Digitized by the Internet Arciiive in 2010 witin funding from Open Knowledge Commons http://www.archive.org/details/popularessayondiOOwhit '" A POPULAR ESSAY aN THE DISORDER FAMILIARLY TERMED A COLD, A POPULAR ESSAY ON THE DISORDER FAMILIARLY TERMED A COLD: IN WHiCH The Means of obviating" the various Causes are explained in a Manner familiar to the meanest capacity; ■\VITH A COLLECTION OF APPROVED RECEIPTS, AND OBSES- VATIONS ON THE MOST POPULAR REMEDIES; PRINCIPALLY DESIGNED For the Use of Families. BY E. L. WHITE, SURGEON, Istc " Les rhumes emportent plus de malades que la pestev" Colds are morfi destniptivp than the plague. • TO ViTHICH ARE ADDED, ANNOTATIONS, EXPLANATORY AND PRACTICAL: E,xhibiting- a New Theory on the Action of many of the predisposing- and exciting Causes of Catarrh, with ori- ginal and approved Receipts for the Cure of that Dis- order in the United States. BY J, STUART. M D., i:fc. PHILADELPHIA, rsiNTED FOR BRADFORD iSf INSKEEP, N. G. DUFIEFi AND ALSOP, BRANNAN, kS" ALSOP, BY T. AND G. PALMER. 1808. T>istrict of Pennsylvania, to wit : Be it remembered, that ^ ^ on the twenty-sixth day of January, in the thirty-se- (L. S.) cond year of the independence of the United States ■ ' of America, A. D. 1808, N. G. Dufief, of the said district, hath deposited in this office the title of a book, ihe right whereof he claims as^ proprietor, in the words following, to wit : " A Popular Essay on the disorder familiarly termed a Cold : in which the means of obviating the -various causes are explained iu a manner familiar to the meanest capacity ; with a collection of approved receipts, and observations on the most popular remedies ; principally designed for the use of families. By E. L. White, surgeon, &c. *♦ Les rhumes emportent plus de mdades que la peste."* Colds are more destructive than the plague. To which are added, Annotations, explanatory and practical : exhibiting a new theory on the action of many of the predis- posing and exciting causes of catarrh, with original and ap- proved receipts for the cure of that disorder in the United States. By J. Stuart, M. D., &c." In conformity to the act of the congress of the United States, intituled, " An act for the encouragement of learning, by se- curing the copies of maps, charts, and books to the authors and proprietors of such copies, during the times therein men- tioned;" and also to the act entitled " An act supplementary to an act, intituled, * An act for the encouragement of learn- ing, by securing the copies of maps, charts, and books to the authors atid proprietors of such copies, during the times there- in mentioned,' and extending the benefits thereof to the arts of designing, engraving, and etching historical and other prints." D CALDWELL, Ckrh of the Dktrict of Pennsylvania^ DEDICATORY ADDRESS, TO THE LEGISLATURE OF THE STATE OF PENNSYLVANIA. GENTLEMEN, ALTHOUGH patronage could be solicited of none with better prospects of success, than of those who have ac- quired the highest confidence and es- teem, 4n the hearts of their fellow-citi- zens, and eminently distinguished themselves in the encouragement of every art and science either useful to 11 man or profitable to society, yet have not personal considerations had the least share in the motives prompting to the liberty of addressing these pages to your notice. In the mitigation of the criminal code of this state, you have found the means to prove that man may become useful to his connections and profitable to society, even after he shall have for- feited their protection, in the atrocity of his crimes. With a virtuous concern for morals, a laudable jealousy for the liberties of the citizen, and an anxious solicitude for the encouragement of industry, you have held forth an ex- ample in legislation not only to be emulated by our sister states, but worthy the imitation of every civilized nation under the heavens. Yet, per- mit me to say, that, whilst empiricism is suffered to roam with impunity in this state, a most important part of your duty as legislators still remains to be performed. This is productive of real evils, and evils of the greatest magnitude ; it is to this state, what the fabulous mon- ster of Lerna is said to have been to those of ancient Greece : Not Hydra stronger, when dismeraber'd, rose Against Aclmxna's^much-enduring son. IV Grieving to find, from his repeated blows? The foe redoubled, and his toil begun ; Nor Colchis teem'd, nor Echionian Thebes A feller monster from their bursting glebes*. I wovild not, however, be supposed to solicit, by this address, that which has been withheld from the combined interests of the faculty f. Such a soli- citation might justly merit the impu- tation of presumption. But, firmly persuaded, you need only to be made * Non Hydra secto corpore firmior Vinci dolentem crevit in Herculem, Monstrumve submisere Colcbi Majus, Echioniaeve Thebs. Hor, Carm. lib. 4. ode 4. t Vide .the petition of the faculty to the last ses- sion of the legislature, and its fate. acquainted with an abuse as an in- ducement to apply an appropriate re- medy, I presume no farther than to call to your notice a few of the evils arising from empiricism, and then to leave to your own consideration and reflection, whether or not they may be sufficiently important to demand your attention. Is education of any importance to government, the legislature of this state are certainly .the guardians of it. You, gentlemen, are the legitimate guardians of this university, the medical department of which, under the auspices of the present professors, a 2. VI is already the envy, and promises, ere long, to become the rival of the most celebrated seminaries in the world. But what protection, or what encou- ragement does it receive at your, hands, if, by an omission in legisla- tion, those educated therein shall be degraded to hold the same rank, in the public estimation, with the most illiterate and mercenary impostor! What inducement is held forth to the wishes of the tender parent, or the guardian ambitious for the future welfare of his son or ward, to see him possessed of a liberal education in the science of medicine, whilst he is daily a witness to the toleration and ca- resses of the most unprincipled and Vll ignorant pretenders ; to tlie degrada- tion of the profession, and, in many- instances, even to the supplanting of those who have been formed by every advantage to be derived from the in- struction of the best preceptors and the accumulated knowledge of ages ; who have studied for years with un- remitted labour; who have sacrificed health, and even expended fortunes, to qualify themselves for the practice of a profession, which, in the estima- tion of all, except in that of the laws of this state, is deemed the most liberal, and to which the empiric can have no farther pretensions than those of an unprincipled character, callous VIU feelings, a mercenary heart, and an unbhishing effrontery. ^ It is not the university, it is not the FACULTY of this State who are the only sufferers ; the interests and the welfare of the COMMUNITY AT LARGE are equally concerned in arresting the desolating progress of empiricism. Under our present laws, the most ignorant and contemptible wretch in existence, whom indolence, or a want of knowledge in his trade or pro- fession, shall have rendered inade- quate to gaining a pittance in ano- ther state, hurries to this ; and, hy as- suming a title ^ advertising his infalli^ IX Ifte nostrums^ or by subscribing to half' a dozen publications^ and there affixing the initial letters o/" doctor of medi- cine* to his name^ immediately be- comes a inan of consequence, and finds no more difficulty in preying upon the health and lives of your constituents, than remorse in preying upon their fortunes. Our author informs us, his parti- cular situation had supplied him with numerous opportunities of witnessing the destructive progress of these traders in sciencef. It is much * M. D. t Vide page 196 of this work. regretted, that similar opportunities should have exhibited to the editor so many instances of unconscionable extortion, so many objects of decrepi- tude and lingering disease, arid, I may confidently add, so many cases of UNTIMELY DEATH from the samc cause in this, otherwise, one of the best re- gulated cities in the universe. The subordinate and labouring classes of the community are those peculiarly subject to the impositions and knavery of these pretenders. Deprived, for the most part, by the nature of their useful occupations, from acquiring sufficient information XI for the direction of their choice of medical assistance, they easily become a prey to the vain boastings and empty promises of every impostor, who has the effrontery to commend his patent POISONS*, or to publish his own in- fallibility. But what is the issue? Not suspecting the guile which lies concealed under a specious cloak of humanity, by the use of a few inert simples, or that of some more power- ful drugs, given at a dangerous ran- * Almost every thing that has been said of empi- ricism is equally applicable to the vending of patent medicines, and, consequently, the latter should be held in equal detestation with the former. Xll dom, without the least knowledge or regard to the state of the system, the patient is amused and flattered with prospects of certain recovery, until the golden opportunity of obtaining relief is past to return no more. Fi- nally, plunged into despair, exhausted by poverty, and a victim to a disease eminently curable in the beginnings or to the improper treatment of a pan- der of Iniquity, he falls into the arms of Death, his deliverer, leaving the disconsolate partner of his iormer happy days widowed and helpless, With a numerous family of children to provide for ; but who, alas ! from a XUl merciless demand of exorbitant fees, is soon to be reduced to starvation, or to the only and mortifying alternative of becoming a charge to the commu- nity. May not these unprotected unfor- tunates exclaim, in the emphatic lan- guage of scripture, " we have asked, for bread and ye have given us a stone !" Instead of a sympathizing friend, whose office it were to minister to the mind diseased; Pluck from the memory a rooted sorrow, And, with some sweet oblivious antidote, Cleanse the stuff 'd bosom of that perilous stuff Which weighs upon the heart, b XIV ye have given us the most cruel and remorseless enemy ; instead of a be- nefactor and the charitable physician, ye have sent us a robber and an un- principled assassin. Long as I have intruded, gentle- men, upon your time and patience, these observations present you only with a few outlines of the evil under consideration. But, however unfi- nished the portrait, it is certainly a faithful one, and that it may prove a likeness suificiently striking to render the prototype of too short duration to require a completion of the picture, is XV somewhat the expectation, and most assuredly the sincere wish of Your most respectful And very humble servant, J. Stuart. Philadelphia^ Feb, 4^/z, 1808. PREFACE. There is no work which less re- quires the aid of a preface than one, the object of which, evidently, is pub- lic utility, and the general welfare of mankind. The author of the present essay, however, is unwilling to let it pass through his hands without oflFer- ing a few words in explanation of the motives which induced him to employ his pen on a subject which constitutes a part of each of the numerous sys- b 2 xvni terns of domestic medicine already in the possession of the non-medical world. The number of popular works of this description has lately, it is true, been much increased by the addition of several valuable publications ; yet the author ventures to assert, that there is none in which the complaint which forms the subject of the follow- ing pages is satisfactorily treated of. In a work, indeed, the object of which is to present, within the compass of a volume, a general outhne of the heal- ing art, it is impossible that each in- dividual disease can be given at any XIX length, and with a due degree of per- spicviity; more particularly those which are commonly regarded as least important. Scarcely is there an individual in the British dominions, who has not an interest in the disorder commonly termed " a cold f' in the language of nosologists, catarrh. Almost every one is occasionally affected with it ; to thousands it has proved the bane of health : and it is melancholy to relkct, but, at the same time, it is indisputa- bly true, that this complaint is daily gaining ground, both by the increas- XX ing frequency of its occurrence, and by its being oftener followed by cala- mitous consequences. Errors in the conduct of individuals, sometimes the effect of ignorance, more generally, however, of folly, usually give rise to its production, and the common do- mestic mode of treatment, influenced by mistaken notions of its origin, tends to render it inveterate. A simple cold is the common fore-runner of the most dreadful diseases incident to human nature, and its importance cannot be too strongly impressed upon the minds of those who are ignorant of ixiedicin^. XXI The object of the author, therefore, has been, to afford to the unprofes- sional reader a general yet clear view of the nature of this insidious com- plaint ; to point oat to him the various causes by which it is liable to be in- duced ; and to put him in possession of rational principles, by which his conduct may be directed with a view to its prevention and removal. The work, if accidentally perused by medical men, will be found to have only few pretensions to originality ; to the class of readers, however, for the eye of whom it is designed, it will not be the less useful. XXll The author has only to observe, that the treatment he has ventured to recommend (though m some respects novel) has had the sanction of much experience. The observations on some of the most popular remedies, it is hoped, will not be found an un- acceptable addition. CONTENTS, fiage Preliminary observations, comprising the history of the disease and its various con- sequences, and the division of the work 1 Section I. Predisposing causes - 25 1st. Original pecuHarity of constitution ibid. 2d. An acquired irritability of the pulmonary system - - 33 3d. A morbid delicacy of frame, induced ei- ther by enervating indulgence, or by de- bilitating occupations - 38 Section II. Exciting causes - 41 1st. Alternations of temperature in the at- mosphere - - ibid. XXIV 2d. The application of chemical or me- chanical STIMULI to the mucous mem- brane which lines the air passages 103 3d. The application of moisture to the whole or part of the body - 113 4th. Certain intemperaries of the atmos- phere, independent of its sensible qualities 117 Temperature, diet, and medicine 135 I. Temperature - - ibid. II. Diet - - 139 III. Medicine - - 141 Laxatives - 146 External use of cold air - 150 Cold applied internally to the stomach 1 5 1 Nauseating doses of emetic tartar 153 Digitalis - - isY Hemlock and ether inhaled 159 Acetum scillse and gum ammoniac ibid. Demulcents and opiates - 161 Sternutatories - 168 Sialagogues - - 169 Pellitory of Spain - ibid. Nitre - - 170 Detergent gargles n - 171 Remarks on some of the most popular remedies - - 175 XXV I. Inhaling vapour of hot water 175 II. Steammg the head 179 III. Pedehivium 180 IV. Inspiration of artificial air 181 V. Opium and paregoric elixir 182 VI. Emetics 184 VII. James' powder 180 VIII. Patent medicines 189 Perrin's balsam of lung-wort ibid. Allen's balsam of liquorice ibid. Balsam of honey 190 Godbould's vegetable balsam ibid. Lucas' pure drops of life 191 Madden's vegetable essence ibid. Solomon's cordial balm of Gilead ibid. Balsam of horehound 192 Essence of ditto 193 Essence of coltsfoot ibid. Balsam of Tolu ibid. IX. Pectoral lozenges 201 Directions to make them ibid. X. Indigenous simples 204 Mallow, horehound, and coltsfoot 205 XXVi EDITOR'S NOTES. 