfectly dry. When the disease has recurred se- 
 veral times, which it will continue to do from the same cause, 
 the upper limbs are at length attacked with palsy; the fingers 
 become contracted from a loss of power in the extensor mus- 
 cles, so that when the arm is extended, the hand hangs down; 
 and the limb thus affected, gradually shrinks. The fit itself 
 is not often fatal. Its duration, under, the most favourable 
 circumstances, and the most judicious treatment, is seldom 
 less than five or six days. 
 
 The disease was at one time termed the Devonshire colic, 
 or colic of Poictou, from being most common in those parts 
 of England and France. The reason of its prevalence in these 
 places, was discovered by Sir George Baker, who ascertained, 
 that the cider of the former country, and the light wine of the 
 latter, contained, in solution, a certain amount of lead. The 
 announcement of this occasioned great alarm to those accus- 
 tomed to drink water from leaden pipes, but it is found that 
 water, when pure, does not possess the power of dissolving 
 metallic lead, and may, therefore, be kept in it, for any period, 
 with entire impunity. 
 
 The laws of the action of this poison are involved in much- 
 obscurity. The most deleterious mode of exposure to its ef- 
 fects, is the inhaling, in large quantities, the fumes which 
 arise from fresh paint, which is prepared by grinding white 
 lead in oil. Lying for a few hours in a close room freshly 
 painted, has proved sufficient to produce colic, palsy, and even 
 sudden death. The following case, known to the author, il- 
 lustrates the rapidity with which a fatal result may take place. 
 A painter of irregular habits, returning to his lodgings at a 
 late hour, and being unable to obtain entrance, went into the 
 shop where were some window-blinds just painted, shut him- 
 self in and went to sleep. The next morning he was found, 
 suffering great agony, but already paralytic. About noon, he 
 expired. 
 
 All persons habitually exposed to the contact or inhalation 
 of the oxydes of lead, are liable to attacks of colic. The ma- 
 nufacturers of white and red lead are the greatest sufferers; 
 then come painters, miners, plumbers, type founders, glaziers, 
 potters, and printers. In all these, the liability to the action 
 of the poison, is very greatly increased by want of cleanliness 
 in the poison and clothing, and by intemperance. The abun- 
 dant use of animal fat as an article of diet, is said to be a pre- 
 ventive. 
 
 The attacks, when they occur, seldom yield to any other 
 treatment than the persevering use of purgative medicine; and 
 no advantage appears to be gained by resorting to the more 
 
464 LIVER C03iPLAI>'T. 
 
 violent remedies of this class. In many instances, the disease 
 will yield to the continued use of castor oil, in small doses, 
 repeated every two or three hours. This may be aided, in 
 obstinate cases, by injections of the same article, or of oil of 
 turpentine. Where these remedies have failed, tobacco has 
 been resorted to, and in some instances, the external applica- 
 tion of cold water has produced a salutary shock; but these 
 are dangerous and uncertain remedies, and only justified by 
 unusual emergencies. The fact we have mentioned already, 
 that the disease will, to a certain extent, have its course, must 
 be kept in mind; or the strength of the patient may be ex- ■ 
 hausted, and unnecessary danger incurred by attempting to 
 effect, prematurely and violently, what nature, if left to her- 
 self, would perhaps be able to accomplish. 
 
 Liver ( 'ompUunL The presence of inflammation of the liver, 
 is recognised by the following symptoms. Together with chill 
 and lever, there occurs pain on the right er the arches 
 
 of the false ribs. The pain is accompanied with some degree 
 of soreness, and tenderness on Daily 
 
 yellow, and the stools clay-coloured. Thirst, a furred tongue, 
 and nausea, are also symptoms; and there is short di 
 dependent, as is generally thought, on irritation of the diaphragm," 
 with which the liver lie's in close contact. Some varie 
 produced in the signs of the disease, by the particular seat of 
 the inflammation. If it be on the surface of the oriran. the 
 suffering is greater than when it is more deeply seated. On 
 the other hand, jaundice is a more prominent symptom, w 
 the disease affects the substance of the orscan, than when it is 
 limited to the surface. In the latter case, the duration of the 
 disease is often short, and resolution takes place on the third, 
 fourth, or fifth day. This result is often marked by critical 
 hemorrhage from the nose, by copious bilious discharge from the 
 bowels, profuse sweat, or turbid urine. Inflammation of the 
 substance of the liver, when not checked, occasionally forms 
 abscess; an occurrence recognised !»•• hills, and external 
 
 swelling over the part, son:' rtiuct hut 
 
 deep-seated fluctuation. 
 
 The course taken by the matter, under these circui 
 is various. Sometimes it approaches the surface, and the sur- 
 geon is enabled to give it vent : sometimes it dischar. 
 into the neighbouring portion of intestine : in which case the 
 pus is discharged by vomiting or . often producing a fatal 
 
 termination within a few hours; and sometimes it passes through 
 the diaphragm into the chest, opening either into the pleural 
 cavity, where it forms an empyema, or into the lungs, from 
 which it is rejected in large amount bv the mouth. In a 
 instances the abscess has been known to open into the cavity 
 
LIVER COMPLAINT. 465 
 
 of the abdomen, where it produces extensive inflammation and 
 death. Abscess, however, from acute hepatic inflammation, s 
 rather uncommon in temperate climates. The substance of 
 the organ is more likely to take on other changes, to become 
 indurated and altered in structure, with increased liability to 
 irritation from the action of remote causes; and thus the in- 
 flammation is rendered chronic. In this form, the pain is less 
 acute, and there is less sympathetic disturbance and general 
 fever. Both acute and chronic inflammation of the liver, are 
 frequently accompanied with pain in the right shoulder, a symp- 
 tom too vague to be much depended on, and one to which un- 
 due importance has been attached. 
 
 Inflammation of the liver is seldom a subject for the domes- 
 tic practitioner, and it is then generally the acute form, induced 
 by excess or atmospheric vicissitude, which demands his assis- 
 tance. 
 
 The abuse of drastic cathartics, especially such as are com- 
 monly sold as specifics, will sometimes bring on an attack of 
 this kind. In these cases the presence of nausea and jaundice 
 will render proper the administration of an emetic; and if chill 
 and general fever be manifested, a gentle perspiration must be 
 excited and encouraged, the bone-set tea, and sweet spirits of 
 nitre being among the best means of effecting this purpose. If 
 the emetic fail to move the bowels, a gentle dose of salts or 
 oil may be employed for this purpose. 
 
 General bleeding is not found to exert the same beneficial in- 
 fluence in this disease, which it exhibits in pleurisy or lung fe- 
 ver. It is useful at the outset, in severe cases; but it must be 
 vigorously followed up by cupping or leeches, to the affected 
 side. These may be advantageously succeeded by fomenta- 
 tions, or, when the force of the pulse has been diminished, by a 
 blister; the latter being best suited to the superficial form of in- 
 flammation, the former to that which is deeper seated. The 
 farther treatment will naturally come under the cognizance of 
 the regular practitioner. The occurrence of severe and re- 
 peated chill, after the second or third day, will inspire a suspi- 
 cion that suppuration is taking place, and suggest the neces- 
 sity of employing those means which are found to accelerate 
 this process; of which, heat and moisture externally applied 
 are the most important. The care and management of hepatic 
 abscess, however, demands all the resources of practised surgi- 
 cal skill. 
 
 Chronic inflammation of the liver, though, as above stated, 
 frequently a sequel of the acute affection, is often developed 
 insidiously, and, under this form the disease deserves a sepa- 
 rate consideration. As seen in temperate regions, it is often 
 induced bv long continued habits of excess, or supervenes in 
 
 59 
 
468 ; irrrLAMMATiox of the kidney. 
 
 obstinate intcrmittents. It is indeed generally accompanied 
 with fever of remittent character, having a daily evening exa- 
 cerbation. The pain is often obtuse or even absent; but the 
 organ, on examination, will generally be found harder and 
 larger than natural, while the digestion is imperfect, the bowels 
 costive, and the stools usually ciay-coloured. This form of the 
 disease is too often the index of a decayed and broken consti- 
 tution, and, as such, yields with great reluctance to the most 
 judicious treatment. 
 
 Inflammation of the Kidney. The symptoms of infiam- 
 rnation of the kidney are. in general, pain in one of the loins, 
 shooting toward the bladder; numbness of the affected side; 
 continual desire to pass urine; vomiting; and retraction of the 
 testicle. The disease is most frequently dependent on ob- 
 struction of the ureter by some mechanical obstacle, especial- 
 ly calculus: it sometimes also results from mechanical violence, 
 or from poisoning by Spanish flies. In these instances the 
 symptoms are strongly marked, and the history of the case 
 points out its character: but sometimes the only assignable 
 cause is cold; and in these cases it is not always easy to dis- 
 tinguish the affection from rheumatism. In the latter, how- 
 ever, the pain is usually felt in both loins: there is no desire 
 to urinate, no pain in the course of the ureter, and no retrac- 
 tion. That the symptoms indicate actual inflammation, and 
 not mere neuralgic affection of the kidney, must be inferred 
 from their constancy and from the state of the pulse. It often 
 happens, for example, that the presence of a 
 or other cause may give rise to nervous irritation, accompa- 
 nied by many of the signs of inflammation: but in tl. 
 the pulse is comparatively but slightly affected, and the pains 
 generally exhibit, decided remission. 1> 
 
 generally rr.n>< high: and i^ singularly marked by frequent mo- 
 mentary chills. Acute inflammation oi the kidney, not de- 
 pendent on mechanical injury, is usually relieved, under active 
 treatment, in from twenty-four to thirty-six hooi 
 being often accompanied with a cop ' of urine, 
 
 times, however, suppuration of the organ follows: in this i 
 the pain is su< . on the third or fourth day. by tor 
 
 heaviness; of the part, and soon nft< r 1 chill superv 
 
 The matter is sometimes discharged by the bladder, some 
 by an external opening, and - e ab- 
 
 domen. The first, as might be supposed, is the most favoura- 
 ble termination: (he last is almost certainly fatal. 
 
 The remedies for this form o( inflammation, are vig. 
 general, and local bleeding, the hot bath, fomentations to the 
 loins, and large injections of as elevated a lemperatui 
 "be borne. Saline purgatives, and the sweet spirits c( nitre, a 
 
 
JAUNDICE. 467 
 
 tea-spoonful every half hour, until relief is obtained, may be ad- 
 ministered with great advantage; and narcotics are occasion- 
 ally, but seldom, demanded by the violence of the pain. When 
 suppu ration occurs, the exit of pus must be promoted by the 
 measures alluded to in treating of inflammation of the liver. 
 
 Jaundice is recognised by the yellow hue of the skin, which 
 is most marked on the chest, and which extends itself to the 
 membrane covering the eye-ball, and to the nails. Along with 
 these appearances, the stools will be found more or less clay- 
 coloured; while the urine, on the contrary, is of much deeper 
 tint than ordinary, and communicates a decided yellow tinge 
 to paper and to linen. These changes are commonly ex- 
 plained by supposing that the bile secreted by the liver is pre- 
 vented from getting into the intestines, and that, enterino; the 
 blood as bile, it is thus carried into the cutaneous vessels, and 
 imparts to the skin its peculiar colour, while the office of con- 
 veying it out of the system is transferred for the time to the 
 kidney. It is probable that, in some cases, the phenomena of 
 the disease depend upon this circumstance. Yet some dis- 
 tinguished chemists have been unable to detect any bile in the 
 blood of jaundiced patients, and, on the other hand, there are 
 many instances of decided jaundice, in which the discharges 
 from the bowels have been found of their usual colour. Those 
 who maintain that the ducts are obstructed in jaundice, ascribe 
 this obstruction mainly to two causes : first, spasm of these ducts, 
 themselves; and secondly, the presence of gall-stones filling 
 their cavity. But the occurrence of the former is at variance 
 with the structure of these canals, and the passage of a gall- 
 stone is a rare occurrence, and when it takes place does not 
 always produce the symptoms of jaundice. But whatever be 
 the difficulty of determining the immediate cause of jaundice, 
 its remote or occasional causes are sufficiently obvious. Jt is 
 generally brought on, either by imprudence in diet, such as eat- 
 ing fermentable, acrimonious, or otherwise indigestible food, by 
 drinking cold water when heated, or by mental emotion. The 
 latter may be either sudden, as a burst of anger or terror, or 
 gradual, as depression and despondency- Long exposure to 
 external heat produces jaundice, as is evident from the yellow- 
 ness of skin exhibited by those who have long resided in very 
 hot climates. 
 
 The attack commences with a sense of fulness at the sto^ 
 mach, attended with nausea and pain. To these succeed vo* 
 miting, and the rejection of all articles of food or medicine, 
 The pain increases in severity, and shoots toward the left shoul- 
 der or spreads to the loins. The belly is usually distended; 
 and the bowels costive. The deep yellow of the urine in the 
 progress of the malady often changes to a dark red, like t.hg 
 
468 PASSAGE OF GALL STONES. 
 
 colour of venous blood. When the disease extends to the hu- 
 mours of the eyes, surrounding objects are seen tinged with yel- 
 low. The colour of the skin often continues after all the other 
 symptoms have disappeared, and sometimes even the bones 
 have become tinged with it. Long continued jaundice, how- 
 ever, generally depends on, or is connected with, chronic dis- 
 ease of the liver itself. In this case there is generally no pain, 
 but the digestion becomes deranged, and the strength is gradu- 
 ally impaired. This is the form of the disease which is brought 
 on by long continued residence in hot climates, especially in 
 persons of luxurious habits, and also by frequent attacks of re- 
 mittent and intermittent fever. 
 
 In the ordinary treatment of jaundice, the chief object is to 
 stimulate the liver to a healthy secretion. • For this purpose, 
 an emetic is usually given at tirst, which at once excites an in- 
 creased flow of bile, and causes it to be thrown into the sto- 
 mach itself. This treatment often produces entire relief. If. 
 however, the jauntiiced hue of the skin continue unabated, the 
 emetic must be followed by a cathartic/, in which calomel 
 should at least form a part. Five grains of this article, com- 
 bined with two or three times the quantity of jalap, forms an 
 excellent purge in cases of this description. With this, active 
 treatment may be closed : but the dil ;nptoms which re- 
 
 main, may still require attention. The I and tender- 
 
 ness on pressure, in the region of the stomach and the liver, 
 may be relieved by some external irritation. A mode of ap- 
 plying this which has been considered as peculiarly appropri- 
 ate, is the nitro-muriatic acid bath: prepared by uni 
 parts of nitric, to three parts of muriatic acid, and dilut 
 the mixture with from tiftv to sixtv pints of water. The 
 ture thus prepared is about as acid a> common vinegar, and is 
 sufficiently Retire to produce slight prickling when applied to 
 the skin. This bath was applied in Iudia, (where re- 
 introduced,) to the whole surface by immersion: but it is suffi- 
 cient to employ it as a foot bath, and at the same time tosponge 
 with it the surface of the body. Employed locally to the 
 gion of the liver, it may be o\ double the strength above di- 
 rected ; the greatest inconvenience which can follow 
 being a sort of rash upon the skin, attended with boom 
 and a discoloration of the surface. We have introduced this 
 mode of applying an external irritation as having been found 
 especially useful in those countries where complaints oi the li- 
 ver are most abundant ; but where the ma inBOt be con- 
 veniently obtained, the more familiar mode* oi p ro duc in g the 
 same effect may be resorted to, with much adv: 
 
 Passage of Gall-stones. Gall-stone bodies of irreuularlv 
 rounded form and brown colour, usually occurring in the 
 
PASSAGE OF GALL-STONES- 469 
 
 bladder, though sometimes in the liver. They vary from the 
 size of a mustard seed, to that of a pullet's egg. The texture 
 is crystalline or lamellated. They are very light, and burn r 
 when dry, with a bright flame, like wax. Their precise com- 
 position has not been determined, but they are evidently formed 
 from the bile itself, and contain the same constituent principles 
 varied somewhat in their proportion. They have been met 
 with sufficiently large to fill and distend the gall bladder much 
 beyond its natural size; but even one of these dimensions oc- 
 casionally makes its way through the tluct into the intestine, 
 though this passage will not, in common, admit a crow quill. 
 
 Gall-stones are more frequently found in women than in men, 
 and appear to be generally connected with a life of repose and 
 indolence. Sometimes they occasion very little disturbance to 
 the system, and are found in considerable numbers after death,, 
 without having been at all suspected during life. Dr. Heber- 
 den mentions an instance of one weighing a quarter of an 
 ounce, which remained during life withoutcausing any distur- 
 bance. Where irritation is produced, the means adopted by 
 nature for the removal of the obstruction are sometimes not a 
 little remarkable. An abscess may form and open externally; 
 and, what is more singular, recovery may follow. By a process 
 which we cannot here explain, the body has made its way inta 
 the intestine without having entered the duct. The latter, 
 however, is the most frequent route, and it is its passage through 
 this which constitutes the affection we now describe. 
 
 We may suspect that a gall-stone is engaged in the duct of the 
 gall bladder when violent pain occurs at the pit of the stomach, 
 accompanied with sickness and vomiting, the pulse, mean while, 
 remaining perfectly unchanged in character. We say suspect, 
 for none but the most experienced practitioners, or those who 
 have already passed concretions of this character, can distin- 
 guish the attack decidedly from ordinary colic. There are 
 two periods in the passage of a gall stone through the duct, 
 at which the pain is supposed to be particularly severe. The 
 first is, when the stone enters the canal, and the second when, 
 quitting this, it passes into the cavity of the intestine. Between 
 these, there is an interval of comparative ease. 
 
 The alleged objects of treatment in these cases are to dimi- 
 nish pain and to relax spasm. Perhaps we might with more 
 propriety omit the last, for the nature of the peculiar action 
 which urges forward the stone, is unknown to us ; and could 
 we succeed in relaxing the parts concerned in it, we might pos- 
 sibly prolong the suffering. Fortunately, nature seems to pro- 
 vide for the ultimate success of the process, when it has once 
 commenced, and leaves us charged with little else than the re- 
 
470 worms. 
 
 lief of the immediate suffering. For this purpose, we employ 
 bleeding, general and local, which maybe carried to the same 
 extent as in other cases where the object is to afford immedi- 
 ate remission of pain. After this it is usually recommended to 
 use purgatives, which, if they produce a beneficial effect, must 
 do so by favouring the efforts of nature to rid herself of the 
 obstruction. When the bowels are freely evacuated, opium 
 may be tried, and probably, in the severer cases, the latter will 
 be found necessary immediately after bleeding. Warm fomen- 
 tations to the skin, and a warm hath, are aUo recommended, 
 and, on the whole, it will be seen that the treatment best adapt- 
 ed to this purpose does not dilfer materially from that of com- 
 mon colic, except in the absence of all nee r emetics 
 and purgative injections; so that an error in the distinction 
 between the two might be practically less important than would 
 be at first supposed. The I : preventing the return 
 of the attacks is to use free exercise, and obviate theordii 
 causes oi dyspcpsB. 
 
 fl'iT/ns. The mode in which worms come to be generated 
 in the human body is a subject of ackno 
 difficulty. Whether the embryo be produced in, or introduced into 
 the canal, ami. if the latter, whether by the food, the water or 
 the air, are qu< Quityofth 
 
 but their consideration does not enter within lb 
 It is sufficient to observe, that th s which are found in the 
 
 inh stinal canal of the human subject have, in this, tic 
 priate abode. They are not fou: it of the body, and, 
 
 when expelled spontaneously or lv. 
 
 Whether any animal, introduced into the - without, 
 
 pt certain ian blingthel <»rm 
 
 of sheep, can withstand tl n o( the gastric juice, and 
 
 remain a tenant of its dark prison, may well —for 
 
 the accounts of adders, toads, frogs, and other annua 
 have been discharged alive from the rectum. . rdetl 
 
 as mere fables, baring their origin \\ 
 part of the patient, aided In pious fraud on that 
 Dr. Elliotsen once saw two centipedes, said to have be 
 ed by a girl twelve year \ had then been living tl 
 
 days. Such case?, if they can he held as well establi? 
 extremely rare. 
 
 The principal varieties of worms peculiar to the human si 
 ject are the long round worm resembling the earth worm, tin: 
 ascarides or thread worms, and the several kinds of tape worm. 
 The first and last are formed in the small iut 
 in the stomach; the ascarides in the rectum, | 
 tremity. The large round worm is too well known to i 
 
worms. 471 
 
 any description. The tapeworm is so called from its flattened, 
 form; it consists of long narrow joints; the head of some spe- 
 cies terminates in a mouth, surrounded by two rows of hooks; 
 the tail, in a semicircular joint, without any aperture. It reaches 
 the length of thirty, forty, and even sixty feet ! It is gene- 
 rally solitary, but sometimes collects in great numbers. The 
 thread worm is about half an inch in length, and when thrown 
 off, as. it usually is, in considerable quantity, resembles the cut 
 ends of thread. A longer thread worm is found in the larger 
 intestines of sickly children, but is much less common than the 
 preceding; it is about two inches in length, and ditfers in seve- 
 ral particulars from the last named animal. 
 
 Worms are of such frequent occurrence in children, that ei- 
 ther the round worm or the thread worm is supposed to ex- 
 ist in fully one half their number, but it is probable that this 
 calculation is greatly exaggerated. It is extremely difficult, 
 without seeing the animals themselves, to decide on their pre- 
 sence; as most of the symptoms which are supposed to be caused 
 by them are common to other internal irritations. Among 
 adults, one of the most certain causes of worms is the privation 
 of salt as an article of food. The long round worms are much 
 more frequently met with than any other variety, but it is by 
 no means uncommon to sec the thread worms associated with 
 them in great numbers ; and instances have occurred, in which 
 all the varieties existed in the body at the same moment. Ge- 
 nerally, the smaller the worms, the greater is their number. 
 
 We are justified in suspecting the presence of stomach- 
 worms, when a child of from two to ten years of age presents 
 the following symptoms: — wasting of the body; swelled and 
 hard belly; gnawing or pricking pain in the stomach; pale 
 countenance; dirty hue of the skin; irritation of the nostrils, 
 manifested by a constant desire to pick the nose; fetid breath; 
 and sleep with eyelids half closed, disturbed by frequent 
 startings. With the ascarides there is less evidence of gene- 
 ral, and more of local irritation: there is usually troublesome 
 itching about the arms, evinced by a disposition to rub the 
 part; and sometimes, on examination, a swelling may be de- 
 tected. Worms have been known to produce obstinate cough, 
 and children have even been supposed to be consumptive, and 
 treated accordingly, until accident has led to the discovery of 
 the source of irritation. The indications to be fulfilled by the 
 treatment are, first, to destroy the life of the animal; secondly, 
 to expel it when dead; and, lastly, to correct those morbid 
 states of the stomach and bowels, which render them a fit re- 
 ceptacle for these troublesome parasites. 
 
 Among the articles which have been relied on, for destroy- 
 ing worms, we may mention the spigelia or pink-root. This 
 
472 worms. 
 
 article is an acrid narcotic, and when given in too large doses, 
 will produce symptoms of poisoning, such as dimness of sight, 
 dizziness, retching, and even convulsions; but the medicine 
 is very popular, both in the hands of regular and irregular 
 practitioners, in the cure of that description of worms, which 
 especially infest the stomach. The mode of administering it 
 is to prepare an infusion of from a quarter of an ounce to an 
 ounce of the root, according to the age of the patient, to give 
 this in divided doses during one day, and, on the next, to work 
 it off by a cathartic of senna. This plan often succeeds in 
 bringing away large quantities of lumbrici, which are much 
 more easily acted upon than the tape worm; but we think 
 that the remedy should not be lightly employed by the inex- 
 perienced. 
 
 The next remedy which we shall mention, is the down of 
 the dolichos jjruriens, or cowhage. The pods of this plant 
 are covered with a hairy substance, which, applied to the skin, 
 irritates and inflames it. We are told, that in Guiana, where 
 the round worms are very abundant, it is the custom for the 
 planters to administer this article to their negroes, and parti- 
 cularly to the children, at least once a year. The dose is a 
 tea-spoonful to a child, and double this quantity for an adult, 
 in syrup or molasses: this is given in the morning, for three 
 days successively, and followed up by a close of rhubarb. 
 After the second dose, the patient 1 incredible quan- 
 
 tity of worms, partly lumbrici, and in part the long thread 
 worm. 
 
 Notwithstanding the irritating character of the medicine, 
 its spiculce are not found to affect the coats of the intestines, 
 so as to occasion any inconvenience. The same article, in- 
 volved carefully in thick mucilage, and introduced din 
 into the lower bowels, is found to dislodge the asearides. 
 
 A dose of calomel, proportioned to the age of the child, two 
 grains for the first year, five grains after the fifth, adding a 
 grain for ever}' succeeding year, until the twelfth, given at 
 night, and followed by senna in the morning, will often suc- 
 ceed in dislodging worms, especially lumbrici. from the i 
 tinal canal. But this remedy should never be our first choice, 
 unless the presence of some other disease require it 
 
 A remedy which probably possesses a more decided con- 
 trol over intestinal worms than any other article, is the oil, 
 or spirit of turpentine. The good effects of this article appear 
 not to be limited to any one form of the disease. Even the 
 tape worm, which is insensible to the action of most other 
 vermifuges, often yields to this. Turpentine is given in d 
 of from half a tea-spoonful to an ounce, according to the 
 of the patient. Though it would be madness in the unpr 
 
RHEUMATISM. 473 
 
 sional adviser even to copy the example, it may be mentioned 
 as a curious fact, that five or six ounces have been taken at 
 once with decidedly good effects, by patients in despair with 
 tape worm. When the object is to attack the small worms in 
 the rectum, it may be thrown directly into tins part in quan- 
 tities not differing* materially, from those above recommended 
 by the mouth. When turpentine, given in the laiter mode, 
 does not operate, it must be followed up by castor oil. 
 
 The last vermifuge we shall mention, is common salt. This 
 substance appears to dislodge every variety of intestinal 
 worms, but it is chiefly employed in the treatment of asca- 
 rides. A tolerably strong solution, thrown up as an injection, 
 will speedily displace them. When, by any accident, this de- 
 scription of worms have travelled upwards toward the sto- 
 mach, draughts of the same mixture are peculiarly efficacious. 
 
 In addition to the list above given, almost all the drastic 
 cathartics have been pressed into the service, either as having 
 power to dislodge the worms, or to remove the slime in which 
 they burrow. 
 
 With the exception of tenia, intestinal worms are usually 
 expelled without serious difficulty. A more important mat- 
 ter in the treatment of children, is so to regulate the state of 
 the stomach, and improve its secretions, that these parasites 
 shall no longer be able to find a resting-place. This may of- 
 ten be effected by a well regulated, nutritious, and simple diet, 
 in which sweetmeats, cakes, and butter, are, in a great degree, 
 prohibited. 
 
 If, by this means, the disorder can be kept within reasona- 
 ble limits, time and the changes it usually effects, will gene- 
 rally complete the cure. 
 
 Worms have, sometimes, existed for a long time, without 
 producing any inconvenience, and instances have happened, 
 where persons have voided tape worms of considerable length, 
 of whose presence, until the moment of expulsion, they had 
 not the most remote idea. 
 
 SECTION VI. 
 
 Diseases of Fibrous Tissue. 
 
 Rheumatism. The signs by which an attack of acute rheu- 
 matism is commonly recognised, are pains in one or more of 
 the larger joints, as the shoulder, hip, knee or loins, aggra- 
 vated by motion, and by exposure to cold or dampness. 
 
 60 
 
474 RHEUMATISM. 
 
 Along; with inflammation in the joint, there is more or less 
 pain in the course of the adjacent muscles, which is likewise 
 increased, when these muscles are brought into action. The 
 muscles are often swollen, and by compressing them with the 
 hand, much uneasiness is caused. In the milder cases, it is 
 remarked, that though motion of the parts affected causes pain, 
 yet, if this motion be persevered in, the sensibility diminishes, 
 and only returns after a period of repose; so that the attack 
 may sometimes be wholly overcome by active exercise; a cir- 
 cumstance peculiar to this form of inflammation. Another 
 peculiarity of rheumatism is its disposition to shift from one 
 joint, or set of muscles, to another. 
 
 This transfer often takes place in consequence of the means 
 adopted to relieve an affected part, as local warmth, for in- 
 stance, in consequence of which, another is left comparatively 
 defenceless. The surface of the affected parts is «flen unna- 
 turally red, swoll . and tender; the joints of the hands 
 and feet, when affected, are always so; but the larger joints 
 sometimes retain their natural colour. In those who have 
 once been affected, there is always reason to fear its recur- 
 rence from slight causes, or without apparent cause. It rare- 
 ly occurs in young children, and is most frequent from the 
 twentieth to the thirty-fifth year. 
 
 When rheumatism attacks the oral Deemed in breath- 
 
 the pain is aggravated by full inspiration, and in t!. 
 the disease makes an approach to pi means < ; 
 
 tinction have been pointed out in our remarks on the latter 
 disease. Generally speaking, the co-existence of rheumatic in- 
 flammatk uttonal liability of the 
 
 ;it to this latter affection, will furnish a ru 
 When the pericardium is affected, which, from it- '.rut- 
 
 lure, it is liable to be, there urse, local pain and disor- 
 
 dered action of the heart: this complication of rheumatu 
 very con from da; times the dura 
 
 : is attar bave delirium and other threatening 
 
 symptoms. Much more frequently th« the 
 
 external muse ,t the head. nded 
 
 with peculiar The eye is not unfi 
 
 of rheumatic affection. 
 
 As rheumatism differs in its general course 1 in- 
 
 flammation, so. many of the with 
 
 benefit in the latter ai in the former. General I 
 
 ing is seldom o\ permanent servi 
 acute cases. Local bleeding h; 
 
 the part primarily affected, but aj> Irana- 
 
 fer to others ; and blisters are liable to tl. on : still. 
 
 they are both necessary adjuvants in the treatment. The best 
 
^RHEUMATISM. 475 
 
 remedies, unless there are circumstances which particularly 
 direct attention to the stomach, are sudorifics. In fact, the ■ 
 tendency of the disease to relieve itself by sweat, is often mani- 
 fested throughout its course, though the energy of the system 
 may not be sufficient to procure complete relief in this way. 
 The sudorifics employed may be partial or general, external 
 or internal. Local fomentations, with flannels wrung out of 
 hot water, or of some anodyne infusion, will often be found ser- 
 viceable. General sweating may be induced in various ways; 
 such as fomenting the abdomen ; placing the patient in a 
 warm bed, and having the feet, while thus covered, immersed in 
 warm water; and the general warm bath. Among internal 
 sudorifics, the most successful, perhaps, are the Dover's and 
 James's powder, particularly the former, which may be taken 
 in the dose of ten to fifteen grains at bed time. In the early 
 stage of rheumatism, when unaccompanied with fever, pow- 
 dered guiacum in the dose of a tea-spoonful, or the tincture in 
 double this amount, is worth a trial. The latter may be swal- 
 lowed in water or milk, but the mixture must not be allowed 
 to stand, as the guiacum very quickly subsides. Sometimes 
 this remedy acts like a charm, producing an agreeable sensa- 
 tion of general warmth, and relieving the disease in a few 
 hours. Like the remedies above mentioned, it should be taken 
 in bed. 
 
 Another remedy which has acquired a reputation in rheu- 
 matism, is the seed or the root of the meadow saffron. Its use 
 requires caution. We shall again refer to it under the head 
 of gout. 
 
 The duration of acute rheumatism, if not relieved within the 
 first twenty-four hours, is very uncertain. It often wanders from 
 joint to joint, for eighteen, twelve, or more days. This migratory 
 state, however, is favourable, as no part becomes seriously af- 
 fected ; but whenever it fixes itself somewhat pertinaciously in 
 a single joint, there is reason to fear permanent lameness of 
 that joint, constituting the chronic form of the disease. In this 
 form it is of indefinite duration ; remitting its severity from time 
 to time, but never wholly quitting the unfortunate member. 
 The chest is rarely affected with chronic rheumatism; its prin- 
 cipal seats are the loins, hip, and knee. The joint, except 
 during the occasional exacerbations, is not either swollen or 
 red, but cold and stiff, and is always relieved by local warmth. 
 In the remissions of pain, it often becomes greatly debilitated, 
 and the limb is rendered useless. 
 
 If the hip is the seat of the disease, the joint, from disuse 
 and inflammation, may become permanently stiffened, so that 
 the motion of the thigh upon the leg isdost. If the loins are 
 affected, a similar result may occur; the spine is then habitual- 
 
476 gout. 
 
 ly bent, and, in this position, a thickening of the fibrous part-', 
 or an actual union of the bones takes place. 
 
 v In this form of the disease, besides the remedies already 
 mentioned, as guiacum, Dover's powder, colchicum, &c, vari- 
 ous external applications, of comparatively little service in the 
 acute disease, may be employed with advantage. Friction with 
 the liniment of ammonia, a cataplasm of mustard, or a bli 
 will often afford relief; a current of steam may be directed 
 upon the part, or electricity may be tried. 
 
 The most remarkable, however, of these local means is a 
 practice which has been introduced into use within a l> 
 under the name of acupuncturation. It originated in the i 
 where it lias been practised from time immemorial, especially 
 in the Celestial Empire. It consists in the verv slow introduc- 
 tion, by a boring motion, of one or more needles to the depth 
 of an inch or more into the inflamed part, and allowing them 
 
 main from rive to six minutes. Little pain is produ 
 and no bleeding follows. At the end of this time the pain will 
 he found to ha d in the part, and perhap 
 
 ferrcd to another; if the same operation be performed 00 the 
 latter, it will often atirelv. Thflfl 
 
 calculate amr parti, and cannot be 
 
 pected to suet ncture, or stillness of a 
 
 joint, has taken place. 
 
 Gout has its immediate seat in the small joints of to 
 mities, and especially in those of the feet. Th 
 occurrence, however, in a large proportion t 
 to be a certain morbid state ot the stomach, and of the di 
 tivc system generally. The subjects in whom it mo^t us 
 shows itself, are those of sanguine temperament, of full habit, 
 florid complexion, and rather coan rsonsof rath 
 
 dentarv, indolent i Life, and who, perhaps, ' be- 
 
 ing intemperate, indulf in the p of the t 
 
 It is more common in cities than in the country, in men than 
 in women, in those using principally animal food than in I 
 restricted t<> vegetable diet From hereditary | re I - 
 however, and otln ; not well understood, persons 
 
 different habits are included among it-; viet'. 
 
 Gout commonly mai . with pain in the ball i t 
 
 the great toe, and with a 1 ml chill. As the pain 
 
 increases, this chill gi- . and the usual symp- 
 
 toms of fever. The joint soon bee; ilea, red, 
 
 tense, the redness disappearing win 
 and returning when the pr - removed. The 
 
 of pain and inflammation continues perhaps with 
 meat for 0! hours. At length, probably on the o 
 that of the attack, it begins to subside, and terminating 
 
gout. 477 
 
 a gentle sweat, leaves the patient to the enjoyment of repose. 
 For several days the symptoms recur in the evening, though 
 perhaps in a more tolerable form ; and then subside, leaving 
 the foot apparently sound, and the system in a state of increased 
 health and vigour. 
 
 After the first fit, especially if the alarm of the patient in- 
 duce him to reform his mode of life, the disease often absents 
 itself for three or four years; then, generally on the occasion 
 of some excess or imprudence, such as exposure, cold, severe 
 bodily labour, mental application, or, in a word, any distur- 
 bance of the system, the attack is renewed : at each return, the 
 interval is usually shortened, while, on the contrary, the dura- 
 tion of the fit is augmented ; and, instead of subsiding in three or 
 four days, it will at length continue, with occasional remissions, 
 for as many weeks. From the prolongation of the fits and the 
 contraction of the intervals, the affection sometimes becomes 
 almost constant, so that the patient scarcely ever enjoys good 
 health. 
 
 As the disease advances the symptoms are modified. At first 
 the paroxysm appears without warning; afterward, it is preceded 
 by a sense of coldness of the lower limbs; occasional pricking, al- 
 ternating with numbness ; slight shiverings ; disturbance of the 
 stomach, &c. At first,only a single joint is affected. Then the two 
 feet are attacked in succession, the pain commencing in one as it 
 subsides in the other. Then, perhaps, both are affected at once 
 or alternately. At last, the other joints become involved, and the 
 disease becomes universal, or nearly so; but the intensity of the 
 pain diminishes, so that although there be no freedom from it 
 at any time, the patient is able to give some attention to his 
 ordinary occupations, even during the paroxysms. 
 
 Some permanent traces of the attacks are soon visible in 
 the principal joints, which become swollen, stiff, and weak- 
 ened, so that walking is performed with more and more diffi- 
 culty. Mean while, the small joints of the toes and fingers 
 are embarrassed by a whitish deposite, once supposed to be 
 actually chalky, and still so called in popular language; .but, 
 in fact, consisting of the acids of the urine in combination 
 with soda. Such quantities of this deposite sometimes accu- 
 mulate, that an individual is mentioned who used in playing 
 cards to score the points of the game on the table with his 
 knuckles. 
 
 It is a general impression that gout, when it becomes ha- 
 bitual, absorbs all the morbid tendencies of the system, and 
 keeps all other diseases at a distance. However this may be, 
 it is worthy of remark, that individuals severely affected with 
 it continue to an advanced age, often transcending the ordinary- 
 bounds of human existence. When gout proves fatal, it is gene- 
 
478 gout. 
 
 rally by receding, as it is termed; that is, by suddenly quitti-ng 
 the extremities, while the stomach, the brain, or some other 
 important organ, becomes the seat of inflammation. 
 
 .On the means of preventing the attacks of this disease lit- 
 tle need be said, after the enumeration of its remote causes. 
 " Live on sixpence a day, and earn it," was the brief answer 
 given by the eccentric Abernethy, to one who questioned him 
 how he should escape; and probably no advice could have 
 been more judicious. It has often been remarked, that per- 
 sons who, after being in comfortable circumstances, were com- 
 pelled by a change of times to labour for their sustenance, 
 have been entirely cured by this reverse. Active exercise, 
 combined with temperance, will sometimes check even the 
 hereditary tendency to gout. 
 
 It would be wrong to conclude that an attack of gout is al- 
 ways a certificate of luxury, wealth, or indulgence. We have 
 repeatedly met with it among the poor, and in the abstemious, 
 both by choice and necessity; in old soldiers, washerwomen, 
 shoe-blacks, sailors, seams' d temperate farmers. 
 
 An empirical medicine, regarded as specific in this disease, 
 has long been in use under the title of Hussou's eau medici- 
 nal. Its immediate effect is to produce abundant evacuation 
 from the bowels, of course increasing greatly the secretions 
 from the whole surface of the intestinal canal. Whether this 
 be or be not the true explanation, certain it is that the article 
 alluded to has the power to shorten the paroxysm of gout. A 
 similar power is possessed by the meadow saffron; which is 
 generally thought to be the active article in the nostrum just 
 mentioned. 
 
 It is now hardly to be doubted that these remedies act by 
 producing counter-irritation on the bowels, and diminishing the 
 inflammation by profuse discharges. They are ver. 
 drastic pu . and their action must be carefully watched. 
 
 Their hyper-action brings on cramps in the bowels, and 
 lieial cholera; which, if tl> ;ed on princi- 
 
 ples already laid down. Their virtues are - 
 solelv in the veratrine which they contain; but as th:^ 
 ble principle, when pure, is exceedingly dangerous in other 
 than experienced hands, the vinous tinctures of the 
 and root of the colchicum, though variable in power and - 
 injured by light and time, are considered th- 
 the class. Of the former, the full dose is thirty, and of the 
 latter, ten drops, three times a day: inci lie former by- 
 
 ten, and the latter by four drops per diem, until some pain in 
 the bowels is produced, or until the doses have reached sixty and 
 twenty drops respectively; but omitting the article instantly 
 on the occurrence of any unpleasant symptom. When 
 
CHOREA, OR ST. VITlTs's DANCE. 479 
 
 the medicine is supplied from a new parcel, we should re-com- 
 mence with the first doses; for the strength of the preparation 
 is always uncertain: and it is only in the absence of medical 
 advice, that such articles should be exhibited bv the inexperi- 
 enced. 
 
 When gout strikes in upon the stomach, head, or heart, 
 every external means should be employed, to provoke its 
 return by stimulation. While the former organ is attacked, the 
 patient for a few minutes is often apparently dying. In this 
 case, a little wine or brandy should be given internally, and 
 it is well to follow it, when the paroxysm is over, by half an 
 ounce of the compound tincture of aloes. 
 
 That class of patients who are doomed to expiate the vices, 
 or suffer the reflection of the misfortunes of their progenitors, 
 often discard all violent remedies, provide themselves with pa- 
 tience, carbonate of soda, and flannel; and endure their appointed 
 purgatory with a calmness and patience, which it is not easy,with 
 eut some actual experience of the suffering, duly to appreciate, 
 
 SECTION VIi. 
 
 Nervous Diseases. 
 
 Chorea, or St. Vitus' 's Dance, is more common in females than 
 in males, and usually occurs in children from eight to fourteen 
 years of age. The procursive symptoms are variable appe- 
 tite, sometimes ravenous and sometimes wanting, a degree of 
 listlessness and inactivity, a swelling and hardness of the belly, 
 usually accompanied with constipation, 'and slight, irregular 
 convulsive motions of the muscles of the face. As the disease 
 advances, the muscles of the extremities, of the lower jaw, the 
 head, and the trunk, are in various degrees affected. In this 
 state the patient is unable to walk steadily, his only movement 
 being a kind of jumping or springing; or, perhaps, he is com- 
 pelled to run in order to make any progress. To whatever 
 set of muscles it is attempted to communicate motion, these im- 
 mediately become affected with the diseased action, and either 
 refuse to obey the will, or obey it imperfectly, and by jerks in 
 uncertain directions. Even if speech be attempted, articula- 
 tion is found impossible, or the words are uttered with embar- 
 rassment and difficulty. In the progress of the disease, the eye 
 loses its brightness and intelligence, and the countenance be- 
 comes pale and vacant. In some cases actual loss of mental 
 power seems to follow. 
 
 The whole muscular system is never simultaneously affected: 
 
480 SHAKING PALSY. 
 
 and, in some instances, the perfect control which is retained 
 over a part, compared with the mutinous state of the remain- 
 der, is very remarkable : sometimes, though the gesticulations 
 are most absurd, the speech is easy and fluent; and sometimes, 
 when unable to walk with any approach to regularity, the pa- 
 tient can sing and play with the most perfect correctness. 
 
 The predisposing cause of this disease is undoubtedly debility, 
 generally dependent upon too rapid growth. The approach of 
 puberty has been considered a predisposing cause of chorea; and 
 so far as the changes then effected are causes of general weak- 
 ness, the idea maybe correct; but their farther influence may 
 well be doubted. In boys, however, sexual excitement, and 
 particularly certain criminal indulgences, not uncommon at 
 this age, should be suspected, when symptoms of chorea begin 
 to manifest themselves. The too frequent use of vegetables, 
 and the presence of worms, are also regarded as common 
 causes. 
 
 The treatment of chorea, in its advanced entirely 
 
 beyond the reach of the domestic practitioner; and all that he 
 can properly attempt, even at the to remove all the 
 
 remote causes of the disease above enumerated, to establish a 
 regular system of light, but nutritious diet, to administer some 
 of the milder vegetable tonic teas, and leave the rest to nature 
 and fresh air. 
 
 Shaking />«/>•// is distinguished from chorea by appearing 
 principally in persona advanced in life: and by the tremu- 
 lous action being nearly constant, and not called forth or 
 mented by attempt at voluntary motion. Shaking pa 
 marked by a tremulous motion of the whole head which is not 
 characteristic of chorea. To palsy, properly so called, the 
 malady in question has but a remote resemblance: the s 
 bility remains unimpaired, and the control over the mu 
 though diminished cely ever wholly 1 
 
 The approach of the die jadual, that si 
 
 or ten months elapse before any material inconvenience occurs, 
 except a disposition to bend the body forward in walking. At 
 length, the legs begin I led, and locomotion is accom- 
 
 plished with more difficulty. When the patient attempts to 
 advance, he finds himself thrown upon his toes, and is compelled 
 to adopt a running gait, in order to prevent himself from fall- 
 ing forward. In a still later stage, the tremulous motions lake 
 place during sleep, and awaken him suddenly in gn 
 tion. The power o( conveying the food to the mouth, and of 
 swallowing it when taken, are as much impaired as ii 
 Vitus's dance. As a fatal termination approaches, the dis 
 assumes more of the character of real palsy. Tlu 
 muscles of the neck gradually lose their i that the 
 
CONVULSIONS EP1LEPSV. 481 
 
 chin rests on the chest; the power of articulation is lost; and 
 at length the control ceases even over the natural evacuations. 
 In this form the disease is peculiar to old age, and to the in- 
 temperate. It seems to be beyond the reach of medicine. 
 
 A peculiar affection, called the gilder's tremor, occurs in 
 those who have been exposed to the fumes of quicksilver. The 
 first symptom is unsteadiness of the arms, which, gradually in- 
 creasing, extends itself to other parts of the body, and renders 
 it impossible for the patient to walk, to speak, or even to chew. 
 If the employment be persevered in, loss of memory, sleepless- 
 ness and delirium ensue. But if the occupation be abandoned, 
 the disease generally proves curable. 
 
 Convulsions are marked by such a variety of symptoms as to 
 make it difficult to embrace them in any general description. 
 What may be considered common to all, however, is an irregu- 
 lar spasmodic action of some of the muscles,, while others are for- 
 cibly contracted. The sensibility is impaired or lost, and the 
 power of utterance suspended. It is said that in the convul- 
 sion fit the two kinds of spasm, the rigid and agitative, are 
 about in equal proportion, while in epilepsy the latter, and in 
 hysterics the former predominate. As epilepsy and hysteria 
 constitute the most severe forms in which convulsion shows it- 
 self, we shall offer a brief description of each; while our cura- 
 tive remarks will be principally directed to the milder and 
 more manageable forms, which depend rather on accidental 
 causes than on peculiarity of constitution. 
 
 In Epilepsy, the person attacked loses suddenly all sense 
 and power of motion; so that, if standing, he falls immediate- 
 ly, or is thrown by convulsion, to the ground. In that situa- 
 tion he is attacked with violent spasms, variously moving his 
 limbs and the trunk of the body. Commonly the limbs on one 
 side are much more violently affected than those on the other. 
 In all cases the muscles of the eyes are especially agitated, so 
 that the lids open and shut in perpetual motion, or are stretched 
 in a full stare, while' the eyeballs are rolled rapidly in every 
 direction. The muscles are alternately rigid and relaxed, the 
 mouth foams, the tongue is forcibly protruded, and often bitten 
 by the spasms which affect the under jaw ; the whole face is 
 hideously distorted, and frequently of a deep purple. The 
 muscular power developed during the paroxysm is enormous, 
 so that the strength of five or six persons is required to restrain 
 the struggles. These fits frequently commence with a violent 
 scream : their ordinary termination is in sleep. They recur upon 
 almost any occasion of bodily or mental excitement, and often 
 without any assignable cause. The disease is frequently he- 
 reditarv. The paroxysms generally commence from the age 
 
 61 
 
482 HYSTERIA. 
 
 of fifteen to twenty-five years, and when the habit is once 
 formed, it is fortunate for the patient if they do not continue 
 through life. If incurable, they terminate sooner or later in 
 madness or idiotcy. 
 
 Hysteria most generally occurs in females, between fifteen 
 and thirty years of age. The fit commences with a coldness 
 and shivering over the whole body, a quick but fluttering pulse, 
 and an acute pain in the head. Some pain is also felt in the 
 belly, generally on the left side; from this a ball seems to move 
 with a grumbling noise through the abdomen; thence, after va- 
 rious evolution?, it rises into the stomach and then into the 
 throat, where it, seems to remain for some time, and, by is 
 pressure on the larynx, to cause a feeling of suffocation. This 
 sensation is peculiarly characteristic of this affection. To this 
 succeed stupor, insensibility, and convulsions. The trunk of 
 the body tosses to and fro, the limbs arc variously agitated, 
 the hands are firmly clenched, and the breast is often violently 
 beaten. Sometimes there is a singular combination of sobbing, 
 crying, laughing, and shrieking, in the midst of the fit, and 
 sometimes obstinate hiccough. The insensibility in hi 
 r'.a is usually incomplete, the patient having some conscious- 
 ness of what i< croinrr on around her. After alternate r« 
 sions and exacerbations, the convuls Be entirely, and are 
 
 succeeded by a state of lethargic Bleep. More* klen- 
 
 ly, and frequently after rep g and sobbing, th< 
 
 tient returns to consciousness, with no other feeling of incon- 
 venience than perhaps a Blight pain and a general -citation 
 of sorene eria is not usually hereditary, and is far less 
 
 likely to be followed by serious coi - than epilog 
 
 Convulsions from occidental and transient causes, pre- 
 sent for the most part those symptoms which are common to 
 the above described d: atcr 
 
 resemblance to epilepsy, from which they differ princi; 
 in being less violent, and in the absence of the cree 
 sation, that precedes the attack of the latter. these 
 
 accidental varieties, however, some deserve particular men- 
 tion; as the infantile cam ually induced by surfeit or 
 by the irritation of teething; those of children, produced 1 
 milar causes, or appearing as precursors or con-equences of 
 eruptive fevers; those manifested during child-birth: and, 1 
 those arising from loss of blood. Convulsions also appeal 
 symptoms or concomitants of other P worms, hy- 
 drocephalus, and gastric or intestinal in;' - on; are > 
 times induced by constipation, and sometimes by affections of 
 the mind. 
 
