Infusion of Senna 7 ounces.

Epsom Salts 2 ounces.

Syrup of Buckthorn 1 ounce.

Sal Volatile 1 drachm.

Mix.—If this does not keep up a frequent and vigorous action

on the bowels, in addition, put two drops of croton oil on the

tongue, or wipe the wet cork or stopper of the bottle on the

patient’s lips.

After twelve hours, and between that and two days, the _second stage_, or

series of symptoms sets in, the headache and wild delirium cease, and are

succeeded by a low indistinct muttering and a state of stupor, from which

it is finally impossible to rouse the patient. Hearing and vision become

imperfect and difficult, with squinting, double vision, and distended

immovable pupil: the spasms have given place to twitching of the muscles,

and starting of the tendons: the limbs are cold and powerless, or

palsied, the countenance ghastly; a cold sweat breaks out over the body,

and the patient dies in a state of profound coma.

_The treatment in this second_ and fatal stage, is necessarily one more

of regimen than medicine. If the pulse is hard, a blister may be put

on the head; but the great art lies in the judicious application of

stimulants, such as ether, ammonia, valerian, beef tea, wine, and opiates.

The following mixture combines most of these agents, and may be employed

to promote reaction, accompanied with thickened beef tea, and bottles of

hot water to the feet.

Carbonate of Ammonia ½ drachm.

Powdered Opium 3 grains.

Ipecacuanha 3 grains.

Mix in a mortar, and add

Camphor Water 5½ ounces.

Compound Tincture of Cinnamon ½ ounce.

Sulphuric Ether 1 drachm.

Mix. A table-spoonful every two hours.

DELIRIUM.

A symptom of some form of disease, as of madness, inflammation of the

substance of the brain, or of its coats, of fevers, erysipelas, disease

of the bladder; or it may supervene after concussion or compression of

the brain, injuries of the head, the result of surgical operations, or

from many vegetable poisons. Delirium, though often the result of an

excess of blood in the head, is by no means invariably so, as delirium

frequently attends as a reactionary symptom after exhaustion; and from

nervous irritation. There are many varieties of this distressing symptom,

as the low muttering delirium of typhus fever, and the quick rambling

chattering of other forms of cerebral disturbance. Delirium is generally

attended with a quick jerking pulse, the face is flushed, the eyes red or

bloodshot, with pain in the head, ringing in the ears, great antipathies

to places, persons, or things, muscular exertions of the arms, or picking

at the bed-clothes, constant and incoherent talk, or low indistinct

muttering. The body is often hot and dry, and the feet cold; and in cases

of vegetable poisoning, the pupils are generally excessively dilated.

_Treatment._—When delirium is attended with a full quick pulse and pains

in the head, it will be necessary to bleed from the arm, apply four or

six leeches to each temple, to place a blister on the nape of the neck,

and a bag of ice on the head, or else cloths constantly wetted in an

evaporating lotion; at the same time mustard poultices should be applied

to the legs and feet, one drop of croton oil put on the tongue, followed

in an hour by a black draught. The room is to be darkened, and the

patient kept perfectly quiet. When delirium proceeds from low fever, and

is attended with a small wiry pulse, the case must be met by palliatives,

anodynes, and tonics. The feet are to be kept warm, the hair cut, and

the head cool, the cupping glasses applied to the nape of the neck, the

mental irritation soothed by an opiate, and the system roused by the

careful employment of wine and arrow-root, and such other remedies as

the concurrent symptoms at the time, and the original character of the

disease, may seem to render expedient.

There is one precaution that should be observed in all cases of

delirium, especially in the more violent kinds, and that is by moral

suasion to obtain a mastery over the patient: this is to be effected by

blending firmness with kindness, as nothing can be more injurious than

intimidation or the threat of coercion, unless, indeed, that monstrous

abuse, the strait waistcoat, an instrument of torment scarcely, if ever,

called for.

DELIRIUM TREMENS.

Trembling delirium, or the drunkard’s palsy, is a disease in which

the mucous membrane of the stomach and bowels, as well as the lining

membranes of the brain, are in a state of chronic inflammation, resulting

almost always from intemperate habits and excessive indulgence in ardent

spirits. This disease is manifested by a total want of sleep, and a

quivering of the lips, hands, and muscles, generally, every attempt

at speech or motion increasing the tremor; rambling, and constant

chattering; the skin is cold and moist, the pulse small and quick, and

the tongue furred in its centre, with red edges, the countenance is

anxious, the patient full of suspicion, and oppressed with dreams and

frightful images.

_Treatment._—The first step to be taken is to tranquillize the system,

which may be effected by giving one grain of opium as a pill every four

hours with two table-spoonfuls of the following mixture every one or two

hours.

Camphor Water 5½ ounces.

Brandy 2 ounces.

Ether 1 drachm.

Spirits of Sal Volatile 1½ drachm.

Mix. In addition to the mixture and pills, it is sometimes

necessary to give brandy-and-water, wine, or pure spirit. When

the trembling is subdued, and the system tranquillized, the

following mixture is to be given in the same dose and quantity

as the former, but discontinuing the pills.

Infusion of Rose Leaves 8 ounces.

Epsom Salts ½ ounce.

Syrup of Red Poppy 2 drachms.

Diluted Sulphuric Acid 20 drops.

Tincture of Opium 1½ drachms.

Mix.—When there is much congestion of the head, it will be

necessary to apply a few leeches to the temples, but as a

general rule, all depletion is injurious. During the whole

attack, the patient is to be steadily watched, kept quiet, and,

as far as possible, amused and interested.

MADNESS.

Disease of the brain eventuating in loss of reason, assumes many shapes,

and has many forms and conditions; though the term madness with some

degree of reason is applied to all, abstractedly considered, and,

relatively understood, no phrase can be more faulty and objectionable.

Insanity, idiocy, cretinism, imbecility, dementia, and melancholia, or

melancholy madness, are some, though by no means all, the forms of mental

aberration that come under this very comprehensive term. Each of these

forms of madness, or loss of judgment and imagination, has a distinctive

character of its own, and has either been excited by some other disease;

some great commotion of the system, caused by violent excitement of the

passions; by direct injury to the head; exposure, uncovered, to the

influence of the summer sun, causing a sun stroke; to some diseased

condition of the brain, induced by some specific affection of that organ;

or an hereditary cause, the consequence of a redundancy or diminution in

some of the lobes of the brain, in which case, the disease being born

with the patient, there can be no hope of cure or improvement.

_Insanity_, or that madness which—of a temporary character, produced

and kept alive by an active disease elsewhere in the body than the

brain itself, though that organ occasionally is the primary cause—is a

symptomatic form of madness subsiding, in general, when the disease that

provoked it is cured.—See INSANITY.

_Idiocy_, being that hopeless state of fatuity, the consequence, as

has been said, of a defective development of the brain, and born with

the patient, it has been thought unnecessary to refer to it in a more

particular manner, the great variety of such cases only filling the mind

with painful images.

_Cretinism_ is a special variety of idiocy, indicated by a large head,

square visage, wide mouth, thick ears, and goitres; in fact, it is the

idiocy peculiar to that form of scrofula whose most marked feature is

the _goître_, attacking whole tribes of people in different parts of the

world, and who, in addition to a fatuity of mind and an enlarged neck,

are noted by a dwarfish stature, seldom exceeding four feet.

_Melancholia_ is that variety of madness depending on some chronic state

of disease, whose chief attributes are, a sad and desponding state of

mind; a settled melancholy, that only sees despair and sorrow in every

purpose of life; and though the imagination may only pursue one line of

reasoning, the patient contemplates it as devoid of every ray of hope,

and eagerly seeks to terminate his existence before the event he broods

upon can overtake him. To such persons an unreasonable dread of poverty

is the most frequent form in which the madness shows itself, and from the

apprehension of which no relief offers itself to the patient but suicide.

Melancholy madness most frequently results from a chronic state of

insanity, or, in other words, insanity, if long standing, is in certain

constitutions liable to degenerate into melancholia. The _treatment_ of

this disease is almost entirely of a moral character, and must consist in

frequent change of scene and society, exercise, and lively conversation,

any temporary oppression of the head being relieved by a few leeches,

and an occasional aperient; at the same time, without seeming to do so,

maintaining an unceasing watch over the patient, and while apparently

reposing confidence in his honour, never relaxing the vigilance of

supervision.

_Hypochondriasis_, or vapours, as it is sometimes called, very often

assumes a species of aberration closely resembling melancholy madness;

and like the many varieties of what is called _monomania_, or madness

on one subject, difficult to determine whether primarily depending on a

diseased state of the brain, or of the digestive organs. The treatment

in all such cases must conform as near as can be traced to the exciting

cause, though in these instances, medicine is generally much less

necessary than moral suasion, and the promotion of a healthier action of

mind and body, by change of air and invigorating exercise, especially

such as rowing, swimming, fencing, climbing hills, horse-riding, and

quick walking.

There only remains one other form of madness to be considered, _mania_,

properly so called, or raving madness; but as this is a subject so

distinct from all the other forms of temporary aberration; is induced

by so many and contrary causes; and demands a course of treatment so

distinct, that it would be unnecessary to do more than give the general

symptoms, and indicate the broad principles on which the treatment is

based; all patients so affected, both for their own comfort and to

further the chance of their recovery, are treated in establishments

specially adapted for the purpose. There are many cases of confirmed

madness, where the patient is neither raving nor furious, but in which

more or less of the same symptoms are common to that condition: these

are, delirium without fever, flushed face, and wild expression of

countenance, sharp pains in the head, ringing in the ears, rolling and

flashing eyes, grinding of the teeth, loud roarings, and violent muscular

exertions, rooted antipathies to objects and places formerly beloved or

attached to, insensibility or indifference to heat and cold, hunger,

thirst, or watching, and attended throughout by a quick, full, and hard

pulse. A remarkable peculiarity with all maniacs is, that periodically,

or once a month, or at the full of the moon, all the symptoms are

exaggerated, and occasionally a perfect remission of the symptoms,

the patient enjoying lucid intervals; from this periodicity they are

called lunatics. The _treatment_ consists in carrying out the three

following objects, each indication, as it is called, requiring a distinct

treatment: first, to gain a perfect command over the maniac; secondly,

to divert his mind from the existing train of thought; and thirdly, to

diminish the preternatural action of the brain.

INSANITY.

This alarming and dangerous state of the mental faculties, is,

fortunately, more frequently the consequence of diseased action

elsewhere, or in other words, a symptomatic affection, than the result

of an organic or morbid condition of the brain itself. Insanity may

arise from any severe constitutional disturbance, or local disease,

so long continued as to affect reciprocally the system, hence it is a

frequent symptom of all fevers, whether of the nervous or inflammatory

type; often supervening upon severe accidents, and very frequently

following the shock sustained by the system on the performance of

important surgical operations. Insanity may also be idiopathic, or

arise without any previous disease, as when the mind has been long kept

preternaturally bent on one engrossing subject; or it may proceed from

some sudden emotion of the mind, acting on the weakened frame, or from

any cause that excites and keeps up a long tension of the reflective

powers. It may also arise from organic disease of some part of the brain,

or follow from an hereditary taint. Insanity is distinguished from

madness, only by the milder character of all the symptoms, and by the

subsidence of the incoherency on the suppression of the immediate cause

that produced it; whereas, madness is excited by the same causes, and

continues for a longer or a shorter time after the subsidence of all the

excitement that gave rise to it. The insanity that constitutes what is

denominated madness, as a special disease, we shall not refer to in this

work, confining ourselves merely to that state which attends or follows

ordinary disease.