1 . Extensive dominion of catarrh 209 2. Loss of appetite - - ibid. 3. Air of manufactories ameliorated 21© 4. Irregulai'ity of animal heat accounted for ibid. 5. Increased action accounted for 211 6. Action of heat - - ibid. 7. Action of cold - 212 8. Unity of disease - - ibid. 9 . Comparative scale of the relative strength of the lungs and the skm - 2 1*3 10. Caution - - ibid. 1 1. Drinking cold water - 214 12. Hysteria and atonic gout 215 13. Of flannels worn next the skin ibid. 14. Absorption of perspiration - 218 15. 16. Of flannels worn next the skin 2 1 9 17. Precaution - - 220 1 8 . Of the decomposition of water by animals 22 1 19. Of the action of oxygen : a new theory 222 20. Catarrh (or cold) by change of atmosphere 24;7 2 1 . Action of musk and of the fumes of the muriatic acid accounted for - 229 22. Uf moisture - - 230 J XXVII 2o. Decomposition of sea-salt: a new theory i23l 24. The operation of cold - 233 25. Rationalia of the two plans of treatment 234 26. Theory of external cold • 236 27. The effects of cold explained 237 28. Of blood-letting in colds - 238 29. Of the use of calomel - - 239 , 30. Of the nauseating plan - ibid. 31. Of cold drinks - - 240 32. Of full vomiting - 241 S3. Nauseating plan repudiated - 242 34. Digitalis and the nitric lac 243 35. Rationalia of the application of blisters to the back - - 244 36. Of blood-letting - - 245 37. Of Seneka snake-root - 246 38. Ofpedeluvium - - 247 39. Of opiates > * ibid. AN ESSAY, &c. Of all the diseases incident to the inha- bitants of this variable climate, there is none so frequent in its occurrence, — none which excites so little attention, — and none, perhaps, which, when neglected, is so often followed by fatal consequences, as that commonly known under the name of cold^ or cough. Its familiarity, and the decep- tive mildness of its symptoms, usually ren- der it so little regarded by the patient, that he is seldom willing to sacrifice the various concerns of business or pleasure, for the sake of an indisposition which he considers so trivial; and, too surely, to this disre- gard may be ascribed the origin of the ma- jority of the numerous train of diseases to v\^hich we are subject. It is the rock upon w^hich the health and lives of thousands have been wrecked. How common is it, in reply to the in- quiries of health, to hear persons say, — they have only a cold; it will soon go off; they are very subject to cold ; hut they never feel ill effects from it; it always goes off as it comes, Sec. ! and yet, if to these very peo- ple, who thus carelessly commit the pre- servation of their health to chance, you urge -the impropriety and danger of their inat^ 3 tention, they will readily acknowledge to you, that *^ no complaint is worse than a cold." And, perhaps, in confirmation of the truth of this observ^ation, will even relate to you some fatal instance of its truth, that may have recently occurred within the immediate circle of their acquaintance : for, unhappily, the melancholy consequences of this disorder are, in our island at least, too frequently the subject of observation, to admit of ignorance being pleaded as an ex- cuse for neglecting the means that are ne- cessary for its prevention and removal (1)*. Thus it is, that hundreds daily run into danger wdth their eyes open, and ultimately •fell sacrifices to their imprudence. * The figures witrtin parentheses refer to the notes by the editor, which are to be found at the end of the Yokime. 4 If we look for the origin of this neglect, and of the distress to which it subjects the human frame, we shall find it to proceed, principally, from two sources :— one of these is a too blind reliance on the curative power of what is commonly understood by the term Nature. There is implanted in the animal frame a certain tutelary or preserving power, which, as it were, presides over its eco- nomy, repels the attacks of injury, and guards it from the dangers with w^hich it is incessantly surrounded. The operation of this principle is powerful and well marked ; but its precise nature has hitherto, and pro- bably ever will, remain concealed behind the veil that screens, from human eye, the mysteries of the creation. It has excited the attention of philosophers from the ear- liest ages, and they have applied to it vari- ous names, expressive of the extent of its agency*. The unlettered, also, have no less observed its effects ; and, accustomed to ascribe effects to causes only which are familiar, and within their own observation, they either imagine it to be the immediate interference of a superior power ; or, sup- posing it a part of that extensive principle which preserves the harmony of the whole creation, they call it Nature, and too often superstitiously leave to its influence the cure of complaints, where the judicious hand of art alone is adequate to their re- moval. * Afx^) ixvroKpxTsix'j vis naiuvtz mcdicatrix. A 2 But, by far, its most frequent cause is indolence, on the one hand, or, on the other, inattention produced by the constant routine of the busy occupations of life : or, as it is commonly expressed by the sufferer himself, want of time to attend to one^s oxvn feelings. How many thousands are there, who, deeply immersed in dissipation, or wholly occupied in the acquirement of wealth, daily feel themselves unwell, and pained by their exertions ; yet, day afterday, neglect the means of assistance until the mischief spreads, and, in the end, becomes irremediable ! It is the persuasion that much may be done towards preventing many of these dreadful ills, by a timely attention to this, their fertile source, that has induced me to offer to the world the following pages ; in which it is my intention, after having pointed out the danger of depending too much upon the fatal expectation of cold going off spontaneously^ to make the means of obviating the various causes which give rise to this destructive complaint more ge- nerally known and better understood, by society at large ; and, as its treatment almost exclusively falls within the province of domestic medicine, to lay down rules, familiar to every capacity, for preventing its fatal effects. And it is my ardent hope that these endeavours ^^ill not wholly fail in the promotion of that most desirable of all objects, the preservation of health ; without which " wealth, honours, and every other consideration, is insipid and even irk- some," 8 I would not be understood to imply, that eoldy or catarrh, is uniformly attended with danger. On the contrary, experience has convinced every one, that in the generality of instances, considering how frequently it occurs, it is perfectly innocent, and usually terminates in the course of a few days, either by an increased expectoration, or a spontaneous perspiration. It is only when aggravated, or rendered extremely frequent in its return, by neglect or imprudence, that it swells into importance, and, in the end, becomes a malady sufficiently formida- ble to combat and defeat the skill of the most experienced physician. There are two periods of life at which the bad effects of catarrh are most to be appre- hended : these are, /r^^, the advanced state y of youth, or the term comprehended be- tween the fifteenth and twenty- sixth year ; secondly, the decline of life : and a long list of dreadful maladies might be enume- rated, to which it occasionally gives rise. I wish, however, to confine the attention of the reader to three or four, which are its most frequent consequences : namely, in the young, pulmonary consumption, and pneumonia, or inflammation of the lungs; in the advanced in years, habitual cough^ and de Auctions from the lungs ; or that disease called chronic catarrh, or pituitous asthma, I believe I speak within compass, when I affirm, that at least eight out of every twelve cases of consumption, occurring in this country, have their foundations 10 laid in neglected cold*. The original seeds of the disease, it is true, have been pre- viously sown in the constitution ; but without being called into life and action by this exciting cause, they would, it is more than probable, in the generality of instances, have for ever lain dormant. . A person, whose pulmonary system is^ more than usually irritable, becomes the subject of a severe cold. He has often be- fore been similarly affected ; and, expecting it to go off spontaneously, as usual, pur- * Numerous authorities might be adduced in sup- port of this assertion, the truth of which, indeed, is universally admitted. I will content myself with re- ferring the reader to the observations of Dr. Hay- garth, vol. Ixiv and Ixv of the Philosophical Trans- actions f and of Dr. Willan, in his Reports of the 11 'Sues his various avocations, and takes no precautions for its removal ; and his ex- pectations soon appear about to be realized ; the violence of the cough, and all the unpleasant concomitant symptoms subside, and nothing but a slight tickling, at the upper part of the throat, occasionally giving rise to a gentle concussion of the thorax, hardly amounting to a cough, remains, and of which he is himself scarcely sensi- ble, although striking, by its peculiarity, to the observation of others. Light, however, as are his feelings, the mischief is now generally irreparable ; and the unfortunate sufferer is marked a victim to the disease, Diseases of London. Vide fi. 86. — What is said of Chester and London may, with little limitation, be ^applied to other places. 12 before he is even conscious of the approach of danger. The uneasy sensation at the larynx becomes more teazing, and at length excites a short intermitting cough, of a peculiarly hollow, hoarse sound*. This * Much has been said on the means by which a cough, truly phthisical, may be distinguished from. that which accompanies catarrh, when it is long pro- tracted ; or, in other words, decide the time at which the disease is catarrh^ and in which actual consumfi- tion. Some have thought that they can readily distin- guish a consumptive cough from a catarrhal, merely by the sound, which is peculiarly hoarse and hollow. Its being usually accompanied with vomiting is con- sidered, by Morton, as a striking and diagnostic mark J and Burserius insists upon the matter expectorated by early phthisical cough being characteristic in its appearance, and consisting of a fluid resembling water in which soap has been dissolved. These, however, are not uniformly present, and, though often well marked, 13 is generally, at first, falsely ascribed to some fresh attack of cold. It soon, however, be- are liable to 'deceive ; the only sure criterion being the expectoration becoming purulent, while the fever assumes the hectic form, characterized by being that oi di quotidian remittent; the chief exacerbation of which commences about five o'clock in the afternoon, goes on increasing till after midnight, is attended with a circumscribed flush upon the cheek, excessive thirst, and a sense of burning heat in the palms of the hands and soles of the feet, and terminates, as morning ad- vances, with a profuse sweat. Dr.Heberden observes, that most coughs n:iturally tend to pulmonary phthisis ; but as there have been many examples of coughs, apparently consumptive, remaining in a tolerable state for twenty years, and which, with proper care, might remain so to the end of life, it is impossible to prognosticate the event, hov/- ever strong the tendency may be, without being able to predict also what will be the patient's manner of B 14 comes an inseparable companion, and in the end is excited by every thing which tends to hurry or impede the breathing. It is generally worst in the evening, du- ring the night, or in a horizontal posture, and upon awakening from a sleep of some continuance; it is, however, as yet, un- attended with fever ; or the febrile symp- toms are so slight as hardly to be perceiv- ed. It is either quite dry, or accompanied with an expectoration of a small quantity of a thin frothy matter, which differs from that of true catarrh, in being easily diffu- sible in other fluids. Sooner or later, the general health becomes impaired, the appe- tite is lost, the nights are restless, and a living, and whether he will always escape fresh colds, &c., &c. Fide Heberden, Comment, de JMorb. Hist. et Curat, c. 92. 15 total disinclination takes place to every kind of bodily exertion. " The vigour sinks, the habit melts away ; The cheerful, pure, and animated bloom Dies from the face, with squalid atrophy Devoured." At length the fatal hectic makes its appearance ; the expectoration becomes purulent^ and a supervening train of horrid symptoms too clearly point out the inevi- table approach of death, to every one but the miserable victim himself-* ; who, * Strange as it may appear, amidst all the horrors of this situation, the patient's hopes seldom abandon him, and generally even increase, as the fatal termina- tion advances. This illusion is not confined to those who are ignorant of medicine; " I have seen," says Dessanet, " physicians just expiring with this com- 16 under the influence of a happy illusion, is amused by hope, and confident of re- covery, amidst a dreadful complication of distress ; and often dies while projecting schemes of future interest or amusement*. plaint, who would not a,dmit that they were consump- tive." A late eminent teacher of anatomy, in his very last lecture (at a time when the symptoms of con- firmed decline were too obvious to be mistaken by the youngest of his pupils), speaking of this circum- stance whilst describing the structure of the lungs, observed : " This deceitful persuasion is not to be v/ondered at in those who have not studied physic j but that any man to whom frequent observations must have made every fatal symptom so familiar, can be blind to his own situation, is truly wonderful." He himself died of phthisis within the fortnight. * There are certain classes of people who appear to be exempted from the ill consequences of catarrh, as far as relates to its termination in consumption. 