 The first object in the treatment of these accidental convul- 
 sions is, to attack the remote cause; this indication, however, can 
 seldom be answered, except in the infantile convulsion, and in 
 
CATALEPSY. 483 
 
 (hat of labour. In these, the necessity for this kind of relief 
 is often imperious; for, though the immediate fit may termi- 
 nate spontaneously, it will continue to recur as long as the 
 cause of offence continues.. In the case of tits from surfeit in 
 children, the cause must be removed by an emetic. In that 
 from teething, the gum which causes the irritation must be 
 lanced; and in the puerperal variety, under certain conditions, 
 delivery must be effected. But we also possess direct means 
 for lessening the violence of the spasmodic action and abridging 
 its duration; and these may be employed where no reference 
 can be had to the remote cause. Of this class is bleeding, 
 which is peculiarly necessary in the puerpernl form, and may 
 with safety be resorted to in adults, whenever there is evi- 
 dence of plethora or vascular fulness. In children, bleeding 
 is seldom needed ; a warm bath, with friction to the extremi- 
 ties, will generally subdue the spasm. At all ages, what are 
 called the antispasmodics deserve a trial, since, if they do no 
 good, there is little danger of injury from their use. Such are 
 ammonia, camphor, and valerian, the advantage of which can 
 be combined byiadding to the ammoniatcd tincture of valerian 
 an equal quantity of a saturated solution of camphor in alco- 
 hol; and administering the compound in doses of twenty to fif- 
 ty drops. In cases where the cause seems to be merely ner- 
 vous irritability, and it is an object to prevent the formation of 
 an injurious habit, the sudden application of cold, by dashing 
 cold water over the head, will sometimes not only terminate 
 the fit, but prevent its recurrence. It is, however, a harsh re- 
 medy, and if it fail at one trial, it will be a useless cruelty to re- 
 peat it. 
 
 We have said nothing of the special treatment of epilepsy 
 and hysteria, because there is always time and opportunity 
 enough for medical consultation in these diseases. On emer- 
 gencies, the practice recommended above may be safely insti- 
 tuted. 
 
 Catalepsy or Trance is characterized by the abolition of 
 sense and voluntary motion, the breathing and pulse continu- 
 ing, and the body, trunk, and limbs receiving and retaining 
 any position which may be communicated to them. It most 
 usually occurs in females of nervous temperament, but from 
 what exciting causes is not known. The disease is, without 
 question, often feigned, but it also occurs under circumstances 
 which wholly forbid the idea of deception. The state of 
 trance commences without previous warning, and generally 
 terminates with sighing. The duration is very various, the 
 fit, in some instances, continuing only a few hours, or even 
 minutes, and in others, lasting whole days. The breathing is 
 extremely feeble, and sometimes the pulse wholly impercep- 
 
464 APOPLEXY. 
 
 tible, so that persons in this state have been supposed to be 
 actually dead. 
 
 Attacks somewhat similar to trance, have been known to 
 occur to persons while walking, and in these instances, though 
 consciousness was lost, the motion was continued, so that 
 the state approached very closely to that of somnambulism. 
 The disease is rare, and is not amenable to medical treatment, 
 except of a general character. There are some instances on 
 record, in which accidental bleeding has proved critical. One 
 is that of a young girl, who became cataleptic at ten years of 
 age, the paroxysms recurring at shorter and shorter intervals, 
 and resisting all medicines. In one of these attacks the girl 
 dashed her head against a sharp stone, and a profuse hemor- 
 rhage ensued. The bleeding not only put an end to the fit, 
 but prevented its return. 
 
 •Apoplexy. A sudden and general loss of sense and motion, 
 with slow breathing and pulse, the inspiration often attended 
 with a snoring sound, constitute apoplexy. It is to be distin- 
 guished from palsy, because, in this last, the loss of motion is 
 partial only, and the functions of the senses, with the excep- 
 tion of the general feeling of the part attacked, though im- 
 paired, are not suspended. 
 
 Apoplexy generally occurs in persons with short necks, and 
 large heads, who have passed sixty years of age, who are 
 more or less inclined to coipulence, and who unite great men- 
 tal application with bodily inactivity and a liberal indulgence 
 of the appetite. Intemperance in drinking is generally re- 
 garded as a cause; and, no doubt, confirmed sots often die of 
 apoplexy: but it is equally proved by experience, as remarked 
 by Dr. Cheyne, that the daily use ot wine or spirits will lead 
 a man of a certain age and constitution, to apoplexy, as cer- 
 tainly as habitual intoxication. ( - - also frequently occur 
 in spare old men, of great bodily activity and temperate ha- 
 bits; so that no kind of constitution can be regarded is 
 empt. 
 
 Among the occasional causes, may be mentioned violent 
 exercise, especially when combined with exposure to the sun; 
 exposure to a warm and impure atmosphere, such as is pro- 
 duced by the collection of large numbers of persons in a con- 
 fined space; excess in drinking; the presence of undig* 
 food; long stooping or hanging of the head: a ligature or tight 
 cravat about the neck; and violent mental emotion. 
 
 The proximate cause of apoplexy, or the state of system 
 which produces it, is probably pressure upon the brain, at the 
 origin of the nerves, which proceed from it. This pressure 
 may be the effect of a tumour within the cavity of the skull; 
 of effusion of blood, or serum; or simply of unusual fulness 
 
APOPLEXY. 485 
 
 of the cerebral veins. That the first and second are causes of 
 apoplexy, has been shown by the examination of those who 
 have died of this disease, and the last appears highly probable 
 from the nature of the remote causes, and the mode of the at- 
 tack. 
 
 In the paroxysm of apoplexy, the patient should, if possi- 
 ble, be carried into a cool apartment, of large size and well 
 ventilated. He should be placed in bed or on a sofa, but with 
 the head considerably raised. 
 
 All unnecessary company should be excluded, and all un- 
 necessary conversation prevented. 
 
 It is probable, indeed, that in genuine apoplexy, all con- 
 sciousness of what is passing around is suspended; but the na- 
 ture of the case may not be such as suspected, and the patient, 
 though unable to express himself, may be fully aware of the 
 import of the expressions used by others. All portions of 
 dress, which encumber or bind the person, especially ligatures 
 about the neck, should be removed; the feet should be im- 
 mersed in warm water, and the legs rubbed with stimulant 
 applications. 
 
 When the movements show that nausea is present, when 
 the attack follows immediately on a meal, or when there \» 
 any strong reason to suspect the presence of indigestible food 
 in the stomach, an emetic should be immediately given, with- 
 out regard to the increased pressure on the brain, produced, 
 for the moment, by the action of the remedy, which pressure 
 is less likely to occur in apoplexy, than in most other dis- 
 eases, because the abdominal and thoracic muscles are pre- 
 vented by their torpidity, from taking their usual very active 
 part in the process of vomiting. They leave the effort main- 
 ly to the stomach itself, and hence, the blood in the thoracic 
 and portal vessels is not forced out mechanically, which is the 
 mode by which all the other blood vessels, and those of the 
 head among the number, are distended in ordinary vomiting. 
 Unfortunately, it is often extremely difficult to rouse the sto- 
 mach to action in apoplexy; and although medical men pos- 
 sess many very powerful and prompt emetics, the only one 
 which we can conscientiously recommend, on emergency, to 
 the domestic practitioner, in the cases under notice, is thirty 
 grains of ipecacuanha, with two grains of tartar emetic, given 
 in a little sirup or molasses. 
 
 If an emetic operation be obtained, it should be followed by 
 the administration of a powerful cathartic, which may be aid- 
 ed in its operation by a stimulant enema. As the object is 
 to produce a prompt effect, the cathartic should be chosen 
 with reference to this property. Perhaps the most conve- 
 nient and effective article, for this purpose, is the croton oil, 
 
486 
 
 APOPLEXY. 
 
 in doses of one drop diffused in water or milk. This may be 
 repeated every two hours, until an effect is obtained. Mean 
 while, active friction, with Cayenne pepper, or other stimu- 
 lating substances, mustard cataplasms to the feet and legs, and 
 external warmth, wherever the temperature is reduced below 
 its natural standard, will be useful auxiliaries. 
 
 There is a popular, but ill-founded notion, that bleeding is 
 a specific in the treatment of apoplexy. That it is generally 
 advisable is certain: but it is equally certain that there are 
 many cases of exception. The populace, and, with them, the 
 unreasoning and less informed of the profession, have run wild 
 in favour of a favourite remedy; and, us usual, partisans of an 
 opposite extreme in opinion have recently arisen. Some mo- 
 dern physiologists, remembering but a few of the predicates of 
 the problem, have concluded that the quantity of blood in the 
 head cannot be either increased or diminished by any cir- 
 cumstances whatever. Hence, say they, bleeding can have 
 no effect in lessening the pressure of blood upon the brain! 
 Not one of the postulates upon which this doctrine is founded 
 is physically true; and the lemma engrafted upon It is an ex- 
 quisite non sequitur! 
 
 As these opinions have received the sanction of men of 
 high note in the profession, who have unfortunately d 
 garded the first principles of hydrostatics in their physiologi- 
 cal reasoning, we think it light to enter our protest against 
 the hypothetical objections to the use of the lancet in the 
 treatment of apoplexy. But let it be distinctly understood, 
 that the remedy must be used with all the precautions ob- 
 served in its employment in other diseu 
 
 When there is no strong reason to suspect that distention 
 or irritation of the stomach has caused or exacerbated the at- 
 tack, there is no temptation to employ an emetic; but whether 
 this remedy be prescribed or not, if the patient be not an ha- 
 bitual toper, if he have no previous disease of great debility, 
 if the face be flushed or purple, and the pulse slow and ex- 
 tremely feeble or irregular, a vein in the arm should be 
 opened with a large orifice, and the patient bled freely, and 
 as rapidly as possible, until the pulse is decidedly diminished 
 in force, or increased in frequency: but where the face is pale, 
 marking a violent revulsion from the surface, or when the 
 constitution has been previously broken down by disease, or 
 when the pulse is feeble and fluttering, and death impend 
 we must depend exclusively upon the counter-irritants and 
 other adjuvant remedies already prescribed. If a pulse, at first 
 weak, should, as it sometimes will, acquire additional force 
 during the progress of bleeding, the flow must not be checked 
 until the force of the circulation again declines. 
 
PALSY. 487 
 
 Palsy. Apoplexy, when not immediately fatal, is apt to 
 terminate in a state in which the power of motion, and usually, 
 the sensibility of one side of the body is lost, and the powers 
 of the mind, especially the memory, impaired'. This state 
 constitutes one form of palsy, and is termed hemiplegia. In 
 these cases there is every reason to believe that the affection 
 or accident in the brain, on which the apoplexy depended, is 
 of a nature to remain permanently, or for a considerable time. 
 It is worthy of observation, that, when palsy proves fatal, it 
 does so by again passing into the state of apoplexy. In a 
 few cases, hemiplegia occurs without any preceding apoplexy. 
 These cases sometimes originate from exposure to the sun, 
 drinking cold water when heated, repelled eruptions, &c. 
 Sometimes an intimation is given of the approach of the at- 
 tack by pain in the head, a difficulty of moving the ton<me, 
 and the loss of perception and of memory. But the attack 
 itself is sudden; so that the patient, if standing upright, drops 
 clown upon the affected side. 
 
 In paraplegia^ which is another variety of palsy, the loss 
 of power and sensibility is confined to the lower part of the 
 body. This disease is often dependent on injury of the spine 
 or the nerves of organic life; but often comes on without any 
 known cause. At first there is a slight numbness in the low- 
 er limbs, with a stiffness or awkwardness in moving the mus- 
 cles. By degrees these symptoms increase; there is great 
 difficulty in walking, and inability to preserve the balance, so 
 that the aid of a staff or the arm of an assistant is needed. At 
 first the bowels are costive, but at length the discharges are 
 made involuntarily. The disease may continue for years, but 
 the patient sinks at last from general exhaustion. Recovery 
 is rare. 
 
 Local palsy occurs most freqently in the muscles, about the 
 angle of the mouth, but may also affect the eye, the cheeks, a 
 hand, an arm, &c. It may originate from disease of the brain, 
 the spine, the bowels, or even from the wound of a nervous 
 fibre. We have known it to occur severely in the face, from 
 the irritation of small fragments of the sockets of extracted 
 teeth. It it sometimes the precursor of a more serious attack, 
 either apoplectic or paralytic, and, therefore, a most dangerous 
 symptom; at others it marks important disorders in the nerves 
 of the abdomen, as when seen in painter's, colic : and some- 
 times it is transient and free from danger, as when it follows 
 the extraction of a tooth. 
 
 In the onset of hemiplegic affection, we may pursue the 
 treatment fitted for apoplexy, except that it would be madness 
 to exhibit emetics here, unless in cases of poisoning, which oc- 
 casionally produces this form of paralysis, though very rarely. 
 
488 DROPSY. 
 
 In paraplegia the spinal marrow is generally the seat of the 
 principal mischief; and this form is often occasioned by poi- 
 sons. Emetics are then our main dependence in the com- 
 mencement. 
 
 The seat of partial palsy is so difficult to determine in most 
 cases, that unless symptomatic of some of the diseases already 
 described, we would seriously advise the intelligent domestic 
 observer, to regulate the diet and habit of the patient on cor- 
 rect hygienic principles, and then to leave the case entirely to 
 nature. 
 
 There appears no sufficient apology for touching upon the 
 after treatment of palsy in the present work. It is a difficult 
 business, requires no particular promptitude, and professional 
 advice on the subject may always be obtained in time for all 
 useful purposes. 
 
 SECTION VIII. 
 
 Prominent Symptoms, and Accidejits. 
 
 Dropsy. — The immediate cause of dropsy is an undue accu- 
 mulation of fluid, either in the cellular substance which inter- 
 venes between the skin and the muscular tissue, or in the se- 
 rous cavities. 
 
 The quantity of effused fluid, in either of the situations just 
 referred to, is dependent upon two opposite processes, — depo- 
 sition and absorption. It is evident that either an augmenta- 
 tion of the former, or a diminution of the latter, would be 
 adequate lo tne production of the disease. Accordingly, it has 
 always been a subject of discussion, whether dropsy should 
 be considered an active or a passive affection; whether the 
 capillaries should be considered in fault for separating too 
 much, or the absorbents for taking up too little. The dispute 
 is much like that regarding the colour of the camelion, and 
 7ce leave the intelligent reader to decide it. 
 
 Cellular Dropsy generally shows itself in the lower limbs, 
 where it is marked by a cold diffused swelling, which, when 
 pressed, leaves a pit or impression of the fingers for some time. 
 It may be either a symptom of some internal effusion, or a 
 distinct affection. In either event, however, the progren 
 slow. The swelling appears first about the feet and ankles, 
 and is more or less observable through the day, disappearing 
 or being much diminished during the night by the recumbent 
 
DROPSY. 489 
 
 posture. By degrees it becomes more permanent, ascends 
 higher, affects the legs and thighs, and finally, may even reach 
 the trunk and face, which last, becomes pale and bloated. If the 
 disease advance, the skin of the legs gives way, and the accu- 
 mulated fluid either collects in sacs under the cuticle, or 
 oozes out in drops. 
 
 Other symptoms, common to this and other forms of dropsy, 
 when not the result of simple debility, are general inactivity, 
 costive bowels, constant thirst, urine deficient in quantity 
 and of deep colour, a failure of the appetite, and emaciation. 
 
 In hydrothorax, or dropsy of the chest, the fluid is accumu- 
 lated in the cavity of the pleura. The peculiar symptoms are 
 a sense of oppression in the chest; difficulty of breathing on ex- 
 ercise or on lying down; livid countenance, irregular pulse, and 
 palpitation. 
 
 These appearances, however, are deceptive, and unless fluc- 
 tuation, of which we shall speak presently, can be perceived, 
 the existence of water in the chest is scarcely to be distin- 
 guished with certainty from other affections. 
 
 When the disease takes the form of ascites, or dropsy of the 
 abdomen, the water is usually contained in the peritoneal ca- 
 vity; and its presence is readily recognised by the sense of fluc- 
 tuation which is produced when one hand is placed on one 
 side of the belly, and the opposite side is gently struck or 
 tapped with the other. This form of dropsy is often compli- 
 cated with more or less disease of the liver. The quantity of 
 fluid collected has been, in many instances, surprisingly great. 
 Twelve gallons and a half have been discharged through an 
 artificial opening at onetime. The symptoms, with the excep- 
 tion of the gradual swelling of the belly, which cannot fail to 
 be remarked, resemble very closely those of hydrothorax; but 
 there is less embarrassment of breathing. 
 
 The three forms of dropsy which have been mentioned, es- 
 pecially the first and last, are very frequently united, and arise, 
 from causes in many respects similar. They form the sequel 
 to fevers and inflammatory affections, especially of the pleura 
 and the peritoneum, and are often among the signs of the decay 
 of constitutions impaired by early excesses, by exposure to 
 varying influences of climate, and by hard labour. 
 
 The treatment is chiefly directed to two objects, the evacu- 
 ation of the effused fluid, and the prevention of its return. Jn 
 cases of anasarca and ascites, direct means of evacuation are 
 afforded by surgery. In the former case, scarifications made 
 with a lancet through the tumid integuments will permit the 
 effused fluid to escape; and in the latter a more complete eva- 
 cuation may be effected by tapping. But as these means are 
 palliative merely, they are now never employed, except under 
 
 G2 
 
4D0 HYDROCEPHALUS. 
 
 urgent necessity. To cause the evacuation of the superfluous 
 fluid through the natural channels, emetics, sudorifics and blis- 
 ters, have been often resorted to ; but the principal remedies 
 employed have been, first, the drastic cathartics, which, from 
 their peculiar operation, have been termed hydragogues, and 
 which produce abundant liquid evacuations from the alimen- 
 tary canal; and secondly, the diuretic class, which cause a 
 like tendency of the fluid to the urinary passages. The parti- 
 cular remedies of both classes are numerous; but we must be 
 content with adverting to the principle on which they act. It 
 is no part of our purpose to encourage the domestic practi- 
 tioner in their employment. The re-accumulation is prevented 
 by whatever has a tendency to strengthen the constitution and 
 increase the vigour of the absorbent system ; and hence tonics, 
 especially the vegetable bitters and the preparations of iron, 
 have always been considered as among the best. Dropsy, and 
 especially that of the feet, when the result of simple debility, 
 as is often the case after rapid growth in children, long conti- 
 nued convalescence, &.c, will often recover gradually without 
 aid. The tonics are properly administered in protracted cases 
 of this character. 
 
 We have reserved for a separate consideration three forms 
 of dropsy, in many respects differing from the foregoing, both 
 in their causes and their course; two of which have this cir- 
 cumstance in common, that they are often congenital, and even 
 exist previously to birth; and, the third, as coming within the 
 domain of surgery, will require only a passing notice. 
 
 Water in the Brain forms a frequent termination of that pe- 
 culiar disease in children, to which the name of hydrocephalus 
 is applied, but in which, frequently, neither the symptoms du- 
 ring life, nor dissection after death, countenance the idea of any 
 elTusion whatever. As, however, the name must be retained, 
 and as the true dropsy of the brain is for the most part an in- 
 fantile affection, it will be most convenient to treat of both 
 forms of a flection under a single head, distinguishing as far 
 as possible the symptoms peculiar to each. 
 
 Inflammatory hydrocephalus, though sometimes found in 
 adults, is mostly limited to the first seven years of life. The 
 commencing symptoms are those of irritation generally, and 
 very similar to those produced by worms. Such are irregu- 
 larity of bowels, and especially costiveness, listlessness, impa- 
 tience, knitting the brows into a frown, a sense of weight in 
 the head, which the patient is constantly desirous of resting 
 upon a chair; irregular fever, and sometimes pain shooting 
 through the head from temple to temple; accompanied, per- 
 haps, with sickness at stomach. The vivacity and good-hu- 
 mour proper to childhood are lost: the eye becomes- dull. 
 
DROPSY OF THE HEAD. 491 
 
 ihe cheek pale, with occasional irregular flushes. The child 
 walks infirmly, and even staggers. The pulse is quick, but 
 irregular, the sleep interrupted and uneasy, and the eye as- 
 sumes an oblique or squinting appearance. The pupil, which 
 is at first contracted, at length dilates, and is no longer affected 
 by light. There are paroxysms of fever, generally coming on 
 towards evening, but sometimes irregular in their appearance. 
 The head is felt to be hot, and severe pains are complained of 
 in the forehead. The approach of the fatal termination, is 
 marked by wild and sudden screams; irregular contraction and 
 dilatation of the pupils; throwing back of the head, delirium, vo- 
 miting and convulsions. 
 
 In many instances, on examination, a certain amount of fluids 
 varying from a iew tea-spoonsful to eight or ten ounces, has 
 been found in the brain. This effusion, however, is not to be 
 considered so much the cause of death as an evidence of the 
 extent to which the inflammatory action has proceeded, and 
 which would be sufficient to destroy life whether effusion took 
 place or not 
 
 The duration of the disease varies: commonly it runs on 
 from three to six weeks; but it may prove fatal in a fortnight, 
 or even in two or three days. When it extends beyond six 
 weeks, it is to be regarded as chronic; and, in this form., 
 may go on even for years. 
 
 From the difficulty of distinguishing this disease, with cer- 
 tainty, in its earlier stage, it has been made a question whether 
 a genuine case has ever recovered. This view is, perhaps, too 
 discouraging; but it seems to be admitted on all hands, that 
 the time for action is at the outset, and that if the disease be 
 neglected or misunderstood in its earlier stages, the chance of 
 recovery is exceedingly small. 
 
 The remedies employed in this disease are mostly those 
 adapted to active inflammation generally, and consist of local 
 bleeding, the application of cold to the head, and mercurial 
 purgatives. The two former should be used freely and fear- 
 lessly, and the calomel has been urged to the extent of pro- 
 ducing salivation with the most happy results. Of course, 
 nothing but dire necessity would induce a domestic practi- 
 tioner to charge himself with the treatment of this affection. 
 
 In the true dropsy of the head the whole course of symp- 
 toms is of a milder and less violent character. It not unfre- 
 -quently commences antecedently to birth, and the head of the 
 infant is then found already enlarged. The accumulation has 
 been known to amount to five pounds of fluid. This disease 
 often shows itself some months, or even two or three years, 
 ^fter birth. As it proceeds the head very gradually enlarges? 
 
 • For farther details, see Diseases of Children, (Chap, iv.) 
 
492 HEART-BURN. 
 
 and the bones are separated from each other. Sometimes a 
 small, distinct tumour appears at the top of the head, which 
 increases for a time, and then declines, being finally merged 
 in the general swelling. 
 
 Cases occasionally happen in which the disease, after reach- 
 ing this stage, passes into a chronic form, and the subject lives 
 to manhood with no other inconvenience but that arising from 
 the deformity and weight of the head itself. In other cases, 
 this protracted form is accompanied with occasional at- 
 tacks of convulsions, under which the patient at last sinks, 
 after having reached the age of twenty or even thirty^ years. 
 In others, again, the fluid is apparently absorbed, and the con- 
 stitution finally triumphs. We are told of one instance in 
 which this favourable change took place under the influence 
 of mercurial medicine. Here the disease commenced at the 
 age of four years, and increased for six months, at the end of 
 which time the head was as large as that of an adult. After 
 the treatment was instituted, the scull ceased to augment, and 
 the intellect gradually brightened. At twenty, the individual 
 was in full possession of his health and faculties, with a head 
 scarcely larger than it had been fourteen years previous. 
 
 In this form of dropsy the head has frequently been punc- 
 tured, and the effused fluid allowed to escape. This opera- 
 tion has generally been attended with relief; and, in some in- 
 stances, has effected a cure of the disease. The most satisfac- 
 tory account of the result of this operation, is one published 
 by Dr. Conquest, of London. Dr. C. operated on nine c 
 in four of which he was entirely successful. 
 
 Heart-burn. This affection is characterized by a peculiar 
 burning sensation at the pit of the stomach, accompanied usu- 
 ally with eructation of an acid liquid. It comes on from one 
 to two hours after taking food, and the acid, which is identi- 
 cal with vinegar, is evidently generated during the process of 
 digestion. The immediate cause of heart-burn, therefore, is 
 derangement or imperfection of the digestive process; and 
 this again arises partly from the debility of the stomach itself, 
 and partly from the introduction of crude and unyielding ar- 
 ticles of diet. It occurs particularly in those who have im- 
 paired the tone of the stomach by the alternate use of very cold 
 and very hot beverages; who have indulged freely in spiritu- 
 ous or fermented liquors; who have long been subjected to the in- 
 fluence of tropical climates, or who have accustomed them- 
 selves to powerful cathartics. The article of food which, as 
 neral rule, is most likely to produce it. is animal oil or fat. in the 
 form of rich meats, gravies, drawn butter, toasted cheese. 
 Pastry, in all its forms, is one of the most efficient means of 
 inducing heart-burn. Next to these arc to be ranked those 
 
WATER-BRASH — FLATULENCE. 493 
 
 culinary compounds which are composed of flour, eggs, sugar, 
 and various other ingredients combined; and which are far- 
 ther prepared for the process of digestion by the addition 
 of hot sauces. Next come cakes of various kinds, and most 
 of the results of the confectionary art ; and fully equal to these 
 in their power to generate acid, are all rich and oily nuts. In 
 enfeebled stomachs, however, and those peculiarly prone to 
 the complaint, nine-tenths of the ordinary articles of food be- 
 come exciting causes. Butter, sugar, fruit, vegetables of all 
 kinds, (excepting, perhaps, a potato,) and even bread itself, are 
 viewed with distrust! till a morsel of dried meat, a soda bis- 
 cuit, and a little brandy and water, constitute the sum total of 
 the luxuries of the table. 
 
 Water-brush, so called, differs from heart-burn in this, that 
 the eructation is generally in greater quantity, and is wholly 
 destitute of taste. It is most apt to occur early in the morn- 
 ing, and at other times when the stomach is empty. It seems 
 to be connected, more peculiarly than the other, with a relaxed 
 state of the fibres of the stomach, brought on by indulgence in 
 spirituous potations, and more particularly perhaps in malt li- 
 quors; but it sometimes affects temperate persons from causes 
 similar to those of common heart-burn. It is often accompa- 
 nied with a sensation of faintness. 
 
 Relief is afforded, during the paroxysms of heart-burn, by 
 the use of alkaline substances, such as magnesia, chalk, and 
 ammonia, which neutralize the acid. The compound formed 
 by the magnesia is cathartic, and that by the chalk, astringent; 
 so that the choice between them is determined by the costive 
 or lax condition of the bowels. Other articles proposed appear 
 to have a direct effect in sheathing the gastric membrane from 
 acrimony. Such is the case with oil, and especially with soap, 
 which is probably decomposed, its alkali being seized upon by 
 the acid, while its oil serves the purpose above mentioned. 
 These remedies are merely palliative and temporary; and oil 
 is objectionable as being one of the very articles which pro- 
 duce the affection. A far better plan consists in avoiding those 
 articles which are found to disagree with the patient; but were 
 this plan rigidly pursued, and every such article positively dis- 
 carded when found to produce acidity, the stomach would soon 
 be found in some cases irritable from exhaustion, and the pa- 
 tient in danger from mere inanition ! It is highly necessary, 
 therefore, in both the affections we have been considering, to 
 impart vigour to the organ by tonics, &c. The remedies and 
 regimen adapted to this end will be considered under the head 
 of dyspepsia. 
 
 Flatulence is another of the annoyances to which feeble 
 stomachs are subject. It consists in the extrication from the 
 
494 FLATULENCE — CGSTIVENESS. 
 
 food of large quantities of gas, principally the carbonic acid, 
 which is sometimes eructed, sometimes passes downwards, or 
 may remain pent up in the cavity, producing a rambling noise 
 and more or less uneasy sensation, though seldom actual pain. 
 This gas is the product of fermentation; and this process, which 
 is prevented when digestion takes place in a healthy manner, 
 here goes on under the combined operation of heat and mois- 
 ture, as if the vital influence were checked or withdrawn. When 
 the quantity of gas thus separated is large, and finds no natu- 
 ral outlet, the abdomen becomes sometimes great)} swelled, and 
 tense like a drum. 
 
 There is a class of remedies called carminatives, supposed to 
 act primarily on the mucous membrane, and. by sympathy, on 
 the muscular fibre of the stomach, so as to enable it to expel 
 its contents, and in a degree to resist distention, when a new 
 supply of gas comes to be produced. Familiar - 
 seen in the seeds of the caraway and cardamom, the aniseed and 
 coriander, the leaves or calv\< - ;nint, 
 
 thyme, etc., also in ginger, and the aromati- Bat it is 
 
 still to be remembered thai th< •-• 
 their repetition, instead of 1 to impair the 
 
 roach. It might be supposed that 
 tic taken with, or immedi. J, would pr 
 
 this affection ; and the f thi^ pi j 
 
 extent, is proved by the beneficial 
 means of effecting the principal ration of i 
 
 i the stomach, by which i( 
 remains yet to be considered under the b i; but 
 
 We cannot resist the temptation to mention ' 
 ral of the most obstinal under our no- 
 
 tice, recovered speedily and perfectly under the us 
 mon table salt, given dry. in 
 times a day. 
 
 Costivencss. Afl ral rule i( 
 
 nance of perfect health, that th< 
 in twenty-four hours, livery deviation, t! 
 condition, though not a ground for alarm, should be at 
 regarded with distrust. Among tfa 
 
 to produce this deviation are sudden changes of diet, such as 
 a change from on< ig principally g to one 
 
 in which animal food has the I 
 from a le<s pure to a purer art 
 
 Dated with saline ingredients, to one destitute oi them: cl 
 of air, as that oi the plain for the mountain. — the land for 
 
 : (but in this I; >ther circumstances usual! 
 
 rate to produce the effect;) also change ot hah m a 
 
 less, to a more sedentary occupatioi I [fenta which, p 
 
COSTIVENESS. 495 
 
 out impairing the general health or appetite, compel the indi- 
 vidual to almost absolute repose, nearly always 4 produce con- 
 stipation. Any circumstance which induces inattention to the 
 regular evacuation, or which makes constant attention inconve- 
 nient, will have the same effect. The immediate, proximate 
 cause of the change in these cases is not easily discovered, but 
 in a few particular cases may readily be conjectured. Thus, 
 the costiveness which belongs to convalescence from long con- 
 tinued disease, is the natural result of the activity with which 
 absorption is carried on for the supply of the system, and which 
 leaves the residuum wholly deprived of its fluid portions, and 
 in a state which renders its expulsion difficult. The costive- 
 ness of jaundice is also easy to be explained ; for here no bile 
 finds its way into the canal, and its fibres are not moved to 
 their natural and healthy action. 
 
 Some of the means, by which the bowels may be relieved 
 from a state of costiveness, have been anticipated in speaking 
 of the causes by which the state in question is induced. The 
 articles of food which have obviously had an influence in 
 causing the complaint must be omitted ; and a diet principally 
 vegetable, with a moderate use of fresh fruit when in season, 
 may be substituted therefor. Of the materials commonly em- 
 ployed in making bread, the flour of Indian or rye meal is more 
 opening than that of wheat, and the latter is rendered more 
 so by being combined with the husk or bran, which is usually 
 separated from it by the process of bolting. Together with an 
 appropriate selection of articles of diet, a due share of bodily 
 activity is highly important; and of all kinds of exercise, pro- 
 bably the best adapted to promote the evacuations, is walking. 
 The effect of exercise on horseback, and in carriages, is, in 
 many persons, entirely opposite, — for reasons of which, we free- 
 ly confess our total ignorance. 
 
 Among the mechanical aids for promoting regular evacua- 
 tions, there is one which has attracted much notice within a few 
 years, though by no means of modern suggestion; — that of 
 kneading or shampooing the belly. This may be easily prac- 
 tised by the patient upon himself, and thus the double pur- 
 pose, of exercise and of mechanical pressure, is answered. 
 
 Of the medicinal articles, commonly employed to relieve 
 constipation, the list is sufficiently long; and the very variety 
 and number of those in common use, serve to show how very 
 unsatisfactory are the results derived from them all, when 
 their use is depended on as a substitute for the natural and 
 spontaneous actions of the system. 
 
 In choosing medicines for habitual constipation, regard 
 seems to have been had principally to the convenience of the 
 form, and the smallness of the bulk, in which they could be 
 
496 COSTIVENESS. 
 
 administered. Hence the preference for the drastic purges, 
 so called ; such as aloes, jalap, scammony, gamboge, &c. These,, 
 with calomel and rhubarb, form the materials of nearly all the 
 popular cathartic pills, whose composition has become known. 
 These nostrums are not ordinarily open to the objection that 
 they purge violently or produce pain: the general difficulty 
 in their use is, that they create more trouble than they re- 
 lieve. Their operation is followed by increased torpor, for 
 which an augmented dose is needed: from one or two pills, 
 'the patient proceeds to ten or twelve, to fifteen or twenty; 
 till finally, the amount necessary to produce the effect desired 
 becomes absolutely enormous. With all this, no immediate or 
 violent effects are manifested; but the digestion, instead of im- 
 proving, becomes more and more deranged, the appetite is 
 lost, and the stomach becomes the seat of sub-acute inflamma- 
 tion, which sooner or later, if the treatment is persisted in, 
 closes in death. Such is not an uncommon termination of 
 the habitual and excessive use of cathartics.- Such a habit 
 should never be formed, if it be possible to avoid it. If there 
 be any mode in which articles of this description can be per- 
 severed in without injury to the system, it is by combining 
 them with the food itself, in such a manner as to supply, in 
 some measure, its defective stimulating power. A small piece 
 of the root of rhubarb, after a meal, chewed and mingled with 
 the saliva, will often answer this purpose in a very effectual 
 manner. 
 
 In most persons, calomel, instead of losing its effect by use, 
 actually acquires force by habitual employment, and is, there- 
 fore, exceedingly well fitted for some forms of costiveness. 
 To be useful in this way, it must be given alone; for in all its 
 combinations with other purgatives, it loses the property 
 above mentioned ; a result which also follows, if it be given 
 in doses unnecessarily large; and this fact we would strong- 
 ly impress upon our western readers, among whom the 
 abuse of calomel is carried to a most shocking extent, even 
 by some professional men. The plea that decidedly larger 
 doses are required, in consequence of the peculiarities of the 
 climate, is absurd, when reference is made to countries within 
 the temperate zone. We have practised in tropical countries, 
 where large doses are really required; but even there, they 
 bore no proportion to the enormous quantities usually given 
 in the West. We have practised in the West, and our chief 
 occupation was the removal of the bad consequences of large 
 doses of calomel, by the proper employment of smaller ones! 
 
 In the habitual costiveness of middle-aged and elderly fe- 
 males, marked by too light a colour of the stools, we have 
 never failed in breaking the habit by the following means. 
 
INDIGESTION OR DYSPEPSIA. 107 
 
 though we have attacked cases of thirty years' standing, in 
 persons aged from sixty to seventy-five years. 
 
 Let the patient take five grains of calomel at bed-time. If 
 it do not produce a free stool by ten o'clock next morning, 
 increase the dose to eight grains, and if it produce more than 
 two stools, diminish the quantity to three grains. Let the 
 medicine be given every other night, until it begins to pro- 
 duce more than two stools. Then omit it until costiveness 
 returns. On this return, commence with the last dose, and 
 continue till more than two stools are again produced. Then 
 omit, and proceed as before. After a time, if the habit prove 
 obstinate, the calomel will frequently produce four or five 
 stools when given in doses of a single grain! but usually the 
 habit is broken before the quantity requires to be diminished 
 below three grains — which is the quantity commonly re- 
 quired from the first. Always diminish the dose whenever 
 the first exhibition brings on three or more evacuations, and 
 increase it if no discharge follow; but when the increased 
 quantity also fails, it is safest to administer some stronger pur- 
 gative, such as senna, or rhubarb, and jalap, omitting the mer- 
 cury for three or four days, when the larger quantity may be 
 tried again. 
 
 Under this course of treatment, if advantageous, the inter- 
 vals between the returns of costiveness, though, at first, en- 
 during but two or three days, are soon elongated to a week, 
 a month, and many months. We thus treated an old lady of 
 seventy-five, and childish, who for more than forty years, had 
 but one stool per week. The remedy was administered at 
 seven intervals. She has been perfectly regular for several 
 years. 
 
 Indigestion or Dyspepsia. That state of the stomach, in 
 which it is incapable of performing its appropriate function, 
 of changing the received food into chyme, is termed dyspep- 
 sia. Some of the effects and concomitants of this state, and 
 the means of relieving them, have been already touched upon, 
 under other heads; but the more general consideration of the 
 affection has been reserved for this. Whether the immediate 
 cause of dyspepsia is to be sought in the debility of the mus- 
 cular fibre of the organ, or, in the defect or bad character of 
 its secretions, is a question not easily determined in all cases. 
 There is little doubt, however, that both causes usually, coex- 
 ist; the tendency of the food to the acetous fermentation seems 
 to be the effect of the latter; while the tendency to distention, 
 and the difficulty with which the aliment is urged forward 
 into the intestines, is a proof of the former. Other symptoms 
 of dyspepsia, besides those already alluded to, are oppression 
 at the stomach after food is taken; a sense of weight and drag- 
 
 63 
 
498 INDIGESTION OR DYSPEPSIA. 
 
 ging about the limbs, while the digestive process is going on? 
 a sensation of gnawing rather than hunger felt whenever the 
 stomach is empty ; a disposition to sleep after meals, which, 
 when a full repast has been taken, is almost irresistible; and 
 frequently a heavy dull pain about the head. The modes in 
 which indigestion is induced, are nearly innumerable; and as 
 almost all of them may be inferred by the intelligent, from 
 the* principles and facts contained in the chapter on Hygiene, 
 we shall not dwell upon them at present; but one very uni- 
 versal cause demands the especial attention of Americans; 
 namely; the habit of too rapidly swallowing food, by which 
 sufficient time is not allowed for the process of mastication, 
 and for the secretion of the fluids which aid digestion. 
 
 The general means by which dyspepsia may be avoided, 
 are to be inferred from the nature of the causes by which it 
 is induced. But its cure requires other considerations, for it 
 is not always that even a bad habit can be wholly omitted 
 with impunity, nor will its discontinuance always repair the 
 mischief which its indulgence has occasioned. As respects 
 intemperance in the quantity, and variety in the kind of food, 
 the principle of sudden reformation may safely be practised; 
 and those accustomed to bolt their aliment without taking 
 time for mastication, will find no inconvenience in adopting 
 more civilized customs. The regulation of the mind and the 
 due control of the passions also require no caution. 
 
 But the change from sedentary to active habits is one of 
 more difficulty. The sedentary student may be fully per- 
 suaded of the advantages of exercise, and may, with all ear- 
 nestness, attempt a reform ; but if the exercise be tedious or dis- 
 tasteful; if he walk without an object or interest, merely to 
 accomplish a task, and with his mind still occupied by his 
 previous studies, he will gain little benefit. Exercise must 
 he an actual relaxation and amusement, or it will fail in pro- 
 ducing its effect. It is on this ground that travelling, which 
 combines bodily motion with a change of scene and pur- 
 suit, is so often recommended. Exercise should produce 
 fatigue, but not exhaustion. The indigestion arising from ar- 
 dent spirits can be cured only by abandoning their use, and 
 substituting therefor some of the bitter tonics, to which al- 
 lusion will presently be made. That from coffee can general- 
 ly be obviated by the substitution of tea; and that from the 
 use of green tea by the use of black; which produces, usually, 
 little disturbance, either of the stomach or the nervous system. 
 Opium, in every form, must be totally abstained from. To- 
 obviate the cravings occasioned by its disuse, the bitter tinc- 
 tures which contain a narcotic principle, such as those of vale- 
 rian, hops, &c.j may be employed. 
 
INDIGESTION OR DYSPEPSIA. 499 
 
 The remedial measures for giving tone lo the stomach, and 
 for improving the character of the secretions, are, in general, 
 those, which are termed tonics. They are supposed to exert 
 their action on the muscular fibre. They are generally bitter 
 substances, and are employed either in their simple state, or 
 in the form of tincture. Of the propriety of employing these 
 spirituous preparations, there has been no little question 
 among the advocates for total abstinence from all distilled li- 
 quor. But it is at least certain, that the injurious effect of the 
 spirit is very considerably modified by the addition of the 
 bitter principle, and that this is generally borne better by the 
 stomach, when first submitted to the action of its appropriate 
 solvents. Among the most popular of these preparations may 
 be mentioned Huxham's, or the compound tincture of bark, 
 which, in addition to its principal ingredient, contains snake- 
 root, saffron, orange peel, (fee. 
 
 Whatever virtue the above articles may possess in their cha- 
 racter of tonics, they are still to be regarded as subordinate to 
 those more general means which communicate vigour to the 
 stomach by strengthening the whole system. Such are the 
 breathing of fresh, pure air; the due exercise of the muscular 
 system ; cold and warm bathing ; and the maintainance of a 
 well regulated mind and a cheerful temper. 
 
 In connexion with the subject of indigestion, it may not be 
 useless to suggest some brief remarks in the choice of articles 
 of diet, and the regulation of meals. In making these, we are 
 not ignorant of the ridicule which attaches to such precepts 
 delivered without regard to the constitution and circumstances 
 of the individuals addressed. We are aware that it is impos- 
 sible to frame rules of living which shall apply at once to the 
 hardy and robust denizen of the country, labouring with his 
 own hands, and eating his bread, literally in the sweat of 
 his brow, and to the pampered and indolent son of fortune sur- 
 rounded by luxuries which he has lost the power to enjoy. Still 
 there is a large class to whom sound maxims of dietetics will 
 apply, and for whom they will possess interest. We allude to 
 that portion of the inhabitants of cities and towns, whose oc- 
 cupation is continued from necessity through eight, ten, twelve 
 or more hours each day, and is not of a nature to bring into 
 exercise the larger and more powerful muscles; in other words, 
 persons of sedentary or stationary employments, fixed to one 
 sphere and to one kind of labour, whether this consist in wri- 
 ting for the press, settling accounts, setting types, regulating 
 watches, mending shoes, or attending to millinery or mantua 
 making. Such persons constitute, perhaps, one-fourth of the 
 adult population of towns. What proportion of them actually 
 suffer from indigestion, we are unable to conjecture ; but we 
 
500 RULES OF DIET. 
 
 are well convinced that, in a very large number, the functions 
 of the stomach arc performed in a manner far from satisfac- 
 tory. All these persons have an interest in the general prin- 
 ciples of dietetics, and however diversified their condition and 
 circumstances, these principles admit of a ready and simple 
 application to all. We shall offer then, for the especial be- 
 nefit of these persons, some few remarks on diet, the choice of 
 food, and the regulation of meals. 
 
 One substantial meal of animal food is sufficient for the daily 
 supply of a man in health, engaged in business involving ordi- 
 nary labour. The custom, therefore, of taking meat for break- 
 fast, and again at supper, is perfectly unnecessary and un- 
 questionably pernicious. The principal meal should be taken 
 about one^ or two o'clock, so as to occupy about the middle of 
 the waking period. The animal food should consist of one 
 dish only, and that, of easy digestion. Fish, and particularly 
 shell-fish, disagree with some weak stomachs, and are apt to 
 occasion an eruption upon the skin. Yet where they sit easily 
 and are relished, several of them, particularly the crab and 
 lobster, are found to neutralize acid in the stomach, better 
 than any other description of animal food. The oyster also 
 forms an exception to the general character of this class, being, 
 when simply cooked, of extremely easy digestion. Of meats, the 
 perfectly healthy kinds, among which the choice is nearly indif- 
 ferent, or may be determined by individual experience, are beet, 
 roasted or broiled, mutton, lamb, or venison. Of poultry, chick- 
 ens, roasted or boiled, are among the least objectionable: of 
 fresh fish, most descriptions, boiled or broiled, with the excep- 
 tion of salmon, which is too rich. Of vegetables, rice and potatoes 
 are the lightest and most nutritious. Peas, beans, and squashes 
 can be indulged in by most with impunity ; and the tomato 
 possesses properties which render it, for a relish, as salutary as 
 it is grateful. Among those viands usually introduced, which 
 are to be received with distrust, are the salted meats, gene- 
 rally; as ham, salted beef, pork, etc. These are objectionable 
 on account of the fat they contain and the form in which it is 
 presented; but, in small quantities, and particularly with the 
 aid of some condimeut,such as mustard, or horse-radish, they are 
 borne well. Fresh pork, whether young or old, is unwhole- 
 some to all but hard-working men. The flesh of goose is oily, 
 and its nutritive qualities not easily extracted, except by a 
 strong stomach. Many meats, however, which are too rich 
 to be eaten alone, are improved by combination with the cruder 
 vegetables, and by the addition of acids and other stimulants. 
 Thus, salad, and even cucumbers, when dressed, assist the diges- 
 tion of ham or pork ; and, on the same principle, a goose may be 
 disposed of with the aid of that well known sauce which is 
 
RULES OF DIET. 501 
 
 obtained by boiling apples in cider. Of such combinations, 
 however, the dyspeptic, unless experience has taught him their 
 adaptation to his own particular system, will be wary; and 
 will rather depend on what he knows to be wholesome, than 
 hazard his comfort by any rash exposure. 
 
 Among culinary vegetables, the turnip disposes to flatulence; 
 a fact equally true of the onion, but this vegetable possesses 
 valuable properties which establish its claims to extensive use. 
 The beet, the carrot, and the ruta baga, have the same fault 
 as the turnip, besides possessing a saccharine principle which 
 is apt to be converted into acid. The class of preparations 
 termed puddings, have not found much favour in the eyes of 
 the learned ; and probably, no one of the tribe has been more 
 generally denounced than the 'dumpling; yet the experiments of 
 Dr. Beaumont go to show, that neither beef nor mutton is so soon 
 disposed of by the human stomach as this same dumpling. We 
 mention this, not to 'encourage the imprudence of eating them, 
 but to show that the rapidity with which an article is digested 
 in a strong stomach is no proof whatever of its fitness for a 
 weak one. According to Beaumont's experiments, a dish of 
 tripe, some boiled salt codfish, with raw cabbage and vinegar, 
 should form the favourite repast of the philosophic. Experi- 
 ence, however, does not justify these conclusions, true as respects 
 a single individual, but not capable of universal application. 
 It is due to the learning and good sense of Dr. B. to acquit him 
 of intending to found general rules on these particular re- 
 sults. 
 
 Articles, perfectly wholesome in themselves, may become 
 objectionable from the form in which they are taken. This 
 observation applies to minced dishes — no very tempting prepa- 
 tions — and to jellies, which are generally considered as peculi- 
 arly fitted for the invalid, from the facility with which they 
 are swallowed. If taken without mastication, they make no 
 impression on the salivary glands, and entering the stomach un- 
 mixed with the secretions of these organs, are digested with 
 difficulty. 
 
 Water is of course the best of beverages. The best substi- 
 tute, when water is found to encourage the formation of acidity 
 in dyspeptics, is perhaps a little tea, of moderate strength, 
 taken after, not during the meal. 
 
 For the morning and evening meals, custom has so fully 
 established the use of coffee and of tea, that any attempt at in- 
 terference would be hopeless. It may be useful, however, in 
 order to determine a choice in doubtful cases, to allude to 
 some of the circumstances by which their respective effects 
 are found to differ from each other. As a general rule, coffee 
 acts more especially on the digestive, and tea upon the ner- 
 
502 VOMITING. 
 
 vous system. Coffee, to most persons, is laxative; and it is 
 this effect, the absence of which is missed when its use is first 
 abandoned for that of tea or other liquids. Coffee, in any 
 quantity, is apt to be followed, in persons of weak digestion, 
 by. a peculiar sensation of sinking and faintness at the pit of 
 the stomach, occurring about two hours after the meal is taken, 
 and lasting, perhaps, for the same period. It is usually 
 most marked in warm weather, and is accompanied by a dis- 
 tressing sense of debility and relaxation. It somewhat resem- 
 bles the sensation of hunger, and is sometimes relieved by swal- 
 lowing some light farinaceous substance. Both coffee and tea 
 produce wakefulness; but the latter is more certainly followed 
 by this effect. In most persons, tea, especially when taken 
 towards evening, produces a brightening of the intellect, and 
 an agreeable sensation of gayety and cheerfulness, which do 
 not belong, in the same degree, to the use of coffee. An occa- 
 sional change from one to the other, is better than a long con- 
 tinued perseverance in either. 
 
