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THE 
 
 ECLECTIC 
 
 PRACTICE OF MEDICINE, 
 
 WxM. BYRD POWELL, M.D., 
 
 Formerly Professor of Chemistry in the Medical College of Louisiana ; late 
 
 Professor of Cerebral Physiolocry and Medical Geology in the Memphis 
 
 Institute; Member " Societas Medica Chirurgica Marylandia;" 
 
 Corresponding Member of Western Academy of Sciences; 
 
 Honorary Member of Antiquarian and Natural History 
 
 Society of the State of Arkansas; Honorary 
 
 member of the "■ Societe Francaise Sta- 
 
 tistique Universelle," at Paris, 
 
 France, etc., etc., etc.; 
 
 E. S. NEWTON, M.D., 
 
 Professor of Practice of Medicine and Pathology in the Eclectic Medical Insti- 
 tute of Cincinnati ; formerly Professor of Surgery in the same ; 
 late Professor of Surgery in Memphis Institute, etc. 
 
 CINCINNATI: 
 PUBLISHED BY H. W. DERBY 
 

 Entered according to Act of Congress, in the year 1854, by 
 H. W. DERBY, 
 In the clerk's office of the DiStficrCoufToftfie United States for the Dis- 
 trict of Ohio. 
 
 Printed by 
 E. MORGAN & CO. 
 
PREFACE. 
 
 The existence of the Eclectic brancli of the Medical pro- 
 fession is too brief, although its development has been unpre- 
 cedented in the history of innovations and professional revo- 
 lutions, to have produced a library for the instruction of 
 its disciples and the conversion of the public. The leisure 
 of its professors and qualified practitioners has been devoted 
 to doing battle to maintain existence against the increasing 
 assaults of their more conservative brethren. But now, as 
 their independence — their ability to maintain an independent 
 existence, is tacitly acknowledged, they are bestirring them- 
 selves to advance and disseminate their doctrines — doctrines 
 which have guided them to a practice that has, for success, 
 been unrivaled at any period since the days of the Father 
 of Medicine. 
 
 The universally-acknowledged want of text-books to pro- 
 mote the advancement of Eclectic students, has alone im- 
 pelled the authors of the following pages to bring them 
 forth, as an embodiment of the practice in those forms of 
 disease to " which they are devoted ; and, considering the 
 multifarious duties through which they were prosecuted, it 
 is not reasonably to be supposed that they are without 
 errors and imperfections ; but the authors ardently hope, 
 
iv PREFACE. 
 
 indeed, tliey are miicli disposed to believe that none will 
 
 be discovered wbicli will prove mischievous in practice. 
 
 It is deemed proper that the public should be informed 
 of the agency which the authors, respectively, have had 
 in the work. Dr. Powell has devoted a large proportion 
 of his life to physiological and pathological investigations, 
 and Dr. Xewtox has been actively and extensively engaged 
 for several years in the Eclectic practice of medicine, and 
 both were educated in distinguished schools of the time- 
 honored Allopathic principles and practice. With their 
 respective acquirements and these advantages, they united 
 their exertions, each acting in his own peculiar sphere, for 
 the common cause of Eclectic medicine. 
 
 For the Practice, as taught in this work. Professor New- 
 ton is alone responsible, and the balance of the work. Pro- 
 fessor Powell — however with a full concurrence of Prof. N. 
 in all the pathological views laid down, and so much of the 
 peculiar views of Prof. P., as has been investigated and 
 understood by Prof. IST. 
 
 It should be known, by the public, that both authors 
 were regularly educated in strictly orthodox Allopathy — 
 that they believe themselves to have abandoned no fact and 
 no truly-founded principle which they acquired, and that, 
 inasmuch as they were not bound, by an oath of alle- 
 giance, to the false doctrines and the mischievous practice 
 that were taught to them (for, certainly, no one will con- 
 tend that a professor ever lived who taught no error), 
 they felt, and still feel, that they have not forfeited their 
 right of private judgment, nor their privilege to abandon 
 
PREFACE. V 
 
 errors, when discovered, no matter whence obtained, and 
 to embrace truth, no matter by whom discovered. 
 
 Whatever may be the feelings and the opinions of those 
 who differ with us, on professional subjects, we can, with 
 unfeigned sincerity, declare that we feel grateful to those 
 professors, and to those writers, who have, in the least, 
 contributed to the making us what we are. If we shall, 
 even to a small extent, liquidate the obligation we owe to 
 those who have preceded us, by our labors in the follow- 
 ing pages, a large portion of our ambition will be achieved. 
 
 When we commenced this work, we remembered how 
 much we had been bored by those professors who seemed 
 to regard it as all-important that they should advance 
 authority for every opinion they uttered. Students visit 
 medical schools, not to obtain and to remember the names 
 of those who have placed upon record a medical opinion, 
 but to be informed, by the professors, as to what are the 
 standard or generally-received opinions or doctrines of the 
 profession, and for the same purpose they read text-books. 
 Special doctrines and opinions are subjects of future inves- 
 tigation. 
 
 In view, then, of the impatience with which students 
 read quotations, and their indifference to authorities in text- 
 books, we have, as little as possible, given reference to 
 authorities. We have simply labored to represent the pro- 
 fession, except where it has been our fortune to differ 
 from it, and in such cases we have given our reasons for 
 so doing. 
 
PREFACE BY PEOFESSOR POWELL. 
 
 Those who shall be benefited by that portion of the fol- 
 lowing work which devolved upon the writer, must feel 
 themselves, to a no small extent, indebted to Professors 
 KixG, Xewtox, and Freeman — who, being upon a former 
 occasion, his colleagues, had frequent opportunities of hear- 
 ing his opinions upon various physiological and pathological 
 subjects, and being pleased with his views in general, and 
 in particular with his modes of thinking and investigating, 
 have been principally instrumental in causing him, in this 
 respect, to become an author. 
 
 It will be found, furthermore, that in his portion of the 
 work, there is not that rigid adherence to the subject 
 before him, which is almost universal in the profession, and 
 for this peculiarity the above-named professors must be held 
 responsible, because they advised him to pursue that course 
 which was characteristic of his professional lectures, which, 
 being extemporaneous, gave him the latitude of suggestion, 
 upon relative subjects, for the purpose of elucidation, illus- 
 tration, or instruction. To this circumstance, perhaps, more 
 than to any other, they attributed that profound attention 
 which his lectures always commanded. 
 
 AVith reference to the professional library of the age, he 
 acknowledges himself to be greatly indebted — to extent of 
 his means. Ii hrs served him for the purposes of sug- 
 gestion, the support of truth, and the illustration of error ; 
 but, knowing how much students are bored by learned 
 
PREFACE BY PROFESSOR POWELL. vii 
 
 references, he has avoided them as much as possible. This 
 omission, with him, has, perhaps, a deeper foundation, and 
 one that he would plant in the mind of every student- 
 He has never permitted any author to produce in his mind 
 a feeling of conviction, and for the reason that we have 
 but one certain source of truth — and that is nature. All 
 authority, for and against all subjects, he respects, until 
 by an appeal to nature, it is found to be false ; and it is 
 by this rule that he would be tried with reference to any 
 new or novel opinion he has advanced. 
 
 He is aware that, in- this sectarian a^e, his character in 
 this respect, is as novel as any opinion he may have ad- 
 vanced ; and, consequently, he has not still to be informed 
 that his abandonment of the lancet and of all indigestible 
 substances, as remedial agents, has so affected those who 
 still use them, that they cannot sufficiently suspect it to be 
 possible that any truth could drop from his pen, as to read 
 after him. Of course, in this respect, he believes that 
 there are a few — very few exceptions. That such a state 
 of the public mind should exist with reference to religion 
 and politics, is to be expected ; but it is disgraceful to 
 discover it within the area of scientific research. Suppose 
 no one to have innovated — to have outraged public opinion 
 as much as he has, where would we, as a people, now be ? 
 Look at our savages, and be reproved. 
 
 He is very much of the opinion that the investigations 
 of his life have resulted in a very considerable addition to 
 our present stock of physiological knowledge — (not learn- 
 ing, God forbid). If the doctrines he has taught in the 
 following pages, particularly upon the subjects of the human 
 temperaments and organic constitution of disease, shall be 
 sustained by a rigid comparison of them with nature, then 
 the result cannot be less than a complete revolution in 
 the sciences of pathology, diagnosis and prognosis. And, 
 inasmuch as these subjects have been rendered demonstrable 
 
viii PREFACE BY PROFESSOR KEWTOIf. 
 
 even by his pupils, lie cannot entertain a reasonable doubt 
 
 about their final reception. 
 
 He does not doubt but that he has taught some hitherto 
 unknown truths, and he is willing to admit it as possible 
 that he may have taught as many hitherto unknown errors ; 
 and, although the two classes may be equal, in both num- 
 ber and magnitude, yet there will still be a positive gain 
 to the profession; because the cupel of time will absorb the 
 latter, while the former will continue to requite, to some 
 extent, the heavy obligation he is under, not to a part or 
 sect, but to the whole of it — as he acknowledges but one 
 Medical profession. 
 
 Covington, Ky., Januaiy, 1854. 
 
 PEEFACE BY PROFESSOR NEWTON. 
 
 Having prepared his portion of this work while con- 
 stantly engaged with his professional duties, he is conscious 
 that it is not as minute in the details of treatment as might 
 have been the case under other circumstances, and that 
 many imperfections have been passed without correction; yet 
 he is confident that they are of a character that will not 
 detract from the real value which he hopes the friends of 
 Eclecticism will place upon the book. It will be seen by 
 the reader, that it embraces, principally, his own practice, 
 and, so far as he has been able to learn, that of the 
 most successful Eclectic practitioners. 
 
 Hoping that he may have added something more for the 
 good of Eclecticism, he confidently resigns the work into 
 the hands of the profession. 
 
 89 West Seventh street, Cincinnati, 0., January, 1854, 
 
CONTENTS 
 
 BOOK I. 
 
 OF THE FimCTIOXS AND PATHOLOGICAL RELATIONS OF THE CEREBELLUM, AND OF 
 THE HUMAN TEMPERAMENTS, FOR THE ELUCIDATION OF DISEASE. 
 
 Part I. — Of the functions and patliological relations of tlie cerebellum. 
 
 Chapter I. — Functions and relations of the cerebellum. 
 
 Section I. — A summarj of the prevailing opinions on the functions 
 of the cerebellum. 
 
 Sect. II. — Special functions of the cerebellum. 
 I. Amativeness. 
 II. Muscular motion. 
 III. Animal sensibility. 
 ly. Physiological inferences in reference to the cerebellum. 
 
 Chapter II. — Pathological relations of the cerebellum. 
 
 Part II. — The human temperaments. 
 
 Chapter I. — A review of the prevailing opinions on this subject. 
 
 " II. — Of the elementary temperaments. 
 I. Sanguine temperament. 
 II. Bilious temperament. 
 III. Lymphatic temperament. 
 IV. Encephalic temperament. 
 
 Chapter III. — The combinations of the elementary temperaments. 
 I. Binary combinations. 
 
 1. The sanguine bilious temperament. 
 
 2. The sanguine lymphatic temperament. 
 
 3. The sanguine encephalic temperament. 
 
 4. The bilious lymphatic temperament. 
 
 5. The bilious encephalic temperament. 
 
 6. The encephalo-lymphatic temperament. 
 II. Ternary combinations. 
 
 1. The sanguine bilious-lymphatic temperament. 
 
 2. The sanguine encephalo-bilious temperament. 
 
 3. The sanguine encephalo-lymphatic temperament. 
 
 4. The bilious encephalo-lymphatic temperament. 
 III. Quarternary combinations. 
 
 1. Sanguine bilious encephalo-lymphatic temperament. 
 
X COI^TENTS. 
 
 B K I I. 
 
 PHYSIOLOGICAL CONSIDERATIONS IN RELATION TO PARENTS AND THE TREAT MENT 
 OF CHILDREN. 
 
 Chapter I. — Parental conditions considered with reference to children. 
 Section I. — Marriage eligibility. 
 " II. — Parental constitution. 
 " III. — Improper Marriages. 
 " IV. — Present health and qualifications. 
 Chapter II. — Influence of maternal conditions on the fetus. * 
 
 Section I. — Psychological influence of the mother on the fetus. 
 
 " II. — Influence of children on a mother by a first husband, 
 with reference to children by a second. 
 Chapter III. — Of maternal duties in relation to her child. 
 " IV. — Of physical injuries to the child. 
 Section I. — Necessity of a foster-mother. 
 
 " II. — Of improper nourishment. 
 
 " III. — Infectious poisons in the milk. 
 
 " IV. — Infectious diseases. 
 
 " V. — Inattention to child's necessities. 
 
 Chapter V. — Of mental injuries to the child. 
 Section I. — The vital forces. 
 
 " II. — The defensive faculties. 
 
 " III. — The moral faculties. 
 
 " IV. — The social faculties, 
 
 v.— The intellect. 
 Chapter VI. — Of personal attentions to the child. 
 Section I. — Washing the child. 
 " II. — The dress of the child. 
 
 " III. — Feeding the child by the mouth. 
 
 Chapter VII. — The nursery. 
 Section I. — Location and construction of the nursery. 
 " II. — The temperature of the nursery. 
 
 " III. — Physical training of the nursery. 
 
 " IV. — Mental training of the nursery. 
 
 Chap. VIII. — Cause's of infantile mortality. 
 " IX. — Of the necessity and utility of juvenile mortality. 
 
 Appendix to Book I. 
 Appendix to Book II. 
 
 BOOK III. 
 
 the natural history, pathology, and treatment of the various forms of 
 disease incidental to infancy and childhood. 
 
 Pathological considerations. 
 Symptomatology. 
 Part I. — Manifestations of disease in the animal or cerebro-spinal system 
 Class I. — Manifestations of disease in the cerebral apparatus. 
 Order I. — Inflammatory forms of cerebral disease. 
 Genus I. — Encephalitis. 
 " II. — Acute hydrocephalus. 
 
CONTEN"TS. XI 
 
 Ordes II. — N'on-inflammatory forms of cerebral disease. 
 Genus I. — Cerebral congestion. 
 Species I. — Acute cerebral congestion. 
 
 " II. — Passive cerebral congestion. 
 Genus II. — Chronic hydrocephalus. 
 " III. — Cerebral hypertrophy. 
 " IV. — Hydrocephaloid disease. 
 Order III. — N'ervous forms of cerebral disease. 
 Genus I. — Epilepsy. 
 " II.— Chorea. 
 " III. — Paralysis. 
 " lY.— Night Terrors. 
 " V. — Trismus Nascentium. 
 " VI. — Convulsions. 
 Class II. — Manifestations of disease in the spinal apparatus. 
 Order I. — Inflammatory forms of spinal disease. 
 Genus I. — Spinal meningitis. 
 " II.— Myelitis. 
 Class III. — Manifestations of disease in the respiratory apparatus. 
 Order I. — Inflammatory forms of disease in the respiratory appara.tus 
 Genus I. — Catarrh. 
 Species I. — Coryza. 
 Genus II. — Laryngitis. 
 Variety I.' — Mucous laryngitis. 
 ^' II. — Sub-mucous laryngitis. 
 " III. — Pseudo-membranous laryngitis. 
 " IV. — Spasmodic laryngitis. 
 Genus III. — Bronchitis. 
 Species I. — Acute bronchitis. 
 
 " II. — Chronic bronchitis. 
 Genus IV. — Pneumonia. 
 
 v.— Pleuritis— Pleurisy. 
 " VI.' — Phthisis pulmonalis. 
 Order II.— K" on-inflammatory forms of disease in the respiratoiN 
 apparatus. 
 Genus I. — Absent or imperfect respiration. 
 " II. — Congestion of the lungs. 
 '^ III. — Apoplexy of the lungs. 
 Order III. — E'ervous forms of disease in the respiratoiy apparatus.. 
 Genus I. — Infantile spasm of the glottis. 
 " IT. — IS'ervous cough. 
 ■" III. — Hooping-cough. 
 Class IV. — Manifestations of disease in the circulatory apparatus. 
 
 Order I.— -jN'on -inflammatory forms of disease in the circulatory 
 apparatus. 
 Genus I. — Establishment of independent circulation. 
 
 1 . Period of the obliteration of the fetal openings. 
 
 2. Mode of obliteration of (lie fetal openings. 
 
 ^^ Jl^-Cjanopathy— Cyanosis' — Blue disease of infancy. 
 
xii COXTEIs^TS. 
 
 Order II. — Inflammatorr fonus of disease in the circiilatoiy apparatus. 
 GExrs I.' — Imperfect cicatrization of the umbilicus. 
 
 " II. — Pericarditis — Inflammation of the heart's enyelope. 
 
 Class Y. — Manifestations of disease in the derma. 
 
 Order I. — Malformation and disease of the derma produced before 
 or at birth. 
 Gexts I.' — Malformation of the derma produced before birth. 
 Species I. — Alterations of color. 
 " II. — Excrescences. 
 " III. — Xsevi materni. 
 Gexus II. — Disease of the derma produced before or at bii'th. 
 Species I. — Absence of the skin. 
 " II. — Tumor of the scalp. 
 " III.— Petecchiffi. 
 " IV. — ^Ecchymosis. 
 Order II. — Moist form of disease in the derma. 
 Genus I. — Yesiculse. 
 Species I. — Herpes. 
 Taeiett I. — ^Herpes zoster. 
 " II. — Herpes circinatus. 
 " III. — Herpes praeputialis. 
 Species II. — Scabies — psora. 
 Genus II. — Bullse. 
 Species I. — Pemphigus. 
 " II. — ^Erysipelas. 
 " III. — Rupia. 
 Genus III. — Pustulse. 
 Species I. — Variola. 
 Variety I. — Complications of variola. 
 " II. — Vesicula varicella. 
 
 1. V. Lenticular. 
 
 2. V. Conoidal. 
 
 3. V. Globate. 
 " III. — Variola vaccina. 
 
 " IV. — Inoculated variola raccina. 
 Species II. — Ecthyma. 
 
 " III. — laipetigo. 
 Variety I. — Impetigo larvalis^-crusta lactea. 
 
 " II. — Impetigo capitas. 
 Species IV. — Porrigo or favus. 
 Variety I. — Porrigo lupinosa. 
 
 '' II- — Porrigo scutulata — Tinea annularis. 
 Order II. — ^Dry forms of disease in the derma. 
 Genus I. — Exanthemata. 
 Species I. — Roseola. 
 
 " II. — Urticaria. 
 
 " III. — Erythema. 
 
 " IV.— Rubeola. 
 v.— Scarlatina. 
 
CON'TEN'TS. xiii 
 
 Yariett I. — S. Simplex. 
 " II. — 'S. Anginosa. 
 " III.— S. Maligna. 
 Genus II. — Papulae. 
 Species I. — Strophulus. 
 Variety I. — Strophulus intertinctus. 
 " II. — Strophulus coufertus. 
 " III. — Strophulus volaticus. 
 " IV. — Strophulus albidus. 
 " V. — Strophulus candidus. 
 • Species II. — Lichen. 
 
 Variety I. — Lichen simplex. 
 " II. — Lichen agrius. 
 " III. — Lichen urticatus. 
 Species III. — Prurigo — Pruritis. 
 Genus III. — Squamae. 
 Species I. — Pityriasis. 
 " II. — Psoriasis. 
 " III.— Ichthyosis. 
 Class VI. — Manifestations of disease in the cellular system. 
 Oi^der I. — Non-inflammatory forms of disease in the cellular tissue. 
 Genus I. — Edema. 
 
 " II. — Gangrene of infants. 
 
 Class VII. — Manifestations of disease in the organs of the external senses. 
 Order I. — Inflammatory forms of disease in the organs of the ex- 
 ternal senses. 
 Genus I. — Ophthalmia purulenta. 
 " II. — Scrofulous ophthalmia. 
 
 III.— Otitis. 
 Class VIII. — Manifestations of disease in the genital apparatus. 
 Order I. Genus I. — Adhesion of the labia pudendi. 
 
 " II.— Discharges from the infantile vagina. 
 " III. — Hydrocele, or dropsy of the scrotum. 
 Part II. — Manifestations of disease in the vegetative system. 
 
 Class I.— Manifestations of disease in the parts above the diaphragm. 
 Order I. — Inflammatory forms of disease in parts located above the 
 diaphragm. 
 Genus L — Stomatitis. 
 Species I. — S. Erythemata. 
 
 , with altered secretion. 
 Follicular. 
 Vesicular. 
 Pustular. 
 Mercurial, 
 ngina. 
 Simplex. 
 " 11. — A. Membranacea. 
 " III.— A. Tonsillaris. 
 Order II. — ISTon-iiiflamraatory forms in parts above the diaphragm. 
 
 " 
 
 II.- 
 
 -s. 
 
 « 
 
 III.- 
 
 -s. 
 
 <e 
 
 IV.- 
 
 -s. 
 
 <e 
 
 V.- 
 
 -s. 
 
 " 
 
 VI.- 
 
 -s. 
 
 Genus 
 
 II.- 
 
 -A] 
 
 Species 
 
 I.- 
 
 -A. 
 
xiv COI^TENTS. 
 
 Gexus I. — Stomatitis gangrenous. 
 " II. — Irritations of dentition. 
 
 Class II.— Manifestations of disease in apparatus below the diaphragm . 
 Ordes, I. — Inflammatory forms of disease in the digestive apparatus. 
 Gexus I. — Peritonitis. 
 
 " I J. — Cholera infantum. 
 
 Oeder II. — Non-inflammatory forms of disease in the digestive 
 apparatus. 
 Gem:s I. — Gastric indigestion. 
 
 " II.— Intestinal indigestion. ^ 
 
 III.— Colic. 
 " IV. — Diarrhea. 
 Species I. — D. Feculent. 
 II.— D. Bilious. 
 " III. — D. Mucous. 
 " IV.— D. Chylous, 
 " V. — D Lienteric. 
 " VL— D. Chronic. 
 Gexus V. — Invermination. 
 " VI. — Costiveness. 
 " VII. — Prolapsus of the rectum. 
 
 BOOK IV. 
 
 XREATMEXT OF THOSE FORMS OF DISEASE TO ^VHICH ADULTS, MORE THAN 
 CHILDREN, ARE LIABLE. 
 
 Glass I. — Pyrexia or febrile forms of disease in general. 
 Pathological and etiological considerations. 
 Order I. — Special forms of fever. 
 
 Gexus I.- 
 
 — Continued fever. 
 
 Species L- 
 
 —Pyrexia sthenica. 
 
 II.- 
 " III- 
 
 — Synochus fever, 
 — T) phous fever. 
 
 Gexus II.- 
 
 —Periodic fever. 
 
 Species L- 
 
 —Intermittent fever. 
 
 Variety I.- 
 « II.- 
 " III.- 
 
 — Inflammatoiy intermittent. 
 —Congestive do 
 —Gastric do 
 
 « IV.- 
 V.- 
 
 —Malignant do 
 —Masked do 
 
 Species II. — Remittent fever. 
 " III. — Congestive fever. 
 " IV. — Yello^v fever. 
 " V. — Infantile remittent fever. 
 Variety I. — Acute infantile remittent. 
 II.— Slow do do 
 
 " III.— Low do do 
 
 Typhoid and typhous fevers. 
 Order II. — Inflammatory forms of disease, or those which are cured 
 by inflammation. 
 
CONTENTS. XV 
 
 Gijsrus I. — Cerebritis. 
 " ir.— Pleuritis. 
 
 Species I. — Acute pleuritis. 
 
 IT.— Chronic do 
 Genus III. — Pulmonitis. 
 
 IV.— Phthisis. 
 Variety I. — Acute phthisis. 
 " II. — Chronic do 
 
 III.— Febrile do 
 IV.— Latent do 
 Genus V. — Parotitis. 
 " IX. — Gastritis. 
 Species I. — Acute gastritis. 
 
 " II. — Chronic do 
 Gen. VII. — Duodinitis. 
 
 " V II.— ]',nteritis. 
 Species I. — Acute enteritis. 
 
 II.— Chronic do 
 Genus IX. — Colorectitis. 
 " X. — Peritonitis. 
 Species I. — Acute peritonitis. 
 
 " II. — Chronic do 
 Genus XI. — Hepatitis. 
 Species I. — Acute hepatitis. 
 
 " II. — Chronic do 
 Genus XII. — Splenitis. 
 Species I. — Acute splenitis. 
 
 " II. — Chronic do 
 Gen. XIII.— Nephritis. 
 
 " XIV.— Cystitis. 
 Species. I. — Acute cystitis. 
 
 " II. — Chronic do 
 
 Genus XV. — Hystentis. 
 Species I. — Acute hysteritis. 
 
 " II. — Chronic do 
 Gen. XVI.— Rheumatism. 
 
 Acute rheumatism. 
 Chronic do 
 " XVII.— Arthritis. 
 
 Acute arthritis. 
 Chronic do 
 " XVIII.— Pericarditis. 
 
 Acute pericarditis. 
 Chronic do 
 " XIX.— Ophthalmia. 
 
 Catarrhal ophthalmia. 
 Purulent do 
 " XX.— Iritis. 
 ** XXI. — Eczema. 
 
xvi CONTEI^'TS. 
 
 Gen. XXII.— Miliaria. 
 " XXIIL— Phlebitis. 
 
 Class. — iN'on-febrile forms of disease. 
 Order I. — Morbid actions from vascular irritation, 
 GEjfus I. — Epistaxis. 
 " II. — Hematemesis. 
 
 " III. — Hematuria. 
 " IV. — Hemoptysis. 
 " V. — Menorrhagia. 
 
 Order II. — Kervous or functional forms of disease. 
 
 Genus I. — Morbid actions in the organs of internal rela- 
 tion. 
 Species I. — Asthma. 
 
 " II. — Asphyxia. 
 
 " III. — Aneurism of the aorta. 
 
 " lY. — Angina pectoris. 
 
 " V. — Hemon'hoids. 
 
 " VI. — Diabetes millitus. 
 
 " VII. — Diabetes insipidus. 
 
 " VIII. — Ischuria renalis. 
 IX.— Enuresis. 
 
 " X. — Scorbutus. 
 XL— Chlorosis. 
 
 " XII.— Hydrops. 
 Variety I. — Ascites. 
 
 *' II. — Hydrothorax. 
 
 " III. — Anasarca. 
 Spe. XIII. — Colica pectonum. 
 
 " XIV. — Delirium tremens. 
 
 " XV.— Lithiasis. 
 
 " XVI.— Scrofula. 
 
 *• XVII. — Epidemic cholera. 
 XVIIL— Tetanus. 
 
 " XIX. — Puerperal convulsions. 
 
 " XX. — Hydrophobia. 
 Genus II.— Morbid actions in the organs of external relation. 
 Species I. — Catalepsy. 
 
 " II. — Hysteria. 
 
 " III. — Neuralgia. 
 IV.— Mania. 
 
 " V. — Monomania. 
 Genus III.— Morbid action of the organs of mixed relation. 
 Species I. — Exoueirosis. 
 II.— Masturpatio. 
 
 " III. — Leucorrhea. 
 
 " IV. — Dysmenorrhea. 
 
 " V. — Amenorrhea. 
 
B 01 I 
 
 OF THE FUNCTIONS AND PATHOLOGICAL EELATIONS OF 
 THE CEREBELLUM, AND OF THE HUMAN TEMPER- 
 AMENTS, FOR THE ELUCIDATION OF DISEASE. 
 
P AET I. 
 
 ON THE FUNCTIONS AND PATHOLOGICAL RELATIONS OF THE 
 CEREBELLUM, 
 
 CHAPTER I. 
 
 mXCIIOKS AND RELATIONS OP THE CEEEBEIIOT. 
 
 SECTION I. 
 
 A SUMMARY OF THE PREVAILING OPINIONS ON THE FUNCTIONS OP 
 THE CEREBELLUM. 
 
 We have been convinced for many years, that the animal 
 functions of the entire system are, in a great measure, if not 
 entirely, founded in, or controlled by, the cerebellum; and 
 hence, for the convenience of a name, we have designated its 
 functions by the title of the "vital forces." 
 
 This investigation will expose physiological and pathologi- 
 cal relations which hitherto have not been thought of; and, 
 although we do not profess to have advanced beyond the por- 
 tals of the subject, yet from this position we are enabled to 
 obtain a shadowed glimpse of the immense advantages which 
 it is destined to confer upon pathology and therapeutics. By 
 the time we shall have done with this chapter, it will be seen, 
 that many of the most obstinate and fatal diseases, to which 
 humanity is heir, are associated with, or founded in particular 
 portions of, this viscus. 
 
 2 (17) 
 
18 PREYAILIXG OPINIONS OF THE FUNCTIONS 
 
 Dr. Carpenter has, in the fifth American edition of his 
 work, set forth, in a very impartial manner, all the evidence 
 that has been had concerning the cerebellar functions, and 
 then drops the subject, simply because the contradictory and 
 entangled character of the evidence, thus far obtained, will 
 not justify a conclusion. In order that our readers may have 
 a just idea of the darkness which envelopes it, and the value 
 of our contributions, we refer them to that work, after they 
 shall have perused the following brief statement of the evi- 
 dence to which we have alluded. 
 
 Flourens discovered that incisions into the cerebellum pro- 
 duced, in the animals experimented upon, no indications of 
 sensation, but that when it was being removed by slices, they 
 became restless, and that when the organ was entirely removed, 
 they " had entirely lost the power of springing, flying, walking, 
 standing, and preserving their equilibrium." According to 
 Magendie, a deep wound inflicted upon the cerebellum on both 
 sides, irresistibly forces the animal to move backward. The 
 section of one of the crura cerebelli causes the animal to fall 
 upon one side and to "roll upon its longitudinal axis." 
 
 " Foville, Pinel-Grandchamp, and Duges have regarded 
 the cerebellum as the center of common sensation." Dr. Car- 
 penter seems to regard it as possible that the cerebellum is the 
 seat of the " muscular sense." It is probably well known to the 
 public that Dr. Gall and his disciples have maintained that the 
 cerebellum was the organ of the sexual desire or instinct. 
 Thus we find that one party contend that the cerebellum is 
 the organ of certain influences over the muscular system ; that 
 another regard it as the organ of common sensation ; and a 
 third believe it to be demonstrably certain that it is the organ 
 of sexual love. This, in brief, is the sum of what is known 
 upon the subject, and which, so far as regards general utility, 
 amounts to about nothing. 
 
 "We are of the opinion that there is not a question in natural 
 history better established than that the sexual desire inheres 
 in the cerebellum ; but this conclusion is not incompatible 
 with the idea, that the same viscus may contain the organs of 
 many other functions. The experiments of physiologists and 
 the varying development of this viscus, induced Mr. George 
 Combe to suspect that it might perform a plurality of func- 
 
OF THE CEREBELLUM. 19 
 
 tions. Amativeness, or the sexual desire, however, he con- 
 ceives to appropriate much the larger portion of it, and 
 the balance, he supposes, to be concerned with muscular 
 motion.* 
 
 But four years before he announced his suspicion, we had 
 discovered as much ; and two years before this event, we had 
 demonstrated the independence of two powers, beside that 
 of amativeness, and determined their organs. That volume 
 of the Journal which announces his suspicion, contains a 
 paper from us, wdiich details a definite account of the organ 
 and function of Muscular Motion. 
 
 But upon what principle he supposed the larger portion of 
 the cerebellum to be employed in the sexual function, we can- 
 not imagine ; because, if this viscus perform a plurality of 
 functions, it must be admitted, as with other divisions of the 
 encephalon, that while in one person the sexual function might 
 appropriate the larger portion of it, yet, in another person, an- 
 other function might appropriate the larger portion of it; and 
 this v^e have found to be absolutely the case. 
 
 We believe that no one of the experimental physiologists 
 have detected any indication of the existence of the sexual 
 function in the cerebellum ; and, for this obvious reason, vivi- 
 section is not the means of exciting such a manifestation of it. 
 Their failure to produce. such a manifestation of this viscus, 
 viewed in connection with the results of the comparisons 
 they have made between the cerebelli of stallions, geld- 
 ings, and mares, leaves us no room to wonder that they 
 should conclude that the cerebellum had no agency in the 
 sexual function. But when it shall be shown that it performs 
 two other functions, which are just as indispensable to pro- 
 creation as amativeness, then the whole aspect of the question 
 becomes changed. The reason why a mare or gelding shall 
 have a cerebellum as large as that of a stallion will become 
 obvious. 
 
 No important pathological purpose has been achieved by 
 the investigations that have been made into the functions of 
 the cerebellum; so true is this, that if we had nothing to add 
 to what is now known upon this subject, we could have no 
 
 * American Phrenological Journal and Miscellany. 
 
20 THE SPECIAL FUNCTIONS 
 
 reasonable apology for introducing it in a work which treats 
 professedly upon the diseases of children; and yet, we feel 
 that we could not dispense with it. "We think it much more 
 than probable that the time is not very far distant when all 
 human diseases will be founded upon the functions of the cere- 
 bellum and base of the cerebrum. 
 
 SECTION II. 
 
 THE SPECIAL FUNCTIONS OF THE CEEEBELLTJM. 
 
 INTRODUCTORY REMARKS. 
 
 We regret that our convictions of propriety will not permit 
 us to present, in this place, the evidence upon which we con- 
 tend for the independence of some of the functions of the 
 cerebellum ; but, fortunately, if this independence be admit- 
 ted, so far as our present purpose is concerned, the proof is 
 not requisite. For this reason, and the fact that in a forth- 
 coming work on cerebral physiology, the proof of the func- 
 tions, to which we allude, will be found, our regret, at our 
 present necessity, is considerably mitigated. For the sake of 
 the relations which we shall unfold, and the arguments which 
 we shall found upon them, we ask our readers, for the time 
 being, to consider the functions that we shall name as being 
 established, and their organs as demonstrated. With this 
 understanding, we proceed with our subject. 
 
 1. Amativeness, or Sexual Desire. 
 
 The proof that this is an independent desire, and that it 
 inheres in the cerebellum, is now before the world, and when 
 we shall, before concluding our treatise on the cerebellum, 
 remove the objections which physiologists have suggested, it 
 will stand as an undisputed and an undebatable proposition. 
 
 The function of this faculty is a desire for congress with 
 the opposite sex, and its object the perpetuity of the race. In 
 these two relations it acts as a sine qua non. Hitherto the 
 magnitude of the cerebellum was regarded as the measure of 
 its power ; and this is most emphatically true ; but this lan- 
 guage contains, with reference to the function in question, a 
 
OF THE CEREBELLUM. 21 
 
 very great error, unless we restrict the meaning of the word 
 j)owei\ to the abstract strength of the desire, without any 
 reference to a manifestation of the function. Some individuals 
 have an insatiable and an uncontrollable desire, and yet very 
 little procreative ability. Dr. Gall maintained that the pro- 
 creative ability of a male animal was indicated by the magni- 
 tude of the cerebellum, and in this he was correct : but he did 
 not know that there were other powers as indispensable to 
 successful coition as desire, which is the whole function of 
 amativeness. Let it be remembered, then, that desire is the 
 whole of the function of this faculty. 
 
 The organs of this propensity are situated immediately on 
 both sides of the median line, and are, therefore, in contact. 
 So far as we now know, if an equally balanced cerebellum, 
 between the mastoid processes, be divided into five spaces, the 
 middle one will represent the location of the organs in ques- 
 tion. In proportion to the development of the neck backward, 
 at its junction with the occiput, is the development of these 
 organs. When they are largely developed, and those, which 
 are to be treated of, are small, the neck, posterior to the mas- 
 toid processes, will be narrow or thin. 
 
 n. MUSCULAK MOTION. 
 
 The function of this faculty is simply a desire of muscular 
 resistance and counter-resistance, or a love of muscular motion. 
 Those who have the organ large cannot brook sedentary habits 
 without an impairment of health. The faculty does not imply 
 a power to use or to command the muscles with facility or 
 ability; but a high endowment of its organ has, incidentally, 
 a powerful influence upon the whole system. The motion that 
 is requisite to secure its gratification, results in a full develop- 
 ment of the osseous, muscular, respiratory, and arterial sys- 
 tems. Many persons who have it rather feebly developed, live 
 very active lives, but this results from other motives than a 
 love of motion. Many of this class, furtliermore, are very 
 active, and use their muscles with great precision. The power 
 of controlling or guiding the muscles, we refer to the organ of 
 weight or momentum — an intellectual faculty. 
 
 All men will be lazy or indolent who have not the rccpiisite 
 motives to industry ; hence many men, with large muscular 
 
22 THE SPECIAL FUNCTIONS 
 
 motion, are very idle, but at the same time they will not be 
 stationary. When these organs are small, the chest is flat and 
 contracted, the muscles are flaccid, the spine and shoulders are 
 drooping and the movements of the body are dragging. 
 
 It is a matter of some surprise that physiologists, particu- 
 larly of the phrenological school, should not have had this 
 faculty suggested to them, long before it was, in consequence 
 of its indispensable relation and importance to the execution 
 of the function of amativeness. There is not in the life of a 
 male animal another function that requires as much muscular 
 energy as the copulative. We have invariably observed, 
 among men, in connection with a high endowment of this 
 power, a disposition to resist whatever was not agreeable to 
 them. We are, furthermore, disposed to regard it as the 
 source of the faculty of ioucJi^ which we conceive to con- 
 sist in a sense of resistance ; but the perception that is founded 
 upon its function, is made by eventuality ; because the weight 
 or resistance, and the hardness or softness of a body, are but 
 conditions that attend its existence. 
 
 The organs of this faculty are located in both sides of the 
 cerebellum, midway between the median line and the mastoid 
 processes, respectively ; and when large, produce a fullness of 
 the corresponding portions of the neck. These organs, like 
 those of amativeness, are usually more developed in males 
 than females. 
 
 III. ANBIAL SENSIBILITY. 
 
 Inasmuch as a delicate sensibility of the cuticular surface is 
 just as indispensable to the success and the enjoyment of the 
 sexual congress, as either or both of the preceding powers, we 
 are again led to marvel that its existence was not long since 
 suspected and even discovered. Indeed, without this faculty, 
 there could be neither success nor enjoyment — it is absolutely 
 indispensable to the perpetuity of the race. 
 
 The function of this faculty appears to consist in a desire 
 for such impressions as can agreeably excite the sense of feel- 
 ing, and, consequently, in proportion to the development of 
 its organs, is the impressibility or sensibility of the cutaneous 
 surface. Those Avho have them large are sensitive to all ex- 
 ternal causes of impression, as atmospheric conditions — they 
 
OF THE CEREBELLUM. 23 
 
 dread surgical operations, and suffer much under their inflic- 
 tion. 
 
 It has, perhaps, ever been remarked, that females are usu- 
 ally less gross than males, more indifferent to atmospheric 
 conditions, and complain less under surgical operations. In 
 the fact that they have generally the organs of this faculty 
 much less developed than men, we find an explanation of these 
 differences between the sexes. 
 
 The organs of this faculty are located immediately behind 
 the mastoid processes, and upon the lateral sinuses, and when 
 large, they give a fullness to the corresponding portions of the 
 neck. When all three of the powers of the cerebellum are 
 well or largely developed, the neck, at its junction with the 
 h^ad, is broad and full. 
 
 IV. PHYSIOLOGICAL INFERENCES. 
 
 When we reflect upon the care which has, in all parts of 
 organic nature, been manifested for the preservation of spe- 
 cies, we cannot rationally conclude that three powers, so essen- 
 tially constituting a sine qua non^ as they do, in the procrea- 
 tive function, would have been located otherwise than as we 
 find them — in close and co-operative relation to each other. 
 That they are independent powers, no one can entertain a 
 doubt ; between either two of them there is no affinity. 
 
 A moment's reflection upon the preceding cerebral facul- 
 ties, will discover a satisfactory solution of the difficulties that 
 have existed for some time among physiologists. We can now 
 understand how it maybe that individual mares and geldings, 
 by having large organs of motion and sensation, may possess 
 a larger cerebellum than a stallion. And we can anticipate 
 how the proprietors of stallions may, by stable confinement, 
 render them incompetent to discharge, with general success, 
 the function for which they are maintained. 
 
 We are, furthermore, by a knowledge of the functions of 
 the cerebellum, enabled to analyze some of the most difficult 
 questions that can arise in mental science. For the purpose 
 of illustration we will present one or two. 
 
 A Mr. Kennedy (the measurement of whose cerebellum will 
 be found in table on page 30), who was hung in Maryland for 
 the violation of a young girl, remarked, while standing on the 
 
24: THE SPECIAL FUNCTIOl^S 
 
 drop, that such an intercourse with female children, had been 
 the leading passion of his life, and that he had been several 
 times guilty of it. ISTow, we feel sure that the psychologist 
 does not live who can, without the developments we have 
 made, give a satisfactory explanation of this fact. Suppose 
 his Amativeness very strong, and Muscular Motion and Ani- 
 mal Sensibility both very feeble, which were the facts, as we 
 have his skull, and it becomes obvious that he would not de- 
 sire an adult woman, because he would not associate with her 
 the idea of so close a copulative intercourse — a condition so 
 indispensable to both his success and his enjoyment. He 
 would avoid an adult for another reason : he would expect 
 resistance, which would be incompatible with his feeble sense 
 of resistance. 
 
 A very feeble condition of the organs of Animal Sensibility 
 explains, also, the fact that onanists will leave the bed of a 
 wife and resort to self-pollution. All the persons whom we 
 have known to suffer from excessive or intemperate indulgence 
 with the opposite sex, had, relatively, large Amativeness, and 
 feeble Muscular Motion and Animal Sensibility ; and the phi- 
 losophy of it appears to be about this : the former power does 
 not so sustain the function and the latter does not so abridge 
 it, as to prevent exhaustion. 
 
 Furthermore, when all three of the cerebellar organs are 
 well developed, the excitement of the whole viscus may be 
 expended in motion, or in the ordinary pursuits of life, or 
 even by social intercourse with refined society, provided the 
 social sentiments are well developed. But when Amative- 
 ness alone is fully developed, the whole tendency is salacious, 
 and frequently so importunate as to impel to excessive veiiery 
 or to self-pollution. 
 
 We do not believe that all of the functions of the cerebellum 
 are yet discovered — we are much inclined to think, that, con- 
 nected with Muscular Motion, or situated in the midst of the 
 convolutions appropriated to the functions of this faculty, and 
 that of Amativeness, are two others, in which inhere the de- 
 sires of urination and defecation. We do not attribute that 
 motive power to the cerebellum which is essential to the exe- 
 cution of these functions, or that of Muscular Motion ; but 
 merely the desires — the source of their respective volitions. 
 
OF THE CEREBELLUM. 25 
 
 The respiratory desire Dr. Grimes locates in the middle 
 iobes of the cerebrum ; and, although we think that we have 
 Been some strong confirmations of his opinions, yet, all a 
 priori reasoning would locate it with Muscular Motion in the 
 cerebellum. If we could conceive the medulla oblongata as 
 being the seat of any one desire, we should be inclined to locate 
 the respiratory one in it; because we have uniformly found 
 it large in those persons who manifested the most anxiety 
 about this function — namely, consumptives. And as a very 
 general fact, it will be found that those who have the most 
 feeble endowment of the organs of Muscular Motion and Ani- 
 mal Sensibility, and the most feeble muscles, have the me- 
 dulla oblongata as large as that of the most muscular men. 
 
 This relation of the medulla oblongata and the organs of 
 Muscular Motion and Animal Sensibility, very clearly shows 
 that the cerebellum has no direct agency in the respiratory 
 fanction, and yet, without its incidental influence, a high en- 
 dowment of the muscular system and of the respiratory func- 
 tion cannot exist. The mutual dependence of these relations 
 is rendered apparent by the table previously referred to. 
 
 In the course of many years of diligent observation, we 
 have not found a well developed thorax associated with a small 
 endowment of the organs of Muscular Motion ; nor have we, 
 in the same time, discovered a dry, contracted, and parchment- 
 like skin, and condensed subcutaneous cellular tissue, asso- 
 ciated with a full development of the organs of animal sensi- 
 bility. 
 
 CHAPTER II. 
 
 PATHOLOGICAL RELATIONS OF THE CEREBELLUM. 
 
 For many years, when we have found a large endowment 
 of the organs of Muscular Motion and Animal Sensibility, 
 but more especially of the former, we do not remember to have 
 been disappointed, in a single instance, in predicting the ex- 
 istence of a rheumatic predisposition. We have seen syphi- 
 litic and other symptomatic varieties of rheumatism under 
 contrary circumstances, but never the idiopathic ; and from 
 
26 PATHOLOGICAL RELATIOTTS 
 
 what we liave learned, we conclude that gout is a disease of 
 the same family. 
 
 Dr. Wood, speaking of rheumatism, says, that " there must 
 be a peculiar state of system predisposing to this form of dis- 
 ease. There must be a rheumatic diathesis. In what this 
 diathesis consists, has not been discovered. There are no 
 signs by which its existence can be detected, with an approach 
 to certainty." We contend that it exists in a high endowment 
 of the animal muscles, with considerable sensibility of the 
 skin. And, in confirmation, to some extent, of this opinion, 
 are the following remarks of Dr. Wood : " Children under ten 
 years, and adults over sixty, are seldom attacked ; and men 
 are more subject to the disease tha^n women." Women, as 
 we have before remarked, have all parts of the cerebellum less 
 developed than men, and so have boys, and in men of sixty 
 they are on the decline. 
 
 We have not been able to learn of a sino;le instance of ac- 
 live congestion of the brain, terminating either in apoplexy, 
 palsy, or epilepsy, which, when of an idiopathic character, 
 was not associated with a high endowment of these organs. 
 
 We have not known erysipelatous inflammations, of an 
 original character, to be unattended by a similar endowment. 
 
 Attending this condition of the cerebellum, is a correspond- 
 ing liability to cutaneous diseases ; while those of a contrary 
 organization contract such diseases with difficulty, and with 
 an equal difficulty are they cured. 
 
 In proportion to the development of the two organs above 
 named, will be the liability to, and the progress of, cancerous 
 diseases. 
 
 And, on the contrary, onanism is associated with a feeble- 
 ness of these organs, and particularly of that of Animal Sen- 
 sibility. Those boys who are seduced into this practice, will 
 spontaneously abandon it, unless they should be organically 
 predisposed to it. 
 
 We have never known passive congestions of the brain, 
 convulsions, chronic hydrocephalus, chorea sancti viti, tubercu- 
 lar diseases of the lungs, etc., to be unattended by a feeble 
 endowment of tlie organs above named. But it is proper to 
 remark, that there is one exception to this doctrine as it now 
 stands. When the hemispheres, or that portion of the cere- 
 
OF THE CEREBELLUM. 27 
 
 brum wMcli includes the peculiarly human faculties, prepon- 
 derates OYer the balance of it, then it follows that the vital 
 forces may be very feeble, and yet indicate no tubercular dis- 
 position, because, under such circumstances, the venous sys- 
 tem preponderates over the arterial — a condition which has 
 been discovered to be incompatible with tuberculosis. This 
 condition of the cerebral system will be treated of, in a future 
 page, under the name of " Encephalic Temperament." 
 
 It appears then, that the cerebellum is indirectly connected 
 •with all the morbid affections which we have named, and, per- 
 haps with many others. Animal sensibility presides over the 
 cutaneous surface, and derangement in it may be followed by 
 abnormal actions in the functions of the urinary apparatus, 
 and to these may succeed, as sequents, rheumatism, gout, epi- 
 lepsy, palsy, and other diseases among those before named. 
 
 When the organ of Muscular Motion is but feebly devel- 
 oped, then we have passive congestions of the brain, convul- 
 sions, hydrocephalus, and consumption. When largely devel- 
 oped, with deficient exercise, we have pulmonary congestion 
 and hemorrhage, or cerebral apoplexy, or gout. And vv^hen 
 over exercised, the kidneys may fail to eliminate the urea that 
 is elaborated in the metamorphosis of the muscular tissue, 
 and then rheumatism, epilepsy, or some other disease may 
 result. 
 
 And attending a high endowment of Amativeness, under a 
 deficiency of the other two organs of the cerebellum, amaurosis, 
 paralysis and imbecility ; and with a high endowment of the 
 other two, and a deficiency of the posterior lobes of the cere- 
 brum, to furnish motives for such exertions as would expend 
 cerebellar irritation, we have cerebellar apoplexy and mania. 
 
 There is yet another physical condition connected with a 
 relation that is sometimes found to exist between the cerebel- 
 lum and medulla oblongata. When the latter organ prepon- 
 derates over the former, there exists a liability to tuberculosis ; 
 and when this condition is reversed, there exists an idiopathic 
 disposition to fat, or obesity and dropsy. In these cases the 
 thorax is large enough, but the lungs have but little expan- 
 sive power ^ — persons thus constituted are said to be short- 
 winded. They never manifest in the facial muscles any respi- 
 ratory action. 
 
23 PATHOLOGICAL RELATIOJS^S 
 
 If our premises be correct, it will be perceived that all the 
 diseases we have named originate in parts which are exclu- 
 sively appropriated to the functions of animal vitality ; and 
 when we shall conclude the consideration of the temperaments, 
 it will be understood how they may so modify the influence of 
 predisposing and exciting causes, as to produce many, and ap- 
 parently very difierent, diseases. 
 
 If we shall be asked for the source of the diseases of the 
 vegetative system, we can only answer that we do not know ; 
 but very strongly suspect that it is in the ganglionic system, 
 and connected, by a telegraphic arrangement, with the ante- 
 rior extremities of the middle lobes of the cerebrum. 
 
 Thus far, we have introduced no evidence in support of our 
 conclusions, but it is not yet too late. 
 
 As to the independence of the cerebellar functions, as we 
 have stated, we shall offer no proof in this place, but will sim- 
 ply ask to have it admitted "that the cerebellum does perform 
 a function ; and then, after a.ssuming it to have been clearly 
 shown by physiologists that the medulla oblongata expends its 
 force directly upon the respiratory function, we beg leave to 
 refer our readers to the following table while attending to the 
 explanations we are about to make — assuming as true that the 
 size of the occipital foramen indicates the size of the medulla 
 oblongata. 
 
 In the first class will be found those who have large chests 
 and thoroughly developed animal muscles — those in whom 
 respiration and circulation are greatly promoted by muscular 
 action — those in whom the cervical, thoracic, and abdominal 
 muscles aid the diaphragm in securing the full accomplish- 
 ment of the respiratory function — those in whom, accordingly, 
 we find a high development of both the medulla oblongata 
 and cerebellum. Such a coincidence, as is here presented, 
 and, as we believe, uniformly obtains, cannot be regarded as 
 one of accident, nor as one of no import. 
 
 Nixon Curry, the first on the list, is the only one in his 
 class who could be, even remotely, suspected to possess a lia- 
 bility to phthisis — his vital forces are not large enough, consid- 
 ering the magnitude of his medulla oblongata — he was a largo 
 and muscular man, without lymph or obesity. 
 
 Now, compare the first class with the third: In this the 
 
OF THE CEREBELLUM. 29 
 
 medulla oblongata is equal to that of the first ; but mark how 
 inferior is the cerebellum ; and mark too, the relation of this 
 inferiority to the existence of consumption ! We infer from 
 the feebleness of the animal muscles of this class, that respi- 
 ration is mainly sustained by the diaphragm, and, conse- 
 quently, the superior portions of the lungs are but raroiy in- 
 flated, and becoming feeble from inactivity, they become the 
 seats of tubercles — for we believe that it is now admitted that 
 tubercles first invade the superior portions of the lungs. 
 
 It is a very general opinion that tubercular consumption is 
 of hereditary origin, perhaps in all cases, but this is not our 
 conviction ; while we admit that it is hereditary to a great ex- 
 tent, we contend that certain violations of the procreative 
 laws result in that state or condition of cerebellar develop- 
 ment, that disposes to pulmonary tubercle, and the most fre- 
 quent variety of this violation consists in the marriage of 
 individuals who are too nearly of the same temperament. 
 And we as much believe that a perseverance in dancing, fenc- 
 ing, and public speaking, with a constant change of air, diet, 
 climate, and society will remove the predisposition from those 
 who have inherited it. 
 
 In the second class of subjects, exhibited by our table, it 
 will be seen that the cerebellum is sufficiently developed, but 
 that the medulla oblongata is deficient ; and the consequence 
 is a disposition to adipose deposition — a mode of decarboniz- 
 ing the blood that predisposes to dropsical afiTections of the 
 vegetative system, and possibly of both systems ; because, in 
 this constitution, we have seen oedema of the inferior extremi- 
 ties, hydrothorax, and ascites. 
 
 We may not be able to give the rationale of the conditions 
 above unfolded to the production of the diseases to which they 
 give origin, but we flatter ourselves that we have produced a 
 permanent foundation for the future observation of others. 
 
 In the fourth division, there are but two cases, and they 
 were introduced for the purpose of a few remarks. Kennedy 
 had altogether a consumptive organization, and when hung 
 may have had tubercles in his lungs. His organ of Amative- 
 ness is not larger than that of the Osage and Kaskiau Indians, 
 but the difierence between the development of the organs of 
 motion and sensation, respectively, explains, or rather confirms 
 
30 
 
 PATHOLOGICAL RELATIOi^S 
 
 the rationale previously given with reference to the propensity 
 of the former. 
 
 Davis was more than eighty years of age, and when in the 
 prime of life, was six feet seven inches high and very muscu- 
 lar. For some time before his death, which happened by a 
 mechanical accident, he was much troubled with a cough, and 
 would probably have died of phthisis. As he advanced in 
 age, it would seem that his cerebellum decreased in size, 
 which enables us to understand why it is, as Dr. Wood re- 
 marks, that men over sixty years of age are not the proper 
 subjects for rheumatism. 
 
 In the case of the eunuch, we have put the organ of Ama- 
 tiveness down as absent, and so it appears by external mea- 
 surement, but internally it existed, but was not more than an 
 eighth of an inch thick. His skull presents an unusually ex- 
 tensive hypertrophy of the social and reflecting regions, pro- 
 duced, no doubt, indirectly, by the feebleness of his vital 
 forces. 
 
 FIRST CLASS, 
 
 IS'ixon Cuny, alias John Hill . . . 
 
 Piper 
 
 Loper 
 
 Osage Indian 
 
 Kaskian Indian 
 
 JS'egro man. _ , 
 
 SECOND CLASS. 
 
 A patricide, who died of dropsy 
 Choctaw Indian do 
 
 Creek Indian chief 
 
 Polish officer 
 
 Spanish pirate 
 
 Natural eunuch 
 
 THIRD CLASS. 
 
 13. Fegan, died of consumption. 
 
 Negro, 
 Dubois, 
 A Preacher, 
 A German, 
 Dr. L , 
 
 do 
 do 
 do 
 do 
 do 
 
 FOURTH CLASS. 
 
 19. Kennedy, hung for rape. 
 
 20. Davis 
 
 9.1 
 10 
 10 
 
 9.1 
 10.1 
 
 9 
 
 11.1 
 
 11.1 
 
 11.1 
 
 11.1 
 
 12 
 
 12 
 
 11.1 
 13 
 
 11 
 
 11 
 
 11.1 
 
 10 
 
 10 
 
 11 
 
 10 
 
 9 
 
 11 
 
 11.1 
 10 
 10 
 
 41 5 
 
 78 
 67 
 67 
 8^9 
 818 
 5'8 
 
 The above measurements or numbers represent eighths of 
 an inch, and the fractions a sixteenth. In the first column 
 is placed the space between the mastoid processes ; the second, 
 
OF THE CEREBELLUM. 31 
 
 the longitudinal diameter of the occipital foramen ; the third, 
 the transverse diameter; the fourth, fifth, and sixth, the verti- 
 cal depth of the cerebellum at the center of the external sur- 
 face of Amativeness, Muscular Motion and Animal Sensibility. 
 The measurements being made upon the external surface of the 
 cranium, cannot be absolutely correct ; but, as all of them are 
 upon an equality, in this respect, the accuracy is sufficient to 
 develop the inferences we have drawn from them. The cra- 
 nia belong to our cabinet, and in each instance we either 
 knew the subject or had correct information of him. 
 
 It will be perceived, by a proper attention to the preceding- 
 facts, that a special liability to many diseases, if not to all, 
 is founded in a want of a proper balance, or equilibrium, in 
 the organization of the brain ; and this is indicated, and in- 
 deed demonstrated, by an inequilibrium of its various por- 
 tions ; and, therefore, it is impossible that life can be prolonged, 
 to any considerable extent, by medication; more particularly 
 in those diseases that involve the respiratory and circulatory 
 functions. 
 
 We have incidentally expressed the opinion that the cerebel- 
 lum performs other functions than those which we have, with 
 a certainty ascribed to it, and these are mere desires — appe- 
 tites — and the reason why we have supposed it to perform other 
 functions, is its varying modes of development. In some, its 
 greatest development is immediately around the foramen mag- 
 num — in others, it extends scarcely more than half the dis- 
 tance backwardly of the occipital foramen, that obtains in 
 other instances. These difierences have caused us to suspect 
 that the organs of some executive functions may inhere in it. 
 But without a discovery of these supposed organs and func- 
 tions, the measurements we have made, with the conditions 
 that were associated with them, authorize some interesting 
 conclusions, beside those we have presented. 
 
 It is well known, that persons like those of the first class, 
 are the most liable to inflammatory afiections, and that it is 
 far more easy to augment their vital manifestations than to 
 reduce them ; while those who are constituted like those of tho 
 third class, are but little liable to highly inflammatory dis- 
 eases, and that the vital manifestations are easily reduced, but 
 are again elevated with great difiiculty ; and hence the danger 
 
32 PATHOLOGICAL RELATIOXS 
 
 of antiphlogistic treatment in febrile and inflammatory affec- 
 tions of this class. So true is this, that we have discovered, 
 and others have reported to us the same, that a phlogistic 
 course is the best from the veiy start. 
 
 There are yet to be developed other interesting relations of 
 the cerebellum. In youth, when the cares and responsibilities 
 of life exert but a trifling influence, the tax levied by the cere- 
 brum upon the vitol resources is remarkably slight ; and hence 
 the cerebellum is adequate to the demands of physical repair 
 and development. As age advances and responsibilities in- 
 crease, the cerebellum increases, so that at life's meridian, 
 which, from the feebleness of the cerebellum in some individu- 
 als, happens at an early period of their history, we have as 
 much of an equilibrium between the size of this viscus and 
 the demands that are made upon it, as will ever obtain — in 
 other words, we have an equilibrium between the vital and 
 the chemical forces, and with the succeeding decrease of the 
 cerebellum, there is a corresponding increase of the chemical 
 forces and decrease of the vital. The facts we have got and 
 have presented, render these relations as demonstrable as any 
 proposition in Euclid. 
 
 In those who coiTCspond with the third class, the vital and 
 chemical forces are too nearly balanced to admit, even in 
 fevers and inflammations, of any reduction of the former. 
 "We deny that either class have too much vital force, even 
 when inflammation or fever is present, and those who think 
 that inflammatoiy manifestations indicate an antiphlogistic 
 treatment, have frequently found their patients of the third 
 class unable to rally, even after a moderate depletion, the pulse 
 in the outset indicating a very contrary condition. 
 
 The preceding facts and illustrations seem to authorize the 
 conclusion that other faculties than mere desires inhere in the 
 cerebellum — that a high endowment of it imparts a corres- 
 ponding vital capacity to all the parts below — directly to the 
 animal and indirectly to the vegetative — that it antagonizes 
 the chemical agencies — those which are exerting a constant 
 war upon the fundamental principles of life. 
 
 Every practitioner who has been, only to a small extent, a 
 pathological observer, must realize the truth of the preceding 
 discriminations ; and if he will reflect, he will perceive that 
 
OF THE CEREBELLUM. 33 
 
 the conditions cannot be otherwise than we have reported 
 them. He knows that a destruction or a paralysis of the sen- 
 sitive and motor nerves of the whole body, below the head, 
 would deprive him of all chance to restore the patient; con- 
 sequently, in proportion to their feebleness must be the slight- 
 ness of the impressions that can be therapeutically made. In 
 keeping with these views, is the uniformly tardy convalescence 
 of all patients who are constituted like those of the third class. 
 Let it be further observed, that the truth of these conclusions 
 does not depend upon the soundness of our views as to the 
 functions of the cerebellum, but upon the figures we have pre- 
 sented. Whatever may be the view^s entertained by any one 
 upon the special functions of this portion of the encephalon, 
 it is now demonstrable that the extent and modes of its devel- 
 opment, hold certain relations to health, vigor, and longevity. 
 
 Our hopes, then, should be, for the future, founded upon a 
 physiological prophylaxis. We must commence in infancy, 
 and, by a proper physical education, restore the organization 
 to such an equilibrium as shall be compatible with life, health 
 and longevity. In every age of the world, human observa- 
 tion forced upon the thinking portion of society the indispen- 
 sable necessity of physical education ; but it was appreciated 
 more by the ancients than it now is by existing society, and 
 hence they gave more attention to it ; and so it is with our ex- 
 isting savage tribes ; and we do not believe that the two hun- 
 dred savage crania, in our cabinet, furnish a single specimen 
 marked like those of the preceding third class. 
 
 As much as we have been among many of our savage 
 tribes, we never saw a case of phthisis pulmonalis ; and, in 
 harmony with this fact, we find their cerebelli largely devel- 
 oped, and their cerebral hemispheres peculiarly feeble or unde- 
 veloped. Sedentary habits, or extreme old age (which are 
 adequate in their condition to the reduction of the cerebellum) 
 could alone produce in them this disease. 
 
 The moral, social, sustaining, diplomatic, and reflecting 
 faculties, and their corresponding organs in the cerebral 
 hemispheres, are peculiarly human ; and while their support 
 and development depend upon the vital and vegetative forces, 
 their activity and power are antagonistic to the former — ever 
 tending to reduce and to break them down. 
 3 
 
34 OF THE CEREBELLUM. 
 
 If, now, we will contemplate the neglect of gymnastic exer- 
 cises, by those children whose parents intend them for scho- 
 lastic honors, and the ever excited and restless condition of 
 American society, particularly that of our cities — 'equaled in 
 this respect by the people of no other portion of the earth, we 
 can certainly have no difficulty in comprehending how that 
 condition of the cerebellum is produced, which is ever asso- 
 ciated with phthisis pulmonalis, and why it is that this disease 
 is so frequent in our country. 
 
 The differences that exist between the first and third classes, 
 in the preceding table, and their associated consequences, 
 should dictate a complete revolution in the education of those 
 whose cerebellum is comparatively feeble, or whose cerebral 
 hemispheres are particularly large. The public mind must 
 become penetrated with the conviction that a continuance of 
 life depends upon an adequate endowment of the vital and 
 vegetative systems — that a large and finely endowed cerebrum 
 is of no consequence, without a cerebellum that can impart to 
 it, and maintain in it, a vigorous, and, therefore, a useful 
 action. 
 
 Hitherto, exercise, in the abstract, has been contended for, 
 and particular kinds have been empirically recommended, for 
 given purposes ; but the developments we have made, will en- 
 able every physician to decide upon the precise variety that 
 may be required. In the second Book, this subject will claim 
 our particular attention. 
 
P AET II. 
 
 THE HUMAN TEMPERAMENTS. 
 
 CHAPTER I. 
 
 A EEYIEW OF THE PEEYAILING OPINIONS ON THIS SUBJECT. 
 
 The constitutional diversities that exist, even in a single 
 race of the species, have, no doubt, engaged the attention of 
 the observing and reflecting from a period far more remote 
 than the earliest recorded history. Sure we are, that attempts 
 were made to classify them, as early as the time of Hippo- 
 crates ; and, strange to tell, so far as regards description, 
 little advancement has since been made. 
 
 In every age of medical history, and by every school of 
 medicine, the subject has been regarded so important as to 
 command the attention of the most talented and distinguished 
 physicians and physiologists ; and yet, in this great length of 
 time, and by this immense amount of labor, almost the whole 
 of the advancement consists in the single discovery, that the 
 ancients committed an error in attributing the melancholic to 
 the supposed secretions of the atrabiliary capsules and spleen. 
 
 But the detection of this error was followed by the perpe- 
 tration of another of equal magnitude — that of attributing this 
 constitution — a supposed physiological state — to a deranged 
 or pathological condition of the bilious. 
 
 The moderns have committed another error, of no less mag- 
 nitude, in founding what they have been pleased to denomi- 
 nate the nervous temperament on a pathological state of the 
 
 (35) 
 
36 REVIEW OF PREVAILIN'G OPINIONS] 
 
 nervous system. This temperament, says Professor Dungli- 
 son, like the melancholic, is " seldom natm-al or primitive." 
 It is morbid, or secondary, being induced by sedentary life, 
 sexual indulgence, or morbid excitement of the imagination 
 from any cause. To found a physiological condition of the 
 system upon a pathological one, appears to be a gross violation 
 of all sound philosophy. 
 
 We define Temperament to be a mode of animal being, sui 
 generis, compatible with life, health, and longevity. This de- 
 finition agrees with Professor Dunglison's in every essential 
 point ; and with it the ancients were consistent ; they founded 
 the melancholic constitution upon two supposed physiological 
 facts ; but the moderns have been anti-philosophical enough to 
 found two physiological states upon two pathological ones — 
 and that, too, in violation of their own definition ; for it can- 
 not be concluded that life, health, and longevity are compati- 
 ble with pathological conditions of the system. 
 
 The classification and doctrines usually adopted are those 
 of Picherand ; consequently, before attempting to advance any- 
 thing new, it will be proper briefly to review them, and even 
 some others which are not without advocates. But, before 
 proceeding to the discharge of this duty, it may be well to ob- 
 serve, that no one will doubt that it is conformable to natural 
 law, to infer that where there is an equal number of similar 
 organic parts, there may be induced an equal number of similar 
 organic changes. Kegroes, Indians, Malays, and Mongolians, 
 have as many, and similar, organic parts as the white race ; and, 
 consequently, are liable to the same peculiar organic changes. 
 It may, therefore, be physiologically supposed that the same con- 
 stitutional peculiarities that distinguish the white, may also dis- 
 tinguish the other races. In making the proposed reviews, it 
 will be necessary to bear these remarks in remembrance. In 
 the examination of this subject, we shall quote from Professor 
 Dunglison's Physiology, which presents as correct an account 
 of what is known upon it, as any work with which the profes- 
 sion is acquainted. 
 
 The Sanguine Temperament is characterized by a "ruddy 
 complexion, animated countenance, firm flesh, light hair, fair 
 skin, blue eyes, quick conception, ready memory, lively ima- 
 gination," etc. The further account given of it by various 
 
ON HUMAN TEMPERAMENTS. 37 
 
 writers, amounts to about this : The sanguine man is only fit 
 to love ; to feed ; to indulge in every species of sensuality ; to 
 be a friend in prosperity, and a coward in adversity. Such 
 unqualified generalizations are unworthy of philosophers. 
 When it shall be known that two of the most distinguished 
 of the human race were sanguine men, this class of the spe- 
 cies, at least, will know how much physiological opinions are 
 generally worth. 
 
 Have not some Negroes, Indians, Malays, and Mongolians 
 firm flesh, quick conception, ready memory, and a lively ima- 
 gination ? And yet, none of them have a ruddy complexion, 
 light hair, and fair skin. How, then, shall we know a san- 
 guine man of the universally dark-skinned races ? K there is 
 any truth in the doctrine of the temperaments, it should have 
 as discriminating an application to the colored races of the 
 species as to the white. 
 
 In the description of the Bilious Temperament^ there is 
 not a single circumstance named which does not occur in other 
 temperaments, except the brown color of the skin and the 
 dark hair ; and these peculiarities are common to all Indians, 
 Malays, and Mongolians. And yet, all the individuals of 
 these races are not of the bilious constitution. 
 
 It is a remarkable circumstance, that physiologists, almost 
 without exception, have classed all the great men of the world 
 under this head ; and, as strange as it may appear, in doing 
 60, they have violated their own definitions. Under this head 
 they have classed Peter the Great, Cromwell, Julius Caesar, 
 and l^apoleon ; and General Washington, too, and probably 
 by this time General Jackson and General Scott are placed in 
 the same category. 
 
 How can physiologists venture upon such violations of all 
 scientific discrimination, for the shallow and unworthy pur- 
 pose of supporting a mere hypothesis ? Bonaparte, Cromwell, 
 and Julius Csesar had bluish gray eyes ; Bonaparte and Peter 
 the Great did not possess the firm muscle and sharp outline 
 of the bilious man ; and Washington had light hair and blue 
 eyes. Hence, it appears, that there have been some great 
 men who were not of the bilious temperament. 
 
 In the Melancholic Temperament^ we are informed that 
 " the skin assumes a deeper hue than in the bilious ; tlie 
 
3g REVIETV OF PREVAILING OPHflONS 
 
 countenance is sallow and sad ; the bowels are torpid, and all 
 the excretions are tardy ; the pulse is hard and habitually con- 
 tracted ; the imagination is gloomy, and the temper suspi- 
 cious." As we are not informed of the precise depth of 
 "hue" in the color of the bilious man, we cannot judge, with 
 any accuracy, as to the complexion of this temperament ; it 
 may be presumed, however, to be about that of our Indian 
 tribes. The balance of the description applies with much ac- 
 curacy to a bilious man laboring under a chronic disease of 
 the liver. 
 
 This temperament, furthermore, is founded upon no ana- 
 tomical or physiological condition of the system. From all 
 that has been said about it, by modern physiologists, it must 
 be regarded as a pathological condition of the portal system ; 
 and yet they have treated it as a physiological or normal one. 
 
 In the LymjpliatiG Temjperament^ "we find soft flesh; pale 
 skin ; fair hair ; weak, slow, and soft pulse," etc. It is pro- 
 bable that any observer might distinguish a lymphatic negro 
 from any other, by his soft flesh and shapeless body ; never- 
 theless it is not true that a lymphatic negro, Indian, or Malay 
 has a "pale skin and fair hair." 
 
 Great importance has ever been attached to a knowledge of 
 the temperaments in the practice of Medicine ; and yet the 
 knowledge of them that has been acquired, has proved to be 
 scarcely of any avail. The primitive temperaments are but 
 rarely met with, and what is generally known of them, even 
 by the ablest physiologists, is so inconsiderable as to render 
 the combinations unintelligible, and, of course, the whole sub- 
 ject unimportant in practice. 
 
 Phrenologists are as much in the dark on this subject as are 
 the physicians ; they are compelled to be informed of the tem- 
 perament of an individual before they can venture an opinion 
 upon his character, from his skull or bust. 
 
 Inasmuch as the Edinburgh "Phrenological Journal and 
 Miscellany," and the American "Annals of Phrenology," 
 have highly complimented the views, on this subject, of F. 
 Thomas, D. M. P., of Paris, it may not be uninteresting, nor 
 without utility to review them briefly. 
 
 In his classification there are three primitive or elementary 
 temperaments — the encephalic, thoracic, and abdominal — and, 
 
ON HUMAI^ TEMPERAMENTS. 39 
 
 by the combination of these, he produces four others — the 
 mixed, encephalo-thoracic, encephalo-abdominal, and the tho- 
 racico-abdominal : making in all, seven. 
 
 It cannot be discovered that this system is more practically 
 useful than the other. It has, however, the merit of being 
 equally applicable to all races, and in being founded upon real 
 anatomical conditions. But his treatment of the subject shows 
 that with him, it is a mere theory — more plausible than use- 
 ful — that it is not the result of extensive observation and 
 generalization. 
 
 A single illustration will show that his system can be of no 
 nse in the practice of medicine. A walk of twenty minutes 
 in any one of our cities will discover men who possess his ab- 
 dominal temperament; but in one will be found an active and 
 extensive portal system, while in another it is too unimportant, 
 comparatively, to deserve notice. The pathological conditions 
 of these two are so widely different in any one type of disease, 
 as to require very different, almost opposite — therapeutic 
 agents. This single illustration is enough to destroy his sys- 
 tem in the estimation of a discriminating physician. 
 
 He says, that when the brain and lungs are small,' and the 
 abdominal viscera are largely developed, we have the lym- 
 phatic constitution. He seems not to have known that lymph, 
 in a normal condition of the body, never pervades one part of 
 the system to the exclusion of any other. A lymphatic man, 
 with, relatively, a small head, has never been seen. A man 
 may be fat and have a small head, because the brain secretes 
 no fat. The magnitude of this error is sufficient to place 
 under the ban of suspicion every opinion he has advanced 
 upon the subject. If his statement were true, all lymphatic 
 men would be idiots ; but, fortunately, the truth is that some 
 of them are distinguished for their mental abilities. 
 
 He further states, that when the brain and abdomen are 
 small, and the lungs and heart are large, the individual is san- 
 guine. We are confident that this is a condition which he 
 never saw. Can vigorous respiration and circulation be main- 
 tained without a vigorous abdominal apparatus ? The brain 
 may be relatively small because of its superior density, which 
 makes ample compensation. 
 
 His encephalic and his encephalo-thoracic temperaments 
 
40 REVIEW ON HUMAN TEMPERAMENTS. 
 
 are most certainly and demonstrably one and the same ; in 
 the first, he includes the entire encephalon — the cerebrum and 
 cerebellum. Now, it so happens that the cerebrum may be 
 exceedingly large, while the cerebellum may be as remarkably 
 small; and with a small cerebellum, there is a small chest; 
 with a large cerebellum, a large chesfc — and an exception to 
 this relation between the cerebellum and chest cannot be found 
 in any department of creation. The existence then, of a large 
 cerebellum, implies that of a large chest. "We trust that we 
 have made this matter unanswerably clear in our expositions 
 of the functions of the cerebellum. 
 
 Again, he teaches that when the thoracic and abdominal 
 viscera are small and the brain large, the individual possesses 
 great mental energy. It may be concluded then, that if the 
 little he has of abdominal and thoracic viscera were converted 
 into brain, he would possess still more mental energy. (?) The 
 truth is, that it would be just as philosophical to speak of a 
 large steam engine having or manifesting great power without 
 steam. How is it possible for the brain to manifest great 
 power without vigorous nutrition, respiration, and circulation? 
 Can aTfeonaparte, a Cromwell, a Scott, or a Washington be 
 found with small thoracic and abdominal viscera ? 
 
 It is useless to pursue the views of Mr. Thomas any further, 
 except to remark that they are not more inservient to the 
 wants of phrenology than they are to those of medical prac- 
 tice. The phrenologist, when examining a skull, or when 
 comparing certain parts of one with those of another, cannot 
 have before him the chest and abdomen which were, at one 
 time, associated, respectively, with the heads. The ethnolo- 
 gist, in the investigation of national character, from crania, 
 cannot have before him the national chests and abdomens. 
 
 We are not surprised that Mr. Thomas conceived this theo- 
 ry of the temperaments, nor that he placed it before the pub- 
 lic ; but we are truly surprised that the Scotch and Boston 
 phrenologists should have so highly eulogized it as they have. 
 His, like many others, is a useless theory — plausible until put 
 to the test of extensive observation and rigid comparison. 
 
ELEMEI^TARY TEMPERAMENTS. 41 
 
 CHAPTER III. 
 
 OF THE ELEMENTAKY TEMPERAMENTS. 
 
 INTRODUCTORY REMARK 
 
 It is generally agreed that very important changes take 
 place in the temperament of individuals ; but to this opinion 
 we can only give a very partial assent. We have never 
 known a sanguine man to become bilious ; nor a bilious one 
 to become sanguine or lymphatic. We have seen no very im- 
 portant change to take place in any one of the temperaments. 
 The black or red-headed child will show a black or red -headed 
 man. Those persons who possess only moderate powers of 
 assimilation, if mentally constituted to be indifferent to care 
 and responsibility, will become obese ; and it is for this reason 
 that children and all of the inferior animals may become fat. 
 Lymph is a very different matter ; so different that it is not true, 
 as it has usually been represented, that children are generally 
 lymphatic. Lymph prevails in the brain, in common with all 
 other parts of the body ; but this is not the case with fat — it 
 never obtains normally, in the brain. Obesity may occur in 
 several of the temperaments, possibly in all of them, if the 
 mental constitution be favorable to ease and repose. Many, 
 and probably all, normally lymphatic persons, were lean either 
 in youth and early manhood, or during the period of muscular 
 activity, growth, and development; but their heads always 
 indicate their lymphatic constitution ; and if they had not be- 
 come lymphatic they would have become unhealthy and nerv- 
 ous. It sometimes happens, from close application to study, 
 and perhaps other causes, that they do not acquire lymph, and 
 thus the supposed nervous temperament of some authors, 
 originated, we have no doubt, in many instances. 
 
 All the temperaments can be modified by the influence of 
 circumstances ; but not to such an extent as to change one into 
 another. The sanguine and the bilious, by early habits of 
 confinement and study, may become more encephalic, or by 
 active and highly responsible positions, they may become, to a 
 
42 ELEMENTARY TEMPERAMENTS. 
 
 small extent, a quadruple, as in the case of Gen. Washington. 
 But a sanguine man never becomes sanguine-bilious, nor do 
 any of them ever pass into the equally mixed binary combina- 
 tion ; either element, however, can be strengthened or weak- 
 ened. 
 
 Wealth may produce, as it frequently does, ease and luxury, 
 and when it happens with those who are not ambitious — who 
 are well endowed with hope and the vital forces — they pass 
 into what some call the abdominal temperament. This condi- 
 tion obtains very frequently in old and wealthy communities ; 
 but in new and poor ones, it is but rarely met with. 
 
 Physiologists have attributed every degree of talent, and 
 every peculiarity of character to the temperaments ; while the 
 phrenologists have gone to the other extreme. The former 
 were ignorant of the true cause of mental peculiarities, and 
 the latter have yet to learn the range of constitutional influ- 
 ence. It is a little surprising that phrenologists have not dis- 
 covered that although no single affective or intellectual pecu- 
 liarity can be assigned, as a distinguishing feature of any one 
 temperament, yet each of them is distinguished from the 
 others by a sid generis outline of cerebral development, such 
 as gives to each a marked outline of character. 
 
 Phrenologists have supposed that the temperaments indi- 
 cated only to some extent the quality of the brain, but not in 
 anywise its configuration or general functions. If they had 
 taken the trouble to compare the heads of the bilious with 
 those of the lymphatic, they would have discovered their mis- 
 take. Professor Caldwell, who has been laboring in the sci- 
 ence some thirty years, and in physiology nearly all his life, 
 was sufficiently unacquainted with the subject, as to suppose 
 that we were guided in our discriminations, by the texture of 
 the bone, or some other condition of it, not less insignificant.* 
 
 Yarious physiologists have adopted different names for the 
 temperaments ; but this is a matter of but little moment, pro- 
 vided we understand and properly define them. The classifi- 
 cation with which we have been content, is that of the an- 
 cients, with but one exception. We divide them into the 
 sanguine, the bilious, the lymphatic, and the encephalic (which 
 
 ♦American Phrenological Journal. 
 
 i 
 
INTRODUCTORY REMARKS. 43 
 
 we believe to be identical with the melancholic of the ancients ; 
 at all events it agrees with the one of this name in Lavater's 
 works); and their combinations, making in all fifteen. 
 
 The outlines and peculiarities of the several combinations 
 are more easily perceived, by one of our practice, than de- 
 scribed. Nevertheless, they soon become obvious to an in- 
 'dustrious observer. By the use of crania and crayon por- 
 traits, we have found many students who succeeded, by one 
 course of lectures, in distinguishing the temperaments and their 
 combinations in both living subjects and crania. A few soon 
 learn to do it even by chirographic marks. It must be confessed, 
 however, that much difficulty attends some portions of the 
 subject, without the aid of a practical teacher. As complexion 
 of skin, eyes, and hair, in the white race, will greatly aid in 
 distinguishing the temperaments, students, who have not the 
 advantage of a practical teacher, should study the subject 
 thoroughly in this race, before attempting any application of 
 the science to crania and the colored races. 
 
 "With these general remarks, we proceed to the considera- 
 tion of the subject in detail. Our descriptions of complexion, 
 etc., will have reference alone to the white race, and those of 
 crania will apply to all races. 
 
 It should be further remarked of this, as of other depart- 
 ments of natural history, that no description that can be given 
 of a species, will appear applicable to all the varieties, in the 
 judgment of an unpracticed observer. Apparently strong ex- 
 ceptions to the descriptions we shall give, will be found in each 
 division ; but a close investigation will discover that the ap- 
 parent exceptions consist in a departure from the rule, of only 
 some of the features — enough of them preserving their integ- 
 rity to determine the species to which it belongs. An unprac- 
 ticed observer, in looking at the shells that may cover a table, 
 will discover a striking resemblance between individuals of 
 different species, and striking differences between otliers of the 
 same species — 'he knows not how to make the first move 
 toward a classification of them ; but a conch ologist will, in a 
 few minutes, dispose of a majority of them — a few of them 
 may give him some trouble. It is precisely so with the human 
 temperaments. Hence, Professor Caldwell is not the only 
 well informed medical scholar who has manifested an obstinate 
 
44 
 
 ELEMENTARY TEMPERAMEI^TS. 
 
 incredulity wlien first told that we could determine the tem- 
 X^erament and complexion by an examination of the naked 
 skull ; and this incredulity and obstinacy increased, when in- 
 formed that we could do the same with equal facility, by chi- 
 rographic marks. But no naturalist should be astonished or 
 incredulous upon receiving such information ; and no philo- 
 sopher should venture to oppose and denounce such a preten- 
 sion, before he finds it to be in contravention to some known 
 and established law. 
 
 (ge>t:ral "^ashixgtox.) 
 
 I. SANGUINE TEMPERAMENT. 
 
 Our conception of this constitution is precisely analogous to 
 the mixed temperament of Dr. F. Thomas, and to the tonic one 
 of Dr. Darwin, and our observations have induced us to be- 
 lieve that it is the primitive constitution — that it is the only 
 one that can be regarded as perfectly normal. The strongest 
 reason we have for this opinion, consists in this fact — we 
 have, in no instance, discovered any indications of degeneracy 
 to result from parents, wherein both of them were of this 
 
 J 
 
SAN-GUINE TEMPERAMENT. 45 
 
 constitution. In another place we shall have more to saj 
 upon this subject. 
 
 The picture of the Apollo Belvidere, as drawn by Dr. 
 Thomas, is so applicable to the best or most finished specimens 
 of this constitution, that we cannot refrain from placing it be- 
 fore our readers. 
 
 He says, " not only do none of the three cavities preponde- 
 rate, but there is a just proportion in the limbs as compared 
 with the rest of the body and with each other ; and the bones, 
 muscles, bloodvessels, nerves, cellular tissue, and all the 
 secondary parts, are also in beautiful proportion. This clief- 
 d'micvre of art represents man in his most perfect type ; there 
 is nothing too strong and nothing too weak ; nothing in excess 
 and nothing deficient. Phidias, inspired, has created some- 
 thing celestial ! — that brain cannot be the seat of too violent 
 or too impetuous passions, although it can experience them 
 all. The intellectual faculties, sufficiently developed, do not 
 hurry him on to the vagueness of hypothesis and conjecture : 
 his blood is neither too fibrinous nor too much animalized ; 
 his abdominal functions are performed with facility ; the chyle 
 is separated and absorbed in sufficient quantity for the nutri- 
 tion of his beautiful body ; the limbs have all that is required 
 for exercising with the greatest facility all the movements ne- 
 cessary to the whole ; and the physiognomy represents, in all 
 its features, a perfect equality of the whole body." 
 
 This description is not, probably, more applicable to the 
 production of the artist, than it would have been to General 
 "Washington and General Scott, in the prime of their lives, or 
 to Tuskena, a sub-chief in the Creek Indian nation, who was 
 the most beautifully proportioned man we ever saw. 
 
 The language which the Marquis of Chastellux has used 
 with reference to the Antique Apollo and General Washing- 
 ton, may be applied to this division of the human race, as a 
 whole. He says that if you are " presented with medals of 
 Csesar, of Trajan, or Alexander, on examining their features, 
 you will still be led to ask what was their stature, and the form 
 of their persons ; but if you discover, in a heap of ruins, the 
 head or the limb of an Antique Apollo, be not curious about 
 the parts, but rest assured that they were all conformal)le to 
 ♦*hose of a god. Let not this comparison be attributed to en- 
 
4S ELEMENTAYY TEMPERAMENTS. 
 
 thusiasm ! It is not my intention to exaggerate, I wish only 
 to express the impression that General Washington has left on 
 my mind ; the idea of a perfect whole,* brave without temeri- 
 ty, laborious without ambition, generous without prodigality, 
 noble without pride, virtuous without severity." 
 
 In fine, the sanguine constitution is just the one for the pri- 
 meval or Adamic age of the world, in which the only book 
 was nature, and the only duties were those which we owe to 
 our God, our families, and our neighbors — an age in which 
 there were no crowns to covet, nor empires to conquer. It is 
 a constitution in the highest degree compatible with life, 
 health, and happiness ; and a source of pure vitality for the 
 population and replenishment of the world. 
 
 Fickleness and inconstancy have long been charged as char- 
 acteristics of this constitution. Lavater almost hated every one 
 who possessed a blue eye, and Mr. Cook says, that persons of 
 this temperament are light and inconstant, fitted rather for the 
 companionship of the hour than for the vicissitudes and trials 
 of mortal destiny. "In the gay days of hilarity and prosperi- 
 ty, the sanguine man or woman basks beneath the sunny beam, 
 lively, joyful, and extravagant ; but you must not be surprised 
 if you look in vain for this character in the hour of darkness 
 and adversity ; or if it should grow pale at the prospect, when 
 summoned by duty or afiection, to walk by your side through 
 the valley of the shadow of death. This is not the tempera- 
 ment of the martyr or hero." Similar opinions, though not 
 expressed in so many words, are advanced by Broussais, 
 Eicherand, Good, and others. 
 
 These traits of character are frequently to be found in all 
 of the temperaments, but the exceedingly elastic character of 
 this one, may render it more vulnerable to the charge. The 
 perfect adaptation and equality of strength which marks it, 
 and the purity of the blood that stimulates all its organs into 
 
 * Abating a little of liis obesity, incidental to his age, we were similarly im- 
 pressed with the person of General Scott. He is six feet four inches high, and 
 yet, when seen alone, he does not appear to be above a good average size ; and 
 this is because of the fine proportion of all his parts. We once saw a young 
 lady of this temperament, who was six feet two inches high, and who, when 
 seen alone, attracted no attention, on account of her size, but when seen with 
 other ladies, she appeared as a giantess. There was no want of symmetry in 
 any part of her person. 
 
SANGUINE TEMPERAMENT. 47 
 
 action, show that its equilibrium must be easily disturbed by 
 any cause, however inconsiderable ; and for this reason, it is 
 evident, that as soon as the disturbing cause is removed, the 
 equilibrium would be restored. This is positively the condi- 
 tion of the sanguine constitution ; hence it follows that it con- 
 tinues to act during the existence of the motive which produced 
 the action. This is the reason why the sanguine man is never 
 absent-minded or abstracted, but is at all times present to all 
 that surrounds him. It matters nothing whether this pecu- 
 liarity be attributed to the shortness of the posterior lobes of 
 the brain, or to the influence of temperament, because the one 
 always attends the other in this constitution. 
 
 That peculiarity of this constitution which has so disgusted 
 gome physiologists, has had the efiect to save the whole class 
 from lunacy and suicide. The internal motives with which it 
 is endowed, are usually too feeble and evanescent, to impel them 
 forward after crowns and conquests ; but, wdien engaged in 
 such enterprises, as instruments, there are very few, if any, 
 who prove to be more safe or useful. 
 
 Physiologists define this constitution to consist in a prepon- 
 derating activity, influence or development of the sanguiferous 
 system. Such a state of it would be pathological, or at least 
 incompatible with health and longevity. It has been admit- 
 ted that there pervades the whole of it, a perfect adjustment of 
 all its organs and tissues, and therefore, to speak of a prepon- 
 derating influence, is to admit imperfection and a tendency to 
 disease. The great peculiarity of this constitution appears to 
 consist in the purity of the blood, its thorough distribution 
 and adaptation of all the tissues to its impression. 
 
 This constitution may be usually known by its light hair, 
 blue eyes (not a sky blue, but a mixture of blue and white, or 
 a blue ground with white specks), fair skin, nose usually large 
 and frequently convex on the bridge, lips well defined, having 
 the superior one the more prominent ; the limbs and all parts 
 of the body being round, well turned, and more adapted to 
 strong, dignified, and graceful movements, than such as are 
 remarkable for activity or suppleness. 
 
 In consequence of very large perceptive .or small reflective 
 powers, the forehead recedes ; the cerebellar portion of the oc- 
 cipital bone, between the mastoid processes, is full and large, 
 
48 ELEMENTARY TEMPERAMENTS. 
 
 particularly tlie lateral portions; the posterior lobes of the 
 cerebrum are short, ^'hen compared with those of the bilious; 
 the vertex is, relatively, more elevated ; the corona is not 
 fully expanded ; the superciliary ridge is well defined and the 
 glabella is prominent and rough ; the head rests more verti- 
 cally upon the cervical column, than in the bilious, the only- 
 one with which it can be confounded. 
 
 Sanguine people readily know or perceive the things and 
 the relations that exist within the sphere of their pursuits and 
 the results that may grow out of them, without the toil of ratio- 
 cination. They appear never to reason, and yet their judg- 
 ment, for soundness, will favorably compare with the best that 
 the race produces. They are not adapted to the inductive sci- 
 ences, or to sedentary and studious pursu.its, but to the active. 
 They are admirably constituted for horticulture, agriculture, 
 the mechanic arts, and the descriptive sciences. x\flfectively, 
 they are better adapted to occasions that require fortitude and 
 submission, than any other class — they make the best subjects 
 and the best servants, and notwithstanding other physiologists 
 to the contrary, there is none more brave, and certainly none 
 less revengeful. They are furthermore, well constituted to 
 enjoy all the amenities of life, and, as a consequence, they fre- 
 quently become fat, but they very rarely indulge to intemper- 
 ance, and still less frequently to brutal excesses. 
 
 When we contemplate the strong and muscular character of 
 this constitution, we should be entirely unable to assign a rea- 
 son for the fact, that not a single specimen of it is to be found 
 in tlie English Boxiana, but for that discovery of its internal 
 motives which we have explained. 
 
 The brain of the sanguine constitution is neither so dense 
 nor active as that of the bilious or sanguine bilious. As illus- 
 trations of this constitution. General Washington,* General 
 Scott, Lord Cornwallis, Petrarch, and Dr. Caspar Wistar may 
 be cited. 
 
 * In Trumbull's portrait of Washington, the superior part of the forehead is 
 rendered too prominent, and the inferior is not prominent enough. In this 
 wise, the character is weakened rather than strengthened. These faults, as 
 we conceive them to be, we have observed in no other representation of this 
 extraordinary man. 
 
BILIOUS TEMPERAMENT. 49 
 
 (ariosto.) 
 
 II. BILIOUS TEMPERAMENT. 
 
 Under this head, we have, in the white race, two varie- 
 ties, which are, externally, exceedingly unlike, and yet they 
 are intrinsically the same. The one has black hair, dark 
 eyes, and brown skin ; the other has red hair, bluish gray 
 eyes, and a florid complexion. We regard these two varie- 
 ties as being essentially the same, and for these reasons: 
 1st. Black-headed parents have occasionally red-headed chil- 
 dren; 2d. The red-headed variety combines with the other 
 constitutions just as the black does ; 3d. The red and black 
 do not combine with each other to the production of a cross ; 
 4th. Their skulls resemble so closely as not to admit of a dis- 
 tinction ; 5th. We cannot distinguish the one from the other 
 by their chirography — the most delicate of all tests ; 6th. Qui- 
 nine and mercurials have the same efiect upon both ; and, 7th. 
 Both possess the same special and general character. For 
 these reasons we treat of both as being one and the same. As 
 we have no facts to show conclusively why this difierence 
 should exist in the same species, we will not trouble our read- 
 ers with any speculations on the subject ; but we may add that 
 we were engaged many years before the conclusion we have 
 expressed was forced upon us. Physiologists have uniformly 
 taught, that the more florid the complexion the more sanguine 
 the constitution. At one time this was our own impression, 
 
 4: 
 
50 ELEMEN"TARY TEMPERAJSIEK-TS. 
 
 but close and continued observation, for twenty-five years, has 
 relieved us of all doubt, as to the soundness of our conclusion. 
 It may be possible that the red variety was originally pro- 
 duced in the north, and the dark in the south, or they may 
 represent two distinct races. 
 
 In this constitution, every feature and every articulation 
 throughout the system is attended with angularity and abrupt- 
 ness ; the pulse betrays more activity and the subcutaneous 
 veins more prominence than in the sanguine. The complexion 
 is brown or florid, the hair is black or red, the muscles are 
 more moderately developed than in the sanguine, but they are 
 more dense or firm ; the nose is rather large and frequently 
 aquiline, but more frequently, in this country, perhaps, long, 
 slender, and pointed, having the nares well developed and the 
 alae very thin ; the lips are well defined, with the superior one, 
 as in the sanguine, more prominent than the inferior ; the 
 forehead, as in the sanguine, recedes, and for the same reason; 
 the posterior lobes of the brain are much developed backward 
 and upward ; the hemispheres are less elevated ; the corona, 
 as in the isanguine, are not expanded: the cerebellum is more 
 contracted or lees developed laterally and downwardly than in 
 the sanguine, but developed more in a posteriorly direction, 
 and the whole head is adjusted more obliquely upon the cer- 
 vical column. The brain is not usually so large as in the 
 sanguine, but is more dense and much more active. The per- 
 ceptions, conclusions, and actions follow each other in such 
 quick succession, as to be incomprehensible to other classes of 
 men, and hence they are usually suspected of being rash and 
 visionary. 
 
 Physiologists attribute this temperament to a preponderat- 
 ing influence of the liver and portal circle. This doctrine, to 
 us, is objectionable, because it certainly implies a constituted 
 liability to disease or derangement. As persons of this con- 
 stitution are as healthy and live as long as those of the san- 
 guine, we certainly have no evidence that the same law of 
 adjustment or adaptation does not obtain as much in it as in 
 the former constitution. The sanguiferous system in this, is 
 about equal to that of the sanguine, except that the organs of 
 its manifestation are smaller, but then, they are more dense 
 and active, which amply compensate for their inferiority in 
 
BILIOUS TEMPERAMENT. 51 
 
 size. It manifests as much force as does the sanguine and 
 considerably more energy ; it is as easily impressed, but the 
 impression lasts much longer and leads to a greater persistance 
 of action. 
 
 Then what is the cause of the difference between them ? In 
 this : the posterior and superior posterior portions of the brain 
 are considerably more developed, and thereby produce stronger 
 motives to action. But did this cerebral development produce 
 the difference, or did the latter produce the former ? As a 
 sanguine man is sometimes changed into a partially sanguine 
 bilious one, by strong external agents, it may be concluded 
 that the cerebral development and the constitutional difference 
 between the two, were both produced simultaneously, and that 
 when produced, they act reciprocally upon each other. 
 
 As the capacity of this constitution to retain impressions 
 cannot be attributed alone to the cerebral developments above 
 named, we are still called upon to inquire, what it depends 
 upon ? Our own impression is, that the portal system imparts 
 to the blood qualities which have the power, by acting upon 
 tissues constructed in harmony with them, to produce those 
 phenomena, which, taken together, constitute the bilious tem- 
 perament. 
 
 The bilious constitution is not so elastic as the sanguine — it 
 does not cease to feel, and consequently to act, when the cause 
 is removed ; and hence the reason why it is so liable, as it is, 
 to become morbid, even to insanity. The capacity of this tem- 
 perament to produce great men, has been much overrated. In 
 this respect it differs from the sanguine thus : the great men 
 of the latter are those who discharged with able and distin- 
 guished faithfulness the obligations imposed upon them by 
 their country or others in authority ; and the great men of the 
 former are those who were impelled to great achievements by a 
 will or purpose of their own. The latter will never usurp the 
 power intrusted to them ; and the former will never surrender 
 it without reluctance. 
 
 As illustrations of this temperament, physiologists have 
 given Mahomet, Charles XII, Dante, Cortez, Pizarro, Charle- 
 magne, Francis I, king of France, and Lady Huntington. 
 They have cited many others whom we know are not bilious, 
 and hence we exclude them. 
 
52 ELEMENTARY TEMPERAMENTS. 
 
 This constitution is favorably adapted to the elementary sci- 
 ences, particularly the descriptive, and to the active pursuits 
 of life; but not to sedentary habits and philosophical investi- 
 gations. 
 
 In consideration of the very active and muscular character 
 of this constitution, we would, a priori^ expect to find in it a 
 proper proportion of professional pugilists, and, accordingly, 
 the "Boxiana" gives us three, Fosbrook, Stevenson, and 
 Cooper. The former two, though pretty good boxers, never 
 acquired much fame. Cooper was a sturdy fellow, and pos- 
 sessed much good sense ; but he was not a scientific boxer ; he 
 was, however, " a hard, slashing hitter and a long laster." 
 His battle with O'Leary lasted sixty eight minutes, and ended 
 in the death of the latter, though he was regarded as the best 
 boxer. The decisive blow of Cooper is said to have been 
 thrown out as the last paroxysm of a beaten man. 
 
 VAN-TA-QIN A CHINESE GENTLEMAN OF DISTINCTION. 
 
 HI. LYMPHATIC TEMPERAMENT. 
 In this constitution, says Professor Dunglison, " the propor- 
 tion of the fluids is conceived to be too great for that of the 
 solids ; the secretory system appearing to be active, while the 
 
LYMPHATIC TEMPERAMENT. 5-3 
 
 absorbent system does not act so energetically as to prevent 
 the cellular tissue from being filled with the humors." 
 
 For many years this view of the subject satisfied us, as it 
 has no doubt everybody else ; but now, we doubt whether the 
 presence of the lymph is not a mere circumstance, which, 
 though incidental, is not essential to the temperament — a mere 
 efiect and not the cause. Though the lymph is present, gene- 
 rally, perhaps, from childhood, yet it is frequently delayed to 
 the twentieth or twenty-fifth year of age and sometimes to the 
 end of a life extended to fourscore years. 
 
 Now, of what constitution are such individuals ? They are 
 ■^neither the sanguine, the bilious, nor the encephalic. To a 
 scientific observer they are just as distinguishable by the head 
 and the features of the face as they are after the appearance 
 of the lymph. In them, the sanguiferous and portal systems 
 are much less developed than in the bilious ; the hair is light, 
 the nose is pugged, the eyes appear, in some measure, heav;)^, 
 and are of a dirty blue color, the lips are tolerably thick and 
 their cleft is straight, the forehead is rather square and per- 
 pendicular, the head, in figure, is quadrangular and not larger 
 than is common to the dense temperaments, and the disposi- 
 tion is irritable and fidgety. 
 
 As an illustration of this nnlymphatic peculiarity of what 
 is denominated the lymphatic temperament, the Reverend 
 Samuel Parr, L, L. D., may be adduced. 
 
 "Independently of his great acquirements and profound 
 erudition. Dr. Parr possessed much of what is called charac- 
 ter ; that is to say, he was a man of originality of mind, and 
 differed much from the common herd in his opinions and ac- 
 tions. Yet his peculiarities hardly amounted in any case to 
 eccentricity ; they were simply little marks, which caused him 
 to be the observed of all observers — the outward and visible 
 signs which indicated that genius which was more amply de- 
 veloped upon near and closer intercourse." 
 
 " Mr. Porson once remarked, that Dr. Parr would have 
 been a great man, but for his trade, his wife, and his politics." 
 The greatest " fault alleged against him was an infirmity o1l 
 temper, though tried by early disappointment and difiiculty, 
 by pecuniary distress, and by domestic dissension. It is said 
 that he married for a housekeeper, and that his wife married 
 
54: ELEMENTARY TEMPERAMENTS. 
 
 for a home. Her dislike to him took every possible form of 
 annoyance. She described herself as having been educated 
 by three maiden aunts, in "rigidity and frigidity, while the 
 doctor had been born in a whirlwind and bred in a 
 storm." 
 
 The truth is, Dr. Parr did not possess a single element of 
 gi-eatness, all that he had was pugnacity and learning — he was 
 only a bundle of little things, which his pugnacity converted 
 into porcupine quills. He was, however, a good illustration 
 of the dry form of this constitution. 
 
 When we have found the lymph present in early youth, it 
 was associated with good health, and we do not know that we 
 ever discovered good health without it. This want of health 
 in youth may so impress the constitution, in many instances, 
 as to prevent its accumulation in after life. This circumstance 
 and the mental irritability, induce us to think it very probable 
 that the presence of the lymph constitutes the normal state of 
 this constitution. 
 
 That it depends upon some peculiarity of the cellular tissue 
 there cannot, perhaps, be much doubt, and to us it seems to 
 consist in part, or altogether, upon an incapacity in its capil- 
 lary vessels to circulate the red portion of the blood. The 
 skin has an opaque and dough-like appearance — one more in- 
 dicative of death, than vitality. Mr. Combe says that the 
 skin of this constitution is "clear." He has certainly con- 
 founded it with the sanguine lymphatic. 
 
 Upon the appearance of the lymph the head becomes globu- 
 lar and much larger, the eyelids, in a great measure, closed, 
 the cheeks full and ponderous, the nose larger, the lips thicker 
 and the hair longer, finer and thinner. As might be supposed, 
 all the motions of the body are slow and clumsy. The large 
 size and globular form of the head will readily distinguish this 
 from the other constitutions. 
 
 Partly in consequence of the lymph, and of the well-balanced 
 condition of the brain, but mainly for the want of that influ- 
 ence which a highly developed sanguiferous and portal system 
 can impart, this constitution manifests but little energy or en- 
 terprise ; nevertheless, in a safe and judicious common-sense, 
 it is not more than equaled by either of the others. 
 
 We saw in Pennsylvania, a female, who was about seven- 
 
LYMPHATIC TEMPERAMENT. 55 
 
 teen years of age, so lymphatic that she could not walk, and 
 yet she was rather handsome and very sprightly. 
 
 Many ladies and a few gentlemen are much troubled about 
 their superabundance of lymph. If they will live on dry 
 food, and drink but little fluid of any kind, they will soon re- 
 duce themselves to very comfortable dimensions. 
 
 Hogs raised on still-slop become exceedingly lymphatic and 
 unfit for a gentleman's table. All lovers of good ham should 
 regret that our old long-legged, long-nosed, sanguine, and 
 bilious breeds of hogs should ever have been replaced by for- 
 eign lymphatic ones, which are fit for little else than lamp oil 
 and soap. 
 
 " Pomponius Atticus, the friend of Cicero, is offered as an 
 example of this temperament, in ancient times, and Charles 
 TV of Spain, who resigned himself almost wholly into the 
 hands of Godoy ; Augustus, king of Saxony, who equally re- 
 signed himself into the hands of ITapoleon, and Ferdinand, of 
 Sicily, who surrendered for the time the government of his 
 people to the British," are given as examples in modern 
 times. 
 
 The above worthies may all have been lymphatic, but as 
 physiologists have agreed, or apparently so, to regard all great 
 men as bilious, so they may have agreed to consider all the 
 passive ones as lymphatic. From the bust we have seen of 
 Socrates, we look upon him as a fine specimen of this consti- 
 tution; and although he never manifested much enterprise, 
 yet the moral and intellectual excellence of his character is 
 sufficient to redeem the whole class. 
 
 The illustrations which are usually given of this constitu- 
 tion, and, indeed, of the others, are caricatures — libels upon 
 human nature. Yan-ta-gin, the Cliinese gentleman of dis- 
 tinction, whose portrait is here presented, gives as perfect an 
 idea of this constitution as can be conceived of. In Colonel 
 "Washington (American Portrait Gallery), the lymph so pre- 
 ponderates over the sanguine and bilious elements of his con- 
 stitution as to render him a pretty good specimen. Between 
 him and Yan-ta-gin there is a strong family resemblance, 
 although they are of different races. In this constitution mer- 
 curials are inadmissible, because of the feeble influence of the 
 portal system ; and quinine only in small portions. 
 
56 
 
 ELEMENTARY TEMPERAMENTS. 
 
 (rev, dr. reinstadt.) 
 
 lY. ENCEPHALIC TEMPERAMENT. 
 
 This temperament was suggested to us, after a close obser- 
 vation of five years, in search of the anatomical foundation 
 of the fourth or melancholic constitution, by seeing a boy, 
 who was about sixteen years of age, in Professor Hall's col- 
 lege in the city of Baltimore. He was as much like Father 
 Eeinstadt (a native of Switzerland, a clergyman, recluse, and 
 scholar, whose portrait Lavater introduced into his work on 
 physiognomy, as an illustration of the melancholic tempera- 
 ment), as a boy can be like a father. He had a large and 
 well-formed head, but his thorax, abdomen, cerebellum, mus- 
 cles, and bones were all particularly small and feeble. 
 
 If the ancients had attributed the melancholic temperament 
 to a great development of the cerebrum, particularly the hemi- 
 spheres, when compared with other parts of the head, and the 
 head with the general system, instead of the biliary capsules 
 and spleen, they would have been correct. 
 
 When we saw this boy, we could discover no reason why a 
 great endowment of the cerebrum was not as much entitled to 
 
EN-CEPHALIC TEMPERAMENT. 57 
 
 make its mark on tlie constitution, as that of any otlier appa- 
 ratus. So far as we have read, and we have read everything 
 on this subject that we have been able to find, we are the first 
 to have conceived of such a temperament. 
 
 In the encephalic constitution of Dr. Thomas, the whole 
 brain is referred to ; his view of it, therefore, includes too 
 much — it embraces parts which have but little or no relation- 
 ship in function — the cerebellum is appropriated to the vital 
 functions, and the cerebrum to the mental ; with a high en- 
 dowment of the former, we always find a corresponding one 
 of the sanguiferous and muscnlar systems ; and with the lat- 
 ter, only mental phenomena. 
 
 The nervous temperament, as hitherto understood, is de- 
 scribed as having a small head and a great irritability of the 
 nervous system. Professor Dunglison says, that the suscepti- 
 bility of this constitution to excitement from external impres- 
 sions, is nnusnally developed; and, like the melancholic, it is 
 " seldom natural or primitive. Mr. Combe says, that " the 
 whole nervous system, including the brain, is predominantly 
 active " in this constitution, " and the mental manifestations 
 are proportionally vivacious." 
 
 In our review of the prevailing opinions npon this subject, 
 we showed that the so called nervous temperament was con- 
 fessedly founded in a pathological condition of the system ; we 
 will now add, that it exists essentially in a degeneracy of the 
 vital forces of the sanguine encephalic, sanguine encephalo- 
 bilious, and sanguine bilious constitutions ; produced by sed- 
 entary habits, vitiated air, or excessive indulgence of the 
 propensities. It is generally associated with a liability to pul- 
 monary diseases. In fine, it obtains in an entailed preternatu- 
 ral activity of the nervous system and an imperfect and fee- 
 ble development of the vital; producing, on the one hand, 
 genius; and, on the other, infirm health and premature death. 
 If these remarks are true, it requires no argument to prove 
 that such a condition of the system is not a physiological one, 
 and, therefore, cannot be compatible with life, health, and lon- 
 gevity. 
 
 The third class in Table, page 20, furnishes illustrations of 
 the sanguine nervous and bilious nervous temperaments, ac- 
 cording to modern physiologists. 
 
g3 ELEMENTARY TEMPERAMENTS. 
 
 Between these views of the nervous temperament, and ours 
 of the encephalic, it will be found that there is no similarity. 
 "We taught our doctrine of the latter as early as the fall of 
 1S32, in the city of Baltimore, and quite extensively through 
 Virginia during 1833 and 183^1:, and, in Cincinnati and ISTew 
 Orleans, in 1835, and more or less ever since, in the south- 
 west. 
 
 V^Q claim to have discovered the anatomical source of that 
 fourth element in human physiology, which the ancients and 
 moderns have both recognized to exist, and which the former 
 denominated the atrabilious or melancholic ; and we have in- 
 troduced the preceding circumstances as authenticating the 
 period when we made the discovery and the notoriety which 
 it has since obtained. 
 
 Professor Caldwell,* excellent authority in medical history, 
 has said, that if we could determine the temperaments by the 
 cranium, the discovery was our own, and, to do this, with the 
 combinations, it is obvious that we must have discovered all 
 the material conditions involved in the primitive ones. I^Tot- 
 withstanding all this, if any one will show that he taught 
 these views, at a period earlier than we did, w^e will cheerfully 
 abandon all claim to them. 
 
 This constitution may be known by its light, long, lank, 
 and fine hair ; dirty blue eyes ; thin and rather small nose, 
 inclining upward at the extremity; thin lips, having the 
 inferior one the more prominent ; pointed cheek bones, be- 
 cause of the great thinness of the facial muscles ; the forehead 
 being large and projecting; the large and somewdiat quadran- 
 gular form of the head ; the relative smallness of the cerebel- 
 lum ; the contracted thorax and abdomen ; the small and 
 stingy character of the muscles ; the motions being slow and 
 dragging ; the skin pale and opaque ; the countenance seri- 
 ous, bordering on gloominess, and by the tardily performed 
 functions, both animal and vegetative. 
 
 The most distinctive and readily-perceived indication of this 
 constitution, is the full and expanding character of the hemi- 
 spheres throughout the whole extent of the parietal ridges and 
 
 * American Phrenological Journal. 
 
ETTCEPHALIC TEMPEKAMEI^T. 59 
 
 the superior portion of the forehead.* The lateral portions 
 of the cerebellum are particularly feeble and the nervous sys- 
 tem is but tardily impressed by external agents. 
 
 One of its remarkable endowments, is the extent and devel- 
 opment of the venous system ; and it must perform as distin- 
 guished a part, as the portal system does in the bilious. 
 
 As there is, in this constitution, but a little action, so there 
 is but little liability to disease. For the same reason, meta- 
 morphoses go on very slowly ; and hence there exists no neces- 
 sity for a rapid or vigorous assimilation. But, notwithstanding 
 its feebleness, such is the adaptation of all its parts that it is 
 compatible with health and old age. 
 
 This constitution is compatible with great learning and pro- 
 found discrimination ; but all the mental functions, though 
 accurate, are tardy and feeble, like the animal and vegetative ; 
 and consequently no great achievement can be expected 
 from it. 
 
 Dr. Thomas has stated, that when the brain is large, and 
 the thorax and abdomen are small, there is great mental 
 power. Where does this power come from, if not from the 
 thorax and abdomen ? "We have never known a vigorous 
 thinker who did not possess a well-developed thorax and ab- 
 domen. Men with small heads and large chests have achieved 
 great results, but those of large heads and small chests have 
 never become distinguished in the active concerns of life, and 
 very rarely in any other. 
 
 This, and the preceding constitution, are very rarely to be 
 seen in their extreme purity ; but their combination w^ith the 
 sanguine and bilious, constitutes at least one half of society. 
 The encephalic element in the constitution of Hon. Edward 
 Livingston, the Hon. Lewis Cass, and Dr. Franklin, is remark- 
 ably conspicuous. Men of the encephalic constitution are 
 few, and these have not become distinguished, hence it is dif- 
 ficult to obtain ample illustrations. We have seen several 
 well marked cases of it, some of which were as good as 
 Father Eeinstadt, whose portrait is here presented as a fine 
 illustration. 
 
 * A small admixture of it, in combination with the other constitutionSj can 
 be thus detected. 
 
(50 ELEMENTARY TEMPERA^IEXTS. 
 
 Dr. J. Mason Good regards Tasso Torquato as a specimen 
 of this constitution, but I think it more than probable that he 
 was bilious encephalic, with the latter element predominating. 
 He had what is common to the encephalic, a precocity of 
 genius. At the early age of seventeen years he was honored 
 with degn'ees in the four branches of canon and civil law, and 
 theology and philosophy. He wrote many poetical works, but 
 finally became too much deranged to be useful. He was spar- 
 ing of words, sedate and grave in manner, and in conversa- 
 tion displayed but little of the fire that animates his works. 
 All this is highly characteristic of this constitution. 
 
 In consequence of the great feebleness of the vital forces, 
 this constitution becomes almost incapable of an efibrt by or 
 before the meridian of life. Very many of our most intel- 
 lectual lawyers and divines, being highly encephalic, begin, 
 by thirty, to feel their feebleness, and then resort to ardent 
 spirits to obtain that force which nature had denied them, but 
 which they might have acquired by early and constant exer- 
 cise; but as they have no desire for action, they live in inac- 
 tivity, not apparently knowing that without a strong body they 
 cannot possess effective minds. 
 
 In the scholastic walks of life, there is a constant tendency 
 to the degeneracy of the vital forces, with a corresponding 
 increase, either positive or relative, of the encephalic element, 
 of all the combinations in which it obtains. Those who pos- 
 sess it should therefore make it a law of their lives to blend 
 with their mental pursuits some variety of muscular employ- 
 ment. This is a good doctrine for all persons, but more es-pe- 
 cially for the encephalic classes, to whom it is especially 
 addressed. 
 
 'We have deeply commiserated many lawyers and divines, 
 who had become learned and manifested intellect and accurate 
 discrimination, but who had no resource for that life-moving 
 eloquence without which the masses of mankind cannot be 
 effectively influenced. They had no co/j>s de reserve for that 
 reinforcement of their minds upon important emergencies. 
 The truth is, we have many farmers and mechanics who could 
 quell a mob by the energy of their voice or, a penetrating 
 glance of their soul-stirring eyes, while many of our erudite 
 and intellectual lawyers and divines would utterlv fail. Is not 
 
ENCEPHALIC TEMPERAMEI^T. ^1 
 
 this humiliating, more especially as they have brought it upon 
 themselves, or promoted it by a neglect of that law of God's 
 kind providence which he intended should make them men 
 and not women ? As an illustration of this important princi- 
 ple, we will introduce a case. 
 
 While traveling through Tennessee, a young lawyer called 
 upon the author for a phrenological opinion of himself. He 
 was bilious encephalic, with a great preponderance of the lat- 
 ter element. We told him that he had a very fine head, but, 
 unfortunately, he could apply it to no useful purpose. This 
 surprised him, and caused him to demand of us an explanation 
 of our meaning. We told him that his vital forces were too 
 feeble to throw his brain into eflfective motion. " Then," said 
 he, "what shall I do to be saved V We answered, " Follow, 
 sawing and chopping wood, walking and running, but, above 
 all, fencing and dancing." 
 
 Ten months after this, we met with him, and such was the 
 enlargement of his neck and thorax, that, at first, we did not 
 recognize him, but when we did, we gave him our hand, remark- 
 ing at the time, " You must have taken our advice ?" " Yes," 
 said he, " I have not omitted it a single day — I have labored, 
 and I have a black fiddler who plays for me, and I make the 
 young negroes dance with me when I cannot do better." He 
 is now, we have learned, on the bench. 
 
 Did this young man do too much to make an effective man 
 of himself? If our talents are not worth improving and our 
 lives preserving, then certainly, they are not worth the having.* 
 
 * If the fact is not tiniversal, it is as least very general, that those Tvho die 
 of phthisis pulmonalis before the forty or forty-fifth year of their age, have 
 not a large head — the cerebrum is not remarkable for its size, even in relation 
 to a comparatively small cerebellum. And we showed, when treating of this vis- 
 cus, that the phthisical constitution consists in a disproportion of development 
 between the medulla oblongata and the cerebellum. In the encephalic consti- 
 tution, the cerebrum is large, but the medulla oblongata and cerebellum are 
 Doth small, and upon this condition depends the venous or anti-phthisical 
 condition of the encephalic constitution. 
 
Q2 BINARY COMBINATIONS OF 
 
 CHAPTER III. 
 
 THE COIEINATIONS OF THE ELEMENTARY TEMPERAMENTS. 
 
 INTRODUCTORY REMARKS. 
 
 In approaching the consideration of the combination of the 
 temperaments, it may be truly said, that we are venturing 
 upon an uncultivated field. JSTo thing definite or descriptive 
 has ever been written on the subject. If we consult authors 
 on the primitive ones, we obtain nothing that can enable us 
 to infer the combinations ; indeed, all that they have given 
 us amounts to about this : the sanguine man is a toy for the 
 ladies — the creature of folly, extravagance, and dissipation ; — 
 the bilious man is the only great one, and he is so, simply be- 
 cause he has a great liver ; — the lymphatic man is a disgust- 
 ing sack of humors ; — and the melancholic man is a poor, 
 gloomy, miserable, liver-diseased wretch, whom it would be 
 a mercy to dispatch. 
 
 If we shall then mix with the profession in the discharge of 
 its active responsibilities, we shall obtain no additional light, 
 and yet, all of them feel the great importance of the subject. 
 The primitive temperaments are but rarely met with, hence it 
 is impossible that one physician in a thousand can have any 
 knowledge of them, and from what has been written, the com- 
 binations cannot be distinguished, hence it must be conceded 
 that an accurate description and illustration of them cannot 
 be an unacceptable service. 
 
 I. BINARY COMBINATIONS. 
 
 I. THE SANGUINE-BILIOUS TEMPERAMENT. 
 
 In this constitution the head is smaller and the brain more 
 dense than in any other variety of the species. A sight of 
 the skull, at once, gives the idea of compactness. The poste- 
 
THE ELEMENTARY TEMPERAMENTS. g3 
 
 rior lobes of the cerebrum are more developed, relatively, than 
 in the sanguine, and the anterior ones are usually more per- 
 pendicular than in either of its elements ; and this, we think, 
 results from a less development of the perceptive powers. The 
 superciliary ridge is, perhaps, invariably less marked — less 
 prominent than in the sanguine or bilious. The forehead is 
 never expanded ; the nose is usually straight on the dorsum ; 
 the lips are moderately thin and of equal prominence; the 
 cerebellum is never so developed as to lead to brutal excesses; 
 the chest is round ; the abdomen is slender but in a line rela- 
 tion to the chest ; the person is very erect ; the muscles are 
 slender, but very compact and strong ; the bones are relatively 
 well developed ; the motions are all prompt ; the skin, where 
 excluded from the light, is very white, quite unlike the san- 
 guine or bilious ; the hair is coarse, thickly set, and black, or 
 between a light and a red ; the eyes are of a deep blue or bluish 
 grey ; the skin of the face and hands, if much exposed, be- 
 comes of a light tan or a red tan color. In cases where the 
 sanguine element preponderates, the hair may only be brown 
 or sandy ; and if the bilious element preponderates, it will be 
 black or red. 
 
 The vegetative functions are usually performed with great 
 energy, and, comparatively, but little liable to derangement. 
 The tenacity with which this constitution clings to life, has no 
 parallel. We saw a negro woman, who was exhibited in Cin- 
 cinnati, several years since, as a curiosity, on account of her 
 extreme age — one hundred and twenty-seven years — and from 
 documentary evidence presented, the statement of her age was 
 probably correct. She was said to have been a nurse of Gen. 
 Washington. She had totally lost her eyesight, but her hear- 
 ing was good. 
 
 ]^o other temperament can endure as much fatigue and ex- 
 posure — it seems to have been intended for muscular action. 
 In consideration of these capacities it is well adapted to a mili- 
 tary life, to which very many of this class are much disposed. 
 
 Men of this class are principally adapted to mathematical, 
 astronomical, chemical, and military sciences. They have 
 not, however, that power of plan and system of movonicnt, 
 requisite for such positions as were filled by Bonaparte, 
 Washington, and Scott. For subordinate positions they are 
 
^4 BINARY COMBIN'ATIONS OF 
 
 perhaps the best. For mental toil, under responsible and 
 vexatious circumstances, thev are not adapted — they become 
 irritable and then rash. A capricious temper, is, so far as we 
 have observed, a universal attendant upon this constitution.* 
 
 Powell, the London pedestrian, was a fine specimen of this 
 constitution. In the English "Boxiana" there are several 
 fine illustrations, and among them is Bill Keat, the English 
 champion. The battle he fought that gave him his title of 
 champion, was with Thomas Hickman, commonly called the 
 Gaslight-man. Hickman rested his hopes upon his science ; 
 Neat, though not without science, placed his hopes upon his 
 muscular strength and activity. 
 
 Men of this constitution are generally so light, that their 
 strength is usually underrated, more especially by those who 
 have large muscles. It was in this way that Hickman was 
 deceived in Neat. When he first saw him, he said, in allu- 
 sion to the contemplated fight, " Oh ! I'll take the sMne out 
 of him in seven minutes." Hickman is not the only one who 
 has been thus deceived. 
 
 Illustrations — Daniel Boone and General Jackson. 
 
 II. THE SANGUINE-LTIVIPHATIC TEMPERAMENT. 
 
 In this class of our race the skin is white and clear, and ap- 
 parently translucent, with a delicate glow of the rose in the 
 cheeks ; the expression of the eyes is generally soft and 
 agreeable ; their color is but little above a sky-blue ; the hair 
 is light, rather thin and soft; the lips rather thick and of 
 equal prominence ; the nose rather short and straight upon 
 the bridge or dorsum ; in this respect a variation in the pro- 
 portion of the elements will make a difierence in favor of 
 the element having the preponderance. 
 
 The outline of the person is full, plump, and soft ; the mo- 
 tions of the body are rather slow and waddling ; the back of 
 the neck is broad, and so is the entire base of the head ; the 
 temples are highly filled ; the corona is round but not expand- 
 ed ; and the whole head is nearly as round as that of the full 
 
 * A knowledge of the therapeutic compatibilities of the primitive tempera- 
 ments will be a guide in the combinations. As we have done but little medi- 
 cal practice since becoming conversant with this subject, our readers have a 
 fine field for discovery in the relation that exists between it and therapeutics. 
 
THE ELEMEN'TARY TEMPERAMEI^TS. ^5 
 
 lymphatic, but not usually so elevated. In the eyes of lean 
 and dark-complexioned men, the females appear to be pecu- 
 liarly beautiful. 
 
 We infer from a bust we have seen of Nero, that he be- 
 longed to this class — his character certainly harmonizes well 
 with its- criminal and degraded extremity. William Wirt, 
 deceased, of Maryland, was of this constitution, with a slight 
 preponderance of the sanguine. The *'Boxiana" does not 
 furnish an illustration. The tendency of this constitution is 
 not to fight, but to kill. 
 
 As an illustration of this temperament, we refer our readers 
 to the portrait of Judge Story, who, as a jurist, stands, we 
 have no doubt, deservedly high- — higher, we conclude from his 
 organization, than he could possibly stand in any other posi- 
 tion. He is constituted to reverence the law, and to possess, 
 more generally than most men, an unbiased judgment. His 
 head is more elevated than we have before seen in this consti- 
 tution ; and though elevated, it does not present the least in- 
 dication of possessing a particle of the encephalic temperament. 
 Compare it with the sanguine encephalo-lymphatic, the only 
 constitution with which it can be confounded, at the parietal 
 level of the head, and the difference becomes marked and 
 obvious. In the decline of life his lymph appears to have 
 been absorbed. 
 
 III. THE SANGUINE-ENCEPHALIC TEMPERAMENT. 
 
 In this temperament, the hair is light and rather fine ; the 
 eyes are of a pale blue ; the lips are of moderate thinness, and 
 the inferior one slightly the more prominent ; the nose is slen- 
 der and straight on the dorsum, when the elements of the con- 
 stitution are well balanced ; the skin is fair, but less clear than 
 in the sanguine lymphatic ; the person is light and slender ; 
 the muscles are thin and flaccid ; the bones are small and 
 have but slight muscular impressions. The lateral portions 
 of the cerebellum are feeble, and therefore the neck is thin and 
 small ; the posterior lobes of the cerebrum are frequently 
 much developed ; the temples are even or depressed ; the fore- 
 head is nearly vertical and superiorly full and expanded ; the 
 superciliary ridge is very slightly developed ; the lateral por- 
 tions of the head are flattened, and the superior, at the parietal 
 5 
 
QQ BINARY C0MBIXATI0X3 OF 
 
 ridge expanded ; and a line drawn from the condyles of 
 the occipital bone to the inferior extremity of the superior in- 
 cisores, will be very nearly parallel with the top of the head. 
 'No function of the system, whether animal, vegetative, or 
 mental, is performed with energy. 
 
 This temperament, like one of its elements, is not adapted 
 to the practical conflicts of life ; nor is it fitted for the devel- 
 opment of science. It is measurably confined to schools, col- 
 leges, and the three professions. The less gifted class of them 
 never take rough and rugged trades — they are jewelers, tai- 
 lors, etc. 
 
 Among the individuals of this class may frequently be seen 
 learned and literary men, and occasionally a painter or a poet. 
 They are usually conservative, because they have not sufficient 
 constitutional force to brook the thought of, and much less to 
 contend with, revolutionary movements. We express this 
 only as a general fact, to which of course there are exceptions. 
 
 Illustrations — W. White, D. D., formerly of Philadelphia, 
 Cowper, Cbanning, and Voltaire may be cited as illustrations, 
 and they constitute a literary constellation. 
 
 In this constitution, mercurials and venesection should never 
 be used ; and quinine and morphine with much prudence — 
 the former having much power to materially injure and even 
 to destroy the sense of hearing 
 
 IV. THE BILIOUS -LTilPHATIC TEMPERAMENT. 
 
 In this class of men the lateral diameter of the head is less, 
 and the occipito-frontal is relatively greater, than in the san- 
 guine lymphatic. Like all the varieties of the lymphatic, 
 there are no sharp angles about the head, face or person. The 
 face approaches an oval ; the superciliary ridge is well defined, 
 but not so prominent nor sharp as in the sanguine or bilious ; 
 the superior sentiments are usually well developed, giving a 
 handsome finish to the top of the head. The forehead usually 
 recedes, but less than the bilious ; the posterior lobes are of 
 medium length and tolerably broad; the cerebellum is well 
 developed, but laterally, not so much so as in the sanguine 
 lymphatic. The person is fall, plump, and round ; the nose 
 is respectable for size, and though usually straight on the dor- 
 sum, it is sometimes aquiline, and sometimes pugged. The 
 
THE ELEME]N"TARY TEMPERAMENTS. Q^ 
 
 lips are tolerably thick, and of equal prominence ; the hair is 
 fine and brown, or it is fine and yellow or sandy, attended with 
 sandy whiskers ; the complexion is brown with a tinge of red, 
 or it is reddish and freckled ; the eyes are brown or bluish 
 gray. The females of the dark variety are generally regarded 
 as beautiful. Such beauties are said to be quite common in 
 Mexico. Many of them occur in our southern states. 
 
 Not many of this class become distinguished, indeed, it may 
 be said, that they constitute an unambitious class — seeming 
 to care but little for notoriety or distinction. IN'o class of men 
 possess a clearer or sounder judgment, or more simple or art- 
 less manners. Yery few of them visit the penitentiary, but 
 too many of them do the beer-shop. 
 
 The English " Boxiana " furnishes one who became distin- 
 tinguished for his pugilistic abilities. From this reference it 
 will be perceived that the constitution is not without muscular 
 power and activity. 
 
 As illustrations of this class, we may cite the following : 
 Eaphael, General Nathan Greene, W. Pinkney, Rev. L. L. 
 Hamline, Aaron Ward, ex-member of congress from New 
 York, Alexander W. Buel, member of congress from Michi- 
 gan, and President Film ore. 
 
 This class bears mercurials and quinine much better than 
 any of the sanguine varieties, nevertheless, when there is 
 lymph, we should be cautious. 
 
 V. THE BILIOUS-ENCEPHALIC TEMPEKAMENT. 
 
 This is, emphatically, the temperament of philosophy. In 
 this class is to be found some of the most distinguished philo- 
 sophers of every age. " By a union with the encephalic, the 
 impatience and irritability of the bilious is removed, and a 
 large development of the front lobes is secured. It is incom- 
 parably more favorable to the development of a highly mascu- 
 line character than the sanguine encephalic. 
 
 In this constitution we find heads which have their occipito- 
 frontal diameter as high as eight and a-half inches. Late- 
 rally, they are flattened ; the anterior and posterior lobes are 
 highly developed in length, but it is not common for them to 
 be highly expanded at the base. The cerebellum is not, late- 
 rally, highly endowed — not so highly as to incapacitate ibr 
 
gg BINARY COMBII^ATIOl^S, ETC. 
 
 sedentary habits, to any required extent, and not so feeble as 
 to deny to the possessor a respectable share of muscular ability. 
 When the encephalic preponderates, as it very frequently 
 does, then the cerebellum is feeble, and so are the animal and 
 veo-etative functions. l!To constitutional class of the species 
 furnishes such extremes, in strength of character. Some are 
 guides to the species, while others have scarcely force enough 
 to maintain existence, and yet intellectual. 
 
 In this class, the whole forehead is fully developed ; and, 
 as in all who partake of the encephalic, the parietal or supe- 
 rior lateral portions of the head are quite prominently so. The 
 intellectual and moral capacities of this class so preponderate 
 over the propensities, that they are but seldom seduced into 
 gross vice or crime. 
 
 Those who shall become familiar with the bilious head, will 
 have only to add to the superior portions of the frontal lobes, 
 and the superior lateral portions of the hemispheres, to dis- 
 tinguish this from any other. 
 
 The hair is fine and brown or sandy ; the skin is dark or 
 bilious, or it is reddish, without much apparent life, or it is 
 such as contra-indicates much cutaneous circulation. The 
 eyes are brown or bluish gray ; the nose is unusually straight 
 on the dorsum, or a little aquiline, or a little of the opposite 
 curve ; the lips are of moderate thickness and usually of equal 
 prominence, but the inferior one commonly turns a little out 
 at its upper edge. There is a difierence between the brown 
 and the red varieties in this respect : the former are inclined 
 to the physical sciences, and the latter to the abstract. 
 
 Mercurials, quinine, and morphine are as compatible with 
 this constitution, as with any other. We have never seen but 
 one man of this constitution in states' prison, and he was in 
 for counterfeiting a bank-note plate — he was an able en- 
 graver. 
 
 The " Boxiana " furnishes one specimen of this constitu- 
 tion — Tom Owen, the conqueror of Bully Hooper. He was 
 true to his constitutional predisposition : he gained his battles 
 by his science. Few boxers, it is said, have fought more bat- 
 tles than Tom Owen. In the character of a second, he was 
 inferior to no one on the list. 
 
 As illustrations of this constitution, we may cite Lord 
 
TERISTARY COMBIN"ATIONS, ETC. gg 
 
 Bacon, Professor Caldwell, the late Chief Justice Marshall, 
 and Professor James Jackson. 
 
 It is in this constitution, and the encephalo-bilious lym- 
 phatic, that the mistake of attributing all the great men of the 
 world to the bilious temperament, originated. If, however, 
 they had been placed in these classes, it would have still been 
 a great error. 
 
 VI. THE ENCEPHALO -LYMPHATIC TEMPERAMENT. 
 
 We have never seen a specimen of this constitution, nor 
 can we conceive it to be possible that such an one could be 
 produced in this country. By inference, we conclude that it 
 may exist. In the study of thousands of prints we have seen 
 but one that we could not place under some other head. As 
 the character and person of this temperament can be inferred 
 from its elements, and as twenty millions of inhabitants do 
 not probably produce an illustration, it cannot be considered 
 to claim further attention than we have given it — a place in 
 our classification. 
 
 As, however, the sanguine encephalo-lymphatic is frequently 
 met with, even in this country, it is highly probable that in 
 Holland the encephalo-lymphatic elements may so predomi- 
 nate, in some instances, as to constitute such a constitution. 
 
 II. TEENARY COMBINATIONS. 
 
 I. THE SANGUINE BILIOUS-LYMPHATIO TEMPERAMENT. 
 
 This combination produces a greater variety than any other. 
 Illustrations of it abound plentifully in every walk of life, in 
 every grade of society, and in every degree of virtue and 
 vice — and always practical. 
 
 The individuals of this class, while living, are very distin- 
 guishable from all others, but the differences between the cra- 
 nia of this and some others are much more easily perceived, 
 by a practiced eye, than described. The skull, however, can- 
 not be mistaken when it is at all balanced, for that of any ono 
 of the lean varieties ; because it is not so angular. It is 
 
YQ TERNARY COMBINATIONS OF 
 
 neither so large nor so round as the lymphatic, nor is it so 
 round as the sanguine lymphatic; the posterior lobes are more, 
 and the middle lobes are less, developed ; the cerebellum is de- 
 veloped downwardly more, and laterally less ; the glabella and 
 superciliary ridges are much more rough, and the general tex- 
 ture of the bone is less close and compact. 
 
 The person is full, and usually has the appearance of con- 
 siderable solidity. The muscular movements are much more 
 active and ready, than we would, a priori^ imagine, and in 
 the abstract, inferior to no other in muscular strength. 
 
 The complexion is about that of the sanguine bilious ; the 
 hair is coarse and brown or reddish ; the eyes are of a bilious 
 blue or bluish gray ; the lips are tolerably thick and of equal 
 prominence, but never, or very rarely, beautifully defined ; the 
 nose is rather short and straight, or it is pugged, and some- 
 times aquiline, depending upon the preponderating element. 
 Apoplexy frequently occurs in this constitution. 
 
 The "Boxiana" furnishes about twenty specimens of this 
 constitution, and Jack Broughton stands at the head of the 
 list. He maintained the championship of England for eigh- 
 teen years. In the prisons of all of our states a list propor- 
 tionally as large as the preceding, can be found. They are a 
 busy set of fellows in mobs and riots. They are very gene- 
 rally courageous, gregarious in their attachments, and generous 
 in their deportment. 
 
 As illustrations of this constitution, we may cite among the 
 distinguished, Baron Larry, Professor Hare, Stephen Girard, 
 Pope Leo X, Major-General Henry Knox, Dr. Spurzheim, and 
 Lawrence Kearnv. 
 
 II. THE SANGUINE ENCEPHALO-BILIOUS TEMPERAMENT. 
 
 This constitution, like the preceding, in consequence of com- 
 prising three elements, produces a great number of shades or 
 varieties. At one extreme, we find a high grade of the en- 
 cephalic, and on the other a close approximation to the san- 
 guine or the bilious, but more frequently to the sanguine 
 bilious. It is far more fibrous and enduring than the sanguine 
 encephalic ; more intellectual, that is, more expanded or vari- 
 ous than the sanguine bilious, but less tough and less tenacious 
 of life. When once seen and designated, in the white race, 
 
THE ELEMENTARY TEMPERAMENTS. 71 
 
 it will very rarely escape detection. It possesses usually, a 
 higher degree of susceptibility than any other constitution. It 
 is really the most nervous, and when pretty equally balanced, 
 it is highly vivacious. 
 
 In this constitution are to be found many of the masters of 
 the line arts — it might, with considerable propriety, be called 
 the artistic temperament. Some of the finest specimens of 
 the race are found in it, and if the information we have re- 
 ceived be correct, it comprises a large proportion of the Cau- 
 casians. 
 
 Although the crania of this variety are readily distinguished 
 by a practiced eye, yet it is difficult to describe it so accu- 
 rately as to designate all the shades of difference. The head, 
 however, is usually about the size of the sanguine encephalic, 
 possibly a little larger, but more compactly formed — not so 
 long but rather broader ; the cerebellum is more developed 
 laterally; the parietal ridge obeys the common form of the en- 
 cephalic, but is more angular ; the forehead is usually quite 
 vertical and square, sometimes, however, it is full and round ; 
 the superciliary ridge is very generally more transverse than 
 with other crania, and the glabella is rather narrow but rough, 
 like the sanguine bilious lymphatic, but not so prominent ; 
 the temples are usually depressed, while the head expands 
 above them. The hair is brown or sandy and of moderate 
 coarseness ; the iris is of a clear darkish blue, or bluish gray ; 
 the skin is like that of the sanguine bilious ; the nose is of 
 moderate length and size, and straight on the dorsum, when 
 well balanced ; the lips are tolerably thin, with the inferior 
 one a little turned outward — ^an almost uniform characteristic 
 of the encephalic and all of its combinations. 
 
 The " Boxiana " furnishes one specimen of this class, who 
 was highly esteemed for his courage, and, as a boxer, had con- 
 siderable reputation. He never, however, obtained the cham- 
 pionship. 
 
 The president elect. General Franklin Pierce, is the only 
 individual of this constitution, who has ever figured in the 
 official stations of an army, so far as we have been able to 
 learn. 
 
 Yery many individuals of this class are the victims of con- 
 sumption. Those in whom the encephalic predominates much, 
 
72 TERNARY COMBINATIONS OF 
 
 seek positions in schools, chnrclies, etc., while those who par 
 take largely of the sanguine bilious are found in the more 
 practical concerns of life. 
 
 As illustrations of this constitution, we may cite John C. 
 Calhoun, Professor Daniel Drake, T. K. Beck, M. D., and G. 
 A. Mantell, L. L. D., F. E. S. 
 