17 The other disease which I have men- tioned, as occurring more particularly in the early periods of life, in consequence of aggravated cold, is an inflammation of the lungs, produced by an extension of the in- flammatory affection of the trachea and bronchias. When this occurs, the person, after having for some time been the sub- ject of cough, attended with oppression and sense of weight referred to the chest, with more or less difficulty of breathing, That butchers Rndjlshzvives avQ hardly ever known t© die consumptive, is an established fact. The same has been observed of catgut-makers, sailors and luatermen, stable-boys^ groo7ns, and, in a less degree, gardeners, and certain small farmers who assist in cultivating their own lands. Ail these, hov/ever, are liable to colds as other people. Vide Beddoes. Early Signs^ iJ'c.., of ConsumpJioii , 32 18 is suddenly seized with a severe pain in a particular part of the chest ; his respira- tion becomes extremely laborious and painful, and an acute fever, attended with the most urgent symptoms, supervenes : a state always attended with the utmost danger. People advanced beyond the middle age are extremely subject to a complaint, which, when once established, almost in- variably becomes their inseparable tormen- tor for the remainder of life. It is cha- racterized by the following combination of symptoms : a habitual cough, coming on, for the most part, in the form of pa^ roxysms or fits, often extremely violent, and occasionally accompanied with severe pains ia the head ; a copious and almost 19 continual expectoration of a white, viscid, frothy matter ; oppression at the chest, and a wheezing, laborious respiration. These symptoms, during the spring and summer months, are usually considerably alleviated ; but every succeeding winter brings them on with redoubled severity, until the constitu- tion becomes broken : the patient is agi- tated and fatigued ; he is deprived of rest ; a lurking fever preys upon his vitals ; his lungs are shaken, and their action impaired ; digestion, and all the other functions essen- tial to life, are impeded; and at length he is relieved, by friendly Death, from a state of the most miserable existence. Ask the majority of these sufferers, to what they ascribe the origin of their maladies, and they will uniformly tell you, neglected cold. 20 The sensations of what is commonly called having a cold are, in this climate, so universally well known as hardly to need description. There are very few but must, more or less frequently, have experienced some or all of the following symptoms : lassitude or weariness; a sense of chilli- ness alternating with glows of heat upon the skin, referred more particularly to the face and chest ; stuffing of the nose : more or less obtuse pain of the head ; frequent sneezing ; a disagreeable dryness and huski- ness in the nostrils, followed by the dis- tillation of a thin acrid fluid from these, and from the eyes, which are red and sore ; and cough, together with hoarseness, sore- ness of the trachea, some difficulty of breathing, loss of appetite, sense of general 21 indisposition, and a slight degree of fe- ver (2). These have their origin in an inflamma- tory affection of the delicate mucous mem- brane which lines the passage through which the air passes in respiration ; and they vary as the part more immediately affected happens to be the nostrils^ the throaty or the chest. When the disorder chiefly occupies the nostrils and contiguous cavities, the cough and disposition to fever are only slight ; the prominent symptoms being a dull pain, or sense of uncommon weight in the fore- head, redness and turgescence of the eyes, and a distressing fulness and heat in the nostrils. These are soon followed by a 22 copious excretion of mucous fluid from the parts, which most commonly proves a so- lution of the complaint. This is what is commonly understood by the term a cold in the head^ and is the most simple form of the complaint. Sometimes the inflamma- tion is nearly confined to the throat (tra- chea^ larynx^ and adjacent parts) ; in this case the affection of the head is inconsi- derable, but the cough is more severe, and commonly attended with more or less sore throat. Frequently, however, it extends to the ramifications of the air- tube, and occu- pies the greater part of the internal surface of the bronchial system ; when the breath- ing becomes laborious and wheezing, the fever is often considerable, and the disorder assumes its most severe form. 23 Having made these preliminary observa- tions, I shall now enumerate the various causes by which colds are liable to be pro- duced, and afterwards proceed to speak of the best mode of treating them. The causes of disease are usually divided into^^rst, predisposing, or those which ren- der the body susceptible of its attacks; and, secondly, exciting, or those which, when applied to the body, under a state of pre- disposition, excite disease into action. The predisposing causes of catarrh are, 1st, original peculiarity of constitution ; 2dly, an acquired morbid irritability of the pulmonary system ; 3dly, a morbid delicacy of frame, induced by enervating indulgences, or weakening occupations ; 24 or occasional and accidental debility. Its exciting causes are, 1st, alternations of temperature ; 2dly, the application of chemical or mechanical stimuli to the mu- cous membrane of the air passages ; 3dly, moisture applied, in a certain way, to the surface of the body ; 4thly, occult intem- peries of the atmosphere. These it will be necessary to consider separately. 25 I.— PREDISPOSING CAUSES. 1st. — Original peculiarity of constitutio «. Although every one is, more or less, liable to be affected with catarrh, yet there are some whose constitutions render them more particularly obnoxious to its attacks. Owing to a peculiarity of organization, or of the physical condition and composi- tion of the human frame, the constitutions of different individuals are hardly less va- rious than their external form and struc- ture, and give to each a predisposition to certain diseases in preference to others. These varieties have been classed, by phy- 26 siologists, under four heads, from an ancient and erroneous theory, called temperaments^ namely, the sanguineous^ the phlegmatic^ the choleric, and the melancholic. It is in the first of these constitutions that the propensity to what, in common language, is termed taking cold is most observable. The sanguineous tempera- ment is characterized by the following marks : a fair, rosy complexion ; light hair and eyes ; a smooth, soft skin, through which the large blue veins are usually re- markably conspicuous, often assuming a mottled appearance, in consequence of its transparency, which allows of the vessels being seen beneath ; remarkable sensibility, irritability of frame ; and, w^ith regard to the mind, gaiety, volatility, and, generally, 27 uncommon versatility : ideas and impres- sions changing in rapid and capricious suc- cession. The most remarkable instance of extreme susceptibility of catarrh, that has ever come under my own observation, oc- curred in a younglady, in whom the constitu- tion above described was exquisitely marked. So excessively irritable was her nervous system, as even to render her existence mi- serable : the shghtest sudden and unexpect- ed impression upon the mind or senses being sufficient to produce an agitation of frame, under which the pulse Vvould in- crease in frequency often to 110 beats in the minute, and the whole surface of the body would become suffused in one conti- nuous blush. Every inconsiderable alter- nation in the temperature occasioned her to become the subject of catarrh. I once 28 had occasion to attend her for some local afFection, which required the apphcation of cloths, wetted with vinegar and water ; the consequence of their use was a very severe ' cough, attended with urgent symptoms of pulmonary disorder. Upon my expressing some surprise at this extraordinary suscep- tibility, she assured me, that, in the winter months, she seldom plunged her hands into cold water, after having been heated by a warm room, without experiencing a con- siderable rigour, with a sense of oppression at the chest, which, upon again coming near the fire, was uniformly followed by sneezing and tickling at the larynx. A frequent repetition of catarrh at length brought into action a tubercular afFection of the kings, which terminated her existence by a rapid decline, at the age of twenty-two. 29 In these constitutions, the bad efFects of colds are more especially to be dreaded, if there exist, at the same time, that faiilt}^ conformation of the thorax termed a narrow chest. This peculiarity is occasioned by the breast-bone being pressed too much in upon the lungs ; and the shoulder blades, in consequence, thrust out from their pro- per position, and made to assume, in some measure, the form of wings : hence the chest appears flattened or depressed in front, whilst its sides are unnaturally protruded^ When this mal- conformation exists in an}' considerable degree, the neck usually is, or at least appears to be, unnaturally long and slender. Combined also with the sanguineous temperament, are often certain character- G 2 30 istics which mark a disposition to the dis- ease called struma or scrofula. These are, large eyes, an expanded pupil, swollen eye- brows, a peculiar softness of the hair, thick nose, tumid upper lip, a skin unnaturally soft and yielding to the feel, sound teeth, with a singular degree of whiteness and transparency^", a peculiarly clubbed appear- ance of the ends of the fingers, hollow tem- ples, elevated cheek-bones, disposition either to incurvation or reflection of the nails. In these constitutions particularly, the complaint of which we are treating can- not be too justly dreaded, or too carefully guarded against ; its frequent occurrence usually proving the exciting cause to that state of the lungs which terminates in the * Vid^ Simmons on Consumption. 31 most deplorable disease incident to mankind, and by which thousands are yearly carried to an untimely grave ; namely, scrofulom eonsumption. But however predisposed to disease the constitution may be, by carefully guarding against the causes which more immediately produce it, its dreaded incursions may usu- ally be prevented, and health may often be preserved to old age. " With what ease,'* observes Dr. Fothergill*, ** would many of the most incurable consumptions have been prevented, or cured, at their first com- mencement ! A person, whose emaciated figure strikes you with horror, his forehead covered with drops of sweat, his cheeks * See Medical Observations and Inquiries, voLiv. 32 painted with livid crimson, his eyes sunk, all the littie fat which raised them in their orbits, and every where else, being wasted, his pulse quick and tremulous ; his nails bending over the ends of his fingers ; the palms of his hands as dry as they are pain- fully hot to the touch ; his breath offensive, quick, and laborious ; his cough incessant, scarce allowing him time to tell you, that some months ago he ^o^ a cold; but, per- haps, he knew not how he got it ; he neg- lected it for this very reason, and neg- lected every means of assistance, till the mischief was become incurable, and scarce- ly left a hope of palliation. You see mul- titudes of such objects daily, and see them with a mixture of anger and compassion: for their neglect and their sufferings." 33 2d. An acquired morbid irritability of the pulmonary system* It may be regarded as an established law ill the animal economy, that the irritability of a part shall be increased in proportion to the frequency of the repetition of the im- pressions of stimuli. This is very remark- ably observable with regard to the pulmo- nary system. The liability of the bronchial membrane to be affected increases with every repetition of disease ; one irritation paves the way for another ; and every dis- eased action renders the parts more prone to a succeeding one, until, in time, the most trivial cause becomes sufficient to produce the morbid effect. Thus one cold may be justly said to be the predisposing cause of 34 another ; and thus it is, that catarrh ope- rates in producing more formidable dis- eases. An excessive susceptibility is cre- ated, every fresh attack spreads the mis- chief v/ider, the more minute ramifications of the bronchise become affected, and at length either the substance of the lungs puts on that peculiar action which produces tuber- cles, and these, inflamed and matured by subsequent attacks, become a fatal phthisis ; or the membrane itself assumes that distress- ing state of chronic disease we have already spoken of under the name oi chronic catarrh, ov pituitous asthma. The importance, therefore, of avoiding the exciting causes of a disease, so insidious in its nature, cannot be too strongly insisted upon, more particularly in the early periods 35 of life, and in constitutions peculiarly ob- noxious to its attacks. " How often is the meridian and close of life obscured by- clouds of misery, from inattention, or mis- management, in the helpless period of infancy !" There is a powerful cause, producing a permanent state of morbid irritability of the mucous membrane of the air passages, from which, however, the generality of in- dividuals are exempt; it being, fortunately, peculiar to certain artificers. This is the frequent introduction of mechanical sti- muli with the inspired air. The air, thus impregnated with extraneous matter, is in- cessantly irritating the parts through which it passes ; in consequence of which they are perpetually the subject of catai'rh, and often early die consumptive. 36 Of the artisans whose misfortune it is to be rendered thus peculiarly obnoxious to disease, the following are the principal : needle-pointers*, the dressers of flax and feathers, stone-cutters, millersf, bakers, bricklayers' labourers, laboratory men, coal * In thtjifth volume of Memoirs of the Medical Society, we are presented with a very interesting paper, by Dr. Johnston, in which he informs us, that persons employed in the pointing of needles, by dry grinding them, are quickly affected with cough, purulent, and, occasionally, bloody expectoration, and scarcely ever attain the age of forty years. t Millers and bakers, although from the nature of their employment extremely liable to coughs and cold, are said seldom to die consumptive. The same has been observed of jafianners, whose work is car- ried on in an atmosphere of resinous vapour.— iB^rf- does on the Causes, ^c, 0/ Consumption. 37 heavers, chimney-sweepers, hair-dressers, workmen in the warehouses of leather- sellers, workers in plaster of Paris and marble^, those employed in the spinning of silk, cotton, flax, hemp, &c.t, lace weav- ers, tailorsj. — Many persons, thus en- gaged, struggle with a constant, hard, troublesome cough, with oppression at the chest, until it terminates in a pulmonary disease, which proves fatal to them. * The pulmonary affection incident to these arti- ficers has, in France, where it is more frequently observed, obtained the name of the maladic de gres. t Vide Statistical Refiorts for Scotland. \ Scythe grinders are said to be particularly dis- posed to catarrh and consumption.^ — ose most in use are, emetic tartar ( antiynonium tartarisatum) James' powder, and the antimonial powder (pulvis antimonialia); of these the emetic tartar is by far most equal in its operation. Full vomiting, at the commencement of the com- plaint, will seldom fail to prevent its further pro- gress; but the exciting this unpleasant operation by art, would, by most people, perhaps, be considered a remedy even worse than the disease (32) ; but those who have courage to take an emetic upon first feel- ing the symptoms which announce the approach of a severe catarrh, will uniformly find these removed, and the occurrence of those which would otherwise have supervened prevented by its operation. Vide farther observations on the use of emetics, p. 184. 