 Among the usual substitutes for coffee, as a morning meal, 
 may be mentioned milk and chocolate. A sudden change to 
 either, will probably produce heaviness and headach, which 
 are rather to be attributed to the absence of the usual stimu- 
 lant, than to the presence of any principle in these articles 
 themselves. If persevered in, either will at length be found 
 nutritious and digestible. To this rule there are some excep- 
 tions in persons otherwise healthy, but in whom one or other 
 of these articles is always followed by unpleasant effects. For 
 weak stomachs, the shells of the cocoa may be advantageously 
 substituted for chocolate. 
 
 Butter, as an addition to bread, is equally grateful and salu- 
 tary; but the enormous quantities which are used by some 
 persons, at each of the three meals, are decidedly injurious, 
 often producing nausea, and sometimes serious disturbance. 
 
 Vomiting. — The act of vomiting, when spontaneous, is fre- 
 quently a salutary effort, on the part of the stomach, to rid it- 
 self of an offending substance. It is often also artificially and 
 intentionally excited. Under neither of these circumstances, 
 can it be regarded as a disease, unless, in the one case, it con- 
 tinues after the cause is removed, or in the other, passes the 
 bounds by which its beneficial operation is limited. 
 
 There are, however, some other varieties of morbid vomit- 
 ing. Sea-sickness may be considered as one; for although 
 the tendency of this may generally be to health, it often pro- 
 ceeds to an extent which makes remedial measures necessary. 
 The vomiting from inflammation of the stomach, is another 
 morbid variety; and there are many individuals in whom, 
 from habits or peculiarity of constitution, vomiting occurs 
 
VOMITING. 503 
 
 upon very slight occasions, or without apparent cause, and 
 continues until active measures are adopted for its relief. 
 
 Excessive vomiting, after a surfeit, or entire evacuation 6f 
 the organ, may often be relieved by the simple expedient of 
 taking some light nutriment in a liquid form, rendered grate- 
 ful by the addition of spicy, aromatic ingredients, such as 
 arrow root, for example, with nutmeg and wine added. If this 
 be rejected, a little green tea will perhaps be retained: if the 
 vomiting continue obstinate, it may be necessary to adminis- 
 ter a cathartic injection. These means seldom fail in accom- 
 plishing the end proposed. 
 
 When the vomiting from an emetic threatens to prove ob- 
 stinate, it is usual to give a draught of the infusion of chamo- 
 mile, or some aromatic herb, as balm, mint, sage, &c, which 
 usually succeeds in arresting it. Should this not answer, a 
 few drops of laudanum may be given, either alone or in com- 
 bination with a carminative tincture. Sometimes the evolu- 
 tion of carbonic acid gas in the stomach, by a draught of soda 
 water, is found effectual; and sometimes a few drops of a bitter 
 tincture, particularly the Columbo root, has been successful. 
 Vomiting from emetics, unless they have been given in ex- 
 cessive and unreasonable doses, very rarely escapes the con- 
 trol of these and sintilar remedies. 
 
 Sea-sickness is generally regarded as a self-limiting disease; 
 and it is certainly true that it rarely proves fatal. But it is 
 often exceedingly desirable to abridge the duration of this dis- 
 tressing affection, especially in feeble subjects, and those ex- 
 hausted by previous disease. The healthy and vigorous, pro- 
 vided they can command resolution to resist its influence, and 
 to exert their muscles in the open air, soon overcome it. 
 Where this expedient cannot be resorted to, or fails, a little 
 hot brandy, or Jamaica spirit and water, will sometimes serve 
 to settle the stomach; and some nourishment, in a liquid form 
 should be tried as early as possible. But a most powerful 
 remedy for sea-sickness, — one that will often control it after se- 
 veral days have elapsed, and other means have failed, — is a 
 strong tea of horsemint, (monarda punctata) given cold, in the 
 dose of a wine-glassful, every hour. 
 
 Some of the most obstinate cases of vomiting occur in de- 
 bilitated habits, and especially in those who have destroyed the 
 tone of the stomach by the constant use of opium or alcohol. 
 Such persons are in the habit of subduing slighter attacks of 
 nausea by a resort to their favourite sedative; till, at length; 
 the irritability of the digestive organs become so highly exalt- 
 ed, that these means prove wholly unavailing, and the stomach 
 obstinately refuses to receive the slightest portion of food ef- 
 
504 HICCOUGH. 
 
 ther solid or fluid. These attacks are, in the habitual drunk- 
 ard, sometimes of a salutary character; the liver assumes un- 
 wonted activity, the bile is secreted in great abundance, and 
 the system undergoes a thorough renovation. Frequently, when 
 the vomiting ceases, or is checked, in such cases, inflammatory 
 disease or the delirium peculiar to drunkards at once succeeds, 
 and we are justified in supposing that these affections are in 
 many instances prevented, in others rendered milder, by the pro- 
 cess in question. The propriety of arresting it, therefore, when 
 occurring in such subjects, might be questioned ; but decide as 
 we may, its arrest is rarely within the ordinary resources of 
 art. It will almost invariably run its course. These attacks 
 may sometimes be checked without much hazard, by employ- 
 ing the vegetable bitters; the chamomile and worm-wood have 
 been particularly recommended. A blister applied to the re- 
 gion of the stomach is another appropriate remedy. 
 
 Inflammation of the stomach may be suspected, when, to ob- 
 stinate vomiting, continued for many days in succession and 
 recurring after apparent relief, great tenderness at the pit of 
 the stomach is added. In some of these cases, the patient, 
 though tormented with intense thirst, dares not swallow the 
 slightest portion of liquid; and yet total abstinence itself af- 
 fords but a partial and imperfect relief; for an empty retching 
 torments the sufferer, when nothing is introduced into the or- 
 gan from without. These cases require, in some respects, the 
 ordinary treatment of inflammation in general; but their ma- 
 nagement demands the highest order of medical skill, and can- 
 not be discussed in a popular work. 
 
 Hiccough. Although hiccough has its immediate seat in 
 the diaphragm or midriff, it is seldom or never dependent on 
 disease of that organ, but almost always arises from irritation 
 in some other part, and especially in the stomach. It may be 
 induced by mere distention of this organ ; as in infants, in whom 
 the disorder is very common, from over-nursing. The presence 
 of flatulence is a very frequent cause of hiccough : as is also 
 the irritation produced by worms. Other causes, more distant 
 or more general, will occasionally excite it, as disorder of the 
 liver, and the irritation produced by strangulated hernia. Last- 
 ly, it is among the signs, and, in certain cases, the surest sign 
 of approaching dissolution. 
 
 Although hiccough generally disappears with the cause which 
 gave rise to it, it is, like other spasmodic affections, very de- 
 pendent upon habit, and, hence, not only liable to recur upon 
 slight occasions, but, when present, to go on obstinately at in- 
 tervals of a few seconds, until it becomes a serious inconveni- 
 ence. 
 
 Hiccough may usually be checked by forcibly holding the 
 
HICCOUGH CRAMP. 505 
 
 breath : and it is also a familiar fact that any sudden emotion, 
 especially of fear or surprise, which powerfully arrests the at- 
 tention, will have the same effect. This principle is often ren- 
 dered available, in a familiar way ; but its operation was pro- 
 bably never more effectually displayed than in the case of a 
 young girl in Paris, who had been tormented almost constantly 
 for six months, and who was brought to the hospital under the 
 charge of Dupuytren. After trying the warm bath, and some 
 other remedies to no purpose, the Baron ordered a red hot iron 
 to be applied to the pit of the stomach, on which the spasms 
 immediately ceased. 
 
 When the complaint occurs in severe diseases, it sometimes 
 requires vigorous treatment as a symptom, but the application 
 of the necessary measures must be left exclusively to the pro- 
 fession. 
 
 Cramp. The precise nature of the influence which the 
 brain ordinarily exercises over the voluntary muscles is not 
 known ; but the fact is obvious that by the mere exercise of 
 volition we are able to contract these muscles, and by so doing 
 to communicate motion to the parts to which they are attached. 
 In a state of health these muscles, if not acted on by the will, 
 remain quiescent; but in various morbid states of either of these 
 organs, the nerves of organic life, the spine, or the brain itself, 
 this exclusive control is lost; and the muscle may contract, not 
 only without any exercise of volition, but in defiance of the 
 will. These deviations from healthy action are, in general, 
 termed spasms; and these may be either constrictive, when the 
 affected muscle is fixed rigidly until a counteracting force or 
 another spasm produces relaxation; or clonic, when the affected 
 part is made to move in short irregular twitches. Under the 
 head of constrictive spasm are included some of the severest 
 diseases to which the human system is subjected ; but the affec- 
 tion at present under notice, though often exquisitely painful, 
 is seldom dangerous. 
 
 The most usual seats of cramp are the calves of the legs, 
 the neck and the stomach. In regard to affections of the last 
 organ, it cannot with propriety be said that the control of the 
 will is withdrawn, since in fact the organ is not usually subject 
 to this control; the disease here consists in the substitution, for 
 the ordinary and healthy peristaltic actions of the fibres, others 
 which are irregular and unhealthy. The cramp which attacks 
 the legs usually occurs in the night, when the limbs by long 
 rest have become stiffened. Cramp often occurs in swimming, 
 and seems here to be owing partly to the impression of cold on 
 the surface, and partly to the restraint imposed on the muscles 
 by being employed in an unaccustomed serie« of movements : 
 
 64 
 
50G CRAMP — BLEEDING FROM THE NOSE. 
 
 for, the more familiar the exercise, the less likely is this effect 
 to follow. 
 
 The relief of cramp, which is for the most part obtained 
 without medical aid, consists in opposing the constrictive action 
 o( one set of muscles by a voluntary exertion of the opposite. 
 If, for example, the legs be spasmodically contracted, the will 
 must be exerted to extend them. Often, however, it is found 
 necessary to bring some extraneous force to bear on the part 
 for the same purpose; and hence we find persons affected with 
 cramp of the leg drawing the limb with the hand in the oppo- 
 site direction. This plan is often aided by friction. 
 
 Habitual cramp is generally a symptom of chronic irritation 
 of the small intestines, resulting from some error of habit or 
 diet, which being discovered and removed, the paroxysms of 
 cramp disappear. 
 
 Bleeding from the Nose occurs spontaneously under a great 
 variety of circumstances, in many of which it may be regarded 
 as unquestionably a salutary evacuation. We have already 
 noticed its occurrence in catarrh, in which disease it often af- 
 fords immediate relief to the inflamed mucous membrane. In 
 other cases, the inflammations relieved by hemorrhage from the 
 nose are located in distant parts ; as, for example in the throat, 
 the lungs, or the membranes of the brain. 
 
 This discharge is often of advantage when it supervenes upon 
 local plethora or congestion, such as is produced in the vessels 
 of the brain by close mental application. It is a common occur- 
 rence, and often equally advantageous, in children who are un- 
 dergoing the natural changes which take place as they ap- 
 proach the age of puberty. Where habitual excesses at the 
 table, and inactive habits, bring on a confirmed and general 
 plethora, requiring periodical evacuations, the nose often acts 
 as the flood-gate of the system ; and on the sudden suppression 
 of established discharges or local irritations, which, though mor- 
 bid in their nature, have become necessary to the health, by 
 custom, the blood vessels of the nose occasionally open their 
 sluices to the relief of the vital organs too frequently at- 
 tacked in such cases. In violent paroxysms of passion or emo- 
 tion, and in powerful muscular exertions, the ru^h of blood to 
 the head would much more frequently occasion apoplexy, were 
 it not that the sudden flow of blood from the nose often comes 
 on and checks the attack. 
 
 In these cases, hemorrhage from the nose cannot be regard- 
 ed in the light of a disease, but the amount lost in certain in- 
 stances becomes in itself a source of immediate danger, and 
 in others the vessels of the mucous membrane become debili- 
 tated by habit or disease, in such a manner as to lose in part 
 
BLEEDING FROM THE NOSE. 507 
 
 their power of retraction ; and thus what are termed passive 
 hemorrhages are produced, which are always more difficult of 
 restraint either by natural or artificial means. In certain fa- 
 milies, a tendency to this form of hemorrhage is hereditary, and 
 frequently the same disposition is noticed in individuals as an 
 idiosyncrasy. These last are by far the most troublesome forms 
 of the complaint. It is certain, however, that when bleeding 
 from the nose has become purely passive, it will proceed, if un- 
 checked by art till it produces the most alarming symptoms. 
 The quantity lost under these circumstances is sometimes enor- 
 mous. Ten, twelve, and even twenty pounds, have been 
 known to flow before the bleeding stopped. One case is re^ 
 corded of forty-eight pounds ; one of eighteen pounds, within 
 twenty-four hours; and one of seventy-five pounds within ten 
 days, being double the quantity generally supposed to be con- 
 tained in the whole body. It is evident that in the last case im- 
 mense supplies must have been furnished by absorption to com- 
 pensate the drain thus made upon the system. 
 
 Independently, however, of those protracted hemorrhages 
 which demand prompt and effective relief, there are conside- 
 rations of convenience and comfort which make it desirable 
 to check all bleedings, as soon as the relief demanded by the 
 system is obtained. Nothing so readily becomes a habit, 
 when indulged; and there is no habit with which, when con- 
 firmed, it is more dangerous to interfere. It must be checked, 
 therefore, if at all, at the onset; and, except under very pecu- 
 liar circumstances, such as the presence of inflammatory dis- 
 ease, apprehension of apoplexy, or the recent suppression of 
 some very important discharge, the attempt may be made with 
 safety, even from the commencement of the flow. When the 
 evacuation is absolutely needed, mild measures will rarely 
 prevent it from proceeding; while more severe remedies will, 
 of course, be deferred, until the symptoms become alarming. 
 
 The complaint rarely comes on, absolutely, without provo- 
 cation. The slightest local irritation will produce it; but 
 some irritation is necessary. Sneezing, the act of picking 
 the nose, friction of the face after washing, stooping, &c* 
 will often be sufficient to induce it in those predisposed. The 
 entire avoidance of all these causes is, of course, impossible; 
 but if they have been observed to act only periodically, as at 
 a certain hour of the day, &c, a little caution will often pre- 
 vent the anticipated attack; and thus, at least, break in upon 
 the habit. 
 
 The bleeding itself may frequently be arrested by the most 
 simple means. The application of cold to almost any part of 
 the surface will produce contraction of the extreme vessels 
 generally, in which those of the mucous membrane affected 
 
508 STRANGURY. 
 
 will participate. The simple expedient of placing a cold body, 
 as a piece of iron in winter, or ice in summer, on the neck or 
 back, will often be sufficient. A decided chill may be in- 
 duced by the application of ice to the forehead and temples; 
 and with more certainty, but less safety, by immersing the 
 feet in extremely cold water. An agent of still more power, 
 when it can be brought into action, is pressure upon the bleed- 
 ing vessels by means of tents of sponge, lint, or muslin, 
 which may be pushed into the nostrils from before, — or, if ne- 
 cessary, and surgical assistance be present, — from behind also. 
 
 Injections of astringent substances into the nostrils, have 
 often arrested hemorrhage; and, of these, the best is the 
 saturated solution of alum. When the plugs of lint, above 
 mentioned, are steeped in this solution, their usefulness is ge- 
 nerally increased. Creosote has been recommended for the 
 same purpose; but our experience with this boasted remedy 
 has not tended to raise our opinion of its powers in controlling 
 hemorrhage. The dry powders of vegetable substances, have 
 proved very efficacious, when taken in the form of snuff. 
 They act by promoting coagulation; but the powdered leaves 
 of the St. John's wort, {Uypericum perforatum,) has succeed- 
 ed so admirably, in three cases of obstinate passive bleeding 
 from the nose, that we cannot but recommend it to farther 
 notice, as probably possessing other more efficient virtues. 
 
 In some cases of obstinate and long continued bleeding from 
 the nose, after every other remedy, internal and external, has 
 been tried to no purpose, and great exhaustion has followed, 
 it is found advantageous to resort to the use of direct stimu- 
 lants. In a case of this kind, related by a distinguished me- 
 dical author, the bleeding had continued for four days; during 
 which time, the patient, a feeble woman, had been allowed no 
 other nourishment than toast water. She was pale, sick, and 
 without pulse. Port wine, with astringent injections into 
 the nostrils, were prescribed, and, in a short time, the bleed- 
 ing began to abate. 
 
 The change from a meager to a better diet has had a happy 
 effect in somewhat similar hemorrhages, from other parts; and 
 in the hereditary variety, opiates appear to have succeeded in 
 one case. 
 
 Strangury consists in a painful emission of urine, which 
 comes away only by drops, and generally with a sense of 
 burning or scalding. The most common of its remote causes 
 is the application of cantharides, in blisters, or internally ad- 
 ministered. The immediate difficulty in this case, is proba- 
 bly an inflammation of the neck of the bladder from the ab- 
 sorption of the flies. Strangury is sometimes brought on by 
 eolds. The indications of treatment are, to diminish the local 
 
DIABETES — GRAVEL. 509 
 
 irritation, and to dilute the urine. The first object may be 
 attained by the warm bath, fomentations to the abdomen, and 
 warm injections; the latter being, sometimes, rendered more 
 effectual by the addition of laudanum. At the same time, the 
 mucilage of flaxseed or gum Arabic should be taken internally, 
 in unlimited amount. 
 
 A total stoppage of the urine may arise from the aggrava- 
 tion of those causes which produce strangury, and, in this 
 case, is removable by like means. But there are other causes 
 also peculiar to this affection. A spasm of the sphincter mus- 
 cle of the bladder may ensue on long continued voluntary re- 
 tention, as when the mind is ardently engaged, and the calls 
 of nature are neglected. This stoppage is generally relieved 
 by the warm bath. There are other causes of strangury or 
 retention of urine, but they are surgical in character, and need 
 not be mentioned here. 
 
 Diabetes. — The peculiar symptoms of diabetes mellitus, or sac- 
 charine urine, is a profuse discharge of the urinary secretion, 
 of a peculiar odour, resembling that of violets, and a sweet 
 taste. The latter has been distinctly traced to the presence 
 of sugar, resembling in all important particulars that of the 
 cane. The attendant symptoms are thirst and debility; the 
 accompanying circumstances are a voracious appetite, a dry, 
 harsh skin, a clammy tongue, and general emaciation. 
 
 It would be impossible, within our limits, to do justice 
 to the description and treatment of this singular affection, 
 which is too frequently fatal in spite of all the exertion of the 
 practitioner; but the possibility of its occurrence, and the 
 leading circumstances that characterize it, should be known to 
 every one; since, if not checked at its outset, it is rarely con- 
 trollable at a later stage. Whenever, therefore, the above 
 combination of symptoms presents itself, it should attract im- 
 mediate attention, and no time should be lost in seeking the 
 best advice. 
 
 Gravel. — The urine in its healthy state always contains 
 more or less alkaline matter, held in solution by its peculiar 
 acid, the uric or lithic. This alkali, which is for the most 
 part of a calcareous character, is immediately secreted by the 
 kidney itself. If either of these principles be in excess in 
 proportion to the other, a deposite will take place, either acid 
 or alkaline. In the former case, it sometimes concretes in 
 the kidney, where it forms masses of considerable size, and 
 sometimes is carried on to the bladder, where it shows itself 
 in the form of red sand. In the latter case, the alkali, then 
 set free, immediately unites with the phosphoric or oxalic 
 acid, most commonly the former, which is always present, and 
 forms a phosphate 6r oxalate of lime. For some reason, how- 
 
,510 GRAVEL. 
 
 ever, yet unexplained, the phosphates rarely, if ever, concrete 
 in the kidneys, but pass on to the bladder, where they consti- 
 tute the alkaline or white sand. The presence of these de- 
 posites is easily recognised by the appearance of the excretion. 
 Late researches go to show, that the precipitation of lithic 
 acid depends upon the presence in the urine of a free acid, 
 commonly the muriatic, sometimes the phosphoric or sul- 
 phuric, which acts by decomposing the lithates, and setting 
 their acids free. 
 
 A third form of calculous disease, and by far the most pain- 
 ful and formidable, is that of a solid concretion in the bladder 
 itself, constituting what is usually termed stone. These con- 
 cretions are formed in the bladder by gradual deposite from 
 the urine itself, around a central nucleus, which may be either 
 a calculus which has made its way from the kidney, or some 
 foreign substance introduced accidentally into the cavity- 
 The most painful circumstance connected with this disease is 
 the passage of the calculous concretion, when already large, 
 from the kidney into the bladder. During this process there is 
 fixed pain in the region of the affected kidney, with a numb- 
 ness of the thigh on the same side, the pain alternating with a 
 sense of weight in the part. The pain is acute, and accompa- 
 nied with nausea and faintness, from the time when the calcu- 
 lus has entered the ureter, until it enters the bladder; after 
 which, there is a remission. If the stone should fortunately 
 become engaged in the urethra, after reposing for a time in the 
 bladder, its farther passage is attended with some pain; but the 
 nausea that accompanies its previous course is wanting ; and 
 the pain, instead of being deep-seated, is referred to the open- 
 ing of the canal, and the actual seat of the concretion. While 
 the stone is passing from the kidney to the bladder, the urine 
 is usually high-coloured, and deposites a reddish sediment, not 
 unlike coffee-grounds, the effect, probably, of altered blood 
 flowing from lacerations of the mucous membrane of the ureter. 
 The presence of stone in the bladder can only be certainly 
 determined by actual examination by a surgeon; but if, after 
 the passage of one or more calculi from the kidney, there is 
 experienced a permanent difficulty in the evacuation of urine, 
 with a frequent desire to discharge it, and this accompanied 
 with acute pain at the termination of the urethra, the presence 
 of stone in the bladder may well be suspected. When no 
 passage of calculus or discharges of sand have been noticed, the 
 existence of the disease is less readily recognised, but that some 
 cause of irritation is present, will be perfectly evident ; since, 
 in addition to the pain, it will soon be observed that the stream 
 of water once commenced, is suddenly interrupted before its 
 completion. As the stone enlarges, there will be a dull pain 
 
DROWNING. 51) 
 
 about the neck of the bladder; while the irritation, extending 
 itself to the rectum, will produce a straining and frequent de- 
 sire to evacuate the bowels. These last symptoms do not ab- 
 solutely determine the actual presence of calculus, but point 
 out the propriety of a strict examination. 
 
 Drowning. — In complete suffocation from drowning, all the 
 mental and bodily powers, the sensibility, the action of all the 
 muscles, voluntary and involuntary, are suspended ; the surface 
 is cold, the heart ceases to beat, and no effort can detect the 
 slightest action of the lungs. ■ 
 
 The primary cause of death in drowning is believed to be as 
 follows. The non-admission of air to the lungs, prevents the 
 necessary changes in the blood circulating in their vessels. 
 Hence this fluid passes, in the venous state, to the left -side of 
 the heart, from which it is sent to the brain in such quantity 
 as to destroy, or materially to impair, the vital powers. 
 
 The following are the directions given by the humane 
 society for the recovery of the drowned. The clothes should 
 be immediately taken off, and the body wiped, cleaned, and 
 wrapped in dry cloths or blankets, so as to prevent evapora- 
 tion, and the effects of exposure to a cold medium. The body 
 should then be carried in a recumbent posture on the back, 
 with the head and breast raised. As soon as it has arrived in 
 the room for its reception, it should be stripped and covered 
 with warm blankets. If the mouth and nostrils be obstructed, 
 they must be thoroughly cleansed. The lungs are then to be 
 inflated, and dry warm flannels, bags of warm grain, or bot- 
 tles or bladders of warm water applied to the region of the 
 stomach, the soles of the feet, and other parts of the body. 
 Bleeding ought never to be employed in this stage of the process; 
 though it may become necessary, when reaction has taken 
 place, and the circulation has returned. 
 
 The longest period after submersion at which success from 
 these means can reasonably be anticipated, is about fifteen to 
 twenty minutes; but they should be tried after almost any 
 interval, provided no structural injury has been inflicted, and 
 there is no evidence of commencing putrefaction. The ac- 
 counts which we have of recovery after eighteen, twenty-four, 
 and even forty -eight hours of immersion, extravagant as they 
 may be in themselves, are calculated to teach the useful lesson 
 of perseverance, even in cases apparently desperate. The 
 first report of the establishment for the recovery of the 
 drowned at Paris, — one of the most trustworthy documents 
 we possess on this subject,— gives twenty-three instances of in- 
 dividuals brought to life. One had been under water forty- 
 five minutes; four, half an hour; and three, for fifteen minutes. 
 
512 DEATH FROM SUSPENSION. 
 
 In all the other successful cases, the period of immersion was 
 less than this last. 
 
 Death from Suspension may occur in either of three 
 modes: first, hy a fracture or dislocation of the vertebrae, where- 
 by the spinal marrow is compressed, and death occurs instant- 
 ly. This is said to have been always effected in the hands of 
 an expert executioner at Lyons, in France, who gave to the 
 body of the criminal a peculiar rotatory motion in falling; but 
 similar occurrences are very uncommon. Secondly, by pres- 
 sure upon the superficial veins of the neck, so that the blood 
 is arrested in its return from the brain toward the heart. 
 This is an auxiliary cause, no doubt, in the great majority of 
 instances; but. death may occur from this cause alone, when 
 the cord is not tied with sufficient tightness to prevent respi- 
 ration. In this case, the appearance of the face, and the gene- 
 ral symptoms, are those of apoplexy. It is very unusual for 
 individuals to recover under these circumstances, unless taken 
 down very soon after insensibility takes place: We are told, 
 however, of one or two instances, in which the victim of jus- 
 tice has escaped death, in consequence of an ossification of 
 the trachea. There is also a case recorded, in which a crimi- 
 nal, before his execution, induced a surgeon to pass a cannula 
 into the throat, by which, of course, the passage was rendered 
 incompressible. After remaining suspended the usual time, 
 he was cut down, and conveyed to the house of one of his 
 friends; the jugular vein was immediately opened, and some 
 blood obtained; he gave some sign, of returning animation, 
 but soon expired. Recovery is still more difficult, when, as 
 occurs in most cases, some obstruction of the air passage is 
 superadded. Thirdly, the usual mode in which death occurs 
 from suspension is, as in drowning, from suffocation; but, from 
 the circumstance already mentioned, and the local injury 
 usually done to the parts by pressure, reanimation, after hang- 
 ing, is much more rare than when asphyxia has followed on 
 submersion. As the occasion is seldom accidental, but usual- 
 ly designed, in execution of the laws, or premeditated self- 
 destruction, the opportunity of applying the appropriate means 
 of relief is seldom offered for some hours. The treatment, in 
 cases of death by suspension, should be, in most respect- 
 milar to that already advised for cases of suspended animation; 
 but, in the former, venesection affords, perhaps, a somewhat 
 better chance of success, than in the latter class of accidents. 
 
L 
 
 CHAPTER III. 
 DISEASES OF MARRIED WOMEN. 
 
 n the chapter on Hygiene we offered some remarks on the 
 Subject of marriage. Supposing this ceremony to have been 
 accomplished, it is now proper to impart some instruction to 
 those who are anxious to be the parents of vigorous offspring. 
 To promote this object, both parents should be in good gene- 
 ral health; but the lady will claim our more especial attention 
 in this chapter, as she is to be intrusted with a most sacred 
 charge — the germ of a new being, whose destiny she cannot 
 foresee, but whose position and usefulness in life will not be 
 lightly influenced by her prudence or indiscretion. 
 
 As it is our earnest desire to confine ourselves to the com- 
 munication of information calculated to prove of real and 
 practical value, and fitted for the class of readers to whom 
 our remarks are addressed, we shall avoid, as impertinent to 
 our object, those matters which are merely speculative, or 
 adapted solely to the professional student. 
 
 On Pregnancy, and the Position and Connexions of 
 the Child in the Womb. After the foetus has been lodged 
 for some time in the womb, and the several parts of its body 
 and appendages have had time to become partially developed, 
 it is found floating in a large sac, composed of three thin 
 membranes placed one upon another, which line the whole 1 
 interior of the womb, and enclose a large amount of a pe- 
 culiar serous fluid, in which the foetus swims. 
 
 At one spot on the outer surface of the external membrane, 
 we find a large, thick, spongy, circular body, composed of in- 
 numerable ramifications of blood vessels, which is really a 
 vascular development of the membrane itself, and lies in im- 
 mediate contact, but is not amalgamated with the inner sur- 
 
 65 
 
514 PREGNANCY THE PLACENTA. 
 
 face of the womb. This is the placenta, or after-birth. 
 From the navel of the infant, to near the centre of the after- 
 birth, we find a long tendinous cord, which is twisted, like a 
 rope, and encloses within its substance, three great blood ves- 
 sels; two of them termed the umbilical arteries, and the 
 third, the umbilical vein. 
 
 The child in the womb cannot breathe the air; and its lungs, 
 even when fully developed, cannot contribute to the function 
 of respiration; yet its blood requires the same change as that 
 of animals after birth. (See Circulation.) This is effected in 
 the following manner. The blood in the foetus, as it courses 
 through the route of circulation, is made to pass through the 
 umbilical arteries, which convey it to the afterbirth, where it is 
 distributed through the exceedingly thin terminal branches of 
 these vessels, and comes almost into contact with the blood of 
 the mother in the minute arteries of the womb. It there ex- 
 tracts from the latter the materials necessary to fit it for nou- 
 rishing the body, and parts with such as unfit it for that pro- 
 cess; in other words, the foetus breathes the blood of the mo- 
 ther! and the after-birth is a kind of external, temporary lung, 
 by means of which the child respires, much as certain reptiles 
 do, which dwell perpetually in the water. 
 
 The attachment of the placenta to the womb, has been com- 
 pared to that of the little piece of wet leather which children 
 call a sucker, and apply closely to bricks or other solid bodies, 
 to lift them by atmospheric pressure. The umbilical cord cor- 
 responds to the string which is fastened to the centre of the 
 leather, by which, when traction is made in a direction nearly 
 perpendicular to the surface of the leather, great force may be 
 applied before the adhesion will be separated : but should 
 separation occur between a considerable part of the surface of 
 the placenta, and the corresponding part of the womb, the at- 
 tachment becomes enfeebled, and little force is then requisite to 
 complete the separation. We see, therefore, that while the 
 development or growth of the placenta advances in proportion 
 to the expansion or development of the womb, the adhesion 
 remains strong, and the necessary and important changes in 
 the circulating fluids of the child take place in this organ. 
 But if any disturbing influence operate upon the muscular 
 tissue of the uterus, to excite it prematurely to contraction, its 
 connexion with the placenta is liable to be disturbed ; and, if 
 any portion of the surface of the latter be detached, we shall 
 not only have hemorrhage from the maternal vessels opposite 
 to this detached portion, but the foetus must suffer for want of 
 that nutriment, which is as essential to its growth and health 
 as atmospheric air is to the respiratory animal. In this man- 
 
PREGNANCY — UNPLEASANT SYMPTOMS. 515 
 
 her, if the foetus do not wither, its structure will be rendered 
 imperfect; and if premature birth do not follow, it may be born 
 at full time, but in a state of disease or deformity. From 
 similar causes, it sometimes falls an early victim to chronic 
 disorder; such as consumption, diseased spine, or hip joint, and 
 scrofula. Even if the unfortunate infant should reach adult 
 age under all these disadvantages, it may entail upon its off- 
 spring the diseases acquired in its embryotic state. The mo- 
 ther does not always escape the consequences of this separa- 
 tion of the placenta : she may be very much exhausted by the 
 discharge of blood at the time, whether abortion take place or 
 not; and the unnatural drain from her system sometimes sub- 
 jects her to protracted diseases of various kinds; and it has 
 been observed, that women who thus suffered once, are sub- 
 ject to repetitions of the same accident, in subsequent preg- 
 nancies. Although it is difficult to establish such general rules* 
 we might, perhaps, assert that a female is more exhausted by 
 the effects of an abortion, than she would be by three succes- 
 sive labours at full time, and at seasonable intervals. 
 
 We have made these remarks, with the view to explain the 
 slight mode of attachment between the ovum and uterus ; and 
 when we consider the amount of blood which must circulate 
 through the latter, to supply the wants of the foetus, we must 
 regard the safe keeping of the ovum as a matter of very great 
 importance to the mother. Both her moral and physical con- 
 dition should be carefully regulated, and kept free from any ex- 
 citement by over-exertion, excessive indulgence in eating or 
 drinking, sudden changes in dress, &c. ; while every care 
 should be taken to cultivate cheerfulness and tranquillity of 
 mind. Her imagination should be as little excited as possible. 
 
 The new action which the womb and its blood vessels 
 assumes in consequence of conception, is very often the cause 
 of disturbance to the functions of other organs; and hence the 
 nausea and sickness of the stomach, especially in the morning, 
 the capriciousness of the appetite, and the frequent desire to 
 eat substances usually regarded as every way unsuitable for 
 food; such as charcoal, dirt, putrid meat, &c. The nervous 
 system becomes disordered ; hence the neuralgic pains, in the 
 face or teeth. The temper is often petulant and morose, and 
 in some cases the intellect becomes manifestly deranged. 
 
 In many females, we observe, during pregnancy, a strong 
 disposition to plethora or fulness of the blood vessels, and in- 
 flammatory diseases ; but this is far from requiring, universally, 
 the abstraction of blood; an opinion which has hitherto been so 
 popular that almost every female seemed to consider preg- 
 nancy and blood-letting, as necessarily associated. We do not 
 hesitate to admit that, under these circumstances, some indi- 
 
516 PREGNANCY — CONSTIPATION. 
 
 viduals require the use of the lancet, or some other raeana 
 which will lessen the plethora; but we deprecate as injurious 
 its indiscriminate employment in every pregnancy, and we be- 
 lieve that a steady attention to diet, exercise, and the state of 
 the bowels would generally render it unnecessary. 
 
 Pregnancy is very often attended by constipation of the 
 bowels; and some females, from ignorance or neglect, too fre- 
 quently allow very large accumulations of hard fecal matter 
 to fill up the rectum: these may sometimes become sources of 
 irritation, capable of exciting premature uterine contractions, 
 as well as a distressing bearing-down pain in the lower bow- 
 els: they are also prone to cause the formation of piles, which 
 often prove extremely troublesome. 
 
 As we have already said, the digestive functions often share 
 in the disturbance produced by pregnancy; hence flatulence, 
 heart-burn, &c; which occasion such distress, that the patient 
 will often seek relief by any means proposed, however ill-ad- 
 vised. 
 
 As pregnancy advances, many females are extremely fear- 
 ful about the effect of the imagination upon the child; and if 
 they meet with any untoward accident, or become suddenly 
 frightened at any object, they conclude that an image of that 
 object is immediately stamped upon the person of the foetus. 
 If a strong desire be felt for fruit, fish, or any other article, 
 the mother eagerly infers that, if unsatisfied, the infant will 
 be born with the figure of the thing desired, impressed 
 upon some part of its surface. On the other hand, if the 
 child be born with any peculiar accidental mark, exube- 
 rance, or deficiency, the memory is tortured to recall some 
 cause for the appearance, of a similar character to those above 
 noted. 
 
 That strong impressions upon the feelings of the mother 
 will produce a prejudicial' influence upon the health of the 
 child, is indisputably true: and although the laws of nature 
 are altogether opposed to the doctrine of mother-marks just 
 mentioned, the prejudices of the ignorant upon this subject 
 may be attended with some benefit to woman kind, 1 
 curing more caution in the treatment of women during preg- 
 nancy. 
 
 If we except the errors of diet resulting from these notions, 
 no great evil can be produced by them; and as it is utterly 
 impossible to eradicate them from the minds of nurses, and 
 many other kind and careful people, the medical philosopher, 
 in addressing popular readers, must even be content to let them 
 enjoy their reign. 
 
 Constipation. For the all-important duty of regulating 
 the discharge from the bowels, we should depend, as much a? 
 
PREGNANGY — HEART BURN. 517 
 
 possible, on opening articles of food. If a daily effort at stool 
 soon after breakfast fail to effect the purpose, the use of bran 
 bread, and a little laxative fruit, such as apples, figs, or prunes, 
 every day, will often succeed; and it is only when these means 
 fail, that we should employ magnesia alone, or mixed with 
 sirup of rhubarb, in a little lemonade. Pills of rhubarb and 
 Castile soap, or castor oil, may be sometimes taken with pro- 
 priety, to restore the daily evacuation; moderate dcses of ca- 
 thartics, only, should be given in cases of pregnancy. 
 
 The heart-burn is extremely apt to be induced or ag- 
 gravated by constipated bowels and improper diet. Let those, 
 therefore, who would escape so severe an affection, study the 
 kind of food which is most easy of digestion, and does not 
 produce acidity of stomach; an affection of very frequent oc- 
 currence in pregnancy. 
 
 The food of pregnant women should be simple, without 
 much variety at the same meal, free from much spicing, and 
 not consisting of too large a portion of animal substances. 
 The breakfast should consist of stale, well made bread, with 
 good butter, a little relish of dried beef, ham, &c, with a mo- 
 derate amount of milk, coffee, tea, or chocolate. If the pa- 
 tient be very far advanced, it is improper for her to stoop 
 much; and if she be harassed with the " morning sickness," 
 it is, perhaps, better that she should take her breakfast in bed, 
 or rather that she should at least eat a little solid food before 
 she rises. By a precautionary indulgence of this kind, we 
 have known persons who had been previously much distressed 
 with nausea in the morning, to be quite relieved. 
 
 The dinner should consist of a moderate quantity of animal 
 food, plainly prepared, with the addition of such vegetables as 
 will not cause flatulence. Satiety should be carefully avoid- 
 ed, as it is often followed by oppression, particularly in the 
 advanced stage of pregnancy. The drink at dinner should be 
 water, molasses and water, or milk and water. Wine, brandy, 
 cider, porter, ale, and beer, should entirely be dispensed with, 
 unless prescribed by a physician. 
 
 The evening meal should always be light, composed of weak 
 tea and coffee, plain bread and butter, with a relish of dried 
 beef, ham, or fish. Hot bread or cakes, with melted butter, 
 are highly objectionable in any stage of pregnancy. Few 
 stomachs can digest them comfortably when in perfect health; 
 and when this important organ is disturbed by pregnancy, 
 great inconvenience is liable to result from indulgence in this 
 kind of food. Late and hot suppers should be positively pro- 
 hibited. 
 
 Let the evening be passed tranquilly in the midst of the 
 
518 APPROACH OF LABOUR. 
 
 domestic or social circle, free from any stirring emotions, 
 especially avoiding the throng of the theatre and ball-room. 
 Her own home, in the midst of substantial domestic comforts, 
 is every way best adapted to a woman in this situation. There 
 is often a sense of great languor and debility experienced by 
 females, during some part of gestation; we would, however, 
 advise them against too much indulgence in warm feather, or 
 down beds, as by this means the system may become greatly 
 relaxed and enervated: moderate exercise in open air, either 
 in a carriage or on foot, is far better than a state of inactivity 
 or indolent indulgence. The females of the labouring classes, 
 who are able to command plain but wholesome food, but are 
 obliged to use considerable exercise, usually enjoy better 
 health, and transmit to their children more vigorous constitu- 
 tions, than those of luxurious society^ 
 
 The political economist is perfectly aware that, while the off- 
 spring of the wealthy and hyper-refined become depreciated 
 in physical and intellectual vigour, the children of those who, 
 in the middle path of life, inherit the corporeal energies, and 
 imitate the frugal habits of their parents, will rise to the high- 
 est ranks of the community. Let then that female who ho- 
 nourably aspires to transmit through a long line of posterity 
 the impress of her own virtue, train herself for the important 
 function of giving birth to, and educating healthy children. Let 
 not wealth be apology for luxury, but let her lay aside every 
 indulgence which would enervate her physical or depress her 
 mental powers. 
 
 Approach of Labour. Of this period the patient will pro- 
 bably be apprized not only by her careful calculation that her 
 " full time has expired," but by certain sensations of uneasiness 
 about the lower part of the abdomen; a sinking down of the 
 tumour which had been encroaching upon the region of the sto- 
 mach; attacks of strangury or suppression of her urine; and, 
 perhaps more frequently, a disability to retain it. She has at 
 this time a strong sense of the necessity of evacuating the bowels: 
 which are sometimes in a laxative, though more frequently in a 
 very costive state. There is also generally a discharge of mu- 
 cus, tinged with blood, from the vagina. The uneasiness and anx- 
 iety now commonly become very great, and unless the patient 
 possess much moral fortitude, she is apt, on the increase of these 
 symptoms, to be affected with restlessness and fretfulness to such 
 an extent as to super-induce febrile action, requiring restraint 
 in a cool room, and the use of cold and laxative drinks. If 
 there be headach with throbbing in the temples, the loss of a 
 sufficient amount of blood to restore tranquillity may be re- 
 quired. 
 
APPROACH OF LABOUR. 510 
 
 By this kind of treatment, the pains and other symptoms are 
 relieved for some time; and if the period of gestation be not 
 completed, the relief will frequently continue till its termination; 
 when there will be a recurrence of the same phenomena, and 
 the patient should hold herself in readiness for an early 
 labour. Her personal attire, and the furniture of her cham- 
 ber, and bed, &c, should be arranged. For this purpose she 
 should be provided with a loose wrapper, of a texture adapted 
 to the temperature of her room, the under-dress should consist of 
 a simple chemise, and a petticoat, which should be easy to slip 
 off when necessary; she should have stockings without garters, 
 and slippers on her feet : in this dress she may be allowed to 
 move about as long as it is prudent for her to be out of bed; but 
 when she is placed upon it for delivery, she should substitute a 
 short night gown for the long wrapper. The chamber should be 
 well ventilated, and properly warmed in cold weather. The win- 
 dows should be so constructed that the air and light may be ad- 
 mitted when needed, and excluded when unnecessary. If the 
 labour take place at night, the lamp should be concealed be- 
 hind some object, so that the persons in the room may be merely 
 able to see their way about the room. Every thing should now 
 be so conducted as to inspire the woman with courage and tran- 
 quillity; and for this purpose the narration, in her presence, of 
 unfavourable or tedious cases, of instrumental deliveries, &c, 
 should be conscientiously avoided. Her bed should be placed 
 with its foot and both sides at some distance from a wall, that 
 the attendants may have a free passage about it, and the pa- 
 tient may enjoy the fresh air. A mattress is decidedly prefer- 
 able at any season of the year ; but if not at hand, such other bed 
 as the patient possesses, should now be adjusted with the great- 
 est regard to her present and future comfort. Let it be laid 
 smoothly over the whole sacking bottom, and on its centre place 
 a piece of oiled cloth, say a yard square, or more ; or, a blanket, 
 or comfortable, as is most convenient, may be folded up and 
 placed on the bed. Upon this cloth, lay the sheet or blanket on 
 which the patient is to be placed after delivery. At the foot 
 of the bed, and when practicable, at the right corner, let a si- 
 milar arrangement of oil-cloth, or doubled bed-clothes be made. 
 On this latter, the patient is to lay during the delivery. About 
 the middle of the right side of the bed, a sufficient number of 
 pillows should be placed for the comfortable support of the pa- 
 tient's head. To the bed-post against which the feet are to 
 be applied during the pains, a strong band or towel, a sheet, 
 handkerchief, skein of yarn, or something of the kind is to be 
 fastened, which the woman is to lay hold of when she make's 
 an effort. Some loose light covering should be at hand, for her 
 
520 OF LABOUR. 
 
 protection when in bed. While this preparation is being made, 
 the patient may be allowed to place herself in any position she 
 prefers; either to walk about the room, sit in her chair, or take 
 her pains in a kneeling position, as is most agreeable to her. 
 Strict inquiry should now be made into the state of the bowels and 
 bladder; and if they have not been freely evacuated, by efforts 
 which she has been forced to make, she should take a dose of me- 
 dicine, when there appears to be time sufficient for the purpose. 
 An ounce of castor oil will answer ; or, if the pains be urgent, 
 we may give a large injection of a solution of Castile soap, or 
 of molasses, with oil or lard and common salt, of each a table- 
 spoonful, mixed with a pint and half of water. 
 
 This measure will very frequently cause a full evacuation of 
 the bladder; but if such a discharge do not occur, either from 
 the action of the injection or in the natural way, the catheter 
 must be introduced. This operation should be left in profes- 
 sional hands, ;ind we shall not attempt to describe it. 
 
 Of Labour. As it forms no part of our design in the pre- 
 sent work to encourage the rash attempts of the ignorant to 
 meddle in matters beyond their depth, we shall carefully con- 
 fine our remarks to those subjects which may call for and ivar- 
 rant the action of nurses and friendly attendants, whether in 
 the ordinary progress of natural labour, when medical aid is at 
 hand, or in emergencies, where it cannot be obtained. 
 
 When the pains begin to be frequent, and pressing — it is time 
 to send for the accoucheur, whose services, let us mention, 
 ought in courtesy to be bespoke not less than three months be- 
 fore the full period of pregnancy. But as the practitioner can- 
 not always be obtained at a moment's notice, and there are 
 other things besides Time a?i(/ Tide which wait for no man, 
 the following directions may prove serviceable when women 
 are confined, by necessity, in the absence of any experienced 
 attendant. 
 
 The bed having been arranged as already directed, (p. 519) 
 the patient should be placed on her left side, with her dress 
 rolled up, or folded under her hips, that it may be kept dry. 
 The limbs should be drawn up towards the abdomen, the knees 
 separated about five or six inches by a pillow or cushion, and 
 the feet placed against the bed-post, while the head lies near 
 the middle of the bed, supported by pillows at the height most 
 agreeable to the patient. The hips should be brought within 
 a foot of the lower edge of the bed; and the band, towel or skein 
 of yarn already spoken of, should be placed within reach of 
 the patient, that it may be laid hold of, whenever the pains in- 
 duce her to seek such support. It should be impressed on the 
 minds of all, however, that the straining exertions to assist na- 
 
OF LABOUR. 521 
 
 ture which are often recommended by ignorant nurses, are ne- 
 ver proper, and often highly injurious. The support afforded 
 by the band or towel, should never be permitted to tempt the 
 patient into powerful bearing down efforts. 
 
 When the labour pains, at first sharp, cutting, and grinding, 
 provoking a disposition to scream, become more supportable, 
 and induce the woman to hold her breath, and make efforts 
 to bear down, uttering, perhaps, occasional groans, we know 
 that labour is advancing; and it is time to place the patient in 
 bed, though the attitude above described, need not be assumed 
 so early. Not long after the pains undergo this change, the 
 membranes of the sac which contains the foetus are ruptured, 
 and the contained fluid escapes, often much to the alarm of the 
 patient. Sometimes the membranes may give way long be* 
 fore this time; or they may be so firm as not to yield until they 
 have distended the vagina, unless they be ruptured by artificial 
 aid: this assistance may be safely given, whenever the bag of 
 waters appears at the external orifice. By this time the head 
 has generally passed so far through the pelvis, as to rest upon 
 the perineum, which condition marks the beginning of the third 
 stage: in this, the pains usually become more severe, as the ex* 
 ternal parts are subjected to greater distention. 
 
 When the head is about to escape from the vulva, the suf- 
 fering of the patient is generally very acute, even when the 
 labour has been tedious, especially if the parts have been 
 fretted by frequent examinations, which too frequently excite 
 an inflammatory disposition in these parts, and arrest the 
 healthful secretion of the mucus which is designed to relax 
 and lubricate the passage. 
 
 It is at this time, therefore, that the most careful attention 
 should be bestowed upon the perineum, which is exposed to 
 danger. This part should be freely lubricated with lard, or 
 some animal oil; after which the attendant should be prepared 
 to support it, during the expulsion of the head, by applying to 
 it the palm of the hand, covered by a soft towel, and making 
 gentle pressure till the head has passed. 
 