_Symptoms._—Insanity appears in many forms, seldom showing twice alike;

but, as a general rule, its characteristics are in the following order:

severe pains in the head; noise in the ears; redness of the face;

peculiar wildness of the countenance; rolling and glistening of the eyes;

grinding of the teeth; loud roarings; violent exertions of strength;

incoherent discourse; unaccountable antipathy to certain persons,

particularly to their nearest relatives and friends; a dislike to such

places and scenes as formerly afforded particular pleasure; a diminution

of the irritability of the body with respect to the morbid effects of

cold, hunger, and watching: together with a full strong pulse.

_Causes._—Hereditary predisposition; sanguineous temperament; violent

emotions of the mind; immoderate indulgence in any passion; violent

exercise; frequent intoxication; sedentary life; abtruse study;

parturition or lactation; tumours compressing the brain; preceding

attacks of epilepsy, fever, &c.

_Treatment._—Before proceeding to the mode of treatment, the following

objects are to be strictly borne in mind:—1. To gain a perfect command

over the maniac. 2. To divert the patient’s mind from the existing

train of thought. 3. To diminish the preternatural action of the brain.

To effect these results, the following remedies must be had recourse

to:—1. By bleeding, if of a plethoric habit, and the attack recent.

2. Purgatives; both the drastic and cooling aperiatives have been

recommended—perhaps the former are preferable; hellebore, senna, and

jalap. 3. A spare low diet. 4. Emetics of sulphate of zinc, or of tartar

emetic. 5. Nauseating remedies. 6. Cold bath during the paroxysms. 7.

Sedatives; hemlock, camphor, and henbane; opium is generally prejudicial.

8. Counter-irritants; blisters, setons or issues. 9. Where great debility

is present from the first, or supervenes after the employment of active

remedies, tonics and stimulants, as in debility from other causes.

Insanity, to a greater or less extent, may be regarded as an effect of

many fevers, especially those of nervous order and typhoid type, and

though in general the hallucinations of this mental disturbance subside

on the decadence of the symptoms, cases arise where the balance of

mental power is not restored for some considerable time after the bodily

recovery, and others in which a predisposition is left behind, upon

which, at the slightest excitement, the insanity returns with perhaps

increased severity; in such cases the disease assumes a new phase, and

more properly comes under the denomination of lunacy.

HYDROPHOBIA.

Hydrophobia, or dread of water, as the name signifies, is a disease

peculiarly affecting the nervous system, caused by the bite and

absorption into the blood of the saliva, or _virus_, as it is called,

of some rabid or strongly irritated animal, but most frequently of the

two domestic species, the dog and cat, though, from the almost analogous

symptoms excited in the system by certain accidents, eventuating in what

has been called _tetanus_, the two diseases by many medical men have

been considered as synonymous. The influence exerted by the mind on the

body, both for good and evil, is a fact well known to the most casual

observer, but in no instance is that effect exercised with more dangerous

consequences than in the disease under notice; for it is unquestioned

that many persons have been forced into a state of hydrophobia, simply

through the terror inspired by the scratch or abrasion of an animal

perfectly in health, though perhaps under a temporary fit of displeasure

or pain. The peculiarity of this disease, is the great length of time

that usually takes place between the receipt of the accident, or bite,

and the disease itself, or the manifestation of the constitutional

symptoms; sometimes weeks elapse, at others months, and not unfrequently

years have supervened between the cause and the effect.

_Symptoms._—At whatever time these may show themselves, they commence

with wandering pains over the body, anxiety, restlessness, disturbed

sleep, and frightful dreams, the patient starting up in horror and

bedewed with cold perspiration; by degrees muscular contractions occur

at intervals, weight and oppression of the stomach, a tightness in the

throat, and difficulty of swallowing, till suddenly the crowning symptom

takes place, and the patient, in attempting to drink, is seized with a

sudden horror, and recoils in terror from the wished-for potation; the

very sight or sound of water, or the motion of fluid, throwing the body

into violent convulsions. From this stage the symptoms rush on to their

climax; the countenance is contracted, the eyes wild and staring, the

teeth set firmly, and with the tightened lips covered with a ropy foam,

or a thin watery saliva pours from them; this state is alternated with

shrieks, animal noises, bilious vomitings, convulsive jerks and plunges,

till one fearful spasm that draws the body like a bent bow, resting on

head and heel, releases the patient from his sufferings.

_Treatment._—The hot bath, electricity, blisters, bleeding and opium in

immense doses, are the only agents that art can employ in this formidable

disease; the most violent measures and the most opposite have been

resorted to; but, unfortunately for science, hitherto with but little

effect or benefit. In no disease is the old adage of “prevention better

than cure” so applicable as in this. For the tranquillity of mind, for

the satisfaction of the patient, and for motives of safety, in all cases

of bite or abrasion from the tooth of an animal, the part should be

cauterised. A tape or bandage being first tied tightly above the part

to prevent absorption, the part is then to be washed with warm water,

and lunar caustic then applied. If these steps are adopted quickly and

effectually, and, if possible, the part sucked or dry-cupped before

applying the caustic, and the ligature or pressure continued for some

time, there will seldom be any necessity for the painful and questionable

practice of excision. The patient’s mind must be soothed; an aperient and

a sedative given, and a warm poultice applied over the eschar. A mode of

treating hydrophobia by means of ice, internally, down the spine, over

the throat and chest, has been adopted with success, but the cases are

too few to warrant pronouncing it either safe or certain.

INTERMITTENT FEVER, OR AGUE.

The term intermittent is applied to that kind of fever which consists

of a succession of paroxysms, between each of which there is a distinct

and perfect decline of fever symptoms. Different names have been applied

to this fever, according to the distance of time observed between the

periods of its return. When it comes on within the space of twenty-four

hours, it is called a quotidian; when it returns every other day, it is

called a tertian; and when it attends on the first and fourth day, it is

named a quartan ague. That under the tertian type is most apt to prevail

in the spring, and the quartan in autumn.

Intermittents often prove obstinate, and are of long duration in warm

climates; and they not unfrequently resist every mode of cure, so as

to become very distressing to the patient; a fact, to which the writer

can bear testimony from personal experience. It is very generally

acknowledged, that marsh exhalations, or the effluvia arising from

stagnant water, when acted upon by heat, are the most frequent exciting

causes of ague. A low diet, great fatigue, and the sudden disappearance

of eruptions, have been ranked among the exciting causes of intermittents.

Some persons imagine this fever may be communicated by contagion; but

this supposition is by no means consistent with general observation.

One peculiarity in this fever is, its great susceptibility of a renewal

from very slight causes, as from the prevalence of an easterly wind, or

from the repetition of the original exciting agency. It would appear,

likewise, that a predisposition is left in the habit, which favours a

return of the complaint.

Each paroxysm of an intermittent fever is divided into three different

stages, which are called the cold, the hot, and the moist stage. The

cold stage commences with languor, a sense of great debility, frequent

yawning and stretching, and an aversion to food. The face and extremities

become pale, the features shrink, the bulk of every external part becomes

diminished, the nails turn a dark blue colour, and the skin, over the

whole body, bears the appearance of having been exposed to excessive

cold: at this time, universal rigours come on, together with pains in the

head, back, loins, and joints, nausea and vomiting of bilious matter;

the breathing is small, frequent, and anxious; the urine is almost

colourless; the thoughts are confused; and the pulse is small, frequent,

and often irregular. After a short time, these symptoms abate, and the

second stage commences with an increase of heat over the whole body,

redness of the face, dryness of the skin, thirst, pain in the head,

throbbing in the temples, anxiety and restlessness; the respiration

(breathing) is fuller and more free, but still frequent; the tongue is

furred, and the pulse has become regular, hard, and full. If the attack

has been very severe, delirium will perhaps arise at this time. After

these symptoms have continued for some time, a moisture breaks out on the

forehead, and, by degrees, becomes a profuse perspiration, extending over

the whole body.

Having pointed out the phenomena usually attending a paroxysm of

intermittent fever, and likewise their mode of succession, it may be as

well to observe, that they prevail in different degrees of intensity, and

that the series of them may be more or less complete.

The treatment of intermittents is, first, to put as speedy a stop to the

fit as possible when it has taken place; and, secondly, to prevent its

return at the usual, or any after period. Two drachms of Peruvian bark,

powdered, may be taken every two hours, as the benefit to be expected

from this medicine will greatly depend on the large quantity administered

in a short space of time; for, five or six ounces of bark taken in a few

days, will be attended with a much better effect than perhaps as many

pounds taken in the course of some weeks. In instances where bark fails

of remaining on the stomach (as in the writer’s case), arsenic is almost

invariably successful: it must be prepared as follows:—

Take 64 grains of white arsenic reduced to a very fine powder, and

the same quantity of vegetable alkali; mix these together; add half a

pound of distilled water, and let it boil slowly until the arsenic is

completely dissolved: half a pound of compound spirit of lavender is

then to be added to it, and as much more distilled water as makes the

whole solution amount to a pound. The dose of this is from two to ten

drops, given in milk, once, twice, or even thrice in the day, according

to the age and strength of the patient. Eight days’ administration of the

medicine in this way will be generally found sufficient for a cure of

this complaint.

Vomitings and gripings are the troublesome symptoms now and then produced

by this medicine: they disappear, however, on discontinuing the drops,

or only require a gentle opiate, or some warm cathartic (aperient), such

as the tincture of rhubarb. I would by all means recommend those who

are living in or near a town, to have the solution of arsenic made by a

chemist of known respectability, and to keep it securely locked up, with

_Poison_ on its label.

The food of the patient must be of a light and nourishing description,

such as sago or arrow-root; but when the fit is off, he may partake of

animal food, and a spare quantity of wine. The passions of the mind

exercise a wonderful influence on ague; the writer has known the disease

instantaneously removed by a sudden shock, and whether of surprise,

fright, joy, or grief, appears immaterial; as long as it exercises a

sudden and violent effect on the nervous system, the cure is complete.

APOPLEXY.

Apoplexy is a disease which arrests all voluntary motion, and deprives

a person of consciousness, as though he had been struck by a blow.

Sometimes a person is warned of the approach of apoplexy by various

symptoms, such as giddiness, drowsiness, loss of memory, twitching of

the muscles, faltering of the speech, &c.; but most frequently he falls

to the ground without any warning, and lies as though in a deep sleep.

While so lying he breathes heavily, with a _snorting_ kind of noise,

and with considerable muscular action of the features. The face is red

and swollen, the veins distended, the eyes protruding and bloodshot,

remaining half open or quite closed, and a foam frequently forms about

the mouth.

Apoplexy mostly arises from accumulation of blood in the system, but

it may be the result of an enfeebled constitution, and general want of

vitality.

Where a person is seized as described, a medical man should be sent

for, and the patient should be carried into a cool room and placed in a

sitting posture, in such a situation that the air may be freely admitted

to him. The neckcloth, shirt collar, waistband, and other ligatures

should be unfastened, and cold water should be poured over the head.