155 a very gentle nausea, without creating any- considerable degree of uncomfortable sen- sation. In younger subjects, or under pe- culiarities of constitution, it must be pro« portionately more diluted* (33). * Take of emetic tartar (antimonium tartarua* turn) four grains; pure cold water two pints : Dissolve the emetic tartar in the water by tritura- tion. — Of this solution from a quarter to half a puit may be taken every five or six hours. In cases where, notwithstanding the use of the so- lution, the skin remains obstinately dry, and there is a general feverish disposition, either the following saline neutral draught, or one of the pills, may be added with advantage to each dose : Take of fresh lemon-juice half an ounce by mea- sure; salt of tartar (kali fir^fiaratum) one scruple ; 156 Thus administered, during the period in which a state of actual inflammatory action is going on in the mucous membrane, this remedy seldom fails to induce a speedy solution of the complaint; but wherever a cold, either in consequence of its severity, laudanum (tinctura ofiii) ten drops : Mix the salt of tartar with the lemon-juice, and upon the ceasing of the effervescence add the lau- danum. Take of calomel (calomelas) four grains ; purified opium (extractum ofiii) three grains ; or, of the extract of white poppies (extractum pafiaveris alhi) six grains : Beat these together until they become intimately mixed, and divide the mass into six pills. These, conjoined with the use of the emetic tartar, are sin- gularly beneficial in all febrile affections. 157 or from its having been neglected in the first instance, runs oiit to a considerable length, it is usually kept up by a state of simple irritation of the part, which super- venes upon the disappearance of the inflam- mation^ and becomes as it were habitual, exciting the vessels to an increased secre- tion of mucus, and producing cough by sympathy with the larynx. In this state^ recourse should be had to the use of digi- talis^ (fox-glove) (34), which will be found * The digitalis^ ovfox'glove, is most commodi- ously and effectually administered in the form of tincture; but I beg leave to recommend to those who employ this remedy, to be careful in procuring it of an apothecary or druggist upon whom they can rely for the accuracy of its preparation, as, when pi'epared incautiously, the dose is liable to the great- -est uncertainty. The dose of \X\q fox-glove^ in tinc- o 158 .in the highest degree beneficial, and its efficacy will be increased by the patient's ture, is from five to fifteen drops every six hours. It may be administered in any convenient vehicle^ and its use should be persevered in till a sensible mitigation of the symptoms takes place, unless it should previously produce either a disposition to sickness, pain in the region of the stomach, giddiness and pain in the head, or a very considerable reduc- tion of the frequency of the pulse; in all vi^hich cases it should immediately be discontinued. In this stage of catarrh, ofiium also may be ad- ministered with the best effects. Of still more con- siderable efficacy, however, I am inclined to believe, is the extract ofivhite popiiies. This remedy, how- ever, is usually given in doses too small to produce any effect : administered in .the dose of five grains, every three, four, or five hours, according to the age and constitution of the patient, it will be found a very useful medicine in all those tickling coughs that re- main after the inflammatory stage of catarrh. 159 inhaling, at the same time, the vapour aris- ing from cicuta (hemlock) and aether^ in the manner prescribed below^. In pro- tracted catarrhs, likewise, I have often known much benefit derived from wearing a warm adhesive plaster upon the chestf . * In an inhaler, or common tea-pot, mix a spoon- full of (Zther with about half a drachm of the extract of cicuta^ previously dissolved in a tea-cupful of boiling water ; close the lid with care, and set the whole in a pan of warm water, when the vapour may be inhaled through the spout of the vessel con- taining the ingredients. t Take of pure gum ammoniac (gum amino- niacumj, vinegar of squills (ace turn scilU)^ each two drachms ; soft extract of opium (opium fiuri- Jicatum) a scruple : First reduce the gum ammonial into a fine powder. 160 This appears to be serviceable chiefly by defending the part from partial cold. The more prominent symptoms of ca- tarrh, and, in consequence, those which then add the other ingredients, and nib the whole together until it forms a thick consistent paste. This, spread upon leather, should be applied to the chest in its recent state, and suffered to remain on until it loosens spontaneously. Dr. Buchan speaks in the highest terms of the use of a Burgundy pitch plaster worn upon the back. Why it should be applied to the back in preference to the front of the chest, I am at a loss to con- ceive (35). The external use of various articles of the materia medica is occasionally resorted to with more or less advantage ; camphor is said to have been used with the best effect. Vide Le?itWy J^eo- bacht, Efiidem. Isfc.jfi. 158. 161 are liable to be most urgent, are, cough, gravedo (or obtuse pain and weight in the fore part of the head), oppression at the chest, with difficulty of breathing, and sore throat. The first of these is uniformly present, is often extremely urgent and severe, and IS usually that to which the patient directs the chief part of his attention. The medicines commonly employed for the purpose of alleviating cough are demulcents and opiates; of which a list is subjoined^; but the syrup of white pop- * Take of best purified honey, oil of sweet almonds, each two ounces ; fresh lemon juice one ounce ; syrup of white poppies half an ounces o2 162 pies, in the dose of a moderate-sized tea- Mix by triture to form a linctus. — Dose, a tea- spoonful whenever the cough is most troublesome. Take of oil of sweet almonds one ounce ; pure rain water half a pint ; salt of tartar five grains ; purified sugar half an ounce. Bissolve the salt of tartar and the sugar in the water, and afterwards add the oil, when, by agitating the phial, an emulsion will be formed of cream-like appearance. To this add paregoric elixir ftincnira opu ca?n/ihorataJ half an ounce. In making this emulsion, it is necessary to em- ploy soft water, otherwise, the oil will not combine 163 spoonful, upon the first feeling of the tickling in the throat, is not only the intimately with the other ingredients; but if this cannot readily be procured, the oil may be dissolved equally well by triturating it with the yolk of an eg^, and afterwards gradually adding the water. When it is prepared in this way, the alkali may be omitted ; its only use being that of a solvent. It is here supposed that the patient is at the same time taking the antimony^ as directed above ; but where this is not the case, the addition of a grain and a half of emetic tartar, to the above, may be made with advantage. The following emulsion is some- what similar : Take of oil of sweet almonds one ounce ;' barley-water six ounces j best white sugar, 164 most simple, but, I am inclined to believe, the most effectual. pulverized gum arable, each half an ounce ; laudanum (tinctura opii) forty drops. Incorporate the sugar and gum arable together in a mortar, with a small quantity of the water, then gradually mix the oil, and afterwards add, by little at a time, the remaining portion of the water with the laudanum. Spermaceti is often employed, under various forms, as a remedy for cough, as well on account of its demulcent quality, as from an idea of its pro- moting expectoration. Its expectorant quality, however, is extremely trifling, and as the liquid mixture made of it is very liable to turn sour, even in the course of a few hours, the preceding formulas are to be preferred. When it is employed, the 165 The pain and heaviness in the head, which often occurs in this complaint to form of a linctus is preferable to that of an emul- sion. The foUowmg is a convenient/ormw/a; Take of spermaceti (previously reduced to a fine powder, by being triturated with a lit- tle spirit of any kind) one ounce ; yolk of an egg, or mucilage of gum ara- bic (prepared by dissolving half an ounce of gum in an ounce of warm water), one ounce ; conserve of roses, syrup of white poppies, each half an ounce. Kub the sfiermaceti with the egg^ or mucilage, until they form a tenacious paste, then add the con- serve, and, lastly, the syru/i j when the whole being incorporated will form a grateful linctus. 166 a distressing degree, may be generally much relieved by holding the head over Sfianish liquorice^ lozenges of various kinds, soft marmalades^ currant and raspberry jellies^ rob of eldery sugar candy, barley sugar, i^c, is'c, are re- medies in universal use for the purpose of allaying the tickling which produces cough. The effect of all remedies of this kind is to smear over the glottis and fauces, and, by thus sheathing them, rendering them less sensible to the irritation. As they have the advantage of being innocent, and are usually found to afford a temporary relief, they may, in every case, be resorted to with advantage as pallia- tives ; further than this they have no effect. Troches, prepared after the following recipe, are often found to have a wonderful efficacy in allaying tickling coughs, and promoting expectoration: Take of purified opium, two scruples ; tincture of balsam of Tr>lu, (tinctura 167 the steam of hot water, impregnated bahaini ToLutani) two drachms, by mea- sure ; syrup, composed of one part water, and two parts purified sugar, four ounces ; refined Spanish liquorice, previously moistened with a little warm water so as to make it soft ; gum arabic, in fine powder, each two ounces and a half; emetic tartar, eight grains : Rub the ofiium and the emetic tartar with the tincture and the syrup until the former is perfectly dissolved, then add the liquorice, softened with warm water, and, whilst beating them together, gradually sprinkle in the gum arabic. Divide the mass into troches, each weighmg ten grains, and exsiccate them gradually in the air. 168 with camphor*. Applying aether to the forehead by means of a feather is often resorted to with advantage ; as is also the use of sternutatoriesf and siala- Dr. Buchan strenuously recommends the use of the following infusion: Take of liquorice one ounce ; salt of tartar three drachms ', boiling water two pints : Infuse for one night, and to the strained liquor add an ounce and a half of syrup of white poppies. Dose — A tea-cupful three or four times a day. * Vide page 179, et seq. t Common snuff proves errhine to those who art not snuff-takers ; but for those who have accustomed themselves to this stimulus, a more powerful one 169 gogues^ ; but when the pain is extremely severe, the patient will experience most relief from a blister applied to one or both temples. In cases of catarrh, attended with considerable pain and oppression of the chest, it will be necessary to apply a blister to the pit of the stomach, and this should never be omitted when the breathing is much affected (36)* will be necessary, as the herb-snufF, ov pulvis asari compositus of the pharmacopoeias, which may be procured of the druggist. * The best sialagogue is the pellitory-root (radix jihyrethri, pellitory of Spain). A piece of this should be held in the mouth, and chewed until it excites a <:opious flow of saliva. P 170 An inflammation of the throat, pro- ducing soreness, tumefaction, and pain or difficulty in swallowing, is usually con- sidered a distinct complaint, and deno- minated quincy^ ; but as it often also occurs, in a less degree, in consequence of an extension of the affection of the nerves and trachea, in catarrh, I have mentioned it as an occasional symptom of this com- plaint, under the common term of sore throat. When it is present in a slight degree only, it may, generally, be readily removed by keeping small portions of nitre in the mouth, and swallowing them as they slowly dissolvef ; as also by the frequent * Cynanche. Cullen. Synopsis jYosolog. Cl. 1 . Ord. 2. t Take of purified nitre two drachms ; refined sugar, reduced to a fine powder, six drachms; 171 ©ccasional use of emollient and detergent gargles*. The treatment of cases of a more severe nature does not fall within the province of domestic medicine. pulverized gum tragacanth three drachms: Beat these together with a small portion of water, until they are intimately mixed and form a coherent mass, which may be divided into moderate-sized troches^ or lozenges, to be dried by means of a gentle heat. * Boil about half an ounce of raisins, or figs, in half a pint of new milk ; and to the decoction, when cold, add a drachm of sal volatile (spiritus amraQiii^ compositus) : or. Take of barley-water six ounces ; honey of roses (mel rosaj one ounce ; lemon juice half an ounce. Mix. A portion of either of these may be used as a gargle every three or four hours. 172 An unpleasant and not an unfrequenfe sequel of this complaint is, a partial or com- plete loss of voice, depending upon a state of the muscles subservient to speech, ap- proaching to palsy. This is sometimes only of a very temporary nature ; at others, it has been known to continue for several months after the disappearance of the other symptoms ; and, in some in- stances, the speech, after having been thus lost, has suddenly returned for a minute, and, in the succeeding minute, has been again taken away. This symptom, al- though extremely distressing, should never excite alarm, as in no instance, I believe, has the loss of voice, produced in this way, been permanent (37). It is in general easily to be restored by the use of stimu- lating gargles, composed of mustard seeds^ 173 and horse- raddish*, or by frequently retain- ing, for some time, in the mouth a piece of horse-raddish, or pellitory root\^ at the same time that the patient removes to a pure air, and, if in a state of debility, endeavours to invigorate his constitution by nutritious diet, and regular exercise. This symptom has been known to be instantly removed by means of electricity^ and also by inspiring oxygen^ or pure air, * Take of mustard seeds bruised, horse-raddish cut into small slices, each half an ounce ; boiling water half a pint. Steep the mustard and horse-raddish in the water in a covered vessel, for the space of an hour, then strain the infusion, and, when cold, add to it a drachm of sal volatile, or hartshorn. "**^"t Radix pijrethri. p 2 174 A case once occurred to me, in which not only a loss of voice, but a partial palsy of the muscles of deglutition, producing an imperfection, and, at times, a total inca- pacity of swallowing, ensued upon the dis- appearance of a severe catarrh, attended with sore throat ; and which did not entire- ly go off for the space of a month. In this case, the patient was in the habit always, previous to an attempt to deglutition, to suf- fer a tea-spoonful of brandy to pass over the affected parts ; after which, she immediate- ly became capable of swallowing with ease, but again lost the pov/er of doing so, after the effect of the stimulus had worn off. I have now laid down that plan of cure, which I earnestly advise to be adopted in the domestic management of 175 colds, and which I flatter myself will be found to merit the attention of those to whom this complaint may be a source of distress. Before I quit the subject, how- ever, I will beg leave, as well for the ge- neral information of the reader, as for the purpose of correcting errors in judg- ment, to which those who are unacquaint- ed with the principles of medicine can- not fail to be liable, to offer a few re- marks on some of the principal popular remedies. I. Inhaling the vapour of hot water. This is a remedy which has been long in use in this complaint, and is strongly recommended by Boerhaave, Van Svvie- ton, sir John Pringle, Cullen, &c., in all inflammatory complaints of the chest. 