 The patient ought to be soothed and tranquillized as much 
 as possible; for the intelligence that the head is born is often so 
 pleasing, after a rending pain, that she will weep. Two or 
 three lighter efforts of the uterus, without any aid from the mo- 
 ther, now complete the third stage of the labour, and the 
 delivery of the child. Let us here repeat our caution, that in- 
 terference with the progress of this stage is injurious. Any 
 effort on the part of the attendants, suddenly to withdraw the 
 child from the body of the mother, may be very prejudicial ; 
 for it is important that the uterus be allowed to contract gra- 
 duallv, so as to expel the child by its own unaided efforts. The 
 
 66 
 
522 OF LABOUR. 
 
 only business of the attendant, at this moment, is to place a 
 hand under the body of the child, and conduct it safely along 
 the surface of the bed, keeping its mouth, in the mean time, 
 entirely above the discharges which may be found on the 
 bed. Its head should be covered, except the mouth, which 
 should be freely exposed to the air until it breathes and cries, 
 and until the pulse in the navel string has ceased, or has be- 
 come very feeble. Then the navel string should be tied very 
 tightly, with a thick, and pretty strong string, about three 
 inches from the child's abdomen; it may then be cut about 
 half an inch above the ligature. After ascertaining by careful 
 inspection, that the ligature has entirely arrested the flow of 
 the blood from the cut surface, the child should be laid in a 
 flannel, or soft muslin cloth, and given to an assistant. The 
 labour, which before engaged the whole attention of the mother, 
 is now apparently, forgotten, all her complaints have ceased, 
 and she lies quiet, unless active in giving directions about the 
 dress of her babe, until after a few minutes, she feels another 
 slight pain, which excites some alarm, unless its cause is ex- 
 plained to her. This is an important moment with a well-in- 
 structed attendant, who is aware of the hazard into which a 
 patient may be thrown by mismanagement or neglect. The 
 uterus, which has been firmly compressed about the whole 
 ovum until the rupture of the membranes, has now become 
 suddenly emptied of every thing but the placenta and mem- 
 branes. From the surface of the womb, hemorrhage, to a 
 greater or less extent, will follow, unless the contractions of the 
 uterus have closed up the orifice of the vessels. To prevent 
 mischief of this kind, a hand should be conveyed beneath the 
 bed-clothes, and placed upon the abdomen of the patient; and 
 frictions should be made over the region of the uterus, until the 
 or^an is felt contracted into a hard tumour just above the 
 pubes. No effort should be made forcibly to extract the placenta, 
 unless the precautionary friction has effected a decided disposition 
 in the uterus to contract upon it. The cord may then be em- 
 braced in the fingers of the other hand, and a very gentle 
 traction may be made; the cord beinej carried backward as 
 far as possible toward the perineum, if the placenta be high 
 up in the pelvis, and more forwards toward the thighs, if it be 
 near the external parts. 
 
 The patient usually feels some slight pains during the expul- 
 sion of the after-birth. When the mass of it has passed the 
 vulva, it should be carefully twisted two or three times upon 
 itself, that the membranes may be more certainly brought 
 away entire. As soon as this is done, it should be removed in 
 a suitable vessel. A soft cloth should then be placed gently 
 against the vulva, the pillow removed from between the knees.- 
 
LABOUR — MANAGEMENT OF THE CHILD. 523 
 
 and the patient allowed to straighten herself out on the bed. 
 A bandage, ten or twelve inches in widlh, and long enough to 
 surround the waist, should be applied under the hips and back, 
 then brought round to be fastened in front, just above the 
 pubes, and along the middle line of the belly, to give uniform 
 pressure to the whole abdomen. If there be any disposition to 
 hemorrhage, it will be proper to apply a few folds of compress 
 upon the pubic region, beneath the bandage, to prevent the 
 womb from being distended with blood. 
 
 When this has been done, the patient, if fatigued or debili- 
 tated, should be allowed to remain for some time at rest, without 
 being drawn up in bed; but if not so to any considerable 
 degree, she should be gently slipped up to her proper position, 
 all the wet clothes removed from about her, and the articles 
 of dress which have been folded up above her hips, spread 
 about her lower extremities. It is not unusual for women at 
 this time to have a shivering, and apparent chill ; when this 
 occurs, they should be well covered up, and allowed some mo- 
 derately warm gruel or panada, free from any stimulating 
 liquors, the room should be made quiet, and they should be 
 allowed a little repose. 
 
 Management of the Child. — Mean while the child will re- 
 quire attention. A basin of tepid water with fine soap, and a 
 cup of lard should be at hand, for the necessary ablution. It 
 is usual for children to be born with a considerable quantity of 
 sebaceous matter upon the skin, which the nurses find difficult 
 to remove by the ordinary modes of washing; but if the body 
 of the child be well anointed with lard, it is very easily taken 
 away by a subsequent washing with soap-suds. The towel 
 which is used in washing or wiping, should be soft and plea- 
 sant. We have seen some careless nurses use coarse crash 
 towels, with which they would almost peal off the cuticle, re- 
 gardless of the cries of the child. The navel is to be dressed by 
 taking a little fine linen rag, and having doubled it two or 
 three times, a perforation is to be made in its centre, through 
 which the cord is to be passed ; the linen is then to be folded 
 neatly around it, and placed on the middle line of the abdo- 
 men, towards the child's chin ; over this is applied a broad flan- 
 nel bandage, extending from the hips to the armpits, over-lap- 
 ping a little in front, that it may be readily secured by tape or 
 braid strings. This bandage should be moderately tight. We have 
 seen children so girdled that they could scarcely breathe, and 
 would have died, if the bandage had not been very soon slack- 
 ened ! The rest of the dress should be loose and easy, but may 
 in other respects be made to suit the taste of the mother. 
 
 It has long been the custom of nurses literally to cram the 
 infant with panada, gruel, or tiff; and even at the present day 
 
524 LABOUR SUSPENDED ANIMATION AT BIRTH. 
 
 it is said, a little molasses and water are necessary, " to purge 
 offthe economy." But nature, mostly provident of her offspring, 
 supplies the only true source of nutriment and physic in the 
 mother's breasts. To these, therefore, let the child be applied, 
 as soon as it is dressed, and the mother a little refreshed. The 
 advantages to be derived from this course are such as to com- 
 pensate the mother and nurse for their early pains. The child, 
 by this means, clears the mucus from its mouth in the effort 
 at suction. If it draw any fluid from the breasts, this com- 
 monly purges it sufficiently. By the suction, the breasts are 
 also excited into action, the nipple becomes erect, and milk 
 flows readily, much sooner than if they were kept in a quies- 
 cent state for several days. VV 7 e believe we may safely state 
 that, after attentive observation for several years, we have 
 never known a case of milk fever or milk abscess, in a person 
 who has used the precaution of an early and persevering ap- 
 plication of the child to her breasts. 
 
 After difficult labours, when the head of the child has been 
 long locked between the bones of the pelvis, it will frequently 
 be moulded into a conical shape, with the bones in some 
 measure over-lapping each other. This appearance usually 
 alarms inexperienced mothers and nurses, who think it neces- 
 sary to set about correcting the defect. Nothing, however, 
 should be done in such cases; for, if let alone, the parts will be 
 restored to their proper form in the course of a few days. If, 
 however, the scalp is very much bruised or swollen, a cloth 
 wet with vinegar or diluted spirits, may be laid over it. 
 
 Some children are born apparently dead, when, by a little 
 care, they may be resuscitated: for this purpose, they should 
 not be separated from the placenta, by dividing the cord, 
 while there is any pulsation in it, and the children are feeble 
 and pale; but if they be purple or livid, the cord should be 
 cut, and an ounce or two of blood abstracted from the foetal 
 part of it; care being taken to apply a ligature securely 
 around it, as soon as it has bled enough to relieve the child 
 from this apoplectic state. This treatment, however, is hardly 
 safe except in professional hands. The child should next be 
 taken from the bed, and laid in the lap of an assistant near 
 the tire, wrapped in warm flannel, and its whole body very 
 gently but briskly rubbed with a piece of the same cloth, wet 
 with warm spirits: the soles, palms and back, should be rubbed 
 with a soft brush; the throat of the child should be carefully 
 examined, and if it contain mucus, this should be cleared 
 away by a soft rag, wrapped upon the end of the little-finger. 
 A little ammonia, or some other pungent volatile substance, 
 may then be held near its nose or mouth, or a small quantity 
 may be rubbed on the tongue. If this do not succeed in soon pro- 
 
LABOUR AFTER-TREATMENT. 525 
 
 voking an effort to sob, artificial respiration must be attempted. 
 For this purpose, the nostrils should be closed, and air breathed 
 by the attendant into the mouth of the child, and thus into its 
 lungs; this is to be gently pressed out again by the hand of the 
 operator, and the operation repeated several times, at intervals 
 of a few seconds. In a case of asphyxia, which came under 
 our care, the heart continued to throb for nearly thirty minutes, 
 while we employed artificial respiration, though it ceased as 
 soon as we remitted our exertions in the least degree. In ad- 
 dition to the above means, warm injections thrown into the 
 bowels have been very useful. 
 
 Instances are recorded in which respiration has been esta- 
 blished even after the interval of two hours from the birth of 
 the child. A faint sighing, or a full pulsation of the heart, are 
 the first signs of returning life. They should be encouraged by 
 gentle perseverance, but always without any harsh measures. 
 
 The After-treatment of the Lying-in Female should be mild. 
 By careful attention to the diet, bowels, bladder, and breasts, 
 she will usually escape any indisposition. As a general rule, 
 she should have her bowels opened by a dose of castor oil or 
 magnesia, about the second or third day. After this, if the 
 diet be of the proper kind, the bowels act for themselves ; but 
 if I hey do not, either oil or magnesia, or, if there be a little dispo- 
 sition to fever, a Seidlitz powder may be given every other 
 day. The patient should be kept quietly in bed for the first 
 three or four days; after which, she should be allowed, under 
 favourable circumstances, to sit up in bed, or even to leave it 
 for a few minutes that it may be made up. The parts which 
 have been recently too much distended should be washed with 
 tepid water, which will be not only very refreshing, but prevent 
 the accumulation of any of the lochial discharge, that con- 
 tinues for some time after delivery. After-pains, which seem 
 to arise from continued contractions of the uterus after the 
 expulsion of the ovum, rarely succeed a first labour: but in 
 subsequent labours, they sometimes become very annoying. 
 They may be mitigated by twenty or thirty drops of lauda- 
 num, or one-eighth of a grain of the sulphate of morphia, every 
 two or three hours: or sixty drops of the former may be given 
 in an ounce or two of starch water, as an injection. After the 
 fourth or fifth day, the patient may be permitted to assume more 
 frequently the sitting posture, and to indulge in food of a more 
 nutritious kind, but she is constantly to remember that partu- 
 rient women are very liable to attacks of inflammatory dis- 
 eases, especially after the use of stimulating food or drinks. 
 
 Of Rupture of the Uterus. Either from deformity of the 
 pelvis, from some imperfect or irregular action of the muscu- 
 lar fibresof the womb, or from some diseased condition of its 
 
526 rupture or THE uterus. 
 
 structure, it is liable, during labour, to be lacerated in some 
 portion of its substance, so as to permit the escape of the child 
 into the cavity of the abdomen. The accident may happen 
 at various periods of labour, and has even been known to oc- 
 cur during the last pain which delivers the child. This un- 
 happy circumstance is indicated by a sense of something 
 giving way internally, preceded by a very severe pain, gene- 
 rally mistaken for a cramp, and immediately followed by a 
 sensation of great languor and debility; a speedy and, some- 
 times, instantaneous vomiting of the food previously taken, 
 or of a brownish, coffee-coloured fluid; a very quick, weak, 
 fluttering pulse; cold sweat; difficult respiration ; and an in- 
 stantaneous cessation of the labour pains. Through this lace- 
 ration, either a part, or the whole of a foetus may pass. There 
 have been instances in which the head has been retained in the 
 cavity of the pelvis, whilst the body and the lower extremities 
 were found in the cavity of the abdomen. The peritoneum 
 is not invariably lacerated, even when such protrusion takes 
 place — nor does this species of accident always cause the 
 death of the patient. Cases of this kind are, of course, beyond 
 the aid of any but the most able practitioners, and cannot be 
 treated by popular skill. 
 
 Uterine Hemorrhage. Let us suppose the delivery of the 
 child happily completed, and both the patients and her friends 
 expressing their satisfaction. In the midst of these seemingly 
 happy circumstances, the former may cry out, "Doctor! I am 
 sinking! I've a great discharge!" On examination, the practi- 
 tioner is startled to find his patient drenched with blood, 
 escaping in such quantity, as not only to flood the bed, but, 
 perhaps, to form a puddle on the floor! In other cases, there 
 may be no external discharge, but the cold skin, pale visage, 
 eyes rolled up, and the exclamation " How the room turns 
 round!" all speak the mischief which is going on within. 
 The vessels of the surface of the uterus are bleeding with open 
 mouthsy either in consequence of a partial separation of the 
 placenta, or a want of tonic contractile powers in the fibres of 
 the womb. 
 
 In this condition, not a moment is to be lost. If no physi- 
 cian be present, and the placenta be undelivered, an experienced 
 nurse may venture to introduce into the passage the fore-fin- 
 ger of her right hand, well coated with lard, — back, palm and 
 all. — If the after-birth be found chiefly in the vagina, she may 
 introduce the whole hand, and passing her fingers to the open 
 neck of the womb, she may remove it, if this can be done with- 
 out force, by pressing it down from above, while she draws 
 gently on the cord with the other hand. But if she meet with 
 resistance from the part of the placenta within the womb, or 
 
PUERPERAL CONVULSIONS. 527 
 
 if no considerable portion of the former be found within the 
 vagina, then the hand must be withdrawn. 
 
 When the after-birth is retained partly or wholly within 
 the womb, during uterine hemorrhage, it should be as little 
 disturbed as possible, until the organ contracts sufficiently to 
 expel the placenta entirely into the vagina. This contraction 
 may be safely promoted by the following measures: First, by 
 friction steadily made with the hand above the pubis, and fre- 
 quently patting the same part in a gentle manner. This is 
 the feeblest measure, but it will often succeed in mild cases, 
 and is a valuable assistant to other means. Secondly, by the ex- 
 hibition of twenty grains of ergot in a gill of water every half 
 hour. This should not be continued beyond the fourth dose. 
 It often acts very powerfully. Thirdl}', by cold affusion on 
 the surface of the abdomen, by pouring upon it, from a consi- 
 derable height, a stream of cold water. This is best accom- 
 plished by employing a pitcher or tea-pot for the purpose. 
 The impression should be sudden, so as to secure a decided 
 shock. It is a powerful remedy. 
 
 The art has other and more certain resources; but as they 
 can only be safely directed by professional men, we shall not 
 attempt to describe them here. Even after the placenta is 
 delivered, there is no absolute safety, until the uterus can be 
 felt, firmly contracted into a hard, round ball behind the 
 pubes. In some instances, after copious hemorrhages, which 
 have been, in great degree, arrested by the uterine contrac- 
 tions, there remains a slight dribbling of blood, proving a 
 source of exhaustion and subsequent ill health. This dis- 
 charge often yields to the employment of cool astringent in- 
 jections, which may be safely employed, when the general 
 health of the patient has been good. Among the best of these 
 are lead water, and the solution of alum. Muriated tincture of 
 iron, greatly diluted, is employed as a powerful remedy by 
 practitioners, but it is not a safe article in unprofessional hands. 
 The after-treatment of the debility occasioned by the hemor- 
 rhage, should be conducted on the same general principle. 
 This diminished discharge sometimes yields to the internal 
 use of two or three grains of sugar of lead, or the same quan- 
 tity of ergot, administered every two or three hours, during 
 one or two days. 
 
 Of Puerperal Convulsions. There is another class of af- 
 fections, of a most terrific nature, to which women are occa- 
 sionally liable, generally about the parturient period; though, 
 sometimes, before the time of confinement, and, in a few in- 
 stances, shortly after delivery: we mean puerperal convul- 
 sions. This terrible class of maladies is most commonly ma- 
 nifested in first pregnancies. 
 
528 PUERPERAL CONVULSIONS. 
 
 Affections of this character appear under several varieties. 
 They are either apoplectic, hysteric, or epileptic, each of which 
 forms is preceded by peculiar symptoms denoting its approach. 
 The apoplectic species is generally ushered in by a strong deter- 
 mination of blood to the head, with an engorgement of the ves- 
 sels, more or less severe headach, ringing in the ears, loss of 
 sight, giddiness, &c. These precursors often continue but a 
 very short time before the convulsion is ushered in by coma 
 and stertorous breathing. In some cases the patient has sud- 
 denly cried out, "My head!" "my head!" has become con- 
 vulsed, and died in a few hours. 
 
 In the epileptic variety, these premonitory symptoms may 
 be present several days before the convulsive movement be- 
 comes very conspicuous. There is, during the paroxysm, a 
 perfect suspension of all consciousness; for, when it has passed 
 over, the patient is not aware of what has happened. She 
 may look around the room, apparently in a state of surprise, 
 then gradually sink into another convulsion of more or less 
 intensity. 
 
 The epileptic variety of puerperal convulsions is not pre- 
 ceded by that peculiar creeping sensation along the limbs and 
 back, which is so often felt before an attack of common epi- 
 lepsy; but, in other respects, the former resembles the latter 
 very closely. The face is swelled, and the countenance is 
 contorted by twitches which contract the muscles suddenly 
 and in all directions, while the eyes are rolled about with 
 great rapidity, and the tongue protrudes and becomes black. 
 The whole body is violently agitated, though sometimes one 
 side is more affected than the other. Respiration is alternate- 
 ly hurried and suspended, and the accumulation of saliva about 
 the teeth causes a hissing sound in breathing. The pulse is 
 at first full, frequent, and tense; but quickly becomes rapid, 
 small, and almost imperceptible. During the paroxysm, the 
 urine and feces often escape involuntarily; and the attack usu- 
 ally declines with a cold, clammy sweat, covering the whole 
 body of the patient. 
 
 In the hysteric form of this disease, the headach, if present, 
 is neither so severe nor permanent; there are ringing in the 
 ears, hysterical ball, and palpitation of the heart. The face 
 is not so much convulsed; the eyes do not vacillate so much, 
 though there is more violent contraction of the large muscles 
 of the body; the countenance is less flushed than in either 
 the apoplectic or epileptic variety; there is rarely much 
 frothing at the mouth, nor is there any hissing sound in 
 breathing, and the pulse is less disturbed. This last species 
 of the disease is more prone than any other to attack women 
 
PUERPERAL CONVULSIONS. 529 
 
 of delicate nervous habits; who, however, generally recover 
 from it more rapidly than those affected with either of the 
 other varieties. 
 
 There are several other forms spoken of by different au- 
 thors; as the tetanic, cataleptic, &c, all of which appear to us 
 to be but grades of the same terrible disorder, requiring mere- 
 ly a slight modification in the treatment. There is, however, 
 a species of convulsion, mentioned by a late practical writer, 
 occurring under circumstances entirely different: we mean the 
 anemic convulsion, in which powerful muscular efforts take 
 place after the system has been almost drained of its blood 
 by uterine or other hemorrhages. 
 
 Puerperal convulsions arise from a variety of causes. It is 
 well known that, during gestation, there is in most women a 
 greater than ordinary disposition to plethora, as well as to 
 nervous irritability. In most instances of this disease, there 
 is a great determination of blood to the head, evinced even 
 for some time anterior to the attack. The efforts of the pa- 
 tient during labour, as well as the interruption to the free cir- 
 culation of the blood through the lower extremities, in conse- 
 quence of the pressure made upon the blood vessels by the 
 enlarged womb, are obvious causes of the apoplectic variety; 
 while a certain degree of plethora* complicated with nervous 
 excitability, may induce the epileptic form of the disease. On 
 the other hand, the hysterical form probably depends entirely 
 upon the exalted sensibility of the nervous system; as do also 
 the tetanic and cataleptic varieties. The treatment of this 
 disease, therefore, must be modified by the- circumstances 
 which contribute to its occurrence. 
 
 In the apoplectic variety, the lancet should be freely used, 
 and blood drawn copiously from the general system. Cold 
 should be kept about the head, whilst powerful revulsives, 
 such as strong mustard plasters, should be applied to the low- 
 er extremities. If the patient can be made to swallow ten or 
 fifteen grains of calomel, followed by an active dose of the 
 infusion of senna, it should be promptly administered, and 
 the operation quickened by free injections of senna tea, or 
 other powerful purgatives. Opiates, or narcotics, in any form, 
 are highly prejudicial in this species of the disease, unless af- 
 ter much depletion, when the case becomes resolved into one 
 of nervous excitement alone. The same course is to be pur- 
 sued in the epileptic form, except that depletion need not be 
 carried quite so far, and anodynes and antispasmodics may be 
 administered rather earlier, and in conjunction with the other 
 measures. * 
 
 In the hysteric variety, vascular depletion is less necessary, 
 and may be often dispensed with altogether. A brisk purgative 
 
 67 
 
530 INVERSION OF THE UTERUS. 
 
 combined with an anodyne or antispasmodic, such as Hoffman's 
 anodyne, or asafcetida, with revulsive applications, are gene- 
 rally sufficient to restore the regularity of the nervous action. 
 
 Of the tetanic, cataleptic, and anemic varieties, we know 
 very little; but should we meet with them, we should be dis- 
 posed to treat them in nearly the same manner as other forms 
 of the disease. 
 
 In some cases it is proper to deliver the child immediately, 
 by artificial means, when puerperal convulsions occur before 
 the birth of the child; and there are not wanting instances in 
 which the life of the child has been sacrificed to save that of 
 the mother, under such circumstances. But the fearful respon- 
 sibility assumed by those who dare to act as the arbiters of 
 life and death, confine the practice within the highest walks of 
 the profession. 
 
 Inversion of the Uterus may be partial or complete: in the 
 latter case, the whole organ becomes turned inside out, ex- 
 posing its internal surface. The whole mass may either be 
 thus presented at the external orifice of the vagina, or, if not 
 very large and engorged, may be concealed within that canal. 
 
 The symptoms attendant upon this event, are severe and 
 distressing pain about the region of the uterus ; an effort to 
 force or bear down, nausea and sometimes vomiting, great 
 faintness, with more or less hemorrhage, cold clammy sweats, 
 and a pulse small, frequent, or perhaps entirely absent. The pa- 
 tient also suffers very much from nervous agitation of the sys- 
 tem. 
 
 The symptoms of partial invertion are similar to those of 
 complete invertion; but there is almost always a greater amount 
 of hemorrhage in the former case, probably in consequence of 
 the constriction of the orifice of the womb upon the parts 
 which have become engaged in it, which has been known ac- 
 tually to arrest the circulation, and produce gangrene of the 
 prolapsed portion of the organ. The pain suffered by the pa- 
 tient, is in some degree proportional to the extent of the in- 
 version. It is comparatively slight when no part of the body 
 of the womb has passed through the neck, and in more consi- 
 derable inversions it depends much upon the tightness with 
 which the orifice of the womb contracts. 
 
 It would be folly to enter upon the mode of treating this 
 accident, in a popular work, except to mention that if a com- 
 plete inversion of the womb should occur where no medical 
 aid can possibly be obtained, it would be warrantable in an 
 intelligent assistant to attempt the reduction by pressing up- 
 ward the middle of the tumour with well greased fingers, and 
 then proceeding in much the same manner as in prolapsus of 
 the anus. After the reduction,, the hand, smoothly doubled up 
 
INFLAMMATION OF THE WOMB. 531 
 
 should be fairly introduced into the cavity, and there retained 
 till expelled by the contractions of the womb. It has been gene- 
 rally supposed that a womb completely inverted, could not be 
 reduced; but we fear that the attempt has not been made judi- 
 ciously as often as it should have been. If a few hours of time 
 are lost,. it will probably prove impossible; but we cannot per- 
 ceive any insuperable barrier against success, when it is made 
 with promptitude. Dr. C. D. Meigs has succeeded recently in 
 one case in Philadelphia, and the ease with which the reduc- 
 tion is effected in the larger domestic animals is no weak ar- 
 gument in favour of its possibility in the human species. Com- 
 plete inversion is not always fatal. There is one case in this 
 city, in which it has existed for many years; and it is even re- 
 commended that, when incomplete and irreducible, it should be 
 completed, to secure additional safety from the fatal effects of 
 stricture. 
 
 Inflammation of the Womb may occur at almost any period; 
 but is, of course, most frequent soon after delivery. It usually 
 appears between the second and fifth days, inclusive. The 
 pain in the uterus is constant and violent, but subject to con- 
 siderable exacerbations. This pain is distinguished from after- 
 pains by its constancy, and by extreme soreness on touch over 
 the lower part of the abdomen; but the tenderness extends 
 no farther, unless the peritoneum become implicated. 
 
 Both the milk and the lochia, (discharges of bloody serum 
 following confinement) are suppressed soon after the attack, 
 and general fever soon makes its appearance. This fever is 
 rarely ushered in by a chill; it is, however, attended by head- 
 ach, and if not soon relieved, by delirium. The tongue is 
 white, furred, and sometimes dry, or covered by a clammy 
 fluid, causing great thirst. In the progress of the affection, the 
 back and thighs participate in the pain. Pretty severe pain is 
 also felt in many cases on the left side below the ribs. The 
 urine is scanty, high-coloured, and deposites a sediment: some- 
 times it is almost suppressed. The bowels, in the commence- 
 ment of tiiis disease, are generally bound, though in the latter 
 stages a diarrhoea comes on, proving critical in some cases. 
 The disease sometimes runs into suppuration, but mortifi- 
 cation is a rare occurrence. 
 
 Active vascular depletion during the inflammatory stage is 
 most useful : bleeding from the general system should be 
 promptly effected ; after which, the application of leeches to the 
 vulva, groins, and, if medical aid be in attendance, even to the 
 neck of the uterus itself, will be highly advantageous. These 
 measures may be followed up with much relief to the patient, 
 by warm fomentations to the parts. The bowels should be 
 kept moderately open by laxatives or even saline cathartics. 
 
532 PUERPERAL FEVER. 
 
 After the febrile action has been reduced, if there remain much 
 local unneasiness, a blister applied to the lower part of the ab- 
 domen, sacrum or thighs, will generally afford great relief. 
 The various secretions should be restored by appropriate means, 
 and sleep induced by opiates, after the vascular excitement has 
 been sufficiently reduced. If there be a throbbing sensation 
 felt in the uterus, with an irritated state of the pulse, blood- 
 letting, if performed at all, should be resorted to with great 
 caution ; as suppuration being about to take place, the system 
 will not bear vascular depletion. If an abscess should form, 
 and the pus be discharged, the parts should be kept well 
 cleansed by bland injections; such as warm gum-water, flax- 
 seed tea, or infusion of slippery elm, thrown into the vagina 
 by a proper syringe. Under all circumstances, the patient 
 should be confined to the horizontal position for sometime after 
 the disease has apparently subsided, as the uterus, while re- 
 maining in a state of engorgement, will be much disposed to 
 prolapsus or falling. 
 
 Of Puerperal Fever. Women in child-bed are, occasion- 
 ally, the subject of a more terrific and unmanageable form of 
 disease than that just described, — a disease which sometimes 
 becomes epidemic or endemic, sweeping; off great numbers 
 of lying-in women, whether in the wards of an hospital, or 
 scattered over large cities or sections of country. 
 
 This affection does not appear to be attributable either to 
 variety of constitution, or to the easy, severe, natural, or in- 
 strumental character of the labours; but about the second day 
 after delivery, the patient complains loudly of after-pains, and 
 refers her suffering to the region of the pubes and uterus. She 
 will have severe rigors, with a pulse varying from one hun- 
 dred and twenty to one hundred and sixty. Both her bodily 
 and mental energies are very much prostrated, there being an 
 indescribable sense of distress about the chest, with a total sus- 
 pension of maternal feelings. The skin sometimes becomes 
 hot and dry, the face flushed, and the intellect evidently dis- 
 turbed. Respiration is performed laboriously, and by sighs. 
 The abdomen is so sore, that it will not bear the slightest 
 pressure, and it is rapidly distended, till as large as it was be- 
 fore delivery. The stomach soon shares in this disturbance; 
 and in the midst of the tossing and restlessness of the patient, 
 it throws up morbid secretions, at first, of a bilious character, 
 but afterwards, of the colour of coffee-grounds. The face as- 
 sumes a ghastly appearance; there is a livid circle about the 
 eyes, singing in the ears, headach, a pale or red tongue, and 
 parched lips. The breasts fall, and the lochia sometimes be- 
 come suppressed. The bowels in the early stage are consti- 
 pated, — the urine scanty and high-coloured. The eves be- 
 
PUERPERAL FEVER. 533 
 
 come dull and the pupils dilated, the features appear sharpened, 
 the cheeks suffused with a hectic flush, the skin presents a ca- 
 daverous hue, the patient lies on her back with her lower limbs 
 drawn up to relieve her respiration, which is greatly impeded 
 by the tumefaction of the abdomen, and, as the affection has- 
 tens towards its fatal termination, it assumes many of the cha- 
 racters of the gravest fdrms of typhus fever. This whole 
 round of changes from apparently safe delivery to death, has 
 been known to be completed in thirty-six or forty-eight 
 hours. 
 
 In a disease of so fatal a character, and involving so serious 
 a responsibility, as that now under consideration, we shall be 
 justified in urging the following important directions, when 
 medical aid cannot be procured. 
 
 Let the patient, if possible, be kept in a large, well venti- 
 lated, quiet apartment, secluded from any disturbing influence 
 of visiters: let her be freely bled at the very onset of the dis- 
 ease; let her bowels be thoroughly evacuated with calomel 
 and jalap, say ten grains of each. Should not the first bleeding 
 afford decided relief of the sufferings, direct the repetition 
 of the operation, even though the blood at first drawn do not 
 present a buffy coat. Whenever the pulse, by such repetition, 
 becomes somewhat reduced in force, if the tenderness still 
 continue, let the abdomen be covered over by a number of 
 leeches, particularly about the affected part. After this, if 
 the constitutional symptoms continue while the system is 
 in a situation not to warrant farther vascular depletion, and if 
 the stomach be irritable, administer the saline draught. If the 
 pulse become small and somewhat feeble, give twenty or thir- 
 ty drops of spirits of turpentine every hour, with the mercu- 
 rial ointment, covering the abdomen at the same time. If there 
 be a discharge of the lochia, it is almost always intolerably 
 offensive: when this is the case, the vulva should be carefully 
 cleansed with luke-warm water, and the clothes constantly 
 moistened with pyroligneous acid or solutions of the chlorides 
 of soda or of lime; or small quantities of these salts may be 
 kept in saucers in various parts of the room, or under the bed- 
 clothes. 
 
 The diet should be extremely light in the inflammatory 
 stage, and confined to the following articles; namely, toast 
 water, gum water, thin barley or rice water, lemonade, rennet 
 whey, molasses and water, and balm tea; carefully avoiding 
 every preparation of animal substance, however delicately 
 prepared, so long as the patient has the slightest. symptom 
 of fever; for although chicken water may enter the dietetic 
 list of European writers on this disease, it must be kept out 
 of the catalogue of indulgences in the affection, as it generally 
 
534 PHLEGMASIA DOLENS. 
 
 occurs in this country. To avoid fatigue from rising to re- 
 ceive the nourishment, it should always be administered from 
 a sick cup or tea-pot spout. The medicine should be given 
 by a spoon, and the discharges from the bowels should be re- 
 ceived in a bed-pan, or what is still better, in states of great 
 debility, an ordinary tin dusting pan, the thin front edge 
 of which can readily be slipped under the nates of the patient 
 without disturbance. 
 
 The bed and body clothes should be changed and well pu- 
 rified very frequently, as far as can be done without exposing 
 the patient to too much fatigue. The bed-clothes should be 
 supported above the body by a suitable frame-work, the most 
 simple of which is described at page 327. The abdomen may 
 be kept wet with some spirits of hartshorn, camphor, or tur- 
 pentine, if it be grateful to the patient. The secretion of the 
 breasts should be promoted by the occasional application of 
 the child, or some other suction power, whenever this can be 
 done without too much fatigue and disturbance to the mo- 
 ther. 
 
 The gradual subsidence of this state of severe indisposition 
 will be known by the diminution of the frequency of the pulse, 
 and an increase of its volume and force, a gentle perspiration 
 on the whole cutaneous surface, a moderate and frequent dis- 
 charge from the bowels, a restoration of the urinary secretions, 
 tranquillity of mind, &c. The diet may be gradually increased 
 in strength, and moderate exercise should be encouraged. 
 
 Swelled Leg, Milk Leg, or Phlegmasia Dolens. — This very 
 troublesome, painful, and tedious, but not very dangerous affec- 
 tion, may occur to the lying-in female at an earlier or later 
 period. 
 
 The patient, perhaps previously well, is attacked by chill, 
 followed by fever, with pain in the hip, the groin, and perhaps 
 the back, or the calf of the leg. In a few hours, the painful 
 parts of the affected limb begin to swell rapidly. The swelling 
 extends in all directions, until the member becomes hard, 
 white, glossy, incapable of receiving an impression from the 
 finger, exquisitely sensitive in every part, and moveable with 
 great difficulty, or not at all. 
 
 But one limb is affected at a time, but when the inflamma- 
 tion begins to decline in this, it sometimes commences in the 
 other. The swelling often affects the labium of the diseased 
 side, but finds itself accurately bounded by the middle line of 
 the body. 
 
 Suppuration rarely takes place in this disease, but we have 
 seen a case of repeated ulcerations in a limb affected with 
 chronic phlegmasia dolens. 
 
 This disease being inflammatory in its nature, requires de- 
 
PUERPERAL NERVOUSNESS, MANIA, AND MELANCHOLY. 535 
 
 pletion for its relief. In general, a pretty free bleeding from 
 the arm, sufficient to reduce the pulse, should be performed, 
 the bowels should be freely purged by salts and senna, or mag- 
 nesia, and if the acute symptoms be not relieved, leeches should 
 be applied to the limb. 
 
 The farther treatment of this tedious affection need not 
 occupy our attention, for it should be left in the hands of the 
 profession, and it is not of that urgent character which demands 
 the risk of trusting to less informed advisers, eVen when medi- 
 cal assistance cannot be had in reasonable time. Much good 
 may be done by methodical bandaging, after the first violence 
 of the disease is over; but errors in bandaging might be at- 
 tended with evils worse than the complaint itself, and unfortu- 
 nately, methodical bandaging, is not only above the skill of 
 most domestic advisers, but is practised by too small a portion 
 even of professional men. 
 
 Of Puerperal Nervousness, Mania, and Melancholy. — As all wo- 
 men are more irritable in the puerperal state, and more easily 
 affected, both in mind and body, than at other times, they are 
 not only more subject to inflammatory diseases, but occasion- 
 ally become even maniacal, either a little before, during, or 
 shortly after their lying-in, or, perhaps, after they have been 
 nursing for some time. This attack of mental aberration often 
 comes on suddenly: for example, the patient may awaken in 
 terror out of an apparently sound sleep; or some trifling alarm 
 may excite her very much; and, from that moment she may be 
 more or less maniacal ; her wandering mind, still harping on her 
 child. Sometimes she is conscious of her situation, and knows 
 that she has a strong propensity for the destruction of her own 
 offspring. A lady, who had been strongly attached to her infant, 
 on one occasion, while nursing it, screamed to her nurse, " Take 
 this child from me, or I shall throw it into the fire!" 
 
 Under this mental obliquity, a pious woman will utter oaths, 
 and use obscene language. In some instances, the derange- 
 ment is evinced less in the language than in the irregular con- 
 duct. There is, perhaps, most frequently, a tendency to 
 raving rather than melancholy. The patient always recognises 
 sorrounding objects, and either answers any questions ad- 
 dressed to her, or allows^ herself to be disturbed by them. She 
 sometimes reasons pretty correctly on her insane idea, and can 
 be, for a little while, interrupted in her madness,, by her own 
 efforts, or by proper management. Her face is commonly 
 rather pallid, evincing trepidation and imbecility; her eye has 
 a troubled appearance ; her pulse becomes frequent upon the 
 slightest nervous irritation or bodily exertion: the tongue is 
 generally white; the skin sometimes hot, particularly at the com- 
 mencement of the attack; the secretion of milk is occasionally 
 
530 PUERPERAL NERVOUSNESS, MANIA, AND MELANCHOLY. 
 
 diminished; excepting when there has been a previous at- 
 tack of diarrhoea, the bowels are confined; and, in many 
 cases, there is decided derangement of the functions of the 
 liver. 
 
 'There appear to be two forms of puerperal mania; one at- 
 tended by fever, or a rapid pulse, the other accompanied by 
 only a very moderate disturbance of the circulation; and it is 
 the experience of some practitioners who have had charge of 
 both kinds of cases, that most of the latter recover, while those 
 with rapid circulation generally die. Mania soon after de- 
 livery is more dangerous to life than melancholy beginning 
 several months afterwards. If the patient can sleep, and her 
 pulse becomes slower and firmer, even should her mind con- 
 tinue disturbed, she may recover; but, on the contrary, if she 
 have a quick, weak, fluttering pulse, with constant wakeful- 
 ness, and symptoms of increasing exhaustion, she is likely to 
 die, even though her mental condition may be apparently im- 
 proving. It is a popular impression, that intellectual derange- 
 ment is almost uniformly owing to excessive action of the blood 
 vessels of the brain. While conceding the fact, that there is 
 an inflammatory condition of the brain attended by delirium, 
 and that too, often of the most acute kind, it must be borne in 
 mind that the mania which attacks women whilst lying-in, or 
 after nursing for some time, is generally one of exhaustion of 
 the physical energies ; and that, while all moral stimuli should 
 be carefully removed or guarded against, vascular depletion 
 should be resorted to with extreme caution, if at all. Bleeding 
 has often aggravated the symptoms, and has sometimes de- 
 pressed the patient below the power of recovery. The bowels, 
 being generally very much constipated, particularly in cases 
 of attack' about the period of delivery, let them be thoroughly 
 opened by some safe cathartic pills, or by senna and salts. If 
 there be evidence of much disturbance of the biliary function, 
 adminster a dose of five or ten grains of calomel alone, and 
 follow it up next morning by rhubarb and magnesia, Epsom 
 salts, or senna tea. After thus clearing out the alimentary 
 canal, the bowels should be kept regularly excited by the com- 
 pound rhubarb pill, or by the pills of aloes and asafcetida. If the 
 patient be extremely restless and unmanageable, confine her mo- 
 tions by the strait waistcoat, or by binding the elbows with a strap. 
 Keep her room dark, and exclude her friends and all persons 
 but a nurse who can exercise a proper influence over her, and 
 her physician ; let her diet be nutritious, easily digestible, and if 
 she have lost much blood by hemorrhage or otherwise, or if 
 her disease have been produced by too long nursing, administer a 
 small quantity of wine; say one or two ounces in the course of 
 twenty-four hours. 
 
PALSY OF THE BLADDER SWELLED THROAT. 537 
 
 In order to procure rest at night, the patient should take 
 some anodyne article, such as twenty drops of hartshorn 
 or acetic tincture of opium, or a grain of opium in. a solid pill. 
 
 Thus far, on emergency, the domestic adviser may go; but 
 if the disease continue unchecked or increasing, the farther 
 treatment depends so much upon nice distinctions in the cha- 
 racter of the particular case, and the feelings and disposition 
 of the patient, that we believe it would be safer to leave the 
 powers of nature to their course, than to place the very deli- 
 cate subject under other jurisdiction than that of the profes- 
 sion. 
 
 Of Palsy of the Bladder. Some females, after the easiest 
 as well as after instrumental deliveries, become the subjects 
 of paralysis of the lower extremities and bladder. They are 
 then incapable of evacuating the urine; and unless the blad- 
 der be relieved by art, it would be liable to laceration. The 
 catheter should, therefore, be introduced at least twice a day, 
 during the whole continuance of the disease. The patient 
 can soon be taught to use it herself. By the free use of fric- 
 tions, tonics, and exercise, the disease generally goes off in a 
 few weeks. Some nurses are instructed in the art of intro- 
 ducing the catheter, which is a much easier and safer opera- 
 tion in females than it is in males. 
 
 Of Swelled Throat. In some peculiar constitutions, and 
 from some peculiar causes, swelling of the thyroid gland (the 
 gland which is the seat of goitre) takes place after parturition. 
 It generally appears within a few days after delivery. Some- 
 times the woman feels as though something had given way in 
 her throat; the gland may swell rapidly and enormously, 
 giving rise to great distress, and a suffocating sensation. Oc- 
 casionally it becomes inflamed, and suppurates: at other times 
 its growth is gradual. It may then remain for a time station- 
 ary, or in an indolent state, giving rise to very little inconve- 
 nience; perhaps merely a slight difficulty in swallowing. 
 
 We have seen the sudden enlargement of this gland sub- 
 side rapidly under the application of a number of leeches, and 
 frictions with iodine ointment. Frictions with salt and wa- 
 ter, repeated blistering, and the internal and external use of 
 iodine, have been found useful in the chronic form of the en- 
 largement; but the last named remedy is too dangerous to 
 be trusted in unprofessional hands. 
 
 Inflammation and Jlbscess of the Mamma. Almost al- 
 ways on the second or third day after delivery, especially if 
 the nurse have neglected the application of the child to the 
 breast very soon after its birth, there occurs a sudden sensa- 
 tion of fulness in the bosom, often ushered in by chill and fe- 
 ver, with headach, dry skin, furred tongue, &c, particularly 
 
 6S 
 
538 abscess or the mamma. 
 
 if the diet or drinks have been stimulating, and the bowels 
 have not been freely evacuated. The breasts soon become 
 turgid, not only with milk, but blood; they are painful and 
 throbbing, and, if not soon relieved, the pain extends to the 
 arm-pits, the glands of which become sore, and the suffering 
 is almost intolerable. In some women, this affection rapid- 
 ly runs on to suppuration, and a part or the whole of the 
 breast becomes involved in one extensive abscess. 
 
 If this affection be treated early, before the symptoms run 
 high, much mischief may be prevented by administering a 
 brisk saline purgative, such as salts and magnesia, salts and 
 senna, &c. ; bathing the breast with a sponge which has been 
 saturated with warm vinegar, or applying a soft poultice of 
 hops stewed in vinegar and water, and thickened with flaxseed 
 meal or wheat bran, &.c, repeating this as often as it becomes 
 cool; allaying thirst with toast water and sweet spirits of 
 nitre, the latter in the amount of a tea-spoonful every hour or 
 two, till free perspiration is induced; or refreshing the patient 
 with soda powders or saline mixture, in small but frequent- 
 ly repeated doses, till the febrile symptoms abate. The diet, 
 during this time, should consist of a little thin water gruel, 
 panada, or sago. 
 
 If the fever be high, and the pain intense, accompanied by 
 delirium, the patient should be bled from the arm, until a little 
 faint; and if not decidedly relieved, twenty or thirty Ameri- 
 can, or ten or fifteen imported leeches should be applied about 
 the inflamed part, but especially at the lower edge of the tu- 
 mefied breast — the bleeding from these should be encouraged 
 by cloths wrung out of warm water. The purging should 
 be kept up by a repetition of the salts or magnesia, if neces- 
 sary. 
 
 The inflamed breast should be frequently examined, espe- 
 cially when the pain is of a throbbing kind, as abscesses are 
 very likely to form deep in the substance of the gland, and if 
 not soon opened, they sometimes form suppurating passages, 
 running, to a great extent, under the surface. Generally, 
 however, the abscess is more superficial, and readily points 
 outward. If the abscess be small and superficial, it is common- 
 ly deemed advisable to permit it to burst spontaneously : but 
 when the disease is extensive, so much of the substance of the 
 breast is liable to be involved, that surgeons prefer nuking 
 an opening with a lancet as soon as the formation of pus can 
 be ascertained. When the disease is deep-seated, involving 
 the substance beneath the gland, great adroitness is requisite 
 to discover the existence of pus, and the proper time and 
 place for making an opening through which to evacuate it. 
 
 Poultices of bread and milk, flaxseed, or powdered slippery 
 
INFLAMMATION OP THE NIPPLES. 539 
 
 elm bark, kept soft by a proper quantity of sweet oil or lard, 
 make decidedly the best dressings for this affection, until the 
 abscess begins to heal, when it may be treated like abscesses 
 in general. — See Inflammation, Terminations in Suppura- 
 tion and Ulceration. 
 
 Should the patient be much debilitated by the discharge of 
 pus, we should sustain her by a nutritious diet, and even allow 
 her a small quantity of good wine in her gruel or soup, till 
 her constitutional powers become somewhat invigorated. 
 
 Particular care should be taken, throughout the whole af- 
 fection, to keep up, if possible, the secretory power of the 
 gland: if this be neglected, the breast is apt to be permanently 
 ruined, so far as regards its usefulness in supplying nourish- 
 ment to an infant. Suction, gently but perseveringly applied, 
 should either be made by the mouth of some attendant, or by 
 a glass nipple pipe, or other suitable instrument. 
 
 It unfortunately happens, that many who have had milk 
 abscess to any extent, continue very liable to a repetition of 
 the disease during subsequent confinements; and when this is 
 not the case, the occurrence of even a slight cold is liable to 
 reproduce a most painful swelling of the affected breast. 
 
 The nipple is very apt to become buried in the substance 
 of the breast ; or, if the abscess has opened very near it, it is 
 liable to be drawn down in consequence of the contractions 
 caused by cicatrization. 
 
 Of Inflammation of the Nipples. The nipples are some- 
 times the seat of excoriations, fissures, and occasionally of 
 such high sensibility, that the mother is utterly incapable af 
 suckling her child. 
 
 This state of morbid sensibility may, or may not be attend- 
 ed by a breach in the surface of the nipple. If carefully exa- 
 mined, the extremities of the lactiferous ducts will appear 
 erect, somewhat turgid, and the end of the nipple will seem 
 to be granulated like a raspberry. Slight pressure upon any 
 part of the nipple, will then cause a stinging sensation, which 
 the patient will sometimes declare to you extends not merely 
 into the breast, but up to the arm-pit; yet, when the nipple is 
 protected from pressure by a proper shield, armed with an 
 artificial teat, so that the child can draw freely, she frequently 
 does not experience any pain. 
 
 , If soreness of the nipples be attended to early, and the ge- 
 neral health of the patient be good, it is easily cured, in most 
 cases; and, at first, by simply washing with a little weak 
 brandy, whisky and water, mucilage of gum Arabic, flaxseed, 
 pith of sassafras, slippery elm, or quince seeds: but where it 
 has continued several days, and the parts have become much in- 
 earned, soft poultices with lead water should be applied imme- 
 
540 INFLAMMATION OF THE NIPPLES. 
 
 diately after the child is removed from the breast, or a weak 
 solution of nitrate of silver, three grains to the ounce of «r*» 
 ter," may be applied to the fissures by a soft hair pencil, every 
 day, till the surface is found to heal up rapidly. Great care 
 should be taken to wash the nipple thoroughly, before the 
 child takes the breast. Solutions of borax have often been found 
 very useful, particularly when the sore nipples occur simulta- 
 neously with the aphthous sore mouth in the child. There are 
 some women, whose breasts are as round as a melon, and the 
 protrusion of the nipple not greater than the blossom-end of 
 that fruit; they have, indeed, apparently no nipple at all. 
 This deficiency is generally charged to the account of tight 
 lacing with corsets. Tight lacing with corsets is an abomina- 
 ble practice, and often productive of much greater evil than 
 depression of the nipples: but we aver, that we have met with 
 this defect in middle-aged, well-grown, young ladies, who 
 with singularly good resolution, have never worn corsets 
 during life. With these, therefore, the defect has probably 
 been congenital, and though it causes no inconvenience in the 
 virgin state, produces much mental uneasiness to a mother: 
 let her then set about the regular business of drawing out the 
 centre of the areola on her breasts, by means of the common 
 breast glass, or a smooth edged tobacco-pipe, upon which she 
 may exert suction with her own mouth; or she may use the 
 gum elastic bag, which, if applied in a compressed state, will 
 keep up a constant and gradual draught upon it. In most in- 
 stances, the nipple can be drawn out so far, that the infant 
 can seize it with its mouth; after which, it can readily be 
 formed into a regular, permanent protuberance. 
 
CHAPTER IV. 
 ON DISEASES OF CHILDREN. 
 
 Tongue-tie. Children, soon after birth, frequently expe* 
 rience some difficulty in nursing; they either apply the mouth 
 irregularly to the nipple, or take in so much of the breast as 
 to distend the mouth, and a chuckling noise is made by the 
 entrance of air, at its corners: this circumstance is often owing 
 to the child being tongue-tied. 
 
 The fraenum or bridle, which extends from the central line 
 of the tongue to the bottom of the mouth, is either too short, 
 or reaches so nearly to the point of the tongue, that the move- 
 ments of the latter are very much restrained. Upon exa- 
 mining the mouth, the point of the tongue is found bound 
 down by a thin membrane, which is transparent and without 
 blood vessels. When this band exists, the child is generally 
 unable to apply the tongue around the nipple; for, at almost eve- 
 ry attempt, the nipple is forced out of its mouth, until it be- 
 comes fretted and fatigued. When this state of things exists, 
 the child should be placed across the lap of the nurse, with a 
 clear light falling upon the part; the membrane should be di- 
 vided, either by a pair of sharp-edged, but blunt-pointed scis- 
 sors, a gum lancet, or, what we have mostly preferred, a sharp- 
 pointed bistoury, wrapped to near its point with linen. As a 
 little carelessness may produce troublesome bleeding in this 
 operation, it should not be attempted by any one wholly igno- 
 rant of anatomy. 
 
 The wound made by a proper incision generally heals with- 
 out farther attention; but if, by accident, any vessels should be 
 cut, and hemorrhage arise, it must be suppressed by the pres- 
 sure of a dossil of lint, the application of some wheat or rye 
 flour, a little powdered gum Arabic, or a little piece of alum. 
 In some rare instances the tongue is bound down, and its mo- 
 tions restrained by the extension of the fleshy fraenum almost 
 
542 SWELLED BREASTS — SORE NAVEL. 
 
 to its very extremity. An operation in this case would be so 
 hazardous, that nothing can be done with propriety until later 
 in life. Fortunately this condition rarely prevents the child 
 from sucking. 
 