 III. THE SANGUINE ENCEPHALO-LYMPHATIC TEMPEEAMENT. 
 
 This constitution is but seldom met with in this country, 
 that is, it is not seen every day, even in a large city ; but in 
 Holland it is of frequent occurrence. It is far from being an 
 active condition of the system, but it is, perhaps, unequaled 
 for industry and patience ; consequently, men of this class fre- 
 quently accomplish more, in the course of life, than others of 
 a more forcible and active nature. 
 
 There is just enough of the sanguine in it to maintain a 
 moderately vital action ; the encephalic famishes a high order 
 of mental organization, and the lymph saves it from irrita- 
 bility. The head is large and rather quadrangular ; the pos- 
 terior lobes are very broad in densely populated countries ; 
 but in this, where they are cultivated by a necessit}^ for go- 
 ahead or forward movement, in the prosecution of business, 
 they are considerably longer but not so broad;* the anterior 
 lobes are elevated, prominent, and broad ; the sides of the 
 head are flattened ; and the parietal ridge is prominent, but 
 not sharp ; the cerebellum is broad ; the superciliary ridge is 
 but little developed ; the skin is of a pale white, passing into 
 a slight translucency ; the person is full and soft, and though 
 abundant, the muscles appear to be stingy ; the flesh hangs 
 loosely from its attachments ; the iris is of a moderately pale 
 blue ; the nose is moderately thick, rather short, and sti'aight 
 on the dorsum ; the lips are not so thick as in the other forms 
 of the lymphatic. 
 
 Many of the German scholars and philosophers are of this 
 constitution ; but generally they are more distinguished for 
 their learning, than for their discoveries or originality. 
 
 The justly distinguished Dr. B. Franklin is an illustration 
 
 * These remarks apply to all temperaments, but their truth is less obvious 
 in the lean and dense varieties. 
 
THE ELEMEJS'TARY TEMPERAMENTS. Y3 
 
 of this constitution : also the late Dr. Troost, of the university 
 at Nashville, Tennessee, Major-General Lincoln, and the Hon. 
 Lewis Cass. 
 
 IV. THE BILIIOUS ENCEPHALO-LYMPHATIC TEMPERAMENT. 
 
 The head, in this constitution, is more dense than in the 
 preceding, and therefore not so large. The posterior lobes are 
 about as in the previous temperament, except that in the for- 
 mer the parietal projections are large or more prominent, and 
 so is the superior portion of the forehead, but in this consti- 
 tution the forehead is more round, and apparently more com- 
 pactly put up ; the corona and the hemispheres are not so 
 elevated nor so much expanded ; the cerebellum less broad, 
 but more developed downward. The hair is fine, brown, or 
 auburn ; the eyes are brown or bluish gray ; the nose is 
 straight, aquiline, or pugged ; the lips are of tolerable thick- 
 ness, and most generally defined handsomely. 
 
 This temperament is admirably calculated for the develop- 
 of great subjects, but not so ready or instantaneous as many 
 others. The men of this class are more than ordinarily liable 
 to the use of unnatural stimuli, and by this means the useful- 
 ness of many of them is greatly abridged. 
 
 It is not a very difficult matter for those of the sanguine 
 constitution, and its combinations, to quit the use of tobacco, 
 coffee, tea, and even ardent spirits ; but the reverse is the case 
 with those of the bilious and its combinations ; hence those 
 varieties should be careful how they indulge, unless they in- 
 tend to contract a permanent habit. 
 
 As illustrations of this constitution, the Hon. Daniel Web- 
 ster, Peter the Great, and Dr. Gall. 
 
 The portrait of Mr. Webster, as seen in the American Por- 
 trait Gallery, was taken at a period of life too young for a 
 full development of the lymphatic element; and in his old age 
 the lymph appears to have been absorbed.* 
 
 If we have been correctly informed, this combination is of 
 
 * It may be as well for us to remark, tliat as we have to be governed bv the 
 published portraits of distinguished individuals, it follows that if thej be 
 very inaccurate, we may err— and iu this way we may have erred. 
 
74 QUARTERNARY COMBIIS-ATIOXS, ETC. 
 
 frequent occurrence in Persia. The females are very beauti- 
 ful, and the men fine looking and commanding. Of this con- 
 stitution and the preceding, the "Boxiana" gives us no illus- 
 tration ; nor does it of the one that follows. 
 
 III. QUARTERNARY COMBINATIONS. 
 
 I. SANGUINE BILIOUS ENCEPHALO -LYMPHATIC TEMPERAMENT. 
 
 This is possibly the most favorable combination that can 
 happen in the species, with reference to the highest order of 
 achievements. The sanguine gives force — the bilious, motive 
 and durability of impression — the encephalic, mental appara- 
 tus — and the lymphatic equalizes them, or prevents waste by 
 preventing useless motion ; or, in other words, it prevents that 
 irritability of the fibrous tissues which so rapidly hastens that 
 metamorphosis which wears out and exhausts the lean varie- 
 ties. Under this condition, and that species of absence from 
 all animal wants, which the encephalic imparts, it is, that men 
 of this class can excel all others in doing without food, sleep, 
 and repose. 
 
 The head is above the average size, and developed in all of 
 its aspects, and yet preserves, considerably, a quadrangular 
 form, particularly when the intellectual lobes are not promi- 
 nently developed. The hair is brown or sandy and of mode- 
 rate fineness ; the eyes are of a dark blue or bluish gray ; and 
 the face, how shall we describe it ? No part, unless it may be 
 the forehead, appears too large or too small, and yet there is 
 not that blending and losing of one part into another that 
 generally characterizes the human face. Each part looks as 
 though it had been separately made — finished and then fitted 
 to its place. In fine, a sui generis abruptness, a right-angle- 
 ness marks, not only the face, but the whole body. 
 
 The person, though full, is nevertheless quite firm and com- 
 pact, and the complexion, beside having the blue tint common 
 to the other combinations into which the sanguine and the 
 bilious enter, has a shade of brown, or it is fair and rather 
 florid. The former variety darkens greatly under the influ- 
 
CON-CLUDING REMARKS, ETC. 75 
 
 ence of light. As this constitution does not obtain frequently, 
 many distinguished illustrations of it cannot be given, but 
 Kapoleon Bonaparte, Caius, Julius Csesar, and Mr. Whitney, 
 of Pacific and Atlantic railroad notoriety, may be cited. 
 
 CONCLUDING KEMARKS. 
 
 In the application of this subject to national crania, except 
 to some of the nations of Europe — their descendants in Ameri- 
 ca, our negroes, and some of our native tribes, much difiiculty 
 will be met with in consequence of cranial deformities. That 
 an artificial deformity of the head can become permanently 
 congenital, we have the facts to prove beyond the possibility 
 of a doubt. And that considerable deformity can be, and is, 
 produced by slight and even unintentional causes, we have as 
 little doubt. 
 
 The Osage Indians are known to have the occipital portion 
 of the head broad, flat, and generally deformed, so that the 
 occipital foramen approximates very closely to the posterior 
 basis cranii. We believe that the cause of this is to be sought 
 in the fact that they strap a board to the backs of their chil- 
 dren. The occiput is continually in contact with the board — 
 bound to it by a strap passing over the sinciput. We have 
 seen German, Polish, Swiss, and Tyrolese crania flattened, 
 more or less, like the Osage, and we think it probable that 
 each of them is referrable, remotely, to some similar cause. 
 
 A portion of the Choctaw tribe of Indians have a congeni- 
 tal deformity of the cranium — the result of artificial deformity 
 which was produced by their remote maternal ancestors, the 
 Shockshumas. Of this fact, we have a chain of evidence, 
 with illustrations, that cannot be invalidated. 
 
 In cases of cranial deformity, the want of harmony between 
 their several parts, will usually determine whether they have, 
 or not, been deformed, and by restoring these relations, pretty 
 correct conclusions may be arrived at by careful examination. 
 
 It is possible for an individual to become so conversant with 
 our doctrines of the temperaments, as to apply them with 
 great facility and accuracy to the population of one country, 
 
7g CONCLUDING REMARKS ON 
 
 and fail with reference to those of another, unless he shall 
 have given an extensive attention to those of other countries ; 
 because diflerent conditions in human society very materially 
 modify the human head. In old and densely populated coun- 
 tries, it is broader and shorter than it will be found where the 
 population has for centuries, or even for several generations, 
 been subject to a contrary state of social existence. These re- 
 marks are intended to place students on their guard when 
 studying foreign crania. 
 
 The several races, and even different branches of the same, 
 present considerable differences of external configuration, and 
 it is worthy of remark, that those of the latter are equal, at 
 least, to those of the former ; and the constitutional marks, as 
 we have unfolded them, are as clearly indicated upon savage 
 crania as upon the civilized. There is, however, one differ- 
 ence — the triple combinations with the encephalic are never 
 met with, and even the binary is so rare as scarcely to de- 
 serve a notice. 
 
 The encephalic constitution appears to be a result of civiliza- 
 tion — a product of moral and literary culture — the work of 
 many centuries. It is founded in a higher development of the 
 cerebral hemispheres than is necessary to the savage mode of 
 existence. 
 
 With a higher development of the hemispheres is associated 
 diseases to which the savage is a stranger — this we believe to 
 be particularly the case as regards phthisis pulmonalis and its 
 kindred affections. But each constitution has its physiologi- 
 cal, pathological, and therapeutical peculiarities, and the in- 
 habitants of each country differ, in these three respects, from 
 those of others ; and a neglect of these conditions has done 
 very much to retard the advancement of pathology and thera- 
 peutics. Remedies that succeed in certain diseases in one 
 country, in a great measure fail in another, because of the dif- 
 ference of constitution. How should it be expected that the 
 most effective remedies upon the sanguine and sanguine lym- 
 phatic constitutions of the north, in which the skin and kid- 
 neys are the great depurators, should succeed with the bilious 
 and bilious lymphatic constitutions of the south, in which the 
 portal system and the mucous lining of the intestinal canal 
 are the great depurators ? 
 
THE ELEMEIs^TARY TEMPERAMENTS. 77 
 
 We have not time, nor is this the place, to do more than to 
 briefly hint at the importance of a knowledge of the human 
 temperaments ; and if every circumstance favored such a pur- 
 pose, we confess ourself unable to do it justice, nor do we pre- 
 tend to have discovered all the facts that are involved in it, 
 nor to have properly applied all those which we have disco- 
 vered; and yet, the success that has, for many years, attended 
 our demonstrations, would seem to prove that we have suc- 
 ceeded in establishing a foundation that will sustain the dis- 
 coveries, in this connection, of all future ages. It is for others, 
 therefore, to finish the edifice. 
 
 If any one had suggested to us, twenty-two years ago, the 
 possibility that a time would come when physiologists would 
 be able to read, from the naked skull of a Caucasian, the color 
 of his hair, eyes, and skin, and the details of his personal con- 
 dition, we would most certainly have regarded him as ex- 
 ceedingly visionary ; and if he had gone further, and added, 
 that they would also do the same with facility and ease from 
 chirographic marks alone, we would most assuredly have con- 
 cluded that he was insane. 
 
 We are not, therefore, surprised that people now should be 
 as skeptical as we were then. We are not surprised that even 
 Professor Caldwell should have suspected us of being guilty 
 of a mere " pretension," but we were surprised that he carried 
 his incredulity as far as he did, knowing that such a '' preten- 
 sion " was not in contravention of any established law — that 
 we had the same immutable laws of animal organization to 
 guide us, that guided Cuvier — the two subjects being only 
 parts of the same, and about equal in magnitude and difii- 
 culty. 
 
 It is known that difierences exist between all the individuals 
 of society — and will any one affirm that these differences are 
 not impressed upon the solid parts of the system ? Will any 
 one affirm that it is impossible to classify these differences ? 
 The great wonder wdth us, at this time, is that the discovery 
 was not made a century or two since, because the subject has 
 had the attention of physiologists ever since the dawn of the 
 profession. 
 
 As all the facts or conditions involved in the subject exist 
 in abundance, we may certainly conclude that no one is stupid 
 
Y3 COITCLUDIIv^G REMARKS 01^ 
 
 enough to assert that they cannot be arranged, and if they can 
 Rearranged, then our " pretension " is possible, and being 
 possible, it does not involve an impossibility. 
 
 But, says one, " thus far I have some faith in your preten- 
 sion, more especially as Cuvier did as much in another de- 
 partment of the same great subject, but you have gone far 
 beyond him in asserting that you can distinguish the tempera- 
 ments by chirographic marks." Yery true ; and what are 
 marks made with a pen but acts of the individual, in any 
 given case ? And will any one assert that a man with a round 
 head, will use his pen like one who has a long head ? The 
 very idea is preposterous. If differently shaped heads did not 
 dictate differently shaped marks, and if certain parts of the 
 same head did not produce marks that differed from those of 
 other parts of it, we should have never made such a preten- 
 sion. But as the contrary of all this is true — that is, as each 
 organic form makes its own peculiar mark, we are enabled, 
 by seeing the marks a man makes in writing a letter, to 
 arrive at a knowledge of the form of his head, which deter- 
 mines his temperament — ^yes, and his character too. 
 
 Such is the amount of public incredulity npon all new dis- 
 coveries, more especially if they relate to humanity, and still 
 more especially as regards our " pretensions," as Professor 
 Caldwell has been pleased to regard them, that we hope to be 
 excused for attempting to sustain our own declarations, by add- 
 ing the testimony of others. We do not do it, however, with 
 a view of convincing any one — such conviction is useless — but 
 for the purpose of preventing any rash action with reference 
 to them — to induce all to withhold an expression of opinion 
 until they shall investigate the subject ; and, as far as possi- 
 ble, to induce others to examine it. 
 
 If we have, unaided, made such progress, it would seem to 
 be an easy task, with the aid of our instructions, for others to 
 advance beyond us— some of our pupils, in some practical re- 
 spects, are now in advance of us. Out of the many certifi- 
 cates we have, confirming the validity of our " pretensions," 
 we shall present but two ; one from the Hon. Judge Chalmers 
 and Dr. Reed, testifying to the accuracy of our discriminations 
 upon crania ; and another from a number of medical gentle- 
 men, who testify to an equal accuracy upon chirographic marks: 
 
THE ELEME]S"TAIIY TEMPEEAMENTS. 79 
 
 "Holly Springs, Miss., December, 1840. 
 
 " We presented the skull of Loper to Dr. Powell, before his 
 audience, which was large, to test his ability as a phrenolo- 
 gist, but more particularly to test his pretension of distinguish- 
 ing temperament by the denuded skull. We are sure he had 
 no information with regard to Loper — we guarded our own 
 secret. He informed the audience that the skull he held in 
 his hands indicated a sanguine bilious lymphatic man — that 
 his person was full and round, not too lymphatic to be both 
 strong and handsomely shaped — that he had had darkish blue 
 eyes, and dark brown hair. In the above remarks he was pe- 
 culiarly correct ; and so far as is known, he was equally cor- 
 rect in pointing out his character. 
 
 Jos. W. Chalmers, 
 Will. S. Eeed, M. D." 
 
 The following certificate is equally conclusive : 
 
 "Memphis, Tenn., February 24, 1851. 
 
 " We, the undersigned, gave to Professor Powell, at the 
 close of one of his lectures, about thirty letters, from gentle- 
 men who were known to us, but unknown to him. In each 
 instance he gave the complexion of the hair, eyes, and skin, 
 make of person, shape of the head, and the mental character 
 of the writers ; and with a precision that could not have been 
 surpassed by their personal acquaintance. 
 T. B. Burnet, M. D., S. R. Jones, M. D., Phys. Prof., 
 
 Geo. Salmon, M. D., J- King, M. D., Mat. Medica 
 
 D. S. Mills, M. D., Prof., 
 
 J. A. Powell, M. D., E. S. IS^ewton, M.D., Chirurg. 
 
 W. G. Weathersby, M. D., Prof., 
 
 ]Sr. D. West, M. D., J. B. DeWitt, M. D., 
 
 A. L. Gray, M. D., G. J. D. Funchess, M. D., 
 
 J. A. Secord, M. D." 
 
 There remains to be considered two applications of the tem- 
 peram.ents — one of which is, perhaps, only interesting, but 
 the other is of paramount importance to society. We allude 
 to the parental likeness of progeny, and to the degeneracy of 
 the species by a union of incompatible constitutions in mar- 
 riage. 
 
 It has long been known that the intermarriage of near re- 
 lations, in consanguinity, will produce degeneracy in the 
 
30 co:N'CLTn)iNG remarks, etc. 
 
 species ; but so far as we have learned, it has not hitherto 
 been known that the union of incompatible temperaments pro- 
 duces a more fatal degeneracy of the vital forces, than any 
 variety of that which attends those of consanguinity. The 
 results are so strongly marked and so particularly fatal, that 
 we cannot imagine how it should have so long escaped the at- 
 tention of physiologists. A tolerably full consideration of 
 this subject will be found in the next Book. 
 
 As regards parental likeness, we have to observe, that 
 it is an old opinion that the sons who resemble their father 
 or his family, and the daughters who resemble their mothers 
 or her family, are inferior to their parents, respectively. We 
 believe this opinion to be founded in truth — ^in an organic law 
 that governs all animal existence ; except when the parent or 
 family, so resembled, is of the sanguine constitution. "With 
 this exception, the following observations will be found to be 
 generally true. The reason of this exception may be inferred 
 from what we have said npon the sanguine constitution. 
 
 Sons should resemble their mother, and daughters their 
 father, and when they do, the fact is indicated by the full, 
 round, and symmetrical forehead; and when the contrary is 
 unfortunately the case, the front of the forehead is flat, indi- 
 cating a shortened condition of the front lobes of the cere- 
 brum — the face and forehead appear upon the same plane. 
 Bonaparte and Washington are fine illustrations of maternal 
 resemblance. Among the distinguished we know of no illus- 
 tration of paternal resemblance. 
 
 Those of a mixed resemblance, who have inherited the best 
 elements of both parents, are superior to them ; but, on the 
 contrary, those who have inherited the inferior qualities of 
 both, are inferior to both — possibly idiotic. In either event, 
 the middle or relative range of the forehead is more or less 
 depressed. According to this law we can comprehend why it 
 is that we sometimes find the two extremes of mental ability 
 in the same family of children. As illustrations of such a mix- 
 ture, we may cite the Hon. J. C. Calhoun and Chief Justice 
 Marshall. 
 
 This Book now closes, and as it is, in a great degree, the 
 work of one mind, an exemption from error is not claimed for 
 it ; and yet its fundamental tniths are demonstrable. 
 
BOOK II. 
 
 PHYSIOLOGICAL CONSIDERATIONS IN EELATION TO 
 PARENTS AND THE TREATMENT OP CHILDREN. 
 
INTRODUCTION 
 
 When we contemplate the inferior departments of animated 
 nature, we cannot rationally conclude that disease and prema- 
 ture death were ever intended to constitute, necessarily, a part 
 of God's physical providence, with reference to man. Sick- 
 ness and premature death are much more common to man than 
 to his inferior domestic animals ; and more common to them 
 than to the wild and undomesticated. They are also more 
 common to man in his civilized than in his savage state. 
 
 These sentiments being admitted as facts, the conclusion 
 seems to follow, that those conditions which are indispeu sable 
 to health and longevity are more frequently violated by the 
 former than the latter. Civilization creates motives which are 
 very frequently stronger than his un perverted instincts, and 
 his domestic animals are rendered highly artificial by the re- 
 straints he has imposed upon them. But in the wild state, 
 both men and animals live in greater conformity with their 
 inherent appetites and instincts. 
 
 Sickness and premature death may then, in civilized socie- 
 ty, be far more properly attributed to his sins, or infractions of 
 the laws which his Creator impressed upon him, than to him — 
 his agency, or his providence, as they too frequently are. 
 
 Disobedience to the laws of his organic nature, may be said 
 to have commenced with the dawn of his existence, and an 
 enlarged edition of it with that of his civilization, and the in- 
 equilibrium it produced in his organization, rendered it inca- 
 pable of repelling many of the various causes of disease. 
 This inequilibrium has so multiplied, if not increased, that it 
 may be safely asserted, at this time, that not the half of one 
 per centum of children, now born, possess an organization in 
 such equilibrium with the climate and the existius; modes of 
 
 ^(83) 
 
84 INTRODUCTION. 
 
 living, as to be exempt from fi-equent disease and death before 
 the attainment of threescore years. 
 
 In view, then, of this existing state of society, it becomes 
 proper, in a work professedly treating of the Diseases of Chil 
 dren, that we should first treat of those who are, or rathei 
 who should become parents ; because a very large proportion 
 of the diseases, not only of children, but of adults, have their 
 remote causes in them. So true is this, that it would be just 
 as rational to look for pippin apples on crab-trees, as happily 
 constituted children from unhappily constituted parents. 
 
 The vegetable kingdom furnishes, analogically, a satisfac- 
 tory illustration of the truth of this doctrine and the impor- 
 tance of the attention we are about to bestow upon it. It is 
 now well known to horticulturists that so much depends upon 
 the perfection or stamina of vegetable seeds, that while some 
 produce vigorous and healthy plants, others cannot sustain 
 their existence to maturity — some dying very young — having, 
 nevertheless, equal advantages of soil and season. 
 
 In human society, it may be safely assumed that one-fourth 
 of the annual mortality consists of children under one year of 
 age ; that about one-half consists of children under five years 
 of age ; that three-fourths consist of those under forty-five 
 years of age ; six-eighths under sixty ; seven-eighths under 
 eighty, and a few live to be one hundred and upward: and 
 this difierence of longevity, in the main, depends upon a cor- 
 responding one in the original constitution — in that vital force 
 which the original germ received from the parent. 
 
 In our frequent travels on the Mississippi river, we have 
 frequently witnessed, in the young cotton wood forests, a beau- 
 tiful exemplification of this principle in the aggregate of hu- 
 man life. The spring deposits of alluvial mud, throw up a 
 dense forest of young cottonwood plants — during the first sea- 
 son one-half of them die; during the next season one-fourth 
 of the remainder ; and thus the reduction goes on, until but 
 few, perhaps a dozen, are to be seen, where there were mil- 
 lions in the beginning. A wise provision ! — those of unsound 
 seed are not permitted to live to bear seed ; and so it is in hu- 
 man society. This Book is, therefore, devoted to the improve- 
 ment of the seed and the culture of the plants. 
 
CHAPTER I. 
 
 PAEENTAL CONDITIONS CONSIDERED WITH REFERENCE TO CHILDREN. 
 
 INTKODUCTION. 
 
 In the condition of parents, and the manner in which they 
 respectively discharge their functions, exists the health and 
 the happiness, or the disease and the misery, of individuals 
 and society, in a higher degree, than upon any other two cir- 
 cumstances connected with human existence. 
 
 The very idea of sex is pregnant with that of progeny, and 
 in the union of the sexes, or marriage, is founded the provi- 
 sion for the perpetuity of the species ; and for the security 
 of this provision, it was placed under the government of laws, 
 without which the animal world would have exhibited as great 
 a confusion — as complete a chaos, as a mere mechanical ag- 
 gregation. 'No particular type of body or mind could have 
 been secured to progeny — every variety of monstrosity would 
 have prevailed — there could have been no division of the ani- 
 mal world into classes, orders, genera, and species, but an in- 
 conceivable commingling of the whole. 
 
 By these laws, then, when strictly obeyed, parents have 
 secured to them, their own vital stamina, their own virtues 
 and talents, and also their own infirmities, vices, and crimes, 
 or rather, inherent proclivities to them. By these laws, 
 parents may hope to the full extent of their obedience to them, 
 but no further. They must never expect to find in their chil- 
 dren amiable dispositions and sound constitutions, when they 
 themselves have not got them — children cannot inherit that 
 which the parents have not, and they must and will inherit 
 that which they have, be it good or bad. No man of common 
 sense and observation expects to produce on thorn- bushes, fine 
 
 (85) 
 
gg PARENTAL CONDITION-S, ETC. 
 
 apples — each tree may produce its own kind, in both size and 
 quality, and human parents can do nothing better. 
 
 What a motive do these laws present to a reflecting and am- 
 bitious mind ! What must be the depth of the degradation 
 of that parent whose soul would not be frozen with the thought 
 of bringing into existence a progeny to suffer from the frowns 
 and restraints of civil authority, to live in constant and con- 
 scious degradation — to be a practical curse to their race, and 
 multiplying, in every generation, to the end of time, without 
 some fortunate event should occur to turn the tide of such a 
 deepening, widening, and blackening scroll upon the face of 
 time ! 
 
 How ignorant of, or indifferent to, the certainty and immu- 
 tability of these laws must existing society be, if we may judge 
 from the incompatible alliances and the violations of domestic 
 and social duties which are perpetrated every day, and almost 
 in every walk of life ! 
 
 Do we not see men and women hazarding the consequences 
 of an alliance with consumption, scrofula, cancer, intempe- 
 rance, insanity, epilepsy, their own cousins, and incompatible 
 constitutions ? Can they have an abiding faith in the integ- 
 rity of God's ordinances ? We see, furthermore, scolding, 
 brawling, and fighting within the domestic precincts of the 
 bed-curtains — the sanctuary of the procreating genius. Is not 
 such conduct a wicked braving of the ordinances of heaven ? 
 Can they expect that such uncompanionable dispositions will 
 not be entailed upon the fruits of their intercourse — do they 
 never reflect that they are laying a foundation for their own 
 degradation, through the crime of manslaughter in their chil- 
 dren ? 
 
 If we turn our attention to even the most intelligent por- 
 tions of society, we shall find inconsistencies of a more glar- 
 ing and mischievous character, than those we have been 
 exposing. We find both men and women who are socially 
 and perhaps morally unexceptionable — such as are very par- 
 ticular in doing right, and to the best and most useful end, all 
 that they do. Should we not look to such people for good, 
 happy and useful children ? But are we not sometimes greatly 
 disappointed? When they desired progeny to smile upon 
 them in their old age, and to ornament and prosper society, 
 
MARRIAGE ELIGIBILITY. §7 
 
 did they observe the same care that they manifested in their 
 other concerns? Did they pause to consider whether their 
 own bodies and minds were in a proper physiological state to 
 justify so responsible a function ? Was he in good health — 
 was his mind relieved upon every other subject ? Was her 
 mind and body in a similar condition ? If all this were so, 
 look back, in due time, and the result will occasion no regret. 
 But if conditions of a contrary character obtained, shed a 
 tear of pity for the result, and another of contrition for the 
 imprudence. Blame not the author of the laws — he has only 
 promised success for obedience. 
 
 The great end and aim of marriage was progeny, and con- 
 sequently, we do not expect any very signal improvement in 
 society until the organic laws that govern the marriage func- 
 tion shall be better and generally understood, and as generally 
 obeyed. 
 
 SECTION I 
 
 MAKEIAGE ELIGIBILITY. 
 
 Much has been said about the periods for the consummation 
 of marriage by the two sexes respectively ; and yet consider- 
 able contrariety of opinion prevails. The ancient Germans 
 did not allow their young men to marry before they were 
 twenty -four or five years of age ; and in Wirtemberg, at this 
 time, it is illegal for a man to marry before he is twenty-five, 
 or a young woman before she is eighteen. This statute is, in 
 every instance, an outrage upon organic law, but probably not 
 upon that condition of society which has resulted from tlie 
 artificial influences of an imperfect civilization. 
 
 Professor Dewees fixes the time of marriage for the male 
 at a little over twenty-three years of age, and the female at a 
 little over nineteen, in this countr3^ But he teaches, '* that 
 no precise or absolute rules, based upon the lapse of years, 
 can be laid down ; since the body of both male and female 
 may be precociously expanded, or may be unusually and mor- 
 bidly retarded. In the first instance, the period we luive as- 
 signed may be anticipated with safety ; but in the second, it 
 would be wise to extend it. Thus, oftentimes in India, females 
 
gg MARRIAGE ELIGIBILITY. 
 
 become motliers at ten ; while in Lapland they rarely give 
 evidence of womanhood until eighteen; consequently, the 
 women of India would be on the wane, did they wait for the 
 limit at which it would be proper for a Lapland woman to 
 marry : and the Lapland woman could not support the con- 
 tingencies of marriage, did she attempt to regulate it by the 
 usage of India." 
 
 Dr. Dewees is the advocate of early marriages, ccetens 
 parihus, nevertheless, he attributes to them evils, which we 
 think should be referred to other and very different causes ; 
 such as " diminished vigor and shortened life of the male ; 
 faded beauty, blasted health, and premature old age of the 
 female ;" with an entail upon the progeny of " diminutive 
 stature, debility of body, imbecility of mind, and a predispo- 
 sition to consumption, rickets, scrofula," etc. 
 
 " It has fi;equently excited the surprise," he observes, " as 
 well as provoked the reproach of foreigners, that the females 
 of this country lose their beauty so early, especially when 
 compared with the females of Europe, and particularly those 
 of Great Britain. The cause of this hasty decay must be 
 principally sought for in our very early or premature mar- 
 riages ; but we confess that climate has also a certain, though 
 more limited, agency." 
 
 Upon this subject, it really appears, that there has been a 
 very general want of accurate observation and philosophical 
 discrimination ; — to attribute an early loss of either beauty or 
 health to early marriages, is, in our opinion, equivalent to 
 charging our Creator with unwise provisions — to refen-ing our 
 misfortunes to him — to his " mysterious providence," instead 
 of our disregard and disobedience of his institutions. 
 
 It has now become a well ascertained fact, that our capaci- 
 ties are not simultaneously, but successively developed ; the 
 first faculties manifested by children are those which preside 
 over physical development, and those that take cognizance of 
 surrounding objects ; then come those animal ones which pre- 
 side over our relations, both affectively and intellectually; 
 then our moral and reflecting ; then those which are usually 
 denominated the religious ; and lastly, the sexual, or those 
 which preside over the perpetuation of the species. 
 
 It would now be exceedingly unreasonable to conclude that 
 
MARRIAGE ELIGIBILITY. 89 
 
 it was the intention of our Creator that either of these classes 
 of powers should be developed, before their functions should 
 be manifested. In such a design there would be no utility, 
 hence no wisdom. We allude to what appears to be the law 
 of the race, and not to exceptions, or instances of precocity, 
 and therefore of morbid or abnormal development. 
 
 With the undomesticated animals we find uniformity and 
 harmony in the manifestation of their functions — as soon as 
 the sexual capacities of the females are developed we find 
 them to be successfully manifested, and that too without any 
 stinting of the species. 
 
 The same is true of all people whose mode of existence is 
 primitive. Even twenty years since it was particularly the 
 case with our Creek Indians, and yet the men were not dimin- 
 ished in either size or vigor, nor were the females faded in 
 beauty, blighted in health, or visited with premature old age ; 
 nor did they entail upon their progeny a predisposition to con- 
 sumption, rickets, or scrofula. What is true, therefore, of 
 one people may be true of all others, under similar circum- 
 stances. 
 
 Dr. Dewees regards marriage with females, at a little over 
 nineteen, as being early — it is the period at about which the 
 female body receives its final " expansion." Now, inasmuch 
 as her sexual capacities are developed from three to five years 
 earlier than this, we should, with as much justice and proprie- 
 ty, assert that the manifestations of her intellectual, moral, 
 and religious capacities should neither be trusted nor tolerated 
 until about the same period of life, or until the body receives 
 its final " expansion." 
 
 Philosophically considered, there is just as much propriety 
 in the one position as the other, because it is not to be sup- 
 posed that the Creator would implant in her mind a desire, 
 and in her system a capacity to conceive, without the ability 
 to execute, in good faith, the function. We cannot, therefore, 
 attribute the early decay of beauty in the American women, 
 as compared with the English, to premature marriages — we 
 deny that they do, in the abstract, take place prematurely, so 
 far as age and the development of the sexual systom are con- 
 cerned. Nor are we disposed to attribute our troubles upon. 
 
90 MARRIAGE ELIGIBILITY. 
 
 this subject to any peculiarity of our climate, but to our arti- 
 ficial modes of existence. 
 
 Our own observations have confirmed the truth of those 
 expressed by foreigners ; and to show that the evil is not attri- 
 butable to premature marriages, we have but to compare our 
 single women, over the age of twenty -five, with those of Eng- 
 land. These appear vigorous, youthful, and healthy, while 
 those are as generally lean, pale, wrinkled, and prematurely 
 old in appearance. In American society, single women, at ' 
 the age of twenty, or thirty, are, in point of beauty and 
 healthy appearance, inferior to the married women or mothers 
 of the same age. 
 
 We must, then, attribute the premature decay of our wo- 
 men, so far as the fact may exist, to some other cause than 
 premature marriage. 
 
 English women, as well as men, can, and always do, find 
 time to eat, to laugh, to rise early, to be cheerful, and to take 
 exercise in the open air, while the American women, we al- 
 lude to the young ones, have no time for early rising, no ap- 
 petite when they have risen, no time to be cheerful, except in 
 spasms, or upon exciting occasions, and no time to take exer- 
 cise in the open air. English women delight in walking four, 
 five, or six miles at a time ; but American women fancy that 
 such walks would kill them. English women aim at red 
 cheeks and well-turned limbs ; American women aim at shriv- 
 eled limbs and blanched faces. The consequences are that 
 the English women, whether married or single, maintain a 
 healthy appearance, while those of America, in either condi- 
 tion, soon arrive at premature old age. Marriage, with such 
 American women is premature, no matter at what age it takes 
 ]3lace. 
 
 These remarks, of course, apply mostly to our city society, 
 but not entirely. If our readers will compare the neck and 
 thorax of our English women with those of American women, 
 especially as we find them, very generally in om' cities, and 
 then appeal to our expositions of the cerebellar functions for 
 an explanation of the difierence, then they will discover that 
 early marriages have not done the mischief complained of. 
 
 "We have never known an American woman to marry too 
 
MARRIAGE ELIGIBILITY. 91 
 
 young, but we know very many who should not have married 
 at all. As there is but little, if any, tendency in females to 
 maiTy before the development of the sexual system has caused 
 them to desire to do so, there is as little danger of their mar- 
 rying too young. The question then, should be one of health, 
 of constitutional stamina — and not one of age. The natural 
 laws command early marriage, with sound and healthy indi- 
 viduals, and no marriage at all with those of a contrary char- 
 acter ; and such is our faith in the wisdom of these laws that 
 we urge obedience to them. 
 
 "VVe have not made observations upon society in Europe, nor 
 in the eastern portion of the United States, but we have in the 
 western, and hesitate not to affirm that the first children of 
 early marriages are as sound and as intellectual as those of 
 riper years. The difi'erence which we have observed appears 
 to be in their favor — they are more impulsive, sprightly, and 
 enterprising, and to us the reason is obvious : they were con- 
 ceived or produced under the prevalence of the greatest ac- 
 tivity of the physical and mental faculties — when the parents 
 felt themselves to be bound together by no other bond than 
 that of love, and at the period, too, of their greatest and most 
 expanding hopes. 
 
 As physiologists we should not look to old and densely 
 populated countries for normal manifestations of human na- 
 ture. There, poverty and position, on the one hand, do not 
 engender the inspiring influence of hope — the mill-boy there, 
 only makes a mill-man, and not the owner of land or the gov- 
 ernor of a country ; and on the other, among the affluent, 
 marriage is too much a matter of commerce, to produce, gene- 
 rally, enterprising genius. But in this country, hitherto, 
 society has been as free as the undomesticated animals of the 
 forest, and hence all the human functions have been mani- 
 fested in the order and at the time intended — no complaints 
 have been heard about the misfortunes of early marriages. 
 
 This appearance of premature decay that has been spoken 
 of, as being peculiar to this country, is not confined to the 
 females — the males are also marked with it to a very conside- 
 rable extent. For this fact, as it applies to both sexes, there 
 is another cause far more fruitful in mischief than early mar- 
 riages have been. 
 
92 PARENTAL CONSTITUTION". 
 
 In England, Ireland, and we believe in Scotland also, it is, 
 in good families, the practice to set a separate table for the 
 children, which is provided with such food as is thought to 
 be the best for them — such as is simple and of easy digestion. 
 In this way they are removed from the temptations of the 
 adult table, which is adapted to adult constitutions. This 
 practice, modified more or less by the circumstances of fami- 
 lies, is no doubt practiced by all classes of society. 
 
 How stands the case in this country ? As soon as they can 
 sit, and even before, they are taken to, and fed from, the adult 
 table, and fed with such food as it may contain — with the re- 
 mark, ''if the poor child cannot have substantial food it will 
 not become strong." In this practice, through gastric derange- 
 ments, we can certainly discover the premature loss of teeth, 
 and with them departs the rose of health and the bloom of 
 beauty. 
 
 SECTION II. 
 
 PARENTAL CONSTITUTION. 
 
 It is a very prevalent opinion among the unprofessional 
 that those persons who are the most fresh and rotund in ap- 
 pearance possess the best constitution. As these appearances 
 very frequently depend upon plethora, we have the reason why 
 so large a proportion of fine, healthy -looking persons die during 
 the prevalence of severe epidemics. Women with such con- 
 stitutions, though well and healthy looking, have usually but 
 few children, and they are of an inferior quality. 
 
 On the other hand, very many feeble and infirm women 
 have many fresh and rosy-looking children, but their appear- 
 ance is deceptive — their condition is one of obesity — a consti- 
 tutional weakness of the vital forces, which has been entailed 
 upon them. 
 
 The rich, or those who live high, are too plethoric to be 
 fruitful, and hence such people have usually few children. 
 The poorer classes, or those who have enough, such as it is, 
 consisting mostly of vegetables, are much more prolific, and 
 the children have the best promise of health and longevity. 
 But the most prolific women, for the time being, are those who 
 
PARENTAL CONSTITUTION 93 
 
 are laboring under some slow, chronic, but certainly fatal, dis- 
 ease, as consumption. This appears to be a law of the vegeta- 
 ble and animal kingdoms, that in proportion to the danger of 
 the species becoming extinct, so far as the individuals are con- 
 cerned, is the increase of fecundity. Fruit trees, so battered 
 and bruised that they must die in a year or two, are certain 
 to have a full crop of fruit the year before they die. 
 
 Women thus circumstanced should not marry, and if, after 
 marriage, they should become so, they should cease to become 
 mothers. 
 
 The amount of disease and premature death that is entailed 
 upon society by the marriage of unhealthy persons, is such as 
 to demand, on the part of society, the enactment of some pro- 
 tective ordinance. If the consequences were confined to the 
 parties themselves, or even to their children, the evil would 
 be comparatively small ; but the multiplication of it is so 
 rapid, that, in a few generations, a very large extent of country 
 becomes similarly afflicted. Because a man or woman has 
 acquired a predisposition to consumption or some other form 
 of disease, it does not follow that the privilege should exist to 
 entail it upon others. 
 
 There is scarcely an individual in society who has not wit- 
 nessed the deplorable consequences of the marriage of those 
 who have had entailed upon them a predisposition to con- 
 sumption, to insanity, to apoplexy, etc.; then what should we 
 think of those who, knowing themselves, by what they know 
 of their ancestors, to exist with such predispositions, place 
 themselves in such a situation as to visit the mischief upon 
 unborn hundreds, perhaps, thousands ? We must conclude 
 that they have never seriously thought upon the subject, or 
 else, that they are superlatively selfish or inexcusably dis- 
 honest. 
 
 There has become, broad-cast, in our country, a predispo- 
 sition more mischievous than consumption, insanity, or any 
 other form of disease that now occurs to us, though not so 
 certainly and speedily fatal — it is intemperance in the use of 
 ardent spirits. A drunkard is almost sure to be the grand- 
 father of drunkards, through the female part of his children, 
 and it is probable, that he may also be the father of them. 
 
 A practical phrenologist rarely fails to detect this predispo- 
 
94 PARENTAL COIs'STITUTION'. 
 
 sition. Indeed, it may be truly said, that all predispositions 
 to disease, as well as to crime or moral depravity, are adver- 
 tised upon the outside of the head. 
 
 All predispositions may be removed by appropriate physi- 
 cal and mental education, and by judicious marriage alliances ; 
 but who is to direct these ? All that we can do is to announce 
 their existence, and to admonish all young people against form- 
 ing an alliance with them. 
 
 There is yet another predisposition, which has hitherto, so 
 far as we know, entirely escaped the notice of physiologists, 
 and yet it is one which every person should avoid, in a mar- 
 riage alliance, and every one would avoid it, who entertains 
 ambitious hopes of his children, if they knew it. We allude 
 to those women who very closely resemble their mothers, and 
 in consequence of this entail upon them, they will entail their 
 own likeness and constitution upon their daughters, and those 
 of their husbands upon their sons. Such children never equal 
 their parents, respectively — the fact indicates that the work 
 of degeneracy is in progress, and if continued will result in 
 physical infirmity and mental imbecility. To this law there 
 is possibly an exception in the sanguine temperament. 
 
 The Arabians seem to have understood this long since — they 
 maintain that the blood in any species of animals is transmit- 
 ted through the female ; hence they will cheerfully sell their 
 stallions to foreigners, but not their mares. 
 
 As a very general law with all classes and species of ani- 
 mals, man included, males inherit through the mother, and 
 females through the father. Daughters, though inheriting the 
 mental peculiarities of a father may never manifest them, be- 
 cause of their more restrained position in society, but her sons 
 will. The character of the sons may be inferred from that 
 of the maternal grandfather. 
 
 These rules are always applicable, except when the ele- 
 ments of both parents are blended in the children, which is 
 frequently the case. 
 
IMPROPER MARRIAGES. 95 
 
 SECTION III. 
 
 IMPROPER MARRIAGES. 
 
 It is universally admitted, but not always avoided, that con- 
 sanguineous marriages are gross violations of the laws of pro- 
 creation. Physical deformity or mental inferiority is certain 
 to appear in some of the descendants of such alliances. The 
 unfortunate consequences of such marriages upon society are 
 so notorious, and have been for centuries, that it is a matter 
 of surprise that penal statutes have not been enacted against 
 them, by all civilized countries. Conventional statutes are 
 enacted to enforce obedience to very many of the organic laws 
 which are very far inferior to this, in their importance, or in 
 the consequences of their violation. Organic law has as posi- 
 tively prohibited marriage alliances between blood relations, 
 as it has murder, theft, and falsehood ; and the individual 
 who contracts such an alliance, knowingly, is just as guilty 
 of crime — of an outrage upon society — of disobedience to his 
 Creator, as if he had stolen his neighbor's horse. 
 
 As an illustration of the magnitude of this increasing evil, 
 in some of the old states, we extract the following history of 
 one family from the Fredericksburg "Kews:" 
 
 " In the county," says the editor, " in which we were raised, 
 for twenty generations back, a certain family of wealth and 
 respectability have intermarried, until there cannot be found 
 in three of them a sound man or woman. One has sore eyes, 
 another scrofula, a third is idiotic, a fourth blind, a fifth 
 bandy-legged, a sixth with a head about the size of a tin-cup, 
 with not one out of the number exempt from some physical or 
 mental defects of some kind. Yet this family perseveres to 
 intermarry with each other, with those living monuments of 
 their folly constantly before them." 
 
 Who can say that, ultimately, this family connection will 
 not become a heavy expense to the state ? When they shall 
 so degenerate that they cannot take care of their property, 
 then the state will have to provide for them. It is even now 
 a question whether one-half of the adult males are fit for mili- 
 tary duty J and when a people become too degonorate to 
 defend themselves, what are they but Ilindoos — unfit for 
 
0g IMPEOPER MARRIAGES. 
 
 anything but the most stupid and degrading idolatry. In the 
 very face of this enervating and dehumanizing practice, legis- 
 lators look on, with their arms folded, and say, " well^ — this is 
 none of our business — our country is free, and they have a 
 right to marry whom they please." This false notion of lib- 
 erty, unfortunately, exists in every part of our country ; when 
 in truth, no one ever had a right to do wrong. 
 
 There is another alliance that frequently happens, which, 
 if possible, is more objectionable than the consanguineous, so 
 far as regards the immediate progeny, but not so far as con- 
 cerns society at large ; and for the reason that they do not live 
 to propagate. We allude to the union of individuals of the 
 same temperament or constitution. We are now acquainted 
 with intellectual, energetic, and healthy parents whose chil- 
 dren are all dead, or else possess so little stamina that they 
 will not reach maturity. This law obtains with all the tem- 
 peraments, except the sanguine, but more particularly with the 
 triple and quadruple combinations. So marked are the con- 
 sequences of these marriages, that it may be regarded as a 
 matter of much surprise that it should, up to this time, have 
 entirely escaped the notice of physiologists. 
 
 Such parents, having fine health, deem the cause of the 
 early loss of their children, as entirely inscrutable. They 
 never imagine that they have violated an ordinance of their 
 Maker, and that in the loss of their children they are sufief- 
 ing the consequent penalties. 
 
 In consideration of the existence of this law, let all persons 
 be admonished to avoid a marriage alliance with those who 
 have their own complexion and habit of person. 
 
 This topic is too important and too little understood to be 
 passed over with a mere mention of it; and therefore we will 
 illustrate it by the introduction of two cases out of the many 
 we have. 
 
 In Mississippi, we boarded two or three weeks with a very 
 excellent man of the sanguine bilious lymphatic constitution. 
 He was large, and had a large and finely-proportioned head — 
 in fact, he was an excellent specimen of this constitution. 
 His wife was large, and as fine a specimen of the same con- 
 stitution as he was. The cerebellar and coronal portions of 
 both their heads were fully developed. 
 
IMPROPER MARRIAGES. 97 
 
 At this time we had not discovered this law, and from the 
 healthy and fine appearance of the parents, we expected to see 
 fine children. IS'ow,'^ imagine, if possible, our disappointment! 
 They had six children, and a description of one will answer 
 for all of them. The head was large but the cerebellum was 
 exceedingly small, and, consequently, so were the neck and 
 chest, and, indeed, every other part of the body. The parents 
 had beautifully rounded and elevated coronse to their heads, 
 and therefore capable of all the more elevated feelings of our 
 nature ; but the head of each child was very nearly as flat as 
 the table on which we write. They were all highly encepha- 
 lic, with the exception of the superior portions of the hemi- 
 spheres, which were too flat and defective, to constitute nor- 
 mal specimens of it. The complexion of all of them indicated 
 great feebleness of the respiratory and circulatory functions. 
 It is not our opinion that either of them could have lived to 
 the age of ten years ; but we do not know what has been their 
 fate. 
 
 Upon a recurrence to the facts in this case, we shall find 
 that the mischief was two fold. First — Both parents had the 
 vital forces large — the children had them too feeble to sustain 
 them to maturity. Second — Both parents had large religious 
 and moral organs— all the children were as defective in these 
 as in the vital forces. The children, then, of this marriage 
 sufiered, immediately, both vitally and mentally. 
 
 ]N"ow, we think it very probable that our readers are as 
 much puzzled as we were, to comprehend the intention of the 
 law that governed in this case ; but do not doubt the wisdom 
 of it — all of God's laws — the natural laws, are pregnant with 
 wisdom and the good of the human race. We were six or 
 seven years laboring to discover its intention, but in the mean- 
 time we discovered many similar cases — enough to convince 
 us that the law of procreation governs in the premises. 
 
 We will disclose it. Suppose the children had inherited 
 from their parents the combined strength of their vital forces, 
 would not the consequences have been monstrous ? Suppose, 
 again, that they had inherited the combined strength of the 
 moral and religious faculties of the parents, and they should, 
 in turn, obtain wives like themselves, and that their children 
 again should do the same, does it not become obvious that 
 
93 IMPROPER MARRIAGES. 
 
 the most lamentable monstrosity of mind would be the 
 result ? 
 
 Now, what is the law which was violated by this gentleman 
 and his wife ? It was this : — The husband and the wife must 
 be the compliment of each other. They were not, but were 
 like each other. K the moral and religious faculties had been 
 the compliment of each other, then the children would only 
 have sufiered in their vital systems — reverse the case, and 
 then they would only have suffered in having veiy feeble emo- 
 tions of morality and religion. "When, therefore, this law is 
 violated, the extent of the consequence will depend upon the 
 character of the violation. If it be in relation to the vital 
 forces, then the law cuts off from life, the acquisition of the 
 outrage, which is the child. 
 
 Can any one reflect upon this law without being forcibly 
 penetrated with the wisdom and philanthropy of it ? In the 
 criminal walks of life, the mischief-doing propensities are 
 strong ; now, suppose that this law did not exist, how fre- 
 quently would children inherit the combined strength of them 
 in both parents ? And suppose they did ; what would be the 
 extent of the theft, burglary, robbery, piracy, murder, and 
 arson, inflicted upon society ? 
 
 One morning, a large, fine-looking, sanguine bilious lym- 
 phatic gentleman, who had heard us the night before upon 
 this subject, called upon us, and commenced thus: ''My wife, 
 sir, was in many respects like myself; her hair, eyes, skin, 
 and general make of person were like mine ; her head differed 
 from mine about the front, it was not so wide, particularly 
 about the top, but her neck and the back part of her head 
 were like mine; now, what would be the character of our 
 children ?" 
 
 We answered : ''In the first place, it is possible that you 
 had none; but if you had, it is very probable that you did not 
 preserve one to maturity." He replied : "We had six, and all 
 died before they reached their tenth year ; and I never had 
 any idea of the cause until I heard your lecture last night, for 
 both of us were healthy, and we lived on a healthy place, and 
 our young negroes ha^e aU done well, which seems to show 
 that there was no cause for such a fatality, except the one you 
 have given. Finally, the mother of these children died, and 
 
IMPROPER MARRIAGES. 99 
 
 I married a lean, dark-skinned woman, and we have now 
 three promising children." 
 
 The marriage of old men with young women is not an un- 
 common occurrence — too common, indeed, for the happiness 
 of the parties or the political good of society. Although more 
 males than females are born, yet, in consequence of the greater 
 exposure of the former, the latter prevail in all old communi- 
 ties, which is comparatively a social or political evil ; and as it 
 is usually increased by such marriages, they are objectionable. 
 "When such marriages produce sons, they are usually of an 
 inferior quality. 
 
 It is contended by some that it is better, on all accounts, for 
 a young woman to marry a sound, and, in other respects, un- 
 objectionable old man, than an unsound and debauched young 
 one. We admit this, but contend that it would be better for 
 her and for society, as a general rule, to avoid both. 
 
 Professor Caldwell says, and Mr. Combe has indorsed it, 
 that " old men should in no case contract marriages likely to 
 prove fruitful. Age has impaired their constitutional quali- 
 ties, which descending to their offspring, the practice tends to 
 deteriorate our race. It is rare for descendants of men far 
 advanced in years to be distinguished for high qualities of 
 either body or mind." 
 
 . In this quotation there are two errors — one of principle and 
 one of fact ; and we are surprised that either of these distin- 
 guished gentlemen should have committed them. Our Crea- 
 tor, in fixing the constitution of the female, so arranged it 
 that she should not have children when she became too old 
 to entail upon them vigor both of body and mind ; and no 
 reasonable man can doubt that he would have similarly con- 
 stituted the male, if, in his arrangements, there had existed 
 the same necessity for it. To allow to man the power of 
 performing a function, in connection with a strong desire to 
 do it, and yet deny to him the privilege of doing it, would be 
 just cause for the impeachment of his wisdom. 
 
 Young women have as fine and as vigorous daugliters by 
 old men, as they could have had by any other class of men. 
 By such husbands they were never intended to have sons, and 
 when they do, it is in consequence of some fault in their own 
 constitution. The sons of such marriages should have been 
 
100 IMPEOPER MARRIAGES. 
 
 daughters, and in being daughters, they should not have been 
 at all. It is true, that old men but rarely, or never, have dis- 
 tinguished sons, but they have what is more valuable, daugh- 
 ters who may become distinguished through their sons. 
 
 There is yet another and frequent alliance, particularly in 
 our cities, which is still more incompatible than either of the 
 preceding, because it is very generally attended with the pre- 
 mature death of one of the parties, with the nonproduction of 
 issue, or, if produced, they possess a feeble constitution and 
 but rarely fail to meet an early grave. We allude to an ex- 
 treme difference in the strength of the sexual desires of the 
 parties. The man or woman who possesses an extraordinary 
 strength in this respect, is a monster — as much so as the other 
 extreme. Both extremes are fruitless. Judicious and well- 
 informed parents would sooner yield their daughter, who has 
 a delicate person with an extremely small neck, to an execu- 
 tioner, than in marriage to a man who is firm in muscle, and 
 withal has a neck enormously developed in a backward direc- 
 tion. She will not only prove barren, but by worse than any 
 known brutality, be forced into a premature grave. A^ady in 
 Maryland, some years since, obtained a divorce from her hus- 
 band, on this ground, and never was there a divorce more 
 justly granted. 
 
 There are many incompatibilities of less magnitude, which 
 however, produce much mischief in society. One of them is 
 an incompatibility of temper or disposition. If the injury did 
 not extend beyond the parties themselves, and cast its shadow 
 far in the future, we might excuse legislators and judicial tri- 
 bunals for refusing to grant divorces upon such a plea. But 
 when we contemplate the fact that unhappy parents can pro- 
 duce neither healthy nor happily constituted children, the ap- 
 parently small and insignificant incompatibility becomes one 
 of enormous dimensions. Leaving out of the account petu- 
 lance and capriciousness of temper, if we could furnish the 
 statistics of manslaughter and suicide which have resulted 
 from this incompatibility of temper between parents, it would 
 be contemplated by the popular mind with wonder and aston- 
 ishment. 
 
 Powerful illustrations of the truth of these remarks are fre- 
 quently to be met with in the cotton and sugar planting 
 
JfEESE:N'T HEALTH AND QUALIFICATIONS. IQl 
 
 districts of our country. The negro children on those planta- 
 tions which are governed by kind and discreet overseers, are 
 playful, healthy, buoyant, and cheerful ; while those whose 
 parents are under the government of heartless task-masters, 
 appear to be sour and carew^orn — taciturn and unhappy ^ — so 
 destitute of both physical and mental energy, as to become 
 the legitimate food of the first epidemic that visits that 
 quarter. 
 
 Could any better fruit than this be expected of a mother 
 who receives a cowhiding in the morning, sees her children 
 whipped through the day, and her husband at night? Pa- 
 rents, then, who cannot live in peace and happiness with each 
 other, should, for the good of society, separate ; and as the 
 well-being of society is paramount to every other consideration, 
 no obstacles should be interposed to prevent those from sepa- 
 rating who do not desire to live together. Our divorce laws 
 are doomed to undergo a total change when the constitution 
 of the human mind and the influence which parental discord 
 has upon the health, happiness, and usefulness of progeny 
 shall become to be properly understood. 
 
 SECTION lY 
 
 PRESENT HEALTH AND QUALIFICATIONS. 
 
 By present health, the condition of the parents at the time 
 of marriage, is to be understood. It might, a priori^ be rea- 
 sonably concluded that no one would venture or presume to 
 contract a marriage alliance under any variety of permanent 
 or greatly incurable disease ; such as either gout, cancer, apo- 
 plexy, scrofula, consumption, occasional insanity, or secondary 
 syphilis; but such is the state of human depravity, that 
 through selfishness, recklessness, or thoughtlessness, the ut- 
 most care is sometimes practiced to conceal the presence of 
 existing disease. 
 
 We have not yet presented the most depraved view of the 
 picture. Marriage is frequently contracted when the exist- 
 ence of such disease, in one of the parties, is known to the 
 other. This may sometimes happen through an ignorance of 
 
102 PRESENT HEALTH AND QUALIFICATIONS. 
 
 the laws of hereditary descent, but it most generally does 
 happen through a highly culpable and equally degrading sacri- 
 fice of the prospective health and happiness of progeny at the 
 shrine of fortune and influence. 
 
 We had, a few days since, from a very intelligent lady, the 
 history of a case that is worth relating, and one that came 
 under her own knowledge. 
 
 An Irish lady was addressed by an officer of the British 
 army — she declined his suit on the ground that she possessed 
 a scrofulous constitution. He assured her that this should be 
 with him no objection ; but she persisted in refusing to become 
 the wife of any one, for the reason before assigned. At length 
 he informed her that his condition was that of hers, and con- 
 vinced her that such was the fact, by showing her the unmistak- 
 able evidence that he had, at an antecedent period, been inti- 
 mately acquainted with the " King's evil." At length she 
 consented to have him — they were married — had many chil- 
 dren, and all of them died at an early period, after much 
 scrofulous suffering. 
 
 As hereditary diseases are held in more abhorrence in Eu- 
 rope than they are here, the consequences of such an alliance 
 were well known to them. Knowing the complying character 
 of woman, when she loves, we can excuse her, but what must 
 we think of him ? — a man, too, capable of defending his coun- 
 try in an official capacity. 
 
 There is yet another condition which is entirely incompati- 
 ble with marriage, and we introduce it because there are very 
 few young physicians who know anything about it; indeed, 
 there are but few of an}^ age, who have had experience on the 
 subject. 
 
 A medical gentleman, who had had an extensive practice in 
 the city of New York, and with this general practice he had 
 much of that which is known as "private diseases." He 
 assured us that he was never able to cure a child (under the 
 age of one year) of a man who had practiced, to much ex- 
 tent, self-pollution. He, of course, associated the previous 
 practice of the sire with the fate of the child, in the relation 
 of cause and effect ; but this may not be correct, or it may be 
 only in part so. 
 
 Let it be remembered, and we think that we have probably 
 
PRESEN-T HEALTH AND QUALIFICATIONS. 103 
 
 made the remark somewhere else, that those who are organic- 
 ally disposed or forced to self-pollution, have generally that 
 division of the vital forces which was intended for the per- 
 petuation of the species, in high endowment, while those upon 
 w^hich their own existence depended, are generally very feeble. 
 The case of Kennedy, page 20, is an illustration of this con- 
 dition. The unviable condition of the children, may de- 
 pend u]^on the feeble endowments of the father, or upon his 
 abuse of them, or upon both. 
 
 In our large cities, men are probably more guilty of forni- 
 cation, and women of masturbation, but both injure the con- 
 stitution and defeat the expectations of marriage. 
 
 But, beside the existence of either of the diseases above- 
 named, or even a predisposition to either of them, there are 
 moral manifestations of morbid action which should as cer- 
 tainly be a bar to marriage — such as gambling, the tippling 
 use of ardent spirits, and dissipation in general. They are 
 very nearly as incurable as consumption and are as transmis- 
 sible. 
 
 In both sexes there sometimes exists physical disqualifica- 
 tions for the principal function or object of marriage. It is 
 truly astonishing that either sex would enter into such an alli- 
 ance, under such circumstances, when the merest common- 
 sense cannot avoid assuring them that if made, it will and 
 should be broken. 
 
 Early in our professional life, a gentleman of polite and 
 liberal acquirements, a few days before the appointed time of 
 his marriage, called upon us and submitted his sexual appa- 
 ratus to our inspection, for a professional opinion. The testes 
 were contained in two separate and independent sacks, and 
 the urethra terminated, anteriorly, between them. The origi- 
 nal track of the urethra w^as a hardened cicatrix, which, act- 
 ing as an unyielding cord, drew the penis into a little more 
 than a semicircle when erected. As might rationally be sup- 
 posed, we advised him to abondon forever all idea of placing 
 himself in the position of a husband, and he agreed to break 
 up the marriage agreement he had contracted ; but, neverthe- 
 less, in three days he complied wn'th his engagement to the 
 lady, and in a few wrecks after she left him. From a gentle- 
 man of engaging and courtly manners and enterprising habits^ 
 
104 PRESENT HEALTH AND QUALIFICATIONS. 
 
 he became, from this event, a bloated sot, and died most dis- 
 gustingly scabious. 
 
 Beside an equal disability on the part of females, there are 
 other conditions which should sometimes cause them to prefer 
 celibacy to the hazards of matrimony. AVomen much ad- 
 vanced beyond the usual period of matrimony, of a dry, dense, 
 and fibrous system, can but rarely become a mother without 
 the cost of her life — her paturient apparatus absolutely refuses 
 to perform the function for which it was intended. 
 
 On the other hand, there are many young women of stinted 
 development and feeble stamina, with whom every particle of 
 life is expended upon the parturient function, and even then a 
 failure not unfrequently results. The cost, then, of becoming 
 a mother, a probable event, should be well calculated by these 
 two classes of women before venturing to become wives. 
 
 Professor Dewees, speaking of the parturient dijQficulties 
 that attend early marriages, asks the question, " Do not these 
 facts emphatically declare there is a time best for marriage? 
 This time we shall fix at nineteen for the earliest, and thirty 
 for the latest periods." 
 
 Every girl, who feels that she has arrived at womanhood, 
 will be facetiously disposed to inquire what right he had to fix 
 the age at which she should marry, when her Creator had 
 fixed it at a much earlier period ? 
 
 We cannot make war upon nature's institutions, but we do 
 upon the violations of them. The proper question for girls 
 and parents to consider is fitness, for the functions of a 
 mother.* 
 
 * We axe, upon tliis subject, mucli disposed to agree vrith. an aged and rev- 
 erend gentleman Tvliom we knew in Pennsylvania. "When called upon to con- 
 summate a marriage, his daughter would say, " Why, pa, she is too young ;" 
 then he inquired, " Is she large enough ?" and upon being informed that she 
 ■was, he would remark, " Then she is old enough." Upon other occasions, she 
 would say to him that the bride was too small, and then he inquired if she was 
 old enough, and upon receiving an affirmative answer, he would remark, 
 " Then, she is large enough." This is our opinion, presupposing that the 
 organic laws, which govern in the premises, have been obeyed by her ances- 
 tors and by herself. 
 
CHAPTER II. 
 
 IJs^FLUENCE OP MATERNAL CONDITIONS ON THE EETFS. 
 
 INTRODUCTION. 
 
 If it be true that the impressions made upon the maternal 
 mind or body can affect the fetus, the fact should be placed 
 beyond controversy, because, such is our faith in the wisdom 
 of all the natural laws, that their discovery and establishment 
 must contribute to the improvement of the human race ; for 
 if such a possibility exists, it is to the advantage of the spe- 
 cies, while the injurious consequences fall only upon indi- 
 viduals. 
 
 If such a possibility exists, it can be the recipient of favor- 
 able impressions, as well as those of a contrary character. It 
 is, therefore, all important to settle the question, as one of fact, 
 because women, in general, seem not to know or believe that 
 any impression ^can influence their offspring, except one of 
 fear or apprehension. This general conviction should be 
 eradicated, and the profession should be active in trying to 
 effect it. 
 
 Such is our conviction of the affirmative of this question, 
 and such our estimate of the value of truth, that we beg our 
 readers to excuse us, in the event that we shall prosecute 
 the subject to an extent beyond w^hat they may deem neces- 
 sary. 
 
 The question is one of inference from facts, and to acknow- 
 ledge it as such, displays no exercise of credulity, it is a mere 
 acknowledgment of coincidence, and upon the same kind of 
 evidence that we admit the conclusion that the brain is the in- 
 strument of the mental functions ; and the phenomena are as 
 explicable in the one case as in the other. 
 
 (105) 
 
IQQ PSYCHOLOGICAL INFLUENCE OF 
 
 SECTION I. 
 
 PSYCHOLOGICAL INFLUENCE OF THE MOTHER ON THE FETUS. 
 
 The opinion that impressions made upon the mother's mind 
 may, and very frequently do, affect the fetus, is regarded by 
 some as being, in point of fact, true ; and by others as false 
 and delusive. The former, under the conviction that all truth 
 should be known and defended, do not hesitate to avow their 
 convictions ; while the latter, no doubt from equally honest 
 motives, deprecate the doctrine as being greatly mischievous 
 in its influence upon the female mind. One thing is certain, 
 that so far as we know to the contrary, it is as old as the hu- 
 man race, and almost universally believed by all nations, both 
 civil and savage. 
 
 It has been our lot to become convinced, that however much 
 we may decry the philosophy of the ancients, we are bound 
 to respect their observations. They did not possess our ad- 
 vantages to become learned, and, consequently, having to rely 
 almost exclusively upon themselves, their observations were 
 directed with more careful attention ; and to be correctly in- 
 formed that Galen and Hippocrates maintained the opinion, 
 as one of fact, is sufficient to secure our respect for it. 
 
 Those who contend for the negative, refer us to the existing 
 anatomical relations between the mother and her fetus. They 
 assure us that the connection between them is entirelj^ through 
 the circulation — that no nervous communication has ever been 
 detected — that there is no direct communication of any kind; 
 and hence, they conclude that it is impossible that any arte- 
 rial or nervous condition of the mother can affect or influence 
 those systems of the fetus. 
 
 It appears to us that the man who can, on this account, re- 
 ject the docti'ine, and all the facts that sustain it, is capable 
 of rejecting a fact because he cannot explain it. Our know- 
 ledge of human dynamics would be reduced to a very small 
 compass if we were to reject everything for which the anato- 
 mist has not detected an appropriate apparatus. Upon this 
 principle we might deny that the brain is the apparatus of 
 thought and feeling — that there is any difference between the 
 
THEtMOTHER ON" THE FETUS. 107 
 
 nerves of motion and sensation, and reject the whole doctrine, 
 that the agency of the male is requisite in the work of pro- 
 creation. 
 
 Notwithstanding the almost independent existence of the 
 mother and fetus from each other, it is admitted on all hands, 
 even by those who deny the doctrine under consideration, that 
 the existence of the fetus produces nausea and vomiting in 
 the mother — that it produces a " longing " or desire for unu- 
 sual, and frequently, for the most filthy species of food, as 
 putrid fish and " bacon skin from a soap kettle." If the con- 
 nection between the mother and fetus is so indirect and insig- 
 nificant, that impressions upon the former cannot affect the 
 latter, how does it happen that the latter can so powerfully 
 afiect the former ? In all other known instances a rule will 
 work both ways. 
 
 Dr. Dewees, who repels the doctrine, says, "Nothing con- 
 tributes more certainly to the safety and future good health of 
 the child, than cheerfulness of mind ; or, at least, equanimity 
 on the part of the mother: this fact was well known to the 
 ancients ; and they acted upon it accordingly, by giving great 
 attention to the little wants of the pregnant women." Again, 
 he says, "It would appear that the woman has an important 
 duty to perform, during the whole period of utero-gestation ; 
 that her ofispring may not sufier, in either body or mind by 
 her imprudence," etc. Again, he continues, " She may entail 
 [by neglect of duty] a frail constitution of body, or perpetual 
 feebleness of mind^ or qyqh fatuity itself." 
 
 1^0 w, suppose a person, who is ignorant of the anatomical 
 relations in question, to read these extracts, would he not con- 
 clude that tlie connection between the mother and her fetus 
 was peculiarly direct and intimate ? 
 
 Of all the tasks that men are called upon to perform, that 
 of being consistent in the defense of error is the greatest^ — 
 truth will occasionally peep through the fogs of error with the 
 brightness of the sun's rays through broken clouds. In our 
 judgment, the confessions contained in the above extracts are 
 fatal to his defense of the negative of the question under con- 
 sideration. 
 
 We are not contending that hopes, fears, and frights pro- 
 duce all the calamities that are known to liappen to fetuses, 
 
108 PSYCHOLOGICAL INFLUENCE OF 
 
 any more than we contend that ntero-gestation is the cause of 
 all the nausea, vomitings, and longings of the mother; and 
 when it is admitted that a fit of anger may produce abortion — 
 that irritability and petulance of disposition may greatly in- 
 jure the future health and mind of the child, the substance of 
 the whole question is conceded. 
 
 There are other phenomena in the human economy much 
 more obscurely connected with their cause, than the facts con- 
 tended for in the premises. The connection of the semen 
 masculinum, in the vagina, with the ovum is as obscure and 
 indirect as that between the mother and fetus, and yet, through 
 this double difficulty — this double obscurity, fathers entail 
 their present and accidental condition upon their children. 
 As an illustration of this truth, we cite one case, out of many 
 which are at our command. Mr. George Combe (Constitution 
 of Man) informs us, that " a man's first child was of sound 
 mind ; afterward he had a fall from his horse, by which his 
 head was much injured. His next two children proved to be 
 idiots. After this he was trepanned, and had other children, 
 and they turned out to be of sound mind." 
 
 But even such cases as these do not prove or illustrate the 
 entire strength of our position. It is now a well known fact, 
 that both men and the males of the inferior animals transmit 
 to their progeny their acquired habits and peculiarities. The 
 English fox-hound was crossed with the Spanish pointer, and 
 the progeny trained to stand at game, and after being thus 
 trained, their puppies were seen, untrained, to stand at swal- 
 lows and pigeons. 
 
 The whole subject of human impressibility is closely allied 
 to the one under consideration; indeed, the latter is only a 
 fragment of the former, and therefore illustrations of the one 
 are equally applicable to the other. 
 
 Intellectual and educated men at the present day do not pre- 
 tend to believe that amulets and other kindred means can 
 exert an influence either in the cure or prevention of disease, 
 or in anywise aftect the human solids or fluids ; and yet, they 
 admit themselves to be greatly puzzled with the coincidences 
 which they have been forced to observe between the assigned 
 causes and certain obvious results. 
 
 An old gentleman, highly educated in some of the exact 
 
THE MOTHER ON THE FETUS. 109 
 
 sciences, very nnimpressible and incredulous, was afflicted 
 with rheumatism, and upon complaining of it in the presence 
 of some gentlemen, one of them told him that if he would carry, 
 in his pocket, constantly, a buckeye nut, he would not be 
 afflicted with the disease any more, and as he concluded 
 his prescription, he handed him one. He has carried the 
 buckeye ever since, says that it is light and of no inconve- 
 nience to him — professes no faith in its influence — laughs at 
 the idea, but admits that he has not been afflicted with the dis- 
 ease since. 
 
 The writer, while a student of medicine, had a large wart 
 on his ring-flnger, and shortly after he engaged in practice, a 
 young lady asked him why he did not remove the " ugly 
 wart " from his finger ; he answered that he intended to do 
 it when the weather became a little warmer. She then told him 
 that if he would agree to cure her of the ague the next fall, 
 she would remove his wart. He, of course, assented to it. 
 She obtained a bit of chalk and rubbed the wart until it be- 
 came white, and then made a mark on the back wall of the 
 fireplace, remarking at the time, that when the mark became 
 obliterated the wart would be gone. He laughed at this as a 
 bit of girlish mischief, and thought no more of it at the time. 
 Some two or three weeks subsequently, he was dressing his 
 finger-nails, and happening, spontaneously, to cast his eyes 
 upon the wart, he discovered, with considerable astonishment, 
 that it was nearly gone ; and in a few days more no trace of 
 it was to be seen, nor has it ever reappeared. 
 
 A gentleman in Memphis, of a high order of intellect and 
 respectable acquirements, but constitutionally ver}^ impressible, 
 informed the writer that when he was a schoolboy, it was a 
 prevailing opinion among the boys that if the water in which 
 eggs have been boiled happen to get upon the human skin, it 
 would produce a crop of warts ; and, one morning when at 
 breakfast, he offended his little sister, who, for revenge, threw 
 some tea on his hand, telling him that it was egg-water. In 
 a few days his hand was covered with small warts which grew 
 to such a size as to render his hand a disgusting object. Sub- 
 sequently a boy told him that if he would wash his hand in 
 the first stump-water he found, they would all go away ; and 
 
210 PSYCHOLOGICAL INFLUENCE OF 
 
 he did so, and in a few days, comparatively, they were gone, 
 and he had had none since. 
 
 A lady, in Cincinnati, the handsome widow of a late wealthy 
 merchant, had a wart on her hand, and being in the store at- 
 tending to some business, a country woman came in and ob- 
 served the wart, and remarked, " You have an ugly wart on 
 your hand." " Yes," answered the lady, " and I would give 
 a good deal to have it off." " I will take it off for you," said 
 the woman. '' K you will," said the lady, " I will give you 
 the handsomest silk dress in the store." The woman pricked 
 the wai-t with a needle until it bled, she then stained a boss 
 thread with the blood, inclosed it in some paper, and walked 
 off. The lady, as in the case of the writer, had no faith in 
 the remedy, and therefore thought no more about it. Some 
 weeks afterward the woman called again at the store and re- 
 marked to the lady, " I see that your wart is gone." The na- 
 ture of the remark caused the lady to remember the circum- 
 stance of the wart, and to recognize the one who had relieved 
 her of it, answered, " Yes, and I owe you the best silk dress 
 in the store," and forthwith cut it off for her. 
 
 ITow, in these instances, and hundreds of others of a similar 
 character of which we have been credibly informed, not know- 
 ing anything of the modus operandi of the assigned cause, 
 we do not know that the one depended upon the other in the 
 relation of cause and effect. We must confess, however, that 
 they place us in a dilemma out of which we cannot escape. 
 If we deny that the effect was produced by the assigned cause, 
 it may be inquired why the effect was produced in the time 
 that would have been expected from a known and adequate 
 cause ? If we affirm that the assigned cause did produce the 
 result, then comes the question, how did it effect it? In the 
 first position, we cannot deny ; and, in the second, we cannot 
 explain ; the first, therefore, is sustained by the greater pro- 
 bability, for the reason that a given cause may effect a given 
 result, although we cannot comprehend its modus oi^erandi. 
 
 In the same category of incomprehensible phenomena must 
 be placed the fact that some species of snakes capture birds 
 by impressing their minds. Some people, however, deny this, 
 but as the wTiter has seen it, and shot a black snake in the 
 
THE MOTHER ON" THE FETUS. m 
 
 act of taking a small bird into its mouth, it is not probable 
 that he will be convinced that they do not do it. 
 
 The assertion of Dr. Hunter that he could not authenticate 
 a single instance in two thousand cases m a lying-in hospital 
 in which impressions upon the mother's mind had marked the 
 child, proves about as much as the denial of the late Professor 
 Harrison, of New Orleans, that the white substance of the 
 brain was fibrous, after we had made such an exhibition of it 
 that every one present, but him, saw it. 
 
 As no mother can know whether her child has been injured 
 or marked before she sees it, it is not to be expected that every 
 one who entertains such apprehensions should find them real- 
 ized ; and, on the contrary, it is not to be expected that every 
 mother who has received an impression should either remem- 
 ber it, or found upon it apprehensions of something disastrous 
 to the child. In the present state of our acquaintance with 
 human physiology, we cannot, and dare not, without presump- 
 tion, assert that a very slight apprehension, made upon the 
 mind under favorable circumstances, may not produce upon 
 some part of the system a very marked result. 
 
 A gentleman, about fifty-five years of age, highly intelligent 
 and of a sanguine bilious lymphatic constitution, called upon 
 the writer in his cabinet, and exhibited to him a highly aggra- 
 vated case of parenchyma of the thumb, stating that he de- 
 sired for a little while, the use of a piece of loadstone, or 
 natural magnet, to reduce the swelling and inflammation of 
 his thumb with. We gave him a piece very strongly charged, 
 which weighed about a pound and a-half, and not having any 
 faith in the virtue of such an application we desired to wit- 
 ness the operation. He carried it over the thumb, but close 
 to it, from the extremity toward tlie elbow, and then by a 
 semicircular movement brought it back again. He continued 
 this operation about an hour, in which time the thumb became 
 much reduced in size, and from a deep florid color it became 
 nearly white. ISTow, the question is, were these eflects pro- 
 duced by the magnet or by his faith in its application ? AVo 
 must admit the one or the other, and when admitted we are 
 as much in the dark about the modus ojjerandi^ as we can bo 
 about the psychological influence of the mother on her fetus. 
 
1-^2 PSYCHOLOGICAL INFLUENCE OF 
 
 1. Mrs. G., who was well known to tlie writer, upon going 
 home rather late one evening from a neighbor's house, became 
 frio'htened at a mole. The circumstance inspired her with 
 fearful apprehensions, which upon the birth of the child were 
 discovered to have been well founded, for its hands were 
 turned outward like those of a mole. It lived but a few days. 
 
 2. A friend of the writer, a Scotchman, lost his mother in 
 the act of his birth ; shortly after this event his father came 
 to this country and never returned ; but twenty years after, 
 his son came to this country, and when they met the following 
 dialogue took place : 
 
 Father. "You say that you are my son; please to tell 
 me how you know it ?" 
 
 Sox. " I do not know it, but I was so informed by my con- 
 nections in Scotland." 
 
 Father. " But how do you know that I am the identical 
 individual of whom your relations informed you ?" 
 
 Sox. "I do not know it, but I have inferred it from cir- 
 cumstances connected with you." 
 
 Father. " What are those circumstances ?" 
 
 Sox. " You appear to be about the proper age — you have 
 the person which I expected to see, and I have found you liv- 
 ing where I was instructed to go, and you have the proper 
 name." 
 
 Father. " Such evidence may satisfy you, but it will not 
 do for me. Take ofl' your coat ; now take off your shirt ; 
 now turn your back to me — you are my son !" and he threw 
 his arms around him, and kissed him, and wept upon him. 
 When he had so far recovered from his joy, he proceeded : " I 
 will now tell yoa how I know you to be my son. When I 
 married your mother, she would not eat eggs, but sometime 
 afterward, when she was carrying you, I was approaching my 
 door, unobserved by her, and found her standing in the door 
 picking the shell from a roasted egg. 'Ah !' said I, to her, 
 'you have come to that, have you?' at which she threw the 
 egg at me, and I caught it in my hand, and as I raised my 
 arm to throw it back at her, she turned her back to me, and I 
 hit her in the middle of it, and here is the splash it made 
 upon your back." 
 
 The writer has no doubt of the truth of the above state- 
 
THE MOTHER ON" THE FETUS. II3 
 
 ment — he has seen the mark, and knows of nothing but an 
 ^gg that could have made such a splash. 
 
 3. Mr. F., a good scholar and able mathematician, thirty- 
 five years since a teacher of the writer in mathematics, was 
 very greatly deformed in his body ; when down, he could not 
 get up, nor could he do more than get the points of his fingers 
 to his face or any part of his head. When he moved, he did 
 it by the aid of a long stick which he would project and plant 
 before him, and then drag his body upon the points of his 
 toes, with a serpentine motion after it. The last joint of each 
 fore-finger had the shape of a snake's head, and always had, 
 to the balance of the finger, the position which a snake's head 
 usually holds to its neck. He was very strong in his neck 
 and jaws, and when angry he desired to bite. He could 
 neither mount nor dismount from a horse, and yet he traveled 
 much on horseback ; and when his horse would run away or 
 become unmanageable, he would pitch himself headforemost 
 upon the ground. He was the most talented and enterprising 
 member of the family. 
 
 The cause assigned by his mother for his condition was the 
 coiling of a snake around her ancle. The writer has heard 
 her narrate the circumstances of the event, and the conviction 
 it produced on her mind that it would prove unfortunate to her 
 child. 
 
 4. "Esquiral, a celebrated French medical writer, in ad- 
 verting to the causes of madness, mentions that many children 
 whose existence dated from periods when the horrors of the 
 French revolution were at their height, turned out subse- 
 quently to be weak, nervous, and irritable in mind, extremely 
 susceptible of impressions, and liable to be thrown by the least 
 extraordinary excitement into absolute insanity." — Camlets 
 Constitution of Man. 
 
 5. "A lady of considerable talent wrote as follows to a 
 phrenological friend : ' From the age of two years I foresaw 
 that my eldest son's restlessness would ruin him, and it has 
 been even so. Yet he was kind, brave, and alioctionate. I 
 read the Iliad for six months before he saw tlie light, and liavo 
 often wondered if that could have any influence on him. He 
 was actually an Achilles.'" — Cojnhe's Constitution of Jfafi. 
 
 6. The following case, by S. Sleeper, M. D., is reported at 
 
 8 
 
-j^-^^ PSYCHOLOGICAL i:N'FLirEIs"CE OF 
 
 more length than was necessary to our purpose, and hence we 
 have availed ourselves of its important facts only. 
 
 Mrs. B., aged about thirty-four years, and of more than 
 ordinary strength of mind and cultivated intellect, in the sixth 
 month of gestation, with unusually good health, for one in 
 her situation, and buoyant spirits at her prospects of issue, 
 which she much desired, was compelled to see and hear fre- 
 quently a young bear from California, which was housed upon 
 a lot adjoining her residence — it made what she called an 
 " unearthly noise," but one that much resembled that which a 
 lunatic brother of hers made while a member of her family. 
 This noise gave her much trouble, she strove against it, but to 
 no appreciable effect. She never saw the animal without hav- 
 ing her mental equilibrium much aflected. Her health de- 
 clined, and before the full period of gestation anived, she had 
 all those troublesome symptoms that the gravid uterus fre- 
 quently produces, and in the most aggravated forms. 
 
 Finally the child was born, and lived about twenty hours. 
 Dr. L. Sleeper and Dr. Darland then examined its physical 
 conformation, and the following is their report of it: "The 
 feet and ancles resemble talipes vulgus — the soles of the feet 
 are flat, and the heels project beyond the usual length ; the 
 thighs are flexed upon the abdomen, and the flexor muscles 
 so contracted as not to admit of full extension, without 
 violence to the tissues involved ; the same is the case with 
 the superior extremities, they could not be raised above a 
 right angle with the body ; the wrists turn outwardly ; the 
 fingers overlap each other ; the nails are elevated on the dor- 
 sum and quite pointed — much resembling claws ; the arms, 
 legs, and back are covered with a fine hair, from three to six 
 lines in length, and of a dark brown color, and so abundant 
 as to strike all with astonishment; the skin on the back and 
 extremities was remarkably rough ; the face and head ap- 
 peared natural." — Medical Examiner. 
 
 The gentleman who can separate this monstrosity from the 
 assigned cause of it, must have a very pliable imagination. 
 
 7. By B. F. Hatch, M. D. " Six years ago my brother had 
 in his employ, as domestics, a young married couple, who 
 procured a turtle about the second month of her pregnancy, 
 with which she used to amuse herself by placing a coal of fire 
 
THE MOTHER ON" THE FETUS. II5 
 
 upon its back, to witness its struggles for relief. In this case 
 there was no fright: but for some weeks a daily recreation. 
 The birth of the child clearly evinced the folly of the mother. 
 Its deformity was frightful in the extreme. The upper jaw 
 was entirely wanting, there being nothing to fill the space be- 
 tween the lower jaw and the nose. The nose was merely a 
 fleshy flap with a tooth protruding from its end. Its head 
 was so greatly deformed as hardly to be considered human ; it 
 fortunately died in about two weeks." — Boston Domestic 
 Journal of Medicine^ Vol. 1, JS'o. 8. 
 
 8. By M. J. McCormack, M. D. " The first case I will 
 allude to is a near relative (an uncle), who presents a very ex- 
 traordinary mark all down his thigh and leg, which (strange 
 though it may seem, is nevertheless true) is much more vivid 
 and prominent during the summer season than any other time. 
 The appearance it then presents is that of a red currant tree 
 branch in full fruit ; the fruit being regularly raised and 
 standing out of the cuticle, having a bruised appearance, with 
 the juice squirted all over the limb. Now, in connection with 
 this is the circumstance of his mother, when not more than 
 six weeks or two months pregnant with him, being engaged 
 (as the ladies of that period were in the habit of being) in 
 making some preserves from red currants ; and while in 
 the act of squeezing the muslin bag containing the fruit, it 
 burst and covered her whole face. Being a woman of strong 
 presence of mind, and being fully impressed with the preju- 
 judices of that day, of the eflect the mother's mind had on 
 the child, instead of putting her hand up to her face, at once 
 passed it down the thigh and leg ; at the time she did so she 
 declared it was to prevent her ofispring being disfigured ; the 
 result was as above described. I may further add, that the 
 party alluded to is now a very distinguished officer in her ma- 
 jesty's navy, and I have myself often seen the appearance of 
 the leg, which in summer is very startling." — London Lancet. 
 
 In this case the mark seems to have resulted from the cir- 
 cumstance, but its location was from her volition, and this 
 peculiarity renders the case more confirmatory, but at the 
 same time more mysterious. 
 
 The three following very interesting cases wc extract from 
 the New York Scalpel : 
 
IIQ PSYCHOLOGICAL IN'FLUENCE OF 
 
 "A few years since, we were requested by Dr. Moore Hoyt, 
 a gentleman whose powers of observation and veracity will 
 not be questioned in this city, to examine an infant of a few 
 months' age, and to bring with us our pencil and a bit of 
 Bristol board, as he designed to publish a description and 
 drawing of the case he wished to submit to our notice. We 
 found a very healthy child and mother ; the former presenting 
 an eschar directly across the patella — or knee-pan, as it is 
 called by the people — of each knee. They were of irregular 
 form, as if made by the scratch of a nail or pointed instru- 
 ment, and from two to two and a-half inches in length. The 
 doctor was much astonished to observe these wounds at the 
 birth, as there was no instrument or hard substance near, 
 and the labor was perfectly natural. On careful examination 
 of the eschars, this astonishment was greatly increased, by 
 observing that the wound on one knee was half united by a 
 recent cicatrix. This was sufficiently defined to put its char- 
 acter beyond a doubt. No one in this city who knows Dr. 
 Hoyt will question the accuracy of his conclusion, or his want 
 of sufficient interest in so remarkable a case, to induce a tho- 
 rough and critical examination. It was then evident, that this 
 state of the knees had been produced within the womb. But 
 how ? The mother had spent, for a number of days, some 
 hours daily on her knees, leaning over a cradle, and nursing a 
 sick child. She complained of pain on arising, but did not 
 anticipate any deformity in her child. When we saw the 
 eschars, they were completely healed. This process. Dr. Hoyt 
 informed us, went on without interruption. 
 
 ^•The next case occurred in our own practice. A lady of 
 great equanimity of temper, and extremely delicate constitu- 
 tion, during the second month of gestation was presented by 
 her husband with a pair of earrings. These she was exceed- 
 ingly desirous to wear the same evening to a party, but found 
 it impossible to insert the hoop into one ear, as the hole had 
 partially grown up. The attempt was therefore abandoned, 
 with some disappointment, and the expression of apprehen- 
 sion that her child would be marked. We were consulted on 
 this point, a few days after the event, and asked if such things 
 were ever true. We unhesitatingly answered, no ; for at that 
 time we treated such stories with ridicule. Judge, then, of 
 
THE MOTHER ON" THE FETUS. 1x7 
 
 our surprise on observing one of the ears of the child present, 
 at birth, a hole in the center of one lobe of the ear, so nearly 
 perforated, that, on stretching it slightly with two fingers, the 
 unperforated part proved so thin as to be absolutely diapha- 
 nous ; a deep cleft running downward for a quarter of an inch 
 from the center of the hole. 
 
 " But these cases, astonishing as they are, are far surpassed 
 in interest by one, which, from its very peculiar nature, it was 
 impossible for us to authenticate by personal inquiry and ob- 
 servation. The high respectability of the parties .who were 
 our informants, and the circumstances under which the case 
 was related to us, leave no other course than to give the 
 facts, however wonderful, our entire belief. In narrating it, 
 the parties must be nameless, as all, so far as we know, are 
 living. We trust they will perceive our intention, and impute 
 it solely to our desire to post up a matter of intense interest to 
 humanity and science. 
 
 " Mr. A., of the northern part of this state, married, 
 some forty years since, a lady of an adjoining state. Pecu- 
 niary circumstances, at the time of the marriage, rendered 
 offspring undesirable. Within a year, however, it became 
 evident to the wife that their wishes were no longer to be real- 
 ized ; on expressing this belief to her husband, she was, at the 
 moment, quite shocked at the dissatisfaction with which he 
 received it. Taking his hat shortly afterward, he left the 
 house, and was absent for nearly an hour. He was distressed, 
 on his return, to find his wife in tears. He assured her imme- 
 diately (for they were devotedly attached) that he was rejoiced 
 to learn the probable realization of her announcement ; that 
 he was now satisfied with the condition of his pecuniary afiairs 
 and convinced of their stability. 
 
 " The wife dried her tears, but soon expressed her conviction 
 that, in some way, her expected offspring would suffer from 
 her agitation. The husband endeavored to remove her appre- 
 hensions, by gentle and affectionate ridicule. But her fears 
 continued at intervals during her early months, and gradually 
 increased as gestation advanced. The relief of the parties 
 was great, at the birth of a healthy and well-formed boy. jS'o 
 peculiarity of conduct in the child was observed, until several 
 months had elapsed, and then their fears were renewed, by its 
 
128 PSYCHOLOGICAL INFLUEIs^CE OF 
 
 extreme unwillingness to approach the father. This gradually 
 increased, until its dissatisfaction was manifested by loud and 
 continued screaming when brought near him. As age ad- 
 vanced, the most persevering efforts were made to overcome 
 this repugnance ; the utmost degree of persuasiveness and in- 
 genuity, diversity of childish gifts and sports, all were tried 
 in vain, and the attempt was abandoned in despair. The 
 feelings of the father may be judged by parents, for he was, 
 and is, an exceedingly affectionate man. 
 
 " This continued, and at the time of our receiving the in- 
 formation from a near personal relative, the son, then an active 
 and rising member of the bar, had never been able to speak 
 a word to his father, though the most painful efforts were 
 made. 
 
 " "We give this case as we heard it from a lady and her hus- 
 band, whom to know is to revere. It was told us by the lady 
 just arising from what we all supposed would be her death- 
 bed, and an offer was made at the time to introduce us to the 
 parties. We now regi-et that our years induced us to decline 
 the proffered introduction. We did not feel willing, at the 
 time, to make any personal inquiries in a matter that had been 
 productive of so much distress, and that time had somewhat 
 alleviated. 
 
 " The next case was related to us by Dr. Cox, now prac- 
 ticing at Williamsburg, Long Island. Dr. Cox is certainly 
 authority that few who know him will doubt. His urbanity and 
 truthfulness are known. A lady constantly attended upon 
 her dying father ; his disease was a cancer on the forehead, 
 and required repeated daily dressing: this was done by the 
 daughter, who was in the early period of pregnancy. In a 
 few months the father died, and the daughter was delivered, 
 at the full period, of an infant disfigured by a large tumor on 
 the forehead. This, the doctor assured us, became an open 
 sore, in all respects similar to the one of which its grandfather 
 died. It resisted every application, and soon terminated the 
 child's life. ]!^o one. Dr. C. observed to us, could have told 
 it from a cancer." 
 
 The preceding cases present an illustration of each possible 
 class of psychological impression — in some, fearful apprehen- 
 sions were entertained, from the previous mental shock ; in 
 
THE MOTHER ON" THE FETUS. HQ 
 
 one the fetus suffered from the mother's amusement, where no 
 apprehension existed ; in another no apprehension existed, 
 but the fetal injury was directly referable to the mother's un- 
 comfortable situation at a given time ; in another the fetus 
 was marked on the leg instead of the face, and the choice was 
 determined by the mother's volition ; in another the fetus suf- 
 fered through the mental agitation of society ; in another the 
 mother's repugnance to the father, at a particular moment, was 
 entailed upon the child for life, to which a very similar case 
 now exists in Cincinnati. 
 
 In some of these cases, the cause embraced no object — it 
 was mental, and therefore it could only affect the fetus, men- 
 tally ; while others of them had direct reference to the fetal 
 body, and it alone suffered. 
 
 Finally, all of them hold such a natural relation to their 
 assigned causes, as to render it far more difficult to doubt, 
 than to believe. 
 
 SECTION II. 
 
 WITH KEFEKENCE TO CHILDREN BY A SECOND. 
 
 This subject, if possible, is more mysterious than the 
 former, and probably not less important in its intended influ- 
 ences upon society, and therefore its discussion and establish- 
 ment, beyond doubt or equivocation, will have that influence 
 which is extended to all the organic laws, that admonish us 
 with reference to all that is near and dear to us in life. 
 
 The conclusion contended for, under the circumstances, is, 
 that a mother's constitutional identity becomes merged in that 
 of her first husband, and consequently her children, by a 
 second husband, will not resemble their father nor inherit his 
 qualities, necessarily, nor her own, but those of her first hus- 
 band. 
 
 In support of this law, there is not wanting an abundance 
 of facts — enough to arrest avaricious parents in the sale of 
 their daughters to old and debauched rakes for property, under 
 the expectation that they will soon die — enough to convince 
 
120 CHILD'S I^^FLUENCE OjS" A MOTHER, ETC. 
 
 young women that just as certain as they shall have one child 
 by such a creature, her own constitution becomes as base as 
 his — nay, more, that she has bartered for property or some 
 other unworthy consideration that power which she originally 
 possessed, to render justice to a second husband (through his 
 children), whom she may wed through love and affection. 
 But to the facts. 
 
 It is now an undoubted fact, a fact admitted by every one 
 conversant with the subject, that a mare, after having a foal 
 by an ass, will never after bear a colt by a pure-blooded horse 
 that will not possess qualities and resemblances of the ass ; and 
 among stock raisers, no one can be found who would put a 
 mare, no matter how excellent her blood, to the best or any 
 other blooded horse, after she has once had a colt by an ass. 
 
 When the writer was a student of medicine, Professor Cald- 
 well, in support of his doctrines of sympathy, introduced the 
 following well known fact : Lord Morton had a finely blooded 
 mare, and, by an accident, a quagga (which is a variety, pos- 
 sibly a species, of the wild ass of Africa) found an opportu- 
 nity to cover her once, and after the due term of pregnancy 
 she had a hybrid foal which in very many respects, bore strong 
 resemblances to the quagga. In the proper season of the three 
 succeeding years, she was covered by a black Arabian horse, 
 and she had three foals, all of which, however, bore strong 
 resemblances to the quagga. These facts may also be found 
 in a late number of the ISTew York Scalpel. 
 
 To the same point there is another fact which we add: 
 
 "A mare belonging to Sir Gore Ouseley, was covered by a 
 zebra, and she gave birth to a striped hybrid. The year fol- 
 lowing, the same mare was covered by a thorough-bred horse, 
 and the next succeeding year by another horse. Both of the 
 foals thus produced were stripid, i. e., partook of the charac- 
 ter of the zebra." — Socdpel. 
 
 In the preceding cases, it is proper to remark, that the 
 males were of species widely differing from their own, conse- 
 quently other evidence becomes requisite for the establishment 
 of the proposition : but this can be easily done. 
 
 Mr. McGillivray states, that " in several foals, in the royal 
 stud at Hampton Court, got by the horse Actseon, there were 
 unequivocal marks of the horse Colonel — the dams of these 
 
CHILD'S INFLUEI^CE ON" A MOTHER, ETC. 121 
 
 foals were bred from bj the Colonel the previous year. Again, 
 a colt, tlie property of the Earl of Snffield, got by Laurel, so 
 resembled another horse. Camel, ' that it was whispered, nay 
 even asserted at l!^ewmarket, that he must have been got by 
 Camel.' It was ascertained, however, that the mother of the 
 colt was covered the previous year by Camel." — Scalpel. 
 
 Facts like the preceding are well known among all growers 
 of cattle, hogs, and dogs ; but, while upon the subject, we 
 may as well present two or three more facts from the same ex- 
 cellent authority, Mr. McGillivray. 
 
 He says: "It has often been observed, that a well-bred 
 bitch, if she has been impregnated by a mongrel, will not, 
 although lined subsequently by a pure dog, bear thorough- 
 bred puppies in the next two or three litters." 
 
 " The like occurrence has been noticed in respect to the 
 sow. A sow of the black and white breed (known as Mr. 
 Western's breed) became pregnant by a boar of the wild breed, 
 of a deep chesnut color. The pigs produced were duly mixed, 
 the color of the boar in some of them was very predominant. 
 The sow being afterward put to a boar of the same breed with 
 her own, some of the produce were observed to be stained or 
 marked with the chesnut color that prevailed in the former 
 litter ; and, on a subsequent impregnation, the boar being 
 still the same breed with the sow, some of the litter were also 
 slightly marked with the chesnut color." 
 
 "A pure Aberdeen heifer was served with a pure Teeswater 
 bull, to whom she had a first-cross calf. The following sea- 
 son the same cow was served with a pure Aberdeenshire bull ; 
 the produce was a cross calf, which at two years had very 
 long horns, the parents both hummel. A pure Aberdeenshire 
 cow w^as served, in 1845, with a cross bull, i. e., an animal 
 produced between a first-cross cow and a pure Teeswater buU. 
 To this bull she had a cross calf. Next season she was served 
 with a pure Aberdeenshire bull — the calf was quite a cross in 
 shape and color." 
 
 To settle this question, pretty conclusively, we have pre- 
 sented facts enough from the inferior animals, but as man has 
 ever, if not philosophically, at least practicall}", considered 
 himself an exception to all the laws that govern the former, 
 
122 CHILD'S INFLUEXCE ON A MOTHER, ETC. 
 
 observations enough, bearing upon the same subject, have 
 not been made upon human society to produce an equal con- 
 viction ; we have, however, a few, which are much to the point. 
 But we do not believe that they so frequently occur, and for 
 this opinion our reason is this : The females of the domesti- 
 cated inferior animals have no choice as to the males with 
 which they shall have connection, constitutional incompati- 
 bilities, though of good blood in the abstract, may frequently 
 be brought together ; but with man there exists an inherent 
 sympathy or affinity between individuals of the two sexes, and 
 this affinity is generally in accordance with organic law, and 
 hence this law is more frequently infracted through mercenary 
 motives than any other. We do exceedingly doubt whether 
 such phenomena would result from constitutionally normal 
 marriages. To convey more clearly our opinion, or rather 
 suggestion, we will present cases to illustrate it. 
 
 Suppose a bilious woman should marry a bilious man, or 
 one of the compounds of the bilious, and more particularly 
 one of the lean ones, as the bilious sanguine, or bilious en- 
 cephalic, she would most clearly violate one of the organic 
 laws which was intended to regulate the fanction of procrea- 
 tion ; and by so doing she has contaminated her own consti- 
 tution — she has almost as greatly violated a law, as the mare 
 which has a foal by an ass — such a man was not her choice — 
 she sacrificed it at the shrine of some other consideration ; 
 but she has done it. Wow, suppose her to take a second hus- 
 band, and in doing so makes a normal selection, possibly a 
 sanguine, or sanguine en cephalo -lymphatic one, her children, 
 as in the case of the mare and the horse, after the former had 
 had a mule, would partake more or less of her first husband. 
 But, in supposing her to Lave made, in both instances, a nor- 
 mal alliance, it does not appear to us that her second children 
 would partake of the marks and qualities of her first hus- 
 band ; and for the reason that she violated no law, and in 
 conforming to the law, she did not lose her own constitutional 
 identity. 
 
 We do not know that this reasoning is valid, yet we think 
 it deserves attention in the investigation of this subject. So 
 long as a woman obeys the organic laws of procreation, we 
 
CHILD'S INFLUEN-CE ON" A MOTHER, ETC. 123 
 
 can conceive of no reason why she should lose her own con- 
 stitutional identity. Our suggestion in the premises is partly 
 the result of one case which we have observed. 
 
 In the interior of Kentucky, a bilious encephalic lady mar- 
 ried a bilious gentleman of the florid variety, and had chil- 
 dren, but we never saw any of them ; subsequently she mar- 
 ried a bilious lymphatic, though not entirely normal, was far 
 less objectionable than the former, by whom she had one 
 daughter. Kow, let it be remembered that the first husband 
 had reddish hair and grayish blue eyes, and the second had 
 brown hair and eyes, and so had she. The daughter had the 
 features of her father, one eye and the hair of one side of the 
 head had the color which was common to both of her parents ; 
 but the other eye was bluish gray, and the corresponding side 
 of the head was red — marks peculiar to her mother's first hus- 
 band, between whom there existed an organic incompati- 
 bility. 
 
 In further confirmation of this subject, we have two cases 
 by Dr. Harvey, who states that the first was communicated to 
 him by the Reverend Charles Combie, of Tillyfour, minister 
 of Lumphanon, in Aberdeenshire, and the second by Professor 
 (Simpson, of Edinburgh. 
 
 '^1. Mrs. , a neighbor of Mr. Combie, was twice mar- 
 ried, and had issue by both husbands. The children of the 
 first marriage were five in number ; of the second, three. 
 One of these three, a daughter, bears an unmistakable resem- 
 blance to her mother's first husband. What makes the like- 
 ness the more discernible is, that there was the most marked 
 difference in their features and general appearance, between 
 the two husbands." 
 
 As " there was the most marked difference in their features 
 and general appearance, between the two husbands," it is 
 much more than probable that they were of very different 
 temperaments, because, between individuals of the same tem- 
 perament there is something of a family likeness, invariably. 
 In conformity, then, with our suggestion, her first husband, 
 at least, may have possessed a constitution incompatible witli 
 her own. 
 
 " 2. A young woman, residing in Edinburgh, and born of 
 white (Scottish) parents, but whose mother sometime previous 
 
124 CHILD'S IXFLUEXCE Oi^ A MOTHER, ETC. 
 
 to her marriage, had a natural (mulatto) child by a negro man- 
 servant, in Edinburgh, exhibits distinct traces of the negro." 
 
 This case is in precise conformity with our suggestion. 
 
 The two following cases were communicated to Dr. Harvey 
 by Dr. George Ogilvie, and Professor Pirre, respectively: 
 
 1. "A woman was twice married, and had children by both 
 husbands," and those of " both marriages were scrofulous, 
 although only the first husband had marks of this diathesis ; 
 the woman herself, and second husband, being to all appear- 
 ance quite healthy." 
 
 2. " Mrs. H., apparently, perfectly free from scrofula, mar- 
 ried a man who died of phthisis. She had one child by him, 
 which also died of phthisis. She next married a person who 
 was to all appearance equally healthy as herself, and had two 
 children by him, one of which died of phthisis, the other of 
 tubercular mesenteric disease — having at the same time scro- 
 fulous ulceration of the under extremity." — Scalpel. 
 
 These cases are strong, interesting, and instructive, but as 
 they do not show that they did not originate in a violation of 
 constitutional law, they do not really establish any new prin- 
 ciple in the animal economy, because it has long since been 
 conceded that mischief will forever succeed the violation of 
 organic law. We are not informed as to the constitution of 
 the mothers, and we can only approximate to that of the 
 first husbands. Phthisis, idiopathically, occurs most fre- 
 quently in the sanguine encephalic and sanguine encephalo- 
 bilious constitutions. ISTow, the mothers may have been one 
 of these, or a sanguine bilious, or a bilious encephalic. 
 
 There is yet another question involved in this subject. We 
 have suggested that the impression made on the female by 
 children of a first husband may possibly result fi*om a tem- 
 peramental incompatibility between the parents ; now, the 
 question is, may not an unsoundness in the first husband con- 
 stitute an organic incompatibility — such as should aflect her 
 constitutional identity ? It must certainly be a violation of 
 organic law for a woman to have children by a man who pos- 
 sesses a mercurial or syphilitic disease in an occult form, or a 
 hereditary predisposition to cancer or phthisis. 
 
 It must now, we think, be quite obvious, that before these 
 nice questions in physiology can be satisfactorily settled, we 
 
CHILD'S IN-FLUEl^CE ON A MOTHER, ETC. 125 
 
 must know more about the subject of the human tempera- 
 ments. Nevertheless, the facts as they stand, by the exercise 
 of proper discretion, may be rendered inservient of important 
 consequences. They should make women prudent as to whom 
 they take for a first husband, and men more prudent as to 
 their marriage with widows. They should at least learn 
 whether her first husband was mentally a villain, or corpo- 
 really a putrid mass. In either event she has probably, either 
 through ignorance or willfulness, rendered herself unfit for a 
 future mother. Under such a circumstance, she would much 
 more promote the good of society by living a widow, than by 
 becoming the mother of either social pests, or the victims of 
 early disease and premature death. 
 
 We have before us a case of a directly opposite character- 
 one that has been a matter of surprise to many individuals in 
 the community where it exists. A white man in the vicinity 
 of Covington, Ky., had eight or nine children by a dark mu- 
 latto woman — all of the children, of course, had impressed 
 upon them unmistakable indications of the black race. The 
 mother of these children died, and the father married a white 
 woman, by whom he had two children, which are now living, 
 and which bear as indubitable marks of the black race as do 
 many of the first children. 
 
 We shall not attempt to found upon this, or any other one 
 fact, a principle, and yet we may indulge a little in specula- 
 tion. It will scarcely be denied as being possible that he may 
 have absorbed, by his cutaneous surface, some of the elements 
 peculiar to the negro constitution, by sleeping in contact with 
 one thirty or more years. It is, further, well known that the 
 surface of the negro emits a peculiar odor, and therefore is it 
 not possible that he may have received, through his lungs, 
 some of the elements of the negro constitution ? Finally, is 
 it not possible that he may have lost his constitutional iden- 
 tity by sleeping and otherwise living with a colored woman 
 for so many years ? 
 
 Another modification of this subject comes up for a passing 
 consideration, before we conclude. When an aboriginal 
 female has had successful intercourse with a white man, can 
 she afterward conceive by one of her own race ? 
 
 By the Scalpel, we are informed that Dr. Ilarvey says : — 
 
126 CHILD'S INFLUEiN'CE ON" A MOTHER, ETC. 
 
 " This question is suggested by an observation made, in vari- 
 ous parts of the world, by the excellent Count de Stuzelecki." 
 That they will not, he says, that " Whenever such intercourse 
 takes place, the native female is found to lose the power of 
 conception on a renewal of intercourse with the male of her 
 own race, retaining only that of procreating with the white 
 man." 
 
 We have been much among our south-western Indians, and 
 although we never made any observations with reference to 
 this question, yet we feel confident that if the fact had so 
 existed among them, we would have heard of it. It is cer- 
 tainly not the case with our black women. There is now in 
 the city of Covington, a black woman whose first child was 
 by a white man, and yet she had, afterward, several children 
 by a black one. 
 
CHAPTER III. 
 
 OP MATERNAL DUTIES IN RELATION TO HER CHILD. 
 
 It is not our purpose, at present, to treat of female diseases, 
 but the duty we are endeavoring to render to children, makes 
 it, as it has thus far been obligatory upon us, to involve the 
 mothers in our remarks during the period that their well-being 
 shall especially depend upon them. 
 
 The life, health, and proper development of the child, de- 
 pend upon the quality of its food, which should consist of the 
 mother's milk, and upon indispensable attentions to its per- 
 son ; consequently she should now, in a great measure, cease 
 to think of drink, food, rest, or exercise, except in relation to 
 the well-being of her child. Her wants should now originate 
 in it, and not in any of her own personal desires. 
 
 Under the influence of such a responsibility, she will care- 
 fully avoid, after the delivery of her child, every variety of 
 drink or food which is suspected to possess a fever-producing 
 influence. She should not attempt to sit up too soon, nor too 
 long at a time when she does. Her chamber should admit of 
 sufficient ventilation, and be maintained, at a comfortable 
 temperature. Stimulating diet and drinks should, in a great 
 measure, be avoided — the wisdom of officious old ladies to the 
 contrary, notwithstanding. Last, but not least in point of 
 importance, she should see but little company. To sustain 
 this injunction, we are aware, in some sections of the country, 
 is very difficult. The lying-in chamber is too frequently 
 regarded as the proper place for the neighboring women to 
 assemble for the purposes of talking and feasting. We have 
 seen women more troubled about the accommodation of their 
 guests than about themselves and children. As the attending 
 
 (127) 
 
;[28 MATERIAL DUTIES 
 
 physician is held responsible for the proper recovery of his 
 patient, he should protect his responsibility by ejecting from 
 the house all those who had no other business there but to 
 talk and eat. 
 
 If she did not commence before the birth of her child, she 
 should not now lose a moment of time in guarding against a 
 common calamity, to both mother and child, known as " sore 
 nipples." As soon as she recovers from the fatigue of partu- 
 rition enough to admit of it, the child should be applied to 
 them, and this application should be repeated as frequently as 
 every three, four, or 'Rye hours, unless contra-indicated by 
 some important contingency. This duty is imperious, if 
 she would avoid the suffering to herself and the injury 
 to her child, which are inseparable from sore nipples. We 
 say imperious, because we regard the affection as being pro- 
 duced by the effort of the child to draw the milk from the 
 greatly distended milk-vessels in a state of incipient inflam- 
 mation, produced not only by this distension, but in part by 
 an inspissated condition of the milk, which has partially ob- 
 literated the vessels themselves. In this condition of the nip- 
 ples, the efforts of the child to obtain its proper nourishment, 
 draws the skin from them, which terminates all her comfort in 
 suckling the child, and all certainty that it wiU be regularly 
 and sufficiently fed. 
 
 As such attentions to the nipples and breast as will tend to 
 prepare them for their important functions should not be post- 
 poned until the moment of impending danger arrives, she 
 should, about the close of the seventh month of pregnancy, 
 have them drawn two or three times a day by one of her chil- 
 dren, a servant, a puppy, or a lamb. By this practice they 
 become accustomed to the process, the cuticle is rendered pli- 
 able and delicate, the skin becomes fit for its function, and 
 inspissation of any secretion that may happen and consequent 
 inflammation are prevented. 
 
 Many lotions have been recommended for hardening the 
 nipples. Such a thought is ridiculously mechanical. Who 
 ever knew any portion of the cutaneous surface to become 
 hardened by washing ? By friction the epidermis is hardened 
 and the skin rendered more healthy to a certain extent. This, 
 in the absence of an agent to draw them, the woman can do 
 
m RELATION TO HER CHILD. 129 
 
 for herself, by the use of her fingers and a little flour paste 
 and warm water. This process will also keep them clean and 
 prevent the deposition of cuticular matter in the superficial 
 follicles, which, when it happens, never fails to irritate and 
 inflame. For this purpose, the use of soap and water have 
 been recommended, but soap is as incompatible to the nipple 
 as to other parts of the surface — paste is much better, and 
 after the use of the napkin, they should be allowed to dry in 
 both air and light. 
 
 "When we compare the entire compatibility which nature has 
 established between the milk of all healthy women and the 
 development of their children, it can be regarded as but little 
 less than criminal for her to delegate to any other woman the 
 privilege of nursing or suckling her child. This important 
 duty, it is true, under some contingencies, may be contra- 
 indicated, but as a general rule, even when the mother's health 
 is far from being good, her milk is its most compatible food, 
 for at least several of the first weeks of infancy. Further- 
 more, she should not allow it to be fed with anything, while 
 very young, unless she cannot possibly support it at the 
 breast. Careless and inexperienced nurses frequently do im- 
 plant irreparable mischief in the cleansing, dressing, and un- 
 dressing them — hence these offices should be scrupulously 
 attended to by herself. Furthermore, she should not allow it 
 to remain either wet or cold, under any pretext. 
 
 As soon as practicable, she should take moderate exercise 
 in the open air, but only in dry weather, and she should par- 
 ticipate in such society and amusements as may contribute to 
 the healthfulness of her secretions, avoiding every species of 
 dissipation. Furthermore, she should carefully resist the im- 
 portunities to eat that which is improper, or too much of any- 
 thing, under the plea that she has her child to support; 
 because the milk of a plethoric woman will prove as mischiev- 
 ous to the child, as that of a partially starved one. Nature 
 has been careful to provide for both her and her child under 
 the observance of the strictest temperance in all things. 
 
 Finally, every woman, after having called to her aid tlic 
 
 services of a physician, should consider herself bound by 
 
 every moral consideration, and also by every selfish one, that 
 
 has the well-being of herself and child for its object, to 
 
 9 
 
l^Q MATERI^AL DUTIES, ETC. 
 
 implicitly cany ont his instructions, and to enforce this duty 
 upon her nurse. If she have unfortunately employed a block- 
 head, it is not to be supposed that she was more discrimi- 
 nating in the selection of her nurse ; consequently, it is to be 
 presumed that the advantage is still in his favor. 
 
 And yet, it must be confessed, that there is in society, even 
 among the well informed, an astonishing amount of credulity 
 and a superstition that would scarcely deserve toleration in a 
 savage community. We have known wealthy and intelligent 
 gentlemen to employ, as a physician, a man so stupid and 
 dull that he would not have employed him to groom his horse, 
 and for no more cogent reason than that he was a seventh son, 
 or had been among the Indians, or for some imagined reason, 
 that he must possess a pathological and therapeutical instinct. 
 
CHAPTER IV. 
 
 OF PHYSICAL INJURIES TO THE CHILI, 
 
 SECTION I. 
 
 NECESSITY OF A FOSTER MOTHER. 
 
 Phrenologists well know that there are many women who 
 have an insuperable aversion to the care of their own chil- 
 dren — are always pleased to find some one — any one, who 
 will relieve them of this responsibility. The crime of infanti- 
 cide proves the existence of such women. It always gives us 
 pain to see any one, but more especially a woman who has an 
 aversion to children. We, of course, do not blame them — 
 none of us can avoid our liTces and dislikes — they are most 
 generally entailed upon us ; but it is very unfortunate to a 
 man to have such a wife, and equally unfortunate that such a 
 woman should become a mother. 
 
 That it is the duty of every mother to suckle her own child 
 no one will doubt, except when by so doing her life or that of 
 the child is endangered. We are taught that no woman 
 should be relieved from the discharge of this duty, through a 
 mere aversion to it, nor through the plea of ill health, unless 
 confirmed by the judgment of an intelligent physician. 
 
 Hundreds of women, who have but a feeble sense of moral 
 obligation or duty, possess, nevertheless, such an attachment 
 to their children, that they would almost as soon part with 
 life, as to surrender their infants to the care of others. When, 
 therefore, the child has no other ground of hope and. protec- 
 tion than its mother's sense or feeling of moral duty, its chance 
 for a continued existence is very precarious. Now conies tlio 
 proper question for the consideration of the husband and his 
 
 (131) 
 
J 32 IMPROPER If OURISHMENT. 
 
 friends — which offers the best chance for the well-being of the 
 child, the mother who has no affection for it, or a wet nurse 
 who may or may not be dutiful ? 
 
 We repeat that the motlier's milk is the best for the child, 
 other things being equal, and it should not be deprived of it 
 for any trifling consideration ; but it must be remembered that 
 objectionable food is not the only cause of fatality among chil- 
 dren ; consequently a mother who entertains an antipathy for 
 her child, or even views it with indifference, may by negligence 
 destroy it. (We here remark that such a woman should not 
 be permitted to become a mother a second time, for the reason 
 that she will probably, according to the laws of procreation, 
 entail her own mental constitution, in this respect, upon her 
 daughters, and thus spread the evil upon society.) 
 
 We will now suppose that every fact and contingency, so 
 far as known, has been duly weighed, and that it has been 
 decided, either on account of the disability of the mother to 
 nurse her child, or on account of an unwillingness to do it, or 
 perhaps from some insuperable objection to her doing it, to 
 employ a wet nurse for it. It should now be remembered, 
 that, as a general fact, a wet nurse holds about the same rela- 
 tion to a good mother, that an artificial tooth or leg does to 
 a natural one — even under the most favorable circumstances 
 a poor substitute — but it is the only alternative, whether it 
 does or does not destroy the child. 
 
 SECTION II. 
 
 OF IMPKOPEK NOURISHMENT 
 
 The old adage, " tricks in all trades but ours," applies with 
 as much truth to wet nurses as to any other class of indi- 
 viduals. They serve for a consideration, and like those of 
 other professions, they wdll never fail to represent their own 
 pretensions in the most favorable light. 
 
 If the child of the nurse shall be living, she is more to be 
 suspected and watched than otherwise, because it is not to be 
 supposed that she will, even for wages, neglect or endanger the 
 health of her own child ; and although she will probably 
 
IMPROPER ITOURISHMENT. -[33 
 
 represent herself as having an abundance of milk for both, 
 and she may have so prepared appearances as to indicate the 
 same, yet the mother should exercise over her services an un- 
 sleeping vigilance, for in the event of her not having enough 
 of milk for both, she will not starve her own, but will clandes- 
 tinely feed the other. Young and credulous mothers are fre- 
 quently imposed upon in this way. 
 
 Vigilance, however, will soon detect any fraud that may be 
 practiced, for if the child be sustained by other food than suit- 
 able milk, fretfulness and various manifestations of pain will 
 attend it. The nurse may, as she frequently does, parry all 
 this by the use of laudanum and such personal address as will 
 make the mother believe that nothing but a little "colic" 
 ails it. 
 
 But the time is not far distant when the cheat will become 
 obvious — the mother will perceive that her child is not grow- 
 ing — that it is stinted, and presently diarrhea appears, and 
 then she sends for her physician, whose investigations detect 
 the fraud — possibly in time to save the child, and possibly not. 
 
 Thus, it not unfrequently happens that when parents have, 
 as they believe, provided in the best manner for the nourish- 
 ment of their infant, they lose it through the clandestine use 
 of improper food. 
 
 On the other hand, the nurse may be honest and faithful — 
 she may provide plenty of milk, and she may give it to the 
 child, and yet it may not be nourished. Her milk may be as 
 mischievous to the child as the improper food above remarked 
 upon ; and all this may result from the ill health or improper 
 feeding of the nurse. If she live upon gross and indigestible 
 food, or if she indulge in the use of ardent spirits, or if she 
 be dyspeptic, or is laboring under a tardy condition of the 
 liver, and if so, many gross and even poisonous elements, 
 which should have been disposed of by the agency of the liver, 
 are eliminated through the milk. Her skin or kidneys, or 
 both, or the uterine system, may be at fault, and effete matter 
 is vicariously cast off through the mammary secretion. 
 
 It is also well known that a capricious temper, more espe- 
 cially paroxysms of anger will render a woman's milk poison- 
 ous to a child. 
 
 That a mother can maintain, so far as can bo ascertained, 
 
;[34 INFECTIOUS POISON IN THE MILK. 
 
 even sound health, and fatally poison her offspring, and all 
 other animals that partake of her milk, is a fact well known 
 in this country to those who are familiar with the disease 
 known as the " milk-sick," which is communicated by the 
 cow to her calf and to those who use her milk. This single 
 but well known and established fact, should teach every 
 mother to be careful as to what she eats. 
 
 'No matter, however, what has given the nurse's milk a dis- 
 eased or bad quality, the fact can be detected by a close atten- 
 tion to the manifestations of the child. It does not sleep like 
 a well child ; it starts and cries as though penetrated with 
 severe pain, and almost as suddenly falls again into unrefresh- 
 ing slumber. When awake, it is uneasy and fretful, and the 
 milk it receives is soon after rejected, or it excites alvine 
 action, and passes through the bowels with rapidity and pain- 
 fulness. The stools are of a pale green color with offensive 
 odor and frequently mixed with milk curd; they are not gene- 
 rally frequent, but aqueous and copious, which, consequently, 
 rapidly reduces and weakens it. Its flesh is flaccid, and skin 
 pale. It does not continue long in this condition, before it 
 suddenly emaciates and exhibits an alarming illness of both 
 head and bowels. 
 
 SECTION III 
 
 INFECTIOUS POISON IN THE MILK. 
 
 Although we have no direct evidence in support of the 
 opinion conveyed by the heading of this article, yet we have 
 enough, of an analogical character, to render all parents care- 
 ful and vigilant upon the subject. 
 
 It will not probably be denied by any medical scholar of 
 the present day, that a father possessing occult or secondary 
 syphilis may transmit the disease in an active form to his 
 child through the sperm that brought it into existence. No 
 doubt but that it sometimes has a different effect, and pro- 
 duces some other form of disease. If this disease can be so 
 obscurely communicated, as through the semen of the father, 
 may it not be communicated through the milk of a nurse ? 
 
INFECTIOUS DISEASES. I35 
 
 But suppose it cannot ; may it not produce some other, but 
 unrecognized, form of disease ? and may it not be applicable 
 with reference to porrigo, herpes, psora, etc.? 
 
 These last remarks are, perhaps, practically useless, as no 
 parent would employ a nurse who was afflicted with either of 
 them, in an active form, and it is not known that they exist in 
 an occult one. 
 
 There is, then, at least, analogical evidence that such a 
 transfer of syphilis is possible, whatever reason there may be 
 against it; at all events, no discreet person will employ a 
 nurse, if avoidable, who is thus afflicted. 
 
 "Whatever may be the fact, touching the communicability of 
 syphilis through the milk of a nurse, we can scarcely doubt 
 that scrofula can be and has been. In confirmation of this 
 opinion, we present a case that occurred in our practice : 
 
 Miss 0., aged sixteen years, was, when only a few weeks 
 old, in consequence of her mother's inability to nurse her, 
 placed in the care of a wet-nurse, whose health at the time 
 was supposed to be sound and vigorous ; but before the time 
 arrived when it was thought advisable to wean her, suspicion 
 arose that she might not be, as the child did not flourish as 
 much as all had reason to hope ; when an investigation of the 
 condition of the nurse was instituted, it resulted in the dis- 
 covery that she possessed a scrofulous diathesis, and was there- 
 fore discharged. The child came under our treatment at the 
 time, and has been, more or less, up to the present. Her ail- 
 ment is evidently scrofulous, but manifests itself in a local, 
 rather than a constitutional, form. We have been long and 
 well acquainted with both of her families, and are sure that 
 such a diathesis does not exist in either. 
 
 SECTION IV 
 
 INFECTIOUS DISEASES. 
 
 The introduction of strangers into a family, to fill any do- 
 mestic position, is always attended with some danger from 
 infectious diseases. We have known white members of a 
 family, as well as black ones, in the south, to contract 
 
13g II?"ATTENTIOI^ TO CHILD'S NECESSITIES. 
 
 secondary syphilis from a house servant; and we have known 
 the same misfortune to happen in the free states, through the 
 instrumentality of hired white ones. 
 
 K a wet-nurse should have this disease, or either of the in- 
 fectious ones of the skin, we may well suppose that the child, 
 of which she has the care, will contract it. Such occurrences 
 are said to be frequent on the continent of Europe, less fre- 
 quent in England, and still less in the United States. How- 
 ever this may be, we know not ; but sure we are that the 
 propagation of syphilis into American families, by domestics, 
 is not infrequent. 
 
 SECTION V. 
 
 INATTENTION TO CHILd's NECESSITIES. 
 
 To attribute a mother's attentions to her child, to benevo- 
 lence, a feeling of moral obligation, or to rej&ection, as the 
 metaphysicians have done, is to mistake very widely the pro- 
 visions of our Creator for the care and protection of our 
 infancy. If the protection of progeny had been confided to 
 the care of the superior sentiments, the population of the 
 earth, at this day, would have been very small, compared 
 with what it now is. Under such an ordination we would have 
 had no savage races, nor degraded and brutal classes in civil 
 society. No, the author of our being did not leave the help- 
 less period of our existence to the vicarious functions of facul- 
 ties which may or may not have even an appreciable exist- 
 ence. The feeling that binds a mother to her new-born babe, 
 exhibits more passion, more enthusiasm, than her own love of 
 life could exhibit — the only other feeling that can equal it, is 
 that which constitutes the religious martyr. During the early 
 infancy of her child, when it can interest no one else, she be- 
 trays for it a care, a vigilance, a self-denial, and a devotion 
 that baffles all conception. We have often thought that a 
 mother is amply compensated for her pains and privations in 
 child-bearing and nursing by the pleasure she finds in her 
 child — witness her pleasurable emotion at its very smile — it is 
 now the exclusive object of her worship. 
 
mATTEI^TIOI^r TO CHILD'S NECESSITIES. I37 
 
 We have dwelt thus long upon maternal attachment, to 
 enable our readers to fully appreciate the hazards to which 
 a child is exposed, in being separated from its mother, even as 
 regards its physical existence. If a mother's attentions are 
 frequently insufficient to save the tender infant, how precari- 
 ous must its chance for a continued existence be, with even 
 the best of other women, and how much better its chance 
 would be with them, than with those hirelings into whose 
 hands they are generally cast. 
 
 The first and great care due to a child is the regular and 
 timely application of it to the breast, that it may not be injured 
 by hunger or over-feeding; the second consists in a vigilant 
 attention to cleanliness ; and the third, in cultivating regular 
 habits, as regards its evacuations, exercise, sleep, and airing. 
 
 These attentions, to secure their accomplishment, must be 
 urged by a much stronger feeling than that sense of hired obli- 
 gation, which alone, in most cases, actuates the wet-nurse ; 
 and yet it must be confessed that a neglect in either respect 
 may stint the child, impair its constitution, or terminate, pre- 
 maturely, its existence. 
 
CHAPTER V, 
 
 OP MENTAL INJURIES TO THE CHILD 
 
 SECTION I. 
 
 THE YITAL FORCES. 
 
 We found the preceding chapter all important to the physi- 
 cal well-being of the child ; and if, as we believe, life was 
 given for usefulness and enjoyment, it will, a jpriori^ be ad- 
 mitted that these two great ends as much depend upon a pro- 
 per training of the mental faculties, as upon the good health 
 and strength of the body. 
 
 The faculties in this class which fall under the care of the 
 nurse, are those which preside over voluntary motion and the 
 sensibility of the body, particularly to the skin, to the impres- 
 sion of surrounding bodies. Upon the proper cultivation of 
 these faculties depend, in a great measure, the future useful- 
 ness and happiness of the adult. A lounging and idle man 
 is never happy or useful, nor has he that mobility of muscle, 
 or expansibility of lungs, which fit him for those occasions 
 that peculiarly require the exertions of a man or woman. 
 Their existence is mostly vegetative. This subject, although 
 important, has hitherto claimed no part of the attention of 
 either parents or nurses — accident has alone governed. 
 
 The idle man or woman is eschewed by every useful citi- 
 zen — then, why should a child be permitted to be idle, how- 
 ever young, when it is not asleep ? As we indulge the body, 
 so we develop the mental faculties which hold a relation to 
 such indulgence. The great wish of most parents, and all 
 nurses, is that the child, even when awake, shall lie still and 
 be quiet ; if it do these, it is called a " good child," — yes, and 
 (138) 
 
THE VITAL FORCES. I39 
 
 euch children, without some unanticipated revolution, make 
 good men, but the goodness is of that kind which we denomi- 
 nate good-for-nothing. 
 
 Some children are said to be cross — that is, when not asleep 
 they are crying, and wherefore, for they are neither vicious 
 nor sick ? It is usually because of that condition of the sys- 
 tem which demands motion as the only means of relief, and 
 relief they usually obtain by crying, which gives exercise to 
 the lungs and most of the muscles of the body. When they 
 have cried enough to produce the necessary amount of fatigue, 
 they again fall to sleep. 
 
 When a child is cross, it is usually appeased by giving it 
 the breast, and through a desire of something to do, rather 
 than through a want of food, it sucks. The practice of feed- 
 ing children to quiet them, is attended with serious mischief. 
 The stomach being frequently filled to repletion, at length be- 
 comes to require that distension which repletion produces, and 
 thus the digestive function becomes impaired, and speedily 
 following it is an impairment of the general health. 
 
 This repletion, furthermore, if it should fail in producing 
 disease, by making a heavy demand upon the nervous system 
 to dispose of it, produces sluggishness and an indisposition to 
 motion, and finally plethora, and with it an aversion to mo- 
 tion, with dullness of mind. 
 
 To aid in manufacturing out of active and sprightly infants 
 stupid men, the cradle was invented, which by the lulling in- 
 fluence of its motion, keeps the child quiet, promotes obesity 
 and an indisposition to voluntary motion. In all our own 
 reflections upon living organized structures, we should remem- 
 ber that nature always secures an adaptation between all the 
 parts which are in anywise dependent upon each other. 
 Hence, if we train the child to rest, to an indisposition to 
 motion, all of the other faculties become adapted to this state 
 of things ; and nothing less than some extraordinary and con- 
 tinually active, or revolutionizing motive can efiect the neces- 
 sary change. A new order of development, in solid parts, 
 and new modes of action must become established. 
 
 If we are understood by our readers, it will be clearly per- 
 ceived by them that the old proverb, ''Bring up a child in the 
 way he should go," is as applicable here as in any portion of 
 
24.0 THE VITAL FORCES. 
 
 a child's education. Instead of being trained to inertia^ it 
 should be trained to motion ; therefore, as soon as it wakes it 
 should be taken up, and kept up, until the proper period 
 arrives for rest, and while it is up it should be carried about 
 that the various objects in the chamber may become addressed 
 to its senses. This motion of carrying it about, while an 
 infant, will give it, in a sensible nurse, all the motion it may 
 require, and its mind (which, for our present purpose, is only 
 the motion of the brain) will obtain all the action that may 
 be requisite. 
 
 By this mode of training, the faculty of motion will become 
 active, and more developed — motion will be demanded for its 
 gratification — this motion will promote a favorable develop- 
 ment of the pulmonary, arterial, and venous systems, and 
 nearly all the mental faculties, and gTeatly diminish the 
 chances for consumption and general feebleness of health. 
 
 Kow, what does it matter to a hired wet-nurse whether her 
 charge shall finally be an idiot or a Webster ? She is hired 
 to give it nourishment and to take such care of it as circum- 
 stances may force. The more the child will sleep and the 
 more quiet it is, the more time she will have for amusement 
 or her own selfish purposes. If the child be fretful and indis- 
 posed to sleep to stultification, she will, as they frequently do, 
 clandestinely give it laudanum. 
 
 Under this head there is another subject, which is highly 
 important, but perhaps less so than the one we have just con- 
 cluded; we allude to that mental faculty which, when pro- 
 perly endowed, forces us to personal purity or cleanliness in 
 all things. The child that is brought up in filth has the deli- 
 cate and healthful sensibility of the skin greatly obtunded. 
 If its training is commenced by keeping its skin and clothes 
 clean, it will, in a short time seek the cleansing process 
 for the ptleasure it afibrds it. By this attention the faculty 
 will be improved, the skin maintained in a delicate and health- 
 ful condition, and in future life, it will give evidence, by per- 
 sonal cleanliness, that it was educated under civilized influ- 
 ences. 
 
 By a reference to our closing remarks upon the functions of 
 the cerebellum, it must be perceived that now is the time to 
 commence the development of the lateral portions of the 
 
THE DEFEN-SIVE FACULTIES. 141 
 
 cerebellum, particularly with such children as may have a 
 small chest, because upon this depends their exemption from 
 consumption in future life. 
 
 By a proper attention to the skin, the organ of animal sen- 
 sibility is developed ; and by a proper exercise of the body the 
 organ of muscular motion is developed ; and under a proper 
 development of both, there is no danger of consumption, of 
 passive congestions of the brain, etc. 
 
 If, therefore, infants and young children be exercised until 
 they become fatigued, they will not require a cradle to put 
 them to sleep. We rejoice that in our exposition of the func- 
 tions of the cerebellum, we have placed the necessity of early 
 and thorough exercise beyond the reach of debate or possibility 
 of doubt. Every intelligent parent can comprehend how it is 
 that the life, health, and usefulness of his child are made to 
 depend, not upon the rest, sleep, and fat of the infant, but 
 upon as thorough attention to exercise as to food or rest. 
 
 Finally, neither infants, nor older children, should be 
 allowed to become fat — it is not a condition of healthy nutri- 
 tion, and a little interruption to it, is pretty certain to develop 
 cutaneous or other diseases. If its fat cannot be kept down 
 by exercise and a diminution of sleep, diminish also its food ; 
 but this reduction can generally be effected by exercise and 
 waking. By this early training, a vital system may be pro- 
 duced adequate to health, age, and usefulness. 
 
 SECTION II 
 
 OF THE DEFENSIVE FACULTIES. 
 
 Kesentfulness, fretfulness, harshness, and capriciousness of 
 temper never fail to render their possessor, and those asso- 
 ciated with and dependent upon them, unhappy, to say noth- 
 ing of murder and manslaughter, which are sometimes their 
 extreme results. A nurse, then, who is not particularly fond 
 of children, or who is irritable, impatient, and fretful, may 
 ruin the disposition of a child for life. If it cry much, it is 
 scolded and perhaps spanked, and these are the remedies for 
 
1^2 THE MORAL FACULTIES. 
 
 all its acts of disobedience, of willfulness, and of accident. 
 She sometimes calls them directly into improper action, as, 
 when the child hurts itself, it is taught to strike the object for 
 retaliatory satisfaction. 
 
 There is, perhaps, no quality in a parent or nurse so essen- 
 tial to the future happiness of children, as patience — forbear- 
 ance, and amiability of temper. Children should be taught 
 self government — and to this end the nurse must manifest it. 
 To suppose that scolding or whipping will put a child in a 
 good and pleasant humor, is about as consistent as to suppose 
 that an animal government can improve the moral faculties. 
 A child should never receive from a nurse, and much less 
 from a parent, a cross or angry word, nor should it ever hear 
 such words between its parents. 
 
 With all these objections, it is better that the child should 
 be sustained by a bottle, than by a wet-nurse whose mental 
 faculties have not been properly disciplined. 
 
 When children are taught to know that they can obtain no 
 gratification by crying for it, or by any exhibition of ill-tem- 
 per, they learn to effectually govern themselves. It but seldom 
 happens that either adults or children are discovered to persist 
 in a course of conduct that yields them nothing but disap- 
 pointment. The christian sect known as Friends or Quakers, 
 succeed better than any other people with whom we have be- 
 come acquainted, in teaching their children practical self- 
 government. 
 
 SECTION III. 
 
 THE MORAL FACULTIES. 
 
 The moral faculties of children are manifested at a very 
 early period, and any obliquity imparted to their action while 
 young, is but too apt to follow them through life. We have 
 frequently heard parents say that they would whip the faults 
 of their very young children out of them, when they got older. 
 Such an attempt as this would display as much ignorance of the 
 laws of the human mind, as an attempt to whip out of them 
 
THE MORAL FACULTIES. 143 
 
 the color of their hair or eyes, would an ignorance of the 
 physical. 
 
 In our southern states, a gentleman selects his most intelli- 
 gent and faithful servant to groom his horse, and usually the 
 most lazy, awkward, stupid, and lying maid he has to take 
 care of his children, simply for the reason that she is good for 
 nothing. 
 
 In the free states the case is no better — most generally no 
 inquiry is made about her parents, or about her own moral 
 dispositions, but, is she able to carry the child, and can she be 
 had for her food and a scanty wardrobe. 
 
 This subject is too important to be dismissed with only a 
 passing remark ; therefore, we beg leave to enforce its claims 
 upon the attention of parents, by two illustrations out of the 
 multitude we have. 
 
 In traveling through one of our southern states, we called 
 at a village hotel for dinner — the usual dining hour had 
 passed, and our only company was the landlady, a most ami- 
 able and excellent woman. Upon entering the dining-room, 
 we saw a servant girl, about nine years of age, with a child 
 on her hip — she had, strongly marked, the head of a mur- 
 deress. We turned to our hostess and addressed her thus : — 
 "Madam, do you wish to have your children murdered?" 
 She looked at us with astonishment, and answered, "No, sir !" 
 "Then, take that servant out of your family." With amaze- 
 ment, she remarked, " That brings to my mind what has hap- 
 pened." " What has happened?" we inquired. She replied, 
 "About two weeks ago my little son fell out of the second 
 story window ; he says that this girl pushed him out, but I 
 thought he must be mistaken, because I could not imagine 
 any one so cruel as to do so ; and a few days ago my little 
 girl came to me wet all over, and said that this girl put her 
 in the creek and tried to hold her under the water ; but the 
 servant, when challenged about it, said that the child fell in, 
 and this seemed to me to be the more likely, because I could 
 not believe any one to be so heartless as to drown a child." 
 We afterward learned that this girl was sent to the Louisiana 
 market. 
 
 Under circumstances almost similar, we inquired of a lady 
 
144 THE SOCIAL FACULTIES. 
 
 in Pennsylvania, if she wished to make thieves of her chil- 
 dren ? As may be presumed, she answered in the negative. 
 "Then," said we, "you will discharge that nurse" — a girl 
 about ten years of age. "It is a fact," observed the lady, 
 "she does steal, and I have corrected her for it several times, 
 but I never supposed that that would make thieves of my chil- 
 dren." We then remarked, "It is no business of ours, 
 madam ; but as the friend of children, we have admonished 
 you." 
 
 Ko one, who is the least informed upon the subject of human 
 nature can now doubt, that it is a matter of the first import- 
 ance that those who are to be associated with children, no 
 matter in what capacity, should be constantly under the influ- 
 ence of a chaste and moral mind. 
 
 We do not contend that it must follow that a child which 
 has been under the care of a thief will become one, because it 
 is both possible and probable that its native powers of intel- 
 lect and moral endowment will prevent it, but we still insist 
 that such influences upon infancy do blunt the moral percep- 
 tions — do impress them with an unfortunate obliquity. 
 
 The moral faculties consist of justice and stability, and it is 
 the duty of parents to train their children to a strict discharge 
 of them. Such is the native strength of these faculties in 
 children, that they are easily trained. The procrastination of 
 duties or the evasion of them, should never be tolerated. 
 When habits of honesty and punctuality are established in 
 early youth, they are apt to continue through life. 
 
 SECTION lY 
 
 THE SOCIAL FACULTIES. 
 
 These, like the moral, are manifested very early in life, and 
 consequently, on behalf of children, they claim our special 
 attention. 
 
 It is admitted, by all writers, that children are very imita- 
 tive, more especially in all things that pertain to manners and 
 habits. A woman, then, who sits, stands, walks, or dresses 
 
THE SOCIAL FACULTIES. ^45 
 
 in an -angraceful manner, should never be employed in a good 
 family, or trusted with the charge of a child, more especially 
 if a female. What can injure a woman more than ungrace- 
 ful manners ? And will not female infants as certainly ac- 
 quire them from their nurse as they do nourishment from her 
 breast ? In truth, the nurse should manifest good taste in 
 everything. 
 