176 A book, however, Has been written ex- pressly on the advantage of this practice, by Mr. Mudge, of Plymouth, who in- vented a machine, called an inhaler, for the purpose of conveyhig steam more commodiously to the trachea and lungs. In this publication, he declares, that a tea- spoonful of paregoric elixir, taken at bed- time, in some warm liquid, and the use of the warm vapour arising from sim- ple water, through this machine, will be sufficient to cure a catarrhous cough in a night's time*. It were happy, had the success attending its use answered the sanguine expectations of this author. It is certainly, however, a remedy of very con- ^derable efficacy, when employed under * Mudge on Catarrhous Cough. 177 certain circumstances of the disease, and may always be advantageously resorted to as an adjuvant, with due precaution, and an attention to the period of the complaint. Upon the first commencement of catan'h, and before the inflammatory affection of the trachea is completely formed, I have suspected, that it has often had the effect of rendering the subsequent symptoms more severe ; and this we may suppose, a priori^ to be the case in a majority of instances, where it is used too early ^ : but at a more advanced period of the complaint, it tends powerfully to arrest its progress, by increas- ing the secretion from the glands and ves- sels of the part, and thereby diminishing their inflammatory action. The vapour * Vide page 123, et -seq. 178 has been found most efficacious when im- pregnated with a sedative, as cicuta* fhem- hck)^ or the white poppy (papavur al- bum\J. Vinegar, and Hoffman's anodyne liquor fspiritus atheris vitriolici compose tusjj are also combined with it with advan- tage. A common funnel may be made to form a very good succedaneum for the in- haler, when this cannot be conveniently procured; the broad part being inverted over a vessel containing the water, and the steam being received by the mouth applied to the small end. * Vide page 159. t By means of boiling a few heads of the ivhite fiotifiy in the water, the steam of which is intended to be inspired. 179 II. Steaming the head. When the cdd chiefly occupies the head, it has been re- commended, by some people, to suffer the whole head, face, and neck to remain, for a considerable time, in contact with the steam of water, as hot as the patient can bear. This is advised to be done in the following way. While the patient sits up in bed, a pan containing two or three quarts of water may be placed immediately under and before his face, letting it rest on his lap, and a piece of flannel, not too thick, being put over the head, and extending un- der and around the pan ; this will keep the steam in contact with the face, neck and head, and, at the same time, will admit suf- ficient air for respiration*. In cases of * Hays on Coughs and Colds. 180 great stuffing up of the nose, and difficulty of breathing through the nostrils, I have known this practice have the effect of re- moving these symptoms in the course of a few hours; but it is seldom successful, where there is considerable pain and op- pression at the fore-part of the head, in con- sequence of some inflammation occupying the cavities communicating with the nos- trils. In this case, the symptoms are ge- nerally aggravated by the stimulus of the heat, III. Pedeluvium (38). Bathing the feet in luke-warm water, or bran and water, a little hotter than milk just taken from the cow, at the same time that something warm, as a glass of rum and water, sweetened with sugar, or water gruel, is taken internally, 181 forms a remedy upon which many people place their sole reliance for the removal of their colds. The pediluvium is a simple, and often found to be a powerful assistant to the operation of other remedies, by equalizing the circulation, and tending to promote sweat. In employing this prac- tice, however, much caution is neces- sary not to get fresh cold ; the feet should be carefully and speedily wiped dry, and afterwards wrapped up in a warm dry flan- nel, or the patient should immediately go into a warm bed. IV. Inspiration of artificial air. The reports of those who are advocates for pneumatic medicine represent the use of different kinds of factitious or modified air, inspired by means of an appropriate ap- 182 paratus, as having been productive of the best effects in cases of catarrh. In obsti- nate cases of the complaint the use of these may be resorted to with a fair prospect of success*. V. Opium and paregoric elixir. Pare- goric elixir is a very common, and, by a very large class of people, considered a so- vereign remedy for colds ; being supposed to possess some specific property. It also forms the basis of most of the cough drops vended by empirics. If a person who has not the means of obtaining better advice go to a chymistf, and enquire for the best * Vide the writings of Dr. Beddoes, Dr. Thom- ton, Cavallo, and others. t It is a common practice for druggists and chy- mists, as a means of retailing their medicines, to 183 remedy for a cold, he will be given (pro- vided at least the person to whom he ap- plies do not happen to be the vender of any quack medicine for this purpose) paregoric elixir. The properties of this medicine are diaphoretic, slightly expectorant, and anodyne ; it containing a grain of opium in about every thirty- six drops. It has recom- mendations from its simplicity, as well as from its efficacy ; for that it often has the best effect there can be no doubt : many people entirely depending upon it for the removal of their complaint, and are seldom disappointed in their expectations of its good effects. The form in which it is usually administered, is the value of a tea-spoonful give advice in simple cases, gratis, to the lower order of people who apply to them. 184 about every six hours, and the last thing upon going to bed. Its efficacy may be increased by adding to each dose about ten drops of antimonial wine. VI. Emetics, The operation of an emetic, besides its more immediate effect in evacuating the contents of the stomachy produces such a universal commotion in the system, as to excite every minute fibre into action ; and in this way it is that eme- tics prove salutary in the majority of com- plaints in which they are administered. They excite a new and powerful action, which expels or overbalances the pre-exist- ing weaker one. Thus they arrest the pro- gress of fever, and thus, if administered at the accession of catarrh, they will prevent the occurrence of the symptoms which 185 would otherwise infallibly ensue. In three cases out of four, perhaps, if upon feeling a stuffing of the nose, dull pain in the head, sneezing, and other symptoms which mark the commencement of the complaint, a per- son has resolution to try the experiment, he will find a brisk emetic have the effect of completely restoring him to his natural feel- ing* ; but I have before observed, that this is .a remedy so extremely unpleasant in its nature, that most people would rather put up with a cold than submit to its operation ; when the complaint, however, threatens to assume a very severe form, this plan of prevention may be resorted to with every prospect of success. Vomiting, from * On the use of emetics in catarrh. Vide Stoli Rat. Med. p. 7. ^2 186 whcitever cause, will also prove beneficial, not only at the commencement, but at every period of the complaint. Subjoined are the most convenient forms of emetics*. VII. Z);-. James* powder. All slight febrile dispositions, not sufficiently urgent * Take of powder of ipecacuanha from seven to fifteen grains, according to the age and strength of the patient ; emetic tartar one grain ; Mix them with a few table-spoonfuls either of water or white wine. Take of wine of i/iecacuanha from half an ounce to an ounce ; wine of antimony a drachm j Mix them. During the operation of an emetic, it is advisable to drink copiously of some warm diluent fluid, a^s cnamoir-ile tea, or warm water. 187 to call for medical advice (of which the principal is a severe cold), are usually- treated by the administration of James* powder • This is a preparation oi antimony^ apparently in no respect differing from the pulvts antimonialis of the London Pharma- copoeia than in being milder, and is perhaps the only patent medicine that can be re- garded as really useful. In the v^ay, how^- ever, in which it is usually made up by the venders*, it is liable to be administered in * Principally Newberry, the proprietor, and Per- rin, of Southampton-street, who professes to have made the medicine for many years under the direc- tion of the inventor. It is to be lamented that this medicine is sold at such an exorbitant price, each packet vended by Newberry being now charged half a crown, whereas its intrinsic value, exclusive of paper, &c., &c., cannot be more than one penny. 188 very unequal and uncertain doses ; a pack- et often containing some grains more or less than is specified* : a circumstance which may often be attended with inconve- nience, and perhaps with unpleasant conse- quences to the patient. I would recom- mend it, therefore, to every one who places any reliance upon this remedy, to weigh accurately the number of grains they design to take, or, if economy is an object to them, to supply its place with the common antimonial powder, which is in every res- pect an equally good medicine. The dose of this is from three to eight grains, made up into the form of a pill, or taken in a lit* tie honey or jelly. * Vide what is said on this subject by Mr. David- son, in his Observations on the Pulmonary System. 189 VIII. Patent medicines. Of the various medicines advertised as infallible remedies for the cure of coughs and colds ^ the more noted are — Perrin's balsam of lungwort*, Allen's balsam of liquoricef, the balsam of * Lungwort (fiulmonaria maculata^ pubnonaria •fficinalis^ Linn.) was formerly much employed m pulmonary complaints, but has long since been re- garded as perfectly inert, and is now deservedly fallen into disuse. With regard to this supposed preparation of it, it is much to be doubted whether a single grain of the plant is employed in the com- position. The lungwort possesses no properties that can be deemed balsamic, and the mucilaginous part of the plant, in which its virtues are supposed to reside, cannot be imparted to the spiritous men- struum with which the medicine in question is made. Vide Medical Obseruer^ A'b. l.p. 11. t Apparently consisting of nothing more than % 190 honey*, Godbould's vegetable balsamf, kind of paregoric elixir, impregnated with aniseeds. Med. Observer^ fi. 3. * Sold by Shaw, in St. Paul's Church-yard, and ad- vertised as being invented by sir John Hill. " A preparation which every one, the least versed in chymistry, must know could not, by any chymical process whatever, be made from honey. In phar- macy, or chymistry, there is no such preparation known as balsam of honey ^ nor is the spirit with which this pretended balsam is made capable of ex- tracting any of its medical properties." Med. Ob- server, p. 17. t " On examining this nostrum we do not discover any property that can possibly entitle it to the appel- lation of a balsam ; but the propriety of the term ve- getable we cannot dispute, since vinegar, sugar, and honey, are vegetable productions. We can, how- ever, positively deny, that it possesses the balsamic property of vegetables, and our examinations, as 191 Lucas' pure drops oflife^, Madden* s vege^ table essence-\, Solomon^ s cordial balm of ivell as the trials we have known to have been made with it, do not justify our attributing' to it any vir- tues superior to the common oxymel of the shops, although sold at the very exorbitant rate of eighteen shillings per pint, for which a regular chymist would be ashamed to ask as many pence." Med. Observer^ p. 33. * The title of this medicine is so truly ridiculous, and the complaints for which it is recommended so opposite in their nature (coughs and colds, consump- tions and cholera morbus), that it is extremely doubtful whether it possesses any property really useful, other than that of a simple carminative, which in complaints of the chest is often more likely to prove injurious than beneficial. t " Mr. Madden declares, that no mineral or me- tallic substance enters into the composition of bis 192 Gilead^, the balsam of horehound-f, the es- nostrum, but that it is merely a vegetable essence. It resembles much the infusion of roses of the Lon- don PharmacopcEia, both in taste and appearance, and the dose for an adult being only sixty drops, we are inclined to doubt much the accuracy of the as- sertion ; probably Mr. M. may not be aware that oil of vitriol is a mineral production ! It is by no means deserving of the title of an essence of vegeta- bles." Its having any efficacy whatever in the cure of coughs and colds may be reasonably suspected, if not positively denied. Vide Med. Observer^ fi. 50. * This is one of the most celebrated medicines that has been offered to the -world for many years past ; so extensive indeed has been its sale, that the proprietor has already made a princely fortune. Among its other boasted properties, it has lately been much extolled as a remedy for coughs and colds. 193 sence of horehound\^ the essence of colts- foot\^ various preparations of the balsam of Tolu^. Its title is not sufficient to convince us, neither does examination discover that it is, in the slightest de- gree, impregnated with the true balm of Gilead or Mecca. The author has suspected it to contain a preparation of the digatalis ; if this be really the case, the greatest degree of caution is required in its use. t The sensible qualities of the horehound ave, " a moderately aromatic smell and bitter taste." The coltsfoot has " a rough, mucilaginous taste, bu' no remarkable smell." How it is possible to make an essence from these indigenous plants, possessing their demulcent properties, is 'truly incomprehen- sible. * Balsam of Tolu is a very grateful medicine, in consequence of its having a warm, sweetish taste R 194 I here beg leave earnestly to recommend to every one who values the preservation of health, never to trust for the cure of any complaint, more especially an obstinate cough, to medicines of the description of those just mentioned ; or, in other word^, to the arcana of charlatans. Most of them, they may be assured, are either perfectly inert, or really hurtful. By resorting to these, therefore, and persisting in their use, they are liable to let slip the favourable op- and an extremely fragrant smell, somewhat resem- bling that of citrons. It is one of the reputed reme- dies for " coughs^ coldsy and co7isu7n/itzo7is." It re- quires, however, to be employed with some caution ; its properties are too stimulant to render its use ad- visable in recent coughs; in protracted ones, and under a weakened state of the lungs, it may prove beneficial by being balsamic and corroborant. 