 - Swelled Breasts. Infants are sometimes subject to enlarge- 
 ment of the breasts at the time of birth, or shortly after it Both 
 mothers and nurses ascribe this condition to accumulations of 
 milk in the child's breasts, and believe that it must be squeezed 
 out to effect a cure! Hence they set about the process of milk- 
 ing the poor little creature, who has probably not yet even 
 milked its mother; by which folly the breasts are inflamed, 
 and often seriously injured. A highly respectable medical 
 author reports a case, in which such extensive suppuration 
 followed this kind of treatment, that both breasts of his little 
 patient {a female) were entirely destroyed! 
 
 These swellings are tense, firm, and elastic; inflamed, and 
 accompanied by an effusion of serum into the cellular mem- 
 brane beneath the skin. If the inflammation run high, the 
 central portions of the tumours assume a purple appearance. 
 Though the affection is usually mild, it sometimes lasts nearly 
 a week, even under the best treatment; but, unless roughly 
 handled at the beginning, it very seldom terminates in ab- 
 scess. Cloths, moistened with sweet oil, or a soft bread and 
 milk poultice, changed every three or four hours, are highly 
 useful; and the swelling and inflammation are said to be very 
 rapidly reduced by the application of a warm lotion, composed 
 of one drachm of the muriate of ammonia, (sal ammoniac) dis- 
 solved in eight ounces of vinegar and water. When suppu- 
 ration is threatened, a few — say two or four — American leeches 
 should be applied to the parts as a preventive. 
 
 Sore Navel. This complaint is frequently the result of 
 carelessness in dressing the cord. Besides a deep-red appear- 
 ance of the abraded surface of the navel, we find there is a 
 spongy or fungous formation, which discharges a thin purulent 
 offensive matter, and the patient suffers much distress and 
 pain. The discharge is sometimes caustic, and inflames every 
 part it happens (o touch. The fungous growth generally springs 
 up after the cord has fallen off, but occasionally, also, while it 
 is still adherent. 
 
 In treating this affection, every irritating matter should be 
 carefully removed. If any portion of the cord remain at- 
 tached, it should be cut off close to the navel with sharp 
 scissors, or a scalpel; then washed with milk and water, or 
 flaxseed tea. If a fungous or polypous tumour exist, it should 
 be destroyed by passing a fine silk ligature around its h 
 after which it may be dressed with the Goulard's ointment, 
 or Turner's cerate. If the fungus be disposed to shoot up 
 
YELLOW-SKIN AND JAUNDICE OF INFANTS. 543 
 
 again, the powder of the Indian blood root, (sanguinaria ca- 
 nadensis,) or a little powdered alum, should be dusted on the 
 part, and the whole surface covered with lint, spread with 
 either of the above named ointments. If the excoriation be 
 extensive, and the discharge copious, washes of lead water, 
 or oak bark tea, are very useful. If this fungous growth be 
 broad at its base, it must be repressed by a solution of lunar 
 caustic, (nitrate of silver,) say ten grains to an ounce of wa- 
 ter, applied with a camel's hair pencil, until the parts begin 
 to heal: if this do not succeed in a short time, a drachm of 
 sulphate of copper (blue vitriol) should be dissolved in an 
 ounce of water, and applied once or twice every day by 
 means of a hair pencil or a little lint. Powdered galls, or 
 oak bark, dusted on the part very frequently, will often suc- 
 ceed in causing a healthful cicatrization. If the navel should 
 exhibit an ulcerated appearance, surrounded by swelling, it 
 may be relieved by a bread poultice, well moistened with 
 lead water, and applied as long as there is any inflammation; 
 after which, a solution of the sulphate of copper, of one-sixth 
 the strength before mentioned, will commonly succeed. We 
 repeat, however, that unremitting care should be used to keep 
 the diseased surface constantly clean, and the surrounding 
 parts dry and comfortably dressed. 
 
 Of the Yellow-Skin and Jaundice of Infants. Most children, 
 when three or four days old, exhibit a yellow state of the skin, 
 for which the officious nurse would promptly administer the 
 saffron or sweet marjoram tea, "very plentifully, with a view 
 to keep out the yellow gum," and thus torture the child with 
 a distended stomach more disturbing than even the disease, 
 which, if left to itself, will usually pass off in a few days. Very 
 young children are, however, occasionally subject to such se- 
 rious derangements of the functions of the liver, as not only 
 to occasion a deep yellow tint of the skin and the whites of the 
 eyes, but also to impart the same colour to the urinary dis- 
 charges, while the stools are pale or clay-coloured, from a 
 deficiency of bile. 
 
 The proper distinction between the common yellow-skin, 
 which may be said to require no other attention than cleanli- 
 ness, and the real jaundice, which manifests serious disorder of 
 the internal organs, is this, that the yellow state of the skin in 
 the first affection is unattended by any uneasiness, yellowness 
 of the urine, or costiveness ; while, in the latter, the white of 
 the eye is yellow, the patient is restless, fretful, vomits fre- 
 quently, or exhibits symptoms of nausea, and is little inclined to 
 take the breast ; the stools, when they occur, are whitish or 
 clay-coloured, the urine stains the diapers, and very frequently the 
 slightest pressure over the stomach or liver produces pain. This 
 
544 YELLOW-SKIN AND JAUNDICE OF INFANTS. 
 
 last is an unfavourable sign. The latter train of symptoms 
 will require prompt and skilful treatment. 
 
 If the patient be free from fever and tenderness in the sto- 
 mach or liver, two or three grains of powdered ipecacuanha 
 should be given every ten or rifteen minutes until vomiting is 
 produced ; and if the disease should be obstinate, this must be 
 repeated every two or three days, till the stools assume a 
 bilious or dark green colour. Avoid the use of emetics, if 
 there be any marks of inflammation in the stomach, liver, or 
 bowels. In any case, however, the bowels must be kept freely 
 open, and the best purgative is calomel follovyed by magnesia or 
 castor oil. We are much in the habit of administering the tenth 
 or twelfth of a grain of calomel with half a grain of the bi-carbo- 
 nateofsoda, and a little powdered gum Arabic, every hour until 
 ten or twelve doses have been taken ; then if the bowels be not 
 moved with bilious evacuations, we give a tea-.spoonful of cas- 
 tor oil, or about as much magnesia. Our success with this 
 practice has been so uniform in the course of a few days, that 
 we rarely find it necessary to use any other medicine. It 
 is frequently necessary to repeat the calomel and oil every 
 few days, even after convalescence has commenced, for the 
 purpose of keeping up the healthy action of the liver. The 
 warm bath is highly recommended by some practitioners. 
 Gentle frictions over the whole cutaneous surface are useful 
 when there is no internal soreness. When intlammation of the 
 stomach and liver is manifested by great tenderness under the 
 slightest pressure, with fever and vomiting, accompanied by 
 great anxiety and distressful features, four or rive American 
 leeches should be applied to the part; or, if they cannot be pro- 
 cured, an ounce or two of blood should be taken from a vein 
 in the arm or leg. If this do not relieve the affection, spread 
 a piece of leather or muslin with a layer of blistering ointment as 
 thick as a wafer; then, with the blunt ed-:e of your spatula or 
 knife, scratch a number of furrows in various directions upon 
 the ointment ; till these fissures with common spirits of camphor, 
 cover it with book or mul-muslin, apply it with a tolerably 
 tight bandage to the skin, over the region of the liver; allow 
 this to remain on about two hours, then remove it, and if the 
 skin appear very red, lay this plaster aside, and dress the part 
 with a soft poultice: repeat this poultice as it becomes cool or 
 dry, and evacuate the blister as soon as it is formed. By this 
 process the patient will experience very little pain from the 
 blister, while the internal disease is very much relieved by it. 
 If a troublesome and debilitating diarrhoea should occur after 
 the disease has existed some days, half a grain of the bi-car- 
 bonate of soda, and a quarter of a grain of Dover's powders, 
 should be given, and repeated every three or four hours, until 
 
ON RETENTION AND SUPPRESSION OF URINE. 545 
 
 the irritation of the bowels is allayed, and the diarrhoea 
 arrested. When the jaundice has either been neglected, or 
 has not yielded to the means already directed, two grains of 
 the soda may be given with ten grains of the extract of dan- 
 delion, dissolved in a little warm water, two or three times a 
 day. If the little patient should suffer much from flatulence 
 or spasmodic pains, let three or four grains of asafcetida be 
 dissolved in about the same number of table-spoonsful of warm 
 water, and used as an injection into the bowels: if this does not 
 produce relief, give two or three drops of sulphuric ether, in a 
 tea-spoonful of hop tea, keeping up at the same time gentle 
 but brisk frictions on the back and abdomen, if the patient can 
 bear them. 
 
 On Retention and Suppression of Urine. It is the positive duty 
 of the attendant upon new-born children to inquire into the 
 condition of the bladder; for the urine is liable to accumulate, 
 giving rise to great distention and distress. In general, a delay 
 of fifteen or twenty hours is serious to the patient, whether it 
 depend upon the want of secretion by the kidneys, or reten- 
 tion in the bladder after the kidneys have done their duty. 
 Where we have reason to suppose that the kidneys do not se- 
 crete this fluid, they can be frequently excited into action by 
 the administration of a few tea-spoonsful of parsley or wild 
 carrot seed tea containing two or three drops of sweet spirits of 
 nitre, every half hour. The child should be plunged into a 
 warm hip bath, care being taken to have its bowels well eva- 
 cuated. The external use of vinegar, squills, or a tea-spoonful 
 of juniper oil, with two table-spoonsful of sweet oil, or the juice of 
 onions diluted with water, will promote the object. A drop of 
 spirits of turpentine mixed in milk, or four or five drops of 
 onion juice mixed in the same fluid, may be given two or 
 three times an hour till the" secretory process is established. 
 This internal stimulant may be greatly aided by the frequent 
 repetition of injections of warm water. 
 
 The urine is occasionally allowed to accumulate and dis- 
 tend the bladder very much ; in some cases without the escape 
 of a single drop, at other times with a constant dribbling; so 
 that although the diapers are continually wet, and the nurse 
 inclined to believe that all goes on well, yet the bladder has 
 been known even to burst, and the urine to be poured out into 
 the cavity of the peritoneum. Nothing will afford relief until 
 a catheter of proper size has been introduced by a skilful sur- 
 geon. 
 
 Painful Urination. — There is another serious inconvenience 
 to which children are occasionally subjected: their kidneys 
 may secrete freely, and the bladder contract promptly, but the 
 patient shrinks from the inclination, in consequence of the pain 
 
 69 . , 
 
540 FALtfFUL URINATION. 
 
 experienced in the evacuation. The child will have occasional 
 fits of violent shrieking or agitation, as though it had an attack 
 of severe colic pains; upon attentive examination, however, it 
 may, perhaps, be perceived that the uneasiness and pain are 
 coincident with the discharges from the bladder: the urine it- 
 self is almost always in an unhealthy condition in these cases: 
 it generally contains too much acid, which irritates the deli- 
 cate internal surface of the bladder and urethra. 
 
 The treatment of this troublesome affection must be regulated 
 by the following circumstances. U the diapers worn by the 
 child should be tinged red by the urine, two or three grains of 
 rhubarb, and double the quantity of magnesia should be given 
 every few hours, till they open the bowels freely, which should 
 then be kept regular by half a grain of calomel and one-eighth 
 of a grain of powdered ipecacuanha, daily, till the digestive 
 functions are restored. If there be eructation from the stomach, 
 or acid odour in the discharges from the bowels, give three 
 or four grains of the carbonate of potash, dissolved in a tea- 
 spoonful of weak infusion of Columbo root, the whole diluted in 
 a little flaxseed ten, or bailey or gum Arabic water, and re- 
 peat it two or three times a day. If the skin be dry, perspira- 
 tion should be promoted by the acetate of ammonia, sweet 
 spirits of nitre, and the juice of onions or sirup of squills; but 
 the regulation of these remedies must rest with the physician. 
 Jf there be a strong disposition to form acid in the stomach and 
 bowels, mild animal soups would be better as diet than any 
 farinaceous articles. 
 
 When, on the contrary, painful urination is accompanied by 
 a free deposite of white or yellow sediment, and when the urine 
 itself is pale, instead of red, the treatment must be reversed. 
 The bowels should be emptied by castor oil or rhubarb; and 
 half a grain of powdered valerian root, with one-fourth of a grain 
 of Dover's powder, must be administered two or three times a 
 day, to a child from a week to a year old. Its drinks must con- 
 sist of lemonade, or water sweetened with lemon sirup, and 
 from one to two drops of the tincture of the muriate of iron, may 
 be given three times a day with considerable advantage. Beef 
 tea or chicken water may be taken, if the child require any 
 thing besides its mother's milk: no alkaline substances should 
 be given, while this condition of urine continues. If the un- 
 easiness be not attended by an unhealthy state of the urine, 
 mucilaginous drinks may, perhaps, remove it. 
 
 It is necessary to examine the condition of the urethra in all 
 cases of painful urination, as much protracted suffering has in 
 some cases been kept up, not so much by the morbid con- 
 dition of the urine, as by inflammation at the extremity of the 
 passage : female children are said to be more especially sub- 
 
DIABETES. 547 
 
 ject to this state of things. Solutions of borax in water, or flax- 
 seed tea, should be first applied as a wash to the inflamed sur- 
 face. The watery solution of opium is sometimes a very 
 soothing application. The parts should at least be kept con- 
 stantly shielded from the discharges of urine by some lard or 
 mild ointment. 
 
 , Incontinence of Urine. — Some children continue to have in- 
 voluntary discharges from the bladder, long after they obtain 
 a control over the sphincter muscle of the bowels, to the 
 great inconvenience of the mother or nurse, and to their own 
 extreme mortification if the habit continue as they grow up. 
 
 It is said that children are rarely known to pass their urine 
 during sleep, unless they lie upon their backs. 
 
 One part of the treatment is sufficiently obvious: and pro- 
 per precaution in emptying the bladder before lying down, 
 allowing the child to have but a small portion of fluid in the 
 evening, would contribute much to the cure of this disgusting 
 difficulty. The fear of corporeal punishment has sometimes 
 operated favourably, by causing the child to sleep lightly, 
 ' and to be easily aroused by the slightest impulse to employ the 
 bladder. There is much cruelty in this plan, as in some other 
 remedies advocated by nurses of by-gone days, consisting in 
 obliging the children to eat a disgusting breakfast every morn- 
 ing after wetting the bed. If, however, a really morbid condition 
 of the bladder exist, every effort should be made to invigorate 
 the general health, as well as to strengthen or excite the uri- 
 nary organs in particular. Cold bathing, free frictions with a 
 piece of flannel, or a flesh brush, should be used; and the child 
 should take from tw r o to five drops of the tincture of muriate 
 of iron, according to the age, two or three times daily. In 
 children over five years old, from one to three drops of the tinc- 
 ture of the Spanish fly, according to the age, may be given two 
 or three times a day, till it arouse the sensibility of the neck of 
 the bladder, and cause a little pain in discharging urine. The 
 free use of a decoction of the bear-berry leaves {arbutus uva 
 ursi,) has been found effective in many cases of long standing. 
 Excessive Urination, Urinary Consumption, or Diabetes. 
 Another affection of the urinary organs, to which some chil- 
 dren are subject, is an excessive secretion of urine, common- 
 ly accompanied by considerable disturbance of the digestive 
 functions, and some morbid changes in the character of the dis- 
 charge. This complaint generally exhausts the strength of 
 the child with great rapidity. In many instances the urine is 
 quite clear; in some, it has a white deposite, or resembles 
 chalk mixed in water; at other times, it is of a pale straw 
 colour, and has even been noticed of a greenish hue. In 
 some cases this discharge may be coagulated by heat; and it 
 
548 SORE MOUTH THRUSH APHTHA. 
 
 is remarked that, when this coagulating substance is most 
 abundant, the flesh and strength of the patient decline most 
 rapidly. The little patient suffers from pains in the head, 
 giddiness, and even mental disturbance amounting to tempo- 
 rary delirium; and a stupid, sleepy state sometimes precedes 
 an apoplexj', which concludes the scene. This disease occa- 
 sionally comes on so gradually, that its daily changes are 
 scarcely noticed; and extensive disorder of the digestive or- 
 gans takes place before any attention is given to the patient. 
 It has frequently been mistaken for dropsy in the brain, ma- 
 rasmus, or general consumption, even by experienced medical 
 men. When it has advanced considerably, it is very likely to 
 terminate fatally. 
 
 "We shall not attempt to describe the treatment of this dan- 
 gerous and obstinate disease. The best medical aid must be 
 obtairred as soon as possible; and, in its absence, nothing can 
 be safely done farther than to keep up the action of the bow- 
 els and skin, and to rid the stomach of improper accumula- 
 tions by castor oil, small doses of the Dover's powder, and an 
 emetic, when required, should there be no great tendency of 
 blood to the head. Cientle stimulation of the loins by fric- 
 tions with spirits of turpentine, and the use of uva ursi tea, 
 are safe, and may prove serviceable. 
 
 If the abdomen become tumid, and there be much irritation 
 of the bowels, the patient's diet should be restricted to bar- 
 ley water, rice water, oat meal gruel, or rye mush and milk; 
 but if the digestive powers be still good, and there be no evi- 
 dent affection of the bowels, beef tea, or chicken soup, may 
 be added to the list. If the head appear to be affected, and 
 the gums inflamed, small blisters should be put behind the 
 ears, and kept running some days. The warm bath should be 
 frequently used; placing the infant first in water about the 
 temperature of the skin, and keeping it in the bath for fifteen 
 or twenty minutes, gradually raising the temperature of the 
 water to ninety or ninety -five decrees of Fahrenheit's thermo- 
 meter. When taken out, the whole surface is to be wiped 
 perfectly dry, and a dress of flannel should be constantly worn 
 next the skin. 
 
 Sore Mouth, Thrush, Aphthae. This is a very common 
 disease amongst children, and almost certain to occur when 
 there has been any marked irregularity in diet; the little crea- 
 tures who have been drenched with nurse's teas, for colic, red 
 gum, &c, being pretty certain to show a plentiful crop of 
 aphthous eruption about the tongue and cheeks a day or two 
 afterward. On the contrary, however, when due attention lias 
 been paid to cleanliness, when the child has been sustained 
 on the milk alone, and this fluid is of good quality, the aflee- 
 
SORE MOUTH THRUSH — APHTHJE. 549 
 
 lion is rarely to be met with, and when it does occur under 
 these circumstances, it is always easily managed. In its mild- 
 est form, there is little, if any, manifest disturbance of the 
 general system; there being merely a slight increase of the red 
 colour of the lining membrane of the mouth and tongue, 
 which is covered by white flakes, resembling curdled milk, 
 scattered over the tongue and lips. But in graver cases, the 
 child will show its indisposition by fretfulness, by an in- 
 creased slavering, and hesitation in sucking. It appears dull 
 and sleepy, but starts frequently from a doze, as if frightened, 
 or in pain. Its breath will be acid, and flatulent eructations 
 will occur sooner or later, with green, watery and griping 
 discharges from the bowels. The child will now vomit up 
 any substance taken into the stomach, and the milk it has 
 swallowed generally returns, very soon afterwards, completely 
 coagulated. The mouth will now be found hot, with its lining 
 membrane deeply reddened beneath a thick layer of white 
 flakes, resembling finely masticated new cheese. Connected 
 with this condition of the mouth, there are usually severe irri- 
 tation of the bowels, colic, and sour; watery discharges run- 
 ning off almost constantly; the lower orifice of the bowels 
 becomes also inflamed, and sometimes excoriated by these 
 acid evacuations. The child loses flesh very rapidly, becomes 
 very pale, and so sore is its throat' that swallowing would be 
 scarcely possible, even were it inclined to take nourishment. 
 In all forms of this affection, the borax is one of the most 
 useful articles. When the disease is slight and confined to 
 the mouth alone, borax and loaf sugar, in equal quantities, 
 finely powdered, and applied upon the tongue, allowing the 
 child to convey it to every part of its mouth by the natural 
 movements of that organ, will generally cure the eruption 
 very speedily. The bowels should be attended to, and if they 
 be confined, as is frequently the case at the beginning of this 
 disease, a few grains of magnesia should be given, till gentle 
 purging is effected. If there be already a general disturbance 
 of the system, and the bowels frequently moved by acid dis- 
 charges, the borax should be combined with equal parts of 
 powdered gum Arabic, and applied to the mouth; while small 
 doses of magnesia and rhubarb, with a little valerian, should 
 be given, in the proportion of four grains of magnesia to one 
 grain of powdered valerian root, mixed in half a tea-spoonful 
 of sirup of rhubarb, every three or four hours, till the dis- 
 charges are corrected. If there be much irritation of the 
 bowels, the little patient should be placed for five or ten mi- 
 nutes in a bath of about eighty degrees of Fahrenheit's scale, 
 then wrapped up warm and dry, and, if not composed, a drop 
 of laudanum should be administered. If there be small thin 
 
550 SORE MOUTH THRUSH APHTHA. 
 
 discharges, attended by pain or straining, a tea-spoonful of 
 the following mixture should be given every two hours till 
 the child is composed. 
 
 Magnesia, 12 grains. 
 
 Laudanum, 3 drops. 
 
 Water, 1 ounce. 
 
 With sugar enough to make it palatable. 
 
 When the discharges are very green and abundant, a drachm 
 of prepared chalk should be used instead of the magnesia, or 
 if the child is pretty strong, the magnesia and chalk may be 
 mixed together with the laudanum and sweetened water, as 
 before directed. Lime water and milk, in equal quantities, 
 may be given the child in tea-spoonful doses, three or four 
 times a day, when there are sour stools without much loose- 
 ness. 
 
 It frequently happens, that if the disease of the mouth con- 
 tinue unchecked for several days, the discharges from the 
 bowels are not only frequent and watery, but streaked with 
 blood. This may be relieved, in most cases, by giving three 
 or four times a day a tea-spoonful of oil of butter, prepared 
 by placing a small quantity of good sweet butter in the bot- 
 tom of a vessel, pouring over it a pint or more of hot water, 
 and skimming off the oil which then rises to the surface. 
 Thick gum Arabic water, or the thick mucilage of flaxseed, 
 slippery elm, or pith of sassafras, in tea-spoonful doses, ad- 
 ministered frequently, will be useful in relieving this condi- 
 tion of the bowels. 
 
 While we have before remarked, that we consider the bo- 
 rax the most useful of all local applications in this disease, 
 we mean to confine its application to the white incrustations; 
 but if these become yellow, or brown, we would rely more 
 confidently upon the Armenian bole, rubbed up with an equal 
 quantity of loaf sugar into fine powder — and dusted upon the 
 mouth, in small quantities, every two or three hours. A de- 
 coction prepared by boiling half an ounce of Peruvian bark 
 in a pint of water, and given in doses of twenty or thirty 
 drops every hour or two, is advisable, when the mouth is 
 livid or ulcerated. 
 
 When the lower extremity of the bowels becomes inflamed 
 by the acrid discharges, the part should be well washed; first, 
 with clean water, milk and water, or flaxseed tea: after which, 
 it should be well anointed with lard, or Goulard's cerate. 
 No diaper should be applied the second time, without being 
 carefully washed. 
 
colic. 551 
 
 If the child have not been weaned, it should be confined 
 strictly to the breast for nourishment. The mother's diet, in 
 the mean time, should be so regulated as to ensure the great- 
 est amount of health in herself, and consequent purity of her 
 milk: for this purpose, she should abstain from all spirituous 
 or exciting liquors; she should eat plain animal food with stale 
 bread, rice, &c, drinking water only at dinner. If the child 
 have been previously weaned, its diet must be closely re- 
 stricted to gum water, lime-water and milk, or chicken-water 
 and beef-tea. 
 
 The cruel practice among some nurses of rubbing the child's 
 mouth with a rough cloth, charged with medicaments, should 
 not be tolerated by any parent. 
 
 Colic. Scarcely a child is born in the temperate zone, 
 even in our day of refinement, but it must have a " little cat- 
 nip tea to ease the wind," according to the opinion of the 
 nurses, who have been slow to abandon the doses of " tiff" 
 which their wise grand-mothers constantly administered, with 
 as much seeming necessity as the good cottager would give 
 pepper corns and a drink of cold water to the young turkeys, 
 11 she did not know why, but because her mother used to 
 do it." 
 
 To be serious, however, children are, under almost any cir- 
 cumstances, extremely liable to suffer from colic; as may be 
 seen by their becoming suddenly fretful, drawing up their 
 legs, and crying for a few moments, then becoming apparent- 
 ly easy again, for a short time, then going through nearly the 
 same course of symptoms, till there is a discharge of wind 
 from the stomach or bowels. The distress caused by this 
 flatulence is sometimes so great that the child screams vehe- 
 mently, drawing up its legs, and then stretching them out 
 again, forcibly and suddenly, its face becoming red and bloat- 
 ed, while its abdomen is tightly distended with the flatus 
 which is contained in the bowels. Some children will suffer 
 greatly in this way, with occasional intervals, for some weeks; 
 yet they will thrive, and become quite fat. In these cases, 
 the bowels are rather costive than otherwise, and the colic 
 comes on at some particular hour of the day, like an intermit- 
 tent fever. This, however, is not the case with many of the 
 subjects of severe colic, as there is very commonly a more or 
 less serious derangement of the digestive organs, attended by 
 grass-green or slimy stools, frequently containing undigested 
 food. The eructations sometimes bring on vomiting of hard 
 clots of sour milk. When this is the case, the child will often 
 be thin and puny. v 
 
 Colic unquestionably, in many cases, depends upon some 
 ill quality, or excess of quantity of the food taken. When 
 
552 OPHTHALMIA — SORE EYES. 
 
 irritating purges are given to new-born children, weakened di- 
 gestion and colic are almost sure to ensue. Great distention 
 of the child's stomach, — even with molasses and waler, manna 
 tea, as a purgative, or the large doses of other teas which are 
 too frequently given for the rash, — is highly prejudicial. 
 Improper exposure to cold air, with insufficient clothing, is 
 another frequent cause of colic. Gruel, panada, soaked crack- 
 ers, &c, which are too often given, even to very young chil- 
 dren, will commonly occasion colic, with vomiting, green 
 watery stools, and other disturbances. The milk of the mo- 
 ther, from improper diet on her part, may give the child se- 
 vere colic. Sudden frights, the strong sensation produced by 
 some painful intelligence, or even a painful affection of the 
 nerves of the face of the mother, have been known to cause 
 colic in children, and require, in the two former cases, the re- 
 moval of the child from the breast, and in the latter, the ex- 
 traction of carious teeth. 
 
 Children often suffer from colic, induced by inattention to 
 the speedy removal of the diapers of the child, after evacua- 
 tions either from the bowels or bladder. 
 
 The mild forms of colic can generally be removed by 
 wrapping the child warmly, briskly rubbing its back and ab- 
 domen with a warm dry hand, changing its position, and al- 
 lowing it to lie with its abdomen upon the nurse's lap, while 
 gently agitating its whole body upon the knee. Should it 
 continue to evince pain, a tea-spoonful of warm infusion of 
 fennel seed, or annise seed, may be given at intervals, of five 
 or ten minutes, till five or six doses are taken. Beyond this 
 amount, if the child be very young, no liquid should be given. 
 A table-spoonful of milk of asafcetida, as an injection to a 
 small child, will sometimes be attended with benefit. Opium 
 in almost any of its forms, should be avoided as long as pos- 
 sible — as it is very liable to constipate the bowels, and also 
 operates unfavourably upon the brain. Paregoric, laudanum, 
 and the various carminatives, and " colic tinctures/' are all 
 hazardous remedies. The laudanum, particularly, is often re- 
 duced in strength, by the dishonesty of some apothecaries, 
 until children "liuve been nearly or quite destroyed, by using 
 that which is properly made, in doses to which they have 
 become accustomed when employing that prepared by unprin- 
 cipled but cheap dealers. 
 
 Two or three drops of sweet spirits of nitre in a tea-spoon- 
 ful of water, will often relieve obstinate colic; but if all the 
 means pointed out should fail, a trust in Providence will 
 prove safer than that jn nostrums or popular remedies where 
 physicians cannot be had. 
 
 Ophthalmia — Sort Eyes. Thi* is a troublesome affection 
 
OPHTHALMIA — SORE EYES. 553 
 
 which many young children are subject, from a variety of causes. 
 It generally shows itself from the second to the eighth day, 
 and is first observed, by the adhesion of the eyelids, which are 
 slightly swelled and red. On separating the lids, the eye-ball 
 itself appears red and thickened. In a day or two the swelling 
 of the eye-lids increases, and a thick matter escapes from be- 
 tween them ; the child is very fretful and keeps its eyes closely 
 shut. Unless the disease be arrested at this stage, it will in- 
 crease so rapidly that the membrane covering the eye-ball be- 
 comes intensely red and swelled, as if filled with bloody water. 
 The discharge is now so copious, that it will frequently burst 
 out from between the lids and run down in a stream upon the 
 child's cheeks, inflaming the skin wherever it travels. If the 
 disease be not promptly checked in its progress, the eye-lids be- 
 come everted, the cornea may ulcerate and the humours of the 
 eye run out. 
 
 In some cases this disease is confined to the eye-lids alone, the 
 ball not being affected. This case is usually as difficult to cure, 
 though it is much less dangerous to the safety of the eye, than 
 the other. 
 
 In the early stage of the red, sticky condition of the eye-lids, 
 we have generally found, that washes of flaxseed tea, carefully 
 strained and poured on the eyes several times a day, answer a 
 good purpose ; after which a few drops of rose water have ge- 
 nerally completed the cure: but when, from neglect of the first 
 stage, the inflammation has run high, attended by much swell- 
 ing of the eye-lids and discharge of pus from the eye-ball or 
 lining of the lids, soft poultices of bread and milk, containing a 
 small quantity of lead w T ater, should be applied over the eyes, 
 and renewed as often as they become dry or hot, — the lids should 
 be drawn open occasionally, that the hot fluid may escape, and 
 this should be instantly washed away by a thin mucilage of flax- 
 seed, quince seeds, slippery elm, or, what is better than all, the 
 pith of sassafras. If marked relief be not obtained from this 
 treatment, two or three common sized leeches should be applied 
 to each eye, or to the temples; the blood should be encouraged 
 to flow from the bites after the leeches fall off, by soft cloths 
 dipped in either of the above named mucilages, (made warm,) or 
 by soft bread and milk poultices, which must be changed as often 
 as they become bloody : .afterwards the eyes may be washed, or 
 rather wet frequently with a very soft linen rag, saturated with 
 a solution of two grains of sugar of lead in an ounce of rose 
 w r ater. The little patient is to be kept constantly in a dark room ; 
 and the eyes protected from compression by bandages: its diet, of 
 course, should be confined to its mother's milk, or to two parts 
 of cow's milk with one of water, and a little sugar: its bow- 
 els kept loose by half a grain of calomel, and one grain of cal- 
 
 70 
 
554 COSTIVENESS. 
 
 cined magnesia, given every morning and evening in a little 
 milk, or in sirup. These doses must be increased or diminished 
 according to the effect on the bowels. Should not the disease 
 become much lessened in a day or two by this course, the 
 same remedies must be repeated till the violence of the in- 
 flammation is moderated; after which the cure can generally 
 be completed, if chronic inflammation continue, by the applica- 
 tion of a small blister to each temple, or to the back of the neck, 
 having them kept open for several days by dressing with ba- 
 silicon, or even weak savin ointment. As soon as the eye-lids 
 can be raised in a very faint light and the discharge has become 
 thin, they may be washed with a solution of a grain of acetate 
 of zinc to an ounce of rose water, four or five times a day. 
 The eye-lids should be kept from adhering to each other by a 
 little mucilage, or a few drops of the mother's milk, or a little 
 fresh butter every evening. 
 
 If ulceration of the cornea should unhappily occur, and the 
 humours of the eye be poured out, the patient's system most be 
 supported by bark tea and mild anodynes. One of the most 
 frequent and terrible consequences of this affection is opacity 
 of the cornea, which is rarely curable. That must be a very 
 strong necessity, therefore, which should compel the domi 
 adviser to tamper with the case; especially, as the more ener- 
 getic mode of leeching recommended in the article on ophthal- 
 mia, in the surgical part of this work, gives to the adroit sur- 
 geon an almo>t absolute command of the disease, but cannot 
 be employed on young children by any other person. 
 
 Costivencss. The apprehensions of a mother or nurse arc 
 very commonly aroused, upon the discovery that; the child's 
 bowels arc cither rather sluggish ov very much constipated. 
 While we would not wish to lull them into any false security 
 on this subject, and thus induce them to become indifferent to 
 such a condition of the child's system, they should be aware 
 that children do occasionally remain for several days in a state 
 of perfect health, without any evacuation from the bowels. 
 While, therefore, the child continues to thrive and is cheerful, 
 we would advise them to leave the case to nature; — but. 
 general rule, children within the month usually evacuate their 
 bowels from two to six times in twenty-four hours: after that 
 time, once or twice. We should carefully inquire into the - 
 of the intestinal canal upon the occurrence of any indisposi- 
 tion ; such as flatulence, fever, stupor, or thrcatenings of con- 
 vulsions. 
 
 Very simple measures arc sometimes sufficient to excite the 
 bowels into healthy action : a small quantity ot the West India 
 molasses with water; a little manna tea; sweet oil and mo! i 
 of each, half a tea-spoonful, given every three or four hours. 
 
VOMITING. 555 
 
 will often procure free discharges. A tea-spoonful of warm 
 castor oil, given alone, or from one to two tea-spoonsful of fresh 
 calcined magnesia, thoroughly mixed with milk, may be given 
 from the age of a month to that of two or three years. Ano- 
 ther valuable remedy for habitual constipation in children be- 
 yond six months old, is a thin gruel, made by boiling well a 
 small portion of unbolted wheat flour, and straining it through 
 a sieve while hot : this may be sweetened with molasses, man- 
 na, or brown sugar, and made an article of diet for the child. 
 
 Among the best injections arc, one or two ounces of molasses 
 and water, oil and water, or Castile soap and water: among 
 suppositories, a small piece of hard brown soap, cut in pro- 
 per length and rolled round, a little pointed at one end, dipped 
 into warm water till its surface is slightly dissolved, and then 
 passed into the rectum a quarter of an inch within the anus, — 
 or small pieces of tallow candle, or molasses candy used in the 
 same way. A very common source of constipation in infants,, 
 is the abuse of laudanum, either given injudiciously in colic or 
 other diseases, or by nurses in the unprincipled practice of 
 " keeping the child quiet," by the use of a violent poison. 
 
 Vomiting. — Children generally possess the pow r er of throw- 
 ing off' from the stomach with great readiness any excess of 
 food which they may have drawn from the breast, or which 
 may have been injudiciously poured into them by the nurse. 
 This is a happy provision of nature, to prevent injury to the 
 extremely delicate digestive organs of an infant, who has not 
 instinctive perceptions with regard to the amount which its 
 little stomach can manage; while it is too common a habit 
 with those who supply the child with food from a spoon, lite- 
 rally " to fill them up to the chin " before they desist. We. have 
 not un frequently been pained to see spoonful after spoonful, 
 poured into the oesophagus of' a child stretched out upon its 
 back in the mostjresistless attitude, till the escape of the fluid 
 at the corners of the mouth, gives the signal for raising it up, 
 and jolting it on the knee till they have "settled it," and then 
 the. same process repeated, till, happily for the child, the sto- 
 mach vomits it up. Could this satisfy the nurse, perhaps no 
 great harm would be done; but, "lest the poor little thing 
 should starve," its stomach is again replenished in the same 
 manner, till the nurse becomes wearied with her toil, and al- 
 lows it a little rest. What better can be expected, than sour 
 vomitings and griping stools, after the organic functions of a 
 child have been so severely persecuted? 
 
 The vomiting of children, especially when it takes place soon 
 after free nursing, and the milk comes up unchanged, requires 
 no other attention on the part of the mother than to pre- 
 vent the child from sucking too much: let her then take the 
 
556 VOMITING. 
 
 child away from, her breast, as soon as she perceives that it 
 " begins to dally with the organ, or when it ceases to draw as 
 though it were gratifying a necessary and proper appetite." 
 -Then keep the child quiet for some time, not jolting or tossing 
 it about, and thus agitating its stomach. But children may 
 have vomiting from causes similar to those which affect adults, 
 and then, careful, prompt treatment, will be necessary. Thus, 
 the suppression of any habitual discharge from the skin, as 
 that from sores behind the ears, perspiration, &c, or a confined 
 state of the bowels, may give rise to this complaint ; severe falls, 
 bruises, the accumulation of bile or acid in the stomach, <Lc, 
 produce sympathetic vomiting. The stomach is common.; 
 Jieved simply by removing the cause. If the vomiting should 
 be brought on by the presence of noxious substances in the 
 stomach itself, the effort to throw these ofF should be encou- 
 raged by copious draughts of warm water, weak warm camo- 
 mile tea, or common tea, till the disturbing; cause appears to 
 be removed; after which two tea-spoonslul of common salt 
 should be dissolved in four ounces of warm water and thrown 
 up into the bowels; and this injection should be repeated 
 every half hour, till it procures a full discharge. If this do 
 not quiet the stomach, six or eight drops of laudanum may be 
 diluted in a table-spoonful of warm water and salt, and used 
 as an anodyne injection, for a child between six months and 
 one year old; giving it, at the same time, two tea-spoonsful 
 of lime water and milk, every hour by the watch. When 
 the child appears to be in pain before the attack of vomit- 
 ing comes on, much advantage may be derived from the 
 use of the " spice bag," in addition to the other means. It is 
 made by mixing together powdered ginger, cinnamon, allspice 
 and cloves, a tea-spoonful of each, putting them into a thin 
 iiannel bag about the size of an adult hand, and quilting these 
 powders into the bag by a few stitches, to prevent them from 
 being pressed up into a heap. Lay this bag on a plate or 
 saucer, and pour over it a quantity of warm brandy or spirits, 
 sufficient to saturate it, then apply it upon the skin over the 
 stomach: when it becomes cold or dry, let it be saturated 
 again and again. A most essential advantage is usually de- 
 rived from this application. 
 
 If vomiting be caused by the superabundance of acid gene- 
 rated in the stomach, the milk is thrown up in a completely 
 curdled state. If the curd be very hard, it is because the acid 
 is very abundant. A looseness of the bowels generally attends 
 on this state, if the child be teething : but at other times it is 
 costive. If loose, — the lime water and milk, as before directed. 
 two grains of bi-carbonate of soda with a little powdered gum 
 Arabic, or a tea-spoonful of the common ohalk mixture may 
 
ERYSIPELAS. 557 
 
 be given every two or three hours; and, if necessary, half a 
 drop of laudanum may be combined with each dose of either 
 of these prescriptions, until the irritation of the stomach and 
 bowels is quieted. On the contrary, if the bowels be consti- 
 pated, a tea-spoonful of fresh calcined magnesia should be 
 mixed with ten tea-spoonsful of milk or water, sweetened with 
 a little sugar, and a tea-spoonful of the mixture given every 
 hour, till it operates. If the torpor of the bowels be very 
 great, the saline injection mentioned already should be given 
 to aid the purgative action of the magnesia: lime water and 
 milk may be taken in tea-spoonful doses very frequently, if 
 there be much thirst. If the child appear to be feeble, and 
 without fever, ten grains of the the bi-carbonate of soda may 
 be dissolved in an ounce of weak Columbo tea, and a tea- 
 spoonful given every hour. 
 
 When the child, after having been nursed at the breast, ap- 
 pears to be pale and distressed for some time, and then, in a mo- 
 ment, vomits up the milk unchanged and with great force, there is 
 reason to suspect a deficiency of the acid necessary to effect 
 the change which is preparatory to complete digestion. Under 
 these circumstances it is necessary to supply the deficiency ar- 
 tificially, by giving the child a small quantity of lemonade, oc- 
 casionally, which must be discontinued, as soon the milk is 
 found coagulated upon being vomited. If the child have been 
 weaned when attacked with vomiting, its diet should be care- 
 fully attended to, and it will frequently be found necessary to 
 allow it chicken water, with its common farinaceous food. 
 
 Erysipelas. Some children become the, unfortunate subjects 
 of erysipelas soon after birth. A few instances are recorded, in 
 which they were born with patches of this kind of inflamma- 
 tion, which had advanced so far as to present vesications, and 
 even gangrenous spots. When it does attack children, it is 
 generally shortly after birth, say from the first week to the 
 third month, and commonly commences in the form of a red 
 blotch, on the lower parts of the body, groins, hips, navel, or in- 
 side of the thigh. It is painful from the beginning, and is swelled, 
 dark red, or purple, with an irregular surface. Within the 
 first twenty-four hours, small blisters may often be seen scat- 
 tered thinly over this inflamed part, though some cases run 
 through their whole course, without a single blister being 
 formed. Rapid vesication coming on shortly after the com- 
 mencement of the disease, is a very unfavourable symptom, as 
 there is then a strong disposition to mortification : this is more 
 particularly the case when the disease happens to affect the 
 abdomen. When it is seated on the limbs, or about the hips, 
 it is. more likely to occasion ulcerations from destruction of the 
 cellular substance beneath the skin. This disease and its con- 
 sequences have been described in the second chapter of the 
 
558 DENTITION. 
 
 second part of this work. The course of the complaint is nrucfr 
 more rapid in infancy. 
 
 In some cases, the affection is easily managed, giving way 
 in two or three days without any unpleasant consequences. J t is 
 always, however, to be watched with solicitude, as some cases 
 - which appear mild and local at first, spread very rapidly over 
 various parts of the body. We have seen it attack one arm. 
 and thence traverse the whole body regularly: even when 
 we hoped that it was completely subdued, we had the morti- 
 fication to see it re-commence, and travel over precisely the 
 same surface, till it destroyed the child in the course of ten 
 days. Sometimes, however, it leaves one place suddenly, and 
 attacks another remotely situated from it. Some children 
 have attacks of erysipelas, whenever they happen to receive 
 the slightest wound. 
 
 Children in all situations, are occasionally subject to this dis- 
 ease; but those who are nursed in ill-ventilated apartments' 
 are especially so. We cannot regard the treatment of this af- 
 fection as a suitable subject for popular directions. 
 
 Dentition, or the process of growth of the primary teeth, does 
 not often, in itself, involve any hazard to the child; but it is 
 universally remarked, that, at this period, the system is by 
 far more excitable, and that ordinary disorders make much> 
 more impression on the health than at any other. The mecha- 
 nical obstruction which the firm membrane covering the gums 
 gives to the ready passage of the tooth in some children, does 
 occasionally involve the little patient in great local pain, as- 
 well as severe sympathetic irritation, c; ver, hcadach, 
 sometimes inflammation of the brain resulting in dropsy, or 
 producing disturbances of the nervous system, from a slight 
 start in the sleep, to the most terrific convulsions, which may 
 terminate in sudden death. 
 
 In mild cases, when the child has been well nursed, almost 
 the only affection attending the process of teething is some 
 slight rash, or eruption. None of these eruptions are dangerous 
 to the child's health, if not interfered with, and the officious 
 meddler will often pay dearly for his temerity, in attempt:: 
 dry up an eruption on the skin behind the ears, the top of 
 the head, or any portion of the external surface. We have 
 seen, diarrhoea, bloody stools, fever, convulsions, and drop>v of 
 the brain terminating in deatji, where the mother, contrary to 
 our counsel, anxious to remove an unsightly eruption on her 
 child's head, anointed the sores well with the red ointment. 
 which a female friend had assured her could not hurt the child. 
 This, we believe, to be the history of hundreds of fatal cases of 
 dentition; and our experience on this subject, is sufficient to 
 warrant us in giving instructions positively, and in a few words. 
 
 Keep your child clean by proper and frequent ablutions. 
 
DENTITION. 590 
 
 and changes of dress, especially next the skin. It is folly to 
 -neglect its flannel, muslin, or linen shirt and under dress 
 for a week or longer, while its over dresses are changed al- 
 most hourly, upon the arrival of every new visiter ! Daily 
 changes in the under dress, are far more important to the 
 ■health of the child. Keep it upon such diet as has been found 
 to agree with it, and almost uniformly this is the mother's 
 milk, if she have it insufficient abundance. Wait until the 
 process of dentition is complete, before you tax the child's sto- 
 mach with digesting solid or crude food. When the child 
 slavers fully, and you perceive it strongly disposed to bite hard 
 •substances, procure an ivory, or what is better still, a gum 
 elastic ring, one-fourth of an inch thick, and two inches in 
 diameter, so that the child cannot swallow it. Let it press its 
 "gums at pleasure upon this, and generally you will soon find 
 the teeth protruding. If the child be feverish, without appa- 
 rent reason, and if the gum be swelled, even if there should be 
 no very certain sign of the approach of a tooth, you will be 
 justifiable in cutting the gum. For this purpose lay the child 
 horizontally with its head upon your knee, having the hands 
 held by an assistant: depress the lower jaw firmly, apply the 
 sharp edge of your tooth lancet, or a pen knife with the edge 
 chiefly covered by winding cotton or silk around it, upon the 
 gum over the seat of the tooth ; then, carefully removing the 
 lips and tongue by interposing the ringers, cut freely down 
 upon the tooth. This operation will give little or no real pain 
 to the child. When the tooth lies Very deep, we need not at- 
 tempt to reach it. Should there be much bleeding, the pointed 
 end of a piece of alum passed over the wound, will generally 
 arrest it. Let the condition of the bowels be carefully watched. 
 A gentle diarrhoaa is often established by nature, when there is 
 no sympathetic cutaneous disease. This must not be stopped, 
 but only regulated. If it appear to be prostrating the powers 
 of the child by thin watery, copious, and frequent evacua- 
 tions, it will require prompt and skilful medical care. The diet 
 should be the mother's milk exclusively, or thick gum Arabic 
 water, rice water, barley water, &c. When the cutaneous 
 eruption becomes troublesome, it is to be relieved by washes of 
 tepid flaxseed, slippery elm, or pith of sassafrass tea, and the 
 bowels regulated by the magnesia, or castor oil, when costive. 
 Children, as well as adults, often find much relief to the itching 
 and burning in the skin, by dusting upon its dry surface a little 
 powdered starch, arrow-root, rye meal, or flour. This should 
 never be done when the skin is broken, and a discharge issuing 
 from it. Let the child's mouth be washed every morning, or 
 more frequently, with cold water ; and if it have no fever, let 
 it be carried out into the open air every day, hi suitable wea- 
 
560 DENTITION. 
 
 ther. The child's head should be kept cool by day and by 
 night, and it should dispense with wearing caps, and sleeping 
 on soft pillows. 
 
 If convulsions occur during dentition, the gums should be 
 promptly and freely lanced over the spot at which a tooth pre- 
 sents itself. This is most likely to happen, when the molar, 
 eye, or stomach teeth are about to come through. It is espe- 
 cially necessary, at this period, to watch the child carefully, 
 and to avoid all irritating articles of food. The bowels should 
 be kept open by calomel, castor oil, or magnesia. Three or 
 four grains of the former, followed in an hour by a dessert- 
 spoonful of oil, or a tea-spoonful of magnesia, mixed in a little 
 rnilk or sweetened water, will be likely to purge freely. Im- 
 mersion of the whole body, for fifteen or twenty minutes, in a 
 bath heated to ninety degrees, — if practicable, will be very ser- 
 viceable in the spasrn. 
 
 The foot bath of the same temperature wifl act as a partial 
 substitute. Poultices of onions, well stewed in vinegar and 
 water, with the addition of a little flour of mustard or Cayenne 
 pepper, or even soft bread with the mustard or pepper, applied 
 to the ankles or soles of the feet until the skin becomes red, 
 will be useful on this occasion. When the bowels have been freely 
 opened, a table-spoonful of strong asafcetida tea should be inject- 
 ed into the bowels, if the spasms be not already relieved. Should 
 the case prove obstinate, and not manifestly relieved by the 
 treatment already proposed, or if the child's face appear flushed, 
 two or three American leeches should be applied to each tem- 
 ple, and the blood encouraged to flow till there is a little pale- 
 ness. Next, if necessary, should be a pair of small blisters ap- 
 plied by narrow bands o( adhesive plaster to the bare space 
 behind the ears, or a 'blister may be put on the back of the 
 neck. Cool drinks, and light nourishment, as rice, barley, or 
 arrow root water, should be given occasionally. Cold cloths, 
 or a bladder one-third rilled with cold water, with all the air 
 excluded, that it. may fit like a cap to the head, should be kept 
 applied during the continuance of the disturbance of the brain, 
 removing it for a short time every five or ten minutes, that it 
 may not endanger the freezing of the scalp. It sometimes 
 occurs, that the gums at about the period of dentition become 
 ulcerated. If the tooth has not come through this spot, it is 
 proper to cut down upon it, and then touch the ulcer with a 
 solution of six grains of the sulphate of copper, in an ounce of 
 water, applying it upon the ulcer by means of a camel's hair 
 pencil, or a dossil of lint saturated with the solution, and taking 
 great care that the child does not swallow any portion of it. 
 It may be washed ofTin a few moments with clean water, and 
 the application repeated twice a day. 
 
worms. 5G1 
 
 Worms. — We have treated of worms in a preceding chap- 
 ter, and we introduce the subject here, merely to protest 
 against a popular opinion amongst nurses and some mothers, 
 that those children whose health is not in every respect per- 
 fect, are afflicted with worms, and consequently, that the poor 
 child who rubs its nose, or has any irregularity in its appetite, 
 is to be well dosed with worm lozenges, worm tea, Swaim's 
 vermifuge, or some other of those celebrated nostrums which may 
 be known to the superintendent of the child's welfare. As 
 many causes operate in producing the above symptoms, and as 
 they very often yield readily to other medicines skilfully ad- 
 ministered, while the reputed -worm medicines are often given 
 without any manifest discharge of these vermin r we feel safe 
 in declaring that there is no positive proof of their existence, 
 until they have been seen expelled from the bodies of children. 
 For the treatment then proper, we refer to the article worms, 
 in the second chapter. 
 