Mustard plasters may be applied to the soles of the feet and the calves

of the legs, or where the mustard cannot be immediately procured, the

feet and legs should be placed in hot water.

If the attack occurs with a person of _full habit_ of body, a dozen

leeches may be applied behind the ears and on the temples. It is of

great importance that the bowels should be freed of their contents, and

as there is a great difficulty in swallowing, _one drop of croton oil_

should be placed on the tongue and repeated every two hours, until

the object is entirely accomplished. Blood-letting should in no case

be attempted by a non-professional person. Where the fit arises from

enfeebled strength (which is indicated by a small irregular pulse) the

remedies should be of a milder form, and stimulants may be cautiously

administered at intervals.

The most common _immediate cause_ of apoplexy is pressure of the

brain, either from an effusion of blood or serum, or from a distention

of the vessels of the brain by an accumulation of the blood in them,

independently of effusion.

The _predisposing causes_ are the habitual indulgence of the appetite in

rich and gross food, or stimulating drinks, coupled with luxurious and

indolent habits, sedentary employments carried to an undue length; the

habit of sleeping, especially in a recumbent posture, after a full meal;

and lying too long in bed.

The _exciting causes_ are excesses in eating and drinking; violent mental

emotions; the sudden suppression of piles, gout, rheumatism; or any other

cause which augments the circulation of blood to, or extracts the flow of

blood from, the brain.

Persons below the middle height, robust, with large hands and short thick

necks, are generally recognised as apoplectic subjects; but it is, in

truth, confined to no particular conformation of the body, _all persons_

being alike liable to be attacked by it.

Persons, however, who are _predisposed_ to this disease should not fail

to profit by the warnings of its approach mentioned at the commencement

of this article. Their diet should be light and nutritious; all luxurious

habits should be abandoned, and moderate exercise should be taken. Above

all, they should avoid giving way to their passions, as it is well known

that many persons have been struck with death in the midst of a fit of

anger.

EPILEPSY, OR FALLING SICKNESS.

This is a disease coming on in convulsive paroxysms, returning at

undefined and irregular periods, accompanied by great muscular exertion,

foaming at the mouth, loss of memory and of voluntary motion, and ending

in sleep or a state of coma. The attacks are often sudden, the patient

without notice falling to the ground; at other times, it is preceded by

a sense of weight in the head, drowsiness, and languor, indicating the

approach of the fit.

The causes of epilepsy are various; in some cases it is hereditary, in

others it proceeds from softening of the brain, or organic disease of

that organ and the spinal marrow; it sometimes results from blows, very

frequently in children from worms, or other sources of irritation in the

bowels and stomach. Epilepsy is most frequent in the young, the spare,

and those of a delicate organization.

_Symptoms._—The fit usually begins with an excessive and involuntary

action of the muscles, the body is bent forward, or drawn violently

backward with great force, the eyes roll in a rapid and furious manner,

the lips are convulsed, and a frothy saliva, like the champ of a horse,

covers the lips and teeth; the tongue is violently protruded, and often

dreadfully injured by the spasmodic closing of the teeth; the pulse is

quick and irregular, the breathing heavy and laboured, the muscular

action of the arms and legs and the writhings of the body are immense,

and often the exertions of more than five or six strong persons are

requisite to restrain even a woman. After a time, which varies from

ten minutes to half an hour, nature becomes exhausted, and the patient

sinks into a state of sleep, or more properly coma, from which in a few

hours he awakes, exhausted, low and feeble. The only diseases with which

epilepsy could be confounded, are hysteria and apoplexy; from the first,

it is known by the absence of tears, sobs, and laughter, and the rising

in the throat, like a ball or lump, that always characterizes it; and

from apoplexy, by the stertorous breathing and the dilated pupil.

_Treatment._—Where the patient is young, and it is the first attack,

bleeding to a small extent is advisable; but in general, beyond the

exhibition of stimulating draughts of ammonia and brandy, cold water

dashed on the face, and heat applied to the feet, little or nothing

can be done during the paroxysm beyond putting a gag in the mouth, and

fastening it behind the head, so as to save the patient’s tongue; the

treatment must be left till after the fit, and the remedies used with the

hope of preventing a recurrence of the attack. When epilepsy proceeds

from disease of the brain or spinal column, a seton should be established

in the neck, the general correction of the system attended to, by change

of scene, a course of mineral waters, a plain but unexciting diet, and

the daily use of the subjoined pills, marked 1 and 2, continuing each for

three weeks, resting one week, and then beginning the other with exactly

the same routine. It may be here remarked, that no medicine has been

found so efficacious in epilepsy as nitrate of silver or lunar caustic,

and after that a preparation of copper.

No. 1.—Take of

Nitrate of Silver 4 grains.

Bread Crumbs 1 drachm.

Mix. Extract of gentian, sufficient to make a mass, which

divide into twenty-four pills, of which give one, three times a

day.

No. 2.—Take of

Ammoniate of Copper 6 grains.

Bread Crumbs 1 drachm.

Mix well, and add extract of camomile, enough to make into a

mass, which divide into twenty-four pills, one to be given

three times a day.

When epilepsy is symptomatic, or the cause of worms or irritation in

the bowels, it must be treated according to the provocative cause; in

other cases, a course of mild aperient medicines should be adopted, and

the bowels kept regularly open; exercise by walking, sea bathing, early

hours, and such pastimes as give a healthy tone to the mind, steadily

persisted in. For the tremor that sometimes follows the recovery from

the fit, the following antispasmodic mixture will be found efficacious,

though, as a general rule for symptomatic epilepsy, a regular diet,

change of scene and air, exercise, and a constant mild action on the

bowels, will be found sufficient.

Take of

Valerian Root 2 drachms.

Serpentaria Root 1 drachm.

Boiling Water ½ pint.

Infuse for six hours, strain, and add

Spirits of Hartshorn 3 drachms.

Sulphuric Ether 1 drachm.

Mix, and give one or two table-spoonfuls three times a day.

By adding half a drachm of quassia to this infusion, a tonic

property will be added to the antispasmodic effect of the

mixture.

FAINTING, OR SYNCOPE.

Fainting, or Syncope, as it is professionally called, very often

attacks the individual without warning, though at other times, and in

those subject to these distressing symptoms, fainting is preceded by

well-defined sensations, such as a feeling of distress, languor, and

sickness; the sight becomes dim, and the eyes appear covered by a film;

an areola or dark circle appears round the orbits; a buzzing, or low

singing noise, is heard in the ears; the face and lips are pale, a cold

perspiration breaks out over the skin; the pulse sinks to a mere flutter,

and finally ceases; the body totters, and unless upheld, falls to the

ground. The loss of consciousness is sometimes complete; at others,

the patient retains a partial amount of recollection; the pallor, too,

is occasionally more intense, and corpse-like, the eyes shut, mouth

open, the limbs flaccid, and the extremities deadly cold. This state

lasts from five minutes to half an hour; a spasm of the chest and a few

gasping sobs, each more prolonged than the last, are the first signs of

returning consciousness. When the fit is prolonged, it may terminate in

epilepsy or convulsions. The causes that predispose to faintings, are

an intensely nervous state of the system, a delicate constitution, and

extreme debility from whatever cause produced, or a diseased state of the

heart. Youth is more subject than age to fainting, and females are more

frequently affected by it than males.

_Treatment._—When fainting is the result of nervous sensibility, or when

it occurs in hysterical women, there is seldom any danger; all that is

generally necessary is to lay the patient on her back in the horizontal

position; loosen any string that may compress the chest or neck, open

the window, dash water in the face, and apply volatile salts to the

nostrils, and give a draught with half a tea-spoonful of spirits of

lavender, or thirty drops of sal volatile, and twenty of ether, added

to the lavender and water, where the fainting threatens to merge into

hysteria. Should the case be obstinate, heated bricks or mustard plasters

must be applied to the feet or thighs. Where the fainting proceeds from

organic disease, the treatment must be guided by the nature of the

primary affection.

AFFECTIONS OF THE FACE.

Under this head must be comprehended face-ache, consequent on cold,

tic-douloureux and other nervous affections, erysipelas, pimples,

blotches, and other eruptive diseases of the cuticle. As many of the

most serious and painful affections of the face are the result of some

disorganization of the system, or disease more remotely situated, such

as erysipelas, tic-douloureux, and tooth-ache, these affections must

be looked for under their respective heads; the present section being

confined merely to those blotches and pimples that so often disfigure the

countenance. These are sometimes of a scorbutic character; when they are

distinguished by irregular red or reddish brown patches on the cheeks and

nose, attended with heat and itching, occasionally disappearing and again

returning, after the least excitement.

_Treatment._—Take of corrosive sublimate two grains, spirits of wine, one

ounce. Dissolve and mix, and take five drops in a wine-glass of decoction

of dandelion, or wormwood tea, three times a day, for a week; when it is

to be intermitted for a few days, and again resumed in the same order

and dose. In bad cases, a lotion made by mixing milk of sulphur in

elder-flower water, till the whole is of the consistency of cream, may be

applied every night, in addition to the medicine, and washed off in the

morning with warm water.

Black spots and freckles are to be treated by making an emulsion of

bitter almonds, and dissolving in every half-pint two grains of corrosive

sublimate; and after softening the cuticle by bathing the face for a few

minutes with warm water, applying the emulsion so prepared before going

to bed, letting the lotion dry into the skin and washing well off in

the morning. At the same time, a wine-glassful of wormwood tea should

be taken every day, either two or three times. In all affections of the

skin, proceeding from functional disorder in the stomach, liver, or

other organs, producing blemishes on the face, there is no remedy that

exercises so permanently beneficial an effect as a course of wormwood;

and the infusion should, therefore, in all cases where the complexion

is injured, especially in females, be made the primary and principal

remedial agent.

In long standing discoloration of the face, proceeding from impaired

action of the liver, a steady course of alternative medicine must be

persisted in for some time, if any permanent benefit is to be expected;

and for this purpose a compound Plummer’s pill must be taken every

night for one or two weeks, with a wine-glass of the compound decoction

of sarsaparilla twice a day; alternating this treatment every week or

fortnight, by one of the following pills, and a decoction of dulcamara

and dandelion, in the proportion of an ounce of each to a pint of water.

_Pills._

Blue Pill 1 scruple.

Extract of Colocynth 1 scruple.

Compound Rhubarb Pill 1 scruple.

Mix and divide into twelve pills.

At the same time, under either treatment, a warm bath should be taken

once a week, and a constant friction kept up over the body; and

especially above the region of the liver, while in the water, by the

flesh-brush, or a rough irritating towel.

AFFECTIONS OF THE EYE.

Most of the affections of this organ are of too complicated a character

to be popularly treated. In this place the only disease noticed will be

that condition of the organ known as general inflammation, and those

affections that belong to the appendage of the eye. Inflammation of

the eye commences with heat and pricking, and a sense of tightness in

the part; the upper lid first and then the lower, become red, swollen,

and extremely painful, attended with great tenderness when pressed;

the eyeball itself is bloodshot, intolerant of light, and feels as if

particles of sand were between the ball and the lids, the surrounding

parts sympathize in the swelling, and there is an abundant flow of tears.

The constitution at the same time suffers, there is more or less fever, a

quick pulse, and considerable pain in the head.