195 portunity, when, by more rational means, their heahh might have been easily restored, and their complaint, thus gaining ground under the use of an ineffectual remedy, will often become inveterate in its nature, and set all human skill at defiance. Even supposing the medicine employed really possesses the virtues ascribed to it by the proprietor, it cannot be equally applicable to all the various forms and stages of the complaint for which it is recommended. If in one state of a disease, judiciously ad- ministered, it prove a successful remedy, in another it must of consequence be in the highest degree injurious. When we reflect upon the extreme ig- norance of the generality of our empirics, and look to the unblushing impudence 196 with vvhich they usher into the world a col- lection of trash, the inefficacy of which it is in the power of every one, in the least ac- quainted with medicine, to detect, every Reflecting mind must be conscious of the mischief that must occasionally result from the destructive traffic in which they are suf- fered to proceed with impunity. It is the lower classes of society that are more especially liable to be taken in by the false assertions of these infamous venders of poison, and these almost uniformly pre- fer the use of a patent medicine to the ad- vice of a regular practitioner. The author of these pages, from having had the care of the poor in a very populous district, has often had an opportunity of observing this 197 fatal prepossession, and has repeatedly seen the industrious peasant, the pride of Bri- tain, fall a sacrifice to the delusion. It is only a short time since, that a poor and ho- nest fellow, who had been universally res- pected in the parish where he resided, for his industry and the economy which enabled him to support a large family with credit, ap- plied for advice, in an advanced stage of pulmonary consumption. Upon an inquiry into the history of his complaint, it ap- peared, that, by the strong recommendation of a neighbour, he had been induced to take a celebrated advertised medicine for coughs and colds, and had continued its use, under the firm persuasion of its infalli- bility, until the little money he had saved by industry was expended in purchasing it R 2 198 at the enormous price at which it is sold by the quack ; his lungs became incurably- diseased, for want of proper timely assist- ance, and in this state he was reduced to the necessity of applying to the parish for relief. Thus was a worthy and res- pectable family for ever deprived of their support, and society of a valuable member, by the barefaced protestations of an impu- dent empiric, who, totally ignorant of phy- sic, and the administration of remedies, and actually unable to spell one word out of three, correctly^ in his letters to his corres- pondents, from having been a journey- man BAKER, became at once a self-dubbed doctor, and unblushingly offered to the world the product of perhaps a few insipid vegetables, for the cure of a complaint 199 which even the judicious hand of science is too often unable to cope with. Doubt- less the Uves of many are yearly sacrificed in the same way. These fatal impositions are surely of sufficient importance to merit the attention of the legislature : the whole system of quackery cannot be too much reprobated by " every medical man, every friend to humanity, and every advocate for the respec- tability of our national character ; inasmuch as it not only affects the lives of the ignorant and credulous, but must tend to injure our professional reputation, and render us con- temptible abroad : for what opinion must the physicians on the continent form of us, on ob- serving, in our public prints, and in the Ham- 200 burgh papers*, specifics advertised for the cure of consumption, cancer, stone, the ve- nereal disease, without mercury, &c., when, from the very nature of those diseases, they must know that their different stages require different treatment? and what must the con- tinental chymists say on seeing such pre- parations as balsam of liquorice, balsam of horehound, balsam of honey, a concentrated solution of charcoal, &c.t, which they must know to be fictitious names? and it is a * " Many of this class of medicines the author has observed to be advertised in the Hamburgh Correspondence and American papers." t " In Russia, to the great disgrace of our country, the importation of English quack medicines has been prohibited, notwithstanding they were sanc- tioned by a patent from this country : a convincing proof of the wisdom and policy of that government." 201 well known fact, that the characters of our chy mists have so much suffered on the con- tinent, inconsequence of these dishonourable practices of empirics, that the medical men of France, Germany, Denmark, &c., sus- pect every preparation, or article in powder, coming from this country, to be adulterated. Thus the industrious and honest chymist is punished for the imposition of others*." IX. Pectoral lozenges* All lozenges are composed of powders made up with gluti- nous substances into little cakes, and after- wards dried, either in the air or by a slow fire. Those which are sold by chymists and patent medicine venders, under the ti- tle of cough lozenges, pectoral lozenges, * Medical Observer^ J^^imber 1.-/?. 5. 202 &c., &c., consist of saccharine matter va- riously impregnated. Many of these, no doubt, are made the vehicles of some use- ful expectorating medicine ; but I can take upon me to assert, that the greater number of them possess no property whatever, but that of a simple mucilage, flavoured with some grateful aromatic, and, in consequence, that they operate only as common liquorice, or sugar- candy, by smearing over, and tiiereby rendering the parts they cover in their descent less sensible to irritation. The following is a receipt for lozenges, at least equal in flavour, and, in all probability, superior in point of efiicacy, to any sold under a patent : Take of refined sugar, in fine powder, three ounces ; of raspberry jam one ounce ; 203 of finely pulverized gum arable one ounce-; of soft purified opium two scruples; of emetic tartar four grains. Rub the opium and the emetic tartar with the raspberry jam, until they are intimately incorporated, and then add the other ingredients, either with or without a little warm water, as the paste hap- pens to be more or less consistent. Form lozenges, each weighing about eight or ten grains, and dry them by means of a very gentle heat. To those who make their own lozenges, the following general rules may, perhaps, prove useful : "1. If the mass prove so glutinous as to stick to the fingers in making up, the hands may be anointed with any sweet or 204 aromatic oil, or else sprinkled with starch, or powder of liquorice, or flour." " 2. In order thoroughly to dry the lo- zenges, put them on an inverted sieve, in a shady, airy place, and frequently turn them." ** 3. Lozenges are to be kept in glass vessels, or in earthen ones well glazed."* X. Indigenous simples* A list of these, far too copious to enumerate, have long been in dome:;tic use, for the cure of coughs and colds. Our native herbs, how- ever, were formerly much more employed than they are at present ; but their good quJities have been carefully handed down to posterity, and are stiii held in religious 205 veneration by many a good old lady, who prides herself upon her knowledge of the healing art. I will not take upon me to decide whether they really possess the efB- cacy ascribed to them. The virtues of those in common estimation, for the cure of colds, appear to reside exclusively in the glutinous or mucilaginous matter with which many of them abound, and the in- fusions made of these are, in the language of our house- wives, '' soft and healing,'^^ Suffice it to observe, that those most fre- quently employed for this purpose are the marsh mallow^y the horehound^^ and the coltsfoot%, * ALthoea officinalis, Lin. t Marrubium alburn^ marrubium vulgar e. Lin. % Tu^silago. Farfara bechiavu S, ANNOTATIONS, EXPLANATORY AND PRACTICAL: IN WHICH IS EXHIBITED A NEW THEORY ©N THE ACTION OF MANY OF THE PREDISPOSING AND EXCITING CAUSES OF CATARRH; WITH ORIGINAL AND APPROVED RECEIPTS TOR THT CURE OF THAT DISORDER IN THE UNITED STATES. BY J. STUART, M. D., ^c. juvat integros accedere fonteis, Atque haurire: juvatque novos decerpere flores: Insignemque meo capiti petere inde coronam, Unde prius nuUi velarint tempera Musje. LucRET. lib. I. V. 926. NOTES, &c. 1. THE EXTENSIVE DOMINION OF CATARRH. Page 3. IT is much to be lamented, that the preceding paragraphs should contain truths of too general application to be confined to the island of Great Britain alone. They extend to every country and place on the globe, but to none are they more particularly applicable than to the climate of North America, and that of Philadelphia. 2. LOSS OF APPETITE. Page 21. The loss of appetite, in this climate, is by no means an inseparable attendant on catarrh ; on the contrary, in many cases, the appetite remains totally unimpaired, and, in some, it is increased almost to voraciousness. 210 3. AIR OF MANUFACTORIES AMELIORATED. Page 40. This, probably, is to be attributed as much to the rarity of the air, in such places, not admitting the usual quantit}^ of oxygen in a given volume, as to any other cause. Hence, might not this evil be remedied, or prevented, by increasing the rela- tive proportion of this principle by art ? 4. IRREGULARITY OF ANIMAL HEAT. Page 51. This may be accounted for, by supposing it to depend on an occasional increased compression of the cerebellum diminishing the susceptibilit}^ of the arterial system to stimuli. The same thing takes place in the comatous state of fever, when even that extremely delicate and sensible organ, the eye, may be touched with the finger, without evi- dencing the least sensibilit\'^ or symptom of ex- citement. 211 5. INCREASED ACTION ACCOUNTED FOR. Page 54. This rather happens from the re-accumulation of susceptibihty, by the abstraction of heat, which before acted with too much power for the system near a state of exhaustion. 6. THE ACTION OF HEAT. Page 54. This is a true state of exhaustion. Long-con- tinued heat so far transcends the action of the or- dinary stimuli of life, that the nervous system becomes insensible to these almost altogether, or, in the language of the day, excitability becomes exhausted. 212 7. or THE ACTION OF COLD. Page 55. Upon the application of intense or long-con- tinued cold to the extremities, debility in the ex- treme capillary arteries succeeds, and, consequent to this, a diminished circulation in the skin, which is followed by an imperfect oxygenation of the blood, which last, if the system be so balanced as to escape topical inflammation, always predis- poses to, or actually induces sleep. The same takes place in ascending the Alps, and in many other places surrounded by rarefied air. Vide M. Saussure. 8. UNITY OF DISEASE. Page 57. Did the doctrine of the unity of disease require any thing more than a knowledge of nature and of the functions of the animal economy for its support, this observation should certainly set it far beyond the p?Je of rontroversv. In it are con- 213 tained truths, than the knowledge of which no principle in medicine is of more importance in the cure of disease ; and yet, until the day of our American Hippocrates, how strangely have they been neglected ! 9. COMPARATIVE SCALE OF THE RELATIVE STRENGTH OF THE LUNGS AND SKIN. Page 58. Hence it may be inferred, that some parts of the system are relatively sti^onger at some times than at others ; and hence also might be formed a comparative scale of the strength of the lungs with that of other parts, and more particularly with that of the superficies. 10. CAUTION. Page ^'2,, In these observations is suggested the necessity of the greatest caution in approaching the fire, drinking stimulating liquors, the eating generous 214 and high-seasoned viands, lying under a great weight of hed-clothes, or in heated rooms ; after long exposure to cold, a camp life, &c., &c. 11. OF DRINKING COLD FLUIDS. Page 64. So many melancholy occurrences of this nature have happened in the different towns and cities of the United States, and more particularly such great numbers in the city of Philadelphia, that na opportunity of precautioning the inhabitants against an indulgence in drinking cold water, when warm, should ever be neglected. The pernicious consequences incident to this act of imprudence may be always avoided by waiting for the body to cool before drinking ; or by fre- quently rinsing the niouth, and washing the hands and face with some of the cold fluid, before any is swallowed; or, finally, by taking a very small portion at a time, until the appetite for it is some what allayed. 215 12. HYSTERIA AND ATONIC GOUT. Page 95. The ladies, in this and many other cold climates, are obser\-ed to be much subject to dyspepsia, hysteria, colic, and various other diseases termed nervous. These in most cases, it is presumed, may veiy justly be considered only so many forms of atonic gout, passing by the extremities, to use the words of a celebrated ph^'sician of this city, and arising from deficient excitement, by want of attention.to clothing these paits sufficiently warm. IS. OF FLANNELS WORN NEXT THE SKIN. Page 96. Better authority could not be adduced for the salutar}^ effects of wearing flannels next the skhu But when warm rooms, a large quantity of bed- clothing, warming of beds, and even clothing the body unusually wai'm, are considered predispos- ing causes to catarrh, and wearing flannels next the skin a preventive of the same disease, our 216 author certainly speaks in paradoxes. For if it be true, and, it is presumed, none will be hardy enough to deny, that the causes mentioned as noxi- ous must produce their hurtful effects by so pre- venting the escape of heat, generated in the body as to accumulate an artificial atmosphere too warm for the preservation of the functions of the body in a state of health and regularit)^, and that the good effects of flannel are to be attributed to its non-con- ducting powers alone, the vmqualified use of this last cannot be admitted without eminent danger of inducing a disposition to catarrh or cold. Howevef novel the doctrine, and however repug- nant tathe generally received opinion of physicians it may be, the editor is fully convinced, both from observation and experience, that the persons most indifferent to the use of flannels next the skin ai'e those only who could wear them with impunity, if not with advantage. These are the robust , and such as are addicted to much and laborious exer- cise. In these the mobilit)^ of the system is less, any occasional excess of action is not propagated firom one part to another with the same facility, and, of consequence, the circulation is more uni- form and regular. 