 Furthermore, she should be so well-bred and kind in her 
 disposition that she would, in the child, awaken its sympathy, 
 even in behalf of a suffering worm ; and yet, she should pos- 
 sess no sickly timidity. Worse than all these, is that credulity 
 which delights in ghosts and hobgoblin stories — impressions 
 are thus made which the best subsequent education and the 
 most manly judgment cannot eradicate. Of all the vices of 
 a nursery maid, an attempt to frighten children into obedience 
 is, perhaps, the worst — they may recover from the evils of 
 every other species of mismanagement, but from those w^hich 
 this practice engenders, never. 
 
 In every age of the w^orld, the few have governed the many 
 through the instrumentality of their superstitious fears and 
 hopes. Man has ever been the dupe of his own credulity, and 
 no class of men are so universally unpopular as the fearlessly 
 candid — those who will not condescend to mislead their 
 fellows. 
 
 And, furthermore, it is remarkably strange that not less 
 than seventy -five per centum of men, in the formation of their 
 belief, make no distinction between the possible and impossi- 
 ble ; indeed, there are very many, even among the well- 
 informed, who are more likely to adopt the latter than the 
 former. A mere impossibility, like the " spirit rappings," 
 will more readily find advocates than a new demonstrability, 
 such as those discoveries of Galileo, Harvey, Jenner, and 
 Gall. 
 
 Upon a subject that admits of doubt, the people generally 
 do not search for the truth, but for evidence to sustain some 
 preconceived or selfish notion of it ; and under such an influ- 
 ence almost every child in the land is now being educated. 
 As people generally do not wish to see their trickery upon 
 this subject exposed, we shall pass on to an application of the 
 principle to the use of the nursery. 
 10 
 
146 THE SOCIAL FACULTIES 
 
 If there be a spot on earth in which candor, truth, honesty, 
 kindness, chastity, and forbearance, should supremely reign, 
 it is, in our opinion, the nursery of children ; and yet it is, 
 most generally, the private abode of deception and falsehood. 
 The nurse, and very frequently the mother, for the purpose of 
 securing her government over them, fill their minds with 
 superstitious fears that follow them to the close of life, in defi- 
 ance of their better judgment. What else has made almost 
 every man in the land a coward in the graveyard ? "We have 
 seen intelligent men in a graveyard shake with fear, as though 
 they had an ague paroxysm ; and we have seen them run, as 
 though a squadron of hostile Indians were after them. 
 
 A few months since, a servant girl in our own family was 
 told that we had two or three large boxes of human skulls in 
 our cellar ; she came home frightened into passionate crying 
 or bawling at the recollection of having been so frequently 
 exposed to an imminent danger of being devoured or taken to 
 the abode by his satanic majesty by ghosts or hobgoblins. 
 She sufiered immensely, and had her constitution been more 
 encephalic, it is possible that she might have been rendered a 
 lunatic for life. 
 
 Some pious and well-meaning parents often injure their 
 children to an irreparable extent. When the child is naughty, 
 they often tell him that unless he becomes better, the " bad 
 man " will carry him ofi*. After a short time he becomes 
 afraid to go into a dark place, lest the " bad man " might be 
 there ; but after innumerable admonitions of this kind, and 
 finding himself to have invariably escaped, he ceases to have 
 any fear of him, though he continues to avoid the dark, but 
 why he cannot tell. 
 
 The child has now become absolutely injured — prepared for 
 a reckless course of evil conduct. Instead of fearing the " bad 
 man," he suspects his parents for having imposed upon him, 
 and consequently he gives no attention to any of their admo- 
 nitions. 
 
 If they had understood the peculiarities of the infantile 
 mind, they could have, from such a government, anticipated 
 the result. Let it be remembered, then, that a child has not, 
 to an appreciable extent, either hope or fear as to any future — • 
 it acknowledges no future tense — it lives, hopes, desires, and 
 
THE INTELLECT. I47 
 
 fears in the present tense only. The parent, therefore, who 
 talks about a 7iereofte7\ another yjorld^ etc., has great need 
 of a teacher for his own mind. And such a teacher is now 
 needed throughout the whole land. And upon thi& principle, 
 if the time which is now devoted to the religious instruction 
 of children, up to puberty, was directed, with the same atten- 
 tion at home and at (Sunday school, to natural history and the 
 moral relations of society, we would have, comparatively, but 
 few bad boys, and many more and better christian men. 
 "We do not entertain a single doubt but that this doctrine will 
 become universal in practice ; but, as we are fully apprised, it 
 will be a long time first — not until teachers, generally, shall 
 understand the juvenile mind, and preachers and legislators, 
 the adult. 
 
 We have said enough to indicate to every parent his duty 
 to his children in this relation, and upon the discharge of this 
 duty, in a great measure, the happiness of the adult and the 
 good of society depend. 
 
 Finally, under this head, a woman should not be intrusted 
 with the charge of a child, unless she manifested good taste, 
 amiable feelings, courteous manners, and a truthful intercourse 
 with the children and domestics. 
 
 SECTION V 
 
 THE INTELLECT. 
 
 If women, intellectually, were generally constituted like 
 men, we would have much to say upon this subject; but, for- 
 tunately, most women know something, while most men have 
 learned something; — we speak, more particularly with refer- 
 ence to the Americans, the Scotch, and Irish. To find a Ger- 
 man who does not know something, is impossible, though he 
 may have learned but little — we allude to the function of ob- 
 servation as directed to material things. 
 
 The faculties concerned in this function are the first of the 
 intellectual which become developed — they enter upon their 
 duty, feebly it is true, at birth ; and a properly-constituted 
 nurse will avail herself of every possible means to gratify 
 
148 THE IIS^TELLECT. 
 
 them, as being the best means of employing the attention of a 
 child. Witness the anxiety of infants to gratify their senses 
 of hearing, tasting, smelling, seeing, and feeling. This fact 
 indicates the proper duty of the nurse. 
 
 But women who are defective in these faculties resort to 
 every other possible means to entertain the child, except those 
 indicated by nature. She will sing to them, rock them, but 
 never show them any unfamiliar object. K old enough to 
 listen to her, she will entertain them by a recitation of non- 
 sensical stories. As soon as the child begins to notice objects, 
 it should be trained to love nature, not alone for its happiness 
 and usefulness, but in order that its mind may always find an 
 employment more agreeable than tippling, gambling, or any- 
 other variety of dissipation. 
 
 By this early neglect of the perceptive powers of children, 
 they do not become either sufficiently developed or active to save 
 future life from unprofitable abstractions and worthless specu- 
 lations upon all of the most useful or momentous concerns of 
 life. 
 
 In view of what has been said in the two preceding chap- 
 ters, what must be the maternal constitution of the woman 
 who could willingly or indifferently resign her child to the care 
 of a wet-nurse ? Will any one contend that a husband should 
 not find, in such a fact, an ample plea for a divorce ? 
 
CHAPTER VI, 
 
 OP PERSONAL ATTENTIONS TO THE CHILD, 
 
 SECTION I 
 
 WASHING THE CHILD. 
 
 This duty should be performed by the mother herself, but if 
 she cannot, or should not, she should at least be cognizant of 
 it. The first part of the duty involves two important ques- 
 tions, and we, of course, have a choice in both, and if we fail 
 to sustain our preferences, our readers can adopt the contrary. 
 
 The skin of the child, at birth, is covered with a pecu- 
 liar (we will not say " impurity," because nature uses nothing 
 that is impure in the construction of her works), which was 
 essential to its mode of fetal existence ; it is tenacious, and of 
 a soft gummy consistence. Now, the question arises, is it best 
 to remove the substance immediately after birth, before it 
 dries, or suifer it to remain, dry upon the surface, and finally 
 scale or peel off? Both opinions have its advocates. 
 
 It is to be considered, that while this substance was essential 
 to fetal life, it cannot be so to a directly contrary mode of ex- 
 istence ; and to render this conclusion still more obvious, we 
 have but to refer to the fact that it interferes with the func- 
 tion of the skin about as much as would a coating of wax. 
 This is not all — it becomes more or less putrid and ofiensivo 
 to the smell. Furthermore, when it is permitted to remain 
 and dry upon the skin it becomes a source of mechanical irri- 
 tation, and of such an excoriation of some parts, particularly 
 about the joints, as to require medical attention. For those 
 reasons we advocate the immediate and thorough washing of 
 the child before it is dressed. 
 
 (149) 
 
150 WASHING THE CHILD. 
 
 Anotlier question now arises of even greater moment than 
 the preceding; it is, whether this washing should be efiected 
 with warm or cold water ? Both opinions have strong advo- 
 cates. We prefer the former, and for various reasons, which 
 to us are insuperable. 
 
 The second great and indispensable want of a child is heat, 
 as all that it now has, came from the mother, and all that it 
 will have, until digestion and nutrition shall have been 
 effected, must be at the expense of its body, for the oxygen 
 that enters the lungs cannot produce heat without something 
 to combine with. Some infants may have a little fat to spare 
 for such a purpose, and might not suffer any further, under a 
 cold washing, than an unnecessary waste of some of it ; but 
 the case is far different with one that is lean, emaciated, and 
 feeble, which has nothing out of which animal heat can be 
 produced. 
 
 The first want of an infant, at birth, is air, and, unless 
 it be immediately had, death ensues ; and, as we have before 
 remarked, the next want is animal heat, and unless that with 
 which it is born, be protected, death is as certain as it is in 
 the fii-st instance ; therefore the washing of an infant with 
 cold water, immediately after birth, is a direct effort to destroy 
 it, however contrary the motive for such a practice may be. 
 That death has sometimes occurred to such infants from cold 
 washing we have not a doubt. We are fully convinced that 
 the physician who would sanction it upon any child, but more 
 particularly upon the feeble, does it without the sanction of 
 science. Yery young infants rarely take food enough for the 
 production of repair and the development of animal heat, 
 and hence the necessity of taking special care to keep them 
 warm ; consequently it should not be touched with a cold 
 hand or cold air, during the first months of its existence. 
 
 Cold water is used by its advocates to make the child 
 "strong." Cold water, further than a tonic influence upon 
 the nervous system, has no strengthening virtues, and even in 
 this respect, when used out of place, will produce disease. 
 A well child then, has no need of it — would probably be in- 
 jured by it. In adults, when digestion is all the time pro- 
 ducing material for the production of repair and animal heat, 
 we admit it to be frequently useful ; but in new-born infants 
 
WASHmG THE CHILD. 151 
 
 all the facts are reversed — they have no heat of their own, nor 
 material for repair — and yet heat is a sine qua non to their 
 existence. How then is it possible that the abstraction of 
 their borrowed heat, which they have not the means of re- 
 placing, except at the expense of their bodies, can strengthen 
 them ? 
 
 There is yet another powerful argument in favor of our po- 
 sition. Eecent experiments have shown that infants have less 
 power to produce animal heat than adults, in the proportion 
 of 80° to 96°. This fact is illustrated by the efforts which all 
 warm-blooded animals make to keep their young warm. The 
 infant has just emerged from a temperature of 97° or 98°, into 
 one of 65° or Y0°, and with less power than the parent had by 
 16° to produce that temperature which is essential to its exist- 
 ence. Under such circumstances, it would require the abstrac- 
 tion of but a few degrees to destroy it. 
 
 It should be remembered that the child has just been re- 
 moved from a temperature of 98° to that of the mother's cham- 
 ber, which is much below it — respiration and metamorphosis 
 have been rapidly increased to maintain its existence, in the 
 reduced temperature into which it has been introduced ; con- 
 sequently, the obvious and most rational conclusion must be, 
 that it should be washed with water at or about blood-heat. 
 
 The advocates of cold water refer us to the practice of savage 
 tribes. What do savages know about the difference between 
 the dynamics of a child and those of an adult ? They know 
 that an adult will not, usually, suffer by an immersion in cold 
 water, if immediately after, he is enveloped in a blanket. But 
 we have shown that there exists a wide difference between 
 the conditions of an infant and those of an adult ; for a sav- 
 age will infer, through an ignorance of this difference, that if 
 cold water will not injure an adult, it will not injure a child. 
 ISTor is this all ; we have yet to be assured that savage mo- 
 thers prefer cold water. Those acquainted with savage habits 
 state, that women delivered of children while traveling, wash 
 them with cold water ; but this does not prove a preference 
 for it. Some savage tribes, as soon as an infant is born, 
 straighten it out and strap it fast to a board ; we should do 
 this also, if savages are to be our instructors. 
 
 Having: arrived at the conclusion that it is far better and 
 
152 WASHING THE CHILD. 
 
 safer to wash infants with warm water than cold, by a refer- 
 ence to facts which we confidently believe cannot be over- 
 ruled or set aside, we proceed now to the discharge of the 
 duty. 
 
 It has been very generally recommended, that, preparatory 
 to washing, the infant should be " smeared " all over wdth 
 fine lard, and then with fine soap it should be cleansed. "We 
 admit that a mild soap is preferable to strong soap, but as all 
 soap or alkaline substances have more or less a destructive in- 
 fluence upon the epidermis, we would recommend, in lieu of the 
 lard and soap, fine warm and thin flour paste. This will 
 unite with the fetal substance upon the skin, which can then 
 be removed by the use of warm water, and a flannel rag or a 
 piece of sponge. Much care is requisite to remove all the 
 fetal substance, which is the great object of the washing, from 
 all the folds and flectures of the skin, no portion can be left 
 that will not do subsequent mischief, more especially in the 
 duplications of the skin. 
 
 Some people add to the water brandy or whisky ; this is 
 worse than useless — it is mischievous — it produces an irrita- 
 tion of the skin, and as it evaporates with more rapidity than 
 water, it will aid in the abstraction of the animal heat. We 
 have stated that heat is indispensable to infants, and for this 
 reason there should be no current of air about the child while it 
 is being washed, because it promotes evaporation. 
 
 SECTION II. 
 
 OF THE DRESS OF THE CHILD. 
 
 The dress of a child should always be arranged and adapted 
 SO as to secure its comfort, health and growth, or development, 
 and these ends cannot be answered without a proper tem- 
 perature, and an entire liberty of motion in every muscle 
 it has. 
 
 The practice of swaddling children, which is still in use in 
 some old communities and countries, for they are always the 
 least progressive, should be entirely abandoned. Dr. Dewees 
 thinks that this practice probably originated in the deformity 
 
WASHING THE CHILD. 153 
 
 which rickets produces, mistaking an effect of a disease, for a 
 fault of nature. This opinion, however, we think to be erro- 
 neous. For some of our Indian tribes practice it to secure to 
 the child what they conceive to be a proper form, and in Tur- 
 key, the midwives swathe the heads of infants into that shape 
 which best suits the turban. No matter how it originated, it 
 is a vile and mischievous practice. If every species of the in- 
 ferior animals can obtain their proper form without swaddling, 
 what reason can be assigned why the human progeny should 
 not ! Is it not very probable that if the young greyhound or 
 buck was so swaddled, when young, that he could not use his 
 limbs, that he would not exhibit that activity and grace of 
 motion which distinguishes him in age ? 
 
 K its inutility, in this respect, was the only objection to it, 
 we might tolerate its use to gratify those simpletons who desire 
 the practice of it ; but the mischief it does, beside the suffer- 
 ing it inflicts, is too great to admit of justification in a single 
 instance. Dr. Dewees thinks that, inasmuch as the child was 
 bound up in the smallest possible compass, it ought to have 
 entire liberty after it is born. We admit his conclusion as % 
 fact, but we have no sympathy for the child in consideration 
 of the cause he assigns. If the condition of the fetus had been 
 uncomfortable, nature would never have adopted such an ar- 
 rangement. It may be well questioned, whether the fetus is 
 capable of pleasure or pain — comfort or discomfort — but to the 
 question. 
 
 So far as comfort is concerned, let any one confine his limbs 
 in one position for an hour or two, and he will hiow something 
 of the suffering wliich the child must endure before the faculty 
 of motion can become adapted to such a condition of the 
 muscles. But if this terminated the mischief of the practice, 
 it might be suffered. It is well-known that the exercise of the 
 muscles facilitates the circulation of the blood, and conse- 
 quently, strengthens both the heart and lungs ; furthermore, it is 
 well known that in atmospheric or animal life, a part is not 
 developed unless it is exercised, on the contrary, it decreases. 
 A child thus swathed may get fat, but fat performs no func- 
 tion — it is not organic development — it gives capacity to nei- 
 ther body nor mind. 
 
 Exercise, to a child, is as indispensable to its health and 
 
154: WASHING THE CHILD. 
 
 development, as it is to an adult ; consequently we contend that 
 it should have entire liberty to throw its little arms and legs 
 about, whenever it may be impelled to do so, by its faculty of 
 motion — motion Avas the means provided by its Creator for 
 equalizing and expending the nervous accumulations of the 
 animal system. Mothers have too much attachment for their 
 infants to deny them this privilege, after having been caused 
 to observe how much they enjoy it. 
 
 After providing for the liberty of the child to kick and 
 scratch as much as it pleases, we proceed to the consideration 
 of its clothing with reference to its comfort and health. ISTon- 
 conducting substances, such as wool and silk, should always 
 constitute the under clothing during cold weather. Its shirt 
 should be white silk or fine white flannel, we say white flan- 
 nel because it is always softer than the red — because it is 
 warmer, in having less power to radiate caloric, and because, 
 for the sake of decency, the mother will be induced more fre- 
 quently to change it. 
 
 As flannel and silk are preferable to other fabrics only 
 because of their non-conducting power, it follows that they 
 should be used only w^hen it is requisite to retain the tem- 
 perature of the child ; but when the weather is warm and 
 the child uncomfortable from a too great retention of its ani- 
 mal heat, the flannel should be replaced by cotton or linen, 
 and, as a medium, betw^een the two extremes of temperature, 
 a cotton fabric, known as canton flannel, is excellent. What 
 the waiter has said upon the utility of flannel, has been more 
 upon the authority of others, than from his own convictions, 
 growing out of his experience ; with himself, he has found the 
 cotton fabric, above named, far better for him than flannel, 
 and he is decidedly of the opinion, that it would be better for 
 most persons, and even for children. In the case of infants, 
 however, a w^oolen frock should succeed the canton shirt. 
 
 Dr. Dew^ees teaches that when the flannel becomes uncom- 
 fortably warm to the child, it should be removed, and that in 
 case the weather changes to a colder temperature, it should be 
 replaced ; in fine, he thinks that it should be used and disused 
 as indicated by the thermometer ; we think so too, but not as 
 an under garment. If flannel be used as a shirt, it should be 
 put on in the faU and taken ofi' between the first and the mid- 
 
WASHmG THE CHILD I55 
 
 die of June, and its removal should be in the morning ; but no 
 matter at what time, or under what circumstances it be dis- 
 pensed with, the child will be liable to take cold. The impos- 
 sibility of changing the undershirt of a child, without a hazard 
 to its health, constitutes the great reason why we would 
 recommend the cotton flannel — it can be worn all the year, 
 while the comfort of the child can be regulated by a change of 
 its other clothing. 
 
 K fever should supervene during the period that the child 
 wears flannel, we agi*ee with Dr. Dewees, in recommending 
 its removal upon the accession of the fever, and its replace- 
 ment at the close of the sweating stage ; under such circum- 
 stances there is no danger that the child will take cold. 
 
 The following quotation from Dr. Dewees, we think, is preg- 
 nant with a flagrant error, and if the duty it inculcates were 
 strictly observed the mischief would be very considerable. 
 He says, " Examine the skin of a new-born child, and you 
 will find it almost constantly cold, unless well protected by 
 clothing made of materials which are bad conductors of heat, 
 and hence the absolute necessity of maintaining this condition 
 by suitable means." 
 
 The remarks apply with equal truth to all women of a 
 rather full or lympathetic habit who are not accustomed to 
 laborious pursuits, and yet they are perfectly comfortable, and 
 the use of such means as would keep their skin warm would 
 render them exceedingly uncomfortable. 
 
 In the month of August, when the temperature in the shade 
 is nearly that of blood heat, when the child would be perfectly 
 comfortable without any clothing, when removed from a cur- 
 rent of air, its skin will be found to be cold. This coldness of 
 the skin, then, in neither women nor children, indicates a 
 want of clothing. Such women as we have indicated are 
 rarely seen to perspire, except upon such portions of their sur- 
 face as are so bound by their clothing as not to admit of insen- 
 sible perspiration ; and the same remark is true of infants. 
 This coldness, then, results from cutaneous evaporation — the 
 ready means which infants and such women as indicated, 
 have of parting with their superfluous animal heat — it is their 
 means of being comfortable in hot weather. 
 
 Inf/.nts do not perhaps, nor in health maintain, a higli 
 
156 WASHING THE CHILD. 
 
 temperature, but to this end the mother's milk contains more 
 sugar than that of any other recollected animal, and such is 
 the constitution of the subcuticular substance that they readily 
 part with any excess they may have, by insensible perspira- 
 tion and evaporation, and when they are seen to sweat, the 
 cause exists in fever, in a room insufficiently ventilated, or in 
 too much clothing. 
 
 There is sometimes an unconquerable incompatibility be- 
 tween jlannel and the cutaneous surface of some infants ; it 
 may be detected by the child's constant expression of unea- 
 siness, and even fretfulness, without any apparent cause, and 
 by an efflorescence spreading over the body, which disap- 
 pears by a removal of the flannel. 
 
 Up to the time when the child begins to crawl, it matters 
 nothing how long its frocks may be, provided they be not so 
 twisted or tied about the feet as to restrain any variety of mo- 
 tion ; but when they begin to crawl, which is generally about 
 the eighth month, they should be so short as to allow it 
 an entire freedom of its feet and ankles. Long clothes, by 
 causing it to stumble, or by causing a feeling of restraint, be- 
 get in it a fear to make an effort, which greatly retards its in- 
 dustry in efforts at motion. A mother's vanity in the appear- 
 ance of her child very frequently retards its prosperity ; but they 
 should sacrifice their vanity upon the altar of the child's utility. 
 
 As soon as it becomes expedient to shorten the child's 
 dresses, its feet and legs should be dressed in shoes and stock- 
 ings, especially in cold weather. It is of the first considera- 
 tion to keep the child dry, which, from the nature of its wants, 
 will require very frequent attention. It is true that some peo- 
 ple, and even teachers are not very fastidious upon this subject, 
 maintaining that the wet and cold to which the child is ex- 
 posed by the nature of its excretions, will only tend to strengthen 
 its constitution. IS^ature's plan for strengthening the constitu- 
 tion is by the use of nutritious and digestible food, and sufficient 
 exercise of the body in the open air, when its condition is 
 neither too hot nor too damp. It is of advantage to no animal 
 to be either wet or cold, except to the cold-blooded. 
 
 A little investigation of this matter will expose its absurd- 
 ity. We have maintained the propriety of keeping the child 
 warm, for the promotion of its digestion, secretion and devel- 
 
WASHII^G THE CHILD. 157 
 
 opment ; now what must be the effect of wet clothes upon 
 it. The damp or wet clothing reduces the temperature of the 
 child by combining with its caloric to the formation of vapor, 
 and thus the clothing is finally dried at the expense of its 
 animal heat. Under such a circumstance the child must bo 
 exceedingly vigorous if it do not seriously suffer. The three 
 great functions which are promoted by a high temperature, 
 must become less perfectly performed, and that too, as a mat- 
 ter of course, at the expense of the child. This is not all, the 
 skin of the child may absorb a portion of the matter which it had 
 excreted as unfit for any purpose in its economy, l^or is this 
 all, so long as the wet clothes are in contact with it, insensible 
 perspiration will be arrested, and thus other matter which 
 would have been excreted is retained to answer no other pur- 
 pose than one of mischief. 
 
 In the face of these consquences of wet clothes upon a child, 
 how is it possible that one would permit a wet diaper or other 
 clothing to remain upon it for a single moment ? Even hogs 
 will not lie down in their own excretions ; then worse than 
 hoggish must be the decency of those who attempt to justify it 
 in children. In securing the child's clothes to its person tapes 
 should be used in all instances of the usual fastenings, so as to 
 exclude, as far as possible, the use of pins, and more particu- 
 larly the small ones, for under the best care, they will some- 
 times prick the child ; and being handled and nursed by other 
 children of more age, they are certain to do it, and above all 
 a needle or headless pin should never be used, because of the 
 danger of becoming entirely introduced into the flesh of the 
 child. The serious injuries which young children have 
 received by them should be a sufficient admonition to mothers 
 and nurses for all time to come. 
 
 There is yet, to the infant, an indispensable article of dress 
 which claims from us a few remarks, it is the navel or belly- 
 band : — its use is twofold ; it sustains the walls or parietes of 
 the abdomen from unequal and therefore injurious distension, 
 in paroxysms of coughing, crying, and sneezing; its other im- 
 portance is admitted by every woman, though she may not 
 very well understand its philosophy. The umbilical cord, con- 
 sisting of vessels passed from the inside of the fetus through 
 the walls of its belly, and thus connected it with the mother, 
 
258 WASHiisrG the child. 
 
 and throiigli whicli it was nourished and sustained by her, 
 is divided, and most generally the hole into the belly closes 
 quickly and strongly, but sometimes it does not, and the child is 
 exposed to the danger of rupture of the bowels, or a portion of 
 the caul or omentum, in an effort of coughing, or by some 
 other improper motion of the abdomen. 
 
 To prevent the possibility of this rupture, the belly-band 
 has been used from a time more remote than any written his- 
 tory ; and the more certainly to secure, as it is supposed, the 
 child against this accident, it is generally applied so tight as 
 to create the same mischief through other openings of the belly, 
 as those into the groin, and into the scrotum of the male. 
 
 The belly-band should be worn four months, and even 
 longer, if there be any obvious tendency to rupture at the navel; 
 and to avoid producing a rupture at any other point, it is ob- 
 vious that the band should not be drawn so tightly as to con- 
 tract the cavity of the abdomen. In other words, the whole 
 object of the band is to keep the abdomen, in defiance of all 
 the motions the child may make, in its normal condition, and 
 to secure this end, the band should be so elastic as to adapt 
 itself, more or less, to the motions of the belly ; and to answer 
 this purpose a single piece of flannel, and if cut obliquely 
 across its structure, so much the better, may be applied around 
 the body two or three times. 
 
 A few words more upon changing the clothes of children, 
 and we conclude this Chapter. It is a wide-spread opinion 
 that the frequent changing of dress in children, is detrimental 
 to their health, and in confirmation of the opinion we are confi- 
 dently refferred to the chubby red-faced children of filthy hovels. 
 It is proper to remark that the appearances of these children 
 do not indicate, to a physiological observer, the existence of a 
 good constitution — their condition is one of grossness — of 
 plethora, and hence their liability to loathsome and fatal 
 diseases. 
 
 The frequent changing of the clothes of children, if they be 
 imperfectly dried and ventilated, will be attended with mis- 
 chief; but the keeping of children cleanly clad, other things 
 being equal, is indispensable to the founding of a good con- 
 stitution. But to filthy clothes there are obviously great 
 objections. To make ourself understood, conceive a diaper, 
 
FEEDING THE CHILD. I59 
 
 which has been wetted five or six times, dried and replaced, 
 and then to the question, is it mechanically fit for the child ? 
 will not its roughness and stifihess irritate and even excoriate 
 the skin ? Let it be further remembered that it is stiffened by 
 substances which were eliminated from the system as being 
 unfit to be used in its further development, and when they are 
 again dissolved by the next wetting the child gives it, they 
 are in a proper condition to be absolved by the already chafed 
 parts to which it is applied. To feed the child upon its 
 own excrements, to use strong language, would not be more 
 improper, because the one is equivalent to the other, except 
 perhaps, as to quantity. 
 
 SECTION III. 
 
 OF FEEDING THE CHILD BY THE MOUTH. 
 
 In the fourth Chapter we have shown, we think, beyond the 
 possibility of a doubt, that there is no food so compatible 
 with the health and development of the child as the milk of the 
 mother, except when contra-indicated by strong and cogent 
 reasons. We have shown the almost numberless dangers to 
 which infants are exposed by being confided to the care of wet- 
 nurses, and to the remarks which we have already made, we 
 will here add, that we hold any mother to be culpable who 
 permits any other mother to suckle her child, even for one 
 time, which is nevertheless a common practice in the round of 
 female visiting. The child of one who is simple in all her 
 habits, will certainly suff'er from the milk of one who is luxu- 
 rious in her habits. But further than this ; how can any one 
 mother know the constitutional peculiarities of another ? In 
 every such instance, though it be one of courtesy, the mother 
 exposes her child to a hazard. 
 
 Notwithstanding all the arguments that can be used in fiivor 
 of a mother nourishing her own child, it does frequently hap- 
 pen that she cannot do it, and it does as frequently happen, 
 that a wet-nurse cannot be had, and yet every dictate of paren- 
 tal fondness and of humanity declares that the cliild shall bo 
 
IQQ FEEDING THE CHILD. 
 
 noTirished ; and that too by food, which, as regards the child, 
 ma_y be considered as artificial. 
 
 The lacteal glands of some women do not make provision 
 for the support of the child as soon as it is born, or even within 
 several days. It becomes our duty then, in the meantime, to 
 provide for the child an artificial food, which shall as nearly 
 as possible, resemble the milk of the mother, under such cir- 
 cumstances ; which is done by mixing two-thirds cow's milk, 
 one-third water, and then sweeten with loaf-sugar. Upon this 
 the child can be sustained until the mother's milk shall come, 
 and even afterward, if she do not produce enough. 
 
 Other teachers, under such circumstances, recommend, in 
 view of making the food more nourishing, the boiling of the 
 pulp of biscuits in water or fresh milk. We object to it, be- 
 cause it and every other variety of farinaceous food, is liable 
 to, and usually does, ferment — ^become acid, and produce flatu- 
 lence, colic, the iliac passion and death. Some recommend 
 panadoes and gruels, seasoned with sugar, spices and wine. 
 As there is neither spice nor wine in the milk of the mother, 
 no other argument need to be adduced to prove the use of the 
 two latter to be injudicious and consequently hurtful. 
 
 There are others again, who would so far simplify the food 
 of infants, as to deny to it the use of sugar. With this pro- 
 hibition, how is the system of the child to furnish its requisite 
 animal heat ? We desire in all things to make nature our 
 guide, — we have neither the folly, the pride nor the vanity, to 
 believe that we know better than she, as to what is best. She 
 has put into the mother's milk more water and sugar, than 
 she has into that of the cow ; and she has made the mother's 
 milk the best food for the infant, hence when her milk is not 
 to be had, we feel commanded by her to make, by the mixing 
 of other substances, as close an imitation of it as possible. 
 We do not pretend to say that the substitute which we recom- 
 mend, as much becomes the condition of the child, as the mo- 
 ther's milk would — it sometimes produces evil consequences, 
 as flatulence, colic, etc.; but these evils can be greatly reduced 
 by giving a proper care to attending circumstances. 
 
 The most important of these circumstances is, that the milk 
 should be from a healthy cow, and one that is not entirely fed 
 upon slops, nor one that is constantly confined in a close pen, 
 
FEEDING THE CHILD. 161 
 
 nor yet from one that is greatly reduced from the want of food ; 
 in fine, all the circumstances connected with her should be 
 compatible with health and vigor. All that we had to say 
 about wet-nurses, applies now to the cow. As such milk as 
 we are now recommending can but rarely be had in our cities, 
 we have one great cause of the mortality among city 
 children. 
 
 Furthermore, the milk should, if practicable, be always taken 
 from the same cow, and mixed with warm, sweetened water, 
 and fed to the child fresh from the cow, and it should not be 
 made sweeter than the mother's milk. As these rules cannot 
 always be observed, we will add a few others to meet contin- 
 gencies. If milk cannot be had fresh from the cow when 
 wanted, it should be kept cool, either by the use of ice or a 
 frequent change of cold water ; it should never be skimmed, 
 nor should it be heated over the fire, as there would be con- 
 stant danger of scalding it, — the one-third water that is to be 
 added should be made hot, which will warm the milk, and if 
 this is not always practicable, a sand-bath should be used. 
 
 It is proper to observe, furthermore, that the mixture should 
 be fed to the child as soon as made, and that no more be made 
 upon any one occasion, than it will take in a short time. If 
 the milk at any time should exhibit a tendency to acidity, it 
 should not be used, for no reliance is to be placed in the pre- 
 vailing opinion among women, that a little more sugar will 
 correct the evil, while in fact, the sugar, whether little or much, 
 only increases the evil under such a circumstance. So far as 
 the child is concerned, the milk is ruined and cannot be 
 restored. 
 
 There are two practices in society very prevalent, which, 
 though not injurious when the mother is the agent, are never- 
 theless disgusting, but when other persons are the agents, they 
 may prove highly injurious. We allude to the nurse passing 
 the child's food through her own mouth before giving it to the 
 child, and of blowing upon it to cool it. Time should always 
 be allowed for the atmosphere to cool the food, and children 
 should be taught to await the process. If this were practiced 
 upon all children it might aid the American people in finding 
 time enough to take their meals. 
 
 But to refer again to the disgusting practice above-named, 
 11 
 
362 FEEDING THE CHILD. 
 
 what security can the mother have that the saliva of the nurse 
 will not poison her child ? Safety and decency both demand 
 the abandonment of so filthy a practice. But we are told that 
 the child cannot chew its food. We answer, that whenever 
 its stomach is ready for such food, it will have teeth to masti- 
 cate it. If people could only learn to observe nature's arrange- 
 ments what an infinite number of blunders they would avoid. 
 
 We are admonished by highly respectable teachers, not to 
 feed children with food that is too warm, because it may burn 
 the mouth and will relax the coats of the stomach. The first 
 part of the admonition was uselessly given, because there is 
 no nurse so silly as to burn the child's mouth ; and if there be 
 any truth or probability in the second, we should profit by it, 
 and apply cold cloths over the region of the stomach, or give 
 them ice water to promote digestion when it is feeble. ( ? ) 
 To assert that warm blood in the arteries relaxes their coats, 
 would indicate as much common sense, or as much knowledge 
 of nature's arrangements, as to assert that warm food, or 
 such as a child can swallow, because of its temperature, or of 
 any other temperature below scalding, will relax the coats of 
 the stomach. 
 
 On the contrary, digestion is promoted by warm food and 
 drinks, and by all other means of increasing, in a healthy 
 manner, the temperature of the stomach, and after feeding 
 there is nothing more grateful to the child than the applica- 
 tion of a warm hand or a warm flannel and gentle friction 
 upon the region of the stomach. Nor is this all ; it is better 
 for the child, after feeding heartily, that it should be kept 
 awake, provided it can be so exercised as to increase its tem- 
 perature, than that it should sleep.* 
 
 It has been clearly shown by experiment that digestion is 
 promoted by an increase of temperature, over and above that 
 
 * It is better at all periods of life, that after feeding, the mind should be 
 agreeably amused and the body exercised, but not to fatigue. Of this truth we 
 have become convinced from both observation and experience. The writer stu- 
 dies from six o'clock in the morning, in summer, to dinner, no matter at what 
 hour it comes — after dining he follows some kind of manual labor for three hours, 
 and then returns to his study, and even then, in consequence of imperfect di- 
 gestion, his drowsiness sometimes drives him again to labor, before the close 
 ©f another hour. He has thoroughly tried both this and the sleeping practice, 
 and has found the former alone compatible with his health and his duties, 
 
FEEDING THE CHILD. Ig3 
 
 of 98°, or blood heat, and it is equally well-known that exer- 
 cise, avoiding fatigue, will elevate the temperature, and that 
 during sleep it will fall to 96°, and even lower ; hence it is 
 obvious, in view of these facts, that it is better to exercise 
 than to sleep after eating. 
 
 It is well known that students of medicine, particularly 
 those who have been accustomed to active habits, find it very 
 difficult to give attention to the afternoon lectures — they desire 
 to sleep, and sleep may be taken by those who have a strong di- 
 gestive system, but those in whom this system is feeble should 
 not indulge, — they should exercise in something that will 
 amuse the mind, consequently it would be wise in them to 
 unite in clubs and employ a fencing teacher, to exercise them 
 for one hour after dining. By this course they would improve 
 their digestion, their health, and at the same time acquire 
 such a command of a walking-stick, as to defend themselves 
 successfully against dogs and those bipeds who use dirks and 
 bowie-knives. 
 
 Infants at the breast, in general, spontaneously stop when 
 they have fed enough ; but when otherwise fed, they cannot 
 judge so well, and hence they are very liable to feed too much. 
 This circumstance should command the particular attention 
 of the nurse, otherwise the stomach will sometimes be painfully 
 distended, which will most probably be followed by colic or 
 diarrhoea. 
 
CHAPTER VII. 
 
 THE NUESERT. 
 INTEODUCTION. 
 
 The normal activity of the various organs and systems of 
 organs of which our bodies are composed, are followed by 
 agreeable sensations, or constitute what we call enjoyment or 
 happiness, and as this activity promotes the development of 
 all the parts thus active, by adding to their magnitude and 
 strength, and by increasing their facility of action, it follows 
 that every person who is able and properly considers the im- 
 portance of the subject, appropriates a part of his mansion to 
 the purposes of his children, which is called the nursery. 
 
 In its arrangements, then, it should be adapted to all of the 
 important functions, and their most normal modes of mani- 
 festation, as rest, digestion, respiration, circulation, and of 
 course, voluntary motion, domestic, intellectual and moral emo- 
 motions, and social amusements. To answer all these indica- 
 tions it follows, that the nursery should not consist of some, 
 otherwise, waste part of the house, nor of any indifferently cir- 
 cumstanced portion of it, but of such a portion as will an- 
 swer the great purpose for which it is, or should be intended, 
 namely, the production or manufacture of the future mothers, 
 fathers, scholars, soldiers and statesmen of the commonwealth. 
 
 "We never witness the attentions which are bestowed on 
 horses that are intended for the turf or for the perpetuity of 
 the species, without a feeling of shame for the human race. 
 Every natural ordinance that holds relation to his physical and 
 mental constitution is infracted or disregarded in his youth, 
 and yet, in future life, his want of intellect is taken advantage 
 of by the sharks of society, and if his moral manifestations 
 (164) 
 
THE NURSERY. 165 
 
 shall discord with the standard of society, punishment is sub- 
 stituted for that training which he ought to have had ; and 
 if his physical system is too feeble to discharge its required 
 functions, he is pitied and looked upon as one upon whom 
 his Creator has frowned. 
 
 Every animal pursues that course which was prescribed for 
 it by the Author of its existence, except man and those over 
 which he has exerted his supremacy. He disregards that 
 cause — insults all of its ordinances — suflers in his own person 
 or in that of his progeny, the consequences — repines at his 
 misfortunes, and finally refers them to either an unkind or a 
 very mysterious providence ; but never reflects upon his own 
 disobedience to those institutions which were intended to 
 secure to him health, happiness and prosperity. 
 
 SECTION L 
 
 LOCATION AND CONSTRUCTION OF THE NUKSERY. 
 
 Having in the preceding introduction indicated the para- 
 mount importance of a family nursery, we shall, perhaps too 
 briefly, treat of its arrangements, and indispensable provisions. 
 
 It should consist of at least two rooms, one for rest and one 
 for exercise. This arrangement has many advantages beside 
 those indicated ; it allows the superintendent the opportunity 
 of having both alternately ventilated and thoroughly cleansed 
 without any exposure of the children to cold, wet, or dust, 
 and the last, is by no means a circumstance of trifling impor- 
 tance to young children, when we reflect upon the great deli- 
 cacy of the lining membrane of their lungs and their inability 
 to protect themselves as grown persons do, or to help themselves 
 by coughing. The mischievous influence of cold or wet cham- 
 bers to all persons, and much more to children, is too well 
 known to require any comment from us. 
 
 The floors of these chambers should be very tight, and the 
 house so constructed as to admit of a free circulation of the 
 air under them. No matter how tiglit the floors may be, if 
 damp air and moisture exist under them, the chambers will be 
 rendered more or less unhealthy. They should be tall and 
 in every respect sufficiently capacious to admit of all the 
 
IQQ THE NURSERY. 
 
 purposes for which they were intended, without crowding or 
 cramping their delicate inhabitants. 
 
 The windows should be large, and so protected by cross-bars 
 that the children cannot get through or fall out of them, and 
 the outside doors should open on a piazza, which will tempt 
 them, in good weather, to play on it in the open air ; one on 
 each side of the house would, most of the day, furnish them 
 with a shade as might happen to comport with their feelings 
 of comfort. 
 
 Their walls should be exposed to a clear influence of the 
 rising and setting sun ; the former to dissipate all dampness 
 from the house, and the latter to prevent the early damp of 
 the evening and through the night, by the radiation of the 
 walls and all neighboring objects, of their acquired tempera- 
 ture. On the south-east, south and south-w^est, the house 
 should be greatly protected from solar influence by shade 
 trees, so trained as not to obstruct a free circulation of the air 
 around and through the house, when desired for ventilation, 
 and to cast their shadows upon the house above the windows. 
 In every hundred house-groves in this country, which might 
 as easily have been rendered beneficial, there are but few 
 which are truly beneficial and healthy. Shade trees should 
 not be so arranged and trained as to heat the house, dampen 
 the air or prevent a free circulation of the air, but to serve, 
 simply, the purpose of a cloud, to keep out the direct rays 
 of the sun ; and also for another and by no means an unim- 
 portant purpose, the absorption of the carbonic acid gas 
 thrown ofi'by the children and all other sources of it about 
 the house, and, also, perhaps, other gases, which are not neces- 
 sary to, but possibly injurious to, animal life. Shade trees 
 and other vegetation, furthermore, invigorate the atmosphere 
 by an evolution of oxygen. 
 
 This appendage of the nursery is too important to be passed 
 over as merely one of its comforts. As it is, on the score of 
 health and life, as important as anything that can be said 
 upon the subjects of food and drink, it is important that we 
 should make it so appear. By medical writers there is much 
 said about miasma, so much tliat it is now lisped in the 
 streets by those who do not understand even the meaning of 
 the word. 
 
THE NURSERY. 1^7 
 
 We have not the time, and if we had, this is not the place 
 to enter into a discussion about it ; nevertheless, it will nesra- 
 tively appear before we have done, that it is as destitute of 
 truth, as the proposition is, that two and three make four. 
 
 We have lived in the south, and while there, our faculties 
 of observation were never idle on this subject; and without 
 entering into the philosophy of it, we will simply make two 
 statements of fact, which we trust will prove sufficient for our 
 present purpose, which is, to induce all persons to plant shade 
 trees, if they have not, and to prevent the felling of the forest, 
 in future, where dwellings are to be erected. 
 
 A brother of the writer settled in one of the best cotton dis- 
 tricts in Mississippi, and as far as it was the best, so far was it 
 the more sickly and fatal to both the white and black popula- 
 tion. At his solicitation we instructed him to select for his 
 residence and that of his quarter, a dry piece of ground, well 
 timbered, and to pay no attention to the vicinage of ponds or 
 swamps, but to be careful to have a quarter of ^ mile of tim- 
 bered land between his residence and his cotton plantation, 
 and not less than one hundred yards between it and his gar- 
 den ; to remove the under-growth from several acres about his 
 mansion, but to be sure to leave enough timber to shade, 
 thoroughly, the surface of the earth. 
 
 Under these instructions he located his mansion in a quarter 
 of a mile, or about midway between his cotton on the south- 
 east, and an overflowed swamp of several thousands of acres 
 of a lunated form, bounding him on the K. E., north, and north- 
 west. There was a pond of water filled with logs about sixty 
 yards south of his house, which furnished his stock water, 
 and washing water for the quarter. 
 
 Thus circumstanced, he lived seven years, without having a 
 single case of, the so-called, miasmatic disease, while, on all 
 sides of him, sickness and death prevailed every summer and 
 fall. At this time, believing that his quarter had become so 
 acclimated as to be in no danger, and not comprehending the 
 philosophy of our instructions, he felled a hundred acres of his 
 forest to the west of his quarter, and up to the yard fence that 
 surrounded it, and planted it the next spring. In the course 
 of the summer, every negro he had, except one, who was about 
 
168 THE NURSEHY. 
 
 sixty years of age, was sick, and so much so, that he did not 
 make more than half a crop. 
 
 ]^ow a question : Could none of the miasm get from his cot- 
 ton field, through the open timber, to his quarter during the 
 preceding seven years ? could it have no influence upon them 
 while working in the field ? could they bring none of it home 
 with them in their clothes ? could no strong winds blow it 
 from the swamp or from the cotton field in defiance of the 
 vigilance and absorbing powers of the forest ? 
 
 In traveling, we put up for a night with an intelligent Vir- 
 ginian, some three miles east of Yicksburg, and as we ap- 
 proached the house we discovered that his quarter was in the 
 midst of the cotton field, and the cotton growing up to the 
 doors of the houses. After some general conversation with 
 him, we inquired. Whether his quarter was not sickly in the 
 summer and fall ? He answered, that it was considerably so, 
 but not more so, perhaps, than other quarters about there. 
 (This was probably the fact, as all the quarters were more or 
 less similarly circumstanced.) But my question interested 
 him — it involved the value of his property, which induced him 
 to inquire why we made the question. We answered, with a 
 full explanation of our reasons, and concluded by observing — 
 " You have a handsome ridge of timbered land on the opposite 
 side of the road, and if you will move your quarter into it, 
 without felling a single tree, unless it should become neces- 
 sary in planting the houses, you will save doctors' bills and 
 negroes." 
 
 As people generally are so much disposed to regard all such 
 notions as mere speculation, we had very little expectation 
 that he would ever move the quarter. Some three years 
 afterward, while at Yicksburg, we were invited to an in-fair 
 in the country, by some of the friends of the family — we had 
 no idea of the family, nor of their residence ; but upon arriving 
 at the house, we recognized the proprietor as the one with 
 whom we had spent a night, and to whom we had given 
 instructions about his quarter. After our introduction, we 
 turned our eyes to where the quarter was, and found thatit vas 
 not there, but upon turning a little more we discovered it on the 
 ridge, in the timber. Being now anxious to learn the result 
 
THE NURSERY. 169 
 
 of the change, we turned to him and said, " I perceive that 
 you have moved your quarter." He answered very indifferently, 
 " Yes." I then inquired, " Have you discovered the change to 
 contribute materially to their health ? " He answered as 
 indifferently as before, " Well, I think it has been an improve- 
 ment." I again inquired, " Do you recollect to have been 
 advised, about three years since, to move your quarter to the 
 ridge on which you have now got it, by a gentleman who had 
 the benefit of your hospitality during a very unpleasant 
 night ? " Rising from his seat he answered, with apparently 
 deep concern, '' Yes I do, and I moved it ; are you the gentle- 
 man?" When we assured him that we were, no one could 
 have manifested more gratitude than he did — w^e could have 
 been a welcome member of his family for a year. He then 
 went on to remark that the reasons we had advanced, caused 
 him to think that the suggested move might be of some ad- 
 vantage to his blacks, and he moved it, but he had no idea 
 that the advantage w^ould be as great as he had found it ; pre- 
 vious to the move, and for one year after, he had employed a 
 physician by the year, at a high salarj^, to attend his quarter, 
 but that the first year after the move taught him that it was a 
 useless expense, and he quit it ; and that during the preceding 
 two years, a physician had not been called to his quarter more 
 than two or three times." 
 
 Now^ this quarter was separated from the old one by a dis- 
 tance of about one hundred and thirty yards, including a slip 
 of timber about sixty yards w^ide. Did this slip of timber pre- 
 vent all the miasm of the plantation from getting to it ? 
 
 In our large cities, it is a very general opinion that the broad 
 streets are more healthy than the narrow ones ; and yet while 
 we lived in Baltimore, and also in New Orleans, it became 
 obvious to us that the streets which were so narrow that the 
 sun's rays never touched them, except wdien on the meridian, 
 and for this reason they w^ere nearly alw^ays wet, were more 
 healthy than the broader ones, and the broadest were the most 
 sickly in summer and autumn. 
 
 To say that in the narrow streets there was no evaporation 
 or decomposition to produce miasm, will not do, because, in 
 cities, the streets become the channels of the wind, and it 
 traverses all of them. Our observations upon the south 
 
170 TEMPERATURE OF THE I^URSERY. 
 
 brought US almost to an undoubting conviction, that the white 
 race can inhabit the tropics and work in the sun, if they will 
 take all their rest in the woods. 
 
 It is fortunate, however, that while much can be said on 
 both sides of the question, the facts themselves dictate the 
 proper course to be observed, notwithstanding the disgraceful 
 fact that medical men have recommended, and caused to be de- 
 stroyed, the shade trees of a city, for the purpose of promoting 
 its health. 
 
 We have said enough upon this subject to show that shade 
 trees, properly trained, are not only an ornament to a mansion, 
 but a protection to the health of its inhabitants ; but if they 
 be so protective to adults, how much more must they be to 
 infants, whose skin and lungs are so delicate ? 
 
 As regards the other boundaries of the nursery, the N.E., 
 north and N. W., the sources of bleak, and not unfrequently 
 disease-bearing winds, we would suggest that, if possible, they 
 should be guarded or protected by other portions of the man- 
 sion. 
 
 From some remarks of Dr. A. Combe, on Infancy, some 
 persons might draw conclusions adverse to the doctrines we 
 have here presented. He says that " the close vicinity to the 
 house of trees," should be avoided because they prevent venti- 
 lation, produce and furnish humidity. As it is possible for 
 an atmosphere to be too dry as well as too humid, his objection 
 to the presence of trees, when cultivated as we have instructed, 
 is more than obviated. He also prefers an elevated situation; 
 but as we have elsewhere taught, this preference requires many 
 qualifications. In the abstract, it is true in no country, and 
 much less so in the south than in the north. 
 
 SECTION II. 
 
 OF THE TEMPERATURE OF THE NURSERY. 
 
 It is recommended that the temperature of the nursery 
 should be regulated by a thermometer, and kept equable and 
 at about QQ'^ to 67° Fahrenheit. We object to this doctrine, be- 
 cause it is unnatural, and consequently must produce mischief. 
 
TEMPERATURE OF THE NURSERY. 171 
 
 In nature, the atmosphere is not regulated by a thermometer, 
 with a view to equality of temperature ; we cannot be made 
 to doubt that the external world is properly adapted to the 
 conditions of our existence. If children are maintained in an 
 agreeable temperature, both their lungs and skin will form a 
 habit — a constitution precisely in relation to it ; and therefore, 
 when they become exposed to a lower or a higher one by any 
 casualty, they will suffer. What else is it that makes a northern 
 climate so pinching and even hazardous to a southern man ? 
 There are as many and as marked atmospheric changes south 
 as north, but a cold day in the former, would be quite a mild 
 one in the latter. 
 
 We must suppose that our Creator, in constituting the seasons 
 and the atmosphere, was not indifferent to the well-being of the 
 creatures which were to be subjected to them ; consequently, 
 we must suppose it to be beneficial to both infants and adults 
 to be subjected to variations of temperature. Nature has amply 
 provided both infants and adults, with the means of adaptation 
 to variations of temperature. The same number of volumes of 
 atmospheric air, breathed in a cold room, will produce more 
 animal heat than in a warm one, because it is more dense. This 
 would be suflScient, provided they were sufficiently fed, to com- 
 pensate for all ordinary variations of temperature. 
 
 Among cold-blooded and hibernating animals, (and also 
 with vegetables,) in the winter season, the temperature is 
 always above that of the atmosphere a little, and as the one 
 changes, so does the other. Making nature our guide in this 
 matter as in all others, our conclusion is, that infants and older 
 children, should be accustomed to considerable variations of 
 temperature, but to go to the extremes is not essential, and 
 should indeed be avoided. 
 
 The temperature of 67° is not low enough for the hours of 
 rest, nor is it high enough for the hours of waking, in the win- 
 ter. The freezing temperature has a happy tonic influence 
 upon adults, if not endured too long, and that of 40° would 
 have a similar effect upon young children. During the houi-s 
 of waking and exercising there is too much difference between 
 67° and 98° or blood-heat, to enable the skin to perform some 
 of its most important functions. 
 
 Summer-heat or that of 76° is too low for the comfort of an 
 
'l>j2 TEMPERATURE OF THE NURSERY. 
 
 adult, in a state of rest, it is at least 21° below blood-heat, 
 which is too much to admit of comfort, more especially to 
 children. 
 
 We do not advocate an unnecessary exposure of children 
 through the usual plea of making them hardy, nor through 
 any other ; and upon the other hand, we object to regulating 
 the temperature of tlie nursery to equability by a thermometer, 
 as we do that of tropical plants. A cold air is not to be par- 
 ticularly feared under ordinary circumstances, but a damp one 
 should be guarded against at all times in cold weather, and 
 by all persons, but more particularly by infants. 
 
 We would suggest that a fire should be made in the sleep- 
 ing room about sunset and suffered to burn down — it will be 
 warm enough through the balance of the night. During the 
 day, in dry weather, the windows should be raised while 
 cleansing it, and kept up for some time. The morning fire is 
 now presumed to be nearly burned down, and if replenished, the 
 windows should remain up, during the period it may be 
 vacated by the children. The other room should be warmed, 
 cleaned and ventilated in the morning before the children go 
 into it. 
 
 During the season of cold weather, both apartments of the 
 nursery should wear a woolen carpet, because of the greater 
 conducting capacity of wood than wool, it is economy in fuel, 
 and a protection against cold feet and hands and conse- 
 quently against disease. Strong objections are urged against 
 carpeting a nursery floor because of the great liability to which 
 it is exposed to become soiled and wetted, and the difiiculty 
 of drying it. These objections are too easily remedied, to 
 overrule its advantages. Xo matter how wetted, whether by 
 washing out soiled spots with a brush or otherwise, the drying 
 process is rendered easy by always having on hand a few 
 quires of soft or absorbing paper. The application of a quire 
 of this to a wet spot will speedily so far draw the water out of 
 it, that the temperature of the room will soon dry it. During 
 the summer season the floor may be uncovered or matted as 
 may best suit the taste or wishes of the superintendent. 
 
 As to the best plan for warming a nursery, all things con- 
 sidered, is a question of much moment. An open coal fire, 
 indeed a coal fire of any kind is objectionable, because it is 
 
PHYSICAL TRAINING OF THE NURSERY. 173 
 
 next to impossible, to avoid floating dust and ashes, and oc- 
 casionally sulphurous vapors, which are injurious to the lungs. 
 An open coal fire is objectionable because the children may 
 fall into it, or have their clothes take fire ; all things con- 
 sidered we would suggest a wood fire in a close stove with a 
 capacious evaporating dish on the top of it. 
 
 SECTIOiN III. 
 
 PHYSICAL TRAINING OF THE NUESEKT. 
 
 As the preparation for the greatest achievements of our facul- 
 ties must and should commence in the nursery, its provisions 
 and management should be, to every parent and to every com- 
 monwealth, subjects of the deepest solicitude. The neglects or 
 omissions committed here can never be entirely repaired — 
 " early impressions are the most lasting," and, accordingly, 
 early neglects and imprudences are the most irreparable. In 
 view of these fundamental propositions, we shall be particu- 
 larly careful not to teach anything which is not defensible 
 upon well established physiological principles. 
 
 There is a pleasure in the expenditure of nervous and mus- 
 cular energy through the waking hours, and there is a pleasure 
 in the restoration of it, by rest, during the sleeping ones, and 
 unless accumulations of it be effected during sleep, for expen- 
 diture when awake, the health and energies of the system 
 must sink; the best means, then, of procuring rest, is, in point 
 of importance, inferior to no other provision of the nursery. 
 
 Children should be trained to early resting and rising, and 
 after the latter they should be washed, dressed, their minds 
 amused, and bodies exercised for some time before receiving 
 their food. 
 
 The utmost care should be taken to train them to regular 
 habits — a proper time for rest, for exercise, for feeding and the 
 voiding of their excrements. Dr. Dewecs teaclu's that rhoy 
 should not be indulged in voiding their urine too frequently, 
 as it will beget the filthy practice of wetting the bed. In this 
 opinion, we agree with him, but not for the reason he assigns; 
 it is occasioned by lying on the back, causing too much heat 
 
174 PHYSICAL TRAINIITG OF THE PURSER 
 
 and blood to be accumulated in the cerebellum. "When they 
 become one or two years old they should have a hard pillow, 
 which will force them to lie upon the side — one made of cotton 
 or rags. This practice of lying on the back is attended, at 
 a later period of life, with another evil of great magnitude, the 
 nocturnal and spontaneous emission of the semen, to the ruin 
 of the constitution, if not timely restrained. 
 
 The first and great requisite of a nursery is a mother or 
 nurse who possesses sprightliness, intelligence, and amiability — • 
 one who has so much self-government as never to betray anger 
 in the presence of the children — one whose social and moral 
 endowments render her a proper example to them ; and lastly, 
 one who has such intellectual resources as to be able at all 
 times to vary or modify their amusements and exercises. 
 
 After breakfast, dinner and supper, the play -room should 
 be a gymnasium for an hour, more or less ; every practical 
 means should be provided for the exercise of the children, 
 particularly of their superior extremities. This exercise should 
 be made a matter of indispensable duty. When this course 
 shall become adopted throughout our land, consumption and 
 many other avenues to a premature grave, will become rare 
 events in society. The truthfulness of this conclusion no one 
 can doubt, who will carefully consult our doctrines of the 
 cerebellum. 
 
 During the first weeks, in the history of every child, it is 
 too feeble to participate in the sports of the nursery, and yet 
 exercise and airing are as essential to it, as to those of more 
 age. These objects, to a considerable extent, may be efiected 
 by carrying it about through the nursery, and this should be 
 regularly and punctually practiced every day. But to the 
 usual manner in which this is efiected there are some weighty 
 objections. A vertical position to the body of the child should 
 be carefully avoided, as the feeble spine has to sustain the 
 weight of the chest and head. During early infancy it should 
 be sustained in a nearly horizontal position upon a pillow, and 
 thus carried about, or which is still better, to place it on a pil- 
 low in a convenient basket ; in this condition it has liberty of 
 motion, and can be carried about by any domestic. 
 
 The time was when no possible means were neglected to 
 build up the animal machine, and similar means are still 
 
MEN"TAL TRAINI^-G IN" THE l^UESERY. 175 
 
 resorted to by many of our wild tribes ; but now, in civilized 
 society, while the animal is neglected, no efforts are spared to 
 build up the intellectual and religious machine ; thus forgetting 
 that the latter cannot be usefully or happily effected without 
 the former. The attempt is similar to placing upon a column 
 a heavy capital when the foundation is feeble and unsettled. 
 In our country this is the great fault of the age. We have 
 infant schools and Sunday schools and every-day schools for the 
 cerebrum, but no other school than chance, which feeble con- 
 stitutions are sure to neglect, for the development of the cere- 
 bellum or vital forces. In this condition of society we have 
 discovered the great source of consumption, cerebral conges- 
 tions, convulsions and many other nervous affections. 
 
 SECTION lY. 
 
 MENTAL TRAINING IN THE NURSERY. 
 
 We are now to speak of such training as the nurseiy should 
 provide, which is to affect and materially to mould the future 
 man or woman. It must be recollected, that the child is 
 introduced into the world entirely helpless, and with scarcely 
 more of what can be called mind, than is possessed by an 
 oyster — barren of a single thought, and yet, as observation has 
 clearly shown, it possesses the rudiments of all the faculties 
 which, in future life, will be manifested. Over these rudiments 
 we have not an unlimited control — we have to submit to an 
 original determination of their constitution — to the fiat of na- 
 ture, " so far canst thou go, but no further." Within pre- 
 scribed limits we can do great good or mischief, by retarding 
 or promoting the development of these rudiments, and by pro- 
 perly or improperly directing the manisfestation of their 
 faculties. These faculties adapt him to the world in which he 
 lives, and out of which he is to elaborate his happiness or his 
 misery — his usefulness or his mischievousness. Some of his 
 faculties are precisely in kind with those that govern and impe. 
 the brute creation, commanding him to kill that he may oat, 
 to repel aggression, to shun danger and propagate his kind. 
 As far as he has faculties in common with the inferior orders 
 
176 MENTAL TRAII^IJ^G m THE NURSERY. 
 
 of creation, so far are his pleasures or enjoyments like theirs — 
 he has pleasure in eating, drinking, sleeping, and in the exer- 
 cise of his voluntary muscles ; and the great calamity in the 
 present state of the world is, that a preponderating portion of 
 the race is satisfied with these enjoyments, and will make no 
 struggle to reach that superior sphere, where the social and 
 moral sentiments, and the reflecting faculties preside, and se- 
 cure to their possessor a large range of enjoyments, in which 
 the animal world can never participate. They furnish his 
 most exalted, his most refined, and his most impassioned 
 pleasures ; those, compared with which, his animal ones are 
 as dross to pure gold. They introduce him directly to the 
 great and ennobling purposes of his existence — obedience to 
 the institutions of his Creator, and love for his fellow-men. 
 They give him dominion over the earth, by being impelled by 
 his animal wants, and aided by his powers of voluntary mo- 
 tion, to control a part of the stupendous whole that surrounds 
 him, and to adapt himself to the balance in such a way as to 
 render it subservient to his comforts and enjoyments. He can 
 control the horse, the ox, the sheep and dog, and render them 
 subservient to his wants and his pleasures ; he cannot tame the 
 lion and the panther, but he can destroy them ; he cannot con- 
 trol the ocean, but by the use of canvas or steam he can ride 
 upon its bosom, command its treasures, and the commerce of 
 the world. 
 
 When children cry because of being uncomfortable or sick, 
 they should be attended to ; but when they do it as a means 
 to obtain what they desire, they should never be gratified. If 
 under such a motive, they are gratified in things to which there 
 can be no objection, they look for gratification in those to which 
 there may be serious ones. By teaching them to wait your 
 time and pleasure, you cultivate their firmness and fortitude — 
 they acquire the power of self-government, which is indispen- 
 sable to happiness, to success, and to good -citizenship. There 
 is in society no fault, no neglect so lamentably attended in its 
 results, as this. 
 
 Every laudable means and useful temptation that can be 
 devised should be resorted to, to make the children love the 
 nursery, they should delight to be in it more than any other 
 place. The common practice therefore, of using it as a kind 
 
MENTAL TRAINING IN THE NURSERY. I77 
 
 of prison or place of punishment, is very injudicious — it is far 
 better to practice the reverse — take them out of it for improper 
 conduct, which can be made very effective by a little address. 
 Nothing should ever be done to children, which they shall 
 conceive to be intended as punishment. "When such a notion 
 takes possession of them, obstinacy is certain to be engendered. 
 
 The nursery should be regarded as a community of minia- 
 ture women and men, and should be influenced, as we do our 
 fellow-citizens, by the use of adequate motives. They should 
 never be commanded directly, to do anything, but politely re- 
 quested. The tone of command is offensive to self-esteem, 
 while a request is agreeable to approbativeness and benevo- 
 lence, and will very generally secure obedience. But suppose 
 it should not, what then ? Let the parent or superintendent 
 address the offender thus : " We have politely requested you to 
 do us a favor, and you have refused, now this is unkind and 
 ungenerous in you, and a bad example to your sisters and bro- 
 thers, and through a fear that you will spoil them by your 
 example, you must leave the nursery." This course can be 
 variously modified so as to suit age and other circumstances. 
 It is always better to tell a child that he cannot be good or duti- 
 ful, than to tell him that he will not ; because of two reasons : un- 
 der the influence of adequate motives he would have been good, 
 but in the absence of them he was not, and by telling him 
 that he cannot, you create a motive which induces him to show 
 you that he can. It is an impeachment of his capacity, which 
 is worse than a whipping. In the first instance, the sending 
 him out of the nursery for the reason assigned, which was a 
 correct one, you impeach his perfection — he is penetrated with 
 an idea of disgrace, and most generally reformation is the 
 immediate result. By these means, variously varied, one per- 
 son can govern fifty children, and have obedience and good 
 conduct, provided that that person possess patience, and self- 
 government, and those who have not these mental requisites 
 to a nursery, should never have the care of children. 
 
 As mental education commences spontaneously, at a very 
 early period, and as exercise of all the members of the body 
 is indispensable to health and future usefulness, it is obvious 
 that a nursery should be supplied with inducements and facili 
 ties for the exercise of the intellectual faculties. 
 12 
 
178 MEN'TAL TRAIKTSTG llS THE XTJRSERT. 
 
 At an early period, perhaps at birth, an infant manifests 
 consciousness, and soon after a spirit of observation, and as 
 the faculties concerned in this function can neither become 
 active nor developed to a proper extent without early and con- 
 tinued exercise, the nursery should be provided with objects 
 of sense — such as will spontaneously attract attention. To the 
 neglect of this culture, during youth, do we attribute a veiy 
 large proportion of the vice, crime and idleness of society. 
 This end can be achieved by supplying their rooms with draw- 
 ings, paintings, and a selected cabinet of natural history. The 
 presentation of one of these objects, will generally arrest that 
 fretfulness which has resulted from animal irritability, whereby 
 it is not only calmed, but instracted and rendered more intel- 
 lectually able and effective. 
 
CHAPTER VIII. 
 
 CAUSJES OP INFANTILE MOETALITY. 
 
 In the conditions incidental to infancy, in civil society, must 
 we look for the causes of that infantile mortality which dis- 
 tinguishes many of our cities — a mortality that is not more 
 astonishing, as a question of professional investigation, than 
 lamentable to the philanthropist. In 1818 the entire mor- 
 tality in Paris, (France), was 22,421, of which 3,942 were of 
 infants under one year of age. In New York, as we learn 
 from the tables compiled by Dr. Lee, comprising a period of 
 sixteen years, one-fourth of the entire mortality consisted of 
 infants under the age above-named. 
 
 In 1851, between the 21st of June and the 18th of July, 
 the total mortality of Cincinnati was 650, and of this number 
 366 (considerably more than half), were of children under five 
 years of age.* From the usual rates of mortality, as governed 
 by age, we may safely infer that one half the 366 were of 
 children under the age of one year. 
 
 Every writer which it has been our fortune to consult upon 
 infantile forms of disease, enumerates nearly or quite all of the 
 normal differences that distinguish infancy from adolescence, 
 and treats of them as the predisposing causes of disease and death 
 in the former, and thus the greater infantile mortality is ac- 
 counted for. As a matter of fact, we do not believe this doc- 
 trine, and in not believing it, we will not, as a moralist or as 
 a political economist, teach it. 
 
 We have upon several occasions expressed our faith and 
 confidence in the provisions of the physical world for the very 
 best interest of all its creatures. To us, every provision — every 
 
 * Eclectic Medical Journal. 
 
 (179) 
 
180 CAUSES OF IlfFANTILE MORTALITY. 
 
 law bears upon its face the impress of goodness and wisdom. 
 Under these abiding convictions we are unwilling to admit 
 that any provision of our Creator is faulty, or clumsily adapted 
 to a wise and benevolent end. With these convictions, we must 
 believe that the infantile brain, its envelopes and their rela- 
 tions to each other, with all the minor arrangements of the 
 wonderful whole must be just as well adapted to health, to 
 life and to an immunity from disease, under the circumstances 
 of its existence, as the similar sum total of the arrangements 
 with which adults are endowed. We cannot then attribute 
 infantile mortality to any peculiarity of God's providence. 
 We do not believe that it was contemplated by it, that any 
 one should die before extreme old age — before the organiza- 
 tion wore out, and the existing premature mortality results from 
 the countless violations of its ordinances which have been pro- 
 gressing ever since man had an existence. The average of 
 human life has much increased in the last thirty years, and it 
 will continue to increase so long as there shall be an increase 
 of obedience to the organic laws. 
 
 With reference to the great mortality of children, we must 
 now give our opinion as to the causes. We have elsewhere 
 remarked that all special attention to the development of the 
 animal system has very generally ceased, and in its stead a 
 very general one is given to the mental, which is always an- 
 tagonistic to the animal, that is, it depends upon the animal 
 for all its force and efficiency of manifestation, consequently one- 
 half of the children that meet, thus, an early grave, are produced 
 by parents who never possessed a normally physiological 
 condition. Add to this prevailing cause, the morbid condition 
 of mind that distinguishes ISTew York, Cincinnati and many 
 other cities, and the astonishing mortality of infants is ac- 
 counted for. 
 
 We have but for a few days to observe the manifestations of 
 !New York and Cincinnati society, to feel quite convinced 
 that the mental condition of one-half, is in a pathological 
 state, consequently the children of all such persons are born 
 predisposed to inflammation of the brain, convulsions, conges- 
 tion and all those diseases which can result from an unsound 
 brain, and an undeveloped animal system. Happiness is a 
 Btranger to one-half of the community, and pleasure is sought — 
 
CAUSES OF INFANTILE MORTALITY. IgX 
 
 we mean passionate excitement. Some must go to night 
 prayer-meeting at the hazard of property and children — some 
 must be at the theater — some at the concert, some at the card 
 table, — some at a political club — some at the masonic-hall — 
 some at the odd-fellows hall — some at the tippling shop, and 
 nearly all are impelled by a motive precisely similar in kind — 
 abnormal or passionate excitement. Are parents in this con- 
 dition capable of producing healthy children ? It would be an 
 unmerciful fate to doom infants thus conceived, carried and 
 brought forth, to live more than one year. Parents who desire 
 children must learn to maintain their systems in a normal state 
 — a state of health and happiness, and in no-wise indulge a 
 nervous anxiety for pleasure. If physiologists, philanthropists 
 and moralists desire to reduce the present standard of infan- 
 tile mortality, they must devote more of their attention to the 
 social state — they must train society to live in conformity to 
 the organic laws. Our clergy and editors, with the help of 
 good citizens, can effect a complete revolution in ten years. 
 But this work cannot be effected by removing evil institutions 
 alone — in their stead must be erected useful ones — such as are 
 devoted to art, science, literature and physical exercise — gym- 
 nastics — subjects that produce happiness and usefulness, with- 
 out passionate excitement. As a morbid excitability is much 
 less prevalent in Philadelphia than in New York or Cincin- 
 nati, we would expect a less infantile mortality. 
 
 The three great enemies of human life, in the United States, 
 are politics, religion, and ardent spirits. From the first we 
 have an unstable government, and many unhappy citizens ; 
 from the second, very many unhappy and restless Christians, 
 and from the third, very many unsound bodies. We have, 
 therefore, as a people, yet to learn the temperate use of our 
 advantages. The very freedom of our institutions is pregnant 
 with premature death. In countries less free, almost every in- 
 dividual has, by caste, bounds fixed for the hopes of his am- 
 bition ; but here the humblest individual has as large a field 
 for the play of his hopes, and exercise of his ambition, as those 
 of a long line of successful and distinguished ancestry. Every 
 one is born, yes, conceived, in a storm of excited and hopeful 
 expectation and bred in a whirlwind of impassioned exertion. 
 
182 CAUSES OF Ils^FAN-TILE MORTALITY. 
 
 In the American face is depicted irritability, anxiety and 
 care — its pathognomy most clearly indicates that the comforts 
 of life do not constitute the engrossing and all needful purpose 
 of existence. Look at a European face, the Irish excepted, 
 and what does it indicate ? Very little else than a desire for 
 roast beef and puddings. The natural expression is one 
 of ease — of a fitness to enjoy existence — to make the most 
 of it, and to be satisfied with it. 
 
 The great expenditure of vital force in the mental functions 
 of the Americans, particularly those who populate our cities, 
 so reduces the tone and vigor of their bodies as to incapacitate 
 for producing a vigorous progeny. In view, then, of the exist- 
 ing condition of American society, no one who is acquainted 
 with the organic laws, should be astonished at its juvenile 
 mortality. 
 
 Some may say that this argument is not consistent, because 
 juvenile mortality in European cities is as great as it is in 
 the American ! We admit it, and for the reason that there 
 exists a state of society so low and dependent, that we have 
 none to correspond with it — they are enslaved, ignorant and 
 degraded — but here all are free and intelligent — death from 
 absolute poverty has scarcely ever been witnessed in our 
 country. 
 
 Thus far, in our investigations, we have had almost exclu- 
 sive reference to children in a state of atm.ospheric or extra- 
 uterine existence, and although there exists almost an entire per- 
 sonal identity between the fetus and the infant, yet they are 
 intrinsically as difierent as a vegetable and a child ; but notwith- 
 standing this difference, mothers speak of their fetus, as their 
 child, and as familiarly too, as if they had seen it or heard it 
 cry ; consequently we are called upon to drop a few passing re- 
 marks with reference to the intra-uterine children^ more es- 
 pecially as physicians are frequently consulted in their behalf. 
 
 Fetal life and vegetable life present many striking analo- 
 gies ; the fetus is developed from nourishment furnished either 
 by the placenta or the amnion, or both ; and vegetables are 
 developed by nourishment obtained from the earth or the at- 
 mosphere or both ; the fetus manifests, so far as we can dis- 
 cover, no animal function — it may be diseased, and so may a 
 
CAUSES OF INFANTILE MORTALITY. 183 
 
 vegetable, but neither of them can be sick — both are inca- 
 pable of suflering. ISTeither of them manifests an animal 
 sense, nor a voluntary capacity. We may restore a diseased 
 fetus by medicating the mother, and so we may a diseased vege- 
 table, by medicating the soil, which is its mother. 
 
 Philosophically speaking, then, a fetus is not a child, nor can 
 it become one without a greater supply of oxygen than the 
 placenta was ever intended to furnish, but which, normally, 
 is supplied after birth by the respiratory function. We have 
 called attention to intra and extra-uterine life simply for the 
 sake of truth ; for the present it is only important for us to 
 know that fetuses are still-born, because probably of disease, 
 and that they are born with varieties of disease, of which 
 they may die, or from which they may recover. 
 
 It is now, we believe, a settled doctrine that fetuses contract 
 disease, of which they either die or recover, and these events 
 may take place in either the intra or extra-uterine condition ; 
 therefore it is not required that we shall support the affirmative 
 by evidence. Nevertheless, the fact that a fetus is diseased, 
 or has been diseased and recovered, we cannot ascertain, un- 
 equivocally, till after birth ; and if we could, it would, in the 
 present state of medical science, prove of no therapeutical 
 advantage. 
 
 We may be told by some, that by proper attention to the 
 mother we may, in a great measure, ensure the fetus. We 
 admit this as a postulate ; but what are we to understand by a 
 proper attention to the mother ? In one instance a mother has 
 the appearance of possessing line health, and yet she has a half- 
 developed, sickly-looking and feeble child ; while another, who 
 by the time her child is born, wears out all but the last thread 
 of life, and that yields in a short time after, by struggling 
 against consumption or some other fatal malady, and yet her 
 child is fully developed — a fine picture of health ! In both of 
 these instances we would, a priori^ have concluded just the 
 reverse of what happened, and is known to happen frequently. 
 
 In Yirginia, large tracts of land are thrown out of cultiva- 
 tion, as being unfit for the production of tobacco, corn and 
 potatoes, but still it produces a thrifty forest of pine-trees. In 
 the abstract, this land cannot be considered as exhausted, but 
 so only, in relation to the vegetables before named. Hence, it 
 
184: CAUSES OF INFANTILE MORTALITY. 
 
 SO appears, that some women are constituted to enjoy existence, 
 but not to produce children ; while others have but little phy- 
 sical enjoyment, but produce fine, healthy children. With 
 reference to the land, chemistry has taught us how to remedy 
 the evil ; but physiology has not done the same for us with 
 reference to women. As yet the whole subject is enshrouded 
 with darkness and diflBculty. If we shall, therefore, do all 
 that is properly indicated for the mother, considering her con- 
 dition, we shall do all that we certainly can do for the interest 
 of the fetus. 
 
 There is yet another physiological condition with reference 
 to fetuses and children, which we deem too important to be suf- 
 fered to pass unnoticed, though neglected or never thought of 
 by any one else. It should be constantly remembered that 
 during fetal life no animal function is performed — the fetus 
 only vegetates ; consequently it is possible for one to be born 
 well developed, and in a fine condition, because of a fine or- 
 ganic or vegetative system, but for the want of a more highly 
 endowed animal system, it commences soon after birth to de- 
 cline ; and thus, to an extent more or less, it happens, that life 
 cannot be prolonged beyond one, two or three years, or possibly, 
 in some instances, to seven. A large proportion of the mortality 
 that happens among infants, during the first years of existence, 
 results from this cause. On the other hand, another fetus has 
 a fine animal system, but so feeble was the vegetative, at 
 birth, as to appear almost impossible that it could live ; but it is 
 soon discovered that atmospheric existence agrees with it, and 
 it soon becomes a child of promise, and finally makes a strong 
 and healthy man. This distinction is important, particularly 
 as it indicates the great importance of early physical exercise 
 to the former. 
 
 We feel entirely satisfied that we have satisfactorily accounted 
 for the existing mortality of children, without any reference to 
 those organic conditions which constitute infantile normality. 
 Such is our conviction, from extensive observation and years 
 of reflection, that all the arrangements of Providence are fault- 
 less ; and consequently we are much more disposed to look for 
 the causes of social evils to social violations of the organic laws, 
 than to any oversight or neglect in the plans of the former. 
 
CHAPTER IX. 
 
 OP THE NECESSITY AND UTILITY OP JUYENILE MORTALITY. 
 
 It will, no doubt, appear very singular to many of our readers, 
 that we should advocate such a doctrine as that which must be 
 inferred from the caption of this Chapter, more especially in 
 a work of this kind ; but when they have read it, and reflected 
 upon it, we trust that they will agree with us, that it is neither 
 out of time, nor out of place. 
 
 Our proposition when explained, is, that under existing cir- 
 cumstances of the human race, juvenile mortality, to the full 
 extent of its natural causes, is both necessary and useful. That 
 nothing less could result, and nothing less should result, or be 
 even hoped for, by any good citizen. 
 
 Our readers have not yet to learn, we should think, that we 
 unqualifiedly believe that all the arrangements of God's Provi- 
 dence are adequate to the very best ends of the human race; 
 and consequently, we must believe that disease and death, and 
 both, in accordance with all the circumstances that attend 
 them, are wise and beneficial institutions. Believing this doc- 
 trine to be true, and therefore good, we have deemed it proper, 
 as a physiological prophylaxis, to place its defense before the 
 public, hoping that many may be admonished by it, to practice 
 greater obedience to the organic laws, and thereby, in a man- 
 ner compatible with the requisitions of Providence, lessen or 
 reduce the present standard of human mortality. 
 
 We hold that the profession have been shamefully guilty of 
 a dereliction of duty to the public, in having, to this timet 
 sufiered it to continue ignorant of the great and paramount 
 truths with which, it will be seen, this subject is pregnant. 
 K parents had, long since, been made familiar with it, two 
 
 (1S5) 
 
18(5 UTILITY OF JUVENILE MORTALITY. 
 
 great and important results would now be exerting a salutary 
 influence on society ; namely, in view of progeny, every one 
 thus instructed would take more care, than is now thought to 
 be essential, of his physiological condition ; and secondly : 
 every one would meet the loss of children, by the ordinary 
 causes of death, with that propriety and submission which 
 become an intelligent understanding of its necessity. Such 
 events would produce conviction that the organic laws cannot 
 be infracted with impunity — such suffering parents would be 
 penetrated with the conviction that their bereavement was 
 just to them, and merciful to their progeny. Such information 
 could rarely fail to produce a more vigilant obedience for the 
 future. 
 
 How stands the case now, in the public mind ? All act as 
 though all children should live, all desire that they should live, 
 without any reference to consequences, and when they die, the 
 event is referred to a mysterious dispensation of Providence — 
 not a word is said to them by doctor or preacher to enlighten 
 them upon the subject of their own unsoundness, or daily vio- 
 lation, in almost all they do, of the organic laws. They are 
 not taught to look for the cause of their bereavement in the 
 history of their own lives. K the bereaved be piously disposd, 
 he inquires of himself, have I not kept the commandments ? 
 have I not been charitable ? have I not been just? Then why 
 should such a dispensation fall upon me ? "We answer, for the 
 reason that you have not obeyed the organic laws. For all 
 your obedience you will have your reward in kind, and for all 
 your disobedience you will suffer a corresponding consequence 
 in kind — the antecedent and the sequent are always related to 
 each other in kind — if you sow tares you must not expect to 
 reap wheat. Moral rectitude is not rewarded by an immunity 
 from disease. 
 
 It may be considered as an undebatable, and therefore a 
 self-evident proposition, that every animal or living thing was 
 placed here to enjoy existence; and if children leave their 
 parents before they have enjoyed, to any conscious extent, ex- 
 istence, the cause cannot, legitimately be found in the arrange- 
 ments of Providence. And if parents shall suspect us of a 
 disposition to insinuate, that if their histories were properly 
 investigated, the cause of juvenile mortality might be found ; 
 
UTILITY OF JUVENILE MORTALITY. 187 
 
 ■we will only say, that we would feel greatly enlightened by 
 having the histories of all such. What a flood of light the 
 profession might, in a few years, shed upon this subject, by 
 making a record of the organic history of all parents, whose 
 children die under five years of age. It would, we suspect, 
 be found that a few had married cousins ; many had married 
 incompatible constitutions ; many had married diseased ones ; 
 many dissipated in exciting amusements ; many were in a 
 constant excitement about their pecuniary liabilities ; others, 
 about their political prospects; some were gloomy for the 
 want of business ; others for having failed in business ; and 
 many were miserable because of discord. 
 
 Our whole purpose for introducing this subject, is, to make 
 parents, and all who expect to become parents, think of the 
 organic laws, to which they must render obedience, or suffer in 
 themselves, in their children, or in both. We desire that it 
 shall furnish a motive to individual and social improvement. 
 K any have applied our remarks to themselves, the fault is 
 not ours ; we have followed the plan of Providence — we 
 have aimed at the good of the race, and not at that of indivi- 
 duals. 
 
 With these introductory considerations, we proceed to an 
 exposition of the truth of our proposition. 
 
 There is no principle in the dynamics of the natural admin- 
 istration of this world more obvious, more visibly displayed, 
 or more defensible, than that the organic laws were so arranged, 
 as to provide for the preservation of species, at the expense 
 of individuals. The principle, furthermore, is illustrated by 
 all nations, civilly, politically, and religiously. All commu- 
 nities cut off criminal individuals for the good of the many — 
 the community ; all nations lose thousands of their citizens in 
 war, for the preservation of their political independence and 
 privileges ; and all religious associations expel irreligious indi- 
 viduals, for the purpose of maintaining the purity of the 
 church. The least attention to the principle will show, that it 
 is eminently philanthropic ; and a little more attention to it, 
 will we think, show that philanthropy is a more exalted virtue 
 than either justice or charity. If we shall now show, that the 
 good of the race — the species — is promoted by an extensive ju- 
 venile mortality, then we will have gained our point. In doing 
 
188 UTILITY OF JUVENILE MORTALITY. 
 
 this, we admit that we throw all the responsibility upon the 
 parents — we take from them the consoling unction, that the 
 fault was not theirs ; although they may have loved their 
 children, tenderly nursed them, and employed the most dis- 
 tinguished medical skill for them. Behind all this lies con- 
 cealed their disobedience ; and their children were taken out of 
 the species, and as certainly for the good of the species, as that 
 criminals are taken out of society, for the good of it. 
 
 Suppose any given number of children should take the 
 small-pox, and all exist under equal circumstances, and one- 
 third of them should die ; would not the conclusion be, that 
 with reference to this disease, that the two-thirds who recovered, 
 possessed a more conservative, a more efiective vital force than 
 those who died ? If this conclusion be admitted, then it fol- 
 lows, that some children have a greater constitutional tenacity 
 of life than others, and that diseases are the proper tests of 
 this vital force. 
 
 Children are the acts of parents, and their early death proves, 
 coeteris paribus^ that they were incompetent to stand disease, 
 the test of vital force ; or capacity to maintain existence, three- 
 score and ten years, and consequently the cause is justly refer- 
 able to the parents. 
 
 The fact is well known, that great longevity is peculiar to 
 some families, and it exists in defiance of every variety of mor- 
 bid invasion. We may speculate as we please as to the cause, 
 but we will have to conclude, virtually, that it depends upon a 
 strength of vital force which is capable of expelling from the 
 system all causes of morbid action, until worn-out or exhausted 
 by age. We are acquainted with a gentleman who had a 
 severe attack of Asiatic cholera, in the seventy-ninth year of 
 his age — he was self-willed — obeyed neither his physician nor 
 any one else — he would have to eat and drink whatever his 
 appetite desired ; consequently he ate heartily of pickled 
 cucumbers, and drank freely of buttermilk — no one expected 
 him to live, and yet he is still living in the eighty-third year 
 of his age, and apparently as able to sustain another attack 
 of cholera as he was before. Now, we may inquire : What 
 enabled him to live so long in the midst of epidemics that have 
 carried off thousands of younger men, from immediately around 
 liim ? Shall we not attribute his present existence, under all 
 
UTILITY OF JUYEMLE MORTALITY. 189 
 
 the circumstances by which he has been surrounded, to the 
 superior integrity of his vital force ? 
 
 The principle that aims at the perpetuity or preservation of 
 the species, is strongly exemplified in various conditions of 
 human society. In hospitals and prisons, where very many 
 are crowded together — too many for the health of all — so many 
 that all will perish without a reduction of their number, a 
 cause of disease is generated, which fells all but the few whose 
 vital force can resist it ; and thus at the expense of many, a 
 few are spared to preserve the race. Did not these few possess 
 a stronger vital force — more power to resist disease than the 
 others ? 
 
 In old and dense communities, where vicious habits, out- 
 rages upon the organic laws, have become so extensive as to 
 render enfeebled a large proportion of the population, a poison- 
 ous epidemic makes an assault, carrying off all whose vital 
 force cannot resist it. Can any one be so stupid as not to per- 
 ceive in this, not only that the survivors possessed a stronger- - 
 a more resisting vital force, but also an immense advantage to 
 the cause of human existence, as a species? Those who 
 escaped, possessed the requisite vital force to become the pro- 
 genitors of a vigorous posterity. 
 
 It will, we think, be perceived from what we have said, that 
 disease is the test of vital force; and consequently the younger 
 a person dies, the greater the defect in this essential of exist- 
 ence. When, therefore, we contemplate epidemics — disease 
 in general, with a proper philosophical spirit — it becomes 
 apparent, that it is not only the great avenger for sins against 
 the organic laws, but is indispensable to the aggregate of hu- 
 man life; and that without it, the species would become ex- 
 tinct, through the degeneracy of vital organization. 
 
 Horticulturists select the seed of their various crops from 
 the most developed and vigorous plants ; and yet some of the 
 seeds will have a feeble vital force, indicated by the feebleness 
 of the plants they produce, which he extirpates from the soil. 
 Does not death perform the same important function in the 
 garden of human life ? He destroys its plants in their youth — 
 he does not allow them to produce seed, and in so doing, lie 
 preserves the species in that condition which is adequate to a 
 perpetual existence. We have frequently heard it said, that 
 
190 UTILITY OF JUVENILE MORTALITY. 
 
 epidemics were, no doubt, wise and profitable dispensations of 
 Providence, but inscrutable to man. "We admit the first, but 
 deny that their purpose is inscrutable — indeed, we think that 
 we have made their purpose so plain, that the most ordinary- 
 intellect can understand it ; and in understanding it, the pre- 
 sumption is, that it will admonish all to become more ac- 
 quainted with, and to practice a greater obedience to, the organic 
 laws. 
 
 If disease was intended to test the vital force, and to cut 
 down the feeble in their youth, some may be disposed to sus- 
 pect that it is useless, if not improper, to attempt to save those 
 who may be thus assailed. We should come to no such conclu- 
 sion. In very many instances the vital force is nearly equal to the 
 disease, and with a little judicious aid, would overcome it ; and 
 then by proper culture, the former may be so strengthened, as 
 to contend with epidemic and other causes of disease, even to 
 old age. And in cases where the vital force is sufficient to 
 overcome the disease, it must be perceived, that a little inju- 
 dicious meddling may reverse the relation, and then death must 
 supervene. 
 
 A few illustrations wiU render this principle obvious. Sup- 
 pose a case in which the vital force is inadequate to the removal 
 of the disease, it is clear that by rendering a little judicious 
 aid to the former, in removing impediments and equalizing its 
 forces, it may obtain a sufficient ascendency. 
 
 Suppose again the disease to have resulted from epidemic 
 poison, and that the vital force is adequate to its removal ; but 
 as the friends do not know this, a physician is sent for. Upon 
 his arrival, he finds a high degree of febrile excitement, and 
 mistaking it for the disease, and a very general mistake this 
 is, he bleeds the patient. Does he not, by this act, reduce the 
 vital force ? Suppose again that he gives a purgative ; will it 
 not also reduce the vital force ? And lastly, suppose he gives 
 mercurial alteratives ; does he not add to the labor of the vital 
 force, by introducing another poison ? In view of these mis- 
 takes, and they are the prevailing practice of the age, is it 
 strange that the patient should die ? would it not be strange 
 if he did not ? And yet in first class constitutions, the vital 
 force is frequently able to contend with both the disease and 
 the doctor. 
 
UTILITY OF JUVENILE MORTALITY. j[9l 
 
 In review of the prevailing practice, we feel justly called 
 upon to attribute a large percentum of the existing juvenile 
 mortality, to the medical profession. When the febrile symp- 
 toms, in any given case, run so high as to induce those who 
 maintain that fever is disease, to bleed and purge; they would 
 induce us to believe that there was present, vital force enough 
 to save the patient, consequently we are inclined to hold that 
 branch of the profession responsible for every instance of mor- 
 tality, that supervenes such a practice. 
 
 This question we shall discuss in the next Book — it has inci- 
 dentally come up here, in our purpose of showing to what 
 extent the existing juvenile mortality, is indispensable and 
 useful in the consummation of the great purpose of Provi- 
 dence — the preservation of the species. 
 
 In the preceding Chapters of this book, we have labored to 
 enlighten our readers upon the subject of their duties to them- 
 selves, with reference to children, and of their duties to their 
 children in view of life, health, longevity, usefulness and hap- 
 piness ; and in conclusion, we conceive it to be our duty to 
 make an exposition of the necessity, utility and philanthropy 
 of that mortality which results from their neglect of those 
 duties. 
 
 If, in the discharge of this duty, we have inspired in some, 
 a desire to become more extensively informed with reference to 
 the laws by which God governs his physical Providence, we 
 advise them to read, and to study the " Constitution of Man " 
 by George Combe, Esq 
 
APPENDII TO BOOK I. 
 
 (PAGE 73.) 
 
 The subject of this appendix, Mrs. Catharine Schooley, the 
 wonderfully Adipo-Lymphatic Lady, was unknown to the pub- 
 lic at the time our first book passed through the press ; and as 
 her case is one of much interest, we conclude to introduce it 
 in this manner, rather than not all. The following wood -cut 
 presents a good likeness of 
 
 ■•^^.^■■#1 
 
 f ■ ^^ If -:^ 
 
 MRS. CATHARINE SCHOOLEY. 
 
 The condition of this lady belongs legitimately to the doc- 
 trine of the temperaments, and as her case has suggested some 
 thoughts which did not occur to us when treating of that sub- 
 ject, and as she is an admirable illustration of them, we hope 
 to render clear some distinctions which physiologists have not 
 hitherto noticed, so far as we have observed. 
 
 (192) 
 
APPENDIX TO BOOK I. 193 
 
 Anatomists and physiologists have expended much labor in 
 an endeavor to ascertain the average amount of fat or adipous 
 matter which is common to the human race ; but when we re- 
 flect that the largest accumulation of it was in a German 
 individual who weighed eight hundred pounds, and the small- 
 est, which, perhaps, amounted to a total absence of it, was the 
 well known Calvin Edson, who weighed only fifty-eight pounds, 
 and whose stature was that of a man— being some five feet 
 ten inches high, and of good general health. Between these 
 extremes there is a difierence of seven hundred and forty -two 
 pounds. Therefore, as we were about to remark, that where 
 such extremes exist, it cannot be an easy task to determine the 
 average. Nevertheless, it has been agreed to consider one- 
 twentieth part of each human being, upon an average, to be 
 fat or adeps. According to this rule, a man weighing one 
 hundred and sixty pounds would have eight pounds of fat. 
 
 In this active and excitable country, cases of leanness or 
 atrophy are much more numerous than those of even mode- 
 rate hypertrophy ; but in Holland, and in some parts of 
 Africa, it is probable that, in a majority of individuals, the 
 tendency is to hypertrophy; and yet the instances of such 
 astonishing fatness, or hypertrophy, as Mrs. School ey exhibits, 
 have been remarkably few among all nations and in all ages. 
 
 In 1834:, a gentleman from Kentucky, by the name of Pri- 
 chard, exhibited himself in the Cincinnati Museum on account 
 of his fat — he weighed 550 pounds. We regret that we do not 
 know his height and other proportions, because, upon these 
 depend much of the interest of the case. Some twenty-five 
 years since, a man exhibited himself in Philadelphia under 
 the designation of " the Canadian Giant," who weighed 618 
 pounds, and had an altitude of six feet four inches. Dupey- 
 tr^n has published the case of a beggar-woman, who was five 
 feet one inch high, and five feet two inches in circumference, 
 but he has not given her weight. But the most distinguished 
 case known to physiological history is that of Daniel Lambert, 
 of England, who weighed 739 pounds. His altitude we do not 
 remember, but it was over six feet. 
 
 Before proceeding to an elucidation of this subject, we will 
 introduce the facts as to the person of Mrs. Schooley, and a 
 brief outline of her history : 
 13 
 
194 APPEI^DIX TO BOOK I. 
 
 Mrs. Schoolej was born March 28tli, 1816, in Warren coun- 
 ty, IsTew Jersey. Her father, Anthony Lurch, when in tho 
 prime of his life, weighed about 250 pounds, and her paternal 
 grandfather weighed more than three hundred, and his wife 
 more than two hundred. She had seventeen children — twelve 
 boys and five girls — and at her death, which happened in the 
 TSth year of her age, she had, to the best of Mrs. Schooley's 
 information, about two hundred grandchildren, and one hun- 
 dred great grandchildren. 
 
 Mrs. Schooley herself has a brother and sister, who respec- 
 tively weigh about two hundred. It appears, then, from the 
 history of her family, that she has inherited a liability to an 
 adipous hypertrophy of constitution; and, so far as she knows 
 anything of herself, she has been, with more or less regularity 
 and rapidity, gaining fat and increasing in size ever since her 
 infancy. 
 
 When she married, which was in 1835, she weighed 160 
 pounds, and in 1836 she had a son, who lived to be more than 
 four years old, (this was the only child she ever had). In 1839, 
 Mr. Schooley and she moved from Isew Jersey and settled in 
 Pickaway county, Ohio, at which time she weighed 280 pounds. 
 She has had up to the present moment, as a general condition, 
 excellent health, and weighed, in 1845, five hundred and fifty- 
 three pounds, and she thinks that she has gained one hundred 
 pounds since ; but good judges of weight, from appearances, 
 estimate her weight at six hundred and thirty-five or forty 
 pounds. 
 
 The following measurements will convey a pretty accurate 
 idea of her magnitude : 
 
 Height of person, 5 feet 2 inches. 
 
 1 foot 11 " 
 
 1 " Ti " 
 
 5 feet 5 " 
 
 7 " " 
 
 Circumference of the head, . 
 
 " " neck, . 
 
 *' " chest, . 
 
 " " abdomen 
 
 " " arm near the chest, 3 " 2 
 
 *' " arm 4 inches above 
 
 elbow, 1 foot 10 
 
 Measure over head from meatus to meatus 1 " 2 
 Measure over head from nasal suture to 
 
 occipital protuberance, .... 1 " 3 
 
APPENDIX TO BOOK I. I95 
 
 Her hair is of a light chesniit color, and very sparsely set 
 upon the head ; the complexion of her skin is about that of a 
 middle-aged sanguine man — rather opaque and reddish on the 
 face and hands, but fair where not exposed. 
 
 Her eyes are unusually full and prominent, and of a bluish 
 gray color, but the eye-lids do not approximate as they usually 
 do in the lymphatic constitution, but they do, nevertheless, 
 give to the face an expression of heaviness. Her features, as 
 a whole, are much of the sanguine order, large, fully defined, 
 and withal, good-looking. It should be remarked, however, 
 that her forehead is more vertical, and the crown of the head 
 is more elevated and expanded than is common to the sanguine 
 constitution. All of the superior anterior part of her head is 
 peculiarly lymphatic in its appearance. Her nose is straighter 
 and of a more graceful form, and the lips are thinner than is 
 common to the lymphatic constitution. 
 
 In her chamber she is active — sits down, gets up, and turns 
 about with more quickness and promptness than is common to 
 many ladies of much less portable dimensions ; but a few 
 movements, however, exhaust her. The walking of thirty 
 yards would prove a very fatiguing task to her. 
 
 From the time of her accouchement to 1847, she was disposed 
 to sleep the most of her time — she would fall to sleep when eat- 
 ing, with food in her mouth ; the presence of no ordinary excite- 
 ment could restrain this propensity. During this soporiferous 
 condition, she was much troubled with a feeling of weight or 
 heaviness in the basilar region of the anterior lobes of the 
 brain, with aching and tumefaction of the eyes. For the pur- 
 pose of relief, she was advised by a medical friend to smoke 
 tobacco — she did so, and was relieved, and continues so — she 
 is now as wakeful as any one, but cannot dispense with the 
 remedy. 
 
 Her intellect is active and judgment good, superior to that 
 of most of her sex — it even approaches masculinity. She con- 
 verses well, but soon becomes fatigued. She manifests, fur- 
 thermore, a large share of that social delicacy for which her 
 sex is distinguished. The conviction that she is both useless 
 and helpless, and daily becoming more so, if possible, is a 
 source of exquisite grief to her. She cannot refrain from 
 shedding tears when her helplessness is alluded to, but in 
 
igQ APPENDIX TO BOOK I. 
 
 general she is social and apparently bappy. Nothing but a 
 sense of duty, with reference to a possible necessity, occasioned 
 by the conviction that her condition requires the whole of her 
 husband's time, sustains her in becoming an object of public 
 curiosity. 
 
 Finally, she is not to be regarded as merely a large animal, 
 but a lady of excellent judgment, fine social sympathies, and 
 a faultless propriety of deportment. 
 
 When we contemplate the low stature of Mrs. Schooley in 
 connection with her weight, she becomes at once an object of 
 more anatomical and physiological interest than any other one 
 known to history. The Canadian Giant was six feet four 
 inches high, and therefore, if he had been as fat as she, he 
 would have weighed 143 pounds more, while in reality he 
 weighed 17 pounds less. Considering the respective altitudes 
 of Mrs. Schooley and Daniel Lambert, their weight respect- 
 ively, is about equal. 
 
 So far as we have well authenticated information, Daniel 
 Lambert must still be regarded as the largest man who has 
 lived, and as the measurements of Mrs. Schooley are greater 
 than those of the beggar woman named by Dupuytren, she 
 must be regarded as the largest woman known to have existed. 
 
 To the scientific inquirer, the most interesting relations of 
 this class of persons, are yet to be considered. 
 
 What is the difi*erence between the Adipous and Lymphatic 
 constitutions ? Lymph is not fat, and yet physiologists confound 
 the two — they have drawn no distinction between them. Most 
 of them would regard Mrs. Schooley as they did Daniel Lam- 
 bert, as of the Lymphatic constitution. Those who are merely 
 fat or obese, have small heads — that is, they are not larger 
 than those of lean persons ; but those of the Lymphatic constitu- 
 tion have large heads. This is not all ; Lymph is never partial 
 in a normal state of the system — there is never a hypertrophy of 
 it in one part of the system, and an absence of it in another. 
 It pervades equally all parts of the system — the brain as well 
 as the body. Lymphatic individuals never become so heavy 
 as the fat or adipous. Fat persons, furthermore, retain the 
 features of their former and more dense condition, and of the 
 dense varieties from which they had departed, except in the cir- 
 cumstance of their adipous hypertrophy. But the features of 
 
APPEIfDIX TO BOOK I. 197 
 
 the purely Lymphatic, are peculiar and unmistakable — the 
 eyelids are partially closed, the nose is pugged, the lips are 
 thick, and the head is large and round. 
 
 Mrs. Schooley's head indicates the presence of Lymph, but 
 not to the extent of her magnitude ; and although her head is 
 above the average of female heads, yet it is not larger than 
 some among the dense varieties. We decide that she is an 
 obese specimen of the Sanguine-Encephalo-Lymphatic consti- 
 tution. The coronal aspect of her head, and certain peculiar- 
 ities of her mouth and eyes, indicate the presence of Lymph. 
 Her complexion and nose in particular, and to some extent her 
 mouth, eyes and posterior portion of her head indicate the 
 presence of the sanguine, as may be observed by a comparison 
 of her portrait with the cut of Gen. Washington. 
 
 The fullness or breadth of her head at the level of the pari- 
 etal ridges, and the prominence of her inferior jaw, but more 
 particularly the former, show that she participates, to some 
 extent, in the Encephalic temperament, as exhibited by the cut 
 of the Kev. Dr. Keinstadt. 
 
 It appears that Mrs. Schooley's constitution is composed of 
 three ; the sanguine and lymphatic, however, preponderate over 
 the third or encephalic. With the Bilious she seems to have 
 not the least affinity — she is as much unlike it as she is of any 
 distinct race of the species. The bilious constitution is pecu- 
 liar for its denseness or compactness, while her leading peculi- 
 arities are just the reverse. A comparison of her portrait 
 with that of Akiosto, exhibits a bold contrast. 
 
 Having considered the constitutional relations of this re- 
 markable lady to the species, we return to the question. What 
 is the difference between an obese and a lymphatic constitu- 
 tion ? If we are to be directed to our conclusion from the 
 known chemical composition of Lymph, and of Adeps, then 
 there is no similitude between them, and this, in reality, is our 
 conviction. Fat consists of hydrogen and carbon, and lymph 
 of water (about 96 per cent.), a small quantity of the salts, 
 common to animal life (about two per cent.), and variable pro- 
 portions of fibrin and albumen. 
 
 The Esquimaux Indians have been regarded by physiologists 
 as Lymphatic. How is it possible for a lymphatic people to 
 live in such a climate ? The crania I have, show them to be 
 
198 APPENDIX TO BOOK I. 
 
 bilious, while the necessity of their climate and the nature of 
 their food would render them fat. 
 
 K we mistake not, the winter and spring conditions of hiber- 
 nating animals, illustrate the fat and the lymphatic conditions 
 incidental to human life. They never repair to their hiber- 
 nacles until they become very fat, and while there, they drink 
 water, but take no food — their fat maintained or provided for 
 them the necessary animal heat during the winter. When 
 they leave their hibernacles in the spring, they appear to be as 
 fat as when they went in ; but this could not possibly be the 
 case ; and that it is not the case, we may infer from the fact 
 that they soon become very lean after leaving their hibernacles 
 in the spring. Their condition then was that of lymph ; a 
 compound of water, fibrin, albumen and salts, which is entirely 
 incapable of sustaining animal heat. 
 
 There is another circumstance connected with this subject 
 which is not without interest. Lym^Dhatic people live mostly 
 upon fluids, or non-carbonaceous food — the adipous upon the 
 carbonaceous, and so do the tuberculous, but they do not se- 
 lect the gross varieties — having a more fastidious appetite. 
 From the preceding considerations it seems probable that the 
 cellular tissue may be filled to repletion with lymph, in one 
 individual, in another with adeps, and in a third with a com- 
 bination of both. 
 
 I do not feel willing to admit the existence of an adipous 
 temperament, because the presence of adeps is never universal 
 — it is not in the brain, and because we have become satisfied 
 that it depends upon either an abstract or a relative deficiency 
 of the pulmonary function, consequent upon a small medulla 
 oblongata and a large cerebellum. The disposition, then, to 
 obesity results from a local Encephalic arrangement, while 
 lymph depends upon, as yet, some unknown, but general 
 peculiarity of organization. There is another circumstance 
 which sustains this conclusion ; we have never found any diffi- 
 culty in tracing this constitution in its combinations with the 
 other temperaments — but this we cannot do with the adipous. 
 
APPENDIX TO BOOK II. 
 
 (PAGE 118.) 
 
 The following cases were overlooked by the compositor, and 
 as we consider them to bear with great strength upon the 
 question at issue, we have concluded to give our readers the 
 benefit of them, though out of place, more especially as they 
 have never been published. Professor ISTewton, one of the 
 authors, is responsible for their accuracy: 
 
 Mrs. M., formerly of G., Ohio, about seven and a-half 
 months advanced in pregnancy, was picking some fruit from 
 an apple tree, when, in moving a branch, a snake fell, and, as 
 she supposed was falling upon her, and she, in her fright, 
 drew her hands to her face, placing two fingers of each hand 
 into the orbits of her corresponding eyes. In due time she 
 was delivered, and the child was without eyes, but in the 
 orbits were firmly attached the extremities of two fingers of 
 each hand of the respective sides. 
 
 Mrs. S., on the day before she was confined, labored very 
 hard at the wash-tub ; she was not accustomed to such labor, 
 nor was there any necessity for it at the time, but because of 
 some domestic vexation she did it, and did it in a sitting pos- 
 ture, with the washboard resting against her stomach, and her 
 arms resting on the edge. The process of washing had chafed 
 and even removed the cuticle from her wrists and fingers, so 
 that they were sore and somewhat infiamed at the time of 
 her delivery. 
 
 The child, when born, exhibited an extensive bruise across 
 the epigastrium; the skin upon the wrists and fingers was 
 abraded and the muscles of both arms, corresponding with the 
 bruises made by the wash-tub upon the mother's, were 
 divided to the bone, and the clefts were full of blood, which, 
 after being washed, was found coagulated in the deeper por- 
 tions of them. The child was born dead. 
 
 (199) 
 
B 01 III 
 
 THE NATURAL HISTOEY, PATHOLOGY AND TREATMENT 
 
 OF THE VARIOUS FORMS OF DISEASE INCIDENTAL 
 
 TO INFANCY AND CHILDHOOD. 
 
INTRODUCTION. 
 
 PATHOLOGICAL CONSIDERATIONS. 
 
 Before entering upon the consideration of the special mani- 
 festations of disease, a few general remarks, with reference 
 to the whole subject, appear to be called for. 
 
 "We have thus far spoken familiarly of disease and diseased 
 action, and our readers, no doubt, conceived that they 
 thoroughly understood us, and we think it very probable that 
 they did, so far as the nature of the subject demanded ; that 
 is, they have understood us after the manner of unprofessional 
 society. But, as we approach the Practice of Medicine, it be- 
 comes indispensable that we should be definitely understood 
 as to the ideas we attach to certain words, which constitute the 
 initial of medical study. A misapprehension of our meaning 
 of these words will lead to a misunderstanding of all of our 
 subsequent reasoning. A few illustrations will render this 
 matter transparent. 
 
 At this time, the prevailing opinion in the profession is, that 
 fever and inflammation are diseases, and upon this opinion is 
 founded a certain medical practice ; now, suppose this idea to 
 be founded in error, then it follows that the practice founded 
 upon it must be equally erroneous, and consequently mischiev- 
 ous. At this point we will make two or three citations to 
 prove our statement to be correct. 
 
 Watson's Practice, page 94, informs us, that inflammation 
 is " a special form of disease to which all parts of the body 
 are liable — a disease that meets us at every turn." 
 
 Professor Paine's Institutes, page 464, says, that " inflam- 
 mation and fever are the two orders of disease which make 
 up the great amount of human maladies and form the general 
 outlets of life." 
 
 Professor Gregory says, that " fever is the most important, 
 
 (203) 
 
204 PATHOLOGICAL CONSIDERATION'S. 
 
 because the most universal and the most fatal of all the moT' 
 hid affections of which the human body is susceptible." 
 
 These quotations are made from standard and highly 
 esteemed authorities in the allopathic branch of the profession ; 
 but, without any expression of opinion on this subject, the 
 allopathic practice authorizes the inference as to what its fun- 
 damental doctrine must be. If fever be not disease^ then 
 there is no warranty for bleeding, purging, and poisons. 
 
 People generally believe that if the old school physicians 
 neither bleed or give mercury, they are on a par with the new 
 school — but here they are mistaken ; the difference between 
 the two is not confined to a difierence between their therapeu- 
 tical agents, but in the principles that guide to the use of 
 them. Life can be destroyed without the use of the lancet or 
 mercury — and so fever can be brought down without them. 
 
 The proper question is this : which is the jpliysician^ the 
 one who regards fever as a disease, and therefore uses all the 
 means he can command, as bleeding, purging, poisons, and 
 starvation, to reduce and break it down, or the one who 
 regards fever as a proper physiological act of the system to 
 remove disease, and therefore does all he can to sustain and 
 equalize it % It is true that bleeding and purging will equalize 
 it, but in doing this they equalize the patient with the dust 
 from whence he came. But the idea of sustaining fever and 
 inflammation does not belong to their practice. 
 
 Because we sustain fever and inflammation as the two most 
 important physiological friends the animal economy can ac- 
 knowledge, and sustain our principles by a consistent materia 
 medica — one without poisons* — we have been denounced as 
 
 * As there has been much caviling as to what constitutes a poison, we will 
 present our definition of the word, as we use it. Every substance is a poison, 
 in the abstract, absolutely and necessarily, whose inorganic elements cannot 
 be digested, assimilated, or appropriated, by the function of nutrition, to any 
 normal purposes in tlie animal economy. 
 
 Strychnine and hydrocyanic acid are not, in the abstract, poisons, but rela- 
 tively they are, in common with all other substances which are not, in the ab- 
 stract, poisons. 
 
 Under this definition, mercury, arsenic, antimony, bismuth, etc., are, and in 
 defiance of all caviling or sophistry must be, poisons ; and, so long as the 
 smallest conceivable particle of any such absolute poison is in the system, the 
 vital force will labor to cast it out, because it is, per se, a foreign body — a source 
 
PATHOLOGICAL CONSIDERATIONS. 205 
 
 innovators, charlatans, and quacks. We will reverse this 
 charge and clench it, before we have done. 
 
 Most of the modern allopathic writers on inflammation and 
 fever refer us, for the purpose of obtaining a more thorough 
 understanding of these subjects, to Professor John Hunter's 
 work on inflammation. Well, what does Professor Hunter 
 say? 
 
 In vol. iii, page 285, he tells us that " inflammation, in 
 itself, is not to be considered a disease, but as a salutary opera- 
 tion consequent either to some violence or some diseased It 
 " is an action produced for the restoration of the most simple 
 injury in sound parts, which goes beyond the power of union 
 by the first intention." 
 
 He continues, on page 293, " Pure inflammation is rather 
 an efibrt of nature than a disease." 
 
 On page 286, he again remarks, " From whatever cause it 
 (inflammation) arises, it is an efibrt intended to bring about a 
 reinstatement of the parts to nearly their natural functions." 
 
 Upon this doctrine we stand — a doctrine that is recommended 
 by the most distinguished allopaths of the day ; and yet, 
 strange to tell, it is especially and peculiarly the one which 
 they have all abandoned. Who are now the innovators, the 
 charlatans, and the quacks ? The allopaths recommend this 
 doctrine, and yet, practically, denounce it — we believe it and 
 practically conform to it — which, then, is the most consistent ? 
 
 ]N"ow, suppose we try the Hunterian doctrine of infiamma- 
 tion by a few illustrations. 
 
 A mechanic has a splinter forced under his finger nail, and 
 so broken that he cannot extract it. Is not the first observable 
 result in the part infiammation, and then follows suppuration, 
 granulation, and cicatrization ? Is not the whole of this pro- 
 cess normal, under the circumstances ? Could the part origin- 
 ally have been in a normal condition if these phenomena had 
 not succeeded to the accident ? Was not the infiammation 
 
 of irritation and cannot possibly be converted into anything that is not un- 
 friendly to the animal tissues. 
 
 In the Western Journal of Medicine, vol. 2, page 636, Professor Drake says 
 that " mercury has been found in the bones, blood, brain, and nerves," aiul yet 
 it cannot form a part of either of them, nor can any other substance that is 
 embraced by our definition — they are all emphatically poisons. 
 
206 PATHOLOGICAL COI^SIDERATION'S. 
 
 absolutely essential to the expulsion of the splinter ? Now, 
 suppose the patient to have been bled to such an extent as to 
 have prevented the inflammation, would the splinter have 
 been expelled ? 
 
 As a further exemplification of this subject, we extract the 
 following illustration from " Simon's General Pathology :" 
 
 "A man has a sudden and severe pain in some part of the 
 surface of his body, accompanied by a rush of blood to the 
 painful spot, and by a disposition to the pouring out of serum 
 there. This, obviously, is not a condition of health. But, if 
 you knew that a quantity of boiling water had just been 
 dashed on the part, you would be disposed to transfer the term 
 unJiealthy from the effect to the cause — from the man to the 
 kettle. In fact, the man would have been unhealthy if this 
 redness and vesication had not occurred." Then, as they did 
 occur, they were right actions, under the circumstances, and 
 cannot, therefore, under any definition of disease, be called 
 diseased actions. 
 
 Doctrines as sound as this have been proclaimed by several 
 of our living allopathic professors, but they appear only as 
 luminous rays that occasionally flitted across their minds — 
 they were not maintained with consistency, nor followed by 
 practice. In proof of this, we will select a few illustrations : 
 Professor Paine, in his Institutes, page 465, teaches that " in- 
 flammation takes its rise in purely physiological conditions 
 and holds its progress and decline under the same great natu- 
 ral laws of the constitution." The professor could not have 
 expressed himself in language more compatible with truth, 
 but he certainly did not understand the import of it, or he 
 would never have written the following; on page 464, he 
 says, " Inflammation and fever are the two orders of disease 
 which make up the gi-eat amount of human maladies and 
 form the grand outlets of life." 
 
 In inconsistency Professor Watson has more than equaled 
 the preceding. He says. Practice, page 94, that "It is by in- 
 flammation that wounds are closed and fractures repaired — 
 that parts adhere together when their adhesion is essential to 
 the preservation of the individual, and that foreign and hurt- 
 ful matters are conveyed safely out of the body." This doc- 
 trine is correct, but that he should administer calomel to break 
 
PATHOLOGICAL COJ^SIDERATIONS. 207 
 
 down inflammation, and, when down, to expect it to carry 
 BTich a "hurtful matter "out of the system, is much more 
 than we can conceive to be possible with a rational man. But 
 we will hear him again : on the same page, he teaches that 
 " inflammation is a special form of disease, to which all parts 
 of the body are liable — a disease that meets us at every turn." 
 Upon which of these principles did he found his practice ? 
 upon the latter, and in aiming his blows at fever and inflam- 
 mation he destroyed many of his patients, no doubt. 
 
 It is not our purpose to discuss, at length, this question — 
 we only wish to make our pathological position known, that 
 the fundamental principle of our practice may be understood. 
 We will not, therefore, pursue it further than to present two 
 cases to illustrate the two systems of practice which are 
 founded, respectively, upon its two horns. 
 
 In 1837, the writer had the inferior extremity of the right 
 fibula fractured — his general health at the time was, perhaps, 
 never better — it was treated by a Philadelphia graduate, who 
 subsequently devoted a year or two to the surgical wards of 
 the Parisian hospitals. In the course of the treatment he was 
 duly bled, purged, nauseated, calomelized, and starved, and 
 what is equally worthy of note, he approved of it. In four 
 months he left his room by the aid of a crutch, but very much 
 reduced in flesh. In 1841, he had both bones of the left leg 
 fractured ; but, let it be remembered, in the meantime he had 
 changed his opinion of inflammation, and of course his views 
 of practice. In the treatment of this fracture, he was neither 
 bled, purged, nauseated, nor starved ; but upon the superven- 
 tion of fever, he took, in two days, twenty grains of quinine ; 
 this was all the treatment he had, except plenty of palatable 
 and nutritious food. In thirty days, by the aid of a crutch, 
 he left his room, weighing some ten or twelve pounds more 
 than when the accident happened. 
 
 These two cases, in our judgment, perfectly illustrate the 
 two systems of practice. In the first case, the efiorts that 
 were made to break down, and to keep down, the inflamma- 
 tion and fever, kept the patient down. In the second instance 
 these manifestations were received as friends, who had come, 
 expressly, for the purpose of mending a broken limb, and, 
 therefore, instead of trying to bleed, purge, and starve them 
 
208 PATHOLOGICAL COI?"SIDERATIOXS. 
 
 out of existence, they were fed on quinine. In the treatment 
 of this second case, it will be perceived, furthermore, that he 
 had a thorough faith in this doctrine, notwithstanding the 
 force of education to the contraiy. It may be interesting to 
 add, that he had with him a fellow graduate who manifested 
 much concern for his condition — he frequently implored him 
 to abandon his course — that he was risking not only his leg, 
 but his life ; but he gave no ear to him, because he saw that 
 he could not see well — that he was still wearing the old foggy- 
 looking spectacles that were given to him by the university. 
 
 Although we have perhaps sufficiently illustrated our posi- 
 tion, we have not specifically defined om- understanding of the 
 words, disease, fever, inflammation, physiology, and pathology. 
 
 Disease we understand to be that condition of a part which 
 disqualifies it for the performance of its function. 
 
 Fever is a manifestation of an efibrt of the system to 
 remove disease — a physiological action under the circnm- 
 stances — a general or constitutional indication of disease. 
 
 Intla:mmation is an evidence of local disease — an action 
 produced for the restoration of a diseased part — an efibrt of the 
 vital force to remove disease. 
 
 Physiology is the science of life in all its modes of being, 
 but is now usually restricted to life in a state of health. 
 
 Pathology is the science of life in a state of disease — it is 
 physiology under abnormal circumstances. 
 
 We may be asked, what is gained by these views, defini- 
 tions, and explanations ? We answer, everything that can be 
 gained by having the truth, instead of a fiction or a falsehood. 
 There is a wide difierence between considering ourselves as 
 called upon to treat fever as a disease, instead of a physiolo- 
 gical action, or an efibrt of the system to remove disease — as 
 much difierence as there is between bleeding and purging on 
 the one hand and the administration of antispasmodics and 
 tonics on the other. There is, we conceive, a wide difi'erence 
 between supporting the vital force under the infiammation of 
 a broken leg, by nutritious diet and tonics, and such bleed- 
 ing, purging, and starving as will break down the infiamma- 
 tion and defeat a restoration of the part. There is a wide 
 difi'erence between setting up, by the use of means, a new 
 pathological action, that is always hazardous and frequently 
 
PATHOLOGICAL CONSIDERATIONS. 209 
 
 fatal, and that of aiding and regulating a pre-existing one. 
 Finally, we think that there exists a wide and an irreconcilable 
 difference between assisting nature — the vis medicatrix na- 
 tiircB^ to effect a desired physiological change, and that of crip- 
 pling all of her efforts and energies. 
 
 If our definitions be correct, and they are supported by such 
 authority, as the most distinguished allopaths recommend to 
 our study, then the difference between the eclectic and allo- 
 pathic practice is as great as that between noonday and mid- 
 night. 
 
 It will be conceded by all, that without vital force there is 
 no manifest life — death only exists. And it will readily be 
 admitted, that without blood there is no life, and that death 
 can be easily produced by bleeding, and that to the extent of 
 any abstraction of this fluid is the vital force reduced. It is 
 equally well known, that purgatives and poisons will diminish 
 and even destroy the vital force ; and, finally, we think, that 
 it would be difficult to prove that an animal can have too 
 much vital force. 
 
 Now, is it not absolutely true that a very large majority of 
 physicians do pretend to cure disease by bleeding, purging, 
 and the administration of poisons ? Do they not sometimes, 
 yea, frequently, bleed and purge to reduce, or else to equalize 
 vital action, and then, in a short time, give stimulants and 
 tonics to sustain the vital force? Do they not bleed in cholera 
 and then presently inject salted water into the veins to supply 
 the place of the blood they had just abstracted? But we will 
 be more special. 
 
 Dr. Armstrong, speaking of scarlatina maligna, says, "the 
 vehemence of the attack and the intensity of the excitement 
 rapidly exhaust the vital energies." And what does he recom- 
 mend to support them, and to prevent their destruction ? 
 " Emetics followed by brisk purgation." Is not this equiva- 
 lent to bleeding a man to keep him from fainting? A disease 
 must be very violent when it can exhaust vital energy with 
 more rapidity than "brisk purgation." A patient must cer- 
 tainly have a vigorous vital force to sustain himself under both. 
 Professing to be the friend of the "vital energies," he gives 
 aid to the disease ; but this is not the only glaring inconsis- 
 tency of his practice. When he visited the patient, he tbund 
 14 
 
210 PATHOLOGICAL COXSIDERATIO^^S. 
 
 the " vital energies" struggling to force the poison upon the 
 surface, or, in other words, to remove the cutaneous obstruc- 
 tions, and he immediately countermands the effort and orders 
 "brisk purgation," to force the "vital energies " to retreat to 
 the bowels and to leave the disease in possession of its strong- 
 hold. Great must be the " vital energies," when they can 
 successfully resist a malignant disease, reinforced, as it usually 
 is, by bleeding, pui'ging, and poisons. 
 
 J^ext to the lancet, mercury is most prized in the treatment 
 of inflammatory affections, and perhaps on account of that 
 quality which Professor Harrison assigns to it, "a most power- 
 ful depressor of the energies of life." According to our defi- 
 nition, it is a poison, and Hooper's Dictionary teaches, that 
 "all our most valuable medicines are active poisons." 
 
 ]^ow, inasmuch as all epidemics are produced by a poison 
 of some kind, and as the "vital energies are frequently inca- 
 pable of expelling it," would common sense suggest the pro- 
 priety of introducing into the system another poison, on the 
 plea that two poisons are more easily expelled than one, more 
 especially as one of them is unalterably a poison, and "a de- 
 presser of the energies of life?" 
 
 This specimen of practice, by Dr. Armstrong, is a pretty 
 fair illustration of allopathic practice in general — it was once 
 our own — and as one illustration is enough to expose its hide- 
 ous deformity, we will drop it, and proceed to the considera- 
 tion of more agreeable subjects. 
 
 Having disposed of such physiological and pathological 
 matter as became suggested to us, with reference to our leading 
 object, it yet remains for us to indicate and illustrate that fun- 
 damental law or principle that will guide our practice. We 
 say fundamental law or principle, because, maintaining as we 
 do, that disease is but one — a unit, there can be but one fun- 
 damental change, which is to, or from, health ; and, as the 
 leading object of this work is to teach how we may, with the 
 most facility and certainty, effect the first — a change to health, 
 it becomes the paramount duty of students to discover, as far 
 as possible, the processes which li\dng organized systems 
 establish for their own preservation, under the various contin- 
 gencies incidental to existence. So far as they shall accom- 
 plish this, they will find that they have nothing to do but to 
 
PATHOLOGICAL CONSIDERATIOISrS. 211 
 
 aid, and every dose of medicine they shall administer, during 
 their ignorance of the intentions, or the character of the efforts 
 the system is making, will be done empirically. 
 
 It will not, we presume, be disputed, that the vital force is 
 a unit, if not in fact, at least in its action, as much so as 
 steam — neither of them can accomplish anything, without ap- 
 propriate apparatuses to act upon ; and we are so constituted 
 as to believe that all living organizations have been so arranged 
 and endowed as to act, under existing circumstances, not in- 
 telligently, but in harmony or in accordance with the laws of 
 intelligence — that the various organs that constitute the sys- 
 tem cannot and will not act, except as they are compelled by 
 the vital force, and that when they do act, it is with the wis- 
 dom of that intelligence which designed them, and assigned 
 to each its peculiar mode and range of action. A denial of 
 this conclusion is a virtual denial that science does or can exist; 
 it is equivalent to admitting that a living organism, in a state 
 of disease, may become as perfectly a mass of confusion — a 
 chaos — as a mere mechanical aggregate. 
 
 We do not know that any one ever doubted that living 
 organizations act in harmony with the laws of a predetermined 
 wisdom ; but it will be seen, before we have done, that physi- 
 cians have practiced, and now do, with either a shameless 
 ignorance of, or a careless indifference to, the laws or economy 
 of the living system. The man who has not an intelligent, a 
 fixed, and an abiding faith that every action that takes place 
 in a living system, is, under the circumstances, wisely directed — 
 because directed by the provisions of that wisdom which is 
 SCIENCE — which admits of no errors — no accidents in the mea- 
 sureless bounds of the universe, is unfit for the profession. 
 
 The physician who is thus constituted, and thus qualified, 
 never bleeds and purges to support the " vital energies," but 
 removes impediments — the causes of abnormal actions — and 
 aids the vital force to maintain such movements as shall be in 
 harmony with the living norma. 
 
 In a state of health, the vital force is adequate to the main- 
 tenance of an equilibrium of action in all parts of the system, 
 but under the influence of a local injury, this is not the case — > 
 it is indispensable that a major action shall be sustained in 
 the injured part. In the case of a fractured bone, constipation 
 
212 PATHOLOGICAL COI^SIDERATIONS. 
 
 immediately supervenes, or else a diarrhea, which is invaria- 
 bly an unfavorable symptom — and these remarks are equally 
 true of small-pox. All agree that constipation in this malady 
 amounts almost to a pathognomonic symptom ; and when 
 diarrhea happens to appear in its stead, it is regarded by all 
 writers as unfavorable. 
 
 Now, the fact that constipation attends all inflammations of 
 the animal system, cannot be regarded as an accidental cir- 
 cumstance — it should teach us something in reference to the 
 agency of the vital force, under the existence of such forms of 
 disease as we have alluded to. During the inflammatory 
 stage of small-pox, purgatives are positively prohibited ; now, 
 we would be pleased to know why they are not prohibited in 
 fractured bones and gun-shot wounds ? If no valuable reason 
 can be given for this difierence of practice, then it is empirical. 
 
 Let it be remembered, then, that in fractures and other 
 wounds, something more is required of the vital force than 
 barely to maintain repairs ; and to afibrd an additional force 
 to the injured part, an inequilibrium of force must be efiected 
 in the system ; and, as it cannot be taken from the animal, 
 under the circumstances, it is taken from the vegetative, and 
 constipation results, and continues until the work of recovery- 
 has fairly become established. 
 
 If, in such a case, a cathartic be administered before the 
 thorough establishment of inflammation, the recovery of the 
 part is retarded — and how often has it been retarded by a 
 rigid antiphlogistic treatment ? 
 
 In the case of the small-pox, the unmistakable purpose of 
 the system is to become relieved through the cutaneous sur- 
 face — to it the vital energies are directed, and the obvious 
 efiect of a purgative is to counteract the vital force, and to ex- 
 pend as much of it upon the mucous membrane of the alimen- 
 tary canal, as might be sufficient to force the disease or its 
 cause upon the surface. 
 
 Observation, during many years, has satisfied us that 
 cathartics are used too much by every branch of the profes- 
 sion. Our object is a sanative course of treatment in all the 
 manifestations of disease, and we are sure that an injudicious 
 use of cathartics is as far removed from such a practice, as 
 the use of the lancet is. In fevers and inflammations, 
 
PATHOLOGICAL CON'SIDERATIONS. 213 
 
 cathartics become indicated when the fecal contents of the 
 alimentary tube become a source of irritation. Health can- 
 not be restored, in any form of disease, until secretion becomes 
 re-established, and when it is, we have always observed the 
 alvine excretion to return with promptitude, and to continue 
 with more health, than ever follows the use of cathartics. 
 
 In diseased conditions of the tissues and organs of animal 
 life, they are not properly indicated, not even when the brain 
 and lungs are invaded, because more legitimate means of 
 equalizing the circulation can be employed. Except for the 
 purpose of dislodging sources or causes of irritation, and this 
 irritation must become manifest, we have no more use for ca- 
 thartics — purgatives, than we have for the lancet. When the 
 intestinal contents are producing no irritation, is it not better 
 to let them alone, than to introduce into the bowels a certain 
 cause of irritation ? 
 
 In the most confluent forms of small-pox there is no danger 
 so long as an equilibrium exists in the irritation and circula- 
 tion of the system, and if this equilibrium cannot be main- 
 tained without purgatives, then there is but little probability 
 that it will be with them, because they cannot be administered 
 without producing more or less of inequilibrium. In most 
 cases of constipation, to the extent of mischievous irritation, 
 the want of action is most generally confined to the large in- 
 testines, and more particularly the rectum; consequently, it 
 can be relieved by enemas, and nothing further is needed. 
 When disease invades the system of vegetative life, cathartics 
 become indispensable, but not to the extent, even then, of Dr. 
 Armstrong's idea of sustaining the "vital energies, by "brisk 
 purgation." 
 
 In dangerous forms of disease, our allopathic friends resort 
 to what they call " heroic remedies," which consist of bleed- 
 ing, purging, blistering, and mercurialization. Now, it will 
 be admitted, that it is impossible to draw blood without 
 reducing the vital force ; purging will do the same, and as 
 to mercury, Professor Harrison says, that it is "a most power- 
 ful depresser of the energies of life." 
 
 Cholera wastes life as rapidly as bleeding and purging, and 
 it is as great a " depresser of the vital energies of life," as 
 mercury. In view of these facts, it is exceedingly singular 
 
214 PATHOLOGICAL COIs^SIDERATIONS. 
 
 that an attempt to cure it by bleeding and the administration 
 of a pound of mercury, more or less,* should ever have been 
 seriously entertained by a well-informed physician. 
 
 We have also our " heroic remedies," but they only reduce 
 spasm or constriction, equalize the circulation, promote secre- 
 tion, and thus remove disease by depuration; and they do all 
 this without imposing a tax upon the " energies of life," and 
 without the establishment of another form of disease, as a 
 mere sequel, that may prove as fatal as the one it supplanted. 
 
 Although, in the case of inflammatory fevers, the arterial 
 action is very greatly augmented, yet we are not to conclude 
 that there has been an increase of vital power, or of the ener- 
 gies of life, because disease is not creative — it can neither pro- 
 duce nor augment life — it can only occasion a suspension of 
 its manifestation in some functions, and an accumulation of it 
 in others. When that quantity of vital power, which, in 
 health, maintained the functions of secretion, excretion, and 
 nutrition, is again returned to these functions, fever ceases to 
 exist. The increase of vital manifestation, in fevers, is not 
 universal, nor even general, for while there is an exaltation of 
 vitality, in some parts, there is a deficiency in others, as is 
 most clearly evinced by a loss of appetite, the wasting of the 
 body from an absence of nutrition, by the weakness of the 
 muscles, in many instances, and by a sense of prostration. 
 When we can equalize this vitality, we restore health ; but if 
 we abstract vitality, by bleeding and purging, we just so far 
 incapacitate the system to repair the lesion that disease has 
 inflicted ; for this end, then, it is absolutely essential that we 
 should carefully husband the vitality and its resources. 
 
 We have shown that neither fever nor inflammation is dis- 
 ease, but are accumulations of vital force for the removal of 
 it — that disease is an incapacity, in a part, or parts, to perform 
 their functions ; and w^e now add, that this incapacity depends 
 upon chemical, mechanical or vital impediments or obstruc- 
 tions, and when it is of the third character, it is a result of 
 defective or suspended depuration. 
 
 Now, suppose the skin to have failed to perform its function, 
 
 » We cannot prove that more than eleven ounces were administered to the 
 same patient in a case of cholera. 
 
PATHOLOGICAL CONSIDERATION'S. 215 
 
 and that the failure has resulted from suspended secretion, and 
 therefore replete with obstructions from arrested or suspended 
 depuration ; how is it possible for bleeding or purging to re- 
 move the obstruction ? By reducing the vitality, they reduce 
 the energy of the effort that is made for its removal, but the 
 obstruction still exists, and the power to remove it is dimin- 
 ished. Is it not obvious that every effort that is made to 
 remove the disease, by such means, only tends to confirm it ? 
 
 Suppose the lungs to fail in depurating the venous blood, 
 and tubercle shall result, will bleeding and purging remove it ? 
 Suppose, again, the kidneys to fail to eliminate, to a sufficient 
 extent, the urea, and rheumatism shall result, will bleediug 
 and purging remove this urea, and thereby remove the rheu- 
 matism ? Has not experience proved that they cannot ? 
 
 If, then, disease consists in obstructions, and that they re- 
 sult from suspended depuration, is not the indication of cure 
 a re-establishment of the depuration ? Do not the hot-springs 
 of Arkansas, cure rheumatism by establishing secretion and 
 depuration ? 
 
 It will now be understood that our " heroic remedies " con- 
 sist of those articles, and of that mode of practice, which are 
 the best calculated to equalize the circulation, promote secre- 
 tion, and consequent depuration. Is it not equally perceptible 
 that we may do all this without the least intention of reduc- 
 ing the absolute quantity of the vital force ? N^ay, more, that 
 the less we waste of it, the greater is our success ? Is it not, 
 furthermore, obvious that we may, by producing hyper-secre- 
 tion, injudiciously weaken or exhaust the patient? And is it 
 not equally clear that our antiphlogistic treatment consists in 
 removing the disease, and not the vital powers of the patient, 
 or both of them indiscriminately ? 
 
 The preceding views have been advanced with reference to 
 those forms of disease in which the allopathic branch of the 
 profession would bleed and purge ; but there is another form, 
 in which they would not resort to the same practice, and yet, 
 it would be equally rational ; it is that, in which there is less 
 equality between the amount of the obstruction and the power 
 of the vital force — a case of congestion in which there is not 
 existing sufficient power to effect a reaction. In those two 
 forms of disease there is no similitude in the treatment bv the 
 
216 PATHOLOGICAL CONSIDERATIONS. 
 
 allopathic physicians, and yet the two forms are essentially the 
 same — difiering only in degree — the vital power in the one, or 
 the obstruction in the other, predominates. In the former, 
 there is more demand for antispasmodics, and the latter, for 
 revulsives. "When the circulation shall become equalized, 
 secretion will follow — depuration will take place — the blood 
 and tissues will become purified — the obstructions, and, of 
 course, the disease, will be removed. 
 
 "While, as eclectics, we reserve to ourselves the right to use 
 any and every article, now known, or that may become known, 
 when we shall become convinced that it is the best we can do 
 for the patient^ — that we entertain no prejudice against any 
 one — that so long as a jproper use can be made of any one, 
 we advocate it. But, as observation has taught us that the 
 indigestible medicines act unkindly upon the system, and fre- 
 quently do irreparable mischief; and, as the same great 
 teacher has most thoroughly convinced us that we have a 
 digestible materia medica that is adequate to achieve all that 
 is desirable, in a higher degree, too, than the indigestible, we 
 hold it to be humane, wise and philanthropic to discard from 
 our practice all indigestible medicines — that is, all poisonous 
 elements — indeed, we hold this course to be, on the score of 
 justice, absolutely imperious. 
 
 But, after all, more depends upon correct principles, in prac- 
 tice, than upon the agents used. Nothing but mischief can 
 follow the application of a false principle. Those who con- 
 tend that fever is a disease, would do about as much present 
 mischief with purely digestible medicines, as they now do, the 
 difference being only in the sequelae. Those who practice, 
 consistently, upon false principles, do more mischief than 
 those who have no principles, because the latter may some- 
 times be right, while the former never are ; it becomes, then, 
 a matter of the first importance, that we should be certain that 
 our principles constitute the expressions of truth ; when this 
 is the case, so long as we are consistent, we can never be 
 wrong, though we may be ignorant. 
 
 There exists throughout the length and breadth of the medi- 
 cal profession, an opinion — for such it merely is — which we 
 think to be an error, and, as such, is attended with much 
 mischief — we allude to the opinion that some forms of disease 
 
PATHOLOGICAL COI^SIDERATIONS. 217 
 
 are hereditary. If the truth of this opinion was ever ques- 
 tioned, or doubted, we have not learned it; and yet, if there 
 be in the profession an error more clearly exposable than it, it 
 has escaped our notice. 
 
 In the first and second Books of this treatise, we have used 
 the word hereditary in its common acceptation, because, as 
 yet, we had afforded us no proper opportunity to expose the 
 error of it ; but now, as we are about to commence the con- 
 sideration of the special forms of disease, it becomes proper 
 that we should make known our opinions upon all leading sub- 
 jects — and this one is of that character. 
 
 As the hereditary character of phthisis pulmonalis is not 
 doubted, we. shall make a principal use of it in the illustration 
 of our views. 
 
 In table, page 20, we have, by measurement, and we may 
 add, the observation of twenty years, shown, that consump- 
 tion is associated with a certain relative development of the 
 medulla oblongata and the cerebellum. When we consider 
 the functional relation which these parts bear to the lungs, we 
 must conclude, that if the coincidence we have pointed out be- 
 tween the disease of the former and a certain development of 
 the latter be uniform, that they hold the relation, primarily, to 
 each other of cause and effect. 
 
 We have found that those who are liable to phthisis have 
 generally a large medulla oblongata and a small cerebellum, 
 relatively, and the exceptions to this law come under the re- 
 verse of these organic conditions, through the instrumentality 
 of very different exciting causes. Because of these peculiar 
 organic conditions, as to development, it does not follow tliat 
 there existed either active, passive, or latent elements of dis- 
 ease, nor even the most remote possibility of a predisposition 
 to it. 
 