_Treatment._—The patient should either be bled from the arm or cupped

on the temple, four or six leeches applied round the orbit, the bowels

at the same time acted on quickly by one of the following powders every

three hours, and a dose of the accompanying mixture every four hours,

till they are thoroughly relieved, the patient all the time being kept

quiet, and in a darkened room.

_Powders._

Calomel 12 grains.

Antimonialis 12 grains.

Jalap, powdered 2 scruples.

Mix, and divide into four powders.

_Mixture._

Take of

Infusion of Senna 5 ounces.

Epsom Salts 1 ounce.

Dissolve, and add

Syrup of Buckthorn 1 ounce.

Mix. Take two table-spoonfuls for a dose. After the leeches

the eye should be fomented with warm water, or a decoction of

poppy-heads, and should the skin remain dry and hot, a sweating

draught must be given at bed-time, preceded by a mustard and

water foot bath.

_Draught._

Acetated Solution of Ammonia 1 ounce.

Tincture of Squills 30 drops.

Tincture of Opium 30 drops.

Antimonial Wine 1 drachm.

Spirits of Nitre 2 drachms.

AFFECTIONS OF THE EARS.

The delicate yet important organ of the ear is subject to many diseases

and accidents. The most frequent mischief to which the _external_ part

of the organ is subject, is partial or complete loss of the cartilage

or shell of the ear, a result that either follows sabre cuts, gunshot

wounds, or sloughing from blows or pressure. Inflammation seldom attacks

the external parts, or, if it does, is in general of an erysipelatous

character. When the cartilage has been lacerated, or part of its

structure destroyed, the separated parts are to be placed as near as

possible in their natural position, and kept together by two or three

stitches, a warm moist poultice laid over the part, and a light bandage

passed round the head to keep the dressing in its place. The external

ear is also frequently the seat of scrofulous ulcers and ill-conditioned

sores, and the skin behind the ear is particularly liable to small

encysted tumours, which are very tedious in their suppuration, and cause

considerable pain and inconvenience.

The treatment is nearly the same for all these affections; a course of

alterative and tonic medicines, a warm bran or bread poultice night and

morning on the part, and when the discharge is fœtid and thin, a lotion

made by dissolving two grains of nitrate of silver in an ounce of rose

or distilled water, is to be used as a wash to the sores, once or twice

a day; in very obstinate cases a small blister applied to the nape of

the neck will speedily effect a cure, though in general, cleanliness,

attention to the diet, and an alterative and tonic course of medicine,

will effect a sure and far more satisfactory cure than can be obtained by

any counter-irritant remedy that can be used.

_Ear-ache_ is a very painful affection of the auditory passage,

consequent on cold or a slight degree of inflammation in the membrane of

the ear; in all such affections the soothing system will be found the

best and safest practice, and this consists of a little cotton dipped

in oil with a few drops of laudanum placed in the ear, and a warm bran

poultice over all, repeating the poultice every two hours; when, however,

the pain is more intense, apply a leech below or behind the ear, and

promote the bleeding by poultices.

AFFECTIONS OF THE LIPS.

The lips, or rather the lip, for it is to the lower lip that disease is

generally confined, is subject to several affections such as inflammation

and enlargement, ulceration, chapping, and excoriation—all in themselves

trivial and harmless—and is only subject to one, and fortunately rare

disease of any serious moment—cancer. Leaving this for the present out of

consideration, all the others may be regarded as symptomatic of the state

of the stomach, or else are caused by direct irritation from contact

with jagged teeth. The most prevalent form of sore lips is that of deep

cracks or fissures, that on the first stretch of the cuticle bleed; in

persons of a scorbutic habit, instead of cracking, the skin peels off

in scales, leaving a raw, irritable, and painful abrasion, aggravated

by heat or moisture, and which sometimes continues for weeks; both of

these conditions are dependent on the state of the system, and can always

be cured in a few hours, or in the worst case in two or three days, by

a dose or two of aperient medicine, such as a dose of blue pill, and a

spoonful of Epsom salts some hours after, repeating both for two or three

times, should the obstinacy of the case require it. When inflammation and

swelling of the lip takes place, as it sometimes does, from the presence

of a broken tooth, keeping up a constant irritation from the sharp edge

pressing on, or coming in contact with, the soft part, the spicule

should be at once filed down, or else the tooth withdrawn, for while

the exciting cause remains, no means will afford relief. This having

been done, a cold lotion of sal-ammoniac, vinegar, and water applied by

means of wetted pledgets of rag, will speedily reduce the swelling, when

a pill and a draught, such as have been already ordered, will insure a

permanent recovery of the part to health. The lip in all cases should be

kept as dry as possible, and especially from the saliva and the tongue;

and as all such cases are symptomatic of the state of the system, their

own permanent cure is, as we have shown, by an aperient medicine. An

excellent application is a little tallow rubbed in by the finger before

going to bed, the tallow having the advantage over all other grease, in

not becoming rancid.

Cancer of the lip is usually characterized by a callous thickening of

the cuticle and the formation of a warty excrescence; or it may begin by

a painful pimple, which after once or twice being removed, degenerates

into a small irritable ulcer, that discharges a thin ichorous exudation,

and rapidly affects the glands under the jaw, which become distinct and

knotty; the ulcer, after remaining for a length of time in passive,

irritant state, closing over, and again breaking out, suddenly assumes

an active form, and is attended with stiffness in the muscles of the

jaw and darting pains, till it finally assumes all the features of this

much dreaded disease; for which, though caustic and arsenic are the best

remedies we possess, there is no certain cure but excision, in the same

manner as for hare-lip. Though cancer of the lip is generally confined to

_men_ in mid-life, and inveterate smokers, it would appear more to depend

upon some occult state of the blood than on any social habit, however

objectionably pursued.

PRESERVATION OF THE TEETH.

The preservation of the teeth ought to form an important item in the

care of the person. The possession of sound teeth is a great blessing,

as they not only promote the process of digestion, but keep the breath

sweet and pure. Unsound and unclean teeth are also most unsightly and

unpleasant for other persons to be brought in contact with; for these

combined reasons, the greatest care should be observed in the management

of these important organs. It must be understood that the teeth are bones

thinly covered over with a fine enamel, and this enamel is more or less

substantial in different persons. Whenever this enamel is worn through

by too coarse a powder or too frequently cleansing the teeth, or eaten

through by a scorbutic humour in the gums, the tooth cannot long remain

sound. The teeth, therefore, are to be cleaned but with great precaution,

for if the enamel is worn off faster by cleaning the outside than nature

supplies it within, the teeth will probably suffer more by this method

than by neglect. A butcher’s skewer, or the wood with which they are

made, must be bruised and bit at the end till with a little use it will

become the softest and best brush for this purpose; and in general, the

teeth may be cleaned with this brush without any powder. It is necessary

to observe that, very near the gums of persons whose teeth are otherwise

good, there is apt to grow a false kind of enamel, both within and

without, and this false enamel or tartar, if neglected, pushes the gums

higher and higher till it leaves the fangs of the teeth quite bare,

above the true enamel, so that sound teeth are destroyed, because the

gum has forsaken that part which is not sheathed and protected. In the

summer months this tartar may be effectually removed by partaking daily

of strawberries; eating plentifully of watercresses is also considered

a good remedy. An excellent tincture for this defect will be found as

follows:—Mix six ounces of tincture of Peruvian bark with half an ounce

of sal-ammoniac. Shake these well for a few moments every time before

the tincture is used. The method of using it is, to take a spoonful and

hold it near the teeth, then with a finger dipped in, rubbing the gums

and teeth, which are afterwards to be washed with warm water. Another

method of preserving the teeth is to wash out the mouth with water after

every meal, especially if animal food has been eaten; by these means the

particles of food lodging about the teeth and gums are dislodged, which,

when allowed to remain and accumulate, prove excessively injurious. Much

harm is frequently done to the teeth by cleaning them with too hard

a brush or deleterious dentifrices, in either case the enamel being

scratched and otherwise injured. As a matter of course, the preservation

of the teeth is greatly influenced by what is eaten and drunk. All things

that are either very hot or very cold are extremely bad; acids are

especially injurious, as are also sweets.

_The decaying of teeth_ is partly due to chemical decomposition of the

food lodged between the teeth in eating. When there is joined to this

an unhealthy or weak condition of the ivory, which is thus rendered

incapable of resisting the action of external causes, and also the

continual pressure of the adjacent teeth, when too close together, then

decay is almost sure to take place in some part or other of the crown.

When it occurs in the sides of the necks, just below the enamel, the

cause always is in the food, and generally so when in the middle of the

crown of the molars; but sometimes decay takes place beneath the enamel,

and long before the slightest fissure in this part can be detected by

any ordinary observation, or, at all events, while there is no opening

large enough to admit the food. Besides these causes, another exists in

the uncovered state of the roots, or fangs, or on these being covered

by tartar instead of gum, both of which circumstances tend to produce

decomposition and decay, and should be cautiously guarded against. When

a cavity is actually developed, the sooner it is filled the better. When

it is small and has not opened into the natural cavity of the tooth

gold leaf is the best material, the dentist previously cutting away the

decayed matter and pressing in the gold with great force. When, however,

this cavity is exposed, gold is useless under ordinary circumstances. The

following are some of the best methods of filling teeth when beginning to

decay:—1. Mix thirteen parts of pure finely powdered caustic lime with

twelve parts of anhydrous phosphoric acid. This powder is moist during

the mixing, and while in that state is to be introduced into the decayed

tooth. The place in the tooth is to be made dry before receiving the

mixture. This kind of filling must be used two or three minutes after

being prepared. Soon after it is lodged in the decayed cavity, it becomes

very solid. 2. Take pure anhydrous phosphoric acid forty-eight grains,

pure caustic (unslaked) lime forty-two grains. Finely pulverize each

separately, and keep them separate in well-stopped bottles till wanted.

For use, mix the required quantity in a small mortar, as rapidly and

perfectly as possible, and at once press the dry mixture in the cavity

of the tooth. The surface should then be smoothed off and finished by

moistening with water. This cement soon acquires great hardness; it is

very white and durable, and in its composition resembles the natural

earthy matter of the teeth. The whole process requires expertness to

succeed; but the latter, when attained, will amply repay for one or two

failures. If the composition be not mixed and applied quickly it becomes

moist, and is therefore unfit for use. In many cases the odour arising

from carious teeth is very offensive; to remedy this, the mouth should be

well rinsed with a tea-spoonful of the solution of chloride of soda in a

tumbler of water, which will have the desired effect.

PRESERVATION OF THE HAIR.

Under ordinary circumstances, the hair may be preserved by the most

simple means. In a sound and healthy constitution, the best preserver

and beautifier of the hair is regular and careful cleaning. As a general

rule, _the head cannot be too much brushed_, brushing serving as an

active and healthy stimulant upon the skin, rendering the functions more

vigorous, and, as a consequence, the production of hair more easy and its

maintenance more certain. On this account, hard and penetrating brushes

are useful, but in using them it should be borne in mind that it is the

_head_ which requires brushing more than the hair; while, therefore, the

brush is actively applied to the roots of the hair, the surface should

be brushed with a light and gentle hand. Occasional washing with pure

water is to be recommended, providing the hair is not very long, so as

to render drying difficult. To assist in drying it thoroughly, dip the

brush into a very little hair powder and brush it out again; after that,

a little pomatum may be brushed in.