217 Oa the other haiid, in weakly habits^ where there is seldom a well-balanced circulation for twenty-four hours in succession, the heat of the artificial atmosphere and that continual yric^io^i on the skin arising from the non-conducting proper- ties and the elasticity of the flannel, cannot but induce and keep up constant sensation, if not ge- jierate an occasional inflammatory^ diathesis, in that extensive and sympathizing organ. The mobility of these last subjects is such, that action is propa- gated with the greatest facility from one part to another the most remote ; hence a predisposition to catarrh, when present, is increased, or even generated, where no such existed before ; and nothing remains to produce the disease but the application of an exciting cause, which is always ready in the vicissitudes of temperature so fre- quent and sudden in the climates of North Ame- rica. To this may be added, that, after a long ex- posure to cold air, the temperature of the skin and of the clothing must always be reduced, while the excitability of the Schneiderian membrane must be greatly increased, or, in other words, it must be rendered much more susceptible to the action of heat or any other stimulus. On entering a warm T 218 room, under these circumstances, some time is required, by reason of the non-conducting powers of the flannels in contact with the skin, before the temperature of the room can reach the external surface of the body, while every inspiration, in the heated air, brings a most powerful and active sti- mulus immediately to the parts already debilitated by the coolness of the atmosphere without, and, by an accumulated excitability, in high prepara- tion for reflecting the action of stimuli. 14. ABSORPTION OF PERSPIRATION. Page 97. ' For the establishment of this doctrine, it seems necessary to prove that absorption of the perspi- ration is eificacious in preventing catarrh, other- wise this reasoning must be considered merely vox et prefer ea nihil. 219 15. OF THE ACTION OF FLANNELS WORN NEXT THE SKIN. Page 97. If flannels worn next the skin absorb perspira- tion, and evaporation strongly promote the dis- sipation of heat, how is it possible they should contribute to keep the system warm in winter and cool it in summer ? 16. OF FLANNELS WORN NEXT THE SKIN. Fag-e 102. Upon these principles it will appear, no cloth- ing, of any kind whatever, should be employed in such quantity as to produce sensation. When this is the case, it is a certain proof of its being too heavy. Clothing of every description should always be as much as possible accommodated to the state and vicissitudes of the climate in v*^hich we live ; but, on any sudden transition from a lower to a higher temperature, upon the principles here advanced, it is plain, warmer clothing ought 220 never to be exchanged for that which is much lighter. For it may be received as a genexal prin- ciple, that the exposure of the bod}^, or of any part of it, to a colder temperature, is ahvays suc- ceeded by an increased sensibility or susceptibility to the action of a warmer temperamre. Hence, as the inner surface of the lungs and the pituitary membrane, in its whole extent, are always imme- diately exposed to the action of the surrounding atmosphere, a diminution of clothing, by dimi- nishing the circulation on the extremities, must necessarily be followed by an increased determi- nation to these parts, and consequently catarrh or COLD. 17^ PRECAUTION. Fag-e 102. To these precautions maybe added those against an indulgence in animal food and high-seasoned viands, as they all produce the same effects, and are equally dangerous after exposure to cold% 221 18. OF THE DECOMPOSITION OF WATER BY ANIMALS. Page 105. That vegetables have the pov/er of decompos- ing water, and appropriating the constituent parts most congenial, to their nature and nourish- ment, is now incontrovertible, and that animals are endowed with the same or similar powers, the editor believes is not less certain. The great proportion of oxygen in the composition of water, and the extensive use of this among animals of every description, strongly intimates that this is the principle in v^ater exclusively appropriated by them. The editor has suggested an opinion, if not proved, that oxygen is directly sedative, in consequence of its power to unite with the blood, and thereby to remove the foreign nature of that fluid. The use of water by all anim.als, the circumstances under which it is most re- quired, and its effects under these circumstances, all tend to the confirmation of this doctrine. T 2 222 All animals seek this fluid after full meals, and with the more avidity as these are composed of food more than ordinarily stimulating. They seek it when under the influence of exercise ; in ardent and inflammatory fevers; and, finally, un- der all impressions from the influence of excessive stimuli (which are generally composed of highly -^attenuated carbon) ; and it always affords relief, or, at least, it proves a temporary remedy to the unpleasant sensations occasioned by these causes. Now, if oxygen were a direct stimulus, how should a fluid containing eleven parts of fourteen of this gas, and decomposable by the system, produce such strikingly sedative effects ? 19. OF THE ACTION OF OXYGEN. A NEW THEORY. Page 106. This doctrine, with respect to the modus ope- randi of oxygen, however generally received, is by no means the more con-ect. That ox3'gen is not directly stimulating I infer, 1st, Because, al- though a person long exposed to a contaminated 223 atmosphere, in which an insufficiency of this vivi- fying principle is contained, grows pale, although his system languish, although he is affected with a constant inappetancy to motion, yet is he la- bouring under an irritative febricula. 2ndly, That this is not from any deficiency of stimulus, but from an excess, I infer, because, in these cases, blood drawn exhibits an inflammatory crust, while a discharge, in this way, is always followed by temporary relief. This excess, I conceive, is to be attributed to an imperfect state of that fluid, when deficient in one of its elementary or con- stituent parts, oxygen gas. In consequence of this, it may be said, emphatically enough, to be only semi-animalized, and thereby itself to become a foreign fluid, and an inordinate stimulus to the arteries, which keeps up that constant irritation wherein the f^.ver consists. Sdl}", A removal to a more salubrious atmosphere, unless the patient is too much exhausted, is generally followed by a return of health; while the vuse of stimulating medicines is always succeeded by injurious ef- fects. Who, then, in his senses, could, for a mo- ment, suppose a cure like this eflected by any di- rectly stimulating effiects of oxygen, when bark, 224 wine, and other stimuli are employed with no better success than that of producing oedematous legs, obstructed viscera, and general dropsy? The fact is, oxygen, by uniting with the unassi-- milated parts of the blood, only changes its quali- ties from those of an unnatural fluid, to those more congenial to the arteries, and, thereby, gives the system respite from that constant irritation which excited and supported the disease. And, hence ^ the increase of excitement succeeding the use of oxygen, only results from the application of the ordinary stimuli of life, while oxygen does no more than to predispose the system for their influence, by removing the unhealthy stimulus of imperfect blood. r These observations are most clearly elucidated by the following facts. The editor having ob- served that many died of confluent small-pox, as late as the seventeenth, and even the twentieth day, and after all idiopathic symptoms of the dis- ease had ceased J that they generally laboured under great oppilation and oppression at the breast ; and that the blood taken in such cases was invariably sizy, suspected the cause of death 225 to exist in a failure of the skin to absorb a due supply of oxygen gas, in consequence of the ra- vages committed on this organ, by the disease. Upon these principles, he determined on supply- ing this defect, first indirectly by diminishing the quantity of fluids, and, afterwards, directly, by supplying the gas required immediately to the lungs. The difficulty of breathing, which before had been palliated by blood-letting, was much increased by the first few inspirations, but shortly after ceased altogether, w^hile the pulse grew much softer and more open. The same dose was again repeated with exactly the same success, until the twenty-first day, when, finding the means employed, however flattering the success at first, were only calculated to prolong the life of the patient, without affecting a radical cure of his suf- ferings, the further use of the remedy was de- clined, which was followed by the death of the patient, on the twenty-first from the attack* Nor does the theory here advanced rest upon this case alone; the same experiments have been since repeated with the same success, not only in this, but in other diseases wherein the sys- 226 tern was supposed to suffer from a privation of the same principle. No remedy was ever applied with more strongly marked success than this, in what was taken for angina pectoris. Bleeding, in this case, had been used with only temporary respite, while anti-phlogistics, blisters, and the whole catalogue of anti-spasmodics had all been em- ployed without the least advantage. Finally, upon these principles, with the concurrence of the other physician in attendance (Dr. Rush), oxygen gas was resorted to. On the first few inspirations, the cough, dyspnoea, and anxiety were evidently increased. The chagrin and dis- appointment occasioned by this were, how- ever, of such short duration, that it would seem they were sent as a foil to heighten the ex- hilarating sensations which were immediately to succeed. The countenance, from the depths of gloom and despondence, soon became tranquil and serene, the respiration became free and easy, while the pulse, which was before chorded and tense, soon became open and soft, and the unfor- tunate sufferer, in full enjoyment of long-sought 22! ease, and flushed with hopes of permanent relief, exclaimed, with enthusiasm, '' he plainly felt the gas pervade his very toes." It is worthy of re- mark, that, although the blood taken before the use of this remedy evidenced, in every^ instance, an uncommonly sizy appearance, a small portion taken afterwards did not exhibit the least pheno- menon of inflammation. 20. CATARRH BY CHANGE OF ATMOSPHERE. Page 107. The effects of a pm^e atmosphere, on those ac- customed to breathe one more contaminated, can be accounted for, on the principles advanced in this work, in the most satisfactory manner. The blood of those residing in large cities, abounding with the principle of carbon, has a much greater affinity to oxygen than that of more perfect elaboration. Hence, upon exposure to a pm-er atmosphere, in the countiy, the first effects must be an accumulation and detention of blood in the Schneiderian membrane, from that attraction before noticed between the superabounding carbo- 228 iiic principle in the blood and the increased pro- portion of oxygen in the air entering the nares, fauces, and lungs. This is succeeded by a local plethora, in this membrane in particular, while a rapid oxygenation of the general mass of blood must so increase the volume of fluids, as to induce the same state of the whole system, all which must necessarily increase a predisposition, or even produce one which before did not exist, to CATARRH. Hence also may be explained the good effects of the advice of our author. The blood of the children mentioned by him, supersaturated with the carbonic principle, on exposure to an atmos- phere, on the suburbs, containing but a slightly increased proportion of oxygen compared to that of the city, became so slowly oxygenated, that an increase'd determination and accumulation of blood in the Schneiderian membrane, and con- sequently catarrh, did not take place. The practical inference from this theory is, that all persons leaving large cities for the coun- try, will generally be much more exempt from 229 catarrh, . and every other inflammatory disease, by losing a little blood before their departure. 21. ACTION OF MUSK AND OF THE FUMES OF THE MURIATIC ACID ACCOUNTED FOR. Fag-e 111, In the note of the author on this page is con- tained the strongest confirmation of the truth of the principles advanced by the editor, on the ope- ration of oxygen gas. He is acquainted with a gentleman who is invariably affected with a cory- za (or catarrh), by the effluvia of musk. These two agents operate in a manner very different from each other. The action of the fumes of the oxygenated muriatic acid is compound. It pro* duces its effects, partly by a directly stimulating property applied immediately to the vessels of the Schneiderian membrane, and partly by the oxygen in its composition, as explained in Note 20. Musk, on the other hand, operates directly by its stimulating powers applied immediately to the sensible fibre. 230 22, OF MOISTURE. Page 113. " Moisture, agreeable to the theory here advan- ced, operates by absorbing and carrying off from the surface of the body the principle of caloric. By this means the extreme vessels, losing the stimulus of heat, become inactive, the circulation languishes, and the blood, in the skin, not ap- proaching the atmosphere at a proper distance, oxygenation fails. From the internal situation of the pituitary membrane in general, it must con- stantly preserv^e .a higher temperature than the superficies, and the momentum of the circulation will continue the same, while, in consequence of tl>e increased attraction of the blood now h}q)er- earbonated, to the oxygen in the atmosphere, a plethora in this membrane will take place, and that increased action Vv^ill folio v/, which constitutes CATARRH or COLD. 2-31 23. DECOMPOSITION OF SEA SALT.— A NEW THEORY. Pag^es 116 and 117. That part of the salutary powers of sea salt, ill counteracting the noxious effects of moisture, depend upon a diversion to the skin produced by the directly stimulating properties of that sub- stance, cannot be doubted. But, as these effects are not so evident from the application of alcohol, or any other substance more stimulating, it is pro- bable that the sea salt, by being applied particula- ?i;?z to the mouths of the seroinhalants (for it is pre- sumed there are such vessels), suffers decomposi- tion, from whence heat is evolved, vvhich adds directly to its stimulating powers ; while the oxy- gen absorbed, uniting with the abundant carbon in the blood,, takes off from its stimulating pro- perties, and thus, diminishing its attraction to the Qxygen in the atmosphere, prevents that retarda- tion of blood and consequent engorgement and inflammation in the pituitary membrane, in vv^hich consists the proximate cause of catarrh or COLD. 232 It was upon these principles I introduced, in the yellow fever of the ever-metnorable year of 1 798, a strong solution of sea salt in heated brandy, as an embrocation, to recal the lan- guishing circulation to the skin, with the great- est advantage. For it seldom failed, even where that alarming retreat of fever, generally the harbinger of dissolution, had commenced, to produce a return of heat to the skin, when sinapisms, blisters, and other the most stimulat- ing remedies had been tried in vain. The illus- tnous Priestley shov/ed that oxygen was absorbed by the blood through the dense membranes of a bladder. Tlie red colour of hams cured with saltDetre (kali nitrat.) proves that the muscular fibre has really the power of disengaging it from the coinpound of this salt. Why, then, under circumstances much more favourable, those of a constant and unifomi degj'ee of heat, assisted by the almost inscrutable functions of vitality, should not the blood, in the smaller order of cutaneous vessels, be- equal to the decomposition of this principle from sea salt? Reason approves the the theorv, and facts render it incontrovertible. 