 Peculiarities of both size and form are transmissible from 
 parents to their children, and each form, under causes of ex- 
 citement, must and will represent its identity in its mode of 
 action, which, of course will be modified by influencing cir- 
 cumstances. In other words, no two different forms can mani- 
 fest the same mode of action under the same cause of excite- 
 ment and the same attending circumstances. Every one form 
 
218 PATHOLOGICAL CONSTDEEATIONS. 
 
 of disease, therefore, is as vulnerable to the charge of being 
 hereditary as phthisis. 
 
 In one peculiar form of organization, there exists a liability 
 to rheumatism, to gout, to cancer, and perhaps to some other 
 forms of disease ; in another, there will be found a liability to 
 passive congestion of the brain, phthisis pulmonalis, and other 
 kindred forms of disease, depending upon different degrees of 
 development, different, or even the same, causes of excitement 
 and attending influences. 
 
 A large proportion of society are so nearly balanced as to 
 have no preponderating liability to any particular form of dis- 
 ease, and yet may be liable, under the force of exciting causes, 
 to any one. 
 
 The truth of the doctrine we have here taught, can be, we 
 think, amply sustained by a reference to well known facts. 
 
 Take a case of what is called a "hereditary predisposition to 
 phthisis," — tell the patient that this is his condition, and what 
 becomes his conclusion ? Nothing less, inevitably, than pre- 
 mature death — he considers himself fated — doomed irrevo- 
 cably to such an end. With such a conclusion preying upon 
 his mind, how is it possible that he should recover from any 
 form of disease that has become constitutional ? 
 
 Perhaps his physician may send him to the island of Cuba, 
 in order that he may possibly recover under the peculiarities 
 of such a climate. But what is the principle that actuates 
 him in sending him to the south ? If any one has discovered 
 the principle, we have not seen it. He is sent there, so far as 
 we have learned, empirically ; he is sent there under the hope 
 that he may be as fortunate as some who had preceded him. 
 But if his disease be Jiereditary^ how should any one expect 
 him to recover by a change of climate, of diet, or of anything 
 else? 
 
 In Boston, a given measure of atmospheric air contains 
 more oxygen than the same measure does in Cuba, and yet 
 the Boston patient breathes as though he was struggling for 
 more oxygen, and he really is. If then, he obtains, in Cuba, 
 less of what he wants than in Boston, why send him there ? 
 
 A simple illustration will explain why he should go south : 
 A horse is breaking down under the weight of his load, 
 
PATHOLOGICAL COIS^SIDERATIONS. 219 
 
 although lie receives regularly a fall measure of food. ]!Tow, 
 can he not stand the travel better with one-eighth less food, 
 if one-half of the load be taken off him ? Every reader, we 
 think, will answer in the affirmative. 
 
 The lungs perform two functions — by inspiration they re- 
 ceive oxygen, which is indispensable to the production of ani- 
 mal heat (to say nothing of other purposes) ; but in Cuba he 
 requires less animal heat, and therefore for this purpose he 
 requires less oxygen. The other pulmonic function is that of 
 expiration — an elimination of carbon from the system. Kow, 
 while in Boston, the lungs had no aid in the performance of 
 this function — they had to perform the whole duty — that is, 
 they had to carry the whole load ; but in Cuba, the high 
 calorific temperature so excites the skin and liver that they 
 take from the lungs half their load. In view of this explana- 
 tion, we can understand how it is that a young man, before 
 any disease occurs in his lungs, by going to the south, although 
 organized for consumption in the north, will far more proba- 
 bly die of some bilious form of disease than with any pulmo- 
 nic one. 
 
 It seems, then, that the patient had not inherited a predis- 
 position to phthisis pulmonalis, but that he had inherited a 
 peculiar organization, which was not compatible with a con- 
 tinuance of life under certain circumstances. It is possible, 
 however, that, by such training as would develop his cerebel- 
 lum, he could so have changed his organization as to have 
 adapted it to its native situation. 
 
 It is possible that his organic condition may have been just 
 the reverse of what has been previously supposed — his me- 
 dulla oblongata may have been feeble, and the cerebellum 
 large, and consequently, he may have been obese ; but the nu- 
 tritive process, in this relation, may have become arrested, 
 and hence the lungs have to eliminate as much more carbon, 
 than usual, as the system had been in the habit of converting 
 into adeps, which, proving more than they can do, they finally 
 generate tubercles in themselves, or cause them to be deposited 
 in other parts. We do not believe that consumption is often 
 produced under these circumstances, but it does happen — that 
 is, men have become obese, and subsequently have died of 
 phthisis pulmonalis. But in this case, as in the other, proper 
 
220 PATHOLOGICAL CONSIDERATIONS. 
 
 *training in youth — such as will produce an equilibrium be- 
 tween the medulla oblongata and the cerebellum — will pre- 
 vent the disease. 
 
 iSTo age, it seems, is exempt from this fatal form of disease, 
 and the reason why it is so must now be obvious. Some 
 children are born so feeble, in one or the other of the above- 
 named organs, as to render it impossible for them to live to 
 maturity — some have such an endowment of them, in connec- 
 tion wdth circumstances, as will sustain them even to old age ; 
 but as the cerebellum begins to decline at the meridian of life, 
 it finally becomes too feeble to sustain the lungs against dis- 
 ease ; hence the cause of consumption at a very advanced 
 age. 
 
 It is well known, that many men have lived to old age 
 whose parents had died of consumption, and we have no 
 doubt that they would have died of the same disease if they 
 had lived under the same influences. It becomes, then, our 
 duty to investigate the influences by which such persons were 
 saved, so that we may do for some, by design, what accident 
 has done for others. 
 
 We do not doubt the accuracy of our premises — we believe 
 them to be easily and satisfactorily demonstrated, and if so, 
 there can be no doubt as to the proper prophylaxis — exercise of 
 the muscular system, particularly of the superior extremities 
 and chest. This will force a development of the muscles — 
 increase and strengthen the circulatory and the respiratory sys- 
 tems, and, as a matter of course, those portions of the en- 
 cephalon which preside over them. 
 
 By this course, those organic forms which have been trans- 
 mitted from parent to child for numberless generations, are 
 broken up — an improved modification has been eflected, and 
 the further transmission of a phthisical liability is arrested. 
 
 We shall now make a few extracts from " Simon's General 
 Pathology," for the purpose of showing how little is known 
 upon this subject, and how impossible it is to reach a sound 
 conclusion by reasoning from a false position. He is treating 
 of the hereditary character of the tubercular diathesis, and 
 especially about the tuberculous nature of a rabbit's liver that 
 was sent to him. 
 
 1. " On inquiry of a candid poulterer, I found that these 
 
PATHOLOGICAL CONSIDERATIONS. 221 
 
 -tubercular' livers are common — very common; that they 
 will be found often in almost every tame rabbit cut open, and 
 in litter after litter; and, strangely enough, that they do not 
 appear incompatible with good health, or at least with suffi- 
 ciently good for market purposes." 
 
 2. " In continuation, I made various experiments to see if I 
 could produce tubercle artificially, and various other examina- 
 tions to see if I could find it in rabbits dying under other 
 circumstances. The result may be told in a word : I have 
 never seen tubercle in a rabbit." 
 
 3. "One sort of experiment does apparently tend to develop 
 tubercle. As we often stay the process of phthisis in the hu- 
 man subject by transferring our patient to a tropical climate, 
 so, conversely, we can facilitate the development of the dis- 
 ease by importing the subject of our experiment from warmer 
 to colder latitudes. It is said, that among the beasts of the 
 Zoological Society's Gardens, tubercle is a frequent cause of 
 death ; and especially those which come to our climate from 
 one of a higher temperature. From my own knowledge, I 
 will only venture to confirm this statement in regard of mon- 
 keys ; as they have the dignity of standing next to man in 
 form, so they have the inconvenience of this very human lia- 
 bility : when transferred from the hotter climates to England, 
 and when surrounded by the artificial circumstances of a mena- 
 gerie, they are apt to die with tubercles in their lungs, mesen- 
 tery, and spleen." 
 
 5. " Here, however, let me detain you on the subject of 
 hereditary transmission of scrofula, and explain to you what 
 I mean, when I speak of its being continued in this manner 
 from generation to generation ; I do not mean that, in the 
 process of impregnation, actual tubercular matter passes from 
 the system of the scrofulous father into the germ of the infant, 
 to remain latent there, till circumstances call for its develop- 
 ment ; nor that, during uterine life, the blood of the child is 
 poisoned by its mother's blood, as occurs in small-pox or syphi- 
 lis. What I mean is this : that the scrofulous diathesis — that 
 the disposition to form tubercles is transmitted ; that the 
 child inherits an imperfect pattern of development." 
 
 6. " I must explain this more fully, for tlie inheritance of 
 dispositions to disease does not belong to scrofula only ; it 
 
222 PATHOLOGICAL CONSIDERATIOIN'S. 
 
 forms a very important problem in the pathogeny of cancer, 
 with its allied disorders (for they are hereditary), of gout, and 
 rheumatism, for they too are heirlooms in families ; and it, 
 consequently, constitutes one of the most important questions 
 in the study of General Pathology." 
 
 7. " Every one recognizes in the process of generation a 
 certain amount of that influence by which a parent becomes 
 the pattern of formation for his child. Xo man expects to be- 
 come the father of an armadillo, or a flying-fish, or a stag- 
 beetle. But more than this, it is expected, and, on the whole, 
 very generally realized, that the child shall be more like its 
 father than its god-father. So far the case is clear ; but I 
 wish you to observe the tendency further. Follow the child 
 in its ulterior development, for that is the point, and mark 
 how exactly, in various exterior and noticeable signs, he repeats 
 the development of his father ; how, in arriving at the age 
 when his father got corpulent, he acquires the same figure ; 
 how, at the age when his father became gray, or bald, he, too, 
 becomes gray, or bald, and with the same succession of parts — 
 vertex first, or temples first, or forehead first, as the case may 
 be ; how his teeth decay, or drop, or protrude, just as his 
 father's ; how his pulse is of the same character — even, as we 
 have often noticed, to the degree of copying an intermittent 
 rhythm ; and how his habits of sleeping and waking follow the 
 same direction." 
 
 8. " Xow, observe, for the distinction is one of great impor- 
 tance, that these things are not connate; the child is not born 
 a copy of the father as he begat him ; but he is born, having 
 his father's past development as a type for his own future de- 
 velopment, so that he shall be developed as his father was de- 
 veloped, and shall hereafter become like him. In addition to 
 that general law of human development, by virtue of which 
 he is destined to be a mammal rather than a bird ; and a man 
 rather than an ox ; and to reach puberty, manhood, old age, 
 and death in a certain defined succession ; he is further pos- 
 sessed by an vii\\QYiiQ(\. personal and jparticulai' law of devel- 
 opment, which affixes a something peculiar and individual to 
 his passage through each period of his existence." 
 
 9. " If my meaning in all this has been intelKgible to you, 
 you will readily conceive that diseases afi*ecting the development 
 
PATHOLOGICAL CONSIDERATIONS. 223 
 
 of the body are peculiarly those which transmit themselves 
 in the line of hereditary succession ; that the disposition to a 
 disease would be hereditary, where the disease consisted of a 
 faulty type of development, afiecting limb, or viscus, solid or 
 fluid, in the body ; and that no disease would be hereditary, 
 except in so far as it might be developmental." 
 
 10. "Accidental mutilations do not become hereditary; for 
 many centuries the Jews and the Mahommedans have under- 
 gone circumcision of the prepuce ; but the local deformity 
 has never transmitted itself; the new-born Jew or Mussulman 
 oflers probably as much foreskin to the knife, as the immediate 
 successors of Abraham or Mahommed." 
 
 11. "And, if you transfer these arguments to the several 
 varieties of disease, you will know, on the one hand, in what 
 diseases to anticipate hereditary transmission; and on the 
 other hand, what peculiar character of disease, to- wit, its de- 
 velopmental character, may be inferred from the fact of its 
 hereditary succession. Of a disease like scorbutus or ague, 
 dependent on the presence or absence of certain exterior acci- 
 dental conditions, you would anticipate that it could not be 
 hereditary, any more than a wound or a dislocation. Of those 
 accidental accompaniments of scrofula — the morbid processes 
 which arise in defective nutrition, the ulcerations of the cornea 
 or intestines, for instance, which depend on insufficient or in- 
 appropriate nourishment, and which, as I have said, are essen- 
 tially co-extensive in their duration with the exterior causes 
 which produce them — you would know that they have no na- 
 tural tendency to perpetuate themselves in this way. Of an- 
 other disease, on the contrary — one like plethora, relating 
 essentially to the rate or degree of development in an element 
 of the body, you might predict that it would tend to become 
 hereditary. And whereas it is in the blood, more strikingly 
 and more constantly than in any ingredient of the organism, 
 that development is ever in progress ; whereas, it is eminently 
 in the blood, that we have at each moment an epitome of the 
 whole development of the body, and find the earliest rudi- 
 ments and the latest relics of every organized tissue, nascent 
 or in decay ; so surely it would be in this fluid — the scene or 
 the subject of so many developmental metamorphoses, that 
 one would expect to find the material explanation of many 
 
224 PATHOLOGICAL CONSIDERATIOITS. 
 
 hereditary diseases. One would expect that an inherited dis- 
 position to form, at various periods of life, and in a number 
 of difierent organs, certain special and characteristic materials, 
 bearing definite relation to the normal products of the body, 
 would indicate a peculiarity in the development of the blood, 
 whereof those deposited materials would be the result and 
 the expression." 
 
 12. " Such is the state of the case in regard to scrofula ; 
 and therefore it is, that I have analyzed this question of he- 
 reditary tendencies to disease. Strict experiment would not, I 
 think, justify me in telling you, as a certainty^ that the scro- 
 fulous diathesis has its explanation in such grounds as we have 
 gone over." 
 
 13. " But, though we are short of absolute demonstration 
 on the subject, (14) I may tell you this with confidence : there 
 exist many facts rendering it highly probable that tubercle has 
 its rise in disease of the blood ; that this disease of the blood 
 is one afiecting its development; and that it is as adevelopmen- 
 tal disease of the blood that scrofula acquires its tendency to 
 hereditary succession — its tendency to perpetuation as part of 
 a family likeness. I shall presently give you other evidence 
 in support of the same view." 
 
 15. " Meanwhile, to return for a moment to the narrower 
 ground from which we started, remember, that what is meant 
 in calling scrofula a hereditary disease is — not that the tuber- 
 cular material is to pass from parent to child — not that the 
 child is to be born with tubercle already in its body — but that 
 the disposition to form hlood in a manner which shall give 
 tubercle as a collateral jphenomenon^ exists as a clause in the 
 child's charter of life, and forms a part of its type of develop- 
 ment, as truly as any exterior resemblance which he may bear 
 to the configurative growth of his parents." 
 
 16. "I may illustrate to you the importance of these con- 
 siderations, in quoting the result of some statistics collected 
 at the Consumption Hospital, by the oflficers of that institu- 
 tion, and published by them in their last year's Report. They 
 find that, among their female phthisical patients, thirty-six per 
 centum report their parents to have been consumptive. If you 
 consider this statement simply, you will be struck with its im- 
 portance, and with the magnitude of its consequences ; and, 
 
PATHOLOGICAL COIfSIDERATION'S. 225 
 
 in order to do full justice to it, you must further remember, 
 that, in the remaining sixty-four per centum, there may have 
 been another considerable proportion whose parents had not 
 indeed suffered from tubercular phthisis, but may have suf- 
 fered from tubercular deposit predominantly in other organs 
 than the lung — in the lymphatic system, perhaps, or else- 
 • where ; and that there may have been a second considerable 
 proportion, in whose family the parents may, perhaps, have 
 escaped tubercular disease in their own persons, but may yet 
 have transmitted the predisposition from their own immediate, 
 predecessors to those latter inheritors of the disease : for it is 
 notorious, in many matters of family likeness, that some very 
 characteristic feature, healthy or morbid, may develop itself 
 only in alternate generations, or may at least remain latent 
 during a single generation, unless many circumstances con- 
 spire powerfully to favor its evolution." 
 
 We have made the preceding long extract, to give our read- 
 ers the best and most labored argument we have ever seen in 
 support of the hereditary pretensions which has been claimed, 
 from time immemorial, for certain forms of disease, and will 
 now proceed to notice it in detail in the order of the numbers 
 we have attached to it : 
 
 1. The poultry and rabbits, of which he speaks, had been 
 fed to great repletion without exercise, and as, in such cases, 
 there is but little waste and little necessity for repair, the food 
 they took being more than enough for these purposes, the sur- 
 plus was stored away in the form of adeps, but in this pro- 
 cess too much duty had been imposed upon both the lungs and 
 liver, and as a consequence tuberculation would fall upon one 
 or the other, or upon some other part. A similar result is 
 common to our hogs and cattle which are treated in the same 
 manner. The general health of the animal is good, and what- 
 ever of disease that may be discovered to exist, is local, and 
 confined to some glandular structure — but this is not always 
 the case — in a few instances the muscles are full of tubercles. 
 
 2. Why should he expect to find tubercle in rabbits under 
 other circumstances ? It may be reasonably supposed, that 
 rabbits, in a state of liberty, would live in accordance witU 
 their organic laws. 
 
 3. We think it much more than probable, that monkevs 
 
 15 
 
226 PATHOLOGICAL CONSIDERATIONS. 
 
 imported into England, and set at liberty, would, for several 
 generations, if not perpetually, escape from tubercle ; but that 
 they, or any other animal, should acquire tuberculous forms 
 of disease, after years of confinement in a close cage, with 
 even tolerable feeding, is what we should certainly expect. It 
 is certainly very improbable that they acquired the disease by 
 hereditary entail, and if they can, under certain circumstances, 
 spontaneously, acquire the disease, then it may, in a similar 
 manner, obtain in human society. 
 
 "We have shown in the beginning of this paper, and inci- 
 dentally in several other places, how tubercle originates under 
 certain circumstances, with certain organic conditions. A 
 modification of the same principles accounts for it in these 
 monkeys and other animals similarly circumstanced — as the 
 poultry and tame rabbits. (See answer 1.) 
 
 In all cases of phthisis pulmonalis, in our northern latitudes, 
 the lungs are incapable of depurating the venous blood — tu- 
 bercle or obesity is the result ; and should the latter result be- 
 come arrested or distributed, tubercle will or may still result. 
 In the case of the monkeys and other confined animals, a sur- 
 plus of carbon is accumulated in consequence of insufiicient 
 exercise — their lungs, though adequate to all the ends of nor- 
 mal existence, become, under the confinement, as in the case 
 of feeble development, incapable of adequate venous depura- 
 tion, and the consequence must be the same. 
 
 4. If he had possessed the most remote idea of the cause of 
 tubercle, he would never have written this paragraph. The 
 poultry and rabbits were not rendered tuberculous by " defi- 
 ciencies in air, in exercise, (and) in diet." 
 
 5. We perfectly agree with him in this statement, with one 
 qualification, he should have added, under circumstances ; 
 and we also admit his final conclusion, but we claim the same 
 in every instance where there is any kind of imperfection or 
 weakness of constitution. But, in the beginning of this para- 
 graph, he promised to explain what he meant by " hereditary 
 transinission^''^ and concludes by a simple admission or state- 
 ment of the fact, which is not an explanation. " The cfiild 
 inherits an imperfect pattern of development." When was 
 there one born that did not ? 
 
 6. We hope he will, for as yet he has certainly failed. Wc 
 
PATHOLOGICAL CO]N"SIDERATIO]!^S. 227 
 
 admit that all these forms of disease do appear in families in 
 succession, and we admit that a liability to them, under cir- 
 cumstances, is inherited — just as a liability to bilious fever or 
 any other form of disease is inherited by those who have had 
 it, under the circumstances of their exposure to the proper ex- 
 citing causes. 
 
 7. And, he might have added, he has, like his father, a 
 thick lip, a pug nose, or red hair. We admit the whole of 
 this paragraph — every word of it. Under the peculiarities of 
 the child's organization, all is normal — in nowise blended with 
 disease, and, so far as we know, entirely beyond the reach of 
 any modification — no change of place will change the color of 
 his hair or the thickness of his lips ; hence we can see no 
 similitude between these organic conditions and a hereditary 
 transmission of a tubercular disposition. 
 
 8. We admit the whole of this paragraph, except so far as 
 it involves the kind of disease of which he may die. The 
 father may have died of phthisis pulmonalis, but the son may 
 have avoided the necessary exciting circumstances, or his pur- 
 suits in life may have proved a complete protection against it, 
 or he may have gone to the south when young, where he 
 could not have phthisis, but would, under the circumstances 
 of organization, most probably have some form of disease pe- 
 culiar to the digestive system. By the laws of procreation, 
 the child could not be anything else than human, and by the 
 same laws he was forced to follow the type of his parents, no 
 matter what his pursuits may be, or into what country He may 
 travel. He may enfeeble or strengthen his system, but the 
 elements of it will still be the same. Neither disease, nor a 
 predisposition to it, was incorparated into the organic laws ; 
 on the contrary, a strict obedience to these laws constitute 
 a certain prophylaxis. Hence it is seen, that the mo- 
 ment we leave those organic forms which are essential to 
 humanity, the necessary similitude between parent and child 
 ceases. 
 
 9. We do not admit that there are any organic predisposi- 
 tions to disease, but w^e do admit that a faulty type of organi- 
 zation or development must occasion a liability to certain forms 
 of disease, under appropriate exciting circumstances. Our 
 
228 PATHOLOGICAL CON'SIDERATIOXS. 
 
 last comment furnishes a reply to the closing portion of this 
 paragraph — nothing can be hereditary except that which is 
 essential to the organism of the animal ; but all the organic 
 forms may be faulty, and then, as a natural consequence, liable 
 to deranged or morbid actions. 
 
 The existence of any disease indicates the existence, also, of 
 a " faulty type of development ;" — in what other way can we 
 explain the fact that some men live to old age without having 
 been sick, while other individuals cannot escape from the most 
 common forms of disease incidental to the climate in which 
 they live. All forms of disease are developmental, except 
 those which exhaust the susceptibility of the system by one or 
 more invasions. In other forms of disease, one seizure in- 
 creases a liability to a second, a second to a third, until it 
 finally becomes incurable, except by a change of residence. 
 This is as much the case with ague as it is with phthisis. 
 
 10. We admit the whole of this paragraph, and for the 
 reason that such circumstances were not provided for in the 
 laws of procreation in mammals ; and it is upon the very 
 same ground that we deny that any cause of disease, exciting, 
 predisposing or otherwise, ever becomes a part of the organi- 
 zation. 
 
 A disposition to disease, such as is contended for, is 
 just as much a lesion as an incised wound or an amputated 
 arm. The whole arrano;ement of the orsjanic laws contem- 
 plates an exemption from both, and not a disposition to them. 
 A disposition to disease, is not a disposition to health — then, 
 so far as it extends, it is a disease — there cannot be established 
 a point of indifference between health and disease, and if, 
 therefore, the disposition be to the latter, can it be regarded 
 as anything less than a lesion ? — and let it be remembered 
 that lesions cannot be transmitted. 
 
 11. There are in Charleston and I^ew Orleans, as many 
 persons consumptively constituted as there are in Boston, in 
 proportion to the x^opulation of these cities, respectively ; how 
 does it happen, then, that there are no cases of consumption 
 among the native population of the south ? Simply for the 
 reason that a change of temperature and other minor circum- 
 stances, have transferred the major action from the lun^s to 
 
PATHOLOGICAL CON'SIDERATIOIn'S. 229 
 
 the digestive system, which is manifested by diarrhea, dysen- 
 tery, ague and fever, bilious fever, etc. Defective nutrition is 
 not only the cause of the accompaniments of scrofula, but of 
 scrofula itself. He has labored through the preceding pages 
 to show that the hereditary transmission of a disposition to 
 tubercle is a part of that great law which determines that the 
 child's platform or model of life shall be that of its sire ; and 
 as that operation of the law is peculiarly incomprehensible, he 
 resorts to the blood for the purpose of finding a solution for 
 the whole subject. 
 
 Now, if we admit that we find the " earliest rudiments " and 
 the " latest relics of every organized tissue," it becomes essen- 
 tial to his argument for him to show that the hereditary mat- 
 ter in question is so organized that it can furnish to the blood 
 a rudiment, or a relic — the transmissibility treated of, must in- 
 here in something, and that something must be a tissue, or it 
 cannot be under the influence of the blood. All the organs 
 of the body and all its tissues, hold suitable relations to the 
 blood, and it is true that the blood contains rudiments and 
 relics of all the organs and tissues of the body — but does it 
 contain rudiments and relics of the peculiar transmissibility 
 for which he contends ? He may find in it an " epitome " of 
 the nose, eyes, and possibly of the whole body — but can he 
 find the epitome of this hereditary transmissibility of disease ? 
 This is the question. 
 
 The blood is an elaborated fluid, and therefore it must re- 
 present the materials from which it was elaborated and the 
 apparatus that elaborated it ; and, we think, it is about as 
 possible foriiim to discover in the blood, the imperfections of 
 the apparatus that elaborated it, as it would be to discover in a 
 mug of beer the imperfections of the beer-shop. 
 
 12. We admit that he has labored assiduously in the analy- 
 sis of this question, and so did the mountain in lahor — it 
 brought forth a mouse, and he nothing. And we grant, fur- 
 thermore, that he is correct in his " certainty, " that the scrofu- 
 lous diathesis has its explanation in the grounds he has passed 
 over — that is, in the human system ; but we deny that he has 
 discovered it. 
 
 13. In the forepart of this article, he appeared quite certain 
 
O30 PATHOLOGICAL COIv^SIDERATIOXS. 
 
 that tie would conclusively develop this mysterious subject, 
 but now he admits that he has not found a demonstra- 
 tion for it. 
 
 li. When ne first cast his eyes into the blood, and found 
 the rudiments and relics of all the tissues, and even an 
 epitome of the whole being, he appeared quite sanguine that 
 he would accomplish his object, but now his confidence and 
 lengthened argument are reduced to a high probability that 
 "tubercle has its rise in disease of the blood," and in this 
 wise it becomes to constitute a part of the " family likeness." 
 He assures us, that in favor of such a probability there are 
 many facts. "We would like to have one fact to show why it 
 should be in the blood, rather than in the nervous, serous, 
 mucous, fibrous, or osseous tissues ; but, unfortunately, he has 
 omitted to give us one. 
 
 15. We now understand him — the blood is the great agent 
 through which all family resemblance and hereditary trans- 
 mission of certain fonns of disease is perpetuated. It is a 
 very pretty hypothesis, but there exists one serious objection 
 to it, which is this: it is not consistent — and, therefore, it is 
 not true. Any number of boys may be taken to Charleston, 
 S. C, and while each one wiU retain his family likeness, the 
 whole of them will lose their parental liability to a certain 
 form of disease — and yet there may be no change in theii- re- 
 spective organizations. Now, in this case, the blood must 
 undergo a veiy peculiar change to maintain all the elements 
 of the child's charter of life, except one — the disease and 
 mode of death. The man who can conceive of the possibility 
 of such a change, has, we admit, a very difierent capacity 
 from ours. 
 
 16. We admit it to be very probable, that thirty-six per 
 centum of consumptive patients were of consumptive parent- 
 age : but, if we believed the disease to invariably originate 
 in such parentage, we should begin to doubt the truth of our 
 hypothesis if we should fail to trace seventy-two per centum 
 to such an origin ; twenty-eight per centum would then be 
 left to be accounted for in the manner in which he has at- 
 tempted to account for sixty -four. We regard this table as 
 decidedly hostile to his conclusion. But if all of them had 
 
PATHOLOGICAL CONSIDERATIOIIfS. 231 
 
 been of consumptive parents, he would have been sustained 
 only in the result, but not in the cause. (See Answer 3.) 
 
 If it be true, as we contend, that a certain relation of de- 
 velopment between the medulla oblongata and the cerebellum 
 constitutes a liability to this form of disease, under certain 
 influences, as those of a cold climate — and if we shall examine 
 all of them and find the cerebellum to be about the same in 
 all, then the remote cause of the disease, in all, is discovered, 
 and in a manner more satisfactorily than by the unexplainable 
 cause contended for. 
 
 By our doctrine, we can comprehend how it is that the 
 same organization can result in two very difierent forms of 
 disease in two equally diflerent latitudes. But the existing 
 hypothesis explains nothing. If produced by that organic 
 law, which determines the features, complexion, etc., then, it 
 is incurable and unalterable by any medicine or change of 
 circumstances ; or else, it must be shown that features can be 
 changed by medication or change of place. It is now well 
 known that neither of these positions is defensible. 
 
 We have no occasion to prove that organic forms are trans- 
 missible — ^it is admitted ; and, with reference to those who 
 may become afflicted with phthisis, in the north, it is well 
 known that they have in common a similar outline of person, 
 and we only extend the idea a little further, and contend that 
 this morbid condition finds its origin in certain minor or sub- 
 ordinate forms and their relations, under certain circum- 
 stances. It follows, then, that by changing the forms and re- 
 lations, or by changing the circumstances, a security is 
 obtained against the malady. This, as a fact, no one wiU 
 question at this time. 
 
 If this form of disease be hereditary, science can ofier 
 neither a remedy nor a prophylaxis, nor any solid foundation 
 for an indulgence of hope, the great sustainer of life — the pa- 
 tient's doom is well established in this respect, as with refer- 
 ence to the shape of his mouth or nose. But, under our 
 views, science dictates a prophylaxis — a certain exercise or 
 change of place or both, and, consequently, a rational founda- 
 tion for a useful hope. 
 
 But the most remarkable circumstance connected with this 
 
232 PATHOLOGICAL CONSIDERATIONS. 
 
 subject is, that the doctrine should be as old as the profes 
 sion, and still in good character, without a single claim to 
 respectability. 
 
 We shall continue the use of the word hereditary^ as hith- 
 erto, because it is convenient ; but we shall understand by it 
 the transmission of certain organic forms and relations (and 
 when used with reference to disease), which may result in 
 certain forms of disease under certain circumstances. 
 
SYMPTOMATOLOGY. 
 
 Since the dawn of Medical Science, the symptoms or char- 
 acters which indicate particular forms and varieties of disease, 
 have been a leading object with every medical investigator. 
 "We have but to reflect upon the multiplicity of the parts, the 
 multiplicity of the degrees of disease or derangement to which 
 each part is liable, and the multiplicity of complications to 
 which all the parts and degrees of disease are subject, to be 
 convinced that such a science as that of Symptomatology can 
 never exist. 
 
 Each organ has, however, its own pathognomonic expres- 
 sion, which, like the pathognomy of the face, may be per- 
 ceived and even comprehended by a practiced observer ; but 
 the knowledge thus acquired cannot be communicated to 
 others. Such manifestations of disease as appear upon the 
 surface, may be distinguished and described, because they can 
 be seen ; but we can have no such advantage with the pa- 
 thognomonic indications of internal disease. 
 
 In our treatment of disease, we shall treat of such symp- 
 toms as are generally found to obtain, and in this place treat 
 of the manner of arriving at a knowledge of the symptoms, 
 and of some other incidental matters. 
 
 In every portion of our country there appears to be an abun- 
 dance of faith in the benefits to be derived from the medi- 
 cation of children, particularly of infants, at the hands of old 
 women and illiterate impostors, with a disposition to repose 
 but little confidence in the skill of the regularly-educated phy- 
 sician. 
 
 Instead of denouncing this state of the public mind, we 
 should rather endeavor to ascertain the cause, that we may 
 qualify ourselves for its removal. Old and illiterate physi- 
 cians and women do, most generally, possess a rich fund of 
 
 (233) 
 
234: SYMPTOMATOLOGY. 
 
 knowledge whicli they have acquired by observation, and 
 wliicli, because they have not methodized it, they cannot im- 
 part to others in an available manner. On the other hand, 
 reading or learned physicians are not usually so practiced in 
 observation. The former have but few tools, but they are 
 rich in the use of them ; while the latter are rich in tools — 
 they possess the accumulations of centuries — ^but have not ac- 
 quired the use of them. It follows, then, that patient and 
 accurate observation are just as indispensable to a physician, as 
 extensive and accurate study — without the two combined, no 
 one can hope to become an able practitioner. 
 
 It is unfortunate that medical students, too generally, in the 
 course of their studies, come to the conclusion that, as 
 disease in infants is governed by the leading principles of 
 the profession, a special attention to it is comparatively a 
 waste of time. They do not even extend to the professors of 
 this chair that respect which they consider to be due to 
 those of the other departments of their professional education. 
 They seem to be influenced by the principle, that as children 
 are little things, the man who devotes himself to the investi- 
 gation of their diseases, must possess a mind as much below 
 that of a man, as a child is in asre and stature. We are not 
 sure but that a feeling of this kind has more or less pervaded 
 the profession, because that attention which the subject is 
 now receiving cannot boast of a very ancient origin. In this 
 very fact, we should no doubt seek the cause of that general 
 distrust of physicians, in infantile disease, which pervades 
 almost every ramification of society. But students of the pre- 
 sent day should remember that the horticulturist who does not 
 understand the cultivation of his young and tender plants will 
 have no fruit. If children are not sound, there can be no 
 adults. It is clear, then, that this neglect or indifierence, on 
 the part of students, has been followed by an incapacity on 
 the part of practitioners that has resulted fatally to thousands 
 of children, who, otherwise, might have lived and proved as 
 useful as other thousands have been, who were more for- 
 tunate. 
 
 Students ought to remember that it is much more difficult 
 to come at a knowledge of infantile disease than at that of 
 adults. The latter can very generally communicate their 
 
SYMPTOMATOLOGY. 235 
 
 feelin£:s and the locations of them, but from the former no 
 such information can be had, consequently their disease re- 
 quires a closer observation and a clearer discrimination to 
 secure success than is essential to that of adults. The fact 
 that infants cannot communicate their condition, and the fact 
 that they are feeble, are not the greatest obstacles which phy- 
 sicians have to encounter in the management of their dis- 
 ease ; but in the more complicated, extensive, and varying 
 range of their sympathies. 
 
 In the infant, it rarely happens that any one organ sujffers 
 alone, a morbus that is essentially local will so spread its in- 
 fluence throughout the system that it will be found, by the 
 most astute and discriminating, very difficult to detect its pri- 
 mary position. In the adult, the w^ork of development is 
 completed, and therefore it continues much the same from day 
 to day and year to year ; but with children there is a restless 
 mutability — their bodies, like those of adults, sufier waste, 
 which must be repaired, and, attending this repair, develop- 
 ment has to be efiected — new functions are constantly being 
 demanded, and new organs are to be developed to perform 
 them. This is not all. These newly developed organs have 
 absolutely to learn how to perform their respective functions. 
 The organs that exist at any given moment may do their duty, 
 but we cannot infer from this circumstance that those w^hich 
 are yet to come into service will do the same. In this multi- 
 tude of developments, sympathies, and mutations, lie con- 
 cealed hopes and fears, which time and proper attention can 
 alone confirm or dispel. 
 
 Students of medicine must readily perceive, from what has 
 been said, that, in the midst of so many and varying circum- 
 stances, it cannot be an easy matter to obtain a diagnosis of 
 infantile disease, and in this difficulty they ought to discover 
 the magnitude of the advantage to be obtained from a teacher 
 who has had a lifetime practice in the various forms of dis- 
 ease which are incidental to children ; and they ought, fur- 
 thermore, to infer, that this is the first proper step for them 
 to take, in order to acquire a deserved ascendency over the 
 old women of society. 
 
 Now, it is possible for a student to be thoroughly educated 
 ill all that pertains to the various manifestations of disease 
 
236 SYMPTOMATOLOGY. 
 
 which he may be called to treat, and yet, when introduced to 
 the suffering infant, he may feel as little at ease, as it he were 
 in the society of mutes, or those speaking a different language 
 from his own. To relieve all those who may become thus em- 
 barrassed, is our present object; but before we proceed, we 
 must remark, that those who are not instinctively fond of 
 children (for, as strange as it may seem, little children can as 
 certainly discover their friends, as masons can their brethren), 
 will find it very difiicult to reduce to practice any lesson that 
 we can give upon the subject ; while those who possess a con- 
 trary disposition will soon learn to make their way, even with- 
 out our aid. 
 
 We premise, then, by stating that there is as certainly a pa- 
 thognomy of disease, as of health or of mental emotion ; and 
 dull must be the observer who could mistake the language or 
 pantomime of anger for that of kindness or benevolence. The 
 foreigner, whose language we do not understand, and mutes, 
 who must be dumb, can make known all their wants by signs, 
 and these signs constitute the natural language of the faculties 
 that dictate them. 
 
 JSTow, if it be true that the various organs that unite to 
 make up our bodies, throw ofi", spontaneousl}^, when in abnor- 
 mal condition, signs which are expressive of their specific 
 mode of physiological being, then we can understand why an 
 old woman should excel a merely learned or a young and in- 
 experienced physician in the diagnosis of infantile disease. 
 
 The importance, however, of pathological pathognomy is 
 not confined to children. The physician who is guided in his 
 practice by the statements of his patients will never succeed 
 in his profession — with all the learning of the schools, he will 
 still be inferior to an experienced old woman. 
 
 Beside the ignorance and stupidity which we frequently find' 
 among adults, even with reference to their own physiological 
 condition, it often happens that they are not in a state to make 
 any communication whatever. In such cases, therefore, the 
 physician can do nothing, unless he can seize upon the indi- 
 cations of his duty as they are being pathognomonically mani- 
 fested. 
 
 As an illustration, we were, many years since, called to 
 consult with a well-read physician upon a case of protracted 
 
SYMPTOMATOLOGY. 237 
 
 fever — the patient being nnable to speak and almost without 
 consciousness. Upon arriving at the house, we met the doctor 
 at the gate, and asked him how his patient was. "In the 
 course of last night," he answered, " he was seized with pul- 
 monary hemorrhage, and is now, I fear, past recovery." We 
 proceeded to the door of the patient's chamber and discovered 
 him lying on the side of the bed, and the blood running pas- 
 sively from one side of his mouth. 
 
 l^ow, it so happens that nature never intended this physi- 
 cian for the practice of medicine, nor any other one who is so 
 stupid as to refer to the lungs a passive flow of blood from 
 the mouth. Before we approached the patient, in the above 
 case, we were sure that some portion of the bucal cavity was 
 the source of the hemorrhage, and so informed the doctor, and 
 the examination that followed discovered it issuing from a 
 hollow tooth. The attention that we immediately gave to the 
 tooth opened the eyes of the wife to the error of the doctor's 
 diagnosis, and she discharged him. It does appear to us that 
 no one wdio is not too lazy to think, could commit such a 
 mistake. 
 
 The preceding remarks will certainly impress students with 
 the importance of giving a very close attention to every look, 
 movement, sound, and indeed to every variety of manifesta- 
 tion that escapes from a patient, and if possible to investigate 
 the relation that each one holds to the existing disease. 
 
 It is a prevailing opinion, that inasmuch as children cannot 
 communicate their feelings to us by vocal signs, the physician 
 cannot come to a knowledge of their disease, and it is a mat- 
 ter of regret that this opinion is but too well founded, in very 
 many instances ; but still it must be deemed as fortunate that 
 such is not necessarily the case. 
 
 All persons, without distinction as to age or sex, may be 
 regarded as children when sick, and all can testify how un- 
 pleasant it is to have about the chamber one who is blunt, 
 abrupt, or in the least unkind. If such manifestations are un- 
 pleasant to adults, what must be their impression upon young 
 children, who seem to be conscious of their dependent and 
 helpless condition. It follows, then, that the pliysician who 
 is ambitious to be useful, and desires, at the same time, to live 
 by his profession, must first learn to be particularly agreeable 
 
238 SYMPTOMATOLOGY. 
 
 in the sick chamber. His manners, whatever they may be in 
 the drawing-room, should have all the simplicity of those of a 
 child in the abode of disease. Every tone of his voice should 
 indicate kindness and sympathy ; and no matter as to what 
 may be the responsibility of his situation, or the danger of his 
 patient, he should never betray, by his manners or the pathog- 
 nomy of his face, the presence of fearful apprehensions. He 
 should, also, as carefully avoid levity. Cheerfulness should 
 always play upon his face, and to the friends of the sick, 
 nothing but candor should escape from his tongue. In fine, 
 he should be, in the sick chamber, an example of patience, 
 forbearance, kindness, cheerfulness, vigilance, promptness, and 
 decision. While he causes no one to feel restrained or em- 
 barrassed, all should feel that they exist under martial law — 
 that his will, and nothing but his will, can be executed. Any 
 yielding to the suggestions of the unprofessional, however few 
 or many they may be — however light or heavy the responsi- 
 bility, is as unbecoming in a physician, as in a general. He 
 should consider it as imperious to decide upon his duty and 
 do it, without any reflections as to consequences. A compa- 
 ratively trifling want of decision may lose a battle — and it may 
 lose a patient. 
 
 Upon being called to a sick child, the first object of the phy- 
 sician should be to ascertain, under the guidance of what we 
 have taught, under various heads, concerning viability, whether 
 the child is constituted to live. With this view, he will ascer- 
 tain the vital condition of the parents, the disease with which 
 they have been afflicted, and of which their relations have 
 died. But, in the meantime, he should be seated sufficiently 
 near to the child to observe its manifestations, and to afibrd 
 it a chance to observe his, for the reason that he will be un- 
 able to make any satisfactory examinations of it, before it 
 shall have discovered that he is a friend. During the pauses 
 of Conversation with the mother, he should turn his attention, 
 incidentally as it were, to the child — present it some toy as a 
 token of kind feeling, talk to it and play with it. But all this 
 should be done without a suspicion being excited that it is the 
 special object of his visit. 
 
 He should ascertain of the mother whether she has lost any 
 children, and if so, of what forms of disease and at what ages 
 
SYMPTOMATOLOGY. 239 
 
 they died. He should particularly obtain the history of his 
 patient, as to general health, dentition, weaning, food, etc. 
 When he shall discover that the child has become acquainted 
 with him — betrays no alarm or excitement when he puts his 
 hand upon it or takes it up, he may safely proceed to make 
 his personal investigations of it ; otherwise he need scarcely 
 expect to obtain a normal exhibition of its circulation and 
 respiration. 
 
 If the child should be asleep upon his arrival, he should 
 avail himself of the occasion to notice the character of its sleep, 
 the condition of its eyes, as to whether they are closed or par- 
 tially open, the frequency of its respiration, the temperature 
 of its skin, of its head, and the beat of the pulse. If, while 
 making these observations, he should discover it about to 
 wake, its mother or nurse should be at hand to take his place, 
 and he should so dispose of himself as not to be seen by it 
 upon waking, for the reason that a strange face at such a mo- 
 ment, might be productive of unpleasant consequences. 
 
 Without having thoroughly gained the confidence of the 
 child, it is useless to expect to find any portion of its patholo- 
 gical expression, such as it would have been, but for his pre- 
 sence; and for those who are not naturally fond of children, 
 it will be about as difficult as for one to make " sweet sounds,'' 
 whose musical capacity is feeble. But, under the most favor- 
 able circumstances, he should examine the pulse two or three 
 times during his visit, because this function suffers important 
 changes, in infants, from slight and even inappreciable causes. 
 
P A ET I 
 
 MANIFESTATIONS OF DISEASE IN THE ANIMAL OR CEREBRO-SPINAL 
 
 SYSTEM. 
 
 INTRODUCTION. 
 
 A REFERENCE to tliG table of measurements of the medulla 
 oblongata and cerebellum (page 20), leaves no possible room 
 to doubt that those forms of disease which have hitherto been 
 denominated cerebro-spinal, should really be called oblongato- 
 cerebello-spinal, and that the cerebrum has no direct partici- 
 pation in them. Furthermore, they admit of a division into 
 three sub-parts or groups: 1. Into those which result from an 
 equal development of the medulla oblongata and cerebellum — 
 as gout and rheumatism. 2. Those that result from a full 
 endowment of the cerebellum and a feeble one of the medulla 
 oblongata — as obesity, anasarca (perhaps dropsies in general) 
 and probably apoplexy, epilepsy, etc.; and, 3. Those which 
 result from a full endowment of the medulla oblongata with a 
 reversed condition of the cerebellum, as tuberculosis and its 
 kindred manifestations. These conclusions, we contend, are 
 authorized by cranial measurements and observation upon dis- 
 ease and its results. 
 
 We regret exceedingly that we are unable to make such a 
 classification of the clearly recognized forms of disease. In 
 the reports of such forms, we have barely found enough, in- 
 cidentally thrown out in their history, with what we have ob- 
 served, to feel assured of the practical advantages that would 
 result from such a classification, correctly made ; it would be 
 equivalent, so far as etiology and prophylaxis are involved, to 
 all that has been done. 
 
 (240) 
 
INTRODUCTION^. 241 
 
 As we have remarked, we are unable to adopt such a classi- 
 fication, and yet, in the following treatise we may be able, 
 without much risk of error, to designate the primary or or- 
 ganic cause of many of the classes or family forms of disease, 
 but we shall not do it with a view of present advantage to 
 therapeutics, so much as for the purpose of exciting or inviting 
 observation to the subject. And when we shall speak of pa- 
 tients as being of the first, second, or third class, we shall 
 have reference to the table above referred to, on page 20, 
 Book I. 
 
 16 
 
CLASS I 
 
 lLl2rj. 
 
 Tzz 
 
 cks: 
 
 Ot '-' Jk. » ^' 
 
MANIFESTATIONS OF DISEASE, ETO. 243 
 
 the lowest departments of animal existence, we often met with 
 a high degree of vitality with a mere trace of cerebral appa- 
 ratus. Add to the preceding facts the circumstance that hu- 
 man greatness is never found unassociated with a highly en- 
 dowed respiratory apparatus, and the conclusion that most 
 plausibly presents itself is, that oxygen, if not life, is so in- 
 separably connected with it, as to give the lungs more impor- 
 tance in the phenomena of life, than the brain and its asso- 
 ciated parts. We could not avoid the conclusion, cceteris 
 jparibxis^ that as the quantity of steam was the measure of 
 power in any given machine, so the quantity of oxygen was 
 the measure of the power of any given animal organization. 
 
 In harmony with this conclusion, we had seen powerless 
 heads as large as those of Washington, ISfapoleon, and Scott, 
 and that we had met with great men, comparatively, with 
 small or moderately- sized heads ; but in no instance had we 
 found efficiency of character associated with a feebly-endowed 
 pulmonary system. 
 
 These views were entertained by us until we discovered the 
 dependence that exists between the medulla oblongata and 
 cerebellum, acting in co-operation, and the pulmonary system. 
 In this, we discovered that all the vital influence of the respi- 
 ratory function was imparted by the previously-named organs ; 
 their development became to us the measure of the respiratory 
 function. 
 
 But, notwithstanding this conclusion, there is ample room 
 left for debate, as to which of the three great functions, the 
 respiratory, the circulatory, and cerebral, is the most indispen- 
 sable to present existence. Without properly- elaborated blood, 
 there is no cerebral action ; and without respiration such blood 
 cannot be produced, and when produced it is of no vital purpose 
 without the cerebral function. The three systems constitute a 
 circle, and each is indispensable to life — to present or momen- 
 tary existence. 
 
 Separate and apart from these considerations, there yet re- 
 mains one which decides that we should commence the con- 
 sideration of disease with those manifestations of it which 
 appear in the cerebral apparatus ; and that is : it presides over 
 and regulates all the apparatuses of animal life and greatly in- 
 fluences those of the vegetative. 
 
244 MANIFESTATIONS OF DISEASE, ETC. 
 
 Dr. "West says, "beside the general interest and importance 
 of these affections (cerebral), at whatever age they may occur, 
 their extreme frequency in early life gives them an additional 
 claim on our notice." 
 
 He continues: "It appears from the fifth report of the 
 register-general, that 7,603 out of 45,000 persons who died in 
 the metropolis during the year 1842, were destroyed by the 
 various forms of disease of the nervous system. But 4,847 
 of these deaths took place during the first five years of exist- 
 ence ; or, in other words, sixty-four per cent, of the fatal dis- 
 orders of the nervous system occurred within that period." 
 
 Now, it may be inquired, what are the causes of this mor- 
 tality from the cerebral forms of disease ? We answer, none 
 has been assigned, except such as are equally applicable to all 
 the other apparatuses of the system. Their true causes re- 
 main vailed in impenetrable darkness. It is now time, how- 
 ever, that this vail was thrown aside. 
 
 We have shown, page 20, that the power of the respiratory 
 and circulatory functions depends upon the medulla oblongata 
 and the cerebellum. Now, suppose these apparatuses to be 
 too feeble to sustain all the functions of the body ; sixty-four 
 per cent., Dr. West informs us, died of nervous disease under 
 five years of age ; now, if we subtract from this sum those 
 who would have died but for the physicians, the natural mor- 
 tality would probably be reduced to thirty-five per cent.; and 
 this mortality may be assigned to an inherent want of via- 
 bility (the consequence of violated law), which is invariably 
 indicated by a feeble chest or very small cerebellum, more 
 especially if the cerebral hemispheres are large; or it may 
 equally depend upon a large cerebellum and a small medulla 
 oblongata, attended by more or less of obesity, up to the in- 
 vasion. 
 
 If physicians shall find that we have truly indicated the 
 source of vital power — viability — they will find no difficulty 
 in detecting, in most cases, the causes of infantile disease and 
 mortality, more especially if they will extend their observa- 
 tions to the parents, individually and relatively. 
 
FORMS OF CEREBRAL DISEASE. 245 
 
 OEDER I. 
 
 INFLAMMATORY FORMS OF CEREBRAL DISEASE. 
 
 Genus I. — ■ Encephalitis. 
 Sijnple Lifiammation of the Brain. 
 
 We use this term to designate an inflammation of the parts 
 contained within the cranium ; we shall not stop to inquire 
 whether it is confined to the meninges or to the substance of 
 the brain, because it may or may not involve the whole, and, 
 further, a distinction can subserve no practical therapeutical 
 purpose. Post mortem examinations generally reveal more 
 obvious signs of inflammation on the surface and in the ven- 
 tricles than in the substance of the organ ; but this does not 
 prove that the substance of the organ was not invaded, be- 
 cause it is possible and even probable that important, but in- 
 appreciable, changes may have been efiected by the inflam- 
 mation. 
 
 With infants and young children, this malady is thought to 
 be very generally confined to the base of the brain ; we should, 
 a priori^ expect this to be the case, because it can scarcely be 
 supposed that any organ could be much disposed to morbid 
 action before it became so organized as to perform the function 
 for which it was intended, and this is not the case with the 
 cerebral hemispheres in infancy ; but the first moment of extra- 
 uterine existence calls into requisition the hasilar portion of 
 the brain. In a majority of instances, it is stated, that the 
 ventricles also participate in this inflammation. 
 
 The symptoms, however they may vary in diflTerent cases, 
 are strongly marked ; and the disease is, perhaps, more likely 
 to attack children in full and apparently good health than in 
 the feeble and emaciated. In many cases, it commences, ap- 
 parently (for the previous phenomena may not have been ob- 
 served), with the most violent convulsions ; in other cases, after 
 a few hours or a day of restlessness, they supervene ; in 
 others, the first admonition consists of nausea and vomiting, 
 and they may continue for a day or two, or they may speedily 
 cease, or they may mark the whole course of the disease. All 
 ingesta received into the stomach, no matter how bland, is 
 thrown up. Usually there is much constipation. The 
 
246 INFLAMMATORY FORMS 
 
 convulsions are, in some cases, continued almost without in- 
 termission to the close of life. In some cases febrile excite- 
 ment is present at the beginning, or, if it is not, it soon makes 
 its appearance and continues without remission to dissolution, 
 which is rarely procrastinated beyond a week. 
 
 As an illustration of this violent malady, we have deemed 
 it proper to extract from Dr. Abercombie's treatise on cerebral 
 disease the history of one case. 
 
 "A child, aged 2 years, 21st May, 1826, was suddenly 
 seized in the morning with severe and long-continued convul- 
 sions. They left her in a dull and torpid state, in which she 
 did not seem to recognize the persons about her. She had 
 lain in this state for several hours, when the convulsion re- 
 turned, and during the following night it recurred a third 
 time, and was very severe and of long continuance. I saw 
 her on the morning of the 23d, and while I was sitting by her, 
 she was again attacked with severe and long-continued con- 
 vulsion, which affected every part of the body, the face and 
 eyes in particular being frightfully distorted. The counte- 
 nance was pale and expressive of exhaustion ; the pulse fre- 
 quent ; her bowels had been freely opened by medicine previ- 
 ously prescribed by Dr. Beiby, and the motions were dark and 
 unhealthy. Further purging was employed, with topical 
 bleeding, cold applications to the head, and blistering. After 
 this attack, she continued free from convulsion until the after- 
 noon of the 23d ; in the interval she had remained in a par- 
 tially comatose state, with frequent starting ; pulse frequent, 
 but pupil rather dilated; she took some food. In the after 
 noon of the 23d, the convulsion returned with great severity ; 
 on the 24:th, there was a constant succession of paroxysms 
 during the whole day, with sinking of the vital powers ; and 
 she died in the evening. 
 
 " On removing the dura mater, the surface of the brain ap- 
 peared in many places covered by a deposition of adventitious 
 membrane between the arachnoid and pia mater. It was 
 chiefly found above the openings between the convolutions, 
 and in some places appeared to dip a little way between them. 
 The arachnoid membrane, when detached, appeared to be 
 healthy, but the pia mater was throughout in the highest state 
 of vascularity, especially between the convolutions ; and when 
 
OF CEKEBRAL DISEASE. 247 
 
 the brain was cut vertically, the spaces between the convolu- 
 tions were most strikingly marked by a bright line of vivid 
 redness, produced by the inflamed membrane. There was no 
 effusion in the ventricle, and no other morbid appearance." 
 
 Causes. — This form of disease is not of very frequent occur- 
 rence in infancy, and hence its causes, at this period of life, 
 are not well understood . It has been known to occur in chil- 
 dren from exposure to the sun in hot weather, and, also, dur- 
 ing apparent convalescence from scarlatina, but most fre- 
 quently no cause can be assigned. Wq think it very probable 
 that its occurrence is measurably confined to the rheumatic 
 constitution — a high endowment of the vital forces. After 
 the second year, it is seldom manifested until after puberty. 
 Dr. Wood says, that "it is singular that the tendency to tu- 
 berculous meningitis is exactly the reverse, being greatest be- 
 tween two and fifteen." It would not have seemed strange to 
 him if he had known that the first is associated with a full en- 
 downent of the vital forces, and that the latter is always asso- 
 ciated with, and primarily caused by, a feeble condition of 
 them. 
 
 Diagnosis. — This form of cerebral disease is more liable to 
 be mistaken for tuberculous meningitis, but as the former oc- 
 curs with high vital forces, and the latter with feeble and scro- 
 fulous, there is no necessity for such an error. The former is, 
 furthermore, in its early stages, attended with more acute 
 symptoms, as heat, thirst, delirium, etc. The initiatory stage 
 of both of them may be confounded with several febrile afiec- 
 tions, as small-pox, enteritis, etc. 
 
 Pkognosis. — This is always to be regarded as a dangerous 
 affection. 
 
 Indications. — These most evidently consist in causing a de- 
 termination of the blood outward and downward — in dimin- 
 ishing the action of the arterial capillaries, and increasing 
 that of the venous radicals of the brain and its meninges, and 
 ultimately to secure a normal equilibrium of action. 
 
 Treatment. — When we reflect that fever and inflammation 
 are but obstructed general and local vital actions— accumula- 
 tions of vital force to remove obstructions to secretion and ab- 
 sorption, there can remain no doubt as to the proper plan of 
 treatment. 
 
248 IK'FLAMMATORY FORMS 
 
 "We recommend, therefore, that the scalp be thoroughly 
 cleansed of all dirt and dandruff by vinegar washes and a 
 comb, that it may become properly impressible to external 
 agents and the vital actions of the system. To promote the 
 venous and reduce the arterial actions, the patient should be 
 subjected to, and continued in, a warm bath, until symptoms 
 of syncope are induced, and then put to bed ; much care 
 should now be taken to keep the head cool by cloths satu- 
 rated with a mixture of vinegar and water, or by constant 
 sponging — the latter is preferable, because it admits of and pro- 
 motes constant evaporation — a more cooling process than an 
 un ventilated application of cold substances. It is a very 
 general practice to surround the head with ice ; but to this we 
 have the same objection that many thinking and discreet phy- 
 sicians have to blistering the scalp in this affliction. As a 
 source of irritation, it is not inferior, perhaps, to water so hot 
 as barely to avoid vesication, and in this, as in all other forms 
 of disease, all causes of irritation that are not revulsive should 
 be avoided. 
 
 As soon after the warm bath as practicable, the bowels 
 should be stimulated by enemas, and the inferior extremities 
 kept warm with as much care as must be bestowed in keeping 
 the head cool. 
 
 As a further means of inviting circulation and irritation 
 from the brain, the abdomen, lower portion of the spine, and 
 inferior extremities should be kept covered with emollient sub- 
 stances, as a bread-and-milk or corn-meal poultice, sprinkled 
 wdth mustard or cayenne, to a sufficient extent to produce 
 redness without vesication. 
 
 Purgatives, in this form of disease, can act in co-operation 
 with the rubefacients, in promoting a determination of vital 
 action from the brain, and for this purpose, and no other, are 
 they admissible, in violent cases, where the native forces of 
 the system are such as not to seriously contra-indicate their 
 weakening influence ; consequently, the hydrogogue cathartics 
 should be avoided. For this purpose, we would suggest the 
 use of the compound powder of Jalap and Senna, or Podo- 
 phyllin, or Podophyllin and Leptandrin combined, either of 
 which is to be used in small doses to avoid active catharsis ; 
 
OF CEEEBRAL DISEASE. 249 
 
 in many instances stimulating and laxative enemas may be 
 given. 
 
 In the meantime, or as soon as the inflammatory action re- 
 appears upon the surface, after the employment of the warm 
 bath, all parts of the surface, not acted upon by rubefacients, 
 should be kept moist, or in an evaporating condition, by 
 sponging them with an alkaline solution of such a temperature 
 as to be agreeable — not omitting a frequent resort to warm 
 pediluviums ; nauseating antispasmodics should likewise be 
 so administered as to aid the other means to keep down ex- 
 cessive action and promote an equilibrium of the circulation 
 in the system. 
 
 When the most urgent symptoms have abated, a more per- 
 manently depurative practice should be adopted — such as the 
 use of tonic and stimulating alteratives, as Xanthoxylin, My- 
 ricin, Hydrastin, and, in some cases, Quinine combined with 
 one or more of the above articles. 
 V^. Xanthoxylin, 
 Hydrastin, 
 S. Quinine, aa gr.j., 
 Sacch. Alb., q. s. to make a powder, 
 when the articles are triturated together ; and which may be 
 divided into from two to six or eight doses, according to the 
 age of the child, and given three or four times a day. In 
 some cases the Cornine may be substituted for the Quinine 
 with advantage. 
 
 This is the plan of treatment which we have found more 
 generally successful, in this so commonly fatal disease, than 
 any other which we have investigated. 
 
 We would remark here, that the application of blisters to the 
 head, a practice so universally recommended, and as univer- 
 sally fatal, cannot be too highly deprecated. During a prac- 
 tice of many years, we have never known a child to recover 
 in whom the scalp had been shaved and a blister applied, and 
 such is likewise the result of the observation of many of our 
 oldest eclectic practitioners. 
 
250 INTLAMMATORY FORMS 
 
 Genus II. — Acute Hydrocephalus — 
 Complicated Inflammation of the Brain. 
 
 "We have stated that Encephalitis is not a frequent form of 
 cerebral disease in infants ; but Acute Hydrocephalus is, and 
 it never occurs except in phthisical or tuberculous constitu- 
 tions. It is stated, by pathologists, that in a large majority 
 of cases, the inflammation is so predominant at the base of the 
 brain, as to be regarded by some as pathognomonic of a scro- 
 fulous condition of the organ. But this peculiarity is said to 
 be a very frequent condition of Encephalitis. This, a priori^ 
 we would expect, because it is not reasonable to suppose that 
 much disease would invade the hemispheres before they are 
 sufficiently developed to perform, to an appreciable extent, 
 their functions. The base of the brain, and that only, is 
 called into requisition to much extent during infancy and 
 childhood. 
 
 To the usual evidences of cerebral inflammation, may be 
 added, in this form, opacity and thickening of the membranes, 
 serous eflfusions into the ventricles, varying in quantity from 
 very little to six ounces, and softening of the cerebral sub- 
 stance. In this form, furthermore, there are deposits of small 
 and apparently compressed or flattened points of the size of 
 millet seed, which appear friable under pressure, and closely 
 resemble the gray granulations occasionally seen in the 
 lungs or pleura of phthisical people — they are of a grayish or 
 yellowish color, and semi-transparent and resistant. In proof 
 that this is tubercular matter, Dr. West presents briefly the 
 following results of observation : 
 
 '' First: That they are always associated with tubercle else- 
 where. 
 
 " Second : That their abundance is not proportioned to the 
 amount of inflammatory mischief. 
 
 " Third: That they are sometimes met with in cases where 
 no head symptoms were observed during life, and unconnected 
 with any sign of inflammation discovered after death ; and, 
 
 "Fourth: That their chemical composition and their micro- 
 scopic structure are identical with tubercle in other organs of 
 the body." 
 
 If we were to divide this disease into two stages, we should 
 
OF CEREBRAL DISEASE. 251 
 
 have all the indications, during the first, of inflammation of 
 the brain or some of the parts ; and during the second, all 
 those which are characteristic of serous effusions and cerebral 
 softening. Divide it as we may, and much confusion will still 
 exist ; if we adopt the above division, we shall often find both 
 sets of symptoms to be attendant upon both causes. While 
 effusion is taking place in one part inflammation is extending 
 in another, and thus much confusion may result. 
 
 Some divide it into three stages : that of increased sensi- 
 bility — diminished sensihility — and the third is that of 
 jpalsy and convulsions. It has also been divided into four 
 stages : that of turgescence^ inflammation,^ effusion^ and 
 palsy. But the same difficulty attends the whole of them. 
 These efforts at elucidation prove, however, the difficulty that 
 attends the subject. 
 
 "We shall assume that it is divisible into three stages, and 
 among the first indications of its existence is the application, 
 by the child, of its hand to its head, followed by such a cry 
 as indicates severe pain — the motion of the hand to the head 
 leads us to infer the location of the pain. Following or at- 
 tending this symptom, we may probably observe restlessness, 
 an indisposition or inability to sit up. Its sleep is unquiet and 
 often broken by starts and screams, and attended frequently by 
 a grinding of the teeth. When awake, it shuns the light and 
 evinces an indisposition to be disturbed and an impatience to 
 noise. The scalp is hot and the pupils are contracted. The 
 appetite is whimsical or totally lost, the breath is ofiensive, 
 bowels are constipated, the stools are green, or tar-like and 
 black, the urine is highly-colored and generally scanty, the 
 tongue is white, vomiting very commonly attends this stage, 
 but the most pathognomonic symptom is said to consist in the 
 change of the stomach from a tumid and tender condition to 
 one of flatness or apparent emptiness, and that, too, without 
 alvine excretions. The pulse is also regarded as another re- 
 markable symptom, being exceedingly frequent and sharp. 
 These symptoms leave no doubt that the inflammatory action 
 is going on in the brain, but the period of their duration is 
 uncertain — they may continue one, two, or several days, but 
 rarely longer than a week, before they become replaced by 
 those that distinguish the second stage. 
 
252 INFLAMMATORY FORMS 
 
 As the second stage approaches, the pulse is said by some 
 to become less frequent, until finally its beats are slow and 
 irregular, but others assert, that with its irregularity it in- 
 creases in frequency. No great importance, we apprehend, 
 when taken alone, is to be attached to it. The face now be- 
 comes expressive of extreme anxiety and suflering — there is 
 an increased aversion to any kind of annoyance — it seems only 
 desirous to be let alone, its eyes are generally closed to keep 
 out the smallest ray of light, its condition is drowsy, if old 
 enough to speak, it will complain of its head, all questions are 
 answered rationally and briefly, its disposition is very irrita- 
 ble, but when quiet and undistm-bed, it moans in a low tone, 
 which is, very frequently, interrupted by a sharp, suffering 
 cry ; sometimes, instead of the moan and plaintive cry, there 
 will be screams, which are so toned as to indicate the intensity 
 of the pain. As night approaches, the symptoms usually be- 
 come more violent, and the patient becomes noisy, vociferous, 
 and delirious, but this is not always the case ; sometimes the 
 only obvious change is an increased restlessness. Yomiting, 
 which was a troublesome and a painful symptom during the 
 first stage, is apt to cease upon the introduction of this — the 
 bowels have, if anything, become more obstinate in their con- 
 stipation, and the evacuations continue equally unnatural, but 
 all flatus has disappeared. 
 
 Before the conclusion of this stage, the pulse becomes less 
 frequent, and with it an increase of insensibility with heavi- 
 ness and stupor, the light ceases to be troublesome, vision be- 
 comes imperfect, and squinting commences, it lies with its 
 eyes half-closed, convulsions frequently occur, paralysis super- 
 venes, the excrements are passed unconsciously, it picks its 
 lips, or bores its fingers into its nostrils. This stage is ren- 
 dered remarkable by remissions which occasionally character- 
 ize it — but these are sometimes gradual, at other times sudden 
 and always deceitful ; the indications of convalescence are 
 sometimes sufficient to inspire hope, and yet, in a day or so, 
 a relapse supervenes and a deeper coma dispels all expectation 
 of recovery. This stage may continue a week or two. 
 
 The next and last stage differs but little from the preceding, 
 except that the pulse becomes again very frequent — as fre- 
 quent as two hundred strokes per minute. One part of the 
 
OF CEREBRAL DISEASE. 253 
 
 body will be hot and dry, while a cold sweat pervades another, 
 convulsive twitchings take possession of one side and paralysis 
 of the other, one cheek is flushed and the other is pale — fee- 
 bleness rapidly marks the pulse, and death supervenes quietly or 
 in the midst of convulsions. This third stage is very indefi- 
 nite in its duration — lasting in some instances only a few 
 hours, and at other times a week or ten days. The greatest 
 duration of the disease, from the time the symptoms become 
 well defined, is set down at about twenty-one days — terminat- 
 ing in some cases in four or five. 
 
 In view of the symptoms and peculiarities of the three 
 stages, as above described, it becomes proper that we should 
 caution our readers against indulging a hope or expectation 
 that they will ever witness the three stages to appear and pro- 
 gress exactly as we have described them, or that they will find, 
 in every instance, the symptoms to be exactly in the place we 
 have assigned them. 
 
 Many of the symptoms which we have assigned to the 
 second stage may occur in the first, and the reverse. A difie- 
 rence as to their date and the order of their occurrence must 
 be expected — certain symptoms, though never altogether ab- 
 sent, may occur early in one case and late in another. Con- 
 vulsions, per example, which are scarcely ever absent, may 
 not appear at the same date in any two cases, nor be attended 
 with the same phenomena. In one patient, they may convulse 
 only one side ; in another, the whole body. In one instance, 
 they may be succeeded by a stifi* and contracted state of the 
 extremities, and in another by paralysis. But, however greatly 
 the symptoms may be modified, in difierent cases, no error 
 can be made as to the disease they collectively indicate — no 
 mistake can be indulged as to the dangerous nature of their 
 source. 
 
 Causes. — For the opinions of many on this subject, we refer 
 to other and more voluminous works, and in this place record 
 our own notions about it. 
 
 We do not doubt but that it very often depends upon a tu- 
 bercular diathesis, and is therefore hereditary ; but what is the 
 condition of such a diathesis ? To refer this form of disease 
 to such a diathesis, is leaving the cause as much in the dark 
 as it was before. 
 
254 INFLAMMATORY FORMS 
 
 Such is the condition of the vital forces in all these chil- 
 dren, as to place them in the third class, which entitles us to 
 the opinion that this form of disease depends upon an imper- 
 fect pulmonic depuration. The skin aids in this depuration, 
 more particularly when in a state of eruption, and it is known 
 that a suspended cutaneous eruption will produce this form of 
 hydrocephalus ; and so may the arrest of any other secretion 
 that gives aid to the lungs — as the deposition of adeps. 
 
 Diagnosis. — As this form of disease, as we have before re- 
 marked, rarely if ever attacks the strong and healthy, so those 
 who have previously appeared healthy may only have been 
 obese. Hence it is that children of a scrofulous diathesis will 
 gradually lose the rose and flush of health without any 
 assignable cause, and when they have become sufficiently re- 
 duced by the disturbance occasioned to the nutritive process 
 by the tubercular development, then Acute Hydrocephalus 
 takes possession of the case. 
 
 While, therefore, the physician is watching this wasting 
 condition of his patient, he should be sufficiently vigilant as 
 to anticipate the possible result, and this certainly is not a 
 very difficult task when we have a knowledge of the parental 
 diathesis or organization. 
 
 Perhaps the patient has been tolerably well, until very re- 
 cently, when it had an attack of febrile symptoms, attended 
 with constipation, headache, and possibly vomiting ; now, it 
 would not be entirely unlikely that the case might be mis- 
 taken for one of remitting fever, and the only existing circum- 
 stance that should excite suspicion in the premises is the pa- 
 rental diathesis, which can always be known. If the patient 
 be under five years of age, the physician may still more 
 strongly suspect that it is not remittent fever, and if it be 
 under three years of age, he may feel quite sure that it is not. 
 
 As the human temperaments have, hitherto, been a sealed 
 book, but little observation has generally been had upon the 
 subject of human constitutions in general. As the seal is 
 now broken, as we confidently believe, we entertain a san- 
 guine expectation that observation will be commenced, and 
 when a habit of the kind is formed, it becomes one not only 
 of agreeable interest but of useful instruction. It has become 
 as natural for us to observe the constitutional peculiarities of 
 
I 
 
 OF CEREBRAL DISEASE. £55 
 
 every one we meet, as it is to breathe, and certainly it con- 
 sumes neither time nor money. 
 
 If the physician will impress upon his understanding the 
 peculiar symptoms that attend a remittent fever, he need not 
 be long in doubt as to the character of the case before him, 
 even without a knowledge of the circumstances we have 
 named. Some cases of gastric disorder considerably resemble 
 the incipient stage of Acute Hydrocephalus, but then, there 
 are such differences as should prevent any mistake. 
 
 To distinguish this form of cerebral disease from simple 
 Encephalitis, we refer to the diagnosis of the latter. 
 
 Pbognosis. — Upon this topic we have but little to say, fur- 
 ther than that it is, according to authority, very generally un- 
 favorable ; for under every known treatment, and under every 
 other known condition, it generally proves fatal sooner or 
 later ; the number of exceptions only serve to enable us to 
 say that it is not absolutely incurable. 
 
 We are so well satisfied that this form of disease originates 
 in a non -viable condition of the system, as to give it as our 
 unqualified opinion that it is never curable, and that those 
 who have been supposed to have recovered from it never had 
 it. It is possible, however, that a few of the stronger of this 
 class may recover from the less actively inflammatory stages 
 of the affection, but it can only amount to a very short pro- 
 crastination of death. 
 
 Treatment. — As this affection so generally proves fatal 
 under any treatment, we can do nothing more than to suggest 
 a course similar to that recommended for Encephalitis, and 
 would take occasion here to remark, that notwithstanding the 
 general application of blisters in such cases, they have proved 
 as unsuccessful as in Encephalitis. 
 
 The following course has been adopted by several practi- 
 tioners and occasionally with advantage. 
 
 Alkaline bath to the surface, with considerable friction in 
 drying ; bowels kept soluble ; diaphoresis maintained by 
 means of spirit vapor-bath ; compound tincture of Virginia 
 Snake Root, and warm efiusions of Spearmint, Crawley Root, 
 etc.; local applications to the head of cooling lotion, tepid or 
 cool, as indicated by the efiects, and in some instances warm 
 
256 ^-ON-INFLAMMATORY FORMS 
 
 fomentations of Hops, or Stramonium leaves applied to the 
 whole head. Dim-etics are also beneficial, as, 
 V^. Tinct. Digitalis, 3j, 
 
 Spirit. Nitr. Dulc, 3j ; mix. 
 Of this five drops may be given to a child one year old, in an 
 infusion of Parsley root, and repeated three or four times a 
 day. All sources of irritation must be avoided ; if teething, 
 the gums must be cut ; and a change of the nurse's milk will 
 be frequently of service. 
 
 ORDEE II. 
 
 NON-INFLAMMATOKY FOEMS OF CEEEBEAL DISEASE. 
 
 Genus I. — Cekebkal Congestion. 
 
 Congestion of the brain is produced by two distinct sets of 
 causes, and consequently produce two distinct forms of dis- 
 ease. One variety may be produced by any cause that can 
 increase the flow of blood to the brain, and when thus pro- 
 duced it is called active congestion. 
 
 The other variety of cerebral congestion may be produced 
 by any cause that can prevent or retard the reflux of the 
 blood, and when produced in this way, it is called passive. 
 As these two forms are very unlike, it becomes requisite to 
 treat of them separately. 
 
 Species I. — Acute Cerebral Congestion. 
 The period of dentition being one of much vascular irrita- 
 tion, is not unfrequently attended, even from slight causes, 
 with such cerebral congestion as to produce apoplectic symp- 
 toms and even convulsions. Such symptoms precede, or are 
 introduced by, the eruptive fevers. Acute congestion of the 
 brain is sometimes very rapidly produced — manifesting from 
 the start such symptoms as indicate an immediate demand for 
 medical attention. In other instances, it may seem to have 
 commenced as suddenly, and yet, though unobserved at the 
 time, but afterward remembered, that the alarming portion of 
 the attack was preceded, for several days, with manifestations 
 
OF CEREBRAL DISEASE. 257 
 
 of uneasiness — some derangement of the bowels, either too 
 loose, or, more probabl}^, too constipated, and possibly with 
 some febrile disturbance. 
 
 At other times, these symptoms will gradually increase 
 until they attract attention — the child has become more rest- 
 less, troublesome, and fretful, and endeavors to evade the 
 light, places its hand to its head, and if old enough to speak, 
 it will complain of its head, which upon examination will be 
 found to have increased in its temperature. That vomiting 
 which was characteristic of more sudden assaults, now super- 
 venes ; the pulse, though in young children rarely ever trust- 
 worthy, is usually quick, the attending fever is variable in de- 
 gree and attended with considerable irregularity in its exacer- 
 bations. The child's sleep is not natural or healthy, its facial 
 muscles twitch, it starts upon waking, and if the anterior fon- 
 tanelle be unclosed, strong pulsations of the brain may be 
 observed. 
 
 Such paroxysms as this may be frequently seen with chil- 
 dren during the period of dentition, and after continuing seve- 
 ral days may even pass away without any medical attention. 
 
 Notwithstanding that such paroxysms sometimes pass off 
 without inflicting more serious mischief, yet we are not to 
 make such calculations, because just such symptoms as those 
 above detailed, very frequently indicate a formidable mischief, 
 one that may have been accumulating for months, and which 
 is to end, possibly, and even probably, in acute hydrocepha- 
 lus. And, although all of the hitherto enumerated symptoms 
 may subside — pass entirely off, and thereby inspire the most 
 sanguine hopes, yet we should look out for the supervention 
 of another and a very different set, to introduce what may be 
 designated the second stage. 
 
 As the disease emerges from the first stage, as the heat of 
 the head may diminish, and the flush become slight and less 
 constant, we may observe stealing over the patient an indiffe- 
 rence to all objects of sense, with an increased weight and 
 anxiety of the countenance and an increasing tendency to 
 torpor. The bowels are still more or less constipated, and the 
 vomiting is still in attendance, but probably less frequent than 
 in the first stage. Sometimes the second stage is introduced 
 by an attack of convulsions, and if not, the state of torpor 
 17 
 
258 NON-II^LAMMATORY FOEMS 
 
 may gradually pass into one of convulsion, and after eacli 
 repetition of the latter the torpor becomes more deeply founded, 
 until finally coma supplants the convulsive tendency and 
 closes the scene. This finale may supervene the first fit in 
 forty-eight hours, or the disease may be procrastinated for 
 several weeks, and even then recover. It is thought that in 
 cases of such procrastination, the cranial sutures and fonta- 
 nelles are not completed, and that the congestion is relieved 
 by an effusion of serum into the ventricles, the yielding condi- 
 tion of the cerebral parietis admitting of easy adaptation to 
 the corresponding increase of the mass. If we admit this 
 solution to be the fact, we have an exchange of an acute form 
 of disease for a chronic one — the congestion has produced hy- 
 drocephalus, an afiection which is not always, but most gene- 
 rally, fatal. 
 
 "When the exanthemata are introduced by cerebral symp- 
 toms, the danger for a time must be considered as very great, 
 but under such circumstances we know that if we can remove 
 the congestion we will save the patient by the aid of the erup- 
 tion that will soon follow. The attending vomiting may be a 
 symptom of cerebral disturbance, or it may be consequent 
 upon the ingesta of some indigestible substance. This is a 
 matter which must not be overlooked by the attending physi- 
 cian, because an emetic in the first instance is as strongly 
 contra-indicated, as it would be indicated in the second. 
 
 As cerebral congestion results from such a variety of causes, 
 it is obviously impossible to prescribe a definite course of treat- 
 ment ; consequently, the physician is required to summon to 
 his aid aU the vigilance, discrimination, and judgment he can, 
 inasmuch as a course of treatment that would be wisely 
 adapted to one case, might prove destructive in another. 
 Thus, if the convulsions have succeeded to mechanical vio- 
 lence, inflammation is much to be apprehended, and therefore 
 an energetic treatment is demanded ; but, on the contrary, if 
 they have succeeded to long-continued gastric or intestinal irri- 
 tations, or should occur during the dental process, the danger 
 is to be apprehended from doing too much rather than not 
 enough. 
 
 Causes. — The causes in this form of disease may be the 
 same as those of simple encephalitis, acting under a modifi- 
 
OF CEREBRAL DISEASE. ,259 
 
 cation of circumstances. It is probably confined to those who 
 possess a stronglj^-endowed vital system. Beside falls and 
 blows, it may be produced or excited into action by almost 
 any source of irritation that may be directed to the brain, as 
 suppressed discharges, solar or artificial heat, and the various 
 irritations common to the dental period. 
 
 Diagnosis. — The physician who will observe the difierence 
 of cerebral conformation between the heads of those who are, 
 respectively, sufiering under the active and passive forms of 
 congestion, will never afterward confound them. In active 
 congestion, the face will give evidence of vital existence by its 
 flushed condition, sufiused eyes, and generally turgid appear- 
 ance. For further diagnosis, see the next or second species. 
 
 Prognosis. — If we were to draw our conclusions from the 
 practice we have observed, we should conclude very unfavor- 
 ably as to the prognosis in this form of disease, and yet there 
 is nothing inherently indicative of danger in it. The vital 
 force is, in general, adequate to the removal of the congestion, 
 at least with a little professional aid, and when it proves fatal, 
 it should be charged to the profession, as not having disco- 
 vered the proper treatment, or in adopting an erroneous one — 
 such as we consider bleeding and mercury to be. 
 
 Treatment. — The indications for treatment are to overcome 
 the spasmodic condition of the vascular system, which will 
 produce an equalization of the circulation, and thus relieve 
 the congested state of the brain by diverting the circulation 
 from this organ ; also, to remove all local irritations, whether 
 gastric, intestinal, or dental. 
 
 To fulfill the first indication, we commence with a free and 
 repeated use of the warm bath, in connection with nause- 
 ants: as, 
 
 ^. Syrup of Squills, 
 
 Syrup of Senega, aa gss, 
 Tinct. of Lobelia, 3ij. Mix. 
 Of this, sufficient should be administered to produce nausea, 
 say from ten to twenty drops to a child one or two years old, 
 and which may be repeated sufficiently often to keep up the 
 nausea and accompanying diaphoresis. We prefer this com- 
 bination, inasmuch as it tends to prevent the recession of 
 the exanthema so common to this affection, and which 
 
260 N"ON-IITFLAMMATORY FORMS 
 
 recession is much to be dreaded and must always be carefully 
 
 watched . 
 
 ^. Podophyllin,gr.j, 
 Lupulin, grs. y, 
 Sacch. Alb., Bj. Mix. 
 Triturate thoroughly, and divide into twelve powders; of 
 these, one powder should be administered three times a day, 
 or sufficiently often to allay the irritation ; the laxative effect 
 of this preparation will, in many cases, take place in from 
 twenty-four to thirty-six hours ; if it should prove too active 
 in its operation, the intervals between the doses should be 
 lengthened. 
 
 If the gums are swollen, they must be cut ; and the practitioner 
 should always attend to this matter in children during the 
 period of teething. 
 
 The whole surface of the body must be bathed often with a 
 weak alkaline wash, and in drying use considerable friction. 
 In some instances, ligatures to the extremities will be found 
 beneficial, and care should be taken that they be not applied 
 too tightly, or removed too suddenly. 
 
 Cold, or moderately cold applications must be applied to 
 the head; but in their employment, we should carefully guard 
 against producing a chill, either by having them too cold or 
 by allowing them to remain too long. In connection with 
 these, the extremities must be kept warm by warm foot-baths, 
 stimulating liniments, or mustard. 
 
 In many instances, the compound tincture of Virginia 
 Snakeroot may be used with benefit, for the purpose of allay- 
 ing that irritability of the system which favors this form of 
 congestion, as follows : 
 
 9r. Comp. Tinct. Yirg. Snakeroot, gtt. x, 
 Aqua distil, f. 3j. Mix. 
 Of this, a fluid drachm may be given every three or four hours 
 to a child five years old. 
 
 Or the tincture of Aconite, or tincture of Belladonna, may 
 be administered for a similar purpose ; thus, 
 
 1^. Tinct. Aconitum, (or Belladonna), gtt. viii, 
 Aqua Distil, f. giij. Mix. 
 A fluid drachm of either of these may be given every three or 
 four hours. K dilatation of the pupils should be produced by 
 
OF CEREBRAL DISEASE. 261 
 
 the use of these agents, the doses must be lessened and the 
 intervals between the doses lengthened, or they must be omit- 
 ted altogether. 
 
 If convulsions are present, place the child in a v^arm bath, 
 and administer antispasmodics, as the tincture of Lobelia and 
 Capsicum. 
 
 In all cerebral diseases, both during the attack and the con- 
 valescent stage, the room of the patient should be kept dark- 
 ened and perfectly quiet, and everything calculated to vex or 
 irritate the patient must be avoided. All diet of an irritating 
 character should be strictly forbidden. 
 
 The severer symptoms having abated, the same tonic and 
 stimulating course may be pursued as recommended in treat- 
 ing of encephalitis ; as follows, 
 
 Xanthoxylin, 
 
 Hydras tin, 
 
 S. Quinine, aa gr. j, 
 
 Sacch. Alb., q. s. 
 to make a powder when the articles are well triturated to- 
 gether ; and which may be divided into from two to six or 
 eight doses, according to the age of the child, and given three 
 or four times daily. 
 
 In the treatment of this disease, success mainly depends 
 upon the judgment of the practitioner in the timely adminis- 
 tration of remedial measures. 
 
 Species II. — Passive Cerebral Congestion. 
 
 Although no age is exempt from this form of congestion, 
 yet it occurs much more frequently immediately after birth, 
 and certainly no one can be puzzled to understand why this 
 should be the case. In many still-born children, the swollen 
 scalp and livid face indicate the extreme congestion of the 
 cerebral vessels, that produced the fatal result by sanguineous 
 effusion upon the surface of the brain. When, in a living in- 
 fant, there is great lividity of the face, and the actions of the 
 heart are feeble and of lengthened intervals, there would be 
 reason to fear that cerebral congestion was present. Just in 
 such cases as this, death sometimes takes place without a sin- 
 gle respiratory movement being made. 
 
 When this congestion of the brain has continued for some 
 
K-QlSr-INFLAMMATORY FORMS 
 
 length of time, a sanguineous exhalation is effected upon the 
 surface of the meninges, which, by coagulating, creates pres- 
 sure on the brain, producing symptoms characteristic of apo- 
 plexy. But the effusion takes place most generally into the 
 arachnoid cavity ; sometimes a very large quantity of blood is 
 discharged there, and if death should speedily succeed, the 
 blood will be found unchanged, but otherwise the serum and 
 crassamentum become separated, and the latter, after a further 
 time, loses its coloring matter and passes to the formation of a 
 false membrane which is in close apposition w^ith the parietal 
 arachnoid. When the effusion has been inconsiderable, the 
 serum becomes absorbed, and the only indication remaining 
 to show that the disease has existed, is the false membrane 
 lining a portion of the arachnoid. In the event the serum is 
 not absorbed, it may become encysted, or it may continue in 
 the arachnoid cavity, and if the quantity be great, the cranium 
 may enlarge as in chronic hydrocephalus. 
 
 The symptoms indicative of an effusion of blood upon the 
 surface of the brain, are generally obscure. Paralysis may or 
 may not be present, nor will the occurrence of convulsions, 
 and their frequent repetition, or their alternation with spas- 
 modic contractions of the extremities, be a sufficient indica- 
 tion disconnected from other circumstances and the general 
 history of the child. If great feebleness in the manifestation 
 of the vital forces has from birth characterized the child, the 
 affirmative, under the symptoms above given, maybe strongly 
 suspected. Post mortem examinations prove these effusions 
 to happen much more frequently with exceedingly feeble 
 children than otherwise. 
 
 Upon this subject, with adults, there is, even in the profes- 
 sion, a wide-spread error. It is in this: that a great fullness, 
 of what is called health, with a large chest, small head, and 
 short neck is associated with apoplexy, and that a constitution 
 of a contrary character is, absolutely, exempt from it. Than 
 this, no greater error could exist in the profession. We admit 
 that active congestion is associated with the first ; but apo- 
 plexy, from passive congestion, occurs with a class of men who 
 are constitutionally and organically the opposite. We can 
 give an illustration of this, attended by such circumstances as 
 will forever impress it upon the mind of the reader. 
 
OF CEREBRAL DISEASE. 263 
 
 Sometime about the close of Januar}^, 1840, in Holly 
 Springs J Miss., A. H. Powell, Esq., called upon the writer 
 for his phrenological opinion of himself. The said Powell 
 possessed the sanguine encephalo-bilious constitution, with a 
 very considerable preponderance of the encephalic element; 
 accordingly, his head was large, neck long and slender, and 
 chest small. The opinion given of him, by the writer, was 
 written, and one of its items consisted of an injunction to avoid 
 intemperance, particularly in the use of ardent spirits, or the 
 consequence would probably be, at the close of some debauch, 
 apoplexy. 
 
 This opinion he exhibited to his medical friends, who as- 
 sured him that such an organization was never known to have 
 apoplexy — that the phrenologist might understand his subject, 
 but that he could not be a well-informed physiologist. 
 
 In a little more than two months, we received the following 
 letter from Hon. J. W. Clialmers, which reveals the remain- 
 ing history of this matter. 
 
 "Holly Springs, Mississippi, 
 
 Monday morning^ April 6, 1840. 
 
 "Pkof. Pov^ll: — Dear Sir — We had, on Saturday night, 
 a most fearful confirmation of your foresight and discrimina- 
 tion in the phrenological opinion given by you upon the ex- 
 amination of the head of our distinguished professional 
 brother, Alfred H. Powell, of Holly Springs. You will re- 
 member that you told him, on the examination of his head, 
 and gave the same to him, in writing, that he was liable to 
 apoplexy, particularly when recovering from an intemperate 
 indulgence in ardent spirits. A. H. Powell was taken with a 
 fit of apoplexy on Saturday night last at 10 o'clock, and ex- 
 pired about 7 o'clock next morning. The proximate cause 
 was a hearty supper of cofiee, meat, and pickled oysters, and 
 as his attendant physician thinks, a predisposition caused by 
 a drinking spell of some four days indulged at Hernando, the 
 week before, but from which he had, to all appearance, recov- 
 ered three or four days before the attack. 
 
 " Your remarks upon his conformation and predispositions 
 are the subjects of general remark in Holly Springs at this 
 time, and Dr. T., who has settled with us, joins me in asking 
 from you a more explicit statement of the developments and 
 
264 ]SrO]^-I^^FLAMMATORT FORMS 
 
 mode of reasoning by which you arrived at a conclusion 
 which has so suddenly and fearfully been confirmed. 
 
 "I remain, etc., Jos. W. Chalmers." 
 
 When a gentleman of Dr. T.'s professional attainments 
 shall desire such information as called for in the preceding 
 letter, it may be reasonably supposed that the mass of the pro- 
 fession has something to learn upon the general subject of apo- 
 plexy. If our opinion of his danger had been sustained by 
 his professional friends, it is possible that he would have been 
 still living. 
 
 It is to us a matter of no little gratification that Dr. West 
 sustains our convictions upon this subject.* We do not only 
 maintain that passive congestion may take place in the adult 
 brain, and produce apoplexy, but we can select those who are 
 liable to it, when walking the streets of the city : and those 
 who shall investigate the subject of the first part of this work, 
 will soon find themselves competent to the same. 
 
 Dr. West has illustrated his lecture on this subject with 
 several cases, all of which took place in very feeble subjects. 
 He would very greatly have increased the value of his illus- 
 trations by the addition of their temperaments or those of their 
 parents. How much longer will this subject be neglected as 
 it has been ? 
 
 Cerebral congestion of this kind is very rarely attended 
 with an extravasation of blood into the substance of the brain. 
 
 The symptoms of this malady, in infants, are so obscure to 
 those who are unacquainted with the temperaments and their 
 combinations, and even those who are, can only have a well- 
 grounded suspicion of it, that but little indeed has, conse- 
 quently, been discovered concerning its therapeutics. 
 
 * The letter of Judge Chalmers shows that we taught, as early as 1840, the 
 doctrine of passive congestion or apoplexy of the brain — that this disease 
 could occur in persons of large heads, long small necks, and small chests, as 
 well as in those of a contrary organization. As early as 1840, we had never 
 seen anything like such a doctrine announced, and if such a one had, at that 
 time existed, we believe that a physician as well read as Dr. T. would have 
 known it ; and yet, we were so conversant with the subject, at that time, as to 
 be able to select from any crowd those who were peculiarly liable to it, as we 
 have shown by the letter of Judge Chalmers. If it can be shown that any 
 one taught this doctrine, and described the class of persons liable to it, under 
 specified circumstances, at a period even as early as 1840, then we shall aban- 
 don all claim to the right of discovery or priority. ^ 
 
OF CEREBRAL DISEASE. 265 
 
 Causes. — The difficulty with which respiration becomes 
 established, in certain kinds of children., and the changes to 
 be effected in the circulation, may, to some extent, enable us 
 to understand how this apparatus should frequently become 
 injected with blood to any degree, varying from the normal 
 to the truly apoplectic condition. Among these difficulties, it 
 may be remarked, that any cause which can impede the pas- 
 sage of the blood either into the right side of the heart, or 
 from the right to the left side through the lungs, will produce 
 it. Thus far the cause is mechanical, and of the same char- 
 acter must be considered those instances of cerebral congestion 
 which result from pressure upon the jugular veins by a hyper- 
 trophoid thymus gland and enlarged tuberculated bronchial 
 glands. But it sometimes occurs in feeble children without 
 any assignable cause, and also in adults, having more or less 
 the encephalic constitution, from slight causes, and sometimes, 
 as in children, without any assignable cause. 
 
 Although the shape of the head does not indicate, necessa- 
 rily, the existence of any particular form of disease, yet it 
 does indicate a liability to a certain range of morbid action, 
 and therefore it always justifies a negative inference. When 
 the cerebellum is very small and the hemispheres are, rela- 
 tively, very large, we may feel sure that the acting form of 
 disease is not active congestion of the brain, lungs, or any 
 other part ; and then, by a reference to the existing symptoms, 
 the particular form may be arrived at. 
 
 We may set down the remote cause of congestion to be, 
 most generally, an inherent non-viable organic condition, and 
 that any of the usual sources of irritation may bring it into 
 action. 
 
 Diagnosis. — In this form of disease, the neck, chest, and, 
 of course, the cerebellum, are all small^ while, relative^, the 
 cerebrum is large and expanded at the level of the parietal 
 ridge ; and, instead of a flushed face, as in the previous spe- 
 cies, it is livid, and all the symptoms indicate exceeding 
 debility. 
 
 Prognosis. — Always unfavorable. 
 
 Treatment. — The indications to be fulfilled in passive con- 
 gestion, are 1st. To divert the blood from the brain, which 
 may be effected by purgatives, stimulants, and counter-irritation 
 
266 NON'-INFLAMMATORY FORMS 
 
 to the spine and inferior extremities ; 2d. To overcome the 
 debility produced by the impression made upon the nervous 
 system by the congested condition of the brain, as well as to 
 increase the action of the heart, and which may be attempted 
 by the administration of Quinine, Myricin, Xanthoxylin, and 
 Hydrastin, in combination, as mentioned in the previous cere- 
 bral aflections. 
 
 Genus II. — Chkonio Hydrocephalus — 
 Drojpsy of the Brain. 
 
 "We have seen several crania of hydrocephalic subjects, and 
 in every instance we have found the external surface marked 
 with inflammatory indications. We have one of a Creek In- 
 dian boy, six years of age, which measures twenty four inches 
 in circumference, and seventeen over the top of the head from 
 one meatus to the other. The frontal suture is not only 
 closed, but obliterated ; the other sutures are all complete — • 
 one squamous suture is entirely obliterated, and every portion 
 of the surface indicates that the pericranium was in an in- 
 flamed condition. 
 
 We have also the skull of a very intemperate Chickasaw 
 Indian — it is remarkably thin, and so rounded at every angle, 
 and so elevated in the hemispheres, that the original or Indian 
 form of it is lost. Every suture is obliterated, except a por- 
 tion of the right squamus ; and every part of the surface 
 bears the impress of pericranial inflammation. In such cases, 
 there can be no doubt that serous accumulations existed in the 
 brain, and such crania beautifully illustrate the physiological 
 powers of the system to adapt the cranium to the changing 
 condition of its contents. 
 
 In those cases of hydrocephalus, in which the cranial bones 
 continue separated, we suppose the absence of pericranial in- 
 flammation — with this inflammation the activity of the ossific 
 process is truly remarkable. But, as to the Indian just men- 
 tioned, we have not been able to decide whether the result of 
 his intemperance was cerebral hypertrophy or hydrocephalus — ■ 
 he was killed in the midst of his dissipated habits. The cra- 
 nium is very thin. 
 
 We are disposed to regard this case as one of hypertrophy 
 of the brain, a frequent disease among those tribes who have 
 
OF CEREBRAL DISEASE. 267 
 
 long had access to ardent spirits, and in all the crania of the 
 kind we have seen, inflammation of the periosteum was an 
 attendant. 
 
 With a cabinet of five hundred crania, with some historical 
 information of almost every specimen, it will be confessed that 
 we have advantages which are rarely possessed by others, 
 perhaps by no other individual in any country, we will be ex- 
 cused from digressing a little to drop such information as may, 
 even remotely, elucidate our subject. 
 
 The cerebral dropsy, as it increases, produces various modi- 
 fications in the form of the cranium — it is perhaps never 
 symmetrical. The basis cranii continues to preserve its normal 
 length and breadth, at least without much variation or depar- 
 ture. The posterior lobes are developed upward and back- 
 ward, the anterior, forward and upward, so as to rise perpen- 
 dicularly above, or even projecting over, the face ; the middle 
 lobes increase outward and upward, while, in some instances, 
 the hemispheres seem to spread laterally, giving the head a 
 projecting aspect in every direction except upward — hence the 
 top of the head appears broad and fiat. 
 
 In other instances, the hemispheres are carried upward, giv- 
 ing to the whole hemispherical portion of the head a beauti- 
 fully-turned and normal aspect. But, in consequence of the 
 child carrying its head more in one direction than in any 
 other, or in resting more in one position than in any other, it 
 is never equably balanced — one portion of one hemisphere 
 appears more developed than the corresponding portion of the 
 other. 
 
 While the head is being thus developed with much more 
 than normal rapidity, the facial bones are enlarged, usually, 
 with even less than is common to health ; hence, the contrast 
 between the size of the face and head becomes so truly re- 
 markable, as never to fail to excite the sympathy of the spec- 
 tator. 
 
 This variety of dropsy sometimes commences before the 
 conclusion of intra-uterine life, and has so far progressed in 
 some instances that the destruction of the fetus became essen- 
 tial to the preservation of the mother in parturition. Under 
 the circumstance of a less accumulation of serum, the fetus is 
 delivered unhurt ; in other instances, this accumulation does 
 
268 Is^ON'-mFLAMMATORT FORMS 
 
 not commence until after birth, and then it may be procrasti- 
 nated for a few weeks or even a few months. 
 
 During the days of Dr. Gall, for the purpose of refuting his 
 doctrines, it was gravely maintained that instances of hydro- 
 cephalus had been discovered in wliich the entire brain had 
 been dissolved, and yet, the men|^l functions had been nor- 
 mally manifested to the close of life. 
 
 Dr. Spurzheim, however, demonstrated the fallacy of this 
 objection, by showing that in such cases as exhibited such an 
 appearance, the brain was absolutely existing in all its integ- 
 rity, but expanded into a membrane, of the extent of the in- 
 ternal parietis of the cranium. In the beginning of the dis- 
 ease, the fluid is contained in the cerebral ventricles, but they 
 are, by the progress of the disease, lost in that general cavity 
 which is formed by the extension of the brain into a sheet or 
 membrane. 
 
 In such a display of the disease, it becomes obvious that all 
 the superficial fissures and all the convolutions must become 
 lost in the process of cerebral expansion. 
 
 We have thus conveyed an idea of the cerebral condition in 
 a large majority of cases ; in the exceptions the brain has 
 not been unfolded, but is situated in the bottom of the cranial 
 cavity, w^hile the fluid is above it and in contact with the 
 dura mater. It is not known that any essential difference ex- 
 ists in the disease, as manifested in these two dispositions of 
 the brain. The first variety is known as internal hydrocepha- 
 lus^ and the second, as external hydrocej^haliis. Although 
 the lateral ventricles present the greatest changes and are the 
 most constant receptacles of the fluid, yet none of them are 
 exempt from the invasion. The transparency and polish of 
 their lining membrane become lost while their thickness and 
 toughness are increased, showing that they have been inflamed. 
 
 The symptoms of cerebral disturbance, in the advanced state 
 of the disease, differ very greatly in different cases. Some- 
 times there is but little disturbance further than uneasiness 
 and restlessness, with an occasional increase of temperature 
 of the head ; in others, convulsions occur very often, and from 
 very slight causes. In some instances, the patient lives to 
 mature age and upward, with a respectable strength and 
 soundness of the mental faculties ; but, in other cases, blind- 
 
OF CEREBRAL DISEASE. 269 
 
 ness, deafness, paralysis, fatuity, and idiocy may all supervene 
 and continue for a period longer or shorter before death. 
 
 It seems reasonable to suppose that these results are pro- 
 duced by pressure upon the brain, and if so, then there must 
 exist a pathological difference between the two forms of dis- 
 ease. In that class of cases which is exempt from these terri- 
 ble symptoms, the cranial sutures must be open, or else the 
 constitutional power of maintaining a constant adaptation be- 
 tween the cranium and its contents, has become lost. In those 
 cases of serous or dropsical accumulations in the brain from 
 intemperance in the use of ardent spirits, the normal relation 
 between the cranium and its contents is thoroughly main- 
 tained, and in these cases there existed an extraordinary ac- 
 tivity in the process of ossific absorption and deposition — 
 apparently an inflammatory condition of the pericranium. 
 The same facts we have noticed to attend the cranium in 
 cases of hypertrophy of the brain, and also in two cases of 
 chronic hydrocephalus, in which all the bones were united 
 and all the faculties were normally manifested. 
 
 In another hydrocephalic cranium, with which idiocy or 
 fatuity was connected, the volume of the Iiead was contracted 
 in the direction of each of the sutures, and upon it the marks 
 existed, also, of a preternatural activity of the pericranium. 
 If we should venture a conclusion from what we have ob- 
 served, it would be this : that where the sutures are unclosed, 
 and where the patient is restless and troubled frequently with 
 an increase of temperature of the scalp, the mental faculties 
 will maintain more or less their normal condition. 
 
 Some instances have been observed in which the disease 
 ceased to progress or become suspended, but the dropsy con- 
 tinued; that is, the fluid is not absorbed, the health becomes 
 reasonably good, and the faculties continue fit for all the ends 
 of society and business. In cases of hypertrophy of the brain, 
 we know that the abnormal growth becomes absorbed, and 
 that the internal table of the skull leaves the external and 
 maintains its adaptation to the decreasing volume within. 
 Now, why should this process never take place in hydro- 
 cephalus ? 
 
 While it is unfortunately true, that almost every case of this 
 disease proves fatal, yet it is equally true that all do not die 
 
270 N'ON'-INFLAMMATOIIY FORMS 
 
 of the disease. All such patients possess a feeble constitu- 
 tion, and are, consequently, unable to contend with other 
 forms of diseases when assailed ; the consequence is, that 
 many die of a disease which has no connection with the cere- 
 bral aflection. 
 
 Upon the treatment of this form, much has been taught, 
 but very little has been effected. In the spring of 1835, Mr. 
 P., a member of the Kew Orleans bar, invited us to see his 
 little son, some six or seven years of age, afflicted with chronic 
 hydrocephalus. "We did not measure his head, but suppose it 
 to have been about two feet in circumference, and rather flat 
 or spread out on the top. In the succeeding January, we met 
 the father again and inquired after the condition of his son, 
 when he informed us that during the preceding fall he had 
 an attack of yeUow fever, which had had the eff'ect to entirely 
 arrest the disease — that he appeared to be in good health, and 
 to have a prospect of doing well. 
 
 In 1845, we met with a black child about a year old, which 
 had chronic hydrocephalus, and as much health and strength 
 as could be considered compatible with the existence of the 
 disease. "We desired of the owner, a gentleman of extensive 
 information, the privilege of trying upon the child an experi- 
 ment, which, as he had no expectation of its recovery, he 
 readily granted. 
 
 Under the hint we derived from the case of the boy in N'ew 
 Orleans, we prescribed the Sul. Quinine, in such portions and 
 with such frequency as to maintain a pretty high arterial ac- 
 tion. We continued this course some two or three weeks, or 
 until we were admonished to cease by the fretfulness, fever- 
 ishness, and loss of appetite of the child. Up to the time of 
 our leaving the State, a period of four or five months, there 
 had been no dropsical increase of the head — its mother and 
 mistress regarded the disease as arrested. We have learned 
 nothing of the case since; but, if it be true that the disease 
 was arrested, it would not be safe to conclude that the arrest 
 was effected by Quinine, yet the result suggests the propriety 
 of a further trial, and we have had no opportunity since of 
 making one. 
 
 Causes. — This disease appears to be one of infancy, almost 
 entirely, and one that appears under a considerable variety of 
 
I 
 
 OF CEREBRAL DISEASE. 271 
 
 circumstances; it is sometimes congenital; sometimes from 
 poverty or meagerness of the food or nom^ishment ; sometimes 
 from a sanguineous congestion of the brain ; at other times, 
 from some error in the cerebral circulation. 
 
 " In the majority of cases, however," says Dr. West, " the 
 disease is not a mere passive dropsy, but is the consequence 
 of a slow kind of inflammation of the arachnoid, especially 
 of that lining the ventricles, which may have existed during 
 fetal life, or not have attacked the child until after its birth." 
 
 Dr. "Wood says, that it is possible that the same condition 
 of the blood that induces other dropsies may induce this. 
 Suppose we admit it, and what do we gain ? What caused 
 that condition of the blood? We are disposed to attribute it, 
 in most cases, to a direct want of organic vital force. This 
 view has been sustained by our observation, but it has not 
 been very extensive. 
 
 Diagnosis. — A highly encephalic constitution has been mis- 
 taken for hydrocephalus, and normal depressions of the cra- 
 nium have been mistaken for mechanical depressions — no 
 diagnostic description can help such observers. It is said that 
 it may possibly be confounded with hypertrophy of the brain, 
 to which we refer for further information. 
 
 Prognosis. — When hydrocephalus results from organic de- 
 fect in the vital forces, its prognosis is decidedly unfavorable, 
 and this condition can always be determined by the develop- 
 ments of the head, particularly the base. If the malady has 
 followed scarlatina or some other febrile afiection, more hope 
 may be indulged — but still, the fact of its presence indicates 
 a constitutional infirmity, which forbids strong expectations 
 of recovery. 
 
 Treatment. — The indications of treatment in this afiection, 
 are, 1st. To arouse the action of the absorbent system, by a 
 judicious administration of hydragogues, diuretics, and sudo- 
 rifics ; 2d. To give tone to the nervous system, by Quinine, 
 or Quinine and Prussiate of Iron, with bathing of the surface 
 followed by stimulating liniments ; and, 3d. To remove the 
 morbid conditions of the various tissues which irivc rise to 
 the efi'usion of serum, and for which we have found the fol- 
 lowing preparation to be decidedly the best : 
 
272 KOIf-mFLAMMATORT FORMS 
 
 Compound Syrup of Stillingia, f. 5 iv, 
 Iodide of Potassa, 3ss; mix. 
 Of tins, twenty drops, three or four times a day, in a table- 
 spoonful of water, may be given to a child five years old, or 
 in proportion to age. 
 
 The diet should be nutritious and not stimulating, and all 
 sources of mental irritation, or gastric derangement, carefully 
 guarded against. 
 
 Compression of the head has been recommended in this 
 form of hydrocephalus, but, from our own experience, we can- 
 not say anything in its favor. 
 
 Genus III. — Cerebral Hypertrophy — 
 Enlargement of the Brain. 
 
 This disease we have not witnessed among children, but 
 among our Indian crania we have a number of remarkable 
 illustrations of its existence and recovery, through which we 
 hope to explain some things with reference to its character. 
 
 In treating of this disease, we shall extract from Dr. Wat- 
 son's Practice all that is pertinent to our purpose. In speak- 
 ing of the first case he saw of this afi'ection in a female, he 
 says: 
 
 "She had been in the hospital scarcely a week, when she 
 had a violent fit of epilepsy ; and when she was somewhat re- 
 covered, she told us, for the first time, that she was subject to 
 such attacks. The convulsions recurred on the same day, and 
 she became insensible, and remained during the whole of the 
 next day, and until the evening of the day after, when she 
 died. During this period of insensibility, she had many con- 
 vulsive fits; the pupils were dilated, the pulse one hundred, 
 small and feeble. 
 
 " When the surface of the brain was exposed, by the re- 
 moval of the skull-cap, and of the dura mater, it was observed 
 that the convolutions were remarkably flattened, so that the 
 little furrows between them were nearly efiaced ; and the sur- 
 face of the arachnoid membrane was perfectly dry. These 
 are not very unusual, though they are unnatural, appearances. 
 The ventricles were even smaller than natural, and contained 
 scarcely any moisture. The skull-cap was afterward examined, 
 
OF CEREBRAL DISEASE. 273 
 
 and the bone was found to be uncommonly thick, dense, and 
 heavy ; and its inner surface, without being rough, was very 
 irregular." 
 
 We must here pause to notice one fact contained in the pre- 
 ceding extract; the skull was found to be "uncommonly 
 thick." It may be stated as a law, to which there are no ex- 
 ceptions, that no part of the cranium will ever become thick 
 so long as it is under the influence of pressure. In the tem- 
 ples, the brain presses against the bone on the inside, and by 
 the temporal muscle on the outside, and the cranium, at this 
 part, is always thin, when compared with parts that are diffe- 
 rently circumstanced. The supra-orbitical plates are thin ; 
 they are pressed upon by the anterior lobes on one side, and 
 by the globe of the eye and its muscles on the other. The 
 base of the occipital is in the same condition. 
 
 With regard to other portions of the cranium, twenty years 
 of observation, under the most favorable circumstances, enable 
 us to assert, without the most remote fear of successful con- 
 tradiction, that so long as even normal pressure, such as is fur- 
 nished by a healthy activity of the brain, at the indicated 
 point, the skull will continue thin, and that just as soon 
 as that part of the brain shall, to any extent, cease to 
 act, it will become atrophied or smaller — just as will an 
 unexercised muscle — and that to the same extent will the 
 skull increase in thickness ; and we further assert, that this 
 law continues the same under abnormal as well as normal cir- 
 cumstances. The remembrance of this law will serve us im- 
 portant purposes in all of our examinations of cerebral con- 
 ditions. 
 
 According to this law, there was no pressure upon the in- 
 ternal surface of the skull alluded to in the above extract, at 
 the time of the bony deposit. The cranial hypertrophy may 
 only have commenced when she became insensible, as the 
 brain may then have ceased to act. 
 
 To illustrate and confirm the truth of this opinion, we will 
 give the history of one which bears directly upon the point 
 before us: 
 
 A Choctaw Indian, in Yicksburg, Miss., some years since, 
 in a drinking scrape, was struck upon the side of the head 
 and felled to the ground. Eight days afterward, he was found 
 18 
 
274 ITON-mrLAMMATORY FORMS 
 
 in the woods, a mile or two from the city, in a comatose and 
 expiring condition. "We have his skull; it was extensively 
 fractured — extending from the base of the left sphenoidalwing 
 obliquely upward and backward, crossing the parietal ridge, 
 and terminating within an inch of the sagittal suture. The 
 edges of the fracture, at about its middle, are separated about 
 the sixteenth of an inch, at which part the original thickness 
 of the skull is clearly discoverable, and the bony matter de- 
 posited upon the inner surface, after the infliction of the in- 
 jury, is nearly equivalent to the original skull. 
 
 In this case, coma succeeded to the injury, and a suspension 
 of the cerebral action was the immediate result, and to this suc- 
 ceeded cerebral absorption, which was attended with cranial 
 hypertrophy. However we may explain the phenomena, the 
 fact is, that the thickness and weight of the skull were nearly 
 doubled in eight days. When absorption of the brain com- 
 mences, no matter from what cause, a plenum is soon pro- 
 duced, and the internal table of the cranium adapts itself to 
 the decreasing volume of the brain. 
 
 Now, in the case of the woman before us, there was, no 
 doubt, pressure on the brain, and that it occasioned the insen- 
 sibility, the absorption of the brain or some of its fluids, and 
 the thickening of the skull ; and this pressure may have been 
 produced by congestion, a circumstance which the doctor 
 overlooked. 
 
 But where is the proof that this was a case of hypertrophy 
 of the brain ? He has not made a statement in proof of it, 
 and the symptoms do not demand the admission of it, and 
 hence we would as soon believe that he was mistaken as to 
 take his word for it. 
 
 He proceeds: " Laennec, also, in Corriesart's Journal, states, 
 that upon opening the bodies of persons whom he had thought 
 afiected with hydrocephalus, he had been surprised at finding 
 a very small quantity of fluid in the ventricles, while the con- 
 volutions on the surface of the brain were strongly flattened ; 
 proving that the cerebral mass had undergone strong compres- 
 sion, which could only have arisen from its preternatural 
 volume and. undue nutrition." 
 
 We shall find good reason for not being surprised at this, 
 without the admission of hypertrophy, before we conclude. 
 
OF CEREBRAL DISEASE. 275 
 
 " Beside the characters we have mentioned, the hypertro- 
 phied and compressed brain is firmer and tougher than natu- 
 ral ; it contains but little blood ; and sections of it seem to be 
 unusually dry and pale. 
 
 " In several of the cases of hypertrophy recorded by authors, 
 the patients had suffered epileptic fits, or rather paroxysms of 
 convulsion ; and in some the convulsions terminated in pa- 
 ralysis. Andral states, that the intellectual faculties have 
 been observed, in some 'distances, to become dull and obtuse. 
 Many of the patients were subject to severe headaches. All 
 these symptoms are common to various cerebral complaints. 
 The diagnosis of this rare disorder can be no better than con- 
 jectural, and its treatment we have still to seek." 
 
 "Andral remarks, what is very true, that hypertrophy of 
 the brain, i. e., an undue and disproportionate development of 
 that organ, may, and does, happen without giving rise to any 
 morbid phenomena at all. But, in such cases, the hrain-case 
 is equally enlarged in capacity ; so that no pressure upon the 
 cerebral mass results from its own preternatural growth. It 
 is only when the brain increases faster than the bony sphere 
 which contains it, that the hypertrophy becomes a disease. In 
 my patient, there was, also, in one sense, a hypertrophy of the 
 skull ; the bone was considerably thicker, and more compact 
 and heavy, than is usual ; but the capacity of the cavity had 
 not undergone a proportional augmentation ; nay, it might, 
 for anything I know, be diminished in consequence of the in- 
 creased thickness of the bone ; the case may have been one 
 of concentric hypertrophy of the bone, without any fault of 
 the brain itself; but what makes this the less probable is, that 
 in other cases, the skull has been found of the ordinary thick- 
 ness and density, but too small for its contents." 
 
 We may possibly fail to shed any light upon the special 
 character of the disease under consideration, but we feel con- 
 fident that we can illuminate some of the darkest spots con- 
 nected with cerebral physiology, and therefore remove some 
 of the heaviest clouds that beshadow cerebral pathology. 
 The preceding paragraph is replete with error and doubt — we 
 do not make this remark with a fault-finding spirit, because 
 no one can be expected to know more than his advantages 
 would or could dictate — and, upon the physiology of the skull 
 
276 KOI^-IN-FLAMMATORY FORMS 
 
 and its relation to the brain, we have found the truth only in 
 our cabinet of crania, which was obtained from various races, 
 tribes, and clans, and in divulging its developments we only 
 liquidate, in some measure, the many obligations we are under 
 to the profession. 
 
 What proof has Andral that hypertrophy exists where there 
 are no morbid phenomena ? By what rule does he judge of 
 it ? Is it not true that there is a physiological harmony in 
 every system in a state of health ? Does not a lesion of this 
 harmony, however insignificant, constitute a pathological 
 state ? "Was it not in the laws of this harmony that Cuvier 
 was enabled to determine the species of an animal by a frag- 
 ment of its skeleton ? He admits a perfect harmony between 
 the skull and the brain, and yet, because the brain is large, it 
 is a case of hypertrophy ! 
 
 We have shown that the lymphatic and encephalic tempera- 
 ments have large heads, and we have shown that the pro- 
 geny of sanguine bilious-lymphatic parents have also large 
 heads ; but these facts belong to whole classes, and therefore 
 they are normal, however disproportionate they may appear 
 to Andral or other persons. We venture to assert, that we 
 have examined more heads than Andral ever did, and yet we 
 have seen no such cases of cerebral hypertrophy. 
 
 Dr. Watson does not seem to be certain that a hypertrophy 
 of the skull, by diminishing its cavity, might not have pro- 
 duced the suffering and the fatality in the case of the woman 
 which he reports — that the brain may not have been at fault. 
 If the profession at large have as much to learn upon this sub- 
 ject as Dr. Watson — and so far as we have learned, they 
 have — they are certainly unfit to judge of cerebral disease. 
 
 We shall now state a circumstance, and assert it to be un- 
 qualifiedly a fact, viz : The skull is subordinate to the brain — 
 it holds the same relation to the brain that the bark of a tree 
 does to its ligneous matter. If the brain wants room, the 
 skull provides it and becomes thinner — if the brain becomes 
 smaller, the cavity of the cranium becomes smaller and the 
 skull thicker. This law holds good both in health and 
 disease. 
 
 The doctor states, that it is only when the brain increases 
 with more rapidity than the cranial cavity that mischief 
 
OF CEREBRAL DISEASE. 277 
 
 ensues. We deny the whole of this proposition, and repeat, 
 that when the brain wants room the physiological forces pro- 
 duce it. He speaks on the subject as though the skull was an 
 unyielding and lifeless box, and not under the control of the 
 vital forces. 
 
 We would first correct the language of Andral, and then 
 explain the difficulty of Watson. When the head is dispro- 
 portionately developed, without congestion or inflammation, 
 it is normal ; and when attended by either of these phenome- 
 na, it is abnormal or diseased. With reference to Dr. Wat- 
 son's difficulty, we say, that the diseased phenomena which 
 attend the last variety of hypertrophy, are occasioned by the 
 turgescence and inflammation consequent upon the disease and 
 the cranial absorption and replacement. Whenever coinci- 
 dent inflammatory action is set up between the cerebral me- 
 ninges and the pericardium, a deposition of cerebral or other 
 matter is effected on one side, and bony absorption and re- 
 placement take place on the other ; consequently, as one pro- 
 cess increases the magnitude of the contained part, the con- 
 taining part maintains a precise adaptation to it. Thus, in 
 chronic hydrocephalus, the cavity of the cranium enlarges in 
 proportion to the fluid accumulation. 
 
 And, further, there is no proof that undue pressure is ever 
 made upon the brain in this form of disease ; and the only 
 conclusive proof of it would be the discovery of a hypertro- 
 phied skull, upon post mortem examination, and this, we be- 
 lieve, has not been done ; because, just as soon as pressure 
 should be made by the skull, upon the principle of the band- 
 age, an absorption of the brain or fluid would commence, and 
 with this would commence a hypertrophy of the skull. 
 
 We have the hemispherical portion of the cranium of a 
 man who died in a lunatic asylum, and who, for some time 
 previous to his death, had been in a state of almost complete 
 fatuity. A brain in a condition so inactive, would necessarily 
 decrease very much in a comparatively short time; and, if 
 our doctrine be true, that the external table of the skull, in an 
 atrophy of the brain, remains stationary, and the internal one 
 maintains a close adaptation to the brain, it would follow that 
 this skull should be unusually thick ; and so it is — generally 
 equal to three-eighths of an inch in thickness and very heavy. 
 
278 
 
 E-ON-INFLAMMATORY FORMS 
 
 We have two crania which show very conclusively that the 
 subjects had had hypertrophy of the hemispheres of the brain 
 and recovered from it. One was a female Hitchetee Indian, 
 of whose history we know nothing, except that she died of 
 the small-pox ; the other was a Chickasaw Indian. Upon 
 obtaining his skull, we became exceedingly anxious to obtain 
 so much of his history as might explain the hypertrophied 
 condition of the whole superior portion of it. We obtained 
 the assistance of a white man who had lived several years in 
 the neighborhood of this subject to assist us. Those Indians 
 who knew him, represented him as " moping about," unfit for 
 any pursuit, and living at the expense of his relatives and 
 friends — and that this diseased condition continued some 
 three years when he recovered, and in six or seven years more 
 he died of cholera. All parts of the cranium indicated the 
 normal thickness, except at the superior portions of the hemi- 
 spheres, where the space between the tables were equal to 
 three-eighths of an inch. The external surface, over this hy- 
 pertrophied portion, bore evident marks of pericranial inflam- 
 mation. The following cut represents a transverse section of 
 it, just anterior of the coronal suture : 
 
 B. External table 
 
 To account for this peculiarity of the cranium, we must 
 conclude, that as he recovered, the hypertrophied portion of 
 the brain was absorbed, and as the absorbing process went on, 
 the internal table of the skull left the external and adapted 
 itself to the decreasing volume within. The female skull is 
 marked in precisely a similar manner. That the brain had 
 been hypertrophoid, the external figure of the skull left no 
 doubt. It is said, by writers, to be difficult to form a diagnosis 
 
I 
 
 OF CEREBRAL DISEASE. 279 
 
 between this disease and chronic hydrocephahis, but this we 
 think to be a mistake, at least, in many instances. 
 
 In the latter disease, as the head enlarges, all the parts of 
 the cranium change their distances from the fixed points — such 
 as the meatus auditorius externus ; the parietal ridges become 
 more elevated ; but this is not the case in hj^pertrophy of the 
 brain — the enlargement is located, usually, between the two 
 parietal ridges, and rises in a manner which no phrenologist 
 •would mistake for a normal development. 
 
 Normal atrophy of the brain, or such as is produced by a 
 neglect or inactivity of the atrophied part, presents no sign 
 external to the cranium, but the internal table leaves the ex- 
 ternal precisely as it does in cases of recovered hypertrophy. 
 
 Atrophy of the brain, more or less general, is quite com- 
 mon among plantation negroes, resulting from an absence of 
 mental excitement, and, of course, of cerebral activity. 
 Having but few cares or responsibilities, there is nothing con- 
 nected with their condition to rouse and maintain cerebral ac- 
 tivity. All ethnologists, we believe, assign to the negro a 
 thick skull ; but this is an error ; free negroes, as a class, have 
 as thin crania as free whites of the same grade of mental 
 activity. 
 
 In civil society, because of a division of labor, partial atro- 
 phy, or atrophy of some portion of the brain, exists more or 
 less in every individual, but, in savage life, where the pursuits 
 of one individual are common to the tribe, the skull presents 
 a uniform thickness. 
 
 As to normal development of the brain, in adult life, or 
 such as is produced by mental activity and toil, we have no 
 indication, except the thickness of the cranium, or measure- 
 ments of the head made at different periods. Some facts of 
 this latter kind which exist are truly remarkable. 
 
 We have dwelt upon the various conditions of the cranium, 
 in several cerebral affections, at considerable lencrth, because 
 our investigations, in this wise, and our advantages have been 
 very extensive, and because the full advantage of post mortem 
 examinations of cerebral affections cannot be had without a 
 correct idea of cerebro-cranial physiology ; and, lastly, because 
 no one can pathologically understand the disease under con- 
 sideration, without the information we have detailed. 
 
280 NOI^-INFLAMMATORY FORMS 
 
 " It is of some importance for you to be aware that the 
 brain, and its case, may be extravagantly developed without 
 there being any disease, or any symptom of disease. M. 
 Scantetlen gives an instance of this which he observed in a 
 child five years old. Its head was as large as that of a well- 
 grown adult person." 
 
 Such language as this, with reference to the head, is not 
 only faulty, but calculated to propagate and perpetuate error 
 in the popular mind. Let it be remembered then, that the 
 cerebellum alone, and not the cerebrum, is developed in rela- 
 tion to the body. A large man may have the little cerebrum 
 of an idiot, and a little man may have the large cerebrum of 
 a ISTapoleon. In brief then, the cerebrum is always devel- 
 oped, not in harmony with the body, but in relation to the 
 mental functions. 
 
 " The skull was from a line and a half to two lines in thick- 
 ness." 
 
 A skull of this thickness, in a young person, has never as 
 yet been known to contain a sound brain, or rather a brain 
 that has always been sound. No amount of human testimony 
 could aifect our opinion on this subject. Human testimony 
 must never be brought to bear against natural law. 
 
 " The dura mater adhered firmly to the bone," [Does this 
 show that there had never been disease ?] " and the cerebral 
 mass exactly filled up the cranial cavity. The superior and 
 posterior part of the brain was developed beyond measure, so 
 that to reach the ventricles it was necessary to make an inci- 
 sion nearly three inches in depth. There was nothing unusual 
 to be remarked in any of the cerebral functions of this child ; 
 it was just like other children of the same age in respect to 
 intellect. It died of inflammation of the bowels." 
 
 The thickness of the skull, in this case, is to us a demon- 
 stration that the hypertrophied brain was in progress of ab- 
 sorption at the time of its death, and probably had been for 
 some time ; and the firm adhesion of the dura mater to the 
 skull, shows that inflammation had existed. But, of all the 
 evidences that can be had of the present or previous dis- 
 ease of the brain, the external surface of the skull invaria- 
 bly presents the most indubitable. No adequate idea of 
 these indications can be conveyed by description, but when 
 
I 
 
 OF CEREBRAL DISEASE. 281 
 
 once recognized, they will never be forgotten. And what ap- 
 pears singular to us, is, that no writer, so far as we have seen, 
 has noticed these cranial evidences of disease, 
 
 " The majority of cases of hypertrophy of the brain that 
 have come under my notice, in London," says Dr. West, 
 '^ have occmTcd in infants about six or eight months of age. 
 Their history has usually been, that, without any definite ill- 
 ness, they had lost their appetite, and grown by degrees dull 
 and apathetic, though restless and uneasy. Notwithstanding 
 the general apathy, this restlessness is often very considerable, 
 though it does not show itself in cries so much as in a state of 
 general uneasiness, and in frequent startings from sleep. Short 
 gleams of cheerfulness occur when the children are awake, but 
 these are usually very transient. The head seems too heavy 
 to be borne, and even when its size is not much greater than 
 natural, it hangs backward, or to one side, as if the muscles 
 were too weak to support it. If placed in its cot, a child thus 
 aflected bores with its occiput in its pillow, while its head is 
 almost constantly in a state of profuse perspiration. Convul- 
 sions sometimes occur without any evident cause, but threat- 
 enings of their attack are much more frequent than their 
 actual occurrence, the child awakening suddenly with a start 
 and a peculiar cry, like that of spasmodic croup, the surface 
 turning livid, and the respiration becoming difficult for a few 
 moments, and the symptoms then subsiding of their own ac- 
 cord. Such attacks may issue in general convulsions, which 
 may terminate fatally ; but infants thus afi;ected do not by any 
 means invariably die of the cerebral disorder, but being 
 weakly, they are often cut ofi' by the first malady that attacks 
 them. 
 
 " If life be prolonged, it becomes more and more evident 
 that the process of nutrition is imperfectly performed ; the 
 child loses fiesh, and looks out of health, and an enlargement 
 of the wrists and ankles shows the connection between this 
 disease and rickets — a connection which becomes more evident 
 in the second and third years of the child's life. When the 
 child survives infancy, or when, as occasionally happens, the 
 symptoms of hypertrophy of the brain do not come on until 
 dentition has been in a great measure accomplished, convul- 
 sions are of very rare occurrence. Complaints of headache, 
 
282 XOIT-INFLAMMATORY FORMS 
 
 however, are frequent and severe ; and, though drowsy in the 
 daytime, the child generally rests ill at night, and often 
 awakes crying and alarmed. Beside these symptoms, too, the 
 child has occasional attacks of feverishness, with great in- 
 crease of the headache, and giddiness, which last for a few 
 hom^s or a day, and then subside of their own accord, while it 
 grows by degrees more and more dull and listless, and its 
 mental powers become obviously impaired. 
 
 " You must not infer that hypertrophy of the brain has 
 existed in every instance in which the organ may appear to 
 be largo, and its convolutions somewhat flattened, although 
 the ventricles are free from fluid. The weight and apparent 
 size of the brain are much influenced by the quantity of blood 
 contained within it, and it may appear too large for the skull, 
 simply because its vessels are over full. In true hypertrophy, 
 on the contrary, the brain is generally pale and anaemic, un- 
 less death should chance to have taken place as the result of 
 an attack of cerebral congestion. Neither, indeed, is the pro- 
 cess one of mere increased growth of the organ, but the nutri- 
 tive process is modified in character as well as increased in 
 activity. The gray matter of the brain is but little involved 
 in it, and, with the exception of its color, being somewhat 
 paler than natural, it shows scarcely any alteration. The white 
 matter, on the contrary, is both paler and firmer than in a 
 state of health ; and Professor Rokitansky states, as the result 
 of many microscopic examinations, that its augmented bulk 
 is not produced either by the development of new nervous 
 fibrils, or by the enlargement of those already existing, but by 
 an increase in the intermediate granular matter. These 
 changes, too, do not afiect indifierently all parts of the brain, 
 but are confined to the hemispheres, implicating neither the 
 base of the organ nor the cerebellum.* 
 
 " The history of the patient would afibrd some help toward 
 determining w^hether the disease be hydrocephalus or hyper- 
 trophy, for the symptoms of the former generally come on 
 earlier, and soon grow much more serious than those of hj^per- 
 trophy of the brain, and the cerebral disturbance is throughout 
 much more marked in cases of the former than in those of the 
 
 * This remark is in harmoBy with an opinion we have given, and with the 
 cut that illustrates it. 
 
\ 
 
 OF CEREBRAL DISEASE. 283 
 
 latter kind. The form and size of the head, too, present pe- 
 culiarities by which jou may often be enabled to distinguish 
 between the two conditions. Both forms of disease are at- 
 tended by enlargement of the head, and in both the ossifica- 
 tion of the skull is very tardy,* but the head does not attain 
 so large a size in hypertrophy of the brain as in chronic hy- 
 drocephalus, neither are the fontanelles and sutures so widely 
 open." 
 
 Our author, Dr. West, now gives some descriptive views, 
 upon which we shall ofier a few comments, and therefore this 
 call of the reader's attention. 
 
 " The skull, likewise, presents some peculiarities in form, 
 which are so remarkable as to have attracted the attention of 
 several observers, though I must own that I do not thoroughly 
 understand how they are produced. The head not merely 
 shows no tendency to assume the rounded form characteristic 
 of chronic hydrocephalus, but its enlargement is first apparent 
 at the occiput, and the bulging of the hindhead continues 
 throughout especially striking. The forehead may, in the 
 course of time, become prominent and overhanging, but the 
 eye remains deep sunk in the socket, for no change takes 
 place in the direction of the orbiter plates, such as is produced 
 by the pressure of fluid within the brain, and which gives to 
 the eye that unnatural prominence, and that peculiar down- 
 ward direction, which are so striking in cases of hydrocepha- 
 lus. In hydrocephalus, the anterior fontanelle is tense and 
 prominent, owing to the pressure of the fluid within, but when 
 the brain is hypertrophied, there is no prominence, but an 
 actual depression in this situation. I have more than once 
 observed this condition, in a very remarkable degree, the de- 
 pression not being limited to the anterior fontanelle, but being 
 observable at all the sutures ; and you may notice something 
 of the kind in this cast." 
 
 We have never seen this peculiar form of head in either 
 the white or red race of the American population, but we have 
 frequently seen it in the black. Persons having such a head, 
 are said to be double-headed. As often as we have seen this 
 
 * We have, in our cabinet, the most irrefutable evidence that cranial ossifi- 
 cation is exceedingly active in chronic hydrocephalus. 
 
284 NOIT-INFLAMMATORT FORMS 
 
 form of head, we have never known it to be attended by any 
 morbid symptom ; and, although the occipital and frontal 
 regions appear, in some cases, very much developed, yet the 
 great depression across the head, involving the coronal suture, 
 in such cases, has been so great, that we have considered the 
 quantity as normal, but forced fore and aft, by the depression. 
 We have not comprehended the physiological cause of this 
 depression, but finding it unattended by any symptom of dis- 
 ease, we have concluded, that whatever the cause might be, it 
 acted in harmony with cerebro-cranial sympathy. 
 
 " When hypertrophy of the brain occurs in adults, the 
 symptoms that arise are, in a great measure, due to the com- 
 pression which the organ undergoes from its bony case being 
 too small to contain it. These sj'mptoms are, of course, ob- 
 scure, while, even if the nature of the affection cannot be 
 recognized, its cure must be hopeless." 
 
 We very much dislike this mechanical mode of reasoning 
 about vital processes. Every mill-boy knows, that if an un- 
 yielding saddle be placed on a horse's back, in a short time 
 the back is moved away from the saddle. Every physician 
 knows, that if an unyielding bandage be placed so tightly on 
 a well finger as to make pressure, the finger is speedily ab- 
 sorbed, and that the process produces no pain, except at the 
 time reaction is taking place. Suppose then, that the skull 
 was to make pressure upon the brain, how long would it last ? 
 Only one or two hours, and then would commence an atrophy 
 of the brain and a hypertrophy of the skull. 
 
 While we repudiate the idea of cranial pressure upon the 
 brain, we admit that there is pressure in it. The cranium, 
 during life, is always ready to accommodate the brain with 
 space or room when it is demanded, either in health or dis- 
 ease. The brain, under mental action and industry, enlarges, 
 much more sometimes than the thickness of the skull — why, 
 in these cases, does the brain not sufier because of the un- 
 yielding character of the skull ? 
 
 Dr. West, furthermore, thinks this disease would be hope- 
 less in an adult ; but in this, we think, he is mistaken, inas- 
 much as we have the crania of two adults who did, spontane- 
 ously, recover from it. 
 
 Beside the various symptoms we have named, we may add, 
 
OF CEREBRAL DISEASE. 285 
 
 profuse perspiration of the head, which is "effectually checked," 
 says Dr. West, " by a thin linen cap which may be removed 
 once or twice during the night." As we approve of the prac- 
 tice of Dr. West, in this disease, we cannot do better than to 
 extract it : 
 
 " The remedies, under the continued use of which 1 have 
 seen the most good result, are the extract of bark, from which 
 you might pass to the preparations of iron — such as Vinum 
 Ferri, or that very elegant syrup of the Ferro-citrate of Qui- 
 nine. I have not made much trial of the Iodide of Potassium, 
 since, in all the cases that I have seen, some more decided 
 tonic appeared necessary. I have, however, given the syrup 
 of the Iodide of Iron sometimes with advantage, and, in cases 
 where the tendency to rickets was well marked, I have ob- 
 served a most decided improvement follow the use of Cod- 
 liver Oil, in doses of a drachm twice a day, for a child three 
 years old. I may just mention, that, notwithstanding its nau- 
 seous taste, this medicine is usually readily taken b}^ children, 
 some of whom even become fond of it. 
 
 " With reference to diet, it will probably be desirable, if the 
 child be not weaned, to obtain for it a healthy wet nurse, while 
 after weaning, a diet of milk, with an egg once or twice daily, 
 will often agree better than any other food. In cases of this 
 kind, and, indeed, in all where the digestive powers are feeble, 
 a preponderance of farinaceous food is not desirable, while the 
 child may with safety be allowed a little veal-broth or beef-tea 
 daily, or even a little meat if it have cut some of its molar 
 teeth." 
 
 Genus IY. — Hydkocephaloid Disease. 
 Debility of tlie Brain. 
 
 This disease was first described by Dr. Marshall Hall, and 
 he named it as above expressed. It bears considerable simili- 
 tude to that condition of the brain which follows excessive 
 venesection, hemorrhage, or purging — such as extremely pain- 
 ful headache and other symptoms of encephalitis. He divides 
 it into two stages ; the first, he calls that of irritability, and 
 the second, that of torpor. He says: 
 
 " In the former, there appears to be a feeble attempt at re- 
 action ; in the latter, the powers appear to be more prostrate. 
 
286 IS'Ol^-II^FLAMMATORY FORMS 
 
 These two stages resemble, in many of their symptoms, the 
 first and second stages of hydrocephalus, respectively. 
 
 " In the first stage, the infant becomes irritable, restless, and 
 feverish; the face flushed, the surface hot, and the pulse fre- 
 quent ; there is an undue sensitiveness of the nerves of feel- 
 ing, and the little patient starts on being touched, or from 
 any sudden noise ; there are sighing or moaning during sleep, 
 and screaming ; the bowels are flatulent and loose, and the 
 evacuations are mucous and disordered. 
 
 "If, through an erroneous notion as to the nature of this 
 aflection, nourishment and cordials be not given, or if the 
 diarrhea continue, either spontaneously or from the adminis- 
 tration of medicine, the exhaustion which ensues is apt to lead 
 to a very difierent train of symptoms. The countenance be- 
 comes pale, and the cheeks cool or cold ; the eye-lids are half 
 closed ; the eyes are unfixed, and unattracted by any object 
 placed before them, the pupil unmoved on the approach of 
 light ; the breathing, from being quick, becomes irregular and 
 afiected by sighs ; the voice becomes husky, and there is 
 sometimes a husky, teazing cough ; and eventually, if the 
 strength of the little patient continues to decline, there is a 
 crepitus or rattling in the breathing ; the evacuations are usu- 
 ally green ; the feet are apt to be cold," 
 
 Any circumstance that can undermine and break down the 
 vital forces of the system, may produce this aflection, more 
 especially if, previously, the encephalon has sufiered from any 
 variety of disease ; a circumstance of this kind acts as a pre- 
 disposing cause. Premature weaning, more especially if fol- 
 lowed by such diet as may so derange the nutritive function 
 as to produce marasmus, or some special disease for the re- 
 moval of which exhausting remedies were pushed too far, may 
 occasion those symptoms which constitute this disease. 
 
 When such symptoms as we have described shall be pre- 
 sent, it may be impossible to determine from them alone 
 whether the complaint be acute hydrocephalus or the hydro- 
 cephaloid disease. In such an event, we should seek the 
 family diathesis of the patient, and the history of its various 
 forms of disease ; in this wise we may become able to deter- 
 mine whether we are called upon to treat a case of threatened 
 encephalic exhaustion, or exaltation. Which ever way the 
 
OF CEREBRAL DISEASE. 287 
 
 mistake might be made, it would be equally fatal to the pa- 
 tient. If the family of the patient be clear of a scrofulous 
 diathesis, if cerebral forms of disease have not been common 
 to the family, and more especially to the patient ; if, further- 
 more, the patient has had bad health since being weaned, or 
 has been weakened by venesection, hemorrhage, or diarrhea, 
 then we may pretty safely conclude that the patient is sufi'er- 
 ing from hydrocephaloid disease. 
 