With regard to _cutting the hair_, it is an operation which should not

be performed too frequently, nor delayed too long; in ordinary cases, it

would be well to have a small portion of the hair removed every month or

six weeks. Where the hair is in an unhealthy condition, especially where

much has fallen off, and a partial and impoverished growth has risen

up to represent that which is lost, the short and impoverished hairs

should be carefully and persistently cut, with the view of giving them

bulk and strength, and improving their growth. The frequent plucking

out of withered hairs is also productive of benefit, as the process is

necessarily accompanied by much stimulation of the skin, which promotes

the growth of the hairs individually and generally.

_The excessive use of grease_ in dressing the hair, is a common error

which cannot fail to be productive of injurious consequences. There is a

natural oil secreted by the hair which in a healthy state should supply

the requisite amount of moisture; sometimes this is defective, and the

hair becomes dry and harsh, it is then proper to supply the deficiency

by a little pomatum or oil. When the artificial grease is applied in

excessive quantities, it produces a matting of the hair, prevents the

pores of the scalp from acting freely, and thus the proper supply of

natural moisture is not communicated freely to the hair.

_The kind of grease to be used_, should be animal fats in preference to

vegetable oils, the latter being apt to become rancid, and not possessing

such active stimulant properties as the former.

_The use of soap_ in washing the hair, should be cautiously and sparingly

observed, as it is apt to change the colour and texture of the hair. A

little white soap dissolved in spirits of wine is more effectual and less

injurious than soap alone. After this the hair should be well washed with

pure water.

When _grayness of the hair_ shows itself, it is and indication of want of

tone in the hair-producing organs, and if this tone can be restored, the

hair will cease to change, and at the same time further change will be

prevented. The plan of cutting, as previously recommended, combined with

judicious plucking, tends very much to prevent the extension of grayness.

_Keeping the head too much covered_ is calculated to prove injurious to

the hair, as by this means an excessive amount of heat is generated,

which tends to enervate and relax the hair-producing organs, and

consequently weaken and thin the hair; for this reason the wearing

of nightcaps is to be condemned, and the practice of wearing the hat

throughout the day is attended with similar evil consequences.

_Curling the hair_, especially when frequently resorted to, is a most

pernicious custom—the inordinate amount of heat that is employed to

produce the desired effect, drying up the natural oils, and otherwise

injuring the roots and texture of the hair.

_Sudden heats and chills_ of all kinds are also productive of ill

consequences; and in short whatever accident or operation the hair is

subjected to, widely differing from its normal state, must produce, more

or less, those diseases and that decay to which it is peculiarly liable.

In every case it should be remembered, that the preservation of the

hair depends not only on local stimulation, but also on constitutional

treatment. This truth is the more to be insisted upon, as a common

notion prevails that the mere application of certain specifics will

remedy defects without any other aid. Above all, the advertised nostrums

which boast of being able to effect such extraordinary results, are

not to be relied upon, and in many cases should be cautiously avoided.

The simple truth is, that these specifics owe their boasted productive

and restorative powers to precisely the same principle that attends

the simplest formula, namely, the stimulation of the skin; and the

application, therefore, must be governed by the same laws, and attended

with the same results in the one case as in the other.

AFFECTIONS OF THE NOSE.

The membrane that lines the whole alimentary canal from the lips and

mouth downwards, has special peculiarities in particular places,

according to the function it has there to perform: in the nostrils, as

the external seat of smell, it is beautifully and remarkably adapted for

its purpose; yet, though being so incessantly in active operation, it

is, perhaps, the least affected part of the body. With the rest of the

lining membrane of the mouth, it suffers from cold, or in affections

of the stomach, discharging a thin fluid in cases of catarrh, and

showing a dry, red, and irritable surface when the bowels and stomach

are affected, hence the involuntary picking of children when they have

worms; but of itself, besides a thickening of its coats from various

causes, and thereby blunting the perception of smell, and obstructing

the reverberance of articulation, and the occasional formation of that

extraordinary zoophyte, the polypus, high up in the nostril, this part

of the frame has no other disease appertaining to it. For the first,

an occasional errhine, as a pinch of snuff, or the smallest atom of

the white of hellebore powder, imbibed in the same way, with a course

of aperient medicine, is all that is generally needed; though cases

may occur in which leeches and a lotion may be demanded, but they are,

however, very rare. The extraction, by surgical means, of the polypus,

as no local or constitutional treatment has any effect on its growth,

renders any further account here of this disease unnecessary. The

external parts of the nose are, however, more frequently affected than

the internal, the cuticle over the cartilage being subject to warts,

inflammation, small painful pimples and abscesses, and to cancer. The

warts are easily removed by a daily application of caustic or blue

stone; the inflammations, by a cold lotion of sugar of lead and water;

and the pimples and abscesses, by the same means assisted with cooling

purgatives. For the more formidable disease of cancer, surgical aid must

be obtained, as the treatment, in unskilful hands, might be attended with

risk.

There is a condition of the nose, usually, but not always justly,

attributed to persons of dissipated habits, in which that feature becomes

enlarged, of a red or purple colour, and covered with unseemly blotches,

pimples, and bright-coloured excrescences, distending the organ sometimes

to an enormous size. Though this disfigurement, undoubtedly, frequently

marks the drunkard, it is more properly an indication of diseased liver

than a characteristic of dissipation, and is more usually found in its

worst form in persons of temperate, than intemperate habits. As this

disease is in general a local system of a constitutional derangement, the

remedies to cure it must more properly be applied to the system rather

than the part. For this purpose a course of Plummer’s pill, alternated

with blue pill, and a decoction of dulcamara and dandelion in water, two

ounces of each, boiled from four to three pints, and a wine-glassful

taken every four hours, and a pill twice a day, must be continued for

some days, or even weeks; at the same time the nose should be enveloped

in a poultice made of scraped Solomon’s seal, damped with vinegar, laid

next the skin; and being put on at bed-time, should be allowed to remain

all night.

AFFECTIONS OF THE THROAT.

The throat is subject to two forms of inflammatory action, acute and

chronic; of the former, there are two conditions which, though both

present acute inflammatory action, and both are diseases of a dangerous

character, are very different in their symptoms and their consequences.

These are—1st. _Inflammatory sore throat._ A disease that attacks persons

of either sex, and of all ages up to forty or forty-five years; after

which period it is but rarely met with. It is very often found attacking

several persons at the same time like an epidemic, in spring and autumn,

especially so when there are great vicissitudes of atmosphere; the

disease being induced by the sudden application of cold to a heated body,

or the reverse, but most frequently from wet feet, a sudden draught of

cold air to the throat or nape of the neck, or even from a drink of cold

water when the body is greatly heated.

The _symptoms_ that first attract attention are, a great difficulty in

swallowing, with heat, constriction, and dryness of the throat; the

difficulty of swallowing rapidly increasing till at length that operation

becomes impossible, every attempt ending in the ejection of the liquid

through the nostrils. As the disease advances, a thick ropy phlegm, of

a yellowish colour, is thrown out from the part, and after much trouble

expelled; at the same time sharp pains run through the jaws and ears,

the voice in some cases is reduced to a whisper, and in all is thick

and hoarse. From the first sensation of dryness in the throat, symptoms

of fever show themselves in the constitution, such as heat, shivering,

thirst, nausea, sickness, and headache. If the earlier remedies have

failed to check the inflammation, the disease at the end of five, or

sometimes seven days, runs into suppuration, and one or more abscesses

are formed in the tonsils, which usually burst into the mouth; but when

the enlargement impedes the respiration, the abscesses must be opened and

the matter discharged.

_Treatment._—When the symptoms are slight, a hot bran poultice, kept

constantly to the throat, a mild aperient, and the immersion of the feet

for a few minutes in hot water, is often all that is needed. In more

severe cases, however, and where the constitution is robust, an emetic

of ten grains of ipecacuanha and one grain of tartar emetic, should be

mixed in warm water and given directly, to be followed in two hours by

two compound colocynth pills, and half an ounce of Epsom salts, dissolved

in a tumblerful of water an hour later. As soon as the emetic has ceased

to act, the front of the throat should be rubbed with hartshorn and oil,

and a hot bran poultice directly after applied round the throat. If the

inflammatory action has set in strong, the emetic should be followed

by bleeding from the arm, or it may be adopted at any subsequent stage

of the treatment, and the poultice put aside and a blister laid on the

throat, should the urgency of the symptoms warrant its use. When the

thick phlegm causes annoyance and cannot be expelled, a gargle of warm

vinegar and water should be employed to facilitate its removal. When

suppuration sets in, which may be known by the throbbing in the part and

frequent shivers, the hot poultice must be frequently changed, and the

steam of hot water repeatedly inhaled, so as to promote the formation of

the matter. In scrofulous constitutions, the tonsils frequently become

chronically enlarged, and upon any slight exposure to heat or cold

commence a tardy process of suppuration. In such cases the treatment

recommended for scrofula must be adopted both internally and locally.

2. _Putrid sore throat._—This serious affection is not regarded as

a substantive disease by many medical men, but rather as a grave

consequence, or severe symptom of some other malady, such as malignant

and scarlet fever, or typhus, in which diseases it is very often found

as a terminating symptom. The _symptoms_ of this disease commence with

cold shivers, pain in the head, giddiness, stiffness in the muscles

of the neck, flushed face, red or suffused eyes, sore throat, nausea,

sickness, and sometimes vomiting. The pulse through all these progressive

changes is small, quick, and feeble, and easily extinguished by

pressure. The throat, when examined, presents an inflamed appearance,

the redness deepening round the fauces, which, after a time, are dotted

here and there by irregular brown spots. The tongue and gums are lined

with a brown fur, while small vesicles filled with a transparent acrid

fluid form on the inner lips, and in the nostrils, which, on breaking,

excoriate the mouth and upper lip. Concurrent with this latter symptom,

diarrhœa takes place, the constitutional disturbance or fever increases,

and the strength of the patient sinks rapidly; the pulse still more

rapid and feeble, is also intermittent, and with increased difficulty

of breathing, there is often both delirium and coma. On the third or

fourth day a scarlet rash not unfrequently breaks out over the chest and

arms, which, on the sixth or seventh, peels off; the mouth is covered

with a dark fur, a fœtid odour issues from the throat, and the patient

exhibits all the characteristics of putrid or malignant typhus. When the

bright red appearance of the throat declines about the fifth day, and

some return of appetite shows itself, a favourable termination may be

hoped for, but when the inflammation passes rapidly into ulceration and

sloughing, and a flow of acrid saliva takes place from the mouth, with

coma, the result of the case is regarded as extremely doubtful.

_Treatment._—The mode of treating this disease is precisely the same as

for typhus, and consists in supporting the patient’s strength by the most

potent and energetic means, to give him strength to resist the first

shock of the disease, and then, to facilitate the separation of the

sloughs and support him over the reactionary stage. To fulfil the first

intention, beef tea, jellies, and a nutritious diet must be employed

from the first, with doses of wine at regular intervals, and where the

depression is great, brandy, either as a substitute or in addition; at

the same time such a stimulating tonic as the following mixture should

be administered every two hours, with, at bed-time when necessary, an

addition to the last dose of fifteen or twenty drops of laudanum.