233 24. THE OPERATION OF COLD. Pa^e 122. Much has lately been said concerning the ope- ration of cold, or cool air, and the old question- again agitated, " whether it is a direct stimulus, or a sedative ;" and, however finnly the sedative operation is supported by its effects, some have lately gone so far, to support a contrary hypo- thesis, as to interdict the exposure of their pa- tients to its salutar)^ influence, even in the eruptive fever of small-pox. The strongest arguments of these theorists is deduced from their definition of a stimulus. ^' Any power is a stimulus (say they) which produces sensation^ motion^ or thought^'' Then, I would reply, is bleeding a stimulus ? By it is produced the sensations peculiar to s\Ticcpe \ bv it is produced ^o. motion of falling and con- vukio?i] and, finally, by it, in the timorous and weak, are produced thoughts or apprehensions cf dying. But of this enough. When we reflect on the .salutary effects of cool air in inflam- matory fevers, and its certain and almost imme- diate influence in checking, and even annihilating u2 234 the eruptive fever of small-pox, to argue against its stimulating powers, would be to abandon every principle in medicine. 25. RATIONALIA OF THE TWO PLANS OF TREATMENT. Page 124. However contradictory these two plans of cure at first view may appear, nothing can be more certain, than that they both occasionally succeed. But in order to determine on the most safe, and consequently the most advisable plan of the two, the RATIONALIA of each should be taken into con- sideration. That which admits of warm drinks, warm rooms, and warm air, when it operates in a manner the least dangerous, produces, by exces- sive excitement, such a relaxation of the exhalants of the bronchise as to admit of a secretion of mu- cus, or pus, which, though it relieve the topical in- flammation by what is called expectoration, either lays the foundation for chronic catarrh, or abso- lutely terminates in an incurable phthisis pulmo- nalis. Now, it is plain that, should these exhal- 235 ants not admit of an increased dilation of their areas, before the cellular texture interposed be- tween the air-cells and blood-vessels of the lungs should give way, this treatment must give rise to inflammation, effusion, and, perhaps, a fatal peri- pneumonia, or, from the same causes, may succeed an inflammation of the pulmonary and costal pleura and its consequences. These form only a few evils in the catalogue which may justly be ap- prehended from the warm plan of treatment ; but, few as they are, they must, it is presumed, be amply sufficient to form the most striking con- trast to that which prescribes cool air and the an- tiphlogistic regimen. By the application of cool air immediately to the parts affected, the power- ful stimulus of heat is abstracted, the activity of the whole arterial system is diminished, the vis a tergo is removed from the inflamed vessels, these are relieved from that redundancy of blood and increased action in which the disease consists, and finally recover their wonted healthy tone without any morbid relaxation of their extremi- ties, while the issue is brought about in the most approved manner the art aspires to — dito^ tuto^ ac jucunde (i. e., quickly, safely, and agreeably). 236 26. OF EXTERNAL COLD. THE THEORY. Page 125. No truth in medicine is more firmly estab- lished than this assertion of our author, that the free and extensive use of external cold is inadmis- sible in catan-h, -however salutary in other febrile complaints of too much action. The rationalia of this are not less evident. Although cold air should reduce the inflammatory action of the parts affected by coming immediately in contact with them, yet, as the action of the general sys- tem does not subside in an equal ratio with that of the topical affection, the vessels of this last must still remain in that state of accumulated ex- citabilit}^, with respect to the general system, which renders them subject to re-assume their former diseased action, as soon as the sedative power of cold shall be removed. 237 2f. THE EFIECTS OF COLD EXPLAlNi:©. Page 132. In the application of cold to the external sur- face of the body in catarrh, three things are always to be taken into consideration : 1st, The stage of the disease ; for it can be applied with success only in the inflammatory or first stage of catarrh* 2d, The mobility of the system. When cold is applied to the extremities, the mobility of the system, or that aptitude to propagate impressions from one part to another, should always be in a state to compensate for the temporary centripetal force given to the fluids by the diminished action of the cutaneous vessels, consequent to the first impression of cold on the surface of the body. 3d, and last. Plethora should always be removed before the application of this part of the treatment. It is probable it was from a difference of circum- stances in the unfortunate case just detailed by our author, and the case of Dr. Hamilton's boy, with respect to these particulars, that exposure to cool air was attended with such various and dif- ferent success. The editor once knew a gentle- 238 man, and has heard of several similar occurrences, cured of the most violent inflammatory catarrh by wading up to his knees two or three hundred yards in the cold month of November. In this case, he supposes, the plethora of the system was inconsiderable, wliile the abstraction of general excitement, through the application of cold to the skin, more than conipensated for the centripetal force consequent to the temporary debility indu- ced on that organ. 28. or BLOOD-LETTING IN CATARRH. Page 135. Scarcely any thing respecting this disease is better calculated to prove the mildness of catarrh in England, when compared with that disorder in the United States, than the omission of a practi- tioner judicious as our author to mention phle- botomy as a remedy. In this country it is almost indispensable, insomuch that, in all cases of any violence, the loss of ten or twelve ounces of blood should be the first means employed. 239 29. OF THE USE OF CALOMEL. Page 147. The operation of calomel in the cure of catarrh is threefold : 1, It reduces action in the general system, by its effects on the alimentary canal, sim- ply as a purgative. For this purpose, as its action is slow, it should always be assisted by some other more brisk cathartic, as jalap or rhubarb. 2, By producing a determination to the liver, an4 thus, by an increased secretion from that organ, securing more vital parts, and relieving those af- fected with catarrh. 3, By exciting a new and general action in the arterial system, which shall transcend or supersede the existing morbid action. 30. OF THE NAUSEATING PLAN, Page 149. That nauseating doses of tartar emetic have a considerable effect in reducing inflammatory ac- tion, cannot be denied. But whatever respect and deference be due to our author as a judicious 240 practitioner, I cannot but observe there are other remedies equally quick and safe, and much more efficacious and pleasant, in the cure of^ catarrh. Nor should I acquit myself of that duty which the public have a right to expect, were I to pass over so strong a recommendation of this cruel PKACTiCE in silence. It is a noisome branch, sprung from that theory which supposed fever to depend on spasm for its proximate cause. The supporting stalk is now withered, nay, almost de- cayed ; it is time, then, this one of its most pol- sonous shoots should be eradicated ; nor may it ever grow in so fair a garden as American prac- tice presents. In this case, fifteen grains of nitre (kali nitraU') every hour, in some convenient fluids will be much more agreeable and equally effica- cious. 51. OF COLD DRINKS. Page 150. ^is is a fact which clearly illustrates the rea- soning in Note to p. 132, on the action of cold TO THE EXTREMITIES, The couscnt of the sto- 241 jaiach with every part of the ammal system is so generally acknowledged, that this organ is now admitted to be the medium through which almost all medicines, taken internally, produce their ef- fects upon every part of the frame. Hence, cold applied to this viscus must be attended with more speedy and certain effects than to any other part whatever. Its operation in this case is simple : it produces its effects merely by the abstraction of the stimulus of heat. 32. OF TULL VOMITING. Page 154. The editor fully concurs with the author in the advantages of full vomiting in the commencement of catarrh ; as, under proper management, it sel- dom fails to terminate the disease in a few hours. But, so far from supposing " most people would consider the remedy worse than the disease," he conceives there are veiy few who would not pre- fer full vomiting, for half an hour, or even for an hour, to a distressing nausea^ constantly kept up for two or three days in succession. X 242 S3, NAUSEATING PLAN REPUDIATED. Pag-e 155. As the GRUEL PRACTICE of nauseating the sto- mach for the cure of any disease may be justly repudiated, the use of gentle saline purgatives, instead of the formula of the author, is here recommended, as much more agreeable and equally efficacious. For this purpose, Take of Glauber's salt (natron vitriolat.^ one ounce ; fresh lemon juice one ounce ; boiling water half a pint j loaf sugar two ounces : Mix and dissolve : when cold, add sweet spi- rits of nitre two drachms. Mix for use. An adult should take two table -spoonfuls every hour, until the bowels have been well opened." Afterwards, as. an alterative. Take of nitre (kali nitrat,) half an ounce ; simple water half a pint ; 243 lemon juice half an ounce ; sweet spirit of nitre half an ounce. Mix and dissolve. One table-spoonful to be taken every hour. ^4. OF THE DIGITALIS AND THE NITRIC LAC. Page 157. It is much to be regretted that the digitalis should not have been so successful in the hands of the editor as to authorize his commendation of its virtues in the cure of pulmonary complaints. On the contrary, he conceives it may be justly con- sidered as a substance which gradually undermines the powers of life ; that it ought seldom to be used in any stage of catarrh, and never v/ithout the ad- vice of a skilful and prudent practitioner. In such cases as this described by the author, and even in many cases of phthisis pulmonalis, the editor, for several years past, has used what has been called by him the nitric lac ammoniac^ with the greatest success. It is prepared in the following manner : 244 Infuse two draichms of pure nitric acid in pure water, eight ounces (half a pint),^ gradually pour the compound on of best gum ammoniac (ferula Africana), two scruples and a half. Triturate them in a glass or composition mortar, until the whole of the gum is dissolved, and a homogeneous milky fluid is formed. The dose is one table-spoonful in six table-spoon- fuls of sweetened water, or of any other conveni- ent vehicle to dilute it, every three or foui' hours. o5, RATIONALIA OF THE APPLICATION Ot BLISTERS TO THE BACK. Page 160. Hovv^ever it may have escaped our author, this preference is founded on the best grounds possi- ble. The lungs are not only contiguous, but they are, in a measure, continuous to the back ; they are connected to it by cellular substance and by the divaricating pleura, and supported by the immediate continuation of membrane in the coats 245 of the larger vessels which lie on the vertebrae of the thorax, or chest. 36. OF BLOOD-LETTING. Page 169. In this climate at least, a remedy should al- ways be premised, which has never once been mentioned by the author, in the whole course of this essay ; that is, bleeding. It is a certain fact, established as well by experience as supported by reason, that very fcAv cases of acute inflamma- tory disease occur in this climate, in which blood- letting should not precede the application of epispastics (blisters). It is also necessary to ob- serve, that blisters seldom produce so good an effect, until the inflammatory action of the system has been pretty well subdued, nor even then earlier than the evening of the third, sixth, or eighth day from the attack. In this case described by the author, the editor would recommend a prudent use of the lancet, and the antiphlogistic plan, as recommended in another part of this work, until inflammatory action is sufliciently reduced, and 246 Aen, on the next succeeding of the days before mentioned, the blister may generally be applied with the desired effect. 37» OF SENEKA SNAKE-ROOt. Fa£rel72. In these cases the editor would recommend the use of a decoction of the seneka snake-root (poly gala seneka), as a remedy the most effica- cious of any other he has ever seen employed. The following is the formula in which he has ge- nerally- used it: Take of the sliced root of seneka snake-root two drachms ; infuse it into eight ounces (i. ^., half a pint) of boiling water; stew it ten minutes; clear off the fluid, and add two ounces of honey. Let an adult take one table-spoonful every two liQurs, and gargle the throat frequently therewith* 247 -38. OF PEDILUVIU3I. Pa^i-e 180. -Pediluvium^ upon the principles before laid down by the editor, it is plain, must be used with caution, or only before the disease is* perfectly formed, or after the inflammatory action has been in some measure reduced by blood-letting or purging. Hence it can be useful only as an auxiliary, after bleeding or purging. The glass of rum and water, to say the least, is certainly a hazardous medicine, and certainly ought never to be admitted as a part of the cure ; on the con- trar\^, the free use of cold water, in this case, forms a safer and a much more efficacious re- medy. 59. OF OPIATES. Page 182, Opium., nor paregoric elixir., should never be administered in the first stage of catarrh. It is only in cases of long continuance, where inflam- 248 matory action has totally ceased, and in which the disease is kept up entirely by irritation, aris- ing from an increased secretion of mucus, occa- sioned by debility in the exhalants, that opiates of any kind can be used with safety, or advantage. In such cases the following recipe is recom- mended with the gi'eatest confidence : Take of paregoric elixir one ounce ; powdered gum arabic one ounce ; simple water two ounces ; sweet spirits of nitre two drachms j antimonial wine one drachm. Mix and dissolve. One table -spoonful to be taken whenever tlie cough is troublesome. FINIS. ^^