 On Convulsions. — Many children, even when very young, are 
 subject to sudden and rapid muscular movements; they will 
 start in the nurse's lap, as though suddenly surprised with dan- 
 ger of falling; their eyes will sometimes exhibit a quickness of 
 movement or a squinting direction, which is calculated to ex- 
 cite much apprehension in the minds of those about them. As 
 the children increase in age and size, however, this mobility 
 generally becomes tranquillized; but if they be fed with 
 unsuitable food, such as pap, boiled crackers, &c, whilst very 
 young, or be indulged in solid food, or crude fruit, when a 
 little older, convulsions and death may follow. 
 
 An attack of these "fits" is very frequently preceded by 
 dulness, stupor, or restlessness, and slightly irregular move- 
 ments of some part of the child ; as the clenching of a hand, 
 and unnatural motion or fixedness of the eye; some distortion 
 of the lips; a forcible gnashing of the gums against the nipple, 
 while sucking, and a rigid closure of the mouth, so that it can 
 scarcely be opened by force; then, a suspension of all action for 
 a few moments, except, perhaps, a quick motion of the eyes and 
 muscles of the mouth. Presently the child becomes very rest- 
 less, again all the former symptoms present themselves, till the 
 whole body is completely convulsed, the mouth foams, and 
 the little creature soon sinks again into a state of tranquillity, 
 from an exhaustion of its physical powers. 
 
 The treatment of these cases must be left to the profession, 
 unless under very peculiar circumstances, and in such situa- 
 tions as that of the missionary in a savage country, the pioneer 
 in the wilderness, and the captain of a transport or convict- 
 ship at sea without a surgeon. We can offer no better advice 
 than to follow the general directions given under the head of 
 
 71 
 
562 DROPS* IN THE TRAIN. 
 
 convulsio?is in a preceding chapter, (p. 481) with an appro- 
 priate diminution of doses. 
 
 Dropsy in the Brain is a disease which very often comes 
 on gradually, and almost imperceptibly; commonly beginning 
 in the same manner as convulsions. The child is wakeful: 
 or, if it sleeps, it grinds its teeth, and often starts or rouses up 
 suddenly, alarmed and screaming. Its bowels become irregu- 
 lar, and the discharges have an unnatural appearance: they 
 are often green, slimy, or watery, and streaked with green 
 and pale coloured matters. The countenance is usually pale, 
 and anxious or disturbed. Sometimes there is a red spot or 
 flush upon one or the other cheek: the eye-brows are knit into a 
 peculiarly unpleasant frown; the eye-lids are half shut when- 
 ever the child is exposed to the light. 
 
 Children, who can speak, complain of pain in the forehead; 
 and even small infants indicate suffering in that place, by a 
 constant disposition to apply the hand upon the head. As the 
 disease progresses, vomiting occurs, and becomes very fre- 
 quent, especially when the child is set upright. It is very 
 restless, and tosses its head from side to side, evincing much 
 suffering by its groans or whining expressions. Its skin is 
 dry, and generally rather hot; the pulse is frequent and hard, 
 but not full; the tongue is seldom coated, but, when so, its 
 edges arc pale, and the fur is in the middle: when, however, 
 the bowels arc much disordered, it is covered with a thick 
 brown coat, which, after a time, becomes dry and rough. Soon 
 after this, the child appears dull and stupid, regardless of sur- 
 rounding circumstances, and inclined to sleep constantly. 
 There is not only a general inactivity, but also a palsy of one 
 or more extremities, by which it is rendered motionles-. 
 cept a slight twitching of the toes or fingers: one or both 
 may now be observed to squint: and either remain fixed, or 
 be in constant motion. The lids themselves become palsied; 
 the upper one falls over the eye, and partially closes it. while 
 the lower one declines towards the cheek, and remains con- 
 stantly open, giving a most ghastly look to the whole counte- 
 nance. 4'hc pupil of t he eye may be found either unnatural- 
 ly contracted or dilated: convulsions soon follow, and, after a 
 lingering indisposition, close the scene: the body having, in 
 some instances, been reduced to a state of complete emacia- 
 tion. 
 
 Except in the very early stage of this disease, we believe little 
 can be done for its cure, or even essential mitigation. The af- 
 fection often creeps on so insidiously, that it escapes the ol 
 vation of even the anxious mother. Sometimes the first thing 
 known is the convulsion. 
 
 The fever should be kept down by such means as invite the 
 
DROPSY IN THE BRAIN— WHOOPING-COUGH. 563 
 
 blood away from the brain; and for this purpose the bowels 
 should be purged by a few (from two to five, or six,) grains of 
 calomel, followed by rhubarb, magnesia, Epsom salts, or cas- 
 tor oil: these must be repeated every day or two, until the 
 discharges are more natural. During all this time the most 
 simple diet only can be allowed the patient, such as boiled 
 milk, barley water, arrow-root, rice water, &c. Should the 
 patient be cutting teeth, the gums must be examined and, 
 if swoln, lanced. If any sore behind the ear have been re- 
 cently dried up, it must be again opened by a blister. A free 
 bleeding from the arm will be necessary; and afterwards, leech- 
 es to the temples and back of the head, or cups to that part 
 and the back of the neck. 
 
 We once saw a most happy change effected in a child about 
 three years old, who was just passing into the sleeping state 
 with this disease of the brain, by having its head shaved and 
 covered over with leeches, allowing them to draw until the 
 child became faint; they were then stripped off, and the child 
 was carried out into the air. In less than twenty-four hours, 
 it began to recover, and in a short time was entirely well. 
 Our experience is, therefore, rather more in favour of free 
 bleeding with leeches than bleeding from the arm alone; but 
 in whichever way it may be done, — to be of any service, it 
 must be done freely. Keep the extremities warm, the bowels 
 open, the head cold, the room dark and quiet, and avoid ex- 
 hibiting any thing which would call for the action of the brain 
 whilst its delicate coverings are so much inflamed. After 
 bleeding and purging, the Dover's powders are thought to be 
 useful in quieting the patient, and disposing to perspiration. 
 We think, they should be given with caution; and the head, 
 at the same time, should be covered with a cap wrung out in 
 cold water, and its temperature constantly kept under. A 
 blister behind the neck might be useful after the system has 
 been sufficiently reduced by bleeding and purgatives. 
 " Of Whooping-Cough. This is an affection to which chil- 
 dren are subject at some period of their existence; and one, 
 also, which is not confined to infancy or childhood, though by 
 far most common in these stages of life. It usually begins as 
 an ordinary cold, or catarrh, at first without fever, and after 
 continuing some days, during which it gradually increases in 
 severity; a peculiar ivhooping sound is caused by the passage 
 of the air through the spasmodically contracted windpipe in in- 
 spiration. The child's face becomes flushed and almost pur- 
 ple from the exertion in coughing, till the stomach rejects its 
 contents, which are thrown up in conjunction with more or 
 less of a ropy mucus that is secreted by the glands of the 
 throat and mouth. The paroxysm then usually abates, and 
 
564 WHOOPING-COUGH. 
 
 the child, after a few moments, resumes its amusements aird re- 
 mains tranquil till a repetition of the tit. The coughing some- 
 times lasts for several minutes, during which the child will 
 be nearly exhausted, and the vessels of the head and chest 
 become so turgid with blood, that a hemorrhage from the 
 lungs, nose, or ears, may take place. It is not unusual for in- 
 fants to be seen reluctantly leaving the nipple to cough till 
 they vomit the milk they have just drawn, and as soon as they 
 recover from the fatigue, again return to the breast. AYhen 
 the child is reduced, it is not unusual for discharges to occur 
 involuntarily from the bowels and bladder at the same time. 
 Fever usually attends this cough, in some part of its course. 
 Occasionally it begins with the cough; but frequently it is not 
 perceived for the tint week or two, and in some cases the dis- 
 ease is so light as to excite very little fever. The cough 
 commonly increases in violence for live or six weeks; when, 
 under favourable circumstances,it gradually declines, and finally 
 disappears. Should it commence in autumn, and the child be 
 exposed to the vicissitudes of winter, it is general. 
 rated, and seldom passes over without some evidence of its de- 
 structive power. If the child survive, it will remain extremely 
 liable to a constant harassing cough, which often results in 
 abscess of the lungs, drops^ of the chest, or rapid consumption. 
 General dropsy sometimes occurs in consequence of severe 
 whooping-cough. The affection is contagious. It is to be 
 managed by a proper attention to clothing, always keeping the 
 body, breast, and extremities warm, regulating the diet to pre- 
 vent fever, keeping the bowels open by castor oil, rhubarb, 
 senna tea, or Epsom salts, giving some expectorant medicine to 
 keep the throat moist, and endeavouring to allay the spasmo- 
 dic action of the windpipe. For this last purpose, from three 
 to thirty drops of antimonial wine, or the same quantity vi the 
 compound sirup of squills may be given in from half a 
 spoonful to a dessert spoonful of milk of asafeetida every half 
 hour or hour, according to the age of the child, or the severity 
 of the symptoms. Should the child be of very full habit, and 
 have fever, or hemorrhage from the lungs, nose, or ears, it 
 will be proper to abstract some blood from the arm, by 
 the lancet; or from the temples or back of the neck, by cups 
 or leeches. From one ounce to three or four ounces may be 
 taken according to circumstances. After this, a plaster of 
 Burgundy pitch should be placed on the back, from the lower 
 part of the neck to the lower part of the chest, and allowed to 
 remain as long as it can be borne. Tf removed before the 
 tient has recovered, it should be replaced bv a piece of flannel. 
 The front pant of the chest may be rubbed from time to time 
 with opodeldoc, or the volatile liniment, whenever there 
 
mumps. 565 
 
 appears to be much difficulty in the respiration. Probably the 
 common custom of rubbing the breast freely with warm goose 
 grease is frequently useful. When the child is much reduced 
 by the effort of coughing, and often vomits the food it takes, its 
 diet should be as nutritious as practicable. Plain animal soups 
 may be given in small quantities at a time, if its teeth be not 
 yet cut; and if able to masticate, it must be allowed to eat a 
 little well cooked meat, to sustain its enfeebled system. Its 
 bowels will require strict attention. Costiveness must be cor- 
 rected by laxative medicines, or injections which contain asa- 
 fcetida. Great care is to be taken of the child during the pe- 
 riod of its convalescence, to prevent its exposure to cold and 
 damp, as it is extremely susceptible of catarrhal affections, 
 which may either run their course rapidly, in a debilitated 
 constitution, or result in a chronic cough, or, ultimately in con- 
 sumption of the lungs. 
 
 Mumps. This is another affection which is sometimes pro- 
 pagated by contagion, though it often springs up spontaneously, 
 and is not very easily communicated to others. It generally 
 begins with a slight fever, with some stiffness of the jaws, and 
 a little swelling of the glands under the ear, on one or both 
 sides. At first, the enlarged gland can generally be moved 
 about under the skin ; but after the fourth day, it becomes firm 
 and tender to the touch. The glands under the mouth often 
 become as much swelled as those under the ear; and the skin, 
 which commonly retains its natural colour, is sometimes slightly 
 reddened. The patient soon experiences great difficulty and 
 pain on masticating and swallowing, and is troubled with rest- 
 lessness, and nervous irritability, though there is seldom muck 
 fever. The swelling usually abates in less than a week from 
 the commencement, and with it, all the feverish symptoms 
 generally disappear. Suppuration of the gland is uncommon, 
 but so strong is the sympathy between these glands and the 
 testicles of the male or the mammae of the female, that these 
 sometimes become very much swelled, causing great pain in the 
 parts, and fever. The brain is sometimes the seat of this 
 translated action, and then delirium, stupor, and even death 
 may follow. 
 
 When the case is mild, little more attention is necessary 
 than to keep the child warm, and give it some mild laxative, 
 and warm drinks, with a few drops of the sweet spirits of nitre, 
 to favour a gentle perspiration. If the swelling suddenly 
 leave the throat and attack the breast or testicles, the parts 
 which were originally affected should be covered with a mus- 
 tard poultice, rubbed with strong volatile liniment, or have 
 a fly-blister applied over them, to excite a return of the in- 
 flammation and swelling. In more severe cases the skin should 
 
506 QUIKSY. 
 
 be kept in a state of perspiration, by nauseating doses of anti- 
 monial wine and sweet spirits of nitre. To lessen the swelling, 
 which is liable to remain after the pain and fever have abated, 
 tbe tumours should be frequently rubbed with the soap lini- 
 ment or opodeldoc. 
 
 Inflammation of the Tonsils — Quinsy. The glands which 
 project into the upper part of the throat, and back part of the 
 mouth, are, in some children, as well as in adults, particularly 
 liable to inflammation; and, unfortunately, those who have once 
 experienced an attack, are very liable to repetitions of it du- 
 ring life. In young children who cannot speak, it is difficult 
 to recognise the commencing symptoms of the attack, and the 
 attention of the mother or nurse is seldom drawn to the infant 
 until it is found unable to swallow. Those who can speak, 
 commonly complain of some chilliness, with pain or unea- 
 at the back part of the mouth. Shortly afterwards swallow- 
 ing becomes very difficult, and upon examination of the j 
 the tongue is found covered with a white fur, through which 
 the red parts of the papillae project, and the whole back part 
 of the mouth has a red or livid hue, while the tonsils are seen 
 swelled and prominent. 
 
 The large vessels of the neck and throat throb violently: 
 there is much headach, fever, and difficulty of breathing and 
 speech; the latter, being shortly reduced to a laborious whis- 
 per. It becomes almost impossible to drink liquids, alth 
 the patient can generally swallow soft food, such as thick 
 gruel, thin mush and similar preparations. 
 
 This swelling commonly increases until matter is formed, 
 and after some hours of great pain and horrid sense of suffoca- 
 tion, it bursts and discharges matter, to the inexpressible 
 lief of the patient. 
 
 The swelled glands, however, are sometimes covered with 
 an ash or gray-coloured spot of matter, which has been B 
 rated from the subjacent inflamed parts: and suppuration rare- 
 ly accompanies this condition of the glands, though the pa- 
 tient is not in a less dangerous state on this account. 
 
 The abscess almost always opens into the mouth, though it 
 sometimes points on the outside, and then leaves an unplea- 
 sant-looking scar in healing. 
 
 This disease is apt to run its course very rapidly, and con- 
 sequently requires the most energetic treatment, if we expect 
 to prevent suppuration. From repeated attacks of the dis 
 the gland is apt to become so large as to prove a source of 
 difficulty in swallowing and speaking; especially after a slight 
 cold has been contracted. 
 
 If there be fever with a pretty full pulse, the patient should 
 be freely bled till the pulse is reduced, and a brisk purgative 
 
CHOLERA INFANTUM. 56? 
 
 should be given, composed of Epsom salts, senna tea, or cas- 
 tor oil. After this the feet should be immersed in warm wa- 
 ter, and the patient should take every hour from three to 
 twenty drops of antimonial wine, and from five to thirty drops 
 of sweet spirits of nitre, according to the age, so as to keep 
 up a little sickness at the "stomach without absolute vomiting. 
 A few American leeches, (from two to twenty,) should be put 
 upon the sides of the throat, or some cups applied to the back 
 of the neck. When this has been done without effectual re- 
 lief, a blister should be placed on the throat or back of the 
 neck, or if the case be mild, bathing with equal parts of spi- 
 rits of turpentine and sweet oil, or two parts of hartshorn 
 water and one of sweet oil will be necessary. "The common 
 remedy of scraped potatoes, saturated with hot vinegar, has 
 often done good in mild cases — so does the inhalation of the 
 steam from hot water, or vinegar and water, when it becomes 
 desirable to hasten suppuration. We are decidedly opposed 
 to the use of any kind of gargle in the early part of this dis- 
 ease. The throat should be kept as quiet as possible, till suppu- 
 ration has taken place, when it may be carefully washed with 
 flaxseed and wheat bran tea, with a little vinegar or lemon 
 juice. Towards the last, however, the gargle may be some- 
 what astringent and composed of oak bark or nut gall tea. 
 
 The Cholera Infantum, or Summer Complaint. This 
 disease is almost peculiar to children of large cities, and is most 
 frequent in those w T ho reside in small, crowded, and ill-venti- 
 lated apartments. It is rarely seen, except between the ages 
 of three and twenty-four months, seldom beginning before or 
 after dentition. It usually begins with vomiting and purging 
 about the same time, though, in some instances, purging may- 
 take place a day or two before the stomach is materially dis- 
 turbed. The tongue, in most instances, is slightly furred at 
 the beginning of the disease; but, after a few days, it becomes 
 smooth and polished, or dry and brown. The stools are com- 
 monly thick, frothy, and fluid, intermixed with little spots of 
 -green bile, though, at other times, they are as transparent as 
 water, having only some flakes of mucus floating through 
 them. After a short time, no bilious matter is to be seen in 
 the discharges. The patient usually becomes immediately 
 prostrate: and, if not speedily destroyed, it emaciates very ra- 
 pidly. The vomiting and purging are not always constant, 
 but sometimes occur in paroxysms, after intervals of a few 
 hours; and, in some fortunate cases, after a duration of five or 
 six hours, they subside entirely. There is evident pain, or great 
 uneasiness in the stomach and bowels, especially in the com- 
 mencement. The hands and feet are cold, the skin of 
 the body and head is hot and dry, and becomes shrivelled or 
 
568 CnOLERA INFANTUM. 
 
 wilted. The eyes lose their lustre, the eye-lids but half cover 
 them, the nose becomes pointed, and the skin contracted upon 
 it, while the lips are thin and shrivelled. In this condition the 
 child lies upon the lap, or upon the pillow, apparently ex- 
 hausted and indisposed to move, except when impelled to vo- 
 mit, or cry for cold water: the only thing which it is willing 
 to take; and this is often either thrown up instantly from the 
 stomach, or suddenly passed off by the bowels. From this 
 st,ate it frequently sinks into stupor and insensibility, and 
 often dies in convulsions. If the disease do not thus speedily 
 destroy life, the stools assume a dark, offensive, and highly 
 irritating character; the mouth becomes sore, covered over 
 with white fur or superficial ulcers, — the face bloated, the 
 abdomen distended with flatulence, and when the system is 
 very greatly reduced, the skin is sometimes studded with 
 spots of blood effused beneath the cuticle, or there may be 
 some watery blisters, scattered about the chest and other 
 parts. 
 
 The treatment of this very fatal disease is so complex and 
 difficult, that it cannot be explained to a popular reader, or 
 intrusted to such, with safety, under any circumstances what- 
 rver. Fortunately, it is rare, except in large cities, where me- 
 dical advice is at hand, and yields, or becomes mild, almost 
 immediately on a removal to a cool country situation. The 
 wealthy should take the general advice of their family pi 
 cian. and then fly with the child to the open air of a farm or 
 small Tillage. The poor should depend on their doctor; and 
 we have but one hint to give them. A well ventilated 
 apartment in the upper story of a house, if not too much 
 heated by the roof, will give their children a much better 
 chance of life, with or without treatment, than the ground 
 floor. Let the child remain day and night in such a room. 
 
 We have frequently seen the disease in the country, and 
 found it very fatal; but only in residences where uncleanly 
 habits, and the miserable construction of residences which 
 we have censured in the chapter on Hygiene, have produced 
 an artificial hot climate and the foul air proper to an alley, in 
 the midst of the free atmosphere of healthful districts! 
 
 For the prevention of this disease, we would earnestly press 
 upon those mothers who reside in large or compact towns, 
 and in the lanes and alleys where the atlection most prevails; 
 to keep their houses clean and well aired ; to wash the whole 
 bodies of their children, daily, or more frequently, with clean, 
 tepid, or cool water, changing their dress sufficiently olten 
 to keep them cleanly clad: to abstain from the use of unripe 
 or unwholesome fruit themselves, and by all means, to pre- 
 vent their children from eating it. Let their infants be sup- 
 
CHOLERA INFANTUM. 569 
 
 plied, as far as possible, from their own breasts, and if they 
 do not supply sufficient nourishment, let the balance be made 
 up with pure cow's milk, either alone or moderately diluted 
 with soft water. When any teeth make their appearance, or 
 the gums appear swelled, and the child is fretful, let the gums 
 be carefully and freely lanced; and if there be any eruption 
 on the skin, or behind the ears, let no applications be made 
 to them, except for the simple purpose of keeping them clean, 
 without suddenly drying them up. If they should heal ra- 
 ther suddenly, and the child become restless or feverish, let 
 a little blister ointment be rubbed behind the ears, till a dis- 
 charge is produced, carefully keeping the blisters open, by 
 dressing them with a little basilicon or savin ointment. Let 
 the child wear flannel next its skin, and worsted stockings on 
 its feet, even during the summer season,; and when it has 
 passed beyond its first year, let the diet be regulated strictly 
 on the principles laid down under the head of weaning. 
 
 12 
 
( II VPTER V 
 
 OF ADULT FEMA] 
 
 JJpjiearance of the Menses. — In the early j 
 is no very materia] differei condition of the I 
 
 except what 1 mthedii. on; but, in tem- 
 
 perate climates, the system 1 from thirl 
 
 years, suddenly set^ about a very important and well ko 
 change. The child leaves oil' the amusements which bo 
 joyed in common with boj (fident and retiring in 
 
 her manners, and pr. I 
 sex. She may now feel a remarkable fulness and 
 
 about the head, with ;. ual dart 
 
 temples, while, at the same tin. 
 
 about the lower part of the abdomen and thighs, with I 
 tude, and pain in the back. If now a lew dr. , 1 co- 
 
 loured fluid escape from the vagina, she obtains immi 
 lief and boon forgets her Bufferings until, after the lap* 
 weeks, the same sensations return, perhaps with less \iol< 
 After a few such periods she becomes, as h^r friends would 
 say. •• right" Sometio 1 a later 
 
 age; and, frequently, >uinc months elapsi - first apj 
 
 ance, before there are any symptoms - 
 Ion- as the* circums *ind to 1 stent with 
 
 continued health, the alarm usually felt by the friends is alto- 
 gether unfounded, and all interference with the 1 : na- 
 ture is worse than foolish. Mure generally, however, 1 
 the delay has continued lor many months, the health of the 
 young girl begins to suffer t and she is found to labour 
 under chlon 
 
 Chlorosis or Green Sickness. If the - o alluded to 
 
 in our introductory remarks do not take place at th< 
 period, the girl is apt to haw coloured, bloated 
 
 face, bad digestion, and palpitation of the heart under the 
 slightest bodily or mental exertion. She becomes languid, 
 ble, and often excessively nervous, or so dull and that 
 
CHLOROSIS OR GREEN SICKNESS, 571 
 
 ■she can scarcely be roused to common activity. Her ankles 
 will swell towards evening; her sleep may be disturbed; and 
 her appetite may become so greatly depraved that she will 
 desire the strangest articles for food"; such as dirt, charcoal, 
 putrid meats, &c. Her bowels are usually costive; and the 
 stools, when they occur, are often clay-coloured, for want of 
 sufficient bile. Though usually costive, she may at times have 
 some griping pains in the bowels. 
 
 In case medical advice cannot be obtained, we believe that 
 the following directions may be observed, with some prospect 
 of advantage, by an intelligent friend. When there exist no 
 obvious objections to this course, growing out of the peculiar 
 situation of the patient, we may commence with the adminis- 
 tration of an emetic of twenty-five or thirty grains of pow- 
 dered ipecacuanha, in a little molasses or sirup. This should 
 be followed up by five grains of calomel, ten of rhubarb, and 
 five of aloes, as a purgative. The bowels should be afterwards 
 kept in regular action, by one grain of calomel and five of 
 aloes, given every second or third night till the tongue is clean, 
 and the evacuations become natural or bilious. After this, the 
 calomel should be omitted, and a grain of the aloes combined 
 with four grains of the carbonate of iron, given in the form of 
 pills, three times a day. Light nourishing diet and exercise 
 in the open air should be recommended in all cases. The pa- 
 tient should use the warm, salt foot-bath, and the flesh brush, 
 every night and morning; sleeping on a mattress, or hard bed. 
 If subject to acidity of stomach, let her take chamomile tea, and 
 the bi-carbonate of soda: a tea-spoonful of the latter in a pint 
 of the former, will be an allowance for twenty-four hours. 
 Bleeding is generally improper in any stage of this affection. 
 If the head become hot and painful, the feet should be im- 
 mersed in a warm bath, made gradually hotter by the addition 
 of hot water : a bladder of cold water, or ice may be kept to 
 the head while the symptoms continue, and a little blood may 
 be drawn from the inside of the thighs by leeches. The usual 
 mode of administering hot infusion of pennyroyal, rue, &c, 
 is not only useless, but often prejudicial, because we are una- 
 ble to ascertain the exact moment when the discharge should 
 appear. The delay or arrest of the usual evacuation often re- 
 sults from other diseases, such as chronic liver complaint, or 
 protracted intermittent fever, and it is worse than folly to endea- 
 vour to force it forward before the disease is cured, when it 
 will generally reappear spontaneously. 
 
 The various nostrums for female diseases, which are recom- 
 mended with so much assurance by the manufacturer or vender, 
 are dangerous, and should never be employed. Though some 
 o( them may have been used originally, with much success, by 
 
572 SUPPRESSION OF THE MENSES. 
 
 eminent physicians whose names they sometimes bear, they 
 have been essentially modified by passing through the hands of 
 a succession of druggists, each of whom combines the ingre- 
 dients in different proportions, or substitutes one for another, 
 tiH they resemble an old ship which still passes under the same 
 name, though she has been so often repaired that not a single 
 original timber remai; 
 
 Suppression of the Menses. — The woman may have u been 
 right," or " regular," for a longer or shorter period, yet c 
 to some such cause as jiettin^ her feet wet, or bein:: in other 
 respects out of health, the discharge may not recur, though she 
 may have the premonitory symptoms in greater degree than 
 usual. There may be headach, pain in the bones, and espe- 
 cially in the back, with fulness, bearing down, and a distressing 
 irritation of the bowels, but no discharge from the uterus. 
 Now the conditions of the system under which this occurs, are 
 various. The patient may be either in a state of vascular ex- 
 citement, or she may have spasm of the uterus. If she have 
 fever, headach, a rapid and full pulse, a hot skin, thirst, and 
 tenderness over the uterus, her > be treated by bleed- 
 
 ing from the arm till she become I 
 
 salts, confinement to bed, low diet, and ulva, 
 
 or cups to the inner side of the thigh<. When the inflamma- 
 tory action is reduced by these means, the will pro- 
 bably return and continue, unless interrupted by some new 
 cause. 
 
 If the patient be thin and delicate, and of a nervous con- 
 stitution, the same causes which excited inflammation i 
 the circumstances just described, n -ion the spasmodic 
 
 contraction of the uterine and thin 
 
 sion of the meow a The patient, instead of 
 will then be chilly, with co!«l extr and alt: 
 
 will sutler some pain, there will not be any particular tender- 
 
 the uterus. In this condi- 
 tion, the patient should be (he warm hip 
 bath; warm drink: Mich as barley water, r. 
 of catnip, or very weak pennyi : and the pow- 
 der, with cample three or 
 hours, till the pain a: >'wo drachma of a>ato?tida, dis- 
 solved in six ounces of hot water, and used warm as an injec- 
 tion, often acts with great promptitude. If it do not give re- 
 lief in a short time, half the quantity may be repealed, with 
 the addition o( i\tiy drops of laudanum. If now no menstrual 
 action take place, we consider the one of obstr 
 menstruation. 
 
 Obstructed Maubruation. — By this term we met 
 pression of some standing. In this form of the complaint, there 
 
OBSTRUCTED AND PAINFUL MENSTRUATION". 573 
 
 are generally some symptoms which resemble those of chlo- 
 rosis. The appetite fails, or becomes deranged ; the patient is 
 often afflicted with headach, dropsical swellings, and many 
 other disturbances, which sometimes involve the mind itself, 
 causing even incurable insanity. In some women the diges- 
 tion alone is affected. If we know that conception and preg- 
 nancy are not the cause of the suppression, the remedies re- 
 commended under the head of chlorosis, will be proper; but it 
 may be added, ^hat the patient who has once menstruated 
 freely, is generally capable of bearing the loss of more blood, 
 than the chlorotic female. An excellent preparation for the 
 purpose of keeping up the regular action of the bowels, and 
 exciting a disposition to menstruation, is the following com- 
 bination. 
 
 Take, Powdered rhubarb, 1 drachm. 
 
 Powdered aloes, ^ drachm. 
 
 Castile soap, 8 grains. 
 
 Oil of pennyroyal, 2 drops. 
 
 Mix them, and divide the mass into forty pills. Let two 
 pills be taken every morning and evening, till they operate; 
 then, one or two daily to keep the bowels open. 
 
 For that obstruction which accompanies consumption, two 
 grains of aloes, with two grains of the dried sulphate of iron, 
 and Venice turpentine enough to make them adhere, may be 
 given two or three times a day for some time. 
 
 Of Painful Menstruation. — Some females are regular enough 
 as to the period of their monthly " visitations," but are an- 
 noyed greatly, at these times, by the pains they experience, in 
 the lower part of the abdomen, resembling colic or diarrhoea, 
 and obliging them to make frequent efforts to relieve the 
 bowels. This distress commonly lasts only for a few hours, 
 and when the discharge is established, it passes away: but, in 
 other cases, there are severe pains, darting through the loins 
 and pubes, attended with an excessive tightness about the 
 head and weakness of the knees, for some time previous to 
 the discharge. The flow now occurs, not in the thin, fluid 
 form which it usually presents, but in flakes or little masses, 
 sometimes resembling a false membrane which has lined the 
 inside of the uterus. The whole amount of the discharge is 
 generally less than when the secretion is healthy, though some- 
 times, after the membranous matter is thrown off, the thinner 
 discharge is so abundant as to enfeeble the patient very much; 
 indeed, she always feels more exhausted after painful menstrua- 
 tion, even though the secretion be small. While this state of 
 things exists, the woman has but a slender chance of becoming 
 a mother. 
 
574 EXCESSIVE MENSTRUATION, OK FLOODING. 
 
 In Ihc treatment of this distressing affection, two things are 
 to be done: First; to relieve the paroxysm. If the patient 
 have a flushed face, a hot skin, full active pulse, and tender- 
 ness on pressure upon the uterus, she should be bled, and 
 purged, and should pass half an hour in the hip bath, the tem- 
 perature of which should be raised gradually, from nine! 
 one hundred and ten degrees, and then gradually lowered be- 
 fore she leaves it. She must abstain from strong food or heat- 
 ing drinks. If, however, the woman have a feeble, nervous 
 constitution, the above directions will not apply: but in their 
 stead, we should order mild laxatives; such as a Seidlitz pow- 
 der or two; or a tea-spoonful of sulphur and molasses, or a table- 
 spoonful of spiced sirup of rhubarb, combined with a tea- 
 spoonful of calcined magnesia. Alter the operation of thi- 
 gative, five grains of camphor mav I every two or 
 
 three hours, in a litt!< -imp, until the pain is abated. 
 
 We have also known much good to result from the folk 
 prescription : — 
 
 Take, -iateofiron, 4 grains. 
 
 Powdered ipecauanha, £ grain. 
 
 Pn\\ urn, rain. 
 
 To be taken at once, in a little sirup or mi 
 
 This Ikk h fiord I relief in several rases in which 
 
 there was no inflammation. The warm hip bat: melj 
 
 useful to the delicate and nervous female, at the time of pain- 
 ful menstruation. In the second pla 
 
 made to prevent the return of the pain, &.C, nt the next men- 
 strual peri pon very high authority, the volatile tincture 
 ofguaiacum is recommended as the best medicine for 
 this object If lh< inflamm 
 position, she is to | lonful of this 
 morning, noon, and e 
 milk, or a little sherry, Ma< 
 
 ten necessary to contii aid it 
 
 sometimes fails alt 
 
 Excessiv M nstrualion, or Flooding females have 
 
 very profuse discharges, regularly and habitually. They ap- 
 pear blanched, thin, or bloated, with waxen countenances. 
 They may have very little pain, but a copious discharge of clot- 
 ted blood at their monthly period. They become nervous, 
 and complain of shortness of breath, palpitations, and faint- 
 ness, or are completely overcome by the slightest mental or 
 physical effort. At first, this hemorrhage obs gulir pe- 
 
 riods; but, after a time, the woman seems to be "always un- 
 well:" having a constant dribbling, which wastes her - 
 
PINAL CESSATION OF THE MENSES. 575 
 
 and at last renders her incapable of exercise. The horizontal 
 posture, repose, a regular state of bowels, and a nourishing, 
 but mild diet, will be proper in such cases. One-fourth of a 
 grain of opium, two grains of sugar of lead, and half a grain 
 of ipecacuanha, should be given every two or three hours, till 
 the discharge is arrested; but the use of this remedy should 
 not be continued long, in the absence of medical advice. An 
 injection of fifteen grains of sugar of lead, a tea-spoonful of 
 laudanum, and two table-spoonsful of water, mixed, may be 
 thrown slowly into the bowels. After the discharge is 
 checked, an injection of hve or six ounces of cold water should 
 be used twice every day for a long time. It should be passed 
 so gradually, that the bowels will not be stimulated to action; 
 and it ought to be given in bed. This remedy is inadmissible 
 during the regular period for being unwell. As a general to- 
 nic, ten drops of elixir of vitriol, one grain of sulphate of 
 zinc, and thirty drops of the tincture of cinnamon may be given 
 in a gill of weak peppermint water, three times a day. The 
 vegetable bitters are less useful than the mineral tonics. When 
 the discharge continues obstinate, and there is reason to sus- 
 pect the existence of cancer, fungus, or some other organic 
 disease, a careful inspection should be made by an experienced 
 member of the profession, as soon as such advice can be ob- 
 tained. 
 
 Final Cessation of the Menses. About the age of forty- 
 five, women, in temperate climates, approach the "time of 
 life." The monthly periods then become irregular, the discharge 
 sometimes diminishing very much in quantity, or remaining 
 absent for several months, and then returning so profusely as 
 to prostrate the patient very much. In other cases, the quan- 
 tity is so small, and gives so little relief, that the woman is 
 subject to giddiness, dimness of vision, vertigo, pain in the head, 
 or other distressing sensations. In some instances the change 
 takes place without any disturbance. Women, in general, 
 look forward to this period with much anxiety; for there is a 
 popular belief, not without too much foundation in truth, that 
 at, or shortly after this period, diseases of the breast and ute- 
 rus exhibit themselves. 
 
 Those who are subject to much pain or inconvenience on 
 account of this irregularity, should carefully attend to their 
 condition. If they feel much fulness about the head, with 
 pain or giddiness, they should reduce the quantity of food, 
 and abstain from meat and all other animal substances. They 
 should keep their bowels free by frequent and small doses of 
 Epsom, Glauber, or Rochelle salts, or cremor tartar and sul- 
 phur; and, if not manifestly relieved by this course, they 
 should lose six or eight ounces of blood from the arm, occa- 
 
576 LEUCORRHGEA OR WHITES — PRURITIS VULViE. 
 
 sionally; making the intervals between the bleedings longer 
 and longer. Regular, but not violent exercise, in the open air 
 is of the highest importance. 
 
 Leucorrhoza, Fluor Jllbus, Whites. Some women are sub- 
 ject to a discharge of a fluid, usually light coloured, but occa- 
 sionally green or yellow. Sometimes it is thin ; at others, 
 thick and adhesive: the quantity varies in different persons, 
 and at different times in the same person. In some individu- 
 als it gives no uneasiness, while in others it occasions much 
 constitutional disturbance, breaking down the health of the 
 strongest female by slow degn 
 
 This discharge is a symptom in various affections of the 
 uterus and vagina. Great mental emotions, severe labours, 
 chronic inflammation or organic disease of the vagina or ute- 
 rus, a displacement of the latter organ, or unsuitable instru- 
 ments introduced into the vagina to support it, often produce 
 irritation and discharge. 
 
 Te relieve this complaint, when there is no organic di.- 
 of the uterus, let the patient pay the strictest attention to the 
 cleanliness of her person in general, and of the parts whence 
 the fluid i If she have pain in the back, quick pulse, 
 
 and headach, with fever, let her lose a few ounces of blood 
 from her arm ; let her bowels be purged with Epsom or 
 Glauber salts, or magnesia, alone or with rhubarb; krep her 
 quiet for several days in the horizontal position, till the pain 
 in the head and back, and the fevi lieved: after this, 
 
 she may use a solution of a drachm of alum in six ounces of 
 water, cold or warm at option, or half a drachm of sulphate of 
 zinc, dissolved in six ounces of rose water — a part of this to 
 be thrown into the vagina, by a proper female sj vo or 
 
 three times a day. A tea made of the black oak bark, or a 
 weak infusion of nut galls, sometimes answer- 
 purpose as an injection: so does weak lead water. All the 
 vegetable injections, however, should be avoided as long as 
 there is heat in the parts. Cold water alone, several tii. 
 day, will be very useful till the inflammation has passed away, 
 or has been much reduced. 
 
 Warm clothing should be worn about the waist and lower 
 extremities of all women subject to this a flection. Flannel draw- 
 ers should always be used in cold weather. We possess much 
 more powerful means for arresting the course of obstinate cases, 
 than those above described; but we do not feel justified in dis- 
 cussing them in a popular treatise. 
 
 Pruritis Vuha\ Etching of Ik* External Gemitml ( _ . — 
 delicate internal lining of the external organs of generation, 
 sometimes becomes the seat of a mo>t I Qg itching, to 
 
 relieve which, the parts may be so irritated by friction, as to 
 become violentlv inflamed. Leeches have been used some- 
 
FALLING OR PROLAPSUS OF THE UTERUS. 577 
 
 times with benefit; so has the application of cold; as ice water, 
 or even lumps of ice introduced into the vagina. When there is 
 an eruption like that in the sore mouth of children, injections 
 of a strong solution of borax' have been very useful ; thick 
 starch water with a solution of sugar of lead, injected into the 
 vagina, and retained for an hour or two, have been also of great 
 utility in a few cases under our care. This irritation some- 
 times arises from disease of the uterus, pregnancy, the presence 
 of a stone in the bladder, or worms in the bowels. The original 
 affection must first be attended to in these cases, as elsewhere 
 directed. 
 
 Falling or Prolapsus of the Uterus. — The uterus is so situated 
 in the human female as to be subject to a variety of displace- 
 ments, some of which excite so much influence on the health 
 of the individuals who have incurred such accidents, that a few 
 observations on the subject appear peculiarly necessary in a 
 work like the present. 
 
 The most common displacement is, perhaps, the descent , 
 falling, or prolapsus of the womb. In this case the uterus be- 
 comes too much depressed towards the bottom of the vagina ; 
 so that its mouth lies upon the lower surface of the passage, 
 producing a slight bearing down, sensation in the part, and 
 some dull or acute pain in the back, especially when the pa- 
 tient is long upon her feet. This pain disappears soon after 
 lying down, and the patient rises in the morning apparently 
 well. Soon after the business of the day commences, her pain 
 and distress return. A discharge of whites now presents itself, 
 if, indeed, it have not preceded, or caused the accident. The 
 inconvenience goes on increasing, under common exercise, till 
 the patient becomes feeble, nervous and dyspeptic, the local 
 suffering may now become worse, or it may be lost in the im- 
 pression of pains low down on the left side of the abdomen and 
 under the short rib, dragging and distressing soreness about the 
 loins, tenderness of the lumbar vertebra, dragging and colic, pains 
 about the umbilicus, and, perhaps, costiveness and painful or 
 difficult urination. But a sudden fall, lifting a heavy weight, 
 light lacing in the ball room, or a walk or ride over a rough 
 road, may produce sudden displacement. The woman is in- 
 stantly seized with pain at the bottom of the stomach, in one of 
 the hips, or all round the back ; with a strong bearing down, 
 an inclination to pass her water every minute, or an im- 
 pulse to evacuate her bowels* She may become faint, or have 
 a paroxysm of hysterics. Under these circumstances, it often 
 happens that the uterus has been suddenly depressed almost to the 
 the orifice of the vagina, pressing upon the rectum and the neck 
 of the bladder, so much as to cause the inclination to evacuate 
 them, 
 
 73 
 
578 FALLING OR PROLAPSUS OF THE UTERUS. 
 
 If this state of things be long neglected, the bladder may al- 
 most assume the position of the uterus, and the latter may slip 
 entirely out of the body. The whole organ is now suspended 
 between the thighs of the wretched patient, and her sufferings 
 commonly exhaust her physical and mental energies. Yet 
 such is the vigour of constitution in some women, that they 
 move about, and attend to laborious business without evincing, 
 to a mere spectator, the existence of any special disorder. This 
 sudden affection is to be treated by rest on the back in bed, 
 with the hips raised, when the displacement is in the Grst de- 
 gree, and of recent occurrence. The same remedies are pro- 
 per when the disorder has reached the second stage, (the 
 mouth of the womb presenting at the external orifice,) except 
 that it is then often necessary lo r< store the womb to its natu- 
 ral situation by pressing it upward and backward by a i. 
 or two passed into the vagina. 1 1 there be any pain in this opera- 
 tion, the vagina should be well crashed by injections of thick 
 flaxseed or slippery elm bark t day or two before the 
 
 astringent washes 11 
 
 When the womb bai ly out of th 
 
 which is always drawn down and inverted, the parts some- 
 times become suddenly so swelled that it would be impossible, 
 as well as improper, to return them at once. The inflamma- 
 tion is to I"' reduced by leeches, ice water, or warm fomei 
 poultices of bread and milk, or hops and flaxseed, continually 
 applied until the swelling and pain subside: then, with the 
 hand well oiled, and the patient's hips well elevated upon a 
 cushion or pillow at the edge of the bed, tl m is to be 
 
 (1 carefully within the vagina, and restored to its natural 
 situation. The bowels and bladder must be regularly evacu 
 but the patient should not be allowed to 
 
 and should even then assume the upright position very ^radu- 
 allv and cautiously, after ha-. 1 anodyne and at in- 
 
 jections from the first. The injection- 1 for the 
 
 support of the vagina and uterus should be made of the fol- 
 lowing ingredii 
 
 Take one drachm of alum and dissolve it in half a pint of 
 clear water: or, half an ounce of the inner bark of the black 
 oak, with three gills of water; boil down to a pint and 
 strain. Two ounces of either of these preparations should 
 be injected into the vagina, by means of a . the 
 
 extremity of which should he perforated with a number of 
 orifices, to conrey the fluid to different points of the surface 
 on which it is to act. The syringe invented by Dr. I Phi- 
 
 ladelphia, we consider the best. This operation should be re- 
 peated twice a day. for a week or more; the syringe being 
 always well lubricated with lard or oil, that it may be intro- 
 duced without difficulty or pain. 
 
ANTIVERSION OF THE WOMB, &C. 579 
 
 From thirty drops to a tea-spoonful of laudanum may be 
 used in the injection, when there is much sensibility; and this 
 may be repeated everyday or two till the sensibility disap- 
 pears. The patient may now be allowed to move about her 
 room ; and if she discover no return of the symptoms, she may 
 gradually resume her domestic duties, avoiding for a long 
 time any efforts at lifting, long walks, &c. 
 
 If there be frequent relapses, or if the case be chronic, she 
 should wear a pessary, which should be accurately adjusted; 
 but this and all other instrumental means of support, should 
 be directed by a professional gentleman who should be made 
 acquainted with the case. 
 
 Most of the pessaries commonly on sale, (none of which 
 are adapted to the whole round of cases,) and all the " abdomi- 
 nal supporters" known to us, are injurious instruments. 
 
 Retroversion, or Falling of the Womb backwards. The 
 uterus is also liable to falling backwards, so that its body, or 
 rather its very top part, presses upon the bowel behind, while 
 the mouth, instead of over-hanging the lower part of the va- 
 gina, is drawn upward so as to press against the neck of the 
 bladder, which, soon becoming distended, very much increases 
 the difficulty, and renders the escape of urine, as well as that 
 of the contents of the bowels, almost impossible, the distress 
 from bearing down is very great, and immediate relief is ne- 
 cessary. The parts should be examined by the finger passed 
 into the vagina, when a tumour will be felt obstructing the 
 passage, making it very short, and pressing upon the bowels. 
 No neck or mouth of the uterus can be found, unless it can 
 be felt, very high upwards, just behind the arch of the pubes. 
 The management of this affection is purely surgical, and must 
 be confided solely to experienced men. 
 
 The bowels and bladder should be kept open by glisters, and 
 the patient ordered to remain in bed till she can be seen by a 
 physician or surgeon. If a practised female accoucheur be 
 present, she should always use the catheter, immediately, to as- 
 certain the nature of the case. 
 
 Antiversion of the Womb. The unimpregnated uterus is also 
 liable to fall forwards; but this extremely rare difficulty is in- 
 telligible to surgeons alone. 
 
 Of Polypus and Cancer of the Womb. Under the head of 
 Flooding, we alluded to the hemorrhage arising from polypus 
 and cancer. We come now to make a few observations in re- 
 lation to each of these affections, merely to point them out to 
 those who are liable to suffer from them ; for we are fully per- 
 suaded that these cases should never be left to run their course 
 without claiming the attentive consideration of the surgeon-ac- 
 coucheur. 
 
580 POLYPUS OF THE UTERUS — CANCER OF THE UTEP 
 
 Polypus of the Uterus. When the woman has been wasting 
 away for some time, under a more or less copious discharge of 
 blood, and the remedies recommended under the head of flood- 
 ing have been faithfully, but unsuccessfully u<ed; — when, during 
 this time, the has remained free from burning and pain in the 
 part, but has merely complained of a sense of weight in the 
 womb, — there is great reason to suppose that she has a poly- 
 pous excrescence growing there. This polypus may spring from 
 any part of the inner surface of the womb : When it arises from 
 the body, or considerably within the neck of the organ, it can- 
 not be detected until it distends the mouth sufficiently to admit 
 the point of the finger; or, until the polypus itself descends into 
 the vagina. In the latter case, it may be found smooth and 
 round, from the size of a walnut to that of a child's head As 
 it grows, (which it sometini' apidly.) it causes much 
 
 unca- lit and by distending the parts. The dis- 
 
 ease beiog i advice should be 
 
 Jit immediately. 
 
 Cancer of the I Some women of active habits and 
 
 devotion to their occupations may, at times, have their at- 
 tention called to a sudden pain \ ots through the bottom 
 of the abdomen, and • after 
 it a dull at- hi i ompanied by more 
 or lea fa fluid, which bsocnet and thin, but 
 soon becomes thi< . pcrhap 1 with biood, 
 and very offensive. This pain is gradually rendered more se- 
 vere and aim "it, and an exhausting hemorr! 
 in at times, perhaps continuing until checked bj In 
 other ind more delicate temperament, 
 a burning heat, followed by barge of mat- 
 ter mixed wil - of blood. At their month! 
 riods, or even in the intervals, they may have a copious irrup- 
 tion of blood which blanches their skins, and gives them a 
 \\a\en, vet bloated counten ihen too much 
 son to fear th f the ute- 
 rus; — cither true l d and equally 
 feet ion. 
 
 The only domestic treatment which c y be adminis- 
 
 tered, in this will he merely palliative. Clean: 
 
 fresh air, plain nutritious diet, regulation of the bowels, and 
 tranquillity o\ mind, are all that can be recommended in a work 
 like this. The woman who has the misfortune to I with 
 
 this affection must resolutely determine to retire early from the 
 active duties of life, and be content I n from in< 
 
 which would heat the system, ex :ite h< r I increase 
 
 the circulation of block! . Bland, soothing nourishment, and lo- 
 cal applications, are all that can be administered until she 
 
POLYPUS OF THE UTERUS. 581 
 
 have judicious and experienced medical assistance. Her bow- 
 els should be kept open by the mildest laxatives that will effect 
 the object, the fetid and erosive discharges should be washed 
 away by injections of flaxseed tea, Castile soap-suds, or a solution 
 of chloride of lime or soda, with a little hop or chamomile tea. 
 When the hemorrhage becomes very profuse, the vagina should 
 be plugged up with a fine sponge, or a strip of fine rag, imbued 
 with strong alum water. 
 