Take of

Aromatic Confection 1 drachm.

Quinine 10 grains.

Camphor Water 5 ounces.

To be rubbed smoothly in a mortar; then add

Compound Tincture of Bark 4 drachms.

Compound Tincture of Cinnamon 4 drachms.

Sal Volatile 1 drachm.

Mix and give a table-spoonful every two hours. Bottles of hot

water should be kept to the feet, and a warm bran poultice

placed round the throat. When the first stage of the disease

has been passed, in addition to a nutritive diet, and a course

of tonic stimulants, only less frequently administered, the

throat must be gargled occasionally with the following gargles

in succession.

_Gargle No. 1._ Take of

Strong Sage Tea 1 pint.

Vinegar 4 ounces.

Mix. To be used every hour for three or four times on each

occasion.

_Gargle No. 2._ Boil

Bruised Oak-Bark 2 ounces.

in a pint of water for ten minutes; and add

Alum 2 drachms.

Mix. To be used as the former.

_Gargle No. 3._ Take of

Infusion of Rose Leaves 1 pint.

Sulphuric Acid 30 drops.

Mix. To be used as the above.

_Gargle No. 4._ Take of

Capsicum Vinegar 6 ounces.

Tincture of Catechu 4 drachms.

Water, to make a pint. Mix, and use as the former. For the

fœtor that arises from the sloughing, the mouth and throat are

to be occasionally washed with a weak solution of chloride of

lime, and, throughout the whole disease, the room should be

frequently sprinkled with aromatic vinegar, or the chloride of

lime or tin.

Ordinary _sore throat_ or hoarseness, when not a symptom of any more

severe illness, may usually be easily disposed of by rubbing the throat

freely with hartshorn and oil, and then enveloping the throat and neck in

two or three folds of hot flannel, plunging the feet two or three times

quickly in very hot water upon stepping into bed, and placing a piece of

Spanish juice in the mouth, allow it to dissolve there during sleep. When

the sore throat is attended with cold chills, a dry hot skin and tendency

to headache, before resorting to the liquorice and being well covered up

with clothes, the patient should drink about half a pint of hot egg-flip

made tolerably potent with a due proportion of gin or rum.

CARE OF THE HANDS.

It is acknowledged, by common consent, that dirty and coarse hands are

marks of slothfulness and low breeding; while, on the contrary, clean and

delicate hands are evidences of cleanliness and refinement. The person

who has much manual labour to perform, cannot, of course, be expected to

keep his hands of that delicate shape and texture, which another person,

whose employment is light, may do. But, at the same time, it is always

possible, under any circumstances, to keep the hands in that state during

the intervals of labour, so that they shall not appear displeasing to the

eye.

To promote the _softness_ and _whiteness_ of the skin, mild emollient

soaps, or those abounding in oil, should alone be used, by which means,

also, chaps and chilblains will generally be avoided. The coarse strong

kinds of soap, or those abounding in alkali, should, for a like reason,

be rejected, as they tend to render the skin rough, dry, and brittle. The

immersion of the hands in alkaline lyes, or strongly acidulated water,

has a like effect.

_Roughness of the skin_ may generally be removed by a little sand being

mixed with the soap, or by rubbing the hands with pumice-stone previously

to applying the soap; in this operation care should be taken not to

allow the gritty particles to come into contact with nails, or they will

scratch them.

_Dirt from the hands_ is more effectually removed by warm water than

cold; the hands, however, are liable to become dirty sooner afterwards,

and perhaps the best plan is to remove the dirt with warm water, and

afterwards rinse the hands in cold.

_Washing the hands too frequently_ has a tendency to discolour them

with a brown or tawny hue. Under ordinary circumstances it will be

sufficient to wash the hands three times a day, namely, on rising,

before dinner, and on retiring to rest. After washing, the hands should

be carefully dried with a moderately coarse towel; this will promote a

free circulation through them, which will ultimately tend to enhance

their appearance. Exposure to cold winds and rain is detrimental to the

appearance of the hands, and gloves should always be worn.

_Fruit and ink stains_ may be eradicated from the hands, by immersing

them in water, slightly acidulated with oxalic acid, or a few drops of

oil of vitriol, or to which a little pearlash or chloride of lime has

been added; observing afterwards to rinse them thoroughly in clean water,

and not to touch them with soap for some hours, as any alkaline matter

will bring back the stains. The hands may be _preserved dry_ for delicate

work, by rubbing a little club moss, in fine powder, over them.

_Hands that perspire, and are inordinately hot_, may arise from

some temporary derangement of the system, or from a constitutional

peculiarity; this may be partially remedied, by inserting the hands into

a water-jug full of water, and lowering them gradually until the elbows

reach, letting them remain at this point for two or three minutes; this

operation will, in general, keep the hands pleasantly cool for some hours

afterwards. In conclusion, it must be observed that an over-anxious care

for the state of the hands is to be deprecated. Some persons who are

possessed of a small and delicate hand are so vain of it that they are

constantly displaying it in an obtrusive manner, which is very offensive

to the looker-on. And in some instances the fear of putting the shape

and outline of the hand out of form, is so great, that every kind of

work is avoided, and even accomplishments, such as the harp, piano, and

guitar, are avoided, for fear of expanding the hand, and flattening

the extremities of the fingers; this is a preposterous error, for the

beauty of the hand does not alone consist in whiteness and a statue-like

contour, but in certain indurations, which may be termed “expression,”

and which are imparted by the pursuit of suitable occupations, and

appropriate accomplishments.

CARE OF THE FEET.

To preserve the feet in a proper condition, they should be frequently

soaked and well washed in warm or tepid water. Many persons are subject

to tender feet. This frequently arises from the use of thin cotton or

silk socks or stockings, and boots and shoes that are either too tight or

stiff, or not sufficiently porous to allow of the escape of perspiration.

Waterproof boots and shoes are on this account frequently the cause of

tender feet. The best remedy for tender feet is the immediate adoption of

worsted stockings or socks, and light easy shoes of buckskin, goatskin,

or some other equally soft kind of leather. For the preservation of

health, it is highly necessary to preserve the feet dry; persons who are

therefore exposed to the wet, or who have much walking in wet weather,

should be particular in wearing sound boots and shoes; through neglecting

this precaution, many persons have brought on pulmonary complaints, which

have frequently had a fatal termination. Coldness and numbness of the

feet is a complaint to which some persons are subject, especially aged

and delicate persons, and those whose employment is sedentary. The best

and most natural remedy for this, is action, exercise, or friction—the

former being always adopted when possible. Retiring to rest with cold

feet is especially to be avoided, and persons so subject, should pace up

and down the room just previously to going to bed, until their feet have

attained a warm glow. Where this is impracticable, owing to weakness,

old age, &c., warm woollen stockings may be put on with great advantage,

or the hot water bottle had recourse to. The peculiarly disagreeable

odour emitted by offensive feet, may be remedied chiefly by scrupulous

attention to cleanliness, and by occasionally soaking the feet in warm

water to which a small quantity of chloride of lime or sal-ammoniac has

been added.

DISEASES OF THE HEART.

There are many affections of this vital organ that, professionally

speaking, do not merit the name of disease, being in fact but temporary

inconveniences, symptomatic derangements, or, as has been said,

affections; but which, nevertheless, for the sake of perspicuity, it

will be better to class generally under the one name of diseases of the

heart, separating them, however, from the graver maladies by a distinct

heading; and, as they form the lighter part of the subject, treating of

them before considering the more serious form of this class of ailments.

The heart, as the centre and source of the circulating system, is

liable to a considerable number of affections, both simple and complex,

which may be divided into two heads—the functional or nervous, and the

structural or organic.

_Functional, or Nervous Affections of the Heart._—Under this head

are comprehended palpitation, syncope or fainting, angina pectoris,

and neuralgia of the heart; all of which, though occasionally very

distressing, and sometimes most alarming to the sufferer, are often only

symptoms of other affections, and consequently of minor importance; and

even when spontaneous, and producing considerable bodily disturbance,

seldom cause any real apprehension, and still more rarely result in

positive danger, and in this respect bear a marked contrast to those

diseases of the opposite class.

_Palpitation._—By this term is understood those frequent, strong, and

irregular movements of the heart, occurring in individuals who have no

indications of organic disease; these movements may be transient or

continuous, frequently accompanied with an audible sound, so loud, as to

be heard at several yards from the patient. Palpitation is often attended

with a feeling of sinking and anxiety, accompanied with fainting fits or

syncope, and sometimes with a pulsation at the pit of the stomach. The

causes of palpitation, irrespective of a naturally nervous temperament,

hysteria and weakness, are any strong emotions of the mind, long study,

violent exercise, or a continued passive repose, the debility consequent

on fever, or whatever weakens the standard of health. Besides these

causes, palpitation may also be a symptom of organic disease of the

heart. The persons most frequently affected with palpitation are females;

the slightest extra exertion, or exposure to damp foggy weather, often

suddenly producing a paroxysm, attended with pain in the head, and a

sense of numbness in the left side or arm. Persons who suffer from spinal

irritation are also liable to palpitation, attended in such cases with

a remarkable acceleration of the pulse, often amounting to 160 beats in

a minute. The respiration is generally difficult, or easily rendered

so, on the slightest exertion or mental emotion, and frequently induced

by the slightest pressure, such as that of the stays on the chest,

waist, or lower part of the spine, the pain often being intolerable.

Palpitation is very common in young females between the ages of 15

and 25, especially where the occupation is long and sedentary, as in

factories, or in dressmakers’ establishments. Indeed, palpitation, with

very rare exceptions, may be said to be a complaint peculiar to the

female sex, and the more the occupation of young women confines them to

a close unvarying atmosphere, the more prone are they to attacks of this

troublesome disorder; and the more exposed they are to the open air, the

less frequent and the less severe are all such maladies.

There are few affections, even of the gravest character, whose symptoms

give rise to greater alarm in the mind of the patient, or doubt and

uncertainty to the inexperienced practitioner, than those of a severe

attack of palpitation: often before seeing his patient he hears the

irregular throbbing of the heart; on looking on the white or lividly

anxious countenance of the sufferer, fancies he reads the external signs

of the most formidable organic mischief, while, in truth, a cheerful

aspect, a few confident words, and the simplest remedies, will not only

remove all the unpleasant symptoms, but restore the apparently diseased

patient to health, and ultimately to strength. It is only when the pulse

is intermittent that any organic disease is to be apprehended, the

velocity or strength of the pulse depending entirely on some accidental

cause, more or less easily removed.

_Treatment._—Though the causes that excite palpitation are numerous,

they may all be reduced to two heads—that of inflammation or a state

of plethora, and a state of local or constitutional debility. When

palpitation can be traced to an inflammatory condition of body it will

be necessary, according to the age and the condition of the patient, to

reduce the circulation by bleeding, either from the arm, or what is more

usual, by leeches, or cupping glasses over the region of the heart, or

still better, between the shoulders, low down on the spinal column, at

the same time giving nauseating doses of tartar emetic, hydrocyanic acid

or tincture of digitalis, or foxglove. The following mixture, combining

all the advantages to be obtained from each, may be safely substituted

for one or either, having the power to allay inflammatory action, reduce

the circulation, subdue pain, and promote a beneficial action on the skin.