 It is possible to mistake the consequences of an over treat- 
 ment of cerebral congestion for a continuance of the disease, 
 instead of exhaustion. In cases of congestion of the brain, 
 if the patient be an infant, we w^ould find the anterior fonta- 
 nelles tense and full, instead of being depressed, as they cer- 
 tainly would be in case of exhaustion. Diarrhea and symp- 
 toms of cerebral disturbance are very apt to run together, 
 hence it is proper to guard against mistaking such as are 
 really consequent upon a diseased condition of the bowels, 
 from such as might indicate cerebral congestion or the hydro- 
 cephaloid afiection. As it would be proper to treat the diar- 
 rhea, a proper vigilance over the case will soon determine the 
 character of the cerebral symptoms. 
 
 In the treatment of infantile forms of disease we should 
 always have before us the possibility of inducing the hydro- 
 cephaloid disease by heroic treatment, and by the history of 
 the patient's condition before the arrival of the physician, the 
 difficulty of diagnosis, from the symptoms in the abstract, may 
 scarcely have to be encountered. 
 
 Treatment. — The only useful treatment in this disease, is 
 the administration of Iron and Quinine, generous and nour- 
 ishing diet, and all means calculated to increase the quantity 
 and quality of the blood, and to invigorate the nervous system. 
 
288 NERVOUS FORMb 
 
 ORDER III. 
 
 NEKVOUS FOKMS OF CEEEBEAL DISEASE. 
 
 Genus I, — Epilepsy. 
 
 This form of disease, when idiopathic, is, beyond all ques- 
 tion, cerebral ; but, when symptomatic, it may frequently re- 
 sult from spinal irritation. A paroxysm or convulsion may 
 occur, having all the features of epilepsy, and not be epileptic, 
 but when it shall frequently recur at irregular intervals, and 
 for months or years, and without any evident cause, then the 
 name epilepsy is given to it. It is a disease of all ages, but 
 that which immediately precedes puberty, seems to be most 
 liable to it. 
 
 The paroxysms are marked by a loss of sensation and con- 
 sciousness, with convulsive motions of the muscles. Most 
 generally the fit attacks suddenly or without the least premo- 
 nition ; at other times, it is preceded by pain in the epigas- 
 trium, or vertigo, or stupor ; sometimes a sensation like a cold 
 vapor is experienced, which, arising in some part of the body, 
 travels toward the head, and upon reaching it the patient falls 
 to the floor. 
 
 The most usual duration of a fit, is from five to twenty-five 
 minutes, but sometimes it is protracted for hours. In all 
 cases, there is a sudden falling, loss of consciousness, distor- 
 tion of the face and eyes ; complexion of the face, in the white 
 race, red, purple, or violet ; foaming at the mouth : convul- 
 sions of the limbs, grinding of the teeth, by which the tongue 
 and cheeks are frequently badly injured ; difficult respiration, 
 and occasionally involuntary discharges of urine and fasces. 
 
 "When the fit has passed ofi', the patient has not the least 
 recollection of having had it, but complains of headache, looks 
 stupid and wearied. 
 
 Causes and Diagnosis. — Dr. Marshall Hall is of the opinion 
 that epileptic seizures are produced by a compression made 
 upon the jugular veins by the platysma and other cervical 
 muscles. He states, as evidence in support of this opinion, 
 that the paroxysm consists in a fixed condition of the head 
 and eyes, dilated pupil, and deep flush. We have shown, in 
 the first part of this work, that idiopathic epilepsy, at least, is 
 
OF CEREBRAL DISEASE. 289 
 
 always associated with a full development of the lateral por- 
 tions of the cerebellum, particularly of the organ of muscular 
 motion. 
 
 It will be remembered, too, that we have shown that apo- 
 plexy, when resulting from active congestion of the brain, is 
 connected with the same condition of the cerebellum ; and Dr. 
 Hall contends that there is no difference between epilepsy and 
 apoplexy, in their milder forms — that the first degree of both 
 of them consists in trachealismus — a spasmodic action ex- 
 hibited in efforts upon the venous circulation of the face and 
 brain . 
 
 We have also shown that idiopathic rheumatism is asso- 
 ciated with a high endowment of the organ of muscular mo- 
 tion and of the medulla oblongata ; hence, when the blood 
 becomes highly charged with urea, through a fault of the kid- 
 neys, rheumatism may result, and epilepsy is said s jmetimes 
 to be produced in the same way; it would seem then, that 
 between an epileptic and a rheumatic constitution, there is 
 some affinity. 
 
 As a loss of consciousness is the most important symptom 
 in epilepsy, and as such a loss cannot be effected by any con- 
 dition of the spinal cord, Dr. Todd concludes that epilepsy 
 must be a disease of the cerebrum, and after a consideration 
 of the function of various parts of the encephalon, he con- 
 cludes that the gray substance is the primary and proper seat 
 of epilepsy, because he considers it to be the seat of conscious- 
 ness. If he include the whole surface of the cerebrum in the 
 function of consciousness, to what portions of the brain will 
 he refer the fifty other functions which the mind is known to 
 manifest ? If this whole surface act as a single instrument, 
 how does it happen that a loss of a portion of it does not im- 
 pair its function ? It is our opinion that phrenology is now 
 too well established to allow of such a pretension. 
 
 We are of the opinion that phrenological inference and 
 vivisections both authorize the conclusion that the source of 
 consciousness is situated in the base of the brain, and possi- 
 bly in the mesocephale ; and Dr. Todd is of opinion that this 
 portion of the brain may be secondarily affected. But if it be 
 the seat of consciousness, then it must be primarily afiected. 
 But as to how it is affected, unless it be by congestive pressure, 
 19 
 
290 NERVOUS FORMS 
 
 we know not, and mere speculation on the subject can be of 
 no avail. 
 
 If epilepsy ever occurs in those who have a small thorax 
 and neck, it must be similar to the passive variety of apoplexy, 
 of which we have given an admirable illustration. If it ever 
 do occur in such subjects, then Dr. Hall's views are still more 
 confirmed, and the distinction we have pointed out between 
 the two classes of subjects, must be attended with important 
 practical results. 
 
 Dr. Todd gives it as his opinion that epilepsy consists in an 
 abnormal nutrition, which manifests itself in an unnatural 
 development of force at particular times ; and Dr. Hall be- 
 lieves that epilepsy and apoplexy are the same during their 
 first stage, and it is admitted that the latter is both active and 
 passive. 
 
 Now, we desire to know how it is possible to reconcile Dr. 
 Todd's development of nervous force with both of these con- 
 ditions. Though we have never seen a case of anaemic or 
 passive epilepsy ; yet, we cannot doubt that it may occur, if 
 the explanation of Dr. Hall is at all reliable. 
 
 Tlie known causes of epilepsy are various, and so are, no 
 doubt, the unknown. In some families, it is hereditary, and 
 in many instances the predisposition is such as to make it de- 
 pend upon the exciting cause as to whether it shall break out 
 in the form of rheumatic mania or epilepsy. The apparent 
 health of the patient seems to have but little to do in the pro- 
 duction of the malady— attacking almost indiscriminately the 
 feeble and the strong. It is frequently occasioned by a fall or 
 blow on the head ; also by a fright or terror, and, lastly, by the 
 presence of worms in the alimentary canal. 
 
 Prognosis. — As to ultimate recovery, it is unfavorable 
 without it is attended to at an early period — it does not much 
 endanger life, but it does worse — leads to imbecility. Under 
 such a prognosis, convulsions, in young children, should re- 
 ceive every possible attention, in order to prevent the forma- 
 tion of an epileptic habit in the system. A mischievous reli- 
 ance is too frequently placed upon the changes which puberty 
 brings about in the removal of this afiection. 
 
 Treatment. — It is always essential, in the treatment of this 
 disease, to remove the cause if possible. During the paroxysm 
 
I 
 
 OF CEREBRAL DISEASE. 291 
 
 but little can be done ; we think that we have sometimes 
 shortened the fit and lessened the subsequent headache and 
 lassitude by dashing cold water over the head, face, and neck. 
 One thing is certain, we have not found it best to indulge the 
 patient in a horizontal position or a sleep after a fit. 
 
 It will be well, if practicable, to introduce a piece of soft 
 wood between the teeth at the beginning of the fit to prevent 
 injury to the tongue and the inside of the cheeks. If the fit 
 has been occasioned by indigestible food, the remedy is obvi- 
 ous, and whatever may have been the cause, indigestible and 
 trashy food will provoke an increased frequency of its recur- 
 rence. Any cause of mental irritation can increase its fre- 
 quency, such as disappointments, children's quarrels, parent's 
 scoldings, etc. 
 
 Whatever the cause may have been, the treatment must be 
 directed to two general objects, the first to break up and 
 abridge the paroxysm, and the second, to prevent its recur- 
 rence. 
 
 With reference to the first, it is not generally requisite to 
 attempt anything, as the paroxysm usually passes ofi* in a few 
 minutes ; but when the paroxysm continues longer than usual, 
 or becomes much more alarming or apoplectic, it will be judi- 
 cious to attempt some relief by the application of cold water, 
 in any convenient form, to the head, and hot water, frictions, 
 and rubefacients to the extremities. 
 
 Beside these external means, injections may be adminis- 
 tered, consisting of the Tincture of Castor, or Asafoetida, with 
 a decoction of Scutellaria. If the case be one of infancy, the 
 warm bath may prove highly beneficial. Should the paroxysm 
 be attended with apnoea. Camphor or ammoniacal liquids 
 may be applied with some good efiect to the nares ; and in the 
 event of suspended respiration, it will be advisable to direct 
 through the diaphragm an electro-magnetic current. 
 
 When the paroxysm is over, in many instances, it is best to 
 rouse the patient to a vertical position, to prevent sleep ; while 
 in other instances, a contrary course may be the most advisa- 
 ble — experience must decide this question in all cases. 
 
 All our hope of eflecting a cure must rest upon our skill 
 and exertions during the intervals we obtain between the 
 paroxysms, and upon our discriminations as to its nature or 
 
292 NERYOUS FORMS 
 
 true character; for it may be only sympathetic, depending 
 ■upon disease in some other part; or it may depend upon cer- 
 tain organic relations in the encephalon ; and it may depend 
 upon such a diseased condition as to render the recurrence of 
 the paroxysms periodical. 
 
 The second variety is the only one that is considered to be 
 incurable ; but even in this, we are not willing to admit the 
 idea of incurability, because organic relations can be changed 
 by proper exercise or training ; indeed, we are not willing to 
 admit the incurability of any disease, in the abstract, because 
 disease is not a constituent element of life — we only admit our 
 ignorance when we fail to cure. 
 
 Our first duty, without reference to the original character of 
 the disease, is to investigate the present state of health, and 
 if we find it vitiated, then we must regulate and repair it, and 
 while engaged in the discharge of this duty, we may discover, 
 in connection with the history of the case, enough of its na- 
 ture or special character as to guide us in our subsequent 
 practice. 
 
 So far as we have observed, the second variety of this form 
 of disease is associated with an imperfection of the respiratory 
 function, as is indicated by small and contracted nostrils, and 
 the same remark is applicable to apoplexy — exceptions may 
 exist, but we have not seen them. If this view be correct, we 
 cannot, so unqualifiedly as has been recommended, place the 
 patient upon an exclusively vegetable diet. Farinaceous food 
 must increase the difficulty, and so will all highly carbona- 
 ceous food — we suggest, therefore, that the diet should consist 
 of succulent vegetables, vegetable and animal albumen, and 
 the fibrinous portions of animals. 
 
 Beside generally impaired health, there may be a troublesome 
 source of irritation — during the first dentition — the revolu- 
 tionary period of infancy, they are many, and at a later pe- 
 riod of life, there may be others of equal magnitude, as 
 family discord, and all such subjects as can disturb mental 
 equanimity. So long as obvious causes of irritation exist, it 
 is idle to attempt a cure. 
 
 The remarks we have made might be considered to embrace 
 all causes of irritation, but it may be proper to be more spe- 
 cific. In epileptic patients, without any reference to the cause, 
 
I 
 
 OF CEREBRAL DISEASE. 293 
 
 there is generally present some variet}^ of derangement in the 
 digestive system — the appetite is precarious — sometimes vora- 
 cious — sometimes fastidious — craving improper food. Under 
 such variations of the appetite, we may naturally expect gas- 
 tric acidity, difficult digestion, and imperfect nutrition. 
 
 Sometimes helminthic irritations prove to be the whole cause 
 of the disease ; at other times, a diseased condition of the 
 spleen, or suppressed menstruation, may be the only cause. 
 When, therefore, we can reach the cause, we have only, in a 
 great measure, to remove it to cure the patient. 
 
 When the paroxysms recur periodically, the case should be 
 considered as curable by a perseverance in the use of anti- 
 spasmodics and antiperiodics ; but even their use is contra- 
 indicated, until the constitution shall become elevated above 
 a generally morbid or vitiated condition. In the use of the 
 former class of remedies, such should be selected as are calcu- 
 lated to maintain a constant determination to the surface ; per- 
 haps Valerian, or Black Snake-root, administered in a syrup 
 of Ginger, would fulfill the indications. To break up the re- 
 currence of the paroxysms, a combination of Quinine, Lep- 
 tandrin, and Hydrastin, will answer every general purpose, 
 where they assume a periodic condition. In cases of anaemia 
 the Prussiate of Iron will be found to be a very valuable ad- 
 junct. 
 
 Dr. Lusanna reports (Braithwait's Ketrospect, part xxv) 
 very favorable results from the use of Atropine ; and Dr. Bul- 
 lar (in the same work, part xix) reports considerable success 
 from the use of the Cotyledon Umbilicus. These and other 
 articles may seem to have a specific efiect in isolated cases, 
 but as a rule of practice, we should rely upon such a plan of 
 treatment as will best secure general health. 
 
 In those cases which result from some peculiar organic con- 
 dition of the encephalon, a rheumatic development of it, we 
 would, in an especial manner, direct attention to the respira- 
 tory function ; and we are inclined to the opinion, that that 
 practice which succeeds best in rheumatism will succeed best 
 in this particular form of disease. We found this conclusion 
 upon the similarity of organization. 
 
 In addition to the foregoing, we give the following treat- 
 ment of Professor J. King, who has had considerable and 
 
294 N"ERVOUS FORMS 
 
 successful experience in the disease. If the cause can be as- 
 certained, as worms, uterine difficulties, etc., treat them 
 accordingly ; but in those instances where the causes are ob- 
 scure, he adopts the following plan : 
 
 During the convulsive paroxysms, he gives to an adult a 
 powder composed of Sulph. Morphine, one- third of a grain, 
 and of Quinine, two-thirds of a grain ; this dose is repeated 
 every ten or twenty minutes, or as the patient may be made 
 to swallow it — having it mixed in water. When the par- 
 oxysm has subsided, the bowels are to be kept regular by the 
 use of Leptandrin, and Podophyllin, given in small doses, 
 and the following pills employed during the intervals : 
 9^. Ext. Stramonium, gr. j, 
 
 Yalerianate, or Sul. Quinia, iv. 
 Hydro-alcoholic ext. of Macrotys, grs. viii; mix, 
 divide into eight pills, and give one three or four times a day. 
 
 A stimulating liniment must be applied to the spine, as the 
 following, which has been much used by ourselves, as well as 
 Professor King : 
 
 Jk. Oil of Stillingia, 5j, 
 Oil of Cajeput, 3ss, 
 Oil of Lobelia, 3ij, 
 Alcohol, 3iij. Mix. 
 The spine may be bathed twice a day with this, and continued 
 until the patient complains of nausea, or an unpleasant acrid 
 taste in the mouth. The surface of the body must be bathed 
 once or twice a week with an alkaline wash ; all acidulous 
 and greasy articles of food must be avoided, and the mind 
 kept perfectly free from excitement of any kind. In acidity 
 of the stomach, he prefers the use of the Carbonate of Am- 
 monia in this disease to any other alkali. 
 
 In pursuing the above treatment, it should be recollected to 
 proportion the doses according to the ages of the children. In 
 young infants, the Antispasmodic Tincture is preferred to the 
 Morphine and Quinine. 
 
 Genus IL — Ohobea. 
 Chorea Sancti- Viti — St. Vitus'^ Dance. 
 This affection is characterized by irregular and involuntary 
 motions of one or more limbs, and of the face and trunk. It 
 
OF CEREBRAL DISEASE. 295 
 
 occurs generally before puberty, and more frequently before 
 the age of ten years than afterward, and is generally asso- 
 ciated with torpor of the system, and particularly of the diges- 
 tive organs. It usually exists for a long time, and without 
 danger to life, and with a complete exemption from it during 
 sleep. 
 
 "We are apprehensive that there prevails a very general want 
 of correct information on the character of this affection, and 
 it is possible that we may leave it as much beclouded as we 
 found it ; nevertheless, the suggestions we may add may result 
 in some good, by directing observation to a new channel of 
 investigation. 
 
 We have found no evidence to satisfy us that this affection 
 depends upon a diseased condition of any organ, but rather 
 upon a feeble or debilitated one. It should be remembered 
 that extreme muscular feebleness and tardiness, or comparative 
 torpor of the digestive functions, characterize one of the hu- 
 man temperaments ; and this one, furthermore, is associated 
 with a feeble endowment of the lateral, or motor and sensitive, 
 portions of the cerebellum. In such persons, the power of 
 volition is feeble, but still more feeble is the motor portion of 
 the cerebellum, hence the latter has not the power to execute 
 the mandates of the former. 
 
 In infancy, the cerebrum merely vegetates, and all the vital 
 power is expended upon the lower and most common func- 
 tions, but at five years of age, and even younger in some 
 cases, the cerebrum manifests all or nearly all of its functions, 
 the vital forces have not strengthened in proportion to the ex- 
 penditure upon both the lower and higher faculties. So long 
 as the patient did but little more than vegetate, the function 
 of animal motion was normally manifested ; but when that 
 large number of powers which place us in relation to all that 
 surrounds us, is brought into action, w^e are forced to the in- 
 quiry, where is the power to come from to effect a normal 
 action of all the instruments common to humanity ? These 
 reflections may be foreign to any utility, in relation to the 
 subject before us ; nevertheless, the fitness of the coincidences, 
 as we have seen them, induce us to believe that the sugges- 
 tions we have thrown out deserve some attention. 
 
 Prof. Wood says, that '' The regular motions are often 
 
2% NERVOUS FORMS 
 
 greatly increased by any emotion ; and it has been noticed 
 that the patient is generally worse when conscious that others 
 are observing." 
 
 This manifestation, to a certain extent, may be observed 
 every day about us, in society, among those who have much 
 caution, little destructiveness, and feeble vital forces. The 
 man who cannot refrain from betraying perturbation and a 
 tremulous motion of his knees and hands, is just so far a sub- 
 ject of chorea. 
 
 "It appears that," continues Dr. Wood, " if the will can- 
 not accurately regulate the movements of the muscles, it has 
 the power of calling them into abnormal action ; for the spas- 
 modic contractions are much more frequent when the patient 
 endeavors to execute any movement with peculiar precision, 
 than when the will is quiescent." 
 
 We think that Dr. Wood is mistaken in supposing the pa- 
 tient capable of calling the muscles into abnormal action — he 
 calls them into action, but has not the power to render their 
 action normal. When a man, who is perturbed, attempts to 
 write, or to do anything else that requires precision, he is cer- 
 tain to fail. 
 
 The doctor continues : "By the exertion of a strong deter- 
 mination, the patient can also often control the muscles in 
 some degree, so as to keep them quiet for a time, though, if 
 he allows or encourages them to move, it is impossible to pre- 
 vent them from moving in their own way." 
 
 What observer has not witnessed all this in men of feeble 
 vital force, under the excitement of responsibility ? Drunk- 
 ards, and those laboring under an ague chill, present the same 
 phenomena. 
 
 The preceding remarks of Professor Wood, go very far to 
 strengthen the suggestions we have made ; and it is possible 
 that this feeble condition of the motor system of nerves may 
 be increased or rendered more deranged by an imperfect dis- 
 charge of the digestive functions. 
 
 Professor Wood again states, that "An unsteady, excitable 
 state of the nervous system, constitutes a predisposition to 
 chorea. Such a state is apt to attend a feeble condition of the 
 general health." 
 
 If this observation of the doctor is reliable, and we think 
 
I 
 
 OF CEREBRAL DISEASE. 297 
 
 that it is, then we are sustained in referring chorea to a very- 
 feeble endowment of the vital forces — an extreme degree of 
 that feebleness which is exhibited every day in mental pertur- 
 bation and nervousness. 
 
 Causes. — Kemotely, the cause may be, in many instances, 
 that division of labor which has assigned to many seden- 
 tary habits, and in very many instances it has resulted, beyond 
 doubt, in intermarriages with blood-relations and incompatible 
 constitutions ; if the statistics could be had, we would not be 
 surprised to find that the latter is the most frightful source. 
 We knew one family in which four or five of the children were 
 thus afflicted, and the parents were of the bilious encephalic 
 constitution. Prof. Wood says, that, "In many instances, the 
 disease has come on in many persons previousl}^ healthy and 
 robust." This language is usually applied to those who are 
 obese, and we have shown (page 20) that an accumulation of 
 fat is as clearly a manifestation of organic relations, as an ac- 
 cumulation of tuberculous matter — they are both produced by 
 an imperfection in the sources of pulmonary action. 
 
 Until we made these discoveries, we could not conceive how 
 it was that obese men sometimes died of phthisis pulmonalis, 
 but now, it clearly appears that any cause calculated to arrest 
 the fat-depositing process, may cause an eruption to appear on 
 the skin, diarrhea, a deposition of tuberculous matter, and 
 therefore it is possible, that by some other modification of ac- 
 tion, chorea may result. 
 
 Tkeatment. — Professor Wood teaches, that " Constipation 
 should be promptly corrected by purgative medicines." This 
 precept, standing unqualified as it does, we hold to be ex- 
 ceedingly dangerous. We have seen that this malady, if such 
 it should be regarded, is founded in debility, and in all such 
 constitutions the normal condition of the bowels is one of 
 much torpidity, and so are all the excretions and secretions, 
 and, consequently, to force them into a more active condition 
 than suits the constitution, is to increase the affliction of the 
 patient. 
 
 It should be the first business of the physician to ascertain 
 the normal habit of the bowels, and the second is to maintain 
 them in that condition. Purgatives, in this case, as in others, 
 are indicated when evidence is manifested that alvine torpidity 
 
298 NERVOUS FORMS 
 
 is occasioning irritation — is aggravating the malady. "We 
 would suggest, that to the maintenance of all the organic 
 functions, there should be added such exercise as will most 
 promote the further development of the thoracic viscera, and 
 to have this eflect, it must be enjoyed. 
 
 In chorea, the bowels should be kept regular by small doses 
 of Leptandrin and Podophyllin, so combined as to produce 
 one alvine discharge daily ; in connection with which, either 
 the Compound Pills of Macrotys, the Compound Pills of Vale- 
 rian, or the Compound Tincture of Cramp Bark, of the Eclec- 
 tic Dispensatory, may be used. The surface should be bathed 
 often with an alkaline wash, and considerable friction used in 
 drying. Electro-magnetism may be used, daily, with ad- 
 vantage. 
 
 If the disease is complicated with rheumatism, or the pa- 
 tient is of a strumous diathesis, the employment of the Com- 
 pound Syrup of Stillingia and lodate of Potassium, hereto- 
 fore referred to, will be found serviceable. 
 
 In cases of obstinate constipation, Prof. J. King recom- 
 mends the use of Extract of Belladonna, one-eighth of a grain, 
 and the Alcoholic Extract of Nux Yomica, one-twentieth of a 
 grain, in form of pill, three of which are to be given daily to 
 an adult, and in proportion to children over six years of age ; 
 below this age, he thinks, it has an injurious influence upon 
 the brain, and should not be administered at all. 
 
 The diet should be nutritious and of easy digestion, avoid- 
 ing tea, cofl:ee, all stimulants, acids, and greasy food. 
 
 Genus IIL — Paralysis — 
 Palsy. 
 This form of disease, when complete, consists in a loss of 
 sensation and of tlie power of motion. In some instances, 
 there is a loss of sensation, without the power of motion being 
 affected — the affection is then called ancesthesia j and when 
 the condition is reversed, that is, the power of motion is lost, 
 while that of sensation is retained, it is called acinesia. 
 When a particular part of the system, as an arm, the muscles 
 of an eye, or the face, have lost the power of motion and sen- 
 sation, the affection is called local palsy ; when the same con- 
 dition happens to one lateral half of the body, it is called 
 
OF CEREBRAL DISEASE. 299 
 
 hemiplegia; and when to the lower half of the body, includ- 
 ing the inferior extremities, it is then called paraplegia; 
 when both pov/ers are lost in any given part, it is denomi- 
 nated comjplete paralysis ; and when either or both powers 
 are in part retained, it is called partial paralysis. 
 
 As we have shown that the functions of motion and sensa- 
 tion are performed by two distinct and independent organs, it 
 can be readily understood how it is that either may be lost or 
 palsied without the other ; and further, the same discovery 
 renders intelligible all of the preceding definitions. 
 
 That loss of motion and sensation, which attends coma, 
 apoplexy, syncope, epilepsy, etc., is not included in the above 
 definitions ; nevertheless, paralysis may succeed to either of 
 them, as a sequent. We have seen all the voluntary muscles, 
 except those of the neck and face, paralyzed, and yet life con- 
 tinued twenty -four hours. Our observations upon one case of 
 this kind, induce us to believe that life could not continue a 
 minute after a complete paralysis of all the voluntary muscles 
 should happen. 
 
 When palsy takes place, in adult life, it comes most fre- 
 quently as a precursor to a final dissolution, but such a conse- 
 quence is not to be apprehended when it seizes upon infancy 
 and childhood ; and yet it may prove quite incurable, or en- 
 tirely so. In infancy, it sometimes appears to depend upon 
 some original defect in the organization, because it so ope- 
 rated before birth, that the aftected part is, at birth, less de- 
 veloped than the unaffected ; but, in such cases, it is more apt 
 to appear as acinesia or anaesthesia, than as complete palsy. 
 
 But the disease, either partial or complete, is much more 
 frequently occasioned subsequent to birth, by some variety of 
 assault upon the brain or spinal cord. When it is the result 
 of spinal irritation, it may be attended by nausea and vomit- 
 ing, but more frequently by flatulence and diarrhea — and by 
 such manifestations of the body as show a disposition to avoid 
 resting the weight of the body upon the spine, and which, 
 upon the appearance of the disease, becomes impossible. The 
 gastric and alvine symptoms above named, have been mis- 
 taken for cholera infantum, and hence the propriety of look- 
 ing out for the spinal manifestation, above noted, in all cases 
 of bowel derangement. 
 
300 I^ERVOUS FORMS 
 
 In many instances, the assault appears very trivial — such, 
 possibly, as a day or two's manifestation of unusual dullness 
 and heaviness of the head, which appeared, perhaps, too un- 
 important to command medical attention, or possibly by a sin- 
 gle convulsion, or perhaps by some dental irritation, which, so 
 far as ascertainable, produced no cerebral disturbance. 
 
 In three-fourths of the cases of paralysis, that occur during 
 the period of dentition, there will be found no local signs of 
 difficult dentition, and yet there can scarcely be a doubt that 
 it was occasioned by the irritations incidental to this period. 
 This is only another illustration that physicians have been in 
 the habit of referring too much to the local circumstance of 
 dentition, and not enough to that general condition that pre- 
 vails during this period, especially with those children w^ho 
 have but feebly endowed vital forces. Paralysis may succeed 
 to spinal irritation, occasioned by a constipated condition of 
 the bowxls. It is reported also to have been produced by the 
 child's sitting upon a cold stone, and therefore it is not impro- 
 bable to suppose that it may be occasioned by w^et and cold 
 clothing. 
 
 It is worthy of remark, that it matters but little as to what 
 form of disease that disturbed the general health, previous to 
 the manifestation of paralysis, nor how^ soon it may subside or 
 disappear, yet the paralysis will so far continue as to produce 
 much inconvenience as to the comfort of the patient, and the 
 appearance and usefulness of the affected part. 
 
 Whatever may be the cause, remedies addressed to the gene- 
 ral health sometimes very readily give relief, but at other 
 times, it persists for weeks, months, years, and even for life, in 
 defiance of all the profession can do. 
 
 The most important point connected with this subject, is 
 diagnosis — to distinguish it from indications of impending 
 mischief — such as organic disease of the brain. Sometimes 
 the history of the disease will be sufficient to determine its 
 character. If the paralysis has suddenly seized upon both 
 extremities, on the same side, unattended by any cerebral 
 symptoms, we may conclude that it indicates no serious mis- 
 chief; but if the paralysis has secretly and slowly made its 
 invasion upon some given part, we may find it very difficult 
 to come to a conclusion. 
 
OF CEREBRAL DISEASE. 301 
 
 Connected with a disease of the brain, there is usually in- 
 voluntary tremor or nervous twitchings, with a contraction of 
 the fingers and toes. In case of convulsions, the paralysis 
 that succeeds may render the cases still more obscure. But 
 we may state, as a general fact, that when the paralysis suc- 
 ceeds to a single fit of convulsions, there is no local mischief in 
 the encephalon ; but when such a lesion does exist, there will 
 be a succession of convulsive assaults before paralysis will be- 
 come manifest, and the part that will manifest it, will, during 
 the convulsions, be probably the only or the most convulsed 
 part. 
 
 In cases of incomplete paralysis of an inferior extremity, 
 the sensibility of the limb is sometimes exalted ; and but for 
 this circumstance, there could be no liability of confounding 
 hip-joint disease with incomplete paralysis — but the almost, if 
 not invariably, fixed pain in the knee, in hip-joint cases, will 
 distinguish it from paralysis. In the latter, that extreme pain 
 can never arise, which is occasioned in the former when the 
 head of the femur is made to strike against the acetabulum, 
 which is apt to follow a slight blow upon the heel. 
 
 Treatment. — Upon this subject. Dr. Wood says: "It may 
 not be amiss to state, in general terms, that the remedies in 
 cases of active congestion, active hemorrhage, or inflammation, 
 are bleeding, general and local, proportioned to the energies 
 of the system, purging, refrigerants, low diet, rest, and if these 
 fail, blisters and a mercurial impression." 
 
 Dr. West says, that " Purgatives and tonics are the reme- 
 dies which I have most frequently employed ; for the bowels 
 are usually constipated, and the child often debilitated." 
 
 The above extracts embrace the doctrine, on this subject, of 
 all the writers whom we have consulted, and as we hold it to 
 be entirely erroneous, it is proper that we should make it the 
 subject of some criticism. 
 
 In the first place, w^e do not believe that two per centum of 
 the cases of infantile congestion and hemorrhage are active in 
 their character — but exclusively passive ; and this opinion is 
 sustained by the closing remark of Dr. West, "the child is 
 often debilitated." We believe, that if he had considered 
 obese children as " debilitated," he would have found no ex- 
 ception — his language would have been, the child is always 
 
302 I^ERVOUS FORMS 
 
 debilitated. The case of the child which we extracted from 
 him, under the head of Phthisis Pulmonalis, is a thorough 
 illustration of this point. We conclude then, that in all cases 
 of palsy, which originate in functional derangement, the child 
 is feeble — feeble because of those organic conditions which we 
 have exposed, that constitute almost a si7ie qua non to the 
 production of infantile palsy in general. 
 
 Now, what is the practice ? The child is feeble, therefore 
 bleed it and purge it, and if these fail to kill it in due time, then 
 try blisters and mercury. We are aware that this course 
 generally succeeds in efiecting its — death. If there can be 
 adopted a course of practice, with a feeble child, better calcu- 
 lated to produce paralysis, than the preceding, we cannot im- 
 agine its character. 
 
 The affection generally consists in debility, and this debility 
 is certainly increased by both bleeding and purging. Irrita- 
 tion in the gums, bowels, etc., have also their origin in de- 
 bility, and purgatives are certain to produce irritation in some 
 part of the system. To speak truly of this practice, we must 
 say that it is not enlightened by one ray of common sense. 
 
 Whatever may be the obstruction that has occasioned pa- 
 ralysis, the system is making an effort to remove it, and for 
 the purpose all of its energy is concentrated upon the one ob- 
 ject, constipation must result, for the time being — it is then, 
 a favorable indication ; and, if in its stead, diarrhea should 
 ensue, it might justly be regarded as a fatal indication. 
 
 So long as constipation gives no evidence of producing irri- 
 tation, we should not only let it alone, but co-operate with the 
 system in removing that disease or obstruction which has oc- 
 casioned the paralytic symptom ; and, therefore, the equaliza- 
 tion of the circulation and the support of the child's energies, 
 should constitute our first duty. 
 
 When we have indications that the fecal contents of the 
 bowels are becoming a source of irritation, they should be re- 
 moved by injections, because the difficulty is always in the 
 large intestines, and thus we avoid the irritation consequent 
 upon the action of cathartics upon the alimentary canal. 
 
 If the paralysis has been occasioned by inflammation, or 
 rather by that disease for the removal of which inflammation 
 was set up, cerebral congestion, or any similar affection of the 
 
OF CEREBRAL DISEASE. 303 
 
 spine, the initiatory treatment will be found under these re- 
 spective heads. If it have originated in some obstruction or 
 irritation incidental to the dental period, it v^^ill be centripetal 
 in its character, and therefore may be removed by revulsives. 
 When the malady is connate, no plan of treatment, it is gene- 
 rally thought, can avail anything. This may be true, but as 
 an abstract conclusion, we cannot assent to it. Connate 
 organic conditions can be changed — we have proof of this in 
 the history of every man who has lived an active life, and as 
 disease depends upon organic conditions and relations, no case 
 should be declared incurable before the mechanical or the 
 chemical laws have declared it to be impossible for the vital 
 forces to regain an ascendency. When it shall be discovered 
 that the palsy has resulted from a tumor pressing upon a 
 nervous trunk, the remedy must be obvious. 
 
 In this disease, among children, the stimulating liniment, 
 mentioned under Epilepsy, should be applied to the spine, and 
 tonics given internally, with gentle stimulants, such as Myri- 
 cin, Xanthoxylin, etc., and a nutritious and easily-digested 
 diet. 
 
 Genus IY. — Night Terkoes — 
 FrigJitful Dreams. 
 
 That set of manifestations which we designate night terrors, 
 are, perhaps, never occasioned by any permanent disease of 
 the brain, but rather through the instrumentality of intestinal 
 derangements ; and when from these, they are sometimes too 
 slight to admit of detection. Children, who have apparently 
 an every-day good health, go to bed, sleep soundly an hour or 
 so, and then (we cannot say awake, because entire conscious- 
 ness is rarely, if ever, present with them at the moment), start 
 suddenly and in great terror, giving a piercing cry or scream. 
 When attention is given to it, the child is found sitting up in 
 bed and betraying the utmost alarm — crying for his nurse or 
 the one wdio most attends to his wants. When spoken to, it 
 will answer, and yet appear unconscious of the presence of 
 any one, or of what it is doing, but still screams under the in- 
 fluence of its frightened imagination ; at length, and gradu- 
 ally, it becomes both conscious and awake. 
 
 In most instances, as soon as aroused to consciousness, the 
 
304: NERVOUS FOEMS 
 
 child is quiet, and again returns to sleep as though nothing 
 had happened; but in other instances, and occasionally at 
 other times with the same individual, it seems to have a deep 
 trouble, weeps passionately, but finally sobs itself to rest. 
 
 In some cases, it is said, that when the fit passes ofi", a 
 quantity of limpid fluid is voided, but we have not seen it. 
 These attacks very rarely occur more than once upon the same 
 night. As the afiection obeys no law of periodicity, it cannot 
 be foretold when the terrors will be likely to return — they may 
 return the next night, and they may not — they may occur 
 almost every night for a year, or only a few times. The par- 
 oxysms are all alike — and are founded upon the idea of some 
 impending danger. 
 
 Parents at first are very apt to be alarmed, fearing that 
 some serious malady is threatened; but after a time they 
 come to regard these terrors as nothing more than the child's 
 frightful dreams. But this indifi*erence may result to the 
 injury of the child, because by indulging such an irritation, it 
 might result in some very serious affection, such as convul- 
 sions, and their frequent recurrence may produce death — and 
 yet a post mortem examination might detect, in neither the 
 brain nor spinal marrow, the slightest indication of disease. 
 
 It is not best to force such children to bed in the dark, and 
 if they be alone — no one to cling to as being capable of pro- 
 tecting them, the light should not be extinguished before they 
 fall to sleep. So long as the child manifests no intolerance of 
 light, complains of no headache, the pulse regular, head cool, 
 and no drowsiness, there will be no occasion to apprehend the 
 approach of hydrocephalus, more especially if the abdomen 
 be full and hard — indicating the presence, perhaps, of consti- 
 pation, which very frequently attends, more or less, these 
 night terrors. The irritation attendant upon both the first 
 and second dentition, may prove an exciting cause in their 
 production. 
 
 Treatment. — This afi*ection, perhaps, is founded entirely 
 upon gastric or intestinal irritation. Children, who are per- 
 mitted to eat anything, particularly of a trashy character, and 
 those who are passing through either the first or second denti- 
 tion, are those who are the most liable to be afflicted in this 
 way — but there is another condition which, so far as our 
 
OF CEREBRAL DISEASE. 305 
 
 observation has extended, may be regarded as a sine qua non 
 in the premises — it is a very moderate expansibility of the 
 lungs, as indicated by small and contracted nostrils, with an 
 absence of respiratory motions in the chest ; this circumstance, 
 particularly, makes it essential that the malady should be at- 
 tended to. 
 
 No other treatment is required, than to confine the patient 
 to simple and nutritious diet, more especially of the azotized 
 variety, and to keep the bowels in a normal condition by the 
 use of mild aperients. 
 
 If worms are present in the intestines, remove them by the 
 proper agents : if there should be irritation of the gums from 
 teething, pursue the course herein recommended for such irri- 
 tation. 
 
 In some instances, a pill composed of Hydro-alcoholic Ex- 
 tract of Macrotys, one grain, and Sulphate of Quinia, one- 
 fourth of a grain, may be administered once or twice a day. 
 
 If the child is permitted to sleep lying on its back, it will 
 be more liable to these attacks. Late suppers and meats for 
 supper must positively be prohibited. 
 
 Genus Y. — Tkismfs IN'ascentium — 
 Infantile Tetanus. 
 
 This very generally fatal disease has hitherto been but little 
 understood, so little indeed, that we should probably have 
 passed it over in silence, but for having found a very valuable 
 paper on the subject in the "Nashville Journal of Medicine 
 and Surgery," by Professor Watson. He has, in our judg- 
 ment, handled the disease in all its aspects, knowingly and 
 intelligently. We shall not, in what we shall say, go beyond 
 his paper, nor shall we follow him any farther than he pursues 
 the disease ; that is, we shall not meddle with his comments 
 upon the opinions and doctrines of others, further than to re- 
 mark, that he has handled them with as much ability as he 
 has the subject. In commenting upon the opinions of Dr. 
 Sims, he says : 
 
 "This reminds me of Dr. CuUen's acknowledgment: *I 
 
 have, in my Nosology, put the trismus, or lock-jaw, as a genus 
 
 distinct from the tetanus ; all this, however, I now judge to 
 
 be improper, and am of opinion, that all the general terms 
 
 20 
 
306 I^'ERYOUS FORMS 
 
 denote, and are only applicable to, different degrees of one 
 and the same disease.' Surely trismus, in the infant or adult, 
 is a mere variety of tetanus, and like the other varieties de- 
 pends upon a pathological condition of some of the cerebro- 
 spinal centers. 
 
 " It is a great misfortune that the term trismus nascentium 
 was -ever adopted ; tetanus nascentium would have been a 
 better, though a less euphonious, one. There was no greater 
 necessity for changing the name of this disease, in the case of 
 infants, than there is to change that of pneumonia, dysentery, 
 or colic, when they attack children." 
 
 He thinks it probable that there may exist, in the constitu- 
 tion of some individuals, a sort of tetanic predisposition, and 
 that cold or damp air, indigestion, exposure to solar heat, 
 "foul and badly-ventilated lying-in-hospitals," a want of 
 cleanliness, etc., may serve as predisposing causes. 
 
 ^' The exciting cause of Tetanus Nascentium. — A trau- 
 matico-tetanic condition of the umbilicus, is, with a very few 
 exceptions, the constant exciting cause of this disease. The 
 analogy between traumatic tetanus, as it occurs in the adult 
 and infant, is both striking and instructive, and well deserves 
 our most particular consideration. In the adult, this disease 
 generally comes on about the eighth or ninth day after the re- 
 ception of the wound, and in the infant, it attacks so fre- 
 quently on the ninth day after the cutting of the umbilicus, 
 that it has been termed ' nine-day fits.' That portion of the 
 cord which, after its division is left in connection with the 
 navel, is as liable to degenerate into an exciting cause of 
 tetanus in the infant, as is a common wound in the adult. 
 
 *' C. M. Billiard's explanation of the separation of the funis 
 is quite satisfactory ; he very properly maintains, ' that desic- 
 cation of the cord is altogether a physiological phenomenon, 
 belonging to the assemblage of vital phenomena, and entirely 
 dependent on them. That part of the cord attached to the 
 placenta, does not exhibit the phenomenon of desiccation, like 
 the portion remaining with the child, but shrinks and decays 
 like a dead substance, while the abnormal portion is not so 
 affected. Here the desiccation ceases as soon as life is extinct; 
 it either does not proceed in still-born children, or is conside- 
 rably retarded. In place of dying and separating at the end 
 
OF CEREBRAL DISEASE. 307 
 
 of a few days, as is observed during life, the cord undergoes 
 in the dead body a perfect decomposition, difi'ering entirely 
 from its normal desiccation.' He further contends, that ' the 
 umbilical cord may, under favorable circumstances, separate 
 from the navel, just as the stem of a cucurbitaceous fruit is 
 separted,' or by what he terms ' a proper suppuration.' Of 
 ■ eighty-six infants examined by him, nineteen had redness and 
 tumefaction of the umbilicus, without suppuration. The 
 period for the detachment of the cord varies from the second 
 to the seventh day." 
 
 He thinks that the liability of infants to irritation, inflam- 
 mation, and sloughing of that portion of the cord which re- 
 mains attached to the abdomen, has been greatly overlooked 
 by medical writers. It is his opinion, furthermore, that there 
 exists a variety of causes which may induce a normal and 
 healthy action to degenerate into a morbid one, and that some 
 children are more exposed to all of them than others. The 
 professor lives in a slave country, and has had extensive op- 
 portunities for observation, in both the white and slave popu- 
 lation, and he states, as a result of such observations, that the 
 slave children are more exposed to all these causes than the 
 white, and hence the disease is much more frequent among 
 them. 
 
 These common causes, which apply to the blacks more than 
 to the whites, he says, "are bad dressings of the umbilicus, 
 improper handling of the infant, wet and soiled dressings, 
 which become alternately wet and dry for several days ; to 
 which may be added, unsuitable applications to the navel 
 itself after the detachment of the cord, that are more calcu- 
 lated to inflame and irritate the part, and in that way to pro- 
 voke lock-jaw, than to soothe, heal, and prevent its suppura- 
 tion." 
 
 From the facts presented by the professor, the conclusion is 
 irresistible, that this fatal morbus is more common to the black 
 than to the white population of the south ; and here, let it be 
 remembered, there are no paupers, as in the free states of this 
 and other countries. It is furthermore ascertained, that the 
 same difference, as to this disease, exists between the poor and 
 pauper classes, on the one hand, and the affluent, on the 
 other, that obtains between the black and white of this country. 
 
308 NERVOUS FORMS 
 
 Those conditions of life, as regards personal comforts, which 
 exist with the blacks, exist also with the poor of all countries. 
 Now, what is the condition which is common to the infants of 
 the poor and the slave infants ? A want of every personal 
 comfort. 
 
 The professor's description of negro infants, as he has fre- 
 quently seen them, is that which we have witnessed in the 
 wretched families of the free states, viz : 
 
 " Their clothes wet around their hips, and often up to their 
 armpits with urine — the umbilical dressings not only wet 
 with urine, but soiled likewise with faeces, freely giving off an 
 offensive and fecal odor, combined at times with a gangrenous 
 fetor, arising from the decomposition — not desiccation — of the 
 cord." 
 
 Under such circumstances, it will readily be admitted that 
 the normal physiological desiccation must be interrupted, ar- 
 rested, or degenerated into a most foul and morbid condition. 
 The professor has presented a large amount of evidence in 
 support of his conclusions — and we think that he has sus- 
 tained them. He has concluded, that " the infant is no sooner 
 born than it becomes a traumatias^ a trauma must of neces- 
 sity be inflicted upon its umbilical cord ; a wound on a part 
 which is very prone to pass into a pathological condition, and 
 thereby excite irritation and inflammation of the umbilicus." 
 
 Two objections have been urged to the professor's conclu- 
 sion, which we will name, and append his answer, lest others 
 may conclude that they have not been anticipated. 
 
 1. " That the navel may be badly inflamed, and yet not 
 cause tetanus." 
 
 2. " That cases of trismus have occurred where there was 
 no imflammation of the umbilicus." 
 
 " But for these considerations, many would doubtless have 
 entertained a much greater dread of a morbid state of the um- 
 bilicus, and would oftener have employed tetano-prophylactic 
 measures in such cases. Indeed, with no little astonishment 
 have I heard well-informed physicians say, that they did not 
 believe that inflammation of the navel is the exciting cause of 
 trismus, merely because they had seen very badly inflamed 
 ones, without the occurrence of lock-jaw ; or, that they had 
 seen cases where the umbilicus had healed over. Yerily, my 
 
OF CEREBRAL DISEASE. 309 
 
 surprise would be equaled by the assertion, that they did not 
 believe that a wound was the exciting cause of tetanus in the 
 adult, because they had seen very bad ones fail to produce it, 
 or had seen cases occur after the healing over of wounds. 
 Almost every practitioner knows, from personal observation, 
 that an adult may receive a deep, dangerous, and painful 
 wound without incurring lock-jaw as a consequence ; also, 
 that a wound may cause the disease after having healed over ; 
 then, may not severe inflammation, or extensive ulceration, 
 of a child's navel run its course without causing trismus ? and 
 may not the part heal over, and yet, by an occult pathological 
 condition, excite the disease ?" 
 
 The professor has not treated of the symptoms, varieties, or 
 therapeutics of this disease, which we very much regret ; he 
 states that his purpose, mainly, has been " a reliable prophy- 
 laxis, by which a disease that cannot be cured, may he jpre- 
 vented ;^^ and so admirable and practical are his remarks upon 
 the purpose of preventing the disease that we feel it to be due 
 to young practitioners, to extract them at full length. 
 
 " Physicians have generally given up the dressing and man- 
 agement of the funis, too much into the hands of unskillful 
 nurses, lest by a careful attention to such small things, they 
 might compromise their fancied dignity. But every one who 
 is properly impressed with a dread of tetanus from bad man- 
 agement of this part, will rather try to maintain his profes- 
 sional character and dignity by preventing a disease which he 
 knows he cannot cure, however trifling the means may seem, 
 in the estimation of the ignorant, inexperienced, and preju- 
 diced." 
 
 " The umbilical cord should be divided as usual about two 
 inches from the abdomen, and well tied with a suitable liga- 
 ture before its division. After the child has been washed by 
 the nurse, another ligature should be applied lest the first one 
 should become too slack from the contraction of the cord. 
 A hole of a proper size should then be made through a piece 
 of soft old domestic or linen, four inches wide and six inches 
 long, through which the funis should be passed, and afterward 
 carefully wrapped with another soft piece of cloth two inches 
 wide and three or four long. The cord should then be turned 
 up toward the child's breast, and the cloth which was first 
 
310 NERVOUS FORMS 
 
 applied, should then be folded in on it from above and below, 
 and from side to side. A soft flannel bandage should then be 
 carefully put around the abdomen and pinned with moderate 
 tightness. After this, should the navel-dressings become wet 
 with urine or soiled with fseces, they should be carefully re- 
 moved and dry ones employed. This should always be done 
 by an experienced and careful nurse, lest the cord should be 
 prematurely detached. On a careful examination, should 
 there be any signs of irritation, inflammation, or ulceration 
 of the navel, the piece of cloth, through which the wrapped 
 funis passes, should be removed, by cutting with a pair of 
 scissors from without into the opening in the middle ; this be- 
 ing done, it may be removed without hurtfully disturbing the 
 cord. After this has been done, it will be necessary to apply 
 another piece of cloth like the one just removed, unless the 
 inflammation be considerable; in that case, the part should 
 be gently washed with warm milk-and-water, and a soft emol- 
 lient poultice applied over the wrapped cord and surrounding 
 surface to the extent of two or three inches. The application, 
 removal, and renewal of this poultice will require great care. 
 "The chief advantage of wrapping the cord, is that of pre- 
 serving it from adhering to the cloth through which it passes, 
 and thereby preventing its removal when necessary. All 
 awkward, rough handling of the cord should be avoided, as 
 the navel string may be, in that way, stretched, torn, or pre- 
 maturely detached. After the funis has separated, the umbili- 
 cus should be carefully washed with castile soap-suds, and if 
 there be the least appearance of irritation or inflammation, a 
 soft mush-poultice, somewhat larger than a dollar and about 
 twice as thick, throughout its whole extent — lest the edges 
 become dry — should be neatly spread on a soft piece of cloth, 
 then moistened on its surface with a little lead water and olive 
 oil, and laid with care immediately over the navel, and should 
 be retained in its place by a proper application of the bandage 
 previously employed. This poultice should be removed in six 
 or eight hours and another applied, and so on until all signs 
 of a morbid state of the part entirely disappear. It will 
 sometimes be necessary to continue this course of poulticing 
 for five or six days, to the entire exclusion of all other topical 
 applications. All predisponent, accessory, or accidental causes 
 
OF CEREBRAL DISEASE. 311 
 
 should be removed with great care as far as possible ; the 
 general health of the child should be closely watched, and in- 
 ternal remedies employed if necessary. 
 
 " Soft, emollient poultices, certainly afibrd even an adult 
 suflering from a wound greater protection than any other 
 means. Who ever saw a patient attacked with traumatic 
 tetanus, who had had all the prophylactic benefits of good 
 poultices, a well-regulated temperature of his room, and ap- 
 propriate remedies ? The soothing action of the poultice 
 seems to prevent a wound from passing into that condition 
 which excites lock-jaw. The terminal extremities of the 
 wounded nerves, or those that have been exposed by ulcera- 
 tion, or irritated by inflammation, are protected by a poultice 
 against that tetano-pathological condition into which they pass 
 sometimes, when not thus guarded, with great facility. 
 
 "But, alas! because the inflammation of the navel is 
 trifling, or the ulcer on it small, the physician does not con- 
 sider either worthy of his attention, when, really, the very 
 elements of death are more actively at work than in many 
 other cases which so readily engage his closest attention and 
 greatest skill. It is probable that a greater amount of human 
 life might be saved by these simple preventives, than most 
 physicians or nurses are aware of; and it is always far more 
 difficult to procure the employment of such prophylactics, than 
 those uncertain remedies which are so zealously administered 
 sometimes for the relief of an incurable malady. 
 
 "Nurses should be properly directed to employ these pre- 
 ventive means, especially among our negroes ; and every prac- 
 titioner should constantly urge their adoption on all large 
 plantations and negro quarters. When these means are faith- 
 fully employed, negro children escape tetanus to as great an 
 extent as do white children. It should be the resolve of every 
 practitioner never to allow an infant to be attacked with tris- 
 mus that may be delivered by him, or placed under his care 
 at birth, since, by a patient and careful employment of appro- 
 priate prophylactics, it may be prevented. These moans, sim- 
 ple and unpretending as they are, require some foresight and 
 tact for their beneficial employment ; if the poultice be not 
 well applied, of proper consistence, or becomes dry and hard, 
 it may do more harm than good. Beside, if the child be not 
 
312 N"ERVOUS FORMS 
 
 protected against wet and soiled clothing, bad air, variable 
 temperature of its body, bad feeding and nursing, these pre 
 disponent, accessory, and accidental causes, may cause the 
 morbid umbilicus to pass into a traumatico-tetanic condition 
 in despite of poultices or any other topical applications what- 
 ever ; so it is highly necessary that all these things — little in 
 themselves, though great in their effects — should be scrupu- 
 lously regarded by every conscientious practitioner. 
 
 " The writer of this treatise, while faithfully discharging 
 his duty to infants in the employment of these prophylactic 
 measures, has often experienced the jeers and taunts of the 
 nurses on such occasions. Every practitioner should, how- 
 ever, perform his duty to his little patient, be it white or black, 
 in protecting it against an attack of a disease which he may 
 prevent but cannot cure, and thereby impress nurses, parents, 
 and even communities, with the great utility of such a course. 
 In that way our prophylactics may be raised above the con- 
 tempt of the ignorant or those too wise to learn." 
 
 As the Nashville Medical Journal may not be within the 
 reach of our readers generally, the opinions of several writers, 
 on this disease, may be found in Dr. Wood's Practice of 
 Medicine. 
 
 So far as a child can manifest the general symptoms of teta- 
 nus, they may be expected in this. If the opinions of Dr. 
 Sims are to be credited, it is quite a curable disease; but 
 other extensive practitioners assert that they never knew a 
 case to be cured. This, we suppose, to be about the fact, 
 hence the great value of Professor Watson's prophylactic 
 measures. 
 
 When an infant is attacked with trismus nascentium, to the 
 gangrenous umbilicus, apply daily a solution of Sulphate of 
 Zinc, one drachm to an ounce of water, and cover this with a 
 poultice of Slippery-elm, to two drachms of which a solution of 
 the Extract of Hyoscyamus, twenty grains to an ounce of water, 
 must be added, and renew the poultice two or three times a 
 day; the solution of Zinc to be applied until healthy granu- 
 lations appear. The bowels are to be kept open by the Com- 
 pound Powder of Rhei, in decoction, or by enemas ; cold 
 water must be applied to the head ; and bathe the whole spine 
 two or three times a day, with the liniment recommended in 
 
OF CEREBEAL DISEASE. 313 
 
 chorea. Internally, administer an infusion of one drachm 
 each of Ictodes Fcetida, Cypripedium Pubescens, and Scutella- 
 ria Lateriflora, to six ounces of water, of which a teaspoonful 
 may be given every hour or two. 
 
 Genus YI. — Convulsions — 
 Infantile Fits. 
 
 " These are clonic spasms of the muscles, producmg visible 
 motions of the limbs or other parts of the body, and generally 
 attended with unconsciousness. When the contraction is 
 slight, feeble, and of short continuance, so as to occasion a 
 mere catching of the tendons, with very little observable 
 movement of the parts into which the tendons are inserted, 
 the affection is denominated subsultus tendinum. It may or 
 may not be accompanied with unconsciousness." — Wood. 
 
 Convulsions are but rarely independent of some of the 
 forms of disease over which we have passed or are yet to con- 
 sider ; and, therefore, if we had passed the subject by, as an 
 independent one, we should not have been guilty of anything 
 like considerable omission. The importance of treating of it, 
 as a separate subject, consists in bringing under one head its 
 various features. 
 
 A convulsive liability of the system is one of increased irri- 
 tability, and a paroxysm is usually anticipated by more than 
 ordinary restlessness — readily excited into a fretful mood of 
 feeling and a peevish temper. At night, the convulsive ap- 
 proach is frequently indicated by an incapacity to sleep, or if 
 sleep should supervene upon going to bed, it will be disturbed 
 or broken by sudden starts and cries. 
 
 The iris is generally very dull and unimpressible by light, 
 or else exceedingly sensitive to it. In the presence of light, 
 the pupil will suddenly contract, and then probably as sud- 
 denly dilate — sometimes one pupil will dilate while the other 
 contracts. 
 
 Mr. ISForth is of the opinion, that when this unequal sensi- 
 bility of the iris exists, that the brain is probably seriously in- 
 volved. Dr. Good says, that when children are strongly liable 
 to convulsions, they lie, when asleep, "with their limbs 
 rigidly extended, the great toes and thumbs beino- turned 
 inward." 
 
314 N'ERYOUS FORMS 
 
 The face, superior and inferior extremities, and the respira- 
 tory muscles, are the most liable to convulsive movements, but 
 no part, endowed with muscular fibers, is exempted. The coun- 
 tenance varies in both color and expression — at one moment, 
 it is flushed, at another, pale — at one time, it is sad, at an- 
 other, cheerful. These changing feelings affect the respira- 
 tion, producing deep and lengthened inspirations, which are 
 followed by a short and interrupted respiration. "When the 
 respiratory function is thus disturbed, it is thought by some, 
 that a paroxysm is near at hand. In this state of strong lia- 
 bility, the fingers are subjected to sudden and frequent 
 motions. 
 
 The face, in some instances, is about the only part that is 
 convulsed — in others, different parts of the body are convul- 
 sively seized, but most generally every voluntary muscle and 
 many of the involuntary are spasmodically excited, and at- 
 tended by a staring of the eyes, protrusion of the tongue, 
 frothing at the mouth, labored breathing, and distortion of the 
 eyes. Frothing at the mouth is but rarely attendant — 'it is 
 perhaps present only in such cases as will most likely prove 
 fatal, and then, before dissolution, the skin becomes of a pur- 
 ple color, and so continues until the close of life. 
 
 The Infantile Constitution in relation to Convulsions 
 and kindred affections. — In Chapter YIII of the preceding 
 Book, we exposed some of the errors that prevail on this sub- 
 ject, and as enlightened views, in relation to disease, consti- 
 tute the only j^roper guide in practice, w^e must be permitted 
 to comment a little on prevailing opinions with reference to 
 infantile convulsions. We shall begin with an extract from 
 Prof. Eberle, "On Children." 
 
 " Both the anatomical and physiological peculiarities of the 
 infantile system, are, indeed, such as to account for the espe- 
 cial aptitude to convulsive maladies during this tender period 
 of life. The mind and body of an infant, not yet inured to 
 the impressions of internal and external causes, possess the 
 most lively susceptibility to the various perturbating and ex- 
 citing influences to which it is unceasingly subjected. 
 
 "All children, however, are not equally disposed to convul- 
 sions. Mr. K'orth observes, that ' the children of parents, 
 who marry at too early or too advanced an age are more 
 
OF CEREBRAL DISEASE. 315 
 
 susceptible of convulsions than the progeny of those persons 
 who marry in the prime of life.' I have met with several in- 
 stances of aptitude to convulsions in families which accord 
 entirely with this observation. That the predisposition to 
 convulsive affections is sometimes hereditary, appears to 
 be highly probable. Boerhaave and Lerry, mention in- 
 ' stances which strikingly illustrate this fact. We often meet 
 with families, in which the occurrence of convulsions, is 
 almost a matter of course in all the children as they success- 
 fully pass through the process of primary dentition ; and, on 
 the other hand, in very many families, blessed with a nume- 
 rous offspring, such affections never occur, although the ordi- 
 nary exciting causes, may be conspicuously present. It would 
 appear also, that convulsions are much more common in cities, 
 and particularly in the higher and more luxurious classes of 
 society, than amono^ those who ' are reo;ular in their mode of 
 living, and who enjoy the calm tranquillity of country life.' 
 The fresh and pure air of the country, has an especial ten- 
 dency to invigorate the infantile system, and to diminish nerv- 
 ous irritability, and thus to render the ordinary causes of con- 
 vulsions less apt to excite such affections. It is, probably, 
 mainly from the want of pure and wholesome air in hospitals, 
 that convulsive diseases are so much more common in these 
 institutions than elsewhere. The children of mothers, en- 
 dowed with a very susceptible physical and moral constitu- 
 tion — with a quick and lively imagination, great sensitiveness, 
 and mobility of temper, are in general peculiarly apt to suffer 
 convulsive affections, during the period of dentition. Mau- 
 ricean, Leuret, and others, assert, that children who have very 
 large heads are more liable to convulsions, than those who are 
 less liberally furnished in this way. This observation, how- 
 ever, appears to be wholly without any foundation, with regard 
 to children v/ho are healthy. In rickety children, the size of 
 the head is disproportionately large ; and from the general 
 symptoms of rachitis, it is evident that the head and spinal 
 marrow are considerably affected ; the brain increases rapidly 
 in size, the senses are usually very acute, and convulsions are 
 very frequent attendants of this distressing malady. It not 
 unfrequently happens, when some children of the same 
 
316 NERVOUS FORMS 
 
 parents are affected with rachitis, that others who are exempted 
 frora the disease are at a very early age destroyed by con- 
 vulsions." 
 
 If this long extract contain one clear or one useful idea, we 
 have failed to find it. Two ideas, however, may be inferred 
 from it: first, children have convulsions; and, second, Prof. 
 Eberle does not know why they do ; and yet, so far as we 
 have been able to discover, he is about as wise as his co- 
 laborers. One reference will show that this remark is correct 
 Prof. Wood says : 
 
 " The peculiar state of the nervous system, in infancy and 
 early childhood, may be considered as a predisposing cause. 
 Yery impressible from the necessities of the organization at 
 this age, it must of course feel more sensibly than at other 
 periods of life the influence of disturbing causes. But there 
 is also a great difierence in children in this respect. In some, 
 the nervous system is peculiarly liable to this mode of derange- 
 ment, either from inheritance, from powerful impressions, as 
 some suppose, upon the nervous system of the mother during 
 pregnancy, or from inappreciable causes, which often deter- 
 mine, in all the children of certain parents, a predisposition 
 of this kind. Nothing is more common than to see all or most 
 of the children of one family peculiarly subject to convulsions, 
 though the parents may have exhibited no such tendency in 
 their own persons. Children, thus predisposed, show them- 
 selves more impressible than others by ordinary causes, start 
 frequently, are usually excitable, if not properly controlled, 
 are apt to be fretful or irascible, and occasionally exhibit great 
 precocity. . . . The anaemic condition strongly predis- 
 poses to convulsions." 
 
 It will now be perceived, that no difference of opinion exists 
 between these two distinguished writers, and that neither of 
 them has one clear idea on the subject. Both of them set out 
 with the idea that convulsions (see Chapter YIII, Book II) are 
 founded upon the abstract imperfections of infancy, and both 
 whittle entirely away this leading idea, before they conclude, 
 and then close by knowing nothing about the subject. These 
 extracts entirely justify the remarks we made in the chapter 
 and book above cited, and afford us another opportunity to 
 
OF CEREBRAL DISEASE. 317 
 
 treat of a subject that constitutes the foundation of nearly all 
 the forms of disease which are incidental to infancy, and, in- 
 deed, to early and middle-aged manhood. 
 
 Divines and speculative philosophers have frequently refer- 
 red to MAN, as an evidence above all the balance of creation, 
 of the wisdom and design of his Creator; pathologists are 
 constantly, by inference, contending for the contrary. If we 
 are to believe them. Deity bungled more in designing the or- 
 ganization of man, than in all the balance of the organic 
 world ; and, as a consequence of this bungling, one-fourth of 
 the human progeny die before the close of the first year, an- 
 other fourth, before the close of four more years, and another 
 fourth, before the attainment of manhood. Does such a mor- 
 tality mark any other department of the animal creation ? 
 Why does it so happen with man ? Prof. Eberle answers, 
 when he states that " both the anatomical and physiological 
 peculiarities of the infantile system, are indeed such as to ac- 
 count for the special aptitude to convulsive maladies during 
 this tender period of life ;" and Prof. Wood, with much more 
 brevity, answers : " The peculiar state of the nervous system 
 in infancy and childhood." The inference from these answers 
 must be, that children possess a nervous peculiarity which is 
 incompatible with life, health, and longevity. 
 
 Our divines seem to think, and very correctly, that man's 
 unfortunate condition, as concerns morality and religion, has 
 resulted from his countless violations of moral and religious 
 laws ; but medical writers seem not to have suspected that his 
 physical condition, as regards disease and premature death, 
 holds any relation to his numberless sins or outrages against 
 his organic laws. No, in this respect, he has not sinned — his 
 premature sufierings and death result from peculiarities inci- 
 dental to his infancy, in the abstract and necessarily. This is 
 the true and legitimate meaning of our professional writers, 
 and yet none of them seem to believe it — at all events, they 
 do not seem to be satisfied with it ; for Prof. Eberle says, that 
 " all children, however, are not equally disposed to convul- 
 sions." What a fortunate discovery this is ! every child is 
 not doomed to have convulsions, notwithstanding their " ana- 
 tomical and physiological peculiarities," which produce an 
 "especial aptitude to convulsive maladies," during inlancy. 
 
318 NERVOUS FORMS 
 
 Prof. Wood, too, admits that there is " a great difference in 
 children in this respect." Does this difference depend upon 
 the necessary infantile peculiarities ? He informs us again, 
 and Prof. Eberle confirms it, that some children inherit a con- 
 vulsive disposition. This may be true — but how did the pa- 
 rents come by it ? He further states, that some children have 
 this predisposition, whose parents never exhibited anything of 
 the kind. We admit this to be probable, under circumstances. 
 He ought to have informed us whether the children were born 
 in the country that the parents were — a material point this 
 
 '' Mauricean, Leuret, and others," says Prof. Eberle, " assert 
 that children who have very large heads are more liable to 
 convulsions," than those of a contrary condition ; but the pro- 
 fessor thinks this observation to be without foundation, and 
 we agree with him, so long as it stands without qualification. 
 The observation should have been thus stated : Children who 
 have a large cerebrum, or mental organization, with a small 
 cerebellum, or animal one, are the most liable to have con- 
 vulsions — they are, indeed, almost the only ones who have 
 them. In harmony with these remarks, are two which Dr. 
 Wood has incidentally dropped, namely : children thus predis- 
 posed " occasionally exhibit great precocity," and, he adds, 
 ^' the ansemic condition strongly predisposes to convulsions ;" 
 but what are the organic features of the anaemic "condition ?" 
 No writer has yet informed us — we suggest then, that all those 
 who constitute the third class, page 20, are ansemics — and 
 among them are frequently found extraordinary specimens of 
 precocity. 
 
 Dr. Eberle informs us, that Mr. ITorth teaches that the chil- 
 dren of parents who are too young and of those who are too 
 old are more liable than the progeny of those who marry in 
 the prime of life. We shall not dispute that the fact may so 
 exist, in many instances, but we shall deny the presumed 
 cause. K the parties did not marry before they were capable 
 of procreating, then they did not marry too 3^oung, because it 
 was never intended in the plan of creation that man or any 
 other animal should have a power and not rightly manifest it, 
 unless indeed, that the Author of all things bungled in this 
 matter, as he did in the constitution of children if medical 
 writers are to be believed. 
 
OF CEREBRAL DISEASE. 319 
 
 But, as we are much more disposed to attribute human 
 misfortunes to human transgression of wisely-ordained laws, 
 60 we are disposed to admit that many persons have married 
 both too young and too old, because they should not have 
 married at all. In the former, there was not a sufficient via- 
 bility, and in the latter, transgression may have impaired that 
 , viabilit}^ which originally may have been good. We have 
 seen as healthy and viable children from mothers of fourteen 
 and fathers of eighty years of age, as we have ever seen. It 
 will not be denied that this is not sometimes the case, cmi- 
 sequently it cannot be contended that youth and age produce., 
 necessarily, unsound children, and a single exception destroys 
 the rule. 
 
 We conclude then, that the liability possessed by Some chil- 
 dren does not depend upon any of the necessary peculiarities 
 of infancy — that the plan of their existence, in the abstract, is 
 as perfect as that of adults, and, cceteris paribus^ they are as 
 little liable to convulsions. 
 
 Remote Causes. — Strictly speaking, we can acknowledge 
 the existence of no predisposing cause — causes produce modifi- 
 cations of organization to a certain extent, or to an extent 
 compatible with life ; in these modifications exist liabilities to 
 certain family forms of disease, and upon the exciting cause 
 and present circumstances, depend the particular member of 
 the family which shall be developed. 
 
 Upon this department of our subject, Prof. Eberle writes 
 with much propriety and correct discrimination, but when 
 reviewed in detail, or as a whole, he completely contradicts 
 the whole of that doctrine which we have had under review. 
 He shows, in effect, that infantile convulsions do not depend 
 upon inherent peculiarities of the infantile constitution, in the 
 abstract, but are produced by causes acting through the pa- 
 rents to the efiect of unbalancing the organization of the pro- 
 geny. It is true, that he knows nothing of the organic changes 
 which the causes produce — and, without being justly vulner- 
 able to the charge of egotism, we may safely assert, that our 
 first book contains the first revelation that has ever been made 
 on this subject. 
 
 He says, that it is the opinion of some writers that infiin- 
 tile convulsions are much more frequent now than formerly, 
 
320 l^ERYOUS FORMS 
 
 and the assigned cause, in meaning, is about this : that in 
 modern times too much attention has been bestowed upon the 
 mental functions, and too little upon the animal ; and this 
 opinion he very appropriately and forcibly illustrates by a re- 
 ference to our Indian tribes, among whom infantile convul- 
 sions are measurably unknown. 
 
 This paragraph embraces pretty mucn his whole idea of the 
 subject, and though correct as far as he goes, he has not fully 
 embraced the idea — his remarks apply too much to the present 
 training of children, and not enough to the peculiarities of 
 organization that is entailed upon them. Many children die 
 of convulsions before their organization could have been ma- 
 terially affected by training. He seems to have no idea of the 
 vital exhaustion which is effected in parents, by their impas- 
 sioned pursuits of pleasure or business, by which a large and 
 preternaturally active cerebrum, and an equally preternatural 
 smallness and feebleness of the cerebellum, or vital forces, are 
 entailed upon the progeny. This difference, in very many in- 
 stances, amounts to an absolutely unviable condition, even for 
 a week, and beyond this, it is graduated to manhood. 
 
 Exciting Causes. — These are necessarily varied and nume- 
 rous — all causes of irritation in the sources of vital action, in 
 early infancy, may produce convulsions in those who are or- 
 ganically liable ; and at a later period they may be occasioned 
 by sudden impressions made upon the mental department of 
 the brain, and for the reason, that a turgescence of the cere- 
 brum cannot be produced without the sources of vital action 
 becoming similarly circumstanced. These views enable us to 
 comprehend how it is, that even intermittent fever is some- 
 times, in children, introduced by convulsions. 
 
 The irritations in the animal and mental systems of the 
 brain, which produce convulsions, are not generally engen- 
 dered in them, but are transmitted to them from other parts. 
 A fright, by acting through the external senses upon the intel- 
 lect, and through it upon the protective faculties, may result 
 in convulsions ; and irritations, produced by worms in the in- 
 testines, acting upon the extremities of the spinal nerves, and 
 through the spine transmitted to the sources of vital action 
 frequently produce them. 
 
 The Deriod of the first dentition, with ansemic children, is 
 
OF CEREBRAL DISEASE. 321 
 
 fruitful in convulsions, because of the many irritations which 
 are generated by the numberless developments in progress dur- 
 ing its existence. Dentition is generally regarded as the cause, 
 but this we are satisfied is an error — the vegetative system, in 
 its troubles, selects the parts w^hich are directly involved in 
 the dental process, as organs through which to make known 
 to our consciousness, its true and suflering condition. Further 
 than this, the dental process has no more agency than others 
 of equal importance. 
 
 Sanguineous turgescence will produce convulsions as well 
 as nervous irritation, and as the treatment in the two forms is 
 very difierent, it is proper that neither of them should be mis- 
 taken for the other. Under the head of Cerebral Congestion, 
 we have treated of the former, and the other frequently occurs 
 in nervous affections of the pulmonary system. The former 
 is distinguished by sanguineous phenomena, as a flushed and 
 turgid countenance, a contracted, frequent, and tense pulse, 
 dilated pupils, a hot and dry skin, and strong arterial action 
 in the temporal arteries. When the affection is of the latter, 
 or nervous character, the pupils are contracted, the counte- 
 nance is pale, the skin is cool, at least, it is not heated, and 
 the pulse is small, frequent, quick, feeble, and irregular, and 
 very probably results from worms, or some other cause of 
 alvine irritation, as indigestible food, or gastric irritation from 
 inappropriate food . 
 
 Convulsions may, and sometimes are, occasioned by the re- 
 pulsion of cutaneous forms of disease or other morbid drains 
 of the system. We have shown, in another place, that the 
 exanthemata are sometimes introduced by convulsions, and 
 tliat they also follow a repulsion of these forms of disease. 
 The milk of the nurse, after violent mental emotions, or ex- 
 cessive fatigue of the body, has been known to produce fatal 
 convulsions of the child. Convulsions may also be produced 
 by mechanical causes, as blows or falls upon the head, and 
 they result rather from the concussion produced, than the local 
 injury inflicted. These concussions have been known to occa- 
 sion morbid developments of the internal table of the cranium 
 and consequent epilepsy. 
 
 Peognosis. — Although convulsive paroxysms not unfre- 
 quently prove fatal, yet more is to be apprehended from that 
 21 
 
322 NERVOUS FORMS 
 
 particular cerebral organization which occasions a liability to 
 them. Such children may escape convulsions, but die of cere- 
 bral or pulmonary congestion, and they may escape these, and 
 die of phthisis pulmonalis. No matter how circumstanced, 
 such is their inevitable condition, organically, that they have 
 the gauntlet to run, and will finally drop before attaining the 
 meridian of life. Our cities are replete -with such living monu- 
 ments of parental transgression. Ought we to marvel that 
 the progeny of such people should meet with an early grave ? 
 
 According to the custom, we have digressed, for writers, in 
 treating of prognosis, confine their remarks to the existing in- 
 vasion ; but, with us, a useful idea or admonition is never 
 dropped out of place. 
 
 Convulsions, originating in remote irritations, as the hel- 
 minthic, are, cceteris parihus^ less dangerous than the proxi- 
 mate, or such as originate in the brain or its spinal prolonga- 
 tion ; but the former may produce such a structural lesion of 
 the brain as to prove fatal. 
 
 ■ Sudden convulsive seizures, such as happen without premo- 
 nitions, are to be regarded as more dangerous than those of a 
 contrary character. When the paroxysm is attended by pa- 
 ralysis, or squinting, the existence of severe mental lesions 
 may be suspected ; but convulsions, however occasioned, should 
 so far be regarded with apprehensions as to command the 
 most prompt and vigilant attention. 
 
 Treatment. — Many forms of disease produce infantile con- 
 vulsions, and hence the first duty of the physician is to ascer- 
 tain the particular form of which they are a manifestation, 
 and then, to treat the case accordingly. 
 
 If they have resulted from cerebral congestion, the treat- 
 ment will be found under that head. 
 
 If they have been caused by the repulsion of some rash or 
 cutaneous eruption, it should be reproduced by such revulsive 
 measures, as emetics, followed by diaphoretics, and warm 
 drinks, with the application of rubefacients to the spine and 
 extremities, occasionally preceded by warm baths. The most 
 suitable emetic for an infant is the Compound Tincture of Lo- 
 belia, or the Acetated Tincture of Bloodroot. 
 
 If occasioned by indigestible food, or by the inaigestion of 
 proper food, the indication will be to empty the stomach by 
 
OF CEREBRAL DISEASE. 323 
 
 emetics, followed by a small dose of the Compound Powder 
 of Jalap. Cloths dipped in hot water, should be applied over 
 the stomach and bowels during the convulsions, repeating their 
 application every few minutes. 
 
 If alvine obstructions have occasioned them, purgative ene- 
 mata should be freely administered, and for the purpose of 
 revulsive influence, they should always be of a stimulating 
 character; thus. Castor Oil, Molasses, and warm water, of 
 each one ounce, to which may be added one or two fluid 
 drachms of the Compound Tincture of Lobelia and Capsicum ; 
 to be employed for a child six or seven years old. 
 
 K worms have occasioned the convulsions, their expulsion 
 becomes the proper remedy. 
 
 In cases of strong determination of blood to the brain, it is 
 quite common to bleed, but the physician who will reflect that 
 more or less of anaemia is always present, and more or less 
 constitutes the foundation of the malady, will never resort to 
 such a measure, but will relax the surface, and equalize the 
 circulation, by the same means as recommended above, in 
 cases of recession of cutaneous eruptions. 
 
 When dentition is ascertained to be the exciting cause — as 
 the difficult or retarded protrusion of a tooth, we are advised 
 to cut down to the tooth, but to do this with a view of facili- 
 tating its exit, is, in our opinion, betraying an ignorance of 
 every physiological principle, but it must be done, however, for 
 the purpose of relieving turgescence. 
 
 In such cases, our reliance, mainly, should be placed 
 upon revulsives, such as cool or evaporating lotions to the 
 head, pediluvia as hot as they can be borne, and the hot 
 or very warm alkaline wash ; — the warm bath so used and 
 repeated, in the event of much cerebral turgescence, as to keep 
 down all excessive arterial action, will generally succeed in 
 counteracting the spasmodic tendency. Absolutely cold ap- 
 plications to the head are objectionable, first, because they irri- 
 tate, and second, because they may produce collapse. When 
 even moderately cool or evaporating applications are used, we 
 should give attention to the appearance of the face, so that we 
 may discontinue their use, in the event it should become pale; 
 the pulse at the same time being frequently examined, for, 
 
324 JS"ERVOUS FORMS OF CEREBRAL DISEASE. 
 
 should it decline or intermit, such revulsives should be discon 
 tinned. When there exist decidedly inflammatory symptoms 
 and a strong determination of blood to the brain, we approve 
 of immersing the feet in very warm water, and then to use 
 eflTusions of moderately cool water upon the head, shoulders, 
 and thorax. In such cases, rubefacients to the ankles, legs, 
 and back will frequently be advisable, but all vesication should 
 be avoided, because it is liable to result in sphacelation in 
 anasmic infants. 
 
 In all cases of infantile convulsions, the Compound Tincture 
 of Lobelia and Capsicum will be found one of the best agents 
 for speedily allaying convulsive action ; it should be given by 
 pouring it into the corner of the mouth, and repeating the 
 dose every ten or twenty minutes, until the convulsion has 
 ceased. For a child one year old, twenty drops may be ad- 
 ministered at a time. As soon as the child can swallow othei 
 agents, then pursue the treatment as above directed. 
 
CLASS II. 
 
 MAOTFESTATIONS OP DISEASE IN THE SPINAL APPARATUS. 
 
 INTRODUCTION. 
 
 We know that life can be continued for twenty-four hours 
 after the destruction of the spinal cord ; therefore, it may be 
 inferred that it is not so indispensable to existence as the basi- 
 lar portions of the brain ; nevertheless, when we contemplate 
 the quadruple character of its functions, no doubt can be en- 
 tertained as to its permanent importance in the animal econo- 
 my. It receives from, and transmits influence to the brain ; 
 and it receives impressions from and transmits them to all 
 other parts of the system, and thus, as a prompt and faithful 
 telegraph , it maintains unity and harmony of action through- 
 out the entire domain of the animal economy. It acts in con- 
 junction with the ganglionic system, and thus, so far as nerv- 
 ous influence is concerned, it regulates a large majority of the 
 organic functions — exciting alike such as may be demanded 
 by the nutritive, respiratory, digestive, circulatory, secretory, 
 motory, sensory, and procreative functions ; any disturbance 
 of its normal condition produces derangement in all of them. 
 The range of its influence is great, and not more great than 
 complicated, and we regret to add, that we know by far too 
 little of its multiplied forms of disease. So true is this, that 
 we shall omit to treat of many of its so-called "diseases " — 
 selecting only two, which are the most strongly marked and 
 destructive. 
 
 (325) 
 
326 INFLAMMATORY FORMS 
 
 OEDER I. 
 
 IISTFLAMMATORY FORMS OF SPINAL DISEASE. 
 
 The pathological relations of the spinal cord and its mem- 
 branes, very much resemble those of the brain and its mem- 
 branes — its several forms of disease partake of the same 
 peculiarities — those of the one frequently extend to the other, 
 and with both there is a similar obscurity in the symptoms. 
 This, indeed, we might expect from its known complexity of 
 function. Through it, mostly, we become conscious of the ill 
 or good health of our animal and automatic systems. It 
 conveys sensitive impressions from most parts of the body to 
 our source of consciousness, and transmits impressions of voli- 
 tion to the muscles of a large portion of the body. Morbid 
 conditions of the cord produce deranged manifestations in all 
 parts of the body below the point of disease. 
 
 Genus I. — Spinal Meningitis — 
 Inflammation of the Tunics of tJie Cord. 
 
 Under this head, we propose to treat of an inflammatory 
 form of disease of the membranes which invest the spinal 
 marrow. In this case, the inflammatory action may or may 
 not extend to the substance of the cord, and it may or 
 may not involve those of the brain. Of the three investing 
 membranes, it is the fate of the jpia mater to be the most 
 usual seat of the morbid action. 
 
 It appears from medical history, that this variety of disease 
 prevailed in some parts of France, in 1843 and 1844, as an 
 epidemic, and in many instances it proved fatal in twenty-four 
 hours ; it did not, however, attack children, so much as those 
 who had passed the age of puberty ; and, although the inflam- 
 mation was very extensive, and the efiiision beneath the mem- 
 branes copious, yet it but seldom happened that the nervous 
 substance of the cord became invaded. Its course was rapid, 
 rarely extending beyond the fourth day ; it was attended, in 
 the outset, with severe pain in the abdomen, vomiting, purg- 
 ing, and general collapse, but reaction speedily succeeded, when 
 the pulse became full and frequent ; the face acquired a tetanic 
 
OF SPINAL DISEASE. 327 
 
 expression with a firmly fixed retraction of the head. To 
 these symptoms succeeded convulsions, coma, and death. 
 
 With adults, it may not be difficult to ascertain that a dis- 
 eased condition of the spine exists, because they can commu- 
 nicate their feelings, but such is not the case with young chil- 
 dren. When pressure is made upon the spine, and they cry, 
 we cannot be sure that the cry was occasioned by any unusual 
 pain ; they totter in walking when well, and therefore we can- 
 not be sure that any spinal afiection has produced it. 
 
 Mons. Billard informs ,us, that this afiection gives rise to 
 convulsions of the limbs, and occasionally of the face, more 
 especially if it be located near the base of the brain. He 
 further informs us, that in twenty instances of convulsions, out 
 of thirty, he had detected well-marked inflammation of the 
 spine, and in these twenty cases there were six with inflam- 
 mation of the meninges of the brain and of the spinal cord, 
 so that it is probable that convulsions of infants are almost 
 always the result of an irritation or inflammation of the rachi- 
 dian meninges. The following case exhibits the development 
 and the progress of the symptoms of meningitis : 
 
 ''Louis Russal, aged three days, entered the infirmary on 
 the 3d of September. During the preceding night, he had 
 been attacked with convulsions, which continued until morn- 
 ing. His limbs were rigid and violently bent ; the muscles 
 of the face were in a continual state of contraction ; the pulse 
 was full, strong, and frequent. The convulsions diminished, 
 without ceasing altogether, immediately after the application 
 of leeches. The child was very feeble, and respired with diffi- 
 culty, and discharged a quantity of frothy saliva from the 
 mouth. On the morning of the 4:th, the convulsions returned 
 with increased intensity ; the pulse was quickened, the integu- 
 ments very hot. The feeble condition of the child forbade the 
 application of leeches, and the treatment was confined to the 
 application of cold to the head. The convulsions continued 
 during the whole day ; the body remained rigid, and the ver- 
 tebral column, which the weight of the trunk will cause to 
 bend with the greatest ease in the young infant, remained 
 straight and immovable whenever the child was raised. The 
 cry was very acute, the muscles of the face contracted with 
 the same force as before, and they appeared a little more 
 
328 IK-PLAMMATORY FORMS 
 
 drawn to the left side. In the evening, the child sunk, became 
 cold, with a small, intermittent pulse, and died during the 
 night." 
 
 ''^Post 7noTtem examination. — General paleness of the in- 
 teguments, spotted redness of the stomach, a discoloration of 
 the mucous membrane of the small intestines, tumefied and 
 red follicles in the large intestines. A large quantity of 
 effused blood appeared on the surface of the right hemisphere 
 of the brain, and a sanguineous serosity in the lateral ventri- 
 cles at the base of the cranium. The meninges of the brain 
 were pale, those of the spine very much injected, and on the 
 surface of the tunica arachnoidea appeared a very thick pelli- 
 cular exudation ; this coating was very easily removed, leaving 
 the membrane beneath covered with red points without any 
 alteration of tissue." 
 
 '• Such," continues Mons. Billard, " are the symptoms and 
 lesions usually presented by spinal meningitis ; yet it is possi- 
 ble that there may exist simple irritation, without exhibiting, 
 on opening the body, any apparent inflammatory lesions. It 
 is not unusual to find after convulsions, in children, nothing 
 more, as in adults, than simple injection of the meninges ; but 
 ought we to doubt that this is the seat of the disease % and do 
 we not see that there is, in this case, only a difierence in de- 
 gree from the slightest irritation to the highest stage of inflam- 
 mation, the progress of which generally leads to lesions, which 
 afford incontestable proof of the nature of the disease ?" 
 
 " The spinal meninges may participate in the inflammation 
 of all the serous membranes. I once found, in a child that 
 died three days after birth, peritonitis, pleuritis, and rachidian 
 meningitis." 
 
 This inflammation, although it may be very circumscribed, 
 is frequently attended with the most serious symptoms ; and 
 then again, very extensive lesions may be produced with- 
 out being attended with a single well-marked symptom. 
 Hence it follows, that great difficulty exists in forming a diag- 
 nosis. The speedy progress of this malady, its numerous 
 complications, the sudden change it makes from exacerbation 
 to remission, and the uncertainty that attends the nature and 
 duration of all the ^ symptoms, tend to confuse the physician 
 and to render his treatment inefl&cacious. 
 
OF SPIN'AL DISEASE. 329 
 
 Treatment. — During the months of April and May, in 
 1844, a similar epidemic to that of France, prevailed in the 
 southern and central portion of the State of Ohio, at which 
 time a large proportion of the inhabitants of one neighbor- 
 hood were at first attacked, after which the disease gradu- 
 ally extended itself over various parts of the country. In 
 many cases, the persons attacked died within six hours from 
 the appearance of the first symptoms, and mostly in a coma- 
 tose condition, a few having death preceded by convulsions; 
 the greater number of those attacked, however, died within 
 thirty-six hours from its commencement, unless relieved at an 
 early period. 
 
 The plan of treatment adopted by the physicians at the 
 commencement of the epidemic, was copious venesection, 
 Calomel, and Opium, which, with the bare exception of one 
 solitary individual, invariably resulted in death, so far as our 
 observation extended. The treatment which wx adopted, was 
 the application of Granville's lotion the whole length of the 
 spine, until free vesication was produced ; Qninine was like- 
 wise administered in large doses, in connection with Aqua 
 Ammonia, and Tinctures of Castor and Valerian ; and where 
 this failed to produce relaxation of the rigid condition of the 
 muscular system, we employed enemas of Tincture of xlsafoe- 
 tida and Tincture of Lobelia. The above, with applications 
 of warm water to the extremities, strong alkaline baths to the 
 surface generally, and rubefacients to the stomach and abdo- 
 men, resulted in the cure of every case thus treated. The 
 observation and experience afibrded by this epidemic, clearly 
 proved to our mind, that it did not depend upon inflammatory 
 or excessive vital action. We would observe that this epi- 
 demic was confined entirely to adults. 
 
 Genus I. — Myelitis — 
 Inflammation of the Spinal Cord. 
 This afiection of the spinal cord occurs much less frequently 
 than spinal meningitis. As nerves of sensation and motion 
 are supplied by the spinal cord to most parts of the body, it 
 may be readily supposed that disturbances in the functions of 
 sensation and motion will become manifested in those parts 
 
330 INFLAMMATORY FORMS 
 
 which are thus connected with the invaded portion of the 
 cord, and such is found to be the case. 
 
 Beside derangement of motion and absohite pain, there is 
 very generally present a sense of numbness, tingling, formica- 
 tion, and coldness in the limbs. These may occur in one-half 
 of the body, or only in a part of one half. The power of the 
 muscles is also affected, and with this an impairment of the 
 voluntary control over them, which may end in complete pa- 
 ralysis. 
 
 As the anterior portions of the cord distribute motor nerves, 
 and the posterior, sensitive nerves, so it follows that either 
 motion or sensation may be separately destroyed, depending 
 upon the special seat of the inflammation. A rigidly con- 
 tracted or a convulsive condition of the muscles may succeed 
 the paralysis. The automatic system of nerves, sympathizing 
 with the animal, is often attended with much derangement of 
 the automatic or vegetative functions, such as constipation of 
 the bowels, retention of the urine, palpitation of the heart, 
 dyspnoea, hiccough, etc. 
 
 If the inflammation be located about, or at the origin of, the 
 respiratory nerves, life is soon extinguished — at most in one 
 or two days ; but if below that point, as the abdominal organs 
 are not so immediately essential to life, death may not super- 
 vene for several days, or the disease may pass into the chronic 
 state, and continue for weeks, and even for months or years. 
 
 It is taught, that the occurrence of rigidity or tonic spasms 
 indicates the existence of meningeal inflammation, and that 
 paralysis may be considered to generally denote inflammation 
 of the substance of the cord ; but this diagnosis is of but little 
 importance, as the treatment in both, so far as we now know, 
 is, and must be, the same. 
 
 A softening of the medulla is the principal anatomical char- 
 acter of this disease, and it may be partial or difliuent, white, 
 or mixed with sanguineous effusion. A partial softening may 
 exist in a part of the cord, with induration of another part ; 
 and when this condition obtains, the softening is at the supe- 
 rior extremity and the hardening at the inferior. When these 
 two extremes exist, we may pretty safely infer, that they were 
 produced by disease, but considerable softening sometimes 
 
OF SPIJ^AL DISEASE. 331 
 
 exists without our being able to infer that it was diseased ; 
 and yet it may, perhaps, be set down as a law, that extreme 
 softening is attended by paralysis of motion or sensation. 
 
 Post mortem examinations of this disease, not unfrequently 
 disclose sanguineous congestion of the lungs, effusions of blood 
 in the abdomen, cranium, or spine. 
 
 Diagnosis. — It is important that we do not mistake either 
 myelitis or meningitis for rheumatism, and with infants it is 
 difficult to obtain a clear diagnosis. With adults, pressure on 
 the spinous processes will give the most pain when the disease 
 is in the cord, and upon the side of the spine when rheuma- 
 tism exists. When the disease has so far advanced as to pro- 
 duce tonic spasms, or paralysis, then we need have no further 
 doubt. 
 
 Causes. — The most certain causes of this form of disease 
 are strainings of the back and falls, which sometimes happen 
 with children in the hands of awkward nurses, and we may 
 add, atmospheric vicissitudes. It may also result from other 
 diseases of the spine, and likewise from inflammation of the 
 corresponding tissue of the brain. 
 
 Prognosis. — This form of disease must always be regarded 
 as dangerous, though by no means necessarily fatal. The 
 words epidemic myelitis and death, appear to mean the same 
 thing — to be assailed is to be destroyed. When the common 
 form passes into well-established paralysis, death may be an- 
 ticipated with much certainty. 
 
 Treatment. — " In the acute affection," Dr. Wood recom- 
 mends, " bleeding as freely and as frequently as the pulse and 
 general strength will permit ; copious and repeated local de- 
 pletion by cups and leeches along the spine, purging with 
 calomel in the beginning, and subsequently with saline 
 cathartics," etc. When a patient can bear all this and the 
 disease too, the constitution may be said to be proof against 
 both doctors and disease. 
 
 Fever and inflammation are essentially the same — accumula- 
 tions of vital force or action to remove obstructions to secre- 
 tion and absorption. The indications then, must be to relax 
 the system, establish an equilibrium of the fluids, to stimulate 
 the obstructed or diseased parts to action, and lastly, to tone 
 up the general system to a state of health. 
 
332 INFLAMMATORY FORMS OF SPIl^AL DISEASE. 
 
 Now, we beg leave to inquire, wliether it is possible to meet 
 these indications by the treatment of Prof. Wood ? It must 
 now be obvious to every reader that the difference between the 
 Eclectic and the Allopathic practice, is not merely a difference 
 of therapeutic agents, but one of plan — one that conforms to 
 the organic laws, and sustains the organs of their manifesta- 
 tation. But to proceed : 
 
 Asj in these inflammatory forms of disease, it is common 
 for the feet to be cold, while the diseased part is hot, and at- 
 tended by much febrile action, it will be proper, under the cir- 
 cumstances, to commence with a warm pediluvium and rube- 
 facients to the feet and ankles ; sponge the heated surface with 
 water, not too cool to be agreeable, and administer by the 
 stomach and by enema some bland and antispasmodic tea. 
 If the stomach shall reject the tea, administer a mild emetic 
 to allay irritation and cleanse the stomach ; when, by this 
 course, the fever has nearly subsided, it will be proper to give 
 the patient a tepid or vapor bath, with antispasmodic enemas 
 and drinks, and this should be pushed to emesis. If this anti- 
 spasmodic course should not sufficiently impress the system 
 or reduce the febrile action, recourse may be had to stimulat- 
 ing and relaxing alteratives. 
 
 In the meantime, the kidneys should not be neglected — in 
 this and similar forms of disease, as much depends upon an 
 active performance of their function as upon that of the skin. 
 
 Rice-water, corn-gruel, chicken-soup, etc., may constitute 
 the food at this time, provided the patient is not at the breast. 
 As a drink, water with any of the sub-acid fruits will be plea- 
 sant and agreeable. 
 
 To answer the last indication, such stimulants and tonics 
 should be administered as will maintain a proper depuration. 
 
CLASS III. 
 
 MANIFESTATIONS OE DISEASE IN THE RESPIEATOEY APPARATUS. 
 
 INTRODUCTION. 
 
 In entering upon the consideration of the respiratory forms 
 of disease, we shall find death equally urgent in his demands, 
 and perhaps no less successful in his enterprises, but we shall 
 have a little less doubt and uncertainty in arriving at a correct 
 diagnosis and prognosis — we shall feel that we are more in the 
 path of science than in that of uncertainty and hypothesis. 
 
 We shall find, in our course, many occasions to lament that 
 our predecessors have been so disobedient to the organic laws, 
 as to have made it necessary that so much life must, in defi- 
 ance of our skill, be wasted through the imperfection of the 
 respiratory apparatus ; and when we contemplate the imme- 
 diate indispensability of a faithful and prompt performance of 
 the functions of this class to the continuance of life, we should 
 not feel surprised, that if exceedingly few of a faulty organi- 
 zation should be spared. 
 
 In these reflections, furthermore, we may find some excuse 
 for ourselves — some consolation, that the fatality depends more 
 upon the necessity of the function and imperfection of the ap- 
 paratus, than upon any relative deficiency of professional 
 ability. 
 
 The great cause of infant mortality must not, and should 
 not, be sought in the normal peculiarities of infantile organi- 
 zation, as has been done, more or less, by all writers, or their 
 manifestations of disease, but in those imperfections of organi- 
 zation which were entailed on them, and in consequence of 
 which they become, to an extent, more or less, non- viable. 
 
 This is not all ; many peculiarities incidental to the infantile 
 
 (333) 
 
334 MAITIFESTATIOIS'S OF DISEASE 
 
 functions, are referred, by different writers, to different ab- 
 normal conditions, and consequently, an error of this kind 
 may lead to errors of pathology and practice. Every physi- 
 cian should, therefore, study in the infants themselves, the 
 normal peculiarities of their functions. This duty will become 
 apparent before we conclude these introductory remarks. 
 
 The respiratory apparatus of infants is as indispensable 
 to them at birth, as it ever will be, and yet between its func- 
 tions in infancy and in adolescence there are some very strong 
 points of difference, which claim our attention in this place, 
 rather than in any other. 
 
 If we take seventy-five pulsations and twelve respirations, 
 per minute, as representing the normal standard of the pulmo- 
 nary and circulatory actions in adults, which probably is very 
 nearly correct, and thirty-nine respirations and one hundred 
 and two, as the normal motions of the same apparatus in chil- 
 dren a week old, we shall discover in them, respectively, a 
 remarkable difference, and one which will greatly deceive us, 
 if we attempt to draw from them, a jpriori^ conclusions in re- 
 spect to any of the known results of respiration. 
 
 It is, for instance, well known that the respiratory function 
 is indispensable to the calorific function, and that it is usual 
 for a rapid respiration and circulation to produce an increase 
 of temperature, and yet the temperature of an infant is much 
 below that of an adult. 
 
 If we w^ere to admit as true, a common impression, that in- 
 fants have a sort of double duty to perform — to provide for 
 their daily waste — to eliminate this waste in the form of effete 
 matter, and also to build up their systems and repair the 
 waste — we say, upon the admission of this proposition, we 
 might contend for a double portion of function in the respira- 
 tory and circulatory apparatus ; but while it is true that they 
 perform one duty from which adults are exempt — the building 
 up of the system — yet it is not true that they do as much in 
 the repairment of waste. 
 
 In infancy, there is very little waste in the animal system, 
 all of the emotional and intellectual portions of the brain are 
 almost or wholly idle, and the same is nearly as true of the 
 locomotive — producing scarcely any waste. In their digestive 
 system there is, relatively less waste, because their food is 
 
m THE RESPIRATORY APPARATUS. 335 
 
 already assimilated to their purpose. Their whole duty then, 
 is scarcely equivalent, indeed it is not equal, to the adult re- 
 pairment of waste. In harmony with these conclusions we 
 will find the results of their respiratory and circulatory func- 
 tions. 
 
 Although infants breathe much more frequently than adults, 
 they generate much less animal heat. The explanation of this 
 we do not think so difficult as it has appeared to some writers 
 on this subject. Men of active habits have usually an abun- 
 dance of animal heat, and the activity of their habits occa- 
 sions much waste. !N"ow, if we contemplate the amount of 
 oxygen requisite for the elimination of the effete matter, and 
 for the supply of the daily waste, we shall discover an ample 
 source of their animal heat ; but in infancy^ there is but little 
 waste, and of course there is not much effete matter to be 
 eliminated ; now, if we include these two processes with that 
 of building up, we shall not have an amount of demand for 
 oxygen in the infant, equal, cceteris paribus^ to that of the 
 adult. This is not the end of the argument: the adult re- 
 ceives, as ingesta, more carbon and hydrogen, than the infant, 
 and yet, by the aid of the respiratory function, he, as a gene- 
 ral fact, uses it in the production of animal heat; but the in- 
 fant, notwithstanding its rapid respiration, cannot use, for this 
 purpose, the little it receives, but stores it away in the adipose 
 tissue. How shall we account for this ? We will give our 
 explanation of it presently. 
 
 It is now an ascertained fact, that the amount of carbonic 
 acid evolved at each expiration is diminished in the ratio of 
 its increased frequency ; consequently the conclusion is au- 
 thorized, that we cannot compute the quantity of the pulmo- 
 nary function by the activity of the respiratory movements ; 
 then, what is gained by the activity of the respiratory appara- 
 tus in infants, and wherefore the necessity of it ? These are 
 the questions we have now to answer. 
 
 In the outset of this inquiry, it must be remembered that 
 the infant manifests very few animal functions ; and these few 
 are, comparatively, of but little importance to it ; from this 
 fact, it is to be inferred that that portion of the brain which 
 was intended to preside over the animal functions is not in a 
 condition to discharge its assigned duty, and will not be until 
 
336 MAMFESTATIONS OF DISEASE 
 
 the functions that constitute the duty shall be required — that 
 its power of volition is exceedingly feeble. 
 
 In the next place, we must consider the respiratory function 
 as being, in a measure, when perfect, an animal or voluntary 
 one. Highly concerned in this function are a great number 
 of the voluntary muscles, and to the respiratory apparatus, as 
 a whole, are sent many of the animal nerves. In the last 
 place, the infantile lungs are of a pale red color — not the color 
 of mature, adult, or perfect lungs. 
 
 The conclusions that appear to be justified by the preceding 
 facts, are these: 1. The lungs being imperfectly developed, 
 are incapable of appropriating to the use of the system all the 
 oxygen that may enter them at any given moment. 2. The 
 incapacity of infants for volition renders them unable to bring 
 to the aid of this function the many muscles which were in- 
 tended to aid it at a future period ; because of this imperfec- 
 tion, the chest or thorax is never, ordinarily or voluntarily, 
 fully expanded. 3. The preceding difficulties create a neces- 
 sity for rapid respiratory movements, that is, rapid under the 
 necessities of the case, to obtain that oxygenation of the blood 
 which both health and development require. 
 
 The above conclusions are, it would seem, more satisfactory 
 than those presented to us by Dr. West, who says : " There 
 seems good reason for believing that the rapid breathing of 
 the child is to some extent the result of its more delicate 
 frame, rendering it unable, at a single effort, to inspire as 
 deeply as the more robust adult, so that it is compelled, by 
 the frequent repetition of its efforts, to make up for their com- 
 parative feebleness." 
 
 We do not like this language — it seems to convey the idea 
 that the infant is not as well adapted to its mode of being as 
 the adult is, which we can never admit. A healthy child is, 
 vitally, just as strong as a healthy man — it can resist dis- 
 ease as well, and is as well adapted to its age. As their 
 lungs are not fully developed, and therefore might be injured 
 by extensive impressions of atmospheric air, and as their 
 functions do not require that high state of oxygenation that is 
 indispensable to the mental functions, the full expansion of 
 their lungs is not required. For some time after birth, they 
 appear to exist, in some measure, in conformity with the laws 
 
IN THE RESPIRATORY APPARATUS. 337 
 
 that governed their intra-uterine existence. This conclusion 
 is sustained by the imperfect condition of their lungs, and the 
 low state of their temperature. 
 
 In adult life, the voluntary portion of the respiratory func- 
 tion, by long practice, becomes habitual and unconscious, as 
 do many of the voluntary functions. That this is not the 
 case in infancy, may be clearly inferred from their manner of 
 breathing, which is intermittent or by pauses. Dr. West 
 regards this manner of breathing as " another token of the 
 feebleness of the respiratory power." " This respiration," he 
 says, " is almost entirely abdominal ; the chest moves but 
 little and its walls are but little expanded." These facts do 
 not support his idea of feebleness, but our conclusion, that the 
 child has no power over the voluntary muscles, for if it had, 
 the chest would both move and expand. 
 
 In the investigation of the morbid manifestations of the 
 several parts involved in the respiratory function, we shall 
 find it to be our duty, frequently, to add physiological remarks 
 for the elucidation of symptoms or pathological conditions — 
 therefore we will now close these general considerations. 
 
 OEDEE I. 
 
 INFLAMMATOET FORMS OF DISEASE IN THE KESPIEATOEY APPA- 
 RATUS. 
 
 Genus I. — Catarrh — 
 A Cold. 
 This form of disease, though very frequent and often trouble- 
 some, scarcely needed a formal notice — it very rarely does, 
 directly, much mischief, and everybody has remedies for it, 
 which are generally efficacious ; we notice it merely because 
 it is an affection which is probably more common to early 
 than to adult life, because the mucous tissues are more vascu- 
 lar in the former period than in the latter. 
 
 Catarrh, when unattended by any other word to give it a 
 special signification, is used to designate an inflammatory 
 afiection of the mucous membrane cf the respiratory passages^ 
 22 
 
838 II^FLAMMATORY FORMS OF DISEASE 
 
 We shall have occasion to treat of individual portions of this 
 membrane, but as the whole of it may be the subject of 
 inflammation, at one and the same time, the word catarrh is 
 used to express it. 
 
 It is difficult to determine why a catarrhal inflammatioD 
 should be generally diffused in this mucous membrane, whilp 
 those of which we shall treat should, in a very great degree 
 be confined to particular portions of it. In catarrh, the cause 
 appears to be general, while in the other forms of disease of 
 this membrane, it seems to be specific. The facts connected 
 with catarrh give it the character of a vicarious function, 
 rather more than that of disease — which is really in some other 
 part. Cold, acting upon the skin, under certain circumstances, 
 so as to check its secretion, produces catarrh. The same is 
 very frequently verified of the mucous membrane of the ali- 
 mentary canal — a want of secretory action in this membrane 
 often results in catarrh. The manifestations of disease in 
 special portions of the respiratory membrane, must be ac- 
 counted for by a reference to special predispositions or to spe- 
 cific causes. Prof. Wood says, that he has " never been able 
 to discover anything specific in its (catarrh) character." We 
 think it to be specific, in being uniformly general, and not con- 
 fined to any particular portion of the respiratory membrane. 
 
 Sneezing, though frequently occasioned by other causes, 
 than those of catarrh, is very frequently the first indication of 
 an assault by the latter, to which succeed, very rapidly, 
 coryza, laryngitis, trachitis, bronchitis, and lastly, the tubes 
 of the bronchia are involved ; but it may commence in the 
 bronchial tubes and travel in the contrary direction. In gene- 
 ral, the grade of infiammation is low and about equal in all 
 the parts assailed. Its seizure upon the pulmonary ramifica- 
 tions of the bronchia is apt to induce catarrhal fever. 
 
 When the catarrh is of a pretty violent character, it is quite 
 apt to make a special assault upon the lining membrane of the 
 nostrils, producing ozsena narium, from which is discharged 
 offensive and often bloody matter, or it may specially assail 
 the superior maxillary sinuses, producing ozsena antri high- 
 mori ; in either event much pain will be complained of, until 
 the ulcers break. It is often difficult to cure these ulcers, and 
 much time is usually required for it. 
 
IN THE RESPIRATORY APPARATUS. 339 
 
 Treatment. — In the treatment of this, usually simple, affec- 
 tion, it is proper to direct our attention to the cause. If it 
 has resulted from a suppression of the cutaneous function, then 
 the indication is to restore this function — and if from a sup- 
 pression of secretion in the liver or alimentary mucous mem- 
 brane, then our attention must be respectively addressed to 
 them. If the morbid affection shall commence or run into 
 the form of coryza, angina, laryngitis, or bronchitis, the treat- 
 ment will be found under these respective heads. When it 
 makes its assault in either of these forms, it should meet with 
 prompt attention, that such further consequences as are fre- 
 quently known to ensue may be prevented. In general, the 
 indications are, to equalize the circulation — remove all causes 
 of irritation, and lastly, to restore the general tone of the 
 system. 
 
 To meet the first indication, a tepid bath, or a vapor bath, 
 which is preferable, aided by diaphoretic and antispasmodic 
 agents, will generally be sufficient, more especially if the affec- 
 tion result from a suppressed secretion of the skin. "* 
 
 If the bowels have been at fault, aperients or stimulating 
 enemas will be indicated. 
 
 The utmost attention should be given to the skin — it should 
 be well cleansed and moderately stimulated ; and this may be 
 done by friction, stimulating liniment, Cayenne or Mustard, 
 poultices, etc., more particularly to the feet, and foot-baths, 
 with the internal use of warm diluent drinks, and in severe 
 cases, expectorants and emetics. 
 
 Genus II. — Coryza — 
 Inflammation of the JSFostrils — Cold in the Head. 
 
 In treating of this subject, we shall incidentally embrace 
 the maxillary and frontal sinuses, because the general treatment 
 of them is the same, and because they are generally, though 
 not always, implicated at the same time. With the unlearned, 
 the affection is generally denominated " a cold in the head." 
 
 Coryza is an inflammation of the schneiderian membrane 
 lining the nose and the sinuses communicating with it, 
 and attended with an increased discharge of mucus. It 
 is very generally introduced by frequent sneezing, which is 
 soon followed by a discharge of thin, ropy mucus from the 
 
340 mFLAMMATORY FORMS OF DISEASE 
 
 nares. If the irritation pass into inflammation, the mucus 
 will become yellow and then purulent. 
 
 This affection, in adults, very seldom demands medical atten- 
 tion, but the case is frequently very different with infants. 
 The nares are not, to those above the age of infancy, necessa- 
 rily air passages — the mouth may be substituted for them. 
 Children cannot suck and breathe at the same time through 
 the mouth — to them, the nose is indispensable — the nares are 
 the true respiratory passages — infants always breathe through 
 them, instinctively and spontaneously when they can, but 
 when they are closed they are spasmodically forced to breathe 
 through the mouth. When the nares are closed, no matter by 
 what cause, infants, not having any reflective ability, do not 
 open the mouth voluntarily to create an air passage to the 
 lungs, but it is, by pauses, spasmodically opened by the vege- 
 tative demands of the system. 
 
 In this wise, a proper oxygenation of the blood cannot be 
 effected, nutrition must cease, because they cannot suck and 
 breathe at the same time, consequently, death must soon ter- 
 minate their existence, and sometimes it does, even before 
 death becomes imperative from marasmus. 
 
 Prof. Meigs has introduced, in his work on children, a case 
 of this disease, and he has done it in a manner so well calcu- 
 lated to arrest the attention of a young practitioner, that we 
 deem it proper to extract his account of it : 
 
 " Being notified, by an urgent message, of the dangerous 
 condition of the young infant, I hastened to the house, and 
 finding the friends solemnized by the approaching event, I, 
 also, was at first convinced that the child was about to perish. 
 
 " It breathed after very long intervals, during which there 
 was no apparent attempt to respire, and I noticed, that when 
 it did make its aspirations, they were very sudden, rapid, and 
 violent, after which it relapsed into its non-respiring condition. 
 
 " I did not understand the nature of the case, but I remarked 
 that it could not be spasmodic nor pseudo-membranous laryn- 
 gitis, nor, indeed, any laryngeal affection, because, when 
 it did respire, it did so with full freedom and perfec- 
 tion, which could not be predicated of any affection of the 
 larynx, of the bronchi, or the lungs. 
 
 " In the doubt in which I was placed, I took the child on 
 
m THE RESPIRATORY APPARATUS. 341 
 
 its pillow upon my knee, in order to inspect it more closely ; 
 an inspection which left me no room to doubt that the obstruc- 
 tion was in the nares, and upon a closer examination, I found 
 that the nares were entirely stopped up, as I before remarked. 
 By means of the head of a pin, I removed the plug from the 
 external nostril, but I could not free the deeper parts of the 
 passages. 
 
 " Seeing that the child was about to die — and I have, at 
 this moment, no doubt that it was, but for the rescue, within 
 half an hour of its death — ^^I lifted it in my hands, and apply- 
 ing my mouth to the nostrils and blowing violently into the 
 openings, I loosened and discharged the plugs into the 
 pharynx, after which it was in a few minutes perfectly well, 
 and I had no further trouble with it." 
 
 However unimportant this disease may be with adults, this 
 case carries with it the strongest conviction, that, with neonati, 
 it may be attended with death, and often, too, as it is a 
 malady of considerable frequency. 
 
 Every adult knows how difficult it is, sometimes, to breathe 
 through the nostrils in this disease, and, admitting the nares 
 not to be entirely closed, but even in a small degree so, it 
 must to an infant be very distressing and injurious, inasmuch 
 as it is not capable of converting the mouth into an air 
 passage. 
 
 Infants usually sleep with the mouth shut, but when suffer- 
 ing under this malady, they cannot do it, although such is the 
 effort to do it, that their rest is broken and unrefreshing. The 
 respiration is noisy and attended with a sort of whistling 
 sound in the nasal fossse ; the respiration becomes more diffi- 
 cult as the nasal mucosities become more copious and consis- 
 tent. The orifices of the nostrils should be closely watched, 
 as the mucus, by drying, is constantly making an effort to 
 close them. 
 
 There is, in some cases, such a rapid increase of the symp- 
 toms as to destroy the infant in three or four days ; but in 
 general, as it does not prevent the child from sucking, it is 
 not dangerous. It is with the tumefaction of the pituitary 
 membrane that difficult respiration begins, and with it the 
 danger. 
 
 The inflammation of the pituitary membrane sometimes 
 
342 INFLAMMATORY FORMS OF DISEASE 
 
 throws out mucus of such a quality that it concretes and forms 
 a pseudo-membranous covering in the nasal fossse. As this 
 is preceded by all the symptoms of coryza, we may conclude, 
 that the formation of the membrane only indicates a more 
 violent form of the disease. It is rarely ever possible to diag- 
 nose the existence of this membrane. Post mortem examina- 
 tions have shown the pituitary membrane to have been in- 
 tensely inflamed. Such cases are generally, if not always, 
 fatal. 
 
 CoTjzsi may pass from the acute to the chronic form, and to 
 harass the. patient for many months, and finally destroy it by 
 the disorganization it produces ; very frequently implicating 
 the brain, producing acute hydrocephalus more likely than 
 any other disease. Such an event is preceded by drowsiness, 
 prostration, and other signs of cerebral irritation. 
 
 Causes. — The most frequent cause of this malady, with 
 children, is, no doubt, exposure to wet and cold — an exposure 
 which requires vigilance to prevent. It is thought to be occa- 
 sioned by a sudden check of cutaneous perspiration, more par- 
 ticularly when the application of the cold is partial, as to the 
 feet and back of the neck. From the cause we have assigned, 
 it may be inferred that the complaint is more common in win- 
 ter than in summer. It is furthermore true, that some persons 
 are more liable to it than others. 
 
 Treatment. — This form of disease is frequently so very 
 mild as to require nothing more than such prudence as may 
 be requisite to prevent an increase of it — it will be sufiicient 
 for this purpose to keep the patient still, its feet warm, and 
 person comfortable, with some reduction of the food. But 
 should it be so violent as to cause considerable complaint, it 
 will only then be necessary to cleanse the surface by a tepid 
 or vapor bath, or simply by washing it thoroughly with a weak 
 lye ; and while this is being done, the patient should drink a 
 warm infusion of Nepeta Cataria, Salvia Officinalis, or Scu- 
 tellaria Lateriflora, and have the feet in a tepid bath rendered 
 stimulating by the addition of ashes, salt, mustard, or cap- 
 sicum ; and then, after being dried with a- warm cloth, to be 
 covered warmly in bed with a hot and moistened brick, or a 
 few ears of boiled corn, to the feet. Warm lemonade is fre- 
 quently very beneficial as a drink while the patient is in bed. 
 
m THE RESPIRATORY APPARATUS. 343 
 
 In this stage of the malady, there is some tendency to con- 
 stipation, which should so far claim our attention, by enemas, 
 as not to permit the fecal accumulations to become a source of 
 irritation. In the milder forms of the disease, this course of 
 treatment will generally be sufficient. 
 
 Should the symptoms be more severe and attended with 
 fever, the Powder of Ipecacuanha and Opium, in small doses, 
 or Compound Tincture of Virginia Snakeroot, with a free use 
 of warm diluent drinks, may be added to the above treatment. 
 
 If there should be much headache, with a full, strong pulse, 
 poultices of Mustard should be applied to the feet, and the 
 head may be bathed with the Cooling Lotion. 
 
 In case of much inflammation of the frontal or maxillary 
 sinuses, the inhalation of vapor of Yinegar will be found use- 
 ful, and which may be accomplished by placing a towel over 
 the child's head, in such a manner as to retain sufficient vapor 
 for inhalation, when the nostrils and mouth are placed over 
 it ; the steam or vapor may be obtained by throwing the 
 Yinegar on a hot brick or shovel. 
 
 The pain in the frontal and maxillary sinuses is sometimes 
 exceedingly severe, and for its mitigation many experiments 
 have been tried. Dr. "Wood states, that he knew an indi- 
 vidual who obtained instant relief by snuffing powdered 
 Cloves, and for the same purpose powdered Cubebs have been 
 used in the same way. It is said that Camphor held to the 
 nose often affords relief. It is further stated, upon the au- 
 thority of Dr. Harrington, of Philadelphia, that the inhala- 
 tion of Chloroform gives immediate ease. 
 
 The discharges from the nares are sometimes exceedingly 
 excoriating, and for the purpose of protecting the nasal orifices 
 and the lip, a little Suet or Spermaceti Cerate may be rubbed 
 on them. It is stated that these discharges depend upon the 
 serum of the blood, and as it becomes diminished they cease; 
 and upon this principle, Dr. Williams prohibits the use of all 
 fluids, and with much advantage, as he conceives. The dis- 
 ease, under this treatment, rarely lasts more than a day, and 
 hence, after two or three days of suffering, the patient is quite 
 relieved, and may again return to the moderate use of 
 liquids. 
 
34:4: INFLAMMATORY FORMS OF DISEASE 
 
 Genus II. — Laryngitis — • 
 Inflammation of the Larynx. 
 Species I. — Acute Laryngitis. 
 There is, among writers, considerable variety of opinion 
 upon the subject before us, and after bestowing upon it con- 
 siderable attention, it seems to us that Prof. Wood has mani- 
 fested the clearest discrimination ; and therefore, we adopt his 
 divisions of it. Under the above head, he has three varieties : 
 1. Mucous Laryngitis; 2. Sub-mucous Laryngitis ; 3. Pseudo- 
 membranous Laryngitis — to which we have added, Spasmodic 
 Laryngitis. 
 
 Yaeiety I. — Mucous Laryngitis — Cold in the Chest. 
 
 This is an erythematic inflammation of the mucous mem- 
 brane of the larynx, which, though of frequent occurrence 
 among infants, is much more frequently met with in children 
 of a more advanced age ; but no age is exempt from it. It 
 sometimes exists alone, but frequently follows coryza, and fre- 
 quently arises in the course of scarlatina, variola, etc. It is 
 not uncommon for it to descend and involve the trachea and 
 bronchia, but more frequently extends upward to the fauces, 
 and sometimes invades all. We usually find, by looking 
 into the fauces, the velum, uvula, and fauces to be some- 
 what red. 
 
 The progress of this disease is usually rapid, but its symp- 
 toms are frequently obscure at first ; the patient, however, will 
 always be found manifesting more irritability and restlessness 
 than would be expected from the existing signs of disease. 
 
 In infancy, the cry is sufficient to diagnose the disease when 
 it is violent. It is frequently so faint as scarcely to be heard, 
 while the reprise is, on the contrary, acute and predominant. 
 This inflammation, even in its mildest form, is attended with 
 an abundant secretion of mucus, which at first is clear and 
 thin, but it soon becomes thick and yellow. 
 
 When the child sleeps, a quantity of mucus is apt to accu- 
 mulate in the larynx, which may cause it to wake with a sud- 
 den start and threatened sufi'ocation ; it coughs, makes an 
 attempt to cry, but cannot do it, until after a powerful eflbrt, 
 which dislodges the mucus that obstructs the passage to the 
 
m THE RESPIRATORY APPARATUS. 345 
 
 glottis. Although the air passage is very narrow, it is scarcely- 
 probable that an inflammation of the mucous membrane of 
 the larynx could close it up so as to produce asphyxia; but, 
 that tough mucus may so collect or accumulate in the larynx, 
 as to produce such a result, is very probable. Asphyxia is 
 produced by one cause or the other. 
 
 In the post mortem examinations of such asphyxied cases 
 as we have been able to find of this disease, we have not found 
 that the asphyxia was caused by tumefaction of the mucous or 
 sub-mucous tissue ; we infer, therefore, that it resulted from 
 an accumulation of mucus. 
 
 This disease is frequently so mild as to attract but little 
 attention, and even this mild form of it, in adults, is apt to 
 destroy all audible voice, a whisper is the loudest sound the 
 patient can make ; in infants, the cry may be similarly affected. 
 But the helplessness of infants renders the disease, however 
 mild, dangerous to them, because, of the mucous accumula- 
 tions, which they cannot readily throw off — it is then, always 
 dangerous to them. 
 
 Some degree of fever usually attends this disease, and it 
 may appear simultaneously with the other symptoms, or not 
 until they have appeared. It usually runs its course in five 
 or six days, terminating in resolution, the secretion of mucus, 
 or it may pass into the chronic state. 
 
 Species II. — Sub-mucous Laryngitis — Cold in tlie Chest, 
 This is said to be the disease of which General Washington 
 died. This circumstance not only distinguishes it, but gives 
 it, almost, a diagnostic character. 
 
 Sub-mucous laryngitis is thought to be more common to 
 adults than to children ; and furthermore, it is thought to be 
 only a violent stage of the mucous or ery thematic variety. 
 Some of the symptoms, such, for example, as commencing 
 with a chill, which is followed by fever, attended with alter- 
 nating sensations of chilliness and heat, would seem to indi- 
 cate a disease of a more extensive invasion and consequently 
 of more danger. 
 
 That an erythcmatic inflammation can be mild or violent, 
 is not a matter of doubt, but when it leaves its proper resi- 
 dence, the surface, and seizes upon a sub-tissue, it is no longer 
 
346 mFLAMMATORY FORMS OF DISEASE 
 
 tlie same form of disease ; consequently if the sub-mucous 
 tissue of the larynx constitute a part of this afiection, it is not 
 simply an inflammation of the mucous surface, though it may 
 have been originally. We do then, regard this as an essen- 
 tially different form of disease, although an observance of the 
 distinction may be of no diagnostic or therapeutic impor- 
 tance. 
 
 That there is not more than one or two per centum of fatal 
 cases in the previous disease, is very probable, and if there be 
 less than fifty in this, it is not so violent as we think it to be. 
 We speak with reference to that kind of practice which General 
 Washington had the misfortune to have. Many of the cases 
 supposed to be of the previous variety, which terminated 
 fatally, may really have passed into this, and effected the mis- 
 chief, but to us, it is more probable that laryngeal accumula- 
 tions of mucus did the mischief, because both varieties appear 
 to maintain an independent consistency from beginning to 
 end. In the treatment of infants, there must generally exist 
 more or less of doubt, because, as they cannot communicate 
 their feelings and sufferings, the means of a clear diagnosis 
 must be greatly reduced. 
 
 If the patient be old enough to communicate his feelings, 
 among the first symptoms of which he will complain, is sore 
 throat — difiicult and painful deglutition — and it should be 
 remembered that this symptom should always excite alarm, 
 unless we are satisfied that the inflamed condition of the fauces 
 is sufficient to explain the full extent of the symptom, which 
 it cannot do, when it is occasioned, mostly, by an inflamma- 
 tion of the epiglottis. 
 
 The function of expiration is perhaps always easy, but that 
 of inspiration is exceedingly painful and difficult, because of 
 the inflamed and swollen condition of the membrane of the 
 glottis, which causes it to close against the entrance of the 
 air, consequently the acts of inspiration are greatly prolonged 
 and attended with a whistling, wheezing sound, as though 
 the air was drawn through a reed. 
 
 When the air passage is very narrow, as it usually is with 
 infants, it is not unfrequent, and it sometimes happens to 
 adults, that the tumefaction of the mucous' and sub-mucous 
 tissues may produce suffocation, and then we have added to 
 
m THE RESPIRATORY APPARATUS 347 
 
 the phenomena which usually follow such an event, the facial 
 expression of great pain and suffering. 
 
 Yomiting very seldom attends this disease, but as the child 
 sucks badly, it sometimes happens that at the moment of deglu- 
 tition, the pain occasioned by the movement of the pharynx, 
 will induce it to quit the breast and suddenly to cry, which 
 will cause the fluid, in the oesophagus, to reflow toward the 
 mouth, and in this movement of it, a little may enter the 
 larynx and cause a sudden, suffocating cough that may greatly 
 endanger the patient. Accumulations of mucus in the larynx 
 may take place during sleep, and produce similar results. 
 
 In this disease, the epiglottis sometimes becomes so inflamed 
 and swollen as to become incapable of a normal adaptation to 
 the glottis, whereby particles of substances, in the process of 
 deglutition, obtain access to the larynx, and produce intense 
 irritation, which is succeeded by paroxysmal coughing and a 
 painful difficulty of breathing. 
 
 In this stage of the disease, the child is exceedingly restless 
 and distressed, never able to sleep bilt a few minutes at a 
 time, so urgent are the demands for fresh air ; its system begins 
 to show signs of insufficient oxygenation — the surface becomes 
 cool ; the pulse becomes small, frequent, and feeble ; the lips 
 bluish; the face livid, and, in the respiratory efforts, the 
 shoulders rise, the chest heaves, the skin becomes covered 
 with a clammy, cold sweat, and then succeeds delirium, coma, 
 and death. 
 
 But death does not always come on thus gradually — life is 
 sometimes suddenly arrested by a complete closure of the air- 
 passage to the windpipe ; but without this event, so rapid is 
 the course of the disease sometimes, that death may super- 
 vene at any time between seven or eight hours and three or 
 four days ; and yet, when the attack is mild and slowly pro- 
 gressive, it may continue three or four weeks, and then termi- 
 nate in death, in resolution, in the chronic form, or by serous 
 effusion into the sub-mucous tissue, and thus death may result 
 from a recuperative process of the system, and it may not — 
 depending entirely upon the extent of the efiusion. 
 
 Cases have been witnessed, in very feeble infants, of an 
 oedematous afiection of the throat, in which the only marked 
 symptom of laryngitis was the cry, the debility being, as was 
 
348 INFLAMMATORY FORMS OF DISEASE 
 
 supposed, too great to produce the inflammatory symptoms to 
 an appreciable extent. But in these cases of cedematous 
 laryngitis, oedema was found to obtain on various parts of the 
 body. 
 
 Diagnosis. — Constitutional results, resembling those of 
 laryngitis, do sometimes attend manifestations of disease in the 
 chest; but still, we cannot consider it as scarcely possible that 
 either can be mistaken for the other. The seat of the pain, 
 the change of voice, and the peculiar cough should always 
 distinguish laryngitis from pectoral affections. 
 
 Teeatment. — The treatment of the mucous and sub-mucous 
 forms of laryngitis will be similar ; it should be commenced 
 with a mild emetic, as the Compound Tincture of Lobelia; 
 after which, some slightly stimulating liniment should be ap- 
 plied to the neck and throat, two or three times a day, followed 
 by the application of cloths wet with warm water, or a warm 
 fomentation of Hops and Mullen leaves, around the throat. The 
 feet and legs should be placed in a vessel of warm lye-water 
 for ten or fifteen minutes, and which may be repeated daily, 
 or even twice a day. Expectorants must be administered, 
 such as the Compound Tincture of Lobelia, in small doses, 
 repeated several times a day ; or, 
 ?r. Syrup of Squills, 
 
 Syrup of Senega, aa^j. 
 Camphorated Tinct. of Opium, 3ij, 
 Tinct. of Lobelia, 3j. Mix. 
 Of this, ten or fifteen drops may be given to a child five years 
 of age, and repeated three or four times a day. 
 
 When children are sufiiciently advanced in years to inhale 
 vapor, the warm vapor of vinegar should be inhaled several 
 times a day. The bowels should be kept open by laxatives, 
 and if there be much febrile disturbance, the Compound 
 Tincture of Virginia Snakeroot may be given in sufficient 
 doses to maintain moderate diaphoresis, with warm diapho- 
 retic infusions. Mustard plasters to the feet should not be 
 omitted. 
 
 When these two forms of disease become more active, and 
 consequently more serious, they demand a prompt and ener- 
 getic course — the emetic maybe repeated daily for several 
 days ; diaphoresis should be constantly kept up, and some 
 
m THE RESPIRATORY APPARATUS. 349 
 
 riibefocient applied to the back of the neck and between the 
 shouklers. 
 
 The room should be kept warm, being careful not to allow 
 a current of cool air to pass over the patient, and the diet 
 should be extremely meager. 
 
 In the case of adults, the only variation in treatment is in 
 the adaptation of the doses, the more active medication, and 
 the use of a gargle composed of an infusion of equal parts of 
 Hydrastis Canadensis, Myrica Cerifera, and common salt, to 
 half a pint of which may be added a drachm of black pep- 
 per, and two ounces of vinegar ; — the throat may be gargled 
 with this four or five times a day. 
 
 After the severe inflammatory symptoms have subsided, 
 leaving a troublesome cough, with irritation of the fauces, 
 glottis, etc., the following compound will prove very beneficial: 
 ^5r. Saturated Solution of Alum, 
 Syrup of Balsam Tolu, aa 3ij, 
 Camphorated Tinct. of Opium, 3j. Mix. 
 An adult may take a tablespoonful of this compound several 
 times a day, especially when the cough is yqvj troublesome ; 
 children may use it in doses proportioned to their ages. 
 
 Species III. — Pseudo-memhranous Laryngitis — Croup. 
 
 In commencing the consideration of this form of disease, 
 we have found ourselves considerably perplexed by the widely 
 diflerent opinions which are entertained by different writers. 
 Dr. Cullen locates the disease in the trachea or windpipe, and 
 Dr. Watson follows him ; Dr. Billard and Prof. Wood locate it 
 in both the larynx and the trachea; Killiet andBerthez locate 
 it in the larynx, and Dr. West locates it in either or both of 
 these organs, and says, that " the chief morbid appearances 
 are alv;ays discovered in the trachea, and air-tubes." In 
 treating of i\iQj)ost mortem appearance presented in this dis- 
 ease, he says : 
 
 " In cases of croup that have come under my observation, 
 the formation of false membrane in the larynx has seemed 
 almost invariably to precede its deposit in the trachea." 
 
 It has been our conviction, since being a student of medi- 
 cine, having at that time a special motive for an investigation 
 of it, that it is essentially a disease of the larynx, but it may, 
 
350 INFLAMMATORY FORMS OF DISEASE 
 
 and probably does, very generally, involve the trachea, and 
 may even extend to the bronchia. Prof. Wood very properly 
 remarks : 
 
 " Croup is not essentially an inflammation of the trachea ; 
 it may exist without disease in that portion of the respiratory 
 passage, and inflammation of the trachea often takes place in 
 infants, as in other catarrhal afiections, but the same is not 
 true of the larynx, without producing the symptoms of croup. 
 The complaint may be conflned to the larynx, though it gene- 
 rally embraces also the trachea, and not unfrequently extends 
 deeply into the bronchial tubes. It may, therefore, occupy 
 one or several divisions of the respiratory passages. If any 
 one part is necessarily affected, it is the larynx; for a case 
 would scarcely come under the designation of croup, in which 
 this organ should not be disordered, at least in its functions." 
 
 If an inflammation of the trachea cannot produce the 
 symptoms of croup, then an inflammation of that tube is not 
 a necessary part of the disease ; but if an inflammation of the 
 larynx does produce the symptoms of croup, the croup is 
 laryngitis — therefore, it appears to us a great want of philo- 
 sophical accuracy to include the trachea in the definition of 
 the disease. 
 
 In the above extracts, the professor has, and he has not, 
 made an inflammation of the trachea necessary to the disease. 
 His definition of the disease, which follows, when deprived of 
 the italicised words, will be correct: 
 
 "Croup may be defined to be a disease, in which inflamma- 
 tion or high vascular irritation of the laryngeal or laryngo- 
 traclieal mucous membrane, is combined with spasm of the 
 interior muscles of the larynx, giving rise to peculiar modifi- 
 cations of voice, cough, and respiration." 
 
 iSTot withstanding our disposition to regard croup as a laryn- 
 geal affection, and notwithstanding that we find ourselves, in 
 this respect, to be in harmony with the weight of the profes- 
 sion, more especially if numbers can give weight, yet we are 
 disposed to confess, that there are some circumstances which 
 favor the opinion of Cullen, which has been adopted by Prof. 
 Watson — the first is an exemption from pain in deglutition, 
 and a second is, there does not appear to be spasmodic action 
 enough for it to be a laryngeal disease. With such authority, 
 
m THE RESPIEATORY APPARATUS. 351 
 
 however, as that of Relliet and Berthez, to say nothing of 
 others, we may feel pretty safe in the conclusion to which our 
 investigations and observations have drawn us. 
 
 As there is, perhaps, no disease that has given the profes- 
 sion more trouble than this, and as it is one which is attended 
 with great fatality, we will be excused for having devoted so 
 much attention to the precise and definite location of it. 
 Without precision of idea there can be no precision in practice. 
 
 But our trouble is not yet concluded. There is another form 
 of disease, or a modification of one, or, at all events, another 
 set of symptoms, which are vulgarly and professionally mis- 
 taken for croup, but which is not the same as that above de- 
 fined ; and like croup, its precise location or character has not 
 been agreed upon, by medical writers ; some regard it as an 
 inflammation of tlie trachea, but more generally it is treated 
 as an affection of the larynx. It is designated by several 
 names, as, spasmodic laryngitis, stridulous laryngitis, stridu- 
 lous angina, false croup, and by Prof. Wood, catarrhal croup, 
 to distinguish it from true croup, or pseudo-membranous croup. 
 As neither of the other names is calculated to keep us clear 
 of confusion, it is best, we think, to adopt his names. Spas- 
 modic laryngitis may be confounded with the other, as both 
 are attended with spasms, and so, also, of the other symptoms. 
 With these remarks we return to the consideration of pseudo- 
 membranous croup, or laryngitis. 
 
 Croup is an inflammation, essentially of the larynx, but it 
 may extend through the trachea, and even into the bronchia, 
 and according to some writers, even into the bronchial cells. 
 It is attended by the rapid formation of a pellicular concre- 
 tion, which is spread over the walls of the larynx, and, in 
 some cases, lines the trachea and extends into the bronchia. 
 Before the production of this pseudo or pellicular membrane, 
 the mucous membrane is always much inflamed, red, and 
 gorged with blood ; the sub -mucous tissue also participates in 
 the injection, and when the inflamed membrane is at the same 
 time the seat of sanguineous exhalation, this exhalation is 
 seen to be accompanied, or followed, by the concretion before 
 named. 
 
 From these circumstances, it may be inferred, that croup is 
 a catarrhal inflammation, or holds some striking afldnities with 
 
352 INFLAMMATORY FORMS OF DISEASE 
 
 it, and the blood, normally destined for mucous secretion, be- 
 comes plastic by the inflammation, and thereby imparts to the 
 mucus, a portion of its fibrin, and hence, by concretion, comes 
 the pseudo-membrane that distinguishes this modification of 
 disease. 
 
 Upon the general features and manifestations of this dis- 
 ease, the profession are pretty well agreed, but in many cir- 
 cumstances related to it, there is considerable contrariety of 
 opinion, which, perhaps, is entirely referable to the difierence 
 of topography, latitude, telluric, and atmospheric conditions. 
 All agree that it is not a disease incidental to the earliest 
 periods of life, and yet, essentially a disease of youth, or early 
 life, most frequently occurring between the ages of two and 
 five years, sometimes younger, sometimes older, and among 
 adults in the ratio of about one-tenth of one per cent. 
 
 In the commencement, the symptoms are precisely like 
 those of catarrhal croup, and so they continue, until the voice 
 begins to become whispering and the cough husky ; up to this 
 time, it is possible that there is only an engorgement of the 
 respiratory passages, with a high state of irritation — the ex- 
 istence of inflammation is barely possible, at all events, no 
 exudation has taken place. K the disease do not begin in 
 the larynx, the introductory cough may, in nowise, difier from 
 a common catarrhal one, and the voice may be equally of the 
 same character; but after a while, the voice sinks to a whisper 
 and no efforts of the patient can raise it ; from sonorousness it 
 becomes husky and apparently stifled in the throat, and ap- 
 pears in paroxysms ; — following the cough, the inspirations are 
 short and whistling. 
 
 Sometimes the disease begins in the bronchia, and then the 
 introductory symptoms are those of bronchitis ; sometimes its 
 outset is in or about the fauces, and then the symptoms are 
 catarrhal, and attended with sore throat and more or less 
 painful deglutition, hoarseness being the first indication of an 
 invasion of the larynx.* 
 
 * It is said that the colds or catarrhs of children are never attended with 
 hoarseness. If this be true, and "we believe that Cheyne is the authority, pa- 
 rents should give particular attention to it — it will give them a timely admoni- 
 tion of the impending danger. 
 
m THE RESPIRATORY APPARATUS. 353 
 
 But no matter where the disease began, the breathing at 
 length becomes labored, and sounds as though it was passing 
 through a contracted and unyielding aperture. 
 
 All audible voice now becomes extinct, and any effort to 
 speak produces paroxysms of a low and smothered cough, 
 with pain in the throat and superior portion of the thorax ; 
 an anxious expression of impending suffocation covers the 
 face; the disposition is restless; the features are swollen 
 and darkened, the breathing very difficult, and the extremities 
 cold. Sooner or later the paroxysm relaxes — the patient ob- 
 tains some rest ; but before his wearied system becomes 
 refreshed, he is roused by another paroxysm of, probably, in- 
 creased violence — the respiration is hurried to three or four 
 times its normal standard. 
 
 Sooner or later in the disease, febrile action sets in, and 
 always in the ratio of the other symptoms ; sometimes it ap- 
 pears at the very onset, and runs high. 
 
 Between this disease and laryngitis, proper, there is this 
 analogy: both run their course rapidly, proving fatal some- 
 times in twenty-four hours, but more frequently in forty-eight ; 
 and then, again, it may continue five or six days. Dr. Craigie 
 states, that whether fatal or favorable in its termination, it is 
 never protracted beyond the eleventh day. 
 
 Upon the event of a favorable turn in the disease, the cough 
 changes and sounds as if something had become loose in the 
 trachea, and with this change there is a general mitigation of 
 all the symptoms; the coughing brings up viscid mucus, 
 sometimes patches, strips, and even tubes of the pseudo-mem- 
 branous concretion. Finally, this membranous matter is 
 either absorbed or discharged, and the patient recovers. 
 