 Formidable as the last two diseases are, they are not always 
 beyond the reach of surgery. 
 
APPENDIX. 
 
 FORMULARY. 
 
 List of Preparations mentioned, but without details, in the body of the work, and 
 which may be prepared at the residence of the patient. Those marked with 
 an • are not prepared exactly in accordance with the custom of Pharma- 
 ceutists, but are either simplified to accommodate the domestic adviser, old 
 hospital prescriptions which have never been published, or modifications 
 employed by the author. 
 
 i 
 
 Mum — Burnt or Dry. 
 
 Take any quantity of alum, and heat it on a clean shovel, 
 over a fire. It will melt in its own water of crystallization, 
 and boil for some time. When it becomes perfectly dry, let 
 it cool, and then reduce it to a fine powder in a mortar. 
 
 Jisofoztida Mixture. 
 
 Jisafodida Tea — Milk of Jlsafcetida. 
 
 Take of, Asafoetida, 2 drachms. 
 
 Pure water, boiling, \ pint. 
 
 Pour the water gradually upon the gum in a mortar, rub- 
 bing the mixture from time to time, and decanting the first 
 portions of the mixture, before each addition of the hot wa- 
 ter. The result is a milky fluid. It will not bear keeping 
 many days. It is a powerful antispasmodic, and a stimulating 
 expectorant. Dose, for an adult, a table-spoonful. 
 
 * Blister Ointment. 
 
 Take of, . Simple Cerate, any required quantity. 
 
 Warm it, and mix it with powdered Spanish flies, by rub- 
 bing in the powder with a knife or spatula, until the mixture 
 
584 APPENDIX. 
 
 shows a disposition to crumble. The back of a plate or 
 dish will present a good surface for making the mixture. 
 When spread on leather or muslin for use, it is well to warm 
 the surface of the plaster, and then dust it with the dry pow- 
 der of the fly, allowing all that adheres to remain. 
 
 * Brown Mixture. 
 Take of, Extract of liquorice, 3 drachms. 
 
 Dissolve it in five ounces of boiling water, by rubbing it ir> 
 a mortar, and adding the water gradually. 
 
 Then add, Powdered gum Arabic, 2 drachms. 
 
 Let the mixture cool, and add — 
 
 Antimonial wine. Iiachms. 
 
 Acetic tincture of opium, I drachm. 
 
 This is a valuable expectorant. The same quantity of lau- 
 danum* or three times the quantity of paregoric elixir, may 
 be substituted for the acetic tincture of opium, if this be not 
 at hand. Dose, for an adult, a table-spoonful every two or 
 three hours. 
 
 Camphor Mixture. 
 
 Camphor, 1 drachm. 
 
 Alcohol, ii ops. 
 
 Calcined magne- £ drachm. 
 
 Powder the camphor with the alcohol in a mortar, next add 
 the magnesia, and rub the ingredients well together, then add, 
 gradually, one pint of pure water, continuing the triturations. 
 When complete, filter the mixture through paper. If alcohol 
 cannot be procured, proof spirits will auswer tolerably well, 
 in four times the quantity. 
 
 This is an anodyne, antispasmodic, and diffusible stimulant. 
 Dose, for an adult, one or two table-spoonsful every hour or 
 two. 
 
 mphor Julap. 
 
 Take of, Camphor, 1 drachm. 
 
 Mcoliol. 10 d: 
 
APPENDIX. 585 
 
 Triturate these in a mortar, then add — 
 
 White sugar, 2 drachms. 
 
 Powdered gum Arabic, 2 drachms. 
 
 Triturate again, thoroughly, and add — 
 
 Boiling water, 6 ounces. 
 
 Boiling milk may be substituted, to advantage, for the wa- 
 ter, in this preparation. Dose, for an adult, a table-spoonful 
 every hour or two. 
 
 * Cerate of Impure Carbonate of Zinc. 
 
 Turner's Cerate. 
 
 i 
 
 Take of, Carbonate of zinc, 2 drachms. 
 
 Simple cerate, ] ounce. 
 
 Rub the carbonate into a fine powder on the back of a plate 
 with the knife or spatula, then add it by degrees to the sim- 
 ple cerate, previously warmed, and rubbed on the back of 
 another plate. Mix them thoroughly by rubbing. If the 
 simple cerate be quite hard when cold, substitute a little lard 
 for a portion of the cerate — and rub it well in before adding 
 the zinc. 
 
 These directions differ a little, but not essentially, from the 
 more troublesome officinal orders for preparing the article. 
 
 Cerate — Simple. 
 
 Take of, White wax, 1 pound. 
 
 Lard, 4 pounds. 
 
 Melt them with a gentle heat, and stir till cool. 
 
 Yellow wax will answer all domestic purposes equally well. 
 
 For other cerates, see Ointment. 
 
 * Chalk Mixture. 
 
 Take of, Prepared chalk, 2 drachms. 
 
 Powdered gum Arabic, 2 drachms. 
 
 Tincture of opium, (laudanum,) 1 drachm. 
 
 Pure water, 6 ounces. 
 
 Mix in a mortar. 
 
 An astringent and antacid. Dose, for an adult, a table- 
 spoonful every three, four, or six hours. The common chalk 
 
 74 
 
586 APPENDIX. 
 
 mixture of the Dispensatories, is prepared without the lauda- 
 num. 
 
 * Chalk Mixture with Kino. 
 
 Take of, Chalk mixture, 6 ounces. 
 
 Add, Tincture of kino, 2 drachms. 
 
 This is powerfully astringent. Dose, as in the last pre- 
 scription. By doubling the quantity of the laudanum and 
 tincture of kino, we form the prescription for the premonito- 
 ry stage of Asiatic cholera, mentioned at page 453. 
 
 * Decoction of Cantharides. 
 
 Take of, Powdered cantharides, | an ounce. 
 
 Spirits of turpentine, ] gill. 
 
 Boil them together, for half an hour, in an earthen vessel 
 or an oil flask, on the top of a hot stove, covered with house- 
 sand. 
 
 This is a powerful rubefacient. It is exceedingly inflam- 
 mable, and must never be brought near the fire. 
 
 Decoction of Oak Bark. 
 
 Take of, Oak bark, 1 ounce. 
 
 Water, 1 quart. 
 
 Boil them down to a pint, cool, and decant 
 
 Decoction of I 
 
 Take of, Bear-berry leaves (arbutus uva ursi,) 1 ounce. 
 Boiling water, 1 pint. 
 
 Boil for ten minutes, in an earthen vessel, and strain. 
 Dose, for an adult, a wine-glassful every three or four hours. 
 
 Decoction of Quince Seed, 
 
 Take of, Quince seeds, 2 drachms. 
 
 Boiling water, 1 pint. 
 
 Boil over a slow fire, for ten minutes, and strain. 
 
 This is a simple mucilage. 
 
 For other decoctions and hot infusions — see Infusions. 
 
APPENDIX. 587 
 
 Dover's Powder. 
 
 Take of, Powdered opium, 15 grains. 
 
 Powdered ipecacuanha, 15 grains. 
 Sulphate of potassa, 2 drachms. 
 
 Mix them well, in a mortar, and divide any quantity of this 
 mixture into powders containing ten grains each. 
 
 We prefer, for convenience, and for some other reasons 
 the following: — 
 
 * Substitute for Dover's Powder. 
 
 Take of, Nitrate of potassa, (salt petre,) 2 drachms. 
 Opium in powder, 12 grains. 
 
 Ipecacuanha in powder, 12 grains. 
 
 Mix them very thoroughly, in a mortar, and divide the 
 mixture into twelve powders. 
 
 Effervescing Draught. 
 
 Take of, Sub-carbonate of potassa, (pearl ash.) 3 drachms. 
 Water, . 6 ounces. 
 
 Mix them in a six ounce vial. Then — 
 
 Take of, Fresh lemon juice, 3 ounces. 
 
 Water, 3 ounces. 
 
 Mix them in another six ounce vial. 
 
 Mix two table-spoonsful of the latter mixture, with one of the 
 former, in a small cup, and let it be taken while foaming. 
 
 * Infusion of Bone-set. 
 Bone-set Tea. 
 
 Take of, The dried leaves of Bone-set, 
 
 (Eupatorium perfoliatum,) f an ounce. 
 Boiling water, 1 pint. 
 
 Let the tea draw over the stove or before the fire in a co- 
 vered earthen vessel, for twenty minutes. The modes of admi- 
 nistering this highly valuable infusion are various. In severe 
 colds, when the object is a powerful perspiration, it should be 
 taken as hot as possible, and always when the patient is co- 
 vered warm in bed. An adult should take half the above quan- 
 tity as rapidly as its heat will permit— the remainder, again 
 
588 APPENDIX. 
 
 heated, may be taken in two doses, at intervals of half an hour. 
 When used as a tonic, it should be taken quite cold, in doses of 
 a wine-glassful every two hours. When taken moderately 
 warm, it often produces vomiting, and if made of twice the 
 above named strength, it constitutes an emetic, popular in coun- 
 try places, but disagreeable in its operation. 
 
 Infusion of Cascarilla. 
 
 Take of, Cascarilla bruised, 1 ounce. 
 
 Boiling water, 1 pint. 
 
 Let the mixture digest in an earthen vessel over a warm 
 stove, or before the fire, for two hours without boiling. Dose 
 for an adult, a wine-glassful every three, four, or six hours. It 
 is a tonic. 
 
 Infusion of Chamomile. 
 
 Chamomile Tta. 
 
 Take of, Chamomile flowers, \ an ounce. 
 
 Boiling water, 1 pint 
 
 Let it draw before the fire for ten minutes, and strain. This 
 is taken generally cold, as a tonic — Dose, a wine-glassful, fre- 
 quently. 
 
 Infusion of Columbo. 
 
 Take of, Columbo root, in slices, | an ounce. 
 
 Boiling water, 1 pint. 
 
 Let it simmer for half an hour, in ;in earthen or iron vessel. 
 This is a powerful tonic. It will not bear being kept beyond 
 two or three days. Dose, a wine-glassful or less every six 
 hours. 
 
 * Infusion of Flaxseed. 
 
 Take of, Flaxseed, I tea-cupful. 
 
 Boiling water, 1 quart. 
 
 Tie the flaxseed in a clean piece of linen ; then pour upon it 
 the boiling water, and let them stand over the stove or near the 
 fire, for an hour or two; taking care that the temperature of 
 the fluid be not permitted to reach quite to the boiling point. 
 Decant the liquor, and if it be designed for a drink, let it be 
 sweetened, to the taste of the patient, with brown sugar. If 
 desired, and admissible, a little lemon juice may be added. 
 
 Prepared in the usual way, by boiling, the flaxseed tea be- 
 comes extremely injurious to "the tone of the stomach: but when 
 
APPENDIX. 589 
 
 made in accordance with the directions just given, it is a de- 
 lightful mucilage. This prescription differs from the officinal 
 preparation, principally in the substitution of brown sugar for 
 liquorice, which is a decided improvement. 
 
 * Infusion of Galls.' 
 
 Take of, Bruised galls, 2 drachms. 
 
 Boiling water, £ a pint. 
 
 Let the mixture stand covered in an earthen vessel, and in 
 a warm place for two hours. Then strain it, and add, 
 
 Rose, Cinnamon, or Mint water, 2 ounces. 
 
 This is a strong astringent. Dose, for an adult, a table-spoon- 
 ful every two hours. Without the aromatic, it is often useful 
 as an external application. 
 
 * Infusion of Horse-mint. 
 
 Take of, The dried leaves of Horse-mint, 
 
 (monarda punctata,) h, an ounce. 
 
 Boiling water, 1 pint. 
 
 Let the mixture stand covered in an earthen vessel, and in a 
 warm place for twenty minutes. Then- cool and decant it. 
 This is a valuable article in protracted vomiting, when not 
 caused by organic disease or high fever. It is very useful in 
 sea-sickness. Dose, a wine-glassful taken frequently. It is an 
 excellent substitute for liquor, when given to the intemperate 
 who attempt reformation. It should be taken cold. 
 
 Infusion of Quassia. 
 
 Take of, Quassia rasped, 2 drachms. 
 
 Water, cold, 1 pint. 
 
 Let the mixture digest twelve hours, and strain. This is an 
 excellent bitter tonic. Dose for an adult, a wine-glassful three 
 times a day. 
 
 Infusion of Senna. 
 
 Senna Tea. 
 
 Take of, Senna, I an ounce. 
 
 Coriander seed, bruised, \ a drachm. 
 
 Boiling water, \ a pint. 
 
 Let them stand for an hour in a warm place, then strain, 
 
590 APPENDIX. 
 
 and let the mixture cool. Half this quantity is a dose for an 
 adult, but it may be repeated in four or six hours, if necessary. 
 It is a powerful purgative, and prone to produce some griping. 
 
 Some other infusions are mentioned in the body of this work, 
 but when express directions for their preparation are not given, 
 it is presumed that the general knowledge of these simple re- 
 medies renders unnecessary any formal prescription. 
 
 Lime Water. 
 For domestic use lime water is best prepared thus — 
 Take of, Unslacked lime, about h a pound. 
 
 Very pure water," 2 or 3 quarts. 
 
 Place the lime in a wide-mouthed earthen vessel, and pou r 
 the water upon it. Let the mixture stand a few minutes ; then 
 stir it well and decant it into clean porter bottles.before the lime 
 subsides. Cork the bottles tightly, and, if designed for long keep- 
 ing, seal them. When used, the lime water is to be poured off 
 without agitation, and only that which is perfectly clear should 
 be used. The slightest access of the air rapidly spoils lime 
 water; and even a cork will not prevent its being changed in a 
 few months, unless covered by sealing. It can be readily pre- 
 pared extemporaneously; but in countries where the spring or 
 river water is not pure, distilled water or rain water collected 
 directly in a wide-mouthed, clean vessel will be required. 
 
 Neutral Mixture. 
 Saline Draught. 
 
 This can be more elegantly and correctly prepared by the 
 apothecary; but in places where such aid cannot be had, the 
 following method will answer every purpose. 
 
 Take of, Fresh lemon juice, 2 ounces. 
 
 Sub-carbonate of potassa, (pearl-ash) 1 drachm. 
 Pure water, 4 ounces. 
 
 Put the lemon juice into an eight-ounce vial, and dissolve 
 the potash in another vessel containing about a gill of pure 
 water. Drop the solution of potash into the lemon juice, at 
 first pretty rapidly, then slowly; shaking the vial occasionally, 
 until the effervescence nearly ceases. Then add more potash, 
 drop by drop, tasting the mixture from time to time, until no 
 acid taste is perceived, and the last drops produce no very per- 
 ceptible effervescence. Be very careful not to add too much 
 potash, for it is better to err a little on the other hand. The 
 mixture completed, add a little loaf sugar, and let the vial stand 
 open for an hour, before corking it. 
 
 
APPENDIX. 591 
 
 This is a delightful diaphoretic in long continued fevers with 
 irritability of stomach. In its preparation, mint water is some- 
 times substituted for pure water. Dose, a table-spoonful every 
 hour. 
 
 Nitro- Muriatic Acid Bath. 
 
 Take of, Nitric acid, by measure, 2 ounces. 
 
 Muriatic acid, by measure, 4 ounces. 
 
 Water, in a narrow, deep bucket, 8 gallons. 
 
 Mix them, and use as a bath for the feet and legs twice or 
 three times a week. When employed in disease of the liver, it 
 is well to bathe the surface over the organ with the same mix- 
 ture, by means of a sponge. The mixture may be kept in a 
 cool, dark place, and may be used repeatedly without renewal, 
 for two weeks. 
 
 We have added two gallons more water than is directed in 
 the U. S. Dispensatory, having found this strength sufficient. 
 
 Ointment of Basilicon. 
 
 Take of, Good resin, 5 parts. 
 
 Lard, 8 parts. 
 
 Yellow wax, 2 parts. 
 
 Melt them together, or stir the mixture till cool. 
 
 * Ointment of Cicuta. 
 
 Take of, Extract of cicuta, 2 drachms. 
 
 Simple cerate, I an ounce. 
 
 Rub them well together on the back, of a plate, with a knife 
 or spatula. 
 
 * Ointment of Celandine. 
 
 Take of, The expressed juice of fresh celandine, 1 ounce. 
 
 Lard, \ an ounce. 
 
 Melt them together, and evaporate the watery parts, stirring 
 the mixture frequently. 
 
 Kentish Ointment. 
 
 Take of, Basilicon ointment, 4 ounces. 
 
 Spirits of turpentine, \ an ounce. 
 
 Rub them well together. 
 
592 APPENDIX. 
 
 Ointment of Red Precipitate. 
 
 ' Take of, Red oxide of mercury, (red preci- 
 pitate,) finely powdered, 1 drachm. 
 Simple cerate, 1 ounce. 
 
 Warm the cerate, then add the precipitate, gradually rubbing 
 it in, thoroughly and evenly, with a knife or spatula. 
 
 Ointment of Savine. 
 
 Take of, Basilicon ointment, 1 ounce. 
 
 Savine, finely powdered, 1 drachm. 
 
 Soften the ointment by heat; then add, the savine, slowly, and 
 mix the articles, thoroughly and evenly, with a knife or spatula. 
 
 * Ointment of Stramonium. 
 
 Ointment of Thorn Apple, or Jamestown Weed. 
 
 Take of, Extract of stramonium, 1 drachm. 
 
 Simple cerate, \ an ounce. 
 
 Lard, Irachms. 
 
 First, rub the cerate and the lard together ; then add the ex- 
 tract, and make a smooth mixture of the same colour through- 
 out. 
 
 This is a substitute for the officinal preparation, which, be- 
 ing made of the fresh leaves of the plant, can be prepared only 
 at one season of the year. 
 
 Tar Ointment. 
 
 Take of, Tar, 1 ounce. 
 
 Suet, or simple cerate, 1 ounce. 
 
 Melt the suet or cerate with a gentle heat, and stir the mix- 
 ture till cool. 
 
 * Ointment of Jflxitc Precipitate. 
 
 Take of, Ammoniated mercury, (white pre- 
 cipitate,) 1 drachm. 
 Simple cerate, 1 ounce. 
 
 Soften the cerate, and thoroughly rub in the white precipi- 
 tate. 
 
APPENDIX. - 59-3 
 
 Camphorated Ointment of White Precipitate. 
 
 Take of, Simple cerate, 1 ounce. 
 
 Powdered camphor, 1 drachm. 
 
 Muriate of ammonia, 2 drachms. 
 
 White precipitate of mercury, 2 drachms. 
 
 Melt the cerate in an earthen vessel, then add the other in- 
 gredients, and stir till cold. Rub the cold cerate on the back 
 of a plate, with a knife or a spatula, until the mixture is per- 
 fectly made. 
 
 This ointment acts powerfully on the skin, giving rise to a 
 cutaneous eruption. lis application must not be carried too 
 far, and when used by women and children it may be reduced 
 in strength one half, by adding simple cerate. 
 
 The citrine and Goulard's ointments, several times prescribed 
 in the body of this work, cannot be well prepared at the Fesi- 
 dence of the patient, but must be procured from the apothe- 
 cary. The lard used for ointments must be perfectly free from 
 salt. 
 
 Charcoal Poultice. 
 
 Take a sufficient quantity of fresh charcoal, (that made by 
 extinguishing live coals with dry sand being best) reduce it to 
 a fine powder, and mix it with the flaxseed poultice, or with, 
 simple Indian mush. 
 
 . Flaxseed Poultice. 
 
 Boil flaxseed meal, in just sufficient water to make a poul- 
 tice of proper consistence. 
 
 Fermenting Poultice. 
 
 Yeast Poultice. 
 
 Take of, Flour, I a pound. 
 
 Yeast, 1 gill. 
 
 Mix, and set the mixture in a warm place, to rise. When 
 it begins to rise, it is ready for use% 
 
 * Cicuta Poultice. 
 
 Take of, Dried leaves of cicuta, (conium maculatum,) 1 part. 
 Crumbs of stale bread, 1 part. 
 
 75 
 
5£U APPENDIX. 
 
 Boil these in milk mixed with pne-third its bulk of water, 
 using just enough to make the mixture, after boiling, of a 
 suitable consistence for a poultice. 
 
 We greatly prefer this mode of preparation, to that directed 
 in the systematic works. 
 
 Carrot Poultice. 
 
 Boil the sliced roots of the carrot in water, until soft enough 
 for a poultice. 
 
 The chamomile, hop, and other poultices, mentioned in this 
 work, are all prepared on the same principle with the carrot 
 poultice. The hop is sometimes stewed in vinegar and wa- 
 ter, when intended for an external application to sound skin. 
 The hop pillow is prepared in this way. The bread and 
 milk poultice is too well known to need description. 
 
 Solution of the Pith of Sassafras. 
 
 Put four or six inches of the pith from the thicker stems of 
 sassafras, or a proportionate quantity from the lesser branches, 
 into a six-ounce vial, containing a gill of pure, fresh, cold 
 water. 
 
 Cork the vial, and agitate it frequently, for ten minutes. 
 The solution is then ready for use as an application to the 
 eye. If intended for an injection, prepare a larger quantity, 
 let it stand in a warm place for two hours: then again agitate 
 it, throw the solution, with the pith, into a piece of linen, over 
 a suitable vessel, and express the mucilage by twisting the 
 cloth. 
 
 In the first preparation, the pith will bear to have the water 
 several times replenished before the mucilage become- 
 hausted. 
 
 * Spice- Plaster. 
 
 Take of, Powdered cloves, 1 tea-spoonful. 
 
 Ground cinnamon, 1 tea-spoonful. 
 
 Ground alspice, 1 tea-spoonful. 
 Ground black pepper, l tea-spoonful. 
 
 Flour, 5 or 4 tea- spoonsful. 
 
 Mix them into a paste with vinegar — and spread them upon 
 muslin. 
 
 If powerful local stimulation be required, Cayenne may be 
 substituted for black pepper. The exact relative quantity of 
 
APPENDIX. 505 
 
 the several spices is not important; but no more flour than is 
 necessary to unite them should be used. The cloves and 
 pepper are more important than the other aromatic ingre- 
 dients, and if either of the latter be omitted, their place should 
 be supplied by an additional amount of cloves. 
 
 Spirit of Minder er us. 
 
 Solution of Acetate of Ammonia. 
 
 Take of, Good pure vinegar, 6 ounces. 
 
 Muriate of ammonia, (sal ammoniac,) 
 a sufficient quantity. 
 
 Drop the powder very slowly into the vinegar, in an open 
 vessel, and continue adding, until the effervescence becomes 
 scarcely perceptible. 
 
 This is an excellent diaphoretic in fevers. Care must be 
 taken to stop adding the powder before the effervescence has 
 entirely ceased; for the decomposition of the salt goes on slow- 
 ly toward the conclusion of the process, and it is better that 
 the acid in the mixture should be in very slight excess. If 
 the solution be kept in a vial, it should be left open for a few 
 hours before corking. Dose, for an adult, a table-spoonful or 
 two, taken every two or three hours. 
 
 Spirit of Camphor. 
 
 Camphor is dissolved without limit, in alcohol. A good 
 proportion for domestic use is an ounce of camphor to a pint 
 of alcohol. A few drops of alcohol in a mortar are necessary 
 to enable us to powder camphor, when the powder is wanting 
 for pills or ointments. 
 
 Terebinthinic Mixture. 
 Turpentine Mixture. 
 Take of, Spirit of turpentine, 1 drachm. 
 
 Laudanum, , 1 drachm. 
 
 Loaf sugar, 2 drachms. 
 
 The whites of two eggs, 
 Pure water, 6 ounces. 
 
 Let the white of egg be placed in a six ounce vial. Then 
 pour over it, the spirit of turpentine, the laudanum and a lit- 
 tle water. Shake the vial well. Dissolve the sugar in a lit- 
 tle water, add it to the mixture and again shake the vial. 
 Then fill the vial wkh water, by little and little, — agitating it 
 at each addition. Dose, for an adult, one or two table-spoon- 
 
596 APPENDIX. 
 
 fuls every three hours in cases of collapse. If the mixture be 
 designed for a purgative, the turpentine may be doubled in 
 quantity, and the laudanum must be omitted. 
 
 Volatile Liniment. 
 
 Take of, Spirit of hartshorn, [aqua ammonias,) 
 
 by measure. 1 part. 
 
 Sweet oil, by measure, 4 or 6 parts. 
 
 Shake them together in a vial. 
 
 The weaker preparation is the more eiegant; but the 
 stronger may be employed, when powerful local stimulation is 
 desired. 
 
 LIS T 
 
 MI- OF THE PRINCIPAL DRUGS, fi nTIONED IN 
 
 THIS 
 
 As many of those for whose use the present work is writ- 
 ten, are placed beyond the reach of pharmaceutical assistance, 
 and are very properly in the habit of keeping medicine chests 
 for the use of their families or establishments; it is deemed 
 advisable to add a list oi' a few of the drugs and implements, 
 mentioned in the work, which arc r occasional us 
 
 families. The physician, when called upon an cmerg 
 will be glad to find these articles accessible, and all neci - 
 additions to the- list may be 8 >usly made by hit 
 
 vice; for they will then be lapted to the peculiar rou- 
 
 tine of practice to which he may have become attached. It. 
 is thought useless to add an estimate of quantities, whether 
 relative or absolute; for these must be determined by the 
 number of persons to be supplied, the location of the family, 
 and other circumstances. The advice of an experienced and 
 honest dealer will supply the absence of any directions from 
 us, on this subject. 
 
 LIST OF DRU( 
 
 Acetate of lead, (Sugar of 1 
 
 Acetic tincture of opium, (Hartsfwr: 
 
 Alcohol. 
 
APPENDIX. 597 
 
 Aloes. 
 Alum. 
 Alspice. 
 
 Antimonial wine. 
 Armenian Bole. 
 
 Bone-set tea — the herb, (Eupatorium perfoliatum.) 
 
 Borax. 
 
 Burgundy pitch. 
 
 Calomel. 
 Camphor. 
 Cantharides, (Spanish flies.) 
 
 Tincture of, 
 Carbonate of iron. 
 
 of lime, {Prepared chalk?} 
 
 of potassa. 
 
 of zinc, (Lapis caliminaris) 
 Carolina pink-root, (Spigelia marilandica.) 
 Cascarilla bark. 
 Castor oil. 
 
 Caustic potassa, (Vegetable caustic.) 
 Chamomile flowers. 
 Chloride of soda, 
 of lime. 
 Cicuta leaves, (Conium maculatum.) 
 Chinchona, (Peruvian bark.) 
 Cinnamon. 
 
 Tincture of, 
 
 Water. 
 Citrine ointment. 
 Cloves. 
 Columbo root. 
 
 powdered 
 Coriander seed. 
 Coxe's hive sirup. 
 Croton oil. 
 
 Elixir of vitriol, (Aromatic sulphuric acid.) 
 Ergot, (Spurred rye,) powdered. 
 Extract of cicuta, (Conium maculatum.) 
 
 of dandelion, (Leontodon taraxacum.) 
 
 of liquorice. 
 
 of stramonium. 
 
 Flaxseed. 
 
 Galls powdered. 
 Gentian root. 
 
 powdered. 
 Goulard's cerate, (Cerate of sub -acetate of lead) 
 Gum ammoniac. 
 Arabic. 
 
 powdered. 
 
598 APPENDIX. 
 
 Gum asafcetida. 
 Gum guaiacum. 
 
 powder of, 
 volatile tincture of, 
 Gum kino. 
 
 tincture of, 
 
 Hoffman's anodyne. 
 
 Horse mint — the herb, (Monarda punctata.) 
 
 Huxham's tincture of bark. 
 
 Ipecacuanha — powdered. 
 India rubber in sheets or cloth. 
 
 Jalap. 
 Juniper oil. 
 
 Lavender compound. 
 
 Laudanum, {Tincture of opium.) 
 
 Magnesia calcined. 
 
 Meadow saffron, (Colchium autumnale,) 
 
 The tincture of the leaves or that of the root. 
 Mercurial ointment. 
 
 plaster. 
 Mercury, red precipitate of, 
 
 white precipitate of, 
 Muriate of ammonia, (Sal ammoniac.) 
 of iron, tincture of, 
 
 Nitric acid. 
 
 Nitrate of silver, (Lunar caustic.) 
 
 of potassa, (Saltpetre.) 
 Oak bark. 
 Opium. 
 
 powdered. 
 Opodeldoc. 
 
 Paregoric elixir. 
 
 Pennyroyal — the herb, (Hcdeoma pulegioides.) 
 
 the oil. 
 Pepper, black, 
 
 Cayenne, 
 Peppermint, the oil. 
 water. 
 Pith of sassafras. 
 
 Quassia. 
 Quince seeds. 
 
 Resin. 
 
 Rhubarb. 
 
 Rose water. 
 
 Savine leaves, powdered. 
 
 Seidlitz powders. 
 
 Senna. 
 
APPENDIX. 593 
 
 Slippery elm bark. 
 
 Soap liniment. 
 
 Spiced sirup of rhubarb. 
 
 Spirit of ammonia or hartshorn, (Aqua ammonim. 
 
 Squills, the sirup. 
 
 Sulphate of copper. 
 
 of iron. 
 
 of magnesia, {Epsom salts.) 
 
 of potassa. 
 
 of quinine. 
 
 of zinc. 
 Sulphur, flowers of. 
 Sulphuric ether. 
 Super-carbonate of soda. 
 Super-tartrate of potassa, (Cremor tartar.) 
 Sweet oil. 
 Sweet spirits of nitre. 
 
 Tar. 
 
 Tartar emetic. 
 
 Turpentine — Venice. 
 
 Uva ursi — the leaves. 
 
 Valerian root, powdered. 
 
 ammoniated tincture of, 
 
 Wax, white, 
 yellow. 
 
 LIST 
 
 SURGICAL AND PHARMACEUTICAL ARTICLES WHICH ARE 
 DESIRABLE FOR PRINCIPALS OF LARGE ESTABLISH- 
 MENTS. 
 
 1. A surgeon's pocket case, containing — 
 one pair of dressing scissors. 
 one pair of operating scissors. 
 two scalpels, 
 two curved bistouries, 
 one straight bistoury. 
 
600' APPENDIX. 
 
 one probe-pointed bistoury, 
 one dressing forceps, 
 one anatomical forceps, 
 two silver probes, 
 one abscess needle, 
 one gum lancet, 
 one spatula. 
 
 one thumb lancet, to be exclusively used for vacci- 
 nation, 
 four curved surgeon's needles, 
 one silver female catheter. 
 
 2. A cupping syringe and glasses. 
 
 3. A quart injecting syringe. 
 
 4. A gill do. do. for children. 
 
 5. One ( 
 
 6. Half a dozen or more gam elastic cathen ed. 
 
 7. One gum elai h tube. 
 
 8. One spring lancet irith two thumb lancets in the same case. 
 
 9. Muslin, linen, bu^ 
 
 10. Borne skeini _ -ilk for ligatures. 
 
 11. Three yards i •• frac- 
 
 ture-, irith two piece* of tape, one inch bn 
 
 12. Ten yards of anglazed domestic m 
 
 -, from two and a half, to three fingers' breadths 
 in width, and roll 
 IS, A piece of cotton wadding. 
 
 14. Half a pound of patent lint. 
 
 15. A roll of tow. 
 
 16. One mortar, of Wedge wood's ware, for mixtures, holding 
 
 one pint. 
 
 17. One mortar, of "Wedge wood's ware, for powders, hoi. 
 
 half a pint. 
 
 18. Two apothecary's spatulas. 
 
 19. Several cedar shingles, planed thin. 
 
 20. A piece of half-inch, fine panel white-pine hoard, without 
 
 a knot, six feet long by two wide: or two pieces of 
 half the width, smoothly planed. 
 
 With these articles, kept in an accessible place, there are 
 few sudden accidents which would be found unprovided for. 
 No vessel should be permitted to go to sea without them, and 
 on large estates, or in extensive manufactories at a distance 
 from cities, they should never be wanting. Even isolated fa- 
 milies would find it to their advantage to provide space 
 enough for all the articles, except, perhaps, the first and se- 
 cond items, which form the most expensive part of the appa- 
 ratus. 
 
INDEX 
 
 TO 
 
 THE FIRST PART. 
 
 Page. 
 
 Abciomen, limits of the cavity 
 of the, 81 
 
 Absorption, function of, 93 
 
 Absorbents. See Lacteals. 
 
 Action and reaction, of the ba- 
 lance of vital, 162 
 
 Air and moisture, hygienic re- 
 marks on, 197 
 
 Alcohol, and alcoholic liquors, 
 hygienic remarks on, 178 
 
 Alcoholic liquors, necessity of 
 using them in tropical cli- 
 mates, 179 
 
 Alimentary canal, anatomy of 
 the, 67 
 
 Anatomy, structure of the hu- 
 man body, 25 
 
 Ankle joint, anatomy of the, 53 
 
 Animals, preliminary remarks 
 on the organization of, 17 
 
 Aorta. See Route of Circula- 
 tion. 
 
 .Arachnoid membrane, defini- 
 tion, 119 
 
 B 
 
 Basin or pelvis, bony anatomy 
 
 of the, 41 
 
 Bladder, anatomy of the, 104 
 
 Blood. See Circulating Fluids. 
 Boarding school discipline, fe- 
 male, errors of, 220 
 Abuses of punishments, which 
 involve exposure to cold and 
 limitations of diet, 223 
 Boarding schools, the food of 
 children at boarding schools 
 76 
 
 Page, 
 often limits their literary 
 advancement, 219 
 
 Calisthenic exercises and 
 
 games, 221 
 
 Choice of the house-keeper, 
 
 matron, or nurse, 222 
 
 111 effects of long sessions, un- 
 comfortable benches, and 
 the music stool, 220 
 
 Improper exposures to cold 
 and dampness, 221 
 
 Boarding schools, ludicrous an- 
 ecdotes of abuses at, 223 
 Bone, of the arm, 48 
 Bones, of the forearm, 49 
 Bones, alterations of bone by 
 
 age and disease, 54 
 
 Bones, growth and structure o£ 31 
 Bones, or osseous system, ana- 
 tomy of the, 31 
 Bone, of the tongue, 54 
 Brain, anatomy of me, 118 
 Brandy, hygienic remarks on 
 
 the use and abuse of, 179 
 
 Breast bone, anatomical re- 
 marks on the, 40 
 Breathing. See Respiration. 
 Bronchia, Anatomy of the, '98 
 Buckskin, as an article of dress, 192 
 Buildings. See Residences. 
 
 Caonchoucl See India Rubber. 
 
 Capillaries, anatomical struc- 
 ture and functions of, 91 
 
 Cartilages, articular, anatomi- 
 cal definition, 35 
 
602 
 
 INDEX TO PART I. 
 
 Page. 
 
 Cavity of the abdomen, limits 
 of the, -1 
 
 Cellular tissue, anatomical struc- 
 ture of the, 25 
 
 •Cerebellum, or lesser brain, 119 
 
 Cerebrum, or greater brain, 120 
 
 Chewing- of tobacco, hygienic 
 remarks on, 174 
 
 Children and old persons re- 
 quire most clothing, II I 
 
 Children, exercise and manners 
 of, erroneous popular proverbs 
 concerning the, 
 
 Children, false doctrine, that 
 children are hardened by ex- 
 posure with light clothing — 
 cruel sacrifices to this d 
 trine, . 190 
 
 Children, food of. See Food. 
 
 Children require more lbod 
 than adu 170 
 
 Children, that "children thrive 
 best in the dirt," an erroneous 
 popular proverb, 
 
 Chyme, definition of. 
 
 Circulating fluids, of the, 
 
 Circulation, of the, 
 
 ( 'imitation, route of the. 
 
 Clavicle. Bee Collar l>< 
 
 Clerks, their in-door exercises 
 unhealthy. 
 
 Clothing, changes of, which are 
 admissible at different hours 
 of the day or night, 101 
 
 Clothing, children and old per- 
 sons require n 
 
 Clothing, dangers of the jwirtial 
 exposures of the person 
 peculiar;!. 186 
 
 Clothing, false doctrine that 
 children are hardened in 
 stitution by light (I res- 
 Clothing, hygienic remark- i n. L89 
 
 Clothing, injurious effects of too 
 little, 
 
 Clothing, injurious effects of too 
 much, 1*1 
 
 Clothing, on buckskin as an ar- 
 ticle of. 192 
 
 Clothing, on cotton as an arti- 
 cle of, 190 
 
 Clothinsr, on India rubber as an 
 article of. 198 
 
 Clothing, on linen as an article at, 199 
 
 skins as articles o£ 
 
 ion 
 
 Page 
 
 Clothing, on silk as an article 
 of. 191 
 
 Clothing, on wollen and flannel 
 as articles of, 192 
 
 Clothing, principles which should 
 regulate the choice of materi- 
 als for, 1S9 
 
 Collapse, phvsiological defini- 
 tion of, 139 
 
 Collar bone, definition, 47 
 
 Colon, or great intestine, func- 
 tions and anatomy of the, 81 
 
 Colon, valve of the, 
 
 Cotton, viewed as an article of 
 dr« 190 
 
 Counter-irritation, physiologi- 
 cal explanation of, 114 
 
 Cranium, osseous structure of 
 the. 
 
 Cuticle, or scarf skin, anatomi- 
 cal character of the, 109 
 
 Cuticle, shed annually, IM 
 
 Cuticle, removal of the surplus 
 cuticle i: to health 
 
 and clean' 195 
 
 vera, or true skin, anato- 
 mical characU- 106 
 
 1). 
 
 . 
 ion, function of, 7<» 
 
 Btive apparatus, anatomi- 
 cal description oft! 
 
 Drink, abominable habit of g - 
 children stimulating. 
 
 Drink, alcoholic, -hygienic re- 
 mark 178 
 
 Drink, distention and debility 
 •omach from taking too 
 large a quantity of. 
 
 Drink, injurious effects of the 
 immoderate use of water by 
 children, 
 
 Duodenum, anatomy and func- 
 tions of the. 
 
 Duplicaturc of organs, remarks 
 on the. 129 
 
 Dura mater, definition, 11** 
 
 Dwelling-houses, see R I 
 
 d bv eating too 
 
 rapidly. 
 Dyspepsia, caused by over cat - 
 inu; 
 
INDEX TO PART I. 
 
 G03 
 
 _ . Page. 
 
 Dyspepsia, caused by taking 
 too much iluid, 176 
 
 Eating rapidly, an American 
 vice, producing dyspepsia, 109 
 
 Engorgement, definition and 
 physiological view of, 156 
 
 Epidemics, atmospheric: causes 
 of, 198 
 
 Epidemics, caused by changes 
 of temperature and moisture, 199 
 
 Epidemics, telluric influences 
 as causes of, 199 
 
 Exciting cause, physiological 
 definition of, 141 
 
 Exercise and rest, bad effects 
 of excessive, 211 
 
 Exercise,domestic, within doory, 
 always insufficient for health, 
 and often injurious, 206 
 
 Exercise, evils of sectarian pre- 
 judices against certain, 208 
 
 Exercise, hygienic remarks on, 206 
 
 Exercise, importance of its be- 
 ing agreeable and voluntary, 209 
 
 Exercise, importance of rest af- 
 ter, 208 
 
 Exercise, rubbing furniture, a 
 popular, but highly injurious 
 prescription for girls who are 
 crooked or round shouldered, 207 
 
 Exercise, importance of surgi- 
 cal advice in regulating, 208 
 
 Exercise, injurious effects of 
 partial, 207 
 
 Exercise, mental, of one facul- 
 ty, a counter-irritant reme- 
 dy in disease or hyper-action 
 of another faculty, 210 
 
 Exercise, muscular, a counter- 
 irritant remedy in mental- 
 and bodily disease, 210 
 
 Exercise, passive, invaluable in 
 states of extreme debility, 212 
 
 Exercise, to be useful, must be 
 taken in the open air, 207 
 
 Exposure, of the person, dan- 
 gers of partial, 186 
 
 Exposure, of the person, dan- 
 gers of, particularly at cer- 
 tain hours, 194 
 
 Exposure, of the person, to ren- 
 der children hardy, destroys 
 numbers, 183, 190 
 
 Extremities, bones of the, 47 
 
 Pag«. 
 
 Fainting, mechanism of, 61 
 
 Fascia, definition of, 6fr 
 
 Fat, structure of, 29 
 
 Femur, the bone of the thigh, 
 
 see Hip Joint. 
 Fever, causes of, definitions of 
 the proximate, exciting and 
 predisposing, 141 
 
 Fever, intermissions in, physio- 
 logical explanation of, 140 
 Fever, remissions in, physiolo- 
 gical explanation of, 140 
 Fever, symptomatic physiolo- 
 gical explanation of, 138 
 Fibula, one of the bones of the 
 
 leg, 52 
 
 Fingers and thumb, bones of 
 
 the, 50 
 
 Flannel, as an article of dress, 192 
 Food, abuse of cakes and doughy 
 
 articles for children, 218 
 
 Food, both vegetable and animal 
 
 food required by man, 166 
 
 Food, children require more 
 
 food than adults, 176 
 
 Food, principles which should 
 regulate the change of the 
 diet of children as they ad- 
 vance in age, 215 
 Food, hygienic remarks on, 166 
 Food, mastification of, rapid 
 
 eating very injurious, 169 
 
 Food, milk improper for food 
 
 after a. certain age, 213 
 
 Food, mode of rendering milk 
 
 wholesome for adults, '214 
 
 Food of children, on the pro- 
 per, 213 
 Food, of the quantity required 
 at different ages and sexes, 
 and by those of different ha- 
 bits, 175- 
 Food, plain biscuit or bread ne- 
 cessary for children immedi- 
 ately after dressing in the 
 morning, 219 1 
 Food required much more fre- 
 quently than at meal times, 
 by growing children, 219 
 Food, see Drink. 
 Food, stimulating, extremely 
 
 improper for children, 218 
 
 Food, required in old age, and 
 in tropical climates after long 
 residence,. 176 
 
001 
 
 I.VDEX TO PART I. 
 
 Food, the quantity required de- 
 pends on the amount of i 
 cise taken by the individual, 
 
 Food, the proper time of wean- 
 ing a child, 
 
 Food, varieties of food arc ren- 
 dered necessary by custom, 
 climate, occupation, age and 
 sex, 
 
 a 
 
 169 
 215 
 
 167 
 
 -lion, nervous, definition, 11 1 
 Gin, hygienic remark 178 
 
 Girls, errors of female school 
 discipline, 
 
 etiolated, and rendered 
 sickly by donp 
 under tip 
 that won: 
 should i to home, 
 
 iiould be 
 agreeable and voluntary, 309 
 
 . poaiefameata for, i 
 - and cruelty of those 
 which invul\< • io 
 
 cold, or limitation of <!. 
 Girlt, improper exposures, to 
 
 cold and dampi 
 Girls, round-shouldered, bad cf- 
 iul 
 rubbing furniture, 
 Girls, Bad effects on their 
 health and figure from 
 sessions at school, uncm; 
 table benches) and the ma 
 ol, 
 Glands, absorbent, l\u 
 
 the, 
 Glands, salivary, snetom 
 
 position and function ofthl . 71 
 
 II 
 
 Hardening the constitution of 
 children by exposure, a I 
 unwarrantable notion, L8a\ 
 Here skins, medicated as arti- 
 cles oi' di 
 Head, bony a tlU C Un s of the. 
 Heart, anatomy and functions 
 
 of the, P6 
 
 Hip-joint, bony anatomy of the. 51 
 Humerus os humeri, see Hone 
 
 of the Arm. 
 Hygiene, remarks on, 1(36 
 
 Hyoidca os, the bone of the 
 
 tongue, 
 Hyper-nutrition, physiological 
 
 view of, 
 Hyper-nutrition, treatment of. 
 
 physiological principles of, 
 
 proper, 
 
 Jejunum. See Y. 5 mill. 
 
 Ileum. See In nil. 
 
 Ilium. 
 
 India-rubber, viewed as an ar- 
 ticle of dress, 
 
 Inflammation, errors in the de- 
 finit: 
 
 Inflammation, general ph\ 
 gicnl vie 
 
 Inflammation, healtl 
 wh I be discart 
 
 .1 de- 
 finit! 
 
 Irritation, capi! '>ogi- 
 
 cal 
 
 cal 
 
 Irritation, physiological 
 
 Irritation. he propa- 
 
 ■ of, 
 
 the, 
 fnteetii 
 
 the. 
 Knee-cap, or knee-pan, 
 
 -joint, bony anatomy 
 
 Lacteals, anatomy and func- 
 tions of the, 
 
 Larynx, anatomy and fum 
 of the. 
 
 Ligaments, anatomical defini- 
 tion of the, 
 
 Linen, as an art reaa, 
 
 the, 
 Lymph. cats. 
 
 147 
 
 l.")l 
 
 l: 1 
 
 117 
 149 
 
 -1 
 
 lfW 
 
 
INDEX TO PART I. 
 
 605 
 
 M 
 
 Matrimony, hygienic princi- 
 ples which should govern it, 226 
 
 Matrimony, its influence on 
 the health of the mother and 
 offspring, on hereditary dis- 
 eases and moral peculiari- 
 ties, 226 
 
 Medical theories, defence of, 131 
 
 Metastasis, physiological defi- 
 nition of, 146 
 
 Miasm, miasmata, definition, ef- 
 fects of, 199 
 
 Milk, becomes unwholesome 
 after the proper time for 
 weaning, 213 
 
 Milk, mode of rendering it 
 wholesome for adults, 214 
 
 Moisture and air, hygienic re- 
 marks on, 197 
 
 Muscle-like coat of the arteries, 
 remarks on the, 61 
 
 Muscles mixed, description of 
 the, 62 
 
 Muscles, notice of the diseases 
 of, 66 
 
 Muscles, or muscular system, 
 anatomy of the, 56 
 
 Muscles, voluntary and invo- 
 luntary, description of the, 59 
 
 Muscular fibre, construction of 
 the, 57 
 
 . Page. 
 
 Page. Os innominatum. See Pelvis. 
 Os ischium. See Pelvis. 
 Os sacrum. See Pelvis. 
 Osseous system, anatomy of the, 31 
 
 N 
 
 Nerves, anatomy and functions 
 of the, 111 
 
 Nerves, colour and consistence 
 of the, 111 
 
 Nerves, divided into several 
 systems, 22 
 
 Nervous matter, intimate struc- 
 ture of, 111 
 
 Nutrition, function of, 92, 126 
 
 Occipital bone, definition, 
 Os coccygis. See Pelvis. 
 Os femoris, the thigh bone. 
 
 See Hip Joint. 
 Os Hyoides. See Bone of the 
 
 Tongue. 
 Os humeri. See Bone of the 
 
 Arm. 
 Os ilium. See Pelvis. 
 
 Pancreas, anatomy and func- 
 tions of the, 78 
 Parietal bones, definition, 46 
 Passive exercise, remarks on, 212 
 Patella, anatomical position and 
 
 action of the, 52 
 
 Pelvis, bony anatomy of the, 41 
 
 Periosteum, definition, 34 
 
 Peritoneum, arrangementof the, 70 
 Phrenology, anatomical basis 
 
 of, 120 
 
 Physiology, definition, 126 
 
 Pia mater, definition, 119 
 
 Plexus,, nervous, definition, 112 
 Portal vessels, anatomy and 
 
 functions of the, 89 
 Pre-disposing cause, physiolo- 
 gical definition of, 141 
 Proximate cause, physiologi- 
 cal definition of, 141 
 Pubis. See Pelvis. 
 
 Radius, one of the bones of the 
 fore-arm, 49 
 
 Re-production of parts in the 
 healing of wounds, 133 
 
 Residences, defects of domestic 
 architecture as displayed in • 
 American, 203 
 
 Residences, effects of vegeta- 
 tion in rendering them 
 healthy, 200 
 
 Residences, effects of heights 
 and ridges in rendering them 
 unhealthy, 204 
 
 Residences, general healthfull- 
 ness of in a well cleared coun- 
 try, 201 
 
 Residences, healthfulness of, in 
 47 wild country, 200 
 
 Residences, heated roofs a 
 source of disease, creating 
 an artificial hot climate, 203 
 
 Residences, importance of an 
 elevated site for, 202 
 
 Residences, importance of the 
 choice of soil, the direction of 
 the prevalent winds, the po- 
 
606 
 
 JNDEX TO PART I. 
 