Take of

Camphor Water 6 ounces.

Powdered Nitre 1 scruple.

Tartar Emetic 3 grains.

Laudanum 1 drachm.

Dissolve and mix. Give two table-spoonfuls at once, and one

spoonful every two or three hours afterwards.

At the same time a low diet, rest, quietude, and strict attention to the

state of the stomach and digestive organs, are imperatively necessary.

Where, however, the exciting cause is debility, the system must be in

the first case braced by cold bathing or the shower bath, followed by

vigorous friction along the spine with the flesh-brush; tonics and steel

in all shapes, as chalybeate waters, or steel, wine or pills, or the

usual iron and myrrh mixture; to this must be added change of air, a rich

and liberal diet, and exercise either on horseback or by walking. The

next affection of the heart is

_Syncope, or fainting_, which is characterised by an indescribable

sense of distress and feeling of faintness; the eyes grow dim, and are

covered with a kind of film, attended with noises in the ears; the face

and lips are pale, a cold perspiration breaks out on the body, the mind

succumbs and grows confused, the body totters, and if not supported,

falls; respiration becomes imperceptible, and the pulse is reduced to an

irregular flutter. For a further account and treatment, see FAINTING.

_Angina Pectoris._—The first symptoms of this distressing complaint are

a sudden and violent pain across the chest, coming on upon any slight

exertion, such as going upstairs, or after a hearty meal. The pain

gradually extends to the shoulder, and runs down to about the middle of

the arm, accompanied with a sense of stricture or tightness across the

chest, the pain becoming so acute as to threaten the patient with instant

death. The pulse sinks and becomes weak and irregular, the countenance

is colourless, cold sweats succeed, and a constant cough, and after a

time an expectoration of a scanty viscid mucus. When the paroxysm first

comes on, the patient is compelled to stand perfectly still, as the only

relief he can obtain from the agony of his suffering is an absolute

repose. After a time the fit comes on from the slightest cause or mental

excitement, and often attacks him in the night upon waking from his first

sleep. Angina pectoris is generally a disease of advanced life, and is

often accompanied with flatulence, and common to gouty or rheumatic and

sedentary habits of body; and though sometimes a symptom of functional

derangement, is more frequently a characteristic of serious organic

disease.

_Treatment._—The first indication is to relieve the urgency of the

symptoms, and then between the pauses of the paroxysm administer

remedies, to prevent the return of the disease. Bleeding is occasionally

beneficial in this affection, but it must be employed in the earliest

stage, and only a small quantity of blood taken from the patient, who is

to be kept in a recumbent position, and as quiet as possible. Where there

is much dyspepsia or gastric disturbance, an emetic is useful; but the

main dependence for relief lies in the employment of anti-spasmodics and

carminatives.

The following mixture, as containing the best of both classes, may be

taken in the manner directed.

Take of

Aromatic Confection 1 drachm.

Peppermint Water 6 ounces.

Rub smoothly down in a mortar, and add

Tincture of Cardamoms, compound 1 ounce.

Laudanum 1 drachm.

Compound Spirits of Ether, or Hoffman’s Anodyne 2 drachms.

Mix. If the pain is very severe, take three table-spoonfuls,

two more in three hours, and one every four hours afterwards;

or, when the symptoms are less urgent, two table-spoonfuls

every four or six hours.

Concurrent with the mixture, a blister or strong warming plaster should

be laid over the left breast, according to the severity of the pain,

and the spine between the shoulders rubbed with warm turpentine, or an

embrocation composed of equal parts of camphorated oil, turpentine,

and oil of amber. Having by these means, and strict repose, subdued the

paroxysms, means must be adopted to prevent, if possible, a recurrence of

the disease. This may be effected by removing all the exciting causes;

by diminishing plethora, through aperients and low diet, by a diminution

of animal and a preponderance of vegetable food; by avoiding all

stimulants, spices, and heating substances, and by guarding against all

violent emotions of the mind, or sudden and undue exertion or exercise.

As all the symptoms of angina pectoris may be caused by dyspepsia, the

state of the stomach should always command the first and most important

consideration.

The next and last of the functional diseases of this organ is _neuralgia

of the heart_, which differs chiefly from angina pectoris in being

characterised by sharp darting pains in the left breast, but unattended

by any obstruction in the respiration, and in most cases without any

change in the heart’s action or the pulse. It is purely a nervous

complaint, and, like the previous affections, most frequently dependent

on dyspepsia or flatulence, and a constipated state of the system.

The _treatment_ must be regulated by the causes that may seem to have

induced the neuralgia; though, as a local application, to allay the pain

of the paroxysms, a plaster of belladonna or opium and litharge will, in

all cases, be found of very great advantage, and may, irrespective of any

mode of internal treatment, be kept on the chest for some considerable

time. There is also another form of heart affection sometimes met with,

though not universally acknowledged by the profession, called spasm of

the heart, in which the treatment must depend upon the age, sex, and

strength of the patient; the chief remedies, however, being the hot bath,

stimulants, such as ether and ammonia, and counter-irritation by friction.

The other class of diseases to which the heart is liable are those which

affect the tissue or substance of the organ itself, and are known as

structural or organic diseases; all of them are, consequently, highly

dangerous and often mortal maladies, and are called:—1. Inflammation,

chronic and acute, of the bag of the heart—Pericarditis. 2. Of the

substance of the heart—Carditis. 3. Hypertrophy, or enlargement of the

heart, either of the whole organ or a part, and frequently accompanied

with ossification, softening, or dilatation, sometimes regarded as a

distinct disease. 4. Atrophy, or wasting of the heart, a species of

emaciation of the organ by which the heart of a full-grown man or woman

becomes as reduced as that of a child—in other words, less than half

its natural dimensions—and its texture growing so attenuated as to be

as thin as tissue or bank paper. Nearly all these affections of the

heart, however distressing their symptoms may be, almost always, when not

the result of structural mischief, proceed from a faulty state of the

digestive organs, and are frequently entirely cured by an assafœtida pill

taken two or three times a week at bed-time, and a little burnt soda and

rhubarb in the morning; and it is only when pain and great oppression

occur that recourse need be had to ether, opium, or anti-spasmodics.

GOUT.

The chain of symptoms which give rise to those general and local

affections, which are professionally denominated gout, proceed from some

constitutional disturbance, of the nature of which medical science is

yet completely ignorant. The symptoms have hitherto been regarded as

the disease, and it has been found, that whenever these have been duly

developed and have passed away, the system, as if relieved of some acrid

poison, has recovered its elasticity and tone; leaving the patient in

the enjoyment of a state of health superior to that usually possessed.

Gout appears to be a state of diseased action, gradually vitiating the

humours of the body, and accumulating a morbid condition of the system,

till the impaired or overcharged organs becoming unable to perform their

functions, that disturbance in the physical economy takes place known

to us as gout, that is, the symptoms, which indicate the first of the

three varieties into which the disease is divided, namely, the acute:

the second is, when these symptoms suddenly cease in the part where they

commenced, and fly to some internal organ, when it is called retrocedent;

and the third, when the system becomes habituated to the malady, which,

though mitigated as respects suffering, continues in a permanent but

subdued force, when it is called chronic gout. Gout is usually divided

into four species or distinctive forms, as—

1. _Regular gout_, attended with violent inflammation of the joints,

enduring for several days, and then receding gradually, with swelling,

itching, and disquamation or peeling off of the cuticle.

2. _Atonic gout_, attended with debility of stomach or some other

internal part, either with or without inflammation of the joints,

accompanied with flying pains and considerable dyspepsia or indigestion.

3. _Retrocedent gout_, marked by inflammation of the joints, suddenly

disappearing, and followed by immediate debility of the stomach or some

other internal organ.

4. _Misplaced gout_, shown by inflammation of some internal part,

preceded or not by some affection of the joints, which, however, quickly

disappears.

_General symptoms._—Dyspepsia, flatulence, lassitude, torpor, low

spirits, cold and numbed extremities, with pricking and gnawing

sensations in the part, cramps, turgescence of the veins of the foot

and leg; the paroxysms usually coming on about two in the morning,

with excruciating pains in the joint of the great toe, succeeded by

shiverings, a sense of horror and general fever; the pain goes on

increasing till the following evening, when it reaches its acme of

suffering, from which time it gradually declines, a moisture breaks out

on the body, and the patient begins to breathe in freedom, he falls into

a tranquil sleep, and discovers on waking that the part so lately in

torture is entirely free from pain, but swollen and inflamed.

_Treatment._—In this disease the first indication is, to alleviate pain,

which must be effected by giving an opiate of sufficient strength to

effect that purpose, and at the same time, to shorten the paroxysm,

exciting an action on the skin. To effect both these objects at once,

doses of the following mixture should be taken every two hours till the

desired result has been attained:—

Take of

Solution of Acetate of Ammonia 2 ounces.

Spirits of Nitre 3 drachms.

Antimonial Wine 2 drachms.

Tincture of Squills 2 drachms.

Laudanum 2 drachms.

Camphor Water 3 ounces.

Mix; two table-spoonfuls to be taken for a dose. The affected

part is to be enveloped in soft wool or flannel, and the

patient’s mind soothed; the limb kept at perfect rest, all

exciting aliment discontinued, and where the patient is young,

a low and abstemious dietary insisted on, and if necessary once

or twice a week giving a mild purgative of magnesia and Epsom

salts. When the paroxysms have been subdued, the colchicum,

which some regard with so much favour, may be given either

in half drachm doses of the wine or tincture, or in, what is

better, the following formulary; but however taken, this drug

should be always preceded by an aperient medicine.

Take of

Epsom Salts ½ ounce.

Magnesia 2 drachms.

Peppermint Water 6 ounces.

Wine of Colchicum 3 drachms.

Mix, and take one table-spoonful three times a day. When the

joint will bear friction, the flesh-brush should be used daily,

a milk and vegetable diet pursued, exercise and change of air

adopted, and, where possible, the bath or chalybeate waters

moderately taken. The gouty deposits or concretions formed in

joints of persons afflicted with gout, or chalk stones, as

they are commonly called, consisting of an insoluble _urate of

soda_, can only be dissipated in one way, by the steady use of

benzoic acid, which, in doses of one scruple combined with two

drachms of the carbonate of potass, is to be taken dissolved

in water every day an hour after breakfast and dinner, and

continued till the depositions are absorbed.

RHEUMATISM.

A very painful disease which affects the muscles and joints of the human

body, chiefly the larger joints and most important muscles, as those of

and around the shoulder, hip, knees, and back. Rheumatism is divided into

acute and chronic; or that condition, when the disease is in vigour and

freshness attended with extreme pain, and more or less of general fever,

and that state, when the system, by long acquaintance with the disease,

has become familiar to its attack, and it comes on from any trifling

exposure to cold, and after affecting a larger or smaller surface,

declines of its own accord—all the symptoms however, being materially

lighter than in the acute state. Besides being acute and chronic,

rheumatism is very often both general and local, and this, under both

previous conditions, and the diseases known as lumbago and sciatica, are

merely forms of acute or chronic _local_ rheumatism.