 But, on the contrary, should no change have been mani- 
 fested for the better, the sonorous and wheezing respiration 
 will become so increased as to be heard to a considerable disr 
 tance — every muscle that can aid the respiratory function is 
 brought into requisition, the arms are spread asunder, the 
 head is thrown back, the nostrils are extended, the chest drawn 
 up, and the facial expression tells that it is all for breath — 
 every expression of agony is impressed upon it, and it is mani- 
 fested through every muscle of the chest and neck — the skin 
 becomes cold and clammy, the pulse increases in quickness 
 23 
 
354 INFLAMMATORY FORMS OF DISEASE 
 
 and feebleness, the lips become livid, the face cold and pale, 
 the brain, not being reinforced by properly oxygenized blood, 
 ceases to snperintend the struggles for relief, and the curtain 
 of stupor or drowsiness drops before the scene, or it rallies the 
 remaining elements of life into a last effort which results in 
 convulsions and death. 
 
 It is not, however, always the case that the patient is per- 
 mitted to struggle while there is strength, for life is frequently 
 cut short by suffocation. 
 
 When the cry is so changed that the reprise portion of it 
 can only be heard, and when, heard, it is acute and sudden, 
 like the crowing of a young cock, and w^hen the voice is lost, 
 we may safely conclude that croup is present ; but we cannot 
 have an absolute certainty of it, until we see detached por- 
 tions of the false membrane thrown up by expectoration. 
 
 Causes. — Croup is much more common to northern than to 
 temperate and southern latitudes — much more common in dry, 
 cold weather, with northern winds, than in any other ; more 
 common to a sea-coast, lake, or river situation than to interior 
 ones. 
 
 It is now generally admitted, that not less than one-half of 
 all the cases which obtain in cold latitudes, terminate fatally. 
 
 In this country, it obtains, but not frequently, and its 
 fatality is not much less than it is in higher latitudes. The 
 cases here, which are generally called, treated, and saved, as 
 croup, are of the catarrhal variety. When croup does occur 
 here, or further south, it is usually during the prevalence of 
 northern winds and storms. 
 
 This disorder is not contagious, but in some situations it is 
 reported to be endemic ; its attacks are generally in the night, 
 and during the one immediately succeeding the exposure of 
 the patient to cold weather, insufficiently protected. Dr. Ali- 
 son says, that it seems to be, not unfrequently, produced by 
 the child's sitting or sleeping in a wet room. 
 
 In some families there seems to prevail a sort of croup dia- 
 thesis, as it is common for many or all of the children to have 
 it as they arrive at the proper age. It is also more frequently 
 met with in males than females, and w^ith sanguine lymphatic, 
 sanguine-bilious lymphatic, and sanguine encephalo-lympha 
 tic temperaments than others. 
 
m THE RESPIRATORY APPARATUS. 355 
 
 Diagnosis. — Spasmodic, cerebral, or catarrhal laryngitis or 
 croup, is the only form of disease with which pseudo-mem- 
 branous laryngitis or croup can be confounded, and between 
 these the diagnosis is so well marked that such a mistake 
 should never be committed. This form of disease comes on 
 slowly, more or less like a common CAtarrh ; that, the spas- 
 modic, attacks suddenly, and is but rarely, if ever, preceded 
 by catarrhal symptoms. The former may appear suddenly, 
 in some instances, but then its character is so essentially 
 febrile, while the latter is not, that they need not to be con- 
 founded. 
 
 Febrile intermissions never attend the former, except occa- 
 sionally after vomiting ; but complete intermissions do attend 
 the latter — remissions only characterize the former. The 
 stridulous sound of the cough and inspiration so peculiar to 
 the former, is absent in the spasmodic form. In the former, 
 the pulse is excited and irritated, generally quick, tense, fre- 
 quent, and full, with an increased or febrile elevation of the 
 cutaneous temperature ; but, in the latter, the pulse is small 
 and contracted, and the cutaneous temperature continues 
 natural. 
 
 Prognosis. — This form of croup is always to be regarded as 
 dangerous, and the extent of the danger is always indicated 
 by the violence of the inflammation ; — its danger, furthermore, 
 as a general fact, is in proportion to the suddenness of the 
 attack. 
 
 At one time a majority of the cases of this form of croup 
 terminated fatally — it is still attended with much fatality, and 
 iiecessarily must be so long as fever and inflammation are 
 treated as forms of disease — so long as the idea of sustaining 
 vital energies consist in breaking them down by bleeding and 
 purging. 
 
 Treatment. — Bleeding, puking, and purging, with calomel, 
 constitute the usual practice in this form of disease — and this, 
 at one time, was our practice — we have given large doses of 
 calomel to a child a year old, and sometimes we approved of 
 the results so much that we abandoned the practice wdth much 
 caution, fearing that we could not do better; long since, we 
 rejoice, however, we not only abandoned the practice, but 
 also the principle upon which it is founded. 
 
356 INFLAMMATORY FORMS OF DISEASE, 
 
 We are required, in aiding nature in this form of disease, 
 to relax the constricted or spasmed organs — the skin is in this 
 condition, as indicated by its heated and febrile condition. In 
 the second place, we are required to strengthen the debilitated 
 organs, which are the larynx and probably the trachea, for 
 otherwise, they would not have become the seat of obstruction 
 or disease, and as a proof of the fact, they are highly excited 
 and labor under an excessive action. 
 
 To meet the first indication, an emetic should be promptly 
 administered, and which should be as promptly repeated, as 
 often as the peculiar croupy inspiration occurs ; and the most 
 efficacious articles that can be used for this purpose, are the 
 Compound Tincture of Lobelia, or the Acetous Emetic Tinc- 
 ture. After having produced free emesis, either of these tinc- 
 tures must be continued in doses sufficient to produce expecto- 
 ration, and in severe cases, even nausea. Hot water should 
 be applied to the throat constantly, and the skin should be 
 thoroughly cleansed, and as far as possible relaxed by the warm 
 lye- wash. 
 
 In the meantime, or as soon as some cutaneous relaxation 
 shall have been effected, the second indication should be 
 attended to. For this purpose, Cayenne or Mustard poultices 
 should be applied to the extremities and the neck, or as near 
 to the weakened parts as possible. For this latter purpose, 
 various poultices have been recommended ; we knew an intel- 
 ligent gentleman who regarded a poultice of roasted onions as 
 an infallible remedy ; Dr. John D. Goodman, says Dr. Gunn, 
 regards dry Scotch snuff, sprinkled on a plaster (which may 
 consist of a piece of greased linen, or it may be sprinkled 
 over the face of any poultice), as a reliable remedy. 
 
 We think it very probable that the roasted onions have 
 been very useful in some cases, and that Scotch snuff may 
 have been so in others, but we are far from being able to 
 regard any one application as being uniformly infallible. One 
 drop of the Oil of Stillingia, placed upon the tongue, has in 
 the practice of several Eclectic physicians, as well as in our 
 own, rendered immediate relief, and ultimately, by its repeti- 
 tion, cured cases of this disease, which had absolutely resisted 
 all previous treatment, and the cases were supposed beyond 
 the influence of medication — thus fulfilling all the indications 
 
IN THE RESPIRATORY APPARATUS. 357 
 
 claimed to be produced by the employment of calomel at the 
 
 hands of the old school physicians. We have, also, found it 
 
 beneficial, when applied externally, in the form of a liniment : 
 
 9r. Oil of Stillingia, 5j, 
 
 Oil of Lobelia, 3ij, 
 
 Alcohol, 3iij. Mix. 
 
 The throat, neck, and chest must be bathed with this three 
 or four times a day ; and after each application, a fomentation 
 should be applied, composed of two parts of Hops, one part 
 of Lobelia, with equal parts of vinegar and water ; boil to- 
 gether and apply the herbs. 
 
 The Nitrate of Silver, in solution, has been highly recom- 
 mended as an application to the fauces, glottis, and even to 
 the larynx, upon the plan proposed by Dr. Green, of New 
 York, but as far as our own experience and observation have 
 extended, we consider the treatment above-named as superior 
 to any other with which we have yet become acquainted. 
 
 We have remarked that both bleeding and purging are 
 quite universall}^ practiced in the treatment of such forms of 
 disease as produce inflammation, for their removal, and we 
 have, in several places, intimated that both are enfeebling or 
 prostrating — destructive of the vital forces, while neither of 
 them is depurating, and consequently neither of them can 
 be properly indicated in the removal of disease, because dis- 
 ease most frequently has its origin in defective depuration. 
 
 x^ccording to these views, and we hold them to be sound, 
 we should direct our efforts to the renal and cutaneous secre- 
 tions first, and then to those of the glandular system in gene- 
 ral. The bowels, therefore, claim our attention no further 
 than to see that their accumulations do not become a source 
 of irritation. 
 
 Although we regard proper external applications to the neck 
 as being of much service, by relieving the part of much of its 
 capillary congestion, yet we should not neglect the use of 
 stimulating gargles, such as the one recommended in the mu- 
 cous forms of laryngitis, and if the child cannot gargle, this 
 should be applied to the fauces and throat by means of a swab, 
 and a small portion of it may be occasionally swallowed. 
 
 It often happens that when the croupy symptoms have been 
 relieved, the evidences of constitutional irritation still exist; 
 
358 I^^FLAMMATOE,Y FOEMS OF DISEASE 
 
 in such cases, we may safely suspect that the liver, and proba- 
 bly other glands, have not resumed their proper functions. In 
 such cases we may have recourse to aperient and stimulating 
 alteratives. 
 
 The child should be kept warmly clothed, and the diet 
 should be light, until convalescence, when, if prostration takes 
 place, stimulants, tonics, and nourishing diet should be used. 
 
 Yaeiett IY. — Spas7nodiG Laryngitis — False Crowp^ Ca- 
 tarrhal Group. 
 
 This form of disease is never attended with the production 
 of a deciduous or pseudo-membrane in any portion of the 
 respiratory passages — the initiatory usually consists of such 
 catarrhal symptoms as coryza, suffusion of the eyes, chilly 
 sensations succeeded by those of heat, some hoarseness and 
 cough. 
 
 These symptoms may continue for several days, or only for 
 twenty-four or forty-eight hours, without much modification, 
 which usually occurs at night and during sleep, consisting of 
 the strongest indications of impending suffocation ; such as 
 cough and dyspnoea, with struggles of the muscular system in 
 aid of the respiratory function. 
 
 Sometimes it is introduced by a croupy cough, some fever, 
 and hoarseness, which may continue a few hours or even days, 
 before the arrival of a paroxysm such as above described. 
 The paroxysms, as they obtain in different cases, present two 
 great extremes: in some they are quite mild, and excite no 
 particular fears — in others, they are so violent as to produce 
 the strongest apprehensions of immediate suffocation. Be- 
 tween these extremes every grade or degree of violence will 
 be observed in practice. 
 
 During a paroxysm, the face is forced into those conditions 
 and expressions which mark a case of strangulation — it is 
 swelled, of a violet or dark red hue, the eyes are humid and 
 projected in their orbits, the expression of the face is anxious, 
 the respiration is hissing and protracted, the voice is reduced, 
 but never to a whisper, the surface is hot, the pulse quick, and 
 the cough, if present, which occurs at intervals, is hoarse. 
 These are the usual phenomena of a paroxysm, and when con- 
 cluded, sleep ensues. 
 
m THE RESPIRATORY APPARATUS. 359 
 
 A single paroxysm may terminate the disease, at ail events, 
 the patient will only be troubled with hoarseness and a dry, 
 barking cough until the next night, when, if the disease have 
 not terminated, the patient will have another paroxysm, pos- 
 sibly two, and thus the disease continues to its close, with one 
 or two paroxysms per night. 
 
 In some cases, however, the paroxysms recur more fre- 
 quently, and each one is characterized by more violence than 
 the preceding, until finally a greater degree of violence be- 
 comes incompatible with life, and death, by asphyxia, closes 
 the scene. 
 
 But in the midst of a paroxysm a change for the better may 
 supervene, and when it does, it is usually indicated by signs 
 of secretion, as a loose cough and the throwing up of some 
 mucus ; the violence of the symptoms is mitigated, the cough 
 loses its harsh ring, the inspiratory sounds have a mucous 
 character, the croupy and febrile symptoms disappear, and be- 
 tween three or four days and two weeks, the patient is well. 
 
 But, instead of a favorable turn, additional and more ex- 
 hausting symptoms may appear, as great restlessness, nausea, 
 and vomiting, followed by a small, frequent, and vanishing 
 pulse, cold extremities, clammy sweats, coma, and death. 
 
 Predisposing Causes. — However difficult it may be to de- 
 termine, precisely, the pathological differences between the 
 several forms of laryngitis, over which we have passed, the diag- 
 noses, in general, are quite unmistakable. When we consider 
 the fact, that they are all more or less inflammatory and in- 
 volve the same parts, it would seem possible, and even proba- 
 ble, that catarrh might be provoked into the mucous laryn- 
 gitis, and that the milder forms of this might likewise be 
 converted into the more severe ; and yet we have no reliable 
 evidence that they do thus merge into each other. 
 
 The only explanation we have for this remarkable fact is 
 this : certain telluric and atmospheric influences, peculiar to 
 certain localities and latitudes, so dispose or constitute the 
 system, that a cause which produces croup in a northern child, 
 could not, Gceteris paribus^ produce the same form of disease 
 in a southern one. To this law occasional exceptions may be 
 admitted. 
 
 The admission of this principle, although we cannot com- 
 
360 IN-FLAMMATORT FORMS OF DISEASE 
 
 prehend its modus ojperandi^ enables us to come to a conclu- 
 sion, as to why it is that croup is frequent in one situation, 
 and pseudo-croup in another. To contend that the south has 
 no weather cold enough to prove an exciting cause, will not 
 do, because the croup is produced in the north by weather 
 more mild than some by which the south is visited. 
 
 There appears, furthermore, to be a croupal organization in 
 some famdies, and that this organization does not exist in 
 early infancy, and when produced, it does not continue usually 
 into adult life, and thus it is that a liability to croup is mea- 
 surably confined to a definite period of life. 
 
 Croupal symptoms and pseudo-membranous concretions are 
 sometimes occasioned by scarlatina, but we have not, from 
 any writer, learned that spasmodic laryngitis is ever pro- 
 duced in the same manner ; and if it be not, then this circum- 
 stance adds to the evidence that croup and pseudo-croup are 
 not difierent degrees of the same form of disease — that they 
 are not varieties of the same species. From what we have 
 been able to learn, we deem it to be as impossible for one 
 form to pass into the other, as it is for catarrh, in early in- 
 fancy, to pass into croup. 
 
 Exciting Causes. — These are usually such as occasion 
 catarrh — such as an improper or unprotected exposure to a 
 cold and damp atmosphere, or sudden atmospheric changes. 
 
 This form of croup is liable to a frequent recurrence — as 
 frequent as may be the exposures to the cause that usually 
 produce it. All the forms of laryngitis may be regarded as 
 being produced by the ordinary causes of catarrh. 
 
 Diagnosis. — The diagnosis between the two forms of croup 
 we have given under the head of pseudo -membranous croup, 
 and therefore, in this place, we will barely add, that the seat of 
 the pain, the change of the voice, and the peculiarity of the 
 cough should always distinguish both forms of croup from all 
 pectoral forms of disease. 
 
 Prognosis. — All the forms of laryngitis, must be regarded 
 as dangerous, if permitted to run their own course, but this 
 form is much less dangerous than the pseudo-membranous, 
 and therefore it may be regarded as generally favorable ; and 
 yet, when prolonged beyond the third day, and is still in- 
 creasing in violence, and more especially when attended by 
 
m THE EESPIRATORY APPARATUS. 3gl 
 
 nausea and vomiting, an unfavorable termination may be ex- 
 pected. 
 
 Tkeatment. — When the affection is characterized by mnch 
 inflammation, the treatment recommended for pseudo-mem- 
 branous croup should be adopted. Lehman recommends us 
 to apply a sponge, dipped in hot water and then squeezed ont, 
 upon the anterior part of the neck, and frequently repeated at 
 short intervals, until the skin becomes red and a general per- 
 spiration follows, which should be promoted by the nse of 
 some mild, tepid diluent. In many instances, this means will 
 arrest all the symptoms and cut short the disease. 
 
 With the exception that this form of the disease requires a 
 liberal use of antispasmodics, the treatment should be very 
 much as in the preceding form. 
 
 Genus III. — Beonchitis — 
 
 Inflammation of the Bronchia. 
 
 Species I. — Acute Bronchitis. 
 
 Under the above title, we include every case of inflamma- 
 tion of the bronchial tubes, which is of short duration, without 
 any reference as to its precise location. 
 
 This form of disease in new-born children, may be of very 
 short duration, and may originate in inappreciable causes, and 
 in a few days spontaneously disappear. In such mild cases, 
 there is frequently no other symptom than the mucus rale, or 
 short, noisy, and frequent respiration without the rattle. Its 
 beginning, sometimes, is that of catarrh — afiecting the nos- 
 trils, fauces, or larynx, and from these parts descends to the 
 bronchia. 
 
 In its mild form, it is vulgarly called a cold in the Ireast — 
 manifesting its existence by hoarseness, mild cough, slight 
 sensations of heat or possibly a little soreness in the thorax. 
 It very rarely demands medication, and as rarely occasions 
 any notable inconvenience. 
 
 After the age of infancy, the disease becomes more obsti- 
 nate, and between the mild stage of it, and the severe, there 
 is every intermediate shade of difierence. It frequently shows 
 its threatening tendency in the onset — and, no n:iatter as to 
 its precise location, the difficulty with which the air enters the 
 
362 INFLAMMATORY FORMS OF DISEASE 
 
 lungs occasions very serious symptoms. In such cases, it is 
 apt to commence with coryza, sore-throat, sensations of lassi- 
 tude, chilliness, and febrile reaction. Cough, being one of the 
 first symptoms, soon becomes one of the most troublesome of 
 its attendants. The symptoms, increasing in magnitude, soon 
 give rise to such as threaten suffocation, a result, possibly, of 
 a serous infiltration in the pulmonary tissue, or it may arise 
 from some modification of the inflammation in the air-pas- 
 sages ; but, as the cause may not always be the same, it is 
 sufficient for the present that the lungs are not freely pene- 
 trated by the air. 
 
 When the disease has entered the smaller tubes, it is apt to 
 invade the air-cells and produce pneumonia. In duration, the 
 attack varies from four to ten days, and though frequently 
 severe and threatening, its termination is not generally fatal. 
 After two or three days a transparent, frothy, or ropy mucus, 
 occasionally streaked with blood, is thrown up by painful and 
 often convulsive coughing. The secretion increases, becomes 
 more opaque, and ultimately yellowish or greenish, and with 
 this change in the secretion the other symptoms become 
 meliorated. 
 
 Causes. — A cold atmosphere, and more especially when 
 moist, is, beyond doubt, the most frequent cause of this com- 
 plaint ; it can, also, be occasioned by both mechanical and 
 chemical causes ; among the first may be named fine dust of 
 almost any kind, and of the second, acid vapors. The class 
 of persons most liable to it is the sanguine encephalo-bilious, 
 in whom animal sensibility is frequently found more developed 
 than muscular motion. Those who are thus sensitive and 
 liable, may be seen, in cold weather, with their necks muffled 
 up — particularly behind the ears. We think it very probable 
 that those children who are particularly liable to it are of the 
 same constitution. 
 
 Diagnosis, — This form of disease may be distinguished 
 from most, if not all, others by the great oppression and 
 tightness in the chest with but little or no pain ; by the 
 wheezing, rattling respiration ; pallor of the countenance; 
 by uneasy sensations in the recumbent position; severe 
 pain in the forehead, which is much increased by cough- 
 ing ; and by the frothy, transparent, and viscid mucus 
 
IN" THE RESPIRATORY APPARATUS. 3^3 
 
 in the bronchia, attended with a moderate febrile excite- 
 ment. 
 
 Pkognosis. — Under judicious treatment, the prognosis can- 
 not, generally, be regarded as unfavorable, but still it is a 
 dangerous affection — in some instances terminating fatally as 
 early as the third day ; but in most fatal cases death is pro- 
 tracted to the sixth day. Coma almost always precedes the 
 fatal termination. 
 
 Treatment. — In the treatment of this form of disease, 
 Prof. Eberle recommends a highly antiphlogistic treatment. 
 We candidly confess that we know of no form of disease that 
 justifies what is uniformly understood by such treatment — 
 which mostly consists of bleeding, purging, mercurializa- 
 tion, etc. 
 
 We have shown in the introduction to this Book, that the 
 immediate cause of fever and inflammation really constitutes 
 the disease, and that it consists in an inability of the part to 
 perform its function, and that this inability, when not occa- 
 sioned by chemical or mechanical causes, can only be relieved 
 by secretion and depuration, and as bleeding and purging in- 
 capacitate the system, and also the affected part to perform 
 either of these functions, they must, as they really do, retard 
 instead of promoting these functions. If debility is required, 
 which is never the fact, it can be effected through secretion — 
 if relaxation be required, and it generally is, it can be effected 
 without these agents, and that, too, without breaking down 
 the system. 
 
 In this form of disease, our efforts should be to produce 
 centrifugal action in the system — the surface, therefore, should 
 be relaxed — stimulant applications should be applied to the 
 surface as near the inflamed parts as possible, as upon the 
 back between the shoulders, upon the breast, upon the arms, 
 and to aid centrifugal action, they may be applied to the feet 
 and ankles ; and, as adjuvants, diaphoretics should not be 
 neglected. When an equalization of the circulation and excite- 
 ment shall have become so far efiected as to admit of secretion, 
 the function of the skin and kidneys should be rendered par- 
 ticularly efiicient, in order that the disease may be removed by 
 depuration. Let this course be pursued with energy, and the 
 fatality of bronchitis will be reduced fifty per centum. 
 
364 INFLAMMATORY FORMS OF DISEASE 
 
 Species II. — Chronic Broncliitis. 
 
 In general, this form of bronchitis need not be considered, 
 in children as a serious one, so long as the functions of the 
 system, generally, are normally manifested. Some children 
 will have it during the whole period of sucking, without any 
 manifest detriment to the general health. 
 
 The acute form may pass into the chronic and occasion for 
 a long time a mucous secretion from the trachea and bronchia, 
 and, in children, it appears, sometimes, as symptomatic of in- 
 flammation of the pulmonary tissue. In such cases, there is 
 a pretty constant cough, thoracic oppressions, noisy and quick 
 respiration, attended with a very appreciable mucous rattle ; 
 the face is pallid and tumefied, and the skin is constantly hot. 
 Under such a state of the respiratory system, the alimentary 
 canal is not always exempted from a mischievous participa- 
 tion ; its mucous membrane becomes so intensely inflamed as 
 to be attended with disorganization. 
 
 As the disease usually exists, the symptoms are cough, short 
 breathing, and the expectoration of an unnatural mucus ; but 
 the symptoms from which we are to draw our conclusions, as 
 to its mild or mischievous character, must be sought in the 
 quantity and quality of the expectorated mucus, and in the 
 existence or non-existence of hectic fever and a tendency to 
 marasmus. When the afiirmative of these symptoms is pre- 
 sent, a recovery is scarcely to be expected — there is less room 
 for hope than in some varieties of consumption. But, not- 
 withstanding the strong simulation of phthisis, which chronic 
 bronchitis frequently presents, it may still be within the reach 
 of medical aid, provided no organic change has been efiected 
 in the bronchial tubes or their mucous lining. 
 
 In a vast majority of the instances of this afiection the pa- 
 tient appears in other respects pretty well — usually no fever is 
 present, and with slight interruptions, produced by atmospheri- 
 cal vicissitudes or irregularities of life, which may occasion 
 slight febrile paroxysms, it may continue for a very long time, 
 presenting such abatement in warm weather as to give proper 
 treatment a chance to effect a cure. But as the disease is, gene- 
 rally, closely identified with a feeble endowment of the vital 
 forces, there will exist a great liability to a return of it. 
 
11^ THE RESPIRATORY APPARATUS. 365 
 
 In the event that, while in such a condition, it is not ar- 
 rested, it may become more aggravated, because it is not in 
 the nature of disease, nor, indeed, of anything else, to remain 
 stationary ; in such an event there may be expected to ensue 
 a copious and purulent expectoration, containing probably a 
 little blood, attended with debility, emaciation, impeded respi- 
 ration, increased by exercise, night sweats, quick pulse, and 
 Buch other symptoms as may constitute that form of disease 
 which is usually denominated catarrhal consumption. This 
 unfavorable condition of the disease, however, very rarely 
 obtains among children, and yet, it is sometimes the case. 
 
 Causes. — It is thought by some, that the greatest number 
 of cases of this disease have resulted from the acute form. 
 "We are inclined to a different opinion : it more frequently 
 obtains with those who belong to the third class, page 20 — 
 those of feeble vital forces, and with them it is rarely ever 
 acute — and when it is, it is generally mild. 
 
 Prof. Wood says, that a liability to this form of disease is 
 frequently associated with "rheumatic or gouty habit of the 
 system." He should have made this remark under the pre- 
 ceding head. This variety is more common to those of a 
 phthisical organization ; it occurs occasionally as a sequel of 
 hooping-cough and measles — in other instances, it occurs for 
 a vicarious object, to fill the purpose of some suspended 
 drain of the system. To the preceding, may be added those 
 causes which usually occasion the acute form. 
 
 Treatment. — The principle that governs the treatment in 
 the acute form, governs in the chronic, but the practice will 
 differ in its details ; in the latter, the same necessity for local 
 applications does not exist, nor does there exist the same 
 necessity for antispasmodics ; secretion and depurition are 
 going on, and therefore, they are not to be established in this 
 form of disease — but the difficulty is, that they are performed 
 by an abnormal structure — in other words, a diseased struc- 
 ture is vicariously performing them. In proof of this, we 
 have but to refer to the excessive expectoration that character- 
 izes the complaint. 
 
 Our treatment must aim at the establishment of a general 
 centrifugal action, and a strong depurating one on the part of 
 
366 INFLAMMATORY FORMS OF DISEASE 
 
 the skin, kidneys, and liver, but more particularly the two 
 former, and we may add, still more particularly the kidneys. 
 
 Dr. Watson says : "I have seen the excessive expectoration 
 diminish, and the patients gain strength, under the use of the 
 balsams, the Compound Tincture of Benzoes, for example ;" 
 but he seems to be entirely uninformed as to the modus 
 o;perandi of the agent. The disease originated in a want of 
 depuration, and finally it takes upon itself the depurating 
 process, and balsams, by acting upon the kidneys and other 
 depurating apparatuses, relieve the bronchi of this labor, and 
 they return to their natural function. 
 
 Balsam Copaiba has been equally efficacious, and in the 
 treatment of catarrh, we know of no more appropriate agent. 
 
 Dr. Watson again adds, that he has found the Sulphate of 
 Iron very useful in this complaint. Iron does not directly pro- 
 mote depuration, but without oxygen depuration cannot go on, 
 and as iron carries oxygen to all parts of the system, it be- 
 comes indirectly an indispensable agent. In cases of much 
 anemia, therefore, it will be judicious to administer iron sep- 
 arately or in combination with the balsams, or such other 
 depurating agents as may be employed. 
 
 If the bowels should be in an abnormal condition, an ape- 
 rient should be administered — as Khei and Bicarbonate of 
 Potassa. 
 
 Genus IY. — Pneitmonia — 
 Inflainmation of tJie Lungs. 
 
 Inflammation of the lungs, in children, may be of the lobar 
 or lobular variety, or it may consist of both. The first is an 
 inflammation of the pulmonary lobes, and the second of the 
 small lobules of the lungs. The inflammation may be con- 
 fined to one lung or to a small portion of it, or it may involve 
 the whole of one or even of both, in either form of the 
 disease. 
 
 The malady, in infants, instead of being idiopathic, a result 
 of developed pulmonary irritation, from atmospheric causes, 
 appears to result from stagnated blood in the lungs ; and, as 
 this blood is unfit for, and really does not perform any func- 
 tion, it must be regarded as foreign animal matter, capable, 
 
m THE ilESPIRATOP.Y APPARATUS. 367 
 
 Tinder the circumstances, of becoming combined with, and of 
 altering the pulmonary tissue, to the formation of a new pro- 
 duct, known as hepatized lung. 
 
 A brief recurrence to facts will show that it is very prob- 
 able that infantile pneumonia must, generally, result from 
 previous congestions and engorgements of the lungs. Pulmo- 
 nary engorgements, in infants, more frequently occur in the 
 posterior border of it, than anywhere else. All this is repre- 
 sented as being the case with infantile pneumonia. 
 
 Again, pleuritis is very generally associated with pneumo- 
 nia in adults, but such is not the case in infants. Every 
 variety and degree of hepatization and disorganization may 
 result from the inflammation when once established. 
 
 A majority of writers, at least many of them, refer pneu- 
 monia, in infants and children, to the same causes that pro- 
 duce it in adults. To this opinion we cannot yield our assent, 
 and for this reason: in infancy, and almost to the period of 
 dentition, the mucous tissues possess less irritability than at 
 any subsequent period of life. But during the dental process, 
 that is, during the period of active development of all parts 
 of the system, the mucous tissues are peculiarly impressible 
 by atmospherical and all other causes which can exert an 
 agency upon them. At and after this period, we admit t^at 
 children are more liable to pneumonia from atmospheric 
 causes than even adults ; and we admit that a catarrh, in 
 childhood, demands more concern and attention, than it would 
 in an adult, because there is more liability of its producing 
 mischievous consequences in the former than in the latter. 
 
 In infants, the symptoms are sometimes very obscure, so 
 much so, that in the care of the best physicians they have 
 died without exciting a suspicion of the existing malady; but 
 when they are obscurely developed, they are, in the begin- 
 ning, those of bronchitis, to which supervene a chill, and then 
 an increase of heat and dryness of the surface, the pulse and 
 respiration become accelerated, cough short and dry, and 
 breathing difficult. 
 
 These symptoms, though well marked sometimes, are fre- 
 quently so obscurely manifested, as scarcely to be observed. 
 They are, however, greatly modified by age— the older the 
 patient the more distinctly they are marked. The symptoms 
 
368 INFLAMMATORY FORMS OF DISEASE 
 
 above-named do not prevail long before their intensity is aug- 
 mented ; the lips become red, the tongue florid and more dry, 
 with a thick white fur along its center. Sometimes vomiting 
 is present, at other times, diarrhea. 
 
 In pneumonia, the pleura is liable to be involved — the two 
 constituting pleuro-pneumonia, but as the symptoms cannot 
 be readily distinguished, in infancy, and as such a diagnosis 
 would not modify the treatment, very little will be required to 
 be said upon the subject. This implication, however, is very 
 rare with infants, and hence it is not the result of pulmonary 
 congestion. When, usually, it does occur, it is with children 
 advanced beyond infancy, and then it is caused by atmospheric 
 influences or other agents — such as produce pneumonia in 
 adults. 
 
 It may be profltable to recapitulate a little the symptoms 
 which occur with infants, and also with reference to pleuro- 
 pneumonia. 
 
 In infants, febrile reaction is, perhaps, never manifested — 
 this is a phenomenon of a more advanced age ; in the former, 
 the surface is usually cold and livid, and the extremities 
 oedematous. 
 
 In pleuro-pneumonia of infants, percussion of the chest 
 gives a dull sound, auscultation of the diseased or hepa- 
 tized lung discovers no respiratory motion, and the breathing 
 is labored and short. The cry is imperfect and smothered — 
 the cough is a mere circumstance, which may or may not be 
 present, and as to expectoration, it is never practiced by 
 infants. 
 
 Such is the irritability of the mucous membranes, during 
 childhood, particularly that of the respiratory system, as to 
 render pneumonia, three times out of every four cases of it, a 
 supervening sequent upon other forms of disease, and in this 
 circumstance consists its most dangerous feature. 
 
 It has, inherently connected with it, another unfortunate 
 feature : those whom it has once assailed, it will assail again 
 in preference to other persons. But these recurrences, as well 
 as the first attack, may all be referable to an original organic 
 liability, and not to any increase of susceptibility from having 
 had it once or frequently — depending upon that organic con- 
 dition of which we have treated at page 20. 
 
m THE RESPIRATORY APPARATUS. 369 
 
 Treatment. — In this form of disease we should avail our- 
 selves of every possible means to overcome the constriction of 
 the surface, and to unload the lungs by inviting the circula- 
 tion to the surface and extremities. The former may be 
 effected by the lye-wash and the use of antispasmodic and 
 stimulant adjuvants, and the latter by the use of sinapized 
 sponging of the hips and chest, and what would be still better, 
 a sinapized bath for the whole person, or a vapor -bath so hot 
 as to render the skin quite red. 
 
 This form of disease, in infants, depends upon a mechanical 
 obstruction — stagnant blood in the lungs, and the object 
 should be to remove such as is not stagnant — to save one lung 
 or as much of both as possible. But we should not neglect 
 to establish secretion and depuration as soon as possible, be- 
 cause if the obstruction should happen to be vital, instead of 
 mechanical, we may equally reach the case ; therefore our at- 
 tention should be directed to the kidneys as well as to the 
 skin. 
 
 In this form of-disease, Dr. West speaks in strong terms of 
 the use of mercurial inunction;* but upon what principle, we 
 confess that we do not know. Dr. Watson says, that our 
 " chief dependence is upon revulsives, applied either upon the 
 chest, or upon the surface generally, Rud perhaps upon a judi- 
 cious mercurial course, particularly by inunction." About 
 the mercurial part of the practice he seems to entertain some 
 doubt, and very justly, we think. 
 
 In addition to the means already named, in the early part 
 of the disease, one or two emetics should be given, and as the 
 
 * During tlie early part of our pupilage, we had a little girl in a poor family 
 laboring with congestive chill, and not knowing what to do, we hastened to 
 our preceptor for instructions. He told us to give calomel and to use mercu- 
 rial inunction upon every tender surface of the body, and to apply heat as ex- 
 tensively to the surface as possible. We asked for the principle upon which 
 he prescribed calomel and the inunction ; he answered, " to stimulate — to 
 stimulate." 
 
 As we were returning, we came to the conclusion that we could stimulate 
 with more rapidity and certainty with French brandy and cayenne, and so 
 provided ourself, and so practiced, and so succeeded. We have adhered to 
 this practice, and as yet we have not lost a case of congestive chill. When 
 our good-natured preceptor, Dr. Pierson, learned what we had done, he had, 
 what he much enjoyed, a hearty laugh. 
 24: 
 
370 IliTFLAMMATORY FORMS OF DISEASE 
 
 disease progresses, the patient should be kept under the influ- 
 ence of nauseants and expectorants, as the Compound Tincture 
 of Lobelia, to be given in small doses often repeated ; and if 
 the inflammatory symptoms run high, the Compound Tincture 
 of Virginia Snakeroot, may be administered in combination 
 with Sweet Spirits of Nitre ; of this tincture, to a child three 
 years of age, three to five drops may be given in water every 
 two or three hours, with about double the quantity of Spirits 
 of Nitre, until the severe inflammatory symptoms have sub- 
 sided. 
 
 To children of highly nervous and irritable temperament, 
 the Compound Powder of Ipecacuanha and Opium, or some 
 other opiate diaphoretic, may be given with advantage to 
 reduce inflammation and lessen coudi. 
 
 A w^arm poultice applied over the whole chest, will always 
 be of beneflt to children laboring under this disease — it may be 
 made of Flaxseed, Elm-bark, or Hops and Hoarhound. 
 
 The bowels must be kept regular by mild purgatives, and 
 excessive catharsis must be especially avoided. 
 
 For drink, warm infusions of Asclepias Tuberosa, or Ptoro- 
 spora Andromeda, may be freely given. 
 
 When there is much difficulty of breathing, the efiect of 
 congestion, ligatures applied to the limbs, even of very young 
 children, will be found very serviceable; and in the more 
 severe forms, dry-cupping over the chest may be employed in 
 addition. 
 
 Toward the latter part of the disease, when signs of debility 
 present themselves, tonics must be given, with generous and 
 nourishing diet, as milk, soups, weak brandy and water, wine, 
 whey, and Arrowroot. 
 
 The best tonic is a combination of Quinine and Cyanuret 
 of L'on ; and for stimulants, Myricin, Xanthoxylin, and Hy- 
 dras tin may be advantageously employed. 
 
 In this disease the diet should be very rigid, confined prin- 
 cipally to demulcent drinks and acidulous draughts ; no solid 
 food whatever should be allowed, and the position of the pa- 
 tient should be gently and carefully changed from time to 
 time, in order to prevent a stasis of blood in the dependent 
 portion of the lungs, and which would increase or perpetuate 
 the disease. 
 
11^ THE RESPIRATORY APPARATUS. 37I 
 
 After the symptoms have lost their severity, and as fever 
 disappears, the food may be gradually increased in its nour- 
 ishing character, until the usual diet can be taken. 
 
 Genus Y. — Pleukitis — Pleurisy — 
 Inflammation of the Pleura. 
 
 Billard states that this disease occurs more frequently with 
 infants than is generally believed, and without any complica- 
 tion with the lungs. As indications of the malady at this 
 tender age, he names " restlessness, cries, sleeplessness — a dull 
 sound of the chest, although the cry may not be altered. From 
 the circumstance of the unaltered cry, he infers that the lungs 
 are not implicated — that air enters freely the pulmonary cells, 
 otherwise the cry would be altered. 
 
 To the above symptoms, after 2in.o\hQY post mortem examina- 
 tion, he adds, " painful expression of the physiognomy, diffi- 
 cult respiration, coldness and lividness of the extremities, 
 while the body was at a high temperature." In this case the 
 lungs were, to some extent, involved, which may account for 
 the difficult respiration, but he adds, that the cry was not 
 altered in proportion to the increase of the disease. Of the 
 pulse, he says: "I will not speak, in this disease, as in almost 
 all others, of new-born children, it is very uncertain, and of 
 little use in diagnosis." 
 
 As nothing, comparatively, is to be found among the writers 
 at our command upon the pleuritic inflammation of infants, 
 we cannot do better than to follow Mons. Billard. He pro- 
 ceeds : 
 
 "Notwithstanding all the care I have taken to ascertain 
 correctly the symptoms, I am not able to offer anything of 
 sufficient importance to enable us to make a correct diagnosis 
 of pleurisy ; but the symptoms mentioned are at least enough 
 to satisfy us that there exists a great probability of the pre- 
 sence of the disease now under consideration, and this is all 
 w^e can obtain at the bedside, when we wish to ascertain the 
 seat and nature of the disease. 
 
 ^^CJiTonio Pleurisy. — Pleurisy may pass into a chronic 
 state even in very young children, and give rise to changes in 
 the tissue similar to those observed in adults. A little girl, 
 aged three months, who had been feeble, pale, and sickly 
 
372 INFLAMMATORY FORMS OF DISEASE 
 
 from birth, and who had been several times in the infirmary 
 with the most uncertain symptoms, died at last on the 18th 
 of April, 1826. She had insensibly arrived at the last stage 
 of marasmus, and had not been affected with diarrhea except 
 in the latter period of life ; she had never been affected with 
 fever, and although the respiration was short, the tone of the 
 cry did not exhibit any alteration, and the nurse remarked 
 that the child died of languor. 
 
 "Upon opening the body, I found the small intestines red, 
 tumefied, and filled with a large quantity of black blood in 
 clots ; the large intestines were healthy. There also existed a 
 very violent pleurisy on the left side. Both the costal and 
 pulmonary pleuree were covered with a layer of plastic lymph, 
 at least a line and a half in thickness. "When this lymph was 
 removed, the pleura beneath was found rugous and very much 
 injected, while the lungs under its coating were found crepi- 
 tant and perfectly healthy. When the lungs were cut trans- 
 versely, a well-marked red line could be seen at the circumfe- 
 rence of this organ, indicating the separation between the 
 inflamed pleurae and the healthy pulmonary tissue. The 
 heart and large vessels were exsanguined ; the fetal openings 
 obliterated ; the brain, although healthy, contained a small 
 quantity of serum in the ventricles. 
 
 " From what has been related, we have seen that the ema- 
 ciation and languor of this child were caused by an obscure 
 pleurisy, the progress of which insensibly led to the death of 
 the patient. In every instance, therefore, in which we see a 
 child languishing, and becoming thin and feeble, we ought 
 carefully to search for the cause of this condition, and endea- 
 vor to ascertain whether it does not arise from some obscure 
 organic lesion ; we ought not to remain in a security which 
 would leave us tranquil spectators of a disease which perhaps 
 might not have terminated fatally if we had examined with 
 scrupulous attention into its cause, seat, and nature." 
 
 The information acquired by this ;post inortem examination 
 is peculiarly interesting. It shows conclusively that even the 
 pleuritic covering of the lungs may be, for a long time and 
 fatally, inflamed, without, in the least degree, involving the 
 lungs. It illustrates, too, the difficulty of diagnosis in this 
 affection in infants. 
 
IN THE RESPIRATORY APPARATUS. 373 
 
 As children above the age of infancy — an age in which the 
 symptoms are developed, as in adults, are, if anything, more 
 liable to this disease than adults, it may be well to define and 
 treat of it in that relation. 
 
 Pleurisy, or pleuritis serosa, is perhaps, most generally pre- 
 ceded by chill and fever, oppression in breathing, but in a less 
 degree than in pneumonia — but the pain is greater and more 
 definitely located in one of the sides. When severe, it is ren- 
 dered intolerable by a deep inspiration and by pressure upon 
 the intercostal muscles. In consequence of pain upon inspi- 
 ration, the respiration is short, and lying upon the affected 
 side next to impossible. If the disease be located in the pos- 
 terior portion of the pleura, all movements of the spine will 
 give pain. 
 
 If the disease terminate in serous effusion, and it frequently 
 does, there will be a considerable change in the symptoms — 
 the breathing becomes more anxious and short, and a feeling 
 of suffocation prevents the possibility of resting upon either 
 Bide. 
 
 Inflammation of the pleura does not thicken it, if it do, it 
 is very slightly, nor does this membrane readily soften or ulce- 
 rate ; but, as we have stated, it throws out serum, and it 
 throws out coagulable lymph, which spreads over adjacent sur- 
 faces, becomes organized, and false membranes are thus 
 formed, or contiguous surfaces are united together by what is 
 called adhesion, or adhesive inflammation. When the inflam- 
 mation is of moderate severity, it usually terminates by reso- 
 lution / when more violent, by an effusion of serum^ or coagu- 
 lable lymjoh; in cases of more violence, or in modified cases, 
 it may terminate in sujppuration. 
 
 Chronic pleurisy frequently simulates hydrothorax by a 
 serous or purulent effusion ; sometimes, phthisis pulmonalis ; 
 sometimes, without definite symptoms, it forms slowly; at 
 other times, it succeeds the acute form. In the former variety, 
 vague pains are complained of in the chest; the cough, which 
 is usually present, is small and dry; oppression is felt at inter- 
 vals, and so are febrile symptoms, as shivering, heat, t' 
 and an inelastic or hard pulse. 
 
 In this form of the disease, the chest undergoes < 
 which it will always be important to investigate for d^* 
 
374 INFLAMMATORY FORMS OF DISEASE 
 
 purposes : the diseased side is more smooth, round, and mo- 
 tionless ; the intercostal spaces may protrude, but more fre- 
 quently they are only dilated ; if the case be very chronic, the 
 aifected side may be the smaller; when the patient speaks, no 
 vibration will be felt by the hand ; the thoracic parities are 
 sometimes cedematous ; percussion gives a dull sound, except 
 at the superior part of the chest, and the usual sounds from 
 the diseased parts, as per auscultation, no longer exist; but no 
 indication has been discovered to determine which is present 
 in the chest, serum or pus. 
 
 Indications. — In this form of disease, there is a pretty 
 general rigidity of the system, and therefore, a general relaxa- 
 tion must be effected ; and, in the next place, all obstruction 
 to free vital action must be removed, and lastly, when an equi- 
 librium is obtained, it must be vigilantly sustained. 
 
 Treatment. — A warm pediluvium, the lye-bath, aromatic 
 and antispasmodic drinks or teas, and enemas, if promptly 
 employed, will satisf}^ the first indication, if at the same time 
 recourse be had to revulsives, as warm poultices, heavily 
 sprinkled with Cayenne, which should be applied as warm as 
 the patient can bear, over the region of the pain, and fre- 
 quently changed. 
 
 If the attack has been violent, antispasmodics and diapho- 
 retics should commence the treatment, with the use, at the 
 same time, of diffusible stimulants, and a gentle cathartic. 
 An energetic perseverance in the use of these means will 
 generally achieve success. 
 
 If physicians will bear it in remembrance, that in the treat- 
 ment of all thoracic inflammations, the general system must 
 be relaxed, and that all excess of vital action upon the affected 
 part must be directed to the surface and inferior extremities, 
 they will certainly achieve general success, without giving 
 themselves any particular trouble as to the particular part 
 affected. 
 
 They should, furthermore, remember, that a cure cannot be 
 effected without active depuration, and consequently the renal 
 and cutaneous secretions should be effectively brought into 
 requisition and sustained by the administration of such tonics 
 as the peculiarities of the constitution may indicate. 
 
 In congested cases, the failures we have witnessed were 
 
m THE RESPIRATORY APPARATUS. 375 
 
 because of the inefficiency of the revulsive measures — a tepid 
 bath, a few bottles of hot water or hot bricks will not be suffi- 
 cient — a more powerful and a more permanent impression must 
 be made upon the cutaneous surface, aided by a liberal use of 
 diffusible stimulants. 
 
 When the congestion is beyond the power of reaction, we 
 have found Mustard and Pepper poultices, tepid bathing, and 
 pediluvia but little better than nothing — they do not appear to 
 act with sufficient promptitude. We have resuscitated the 
 congested patient after death had fixed his seal upon every 
 feature of the face, by the use of the hot vapor bath and the 
 diffusible stimulants, followed by the use of tonics ; and in 
 such cases, we are not prepared to trust any other course of 
 treatment. 
 
 In chronic pleurisy, we must mainly rely, for success, upon 
 renal and cutaneous depuration, well sustained by appropriate 
 tonics, expectorants, and stimulants. Revulsives and anti- 
 spasmodics can only be occasionally indicated, though in obsti- 
 nate and long-standing cases of chronic pleurisy, the Irritat- 
 ing Plaster may be applied with advantage on the chest over 
 the diseased portion of the pleura ; or Croton Oil may be 
 applied once a day, until free pustulation is produced. 
 
 Genus YI. — Phthisis Pulmonalis — 
 Consumption. 
 
 Phthisis pulmonalis consists of tubercles formed in the 
 lungs, which, after an indefinite time, inflame and ulcerate; 
 hectic fever universally attends it, and persists in gradually 
 wearing down the patient, until, ultimately, death ensues. 
 
 Symptoms. — Uneasiness is complained of in the chest, with 
 paroxysms of coughing, or perhaps the cough is dry and short 
 and attended with difficult respiration. Its next stage becomes 
 indicated by the cough becoming very troublesome in the 
 early part of the day — the dyspnoea is much increased upon 
 the slightest exertion. There is a circumscribed redness of 
 the cheeks, purulent expectoration, with fever in the evening, 
 with wasting and colliquative sweats in the morning. The 
 disease may now be regarded as confirmed. 
 
 The hectic continues and is constant, with pungent heat, 
 
376 INFLAMMATORY FORMS OF DISEASE 
 
 small pulse, colliquative sweats, diarrhea, and extreme weak- 
 ness. In the forming stage, while miliary tubercles still exist, 
 the only change that has become effected upon the exterior of 
 the thorax consists of restrained movements under one or 
 both clavicles. It is usual to discover, by percussion, a dimin- 
 ished sound at the top of one lung. Auscultation will disco- 
 ver that inspiration presents a murmur that is either more 
 weak, rough, or confused, with a more distinct sound of the 
 expiration. More wheezing and resonance attend the cough 
 and voice, or instead thereof, mucous rales wiU be heard in the 
 same part. 
 
 The motion of the chest is more discoverably diminished 
 under one or both clavicles, when the tubercular disposition 
 has become increased in quantity. The resonance of the 
 cough and voice is increased ; the expiration is more loud and 
 superficial; upon auscultation, the inspiration will be found to 
 be bronchial ; on percussion, the sound will be less distinct. 
 Whatever of the lung is left, is probably sound, or a puerile 
 respiration will be manifested. 
 
 During the process of tubercular softening, auscultation 
 presents a sub-crepitant rale about the apex of the lung, 
 reaching downward from above. At the close of a deep in- 
 spiration, during or after a cough, this sub-crepitant rale is 
 most to be heard. As the disease advances, a tracheal or 
 cavernous sound attends both inspiration and expiration. As 
 the cavern increases, the sound emitted, by percussion, becomes 
 gradually clearer, and in some cases, tympanitic. 
 
 We have now, as briefly as possible, presented the condi- 
 tion, symptoms, and physical signs of this form of disease, 
 as it usually occurs in adults, believing that we could not with 
 more brevity and precision expose the variations which char- 
 acterize it in childhood. 
 
 The disease as above defined, and as it occurs in children, 
 are essentially the same, yet we shall find the symptoms 
 and physical signs as obscure in the latter as they are lucid 
 and distinct in the former. 
 
 A striking anatomical difference exists with reference to the 
 distribution of the tubercularization. In about twenty-five per 
 centum of adult cases, tubercular deposition will be found in 
 
m THE RESPIRATORY APPARATUS. S17 
 
 the bronchial glands, but its importance, even in these cases, 
 is secondary to that of the lungs ; but, with children, the 
 tubercular disease of these glands is sometimes of more im- 
 portance, than that of the lungs. This is not all. In very 
 nearly one half the cases among children these glands contain 
 tubercles. 
 
 In adults, the apparent perfection of the tubercles in the 
 clavicular region of the lungs, and their immature and incom- 
 plete condition in their inferior portions, indicate that the dis- 
 ease began in the former and gradually extended downward ; 
 but in young children, the tubercles, in all parts of the lungs, 
 indicate the same age, so much so that no particular one point 
 can be selected as that in which tubercularization began. 
 . The next anatomical diflerence worthy of note, is with 
 reference to the cavities, or caverns, formed in the lungs at the 
 two ages respectively. Their existence in children is much 
 more rare, and when they do occur they are rather small exca- 
 vations, than caverns, such as obtain in the adult lungs. 
 They communicate with each other and with the bronchia. 
 They are sometimes very numerous, and are occasioned by the 
 softening of small tubercular deposits. They are not attended 
 with that destruction of tissue which marks the disease in 
 adults. 
 
 As regards the symptoms of this disease in childhood, we 
 have to remark, that as age advances the differences between 
 them and those of adults diminish. But during childhood, 
 there are some obvious differences : — one is, that during this 
 period there is not attending the disease haemoptysis, and very 
 rarely any expectoration. In young children the cough, in the 
 commencement of the disease, is generally very slight, and the 
 colliquative sweats are so inconsiderable as to pass frequently 
 unobserved. Sometimes the child complains for weeks, loses 
 appetite, flesh, and strength, before the cough arrives to excite 
 any fearful apprehensions, and when it does come, it is so 
 mild, short, and dry, that, but for its frequency, it would 
 scarcely attract a notice. Indeed, the early symptoms are fre- 
 quently so indefinite as scarcely to claim a careful diagnostic 
 investigation. So true is this, that the complainings are 
 referred to worms or to some other inconsiderable ailment. 
 
 Diarrhea attends this disease in children, as in ad alts, 
 
378 ixflam:\iatory forms of disease 
 
 but it does not seem to be attended with so prostrating an 
 effect. 
 
 Tuberciilarization of the bronchial glands is, by no means, 
 uncommon to infancy, but obtains much more frequently be- 
 tween the ages of two and six years. When it does occur in 
 infancy, the special symptoms of it are lost in those of the 
 lungs, and they, too, are as likely to be lost in those of a gene- 
 rally deranged nutrition. 
 
 A slight cough, accelerated breathing, diarrhea, vomiting, 
 aphthous mouth, and red tongue, may be the symptoms atten- 
 dant upon a large cavern or excavation in one of the lungs, 
 and cjuite naturally might be mistaken for some disease of the 
 digestive system. 
 
 Such cases illustrate the great importance of very special 
 examinations into all the complaints of children. In every 
 instance where it is possible for a doubt to exist, every impor- 
 tant organ of the system should be investigated by all the 
 means in possession of the profession. But we have not con- 
 cluded our purpose of indicating the differences that exist 
 between the signs and symptoms of this destructive malady 
 in adults and infants, respectively. 
 
 There exist some strong differences in the auscultatory 
 signs of the existence of this disease in the two periods of life 
 before named, and though we should describe them with entire 
 accuracy, the advantage would be exceedingly trifling to those 
 who have no experience in the practice of auscultation, conse- 
 quently, we shall be very brief upon the subject 
 
 We remark, then, in the outset, that auscultatory signs of 
 phthisis, in infants, are much less reliable than in adults ; so 
 much so, that they can, in our judgment, be of very little 
 advantage to the physician who has not an immense practice, 
 or very extensive experience in the subject. 
 
 With adults, the first indication of tubercular deposit in the 
 lungs consists in what is usually denominated "coarse breath- 
 ing,'' and the importance of this is augmented if it be attended 
 with a dry rattling or gurgling sound; and it is rendered still 
 further diagnostic by being heard with more distinctness in the 
 infra-clavicular district of the chest. But, in children, this 
 useful information cannot be had — we cannot decide whether 
 the sound emitted is occasioned by pulmonary tubercle or other 
 
m THE RESPIRATORY APPARATUS. 379 
 
 source of irritation. If the sound above described should be 
 obtained, it should cause us to suspect phthisical mischief, but 
 we should remember that it may obtain from a cause of very 
 inconsiderable importance. These remarks are equally true 
 of the prolonged expiratory sound under the clavicle. These 
 two symptoms, though of important diagnostic import in 
 , adults, are not without great distrust in children. 
 
 In adults, we are enabled to draw important inferences from 
 the modifications of the voice, which is not the case with chil- 
 dren, although they may be able to talk. It is not enough 
 that we shall hear them pronounce a monosyllable — and they 
 do not use sentences. 
 
 The voice of children, furthermore, has not acquired a char- 
 acter — it has not become fixed, and hence causes which could 
 not afiect the voice of adults, might greatly change that of 
 children. 
 
 The difierence between the breathing of the two lungs is 
 often an important symptom in adults, but it is one upon 
 which we can place no reliance in children, except from 
 repeated experiments. However strong or coarse the breathing 
 of a lung, in infancy, it may, in twenty-four hours, change sides. 
 But if, after repeated experiments, we find the same lung to 
 emit the same sounds, then they may be relied on. 
 
 We have thus found that those symptoms which pretty 
 clearly indicate the existence of phthisis, in adults, are really 
 of minor importance in children — this, indeed, we should 
 expect from that extensive range of active sympathies which, 
 at this age, prevail. The progress and rapid development of 
 every tissue and organ in the system, constitute in them a plexus 
 of such delicate irritations, that one diseased point must 
 excite morbid action in every other ; hence, in the treatment 
 of infantile phthisis, we should at all times be ready to anti- 
 cipate many varieties of complication. 
 
 Causes. — Upon this subject so little is known as to be 
 almost equivalent to nothing — vague and uninstructive con- 
 jecture appears to be about the sum of what is obtainable — 
 nothing that approaches a rationale of the malady has been 
 discovered. Under such circumstances, we can certainly be 
 excused for venturing to attempt, to some extent, a solution of 
 die difficulty, even at the hazard of committing some errors. 
 
380 IlfFLAMMATORY FORMS OF DISEASE 
 
 If there be any one point in the entire field of pathology, 
 in which our discovery of the relations that exist between the 
 lungs and cerebellum is likely to be of any avail, it is in this. 
 In our introduction to this Book, we have shown that this 
 form of disease, no more than any other, is hereditary, but 
 depends upon, or results from, the influence of attending cir- 
 cumstances, upon a particular and broadly-marked variety of 
 organization. In a majority of cases, the medulla oblongata 
 preponderates, in development, over the cerebellum, particu- 
 larly its lateral portions ; and in the minority of cases, a re- 
 versed development of these organs obtains. 
 
 Tubercle is very far from being the only diseased manifesta- 
 tion that results from this organization — the whole tribe of pas- 
 sive congestions belong to it, more especially those of the 
 brain. 
 
 Death, from cerebral forms of disease, is more common to 
 children than to adults — but tuberculosis is moi-e common to 
 adults than to children, and both have, as the primary cause, 
 the same organic conditions. 
 
 This peculiar organization is the remote result of that divi- 
 sion of labor which is incidental to civil society — caused by 
 sedentary habits and excessive mental application. The pre- 
 sent time appears to be specially engaged in the production of 
 cachectic subjects — all is being done for the advancement of 
 mind, and nothing for the development of the physical sys- 
 tem. Such influences, acting upon the sanguine-bilious, 
 sanguine- encephalic, bilious-encephalic, and sanguine-bilious 
 encephalic constitutions, will produce that organic condition 
 which is a sine qua non to phthisis pulmonalis. We have 
 never found this peculiar organization, in a single instance, 
 among four hundred savage crania — this is a strong fact in 
 support of the opinion that this organic condition is peculiar 
 to civil society. 
 
 When we reflect, that a vigorous pulmonary function results 
 more from necessity than from volition, or even the vegetative 
 influence of the medulla oblongata, we must perceive the rea- 
 sonableness of the preceding conclusions. By exercise, the 
 blood is forced forward in the circulatory system, and of course 
 into the lungs, and by this necessity they are forced to act. 
 By a constant repetition of this necessity, not only the lungs 
 
m THE RESPIRATORY APPARATUS. 381 
 
 but all parts of the animal system, and indirectly the vegeta- 
 tive, must become strengthened and developed. 
 
 In sedentary life, the Inngs act only through the vegetative 
 necessity — through the action of the diaphragm ; this explains 
 why tubercular deposit begins, in adults, in the clavicular por- 
 tions of the lungs. The vegetative influence upon the lungs 
 can never promote, in a high degree, the development of the 
 respiratory apparatus ; to eflect this end, we must resort to the 
 exercise of the animal muscles in general, and this conclusion 
 is sustained by all experience. 
 
 In infancy and cfiildhood, when the circulatory and respira- 
 tory functions are ably performed, there is no danger of 
 tubercle — whatever of morbid condition circumstances may 
 occasion in the system, will be forced upon the skin in the 
 form of eruptive disease, or taken out of it by depura- 
 tion ; but when a contrary condition of the vital system 
 exists, we may justly apprehend danger from pneumonia, con- 
 vulsions, chronic hydrocephalus, or phthisis — they all origin- 
 ate in a modification of the same organic conditions. 
 
 It is now a well-ascertained fact that feeding, without exer- 
 cise, produces tubercle — this is well illustrated in stall-fed 
 cows, and cage-fed rabbits, poultry, monkeys, and other ani- 
 mals. ISTow, at this point, we would like to be informed of 
 the difference that exists between a cage-fed rabbit, or bird, or 
 monkey, and a cradle-fed child ? If the one is productive of 
 tubercle, why should not the other be? We have elsewhere 
 remarked, that children who become obese are not usually 
 those who become tuberculous ; nevertheless, we have taught 
 that the exceptions are liable, and have named the condition 
 under which it takes place. 
 
 A remarkable case of this kind is reported by Dr. West, 
 which we shall introduce as confirmatory of our conclusion, 
 and as an illustration of what we shall presently attempt to 
 teach. 
 
 "A remarkable instance of this came under my notice some 
 years ago, in the case of a little boy, nine months old, who 
 was fat and ruddy, and had always had perfectly ( ? ) good 
 health, until the 10th of April. On that day he was taken 
 with symptoms which his mother supposed to be those of a 
 bad cold. On account of this, he was kept in the house, and 
 
382 II^FLAMMATORY FORMS OF DISEASE 
 
 various domestic remedies were employed, thougli without any 
 improvement, and on April 24:th, he came under my notice. 
 There did not then appear to be any urgent symptom, though 
 the child seemed much oppressed at the chest. The case 
 appeared to be one of rather serious catarrh, occurring during 
 the period of dentition. The gums were lanced, and a mix- 
 ture containing the Yinum Ipecacuanha was ordered, to which, 
 finding the symptoms not to abate, small doses of Antimonial 
 "Wine were added on the 27th. On the 30th, I was informed 
 that the child was much worse, that his dyspncea was greatly 
 increased, and that his hands and feet had been swollen for 
 the last forty-eight hours. I found the little boy breathing 
 fifty times in the minute, with great oppression at the chest, 
 the face much flushed, the skin dry, the trunk hot, the limbs 
 cool, and the hands and feet much swollen. Auscultation 
 detected generally diffused small crepitation through both 
 lungs, with indistinct bronchial breathing at the upper and 
 back part of the left side. Three hours after this visit, the 
 child died without a struggle, on being lifted out of bed for its 
 mother to apply some leeches to its chest. On examining the 
 body after death, a very thick layer of fat was found every 
 where beneath the integuments. The lungs presented an ex- 
 treme degree of tubercular degeneration, and many of the 
 bronchial glands were enlarged by the morbid deposit to the 
 size of a pigeon's egg. Some of the tubercle in the lungs was 
 softened, but it existed both in the form of yellow tubercle, of 
 tubercular infiltration, and of masses of crude tubercle, formed 
 by the agglomeration of many separate deposits. The pul- 
 monary substance, in the intervals between the tubercular 
 deposits, was of a bright red color in the first stage of pneu- 
 monia, and in many parts bordering on the second stage, and 
 there was very considerable injection of the bronchial tubes. 
 The various abdominal viscera contained tubercle, but it was 
 not far advanced in the mesenteric glands." 
 
 It is proper to add, as a further illustration of such cases 
 that infants of this kind have small contracted nares — chest 
 and neck appear large enough, but the latter has but little ex- 
 pansibility, and that they usually cry but little, and hence, at 
 this early age, it may be said, they have no exercise. In refe- 
 rence to the case just cited, it may be interesting to remark 
 
IN THE RESPIRATORY APPARATUS. 383 
 
 that the child had been apparently in good health up to the 
 10th, and that in twenty days it died with tubercles as large 
 as a pigeon's egg. It will scarcely be doubted, that while it 
 was looking well and acquiring fat^ tubercles w^ere being 
 developed. 
 
 Now, by a proper application of the developments which we 
 naade in the first book, and in the introduction to this, the 
 solution of this and all similar cases will be found easy. 
 
 The child had had, comparatively, no physical exercise, and 
 as the medulla oblongata had imparted but little energy to the 
 diaphragm, it follows that the respiratory function w^as but 
 feebly performed, and yet, nutrition does not appear to have 
 suffered during the formative stage of the tubercle. The 
 venous blood had been depurated more by the conversion of 
 carbon into fat, than into carbonic acid in the lungs. 
 
 Now, if oxygen enough was not inspired to depurate the 
 venous blood, enough w^as not received to prepare the chemi- 
 cal elements, that resulted from metamorphosis, for elimina- 
 tion, and tubercles resulted. 
 
 As it is possible that all of the superfluous carbon could be 
 converted into fat, we are not prepared to say that tubercle is 
 a carbonaceous compound — we are inclined to think that it is 
 not, but would be exceedingly pleased to know certainly what 
 it is ; — but that it results from an insufficient pulmonary func- 
 tion, we have not a single doubt. In fat infants and children 
 the liver performs but feebly its assigned function. 
 
 In those whose organic condition is the reverse of this — a 
 large medulla oblongata and a small cerebellum, we have a 
 different play of functional affinities. The liver and skin, 
 in some measure, even in this latitude, aid the lungs in depu- 
 rating the venous blood, while oxygen enough is not received 
 to fit, for elimination, other chemical elements that result from 
 metamorphosis. 
 
 We are far from being sure that consumptives do not receive 
 as much advantage, in the south, through the renal secretion, 
 as through any other. A fault in this function causes serious 
 mischief, in the rheumatic organization, in one way, and it 
 may do as much in an other, in this. 
 
 We think it quite probable, as in the preceding form of 
 phthisis, an abundance of carbon is obtained, that in this. 
 
384 INFLAMMATORY FORMS OF DISEASE 
 
 because of a very feeble nutrition, there may not be enough in 
 this, for the indispensable purpose of animal heat; and hence 
 the reason why ardent spirits and sugar have been found to be 
 beneficial in many instances. 
 
 In many subjects, no doubt, the lungs, though actively en- 
 gaged in the respiratory motion, are incapable of much respi- 
 ratory function. Oxygen enough to insure the elimination of 
 the metamorphosed tissues is not received — animal heat is 
 not maintained — the venous blood is not depurated, and, in a 
 cold climate, the liver and skin can render but little aid, and 
 therefore tubercular deposits. 
 
 By the use of brandy, the animal temperature is elevated, 
 and consequently the nutritive process is increased, while the 
 carbon and hydrogen of the brandy are converted into fat. 
 We have but little faith in the ultimate utility of brandy or 
 sugar as remedies. 
 
 Finally, we do not pretend to understand all of the affini- 
 ties in this form of disease — but sure we are, that it depends 
 upon those organic conditions in the brain which we have 
 indicated. 
 
 The exciting cause in children is, very generally, an impro- 
 per exposure to cold and damp weather or clothing. 
 
 Indications. — Obtain for the circulation a permanently cen- 
 trifugal action, and rouse into activity the principal depurators 
 of the system. 
 
 Treatment. — If we had to treat of this form of disease in 
 adults, w^e should have much to say, but as it is, we shall be 
 brief, because it is our conviction, that with children, it must 
 very generally be fatal — because, as we have shown, it depends 
 upon a fault in the organization, which, at this early age, does 
 not admit of a remedy. 
 
 It is known that a southern climate secures a mitigation of 
 all the symptoms in this form of disease ; and it is also known 
 that cold weather developes tubercle much more rapidly than 
 warm, in those climates where the malady is produced. Now, 
 if we connect these facts with that organic condition which we 
 have shown to be a sine qua non in this disease, the inference 
 becomes clear as to the special indications of treatment. 
 
 In such cases as that quoted from Dr. West, it is obvious 
 that oxygen enough was not received by the system — that the 
 
IN THE RESPIRATORY APPARATUS. 385 
 
 carbon of the venous blood was not combined with it, to the 
 formation of carbonic acid gas, but with hydrogen to the pro- 
 duction of fat. 
 
 From this circumstance, we are allowed to infer, that other 
 ultimate or proximate elements, derived from metamorphosis, 
 were not, by oxygenation, prepared for elim^ination, and being 
 retained in the system, were converted into tubercles. We 
 may admit that oxygen enough was received, but in conside- 
 ration of defective depuration, more especially on the part of 
 the kidneys, tubercles resulted. 
 
 In the other form of phthisical organization, the absorbing 
 system is very active — the person is always lean, but the chest 
 is contracted and the lungs are feeble, and while the depurat- 
 ing apparatuses readily prevent serous or aqueous plethora, 
 the matter metamorphosed is not sufficiently depurated, as 
 may well be supposed from the feebleness of the pulmonary 
 function, and tubercle is again the result. 
 
 As, in the south, the renal and hepatic functions are much 
 more developed than the cutaneous, and, as in the south 
 phthisis can scarcely be developed, we conclude, that, in the 
 treatment of this malady, we should, in a special manner, 
 address our remedies to the liver and kidneys; consequently, 
 we should place more reliance upon mild alteratives and diu- 
 retics, and particularly the latter, than diaphoretics. 
 
 By way of prophylaxis. Dr. Eberle recommends that the 
 patient should live, measurably, on farinaceous food. This is 
 certainly unsound doctrine, because it creates a necessity for 
 an increased pulmonary action. 
 
 Dr. Watson says : " One man gives all his phthisical pa- 
 tients beefsteaks and porter." This selection is equivalent to 
 none at all — the first is nitrogenous, and the second is carbo- 
 naceous. "Another," adds the doctor, "restricts all his to 
 vegetables and asses' milk." In this instance, the milk is 
 equivalent to the beefsteaks, and if farinaceous vegetables shall 
 be selected, then they are equivalent to the beer. 
 
 Dr. Watson says, for himself, by the way of treatment, that 
 we must keep the patient "on low diet and take blood." He 
 next recommends emetics, and lastly, counter irritation. 
 
 Now, it must be obvious, that, if phthisis exists in conse- 
 quence of imperfect depuration, and can only be cured by it,. 
 25 
 
386 KON-IIs^rLAMMATORT FORMS OF DISEASE 
 
 there is no cause of surprise, according to the usual plan of 
 treatment, that so very few, if any, ever recover from it. In- 
 discriminate low diet and bleeding are directly opposed to 
 recovery — the balance of the treatment may promote an equi- 
 librium of the circulation, but none is resorted to for the pur- 
 pose of effecting a special depuration. 
 
 In this form of disease, we are hostile to the whole class of 
 expectorants, because they promote an increase of action in the 
 diseased part, instead of determining the fluids to other and 
 legitimate depurating apparatuses. We would suggest, that, 
 after a relaxation of the whole system shall have been effected, 
 and the circulation equalized, the patient should live, mostly, 
 upon azotized food, and by pediluvia, alkaline baths, and 
 revulsives should maintain a centrifugal action in the system, 
 and at the same time maintain a pretty active depuration of 
 the kidneys, by the use of Terebinthina Yenita, or Copaifera 
 Officinalis, and, as an adjuvant, some preparation of iron wiU. 
 frequently, and indeed generally, be required. 
 
 We must confess, that we are not, exactly, making these 
 suggestions for the benefit of more than a small number of 
 phthisical children, because we view their case as hopeless — 
 they were doomed, by their organization, to a brief existence. 
 The physician may aid in repairing a lesion, but in the short 
 space allowed him by children thus afflicted, he cannot remodel 
 the organization. 
 
 OEDER II. 
 
 NON-INFLAMMATORY FORMS OF DISEASE IN THE RESPIRATORY 
 
 APPARATUS. 
 
 Genus I. — Absent or Imperfect Respiration. 
 
 During Uterine existence, the lungs are organized and de- 
 veloped with reference to a function which will not be required 
 of them, until the atmospheric mode of being becomes requi- 
 site ; but anterior to this event, they may become the subjects 
 of disease, and even of disorganization. 
 
 As a very general fact, the lungs discharge promptly the 
 function for which they were intended, and at the proper 
 
m THE RESPIRATORY APPARATUS. 387 
 
 moment of time ; but in some instances they do not, and it 
 becomes the duty of the physician to ascertain why they 
 do not. 
 
 The condition cannot be one of asphyxia, because respira- 
 tion has not been established — the case is not one of suspended 
 function, but it is one in which the air has not penetrated the 
 air-cells — the congestion is not such as constitutes true 
 asphyxia. Such infants are marked with exceeding paleness 
 and debility. 
 
 Upon the birth of such an infant, the larynx and bronchia 
 should be immediately examined for such mucosity as may 
 exist to the obstruction of the air in its passage to the air-cells. 
 If this should be discovered to be the case, as it frequently is, 
 it must be removed with a feather, or with the finger armed 
 with a piece of fine rag ; at the same time, the infant should 
 be placed in such a position as to leave the mouth and nose 
 uncovered, and in a position to receive fresh air. 
 
 In our efforts to establish the function, the lungs should be 
 inflated, or rather, the attempt should be made to inflate them 
 by closing its nostrils and blowing into its mouth, and then, 
 by pressure on the chest, force it out ; this exercise may be 
 frequently repeated — dry friction, at the same time, upon the 
 thorax may prove of much advantage. 
 
 In the event that there may be disengaged mucus in the 
 trachea, the child may be held up, with its head down, and 
 shaken a little, that it may pass down and out of the mouth. 
 This effort should not be too readily abandoned, as the mucus, 
 which may have been tough at first, often becomes thin and 
 will run out, more especially if there be life enough to produce 
 a few pulsations in the heart or in the cord, in the event that 
 it has not been divided. 
 
 It is the practice of some to endeavor to excite cries in the 
 child as a means of promoting respiration ; but it is not unat- 
 tended with a suspicion of mischief, because the efforts pro- 
 duced by crying may increase the current of blood to the 
 lungs and augment the difficulty. 
 
 After each effort to establish this function, the ear should 
 be applied to the region of the heart, to discover if any 
 action has been produced. By these or other means, respira- 
 tion has sometimes been thoroughly established, but in others, 
 
388 KOIs^-INFLAMMATORY FORMS OF DISEASE 
 
 too partially so, to sustain existence more than a few days or 
 even hours. 
 
 When a suflacient strength of atmospheric life has obtained, 
 it will be manifested by a short and deep sob, which is gene- 
 rally repeated at longer or shorter intervals, and when deferred 
 too long, we may promote its return by again inflating the 
 langs. 
 
 When the function has become established, no matter to 
 what extent, much subsequent care will be requisite — the child 
 must not be fatigued — it must be attended to with warm 
 applications, and be as little disturbed as possible, by dress- 
 ing or other attentions. 
 
 Post mortem examinations of such cases show but little en- 
 gorgement of the lungs, and in some cases, none ; and if they 
 sink in water, the two circumstances leave no room to doubt 
 that air had not sufficiently entered the air-cells to maintain 
 existence. 
 
 It is too frequently the case, no doubt, that the ligature is 
 applied to the umbilical cord as soon as the child is born. In 
 such cases, therefore, of suspended respiration, the child has 
 a very slender chance of existence. The division of the cord 
 has separated it from all intra-uterine life before the extra- 
 uterine has become established. Prudence would, therefore, 
 dictate that the cord should not be ligatured so long as there 
 continues pulsation in it. 
 
 When respiration has become established, the circulation in 
 the cord will, from the necessity of the case, cease ; so long, 
 therefore, as the cord pulsates, there is no very great danger 
 to be apprehended ; but should the pulsation in the cord have 
 ceased, and a division of it is followed by a few drops of black 
 blood, before the establishment of respiration, the case is one 
 of danger, but not necessarily so hopeless as to forbid such 
 efforts as have been recommended for its establishment. 
 
 Genus II. — Congestion of the Lungs. 
 Respiration, after birth, may be thoroughly established, and 
 yet, infiltration and engorgement of the lungs may soon suc- 
 ceed. It is said to be occasioned by some disturbance to the 
 circulation in the heart and large vessels. This may be very 
 probable, but what is the character of this obstruction ? Cases 
 
m THE RESPIRATORY APPARATUS. 389 
 
 of this nature are not of unfrequent occurrence, and sometimes 
 they continue for a long time, and may be the cause of very 
 serious consequences. 
 
 In pulmonary engorgement, the substance of the organ pre- 
 serves its integrity, and it occurs more frequently in the right 
 lung, than in the left, and in the posterior than in the anterior 
 portions of it. It consists in an infiltration of blood or bloody 
 serum into the substance of the lungs, and the quantity thus 
 infiltrated is sometimes very great. The substance of the 
 lungs crepitates less than when sound, under pressure ; it is 
 also more heavy than natural and less elastic, and is of a dark 
 red color externally, and when cut it is red. It is sometimes 
 the case, that the bronchise are red and covered with an exu- 
 dation of bloody serum, in the body of the engorged portion. 
 In hepatization of the lungs, there is no engorgement of the 
 heart and large vessels, but in the engorgements of them, the 
 contrary is the fact. 
 
 The symptoms of pulmonary engorgement in infants, are 
 enveloped in much obscurity, and therefore, during life, it is 
 very difficult to determine, certainly, what the ailment is — 
 they are simulated by those of other pulmonary forms of dis- 
 ease to such an extent as to render diagnosis very uncertain ; 
 but, in the general, it may be said, that the face is purple ; 
 the respiration labored ; the thorax has not the appearance of 
 being perfectly developed ; the cries are short, painful, and 
 obscure; a dull sound is produced by percussion, and a san- 
 guineous plethora of all the organs is indicated by the general 
 color of the skin. 
 
 As pulmonary engorgement is frequently the precursor of 
 pneumonia, we refer to it for the treatment of this form. 
 
 Genus III. — Apoplexy of the Lungs. 
 
 Between this form of disease in infants, and that of adults, 
 there is a considerable difference, and it occurs more frequently 
 in the former than in the latter. In adults, it is attended with 
 hemorrhage, and very generally symptomatic of an incurable 
 disease; in infants, it consists of a circumscribed effusion of 
 blood in the body of the pulmonary or interlobular cellular 
 tissue. 
 
 The frequency of infantile engorgements, or congestions of 
 
390 NERVOUS FORMS OF DISEASE 
 
 the lungs, accounts for the greater frequency of this affection. 
 It may appear suddenly, or it may come on slowly, depending 
 upon the urgency of the cause that determined the afflux. 
 
 The most prominent symptom of this condition of the lungs, 
 is a suffocating cry; percussion indicates the absence of air in 
 the affected part ; occasionally, bloody mucus is expelled from 
 the lung. 
 
 Under the influence of this malady, the pulmonary tissue 
 becomes hard, and about its circumference apparently hepa- 
 tized ; yet in some cases, it has been found considerably soft- 
 ened. 
 
 This disease always excites alarm, and very justly, but still, 
 it is not always fatal. The effused portion of the lung may 
 become encysted, and thus isolated, and finally, it may, pos- 
 sibly, be absorbed. 
 
 In this affection, no time should be lost in producing a revul- 
 sion of blood from the lungs — at all events, an equalization of 
 it. For the further treatment of this disease, we refer to that 
 of pneumonia. 
 
 OKDER III. 
 
 NEBVOUS FOBMS OF DISEASE IN THE KESPIEATOEY APPARATUS. 
 
 Genus I. — Infantile Spasm of the Glottis — 
 Crowing Disease — Thymic Asthma. 
 
 So far as spasmodic action of the larynx and glottis is con- 
 cerned, this affection resembles catarrhal croup, but here the 
 similitude ends ; the latter, as we have shown, is an inflam- 
 matory disease of structure, while the former is purely nerv- 
 ous — one of function; and one, too, which may mislead the 
 student or young practitioner, without care — he may do, as 
 others have, mistake it for catarrhal croup. 
 
 It commences usually in the night, when the patient is 
 asleep, and suddenly produces an inability to inhale the air; 
 to which succeeds a struggle of all the muscles that can exert 
 an influence in promoting or aiding the respiratory function ; 
 just as we found it to be in a paroxysm of catarrhal croup, 
 the head is inclined backward, the thorax is elevated, the 
 
m THE RESPIRATORY APPARATUS. 391 
 
 nostrils are spread, the month is open, the cervical veins are 
 engorged, the face is flnshed, swelled, and purplish, with a 
 countenance distressed and anxious. 
 
 In a short time, or not until the moment of threatened 
 asphyxia supervenes, the spasm relaxes, and the air enters the 
 lungs, producing an acute or young cock-crowing sound, and 
 the child is again well, or its respiration may be a little short 
 for a while. 
 
 During the paroxysm, the extremities become singularly 
 affected, sometimes, says Dr. West, " the thumb is drawn into 
 the palm by the action of the abductor muscles, while the 
 fingers are unaffected ; at other times, the fingers are closed 
 more or less firmly, and the thumb is shut into the palm ; or, 
 coupled with this, the hand itself is forcibly flexed on the 
 wrist. In the slightest degree of the affection, the great toe 
 is drawn a little way from the other toes; in some degrees of 
 this affection, this abduction of the great toe is very conside- 
 rable, and the whole foot is forcibly bent upon the ankle, and 
 the sole directed a little inward. The afi'ection of the hand 
 generally precedes the affection of the foot, and may even 
 exist without it, but I have never seen spasmodic condition of 
 the foot when the hands were unafiected." 
 
 For a short time, in the fore part of this disease, during the 
 intervals between the paroxysms, the child appears as well as 
 usual, but this exemption only seems to be a preparation for a 
 more dangerous condition of the malady. 
 
 The paroxysms become reproduced by such trivial causes 
 that it is next to impossible to guard against their recurrence. 
 A sudden change of temperature, the least exposure to a cur- 
 rent of air, a slight mental disturbance, deglutition, or any 
 pressure upon the larynx may provoke a paroxysm, more par- 
 ticularly at night. 
 
 The general condition of the child is a departure from 
 health — the bowels are frequently attended with an alternation 
 of diarrhea and constipation — evident symptoms are some- 
 times present of dental irritation, as swelled gums and a hot 
 condition of the mouth. In a long-continued paroxysm, 
 death is sometimes produced by sufibcation ; at other times, 
 the oft-repeated difficulty of breathing produces such a condi- 
 tion of the brain that the child dies convulsed, or in some 
 
392 KERYOUS FORMS OF DISEASE 
 
 other manner, equally indicating snch a pathological condition 
 of it as might be induced by imperfectly organized blood, or 
 congestion from paroxysmal forces. If from these agencies, 
 it should escape death, convalescence will be greatly protracted, 
 because it cannot be protected against occasional returns of 
 the disease. 
 
 Causes. — The causes of this affection are as numerous as 
 are the sources of disturbance to the general function of health. 
 Whatever disturbs digestion, by improperly exciting the gas- 
 tric branches of the pneumogastric or eighth pair of nerves, 
 may produce it ; also disturbances of the dental process, by 
 acting upon the dental branches of the fifth pair. 
 
 It may also be produced by derangements in the function 
 of the intestinal canal, by which the spinal nerves become im- 
 properly excited, and, through them, the spinal marrow, the 
 recurrent laryngeal, and those appropriated to the diaphragm 
 and intercostal muscles. 
 
 Dentition is thought to be the most frequent of the exciting 
 causes of this nervous malady. "We much prefer the idea, 
 that as the disease occurs most generally during the period of 
 dentition, a period of general development, and therefore of 
 general irritation, that the muscles of the glottis and larynx 
 are morbidly excited by a special display of the irritation 
 peculiar to the dental age ; because, in many cases, perhaps 
 in a majority of them, though happening in the dental period, 
 they were not occasioned by any morbid action in the dental 
 process. 
 
 Furthermore, tliis nervous malady has happened with infants 
 at the age of eight or ten weeks, consequently, long before the 
 period of dental irritation ; and it has happened long after the 
 completion of this process — thus showing that there is no 
 necessary connection between the two. 
 
 The disease is sometimes produced by such local causes as 
 enlarged cervical and bronchial glands pressing upon the 
 recurrent and eighth pair of nerves. 
 
 There cannot be a reasonable doubt, but that this and simi- 
 lar forms of disease are frequently occasioned b}^ some peculiar 
 pathological state of that portion of the encephalon which 
 gives origin to the nerves which are distributed upon the 
 spasmed part. 
 
m THE RESPIRATORY APPARATUS. 393 
 
 We Lave the skull of a boy, sixteen years of age, who died 
 of the consequences, as stated upon the hospital register, of 
 onanism. His respiration was in the highest degree asthmatic 
 for some time previous to death. Post mortem examination 
 of the cerebellum discovered a tubercle in one side, and a 
 mass of encysted pus, of about the same size, in the other. 
 He was afiected, also, with paralysis of motion on one side, 
 and of sensation in the other. 
 
 If such results can be produced by such causes, then there 
 cannot be a doubt but that a spasm of the glottis may result 
 from local cerebral irritation. We are disposed to confine this 
 variety of the disease, at least, to those children in whom the 
 middle portion of each cerebellum is relatively small. We 
 have never known a case of asthma or phthisis in which this 
 part of the brain was not defectively developed. 
 
 Upon the subject of this variety of spasm of the glottis. 
 Prof. Meigs has given several interesting illustrations, and one 
 of his paragraphs is so interesting, as to the purely nervous 
 character of the malady, that we cannot refrain from extract- 
 ing it : 
 
 " I have witnessed very numerous specimens of quite young 
 children afiected with laryngismus or croupal respiration, 
 occurring occasionally, and being repeated daily, and even 
 many times a day for a month in succession, in whom no 
 other sign of the least disorder could be discovered, and which 
 finally ceased to appear. In such cases, the children have 
 grown and prospered, as well as if not the least suspicion of 
 doubtful health had arisen concerning them." 
 
 To this cause he refers the " Parson's Cough," and the hold- 
 ing of the breath among children. 
 
 As a further illustration of the subject, we have the skull 
 of a man who became exceedingly angry, and while in his 
 rage died instantly of sufibcation, occasioned by a spasmodic 
 closure of the glottis. 
 
 As the disease generally obtains, it is one of little moment, 
 and yet, its existence may well excite fearful apprehensions, 
 inasmuch as an obstinate persistence of the spasm has pro- 
 duced asphyxia and death ; and even if this result be escaped, 
 the frequent interruptions of the respiratory function, with the 
 
394 N'ERVOUS FORMS OF DISEASE 
 
 struggles tliat attend them, produce such a congestion of the 
 brain, as may end in convulsions and death. 
 
 Treatment. — When treating a child during a paroxysm of 
 laryngismns stridulus, it should be immediately raised to a 
 sitting posture, and gently fanned, and the Compound Tinc- 
 ture of Lobelia and Capsicum should be given by mouth or 
 enema, to overcome the spasm; after which, the Compound 
 Tincture of Lobelia should be administered in doses suffi- 
 ciently large to produce emesis — though it must be borne in 
 mind that, in this form of disease, emetics are attended with 
 some danger. 
 
 The throat, neck, and chest should be bathed freely with 
 the Compound Tincture of Lobelia and Capsicum, or with 
 Oil of Lobelia, and, after each bathing, a fomentation of Hops 
 and Lobelia, of each equal parts, boiled in water, should be 
 applied around the neck as hot as the patient can bear ; these 
 local applications should be continued as well during the par- 
 oxysms as in the intervals between them. 
 
 The liniment composed of the Oils of Stillingia, Lobelia, 
 and Alcohol, recommended in croup, may, if preferred, be 
 used as a local application, instead of the above. There are 
 no agents so useful in this affection, to overcome spasmodic 
 action of the glottis, as the preparations of Lobelia. 
 
 If the child be teething, and there is the least heat or swell- 
 ing over the advancing teeth, the gums should be freely and 
 deeply lanced, once or twice daily. 
 
 Should gastric or intestinal irritation be present, or consti- 
 pation, especial attention should be bestowed upon the diet, 
 selecting that which is light, nourishing, easily digestible, and 
 not disposed to cause acidity of the stomach; at the same 
 thne, laxatives may be given, as Rhubarb and Bicarbonate of 
 Potassa, to which, in some instances, a small portion of Podo- 
 phyllin may be added, and these laxatives may be repeated 
 every day or two. 
 
 If there is diarrhea, the Compound Powder of Rhubarb, or 
 Syrup of Rhubarb and Potassa, will be found fully sufficient 
 to overcome the difficulty in the majority of cases, and when 
 it fails, Geranin may be administered in doses proportioned 
 to the child's age, in connection with the powder or syrup above. 
 
m THE RESPIRATORY APPARATUS. 395 
 
 Djsuria occasionally accompanies tlie affection, for which 
 an infusion of Marsh Mallows may be given, with the addi- 
 tion of Spirits of ISTitr. Diilcis, and one or two drops of Tinc- 
 tm-e of Stramonium. 
 
 If the fauces are swollen, a weak solution of the Nitrate of 
 Silver should be applied to them by means of a camel's hair 
 pencil. 
 
 In the intervals between the spasms, agents must be used to 
 prevent their return, for which purpose, either the Compound 
 Tincture of Cramp-bark, Compound Pill of Black Cohosh, or 
 Compound Pill of Yalerian, may be used — the bowels kept 
 regular, and all species of excitement, either mental or physi- 
 cal, should be carefully avoided. 
 
 If the case be very intractable, in addition to the preceding, 
 pustulation should be produced over the seat of the disease, 
 by rubbing on Croton Oil. 
 
 As the child improves, tonics, as Quinine and Iron, maybe 
 employed, but the diet should remain the same. 
 
 In all cases, where it can be accomplished, a removal to the 
 pure, mild air of the country will be found to facilitate the 
 cure. 
 
 Genus II. — Nervous Cough. 
 
 This form of disease, taking society at large, is not unfre- 
 quent, but its occurrence among children is only occasional, 
 more especially with the very young. 
 
 So far as has been observed, it exists exclusively in a cough, 
 which, although having several modifications, is unlike any 
 other, more especially when associated circumstances are taken 
 into consideration — independent of these, it occasionally has 
 some resemblance to that of catarrh, and even, to some extent, 
 simulates hooping-cough, but with these there are other indi- 
 cations of disease. It has not been detected in the chest, and, 
 except when most obviously a symptom, it seems to exist inde- 
 pendently of disease, for the patient, though much annoyed 
 with it, has no other indication of ill health ; consequently, it 
 is thought to be purely a nervous affection. 
 
 A variety of it frequently exists as a symptom of gastric 
 irritation, through the instrumentality of the per vaguni; but 
 when it is of this character, it is easily detected by every pliy- 
 Bician, and therefore, it does not, in this place, demand our 
 
396 NERVOUS FORMS OF DISEASE 
 
 attention. Furthermore, it does not closely simulate the idio 
 pathic nervous cough which at present alone engages our atten- 
 tion. 
 
 This cough presents no discoverable indications of being 
 symptomatic, and it is usually dry and short, unless rendered 
 otherwise by a severe and lengthened paroxysm of it, whereby 
 the respiratory apparatus, in general, is excited by it, and 
 then a little mucus may be thrown up. Its sound, however, 
 is sometimes more full, lengthened and liquid. 
 
 With some children, it will occur at irregular intervals 
 throughout the year, without reference to season, and without 
 reference to time, as to day and night; with others, it occurs 
 only during the cold season, and with some it occurs only dur- 
 ing the night. 
 
 It sometimes presents such a hollowness and loudness of 
 sound, as to arrest the attention of all observers. The par- 
 oxysm may consist of only two or three coughs, or it may con- 
 sist of a single cough at frequent and irregular intervals, or it 
 may be almost continuous through both day and night — allow- 
 ing the patient but little unbroken rest; or it may occur in 
 paroxysms of such severity as to excite perspiration, a secre- 
 tion of mucus in the respiratory passages, and a full and 
 flushed condition of the face. 
 
 When hearing the cough, we cannot realize that the chest is 
 either deep or capacious enough to produce it — in this respect, 
 and even sometimes in the sound of the cough, we have 
 thought it to simulate the sound made by some frogs. The 
 listener is, furthermore, astonished, to find such a cough to 
 attend the appearance of so much health. 
 
 The most notable instance of this kind, which we have 
 seen, is that of a very healthy girl, about fourteen years of 
 age. She has been exempt from it during the three preceding 
 summers, but it has troubled her very much during the suc- 
 ceeding winters. In all other respects she has excellent 
 health. 
 
 There is, in her case, an organic circumstance which de- 
 serves notice — her fauces and pharynx are exceedingly devel- 
 oped and appear entirely healthy. If all such patients have 
 so large a pharyngeal chamber, all the peculiarities of the 
 cough may be accounted for. 
 
m THE RESPIRATORY APPARATUS. 397 
 
 This patient, furthermore, is very phimply developed, flesh 
 firro, neck rather short, complexion fair, the chest large, but 
 not flexible, the nose is small, and the nares are contracted — 
 contra-indicative of a vigorous pulmonary function. In her 
 case, the nutritive and cutaneous functions are well performed, 
 and, from the lively character of the skin, we would infer that 
 her kidneys do not perform as much duty, as they gene- 
 rally do. 
 
 As this is the only well-marked case we have seen, since 
 the formation of our present physiological views, we are una- 
 ble to determine how far her peculiar organic conditions are 
 involved in the production of the cough ; but this much we 
 are willing to venture : if this cough is always associated with 
 such an organization, more or less, then the cough is but an 
 indication of an imperfect pulmonary system, and conse- 
 quently of a deficient renal one. 
 
 This conclusion finds some support in an observation made 
 by Prof. Wood ; in speaking of the cause of this afiection, he 
 says : " I have seen it associated with tenderness of the spine 
 between the scapulse. I have also seen it, apparently, the 
 result of gouty and rheumatic irritation." 
 
 Teeatmekt. — Dr. Wood states that he has found nothing so 
 effectual as Asafoetida. We have tried this, and know that it 
 will give almost immediate relief, but it will not eflect a 
 cure — the cough will return. Based upon our pathological 
 suspicions, we would suggest, for the purpose of trial, much 
 exercise, the use of light clothing, azotized food, and diuretics. 
 
 In this disease, much benefit may be derived from the use 
 of the following compound: 
 
 9^. Podophyllin, gr. j, 
 
 Cyanuret of Iron, grs. v, 
 S. Morphia, gr. ss, 
 White Sugar, 3j. Mix. 
 Divide into twelve powders ; give one powder three times a 
 day, to a child about three years of age, or in proportion. In 
 connection with this : 
 
 1^. lodate of Potassium, grs. iij, 
 Tinct of Belladonna, gtt. xx, 
 Distilled Water, 3vi. Mix, and give a table- 
 spoonful every half hour. 
 
398 l^ERYOUS FORMS OF DISEASE 
 
 A strong infusion of Peach Leaves, or Wild Cherry Bark, 
 may be used as a drink through the day, which will be 
 found to have a sedative influence upon the cough. 
 
 Genus III. — Hooping-Cough. 
 
 "When we reflect that this disease is almost peculiar to chil- 
 dren — that it stands third in the order of fatality, and that it 
 occasions, in the parental mind, much painful anxiety, it must 
 be admitted to deserve particular attention ; much more, we fear, 
 than it receives from a large portion of the profession, because 
 of the fact, that all grandmothers, and a large proportion of the 
 motliers profess to understand and to treat it. 
 
 But as physicians, this circumstance should not abridge our 
 attention to it ; on the contrary, we should as thoroughly as 
 possible understand it, and then we should difiuse our know- 
 ledge of it to all the mothers in the land. This course is more 
 imperative with this disease, than with any other, because 
 every child, as a general fact, must have it. 
 
 A close attention to its peculiarities renders it of easy diag- 
 nosis — it consists of paroxysms of coughing, in which there 
 is a lengthened and thorough inspiration, followed by a suc- 
 cession of short expirations or coughs, until no air continues 
 or remains in the lungs. When the disease exhibits these two 
 well-marked symptoms, there can be no doubt as to its indi- 
 viduality, whether hooping attends it or not. 
 
 For the purpose of a more detailed definition of it, some 
 advantage will be obtained by dividing it into three stages, 
 the catarrhal, the spasmodic, and the declining ; the first two 
 are, generally, quite distinct, and the third is not of very dif- 
 ficult recognition. The catarrhal stage is of very indefinite 
 duration ; Dr. West states, that the average of fifty-five cases 
 was twelve days and seven-tenths, and that two extremes 
 were, respectively, two, and thirty-five days. But, in six of 
 the fifty-five cases, there was no formative, or so-called first 
 stage, they were paroxysmal from the start. 
 
 We may say then, as an approximation, that the forming 
 or first stage continues two weeks, more or less, and is scarcely 
 ever attended with any symptom that distinguishes it from 
 catarrh. It begins with coryza, red and sufiused eyes, sneez- 
 ing, irritation of the fauces, dry cough, and sometimes febrile 
 
m THE RESPIRATORY APPARATUS. 399 
 
 symptoms. More is to be determined from the prevailing pre- 
 sence or absence of the disease than from symptoms during 
 this stage. If catarrh is prevalent at the same time, which is 
 not usually the case, it has been observed to run the same 
 course (save the spasmodic and hooping symptoms), as though 
 it originated in the same cause. 
 
 The distinguishing symptom of the second stage, is spasm — 
 the hooping sound of the inspiration may commence with the 
 spasms, but frequently it does not supervene upon them, under 
 several days, and occasionally not at all. 
 
 In defining the disease, we stated that the paroxysm formed 
 or commenced with a protracted inspiration — the hooping, 
 when present, is occasioned by it, and that the coughing con- 
 sists in the discharging or expiring the air of this inspiration, 
 in broken, or interrupted, or spasmodic efforts, each of which 
 constitutes a cough. A paroxysm may continue from thirty 
 seconds to the fourth of an hour. During a paroxysm, the 
 face becomes flushed, then purplish or livid, the cervical veins 
 distended, eyes prominent and probably suffused. 
 
 It is thought that during the opening and closing of an 
 epidemic of this disease, the cases which are marked by a 
 protracted forming stage, are produced. This would seem to 
 imply that the cause is less concentrated. 
 
 It is further stated, that when the catarrhal stage is pro- 
 tracted, the spasmodic stage will be mild, or comparatively 
 light; but on the other hand, it is not said to follow, that 
 when this stage is short, that therefore the one of spasm will 
 be more severe. The absence of the hoop, in . the second 
 stage, is regarded as an indication of intensity or violence. 
 "We do not remember to have seen it noted, that in those cases 
 in which the violence of the spasm forces blood from the nose, 
 mouth, and ears, and to extravasate the conjunctiva, were, or 
 were not, attended by the hoop, yet so far as our own observa- 
 tion has extended, the hoop has always been present in these 
 instances. 
 
 In some cases, as we have remarked, the second stage 
 begins the disease with high fever, dyspnoea, and other indi- 
 cations of bronchitis, but upon the subsidence of these acute 
 symptoms, the real disease becomes developed. After the 
 spasmodic character of this stage has become clearly defined, 
 
400 NERVOUS FORMS OF DISEASE 
 
 some days elapse before it reaches its maximum, and during 
 this time, it is worse through the night than through the day. 
 In milder cases, there is but little, if any, difference in the 
 paroxysms between the day and the night, and it frequently 
 happens, that when the pS-tient is tolerably well all day and 
 rests pretty well at night, it will have a severe paroxysm at 
 going to bed and another upon rising in the morning. The 
 first, probably, is caused by going into a cooler room for bed, 
 and the second by the bronchial accumulations of mucus 
 through the night. So long as a strong, loud hoop attends 
 the disease, we can feel sure that the spasm does not close the 
 glottis, and therefore the child is safe from suffocation for the 
 present. 
 
 When the disease has obtained its acme, it may continue 
 with about the same intensity two or three weeks, when the 
 third stage commences — the paroxysms become less frequent, 
 the inspirations less protracted, and the broken expiration less 
 spasmodic — in fine, the disease, again, takes on the catarrhal 
 form, and the patient is comparatively well ; but at other 
 times, the termination is not so speedily favorable — it is some- 
 times marked with relapses, or it may assume the chronic 
 form, and thus become protracted to months, and possibly to 
 a year or two. 
 
 When, however, the disease does not take a favorable turn, 
 all the symptoms of the second stage continue to increase in 
 violence, the hooping-pauses in the paroxysms cease to be 
 heard; a short inspiration, however, is made and the cough- 
 ing returns ; at length, as the paroxysm is going ofi', the hoop 
 may again be heard, and though not so loud it will be more 
 stridulous. The paroxysms become more frequent, and the 
 intervals are measurably filled with dyspnoea — the inspiration 
 is no longer announced, or but seldom, by the hoop, the cough 
 changes, the larynx becomes closed, struggles ensue, the con- 
 striction at length yields, and the respiration is effected. These 
 paroxysms so increase, that before one is completed anothei 
 commences, and thus they recur, until one of them closes the 
 scene. 
 
 The greatest danger from this disease, however, results from 
 its complications, which are numerous, as with convulsions, 
 croup, diarrhea, inflammation of some portion of the intestinal 
 
IN" THE RESPIRATORY APPARATUS. 401 
 
 canal, with tubercular predisposition, bronchitis, etc. Pertus- 
 sis is admitted to be epidemical, and some contend that it is 
 contagious. 
 
 Prof. Bigelow says, that it is one of those diseases which 
 cannot be shortened or mitigated to much extent. We admit 
 that it cannot be materially shortened, but we feel pretty con- 
 . fident that it may be materiallj^ mitigated by such a course of 
 medication as it naturally indicates — which is to equalize the 
 circulation, remove constriction, establish depuration, and 
 maintain a centrifugal action in the system. 
 
 Treatment. — It is very seldom that the practitioner is called 
 in the first or catarrhal stage of pertussis, unless the symp- 
 toms are very severe, in which case he will treat them upon 
 the principles indicated under the head of Catarrh. 
 
 Sometimes the first stage is wanting, and the disease then 
 assumes its peculiar characters from the commencement; but, 
 more usually, this stage is mild, and it rarely happens that 
 the physician is consulted, except in the second stage, when 
 the disease is properly manifested. 
 
 As we cannot expect to curtail the duration of pertussis, our 
 only course is to employ measures to moderate its violence and 
 diminish the frequency and intensity of the paroxysms ; for 
 this purpose, during the earlier part of the second stage, 
 should inflammatory symptoms be present, an emetic should 
 be given, daily or every other day, according to the urgency 
 of the case, and which should be followed by an expectorant. 
 
 To fulfill both of these indications the Compound Tincture 
 of Lobelia will be found the most efiectual agent — and indeed, 
 from its antispasmodic influence, it will prove, in rtiany in- 
 stances, an agent fully sufiicient to accomplish all that can be 
 desired, and that too, even after the inflammatory symptoms 
 have subsided. 
 
 In this afiection, constipation should be overcome, and the 
 bowels kept regular, not by active cathartics, but by mild, 
 laxative agents. 
 
 After the inflammatory symptoms have fully subsided, some 
 of the specific remedies, so named, may be given — among 
 which, however, we prefer the following, having used each of 
 them with much advantage: 
 26 
 
402 NERVOUS FORMS OF DISEASE, ETC. 
 
 ^. Carbonate of Potassa, 9j, 
 Pulv. Cochineal, 9 ss, 
 "White Sugar, 3i, 
 Distilled Water, 3iv. Mix. 
 Of this, a teaspoonful may be given three or four times a day 
 to a child one year old, and in proportion. 
 
 Alum, likewise, affords prompt relief in this disease, and 
 may be given according to the following formula ; it does not 
 constipate the bowels or produce any injurious effects, except 
 its tendency to cause vomiting when given in large doses, and 
 to induce diarrhea from too long an employment of it : 
 1^. Alum grs. xxv. 
 
 Syrup Ginger, 3ij, 
 Water, giij. Mix. 
 
 Of this, an ordinary sized teaspoonful may be given every 
 six hours to a child a year old. 
 
 In protracted, obstinate cases, a change of air will be found 
 advantageous, often cutting short the disease at once. 
 
 Infants sometimes have the paroxysms very violent, so 
 much so as to cause an apprehension of suffocation or convul- 
 sions, to overcome which. Dr. Meigs recommends the appli- 
 cation of compresses dipped in cold water to the sternum, or 
 a piece of ice wrapped in linen and suddenly applied to the 
 epigastrium. 
 
 In those instances where, from spasmodic closure of the 
 glottis during the paroxysm, there is a suspension of breathing 
 for several seconds, greatly endangering life, the free use of 
 the Compound Liniment of Stillingia and Lobelia, referred to 
 under CK)up, may be freely applied to the throat, neck, and 
 chest, for the purpose of preventing such closure in subse- 
 quent paroxysms. 
 
 The clothing of the child laboring under pertussis, should 
 be warm, with flannel worn next to the skin in cold or damp 
 weather, and in such seasons, it should likewise be kept in the 
 house ; but in fine weather, during the second stage, the free, 
 open air, in the middle of the day, will prove beneficial. The 
 diet should be nutritious and of easy digestion. 
 
CLASS IV. 
 
 MANIPESTATIONS OF DISEASE IN THE CIRCULATOM APPARATUS. 
 
 OEDER I. 
 
 NON-INFLAMMATORY FORMS OF DISEASE IN THE CIRCULATORY 
 
 APPARATUS. 
 
 Genus I. — Establishment of Independent Circulation. 
 
 This subject has been so interestingly and ably developed 
 by Mons. Billard, that we feel it to be our duty to present to 
 our readers his investigations without modification or abridge- 
 ment: 
 
 " I have studied with the greatest care the changes which 
 occur in the heart, ductus arteriosus, ductus venosus, and um- 
 bilical arteries, during the first days of extra-uterine life, and 
 shall exhibit here the results of these researches. 
 
 "I shall consider successively — 1st. The period at which 
 the fetal openings are obliterated; 2d. Their mode of oblite- 
 ration ; 3d. I will exhibit the physiological and pathological 
 consequences which naturally flow from these researches. 
 
 ''^Infants of the age of one day. — In nineteen children, aged 
 one day, there were fourteen in whom the foramen ovale was 
 completely open ; in two of them it had begun to be oblite- 
 rated ; and in two it was entirely closed. Consequently no 
 blood passed through it. 
 
 ^'In the same children, the ductus arteriosus was free, and 
 filled with blood in thirteen ; its obliteration had commenced 
 in four, and in the remainder it was completely obliterated. I 
 also noticed that, in one of the last mentioned children, there 
 
 (403) 
 
404 NOI^'-INFLAMMATORY FORMS OF DISEASE 
 
 was a complete occlusion of the foramen ovale. In the 
 other children, in the same state the ductus arteriosus was 
 still open. 
 
 " With respect to the umbilical arteries, they were still open 
 near their junction with the iliac arteries, but their caliber 
 was narrowed in consequence of a very remarkable thickening 
 in their walls. In all these children, the umbilical vein and 
 ductus venosus were free, and the latter was most generally 
 gorged with blood. 
 
 "From this examination, it appears that the foramen ovale 
 and ductus arteriosus are still open on the first day of birth in 
 most instances, although they may be obliterated at this 
 period. 
 
 " Infants of the age of tico days. — In twenty-two children, 
 aged two days, there were fifteen where the foramen ovale was 
 perfectly open ; in three of them it was almost obliterated, 
 and in four entirely closed. In thirteen of these children, I 
 found the ductus arteriosus still open ; in six the obliteration 
 had commenced, and in three was entirely obliterated. In all, 
 the umbilical arteries were obliterated to a greater or less ex- 
 tent, but the umbilical vein and ductus venosus, although 
 empty and flattened, would not allow of the passage of a 
 moderate sized stylet. These facts are sufficient to demon- 
 strate that, in most instances, the foramen ovale and ductus 
 arteriosus are not obliterated on the second day after birth, 
 although the child may enjoy independent life ; as to the um- 
 bilical arteries, having now become useless, they undergo the 
 changes resulting from their default of action. 
 
 " Infants of the age of three days. — I also subjected the 
 bodies of twenty-two children, aged three days, to the same 
 examination. In fourteen of these the foramen ovale was still 
 open ; in five the obliteration had already commenced, and 
 was complete in the remaining three. 
 
 " The ductus arteriosus was also open in fifteen ; the oblite- 
 ration had commenced in five, and was complete in two. 
 Both of these subjects also presented the closure of the fora- 
 men ovale. The umbilical vessels and the ductus venosus 
 were empty and obliterated in all these subjects. Now, it is 
 evident that these vessels are obliterated before the foramen 
 ovale and ductus arteriosus have undergone any complete 
 
IN THE CIRCULATORY APPARATUS. 405 
 
 occlusion, and it can therefore be asserted, that at the third 
 day the ductus arteriosus and foramen ovale are not generally 
 closed. 
 
 ^^ Infants of the age of four days. — I found in twenty- 
 seven children, aged four days, the foramen ovale open in 
 seventeen. In these seventeen cases, there were six where this 
 opening was very large, and distended with a considerable 
 quantity of blood, and in the remaining number it was 
 slightly open. In the twenty-seven cases now under conside- 
 ration, the closure of this opening had commenced in eight, 
 and it was completely closed in two. 
 
 " The ductus arteriosus was still open in seventeen children ; 
 its obliteration had begun and it exhibited nothing more than 
 a small hole in seven of these, and its closure was complete 
 in three ; the umbilical arteries, in almost all, were obliterated 
 near the umbilicus, but still susceptible of dilatation near the 
 junction with the iliac arteries. The umbilical vein and the 
 venous canal were completely empty and considerably con- 
 tracted. 
 
 ''^Infants of the age of five days. — Twenty-nine children, 
 aged five days, were subjected to the same examination as in 
 the preceding instance ; thirteen exhibited the foramen ovale 
 still open ; but this opening did not exist in the same degree 
 in all. It was largely dilated in four individuals, and in ten 
 others its diameter was much smaller. 
 
 "This passage was almost completely obliterated in ten in- 
 dividuals, and in six others sufficiently so as to leave no com- 
 munication between the auricles. 
 
 "I found, in these twenty-nine cases, the ductus arteriosus 
 open in fifteen ; in these, there were ten where the duct was 
 very large. The obliteration had made considerable progress 
 in the remaining five, and was almost complete, or at least the 
 caliber of the duct consisted of nothing more than a narrow 
 hole, in seven, and in seven others the obliteration w^as com- 
 plete. As to the umbilical vessels, their obliteration w^as com- 
 plete in all. 
 
 "We have seen, thus far, that the fetal openings remained 
 free in a number of children five days after their birth. None 
 of the children exhibited any peculiar symptoms which ap- 
 peared to have their seat in the circulatory apparatus. We 
 
406 NON'-INFLAMMATORY FORMS OF DISEASE 
 
 shall find the number dimmish in subjects of more advanced 
 age than those which have akeady been the object of our 
 researches. 
 
 " Infants of the age of eigJit days. — I have not observed 
 any well-marked difierence between children of six or seven 
 days, and those which we have just described. This remark, 
 however, is not applicable to those of eight days. Indeed, I 
 have found but five where the foramen ovale was still open in 
 twenty cases that I examined. It was partially closed in four 
 individuals, and its occlusion was complete in eleven. 
 
 " In these twenty children, there were but three in whom 
 the ductus arteriosus was not yet obliterated ; one of them 
 presented an aneurism of the duct of the size of a hazelnut; 
 interiorly, it was coverexi with a thick layer of a yellow 
 color and fibrinous consistence, analogous in every respect to 
 those fibrous layers which cover the interior of an aneurismal 
 pouch. 
 
 "In these twenty individuals, I found in six the ductus 
 arteriosus almost entirely obliterated, and its obliteration was 
 complete in eleven. The umbilical vessels were perfectly 
 closed in almost all ; I say almost all, because I observed 
 neither the umbilical arteries nor vein in five of them. 
 
 "From the last examination, it appears that the fetal open- 
 ings are usually obliterated on the eighth day, but they may 
 yet be found open even on that day ; I will also add, that even 
 on the twelfth and fifteenth day, and in the third week, the 
 foramen ovale or ductus arteriosus may still be open, without 
 the child experiencing any particular symptom ; for I will 
 again observe, that I have chosen for these researches children 
 who, for the most part, died from afiections in which the res- 
 piratory apparatus did not participate. 
 
 "From this exposition, it is evident that the fetal openings 
 are not obliterated immediately after birth ; that the period at 
 which this occurs is extremely variable, yet the foramen ovale 
 and ductus arteriosus are usually closed on the eighth or tenth 
 day. It results, also, from the examinations we have made, 
 that the modifications which follow the cessation of fetal life, 
 in the circulatory organs of a new-born child, occur in the 
 following order : the umbilical arteries are first obliterated, 
 then the vein, next the ductus arteriosus, and lastly, the 
 
m THE CIRCULATORY APPARATUS. 407 
 
 foramen ovale. The persistence then of the fetal openings, 
 for some days after birth, ought not to be considered as a dis- 
 ease, since it is not uncommon to meet with it without having 
 given rise to any particular symptom. This irregularity or 
 tardiness is attributable, as will be presently seen, to the mode 
 of obliteration. 
 
 "ll. MODE OF OBLITERATION OF THE FETAL OFENINGS. 
 
 " When the arrangement, which gradually occurs in the fora- 
 men ovale, from the earliest months of conception until the 
 period of birth, is examined, it will be perceived that the form 
 of this opening and the disposition of the surrounding parts, 
 and particularly that of the eustachian valve, are such that 
 the blood, which at first flows without any obstacle from one 
 auricle to the other, by degrees experiences some difficulty in 
 its passage. Sabatier especially has remarked this. Thus the 
 first modification in the organization of the heart forces the 
 blood to change its course; this fluid, in itself inert, is under 
 the immediate dependence of the moving power which pro- 
 jects and directs it through the proper passage. If this be 
 so, it must also follow, that in those parts which the blood 
 leaves, an anatomical modification occurs, which changes the 
 form and modifies the action of these organs, and produces in 
 the blood which flows through them, a change of direction. 
 Now, if the umbilical arteries and the arterial duct are ex- 
 amined, in proportion as they become obliterated, it will be 
 seen that their walls gradually become thickened. The thick- 
 ening of the umbilical arteries is more remarkable at the point 
 of insertion at the umbilicus, at which point they exhibit a 
 kind of swelling which materially afiects the caliber of the 
 artery, and this swelling appears to be the result of a species 
 of hypertroph}^ of the yellow, elastic, fibrous tissue; whence 
 it follows, that the artery exercises, at this part, a contractile 
 force superior to the dilating power of the blood propelled by 
 the iliac arteries. It is very easy to prove the thickness of the 
 walls of the artery, by cutting it in sections at this part; the 
 thickness, it will be also perceived, diminishes in proportion 
 as we approach the iliac arteries, and it is precisel}^ in this 
 direction that the progress of the obliteration is observed to 
 occur after birth. Two conditions, therefore, cause the blood, 
 
4:08 Il^FLAMMATORY FORMS OF DISEASE 
 
 after birth to leave the course it had while in the uterus : 1st. 
 the establishment of respiration and the pulmonary circula- 
 tion ; 2d. the modification of texture occurring in the umbili- 
 cal arteries. 
 
 " The following phenomenon proves also that the contrac- 
 tility of the umbilical vessels is susceptible of suspending the 
 course of the blood in them ; if the umbilical cord be cut at 
 some distance from the umbilicus at the time of birth, in a 
 plethoric child, the blood will at first be seen to issue in a jet 
 with considerable force, then becoming slower, and afterward 
 stopping altogether; if another portion of the cord be cut, 
 another jet of blood occurs, and soon stops. This hemorrhage 
 may be renewed at each section of the cord. M. P. Dubois 
 has informed me that he has seen this frequently occur. 
 
 "Now, the course of the blood is in some degree arrested, 
 because the umbilical arteries contract on it and force it to 
 retrograde ; if there exist near the umbilicus and within the 
 abdomen a portion of the umbilical arteries more contractile 
 from the existence of a greater quanty of elastic, fibrous tis- 
 sue, it can easily be conceived that the course of the blood in 
 the child, becoming less quick when the calm which occurs 
 after birth begins to be established, these arteries may have 
 power to resist from the first the progress of the blood ; in 
 proportion as the child advances in age, the artery becomes 
 more obliterated, and, undergoing a kind of traction from 
 the progressive widening of the abdominal parietes, it loses 
 altogether its vascular form, and is transformed into a true 
 ligament. 
 
 "What is observed in these arteries occurs also in the duc- 
 tus arteriosus. In the embryo, it is as flexible as the other 
 arteries, and is, therefore, as easily dilated by the column of 
 blood which flows through it, which penetrates without any 
 obstacle into the aorta ; but at birth, and after this period, the 
 walls of this duct become gradually thicker, and a sort of con- 
 centric hypertrophy is developed in them, which, without 
 diminishing in appearance the size of the vessels, nevertheless 
 produces a contraction of its caliber, by which the blood 
 driven from this duct passes through the pulmonary arteries. 
 When the ductus arteriosus has undergone this hypertrophy 
 and obliteration, I cannot describe it better than by comparing 
 
IK THE CIRCULATORY APPARATUS. 409 
 
 it to a tube, tlie circumference of which is very thick and that 
 presents in its centre nothing more than a small hole. 
 
 "The obliteration of the vein and duct does not occur in 
 the same manner. These vessels do not exhibit, as do the 
 others, any remarkable thickening of their walls ; the moment 
 the umbilical cord is cut, the vein is no longer susceptible of 
 receiving blood in its caliber, at least except by regurgitation 
 from the vena cava. The sides collapse and approach each 
 other ; they thus come in contact, and the passage is at last 
 obliterated, as is seen in all tubes of every character as soon 
 as they no longer give passage to the fluid usually passing 
 through them. Yet they still preserve for a long time a free 
 passage, for they may easily be distended by introducing into 
 them any ordinary-sized stylet, w^hile this is not the case with 
 the arteries. 
 
 "In the arteries, there is, if I may be allowed the expres- 
 sion, an active obliteration; the blood has been forced to 
 abandon them by a succession of organic modifications occur- 
 ring in the texture of their walls, while, in regard to the um- 
 bilical vein and venous duct, there is a passive ol)literation— - 
 that is to say, it follows the absence of the blood ; and it is 
 the result, and not the cause of the retropulsion of the san- 
 guineous fluid. The difierence, doubtless, depends on the dif- 
 ference of organization between the arterial and venous 
 system. If it be necessary that the foramen ovale and ductus 
 arteriosus should undergo organic changes for their oblitera- 
 tion, it will be easily understood, that nature, so fertile in 
 anomalies, may prepare these modifications either prematurely 
 or tardily ; hence the cause of the obliteration of the fetal 
 openings from the first, in some children, and the persistence 
 of the foramen ovale and ductus arteriosus in others, to a 
 period far removed from birth. Hence, also, the necessity of 
 greater or less time in most cases for the completion of this 
 obliteration. In this manner can be explained the irregulari- 
 ties of the period of the complete establishment of the inde- 
 pendent circulation, without the necessity of considering them 
 as the cause or efiect of certain diseases of the heart or lunos. 
 
 "The accomplishment of these phenomena of transition 
 must doubtless be attended with an incomplete oxygenation 
 of blood, since all this fluid which the heart propels to the 
 
410 INFLAMMATORY FOllMS OF DISEASE 
 
 diflerent parts of the body Las not passed through the lungs. 
 But, after all, is it necessary that the blood of an infant just 
 born should be oxygenated, equally with that which passes 
 through the arteries of an adult ? Would it not rather appear 
 that the tender frame of a new-born child ought not to receive 
 blood possessing too much stimulating properties, that the 
 materials of nutrition should not be too suddenly charged 
 with exciting principles, the action of which on the organs of 
 an infant may be injurious to its health, and to the progressive 
 establishment of independent life ? I am of this opinion, and 
 do not think its correctness can be denied, flowing, as it does, 
 from the anatomical examination of the circulatory organs of 
 a young child. This assertion is supported by another remark : 
 the lungs would be exposed to fatal congestions if the pulmo- 
 nary arteries should suddenly throw into them all the blood 
 which flows into the heart. The ductus arteriosus, by permit- 
 ting the blood to pass through it, comes, as it were, to the aid 
 of the respiratory organs, the congested state of which will 
 not permit the air to arrive freely in the cells ; the establish- 
 ment of independent life is, therefore, actually promoted by 
 the continuance of fetal life. Thus, then, there is a connec- 
 tion between the organization and disposition of parts, and 
 the exercise of their functions, and they follow in a regular 
 order, and by transitions prepared by nature, to the end that 
 no sudden and unexpected change may interrupt the order 
 and harmony of the phenomena of life." 
 
 Genus II. — Cyanopatht — Cyanosis — 
 Blue Disease of Infancy. 
 
 We have placed this infantile afiection here, rather than in 
 the pulmonary division, because it appears to us as probable 
 that it originates more frequently in some cardiac imperfec- 
 tion, than a pulmonary one; and yet, it maybe occasioned 
 by some incompleteness of the respiratory apparatus. Though 
 it may not depend upon the direct communication that exists 
 between the right and left cavities of the heart, yet it is gene- 
 rally thought to be occasioned by some obstacle to the circu- 
 lation in the right side of the heart. 
 
 In this afiection the integuments have a blue or violet-blue 
 color, one that very much resembles that which is produced 
 
m THE CIECULATORY APPARATUS. 411 
 
 in adults by several species of asphyxia. So far as we can 
 judge from appearances, the blood has not been properly oxy- 
 genated, and therefore, if the lungs should fail to perform 
 their duty, the disease may become manifest without any car- 
 diac malformation. Some think that it may be occasioned by 
 a mixture of the two kinds of blood, but others do not believe 
 that it can result in this way. 
 
 We have cyanosis produced, in infants, by an engorgement or 
 an inflammation of the lungs ; whatever the remote cause may 
 be, therefore, it seems pretty evident that the proximate one 
 is an unoxygenated condition of the blood; and it will proba- 
 be the safest practice to assume it as being generally the fact, 
 that it is produced by a sanguineous congestion of the heart 
 or lungs — and, in practice, the best remedy consists in holding 
 the child near to some source of heat, as a stove or even open 
 fire, and to rub its head and body gently with hot cloths, and 
 this should be persevered in, at the same time keeping the 
 the child, when lying, constantly upon its right side. 
 
 OKDER II. 
 
 INFLAMMATOKY FORMS OF DISEASE IN THE CIKCULATOEY APPA- 
 
 KATDS. 
 
 Genus I. — Imperfect Cicatrization of the Umbilicus. 
 
 The period at which the umbilicus separates, varies from 
 two to fifteen days, but it is usually efiected on the fourth or 
 fifth. In a large proportion of cases, the cord is small and 
 the desiccating process is soon completed, and generally with- 
 out any unpleasant attendants ; but in many cases the cord 
 contains a large quantity of gelatinous matter, by which the 
 process of desiccation is retarded ; and, in such cases, intlam- 
 mation and suppuration may supervene — that is, the liability 
 to these results in the latter is greater than in the former. 
 
 These results are in nowise essential to the separtion of the 
 cord, but are produced, sometimes, by causes of local irrita- 
 tion, and in some cases, no doubt, by some imperfection in 
 the constitution of the cord, at all events, it is made necessary 
 
412 NOl^-INFLAMMATORY FORMS OF DISEASE 
 
 that we should interfere to prevent mischief, and to effect a 
 perfect cicatrization. 
 
 The cicatrization is usually complete in ten or twelve days. 
 If the cord be small and the ring that forms around it be thin, 
 the cicatrix is soon effected ; but, on the contrary, if the ring 
 be large and much extended up the cord, the absorption will 
 require time, and the cicatrization will be proportionally de- 
 layed. In some cases, after the usual period for the separation 
 of the cord has passed, it will be found still attached by a fila- 
 ment which should be divided, because its existence is an im- 
 pediment to cicatrization. This process is somethnes retarded 
 by the formation of a sort of mucous membrane at the place 
 of the separation of the cord, which produces a puriform dis- 
 charge, while the cellular tissue at the same time produces 
 pus. A soft tubercle, more or less red, consisting of the ex- 
 tremities of vessels reunited, forms in the center of the umbili- 
 cus, which, when its normal condition is maintained, is 
 finally imbedded in the abdomen. This tubercle sometimes 
 inflames, becomes fungous, and discharges a purulent matter 
 and refuses to heal, but goes on to form an elevated and ulce- 
 rating surface, or it may take on the form of a pediculated 
 button or one having a large base. 
 
 Tkeatment. — Mayer's Ointment will generally effect a 
 healthy cicatrization ; but, in cases where stimulants are re- 
 quired, for the purpose of aiding the granulating process, the 
 Sesquicarbonate of Potassa, or the Sulphate of Zinc, may be 
 previously sprinkled lightly on the umbilicus ; care should be 
 taken not to apply too much of either of these agents, lest 
 excessive inflammation should follow, and which must, when- 
 ever it occurs, be treated by poultices of Slippery-elm. 
 
 Genus II . — Peeic aeditis — 
 Ivflammaiion of the Hearts Envelojpe. 
 All the symptoms which usually attend this form of disease, 
 in adults, are rarely sufficient to serve as a safe foundation for 
 a diagnosis ; if this be the case with adults, how much more 
 obscure must be the symptoms in infants ? And, when we 
 contemplate the causes of it, in adults, we are puzzled to sur- 
 mise a cause for its occurrence in infants. 
 
 In the presence of such obscurity, Billard states, "that 
 
m THE CIRCULATORY APPARATUS. 41 3 
 
 when there exists a state of general restlessness, distress, and 
 Buffering, in young infants, there is almost always a gelatinous 
 softening of the stomach, pericarditis, or acute pleurisy; and 
 our judgment must be directed to a decision between these 
 three different diseases." 
 
 The pulse, which is a marked symptom in the adult, is 
 worthy of no attention in infancy ; the child may manifest 
 the existence of pain by its cry, the face may be pinched, the 
 breathing labored, and even suffocating, but these are not 
 diagnostic symptoms. 
 
 As the treatment of pericarditis is the same as that of pleu- 
 risy, of which we have treated, we dismiss this subject here ; 
 and also the further consideration of the diseased conditions 
 of the circulatory apparatus, inasmuch as they offer nothing 
 that is not common to adults except greater obscurity in their 
 symptoms. 
 
CLASS V. 
 
 MANIPESTATIONS OP DISEASE IN THE DEHMA. 
 
 INTRODUCTION. 
 
 Before proceeding to the consideration of the special mani- 
 festations of disease in the dermoid system, we desire to in- 
 dulge in some general remarks upon its structure, functions, 
 and pathology, for the purpose of finding a suitable place to 
 drop a few suggestions, which to us, appear to have a vital 
 bearing on the subject. 
 
 Upon the anatomical structure of the skin, anatomists and 
 physiologists are considerably divided in opinion. Chaussir 
 teaches that it consists of two parts, the derma, cutis vera, or 
 true skin, and epidermis or scarf-skin ; while Cruikshank 
 maintains that it consists of six laminae ; but the most preva- 
 lent opinion is, that it consists of three — the cutis vera, rete 
 mucosum, and the cuticle or scarf-skin ; but as the rete muco- 
 sum has never been demonstrated to exist in the white race, 
 so it is denied to it, by many, while others infer, and we think 
 with just probability, that, inasmuch as it is demonstrated to 
 exist in the negro and some other dark-colored races, it must 
 exist also in the white. 
 
 As the rete mucosum is the lamina that imparts the dark 
 color of the dark-colored races, it may reasonably be pre- 
 sumed to be present in all human beings, except the albino. 
 It is supposed that the rete mucosum is secreted by the corion 
 or cutis vera. The scarf-skin or cuticle is a translucent inor- 
 ganic membrane that invests all parts of the body. The cutis 
 vera is supposed to consist almost entirely of a uniform net- 
 work of minute vessels, some of which, from their exceeding 
 delicacy, transmit only a colorless fluid. 
 
 The secretions of the skin are essentially of two kinds — the 
 (414) 
 
DISEASE m THE DERMA. 415 
 
 sudoriparous or coramon perspirable matter, and sebiparous or 
 sebaceous matter. The latter is confined to a small extent of 
 surface, such as the point of the nose, the arm-pits, margins 
 of the eye-lids, the pubis, and some other places. These 
 secreted matters are produced by follicles which are about a 
 quarter of an inch deep, and Dr. Willson, from his attention 
 to this subject, concludes that there are in each square inch of 
 surface, two thousand eight hundred of these pores, which, 
 according to the length assigned them, would make a tube 
 seven hundred inches in length. ISow^, supposing the surface 
 of a man of medium size to be two thousand five hundred 
 square inches, we would have, for the number of the pores, 
 seven millions, and the length of tube one million seven hun- 
 dred and fifty thousand inches, which is equal to twenty-eight 
 miles. Supposing this calculation to approximate the truth, 
 we can then entertain no doubt as to the importance of the 
 skin as a secretory organ.* 
 
 It is difl&cult to ascertain accurately the quantity of the 
 secreted matter of the skin, but it may be assumed as an ap- 
 proximation of the average quantity that nine parts of solid 
 matter are contained in every hundred secreted ; and the greater 
 portion of this consists of a compound of protein, and the 
 balance of chlorides of sodium and potassium, muriate of 
 ammonia, alkaline phosphates, free acetic and butyric acids, 
 and occasionally other salts. To this may be added as an 
 excreted product, the scarf-skin, which is constantly passing 
 off from the surface : it consists of carbon, forty-eight, hydrogen, 
 thirty-nine, nitrogen, seven, and oxygen, eighteen parts. In 
 this extensive elimination of carbon, we perceive that the skin 
 aids, considerably, the respiratory function. 
 
 * An importance at least that should place under condemnation of perpetual 
 exile from the profession the physician who would permit his patient to suffer 
 and die, of any form of disease, and more especially of an inflammatory one, 
 without giving the least attention to his cutaneous surface. We have known 
 hearty and sound men to die of pneumonia, and other inflammatory foims of 
 disease, whose skins had not been eyen moistened during the whole of their 
 illness. Such patients would have recovered without their physicians, — 
 although they belonged to that class of the profession which claims to possess 
 all the medical skill of the age. We do not intend to intimate that they killed 
 their patients, but we intimate that if they had shed no blood, and had admin- 
 istered no indigestible medicine, and had cleansed and relaxed the cutiuieous 
 surface, they might have recovered. 
 
416 man'ifestatio:n"s of disease 
 
 We have now treated of as many of the cutaneous functions, 
 and as extensively too, as we deem essential to our present 
 pathological purposes. 
 
 All dermatologists admit that it is peculiarly difficult to 
 arrive at the etiology of cutaneous disease; but all agree, 
 however, that filthy habits have much to do in its production. 
 Dr. Willan attributed the frequency of it, in England, to the 
 want of public baths ; and Dr. Worcester thinks that the 
 same operates to a still greater extent in this country; indeed, 
 he regards it as our most important cause. ISTow, we are not 
 going to question the possibility, nor even the probability, that 
 a want of cleanliness may produce it, but we deny the impor- 
 tance, in this relation, the preceding gentlemen appear to 
 attach to it. 
 
 We are sure that our slave population are less afflicted with 
 this disease than are their more favored and cleanly masters ; 
 and if filth can produce it, then some of our Indian tribes 
 should scarcely present an individual exception. They are 
 eternally besmeared with grease, soot, ashes, and paint, and 
 yet we never saw an Indian with a diseased skin. We have, 
 furthermore, seen many negroes whose appearance indicated 
 that they had a hydrophobic dread of water, and yet they had 
 sound skins. 
 
 When we find a dog with a diseased skin, he is one which 
 has exercised but little and fed much — it is but rarely seen 
 among the huntsman's dogs. Hogs, than which no animal is 
 more filthy, have very rarely a diseased skin, and when they 
 and dogs have such a disease, we cannot attribute it to filth. 
 
 If we are to consider cutaneous inflammation as disease of 
 the skin, as most medical writers have done, if we may infer 
 their pathology from their use of the lancet and purgatives, 
 then of course we would, as they have generally done, look 
 for external causes of it. 
 
 We do not wish to be understood as intimating that etiolo- 
 gists have overlooked other and more probable causes, such as 
 indigestible and greasy food, but they have not dwelt upon 
 such causes with the emphasis they merit. They do not ap- 
 pear to attribute as much importance to the pulmonary and 
 digestive surfaces, in the production of cutaneous diseases, as 
 they deserve. 
 
IN" THE DERMA. 417 
 
 For the purpose of finding a solution to many of the diffi- 
 culties that attend cutaneous disease, we must again refer to 
 the results of our cerebellar investigations. 
 
 In all persons of the first class (page 20), we find a native 
 vigor and health in the skin — a skin in which disease is rarely 
 seen, with the exception of the contagious and erysipelatous — 
 in this class the digestive and pulmonary functions are ably 
 performed, the energy of the former does not permit the pro- 
 duction of cutaneous disease, from the ingesta of ordinarily 
 indigestible food, nor does that of the latter allow such a 
 result, from the use of the carbonaceous, such as fat, butter, 
 sugar, etc. 
 
 The second class is about as exempt from cutaneous disease 
 as the first, in .the absence of any interruption to the general 
 health, because, whatever carbon is taken into the system over 
 and above its demands is converted into fat. This is beauti- 
 fully illustrated upon the sugar plantations of the south — 
 almost every negro becomes fat during the sugar-making 
 season. 
 
 In the third class we have feeble digestive and respiratory 
 functions, and, with them, we have troublesome and even fatal 
 modifications of disease. In this class, indigestible food may 
 not, generally, do anything worse than produce diarrhea, but 
 carbonaceous food, when taken in quantity beyond the wants 
 of the system, must do mischief of some kind — it must act as 
 a foreign irritant. The respiratory powers cannot eliminate 
 it, and those of nutrition cannot convert it into fat; but in the 
 system it cannot remain — the vis conservatrix will find an 
 outlet for it, if it have the power, and if it have not, then 
 death ensues. 
 
 It is in this class of children that we meet with difficult 
 dentition and all of its associated forms of disease; it is in 
 this class that the arresting of a cutaneous eruption is liable 
 to result in convulsions, paralysis, encephalitis, acute or 
 chronic hydrocephalus, or some other modification of disease; 
 consequently it may ultimately become possible to divide the 
 many forms of dermoid disease into three great classes, de- 
 pending for their primary or organic causes, upon the three 
 conditions, as set forth in the table above referred to ; with the 
 27 
 
418 MANIFESTATIOTs^S OF DISEASE 
 
 exception of the contagious ones, and they may be divided 
 into three modifications of character. 
 
 These conclusions are so palpable that we feel that we have 
 a right to infer that those cutaneous modifications of disease 
 which do not depend upon a secreted poison, are referable, 
 most generally, to the causes above assigned, more par- 
 ticularly with children, because of that over-feeding and cra- 
 dle-inactivity in which most mothers indulge them. 
 
 But, in this connection, there is another circumstance, con- 
 nected with children, which is both interesting and important 
 to observe : it is the highly vascular and turgid condition of 
 the cutaneous and mucous systems, which, of themselves, ad- 
 monish mothers to observe the most thorough temperance and 
 care of their children. 
 
 Before we conclude this introduction, a few general remarks 
 upon the subject of diagnosis, treatment, and prognosis seem 
 to be demanded. 
 
 As cutaneous forms of disease are always exposed to an 
 open, day -light investigation, it follows, therefore, if that 
 attention which is usually devoted to the diagnosis of other 
 forms, were given to these, a mistake could scarcely ever 
 result, except perhaps in some instances of the complication 
 of one form of disease with that of another, consequently 
 diagnostic mistakes, in these, are less excusable than when 
 they happen in other forms of disease. 
 
 Some information can usually be had from those who have 
 been in attendance, and as the introductory stage is usually 
 passed before the physician is called, he may be able in many 
 instances to ascertain whether the eruption commenced dry or 
 moist ; and as almost all forms of dermoid disease are succes- 
 sive in their progress, it is generally possible to find an exam- 
 ple of its elementary form, as vesicle^ pajpide^ or pustule^ 
 more particularly in the vicinity of the afiected part. When, 
 however, this cannot be done, it may be possible to detect the 
 family of which it is a member, and learn of the attendant or 
 the patient whether the vesicles appeared clear and limpid, or 
 opake and yellow, and whether the eruptions were distinct or 
 conglomerated, soft or hard, large or small, conical or flat- 
 tened. 
 
m THE DERMA. 419 
 
 By a proper observance of the foregoing means all the infor- 
 mation that may be essential, may generally be had. 
 
 Before venturing a few remarks upon the general indica- 
 tions of treatment of cutaneous disease, it becomes proper to 
 observe, that we do not regard cutaneous eruptions, and the 
 attendant fever, as disease, but as (firstly) indices of the exist- 
 ence in the system of a cause of pathological action, and 
 (secondly) as manifestations of well-directed efforts to elimi- 
 nate it from the system. 
 
 Under these views, it is evidently improper to bleed or 
 purge, because these means will reduce the cutaneous inflam- 
 mation, and thereby cripple the effort the system is making to 
 eradicate the disease. Nor can we, except under the extremest 
 circumstances, reconcile ourselves to the introduction into the 
 system of one poison, for the purpose of removing another. 
 We are aware that Arsenic and the Bichloride of Mercury 
 have much reputation in the cure of various forms of cutane- 
 ous disease, but we have been assured by some old and faith- 
 ful observers, that while they effectually relieve the skin, in 
 many instances, they invariably establish disease in some 
 other part of the system. They are both poisons, and of that 
 kind which cannot, by the power of nutrition, be appropriated 
 to the development or repair of any tissue in the bod}^ conse- 
 quently, any portion of them which may escape elimination 
 from the system must continue to act as a poison, at least as 
 a foreign irritant, hence we cannot therefore recommend their 
 use, until a more safe and consistent course shall have been 
 thoroughly tried. 
 
 The general treatment, then, should consist of alteratives 
 and antispasmodics, with such adjuvants as shall be the best 
 calculated to prevent local and constitutional irritation ; such 
 as the mildest aperients, with soothing applications to the sur- 
 face, which may consist of cataplasms, cleansing washes, and 
 water dressings. These latter means will, in very many cases, 
 alone prove sufficient. 
 
 As a ver}^ large amount of cutaneous disease is, no doubt, 
 produced by the ingesta of too much carbonaceous food, and 
 whether it is or not, such food should be carefully avoided 
 during the existence of the disease. 
 
 Dr. Worcester says, that "Some articles of food, experience 
 
420 MANIFESTATION'S OF DISEASE 
 
 has proved, are particularly to be guarded against ; as the 
 use of pork, of all salted meats, all articles of a fatty or 
 oily nature, most articles containing the nutritious elements 
 in a very concentrated form, etc., though to this last there are 
 exceptions ; in some cases a diet consisting of a large amount 
 of sugar has been efficacious in correcting a depraved and 
 cachectic state of the system. 
 
 In regarding sugar as a nutritious article, the doctor is mis- 
 taken. Sugar must ever be contra-indicated, in deranged 
 conditions of the derma, except in cases of marasmus, when 
 the calorific function is being supported at the expense of the 
 body. 
 