 Po- 
 sition of trees, a garden, and 
 
 ornamental vines, to the 
 
 healthf'ulness of, 203 
 
 Residences, location and venti- 
 
 ' lationof, 200 
 
 Residences, means of regulating 
 the temperature and moist- 
 ure of, 205 
 
 Residences, selection of vines 
 and creepers, for ornament- 
 ing, 205 
 
 Residences, the upper stories 
 more healthy than the 
 ground floors, 
 
 Residences, unhealthy in new- 
 ly cleared, and very fertile 
 reg:< 201 
 
 Residences, unhealthy in the 
 neighbourhood of swamps and 
 
 Respiration, apparatus of, 
 
 Respiration, function of, 100 
 
 MOD, physiological defi- 
 nition of, 1 10 
 
 Ribs, anatomical remarks on 
 the, 30 
 
 S 
 
 Sacrum. See P> 
 
 Saliva, its uses in mastication 
 and digestion, 171 
 
 Salivary glands, anatomical po- 
 sition and function 71 
 
 Scapula, or shoulder blade, 1- 
 
 Schoo <ool. 
 
 Secretion*! defioitia 102 
 
 Share bom ill, 
 
 Shin bone. Bee Tibia. 
 
 Shoulder blade. IS 
 
 Silk, viewed as a material for 
 
 dr. UN 
 
 Skeleton, anatomy of the, 
 Skin, function of the, 110 
 
 Skin, anatomical structure of 
 
 the, 107 
 
 Skin, scarf, or cuticle, of the, 100 
 Skin, true, or cutis vera, of the, 1<N 
 Smoking, hygienic remarks on, 17 1 
 Snuff-taking, hygienic remarks 
 
 on, 1 72 
 
 Spinal marrow, functions of the, 117 
 Spine, anatomy of the, 36 
 
 Sternum or breast bone, ana- 
 tomical remarks on, 10 
 Stomach, anatomical position 
 and functions of the. 7;^ 
 
 Pa^e 
 
 Stomach, distended and debili- 
 tated by excess of drink, 176 
 
 Stomach, distended and debili- 
 tated by excess of food, 175 
 
 Synovial membranes, their po- 
 sition and uses, 35 
 
 System, circulatory. See Cir- 
 culation. 
 
 System, nervous division of 
 the, 22 
 
 Svstem, muscular, anatomy of 
 the, 56 
 
 System, osseous, anatomy of 
 the, 31 
 
 System, portal. See Portal 
 
 M Is. 
 
 Telluric influence, a supposed 
 cause of epidemics 199 
 
 Temporal bones, 
 
 Temperance, ultra, absurdity of 
 the principles of, 177 
 
 Tendons, description of the, 64 
 
 :is, notice of the diseases 
 
 66 
 
 Thumb, bones of the, their im- 
 portance, 50 
 
 Tibia, one of the bones of the 
 leg, 
 
 . ■, adipose, anatomical 
 structure of the, M 
 
 Tissue, cellular, anatomical 
 structure of the, 
 
 !>.p Joint. 
 
 Tobacco, hygienic remarks on, 17'J 
 
 Trachea, or windpipe, anatomy 
 of the, 
 
 Transformation of tissues,. 163 
 
 U 
 
 one of the bones of the 
 forearm, 
 
 Union, in wounds, physiologi- 
 cal history of, 135 
 
 Ureter. See Knhuy. 
 
 Urethra, the external urinary 
 canal, 105 
 
 Urinary apparatus, anatomy of 
 the, ' 
 
 Urine of the, 
 
 Vicarious discharges, physio- 
 logical view of. 
 
NDEX TO PART II. 
 
 007 
 
 W 
 
 Page. 
 
 ^Weaning, the principles which 
 should regulate the weaning 
 ofchildren, 215 
 
 Whisky, hygienic -remarks on, 179 
 Windpipe. See Trachea, 
 Bronchia, and Larynx, 
 
 Wollen, as an article of dress, 
 remarks on, 
 
 Wounds, of the re-prod uctior^ 
 of parts after, 
 
 Wounds, union of, physiologi- 
 cal history of the, 
 
 Wounds, of symptomatic fever 
 from, 
 
 Wrist, bones of the, 
 
 Page. 
 
 192 
 133 
 135 
 
 138 
 
 50 
 
 INDEX OF PART II. 
 
 Paee. 
 
 Abdomen, contusions in the, 275 
 Abdomen, incised wounds of 
 
 the, 250 
 
 Abdomen, lacerated wounds of 
 
 the, 257 
 
 Abscesses, 359 
 
 Abscess, of the mamma (puer- 
 peral,) 537 
 Absorbents, inflammation of 
 
 the, 426 
 
 After-birth, nature of the, 414 
 
 After-birth, partial separation 
 of the, effects on the mother 
 and child, 414 
 
 Ague, 388 
 
 Anasarca. See Cellular Drop- 
 sy. 
 Aneurismal varix, 299 
 
 Aneurism from anastomosis, 300 
 Aneurisms, 298 
 
 Angina pectoris, 443 
 
 Ani prolapsus, 287 
 
 Anus, dilatation of the, 287 
 
 Aphthous sore moutli in chil- 
 dren, 548 
 Apoplexy, 484 
 Appendix, 583 
 Arm, dislocation of the arm 
 
 into the arm pit, 331 
 
 Arm, fractures of the, 323 
 
 Arteries, enlargements of the, 298 
 Asafcetida mixture, or tea, 583 
 
 Ascites, 489 
 
 Asthma, 441 
 
 B 
 
 .Bandage, suspensory, for vari- 
 cocele, 294 
 Bandages, their application in 
 
 wounds, 244 
 
 Basilicon ointment, 591 
 
 Bed-stead, for the bed-ridden, 329 
 Biles, 363 
 
 Bites of serpents. See Poi- 
 soned Wounds. 
 Bladder, palsy of the, 537 
 
 Bleeding, from the nose, 506 
 
 Bleeding, mode of arresting 
 
 hemorrhage in wounds, 236 
 
 Blister ointment, 588 
 
 Blood, spitting of, 439 
 
 Body, coming down of the, 287 
 
 Boxing the ears, ill effects of, 263 
 Brain, concussions of the, 264 
 
 Brain, compression of the, 267 
 
 Breast bone, fractures of the, 
 See Contusions of the Chest. 
 Breast. See Inflammation. 
 Brown mixture, 584 
 
 Burns, remarks on burns produ- 
 cing collapse 346 
 Burns, treatment of burns un- 
 attended by collapse, • 368 
 
 Camphor julap, 
 
 584 
 
 Camphor mixture, 
 
 584 
 
 Cancer, 
 
 378 
 
 Cancer of the uterus, 
 
 " 580 
 
G08 
 
 INDEX TO PART II 
 
 Canker of the mouth, in chil- 
 dren, 806 
 
 Carbuncle, nature and treat- 
 ment of, 
 epsy, 
 rrh," 
 
 Cellular dropsy, 1-- 
 
 Cerate, of impure carbonate of 
 zinc, or Turner's cerate, 
 
 'e, simple, 666 
 
 Chafing, from friction, 
 
 Chafing 1 , in the folds of the 
 groin, . 
 
 Chalk mixture. 
 
 Chalk mixture, with kino, 
 
 Chancre. 
 
 the, 
 lacerated wounds of 
 
 Child, mauagemfOt of the 
 
 Child at hirth, BM 
 
 Child, connexion! of the child 
 
 in th<* womb, 
 Chlorosis, 
 
 ( 'holm, li 1 18 
 
 < "holrra mfaiitiim. 
 
 Cholera, malignant. I'mi 
 
 ' <>n, 
 cle, fractu 
 Club 
 Colic, 
 Colic, in i! ' 
 
 IBB 
 
 Col la; >ntS 
 
 nnd inflammtl 
 Coming down of the body, 
 Compression of the brain, 
 Concussion of the brain, 
 
 Constipation. 
 
 mmption, 
 
 ContuskMM from blows on the 
 tbdomen, 
 
 Contusions, injuries of the head 
 
 from. 
 Contusions m the cavity o\' the 
 
 spine. 
 Contusions of the abdomen, 
 Contusions of the chest, 
 Contusions of the greet C 
 
 Contusion 
 
 Conti; and 
 
 ^ sol 
 
 Contusions of the pelvis and pe- 
 rineum, 
 
 -ions of the soft parts 
 ab ne, 
 
 of the stomach, 
 us, l-l 
 
 Convulsions, from accidental 
 and transient causes, 
 
 al, 
 •1c of curing, 
 . soft, 
 1 ness, V*\ 
 
 Costivcncss, in infants, 
 
 :>ox, 11<» 
 
 ip, 
 Croup, 1 17 
 
 nil 
 
 y of nos- 
 
 larjnirca. See 
 Or. 
 
 nchc, parol idea. See 
 
 tonsillaris. Sec 
 
 D 
 
 Dcco 
 
 f oak bark, 
 nee peed, 
 
 aural passages, 
 
 the ankle, with 
 
 frarture o\' the fibula, 
 
 at ions of the arm into 
 
 ationsof t 
 Dislocations sudden, of the ver- 
 tebra?. 
 
 Dropsy cellular, I — 
 
 v in the brain. 
 Dropsy, in the brain, in infants. 
 
XDEX TO PART II. 
 
 009 
 
 Dropsy in the chest, 
 Dropsy of the abdomen, 
 Drowning, 
 
 Page. 
 
 489 
 489 
 511 
 
 Dry gangrene, 
 
 Dysentery, 
 
 Dyspepsia, 
 
 348 
 457 
 497 
 
 D 
 
 
 Ear-ache and suppurations 
 
 in 
 
 the ear, 
 
 Ear, foreign bodies, and insects 
 in the, ' 
 
 Ears, boxing the, injurious ef- 
 fects of, 
 
 Elbow joint, fractures of the, 
 
 Epilepsy, 
 
 Erysipelas, 
 
 Erysipelas in infants, 
 
 Erysipelas phlegmonodes, 
 
 Excoriations of the mucous ori- 
 fices, 
 
 Excoriations, see Chafing. 
 
 Eye, film on the, 
 
 foreign substances in the, 
 
 Eye, inflammation of the, 
 
 Eye-lashes, ulceration of the, 
 
 Falling of the womb, 
 
 Femoral hernia, definition, 
 
 Fever, bilious, 
 
 Fever, continued, 
 
 Fever, description of, 
 
 Fever, intermittent, 
 
 Fever, miliary, 
 
 Fever, petechial, or spotted, 
 
 Fever, scarlet, 
 
 Fever, yellow, 
 
 Fibula, fractures of the, with 
 
 dislocation of the ankle, 
 Film on the eye, 
 Fingers, fractures of the, 
 
 Flatulence, 
 
 Flooding, see Menstruation, 
 excessive, and Uterine He- 
 morrhage. 
 
 Fluor albus, 
 
 Foetus, see Child. 
 
 Fore-arm, fractures of the, 
 
 Foreign bodies in the ear, 
 
 Foreign bodies in the eye, 
 
 Formulary, 
 
 Fractures, about the shoulder- 
 joint, 
 
 77 
 
 356 
 
 355 
 
 Page. 
 
 Fractures, bed-stead for, 329 
 
 Fractures, general remarks on, 319 
 
 Fractures of the arm, 323 
 
 Fractures of the clavicle, 321 
 
 Fractures of the elbow joint, 324 
 Fractures of the fibula, with 
 
 dislocation of the ankle, 332 
 Fractures of the fingers and 
 
 toes, 328 
 Fractures of the fore-arm, 325 
 Fractures of the leg, 327 
 Fractures of the lower extremi- 
 ties, 327 
 Fractures of the lower jaw, 329 
 
 263 
 
 Fractures of the pelvis, 
 
 279 
 
 324 
 
 Fractures of the ribs and ster- 
 
 
 481 
 
 num, see Contusions of the 
 
 
 421 
 
 Chest. 
 
 
 557 
 
 Fractures of the skull, 
 
 268 
 
 425 
 
 Fractures of the shoulder-blade, 
 
 323 
 
 
 Fractures of the spine, 
 
 271 
 
 359 
 
 Fractures of the thigh, 
 
 Fresh cuts, absurdity of nos- 
 
 326 
 
 &54 
 
 trums for, 
 
 247 
 
 &50 
 
 Frost-bite, gangrene from cold, 
 
 344 
 
 351 
 
 Furuncle, 
 
 364 
 
 349 
 
 G 
 
 
 
 Gall-stones, passage of, 
 
 468 
 
 577 
 
 Gangrene, dry, 
 
 343 
 
 304 
 
 Gangrene from cold, 
 
 344 
 
 400 
 
 Gangrene from excessive in- 
 
 
 393 
 
 flammation, 
 
 343 
 
 387 
 
 Gangrene from internal or 
 
 
 388 
 
 constitutional causes, 
 
 343 
 
 415 
 
 Gangrene from mechanical in- 
 
 
 403 
 
 juries, 
 
 345 
 
 413 
 
 Gangrene from pressure, 
 
 344 
 
 401 
 
 Gangrene of old men, 
 
 342 
 
 
 Gangrene, or mortification, 
 
 342 
 
 332 
 
 Gangrene, see Malignant Pus- 
 
 
 354 
 
 tule, and Carbuncle. 
 
 
 328 
 
 Gangrenous sore mouth of chil- 
 
 
 493 
 
 dren, 
 Gilder's tremors, see Shaking 
 
 Palsy. 
 Glass-wounds, treatment o£ 
 
 366 
 
 
 246 
 
 576 
 
 Gonorrhoea, see Suppuration 
 
 \ 
 
 
 of Mucous Passages, and 
 
 325 
 
 Venereal Disease. 
 
 
 355 
 
 Gout, 
 
 476 
 
 350 
 
 Gravel, 
 
 500 
 
 583 
 
 Green fever, 
 
 570 
 
 . 
 
 Gum-biles, 
 
 357 
 
 323 
 
 Gum-rash, 
 
 420 
 
610 
 
 l.VDEX TO PART II. 
 
 H 
 
 Page 
 
 Hanging, death by, 512 
 
 Head, injuries of the, 20'.} 
 
 Heart-burn, 492 
 
 Heart-burn in pregnancy, 
 
 Heart, dilatation of the, 
 
 Hemiplegia, 
 
 Hemopthisis, 
 
 Hemorrhage, modes of arr 
 ing in wound.-:, 
 
 Hemorrhage, utorino, 
 rrhage, pulmor. 
 
 Hemorrhoids or ; 
 
 Hernia, anatomical view of the 
 pirts concerned in, 
 
 Hernia, common inguinal, and 
 concealed inguinal, defini- 
 tion?, 
 
 Hernia, direct and 
 
 vcrtro-ip 
 
 Horn iical, and 
 
 iona, 304 
 
 Hernia, operation for 
 laled, 
 
 Hernia, or rupture, 
 
 le, irrrduciblo, 
 and Blrai 
 
 Hernia, n ... I on « 
 
 Hern 
 rad 
 
 Hernia, symptoms, and conse- 
 quences of strangulation in, 
 
 Hernia, tax tion. 
 
 Hernia, varicocele mistaken 
 for, 
 ugh, 
 
 Hip-join' 
 
 Hordeolum, 
 
 Hydrocephalus, 
 
 Hydrocephalus in children. 
 
 Leria, 
 
 J 
 
 Jauml 
 
 
 Jaundice in infants. 
 
 MM 
 
 Jaw, lower, fracture? of the. 
 
 
 I leu?, or ii; 
 
 461 
 
 Incised wound?. 
 
 
 Incontinence of urine, in chil- 
 
 
 dren, 
 
 
 Indigestion, 
 
 
 Inflammation, and abscess of 
 
 
 the mamma, 
 
 
 Inflammation, and its c 
 
 
 quences. 
 
 835 
 
 Pag« 
 Inflammation of the absorbents, 426 
 Inflammation of the c 351 
 
 Inflammation of the eyes, in in- 
 
 552 
 Inflammation of the kidney, 466 
 Inflammation of the 1 464 
 
 Inflammation of the 1 
 
 nipples, 
 nation of the pleura, 
 
 Inflammation of; 
 
 i of, 1334 
 , 'nation, termination in 
 
 337 
 Inflammation, termination 
 
 342 
 rmination bv 
 reso! ' 335 
 
 • rmination 
 
 ne 
 
 ■ hen coupled 
 °nt of, 
 
 ' caacariHa, •'■"■•" 
 
 Infos >*"* 
 
 ubo, 
 
 seed, •">-•' 
 
 Ml > 
 
 -mint, 589 
 
 -sia, 560 
 
 na, 
 
 mon and 
 
 nal hernia, 
 
 304 
 
 Injt:r .dlapse, 
 
 ns and sprains 
 of I 
 Joints, incised wounds of the. 
 Join - 
 
 41- 
 
 K 
 
 Kiiln. nsand rupture 
 
 'immation of th 
 
 Labour, management OH 
 
 Labour, management of 
 child at birth. 
 
 Labour, preparations for the ap- 
 proach of. 
 
INDEX TO PART II. 
 
 Gil 
 
 T , ^ Page. 
 
 Labour, after-treatment of the 
 
 mother, 525 
 Lacerated wounds, 254 
 Lacerated wounds of the leg, 257 
 Lacerated wounds of the abdo- 
 men, 057 
 Lacerated wounds of the chest, 257 
 Lacerated wounds of the joints, 253 
 Lacerated wounds of the scalp, 247 
 Leg, fractures of the, 327 
 Leg, see Fibula. 
 
 Leg, swelled or milk, 534 
 
 Leucorrbcea, 576 
 
 Lichen, 417 
 
 Lientery, 456 
 
 Lime water, 590 
 
 Litt of drugs and apparatus, 596 
 Liver, contusions and ruptures 
 
 of the, 275 
 Liver complaint, 464 
 Liver, inflammation of the, 404 
 Local palsy, 4S7 
 Lung fever, 432 
 Lying-in women, after-treat- 
 ment of, 518 
 Lying-in women, see Labour. 
 
 M. 
 
 Malignant pustule, 342 
 Mammary abscess, puerperal, 537 
 Measles, 412 
 Menses, appearance of thr\ 572 
 Menses, final cessation of the, 575 
 Menses, suppression of the, 572 
 Menstruation, excessive, 574 
 Menstruation, obstructed, 573 
 Menstruation, painful, 573 
 Milk abscess, 537 
 Milk of asafcotiJa, a 583 
 Moles, 375 
 Milk leg, 534 
 Mortification, see Gangrene. 
 Mother marks, from fright du- 
 ring pregnancy, _ 516 
 Mother spots, see Aneurism 
 
 from Anastomosis. 
 
 Mouth, ulcerations in the, 355 
 
 Mumps, 444 
 
 Mumps, in children, ' 5G5 
 
 N 
 
 Nails, growing into the flesh, 362 
 
 Navel, sore, 542 
 
 Nettle-rash, 416 
 
 Page. 
 Neutral mixture, 590 
 
 Nipples, inflammation of the, 539 
 Nitro-muriatic bath, 591 
 
 Nose, bleeding from the, 506: 
 
 O 
 
 Ophthalmia, see Inflammation 
 
 of the Eyes. 
 Ointment, basiiicon-, 
 Ointment, blister, 
 Ointment,,cicuta, 
 Ointment, celandine, 
 Ointment, Kentish, 
 Ointment, red precipitate, 
 Ointment, savine, 
 Ointment, stramonium, 
 Ointment, tar, 
 
 Ointment, white precipitate, 
 Ointment, white precipitate, 
 
 with camphor, 
 
 Painful urination, in children, 
 
 Palsy, 
 
 Palsy of the bladder, puerperal, 
 
 Palsy of the bladder, see Conti- 
 nued Fever, Concussions of 
 the Sjnne, and Fractures of 
 the Pelvis. 
 
 Palsy, local, 
 
 Palsy, shaking, 
 
 Paraplegia, 
 
 Pelvis, contusions of the, 
 
 Pelvis, fractures of the, 
 
 Perineum, contusions of the, 
 
 Phlebitis, see Veins. 
 
 Phlegmasia dolens, 
 
 Poultice, carrot, 
 
 Poultice, charcoal, 
 
 Poultice, cicuta, 
 
 Poultice, fermenting,. 
 
 Poultice, flaxseed, 
 
 Poultice, yeast, 
 
 Phthisis, 
 
 Piles, 
 
 Placenta, see After-birth. 
 
 Pleurisy, 
 
 Pneumonia, see Lung Fever. 
 
 Poisoned wounds, 
 
 Polypus of tiie uterus, 
 
 Pregnancy, 
 
 Pregnancy, abuse of blood-let- 
 ting in, 
 
 Pregnancy, unpleasant symp- 
 
 591 
 583 
 
 591 
 591 
 59 L 
 592 
 592 
 592 
 592 
 592 
 
 593 
 
 545 
 
 487 
 537 
 
 487 
 480 
 487 
 278 
 279 
 278 
 
 534 
 594 
 593 
 593 
 593 
 593 
 593 
 435 
 294 
 
 431 
 
 422 
 580 
 513 
 
 515 
 
 515 
 
612 
 
 INDEX TO PART II. 
 
 Papc. 
 
 Pressure, gangrene from, :3i4 
 
 Prickly heat, 417 
 
 Prolapsus ani, 987 
 
 Prolapsus uteri, 
 
 Proud flesh, 3 1 1 
 
 Pruriginous rash, 420 
 
 Pruritis vulva), 
 
 Puerperal convulsions, 
 
 Puerperal fever, 
 
 Puerperal nervousness, mania, 
 
 and melancholy, 
 Puerperal palsy of the bladder. 
 Puerperal swelled throat, 
 Pulmonary, see Lunq, Can- 
 
 siiiujitioii, Hr/norrfi' 
 Punctured won: 
 
 definition, 
 
 Pustule, malignant, 
 
 a 
 
 Quinine, mode of prescribing 
 In i 
 
 Quinine mixture. 
 Quinine pills, 
 Qu i i ■ 
 Quinsy in children, 
 
 l 
 
 R 
 
 Rash, gum, 
 
 
 nettle, 
 
 116 
 
 i, pruriginous, 
 
 
 Been, rose, 
 
 
 Reptiles, bites of, se 
 
 
 Wcundt t 
 
 
 Retention of urine in children, 
 
 
 Retroversion of the ei 
 
 
 Rheumatism, 
 
 
 Ribs, tract n res of the, sec • 
 
 
 fusion* of tin < 
 
 
 Ring-worm, 
 
 
 Run-round, 
 
 
 Rupture of the kidneys, 
 
 
 Rupture of the liver. 
 
 
 Rupture of the spleen. 
 
 
 Rupture of the uterus, 
 
 
 Rupture, see lit 
 
 S 
 Saint Vitus' dance, 
 
 
 
 Saline draught. 
 
 500 
 
 Scab, the healing of a wound 
 
 
 beneath a, 
 
 246 
 
 Scalds, treatment of, 
 
 
 Scalp, wounds of the, 
 
 •J 17 
 
 Page. 
 Scapula, see Shoulder- Blade. 
 Scrofula, 376 
 
 Skull, fractures of the, 906 
 
 Scurvy, 384 
 
 Shaking palsy, 
 
 Shingles, H7 
 
 Shoulder-blade, fractures of 
 
 the. 
 Shoulder-joint, fractures about 
 
 the. 
 Sick-room, proper management 
 
 of the, 
 
 Small -pox, 
 
 Soft e 
 
 Solution of pith of sae; 
 
 Solution of ncetate of ammo- 
 nia. [See Errata.) 
 
 . 
 Sore n 
 
 the, 
 , contusions in the cavity 
 • ; ie, 
 
 , contusions of the soft 
 parts 
 
 ', curvature of the, 
 , fractures and sudden 
 the. 
 Spirits of Mindererus. [See Er- 
 
 -amphor, 
 Spitting of blood, 
 
 i), contusions and ruptures 
 
 :ie, 
 
 ir use in wounds, 
 Sprains of the joints, 
 
 urn, fractures of the, see 
 
 i 
 ■eh, blows on the, 
 in the bladder, see Gra- 
 
 ■ing. habit 
 Strangulated nan 
 Strang 
 
 Summer complaint, sec Ckole- 
 
 I /ant urn. 
 Suppuration of the 
 Suppuration of the ur: 
 
 3o9 
 Suppc .46- 
 
 Suppuration, termination of in- 
 flammation in, 337 
 
 Suspended animation, see 
 Drowning, $r* 
 
 MM 
 
 B86 
 606 
 
 281 
 
 
INDEX TO PART II. 
 
 613 
 
 o Page. 
 
 Suspended animation of the 
 
 child at birth, 524 
 
 Suspension, death from, 512 
 Suture, or stitching in wounds, 242 
 
 Swelled breasts of infants, 542 
 
 Swelled leg, 534 
 
 Swelled throat, puerperal, 537 
 
 Terebinthinic mixture, 595 
 
 Thigh, fractures of the, 326 
 
 Throat, incised wounds of the, 248 
 Thrush, aphthous sore mouth of 
 
 548 
 328 
 541 
 
 children, 
 Toes, fractures of the, 
 Tongue-tie, 
 
 Tourniquet, see Bleeding. 
 Turpentine mixture, 595 
 
 U 
 
 Ulceration of the cornea, 354 
 Ulceration of the eyelashes, 349 
 Ulceration of the mouth, 355 
 Ulceration of the mucous orifi- 
 ces, 359 
 Ulceration, treatment of, 338 
 Ulcer, healthy, a misnomer, 338 
 Ulcer, indolent, 340 
 Ulcer, irritable, 339 
 Ulcer, spreading or phagede- 
 nic, 338 
 Ulcer, varicose, 292 
 Union by the first intention, 239 
 Union by the second intention, 240 
 Urinary consumption, see Dia- 
 betes. 
 Urination, excessive, see Dia- 
 betes. 
 Urination, painful, in children, 545 
 Urine, retention and suppression 
 
 of, in children, 545 
 Urine, incontinence of, in chil- 
 dren, 547 
 Urticaria, see Nettle Rash. 
 Uterine hemorrhage, 526 
 Uterus, anteversion of the, 579 
 Uterus, cancer of the, 580 
 Uterus, inflammation of the, 531 
 Uterus, inversion of the, 530 
 Uterus, polypus of the, 580 
 Uterus, prolapsus of the, 577 
 Uterus, retroversion of the, 579 
 Uterus, rupture of the, 525 
 
 V. 
 
 Vaccination, method of, 411 
 
 Vaccine disease, 410 
 
 Varicose aneurism, 299 
 
 Varicocele, 293 
 
 Varicose ulcers, v 292 
 
 Varicose veins, 290 
 
 Varioloid, 409 
 
 Venereal disease, 380 
 
 Veins, inflammation of the, 426 
 
 Ventral hernia, 304 
 
 Ventro-inguinal hernia, 304 
 
 Volatile liniment, 596 
 
 Vomiting, 502 
 
 Vomiting in infants, 555 
 
 W 
 
 Warts, 375 
 
 Water-brash, 493 
 
 Water in the brain,. 490 
 
 Water in the brain, in chil- 
 dren, 562 
 White looseness, 456 
 Whites, 576 
 White swelling, 370 
 Whitlow, 361 
 Whooping-cough, 563 
 Worms, 470 
 Worms, in infants, 561 
 Womb, see Uterus. 
 Wounds and contusions, 235 
 Wounds, fresh, absurdity of nos- 
 trums for, 247 
 Wounds, healing of, by scab, 246 
 Wounds, incised, 236 
 Wounds, incised, — mode in 
 which nature effects the 
 cure of, 236 
 Wounds, incised, — of the abdo- 
 men, 250 
 Wounds, incised, — of the chest, 249 
 Wounds, incised, — of the joints, 252 
 Wounds, incised, — of the neck 
 
 and throat, 248 
 
 Wounds, incised, — of the scalp, 247 
 Wounds, incised, — treatment 
 
 of, 242 
 
 Wounds, lacerated, 254 
 
 Wounds, lacerated, — of the ab- 
 
 domen, 
 Wounds, 
 
 chest, 
 Wounds, 
 
 joints, 
 
 257 
 
 lacerated, — of the 
 lacerated, — of the 
 
 249 
 
 258 
 
614 
 
 INDEX TO PART II. 
 
 Page. 
 
 Wounds, lacerated, — of the 
 
 leg-, a mode of treating, 257 
 
 Wounds made by glass, 246 
 Wounds, modes of stopping 
 
 bleeding in, 236 
 
 Wounds, poisoned, 422 
 
 Wounds, punctured, 288 
 
 Pat« 
 
 Wounds, union by the first in- 
 tention in, 239 
 
 Wounds, union by the second 
 intention in, 240 
 
 Yellow skin in infants, 
 
 M 
 
ERRATA. 
 
 Page 304, line 3, for "internal," read — external. 
 Page 327, line 21, for " three keg hoops," read— two keg hoops. 
 Page 595, line 9, for "muriate of ammonia," (Sal Jmmonia,) read—car- 
 bonate of ammonia. 
 
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 ture! dependent on rtinmicel Principles, 
 with numerous Engra\ Bj trroui 
 
 I. I' m k. \1. D . hit-' Profeaaof ofChem- 
 i - 1 r v . a. in tin- University of Vermont 
 wuli numerous pi 
 
 MEDICAL LIBRARY. 
 
 THE CYCLOPEDIA OF PRACTICAL 
 MEDICINE \M> SURGERY, \ DI- 
 MEDICAL LITERATURE 
 Edited by Isaai Rats, M. D. I i 
 
 Each article embraced in these volumes 
 is complete within itself, and is of great 
 value as containing information not else- 
 where to be obtained. 
 
 DR CHALMH 
 
 ON THE IDAPTATTONOF EXTERNAL 
 \ ITURETO THE MORAL WD IN- 
 TELLECTUAL CONSTITUTION OF 
 
 M W. By the Rev. Thomas Chalmers. 
 D. D.; being a part of the Bridgewater 
 Treatises <>u the Power, Wisdom, and 
 Goodness of God, as manifested in the 
 Creation. In l vol. 12mo. 
 
 DE LA BECHE. 
 A GEOLOGICAL MANUAL. By Henry 
 
 DR. DEWEES. 
 
 THE PRACTICE OF PHYSIC. By W. P. 
 Dewees, M. D., Adjunct Professor of Mid- 
 wifery, in the University of Pennsylvania, 
 second edition, complete in 1 vol. 8vo. 
 
 By the same Author. 
 
 A TREATISE ON THE PHYSICAL AND 
 MEDICAL TREATMENT OF CHIL- 
 DREN, sixth edition, with corrections. In 
 1 vol. 8vo. 
 
 By the same Author. 
 
 A COMPENDIOUS SYSTEM OF MID- 
 WIFERY; chiefly designed to facilitate 
 the Inquiries of those who may he pursu- 
 ing this Branch of Study. 1 vol. 8vo. with 
 IS Plates. Eighth edition, corrected and 
 enlarged. 
 
 By the same Author. 
 
 A TREATISE ON THE DISEASES OF 
 FEMALES. Sixth edition, revised and 
 Corrected. 1 vol. 8vo. with numerous plates. 
 
 ROBLEY DUNGLISON, M. D. 
 
 HUMAN PHYSIOLOGY, illustrated by nu- 
 merous Engravings. By Robley Dungli- 
 so.w M. D., late Professor of Physiology, Pa- 
 thology, &c, in the University of Virginia, 
 Member of the American Philosophical 
 Society, &c 2 vols. 8vo. Second edition 
 improved. 
 
 By the same Author. 
 
 ON THE INFLUENCE OF ATMOS- 
 PHERE AND LOCALITY; change of 
 Air and Climate, Seasons, Food, Clothing, 
 Bathing, Exercise, Sleep, Corporeal and 
 Intellectual Pursuits, &c. on Human 
 Health, constituting Elements of Hygiene. 
 By Robley Dunglison, M. D., late Profes- 
 sor of Materia Medica, Therapeutics, Hy- 
 giene, and Medical Jurisprudence, in the 
 University of Maryland, &c. 1 vol. 8vo. 
 
hook* Hlunchard. 
 
 GENERAL THERAPE1 TH B 
 'I. I.- 01 MEDICAL 
 
 Wil i 
 and 
 
 
 A * r. 
 
 W. ST I I LIP TO 
 
 dislocation*, a . . i • .- 
 
 eases of worn* n uWlr« ■,. a 
 
 i<mi». To 
 are a«J«J«-«. \ nslotny and 
 
 Physiology of the Human Body, sh- 
 
 Hyg ene, or the 
 inc health. sntW 
 
 
 rr\iBMjn. and m brought op to the 
 
 and doses • 
 rata. Ah» 
 
 •diinn. Bv James 1 
 - lsr»e vol. Eh 
 nh 
 
 I 
 
 — 
 
 .Medical Formulary, hrtng s collection of 
 I nivi r- ''<aihe wnunga and 
 
 jtstIm r of many of the most etainr 
 m in Aaarnca and " 
 
 JAM 
 
 Additions, (at press.) 
 
 Mr.ni 
 
 - 
 
 i:i»\\ 
 
 iLOl MATI Rl \ MF.DH \ WP 
 I'll \i:m %n i:. M m I 
 
 aihr tor the 
 
 
 •«a*rat«on or 
 Rrsesrrh. with sreurarv and surma. By 
 
 Ame- 
 nd London edtbun. wuh 
 
 FITCH. M.D. 
 
 wuh niimrr 
 
 ami to the An <>l I* 
 S 
 
 Iht ol 
 
 and l 
 phia i 
 
 rvd edition, revised, corrected and an- 
 s plates. B»SS Frrcn. 
 
 THE INSTITMKS \\n PR 
 
 \ hr.nc the Outhnesofa Course 
 
 irvM.r of Surrrn I x rfs.lv of I 
 
 .1 VMKS I \\ I I 1 . M I« 
 
 THEMFDICALCOMPANION 
 
 of the I'm* 
 
 MM i 
 
Books published by Carey, Lea fy Blanchard. 
 
 analvtieal summary of the system of Doe- 
 
 .11, on the faculties of man and the 
 
 functiom of the Brain, with plates, in 1 vol. 
 
 E.GEDDINGS, M. I). 
 
 A TREATISE ON THE PRACTK 
 
 MEDICI ^ Bt of the 
 
 Principlai of General and Special Patho- 
 
 uiil Therapeutics By E Gkodiro, 
 Professor in the University of Maryland. 
 
 'J \oI.». Bvow, in the press.) 
 
 w E HORNER, It ft 
 
 A TREATTSEON BPEC1 \l. Wh- 
 im. ANATOMY. Foorto edition, revis- 
 ed oorracted, in I rale 8vo. 
 
 in tin. 
 
 MANUAL of Tin: PHTSIOLO 
 M \ V or option of the 
 
 IrnnixatioB. By P. 
 ii in. Translated in»m the French, 
 wnh Notes, by J. Toono. In ISma 
 
 IIE.WKY 
 
 PRINCIPLES 01 MILITARY SI Bf 
 
 com pi n ationj on the trsensje- 
 
 meni I •pilals, 
 
 : i ory, Tn atnent, and Ano- 
 malieaof Variola and Syphilis; illi 
 with cases and dissections. By John Hen- 
 I R 8 I. Inspector ofMilitary 
 itals— Aral American irmii the third 
 lionoon edition, with tin- Ufa of the Au- 
 thor, by bis Mm, Db. John Hznitkn. 
 
 PROl ESSOR KIDD. 
 
 \ TRI v rin: \DAPTATIO\ 
 
 (>K EXTERN VL N \TI RE TO THE 
 PHYSIC \1. CONDITION OF MAIS, 
 
 {Hrincipally with reference to the supply of 
 lis wants, and the *\<r. ise of his intellec- 
 tual faculties. By John Kinn, M. D., F. 
 of .Medicine in the 
 University of Oxford; being a part of the 
 Bridgewater Treatises on the Power, Wis- 
 dom, and Ooodness of Cod, ns manifested 
 in the Creation. In 1 vol. 12mo. 
 
 PROFESSOR KIRBY. 
 'HE HISTORY, HABITS, AND IN- 
 
 STINCTS OF ANIMALS. By the Rev. 
 William Kirby, M. A., F. R. S. In 1 vol. 
 8vo. Illustrated by numerous engravings 
 on copper; being a part of the Bridgewater 
 Treatises on the Power, Wisdom, and 
 Goodness of God, as manifested in the 
 Creation. 
 
 BARONLARREY. 
 
 SURGICAL MEMOIRS OF THE CAM- 
 PA ICNSOFRUSSI A, GERMANY'. AJND 
 FRANCE. Translated from the French 
 of Baron Larrey. In 8vo. with plates. 
 
 ISAAC LEA. 
 
 I 1 1 \ TRIBITIONS TO GEOLOGY r . Illus- 
 trated by numerous coloured Engravings. 
 By Isaac Lea, Member of the American 
 Philosophical Society, &c. &c. In 1 vol. 8vo. 
 
 By the same Author. 
 
 \ SYNOPSIS OF THE FAMILY OF 
 \ \l IDES. By Isaac Lea, Member of 
 \merican Philosophical Society, &e. 
 .\< . 1 \ol. 8vo. with coloured plates. 
 
 PROFESSOR MECKEL. 
 
 MANUAL OF GENERAL, DESCRIP- 
 TIVE AND PATHOLOGICAL AN- 
 ATOMY. By J. F. Meckel, Professor of 
 Anatomy at Halle. &c. &c. Translated 
 from the French, with Notes, by A. Sidney 
 Doane, A. M., M. D. 3 vols. 8vo. 
 
 MARTINET. 
 
 MANUAL OF PATHOLOGY: containing 
 the symptoms, Diagnosis, and Morhid Cha- 
 racter of Diseases, &c. By L. Martinet. 
 Translated, with Notes and Additions, by 
 Jones Quain. Second American Edition. 
 12mo. 
 
 PHRENOLOGY. 
 
 PHRENOLOGY, and the Moral Influence 
 of Phrenology. Arranged for general 
 study, and the purposes of education, from 
 the first published works of Gall and Spurz- 
 heim, to the latest discoveries of the pre- 
 sent period. By Mrs. L. Miles. 
 
 "Man's greatest knowledge is himself to 
 know." Pope- 
 
Books published by Carey, Lea fy Blanchard. 
 
 PROFESSOR PROUT. 
 
 CHEMISTRY. MPNKRAI/XiY.ANDTHE 
 FUNCTIONS OF DIGESTION, consider- 
 od widi reference to .Natural Theology. 
 By Wm. Pium r. M. U.. V. R. S.. I allow of 
 the Royal College of I' Being 
 
 a part of the Bridgewster Treatises, on) 
 the Power, Wisdom, ami Coodneae of! 
 God, as niauifi ~t< d in tin- Creation. 1 vol. 
 12mo. 
 
 don Fever Hospital, 
 vol. 8vo. 
 
 A new edition. 
 
 PROFESSOR SYME. 
 
 PRINCIPLES John 
 
 Stme, Prolr saor the Univer- 
 
 inborg. Jn 1 \ui. s vu. 
 
 USHER PARSONS, M. D. 
 
 DIRECTIONS FOR MAKING \\ \tomi- 
 CAL PREPARATIONS, formed on the 
 basil of Pole, Marjolio, and i: 
 including the wn method <>i Mr 
 
 By I 
 
 Anatomy and Surgery, l rol. 8va, with 
 Plate.. 
 
 DR. TWEEDIE. 
 CLINICAL ILL! STRATIONOF 
 
 c-oinpriHinir 
 
 I • 
 
 tion in the I lal, 6tc. 
 
 8vo. 
 
 
 
 PROFESSOR RO 
 
 ANIMAL AM' VEGETABLE PIIYSI- 
 ()I/m;y. oonsidsrad with reierei 
 
 M\KK 
 
 Roorr, M. i> luttatreti iriy BOO 
 
 wood-coo. In I . |«rt of 
 
 the r 
 
 INFLAMM 
 
 -il Dortrine*. 
 
 .|.*i.-al and I 
 
 merican edition. 1 \ol. 
 
 
 - 
 
 RICHARD REESE, M D. 
 
 LADT8 MEDICAL Gl tDl Bj Rwauu 
 Rose. M. D. 18 
 
 JAMES BNELL 
 
 APRACTICALGI fDETOOPERA 
 
 on THE ill i H 
 
 bL In 1 vol. Bros with Plates. 
 
 SOUTHWOOD SMITH. 
 A TREATISE ON FE1 EH 
 
 wood Smith. M. IV. Ph\ si< lan to 1 
 
 RAL PHY 
 dered with - Natu- 
 
 I.UAM 
 
 Win .nd Tutor of 
 
 a part 
 
 \\ 
 
 feeted in the Creation. In I \ol. 
 
 WILLI AMS.M.D. 
 \ RATION \I I IXPOSTTIOJi OF THE 
 
 pin - 
 
 ruin v;s v.ndpi 
 
 their Pathology and la 
 
 agnons. By Chasijx J. Williams, M. 
 
Books published by Carey, Lea cy* Blanchard. 
 
 THE MEDICAL STUDENT. 
 
 THE MEDICAL STUDENT, OR AID TO THE STUDY OF MEDICINE, including 
 a Glossary of the terms of the Science, and of the mode of prescribing; Bibliographical 
 Notices of Medical Works; the regulations of the different Medical Colleges of the 
 Union, &c By Robley Dunglison, M. D., Professor of the Institutes of Medicine and 
 Medical Jurisprudence in Jefferson Medical College, late Professor in the University o 
 Maryland, and University of Virginia, &c. In 1 vol. 8vo. 
 
 "This is another of those valuable compilations for which the profession in America is so 
 much indebted to Professor Dunglison. 
 
 "Although chiefly intended for students in the American States, it will be useful for stu- 
 dents in all countries, as it contains a vast deal of that kind of miscellaneous and varied 
 information which is so constantly needed, yet so difficultly found by them. Besides the 
 mere technical matters, this volume touches on many subjects of yet higher importance, 
 and, among others, on the moral duties and professional conduct of the medical practitioner! 
 which are laid down clearly and forcibly, and with a just appreciation of the dignity of the' 
 office. The following titles of the live chapters of which the work consists, C will give a 
 general but not very exact notion of its contents, as it comprehends many things very in- 
 teresting to the student, yet hardly suggested by its title: Preliminary education, Medical 
 education prior to attendance on Lectures, Medical education during the period of atten- 
 dance on Lectures, Medical education after Graduation, a Medical Bibliography for the 
 Student and Young Practitioner. 
 
 "We recommend 'The Medical Student' in the strongest terms to his brethren in all 
 countries, and in an especial manner to his compatriots." — British and Foreign Medical 
 Review. 
 
 GENERAL THERAPEUTICS. 
 
 GENERAL THERAPEUTICS, OR PRINCIPLES OF MEDICAL PRACTICE, with 
 tables of the chief remedial agents and their preparations, and of the different poisons and 
 their antidotes. By Robley Dunglison, M. D., &c. &c. 1 vol. large 8vo. 
 
 "There being at present before the public several American works on Therapeutics, 
 written by physicians and teachers of distinction, it might be deemed unjust in us, and 
 would certainly be invidious, to pronounce any one of them superior to the others. We 
 shall not, therefore, do so. If there be, however, in the English language, any work of the 
 kind more valuable than that we have been examining, its title is unknown to us. 
 
 "We hope to be able to give such an account of the work as will strengthen the desire 
 and determination of our readers to seek for a farther acquaintance with it, by a candid 
 perusal of the volume itself. And, in so doing, we offer them an assurance that they will 
 be amply rewarded for their time and labour." — Transylvania Journal, Vol. IX. No. 3. 
 Dec. 1836. 
 
 "Few writers in our profession have been more industrious than Professor Dunglison, and 
 fewer still have sustained themselves equally well in the course of so many practical pub- 
 lications. From the hasty perusal which we have given it, we are inclined to think that 
 it possesses equal if not superior merit to any which have preceded it from the prolific pen 
 of its author. 
 
 It shown the learning and research of its author on every page, and as an eclectic 
 production it will bear comparison with similar works in any country. We would advise 
 our readers to purchase and peruse it for themselves." — Western Journal of the Medical 
 Sciences, No. XXXVIII. p. 252, for September, 1836. 
 
 The work ought not to be thus hastily dismissed. From an attentive examination less 
 cannot injustice be said, than that while we find nothing to excite a single captious feeling, 
 we find every thing to instruct and entertain. Although Dr. Dunglison may be regarded a 
 prolific writer, if he produces alwavs such volumes as this, we shall certainly notthinkhim 
 in danger of the charge of overworking his genius. We must leave it with the candid 
 advice to every medical man to be soon in possession of this volume of sound and rich ob- 
 servations in the art, he would advance with pleasure, as well as practice as a duty. — 
 Boston Medical and Surgical Journal. 
 
Books published by Carey, Lea fy Bluiichurd. 
 
 YOUNG'S MATHEMATICAL WORKS. 
 
 AN ELEMENTARY TREATISE ON ALGEBRA, Theoretical and Practical: with 
 
 attempts to simplify some of the more difficult parts of the science, particularly the de- 
 
 inonstration of the Binomial Theorem, in its most general form: the Solution of Equations 
 
 of the higher orders; the Summation of Infinite Series, dbe. By J. R. Young. A new 
 
 edition, corrected and improved. 
 
 "A new and ingenious general method of solving Equations has been recently discovered 
 by Mem* II. Atkinson, Holdred, and Horner, independently of each other. For the best 
 practical view of this new method and its applications, consult the Elementary Treatise on 
 Algebra, by Mr. J. R. Young, a work which deserves our cordial recommendation." — Dr. 
 Gregory' $ edition qfHutton't Matin maticg. 
 
 "For the summation of Infinite Series the author g and ingenious method, 
 
 which is very easy and extensive in its application" — NewautU M 
 ELEMENTS OF THE INTEGRAL CALC1 LUSi frith its Applications to Geometry 
 
 and to the Summation of Infinite S' r I and corrected by Michael 
 
 O'Siiawlssv . A. M. 1 vol. 8vo. 
 
 '•The volume before ns forms the tliird of an analytical course, which commences with 
 the 'Elements of Analytical Geometry.' M 
 language, and we trust they will speed Uy be adopted m 
 
 The existence of such auxibarii i will, of itself, we hope, prove an inducement to the culti- 
 vation of" Amlyt: lor. to the H . ntarv works, the indifl. : 
 hitherto manifested m tin.- country on the suhj. . fly to be ascribed. 
 Mr. YoUDg has brought the science within the r- at, and. in so 
 doing, has contributed to the advancement of mathematical learning in Great Brita. 
 Preebwterian Review, January, I 
 ELEMENTS OF Till: DIFFERENTIAL CALCULUS; comprehending the General 
 
 Theory ofCurve Surfaces, and ol Cnrvei of Double Curvature. Revised and corrected 
 
 by Michakl O'SHAjntner, \ M l vol 
 
 •The whole Elements of the Differential Calcuh>. comprehending all that is mot valu- 
 able in the large works of the most celebrated Analvsis, are contained in one volume, 
 beautifully printed on a line paper, and neatly bound m cloth. It appeal! to be in « 
 reaped will fitted rally adopted."— 
 
 I'nshi/irrinn Review, September, 
 
 ELEMENTS OF GEOMETRY; < nl lining a new and universal Treatise on the Doc- 
 trine of Proportions, together with Notes, in which are pointed ool 
 important error> that have hitherto remained unnoticed in the writings of I 
 \1m>, an Examination of the ■\ srioua T!.. .at have bet n proposed 
 
 by Lege n d re, Beitrand, Ivory, I^eslie, and others. 1 vol ftvo. 
 
 "His observations on the theory of parallel lines, the labour he b "n the doc- 
 
 trines of proportion, as well a» his corrections ol niair. -and 
 
 supplying their defects, together with his minute atteni 
 justly considered as rendering bis performance value) 
 losopkical MagosuM 
 
 "We have never seen a work so free from pretension and of such great merit. Vaj 
 fallacics latent in the reasoning of some celebrated tnathei, tfa of ancient 
 
 modern dale, are pointed out and discussed in a tone of calm moderation, which we regret 
 to sty is not always employed in the scientific world." — Month 
 
 "This is a work of valuable information. -itened mind, and 
 
 executed with a simplicity which cannot I important truth it speaks of. home 
 
 to the conviction ofeverv Dndei standing." — IV< 
 
 THE ELEMENTS OF W vl.YTlcu. GEOMETRY; oomprehendtng the latrine of 
 the Conic Sections, and the General Theory of Corves and Surfaces ot the second order, 
 with a variety of local Problems on Lines and S - Intended for the use of Mathe- 
 
 matical Students in S ch ools and 1 
 
 "If works like the present be introduced generally into our schools and colleges, the con- 
 tinent will not long beset of its immense superiority over the count - 
 branch of modern analytical science." — Atlas, 
 
 THE ELEMENTS OF MECHANIC^ comprehend - tad Dvnamics. with a 
 
 copious Collection of Mechanical Problems, intended tor the use of Mathematical Stu- 
 dents, in Schools and Universities] with numerous Plates. Revised and corrected by 
 John D. Williams. I vol - 
 
 ELEMENTSOF PLANE AND SPHERICAL TRIGONOMETRY; with its nppli. ations 
 to the Principles of Navigation and .Nautical Astronomy, with the necessary Locanthmic 
 anil Trigonometrical Tables. By J. R. \ which is added, some Original Re- 
 
 searches in Spherical Ceometry. By T. S. I Revised and corrected by 
 
 John D. Williams. 1 vol v 
 
 906