ACUTE RHEUMATISM, or RHEUMATIC FEVER, is a disease which, in many of its

symptoms, strongly resembles inflammatory fever, and usually commences

after the languor, restlessness, and shivering, which precede all febrile

actions, and is attended with great heat, much thirst, headache, a

quick bounding pulse, white tongue, constipated bowels, and acute pain

either confined to one or two parts, or more generally diffused over

the body. There is at the same time an oppression in the breathing, the

abdomen is often tense and tumid, and the secretion from the bladder,

scant, and of a deep red colour; while, from the surface of the body a

perspiration breaks out, which, though unattended with relief, by its

peculiar acid smell defines the disease, and affords a good diagnosis,

before asking the patient a single question. Upon entering the room the

air seems redolent of stale vinegar, and this fact, while helping the

physician to a suggestion of the disease, serves to define the attack

from inflammatory or any other form of fever. Another characteristic

and distinctive symptom of this disease, is the increase of pain in the

course of the muscles on any attempt to move the patient into another

position. The symptoms, if from the first unrelieved, gradually increase

in intensity; and the pulse in such cases becomes, in addition to its

velocity, hard and jerking. In all cases the symptoms are aggravated

at night, and remit their violence in the morning. The pain though

sometimes intense, is not always continuous, it is often only partial in

its situation, and sometimes abates for hours, but in all cases it is

the _last_ symptom the patient loses. The disease after a course of from

fifteen to thirty days subsides, often leaving one or more members in a

state of chronic tumefaction.

The causes that induce rheumatic fever, are generally exposure to cold

damp air, or transitions from a warm moist atmosphere into a cold or

wet one, and the period most liable to an attack is that of youth and

vigorous manhood, the full-bodied and the active, rather than the spare

and torpid; and men more frequently than women. The only other disease

with which rheumatism can be confounded, is gout, and from this it can

always be known by the indigestion and little constitutional disturbances

which always precede gout; and lastly, by that disease attacking the

_small joints_, as the toes or fingers, instead of, as in rheumatism, the

shoulder, knee, or hip.

_Treatment._—Bleeding has always been regarded as the chief if not

sovereign remedy in this disease; but as depletion is known to favour

that dangerous state known as _metastasis_, or a sudden removal of

the disease from one part to another; and, not unfrequently, from the

surface to some internal organ, bleeding should, therefore, if possible,

not be repeated, the physician depending upon other means to effect the

depletion necessary. Indeed, in many cases, the extraction of blood from

the system is quite uncalled for, as all its benefits can be obtained

by less serious and equally efficacious remedies, and by adopting the

following mode of treatment—one that will generally be found sufficient

to render the lancet quite unnecessary; or should bleeding in the first

stage have been adopted, it may be employed with equal advantage after;

only in that case, it will be less requisite to give the aperient pills

in such large doses.

Take of

Powdered Nitre 1 drachm.

Tartar Emetic 4 grains.

Camphor Water 10 ounces.

Laudanum 2 drachms.

Mix. Give two large table-spoonfuls every three hours, apply

a bottle of hot water to the feet, and administer two of the

following pills an hour after the first dose of the mixture,

and one every six hours after, till an effectual action is

excited in the bowels, when they are to be discontinued.

Take of

Compound Extract of Colocynth 1 scruple.

Calomel 15 grains.

Camphor, powdered 4 grains.

Croton Oil 2 drops.

Mix thoroughly together, make into a mass, and divide into six

pills.

Should the pain continue excessive, and the patient be debarred from

sleep by the nightly irritation, either twenty-five drops of laudanum,

in half a wine-glass of water, with a tea-spoonful of spirits of sweet

nitre, is to be given to him, if an adult, at bed-time; or else ten

grains of Dover’s powder in a little gruel; and should it be required

(one or the other), repeated at night for two, three, or more occasions,

as may be needed; the patient, during the day, reverting to the mixture

and an occasional pill, sufficient to excite one or two actions in the

twenty-four hours. Thin gruel, lemonade, or linseed tea as a diluent,

are to be used frequently to quench the thirst, and a diet of the least

solid or exciting kind established till all the febrile symptoms are

subdued. After a lapse of from four to twelve days, the inflammatory

stage, or the acute form of the disease, will generally have been passed

through; after which, the treatment assumes a different form, such as

_chronic_ rheumatism, though this term strictly signifies a disease

of considerable standing; for the sake of perspicuity, that condition

of the system existing at the termination of the acute form, has been

classed under it, which, though not correct as to fact, is perfectly so

as respects treatment, which is analogous in all conditions not attended

with inflammatory fever. In chronic rheumatism, the inflammation and the

pain are both confined to the locality or part, and the object of the

treatment is to allay that pain by reducing the inflamed condition of

the muscle or member. This is effected either by internal remedies, or

what are called constitutional means, or through friction, by producing

counter-irritation, or an artificial inflammation in the parts of the

body immediately above the suffering place; or else by a judicious

blending of the two modes of practice.

When the fever, or the acute stage has been subdued by the means already

mentioned, and a part of the body remains swollen and tender, or when in

old cases this condition comes on without other symptoms, the following

mixture is to be given, and the part carefully guarded from the cold.

Take of

Solution of Acetate of Ammonia 2 ounces.

Wine of Colchicum ½ ounce.

Syrup of Saffron 2 drachms.

Camphor Water 3½ ounces.

Mix, and give a table-spoonful every three hours, and one of

the following pills every night an hour before bed-time.

Take of

Ipecacuanha 3 grains.

Acetate of Morphia 1 grain.

Liquorice Powder 10 grains.

Mix well, form into a mass with conserve, and divide into six

pills.

When the health is debilitated, and the appetite defective, a grain of

quinine made into a pill may be taken an hour before each meal for a

succession of days. If this course is not marked with early benefit,

it will be necessary to employ friction, which may be carried on

concurrently with the medicine, and the best agent for this purpose is

the camphorated oil, which is to be rubbed gently but steadily in with

the hand for several minutes three times a day, after a few days, or in

old standing rheumatisms, increasing the strength at first by adding a

third part of turpentine to the camphorated oil, and finally another

third of spirits of hartshorn. Mustard plasters and even blisters are

sometimes employed in cases of inveterate rheumatism, but the steady and

judicious use of a stimulating embrocation with a hot bath, friction with

the flesh-brush, warm clothing and exercise, will in almost every case

cure a chronic rheumatism without the necessity of either rubifacient or

blister.

TIC-DOULOUREUX.

This extremely painful affection of the nerves of the face, though

receiving a special name, is in nothing different—except in the more

acute violence of its pain—from the general or local forms of neuralgia;

an inflamed or highly sensitive condition of a certain nerve or set of

nerves, the result of constitutional disturbance, indigestion, or wounds

in the course of one or other of the filaments of the nerves, being

both the exciting cause and the disease itself. The causes that most

frequently produce tic-douloureux, are almost always some long standing

functional derangement of the digestive organs, affections of the liver

or of the kidneys, or alimentary canal. Next in frequency to these

causes, is exposure to long-sustained fatigue or sudden heat or cold,

applied to the body, and sometimes sleeping in the sun. Tic-douloureux

has been frequently known to follow a halt, during a long march in India,

and like tetanus too, tic-douloureux sometimes supervenes upon wounds;

and years after the injury, whether punctured, gunshot, or incised,

has been healed, this agonising disease will break out upon any sudden

application of heat or cold to the body, or indeed after any deep emotion

of the mind. Whatever may be the predisposing cause, the suffering

and consequences induced bear no proportion in their intensity to the

insignificance of the agents that give rise to the disease.

The _symptoms_ of tic-douloureux commence with a sudden plunging

throbbing pain, darting as it were from over the eye, out of the

cheekbone, under the orbit, or from the side of the lower jaw, and

spreading, if the paroxysms are long continued, over the whole of one

side of the face from forehead to chin. The pain is so abrupt, peculiar,

and intense, as almost to deprive the sufferer of breath in its first

assault. These shooting, throbbing, and as they are justly called,

agonizing pains continue for an uncertain time, from only a few minutes

to one or more hours in duration, subsiding either by degrees or by an

instant cessation of pain, and ending as abruptly as the first shock

began. Tic-douloureux is distinguished from tooth-ache by the situation,

and from rheumatism, the only other affection it can be confounded

with, by the peculiarity and violence of the pain, the shortness of its

duration, by always coming on in paroxysms, and by the absence of all

swelling and redness over the part. A peculiarity of this disease is,

that though sometimes induced by the slightest touch of the finger, or

the faintest breath of cold air, at another time the part may be slapped

or rubbed with impunity.

_Treatment._—This consists, in the first instance, acting on the

digestive organs, correcting the functional disturbance, and lastly

by elevating the tone of the system, and enabling it to restore the

irritated nerves to a pristine soundness, or if this cannot be done by

constitutional means, by the employment of _local_ remedies for that

purpose. First, the best mode of acting on the digestive organs is by

the steady employment of gentle aperients, care being taken to avoid any

active or drastic purgative. For this purpose, a five grain compound

rhubarb pill should be taken every night for several days till the bowels

are brought into a healthy state, or a pill composed of equal parts of

the compound rhubarb and colocynth pill may be substituted, where a

little more active medicine is needed, the nightly dose being the same in

this as the former. Secondly, to correct the functional disturbance, if,

as most frequently, the result of indigestion, two table-spoonfuls of the

following mixture are to be taken every four or six hours.

Take of

Hops 2 drachms.

Cascarilla, bruised 1 drachm.

Cloves, bruised 2 drachms.

Infuse in a pint of boiling water for twelve hours; add

Carbonate of Potass 2 drachms.

Dissolve, and strain for use. Or where the stomach is cold and

weak, as in advanced life, let the patient take a tea-spoonful

of _Gregory’s powder_ in a little peppermint water twice or

three times a day. Thirdly, to elevate the tone of the system,

the body must be braced by tonics, which may be effected by

either of the two following forms of medicine.

Take of

Carbonate of Iron 2 drachms.

Sulphate of Quinine 18 grains.

Mix, and divide into six powders, one to be taken three times a

day; or, take of

Infusion of Quassia 8 ounces.

Quinine 1 scruple.

Diluted Sulphuric Acid 30 drops.

Dissolve; two table-spoonfuls to be taken three times a day.

Accompanying the tonic course, the patient should take several

glasses of wine during the day, or else an equivalent of the

best stout, and should live on a liberal dietary, taking as

much exercise as is compatible with age and strength.

When, in despite of all such remedial means, the paroxysms of pain

continue, it often becomes necessary to relieve any local congestion

that may exist around the nerve, either by the application of five or

six leeches over the source of the pain, or by the employment of cupping

glasses or a mustard plaster. In case of both of these means failing,

a blister may be applied behind the ear of the affected side, and in

extreme cases a blister down the spine at the nape of the neck, which

must be converted into an issue, and kept open for a week or two. It is

seldom, however, that this has to be resorted to, the disease, however

intense the paroxysms, generally yielding to any one course if steadily

and judiciously carried through, unless, indeed, the disease is the

consequence of a system shattered by wounds, campaigns, and climate,

then, and only under such unfavourable circumstances, tic-douloureux

becomes most formidable. The discovery of chloroform has, however,

placed in the physician’s hand a boon that in a disease of this nature

is in truth a very blessing to suffering nature, and may be employed

in conditions of system and under circumstances where opium, morphia,

brandy, and both narcotics and stimulants are inadmissible, or, from the

necessary dose to effect relief, would be dangerous.

NEURALGIA.