 Cutaneous disease appears, sometimes, to have been estab- 
 lished for vicarious purposes, and when we can have any sus- 
 picion of this, no attempt should be made to cure it, before 
 the cause for which it was instituted shall have been removed. 
 And when, further, such an eruption has existed so long as to 
 have become naturalized to the system, which not unfre- 
 quently happens to youth, as well as old age, a similar pre- 
 caution is to be observed. 
 
 It will not be going too far to say, that the mass of physi- 
 cians have but little acquaintance with the various forms of 
 dermoid disease ; their dermatological nomenclature consists 
 of " tetter- worm, ring- work, nettle-rash, salt-rheum," and per- 
 haps a few other equally vulgar names ; and to about the 
 same extent may we consider their knowledge of the subject. 
 In harmony with their nosonomy are their therapeutics : Salts, 
 Sarsaparilla, Sulphur, Arsenic, Corrosive Sublimate, and every 
 variety of salve or ointment. But we doubt very much 
 whether the most learned and highly-approved treatment of 
 them is, really, much more commendable than the preceding. 
 
 We are instructed, by Dr. Worcester, to be governed by the 
 great principles that should guide us in the treatment of other 
 forms of disease. This we approve of; and, therefore, it fol- 
 lows, he says, that inasmuch as most forms of cutaneous dis- 
 ease are inflammatory at first, "common sense would direct 
 general depletion by bloodletting and cathartics ;" and when 
 this stage has passed ofi", a resort should be had to " tonics or 
 even stimulants." ]^ow, it so happens that our common sense 
 is deeply penetrated with the conviction that there is no 
 
m THE DERMA; 421 
 
 common sense in this plan of treatment. Our common sense 
 dictates that we should so husband the resources of the patient 
 as to have no occasion for the tonics or the stimulants. 
 
 It is evident that he (his school) is aiming to remove or 
 to break down a symptom, and in the accomplishment of it, 
 and then only to a partial extent, he discovers that he has so 
 broken down his patient as to endanger, more or less, his life, 
 and then resorts to " tonics or even stimulants," to insure his 
 safety. 
 
 "We, on the contrary, at the outset discover that a patho- 
 logical action is in progress to remove an agent that is un- 
 friendly to health, and therefore we are satisfied to stand by, 
 to remove impediments, and to render aid, as circumstances 
 may require. 
 
 A word or two on prognosis, and we close this introduction. 
 When we contemplate the great importance of the cutaneous 
 functions to a continuance of life, notwithstanding the extra- 
 ordinary power of the system to adapt itself to very severe 
 conditions, it necessarily follows, that when, by a long exist- 
 ence of the disease, great constitutional depravity, neglect, and 
 possibly malpractice, it becomes very generally disorganized, 
 death must ensue, notwithstanding the vicarious aid which is 
 rendered by other parts of the system. When a disease of the 
 skin has existed so long as to become important as a depurat- 
 ing organization, it frequently becomes a difficult question to 
 decide whether any attempt should be made to cure it. When 
 the disease is of a hereditary, or rather organic, character, 
 and has come to perform an important function, it may be 
 wise to decide in the negative, more especially if the patient 
 be on the advanced side of life's meridian. When it performs, 
 vicariously, an important function, as the catamenial, no 
 attempt at a cure should be made, until the function has been 
 restored to its proper organ. 
 
422 MANIFESTATIONS OF DISEASE 
 
 OHDER I. 
 
 MALFORMATION AND DISEASE OF THE DERMA PRODUCED BEFORE 
 OR AT BIRTH. 
 
 Genus I. — Malformation of the Derma produced before 
 
 Birth. 
 Species I. — Alterations of Color. 
 
 Haller has reported cases of white children having been 
 born of black parents, and black children of white parents. 
 
 To account for the variety of color in the cutaneous struc- 
 ture of some infants which anatomists have observed, Billard 
 supposes the blood to undergo changes in its composition 
 when circulating toward the integuments. This supposition 
 may, or it may not, be without merit, and the facts attempted 
 to be explained are not of sufficient importance, generally, to 
 justify us in mystifying them by any species of mere specu- 
 lation. For the present, we must content ourselves with the 
 bare statement of the fact that spots or discolorations are pro- 
 duced in some fetuses. 
 
 Species II. — Excrescences. 
 
 Children have been born covered with hair, and although 
 the circumstance excites considerable astonishment in the 
 minds of the unprofessional, and usually inflicts upon the 
 parents a painful shock, yet the phenomenon is not one that 
 should occasion much concern in anywise. About the middle 
 of gestation the skin of the fetus becomes covered with hair, 
 which, generally, falls ofl" before birth, and at birth shows 
 itself in the liquor amnios. 
 
 Existing causes do occasionally produce an extraordinary 
 development, and the action they establish is, in such in- 
 stances, too energetic to allow of its disappearance before 
 birth. In view of the facts, it amounts to nothing more than 
 an unusually developed and greatly prolonged existence of a 
 normal growth. As this pilous growth will spontaneously 
 disappear, in due season, no remedy is demanded, while 
 depilatory agents, if used, might irritate the skin and possibly 
 do mischief. 
 
11^ THE DERMA. 423 
 
 The excrescences produced during fetal life, may occur upon 
 any part of the surface of the body, but are most generally 
 met with on the face, hands, and feet, consisting most fre- 
 quently of an elongation of the skin. It happens that they 
 are so developed, in some instances, as to occasion a real de- 
 formity ; they should be removed as soon after birth as may 
 ,be deemed safe and practicable, for the reason that the cica- 
 trix will be more speedily and certainly obliterated. 
 
 Species III. — Ncbvi Materni — Motlier's Mavlz. 
 
 Professor Dewees, Billard, and others ridicule the idea that 
 these productions are caused by impressions made upon the 
 maternal mind during gestation, and yet Billard admits, as 
 every one must, that their cause is "very obscure." ISTever- 
 theless, it does appear to us that those who maintain the nega- 
 tive of this question, are much more in the dark than those 
 who occupy the affirmative, and, judging from the medical 
 literature of the day, the advocates of the affirmative are 
 rapidly increasing. If the cases we presented, when treating 
 of this subject, be really facts, and some of them we know to 
 be so, and as to the others we entertain no doubt, it appears 
 to us absolutely impossible to resist an affirmative conclusion. 
 
 These nsevi materni may be divided into three classes : the 
 first comprises those which merely indicate an alteration in 
 the cutaneous pigment, representing clouded yellow, rose, red, 
 livid, blue, brown, copper, or black colors ; and, as they con- 
 tinue stationary after birth and through life, we are compelled 
 to infer that there is in them no morbid action — no tendency 
 to disorganization. They are neither more nor less than 
 healthy peculiarities of the skin, and any attempt at their 
 removal will generally do more injury than good, by leaving 
 a cicatrix more disgusting than the nsevus. 
 
 The second class embraces those which are pediculated — 
 having a true erectile tissue, and having for their color some 
 shade of red, with an apparent or real granulated surface. 
 
 The third x^lass contains those which are more deeply seated 
 under the skin, irregular in their shape, broad in their bases, 
 and appear to consist of aneurismatic vessels — sometimes 
 called varicose wens, sanguineous fungi, and aneurisms of the 
 small arteries. They ditfer from true aneurisms inasmuch as 
 
4:24: MANIFESTATIOl^S OF DISEASE 
 
 there is no communication between the arteries and the 
 veins. 
 
 The last two classes are both liable to enlargement, ulcera- 
 tion, and dangerous hemorrhages, consequently they should 
 be removed as soon as possible, with safety to the child. But 
 how should this be done? Some recommend pressure, some 
 the ligature, some actual cautery, and others the knife ; yet 
 very few cases have ever been benefited by either of these 
 means. 
 
 Treatment. — No treatment is necessary in these disfigura- 
 tions, unless they manifest a tendency to enlargement, ulcera- 
 tion, or hemorrhage, under which circumstances there is great 
 danger of other and healthy parts becoming involved, which 
 may take place to such an extent as to demand interference. 
 
 For the removal of these difficulties, especially after hemor- 
 rhage or ulceration has ensued, we employ the pulverized 
 Sulphate of Zinc, applying it over the whole of the afiected 
 part once a day ; when the part has been covered with the 
 zinc, it must be retained there by a piece of linen covered 
 with paste or some soft, simple ointment. This course should 
 be continued until the w^hole of the nsevus is killed, after 
 which a poultice of Slippery-elm must be applied, and changed 
 two or three times a day, until the cauterized portion sloughs 
 ofi". Mayer's Ointment may then be used to heal the remain- 
 ing ulcer. 
 
 During the application of the zinc, it will often cause so 
 much inflammation, as to render it necessary to discontinue its 
 use for a few days, until the inflammation has subsided from 
 the employment of an elm poultice. 
 
 Sometimes it will happen that the ulcer will not heal after 
 the first slight slough has passed ofi*, in which cases it will be 
 requisite to again apply the zinc, and proceed in the treatment 
 as at first. 
 
 With this plan of treatment, we have succeeded in curing 
 many cases, even after the actual cautery had failed. From 
 among them we select the following: 
 
 A child of Mr. B., aged about ten months, had a mark on 
 the orbital process, just above the nose, and immediately be- 
 tween the superciliary ridges. At birth, it was quite small 
 and very red, and continued to increase in sire until it became 
 
m THE DERMA. 425 
 
 nearly as large as a chestnut, presenting a malignant appear- 
 ance, and involving the surrounding tissue, at which time it 
 was considered necessary by the family physician to remove it, 
 which he attempted to accomplish with ligatures introduced 
 through the tumor by means of needles, and tying it in sec- 
 tions, after which he applied the actual cautery, and burned 
 the tumor to a level with the ligatures. A few days were 
 required for the sloughing to pass off, when it was discovered 
 that the tumor grew more rapidly and assumed a more malig- 
 nant condition than before — in consequence of which the case 
 was pronounced incurable. Under these circumstances, the 
 parents brought their child to this city to consult Drs. R. S. 
 and O. E. Newton. After an examination, they considered 
 the case, although very malignant, one that could be cured, 
 and Dr. 0. E. Newton, taking charge of the case, treated it 
 according to the plan above given, and in a few weeks effected 
 a permanent cure, with but very little disfiguration. 
 
 This treatment, so far as we know, has never been pursued 
 by any other practitioners, and we believe it is original with 
 them. 
 
 Genus II. — Disease of the Deema produced befoke oe 
 
 AT Birth. 
 Species I. — Absence of the Shin. 
 
 It is sometimes the fact that infants, at birth, are destitute 
 of a portion of the skin or common integument, at one or 
 more points of the surface of the body. As to the cause of 
 such injuries we may speculate, and this is, in reality, about 
 as much as we can do. 
 
 In the second Book, when treating of the psychological in- 
 fluence of the mother on the fetus (page 100), we introduced 
 one case of lesion of the skin of the knees and muscles of the 
 arms, and another of the skin of the knees which had com- 
 menced to cicatrize before birth. 
 
 Impressions made upon the mind of the mother may, then, 
 sometimes, be the cause of the absence of the fetal cutis, and 
 of the parts below it. Billard states, that it is generally the 
 case, when the skin is absent, so are the subjacent parts; and 
 that in such cases the borders of the defective skin are red and 
 hardened and considerably adherent to the subjacent parts. 
 
4QQ MANIFESTATIONS OF DISEASE 
 
 It is thouglit that the fetal skin may be destroyed at such 
 points as may come in contact with uterine tumors, such, for 
 instance, as polypi; and that it may also be effected by sub- 
 cutaneous tumors of the child, causing, by their enlargement, 
 an absorption of the cutis. 
 
 "Whatever may be the cause of such cutaneous disorganiza- 
 tion, the treatment will consist of such means as will support 
 the subjacent parts and favor cicatrization. 
 
 Species II. — Tumor of the Scalp. 
 
 Tumors of the scalp, when oedematous, consist of an infil- 
 tration of serum, which very rarely becomes of a cone shape, 
 but appears, generally, as a repletion of the cranial integu- 
 ments, and soon disappears ; but when they are sanguineous, 
 they consist of an infiltration into the cellular tissue, or in a 
 repletion of its minute vessels. 
 
 Incisions made into the scalp readily give exit to dark- 
 colored blood; in some instances the adipose substance appears 
 to be mixed with drops of blood ; sometimes the sanguineous 
 efiusion appears betv/een the skin and pericranium, occa- 
 sioned probably by a rupture of fine vessels. In these cases, 
 the blood is dark and fluid, and so easily absorbed that all the 
 contiguous parts are tinged with a violet color. 
 
 Tumors of this kind present much difference as to the period 
 of their duration — extending from one to three weeks. Capu- 
 ron, says Billard, cautions us against confounding these tumors 
 wdth encephalocele, as much mischief might result from such 
 an error. 
 
 Teeat^vIext. — The application of stimulants, as cold water, 
 dilute Tincture of Camphor, etc., with slight compression, will 
 generally be found sufficient. In cases of sanguineous infil- 
 tration, if extensive, a leech or two may be applied, after 
 which a fomentation of the leaves of St. John's Wort (Hyperi- 
 cum Perforatum). 
 
 Species III. — PetecMce. 
 This disease consists of few or many small, round, violet- 
 colored spots, which occur spontaneously in a scorbutic-looking 
 skin. It happens under great prostration of strength; it may 
 therefore be regarded as a debility of the cap>illary vessels, and 
 
IN- THE DERMA. 427 
 
 consequently the system is liable to liemarrhages, both inside 
 and out. 
 
 The children in which this afiection has been seen, were so 
 feeble, appeared so starved and so cadaverous, as to be of no 
 promise even if they had escaped the disease. 
 
 In the milder forms of this disease, it may pass through its 
 stages of development and terminate without any serious or 
 troublesome symptoms ; but in other cases, very various symp- 
 toms supervene, such as hemorrhages from the gums, stomach, 
 intestines, or bladder. 
 
 In such cases, jpost mortem examinations have exhibited 
 petechial spots upon the mucous lining of the stomach, small 
 and large intestines, the surface of the heart, pericardium, 
 pleura, bladder, and kidneys. Beside these marks of debility 
 in the vascular system, extravasation and hemorrhage have 
 been seen to attend almost every organ and tissue of the 
 system. 
 
 Treatment. — In these cases we have derived more benefit 
 from the internal use of the Tincture of Muriate of Iron, than 
 from any other course with which we are acquainted ; it should 
 be given in doses suitable to the age of the child, and well 
 diluted with water. Tiie body may be bathed every day or 
 two with a solution of salt in water, and the addition of Cap- 
 sicum if more stimulant action is required. 
 
 Species IY. — Eccliy mo-sis. 
 
 Ecchymosis consists of a livid, black, or yellow spot, or 
 spots produced by an effusion of blood into the areolar tissue, 
 and, in infants, they are most generally produced by the 
 straits of the pelvis during difficult and protracted labor ; 
 consequently the injury is most usually found upon the head, 
 but it may occur to other portions of the body. 
 
 But the scalp is liable to this affection from gravitation 
 alone, when confined to the same position for a long time, 
 and in some instances, both causes may conspire to pro- 
 duce it. 
 
 Medical treatment is but seldom required in cases of this 
 kind, as they spontaneously disappear by resolution ; never- 
 theless, it would be judicious, as soon as possible after birth. 
 
4:28 MOIST FORMS OF DISEASE 
 
 to batlie the part with water, as hot as it can well be borne. 
 If, after this washing, it should be attended with much swell- 
 ing, resort may be had to topical remedies, such as the Chlo- 
 ride of Soda or Ammonia. 
 
 OEDER II. 
 
 MOIST FOEMS OF DISEASE IN THE DEKMA. 
 
 Genus I. — Yesicul^. 
 The varieties of cutaneous inflammation comprised under 
 this head, originally affect the exterior coat of the cutis vera — 
 they are definite and circumscribed, and their eruptions con- 
 sist of small elevations of the epidermis, filled at first with 
 clear, transparent, and serous fluid, which presently becomes 
 opake and sero-purulent, and, by desiccation, passes into scales 
 or crusts, usually called scabs. We shall notice but two of its 
 species — Herpes and Scabies. 
 
 Species I. — Herpes. 
 
 In herpetic forms of disease, there is always a sensation of 
 burning, itching, and tingling, which is sometimes light or 
 comparatively trifling, and at others great suffering is pro- 
 duced. It shows itself in circumscribed patches, which, at 
 first, are transparent, but soon become opake upon an inflamed 
 surface of a more extensive area ; and between the several 
 inflamed surfaces and their vesiculated patches, there exists a 
 healthy skin. It is a non-contagious aflection — usually acute 
 in its character, having its vesicles to vary in size from that 
 of a pin's head to that of a pea. 
 
 It is not necessarily preceded by, or attended with, a fever, 
 but in all severe cases it is. The period of its duration varies 
 from one to six wrecks, but never terminates fatally, unless the 
 constitution is so vicious that it could scarcely recover from 
 disease however simple. 
 
 The secretion of its vesicles — passing from limpidity into a 
 milky opacity, forms into scabs which in due time fall off and 
 
m THE DERMA. 429 
 
 leave the skin red. Of this eruption there are several varieties, 
 but the difference between them depends, principally, upon 
 the location and the form of the vesicular patches. "When it 
 is most severe, it assumes, to a considerable extent, the ap- 
 pearance of erysipelas, but there attends it this one invariable 
 diaornostic difference — the vesicular clusters are distinct or 
 clearly defined, having the skin that surrounds them of a 
 healthy and natural color. 
 
 It more frequently attacks young people than adults, and 
 among the former, those are the most liable who are the most 
 sanguine, or those who are sanguine-lymphatic. Infants, 
 however, are but rarely the subjects of any of its varieties. 
 "We shall notice particularly but three of them : Herpes Zoster, 
 Herpes Circinatus, and Herpes Prasputialis. 
 
 Yaeiety I. — Herpes Zoster — Shingles. 
 
 In this variety the cutaneous eruption always extends around 
 one-half of the body, and it is affirmed by some that it has 
 been known to spread itself entirely around it; but others 
 maintain that it does not. Be the fact as it may, we deem 
 the settlement of the question of no practical importance. 
 
 It is, furthermore, afiirmed, that it appears mere frequently 
 on the right than on the left side of the body — but this ques- 
 tion, like the preceding, has been contra- affirmed, and like 
 the other, its settlement can be of no great practical utility. 
 All agree, however, that it never makes an assault without 
 completing half the circuit of the body. 
 
 It may commence on one side of the spine and extend itself 
 directly or spirally to the linea-alba ; or it may commence at 
 the other extremity and travel in the contrary direction ; or it 
 may commence at any intermediate point and extend itself in 
 contrary directions ; and, lastly, it may commence at the two 
 extreme points and meet in the middle. When the course of 
 the eruption is spiral or oblique, though commencing on the 
 body, it may begin too high or too low to conclude on the 
 body at the linea-alba, therefore, in such instances, it will 
 conclude on the arm or the thigh. 
 
 Each patch or cluster consists of numerous small vesicles 
 which gradually enlarge to two or three lines in diameter, and 
 from their close proximity in the beginning, they not unfre- 
 
430 MOIST FORMS OF DISEASE 
 
 quently become confluent. The patches are always distin- 
 guished by irregularity of both form and size, but they are 
 usually two or three inches broad, having the greater diameter 
 in the direction of the belt. 
 
 These clusters are marked by another irregularity — the vesi- 
 cles of the several clusters do not appear simultaneously, but 
 succeed each other — that is, some are on the decline before 
 others are fully developed. The limpid contents of the vesi- 
 cles, in three or four days, become opake, and in eight or ten 
 days more they cast their scabs. This is only true of the indi- 
 vidual vesicles, but not of the whole collectively, for, as they 
 appeared successively, so they must decline, consequently, 
 before the last scabs are cast, twenty or more days will have 
 elapsed. 
 
 Like many other cutaneous forms of disease, the eruption 
 of this is generally preceded two or three days by febrile 
 symptoms, as lassitude, general uneasiness, and loathing of 
 food. These symptoms frequently disappear upon the occur- 
 rence of the vesicles, but in some they continue as long as the 
 eruption produces constitutional irritation. 
 
 Much care should be observed to keep the eruption from 
 being scratched or rubbed off, because of the troublesome 
 sores w^hich are liable to result, more especially as the disease, 
 normally, gives the patient much smarting pain in the skin, 
 and frequently no little of a wandering and shooting character 
 in the body. This affection is sometimes preceded, often 
 attended, and generally followed by a neuralgia under the 
 affected part, and not unfrequently continues for months after 
 every other feature of the morbus has departed. 
 
 Notwithstanding the fear that generally prevails as to the 
 danger of this variety of herpes, it is in reality, most gene- 
 rally, mild and by no means dangerous. Some children are 
 so liable to it as to have it almost every year ; and yet it is 
 sometimes indicative of remote danger. 
 
 Yakiety II. — Herpes Circinatus — Ringworm. 
 
 This eruption usually commences upon the face, neck, arms, 
 
 or shoulders, in, apparently, a single vesicle, and then others 
 
 appear around it, and thus it continues to enlarge until it 
 
 becomes exhausted ; but by the time the second or third 
 
m THE DERM. 431 
 
 addition is fully developed the central vesicles have partially 
 disappeared, and thus, as the outer circles appear, the inner 
 ones disappear, so that in a few days the part occupied by the 
 first vesicle and the circles that succeeded it, become well. In 
 its progress, in consequence of this mode of development, 
 nothing but a circle or ring of small, hard, round, and tense 
 vesicles is seen. In three or four days, the vesicles break, and 
 small scabs are formed, which in about a week are cast. But 
 as they appear in succession, the eruption has an indefinite 
 period to run, but it rarely exceeds a month. As it is but 
 rarely, if ever attended with constitutional symptoms, the only 
 trouble arising from it is the itching it produces. 
 
 Yakiety III. — Herpes Proejputialis. 
 
 This is the only other variety of this disease wdiich we shall 
 notice, and we do it only for the purpose of admonishing the 
 student against mistaking it for an eruption of a syphilitic 
 character. As this is a vesicular eruption, it is always distin- 
 guishable from a syphilitic one. The occurrence of herpes in 
 clusters, the superficial character of its ulcers, should they 
 supervene, and the absence of that yellowish-white, adhesive 
 discharge, which is characteristic of chancre, will further aid 
 to distinguish the one from the other. 
 
 Herpes prseputialis may obtain upon the external or inter- 
 nal surface of the prepuce. The vesicles and clusters are very 
 small, and usually run their course in ten days or two weeks. 
 Because of the delicacy of the epithelium, the vesicles are 
 very liable to break, when located on the inuer surface, and 
 therefore, without proper attention, they may run into super- 
 ficial but troublesome ulcers. 
 
 Causes. — Sudden exposure to cold in a state of perspiration 
 and the direct action of irritants have been named as occa- 
 sional causes. We admit that they may act as excitants, but 
 as this form of dermoid disease occurs most frequently with 
 those who have much cutaneous inactivity — feeble organs of 
 animal sensibility and muscular motion — it may most gene- 
 rally be suspected of being symptomatic of some more deep- 
 seated form of disease. The existence of pulmonary irritation 
 is sometimes thus manifested — and, though a very trifling form 
 of disease in the abstract, yet it may indicate much danger. 
 
432 MOIST FORMS OF DISEASE 
 
 Diagnosis of Hekpes in general. — As this eruption 
 has been coDfounded with erysipelas, pemphigus, scabies, 
 and eczema, it may happen again. In herpes, though the 
 vesicles approach very close, yet they are never confluent, 
 though at a glance they appear so, which, with the hard, globu- 
 lar vesicles, associated on an inflamed base, patches always 
 distinct, with healthy intervening skin, should generally dis- 
 tinguish herpes from all other forms of skin disease. 
 
 The rapid development, large size of the bullae of pemphi- 
 gus, their scattered, distinct, and irregular character, with the 
 further fact that their development requires but a day or two, 
 should distinguish it from herpes. 
 
 The more extensive inflammation, the rapid march, and 
 more deeply-seated development of erysipelas, and the bulb- 
 like character of its blisters, should allow no observer to con- 
 found it with herpes. 
 
 The locality of scabies, the sulcus of the acarus, its pruritus 
 and contagious character, should distinguish it from herpes. 
 
 From eczema, herpes is not so readily distinguished. In 
 the former, however, the eruption arises suddenly, its vesicles 
 are smaller, and at first make their full size, and continue only 
 three or four days, while the disease, in the abstract, is con- 
 tinued indefinitely by elementary eruption, exudation, and 
 excoriation. 
 
 The different forms of herpes cannot very easily be con- 
 founded with each other, and the light, thin crusts which are 
 characteristic of its varieties, will distinguish it from favus, 
 the scabs of which are thick and friable. 
 
 Prognosis. — In the young and comparatively healthy, under 
 at least proper treatment, its termination must be regarded as 
 favorable. 
 
 Treatment. — In most cases but little treatment is needed. 
 In the young and vigorous, warm drinks and an absence from 
 gross and indigestible food, will be all the constitutional treat- 
 ment that will be necessary. Should the bowels become so 
 constipated as to occasion irritation, an aperient should be 
 administered. 
 
 To allay the itching and smarting that usually attends these 
 maladies, emollient poultices, water-dressings, antispasmodic, 
 alkaline, and mucilaginous washes may be used. 
 
m THE DERMA. 433 
 
 We have a strong suspicion, that in most cutaneous affec- 
 tions there are some renal and pulmonary defects of function, 
 consequently we would never neglect the kidneys — no mis- 
 chief can attend this practice, even though we be mistaken. 
 
 Species II. — Scabies — Psora — Itch. 
 
 Almost every person, but more particularly those who 
 belong to the lower or less provident classes of society, are 
 practically acquainted with this disease. It locates itself on 
 those parts of the hands, wrists, arms, etc., which are the 
 most delicate, as between and about the roots of the fingers, 
 the middle of the anterior portions of the wrists, and the flexor 
 surface of the fore-arm, and thus it may take possession of all 
 parts of the surface of the body where the cutis is fine and 
 delicate. It is characterized by small, distinct, acuminated, 
 and transparent vesicles, containing a viscous serum. 
 
 This eruption is described by some as being at first papular, 
 and then becoming vesicular and scattered, without any par- 
 ticular arrangement, over its selected surfaces. The face and 
 head appear to be the only parts of the surface for which it 
 has no affinity. 
 
 This is, perhaps, the only cutaneous eruption that produces 
 the unalloyed sensation of itching, and hence it is alone called 
 the itch. The scratching it occasions produces an abrasion of 
 its vesicles which is very apt to convert them into pustules 
 that produce a yellow, viscid matter and much inflammation 
 about their bases. When to that abrasion which attends 
 scratching, is added intemperance, that variety of scabies is 
 produced which is known as the j>urulent or jpoclcy itch. 
 The student who is not prepared to anticipate this change, 
 under provoking circumstances, is greatly liable to unfortunate 
 errors of diagnosis. 
 
 It is difficult to determine why some individuals are not 
 liable to contract the disease under any possible exposure to it. 
 This is shown by the exemption of many hospital physicians 
 and nurses, who resort to no precautionary means for the pur- 
 pose of avoiding it. 
 
 Stimulating food and potations greatly increase the irrita- 
 tion and itching, and although scratching augments the itch- 
 ing, yet it is said to constitute the greatest luxury that is 
 28 
 
434- MOIST FORMS OF DISEASE 
 
 known to the catalogue of human enjoyments. The pruritus 
 that attends it is peculiar and intense, and is usually more 
 severe in the evening than in the morning — in young people 
 than in old. 
 
 Causes. — The infectious character of this disease has never 
 been doubted, and Dr. Wood teaches that it is never produced 
 otherwise. This may be true, but inasmuch as the first case 
 that ever afflicted a human or any other being could not have 
 been occasioned by infection, he is not, certainly, entitled to 
 the conclusion that it cannot be produced by any other cause. 
 The cause that first produced it may still act and occasionally 
 introduce it into communities where infection has not been taken. 
 To be positive, where a possibility to error may exist, is to 
 close the door to further observation. 
 
 So far as is now known, this eruption is occasioned by a 
 parasitic insect, called acarus scabei^ and the communication 
 of the malady is produced by the transplantation of this 
 insect — this has been experimentally proved. It has been 
 asserted that a goat has communicated it to men. Upon those 
 delicate portions of cutaneous surface aflected with the disease, 
 investigation will detect a short line or sort of handle ap- 
 pended to an occasional vesicle, in the further extremity of 
 which the insect may be found and captured by the point of 
 a needle. It is a small, white speck, visible to the unaided 
 vision, having the shape of a turtle with eight legs. Its body 
 is so bristled and bearded that it cannot make a retrograde 
 movement when in its sinus under the cuticle. 
 
 Improper nourishment, dissipation, and filth are thought to 
 be predisposing causes to it. We have long thought that a 
 proper mode of living would prove an efiective prophylaxis. 
 
 Diagnosis. — The sulcus, cuniculus, tail, or handle to the 
 vesicle is found in no other disease, consequently, when this 
 can be detected, a certain diagnosis is had — otherwise there is 
 a possibility that it may sometimes be confounded with ecze- 
 ma, but a careful attention to the description of the two forms, 
 respectively, wdll prevent such a mistake. 
 
 As scabies is a moist and vesicular disease, while prurigo 
 is dry and papular, there is but little danger of mistaking 
 either of these for the other. But there are other diagnostics, 
 prurigo is attended by a black scab, which is not the case 
 
IN THE DERMA. 435 
 
 in scabies, and this is relieved by scratching, while prurigo 
 is not. 
 
 By a careless observer, it is possible that lichen might be 
 confounded with scabies; this attacks the fine and delicate 
 surfaces, but that, the extensor and the more indelicate ones — 
 scabies is, furthermore, moist and vesicular, but lichen is dry 
 and papular. But, in all cases where there is doubt, look 
 carefully for the track of the sinus or sulcus of the acarus, 
 which, if found, removes all doubt. 
 
 Tkeatment. — For the cure of this eruption. Sulphur is uni- 
 versally known as an unfailing remedy; but we object to its 
 use, and to all other external agents, until after the skin shall 
 ^ave been cleansed and relaxed, and secretion, in general, 
 established. 
 
 M. Helmerich has cured the disease effectually in two or 
 three days, by the following course of treatment : The surface 
 of the entire body, but more particularly of the affected parts, 
 should be first washed well with a strong solution of soft-soap, 
 the patient then placed for fifteen minutes in an alkaline bath, 
 containing a pound of the Carbonate of Potash to twenty 
 gallons of water, at the temperature of ninety-two degrees ; 
 the skin is then to be well dried and the following ointment 
 thoroughly rubbed in : 
 
 Vn. Sulphur, gij. 
 
 Carbonate of Potash, gj, 
 
 Lard, gviii. Mix. 
 Of seven hundred persons treated at the Hospital St. Louis, in 
 Paris, on a similar plan, but six were not cured, all the rest 
 being cured on the third day. 
 
 When great objection exists to the use of Sulphur, the body 
 may be bathed as above, and then rubbed with an ointment 
 composed of: 
 
 ]^. Spirits of Turpentine, 3j, 
 
 Oil of Bitter Almonds, 3j, 
 
 Lard, gviii. Mix; 
 or the following wash may be applied : 
 
 5r. Sulphuret of Potash, 3j, 
 
 Soft-Soap, 3ij, 
 
 Rain Water, gviii. Mix. 
 We have found the use of the Compound Ointment of Zinc, 
 
436 MOIST FORMS OF DISEASE 
 
 nsed externally, with the internal use of Sulphur, fully suffi- 
 cient to cure the most obstinate cases of itch. 
 
 During the use of any of the above remedies, the patient 
 should be carefully guarded against cold, damp air, sudden 
 exposures, etc. 
 
 Genus II. — Bull^. 
 
 This division differs from the preceding, mostly in the vesi- 
 cles being, in this case, from the size of a half pea to that of a 
 half egg, and generally of a circular form. The fluid of the 
 vesicles is serous, sero-purulent, or sero-sanguineous ; they 
 usually terminate in the formation of a scab, which, among 
 the species, varies much in thickness. We include in it three 
 species — Pemphigus, Erysipelas, and Rupia, though doubting, 
 in some measure the propriety of including the second. 
 
 Species I. — PemjpJiigus. 
 
 From the information we have been able to obtain concern- 
 ing this disease, we conclude that it is usually associated with 
 a feeble endowment of the cerebellum, as will be perceived 
 before the conclusion of this history of it. It is characterized 
 by blisters or blebs from the size of a split pea to that of an 
 inch, and these may be disposed of separately or they may 
 become confluent, and in the latter case a single vesicle may 
 become to be two inches in diameter. These blebs contain a 
 serous or sero-purulent fluid, which escapes by the rupture of 
 the cuticle, and dries with it, and forms a thin scab or scale, 
 which is succeeded by a slight ulceration or excoriation, and 
 then gradually disappears. 
 
 It appears most generally upon those who possess a delicate 
 skin, and it may appear upon any part of the surface, but 
 most frequently it is confined to the face, neck, and extremi- 
 ties, and apparently founded or located upon erythematic 
 patches. 
 
 When it is of a chronic character, in which form it most 
 frequently appears, the blisters do not so readily heal, as above 
 expressed, but continue to form a succession of scabs, which 
 may cause a very considerable protraction of it, and yet, it is 
 very rarely attended by any febrile symptoms. 
 
 Its acute or apyrectic form is the most common to children 
 at the breast, and it appears in erythematous patches, which 
 
m THE DERMA. 437 
 
 in a few hours, and sometimes almost simultaneously, become 
 covered with blisters. In some instances however, these ery- 
 thematous patches will not, without some additional irritation, 
 as the application of friction, become bullous ; at other times, 
 the center only forms into a blister which can be extended by 
 friction. The blisters, in nowise, differ in appearance from 
 those which are produced by vesicating plasters. The skin 
 that surrounds the blisters is healthy. 
 
 The chronic form is the more liable to be attended with 
 febrile symptoms, as fever, thirst, irregular chills, pain in the 
 head and back, but they are usually too inconsiderable to be 
 noticed. It is more painful and troublesome than the other, 
 and is not unfrequently complicated with inflammation of the 
 mucous lining of the bowels. 
 
 When the face is assailed, the mouth but rarely escapes, 
 and it is reported, in some rare cases, to have invaded the 
 whole intestinal surface. It is never dangerous, except by its 
 complications, and then it is governed by their character. 
 
 Causes. — Bullse is not confined to either sex or to any age, 
 but is more commonly met with in children and the aged. It 
 is not decided as to which sex is the most liable to it. It is 
 said to have been congenital. Those of a debilitated and 
 broken-down constitution, among adults, and children shortly 
 after vaccination are the most frequent subjects of it; but, as 
 in many cases of cutaneous eruptions, it frequently obtains 
 when no cause can be assigned for it. 
 
 Diagnosis. — Being a moist eruption, it is readily distin- 
 guished from the squamous ; from herpes, by its larger blebs 
 and less grouped appearance, it is distinguished. Under the 
 head of Rupia we will give the diagnosis between it and this. 
 
 Pkognosis. — In the acute form, the prognosis is always 
 favorable ; and in the chronic, its complications must deter- 
 mine, in the abstract ; however it is always more or less impor- 
 tant. If the patient have a feeble constitution, and is, at the 
 same time, suffering with other maladies, the prognosis cannot 
 be very favorable. 
 
 Indications. — When inflammation is present, relieve the 
 cutaneous spasm and irritation, promote secretion, and sustain 
 nutrition. 
 
 Tbeatment. — Some of our old school brethren inform us. 
 
488 MOIST FORMS OF DISEASE 
 
 that when highly inflammatory symptoms obtain, depletion is 
 required by venesection and active purgatives. Why have 
 they not recommended a similar practice in variola? — inflam- 
 mation frequently runs as high in it as in pemphigus. 
 
 When cutaneous constriction has been removed by the use 
 of the warm lye-bath, with internal diaphoretics, our chief 
 reliance then must be placed upon renal depuration, more 
 particularly if the afiection be connected with anasarca, which 
 is not unfrequently the case. 
 
 The bowels should not be disturbed, unless their contents 
 are producing irritation, and even then purgatives are not 
 required, but demulcent enemas will be found more beneficial. 
 
 The blebs may be opened and their contents discharged, 
 but much care will be required to save the inflamed surfaces 
 from abrasion. 
 
 As an absorbent, some desiccating powder may be sprinkled 
 upon the blebs. For this purpose, dry, powdered Elm-bark, 
 Flour, Chalk, powdered Hydrastis Canadensis, etc., may be 
 used. 
 
 Dr. Willson teaches, that " When there is reason to believe 
 that the eruption is an effort on the part of nature to deter- 
 mine to the surface a morbid disposition, I should strongly 
 recommend the employment of Mustard -baths to the whole 
 surface of the skin, or a stimulating liniment of some kind, 
 such as that of Croton Oil, in the proportion of a drachm to 
 an ounce of Olive Oil, to be well rubbed into the sound parts 
 of the skin." 
 
 We object seriously to his philosophy, but not to his prac- 
 tice — we approve of it; but we would like to know in which 
 form it is, of eruptive disease, in which nature does not make 
 an efiort to determine to the surface ? So far as we have yet 
 learned, this is her purpose in all forms of disease, and our 
 duty is to aid her in effecting her object, and not to defeat her 
 by bleeding and purging away that vital force by which alone 
 we can hope for success. 
 
 Species II. — Erysipelas. 
 This disease usually makes its attack upon infants within a 
 few days after birth, or at least within a month, and some 
 have thought that it never occurred beyond this period, but 
 
m THE DERMA: 439 
 
 others affirm that they have known it to appear as late as one 
 year, but such cases must be exceedingly rare 
 
 The inferior ])ortions of the body, as the nates, groins, and 
 umbilicus, are the most usual points of attack, in infants, and 
 it introduces itself in the form of a small, red blotch, from 
 which it irregularly, but gradually, extends itself over the 
 abdomen and along the back and inside of the thighs — wear- 
 ing a dijBfused and inflammatory appearance, of a purplish 
 hue, tumefied, resisting, and painful under pressure. It is 
 common for large, but thinly-distributed vesicles to appeal- 
 toward the close of the first day, with livid and inflamed bases, 
 or they may not appear under several days, or in mild cases 
 they may not appear at all. 
 
 When the vesicles quickly succeed the inflammation, they 
 usually become extended with much rapidity, and with equal 
 speed, assume a dangerous appearance. The tendency to 
 gangrene, in its violent forms, is so considerable that it should 
 always be anticipated. 
 
 When the invasion has been made upon the inferior extremi- 
 ties, the most probable termination will be ulcerative suppu- 
 ration of the subcutaneous cellular tissue; but when made 
 upon the abdomen, we are scarcely permitted to expect any 
 other sequent than sphacelation. 
 
 When the suppurative process assails the cellular tissue, its 
 course, in infancy, is very much as it is in the adult — it will 
 not be arrested so long as there is contiguous tissue to prey 
 upon, if life shall be so long continued. 
 
 Visitations of mild forms of this morbus are very rare, and 
 in relation to the duration and violence of its other forms, but 
 little can be said with certainty. In some instances, though 
 not particularly violent, it is greatly procrastinated by its pere- 
 grinations. It w^ill travel and invade almost every part of the 
 surface, and in the rapidity of its movements, it frequently 
 leaves every part sound, except its last and final abiding-place. 
 Its travels and invasions, however, are not always, nor even 
 generally, consecutive, but, like Bonaparte's campaigns — 
 when it leaves a part, there is no predictiDg where it will next 
 appear. 
 
 In infancy, the splanchnic system usually betrays considerable 
 derangement, as frequent alvine evacuations, with griping and 
 
440 MOIST FORMS OF DISEASE 
 
 a grass-green color. In other cases, a reversed condition of the 
 bowels obtains, with colicky pains and acid ejections from the 
 stomach. The urine has usually a bilious, and the skin a 
 jaundiced, color. 
 
 Causes. — These are acknowledged to be particularly obscure. 
 Our observations induce us to believe, that, in adult patients, 
 it depends upon a special organic liability, indicated by a thin 
 and delicate skin, a large organ of animal sensibility, and of 
 course a tolerably full habit of person. But the liability of 
 erysipelas neonatorum to a sphacelous termination, induces U3 
 to suspect that the same organic conditions do not obtain, and 
 yet they may, but modified by some peculiar infantile con- 
 dition. 
 
 The cause is sometimes attributed to a derangement of the 
 chylopoetic viscera, and it is true that such derangement is 
 manifested through the course of the disease, but whether it 
 is a cause, or merely a sequent, is not certainly known. 
 
 Meckel, by jpost mortem examination, discovered, in one 
 case of an infant, the umbilical vein and a surrounding por- 
 tion of the peritoneum to be much inflamed, and several simi- 
 lar cases have since been observed, and hence some have been 
 disposed to attribute this disease in infants to this cause, sup- 
 posing some injury to have been inflicted on the umbilical 
 vein at birth. 
 
 If those organic conditions obtain in infancy, which we 
 hold to constitute a sine qua non in this disease in adults, 
 then we are satisfied that a cause which is adequate to the 
 production of coryza, is capable of developing erysipelas. 
 
 Diagnosis. — A deep-seated inflammation of the skin, a dis- 
 position to spread, symptoms of dangerous fever, and tume- 
 faction of the inflamed parts, may be regarded as the leading 
 diagnostic features of erysipelas. In erythema, the inflamma- 
 tion is superficial, with a very trifling tumefaction. The par- 
 tial location and uniform redness will distinguish it from the 
 exanthematous. In erysipelas phlegmonodes there is no dis- 
 position to travel, the tumefaction is greater and aU the local 
 symptoms are more violent. 
 
 Pkognosis. — The prognosis in this afi*ection may, in a great 
 measure, be inferred from its history. In a mild form and a 
 sound constitution, it is of little consequence ; but, under a 
 
IN THE DERMA. 441 
 
 contrary conibination, it must be considered as particularly 
 dangerous, from the great probability that it will occasion 
 purulent deposits in the viscera, and establish inflammation 
 in the lymphatic vessels and superficial veins. It is also dan- 
 gerous from its metastatic tendency, and it is particularly dan- 
 gerous when complicated with purging and vomiting. 
 
 Indications. — Kelax and cleanse the surface, maintain its 
 centrifugal action — guard against repulsion, equalize the cir- 
 culation, and sustain the vital tone of the system. 
 
 Tkeatment. — To cleanse and relax the surface should 
 be the first object of the practitioner in this disease, and after- 
 ward to maintain the relaxation and to efiect and sustain a 
 determination to the surface, by means of diaphoretics : for 
 which purpose the Compound Powder of Opium and Ipeca- 
 cuanha will be found very beneficial. 
 
 The bowels should be maintained in an aperient condition, 
 but active purgation should be as thoroughly guarded against 
 as in the treatment of sm.all-pox. The Compound Powder of 
 Ehubarb and Potassa will be found the most useful aperient 
 that can be given. 
 
 To absorb the matter as discharged, powdered Starch should 
 be sprinkled over the discharging surfaces ; as, if the least dan- 
 ger is apprehended from mortification, a saturated solution of 
 Sulphate of Zinc may be applied until the vesicated parts 
 become white, after which apply an Elm poultice, and con- 
 tinue it until the inflammation subsides, and the white eschar 
 sloughs ofi*. 
 
 In case of much tumefaction in any part, it should be poul- 
 ticed with bread-and-milk, Slippery-Elm, or with what we 
 regard as much better in this form of disease, a decoction of 
 some vegetable astringent, as the White-Oak bark and corn 
 meal ; yet our principal reliance in the treatment of this dis- 
 ease is the internal use of the Tincture of Muriate of Iron, 
 which may be given to a child two or three years old in doses 
 of three or four drops well diluted with water, every three or 
 four hours, and the aflfected parts bathed freely with the 
 tincture. 
 
 Should the patient become much prostrated, either because 
 of its original debility (which is not usually probable), or 
 
442 MOIST FORMS OF DISEASE 
 
 because of the violence of the disease, tonics and stimulants 
 should be prescribed ; as, 
 
 ^. Pulv. Hydrastis Canadensis, giij, 
 Port Wine, octj. 
 Of this, a teaspoonful may be given three or four times a day 
 to a child two or three years old, or in proportion. 
 
 Authors very generally proscribe animal food under such 
 circumstances as the present, but upon what just principle we 
 cannot determine. We regard carbonaceous food, whether 
 animal or vegetable, as objectionable, but we cannot come to 
 the same conclusion with regard to animal muscle, in the ab- 
 stract. It is already adapted to the nourishment of the human 
 body, and for this purpose produces less irritation than almost 
 any other kind of food. When the muscle cannot be taken, a 
 tea of it can. If the stomach be in a secretory condition, 
 fresh muscle will be the best generally, and if not, salted 
 flesh will prove very palatable, and so will pickles. In this 
 form of disease, the appetite of the patient may very gene- 
 rally be trusted. 
 
 Species III. — Bupia. 
 
 This affection, most generally, is found among the poor, the 
 destitute, the ill-fed, and those possessing naturally a feeble 
 vital system. It appears most frequently upon the loins, 
 nates, and legs, and when of a mild character, it occurs, with- 
 out inflammation, in blisters or bullae, from a line or two to 
 an inch or more in diameter, which contain a transparent 
 fluid that finally becomes opake, sero-purulent, purulent, or 
 sanious, rarely appearing well concocted, often almost black, 
 with a tendency to a rapid formation of scabs, which are 
 generally of a dark-brown or even black color, and more de- 
 veloped or thick at their centers than at their margins. When 
 the scabs are detached, which is easily done, they exhibit 
 ulcerated surfaces, which may cicatrize, or successively, for 
 many times, form new scabs, depending very much upon the 
 more or less depraved condition of the system ; but finally, 
 they heal, leaving the new skin of a livid redness, which con- 
 tinues frequently for a considerable time. 
 
 That variety of rupia which most frequently assails infants, 
 is of a more inveterate character — the blisters appear upoL 
 
m THE DERMA. 443 
 
 previously-inflamed surfaces and contain a dark opake fluid. 
 At first the bullse are small, but they gradually enlarge in 
 breadth and depth, with inflamed borders, and finally even- 
 tuate in ulcers which produce an ofiensive, excoriating, sani- 
 ous pus, accompanied with pain, fever, restlessness, and sleep- 
 lessness. 
 
 In a majority of instances, where scabs become detached, 
 they are successively reproduced, and thus the disease becomes 
 protracted for two weeks or more, when it may or may not 
 destroy its victim. 
 
 Causes.— Beside those constitutional conditions with which 
 we commenced this article, we may add, that in children it 
 sometimes succeeds to the eruptive fevers, as scarlatina, rube- 
 ola, but more particularly variola. It has been contended 
 that it is always a sequel of syphilis, but the unfounded char- 
 acter of this notion has been thoroughly shown. It is said to 
 be frequently complicated with other forms of cutaneous dis- 
 ease, as scabies, pemphigus, and ecthyma. 
 
 Diagnosis. — Rupia bears much resemblance to pemphigus 
 and ecthyma. But the globular bullae and the thin, delicate, 
 brown scab or crust of pemphigus, will distinguish it from 
 the flattened bullae and the thick, rugose, oyster-like, conical 
 scabs of rupia. 
 
 The elementary form in ecthyma is pustular, while that of 
 rupia is vesicular and bullous. Although the elements of 
 these two forms of disease are very decidedly unlike, yet it is 
 sometimes difiicult to distinguish the one from the other. The 
 very obstinate character of the ulcer, in rupia, may serve to 
 aid the diagnosis. The best chance to arrive at a diagnosis is 
 a close investigation of a new pustule or vesicle, as the case 
 may be — one producing pus, and the other serum. 
 
 Prognosis. — In giving the natural history of this aflection, 
 we said enough to authorize an inference as to the prognosis. 
 When the constitution has a viable appearance, the disease is 
 of a mild form, the conclusion may be favorable; but, under 
 contrary conditions, unfavorable. 
 
 Indications and Treatment. — The most important indica- 
 tion is to improve the general health; the next consists in 
 removing all causes of irritation, particularly such as may 
 
444 MOIST FORMS OF DISEASE 
 
 have had an agency in the production of the disease; and, 
 lastly, to keep the surface and the eruption clean. 
 
 The first indication may be answered by a generous and 
 nourishing diet, and such tonic medicines as Hydrastin, Qui- 
 nia, Iron, Ptelein, etc. 
 
 The next indication will require a comfortable chamber, a 
 pure atmosphere, and a proper attention to all the depurating 
 apparatuses, especially the kidneys and skin, and which indi- 
 cation may be fulfilled by the use of diuretics and an alkaline 
 bath two or three times a week. 
 
 The bullae should be punctured early and dressed with dry 
 lint and a bandage, or if the strength is sufficiently reactive, 
 water dressings may be substituted. 
 
 K the general condition of the system is too depraved to 
 admit of improvement under the above treatment, such stimu- 
 lating applications should be made as will excite the ulcers to 
 a more healthy action, such as the Compound Ointment of 
 Zinc. In the meantime the most perfect rest should be 
 required. 
 
 Genus ELI. — PusTULiE. 
 
 Pustulous forms of disease are those which are attended 
 with an elevation of the cuticle, upon an inflamed base, con- 
 taining pus. Pustules are of various sizes, but the largest 
 rarely exceed two lines. Pustulous disease, whatever may be 
 its character in other respects, usually terminates either by 
 absorption, by the formation of pus, by ulceration, or it may 
 pass, by a process of degeneration, into a tubercular disease. 
 Upon healing, it may or may not leave permanent cicatrices. 
 
 In this genus, we include four species : Yariola, Ecthyma, 
 Impetigo, and Porigo. 
 
 Species I. — Yariola — Small-Pox. 
 This form of disease is sporadic and epidemic, and consists 
 in an acute inflammation of the cutaneous investment of the 
 body, attended with fever and an eruption of red points, 
 w^hich pass, in rapid succession, from papules to vesicles, and 
 then into pustules, which very generally attain their maturity 
 between six and nine days, and then, by desiccation, pass into 
 scabs, which lose their attachment between the fifteenth and 
 
IN THE DERMA. 445 
 
 twenty-fifth day, from the commencement of the initial form, 
 leaving upon the skin irregular pits and permanent cicatrices. 
 It invades, very seriously, the mucous membranes, particularly 
 that of the lungs, producing congestion of their surface, and 
 not unfrequently pustules. 
 
 The course of variola is divisible into five pretty distinctly- 
 marked periods, which are those of incubation, invasion, 
 eruption, suppuration, and desiccation. 
 
 1st. TJie period of incubation comprises that time which 
 elapses between the reception of the poison and the beginning 
 of its consequent manifestation, which is usually between nine 
 and twelve days, but sometimes it is procrastinated to twenty 
 days, and in some instances even longer. 
 
 2d. The jperiod of invasion is attended with symptoms 
 that indicate a serious constitutional invasion, such as languor, 
 lassitude, pains in the bones, chilliness, headache, and finally 
 fever. The last symptom, fever, is usually preceded or im- 
 mediately succeeded by nausea and vomiting, in some instances 
 it even happens that these symptoms constitute the first an- 
 nouncement of the morbid invasion. 
 
 Attending these symptoms, there is usually thirst and more 
 or less of obstinate constipation. In this condition of the 
 system, there is generally some pain of a colicky character in 
 the epigastric or umbilical regions, with much redness of the 
 edges and point of the tongue. A characteristic symptom of 
 this stage is pain in the loins, and it generally commences on 
 the third day. 
 
 It is not possible scarcely to ascertain the presence of chilli- 
 ness or headache in children ; but the fever, which varies 
 greatly in degree, may always be ascertained by the dryness 
 and heat of the skin. The existence of cerebral symptoms is 
 indicated by restlessness and irritability, delirium, somnolence, 
 and convulsions. 
 
 The preceding symptoms are usually present from the com- 
 mencement of the eruption, which is between the second and 
 seventh day, but most generally about the third, and the more 
 severe the disease is, the earlier it appears. The confluent 
 form is more severe than the discreet — usually attended with 
 more sickness and vomiting and a sense of exceeding prostra- 
 tion. At the close of the invasion, which most commonly 
 
446 MOIST FORMS OF DISEASE 
 
 happens between the second and fourth day, the eruption ap- 
 pears, and with it may be expected an abatement of the febrile 
 symptoms. It is proper to add, that throughout all the 
 periods there is an exacerbation of the fever during the 
 night. 
 
 3d. The eruptive period is generally introduced by an exa- 
 cerbation of all the constitutional symptoms, as languor, lassi- 
 tude, nausea, oppression, and cough, but the moment the 
 eruption appears they are all relieved — comfort is compara- 
 tively produced. The eruption usually appears first on the 
 lips and forehead, thence upon the face, thence upon the neck 
 and arms, and finally, it travels downward to an investment 
 of the whole surface, and all this in the brief space of twenty- 
 four hours. 
 
 As we before remarked, the eruption begins in small, red 
 points of a conical form, quite resisting, and disseminated in 
 proportion to the pustules which are to be developed. In the 
 simple or discreet variety, they are few and distinct ; in that 
 form known as the coherent, they are numerous and clustered 
 together in patches ; when the eruption is confluent, they are 
 closely aggregated and so numerous as to occasion a general 
 redness of the surface ; they gradually increase in size and 
 prominence for one, two, or three days, and as a general fact, 
 the eruption on the second day passes into the vesicular form, 
 and this change begins and follows the order of papular devel- 
 opment. At first, the vesicles are smaller than the papules 
 and acuminated in shape, but they grow larger, become flat- 
 tened, sunken in the center, and so enlarged as to cover the 
 whole papule and even exceed it in size. 
 
 In the course of these changes, the vesicular fluid passes 
 from transparency to opalescence, and finally the vesicles are 
 converted into pustules, and this change introduces the fourth 
 stage, which happens usually between the fourth and sixth 
 day of the eruption. 
 
 The vesicles are surrounded by small, inflamed areolae dur- 
 ing the various changes, which differ in appearance in accord- 
 ance with the greater or less approximation of the vesicles. 
 In the distinct form, the areolse fade gradually into the natural 
 color of the skin ; but when the pocks are close together, or 
 apparently run into each other, the inter-pock spaces are more 
 
r 
 
 m THE DERMA. 447 
 
 or less of a bright color ; and as the pocks approach to conflu- 
 ence, the areolae become imperfect. 
 
 4th. The period of suppuration is introduced by an en- 
 largement of the vesicles, and the conversion of their contents 
 into pus. As they arrive at maturation, they gradually lose 
 their umbilical shape and become convex on their surface. 
 The same law is observed in the development of the pustules 
 that obtained with the papules and vesicles, beginning on the 
 face and progressing to the extremities. The areolge conse- 
 quent upon the vesicular stage, continues through the early 
 part of the pustular, but they assume a purple tint as they 
 decline. 
 
 Upon seeing a case in the papular stage, and then again in 
 the pustular, no one could realize the fact that there existed no 
 more pustules, until he reflected that the papules were mere 
 points, having much space between them, but that in their 
 passage to pustules they had so much enlarged as to appa- 
 rently cover the surface. The pocks are the most numerous 
 on the face, and the number decreases, proportionally to the 
 size of the space, as they descend ; so true is this, that when 
 confluent on the face, they are distinct on the thorax and 
 abdomen. 
 
 Upon the mucous membranes, the disease becomes evident 
 by a vivid redness, which is succeeded by papular elevations, 
 but whether they are papular or vesicular has not been 
 clearly determined ; but they appear simultaneously with those 
 of the skin, particularly in the mxOuth, nasal passages, fauces, 
 eyelids, and sometimes the vulva. These papular elevations, 
 if such they be, assume the appearance of sm^all, w^hitish, 
 rounded, pseudo-membranous points, which, commencing on 
 the second or third day, continue about five days, and then 
 become detached, leaving, most commonly, a little ulceration 
 or erosion, which recovers without an apparent cicatrix. 
 
 A true inflammation of the mucous membrane of the mouth 
 and throat takes place in a short time after the appearance of 
 the pustules ; the gums become swelled, red, and spongy, and 
 dotted over with white, pseudo-membranous and rounded 
 points, when inflamed. 
 
 The same white points, with redness and injection of the 
 membrane, are sometimes present upon the velum pendulum 
 
4Jt8 MOIST FORMS OF DISEASE 
 
 and the tongue, but with the latter they are much more rare. 
 There is partial or general inflammation, in most cases, of the 
 phaiynx, and it is to be noted that it occurs subsequently to 
 the formation of the variolous pustules, which is denoted by 
 sore throat, more or less severe, and difficulty of swallowing, 
 with tumefaction and soreness of the sub-maxillary glands. It 
 often, perhaps generally, happens that there is pain in the 
 larynx when assailed by the mucous eruption, and the voice 
 becomes hoarse and whispering, with a hoarse, smothered, 
 laryngeal cough. This pharyngo-laryngitis occurs usually 
 between the third and sixth days of the eruption, and from 
 the eighth to the thirteenth ceases. Sometimes it does not 
 supervene, or if it do, it is very slight. 
 
 The subcutaneous tissue becomes more or less inflamed 
 during the variolous eruption, the intensity of which is deter- 
 mined by the extent of the eruption. The skin, more or less 
 hot and painful, becomes red, tense, shining, and elastic in its 
 resistance. Tumefaction supervenes on the fourth or fifth day 
 of the eruption, and progresses for five or six, producing much 
 pain, stiffness, and inconvenience. As desiccation progresses, 
 the swelling subsides, and, in this feature of the disease, the 
 face is always the most afflicted — the eyes becoming sometimes 
 entirely closed by the facial tumefaction. 
 
 We have observed, in another place, that when the papules 
 are fully thrown out, the fever subsides, or disappears, and 
 now, we add, the pulse falls, possibly from one hundred and 
 forty beats to seventy-four, and that throughout the vesicular 
 period the child is clear of fever ; but about the fifth or sixth 
 day of the eruption, when the process of maturation is nearly 
 completed, a new fever, technically called secondary fever ^ 
 announces its appearance by a pulse ranging from eighty-eight 
 to one hundred and forty beats, strong, hard, full — and at- 
 tended by a hot and dry skin. It continues to the ninth or 
 eleventh day, or until the desiccating process is nearly com- 
 pleted on the face, having continued between four and six 
 days. That condition of the system which obtains in the sup- 
 purative stage is evidently the cause of this fever. 
 
 As, in a great measure characteristic of variola, the patient 
 exhales a peculiar, fetid, disagreeable odor when the pustules 
 begin to break and discharge their contents. 
 
I^ THE DERMA. 449 
 
 5th. The period of desiccation is indicated by a diminu- 
 tion of the tumefaction and a desiccation of the discharged 
 pus and purulent matter, which had previously accumulated, 
 by their conversion into scabs. This process, like all the pre- 
 ceding ones, takes place at first on the face, which happens 
 usually on the eighth day of the eruption. The desiccating 
 process is not the same in all cases ; a dark point is formed in 
 the center, in some instances, which gradually extends and 
 forms the whole pustule into a hard crust ; in other cases, the 
 whole surface dries at the same time ; and lastly, the pustule, 
 in many instances, gives way, allowing its contents to escape, 
 which then hardens into irregular yellow crusts, that become 
 brown before detached. It is not uncommon on the arms and 
 legs, for the pustular fluid to be absorbed, leaving the epider- 
 mis to be removed by desquamation. 
 
 The falling of the crusts begins, usually, between the 
 eleventh and sixteenth day, and terminates between the nine- 
 teenth and fortieth, but most generally before the twenty-fifth, 
 of the eruption. 
 
 Upon the detachment of the scabs, the derma presents, in 
 different cases, very different appearances. In some, a true 
 ulceration and loss of substance of the derma has been effected, 
 and when desquamation occurs early in the disease, it pre- 
 sents all the indications of a suppurating ulcer. When des- 
 quamation obtains at an earlier period, the ulcer is discovered 
 to be dry and cicatrized. In both instances, the cicatrices 
 form little pits which continue during life. In other instances, 
 the detachment of the scabs leaves the derma red and exco- 
 riated, without pits, which, upon drying, leaves reddish-brown 
 blotches that continue for months, and finally pass off without 
 leaving cicatrices. And finally, in other instances, the cica- 
 trices are completed before the scabs become detached, and 
 when they do fall nothing is observed but reddish spots, hav- 
 ing a furfuraceous exfoliation of the cuticle ; the whole pro- 
 cess finally terminates without leaving cicatrices. 
 
 With some general remarks, and we close our history of 
 the variolous symptoms or manifestations. 
 
 It should be constantly remembered, that constipation is 
 almost as uniformly present in variola as are the pustules, and 
 when we come to the treatment, it will be seen that it is 
 29 
 
450 MOIST FORMS OF DISEASE 
 
 indispensable to a successful development of the eruption. 
 When diarrhea supervenes, therefore, it is to be dreaded — to 
 be regarded as of bad import, more especially when severe. 
 Abdominal distension is not a common symptom in this dis- 
 ease, and yet it does sometimes occur, to a moderate extent, 
 and attended with some pain in the epigastrium, or in the 
 umbilical or iliac regions ; if, however, it should be seen, 
 some unfavorable complication may be suspected. 
 
 From the preceding history, it might be inferred that chil- 
 dren would sink very much under an attack of variola, but 
 such is not usually the case, except in dangerous cases, which 
 are usually either confluent or irregular. From the great lia- 
 bility of children to cerebral disturbances, it might be sup- 
 posed that the greatest danger should be looked for in that 
 direction, but in regular variola this is not the case ; yet such 
 disturbances do occur, but they are usually light 
 
 COMPLICATIONS OF VARIOLA. 
 
 Under this head, we shall make a few extracts from Dr. 
 Wilson, "On Diseases of the Skin:" 
 
 "Hitherto the favorable course only of variola has been 
 described, but the disease is not unfrequently attended with 
 complications^ which give it the character of a dangerous and 
 often fatal disorder. These complications may occur during 
 any one of the five periods into which the progress of the 
 affection has been divided. 
 
 " Instead of pursuing the mild " and uncomplicated course, 
 "the period of invasion is occasionally marked by symptoms 
 of excessive severity, the accompanying fever runs high, and 
 the rigor which precedes it has been long and enduring, and 
 the pains in the head, the chest, the prsecordia, and the loins, 
 are so violent as to lead to the suspicion of inflammation of 
 the organs situated in those regions. There are sometimes 
 delirium and coma, at other times convulsions, and death may 
 occur before the eruptive stage is established. 
 
 " The period of eruption, like the preceding, is liable to its 
 accidents ; serious congestions of one or more of the inter- 
 nal viscera may ensue. Sometimes the congestion is directed 
 upon the brain and spinal cord, producing twitching of 
 muscles, restlessness, convulsions, or coma ; sometimes on the 
 
IN THE DERMA. 451 
 
 lungs, causing bronchitis, pneumonia, or pleurisy ; sometimes 
 on the mucous membrane of the alimentary canal, giving rise 
 to diarrhea, dysentery, or hemorrhage ; and sometimes upon 
 other of the abdominal organs. In cachectic diathesis, pas- 
 sive hemorrhages and petechise may accompany this period ; 
 and under any of the complications, the case may prove fatal 
 before the completion of the eruption. The variolous vesicles, 
 instead of progressing, become stationary and flaccid, or dis- 
 tended with a sanguinolent or serous fluid. 
 
 " The period of suppuration, as it is most severe in its 
 symptoms, is also the most dangerous in its complications, and 
 the most frequently fatal in its eflects. Alarming symptoms 
 sometimes appear with astonishing rapidity, and destroy life in 
 a few hours, or even in a shorter period. Affections of the 
 brain, of the larynx, and of the trachea, are most to be appre- 
 hended during this period. When these secondary afiections 
 are severe, the pustules remain stationary, or become flaccid, 
 or are converted into sanguinolent bullse; sometimes they are 
 accompanied by petechise and passive hemorrhages, and in 
 rare cases disappear by the absorption of their purulent con- 
 tents. The latter occurrence is always fatal." 
 
 The termination of variola is a period of much anxiety ; 
 for when the disorder has run favorably through its stages, 
 and the danger of the disease has apparently passed away, 
 the secondary afiections are not uncommonly developed, as 
 consequences of the variolous inflammation ; such are chronic 
 inflammation of the various mucous membranes, producing 
 deafness, ophthalmia, opacity of the cornea, staphyloma, 
 oedema glottidis, hemoptysis, pulmonary tubercles, chronic 
 diarrhea, chronic bronchitis, pneumonia, pleuritis, empyema, 
 glandular enlargements, caries of the bones of the face, sub- 
 cutaneous abscesses, erysipelas, gangrene of the skin, disease 
 of the joints, etc. 
 
 Anatomy of the Yariolous Pock. — A knowledge of the 
 structure of variolous pock may not be of any great practical 
 importance, but it must be considered as peculiarly inter- 
 esting. 
 
 A little limpid serum, of an alkaline quality, is found in the 
 vesicle when opened shortly after its formation ; when removed 
 the skin is found to be red, moist, and soft. A filiform 
 
452 MOIST FORMS OF DISEASE 
 
 adhesion is discovered to exist between the center of the pock 
 and the surface of the derma, which creates its umbilical 
 peculiarity. When the pustule becomes globose, it is in con- 
 sequence of a rupture of the filiform adhesion. Yery soon 
 after the vesicles become pustules, a false membrane is disco- 
 verable in the pock, of an opake and white color, soft and 
 friable in its texture, and resting upon the derma in small and 
 isolated points. These points enlarge, unite, and thus consti- 
 tute a pseudo-membranous disc, after the lapse of a little time, 
 which is of an uneven surface, and fills the pock, or is covered 
 with serosity and finally with pus. In the progress of the 
 pustule it forms an adhesion to the surface of the epidermis, 
 and afterward becomes detached, and continues free in the 
 pustule and enveloped in its contents. 
 
 Diagnosis. — As this disease, when developed, can be mis- 
 taken for no other, the only diagnostic desire that can exist is 
 the means of recognizing its character during its prodromic 
 stage, which cannot certainly be done. But if the disease 
 prevail as an epidemic, or if it be known that the patient has 
 been exposed to its contagion, without having been previously 
 vaccinated, then the concurrence of fever, constipation, bilious 
 vomiting, and pains in the back, should be regarded as 
 strongly indicative of its initial existence. 
 
 Causes. — With the exception of a few individuals who are 
 idiosyncratically insusceptible to its invasion, neither sex nor 
 age is exempt from small-pox — not even the fetus. The pro- 
 fession are quite unanimous in the conviction that its cause is 
 a specific animal poison — probably an elaboration of an ab- 
 normal secretory apparatus. It may occur sporadically and 
 epidemically. Most generally one assault of the disease 
 destroys the susceptibility to a second ; but instances have 
 been noted of some persons having had it six times. After 
 the first attack, its invasions are comparatively mild, and yet 
 to this rule strong and marked exceptions have been observed. 
 The suppurative stage is regarded as being most capable of 
 producing the contagion. When it is epidemic, the virus is 
 transmitted by the prevailing winds. 
 
 When we contemplate the variety of the variolous afiec- 
 tions, and the fact, that one form is no preventive against 
 another — even the most malignant is no protection against 
 
m THE DERMA. 453 
 
 the milder, we are induced to suspect that it may, primarily, 
 originate in a purely atmospherical condition. 
 
 Prognosis. — The simple or discreet small-pox may be re- 
 garded as never dangerous, and the same remark is applicable 
 to the confluent variety, when uncomplicated. Rilliet and 
 Barthez confirm this opinion ; they state that all the cases they 
 saw, recovered, when not complicated. The complication, 
 then, of small-pox, must be attributed, in most cases, to some 
 fault or infirmity of the constitution, or to injudicious treat- 
 ment. 
 
 When severe nervous symptoms occur during the first 
 stage — a continuance of the fever after the eruption has ap- 
 peared — an irregular appearance of the eruption — high senso- 
 rial irritation during the secondary fever, or any other depar- 
 ture from the general character of the disease, may be regarded 
 as indicating some complication, and the variety and number 
 of these we have elsewhere indicated. 
 
 Indications. — Maintain the centrifugal action, reduce the 
 spasm and irritation of the surface, remove all causes of irri- 
 tation, and guard against repulsion. 
 
 Treatment. — Dr. Gregory says that small-pox "is a fever 
 which relieves itself by superficial eruption." If fever be the 
 disease, how does it happen that it returns after the eruption 
 is upon the surface? If the physician will regard the fever as 
 indicating an efibrt of the system to cast the disease upon the 
 surface which was produced by the poison, he will have a 
 much more accurate idea of his duty. 
 
 He says, further, that " Heroic remedies are here wholly 
 inapplicable, and the great object of art is simply to place the 
 systeni under the most favorable circumstances for efiecting 
 what the old physicians called the concoction and elimination 
 of the morbid humors." 
 
 If he had made these remarks in his introduction, and had 
 intended them for a universal rule, to be strictly observed in 
 the treatment of all diseased manifestations, we would readily 
 have conceded that he had a clear and intelligent view of his 
 subject; butunder existing circumstances he has thrown them 
 out as expressive of a fact that is applicable to small-pox, and 
 for reasons which he does not understand, as may be clearly 
 
454 MOIST FORMS OF DISEASE 
 
 inferred from his remark, that " heroif remedies are here 
 wholly inapplicable." 
 
 If heroic disease indicates the use of heroic remedies, then 
 they are as applicable to some modifications of small-pox as 
 to pneumonia, bilious fever, broken bones, etc. The only 
 diflerence is this : the consequences of his heroic remedies, in 
 small-pox, are easily perceived, which is not the case with 
 many other forms of disease. 
 
 Dr. Wilson says, that " Meddling in variola is calculated to 
 be as injurious as in other eruptive diseases depending for 
 their origin on a specific poison ;" but why is " meddling in 
 variola " more reprehensible than in other equally dangerous 
 forms of disease ? 
 
 He says, again : " It must be borne in mind, that any vas- 
 cular determination to the surface, whether internal or exter- 
 nal, will be followed by an increase in the number of pustules 
 developed on the irritated spot;" but this increase of pustules 
 can do no mischief, provided they are produced upon the ex- 
 ternal surface. 
 
 He continues: "Thus an incautious purgative, at the outset 
 of the fever, may induce so great a congestion of the mucous 
 membrane of the alimentary canal, as may terminate very 
 seriously." 
 
 This remark is judicious, but it is empirical, because he 
 does not explain why purgatives are demanded in fractured 
 bones and gun-shot wounds, and not in small-pox. Inflam- 
 mation is only inflammation, no matter where located — it is 
 one and the same, and so are the general indications of treat- 
 ment. 
 
 Although Dr. Gregory has stated that small -pox is not the 
 place for the use of heroic remedies, yet he teaches, that when 
 the fever is violent in the initial stage, or even later in the 
 disease, we should have recourse to general bleeding and the 
 use of purgatives every day. Is not this heroic treatment ? 
 During the period of pustulation, under indications of much 
 debility, he advises the use of nutritious diet, wine, brandy, 
 Carbonate of Ammonia, and Quinine. Now, is it not very 
 probable that the exhausting practice, in the former stage, 
 made the use of stimulants requisite in the latter ? Suppose 
 
IN" THE DERMA. 455 
 
 that the vital force, which was destroyed by bleeding and 
 purging, was now present, is it not very probable that the 
 stimulants would not have been indicated ? Would it not be 
 far more wise and judicious to husband the vital force, in the 
 early stages, to aid or sustain the system in the exhausting ? 
 Does not such a practice indicate a most glaring inconsistency? 
 
 In the incipient or forming stage, the patient should be 
 placed on a mattress bed in a room of comfortable temperature, 
 by no means too warm, and then should be treated thoroughly 
 with the alkaline wash and rather stimulating drinks and 
 enemas of the same. We mean that this treatment shall be 
 used at the time that pains in the back and head are com- 
 plained of. This course should be persevered in until the 
 eruption shall make its appearance on the surface. These 
 drinks and enemata may consist of an infusion of Virginia 
 Snakeroot and English Saffron. 
 
 When the objects above specified shall have been obtained, 
 the same course may be continued, but abated or diminished, 
 as barely to keep the eruption upon the surface ; or, in other 
 words, to such an extent as may be found necessary to keep 
 the pustules red and full at their bases. When these condi- 
 tions of them are not maintained, the physician may feel 
 assured that his patient is not doing well ; hence his observa- 
 tion should be constantly directed to them. 
 
 If, notwithstanding this vigilance, he should discover the 
 pustules turn pale and more or less flattened, he should resort 
 again to the previous treatment, taking care not to excite too 
 much action upon the bowels — in this respect nothing more 
 than an irritating constipation is to be avoided. In feeble 
 constitutions a comparatively moderate catharsis may produce 
 a fatal centripetal action. 
 
 If the above treatment should fail, or even tardily reproduce 
 the centrifugal action ; that is, return the pustules to the sur- 
 face, an emetic, as the Acetous Emetic should be adminis- 
 tered. The constitution must be too feeble to contend 
 successfully with the disease when hot alkaline bathing, stimu- 
 lating drinks, and emetics cannot reproduce the eruption upon 
 the surface ; should this be the case, however, warm, stimu- 
 lating drinks may be given, as wine whey, gin sling, brandy 
 
4:56 MOIST FORMS OF DISEASE 
 
 punch, or still better, the Compound Tincture of Virginia 
 Snakeroot. 
 
 The chamber should be kept thoroughly ventilated, the 
 patient's linen and bed should be kept clean, he should be 
 kept quiet, and prevented from scratching or picking the scabs, 
 and his chamber should be frequently purified with the chlo- 
 ride of lime, or with alkaline or soap washings. 
 
 During the filling and maturing of the pustules, the patient 
 may drink water and thin gruel, and, as food, the least irritat- 
 ing and most nourishing is a tea made by boiling fresh beef, 
 without any of the suet or fat, which may be seasoned to suit 
 the appetite ; this may be used, together with guava jelly, 
 apple sauce, and juice of orange, which are generally pre- 
 ferred by the patients. 
 
 Much has been said as to the best means of preventing the 
 formation of pits by the desiccation of the pustules. We are 
 acquainted with an excellent practitioner who opens the pus- 
 tules and cleanses them by alkaline washes, and then covers 
 the face with a delicate oil-cloth. "We have not witnessed the 
 results of this practice, but he represents it as the best he has 
 tried. Tliis practice of cleansing the pustules, we believe, 
 originated with the Persians, and we think favorably of it, as 
 a probable means of lessening the secondary fever, by pre- 
 venting the absorption of pus. 
 
 It is recommended by others, to keep the face, as far as 
 practicable, covered with some bland poultice, or even a wet 
 cloth, for the purpose above-named, and to absorb the pus. 
 
 Various means have been tried to effect an absorption of the 
 pustules, and thereby prevent the production of the pits, and 
 the least exceptionable of these is that of M. Briquet, which 
 became suggested to him by the experiments of M. Serres ; 
 it is the emjplastruw, de vigo. See Emplastrum Hydrargyri, 
 U. S. Dispensatory. 
 
 Dr. Oliffe recommends that the whole face should be covered 
 with the above, except the mouth, nares, and eyes. When ap- 
 plied in the papular state of the eruption, it is said to produce 
 a resolution of it. 
 
 Dr. Picton, as late as 1832, is reported to have prevented 
 the pitting after small-pox, by simply closing out the light 
 
m THE DERMA. 457 
 
 from the patient's chamber. M. Serres states that the best 
 success he ever had in the treatment of this disease was in a 
 very dark and poorly-ventilated cellar. 
 
 Prof. J. King, who has had much experience in this dis- 
 ease, recommends the following course as having proved uni- 
 versally successful in his practice : 
 
 " To prevent the pitting or disfiguration of the face resulting 
 from small-pox, I have, for the last twelve years, pursued the 
 course described below, by which, all who were attentive to 
 the directions, have been cured without a single pit. Having 
 suffered from a severe attack of the confluent form in my own 
 person, I was led to investigate the subject ; and so confident 
 am I of its universal application, that I am willing to render 
 all my services cheerfully and gratuitously to any patient, who, 
 having followed my directions, finds himself at the termina- 
 tion of the disease, in the least degree marked or disfigured. 
 
 "The body, in small-pox, is seldom pitted, because it is not 
 exposed to the action of the light, and that of the atmosphere 
 upon the pustules is greatly modified ; whereas, on the con- 
 trary, the face, whatever other measures are adopted, is always 
 marked, if exposed to the action of these agents, either singly 
 or combined ; we must then protect the face of the patient 
 from the action of both the light and the air. And I am truly 
 proud of the honor of having been the first individual to pre- 
 sent this valuable mode to the public — having published it 
 several years since. 
 
 "To accomplish the above purpose, we must in the first 
 place keep the room in which the patient lies, perfectly dark, 
 but not closed so as to prevent a free circulation of air ; and 
 if this cannot be done, a piece of black oiled silk, well oiled, 
 may be thrown over the face, having one or two apertures in 
 it for the purpose of breathing. In the second place, the face 
 must be kept consta7itly well oiled with Sweet Oil, which must 
 be put on by gently touching^ not rubbing, the face with a 
 soft feather which has been dipped in the oil. Sweet Oil or 
 Almond Oil will answer. The oil must by no means be 
 allowed to dry on the face, and must be applied from the first 
 appearance of the pustules, until they have disappeared or 
 scaled off'. The patient must not be allowed to touch his 
 face with his hands at all; and should he be delirious, the 
 
458 MOIST FORMS OF DISEASE 
 
 hands must be secured; neither must the face be rubbed 
 against the pillow or bed-coverings. 
 
 "The room must be kept dark, using a lamp or candle only 
 when a light is required for the physician or nurse to examine 
 the patient. The eyes must be washed often with rose-water, 
 or mucilage of Slippery-elm, which prevents them from being 
 much injured by the disease ; and the nostrils must be kept 
 free by passing a camel's hair pencil, well oiled, into them 
 several times a day. The treatment, in other respects, to be 
 successful, must be strictly eclectic." 
 
 In patients of the third class (page 20), or those of an un- 
 balanced organization, there exists a constant liability to vario- 
 lous complications, as assaults upon the brain, lungs, bowels, 
 etc. In such cases, the additional treatment that may be 
 required, will be found under the properly-indicated heads. 
 
 In the secondary fever, we have only to equalize the circu- 
 lation and to promote depuration, by the Compound Powder 
 of Ipecacuanha and Opium ; but, unless medicines are 
 actually required in this stage, the less we interfere with it, 
 the better it will be for the patient. 
 
 When the scabs have all fallen, the surface of the patient 
 should be thoroughly cleansed by the use of soap and warm 
 water, and even his cutaneous follicles should be caused, by 
 diaphoretics, to discharge their contents, and every vessel he 
 has used, and also his chamber, should be fumigated by the 
 use of Sulphuric Acid and common salt, or by the Chloride 
 of Lime or Potash, and every article of the clothing of him- 
 self, bed, and chamber should be boiled and cleansed with 
 soap. By these means all variolous contagion may be 
 removed from the premises. 
 
 In this disease, especially in the confluent form, there will 
 often be found a closure of the nostrils from the matter 
 secreted filling them and drying, and which very much inter- 
 feres with the patient's breathing; this may be obviated by 
 removing the obstruction, and afterward passing a camel's 
 hair pencil, moistened with Sweet Oil, up into the nostrils 
 several times a day. When the matter enters the eyes, it 
 should be removed by bathing them frequently through the 
 day with distilled rose-water. 
 
m THE DERMA. 459 
 
 Yabiety I. — Varioloid — Spurious Small-Pox. 
 
 This form of disease presents itself under so many modifi- 
 cations of character as to be of difiicult description, which, 
 indeed, we might have presupposed from the descriptions of 
 various forms of variolous disease by early writers in the pro- 
 fession, under the names of swine-pox, sheep-pox, stone-pox, 
 spurious pox, etc., which had been observed with those who 
 had had the true small-pox, and with those who had not had 
 it ; and yet, no one seems to have doubted that all of these 
 varieties, if indeed the names represent so many varieties, 
 were referable in some mysterious manner to the variolous 
 poison. 
 
 It is now thought that these unclassifiable maladies have 
 occurred more frequently since the introduction of inoculation 
 and vaccination, than before ; but it is not our purpose to pur- 
 sue such histories of disease as can have no practical bearing 
 upon its pathology or treatment. 
 
 At this time we shall treat only of that variety which occurs 
 in those who have been vaccinated, or who have had variola 
 in the natural or inoculated form. 
 
 It appears from observation, that children who have been 
 vaccinated are but little liable to varioloid, until after they 
 shall have passed their fifteenth year, and this is attempted to 
 be accounted for by supposing that the insusceptibility to 
 variolous poison, occasioned by vaccination, becomes replaced 
 by a susceptibility, resulting from the mutations of juvenile 
 development. 
 
 Tne symptoms of varioloid very much resemble those of 
 variola, except that those of the former are more brief in their 
 duration, and more mild in their character. Slio^ht fever, 
 headache, and languor usually introduce the disease to the 
 consciousness of the patient. Constipation, most frequently, 
 soon becomes apparent, and then, in two or three days, the 
 eruption appears. The nervous symptoms, lumbar pains, 
 vomiting, etc., which are constant attendants upon variola, 
 are generally absent in varioloid, and when present they are 
 generally very slight. The eruption that succeeds consists of 
 small pustules, which in number may vary from one to twenty, 
 and in the course of four or five days they may dry up ; the 
 
460 MOIST FORMS OF DISEASE 
 
 duration of this stage, however, is very irregular, and there- 
 fore may terminate on the second day or continue to the 
 fifth, from the commencement. 
 
 In all cases, whether mild or severe, the prodromic fever 
 and its associate symptoms completely subside upon the ap- 
 pearance of the eruption. 
 
 A rash, resembling measles — a transient efflorescence, in 
 many instances, precedes the eruption, which may first appear 
 upon the extremities, or upon various parts of the surface, but 
 the face is the most general locality of its appearance. In the 
 beginning, it consists very generally of small, red, resisting, 
 elevated papula, which pursue very unlike courses — some of 
 them dry up, without further change, and others progress to 
 the vesicular form, and then assume a whitish, opaline ap- 
 pearance, become umbilicated, and change into pustules by 
 the end of the second or third day. 
 
 The secondary fever, characteristic of variola, very rarely 
 occurs in this, and when it does it is very slight, exhibiting a 
 slight acceleration of the pulse, and augmented temperature 
 of the skin, which disappear entirely in one or two days. 
 
 The pustules in this disease do not usually fill so well as 
 they do in variola, and their contents are more sero-purulent 
 than purulent. Like the other stages, the third or desquama- 
 ting, occurs earlier and arrives at its completion with more 
 rapidity than in proper small-pox, so that by the eighth day 
 the scabs are falling off", and by the twelfth or fourteenth it is 
 completed, leaving nothing but reddish spots or blotche-, which 
 soon disappear without leaving cicatrices. The duration of 
 this complaint is from ten to twenty days, but in a majority 
 of instances, it may be considered as continuing from six to 
 twelve. 
 
 Causes. — For a long time the etiology of this disease con- 
 tinued to be a matter of doubt, but at this time it is generally 
 considered to have its origin in variolous poison upon those 
 who have had the natural or inoculated small -pox, or who 
 have been vaccinated. But it is nevertheless confessed, that 
 it does occur sometimes in those who have not been vaccin- 
 ated, nor suffered from any variety of variolous poison. It is 
 furthermore asserted, that it can be reproduced by inoculation, 
 but under no circumstances does it become prophylactic 
 
I 
 
 IN THE DERMA. 461 
 
 against small -pox. This occurrence renders its character par- 
 ticularly obscure, even under the admission that the poison 
 may be atmospherically changed, or that its effects may be 
 idiosyncratically or constitutionally modified. 
 
 Diagnosis. — This presents a difficult feature of the subject, 
 as it sometimes presents the characteristics of varicella ; in 
 other and severe cases, it is scarcely distinguishable from 
 small-pox; and in some instances, it presents a striking 
 resemblance to the pustule of vaccina. 
 
 Professor Eberle reduces its diagnostic signs to the four 
 following : 
 
 1. "The eruption (in varioloid) comes forth in successive 
 clusters, at uncertain periods, between the second and fifth 
 days." 
 
 2. " The eruption, rarely, if ever, enters into complete sup- 
 puration, as occurs in small-pox." 
 
 3. "The eruption is unaccompanied by fever, except in 
 ver}^ violent cases." 
 
 4. " Desiccation or scabbing invariably occurs much earlier 
 than in regular variola. It commences generally on the fifth or 
 sixth day, and the scabs usually separate by the eighth or 
 ninth day, leaving red discs or tuberculous elevations, instead 
 of depressions." 
 
 Prognosis. — The prognosis in this disease can never be un- 
 favorable, except in very feeble constitutions, and then only in 
 cases of complication with disease affecting peculiarly impor^ 
 tant parts. 
 
 Treatment. — As varioloid differs from variola, so far as 
 regards treatment, only in degree, being generally more mild 
 in its character, the indications and treatment must be, too 
 nearly the same in both, to admit of a well-defined difference ; 
 for the treatment of this form of disease, we therefore refer to 
 that of variola. 
 
 Yaeiety II. — Yesicida Varicella — Chicken-Pox. 
 As this affection but seldom, in either of its varieties, 
 betrays a purely pustular character in either of its stages, but 
 is vesicular, it should, if governed by this circumstance, be 
 placed in the class Vesiciilce ; but, as we are, in common with 
 many others, disposed to regard it as a varioloid affection, we 
 
462 MOIST FORMS OF DISEASE 
 
 think it best not to separate it from its varioloid associates. We 
 do this simply through a bias of judgment, for the uncertainty 
 that still invests it, is too great, to justify an expression of 
 certainty with regard to it. 
 
 Its period of incubation has not been determined, but from 
 the circumstances that seem to attend its occurrence, we infer 
 that it differs widely from that of variola. 
 
 Its initial stage is usually introduced by loss of appetite, 
 thirst, restlessness, acceleration of the pulse, increased heat of 
 the surface, and pain in the epigastrium ; and they may be 
 attended by a slight inconvenience to the patient — and they 
 may be attended by a severity equal to the worst cases of 
 small-pox. When thus severe^ marked, it is attended with 
 pain in the head, back, and extremities, and sometimes with 
 soreness of the throat, a severe cough, and even convulsions. 
 This stage continues from one to three days, when it is arrested 
 by the appearance of the eruption, but in some instances, 
 however, it continues even two or three days longer. 
 
 The eruption, which is vesicular, is usually preceded, by a 
 few hours, with a general erythematous rash, and attended with 
 an itching and tingling of the skin. The vesicles appear, 
 most generally, in succession during three or four days, conse- 
 quently while some of them are just appearing, others are 
 matured, others shriveling, and lastly, others have passed into 
 scabs. It is usual for them to appear first on the breast and 
 back, then on the face and scalp, and lastly upon the extremi- 
 ties. It is said that pustules are occasionally found mixed 
 with the vesicles, but they are not considered as constituting a 
 feature of the disease. 
 
 ISTosologists have divided varicella into three varieties, as, 
 Varicella Lenticular, Yaricella Conoidal, and Yaricella Glo- 
 bate, or Sivine-Pox. 
 
 1. Y. Lenticular or Cliicken-Pox. — This variety appears 
 early in the initial stage, and may be known by the eruption 
 consisting of small, red, and rather oblong elevations, with a 
 shining fiat surface, and a very small and lucid vesicle in the 
 centre. At the close of the second day, the vesicle is about 
 one- tenth of an inch in diameter, and contains a whitish 
 lymph, which by the third day has become of a straw color. 
 In one day more, the vesicle is shriveled, and by the seventh 
 
m THE DERMA. 4g3 
 
 it has passed, by desiccation, into a brown crust, which by 
 the ninth or tenth becomes detached, leaving its place red, but 
 without depression. The desiccating process continues two or 
 three days longer, on account of the successive appearance of 
 the vesicles. 
 
 2. V. Co7ioidal or Swine-Pox. — With a border somewhat 
 inflamed, the vesicles, in this variety, appear suddenly; they 
 are acuminated and filled with limpid serum on the first day; 
 on the second, the surrounding inflammation and vesicle have 
 enlarged, and the latter is filled with a pale, yellowish fluid; 
 many of them are sunken on the third day, while others are 
 full, considerably inflamed, and contain a purulent matter, 
 which, upon healing, leave cicatrices ; on the fourth day, the 
 scabs commence forming into several varieties, as brown, 
 yellow, and transparent. On the second and third days, fresh 
 eruptions sometimes appear, which extend the stage of erup- 
 tion to six days — and, therefore, the duration of the disease is 
 continued to the eleventh day, possibly to the twelfth. 
 
 3. Y. Glohate or Hives. — Large, globose, and irregularly 
 circular vesicles, with an inflamed areola, distinguish this 
 variety. Their fluid contents at first are transparent, which, 
 by the second day, has become turbid or whey-like, and by 
 the third they begin to shrivel, and become yellowish, by the 
 passage of lymph into a purulent matter, and by the fourth 
 they pass into dark, thin, small scabs, which by the fifth day 
 become detached, and the surface, though red, does not become 
 cicatrized. 
 
 Causes. — Upon the causes of varicella, professional opinion 
 is divided. By one party, it is maintained that it has avaric- 
 ious origin — that in an epidemic of either variola or varicella, 
 the other is directly or indirectly present — that they never 
 exist separately — that the varicellous poison will produce 
 variola, and vice versa. 
 
 The other party maintain that small-pox epidemics often 
 prevail without being attended by varicella, but the first deny 
 that this is ever the case. 
 
 We do not deem it necessary to enter into all the facts and 
 arguments by which the two parties maintain their respective 
 opinions; but we may add, that it appears to us, that if the 
 two forms of disease can mutually produce each other, they 
 
464 MOIST FORMS OF DISEASE 
 
 should be mutually prophylactic of each other ; this, it seems, 
 however, is not the fact. 
 
 "We will further add, that the various histories which have 
 been presented of epidemics of both, have induced us to enter- 
 tain but little doubt that the variolous poison is atmospherical 
 to an extent sufficient to produce some variety of variola, 
 which in turn may produce a more effective poison. 
 
 Diagnosis. — There can be no difficulty in distinguishing 
 varicella from variola, nor do we believe that a proper atten- 
 tion to the subject should permit the former to be confounded 
 with varioloid. The initial fever in varioloid is, generally, 
 more severe than in varicella, but the most distinguishing 
 diagnostic consists in the fact that varicella is always essen- 
 tially vesicular, while varioloid is as essentially pustular, ex- 
 cept in the vesicular stage of it. 
 
 PROGNOSIS. — As in varioloid, the prognosis in this disease 
 must be regarded as favorable, under even moderately favor- 
 able circumstances as to the previous health and stamina of 
 the patient. 
 
 Treatment. — As very little reaction, usually attends vari- 
 cella, so very little energy is required in the treatment of it. 
 A warm alkaline bath and some mild diaphoretic tea will 
 generally fill the indications, but should the symptoms indi- 
 cate greater energy some emetic should be administered, and 
 then a stimulating enema. The diet should be simple and 
 moderate. 
 
 Yakiety III. — Variola Vaccina — Cow-Pox. 
 
 This is the small-pox of cattle, a contagious inflammation 
 of the skin, which is sometimes communicated to those human 
 beings who attend them, as milk-maids, etc. It consists of 
 multilocular and umbilicated vesicles, upon inflamed bases, 
 w^hich gradually become pustular, and elaborate, dark -brown 
 scabs that leave upon their detachment deep and permanent 
 cicatrices. The constitutional symptoms are mild through its 
 initial and vesicular progress, but they increase, and some- 
 times become quite severe, particularly the secondary inflam- 
 mation, as the pustular or suppurative stage advances to its 
 full development. 
 
 When the disease is contracted in this casual way, the 
 
m THE DERMA. 465 
 
 virus is communicated from the teats or udder of the cow to 
 those who milk them, and from horses to those who groom 
 them, consequently the eruption appears on the backs of the 
 hands and between the fingers where the cuticle is thin, for it 
 has been clearly shown that an abrasion of the surface or epi- 
 dermis is not essential to the inoculation. 
 
 It has also been discovered that when the virus is applied to 
 an abraded or chapped surface, the consequence is apt to be 
 subcutaneous abscesses, which are attended with much severity, 
 producing, more particularly, inflammation of the lymphatic 
 vessels and glands. 
 
 Causes. — It will not perhaps be disputed by any one, that 
 the inferior animals are liable to become diseased by all the 
 causes that inflict disease upon the human race, but in conse- 
 quence of organic differences, it would, a priori, be expected 
 that the manifestations would be, in most animals, very greatly 
 modified ; therefore, it may be presumed that no one, at this 
 time, would be surprised to learn that a disease analogous to 
 small-pox occurs in both the cow and the horse ; but in 1796, 
 the effect upon the public mind was very different, when, for 
 the first time, the fact was announced by the immortal Jenner. 
 The fact is now well established that small-pox appears, not 
 only epidemically but also epizootically, particularly with 
 horses and cattle. Jenner was aware that the horse was some- 
 times afflicted with a disease, which, when communicated to 
 the cow, produced a disease that could not be distinguished 
 from true cow-pox. We can have no doubt, at this time, that 
 the disease which then appeared in the horse was the genuine 
 small-pox, which is now known to appear in the heels of that 
 animal, and for a long time was confounded with the grease. 
 As this work is intended for practical purposes, we cannot 
 enter into the history of the many observations and experi- 
 ments which have produced certainty, in many respects, with 
 reference to this subject — we cannot do more than give a sum- 
 mary of the results. 
 
 It is now pretty satisfactorily ascertained that when the 
 small-pox prevails in human society, as an epidemic, the cow- 
 pox prevails among cattle — that when the small-pox contagion. 
 is transmitted to cattle, a true cow-pox is produced, and also 
 when it is produced by inoculation. And it is, if possible, 
 30 
 
4:QQ MOIST FORMS OF DISEASE 
 
 Btill better known, that when cow-pox is transmitted to the 
 human subject, by inoculation, a pustule, precisely similar to 
 cow-pox is produced. Touching these results, we will cite one 
 experiment : 
 
 Dr. Macmichael, in a paper which was read before the Col- 
 lege of Physicians, in 1828, wi-ote thus: "Yaccine matter 
 having failed in Egypt, medical gentlemen were led to insti- 
 tute certain experiments, by which it has been discovered that 
 by inoculating the cow with small-pox, from the human body, 
 a fine, active, vaccine virus is produced." 
 
 Variety IY. — Inoculattd Variola Vaccina — Vaccination. 
 
 In the operation called vaccination^ several plans have been 
 practiced, but that which is generally preferred is the puncture 
 or punctures, at the inferior extremity of the deltoid muscle, 
 with the point of a lancet, previously imbued with the lymph 
 or virus. In order that the papillary surface may be obtained 
 without the effusion of blood, the punctures should be made 
 obliquely through the epiderma. 
 
 When the virus is of a proper quality, the patient in a 
 proper condition, and the operation has been properly per- 
 formed, there will succeed two or three days of incubation, 
 and upon the third or fourth the papular stage will be intro- 
 duced by some hardness of the skin and some elevation of its 
 surface; on the fifth or sixth day, the vesicular stage will 
 commence, indicated by a slight effusion of the liquor san- 
 guinis beneath the epiderma, which passes into an oval and 
 whitish vesicle of a pearly luster, which increases in size and 
 fullness to the eighth or ninth, when it is umbilicated and per- 
 fect. Upon the eighth or ninth day it begins to become pus- 
 tular, loses its umbilicated character, becomes flattened or 
 even more convex at the center than at the periphery, and ex- 
 hibits numerous small cells of lymph, and then becomes sur- 
 rounded by an inflamed areola which is vividly red — present- 
 ing " the jpearl ujpon the roseP By the tenth day, the areola 
 enlarges from a few lines to one or two inches or more, 
 attended by tumefaction, an increase of redness, some itching 
 in the part, pain upon muscular movements of the arm, sore- 
 ness of the axillary glands, and sometimes an erythematous 
 blush appears in patches on various parts of the body. 
 
m THE DERMA. 407 
 
 The fluid contained in the vesicle becomes purulent by the 
 eleventh day, and the areola begins to diminish, and desicca- 
 tion begins at the center, and proceeds gradually toward the 
 circumference. As the vesicle desiccates into a dark-brownish 
 scab or crust of an irregular form, the areola disappears and 
 the tumefaction subsides. The crust, after assuming a blackish 
 hue, becomes detached at the close of seventeen days after 
 vaccination, and the cicatrix that becomes thus exposed, pre- 
 sents in its bottom numerous little pits or foveolse, corre- 
 sponding with the original cells of the vesicle. 
 
 Corresponding with the inflammation of the areola, there is 
 a febrile reaction, but it is generally slight, and in many 
 instances scarcely perceptible, unless there should exist some 
 adverse idiosyncrasy in the constitution, in which case the 
 symptoms may be severe, and even lead to a fatal termination. 
 
 For vaccination to produce a complete protection against the 
 small-pox, it is indispensable that its course should be about 
 as we have above described it. When its course is irregular 
 or abnormal, it is no security against variola, nor should it be 
 presumed to be, any more than any other inflammation that 
 might succeed to a cause of local irritation. The most suit- 
 able period for vaccination, is between the third and seventh 
 month, because of its greater absence from those forms of dis- 
 ease which are incidental to early youth. It is proper to add 
 that the local afiection, in infancy, is always more efiectually 
 marked than in adult age ; nevertheless, the process should be 
 deferred if there should exist a cutaneous disease, more par- 
 ticularly of the vesicular character. 
 
 Deviations^ in almost all possible respects, do sometimes 
 attend the vaccinating process, and when they do the purpose 
 for which it was instituted may be considered as defeated 
 consequently it becomes a matter of the first importance to 
 observe its progress. 
 
 In some instances, the whole course of the afiection con- 
 sumes but eight or nine days. In other instances, ten, fifteen, 
 or twenty days elapse between the introduction of the virus 
 and the formation of the pustule. In some cases, considerable 
 inflammation and the development of the vesicle will appear 
 by the second day after vaccination. In other instances, a 
 true pustule appears, instead of a vesicle, and that too by the 
 
468 MOIST FORMS OF DISEASE 
 
 first or second day after the vaccination. In other cases 
 again, there maybe present a well-defined areola, surrounding 
 a pustule which is elavated instead of being depressed or um- 
 bilicated. In other cases, the vesicle is perfect, but the areola 
 is absent on the ninth or even the tenth day. Sometimes, 
 again, the vesicle is too small, and beside, it may be flattened 
 without a prominent margin. 
 
 In all such cases as the preceding, doubts should be enter- 
 tained as to the efficiency of the vaccination. It is not com- 
 mon for more than one pock to appear after vaccination, and 
 yet, in some instances, several appear in the immediate 
 vicinity of the original one, and in other instances they have 
 been known to appear on various parts of the body. So far 
 as is yet known, such manifestations of vaccination are valid. 
 
 Vaccination ; lohat does it im^lyf Dr. Wilson answers, 
 in substance, as follows : 
 
 By it we understand that the individual firom whom the 
 lymph or virus is taken, is of good, sound health — is not 
 obese, gross, nor lymphatic. 
 
 That it shall not have become deteriorated by neglect or age. 
 
 That it shall have been taken from the vesicle between the 
 fifth and eighth day, from one who had passed norm^ally, or 
 as we have described the afiection, through the vaccine 
 process. 
 
 That the subject vaccinated shall have passed normally 
 through the several stages of the process. 
 
 That one vesicle at least shall have been permitted to pro- 
 gress to the spontaneous detachment of its scab or crust. 
 
 That the cicatrix shall have all the marks that indicate a 
 successful vaccination. 
 
 Dr. Wilson regards vaccina and variola as absolutely one 
 and the same, and that vaccination, as he understands it, and 
 as we have defined it, to be as thorough a protection against 
 small-pox, as the small-pox itself could be, for neither, nor 
 both, constitute a certain protection to all persons. Some 
 persons are insusceptible to the contagion of small-pox and 
 to the virus of vaccina ; and in others, no number of attacks 
 of the small-pox appears to exhaust their susceptibility to its 
 contagion. 
 
 Vaccination Tests. — Several tests of successful vaccination 
 
IN THE DERMA. 469 
 
 have been proposed, but that recommended by Dr. Bryce, of 
 Edinburgh, is the only one we shall name or recommend ; and 
 this is to re-vaccinate in a few days, three or four, after the 
 first vaccination. If the first shall have properly impressed 
 the system, the second will hurry through its stages, overtake 
 the first, and terminate with it. 
 
 Re-estdblishment of Yaccine Protection. — It is now, per- 
 haps, universally believed, that when the animal organism 
 has been thoroughly operated upon by contagion, that its sus- 
 ceptibility is destroyed to a second assault by a similar conta- 
 gion ; and the opinion is as universally entertained that the 
 impressions of the first contagious attack become gradually 
 obliterated — that the original susceptibility becomes restored ; 
 both conclusions are no doubt true, but in very different degrees 
 in different individuals. 
 
 Some persons, through a great portion of life, and others, 
 possibly through life, are insusceptible to certain contagions ; 
 and it may be said, perhaps, with entire truth, that some 
 are barely susceptible to one assault, while others are so 
 susceptible as to be vulnerable, at short intervals, through 
 life. Some have been rendered invulnerable through a long 
 life by one vaccination or variolation, and yet constantly 
 exposed, while others have had frequent attacks from the same 
 or similar contagion. 
 
 If these views are correct, and so we think them to be, no 
 definite period can be fixed upon for re- vaccination as a requi- 
 site means of re-establishing the protective infiuence of 
 vaccina. 
 
 As no mischief, and but little inconvenience can result from 
 re-vaccination, it would be prudent to have it done at periods 
 of seven years. The most susceptible cannot be secure, we 
 think, for a longer period ; but for the benefit of those who are 
 disposed to risk a discretionary judgment on the subject, we 
 would suggest, without experience in variolous forms of dis- 
 ease, however, but from our acquaintance with the human 
 constitutions or temperaments, that the bilious and its lean 
 and dense varieties are probably rendered secure by one inva- 
 sion ; though this is our opinion, we do not advise them to 
 risk it. The lymphatic combinations with the bilious would 
 do well to re-vaccinnate at intervals of ten years, and also the 
 
470 MOIST FORMS OF DISEASE 
 
 sanguine ; but the lymphatic combinations of the sanguine 
 would act wisely to repeat the process at intervals of seven 
 years. The lean varieties of the sanguine and the encephalic, 
 if not secured by one impression, are not to be considered, at 
 most, as being in much danger. 
 
 If observations had been made during the preceding twenty 
 years, with reference to the existing temperament, measurably 
 all the questions involved in this subject, could now be an- 
 swered. 
 
 As shedding much light on the subject of vaccination, and 
 as an illustration of its value, notwithstanding the errors and 
 carelessness that may have attended its j)ractice, we make a 
 quotation from Dr. West, on infantile forms of disease. 
 
 "But, although we should take a comparatively low esti- 
 mate of the value of vaccination, and confess to the fullest 
 extent the failure in its comjglete preservative virtue, we shall 
 yet find, in the following modifying and mitigating influence 
 which it exerts over small-pox, more than enough to make us 
 value it as a priceless boon. Twenty years ago, small-pox 
 raged epidemically at Marseilles, where it attacked almost 
 exclusively persons under thirty years of age. M. Favart, 
 who sent an account of this epidemic to the Academy of Medi- 
 cine at Marseilles, estimated the number of the inhabitants of 
 that city under thirty years of age at forty thousand. Of 
 these, about three thousand had been vaccinated, two thousand 
 had had the small-pox casually or by inoculation, and eight 
 thousand had had neither variola nor cow-pox. Of this last 
 class, four thousand, or one to two, were attacked by small- 
 pox, and one hundred of them, or one in four, died. Of 
 those who had had small-pox previously, only twenty, or one 
 in one thousand, were again afi"ected ; but four of these, or 
 one in five, died ; while of the vaccinated, although two thou- 
 sand, or one in fifteen, had it, yet it proved fatal only to 
 twenty, or one per cent." 
 
 According to these statistics, the mortality of vaccination 
 and of no vaccination stand related to each other as one to 
 three and three-fourths ; this is a great saving, but it does not 
 equal the desire of the medical philanthropist. 
 
 Treatment. — In the inoculated form of vaccina, but little 
 medication, in general, is demanded; the alkaline bath, warm 
 
11^ THE DERMA. 471 
 
 pediluvia, warm diaphoretic drinks, and slightly stimulating 
 enemas, will usually prove sufficient. Much care, however, is 
 required to prevent children from injuring the vesicle. 
 
 Species II. — Ectliyma. 
 
 The only profitable division that we can make of this dis- 
 ease, is into acute and cJironic. To the former children are 
 peculiarly subject ; and it is very frequently preceded by con- 
 stitutional symptoms, such as lassitude, pains in the limbs, 
 loss of appetite, epigastric uneasiness, and irregularity of the 
 bowels, and with these symptoms the patient is more or less 
 troubled during the continuance of the disease. The erup- 
 tion, most generally, appears upon the neck, breast, and 
 shoulders, sometimes on the extremities, but rarely, if ever, 
 upon the face and head. It appears in large pustules, elevated 
 upon a hard, dry, and inflamed base, and covered with 
 greenish-brown or yellow, wdth little or no inflamed areola 
 surrounding them ; they are rarely grouped or confluent, but 
 separated from each other. In the course of three or four 
 days from the commencement, they exhibit pus at their sum- 
 mits and resemble small boils. In a short time they discharge 
 their pus, which concretes into the scabs above-mentioned. In 
 a week or two from the beginning, these scabs fall ofi*, leaving 
 dark-red surfaces of half an inch or more in diameter. The 
 extent of the attendant fever is such, sometimes, as to occa- 
 sion a swelling of the lymphatic glands in their vicinage. 
 
 The chronic form of ecthyma appears to hold a connection 
 with chronic forms of disease of the digestive and respiratory 
 organs, and becomes developed on those who have become 
 emaciated by them. In this form, the eruption is renewed 
 without ceasing, multiplies, spreads, and becomes confluent. 
 Both forms are attended with constitutional symptoms — both 
 produce a rapid emaciation of the system: but neither of them 
 
 IS contagious. 
 
 Causes. — ^Most generally this disease, in all its forms, ap- 
 pears to be dependent upon some depravity of the system. 
 Some substances are known to produce a disease of this char- 
 acter, and tartar emetic is one of them. Badly-nourislied and 
 greatly-neglected infants are particularly liable to it. Various 
 internal irritations are said, also, to produce it. The general 
 
472 MOIST FORMS OF DISEASE 
 
 causes are said to consist in a want of proper food, clothing, 
 and cleanliness, but when it occurs in children, we suspect 
 that it most generally results from a semi- viable condition of 
 its organization — a feeble cerebellum. 
 
 Diagnosis. — The only disease that may occu., in infancy, 
 with which it could be confounded, is syphilitic, and with 
 reference to this, the history of the case will generally be suffi- 
 cient ; but, as a diagnostic, we may add, that there is not 
 much irritation attending the syphilitic sores, and beside, 
 they have a copper-colored areola, and will, more likely, be 
 located on the forehead and commissure of the nose. 
 
 Prognosis. — If the constitution is good — measurably sound, 
 the prognosis is favorable ; but under a contrary condition of 
 the system, more particularly if complicated with any other 
 form of disease, then it is unfavorable. 
 
 Indications ant) Treatment. — Emollient applications to 
 the local inflammation, remove all causes of irritation, correct 
 the secretions, and sustain nutrition. 
 
 The indications above-named will be sufficient for most 
 cases, but in some there is much inflammation, and in others 
 great debility, and therefore considerable extremes and variety 
 of means will be demanded in the treatment. 
 
 In the acute form, all the ordinary means to overcome 
 spasm or constriction, and to promote depuration, will be 
 required, for which purpose the Compound Powder of Ipeca- 
 cuanha and Opium, or other diaphoretics, with diluents, 
 should be given ; the bowels should be kept in a soluble con- 
 dition by mild laxatives, but active purgation must be avoided. 
 In connection with this, the warm bath (with the addition of 
 Mucilage of Elm to it, in case of much local irritation), may 
 be used daily, or every other day, as required. 
 
 In the chronic form, generally, and at the close of the acute, 
 in feeble children, tonics, as the bitter infusions, mineral acids, 
 Iron, Quinine, etc., may become necessary, and as a local 
 application, the Compound Ointment of Zinc, will be found 
 productive of excellent efiect. The patient should be allowed 
 free access to the open air, if his condition wiU permit. The 
 diet should be light, nutritious, and of easy digestion. 
 
IN THE DERMA. 473 
 
 Species III. — Impetigo. 
 Of this species, some six or seven varieties have been 
 described, but only two of them are of such importance as to 
 claim our attention, viz : Impetigo Larvalis (Porrigo Larvalis 
 of Willan) and Impetigo Capitis. 
 
 Yakiety I. — Impetigo larvalis — Crusta lactea. 
 
 This disease consists of many small pustules of a whitish 
 color, based upon a very red surface. They gradually change 
 to yellow, and then to brown, and in a short time break and 
 form a scab, from which issues an ichorous discharge attended 
 with much itching. As the pustules extend, the scabby sur- 
 face becomes enlarged, and also thickened, by the concretion 
 of fresh matter upon its inferior surface. The eruption is 
 very apt to begin upon the forehead or cheek, and, by the 
 species of reinforcement above-described, it travels to various 
 parts of the body, and sometimes to almost every part of it ; 
 nevertheless, the face, scalp, and neck are its most favorite 
 positions; and, strictly speaking, a red spot, at the point of 
 beginning, and not a whitish pustule, is the first indication of 
 the disease. 
 
 Like most other forms of cutaneous disease, it manifests 
 considerable variety. It is sometimes confined to very limited 
 areas, and the discharge is very mild ; at other times, even 
 when not extensive, the discharge is so acid as to excoriate 
 the adjoining surface; then again, it may be confined to a 
 particular part of the face, as the chin, the cheek, or both of 
 the lips. 
 
 When the crust is removed, the surface is found to be red, 
 inflamed, and excoriated, and so abundant is the secretion 
 sometimes that scabs cannot form. At other times, there is 
 but little discharge, and the scabs are dry and adherent. It 
 causes, sometimes, a considerable inflammation and enlarge- 
 ment of the glands of the neck, and it is liable sometimes to 
 be complicated with inflammation of the eyes and auditory 
 meatus. 
 
 Its name is derived from the circumstance that its scales or 
 crusts form a mask or larva^ and, in keeping with its name, 
 
4,74: MOIST FORMS OF DISEASE 
 
 the features are so covered with irregular, greenish, or yellow- 
 ish crusts as not to be recognizable. 
 
 It is sometimes quite acute, and yields readily to proper 
 medication, but at other times it appears to be chronic and 
 continue^ even for years, indicating, as a matter of course, a 
 general and deeply-founded cause or special anaemia of the 
 system, which is most probably pulmonic, as we shall now 
 show. 
 
 Causes. — Prof. Dewees thinks that it is invariably asso- 
 ciated with dentition, and that it appears sooner or later, 
 depending upon the retarded or advanced condition of this 
 process. 
 
 That the professor is in the general correct, we have no 
 doubt,' but not universally so, because it has been known to 
 appear and disappear before the commencement of that 
 process. 
 
 Billard says, that there does appear to be some plausibility 
 in the vulgar opinion that impetigo larvalis is a salutary depu- 
 ration, because of the vigorous appearance which he had 
 observed some children to possess after the disappearance of 
 the disease. 
 
 Worcester says, that, in a great majority of instances, no 
 satisfactory cause can be assigned for impetigo. " Dentition 
 (he says) seems to be the most common cause of crusta 
 lactea." 
 
 Dr. Wood says, that " the causes of impetigo are not 
 always obvious. Dentition appears to dispose to it." 
 
 As dentition is purely a physiological process, it cannot, 
 therefore, be attended, necessarily, by any form of disease. 
 At most, then, it can only become a source of general irrita- 
 tion — interfere with the physiological processes in general. 
 But, if we admit that this process, when tardy, produces 
 crusta lactea, we have made only a very insignificant advance 
 toward an understanding of the subject. Admit this as a 
 cause, and then the questions arise, what occasioned the diffi- 
 cult dentition? and how did it occasion impetigo larvalis? 
 We may be mistaken, but we think that it will not be diffi- 
 cult to give a satisfactory^ answer to these questions. 
 
 The children who suffer from difficult dentition and impetigo 
 
m THE DERMA. 475 
 
 larvalis, are represented by the second and third classes of 
 Table, page 20. 
 
 In both of these classes there is a feeble pulmonary system ; 
 but children who represent the first class, are those who rarely, 
 or never, suffer from the development of any of the infantile 
 physiological processes. Those of the second class become 
 fat — look well, and yet their obesity is consequent upon their 
 pulmonary incapacity — carbon, instead of being eliminated, 
 is stored away in the form of adeps. Dentition interrupts the 
 process of nutrition (and so may other causes of irritation, 
 and hence impetigo larvalis is not always associated with the 
 dental process), becomes interrupted, the lungs are incapable 
 of sufficient depuration, the kidneys become so, and to aid in 
 these processes another apparatus is established in the skin — 
 impetigo larvalis. The child becomes lean and emaciated, 
 but after a time the causes of irritation become removed — the 
 nutritive process becomes re-established — the child becomes 
 obese — regains its fine looks and meets with Dr. Billard, and 
 he is induced to suspect that there is some plausibilit3^ in the 
 vulgar opinion that impetigo larvalis is a salutary depuration. 
 Our readers may question our reasoning, but the facts are as 
 we have stated them. 
 
 Those children who represent the third class are more liable 
 to convulsions and cerebral congestions, than to impetigo lar- 
 valis; nevertheless, when all the power of their systems is 
 appropriated, before the period of dentition, to the nutritive 
 process, and as they are apt through life to take more food 
 than they can digest, we discover the source of their liability 
 to this disease, and the reason why it continues so long with 
 them. The lungs are incapable of performing their depura- 
 tive duty, and nutrition is incapable of aiding them by the 
 formation of adeps, and thus this disease becomes their com- 
 panion, until exercise shall so increase as to render the lungs so 
 capable of their function, as to promote renal depuration and 
 relieve the skin. 
 
 The table to which we have referred demonstrates the exist- 
 ence of certain organic relations, and death demonstrates the 
 consequences — so far, there is no room for speculation, and 
 when we contemplate these conditions and the results, in con- 
 nection with what we have said of infantile disease, wo 
 
476 MOIST FORMS OF DISEASE 
 
 feel very confident that our conclusions, in the main, are 
 correct. 
 
 Diagnosis. — This afi*ection is pustular, and eczema is vesi- 
 cular, therefore, attention to these facts will distinguish one 
 from the other. See diagnosis to the next species. 
 
 Peognosis. — An arrest of this eruption is very apt to be 
 attended by serious consequences ; nevertheless, when chil- 
 dren die in this complaint, it is generally from some coincident 
 form of disease, which may even have been, remotely, the 
 cause of it. 
 
 Indications. — Cleanse the skin — by soluble applications, 
 remove the scabs — promote secretion — sustain nutrition by 
 nitrogenous food and plenty of exercise. 
 
 Tkeatment. — It is thought to be best, by some, to let this 
 disease alone, inasmuch as it is but rarely fatal, though some- 
 times very severe, and leaves no marks upon the skin. But, 
 we inquire, is it not very troublesome ? Does not the dis- 
 charge, which is characteristic of it, weaken, and even exhaust, 
 the patient? Does not the continual itching it produces, 
 through both day and night, defeat its rest, and therefore its 
 nutrition ? 
 
 If these interrogatories receive an affirmative answer, can it 
 be either wise or humane to allow it to progress to its own 
 exhaustion, without control or melioration ? 
 
 It is contended by others, that this affection is only an indi- 
 cation of an effort on the part of the system to throw off a 
 more troublesome or fatal malady, and that on this account, 
 the best practice is to let it alone. This doctrine applies with 
 as much force to every other form of disease, as it does to this. 
 Are not small-pox, bilious fever, and Asiatic cholera, efforts 
 of the system to cast off or expel disease ? Is not this abso- 
 lutely true of all forms of disease ? If it be, then it must be 
 best to let them all alone. 
 
 According to our pathology, disease is a unit, and conse- 
 quently impunity cannot be granted to one form any more than 
 to another, so far as principle is concerned. And it should fur- 
 thermore, be remembered, that each form of disease has, 
 under circumstances, a prescribed course to run — and to arrest 
 this course, prematurely, is to do mischief; hence it is true, 
 that mischief will result from the drying up of this eruption. 
 
i 
 
 IN THE DERMA. 477 
 
 It must be cured — that is, the disease, of which it is a mani- 
 festation, must be removed, but in the meantime it can be 
 meliorated. 
 
 The cure, then, consists in carrying out the indications — 
 keep the system in that condition which will dispense with 
 eruption as soon as it should be. 
 
 In the treatment of this disease, Prof. Dewees recommends 
 a "diminution of nourishment of every kind," and particu- 
 larly prohibits the use of any "in which animal food enters." 
 We cannot indorse this doctrine, because we have no doubt 
 but that this plan has rendered chronic many cases which 
 otherwise would have terminated as an acute one. We have 
 both tried and witnessed this plan of treatment in inflamma- 
 tions arising from wounds, and we hesitate not to assert that 
 patients are sometimes confined to their beds six months by 
 it, who, under a generous diet, would have been about in one. 
 
 Before the child became sick, a given quantity of nourish- 
 ment was requisite to develop the system and maintain the 
 ordinary repairs ; now, to these demands for aid — for food, is 
 added a wasting disease, and one too, which frequently con- 
 tinues for several months. Now, add to the wasting effects 
 of the disease, partial starvation, and then say whether we 
 should expect any other result than a chronic form of the dis- 
 ease, and such a debility of the system as to render it unable 
 to cast ofi' the disease ? 
 
 We do not advocate feeding to repletion, under any circum- 
 stances, nor do we advocate starving under any. Under the 
 circumstances of waste, the child can spare none of the real 
 elements of nutrition, but it should be deprived of all others, 
 because they produce irritation. Upon this principle, we 
 should advise, if the patient be weaned, azotized food, as ani- 
 mal muscle, or a tea or broth made of it; and, if it be not 
 weaned, the mother should thus live, for the good of the 
 child. 
 
 Carbonaceous food should be prohibited, unless demanded 
 by the necessity of animal heat. By this course the child is 
 simply nourished, and all causes of plethora and irritation are 
 avoided. 
 
 Finally, the treatment under the head of Herpes is equally 
 applicable to Impetigo. 
 
478 MOIST FORMS OF DISEASE 
 
 Yaeiety IL — Impetigo Capitis, 
 
 This ernption does not differ in any essential element from 
 the preceding, except that it attacks the scalp, instead of the 
 face. The discharge, in drying, mats the hair, and both 
 united form thick crusts or scabs, and being by the hair, firmly 
 adherent to the head, produce great irritation and a constant 
 discharge of cero-purulent, or purulent matter, and without 
 great attention to cleanliness, the hair becomes felted into a 
 disgusting mass — furnishing shelter and protection to immense 
 numbers of vermin. 
 
 It commences in a spot or spots which are red and of an 
 oval or round shape, and upon which appear small, flattened, 
 and grouped pustules of slight elevation, that burst, in three 
 or four days, and discharge an abundant secretion of a viscid 
 character, that spreads over the affected part and soon dries 
 into thick, brittle, greenish, or yellow and semi-transparent 
 crusts or scales. Sometimes the patches continue distinct, 
 with healthy skin between them, and at other times they 
 coalesce and form a very large one. 
 
 The detachment of the scabs usually takes the hair with 
 them, but it returns when the disease is cured. The scabs 
 are brittle, and when comminuted, the fragments resemble old 
 mortar in a similar condition. Inflammation sometimes runs 
 high — abscesses form under the scalp — the cervical glands 
 become sore and tumefied, and the general health greatly 
 suffers. 
 
 For its causes, consequences, and therapeutics, see Impetigo 
 Larval is. 
 
 Species IY. — Porrigo or Faviis. 
 
 This species is thought to have its origin in a vegetable 
 cryptogamic growth, and the opinion may be founded in truth. 
 That some of iha phenomena of these forms of disease may 
 have a vegetable cryptogamic appearance, we are ready to 
 admit, but until we have further light upon the subject, we 
 can go no further. Authors notice two varieties, Porrigo Lu- 
 pinoso and Porrigo Scutulata. 
 
i 
 
 m THE DERMA. 479 
 
 Yaeiety I. — Porrigo Lupinosa — Tinea Capitis — Soald- 
 
 Head. 
 
 This form of disease attacks infants, but it is not so com- 
 mon to them, as to children between five and ten years of age. 
 It is most generally confined to the scalp, but it has been seen 
 upon other parts of the body, to which it may have been 
 transferred from the head by the nails or other means, as it is 
 beyond doubt infectious. 
 
 When the scabs are thoroughly formed, they present an 
 appearance similar to a honey-comb, and hence the name of 
 faviis. It first appears in specks of a crust}^ character, and 
 rising but little, if any, above the common level of the sur- 
 rounding surface. They exhibit no method in their location, 
 but are scattered over the surface without order ; sometimes 
 they continue quite distinct, but at other times they are 
 crowded, and as the scabs, which succeed the pustules, enlarge, 
 they mingle together, so as to cover continuously large por- 
 tions of the surface. 
 
 The pustules seem to form or appear about the roots of the 
 hairs, and hence one hair will usually be found passing through 
 the scab. When the inflammation has existed for some length 
 of time, the bulbs of the hairs become so diseased that they 
 fall or disappear, leaving the skin white and smooth. The 
 cellular tissue surrounding these denuded patches, not unfre- 
 quently becomes the seat of chronic abscesses, which, extend- 
 ing their influence to the cervical glands, render them sore 
 and painful. 
 
 When the scabs have enlarged and mingled together, they 
 form a great many cup-like hollows, which bear a considerable 
 resemblance to the depressions in the fructification of some 
 species of lichen. When these scabs are large, their edges 
 often meet, and the scabious surface becomes a continuous 
 incrustation. In this process, as the scabs are round or 
 roundish, they acquire, in the force of crowding, a hexagonal 
 shape, and thus, like the cells of a honeycomb, they fit into 
 each other — each scab still retaining its cup or little central 
 depression. 
 
 When this incrustation is allowed to proceed undisturbed, 
 it may continue for years, but in such an event it becomes 
 
480 MOIST FORMS OF DISEASE 
 
 drier, less cohesive, whitish, and disintegrates into particles 
 which resemble the crumbs and dust of old mortar. In this 
 process, the lichen-like condition of the incrustation is entirely 
 destroyed. 
 
 Pediculi are apt to feast and revel in neglected cases of this 
 disease, and when they do, they very much increase the 
 suffering of the patient, by the severe itching they occasion. 
 
 Treatment. — In the first place, shave the head as closely 
 as possible, and then apply an Elm poultice over the whole 
 scalp, until the soreness and irritation which attend this affec- 
 tion are removed ; then wash the head twice a day with strong 
 soap-suds. Once a day wash the head with the Tincture of 
 Phyl. Decandi. 
 
 This plan of treatment, with the frequent shaving of the 
 head, should be continued for three or four weeks ; but if this 
 should not be sufficient, the following ointment, which has, 
 in many cases, been found to be very successful, may be 
 adopted : 
 
 ]^. Fix Liquida, ea., gij, 
 Capsicum, gr. xxx, 
 Fulv. Sulph. Zinc, gr., 1, 
 Creosote, gtts., xx. 
 This should be well mixed in a mortar and applied to the 
 scalp night and morning. After having well washed the 
 head, as above recommended, this ointment should be con- 
 tinued several days, but if the patient should experience much 
 pain from the application, it should not be applied so fre- 
 quently. It should be remembered, however, that in all cases 
 the head should be shaved close before any treatment is 
 adopted. 
 
 If the above treatment should not be sufficient to remove 
 the disease, in consequence of a hardened condition of the 
 scalp, which frequently attends this disease, the Irritating 
 Plaster should be applied over the whole scalp until free vesi- 
 cation is produced. This will soon be attended with copious, 
 purulent discharges, which should be continued for ten or 
 twelve days. 
 
 When the parts become very much inflamed, the Compound 
 Lead Ointment or Slippery-elm poultice may be applied until 
 it subsides ; and after the parts have healed, if there be any 
 
IN THE DERMA. 481 
 
 portion of the scalp disposed to assume its former appearance, 
 the Irritating Plaster may again be applied and treated as above. 
 
 Constitutional treatment is very important, especially in 
 individuals of a scrofulous habit. The alkaline bath should 
 be applied, accompanied with active friction over the whole 
 body, every day during the treatment. 
 
 K there be any tendency to constipation of the bowels, it 
 should be removed by mild laxatives, after which the Com- 
 pound Syrup of Stillingia, in alterative doses, should be ad- 
 ministered three times a day. 
 
 Where the above plan of treatment has been adopted there 
 has been little difficulty in curing all the cases. 
 
 Yariety II. — PoTTigo Scutulata — Tinea Annularis. 
 
 This eruption more rarely attacks infants than others, and 
 it is more rarely confined to the scalp — appearing sometimes 
 upon the forehead, face, neck, and other portions of the cuta- 
 neous surface. It differs also from the other, in being more 
 obstinate ; but the distinguishing difference between the two, 
 consists in the annular arrangement of the eruptions in this. 
 The scabs have that lichen appearance which is characteristic 
 of the cryptogamic class. 
 
 It begins by planting minute and thickly-crowded crusts 
 upon a red spot or surface, and as they enlarge they exhibit 
 the cup-shape upon their surfaces. They enlarge and progress 
 precisely as in the preceding form, except that they group into 
 circular clusters. The disease extends by the development of 
 new patches upon the periphery of those that preceded ; con- 
 sequently, by the union of many clusters, thus formed, the 
 entire scalp may become incrusted. 
 
 Causes. — But little is certainly known of the causes of 
 porrigo, as of other cutaneous eruptions. 
 
 Dr. Worcester says : " While no doubt of its contagious- 
 ness exists, some are much more liable to contract it than 
 others ; children of a lymphatic* or scrofulous temperament, 
 
 * So far as we have yet learned, the profession, practically at least, have 
 made no distinction between fat and lymph, tlie latter only is constitutional. 
 We think it probable the above reference was to the obese ; if so, it confirms 
 our pathological views. 
 
 31 
 
482 MOIST FORMS OF DISEASE 
 
 ill-fed and clad, living in low, damp, and confined situations, in 
 filth and neglect, are the more frequent subjects of it ; in such 
 situations, occasionally, sporadic cases of disease occur without 
 any exposure to infection." Of this we have no doubt. 
 
 We have seen the disease under circumstances quite the 
 opposite of all this, but we do not remember to have seen it 
 unassociated with the fats. In the mountains of Arkansas, 
 where we have seen it, the children usually live upon old, fat 
 bacon through the summer, and upon fresh bear and hog fat 
 through the winter. With such a life, there is filth, but we 
 think that both the filth and the disease had their origin in 
 the mode of life. Such children, furthermore, often live 
 through the winter without shoes or other means of keeping 
 the feet warm. 
 
 We are candidly of the opinion, that if the profession will 
 turn their attention to the relations we have exposed in the 
 cerebellum, and the use of fats, they will succeed much better 
 than they hitherto have done, in discovering the causes of 
 cutaneous disease. 
 
 Diagnosis. — There is no other disease, common to children, 
 with which this should be confounded, and yet it has been 
 done with impetigo ; but the cup-like scabs of the former will 
 always distinguish it, to which we may add the hair that is 
 usually to be found passing through the cup. The circular 
 form of the patches, in tinea annularis, will serve to distin- 
 guish the two varieties, one from the other. 
 
 Prognosis. — If we were to suppose the disease allowed to 
 run its own course, our prognosis would be decidedly unfa- 
 vorable, because spontaneous recoveries are rare, and even 
 then it is at a heavy cost to the patient — as permanent bald- 
 ness, enfeebled intellect, premature old age, and previous long 
 suffering. Such is the depravity of some constitutions, which 
 it attacks, as to render it incurable ; but instances of this kind 
 are exceedingly few. 
 
 Indications. — Remove all local and general causes of irri- 
 tation — ^excite the diseased parts to a healthy action — improve 
 the general health, and maintain a depurating action of the 
 kidneys. 
 
 The first of these indications can be effected by cutting the 
 hair from the diseased surface with a pair of scissors, and the 
 
I 
 
 m THE DERMA. 483 
 
 removal of the crusts. To eflect the latter, cover the diseased 
 surface with lint saturated with a solution of Subcarbonate of 
 Soda or Potash, and then cover it with an oiled silk cap or 
 one of caoutchouc. By keeping the crusts thus saturated for 
 twelve or twenty-four hours, they may be easily removed ; the 
 part should then be thoroughly washed with soap-and-water, 
 to remove all particles of crust and hair that may be upon the 
 surface. If heat or inflammation be present, evaporating 
 lotions should be applied until it is reduced. 
 
 The general causes of irritation may consist of diarrhea, 
 constipation, or some other symptom of disease — • in other 
 words, all constitutional vices of the system should be removed. 
 
 To excite in the part a healthy action, various stimulants 
 have been recommended — the Tincture of Iodine may answer 
 every purpose. It may be placed on the part by the use of a 
 camel's hair brush after the morning ablutions. 
 
 All possible exercise, avoiding fatigue, should be given to 
 the patient, and, as far as possible, he should live on azotized 
 food. 
 
 OEDEK II. 
 
 DRY FORMS OF DISEASE IN THE DEKMA. 
 
 Genus I. — Exanthemata. 
 Remarks. — This genus comprises those dermoid forms of 
 disease which are distinguished by an inflammatory redness, 
 that is so superficial as to disappear upon pressure. The 
 whole surface may be covered with redness, or it may only 
 appear in spots, with intervals of healthy skin. The spots 
 have no particular size or shape. 
 
 Species I. — Roseola — Rose Rash. 
 This form of disease is exceedingly troublesome to the little 
 patient, and apart from this circumstance, its importance con- 
 sists, mainly, in so understanding its diagnosis as not to con- 
 found it with any other, particularly with those with which it 
 is frequently associated. Children are more liable to it dur- 
 ing dentition, and between the ages of six and twelve months, 
 than at a more early period. 
 
484 DRY FORMS OF DISEASE 
 
 It consists in a superficial inflammation of the skin, which 
 is not as extensive as erythema, but is frequently mixed with 
 symptoms of variola vaccina, which succeed inoculation. 
 Summer is more adapted to its occurrence than any other 
 season ; but no matter at what season it occurs, it renders the 
 little patient cross and resQess. It occurs upon the body, 
 neck, and arms, and consists, very frequently, of nothing 
 more than small patches of a rosy-red color, smooth surface, 
 and irregular form, and so changeable as to appear and dis- 
 appear several times in the course of a day. A large majority 
 of the cases are unattended by either fever or derangement of 
 any of the digestive functions. 
 
 If it should be associated with cerebral, alimentary, or 
 respiratory irritation, it should not be passed over as a slight 
 or unimportant concern, but combated with suitable reme- 
 dies ; but in the absence of any such irritation, its medication 
 will be simple. 
 
 Causes. — These are acknowledged to be obscure, but it is 
 a frequent attendant upon dentition, improper food — irritation 
 of the mucous membrane of the lungs, stomach, and intes- 
 tines. 
 
 Diagnosis. — This is the most diflScult feature of the disease, 
 because it so much resembles rubeola, erythema, and scarla- 
 tina. Rubeola is attended by fever, cough, injected conjunc- 
 tiva, and roseola is not. Its patches are smaller, more nume- 
 rous, less permanent, and of a brighter rose color than those 
 of erythema. Scarlatina is attended with violent fever, great 
 heat, inflamed fauces, peculiar odor, and a deeper tint of color, 
 than roseola. 
 
 Prognosis. — It is attended with no danger, but renders the 
 patient very restless. 
 
 Treatment. — The treatment of roseola is very simple ; the 
 patient should be placed upon warm, diluent drinks, with low 
 diet and confinement to his room, until the eruption appears, 
 when a mild purgative may be given, which will usually 
 be found sufficient. 
 
 However, should there be a high fever, and the eruption but 
 slowly manifests itself, the warm bath with warm diaphoretic 
 drinks will be serviceable. 
 
 If muqh heat or itching attends the eruption, it may be 
 
m THE DERMA. 4S5 
 
 allayed by an aqueous solution of Borax, or Borax dissolved 
 in an infusion of Hydrastis. 
 
 In chronic cases, and in weakly patients, vegetable tonics, 
 as Hydrastis, Columbo, Gentian, etc., together with mineral 
 acids, should be perse veringly employed, and the diet should 
 be nutritious and digestible, avoiding all greasy articles. 
 
 Species H. — Urticaria — Nettle- II asli. 
 
 The appearances presented by the skin, in this disease, and 
 the sensations which attend them, are so much like those pro- 
 duced by the stinging of nettles, as to suggest the name. It is 
 not contagious, and no number of attacks will render the sys- 
 tem invulnerable to it. It is not considered to be dangerous, 
 but it is exceedingly tormenting. The eruption consists of 
 roundish or oblong, solid, little elevations, either red or white, 
 but usually both, with the latter color in the center. 
 
 Appearances, very similar to those which distinguish this 
 disease, may be produced on the skin by a blow with the lash 
 of a whip, which are vulgarly called ichellts^ and the marks 
 of this disease are sometimes called wheals^ because of this 
 resemblance, and it is probable that the former of these vul- 
 garisms is only a corruption of the latter. 
 
 Urticaria has been divided into some half a dozen varieties, 
 but only one of them properly claims our attention, and that 
 one is the variety which appears spontaneously and without 
 fever, and which may appear and disappear several times in a 
 day. It is a very mild disease with infants, producing no 
 mischief, except crying and restlessness. 
 
 Causes. — These are, most generally, in young children, in- 
 testinal irritation, indigestible food, stimulating food or drink, 
 medicines, particularly of a poisonous or indigestible character. 
 
 Diagnosis. — Urticaria may be distinguished from the rash 
 of nettles by its history ; from lichen urticatus, by the papules 
 being more prominent, permanent, larger, rounder, and redder. 
 
 Pkognosis. — The tendency in urticaria to repeated returns, 
 and its obstinacy, are its worst features. It is not danger- 
 ous, but requires perseverance in a judicious course of treat- 
 ment. 
 
 Treatment.— The first step, in the treatment, is to remove 
 the cause, if discoverable ; but whether discoverable or not, it 
 
486 ^^^ FORMS OF DISEASE 
 
 will be proper to allay the itching, and to remove such 
 cutaneous constriction as may exist, by the use of the alkaline 
 bath, which should be followed by a mild emetic, as the 
 Acetous Emetic Tincture, or Compound Tincture of Lobelia, 
 to remove such mucus and other offending matter as the 
 stomach may contain. 
 
 The large intestines should also be evacuated by enemas ; 
 and in full habits, with high fever, purgatives may be admin- 
 istered internally; the Compound Powder of Jalap, or, with 
 infants, the Compound Tincture of Jalap will be found of 
 great service. 
 
 In cases of plethora, venesection is recommended, but the 
 above remedies, energetically used, will be all-sufficient. 
 
 Opiates are recommended to allay the itching and to secure 
 rest, but these objects can be more judiciously obtained by the 
 use of saline, acidulated, or alkaline baths — they will promote 
 an equalization of the circulation and depuration, while 
 Opium will only afford temporary relief by suspending all 
 action. 
 
 In the event that the eruption should be intermittent, 
 recourse should be had to antiperiodics, such as S. Quinia, 
 Tincture of Macrotys ; and in chronic cases, S. Quinia and 
 Ferrocyanuret of Iron. 
 
 The diet should be such as we have hitherto recommended 
 in cutaneous affections ; and when the disease is present dur- 
 ing dentition, proper attention should be paid to the condition 
 of the gums. 
 
 Species III. — Erythema. 
 
 Some eight or nine varieties of this disease have been 
 reported, but the distinctions are more scientific than practi- 
 cally useful. 
 
 Erythema is characterized by a red, glabrous, tumid full- 
 ness of the integuments, attended by burning pain and ter- 
 minating in cuticular scabs or vesicles. The inflammation is 
 usually very superficial, and non-productive of any general 
 derangement of the system. 
 
 The scrotum and superior portions of the thighs, in children, 
 are the most liable to this affection. 
 
 When the affection is on the scrotum, and it assumes a red- 
 copper color, and resists remedial efforts, more especially if 
 
IlSr THE DERMA. 487 
 
 there be much repletion of the cellular tissue, the physician 
 may feel justified in suspecting it to be syphilitic, and 
 equally so in seeking special information as to the health of 
 the parents. 
 
 Causes. — Mucous irritation and external irritants may be 
 regarded as the general causes, and among the latter may be 
 included the excrementitious matters of the child, a want of 
 proper attention to cleanliness, and of the former, visceral dis- 
 ease in general. 
 
 Diagnosis. — In children, it can only be confounded with 
 lichen and psoriasis, and when the small, distinct, conical 
 papule of lichen, and the flattened, scaly tubercle of psoriasis, 
 are considered, such a mistake should not be made. 
 
 Prognosis. — When the cause is removed, the disease dis- 
 appears, except when located at the junction of the skin with 
 a mucous membrane — then trouble may be expected, and cau- 
 tion is demanded. 
 
 Treatment. — If there be any derangement of the digestive 
 organs, or of any other part or function of the general system, 
 this should be more especially attended to, and removed by 
 the appropriate means, after which the warm bath may be 
 employed with advantage. 
 
 The itching may be allayed by some mild application, as 
 Cream, or fresh Olive Oil. The Compound Tincture of Lo- 
 belia will likewise allay itching, and prevent the disease from 
 spreading. 
 
 When scabs form, the following ointment may be applied : 
 ]^. Simple Cerate, 5j, 
 
 Compound Ointment of Zinc, 3ij, 
 Glycerine, 3j. Mix. 
 
 In many cases, the Compound Tincture of Hydrastis, will 
 be found preferable — it may be diluted with water, if required. 
 
 When a syphilitic taint is suspected, the Compound Syrup 
 of Stillingia should be given, the efficacy of which will be 
 much improved by the addition of half an ounce of Iodide 
 of Potassium to a pint of the syrup. 
 
 In debilitated patients, tonics and nourishing diet, are indi- 
 cated. 
 
 Bathing wdth a solution of salt and water, two or three 
 times daily, has often efiectcd a rapid cure in this disease. 
 
488 I>R'Y FORMS OF DISEASE 
 
 Species IY. — Rubeola — Measles. 
 
 This eruption is very generally confined to children, but not 
 entirely so — it sometimes attacks adults, and when it does, it 
 is more critical in its character, leaving, too generally, as it 
 were by replacement, some other form of disease that may 
 prove very afflicting, if not finally fatal. 
 
 In its febrile character, it does not perhaps attack the same 
 individual twice. To the variety of measles under considera- 
 tion, the Germans apply the term morhilli^ and the term 
 rubeola to a more mild variety of the same disease, or possi- 
 bly of roseola — ■ in common language, the Germans call it 
 false measles^ which has been designated rubeola sine ca- 
 tarrho^ by Willan — the same, or analogous to what we call in 
 this country, Frencli measles. An attack of this kind does 
 not secure the constitution against an attack of the other. 
 
 It is asserted by some, that morbillous fever, i. e., the true 
 rubeolous fever, may occur without being attended or followed 
 by the exantheme eruption, but have the usual catarrhal 
 symptoms, with a perfect immunity from the disease, as indi- 
 cated by the dermoid eruption, during the subsequent rage of 
 the epidemic. 
 
 When we witness the different grades of violence that dis- 
 tinguish different epidemics, we cannot doubt that it is greatly 
 influenced by atmospheric peculiarities; and we may add, 
 almost as a matter of course, that much variety in its mani- 
 festation is produced by constitutional peculiarities ; indeed, 
 we could not, a jpriovi.^ suppose it to be as severe — as fatal in 
 those of a vigorous vital system, as in those of a contrary 
 character. 
 
 Its usual period of incubation is from five to seven days, 
 but in some instances it may be less, and in others it may ex- 
 tend to three weeks, depending upon the impressibility of the 
 system. When produced by inoculation, the eruptive stage 
 very generally appears on the seventh day. 
 
 Its usual introduction is that of a catarrhal fever, indicated 
 by creeping chills, alternated with flushes of heat, some red- 
 ness and soreness of the eyes, with an increased lachrymal 
 secretion, cough, and coryza. It happens sometimes that 
 there are two or three days of febrile excitement, before the 
 
m THE DERMA. 489 
 
 supervention of catarrhal symptoms, but they never fail to 
 occur. 
 
 In the beginning, the respiration is apt to be oppressed, the 
 cough dry and harsh, with some soreness in the fauces. The 
 stomach, sometimes, becomes quite irritable, on the second or 
 third day, and may be attended with nausea and vomiting. 
 It is not infrequent for the lymphatic glands of the neck and 
 eyes to become swollen and tender, and when the febrile symp- 
 toms run high, delirium may be expected. The skin is hot 
 and dry, and the pulse is quick, hard, and frequent. 
 
 Causes. — Upon this subject the profession have not agreed, 
 but at present the preponderating opinion is, that rubeola is 
 contagious. In the estimation of those who occupy this posi- 
 tion, the success of Home and ITust, in producing the disease 
 by inoculation, seems conclusive. It is admitted by all, how- 
 ever, that it cannot be traced from house to house, nor from 
 street to street, as can be done with small-pox and scarlatina. 
 But is it the case with these? 
 
 It is furthermore admitted by all to be epidemic, and so it 
 is with small-pox and scarlatina ; but we confess that we are 
 unable to comprehend how a cause can be both contagious 
 and epidemic. The admission of one seems to destroy the 
 possibility of the other, unless it be admitted that all of the 
 so-called contagious forms of disease may be atmospherically 
 produced, and when so produced, have the power of repro- 
 ducing themselves. 
 
 It is a pretty thoroughly -ascertained fact, that small-pox 
 epidemics are generally attended with chicken-pox, and the 
 febrile rubeola by the infebrile varieties. Upon the idea of 
 specific poisons, we cannot account for these facts — to admit 
 that the cause of chicken-pox, if it be a secreted poison, may 
 produce small -pox, is about equivalent to admitting that the 
 cause of gonorrhea may produce syphilis. 
 
 We do not, and never have doubted, but that all contagious 
 forms of disease may be atmospherically produced, and we 
 admit that all those that can be propagated by inoculation, 
 are contagious. It has not yet been proved that small-pox, in 
 every instance, resulted from contagion. 
 
 Diagnosis. — Rubeola and scailatina have not always been 
 successfully diagnosticated: indeed, they were regarded as one 
 
490 I>RY FORMS OF DISEASE 
 
 and the same a century since — at all events, a diagnosis had 
 not been produced ; and still, we cannot see why they should 
 ever be confounded. The catarrhal symptoms of the former, 
 with its small, red spots, and their union into semilunar 
 patches, with intermediate healthy skin, should always distin- 
 guish rubeola from the difiused and uniform blush of the 
 latter, more especially when viewed in connection with its 
 exantheme of innumerable, minute, red points, so united 
 together as to resemble a boiled lobster. 
 
 Pkognosis. — When the patient has good general health, at 
 the time of the attack, and also a strong vital system, the dis- 
 ease is not attended with danger, because the vital force moves 
 on regularly to the elimination of the poison that produced it; 
 but when the vital force is feeble, and more especially if the 
 system be diseased at the time of the assault, the prognosis 
 should be, at least, doubtful. 
 
 When the vital force is incapable of maintaining, upon the 
 surface, a febrile action, congestion is sure to happen to some 
 other and possibly more indispensably vital part ; hence, 
 among the sequelae of this disease, we find pneumonia, bron- 
 chitis, croup, arachnitis, etc. It is apt, furthermore, to afflict 
 the lymphatic system, more especially in those who possess a 
 scrofulous liability ; hence, we have from this cause scrofulous 
 ophthalmia, porriginous eruptions on the head, and tumors 
 about the neck. 
 
 Indications. — Steadily maintain the centrifugal action of 
 the system — guard against revulsion — relax and cleanse the 
 surface — remove all causes of irritation, whether internal or 
 external, and finally, restore nutrition. 
 
 Treatment . — In a very large proportion of rubeolous cases 
 a pediluvium, an alkaline washing of the skin, and some aro- 
 matic tea, as Ginger, Catnip, or Spear-mint, will prove suffi- 
 cient ; but, if in the beginning of the complaint, the patient 
 complains of beiug cold and having pains in his limbs, 
 the pulse being small and feeble — indicative of congestion, 
 beside the pediluvium and alkaline bath, stimulating teas, as 
 of Virginia Snake-root, Saffron, and even the Compound Tinc- 
 ture of Yirginia Snake-root, should be administered ; and it 
 wonld be more agreeable to give them in the aromatic teas 
 first named. If the supervening fever should run high, the 
 
IN" THE DERMA. 491 
 
 Compound Powder of Ipecacuanha and Opium should be 
 given in appropriate doses, with a free use of warm diluents, 
 and the application of the warm lye-bath every hour or two. 
 
 If by this course the oppression is not overcome — and the 
 eruption does not appear, Mustard sinapisms must be applied 
 to the wrists, ankles, and even over the whole abdomen, and 
 allowed to remain until considerable redness of the skin has 
 been produced. 
 
 K the condition of the stomach, either because of mucous 
 or other ofiending matter, or if mucus should clog the 
 respiratory vessels, the Compound Tincture of Lobelia should 
 be given in doses to produce vomiting, or the Acetous Emetic 
 Tincture may be used for a like purpose. Too free emesis 
 should be avoided, except when imperatively required. 
 
 If the condition of the bowels be such as to occasion irrita- 
 tion, they should be operated upon by enemas, or some laxa- 
 tive medicine ; and under such circumstances it is always best 
 to combine it with some diffusible stimulant, to prevent tenes- 
 mus, and to aid in forcing the eruption upon the surface, or if 
 already out, to maintain it there. 
 
 But it should always be remembered, that in all cases of 
 inflammation, when the system is acting favorably, that more 
 or less of constipation is established, and it is done as an initia- 
 tory step in the establishment of a centrifugal action ; conse- 
 quently no effort should ever be made to move the bowels, in 
 this form of disease, until the eruption is out upon the surface, 
 and even then a purgative action should be carefully avoided. 
 
 We are fully satisfied that incomparably more mischief is 
 done, in all branches of the profession, by the use of cathar- 
 tics, than good. This practice is a remnant of the old humoral 
 pathology. Constipation did not exist before the inception of 
 the poison — when it obtained, it was for the restoration of the 
 patient, and so long as it exists as mere constipation, it should 
 not be disturbed, unless it be for the purpose of revulsion or 
 counter-irritation, and then the good that is hoped to result, 
 wall very much depend upon the agent selected. 
 
 If it be conceded that disease cannot be cured or removed, 
 exce])t by secretion or depuration, it follows, upon the princi- 
 ple that two supreme or major actions cannot be maintained 
 in the system at the same time, that so Ions; as the bowels are 
 
492 DI^Y FORMS OF DISEASE 
 
 active but little can be gained by depuration, through tlie 
 skin or kidneys. Admit this, and the folly of bleeding and 
 purging, to remove disease, becomes too apparent to be tole- 
 rated. Our old-school brethren admit that it is dangerous to 
 give cathartics in small-pox — under this admission, how can 
 they justify purgation in any form of inflammation ? 
 
 The patient's condition, as to his bed, clothing, ventila- 
 tion, food, and drink, should be such as that recommended in 
 small-pox. 
 
 Dr. Eberle says, that this eruption, " as in every other ex- 
 anthematous afiection, must be regarded as an effort of the 
 system to relieve itself from the noxious influence of some 
 internal irritation, by a critical or metastatic deposition on the 
 surface." We regard this as sound doctrine — but observe his 
 inconsistency, when he says, that " all that is usually requi- 
 site in such cases, is to keep the bowels in a soluble condition 
 by the employment of mild laxatives." Is not this practice a 
 direct counter-action of the organic law which he has admitted 
 to be correct ? 
 
 He says, in another place : " A high grade of fever un- 
 doubtedly indicates the propriety of moderate venesection." 
 When this is properly interpreted, it means about this : the 
 rubeolous poison has produced a powerful obstruction in the 
 system, and its vital force is making a strong eflbrt to deter- 
 mine it to the surface, or to expel it, and consequently success 
 may be more certainly achieved by removing a part of the 
 force. 
 
 Eclectics entertain the opinion that it is best to equalize this 
 vital force, and save it for the purpose of sustaining existence 
 and the depuration of the disease; consequently, instead of 
 bleeding, they make use of diaphoretics, bathing with lye- 
 water, and rubefacients, which answer all purposes, as a gene- 
 ral rule, in the treatment of this disease. 
 
 Dr. Eberle informs us that Dr. Armstrong advocated the 
 "cautious abstraction of blood in congestive measles;" but 
 he thinks a more prudent method would be to " impart 
 warmth and vigor to the system, and to recall the circulation 
 to the extreme vessels of the surface ;" he therefore recom- 
 mends : "Stimulating frictions to the skin, with Tincture of 
 Capsicum, or flannels wrung out of hot brandy, sinapisms to 
 
IIs^ THE DERMA. 493 
 
 the epigastrium, and bottles filled with hot water applied to 
 difierent parts of the body and extremities, are the means best 
 calculated to procure these ends. Measures of this kind ex- 
 pose the peculiar advantage of exciting the energies of the 
 system {miich letter than hleeding) without diminishing its 
 resources, at the same time that they most efiiciently tend to 
 equalize the circulation and remove the congestion. In addi- 
 tion to the above means, we should not neglect the use of 
 warm and gently-stimulating drinks." 
 
 In the preceding paragraph, the doctor has written as be- 
 comes a medical professor- — but how badly it contrasts with 
 his preceding teaching. His treatment, as a whole, clearly 
 shows that he was guided by no rule of action or governing 
 principle ; and as the allopathists very generally, perhaps uni- 
 formly, teach the same, we are forced to conclude that their 
 practice is nothing else, and nothing less nor more, than 
 learned inconsistency — empiricism — quack er3^ 
 
 A retrocession of the eruption is quite liable to take place 
 with those who have been reduced, in an earlier stage of the 
 disease, by bleeding, purging, etc., and also with those who 
 are naturally feeble — such patients have not the requisite vital 
 force to maintain a centrifugal action in the system. When 
 this event supervenes, tonics and stimulants are required, as 
 Wine, Capsicum, Porter, with Quinia, Hydrastin, and in 
 nervous conditions, Camphor and external friction. 
 
 Measles, in those of an unbalanced constitution, are very 
 liable to induce or complicate with other inflammatory forms 
 of disease, the treatment of which will be found under their 
 appropriate heads; but we may add, by way of prophylaxis, 
 rubeolous patients should be particularly careful to avoid, 
 during convalescence, improper exposures of the surface — 
 indeed, prudence in all respects is higlily imperative. 
 
 Species Y. — Scarlatina — Scarlet Fever. 
 
 This is a disease of the skin which is seated in the cuticular 
 surface, and is manifested by a diffusing or spreading inflam- 
 mation. 
 
 If we may be allowed to form an opinion from the evidence 
 that has been furnished us by the profession, it would be, that 
 scarlatina is produced by an atmosplierical poison, and that 
 
494 DRY FORMS OF DISEASE 
 
 when produced, it furnishes a poison that will reproduce it; 
 that while the cause of it differs from that of measles, it is 
 mainly governed by the same law. 
 
 The period of its most poisonous activity is thought to be 
 that of desquamation, which happens from three to six days 
 after the first impression. Like measles and small-pox, one 
 attack generally destroys the susceptibility of the system to a 
 second assault ; we say generally, because some assert that it 
 does sometimes assail, successfully, a second time, while others 
 positively deny it ; indeed, it has been maintained by some 
 that they have known it to make a third attack. 
 
 Some persons are insusceptible to its impression, as some 
 are to that of small-pox and measles. It has been discovered 
 that those who are, in age, intermediate between that of old 
 age and infancy, are the most liable to it. This may be a 
 general fact, nevertheless it is well known that some epidemics 
 assail children almost exclusively. It observes no particular 
 choice as to season, but is most apt to appear in warm and 
 humid weather, and in such seasons it is most apt to be 
 severe. 
 
 Like other epidemics, it betrays considerable variety — 
 sometimes it is very mild; at others, greatly fatal; sometimes 
 it will rage with violence for a time, and then almost disap- 
 pear, and then return with equal violence in its assaults. 
 
 Because of the differences which have b6en observed in the 
 intensity and character of the disease, it has been divided 
 by nosologists into three varieties: S. Simplex, S. Anginosa, 
 and S. Maligna. 
 
 This division has been founded upon the observed facts in 
 the history of the disease, but, as to why or how they exist, 
 has not been explained ; therefore we may be allowed to 
 hazard a few suggestions. 
 
 With regard to all forms of epidemic disease, some visita- 
 tions are comparatively mild, while others are as signally 
 fatal. This difference may be referred to a less or a greater 
 elaboration of the poison, or to a difference in the prevailing 
 atmosphere, respectively ; but, no matter how mild may be 
 the general character of an epidemic, some cases occur of 
 such malignancy as to destroy life. This difference we must 
 refer to differences of human constitution. 
 
IN" THE DERMA. 495 
 
 Further, there are some constitutions that possess a vital 
 force capable of successful contention with all causes of disease 
 for a hundred years or more ; such persons may have scarla- 
 tina simplex, only, and that too, in the rage of the most fatal 
 epidemics. There is a third class which possesses an average 
 constitution, and are, therefore, liable to scarlatina anginosa ; 
 and there is a fourth and large class, which manifests, in all the 
 relations of life, a feeble vital force, and they are the subjects 
 of scarlatina maligna. 
 
 We were led into this train of thought by the complete 
 fitness that exists between a feeble vital force and the pheno- 
 mena of scarlatina maligna — a fitness that thoroughly pene- 
 trates us with the conviction that these three forms of the 
 disease are founded in the three constitutions above defined; 
 with the exception of those cases, wherein the too general 
 antiphlogistic treatment of a milder form of the disease, has 
 produced a more malignant one, by exhausting the vital force. 
 
 Yaeiety I. — Scarlatina Simplex. 
 
 Symptoms. — ^ Between the premonitory manifestations of 
 febrile irritation and the onset of the eruptive fever, there is 
 usually an interval of three or four days. This period is 
 characterized, by an alternation of momentary flushes of heat 
 and slight chills, with nausea, pain in the loins, head, inferior 
 extremities, and a feeling of general depression. The skin is 
 hot and dry, and the pulse is quick and frequent. After a 
 continuance of febrile symptoms for about forty-eight hours, 
 the eruption appears, first upon the face, and then descends, 
 covering the trunk and extremities, and finally working its 
 way into the nostrils and over the buccal surface and fauces, 
 showing itself by a coalescing of innumerable red points that 
 produce a difiused blush upon the cutaneous surface. 
 
 There is frequently an enlargement of the papillae and 
 miliary glands of the skin to such an extent as to give a feel- 
 ing of roughness to the touch ; in other instances, there ap- 
 pears upon the whole surface a scarlet efflorescence. 
 
 With or about the beginning of the fever, the patient mani- 
 fests some difficulty in deglutition, and complains of some 
 soreness of the fauces, with a voice considerably diminished 
 in sonorousness. The extremity and edges of the tongue are 
 
496 I>^Y FORMS OF DISEASE 
 
 usually red, while a white fur, with the scarlet-colored and 
 enlarged papillse appearing through it, occupy the balance 
 of it. Considerable restlessness and sometimes delirium 
 attend the evening exacerbations, but they generally disappear 
 before morning. The face is usually somewhat swollen during 
 the presence of the fever, and the pulse, instead of being 
 quick and frequent, is sometimes tense and vigorous. These 
 symptoms continue, with more or less modification, until about 
 the fifth day, when they begin to decline — the eruption, and 
 of course, the fever, diminish, ^ari j>assu, until they have 
 entirely disappeared, which happens usually about the seventh 
 day. 
 
 As the disease subsides, there is one peculiar symptom — a 
 copious and reddish sediment in the urine, and frequently 
 some diarrhea. The process of desquamation, which usually 
 begins on the eighth day, is attended with much itching, and 
 is followed by an equal sensibility of the whole surface. 
 
 Autliors inform us that there is a considerable abatement of 
 the febrile symptoms upon the appearance of the eruption. 
 To those who regard fever as a disease, this may be informa- 
 tion, but to those who regard the eruption as the aim and 
 necessary sequence of successful fever, it would be anticipated. 
 Sometimes the fever is remarkably light, as might be expected 
 m a highly physiological condition of the system, but in other 
 instances, and under a contrary condition of the system, it 
 runs high, thus indicating a pretty strongly -founded condition 
 of the disease. 
 
 Yaeiety IL — Scarlati'ia Anginosa. 
 This variety is more severe in its whole character, more par- 
 ticularly in its anginose affection, than the preceding. It is 
 usually attended with considerable prsecordial oppression, 
 nausea, headache, muscular prostration, and occasional vomit- 
 ing during the introductory stage. The febrile action is de- 
 veloped with much rapidity , the pulse becoming very quick 
 and frequent, but has less tension, vigor, and fullness, than the 
 preceding variety. Deglutition becomes painful, a feeling of 
 esophagal stricture is experienced in respiration ; the fauces, 
 palate, tonsils, and uvula become red and slightly tumid; 
 and a sense of stifihess, with a dull pain, seizes the cervical 
 
m THE DERMA. 497 
 
 muscles and those under the ears and about the angles of the 
 jaws ; the skin is said to be more intensely hot than in any 
 other febrile affection, and is attended by a corresponding 
 degree of thirst. The whole course of the disease is marked 
 by unusual languor, restlessness, and prostration ; the tongue 
 is dry, its edges are florid and projecting, and highly-inflamed 
 papillae cover its surface. 
 
 In this variety the vital force is less effective than in the 
 former, and consequently the eruption does not usually appear 
 before the third da}^ of the fever ; and when it does appear, it 
 is neither so regular nor so generally diffused, showing itself 
 on different parts of the body, particularly about the elbows. 
 The rash sometimes disappears, and probabl}' the day after 
 its appearance, and by the next day returns, but this mutation 
 is governed by no regularity — it shows only that the system is 
 struggling to effect a permanent reaction. 
 
 K the disease manifests a declension by the fourth or fifth 
 day, the inflammation of the fauces usually passes off by reso- 
 lution ; but when the symptoms are violent and are protracted 
 beyond the time above specified, ulcers are formed about the 
 tonsils and palate, which rapidly pass into ash-colored superfi- 
 cial sloughs ; at the same time mucus may be secreted in the 
 fauces and concrete into flakes, which, without care, may be 
 mistaken for sloughs. 
 
 As the fever subsides, which happens about the eighth day, 
 the sloughs separate, leaving ulcerated surfaces that readily 
 cicatrize, unless the separation is procrastinated beyond the 
 eighth day, in which event it is common for them to enlarge, 
 become of a brown color, and throw out an acrid and sanious 
 fluid, attended by a hard, painful, and swollen condition of 
 the cervical glands, diarrhea, and possibly tenesmus. 
 
 Yaeiety III. — Scarlatina Maligna. 
 Between the most inflammatory and unmanageable form of 
 scarlatina anginosa, and that of which we are about to treat, 
 the differences may be considered to exist in degree rather 
 than in kind. In malignant scarlatina, the febrile manifesta- 
 tion very early in its history assumes a typhoid character: in 
 scarlatina anginosa, there is a pretty general equality between 
 the constitutional symptoms and the local mischief; but in 
 32 
 
498 I>P^"^ FORMS OF DISEASE 
 
 this, the speedy death that supervenes cannot be explained by 
 the extent of the local lesions. 
 
 Its introduction may resemble scarlatina anginosa, but the 
 mask is soon removed by the dangerous character of the 
 symptoms that su]_3ervene. 'No certain periods are observed 
 for the appearance of the eruption, but it usually appears 
 between the second and fourth day. JSTo definite period can 
 be assigned for its duration ; when it appears it may continue 
 a few hours, and then appear after two or three days, but upon 
 different parts of the body. By the second day, the pulse 
 passes from activity to smallness and feebleness; the skin 
 does not become particularly hot — delirium appears early in 
 the disease, and with occasional intermissions and exacerba- 
 tions continues throughout the disease. 
 
 In the most aggravated cases, a livid flush covers the 
 cheeks, and the eyes appear dull and inflamed — the breath is 
 fetid, and the tongue is dry and covered with a dark-brown 
 fur — gray-colored sloughs appear on the soft palate, in the 
 fauces, and tonsils, which soon become of a dark color ; but 
 before the arrival of these symptoms, death frequently relieves 
 the patient by the infliction of some cerebral outrage. 
 
 It but rarely happens, that when the fever is not protracted 
 beyond the fourth day, that the ulcers become fetid, black, and 
 ill-conditioned sloughs. 
 
 If the disease has shown itself to be particularly malignant, 
 about the middle of the second week, collapse, manifested by 
 a great prostration of the vital force, as a frequent and feeble 
 pulse, a low condition of the cutaneous caloric, exhausting 
 hemorrhages, or diarrheas, dark -brown or black tongue, and 
 the appearance of petechias, may be expected. In some in- 
 stances, the vital force proves entirely insuflficient to force the 
 eruption upon the surface during the existence of the disease. 
 
 Dr. Armstrong has divided scarlatina maligna into three 
 sub-varieties, the inflammatory^ congestive^ and mixed. The 
 first is indicated by a full, hard, and vigorous pulse, early 
 delirium, and very hot skin. In this stage it differs nothing 
 from scarlatina anginosa, but runs speedily into collapse, the 
 eruption appears early and vividly red, but in a short time it 
 acquires a dark purple hue — the vital force is soon expended, 
 and petechiee, colliquative diarrhea, and passive hemorrhage 
 
m THE DERMA 499 
 
 ensue. This form of the disease is better known by the name 
 of ^'' jputfid sore-throat P 
 
 A complete overwhelming or overpowering of the vital 
 force, by congestion, indicates the second or congestive variety. 
 The patient feels oppressed, disposed to syncope, complains 
 of giddiness, weight in the head, nausea, oppression in the 
 prsecordia, and deep-seated pain, if of any at all, and a pale 
 skin. Diarrhea, petechise, gangrenous spots, and exhausting 
 hemorrhages from the nose, mouth, or bowels, precede disso- 
 lution, which is but rarely procrastinated beyond two or three 
 days. 
 
 The third variety can readily be inferred from the two pre- 
 ceding, and therefore no description of it is necessary. 
 
 Sequels. — Anasarca is, probably, the most frequent 
 sequelae of this disease — it generally appears in eight or ten 
 days after the termination of the disease, and continues two 
 or three weeks; but sometimes, it is said, invades the chest 
 and even the brain and thus proves fatal. 
 
 Occasionally it causes gutta serena, rheumatism, eruptions 
 of the derma, neuralgia, hysteria, asthma, chorea, inflamma- 
 tion of the testicles, tonsillar abscesses, tumefaction of the paro- 
 tids, deafness, ophthalmia, otitis, excoriations about the nates, 
 suppuration of the cervical glands, cough, hectic fever, inflam- 
 mation of the mucous lining of the bowels, etc. 
 
 Causes. — All, and perhaps more than we know of this dis- 
 ease, is embraced in our leading remarks. 
 
 Diagnosis. — When treating of rubeola, we gave the diag- 
 nostic difi'erences between it and scarlatina, and the only other 
 eruption with which it can be confounded is miliary fever, and 
 this can only happen with superficial observers. The miliary 
 eruption is generally attended with considerable perspiration, 
 which is not the case with scarlatina. The eruption of miliary 
 fever seems to be seated on a skin which preserves its natural 
 color. 
 
 Prognosis. — This disease is divisible, as we have shown, 
 into three pretty strongly-marked varieties, and each of these 
 is attended with several modifications, consequently, the prog- 
 nosis must be attended with as many qualifications. This is 
 not all, the general character of the prevailing epidemic must 
 be taken into consideration. 
 
500 DI^Y FORMS" OF DISEASE 
 
 We may sslj, however, with reference to scarlatina simplex, 
 that, under judicious treatment, its prognosis may be con- 
 sidered as generally favorable ; as regards scarlatina angi- 
 nosa, where the contending forces are pretty nearly balanced, 
 that a judicious treatment may be expected to produce a favor- 
 able preponderance, and consequently the fatality which has 
 generally attended it, is not justified by its pathological con- 
 ditions. In the third variety, there is no equality in the 
 forces — those of an inimical character greatly preponderate — 
 it is pregnant with the most obvious indications of an inherent 
 deficiency of the vital force, and hence no treatment should 
 be expected to achieve more than a mitigation of its violence, 
 and a brief procrastination of the necessarily fatal termina- 
 tion that attends a large majority of its assaults. 
 
 Indications. — The indications in scarlatina are the same as 
 in measles, particularly in its milder forms ; but its more ma- 
 lignant peculiarities demand more energetic treatment — to 
 effect and maintain a centrifugal action must be the leading 
 principle. 
 
 Treatment. — There is no fitness or proper relation between 
 the symptoms of this disease and the mortality that attends 
 the general practice. If in this opinion we are correct, then 
 the practice must consist too much in a war upon the vital 
 force — upon the fever and inflammation instead of the disease. 
 The accuracy of our opinion is sustained, if we mistake not, 
 by the success of the homoeopathic treatment, which, in our 
 judgment, is about equivalent to none at all. None at all, 
 then, is better than that which generally prevails. 
 
 Prof. Wood says, that "in the vast majority of cases, scarlet 
 fever would end favorably without treatment ; hence the repu- 
 tation acquired by homoeopathy in this disease." 
 
 Under this view of the subject, what should we think of the 
 practice of those physicians who lose a "vast majority" of 
 their scarlet fever patients ? We know a few who are thus 
 unfortunate, and yet they have the presumption to call a more 
 fortunate class " quacks." We are very much mistaken if 
 Prof. Wood, himself, would not have greater success if he 
 would practice the bread-pill system, which is less than 
 homoeopathy, than the one he recommends. If our unfor- 
 tunate physicians make him their guide, we are not surprised 
 
m THE DERMA. 501 
 
 at the fatality of their practice. He teaches, that in all cases, 
 except those of "great mildness, it will be proper, in children, 
 to follow the emetic with a purgative dose of Calomel, which, 
 if it do not operate thoroughly in six or seven hours, should 
 in its turn be followed by Castor Oil, Magnesia, or one of the 
 saline laxatives, xifterward, the bowels should be kept open, 
 if necessary, by cathartics, which should be accommodated to 
 the circumstances of the case ; those of a depletory character, 
 such as Sulphate of Magnesia, being given if there is much 
 excitement with considerable energy of the system." In an- 
 other place, he states, that " the practitioner should always be 
 on his guard for symptoms of debility." Are we to infer 
 that he prescribes Calomel purges as a means of guarding 
 against debility ? 
 
 For the practice of Eberle, Watson, and Armstrong, our 
 opinion is about that which we have above expressed concern- 
 ing that of Prof. Wood. As these four writers measurably lead 
 the profession, we have no occasion of surprise at the fatality 
 that attends this form of disease. 
 
 Among the local remedies, is that of inunction, upon which 
 we desire to offer some comment. It consists in greasing the 
 whole surface, with the exception of the face and scalp, with 
 a piece of fat bacon every morning and evening. Of this 
 practice. Dr. Schneeman, of Hanover, speaks in flattering 
 terms. We have never tried it, and from the ill-success of 
 those whom we know to use it, we think it much inferior to 
 homoeopathy. As a means of counter-irritation in visceral 
 inflammation we think favorably of it, but when applied to an 
 inflamed surface, we are disposed, a j>riori^ to think as badly 
 of it, as of blisters to the scalp in encephalitis. 
 
 We have stated that the leading and principal indication is 
 the maintenance of a steady and constant determination to 
 the surface ; and, if this principle be correct, purgation of any 
 kind must be, in the highest degree, incompatible. Nothing, 
 except the most clearly-manifested alvine irritation, can justify 
 the use of the simplest laxative. Under a highly vital mani- 
 festation of the disease, simple enemas may be used, if 
 required by indications of alvine irritation, and under depres- 
 sion of the vital energies stimulating ones may be used to 
 
502 ^^^ FORMS OF DISEASE 
 
 evacuate the large intestines, and to promote revulsion or a 
 centrifugal action. 
 
 The treatment we have laid down for measles, is all that is 
 required for scarlatina simplex. 
 
 in the anginose form, prompt efforts should be made to 
 reduce the fever, by equalizing the circulation and the promo- 
 tion of secretion, which may be effected by the administration 
 of a mild vegetable emetic, that should be repeated daily 
 for two or three days in succession ; the Acetous Emetic Tinc- 
 ture will be found useful for this purpose. 
 
 After the action of the emetic, the body should be bathed 
 with a weak, warm lye-water, followed by the spirit vapor- 
 bath, in adults, and the free use of the infusion of some of the 
 simple vegetable diaphoretics, as Catnip, Balm, Sage, etc. 
 
 In using the lye-bath, its temperature must be regulated 
 by that of the body ; if this be not above the natural tempe- 
 rature, the bath must be merely blood warm. The more severe 
 or malignant the disease, the oftener must the bathing be 
 repeated, even to every hour. 
 
 Our next duty will be to induce the deep-seated inflamma- 
 tion of the neck to the surface, for which purpose the throat 
 and neck should be bathed with the Camphorated Soap Lini- 
 ment, or the Compound Stillingia Liniment; this should be 
 repeated three or four times daily, applying after each bathing 
 a warm fomentation of Hops and Wormwood, or a Slippery- 
 elm poultice. 
 
 The fever being so far reduced as to admit of secretion, our 
 attention should, in an especial manner, be directed to the kid- 
 neys — depuration through them is, perhaps, indispensable to 
 the cure of this form of disease. An infusion of equal parts 
 of the root of Alth^a Officinalis and Apium Petroselinum 
 may be drank freely, and will prove as effectual in fulfilling 
 this indication as any other diuretic we can employ. 
 
 Scarlatina maligna is but scarlatina in a constitution highly 
 feeble and vitiated. The anginose form, we have no doubt, 
 is very frequently forced into the malignant by allopathic pur- 
 gation. By such a practice the vital force is so reduced that 
 it cannot contend successfully with the disease, and death 
 takes place through mortification — not inflammation. 
 
IN THE DERMA. 503 
 
 The pains and sensations of heaviness — the anxions expres- 
 sion of the countenance, and withal, the alternate chills and 
 heats, indicate a congested condition of the system ; the vital 
 force is inadequate to a successful revulsion, and the morbus 
 settles upon the throat, and that too without much delay. The 
 inside of the throat becomes florid or crimson-colored — spread- 
 ing rapidly, it soon becomes covered with whitish spots that 
 mark the beginning of the ulcers. 
 
 In the malignant form of scarlatina, the treatment above- 
 named must be energetically persevered in. For the ulcera- 
 tions of the throat, a wash or gargle must be employed, and 
 used several times a day, composed of: 
 ^. Black Pepper, 3i, 
 Salt, 3j, 
 
 Boiling decoction of Hydrastis Can., fgiv. 
 Mix, and allow it to stand fifteen minutes ; then add, 
 
 Yinegar, fjiv. 
 "With this, the mouth and throat must frequently be washed 
 with a swab, or gargled, and a child two years old may swal- 
 low a teaspoonful of it several times a day, or in proportion 
 to its age. 
 
 When the low typhoid symptoms appear, as frequent and 
 small pulse, dry and cracked tongue, sordes upon the teeth, 
 jactitation, muttering delirium, etc., stimulants and tonics 
 must be resorted to, with generous, nourishing, and easily- 
 digested food. For tonics and stimulants the agents may be 
 employed which have been heretofore advised for a similar 
 purpose in the treatment for laryngitis. 
 
 The room of the patient must be kept well ventilated, and 
 his clothing should be changed often. 
 
 Genus II. — Papulae. 
 This genus consists of eruptions which are marked by small, 
 hard, resisting, acuminated, and unsecreting elevations of the 
 cuticle, attended with a more intense itching than any other 
 genus, and terminates usually in scurf. Dermatologists de- 
 scribe three species : Strophulus, Lichen, and Prurigo — neither 
 of which is contagious. 
 
504 I)RY FORMS OF DISEASE 
 
 Species I. — Strophulus. 
 This is a disease of infancy, and it consists of pimples, 
 which are usually red, but they are occasionally whiter than 
 the healthy skin — they may occur on a part, or they may ap- 
 pear over the entire surface of the body. They rarely give 
 rise to any constitutional symptoms, but they exceedingly 
 annoy the little patient by the itching they produce, with some 
 increase of cutaneous temperature. Their termination is by 
 resolution and desquamation. It consists of five varieties: 
 Strophulus Intertinctus, S. Confertus, S. Yolaticus, S. Albi- 
 dus, and S. Candidus. 
 
 Yaeiety I. — Strophulus Intertinctus^ or Red-Gum. 
 
 This eruption consists of prominent and vividly-red pim- 
 ples, dispersed generally over the body, or only over several 
 portions of it, in erythematous patches, and covered with 
 small, red points. It more frequently attacks the backs of 
 the hands, the forearms, and cheeks. Its introduction is 
 sometimes preceded by nausea and vomiting, or possibly by 
 diarrhea. 
 
 Prof, Dewees says, that " most nurses are very fond of it, 
 so much so, indeed, and so invaluable and useful do they con- 
 sider its presence, that should indisposition befall the child, 
 and this eruption not have possession of the skin, it is at once 
 attributed to the absence of the gum," They then resort to 
 means to produce it, such as warm clothing, heating teas, etc. 
 
 It is no doubt true, that so long as the infant is in posses- 
 sion of this disease, it will be little liable to any other, but 
 the same argument is as applicable to any other disease ; the 
 possession of one usually precludes every other. Bat this 
 fact can furnish no argument favorable to its retention or in- 
 troduction. It is most probably symptomatic and vicarious 
 in its purpose. 
 
 Yakiety II. — Strophulus Confertus^ or Tooth-Rash. 
 
 This eruption usually appears upon infants about the fourth 
 
 or fifth month, but it may occur at any time during dentition. 
 
 The pimples are of smaller size and more numerous than in 
 
 the preceding variety, and also more aggregated into patches, 
 
m THE DERMA. 505 
 
 which are sometimes confluent. It most generally attacks the 
 cheeks and side of the nose, or it may appear on the arms 
 and forehead, and, if more than ordinarily violent, it may 
 possess the entire surface. 
 
 When of such violence, it is attended with much pain and 
 itching, and sometimes excoriation, more particularl}^ when it 
 is seated upon the thighs or inferior portion of the body. It 
 is less vividly red, more painful, and more lasting than the 
 previous variety. In two weeks it usually attains its height 
 and then declines with a copious furfuraceous desquamation 
 of the epiderma. 
 
 On its decline, it is frequently succeeded by another erup- 
 tion, which Willan describes as attacking infants of seven or 
 eight months. It appears in one or several large, irregular 
 patches of pimples upon the arm, leg or some other part of 
 the body and extends upward and downward. 
 
 The intermediate skin, as well as the patches, is of a deep- 
 red color, and after the epidermal exfoliation, in which they 
 result, the skin is left of a dull, dark-red color, dry and harsh. 
 
 When it visits the legs, it generally becomes painful and 
 most obstinately forces its way to the thighs, and in many 
 instances to the loins and abdomen. The epiderma is apt to 
 crack and separate in large flakes, leaving the derma rough 
 and inflamed. It is frequently continued for several months, 
 and even to the close of the first year, and attended all the 
 time by much heat and irritation. 
 
 Yakiett III. — Strophulus Yolaticus. 
 
 This variety usually betrays itself upon the arms or cheeks, 
 in small, circular, bright-red patches or clusters, varying in 
 number from three to a dozen papulse in each. Sometimes 
 these patches appear in succession upon difierent parts of the 
 body ; and in some instances they have been observed to dis- 
 appear, and then to be quickly replaced, at a little distance, 
 with another, and in this wise to spread over the entire 
 surface. 
 
 The patches and thin interstices have a highly-inflammatory 
 color, and are attended by an increased temperature, a quick 
 pulse, a white tongue, and an irritable disposition. 
 
 In most instances, the inflammatory condition subsides in a 
 
506 33RY FORMS OF DISEASE 
 
 few days — the papiilce become of a brownish tint, in a des- 
 quamation of the epidermis. 
 
 Yariety IY. — StTojpliuliis AlMdus, 
 This cutaneous affection, consisting of a pale or whitish 
 eruption, is very mild in its character — very rarely attended 
 with any constitutional symptoms, and hence, as seldom 
 requiring medical attention. 
 
 It is readily distinguished from the other varieties by the 
 hardness, smallness, and dryness of the papulae, which are 
 but slightly elevated, and cast, as it were, upon a mild-red 
 ground, and in great numbers upon the face, neck and breast. 
 It continues for a considerable time, and though very mild, 
 its repulsion produces sometimes dangerous symptoms. 
 
 Yaeiety Y. — Strophulus Candidus. 
 
 This eruption is said to appear about the close of dentition 
 with children, and to be also a consequent upon convales- 
 cence from fevers, and also inflammations of the intestines 
 and lungs. 
 
 Its papulae are of larger size and broader than in the pre- 
 ceding forms ; they are but sparsely scattered over the loins, 
 arms, and shoulders ; they are hard and smooth, but attended 
 with so little inflammation that, in consequence of their 
 smoothness and brightness, they appear to be less colored 
 than the adjacent skin. They usually continue hard, tense, 
 and elevated for six or seven days, and then disappear. 
 
 Causes. — This species, and all of its varieties, are con- 
 sidered to depend upon, or originate in, the deciduous denti- 
 tion, and are therefore called tooth rashes. 
 
 Upon this subject. Professor Dewees says, that "nothing 
 declares the intimate connection, or play of sympathies be- 
 tween the gums and skin, during dentition, more than the 
 number of eruptions to which it becomes liable at that 
 period." 
 
 Against such an opinion as this, we have much to say, if 
 time and place permitted — it is a part, a fragment of that 
 doctrine that inculcates the plurality of disease — a fragment 
 of that doctrine which leads, in practice, to a contention with 
 symptoms, instead of the disease which they indicate. 
 
IN THE DERMA. 507 
 
 The dental process is just as normal — as physiological, as 
 the cerebral, muscular, or osseous ; and its period of develop- 
 ment is that of al], and if all the others progressed physio- 
 logically, we would have nothing to fear from it. The differ- 
 ence is, that it becomes the organ of complaint for that defec- 
 tive nutrition and consequent development or feeble condition 
 of the vital force, which is characteristic of all such cases. 
 The sympathy, then, is not between the gums and the skin, 
 but between the latter and the system of nutrition. 
 
 In treating of strophulus intertinctus, he makes its cause to 
 be entirely independent of any condition of the teeth or gums. 
 He says: "This derangement may proceed (1st.) from the 
 meconium not having been well purged off, or its being of an 
 unusually acrid quality; (2d.) it may proceed from an acrid 
 state of the stomach, owing to feeding the child with impro- 
 per food, or to its being made to receive too great a quantity 
 of it ; to some ill quality in the mother's milk, or a constitu- 
 tional feebleness of the stomach," etc. 
 
 If these remarks be true, and we are ready to admit that 
 they are, he has thoroughly sustained our conclusion. There 
 is too much similitude between the several varieties of strophu- 
 lus to make them symptomatic of entirely different forms of 
 disease. Such a pathology as would attribute one member of 
 this family to such causes as we have above specified, and at 
 a period, too, long antecedent to the existence of any dental 
 irritation, can never lead to anything else than empirical 
 practice. 
 
 If we consider the remote cause of these eruptions to be the 
 disease — an inability of the nutritive system to discharge its 
 duties, physiologically, all the members of this family are 
 accounted for by differences of age and other attending cir- 
 cumstances. 
 
 Dr. Wilson says, that "Strophulus is generally due to gas- 
 tric and intestinal irritation, and is frequently associated with 
 the constitutional disturbance induced by dentitio?!^ Den- 
 tition induces none — that which is in the system is only mani- 
 fested through it. 
 
 Diagnosis. — The period of life in which this family appears 
 is generally sufficient to distinguish them from all others. If 
 lichen occurred at so early a period, it would be difficult, if 
 
508 I^RY FORMS OF DISEASE 
 
 not impossible, at least in many instances, to diagnosticate 
 them. 
 
 Fkognosis. — If we speak of these eruptions as so many- 
 forms of disease, then the prognosis is favorable — for, instead 
 of being attended with danger, they rarely present features of 
 severity ; but of that constitutional weakness, of which we 
 regard them as symptomatic, very many children die. 
 
 Indications. — Remove all causes of irritation, and promote 
 cutaneous and renal depuration. 
 
 Treatment. — Cleanse the surface with the alkaline wash, 
 and if the child possess a respectable share of vital force, a 
 simple enema and mild aromatic teas will usually be sufficient, 
 aided by decoctions or infusions of some of the vegetable 
 diuretics. 
 
 But if it be feeble, and re-action efiected with difficulty, the 
 enemas and drinks should be stimulating ; and alteratives and 
 tonics may be given with benefit; the Compound Syrup of 
 Yellow Dock will be found to fulfill both indications. 
 
 In some instances it will be judicious to administer mild 
 emetics, especially when much mucus appears to abound in 
 the stomach ; and the bowels should always be kept open by 
 mild aperients. 
 
 The diet should be nutritious and easy of digestion. 
 
 Species II. — Lichen. 
 
 This eruption consists of elevated, acuminated papulae or 
 pimples, which are small, hard, and solid, and grouped to- 
 gether upon particular portions of the cutaneous surface, or 
 distributed over the whole body, and attended with a trouble- 
 some sense of tingling, itching, and pricking. It is common 
 to children of eight or nine ^^ears of age and to adults. It is 
 not necessarily attended with constitutional symptoms. 
 
 Of this species there are three varieties which interest us : 
 Lichen Simplex, L. Agrius, and L. Urticatus. 
 
 Yakiety I. — Lichen Simplex. 
 This form of disease appears usually on the face and arms, 
 but may extend to the neck and breast, and indeed to nearly 
 all parts of the body. It appears in small, red, distinct, coni- 
 cal, and hard pimples, or papules, more or less grouped, with 
 
IN" THE DERMA. 509 
 
 an inflamed base, and attended with various degrees of heat, 
 itching, and tingling ; its duration is from one to several 
 weeks, or even months, but such an extension of it is occa 
 sioned by successive crops of the eruption. 
 
 After the attack, it appears to continue stationary for seve- 
 ral days, and then declination begins and terminates in one or 
 two weeks in a slight scurf, when the disease is of a simple or 
 mild form. 
 
 "When the erupted parts have been exposed to abrading 
 forces, the papillae will frequently be found wearing bloody 
 scabs on their surfaces. 
 
 In chronic cases, the skin has, to the eye, quite a normal 
 appearance, but the passage of the finger over the part will 
 detect the eruption. This form is usually attended with more 
 desquamation than the acute, and the skin, also, becomes 
 thicker and less pliant. 
 
 In the heat of summer, this disease is called jpriGkly Tieat^ 
 by the unlearned, and by the learned, liclien tropicus. In 
 tropical latitudes, it is much more severe than in the tempe- 
 rate ; but in any latitude it is a harassing disease — producing 
 an uncontrollable disposition to scratch. 
 
 In numerous instances, it is attended by no constitutional 
 symptoms, and yet, in some, it is preceded by fever, and other 
 evidences of internal disorder. 
 
 Yariety II. — Lichen Agrius. 
 
 This variety attacks, preferably, the outside of the limbs, 
 and in this wise diflfers from eczema, to which, in some re- 
 spects, it bears a resemblance. It commences with fever, 
 which, upon the appearance of the eruption, generally, but 
 not uniformly, subsides. To the tingling and itching sensa- 
 tion, common to lichen, is added, in this form, burning and 
 smarting, which are greatly augmented by heat and by every- 
 thing else that can excite or irritate the skin. 
 
 The eruption consists of numerous small, red, inflamed 
 papillae, which are clustered upon large areas, and surrounded, 
 often to a considerable extent, by an erythematous redness of 
 the skin. Sometimes small vesicles are intermingled with the 
 papules ; their occun-ence, however, is a mere circumstance, 
 as they soon disappear. 
 
510 DRY FORMS OF DISEASE 
 
 This form of disease is usually marked by remissions in the 
 morning and exacerbations in the evening. After the exist- 
 ence of the pimples for some days, an excoriation or ulcera- 
 tion commences, which throws out a sero-purulent fluid that 
 forms into scabs. 
 
 This circumstance is a considerable violation of the defini- 
 tion of lichen — a proof that all classification is more or less 
 arbitrary. To the scabs, however, succeed minute furfura- 
 ceous scales, which may terminate the disease. 
 
 Two weeks, or a little less, is the usual period of the dis- 
 ease, but sometimes, after the disappearance of the scabs, the 
 surface continues moist, and the departed scales are replaced 
 by others, or the eruption may entirely disappear, and yet, 
 in a short time, re-appear — in this wise the disease may be 
 protracted for several weeks. The passage of the disease 
 through these several modifications leaves the skin chapped, 
 thickened, and tender. 
 
 Yakiety in. — Lichen UrtiGatus. 
 
 In this variety of lichen the papula possess more magni- 
 tude than is common to the other varieties. The papules are 
 clustered, and they are either white or surrounded by a faint- 
 red areola ; sometimes they are prominent and considerably 
 inflamed, and at first bear considerable resemblance to flea 
 bites. The suddenness with which they appear and disappear 
 constitutes a remarkable peculiarity in this disease. Yery fre- 
 quently, they are attended with a burning heat and pun- 
 gent itching, and when scratched, they bleed and form black 
 crusts upon their summits. It is peculiarly obstinate, being 
 maintained indefinitely by succeeding crops of the papules — 
 thus desquamation and reproduction may, pari jpassu^ pro- 
 gress for months. 
 
 Causes. — Children of sanguine and sanguine-lymphatic 
 constitutions are the most liable to these eruptions, and they 
 are more liable to occur in spring and summer than in winter, 
 but the latter season is by no means exempt from them. 
 
 We have no doubt but that they are produced by too much 
 feeding, or food of improper qualities, and deficient exercise. 
 The last variety has been excited into development in children 
 by mental emotion — as a little ill-humor. "When that consti- 
 
m THE DERMA. 511 
 
 tutional condition exists, which seeks relief by these eruptions, 
 they are easily produced, as slight friction, rough clothing, 
 stimulating drinks or food, etc. 
 
 Diagnosis. — Lichen is distinguishable from scabies by the 
 dryness and hardness of its eruption, and by a difference of 
 locality — being found generally upon the thick skin, and not 
 upon the thin, as in scabies. 
 
 It is distinguishable from herpes, by the dryness of the 
 former and the moist and vesicular character of the latter; 
 furthermore, the skin, in the former, is thicker and more 
 harsh. 
 
 From prurigo, it is not so easy to distinguish it; both are 
 sometimes found upon the same individual, and that too, at 
 the same time ; and further, they are species of the same 
 genus, and it is even thought by some that prurigo sometimes 
 degenerates into lichen. 
 
 In general, however, the larger and flatter papules of the 
 former, especially as they are of the common color of the 
 skin, will distinguish it from the smaller and more acuminated 
 papules of lichen, especially as they have more color, and 
 are more grouped into clusters. 
 
 From urticaria, or nettle-rash, lichen is distinguishable by 
 its more permanent or chronic character; — but in confounding 
 them no mischief can result. 
 
 Pkognosis. — Lichen cannot be charged with being danger- 
 ous, but it is obstinate and tormenting, and the longer it exists 
 the more these traits of its character increase. It has some- 
 times proved entirely intractable. 
 
 Indications. — Eegulate the secretions and restore the diges- 
 tive functions. 
 
 Treatment. — When the habit of body is full, the diet 
 should be simple and unstimulating. The large intestines 
 should be maintained in a normal condition by the use of 
 enemas — simply cold water will be best, if sufficient. 
 
 The skin should be maintained, as far as practicable, in a 
 depurating condition by the frequent use of alkaline washings. 
 These washings, furthermore, may be sufficient to allay the 
 pruritus, which is peculiarly tormenting in this malady ; but in 
 the event they fail or are insufficient. Acetic Acid and water 
 
512 DRY FORMS OF DISEASE 
 
 may be tried. This eruption is one in which a proper diuresis 
 should not be neglected. 
 
 When the disease has become chronic, although the skin 
 may be inflamed, Dr. Wilson recommends an ointment to be 
 rubbed upon the skin, containing half a drachm of Croton 
 Oil to two ounces of Ceratum Cetacei, and then, after three, 
 four, or five days, to relieve the irritation occasioned by the 
 Croton Oil, he prescribes an oleaginous cerate containing 
 Licjuor Plumbi, and then, at the termination of another simi- 
 lar period, he prescribes a lotion of Tannin of the strength of 
 two drachms to a pint. The constitutional treatment, at the 
 same time, consisted in taking four pills daily, containing 
 twelve grains of Tannin, with Extr actum Rhei and Extractura 
 Hyoscyami. 
 
 Under circumstances of anemia, he relies much, in the treat- 
 ment of this afiection, upon the mineral acids and the bitter 
 infusions. 
 
 Species III. — Prurigo — Pruritus — Old Marl's Itch. 
 
 This species is made, by dermatologists, to embrace some 
 half a dozen varieties, but that which is known as jprurigo 
 infantilis^ is the only one that interests us. All the varie- 
 ties so closely resemble lichen, that it is generally difficult to 
 make out a satisfactory diagnosis. 
 
 The seats of the disease are generally the neck, shoulders, 
 back, and extensor surfaces of the extremities. It is more 
 confined to one spot, and more disposed to attack several 
 spots simultaneously than lichen. It may be local or general, 
 simple or complicated with afiections of the skin, but more 
 particularly with lichen and psora. Its complication with 
 psora is rather an unexplainable circumstance. 
 
 The papulae are so generally colorless, or so nearly so, as 
 not to be generally observed, the only external appearance 
 that exists to call attention to them are the black scabs or con- 
 cretions of blood which were drawn by scratching, to which 
 the sufferer is impelled by the sensation of extreme itching ; 
 to which, in severe cases, is added a feeling of formication and 
 painful pricking. 
 
 These sensations are almost constant and always increased 
 
IN THE DERMA. 513 
 
 by heat or exposures to cold. Like lichen, it is not con- 
 tagious. 
 
 For its causes, diagnosis, prognosis, and treatment, we may 
 refer to the preceding species, as we can add nothing of mo- 
 ment here. We may add, however, a few remarks from 
 Billard. 
 
 In the treatment of one case, which was cured, he says, the 
 " child was immersed in a decoction of Marsh Mallows, and 
 the limbs and body anointed with Oil of Sweet Almonds, 
 carefully covering up the hands and arms. Rice-water, sweet- 
 ened with the Syrup of Marsh Mallows, was adminis- 
 tered internally, and milk-and-water was given for nourish- 
 ment." 
 
 In the way of general instruction, he further remarks : ''In 
 general prurigo, emollient, saponaceous, or sulphurous baths, 
 demulcent or slightly-acidulated drinks, constitute the treat- 
 ment. In local prurigo, it will be necessary to apply emol- 
 lient, sulphurous, or alkaline lotions alternately to the diseased 
 parts. Gelatino-sulphurous douches have been employed with 
 success. The greatest care should be used to accomplish the 
 early removal of the prurigo that is developed around the 
 vulva or anus in children advanced in age, because the exces- 
 sive itching of these parts, compelling the child to scratch 
 them constantly, they may thereby continue in a state of 
 erythism, and of irritation, extremely prejudicial to their 
 health." 
 
 Dr. Wilson says that the Milk of Sulphur in moderate doses, 
 night and morning, for two or three weeks, is sometimes use- 
 ful with children. He has also presented us with a number 
 of formulae, from the French dermatologists, for ointments. 
 
 For local prurigo : 
 
 ^. Muriate of Ammonia, 3i, 
 
 Powder of White Hellebore, 3ss, 
 Lard, 3iij. Mix, 
 
 ?:. Hydrate of Lime, 3ji, 
 
 Subcarbonate of Soda, 
 
 Laudanum, aa 3ss. 
 
 Lard, 3j. 
 33 
 
514 DRY FORMS OF DISEASE 
 
 ?;. Laudanum, 
 
 Sublimed Sulphur, aa 3ss, 
 Oxide of Zinc, 3J, 
 Oil of Almonds, 5j, 
 Lard, 3iij. M. 
 
 Genus III. — Squama. 
 
 The eruptions included in this genus are characterized by 
 the formation of scabs, without having been preceded by other 
 elementary forms, common to cutaneous eruptions, such as 
 vesicle and pustule. An abnormal and highly- increased pro- 
 duction of the epidermis produces the scabs which distinguish 
 this genus. 
 
 There may or may not be an elevation of the cutis in their 
 formation. When elevations occur and the scabs are removed, 
 the skin is discovered to be red and inflamed. 
 
 Some authors include in this genus four species, Pityriasis, 
 Psoriasis, Ichthyosis, and Lepra. As the last is a stranger in 
 this country, we shall pass it by. 
 
 Species I. — Pityriasis. 
 
 Dermatologists have divided this species into some dozen 
 varieties, but as the difierences between them are but slight, 
 there is nothing to be gained, therapeutically, by a separate 
 consideration of them. 
 
 This affection is sometimes quite generally distributed over 
 the surface, and the patches are frequently successive in their 
 appearance ; at other times, it is confined to some particular 
 spot, as the head, where it may remain without any disposi- 
 tion to spread. Neither sex nor age is exempt from it. The 
 squamse appear in patches of very irregular shape and size, 
 slightly inflamed, and attended with a constant exfoliation 
 of the epidermis in the form of semi-transparent scales or 
 whitish scurf. 
 
 When this affection is located upon the head, it is called 
 pityriasis capitis^ and occasions a copious production of 
 dandruff. It is attended with frequent and troublesome itch- 
 ing, and when the scabs are removed, the skin is seen to be 
 of a slight redness. On the scalp the scales are large, thick, 
 
IN THE DERMA. 515 
 
 and flat, but they are quite light on the temples, chin, and 
 forehead. 
 
 "When it occurs at the junction of the skin and mucous mem- 
 branes, it is always more troublesome than when otherwise 
 located. In most instances, as it usually occurs, the skin is 
 slightly elevated, and of a light rose-red color. When it 
 attacks the palms of the hands and the feet, between the toes, 
 it is peculiarly troublesome. 
 
 Causes. — These are regarded as being peculiarly obscure. 
 We are disposed to believe that it is frequently caused, re- 
 motely, by an imperfect or feeble pulmonary function. We 
 have, in another place, shown that obesity depends upon this 
 cause ; and having seen this disease confined to those who 
 were organically disposed to be obese, and to those who were 
 phthisically liable, and from the great amount of carbon con- 
 tained in epidermoid matter, we have been induced to make 
 the above suggestion. 
 
 Strong mental emotions are said to have produced it in 
 adults. This fact, if such it be, is favorable to our sugges- 
 tion, because the full chested are those who suffer, most gene- 
 rally, from strong mental emotions. The liability of old 
 people to this disease, is another strong circumstance favorable 
 to our opinion. 
 
 Diagnosis. — The vesicular and pustular diseases are all 
 moist, this is dry ; its fine scales and slightly-elevated surface 
 distinguish it from psoriasis, with its large, shining scales, in- 
 flamed and elevated base. 
 
 Prognosis. — As regards life, it is never dangerous, but with 
 the aged it can never be cured — with the young it may be, by 
 a proper attention to food and exercise. 
 
 Treatment. — In pityriasis, we would recommend the bath- 
 ing of the surface of the body with fresh Olive Oil, two or 
 three times a day, for several days in succession, to be fol- 
 lowed by a spirit vapor-bath, in adults, or a warm alkaline 
 bath, in children — and this treatment should be persevered in 
 for several weeks after an apparent cure has been eflected. 
 
 Internally, the use of the Compound Syrup of Yellow Dock, 
 with Iodide of Potassium, four drachms to a pint of the syrup, 
 must be prescribed, together with an attention to diet, avoiding 
 all vegetable acids, fats, liquors, stimulants, and indigestible 
 
516 I>RY FORMS OF DISEASE 
 
 substances. The bowels must be held in a regular condition, 
 and exercise be taken daily, adapted to the ability of the 
 patient 
 
 Species II. — Psoriasis. 
 
 This affection is marked by scaly patches, which are irregu- 
 larly circular, of a red color, and at first small and projecting. 
 The papulous elevations are frequently not larger than a pin's 
 head, and have their summits speedily covered with a slight 
 scab. They enlarge and rise, but their borders are never 
 prominent, nor their centers depressed. They multiply 
 promptly, many of them breaking out at the same time, and 
 often become confounded with one another. They appear on 
 different parts of the body, but more particularly on the face, 
 trunk, and head. 
 
 When they are divested of their scales, either spontaneously 
 or mechanically, as by scratching, they present a red and 
 slightly- elevated surface. In this condition, they are quite 
 painful, but this does not continue long, for they are speedily 
 re-covered with scales. The spaces which separate the 
 patches are of various extent and surrounded by an inflamed 
 border. 
 
 When the patches are considerably elongated and have a 
 spiral direction, they are QdXlQdi psoriasis gyrata ; when the 
 patches spread and coalesce, they are Qs^W^di j^sor lasts diffusa; 
 and when the disease has continued for many months or for 
 years, it is then denominated psoriasis inveterata. 
 
 In this form of the disease, the skin is said to resemble the 
 bark of trees covered with lichens. When it occurs in infants, 
 it is called psoriasis infantilis^ which does not differ from 
 psoriasis diffusa, except that it is more acute and rapid in its 
 course, with a liability, it is said, of causing deep fissures in 
 the diseased skin, which occasion much suffering. 
 
 Beside the preceding, many other varieties are enumerated, 
 which have not sufficient importance to claim our attention. 
 
 Causes. — That condition of the system, of which pityriasis 
 is symptomatic, we suppose to be, also, the cause of psoriasis, 
 under modifying influences. It is said to be more common to 
 females, than males, and it is often " evidently hereditary." 
 
 Diagnosis. — It is distinguishable from all other cutaneous 
 affections, by the dryness of its eruptions, its salient patches, 
 
m THE DERMA. 517 
 
 thickened and inflamed skin, the elevated centers of the 
 patches, their inflamed shape and size, and their covering of 
 scales. 
 
 Treatment. — In this afiection, the warm bath must be used 
 daily, and the following ointment applied locally : 
 ]^. Benzoic Acid, 3ij, 
 
 Spirits of Turpentine, gtts. xx, 
 
 Camphor, grs. x, 
 
 Lard, 3j. Mix; 
 or, if symptoms of irritation or inflammation are present, the 
 Compound Ointment of Zinc will be found highly serviceable. 
 The internal treatment should consist of alteratives and 
 diuretics, as the Compound Syrup of Yellow Dock and Iodide 
 of Potassium, as heretofore named — the bowels kept regular, 
 with a strict attention to diet and regimen — the same as 
 referred to in the treatment of pityriasis. 
 
 Species III. — Ichthyosis. 
 
 The supposed incurability of this disease gives it a greater 
 physiological than pathological importance, but darkness still 
 envelops it in both respects, and should it ever be found, we 
 predict that it will be to serve a vicarious purpose — the 
 elimination of carbon from the system. 
 
 Its appearance in infancy, and that of adult age, presents a 
 great difference, and yet it is one of degree, rather than one 
 of kind. In infancy, it is liable to be mistaken for that epi- 
 dermic exfoliation which is natural to infancy, a few days after 
 birth. It is considered to be, most generally, a congenital and 
 hereditary disease, which may, and usually does, continue 
 for life. 
 
 It is essentially a disease of the epidermis, and appears in 
 patches of a dirty-gray color, and separated from each other 
 by lines which are superficial and irregular. When detached, 
 the epidermis beneath is discovered to be thickened, and to 
 impart to the touch a harsh feeling. The health does not 
 appear to be affected by it, and the skin does not appear to be 
 inflamed when the scales are removed. 
 
 The thickened condition of the epidermis, its continual 
 reproduction, the form and appearance of the patches, and the 
 obstinacy of the malady, will distinguish it from that epidermic 
 
518 Di^Y FORMS OF DISEASE IJST THE DERMA. 
 
 exfoliation which is common to infancy, and also from all 
 other cutaneous affections, which American physicians will 
 probably see. 
 
 No particular or specific remedy has yet been discovered for 
 this malady — so far as is now known, its treatment must 
 consist in observing a proper course of diet, exercise, and 
 tepid baths. Willan recommended the use of tar and pitch 
 water, and as no better remedy has been discovered, this still 
 continues to be in use. Alkaline baths soften the scales so 
 that they can be readily removed, and then stimulant applica- 
 tions are said to have cured recent cases. 
 
CLASS VI. 
 
 MANIFESTATIONS OE DISEASE IN THE CELLULAR TISSUE. 
 
 INTRODUCTI O N. 
 
 A MERE perception of the non-inflammatory affections of the 
 cellular tissue appears to be attended by a momentary impres- 
 sion of incomprehensibility, which results from the fact, that we 
 do not witness an obvious and — a visible cause. When we see 
 destruction succeeding, in point of time, inflammatory action, 
 the momentary impression is that the latter is the cause. But 
 further examination and reflection find in the pre-existing 
 state of the system, in the first instance, ample cause for the 
 phenomena, without a visibly-active agent ; and in the second, 
 we discover that what appeared to be the cause, is only a 
 manifestation of a restorative efibrt of the system. 
 
 Prof. Caldwell used to contend, and with much ingenuity, 
 that Prussic Acid destroyed life by over excitement; but, 
 where is the proof of it ? where is the time for such an action ? 
 All that we can know in the premises is, the existence and 
 the order of two events : the administration of the drug, and 
 the instantaneous death. In the investigation of oedema and 
 gangrene of infants, w^e shall find it as difficult to show that 
 they are results of inflammation, as that Prussic Acid 
 causes over-excitement. We think that it will be disco- 
 vered that the inflammation appears, in these forms of disease, 
 as a secondary event, and for the purpose of separating the 
 dead from the living parts. 
 
 (519) 
 
520 NOl^-INFLAMMATORY FORMS OF DISEASE 
 
 ORDER I. 
 
 non-inflammatokt foems of disease in the cellular tissue. 
 
 Genus !.■ — (Edema — 
 Induration of the Cellular Tissue. 
 
 The above caption is well calculated to produce a confused 
 idea in the mind of the student ; from the first word, he would 
 not infer a serous repletion of the cellular tissue, but he 
 would conclude that the tissue, in the abstract, was indurated, 
 hardened, compacted, or consolidated. 
 
 Now, the fact in the premises is, the cellular tissue is not 
 in the least at fault — it retains its entire integrity, but, in con- 
 sideration of its extraordinary serous repletion, it offers to 
 the sense of touch such a resistance as to produce the idea 
 of hardness or induration. 
 
 The serous and adipose tissues present two varieties of 
 hardness or induration — the former is attended with an in- 
 crease of the size of the limbs or parts affected, and also with 
 a violet color of the integuments, and the other, indications of 
 a sanguineous congestion — such as difiicult respiration and 
 irregular pulse — unequivocal signs of enlargement of the 
 heart and lungs. Adipose induration may, or may not, exist 
 with the serous — it shows itself usually in the calves of the 
 legs, nates, and cheeks. When merely adipose, it will not be 
 attended by the difficulties in the respiratory and circulatory 
 functions, above-named. 
 
 This variety is most generally exhibited in the moment of 
 dissolution, but may be developed after death. To the touch, 
 it produces such a sensation as would be experienced by touch- 
 ing the fat of dead animals. By an inordinate reduction of 
 the animal heat, this hardness may take place before as well 
 as after death, and it is not difficult to conceive of such a pos- 
 sibility, in parts so remotely connected with the centers of cir- 
 culation, more especially in such patients as are usually the 
 subjects of this form of disease, for they are so feeble as to be 
 barely able to manifest the presence of life. 
 
 The light which has been shed upon this subject, goes to 
 show that the so-called induration of the cellular tissue is 
 
m THE CELLULAR TISSUE. 521 
 
 nothing more than such an oedema as may and does occnr 
 with adults. This we conclude to be the fact, however diffe- 
 rently produced. 
 
 When we contemplate the exceeding debility with which 
 such patients are born — the great amount of venous blood in 
 the tissues, particularly in the cellular — and the dry state of 
 the skin, it does not, to us, appear difl&cult to arrive at a pro- 
 bable conclusion. 
 
 The facts above-stated show that no process was in action 
 for the production of animal heat — that the cellular repletion 
 was very probably produced passively or mechanically, and 
 that the condition which might thus result, must continue 
 because of the non-cutaneous transpiration. 
 
 (Edema is very frequently complicated with other forms of 
 disease, but, of itself, it should not be regarded as necessarily 
 fatal. In so tender an age, we can do but little except through 
 the skin, and, fortunately, through it alone we can frequently 
 effect a cure. 
 
 The practice must consist of irritating frictions, woolen gar- 
 ments, and warm covering. In this wise, cutaneous transpi- 
 ration is easily excited. Tepid baths have been tried, and 
 have, pretty uniformly, been found mischievous ; and for the 
 obvious reason that the vital force is incapable of contending 
 against the external pressure ; and the vapor-bath has not been 
 more favorably received, but why, we cannot tell. 
 
 Genus II. — Gangrene of Infants. 
 
 We have always observed that it is exceedingly difficult for 
 men to adopt a false position and maintain consistency in its 
 discussion. We shall find this fact to be strikingly illustrated 
 by Wood and Billard, in the investigation of this subject. 
 
 The latter informs us, that he understands this disease to 
 be a "variety of gangrenous inflammation,"* and that it 
 occurs " in those infants in whom the respiratory and circula- 
 tory functions are imperfectly executed, producing a very evi- 
 dent sanguineous congestion of the extremities, which become 
 purple and cold, and soon shrink, dry, decompose, and spha- 
 celate, until an inflammatory circle forming, bounds the 
 
 * A singular inflammation ! a composition of vitality and death ! 
 
522 NON-INFLAMMATORY FORMS OF DISEASE 
 
 ravages of the gangrene, analogous to the gangrene of old 
 people — or until death terminates this disorganization of the 
 integuments." 
 
 We do not remember ever to have seen, in one paragraph, 
 more inconsistency than the preceding contains. What is in- 
 flammation ? Is it not an accumulation of vitality to remove 
 disease or overcome obstruction, and is it not characterized by 
 redness, heat, and tumefaction? Are these phenomena wit- 
 nessed in the gangrenous part in any stage of the pro- 
 cess? 
 
 In this form of disease, the extremities become cold and 
 purple, and soon shrink and dry, and what stops this process? 
 Simply the absence of death — the gangrene progresses until it 
 reaches a part which has sufficient vitality to make an efibrt 
 to cast off the dead part — and this effort is evinced by the 
 inflammation — by an inflammatory circle which divides the 
 living from the dead parts. The inflammation then, was a 
 sequent and not an antecedent — death takes possession of the 
 part before there appears a single inflammatory indication. 
 
 Prof. Wood thinks it very probable, that many cases of 
 spontaneous gangrene may have their origin in an inflamma- 
 tion of the arteries. Although we would not dispute this 
 position with him, yet we have a right to infer from it, that 
 the disease under consideration may also be sometimes occa- 
 sioned in this way, more especially as he has not treated of 
 gangrene as independent of inflammation. To such an infer- 
 ence, we object, because the circumstances under which infan- 
 tile gangrene takes place, preclude all idea of inflammation as 
 a cause. 
 
 It occurs in those whose circulatory and respiratory func- 
 tions are imperfectly executed. They stand closely allied to 
 the oedematous. They have inherently in them, an absolute 
 inability to discharge the essential functions of life. The same 
 condition becomes true in extreme old age. 
 
 We can perceive no difference between an extremity frozen 
 to death, and one that dies for want of nourishment, espe- 
 cially when it is denied through a positive inability of the con- 
 stitution to provide it. If the gangrene of an extremity frozen 
 to death, is one of gangrenous inflammation, then the terms 
 defy definition, and can serve no other purpose than that of a 
 
m THE CELLULAR TISSUE. 523 
 
 cloak to conceal ignorance, and we feel better under an open 
 confession of ours, than in maintaining a false position. 
 
 This form of disease, ordinarily shows itself upon the toes 
 and fingers, but sometimes upon the arms and legs, and, 
 instead of the skin shrinking and wrinkling, as before 
 remarked, it may become covered with small blisters, which 
 contain a sanguineous fluid. The integuments become em- 
 physematous and yield the well-known gangrenous odor. The 
 blisters break and are replaced by a livid excoriation. The 
 abdomen becomes distended with flatus and the body cedema- 
 tous — the senses become dead, the respiration is barely per- 
 ceptible, and thus the patient gradually sinks. 
 
 The only treatment that can be adopted with any probability 
 of success, is to promote capillary circulation, by bathing and 
 frictions applied to the whole surface of the body, together 
 with tonics and diuretics internally, as Quinia, Hydrastin, 
 Xanthoxylin, etc., for tonics, and the roots of Eupatorium Pur- 
 pureum and Daucus Carota, or Epigea Eepens and Pyrola 
 Maculata, as diuretics. When the gangrene is formed, a solu- 
 tion of Sulphate of Zinc should be applied to the ulcers, over 
 which an Elm poultice, must be placed, both for the purpose 
 of allaying undue action from the zinc solution, and to facili- 
 tate the removal of the slough. However, but little can be 
 expected from any treatment. 
 
CLASS VII. 
 
 MAXIPESTATIOXS OF DISEASE m THE 0RGA:N^S OP THE EXTERNAL SENSES. 
 
 ORDER I. 
 
 mFLAMMATOKY FORMS OF DISEASE IN THE ORGANS OF THE 
 EXTERNAL SENSES. 
 
 Genus I. — Ophthalmia Purulenta — 
 Inflammation of the Eyes. 
 
 Of all the sources of human blindness, this is perhaps the 
 most fruitful, sometimes through neglect, at other times through 
 mal-practice, and sometimes, probably, through its own inhe- 
 rent violence. It sometimes happens that mothers and nurses 
 neglect it frequently in the beginning, under the impression 
 that the infant has taken a little cold in the eyes, and that 
 probably it will subside or leave the child in a few days. In 
 the meantime, the only remedy that has been used was the 
 washing of the eyes with breast-milk — not so "insignifi- 
 cant" a remedy as some have thought it to be — far better than 
 the profession has sometimes prescribed ; but, nevertheless, 
 inadequate to the demands of the case, as many physicians 
 can testify, who upon being called, have found the eye- 
 lids swollen and glued together, and upon obtaining a view of 
 what is going on beneath them, finds sometimes only inflam- 
 mation and suppuration, but at other times he finds one or 
 both eyes destroyed — irreparably ruined — the cornea is opake 
 or it has sloughed, or possibly some variety of staphyloma has 
 been produced. 
 
 It usually attacks the infant between the third and eighth 
 day, but sometimes at a later day, though probably never 
 after the second week from birth. The first manifested sign 
 of its approach, is the gluing together of the eyelids during 
 
 (524) 
 
DISEASE m THE EXTER^-AL SENSES. 525 
 
 the night, but shortly after, they become swollen, which is 
 most apparent in the early part of the day, and quickly fol- 
 lowing, the globes of the eyes are found participating in the 
 inflammation, and the infant keeping its eyelids closed — shun- 
 ning the smallest and most diffused ray of light. 
 
 After the third or fourth day of the attack, there is usually 
 a copious secretion of pus, the inspissation of which between 
 the eyelids, pretty firmly glues them together during the night, 
 and the balance being retained between the lids and globes, 
 gives the appearance of much swelling of the eyes, in the 
 morning. 
 
 When the lids are separated, which is readily done by the 
 use of warm water, considerable pus escapes, and upon sepa- 
 rating the lids, the balls seem to be floating in pus ; no part 
 of the iris can be seen, and when the pus is removed the lining 
 membrane of the lids is found to be of a bright red or scarlet 
 color, indicating a severe inflammation. 
 
 Causes. — Prof. Dewees is of opinion that this form of 
 disease is occasioned by the presence, with the mother, of 
 iCucorrhea or gonorrhea ; and that it is acquired by the infant 
 in transitu. The reason he assigns for this opinion, which has 
 the most influence upon us, is, that in many instances of this 
 afi'ection which came to his notice, he learned, upon inquiry, 
 that the mother was the subject of one or the other of the 
 above forms of disease. In confirmation of this conclusion, 
 or rather one of the facts that induced it, is its appearance in 
 about the proper time for such a cause to have produced it. 
 
 There is another circumstance which he names, in this con- 
 nection, that is entitled to some weight, and that is, the severity 
 of the inflammation ; but Dr. Watson states that it sometimes 
 occurs "in infants of mothers who seem to be health}^, and 
 who deny that they have any unnatural discharge." 
 
 Dr. Watson thinks it probable that it may be induced by 
 other causes, as bad management of the nurse, cold air, a hot 
 and bright fire, soap, ardent spirits, etc. Without any inten- 
 tion of denying the existence of such probability, we would 
 remark, that it seems to us quite reasonable to suppose, that 
 if other than the causes assigned by Prof. Dewees, can pro- 
 duce the disease, that it would not be confined to so early a 
 period of life. 
 
526 INFLAMMATORY FORMS OF DISEASE 
 
 Prognosis. — This form of disease, in adults, says Dr. Wat 
 son, is much more controllable than it is in infants, so much, 
 so, that when the physician finds the cornea, in the case 
 of the latter, to be sound, he may confidently assure the pa- 
 rents that the eyes of the infant are safe ; if opacity has 
 seized upon the cornea, the chance of saving the eyes is 
 doubtful, but not hopeless; and if the cornea cannot be seen, 
 the prognosis is unfavorable, and this should be the statement 
 to the parents, " for such is the ignorance of the vulgar, (and 
 I include both rich and poor under this phrase), that if they 
 are not forewarned of the danger, they are very apt to attri- 
 bute the blindness that ensues to your stuffs as they call it." 
 
 Treatment. — The first indication is to relieve the inflamma- 
 tion, should it exist, and this may be accomplished by the 
 application of cold water to the eyes, continually applied by 
 means of a light compress, and the eyes should be frequently 
 bathed with a decoction of Marsh Mallows or with Eose- 
 water. 
 
 As soon as the inflammation has been subdued, the eyes 
 should be bathed several times a day with a decoction of 
 Hydrastis Canadensis, and, in obstinate cases, the Compound 
 Myrrh Collyrium, or the Compound Collyrium of Golden Seal. 
 
 The bowels must be kept regular by enemas ; active cathar- 
 tics by the mouth must be avoided, as well as the action of 
 excessive light upon the eyes for several days, both during 
 the treatment and after a cure has been efiected. 
 
 Genus II. — Scrofulous Ophthalmia. 
 
 We are not prepared to believe that there is such a specific 
 form of disease, but we admit that common ophthalmia, in- 
 duced in a scrofulous constitution, may be so modified as to 
 deserve a special consideration, more especially as it has this 
 specific feature, namely : infants are the most general subjects 
 of it — in them, it appears, apparently, as the first indication 
 of the existence of a scrofulous constitution. 
 
 When it first invades the conjunctiva, its character is that 
 of simple ophthalmia, and so it continues through the truly 
 inflammatory stage, and therefore, it is not until a somewhat 
 chronic character has been assumed that the scrofulous symp- 
 toms appear, to impede recovery. It is seen that the conjunctiva 
 
m THE EXTERITAL SENSES. 527 
 
 does not return to its normal color and condition ; that the 
 light has become painful ; that the tears flow copiously ; that 
 the purulent discharge has become reduced; that the glands 
 of the tarsi produce a muco-purulent secretion that aggluti- 
 nates the eyelids during sleep ; and in many instances, we 
 find delicately-small vesicles scattered over the cornea and 
 conjunctiva of the sclerotic coat. These vesicles may run on 
 to the formation of ulcers, and they progress and so penetrate 
 the cornea as to communicate with the anterior chamber of 
 the eye, and thus give egress to the aqueous humor. A con- 
 siderable remission of the symptoms frequently, if not gene- 
 rally, takes place in the evening or after sunset. 
 
 Treatment. — In the treatment of this affection, the first in- 
 dication is to correct the depraved condition of the constitu- 
 tion, and this can be best efiected by placing the patient in a 
 pure and healthy atmosphere ; to apply warm and comfortable 
 clothing ; to supply a nutritious diet : beyond these, to efiect 
 a general purpose, we must rely upon tonics, salt-water, and 
 alkaline baths; very little local treatment is required. 
 
 In the early stages, except in cases where the constitutional 
 treatment has been neglected, cold water and Slippery-elm 
 poultices and confinement to a dark room, will, in most cases, 
 prevent any further development of the disease ; but, in cases 
 where this is not sufiiciently active to arrest the inflammation, 
 the leaves of the Scrofula Marylandica may be powdered and 
 mixed with Slippery-elm. This, in many cases, will remove 
 the inflammation in a very short time, but, in more obstinate 
 cases, a strong decoction of Hydrastis Canadensis should be 
 applied to the eyes constantly during the day. 
 
 The Alcoholic vapor-bath, with the Sudorific Tincture, 
 should, in all cases, be used when the skin is dry. 
 
 As soon as free perspiration has commenced, it should be 
 kept up by the aid of diaphoretic teas or by the internal use 
 of cold water, after which cold water may be frequently ap- 
 plied to the eyes. 
 
 If constipation of the bowels be present, the Compound 
 Powder of Jalap and Cream of Tartar should be used until 
 free catharsis is produced. 
 
 If ulceration of the cornea should occur after the active 
 
528 mFLAMMATORY FORMS OF DISEASE 
 
 Stages have subsided, the following prescription may be 
 used : 
 
 ]^. Tinct. Hydrastis, 
 Tinct. Capsicum, 
 Olive Oil, aa 3i. Mix. 
 From two to five drops should be applied to the eye twice a 
 day. This will produce pain when first applied, but it will 
 continue only a few minutes. After having used this for seve- 
 ral days, as above described, and no improvement of the ulcer 
 or opacity takes place, a mild solution of the Sesquicarbonate 
 of Potassa may be applied. 
 
 In all cases, the free use of the Alterative Syrup, or the 
 Compound Syrup of Stillingia should be made, given in as 
 large doses as the patient will bear, without being attended 
 with nausea. 
 
 When the disease resists all of the above treatment, as it 
 may in some cases, the Irritating Plaster may be applied and 
 kept upon the back of the neck, until suppuration is induced, 
 and this, as a general thing, should be kept up by the re- 
 application of the plaster until the disease has disappeared, 
 which may require from three io five months. 
 
 Genus III. — Otitis — 
 Inflainmation of the Mucous Membrane of the Ear. 
 
 This form of disease, with those who are old enough to 
 make known their condition, produces excruciating pain and 
 intolerable humming in the ear, and therefore, we cannot 
 doubt that the same is true of its existence in the infant. 
 
 Otitis is divided into external and internal, according as it 
 afiects the meatus auditorius, or the cavity of the tympanum 
 or internal ear. 
 
 Its occurrence in the internal ear, not unfrequently appears 
 before the completion of the first dentition, producing great 
 suffering, of which the patient is unable to give any particular 
 information : we must be guided to the seat of the disease by 
 its instinctive manifestations. Before the violent stage of the 
 attack, the child is peevish and fretful, from a few hours to a 
 day or so. During this time, it manifests no disposition to 
 play, all sounds are unpleasant to it, and if tossed about, it 
 
m THE EXTERNAL SENSES. 520. 
 
 will cry ; it seems but little disposed to take the breast, but 
 will take food from a spoon. It desires to rest the afiected 
 side of its head upon its mother's bosom, and if on the bed, 
 it turns its head from side to side on the pillow, and finally 
 comes to repose upon its face. After crying, it sleeps, but the 
 repose is short, because of some sudden infliction of pain. It 
 may sometimes cry for hours in defiance of all means to quiet 
 it. If old enough, it will frequently apply its hand to the 
 affected ear. 
 
 The greatest intensity of the pain does not continue long, 
 before it is relieved by a discharge of pus, which may prove a 
 final terminus of the disease, or merely an abatement of it, 
 but in young infants it very rarely puts on the chronic form. 
 
 When the disease becomes chronic, it is accompanied by a 
 puruljiit discharge from the meatus auditorius, and usually 
 proves so incurable that it progresses to an invasion of the 
 internal ear, and after a complete destruction of the organ, it 
 becomes well, in most cases, but, occasionally, it invades the 
 brain and terminates fatally. 
 
 Diagnosis. — There is some little danger of mistaking the 
 acute form of this disease for hydrocephalus ; but if proper 
 attention be given to a few circumstances such a blunder may 
 be avoided. In hydrocephalus, there is costiveness, vomiting, 
 and febrile indications, which are absent in otitis — pressure 
 upon the cartilages of the afiected ear will produce indications 
 of suffering, which the well one will not, and the constant 
 disposition of the patient to rest the head on the same side, 
 and the placing the hand to the same side, furnish an ample 
 diagnosis. 
 
 Tkeatment. — In this afiection, we have found the greatest 
 use by applying sinapisms of Garlics, bruised, to the feet, 
 and behind the ears, with the use of Saffron infusion, or other 
 agents which will equalize the circulation by a cutaneous 
 determination, together with the application of a mixture com- 
 posed of two to four drops of Oil of Sweet Almonds and one 
 of Laudanum, a drop of which, warmed, may be allowed to 
 fall into the afiected ear, or may be pressed gently into the ear 
 on some lint, and repeated as often as required. 
 
 The bowels should likewise be kept free by mild laxatives, 
 brisk purgation being unnecessary. 
 
530 DISEASE 11^ THE EXTERNAL SENSES. 
 
 When a discharge takes place from the ear, and manifests 
 a disposition to become chronic, the abscesses not healing 
 readily, the parts should be kept clean, by frequently syringing 
 out the canal of the ear with Castile Soap and water, or a 
 solution of Chloride of Sodium ; after which, to prevent, if 
 possible, any mischief from an extension of the disease, the 
 ear should be syringed with a weak solution of Sulphate of 
 Zinc, or Sesquicarbonate of Potash. 
 
CLASS VIII. 
 
 MANIFESTATIONS OP DISEASE IN THE GENITAL APPARATUS. 
 
 ORDER I. 
 
 DISEASE OF THE GENITAL APPARATUS. 
 
 Genus I. — Adhesion of the Labia Pudendi. 
 
 This event may sometimes be congenite, but it does not 
 generally occur before the child is six or seven months old, 
 and perhaps it as rarely occurs after the age of twelve months. 
 There is too much solicitude felt about the normal condition 
 of the genital parts to admit of a supposition that it should 
 escape an examination within the first day or two of indepen- 
 dent existence ; we must, therefore, conclude, that when the 
 discovery is made between the sixth and twelfth month, that 
 it resulted from neglect. 
 
 The genital parts of infants should be as regularly cleansed 
 as the child is washed, and this duty should be positively 
 enforced upon nurses. When we consider the extreme deli- 
 cacy and vascularity of the lining membrane of the labia, we 
 should not be surprised that such a result should follow 
 neglect. The uterine and vaginal secretions may, by continu- 
 ing too long upon a surface unadapted to them, produce irrita- 
 tion, and when aided by the salts of the urine, may produce 
 inflammation and consequent adhesion. 
 
 Billard says, that in infants, the labia are very prominent, 
 and become infiltrated, tumefied, and inflamed w^ith the greatest 
 facilit}', when constantly covered with the excretions. 
 
 An event of this kind has, veiy unfortunately, sometimes 
 escaped detection during infancy, and if detected in after 
 years by the female herself, it has been neglected to a moment 
 the most embarrassing in her history — and then a surgeon is 
 sent for to effect their separation. 
 
 (531) 
 
532 MANIFESTATIONS OF DISEASE 
 
 The labia readily separate when in their normal condition, 
 and therefore, when they refuse to separate by a very slight 
 effort, we may suspect that adhesion has taken place, and 
 when it has, it is found to exist through their whole length, 
 as far as the meatus urinarius. Through this opening, the 
 urine is discharged, and so is the menstrual secretion in after 
 years, should the adhesion continue. 
 
 The profession has but one remedy for this accident, which 
 is the knife. The division or separation may be easily per- 
 formed by passing a probe-pointed l^istoury into the unclosed 
 part and cutting down to the junction of the labia. They may 
 be then kept separate by the introduction between them of a 
 little oiled lint. 
 
 This separation is, however, sometimes spontaneously 
 effected ; the adhesive inflammation that closed them may 
 pass into suppuration and separate them. Medical history 
 records several instances of this kind, but &uch an event is 
 never to be hoped for, because it is never so well done as with 
 the bistoury. In two or three days after the operation, the 
 parts are well. 
 
 Genus II. — Discharges feom the Infantile Yagina. 
 
 In infant females, the vagina is very much developed, and 
 its mucous lining secretes a large quantity of white, adherent 
 mucosity. It is, furthermore, not uncommon to observe a red, 
 blood-like £uid to flow continually from the vulva for some 
 days or weeks after birtb — it has much resemblance to the 
 catamenia in adult females. It is not known to produce any 
 inconvenience, and after a time ceases of itself. These physi- 
 ological facts indicate a necessity for great cleanliness during 
 the first weeks of female infancy, a neglect of which occa- 
 sions, no doubt, those unhealthy discharges of which we are 
 about to treat. 
 
 Discharges of a purulent character, from the vagina, show 
 themselves, sometimes, in females of about the age of five 
 years, which may continue indefinitely. In reference to such 
 a condition, mothers should keep over their daughters a vigi- 
 lant care. Upon the indulgence of such conditions, is founded 
 those troublesome cases of fluor albus, wliich do so much to 
 impair and enfeeble the general health in future life. ; 
 
m THE GENITAL APPARATUS. §3^ 
 
 This form of disease cannot be cured without the most 
 strict regard to cleanliness, and hence the treatment should 
 commence with it. Let the vagina and the interior surfaces 
 of the labia be washed with warm water four or five times a 
 d=aj, and after each washing, applj^ the warm Borax Lotion 
 with Morphia. If excoriation of any part exists, let it be 
 coated with fresh Lard, or covered with flour of Slippery-elm: 
 bark. The bowels should be maintained in a normal condi- 
 tion, and the diet should be nourishing — fats, sugars, butter, 
 and old or rancid meats should be avoided. If such a course 
 of "medication does not remove the discharge, then alteratives 
 must be conjoined with the treatment, as the Compound Syrup 
 of Yellow Dock, or the Compound Syrup of Stillingia, with 
 or without the addition of the Iodide of Potassium, as the case 
 may require. 
 
 Genus III. — Hydrocele, or Dropsy of the Scrotum. 
 
 We understand, generally, by this term, a collection of 
 serous fluid in the areolar texture or in some of the coatings, 
 either of the testicle or spermatic cord. When the fluid is in the 
 spermatic cord, it is known as encysted or diffused hydrocele 
 of the spermatic cord, as the case may happen to be. Hydro- 
 cele of the tunica vaginalis occurs when the collection of fluid 
 is confined to the envelope ; and it is regarded as congenital 
 when the interior of the membrane possesses a free communi- 
 cation with the cavity of the abdomen. 
 
 Although the affection may be congenital, it very rarely 
 becomes noticed under several days. As all affections of the 
 genital organs, in consequence of their great importance, 
 excite alarm, it may be readily supposed that this forms no 
 exception, and it is fortunate that such is the case, because a 
 neglect of this might occasion an indifierence to another affec- 
 tion, which it resembles, namely, a rupture, which is really 
 of more importance, as it involves the life of the patient. 
 
 The tumor is sometimes as large as an egg, and it is occa- 
 eionally confined to one side of the scrotum ; it gives the 
 patient no inconvenience, and though it generally occurs in 
 infancy, yet, in some instances, it is dela3^ed several months. 
 
 Diagnosis. — It is important that a clear diagnosis should be 
 had between hydrocele and rupture. The former presents a 
 
534 DISEASE IN THE GENITAL APPARATUS. 
 
 considerable transparency ; the scrotum is more equably dis- 
 tended ; the tumor is not increased by crying ; the handling 
 of it gives no pain, and pressure does not remove it. 
 
 Teeatment. — Cold water poured upon the parts twice a 
 day, from a height of some two or three feet, will usually 
 overcome the difficulty ; about half a gallon may be used at a 
 time, allowing it to run through the spout of a tea-kettle. 
 
 Should the case not readily yield to this, the parts may be 
 kept constantly moistened, in the interim, with a solution of 
 Muriate of Ammonia in vinegar, which may be applied on 
 cotton or lint, and gentle pressure made upon the scrotum by 
 means of a bandage, for the purpose of aiding absorption. In 
 connection with this, an infusion of some diuretic agent may 
 be used, such as, Pyrola Maculata, Aralia Hispida, etc. 
 
 Occasionally, in long-standing cases, where a large amount 
 of fluid is present, and the tunica vaginalis becomes thickened 
 and insensible, which is seldom the case with children, being 
 more common to persons somewhat advanced, the fluid will 
 have to be discharged by means of a trocar, after which stimu- 
 lants are to be injected, such as brandy -and -water, Tincture 
 of Sanguinaria and Capsicum, and even a solution of Sesqui- 
 carbonate of Potash, which are to be continued until the cure 
 is efiected. 
 
P A KT II. 
 
 MANIFESTATIONS OF DISEASE IN THE VEGETATIVE OR DIGESTIVE 
 
 SYSTEM. 
 
 INTRODUCTION. 
 
 If every part and parcel of this system should be suddenly 
 destroyed, it would not be followed by a corresponding sus- 
 pension or destruction of life ; consequently, in point of impor- 
 tance, it is only secondary to that, the consideration of which 
 we have just concluded. 
 
 In the digestive process, life can be continued for a conside- 
 rable time, with a very feeble exercise of the nutritive process, 
 but in the respiratory, there must be precisely function 
 enough^the blood must be oxygenized — and the suspension 
 of a few respirations never fails to extinguish the candle of 
 life. 
 
 Life may be continued, until destroyed by waste, so long as 
 the nervous system shall maintain its integrity, but this it 
 cannot do without the co-operation of the respiratory and cir- 
 culatory functions. To explain — the lungs must discharge 
 their function upon the blood, and the blood must be conveyed 
 to the nervous apparatus, or life is at once extinct. It does 
 not appear, then, according to Prof. Meigs, that ''the source 
 of all vital power is in the nervous mass," for, no matter how 
 perfectly this mass preserves its integrity, its power will 
 depend upon the thoroughness of its oxygenation ; yet it is 
 true, that unless the skin and the digestive apparatus discharge 
 properly their functions, the blood cannot be of a good quality ; 
 but this imperfection affects nutrition much more than nervous 
 innervation — this last process depending more especially upon 
 the presence of oxygen. 
 
 (535) 
 
536 MAMFESTATIONS OF DISEASE 
 
 Without regarding the pulmonary function as the only 
 direct source of innervation to the nervous sj'Stem, we cannot 
 appreciate its great importance. The nervous and circulatory 
 systems hold to the lungs the relation of servants — while the 
 lungs exist, in relation to life and the power of life, as a sine 
 qua 710 n. 
 
 But, however important the cerebro-spinal system may be 
 to our present existence and external relations, yet the vege- 
 tative is not less indispensable to the development of our 
 bodies and their perpetuity to old age ; and as a large portion 
 of our second Book was appropriated to the proper care and 
 development of this system, the necessity of saying much 
 about it, in this place, becomes unnecessary. 
 
 In our investigation of the previous forms of disease, we 
 found them associated with certain conditions of the base of 
 the brain and the spinal column, which were so obvious as to 
 give to our labors somewhat of a scientific accuracy ; but as 
 the various forms of disease, incidental to this system, depend 
 mainly upon the ganglionic, yet, for oar preservation, it 
 is made to hold intimate relations with the cerebro-spinal sys- 
 tem of nervous communication, as to envelop them in much 
 obscurity — an obscurity that is well calculated to test the per- 
 ceptive and discriminating capacities of the practical physician. 
 • We cannot say what may not be discovered in relation to 
 this subject, but as yet we know very little more than that we 
 are particularly ignorant of the modus ojperandi of that nerv- 
 ous influence to which they are subject. 
 
 It should be remembered, that of the existence and func- 
 tions of this system we have not, in a state of health, any 
 consciousness, and that a connection between it and the 
 cerebro-spinal only becomes known to us in a state of disease ; 
 it happens, therefore, that while the morbid action is going 
 on, in one part, the manifestation of existing disease will be 
 in a remote and a very difierent part — that, for illustration, 
 the patient may suffer severely with a pain in the head or in 
 a tooth, while the stomach is the true seat of the morbid 
 action — that while some part of the ganglionic or splanchnic 
 sy-stem is being undermined by serious disease, we have to 
 search for the particular part through its innumerable sympa- 
 thies in the cerebro-spinal. 
 
m THE DIGESTIVE SYSTEM. 537 
 
 Thus it appears, that although we have divided the mani- 
 festations of disease into two great families, which, in reality, 
 differ as widely from each other as any two great families in 
 natural history, yet, so numerous are the points of connection 
 between the two, that it would scarcely have appeared as a 
 violation of order to have treated of both as one. 
 
 In our division, we have included in the cerebro-spinal sys- 
 tem, the respiratory apparatus, because we have, in part, a 
 voluntaryagency over it,and because its strength and develop- 
 ment incidentally result from the exercise of our voluntary 
 agency. We have also embraced in the same family the cir- 
 culatory apparatus, although we have no voluntary agency over 
 it, because of the second reason above assigned for the respi- 
 ratory. 
 
 In fact, we adopted the division we have made, because the 
 functions embraced by the first part can be referred to the base 
 of the brain, directly, for the efficiency they manifest. By 
 this division, therefore, we have been enabled to treat of all 
 that is embraced in the first part with more utility and lucidity 
 than we could have done under any other. 
 
 Every teacher adopts some plan by which he expects to 
 facilitate the performance of his function — and in this consists 
 the greatest importance of classification, for nature, in a great 
 measure repudiates any classification that man can make. 
 
CLASS I, 
 
 MA2sTFE3TAnOXS OP DISEASE IX PAEIS LOCATED A^OTE THE DIAPHEAGK 
 
 ORDEK I. 
 
 ESTLAilMATOEY F0EM5 OF DISEASE IX PAETS LOCATED ABOVE 
 THE DIAPHEAGM. 
 
 Gexus I. — Stomatitis — 
 Injiainmaiioii of the Mouth. 
 Remaeks. — This affection appears under a considerable 
 variety of forms, which result from differences of cause and 
 of constitution. This form of disease appears with such 
 marked differences, in different individuals, as to have caused 
 pathologists to divide it into six or seven sub- forms, for its 
 better elucidation and treatment. 
 
 Species L. — Stomatitis Erythematic — Common Inflajjima- 
 tion of the Mouth. 
 
 This inflammation may so spread itself as to occupy the 
 whole of the linino: membrane of the mouth, but, more gene- 
 rally, it appears in patches. It is sometimes very superficial 
 or erythematic in its character, but at other times it involves 
 the entire thickness of the membrane, and, in some instances, 
 involves the sub-mucous tissue and the adjacent glands, and 
 thereby produces considerable pain and swelling. 
 
 The superficial or erythematic form is characterized by red- 
 ness, heat, and sometimes with dryness of the mouth and 
 tongue. It varies considerably in its duration and intensity; 
 with regard to the first, it may be transitory, or it may con- 
 tinue for a long time. In young infants, it is but rarely 
 attended by febrile symptoms or derangement ; but in children 
 of eight or nine months it is apt to be attended with much 
 (538; 
 
DISEASE ABOVE THE DIAPHRAGM. 539 
 
 pain and febrile derangement. The epithelium sometimes 
 becomes opake, and occasionally rises into blisters, and 
 becomes detached. 
 
 In such states of the system as indicate a more than ordi- 
 nary depravity, superficial ulcers appear, which may spread 
 or become deep, as well as extensive, and finally, if the con- 
 stitution be too depraved and feeble to sustain such an inflam- 
 matory action as may be essential to the removal of the 
 disease, gangrene may supervene. 
 
 When this affection happens to involve the gums, after the 
 teeth have appeared, they swell and rise between the teeth, 
 and frequently ulcerate, and this destructive action may con- 
 tinue until the teeth are disengaged or removed ; but such 
 instances as this are very rare. 
 
 There is a mild variety of this afiection which has been 
 denominated catarrhal — the secretions of the mouth are abun- 
 dant — the tongue is furred, and the taste blunted. This has 
 been, very carelessly, mistaken for disease of the stomach. 
 Such a suspicion should not be found in the absence of all 
 direct gastric symptoms. Stomatitis may accompany gastritis 
 or enteritis, but, in such cases, the symptoms, if attended to, 
 will permit of no mistake. 
 
 Causes. — When it is idiopathic, it results generally from 
 some chemical or mechanical cause — the latter can very sel- 
 dom be a cause in infancy, but the former may, as by an acci- 
 dental use of acid substances. At this early age, it is most 
 generally symptomatic of gastric irritation or disease. It may 
 sometimes result from an extension of either variety of angina. 
 
 Treatment. — If the disease have resulted from chemical or 
 mechanical means, the occasional use of a little Sweet Oil, 
 applied with a hair pencil or a feather may alone prove suffi- 
 cient, but should it prove more obstinate, resort must be had 
 to astringent washes, as infusions of Geranium, and in case of 
 much inflammation, a solution of Borax should be freely used 
 as a wash. 
 
 If it shall be symptomatic, our first duty should be the 
 removal or mitigation of the disease of which it is a conse- 
 quent. 
 
540 INFLAMMATORY FORMS OF DISEASE 
 
 Species II. — Stomatitis lo it Ji altered secretion — Infantile 
 Sore- Mouth — Thrush. 
 
 This form of disease commences with an erythematic inflam- 
 mation of the epithelium of the mouth, or the surface of the 
 tongue ; and after two or three days, small, white points are 
 presented upon its extremity or sides, or upon the internal 
 surface of the lip, particularly the inferior one, and they ap- 
 pear to crown the papillae of the surface to which they adhere. 
 These increase in number and coalesce so as to form patches, 
 which may finally cover the tongue, the roof of the mouth, 
 the inside of the cheeks, and sometimes the fauces. 
 
 The progress of this form, from its most simple to its more 
 complicated character, presents, through its excretion or exu- 
 dation, three distinct results or phenomena: the first we have 
 named, consisting of white points ; the second, is that of vari- 
 ously-sized shreds ; and the third, is that of a pellicle or mem- 
 brane covering all of the diseased parts. This membrane 
 assumes, sometimes, a yellowish or a reddish color, but these 
 are adventitious circumstances — having nothing to do with the 
 disease — mere stains from the presence of bile, or sanguineous 
 exhalation. 
 
 The true seat of the disease appears to be the surface of the 
 epithelium, and not the parts below it; and the state of it, 
 which the white points represent, may be regarded as the first 
 or mild stage, and if it progress no further — the white points 
 disappearing — the attack may be considered as mild. 
 
 When the points coalesce to the formation of patches, which 
 thicken and exfoliate and leave the surfaces they occupied red 
 and inflamed, to produce another crop to exfoliate in like man- 
 ner, without further increase of the inflammation, then there 
 is a termination of the disease in the second degree. 
 
 When the inflammation so spreads as to render the patches 
 confluent — forming follicles of greater thickness and extent, 
 then it is regarded as malignant. Post mortem examinations 
 have discovered patches of the exudation in the oesophagus, 
 stomach, and small intestines. 
 
 In the course of the disease, in either of its forms, the exu- 
 dations may exfoliate and be replaced several times, and con- 
 sequently, there is no definite period for its reign — it may vary 
 
ABOVE THE DIAPHRAGM. 541 
 
 from a few days to several weeks. Diarrh(ja, flatus, and colic 
 pains are frequently attendant upon it. The breath of the 
 child often has an acid odor — the contents of the stomach, 
 when thrown up, are green, and smell like the breath, and 
 this acidity may be the occasion of that redness which is 
 sometimes seen about the anus in this complaint. 
 
 The skin is usually hot and dry and the thirst insatiable, 
 and yet fever is scarcely ever manifested, and the pulse is as 
 rarely aflected. 
 
 No age can be regarded as entirely exempt from this dis- 
 ease, but infancy is peculiarly liable to it, and equally so, per- 
 haps, in all seasons of the year. It is not now considered to 
 be contagious. 
 
 Causes. — Improper nutrition, foul air, and improper or defi- 
 cient attention to the skin, may probably be regarded as the 
 principal exciting causes in early infancy. The remote cause, 
 •it is said, may consist in that predisposition of the mucous 
 membranes of infancy to inflammation — a consequence of their 
 sanguineous repletion. We think it to be far more probable 
 that it consists in some feebleness or depravity of the constitu- 
 tion — a want of vital force; and hence, instead of a predis- 
 position to it, there was only an organic liability to it. And 
 it should be remembered that neither fat nor lymph indicate 
 an adequate vital force. In the first part of this Book, we 
 had several illustrations of this truth. 
 
 . Considerable difierence of opinion prevails in the profession 
 as regards the true source of thrush ; some have maintained 
 that it is always sympathetic, w^hile others are very positive 
 that it is sometimes idiopathic. We are willing to admit the 
 Jatter conclusion, in a very large jn-oportion of instances. We 
 view it as a disease, when idiopathic, as having its origin in 
 la feeble vital force, and this explains why it is so much more 
 frequently met with in hospitals than in private practice. 
 
 Dr. Eberle says, that " feeble and sickly children scarcely 
 ever escape from this disease." Now, when it is remembered 
 that the feeble children are very generally the sickly ones, our 
 conclusion, that it depends greatly upon an original organic 
 and feeble viable condition of the system, is rendered even 
 more than probable. He further states, that " bad and old 
 milk, and thick farinaceous preparations, sweetened with brown 
 
542 INFLAMMATORY FORMS OF DISEASE 
 
 sugar or molasses, are especially apt to give rise to the dis- 
 ease." Here, again, we find our leading argument to be sus- 
 tained. The nutritive system is incapable of converting the 
 carbon into fat, and the lungs cannot combine it witli oxygen, 
 and disease is the consequence. 
 
 Treatment. — As in this form of disease the bowels are, if 
 not always, very generally, in a deranged condition. A 
 superabundance of acid is thought to be generally present, as 
 the evacuations, if diarrhea be not present, are usually of a 
 green color. We are not willing to take it as granted that the 
 green color of the faeces is a certain proof that they are acid — 
 we do not know that it is ever the case, but we are sure that 
 it is not always the case. Green evacuations, are sometimes, 
 and so far as we know to the contrary, entirely insipid and 
 insensible to any test for the presence of acid. Nevertheless, 
 the green color is an evidence that the bowels are not in a 
 normal condition, and therefore it would be judicious to em- 
 ploy the Compound Powder of Rhubarb, or the Syrup of 
 Hhubarb and Potash, to change this condition and restore the 
 vitiated excretions to a state of health. 
 
 In the event the stools are frequent, sparing, aqueous, pain- 
 ful, and straining, a small portion of Paregoric may be added 
 to the above agents, and injections of Starch-water or muci- 
 lage in small quantities, administered immediately after each 
 alvine evacuation ; sometimes infusions or decoctions of 
 astringent vegetables may be advantageously employed, as of 
 Blackberry root. Dewberry root, etc. 
 
 When the diarrheal evacuations shall have a green color, 
 which is sometimes the case, the use of Magnesia and of Lime- 
 water has been recommended, but in the generality of cases, 
 we prefer the course above-named to any other. 
 
 When the bowels indicate the existence of much irritation, 
 the discharges are scanty and possibly stained or streaked 
 with blood. Dr. Dewees strongly recommends the use of the 
 Oil of Butter two or three times a day. For the same pur- 
 pose, he thinks very favorably of Gum Arabic water. 
 
 But in this plan of treatment, even though we shall succeed 
 in preventing a prostrating debility, a circumstance that not 
 unfrequentl}^ results from it, we have incomparably more con- 
 fidence ill the efiicacy of a purely revulsive treatment, because 
 
ABOVE THE DIAPHRAGM. 543 
 
 a thorough equalization of the circulation will be followed by 
 an improved condition of the alvine secretions ; therefore, in 
 addition to the means above pointed out, the whole external 
 surface should be once or twice a day bathed with a warm, 
 weak alkaline wash, and dried with some degree of friction. 
 
 The most proper food for the child is its mother's milk, pro- 
 vided she be in good health, but even then she should, for the 
 time being, live upon simple and very digestible food. 
 
 Local applications, in the treatment of this form of disease, 
 are not to be dispensed with. During the inflammatory stage 
 stimulating applications should be applied under the jaw, as 
 the Compound Capsicum Liniment or the Compound Tincture 
 of Camphor, which, in very young infants, may be diluted 
 by the addition of sufficient Olive Oil ; and, for a mouth 
 wash, or rather, as a remedy for the sores contained within it, 
 a decoction of Hydrastis Canadensis may be used several 
 times a day, and even a portion of it may occasionally be 
 swallowed ; or Borax may be added to the decoction in many 
 instances, with decided advantage. 
 
 Species IIL — Stomatitis Follicular — Infiammation of the 
 Mucous Follicles of the Mouth, 
 
 In the appearance of aphthae and thrush, and in their con- 
 stitutional symptoms, there is a very striking analogy; but 
 still we cannot declare, with Prof. Dewees, that we can per- 
 ceive no diiFerence between them as described by C. M. Bil- 
 lard. The resemblance is one of appearance, and the differ- 
 ence is one of reality — of anatomical location ; and when we 
 consider that both are located in the same districts, we should 
 not consider it strange that the constitutional symptoms should 
 scarcely admit of a distinction. We concede that the distinc- 
 tion appears to us as one of fact — of science, rather more than 
 one of therapeutical utility. 
 
 In muguet or thrush, the disease is confined to the surface 
 of the epithelium, says Billard ; but in aphthae, it is confined 
 to the muciparous follicles of the mucous membrane. Now, 
 if these be the facts, then certainly they are not one and the 
 same disease, although it may be difficult to determine a difier- 
 ence between the symptoms. 
 
 Trof. Wood regards thrush and aphthae as distinct forms of 
 
. 544 INFLAMMATORY FORMS OF DISEASE 
 
 disease, but he does not agree with Billard in considering fol- 
 licular inflammation and aphthae as one and the same. He 
 admits that the muciparous glands may be sometimes the seat 
 of aphthous ulcerations. He teaches that aphthae is a vesi- 
 cular inflammation and embraces all the small ulcers, with 
 whitish surfaces, which are frequently to be seen in the 
 mouth. 
 
 This misunderstanding between pathologists is not as to the 
 true seat and character of those forms of disease wbich visit 
 the mouth, but as to which of them belongs, truly, the name 
 of aphtha. It is fortunate that this diflficulty can avail hut 
 -little, if anything, in practice, because the treatment must be 
 -about the same in all three of the inflammations — the diffused, 
 follicular, and vesicular. 
 
 After digesting the information which we have been able to 
 glean concerning these forms of disease, w^e are disposed to 
 conclude that the one which is generally regarded as aphthae, 
 in this district of countrj^, is the tJirush^ or muguet of French 
 writers — the infantile sore-mouth of common denomination. 
 
 As Prof. Wood, no doubt, understands that form of disease 
 which is generally understood to be aphthse, by the profession 
 of this country, it is perhaps best, for practical purposes at 
 ieast, that we adopt his views. 
 
 The mucous follicles are so exceedingly small that they 
 cannot, ordinarily, be seen; but the infinity of their number 
 suflSciently compensates for their smallness ; but, when they 
 •become inflamed, they may be felt with the finger although 
 they may not be seen, and when first seen they are small, hard, 
 round, whitish eminences, surrounded by a reddish circle. 
 When the inflammation takes its natural or nninterrupted 
 course, these eminences become soft in their centers and ulce- 
 rate, throwing out a whitish matter w^hich is disposed to 
 adhere to the surface. 
 
 These ulcers are either isolated or confluent, and when the 
 latter, they present a continuous, whitened, and ulcerating 
 surface. It is common to adults and infants, but more fre- 
 quently appears in the latter, and with them it is sometimes 
 mistaken for the thrush. 
 
 It is said to attend at the conclusion of the exanthematous 
 fevers and chronic inflammations of the viscera in general. 
 
ABOVE THE DIAPHRAGM. 545 
 
 The treatment of this form of disease, so far as is now 
 known, does not differ from that of aphtha, to which we refer. 
 
 Species IY. — Stomatitis Vesicular — AjpTitTim — Ulcerous 
 Inflammation of the Mouth. 
 
 The term aphthae is applied to all those small and whitish 
 ulcers which frequently appear within the mouth, without 
 reference to their particular seat or source. 
 
 This form of disease generally begins on the inner surface 
 of the inferior lip, or within the angles of the lips, and con- 
 sists of white vesicles, which may be few or many. From 
 these points it spreads rapidly upon the buccal parieties and 
 surfaces of the mouth and gums. At other times, it appears 
 simultaneously, and in the same form, upon several portions 
 of the buccal cavity. Wherever it may begin, it resembles a 
 coagulum of milk. In its severer forms, as in the thrush, the 
 eruption becomes darkish or reddish, and probably because of 
 the presence of blood. 
 
 Aphthae is thought by many to be altogether symptomatic — 
 that it is always preceded by some gastric derangement, but 
 as it sometimes attacks children whose stomachs and bowels 
 are in excellent health, we are justified in doubting its purely 
 symptomatic character. It is thought to appear, sometimes, 
 epidemically, and if it do, we cannot well doubt that it is 
 sometimes idiopathic. 
 
 As in the thrush, so in Aphthse, the stomach, the bowels, 
 and the brain appear to participate in the inflammation of the 
 mouth — the desire to sleep is unusual, and the bowels are 
 troubled with aqueous, acrid, and greenish stools, attended 
 more or less with flatus. 
 
 Young children, when the disease is severe, emaciate 
 rapidly^ they are harassed greatly by colics, diarrhea, and 
 gastric irritability. The last is sometimes so great, that 
 scarcely anything is retained. The oesophagus is sometimes 
 so closed up with aphthae, that the little which the stomach 
 may retain is with great difficulty swallowed. 
 
 It is useless to pursue the symptoms of this disease further, 
 because it is impossible to define an appreciable difierence 
 between the general symptoms of it and thrush and Dr. 
 Eberle uses the two names synonymously. 
 35 
 
546 INFLAMMATORY FORMS OF DISEASE 
 
 Aphthos is not so common to early infancy as to a more 
 advanced stage of childhood, and after this it may attack any 
 age. It is not confined to the mucous membrane of the 
 mouth — Prof. Dewees says, that he has seen it " most plenti- 
 fully within the labia pudendi as well as on the internal face 
 of the prepuce." After this remark, we think it rather sur- 
 prising that he should seriously doubt as to the occurrence of 
 aphthge upon the mucous lining of the stomach and bowels. 
 
 Causes. — Feeble children, and those whose constitution has 
 become depraved by the use of improper food, air, etc., are 
 the most liable to it. Prof. Dewees thinks that farinaceous 
 diet predisposes to the disease, more especially when sweet- 
 ened with brown sugar or molasses. We would, a jpriori^ 
 adjudge sugar and fats as calculated to produce the disease, 
 especially with the feeble — particularly the latter. 
 
 Tkeatment. — Same as that of thrush. 
 
 Species Y. — Stomatitis Pustular — Cancruvi Oris — Canker I 
 Ulcerative Infiammation of the Mouth. 
 
 The disease of which we are about to treat must not be 
 regarded as being a dependant upon, or as a sequent of, any 
 one of the preceding varieties of stomatitis ; but as being one 
 which is entirely independent of them, and, also, as being one 
 to which new-born infants and young children are frequently 
 liable. It may locate itself indifierently upon any portion of 
 the buccal cavity. It may select the base of the tongue, the 
 frsenum, the palatine arch, the gums, the lips, or the internal 
 surface of the cheeks. It has been confounded with aphthae, 
 but by the time we conclude, it will be discovered to be an 
 entirely different form of disease. 
 
 It is but rarely, if ever, noticed before it becomes an ulcer 
 of considerable magnitude, of a grayish color and surrounded 
 by an inflamed border. The adjacent or contiguous parts are 
 usually so far involved as to be inflamed and swollen. If it 
 be located in the cheek or in either of the lips, the swelliog 
 will be exposed to external observation, and the cutaneous 
 surface will be red and shining. The internal swelling is 
 sometimes so great as to render an examination of the ulcer 
 very difficult. 
 
 The ulcer, perhaps, never penetrates through the cheek, nor 
 
ABOVE THE DIAPHRAGM. 547 
 
 destroys the part in which it is located, except, possibly, in 
 some of the fatal instances, and they are exceedingly rare; 
 and though rarely fatal, it is nevertheless a painful disease. 
 
 It is usually attended with fever, constipation, a copious 
 flow of saliva and a fetid breath, but this fetor is distinct from 
 that of gangrene. When located in the gums, it is apt to 
 expose the alveolar processes, and though it may continue for 
 weeks or months it is not apt to be attended with worse con- 
 sequences. 
 
 Causes. — The causes of this disease are fully as obscure as 
 those of thrush and aphthge. While, on the one hand, it has 
 been referred to improper nourishment and depravity of con- 
 stitution, it has, on the other hand, been known to appear 
 under very opposite circumstances — apparently so, at least. 
 
 Writers have not yet learned to consider very feeble and 
 often-ailing children, and very obese ones, as being very simi- 
 larly related to disease and death. The latter may escape for a 
 long time those irritations which for a similar period dis- 
 tressed the former, and yet be equally destitute of vital force ; 
 and this truth becomes manifest as soon as the fat-producing 
 process becomes disturbed or arrested. 
 
 If we were to indicate any one article as being the most 
 productive of juvenile disease, it would be sugar — saccharine 
 matter ; and for two reasons : first, all children are fond of it; 
 and second, parents, almost universally, believe that it is 
 healthy and nutritious. In some sections of our country, it 
 constitutes a leading article of juvenile diet. Ulcers and 
 eruptions are common to those who intemperately indulge in 
 alcoholic drinks ; how then can children escape similar afflic- 
 tions who use much saccharine matter ? Both are carbona- 
 ceous, and both are, measurably, destitute of nourishment. 
 Those infantile and juvenile constitutions which cannot con- 
 vert sugar into fat, we would, a priori^ suppose to be most 
 liable to the present forms of disease, and such we find to be 
 tibe fact. 
 
 We know that hundreds of children have sufiered whose 
 only food had been the mother's milk, but let it be remem- 
 bered, that too many mothers indulge in gross and carbona- 
 ceous food. 
 
 Treatment. — In the treatment of this afiection, the most 
 
548 IIv'FLAMMATORT FORMS OF DISEASE 
 
 •important indication is to arrest the sloughing and prevent its 
 further progress, and if this be not accomplished, the disease 
 will rapidly proceed to a fatal termination, notwithstanding a 
 favorable condition of the pulse, appetite, and mind. And, 
 probably, a reason why the disease generally resists the treat- 
 ment employed, is, that after the afiection has been properly 
 recognized, the local applications are either of too mild a char 
 acter or have been insufficiently applied; and this may bo 
 owing to the difficulty which attends the effectual application 
 of any caustic to the gangrenous parts in the interior of the 
 mouth, both from the swollen and resisting condition of the 
 cheek, and the struggles of the child to free itself from a pain- 
 ful operation. 
 
 A writer, in speaking of the application of caustic in this 
 disease, remarks : 
 
 "Ineffectual cauterization, however, is useless, or worse than 
 useless ; and though every endeavor should be made to pre- 
 vent the needless destruction of healthy parts, yet of the two 
 evils, that of doing too much is unquestionably less than that 
 of doing too little. It is of importance, moreover, not only 
 that the cauterization should be done effectually, but also that 
 it should be practiced early." 
 
 The sloughing advances rapidly from within outward, and 
 when once it has penetrated through the substance of the 
 cheek, the chances of cure are but few; consequently, the 
 treatment must, from the commencement, be active and ener- 
 getic. The caustics which have been recommended are strong 
 Hydrochloric or Nitric Acid, which must be applied to the 
 gangrene in the interior of the mouth, by means of a piece 
 of sponge or lint fastened to a quill, at the same time properly 
 protecting the tongue and other healthy parts, as far as possi- 
 ble, from the action of the caustic. 
 
 We have never used the Sulphate of Zinc in this disease, 
 yet, from its known success in other gangrenous affections, we 
 should deem it an important local agent in arresting the 
 sloughing ; but whatever agent is employed, the mouth must 
 be carefully examined every six or eight hours, to ascertain 
 whether the sloughing has been checked, or whether it has 
 extended into the parts beyond the yellow eschar produced by 
 the acid ; and the cauterization should be repeated sufficiently 
 
ABOVE THE DIAPHRAGM. 549 
 
 often to completely arrest the disease. During the whole 
 course of treatment, the mouth must be frequently washed 
 with astringent decoctions, and the diet should be of a gene- 
 rous and nutritious character, supporting the patient's strength 
 also by Wine, Porter, Quinine, or other tonics and stimulants. 
 
 Great success has obtained in this affection by the following 
 treatment : 
 
 A mild aperient of Rhubarb and Magnesia was adminis- 
 tered, together with four grains of Chlorate of Potash dis- 
 solved in water sweetened with syrup, which last dose was 
 repeated every four hours. The mouth was washed with a 
 weak solution of Chloride of Soda. Recovery took place in 
 about six days, while, in one case, which was treated with 
 tonics and alteratives, three weeks ensued before a cure was 
 effected. This treatment is worthy a trial in cases of a similar 
 character. ; ' 
 
 Species YI. — Stomatitis Mercurial^ — Inflammation and 
 Sloughing of the Mouthy caused hy Mercury. 
 The people of this country, unfortunately, are so well 
 acquainted with this variety of sore mouth, that any descrip- 
 tion of it would seem to be a work of supererogation ; never- 
 theless, a brief account of it will not be out of place to those 
 who desire to learn how to treat it. 
 
 * In the social division of labor, it became the business of one class of men 
 to study the human organization and its organic manifestations, in both health 
 and disease, and, also, the therapeutical relation, to this organization, of all 
 external objects, for the purpose of mitigating or removing the derangements 
 and lesions to which it is incidentally liable. In other words, a class of men 
 were, and are still, set apart for the purpose of treating, and, if possible, cur- 
 ing the diseases with which the individuals of society become afflicted. This 
 class is now distinguished from all others by the title of Doctors of Medicine. 
 It is especially their business and their duty to cure, and not to produce 
 disease. 
 
 Notwithstanding this high and imperious duty, we have before us, and con- 
 stituting a part of a nosological system, a highly unmanageable and frequently 
 fatal disease, which, seventy-five times in eveiy hundred cases, is produced 
 by the profession in their efforts to cure the various forms of disease, which, 
 compared with it, are, absolutely, insignificant. 
 
 This species of stomatitis does more mischief — produces more suffering, 
 more mortality, in the United States, every one year, than the other species 
 have since the creation of man ; and is it, like the others, one of God's scourges 
 
550 INFLAMMATORY FORMS OF DISEASE 
 
 After the disease becomes fully developed, those who visit 
 the patient do not require to be informed as to the nature of 
 the disease — it is announced to them, as soon as the door is 
 opened, by the patient's breath. From first to last, this is 
 a distinguishing symptom. The first indication that the 
 patient has, that he is, to use a common phrase, salivated, is 
 the copper or brass-like taste with which the tongue is im- 
 pressed. The next indication is a sense of soreness of the 
 gums of the inferior incisores, and finally, all doubt is removed 
 by an obvious increase of the saliva. 
 
 When the complaint is first made, of soreness of the gums, 
 a close examination will detect a transverse opacity of the 
 gums just below their edges, resembling a white band, 
 attended with some redness and tumefaction about the necks 
 of the teeth. In a little more time, the inflammation extends 
 to the periosteal linings of the alveoli, causing pain when the 
 jaws are closed upon each other ; by the same time, the in- 
 flammation seems to have afiected the muscles of the jaws, as 
 the patient has now to make some efibrt to open them — there 
 exists in them a sensation of stiffness. 
 
 The disease progresses — all the parts in the mouth become 
 
 because of man's disobedience? Not at all. He has forbidden the use of Mer- 
 cury in language so plain, and in terms so strong, that simple must be the man 
 ■who cannot understand it, and obdurate the one who will not obey it. 
 
 We do not assert that the cause of this nosological addition was, necessarily, 
 the work of the medical profession, because we are aware that this form of 
 stomatitis sometimes occurs in the Mercury mines of Spain, and also, that it 
 has been produced in some other commercial situations. But what does all 
 this amount to, when compared with that which we have, almost daily, pro- 
 duced in our midst, by the medical profession ? The former is merely a homoeo- 
 pathic globule, while the latter is a genuine Cook dose of calomel. 
 
 Is the inquiry made of us : " Do you never use calomel ?" We answer — in 
 such cities as Cincinnati, Philadelphia, etc., we would never have occasion to 
 use it, because, in these and similarly-provided cities, we could always com- 
 mand more safe and effective agents. We would use it under no circumstances, 
 except such as would enable us to feel sure of God's pardon for such a viola- 
 tion of his ordinances. We would use it, if we could not do better, and we 
 will use it, when we cannot do better; and we consider it as granted, that all 
 of our medical brethren, in this respect, act as we do ; that is, they would not 
 use it, if they could do better, aud as they do persist in using it, the inference 
 is plain. 
 
 In considering mercurial stomatitis we could not avoid the preceding reflec- 
 tions, and we have written that others may learn how we, who have in this 
 wise sinned, feel upon the subject. — P. 
 
ABOVE THE DIAPHRAGM. 55I 
 
 sore from the extension of the inflammation. The cheeks, 
 throat, salivary glands, and tongue are all painful. The last 
 organ, the tongue, is covered with a brownish, or possibly 
 a yellowish, fur, and. so swollen as to fill the buccal cavity. 
 
 Ulceration commences generally in the gums, but it is soon 
 extended to the jaws, cheeks, throat, tongue, palatal, and 
 ethmoidal bones. All are destroyed, if life continue long 
 enough. 
 
 This is a rapid and general sketch of the disease, as it usu- 
 ally appears in adults. Now, suppose the disease to attack 
 an infant, in which, as is very generally the case, the tissues 
 are all soft and incomplete, and then we have such an exhibi- 
 tion as should induce the civil authorities to hold that physi- 
 cian to be guilty of a capital offense, who should administer 
 mercury in any form to an infant. 
 
 Prof. Wood remarks, that the " pre-occupation of the sys- 
 tem by a very violent disease, presents, in many instances, a 
 complete obstacle to its action upon the mouth." 
 
 Is he sure that it does not present an equally complete 
 obstacle to its action upon any part of the system ? This is a 
 question of which the profession at large seems never to have 
 thought. We were taught to make calomel, blue-mass, etc., 
 the sheet-anchor of our hope in all congestive forms of dis- 
 ease. We did so until the mortality in that department of 
 our practice forced upon us an investigation of the subject, 
 and then we discovered that calomel is as inert as brick-dust 
 in all congested forms of disease. 
 
 Prof. Wood adds, that " in yellow fever, it is sometimes 
 utterly impossible to induce the mercurial salivation." 
 
 Yes, and in such cases, and by such a practice, it is as 
 utterly impossible to save the patient. It is, to us, much 
 more than probable, that the cases to which he has referred 
 were highly congested, and if so, the whole difficulty is 
 explained. 
 
 We are fully aware the preceding paragraphs are, scientific- 
 ally and systematically, out of place ; but we feel equally sure 
 that those students for whom the work is especially intended, 
 will not only appreciate them, but also our motive for intro- 
 ducing them. 
 
 Treatment. — From all the cases we have witnessed, we 
 
552 INFLAMMATORY FORMS OF DISEASE 
 
 have but little confidence in any treatment either in this or 
 the ulcerative form of stomatitis — for, notwithstanding the 
 most energetic measures, all hasten rapidly to a fatal result ; 
 nevertheless, the treatment suggested for cancrum oris would, 
 probably, be equally indicated under the present affection. 
 
 Genus II. — Angina. 
 
 Species I. — Angina Simplex — Common Inflammation of 
 
 the Fauces. 
 
 Under this caption is embraced all the parts which together 
 constitute the posterior walls of the mouth — the parts which 
 we can see when the mouth is widely opened and the tongue 
 depressed. They consist of the half arches, the velum pen- 
 dulum, the uvula, the tonsils, and the superior portion of the 
 pharynx. 
 
 All of these parts may be implicated, more or less, by the 
 various forms of stomatitis, and also by several of the cuta- 
 neous diseases, of which we have also treated. All of these 
 will be excluded from the present and the succeeding subjects 
 of this class. 
 
 Before entering directly upon the subject before us, it 
 becomes necessary to prepare the reader for judging accu- 
 rately as to the existence of disease in these parts in very 
 young infants. 
 
 From birth up to the exfoliation of the epidermis, the fauces 
 are generally highly congested, and the redness might be mis- 
 taken for that of inflammation ; hence it is not safe to rely 
 upon the appearance of these parts, before the ninth or tenth 
 day, exclusively — other indications should greatly contribute 
 to the announcement of the fact. 
 
 This congestion is usually distributed in a uniform manner, 
 but in some instances, it appears to exist in more or less dis- 
 tinct ramifications. This fact is a strong confirmation of a 
 very })revalent opinion, that there exists an intimate sympathy 
 between the cutaneous and mucous surfaces. 
 
 "With these remarks, we proceed to the consideration of sim- 
 ple angina, or an erythematic inflammation of the parts which 
 constitute the fauces. The subject might be divided into as 
 many varieties as there are parts, but this would be more 
 technical than useful, as it but seldom happens that all the 
 
ABOVE THE DIAPHRAGM. 553 
 
 parts are not more or less involved ; and whether it be so or 
 not, the treatment is the same. 
 
 If the disease should make its attack after the first ten or 
 twelve days, its existence will be indicated by a bright-red 
 color and some tumefaction — if the patient be old enough to 
 make known its condition, then the most certain indication 
 will be the expression of some pain in swallowing; if it be 
 under ten or twelve days old, the existence of disease will be 
 indicated by the high color of the parts, being disposed of in 
 separate points or spots. When the disease is a little more 
 advanced, the red surface will be marked by whitish patches, 
 particularly on the tonsils — their whitishness, consisting pro- 
 bably of coagulated lymph, produced by the inflamed follicles. 
 The parts will also become hot and dry, and from their sore- 
 ness, much pain will attend all efibrts at deglutition. If the 
 tumefaction should be considerable, drinks will sometimes 
 regurgitate through the nostrils, and the cry will be somewhat 
 nasal or hoarse. A viscid mucus may be secreted, in the pro- 
 gress of the disease, which may prove very troublesome, and 
 therefore, the nurse should give particular attention to it. 
 
 It is common for this disease to run its course without pro- 
 ducing fever ; but it is sometimes otherwise the case. The 
 inflammation often continues for several days, and gradually 
 declining, terminates generally by resolution. Any other 
 mode of termination is particularly rare in children. 
 
 Causes. — A moist atmosphere is alone sufficient to restrain 
 the cutaneous function in feeble children, and when of a 
 reduced temperature, it is still more effective, consequently it is 
 very probable that this form of disease is more frequently than 
 otherwise produced by the agency of such an atmosphere. 
 
 Some persons possess a strong organic liability to angina 
 under very slight exposures to a cold and damp air, more 
 especially when they are warm or perspiring. It sometimes 
 results, sympatheticall}^, from gastric derangement or disease. 
 When it occurs in a scrofulous or phthisical organization, it is 
 more obstinate and difficult to treat. 
 
 Dr. Wood remarks, that it appears sometimes to be of a 
 rheumatic nature, as it occasionally alternates with manifesta- 
 tions of that affection. We regard this remark as being very 
 
554 INFLAMMATORY FORMS OF DISEASE 
 
 probably correct, when the subject is of a rheumatic organi- 
 zation. 
 
 Tkeatment. — The treatment of this affection may com- 
 mence with the administration of some mild evacuant, as the 
 Compound Powder of Rhubarb, the Compound Powder of 
 Jalap in small proportions, or the Compound Tincture of 
 Jalap, which may be repeated occasionally as required — to 
 be followed by a warm, stimulating foot-bath, or if there 
 should be much arterial excitement, a warm bath, and the sur- 
 face must be bathed with a weak, warm, alkaline solution as 
 often as the severity of the disease may require. 
 
 At the same time, the throat and neck should be bathed 
 several times a day with some stimulating liniment, after 
 which a piece of flannel should be bandaged around the throat, 
 and in severe cases, a fomentation of Hops and Mullen leaves. 
 A gargle or wash may likewise be used a number of times 
 through the day, as for instance the following : 
 9:. Salvia Officinalis, 
 
 Hyssopus Officinalis, aa 3j, 
 Borate of Soda, 3j, 
 Aqua Bulliens, oct. ij. Mix; 
 let them steep an hour, then strain and sweeten with Honey. 
 Should the child be too 3^oung to gargle, this must be applied 
 on a piece of linen rag to the inflamed parts, and some of it 
 may even be swallowed. Sometimes the substitution of two 
 drachms of Alum for the Borax, will have a more beneficial 
 influence. 
 
 In very many severe and obstinate cases, a solution of the 
 Nitrate of Silver, five or ten grains to an ounce of water, may 
 be applied two or four times a day with advantage. 
 
 The patient should be kept in bed, in a dry and warm 
 room, and its diet should be confined to toast-water, gruel, 
 toast-bread, and similar articles, until all febrile symptoms 
 disappear. 
 
 At any time, when the secretions about the fauces become 
 very abundant and tenacious, interfering with respiration, the 
 Compound Tincture of Lobelia or the Acetous Emetic Tinc- 
 ture may be given in sufficient quantities to produce emesis. 
 
A.BOVE THE DIAPHRAGM. 555 
 
 Species II. — Angiiia MemhranacecB — Inflammation of the 
 Fauces with altered Secretion. 
 
 When we see a child refuse the breast, give evidence of 
 difficult deglutition, such as an expression of pain, the exist- 
 ence of this disease should be suspected. 
 
 Although this disease commences like ordinary sore-throat, 
 with redness of the fauces, yet, very generally, when first 
 seen by the physician, the fauces will present irregularly- 
 circumscribed, whitish, or possibly yellowish-white or ash- 
 colored spots, which may be confined to some part of the 
 fauces, or scattered indiscriminately over the whole of their 
 surface. 
 
 These patches closely resemble the surface of ulcers, while, 
 in realitj^, they consist of a concreted exudation upon a sur- 
 face which has sufiered no apparent lesion. These concretions 
 are sometimes translucent, dense, tough, or they may be soft 
 and pultaceous. 
 
 The tonsils are usually more or less swollen, and the mem- 
 brane around their borders is red and inflamed. The inflam- 
 mation and tumefaction extend sometimes to the cervical and 
 submaxillary glands, and even to the parotids. 
 
 Like other imflammatory forms of disease, it is sometimes 
 mild, and at others very severe. In the former, the patches 
 are few and more regularly bounded — the fever is probably 
 absent, and the tumefaction very inconsiderable. But, what- 
 ever may be the extent of these symptoms, deglutition is very 
 apt to be painful. In the severe forms, deglutition is very 
 painful, and frequently, in attempts to swallow fluids, they are 
 returned through the nose. 
 
 When the scabs have completed their process of formation, 
 it is not long before they begin to disappear, sometimes by 
 absorption, at others, by softening and mixing with the saliva, 
 and at others, by separating into irregular patches. They are 
 frequently renewed, and occasionally several times, each 
 becoming more white and delicate, until they finally disap- 
 pear, leaving on the surface a puriform mucus. 
 
 In the nasal passages, the disease sometimes rages with con- 
 siderable violence, as indicated by fetid discharges from tho 
 
556 INFLAMMATORY FORMS OF DISEASE 
 
 nose. Yitiated secretions, often stained with blood, are fre- 
 quently discharged from the mouth. 
 
 In the course of the complaint, the larynx, trachea, and 
 even bronchia are invaded, and lined to such an extent with 
 the concreted exudation as to interrupt respiration, and some- 
 times to such an extent as to cause a fatal result ; and in this 
 tendency consists the greatest danger of the disease. 
 
 The disease, in its violent form, is attended by constitu- 
 tional symptoms, and continues from two to three weeks. 
 
 Causes. — As to the cause of this malady, we could specu- 
 late, as others have done, but for this we have neither inclina- 
 tion nor time. It is the opinion of some that it is contagious — 
 we do not believe it, but we cannot say that it is not. 
 
 Treatment. — ^A similar course to that recommended in 
 common inJlammation of the fauces may be resorted to with 
 advantage. 
 
 A gargle or wash may be used, composed of: 
 ^. Hydrastis Canadensis, 
 
 Cortex Rhus Glabrum, aa 3j. Mix. 
 
 Add a quart of water, boil down to one pint, strain, and add 
 one ounce of Alum. This will be found quite valuable in 
 many instances. 
 
 Another preparation, which we have often used with de- 
 cided benefit, is, 
 
 ^. Strong decoction of Hydrastis, oct.j, 
 Salt, 3ij, 
 Pepper, 3J, 
 Vinegar, 5ss. 
 
 This may be gargled, or used as a wash, and occasionally a 
 portion of it may be swallowed. 
 
 When the aflection assumes a gangrenous tendency, the 
 parts must be washed with Yeast and Sweet Oil, or a solution 
 of Sulphate of Zinc, with the internal use of tonics and stimu- 
 lants for the accompanying prostration, as Quinine, Hydras- 
 tin, Porter, Wine, etc.; and in this condition care should be 
 taken not to further increase the debility by purgation or dia- 
 phoresis. 
 
ABOVE THE DIAPHRAGM 557 
 
 Species III. — Angina Tonsillaris — Tonsillitis — Quinsy — 
 Inflammation of the Tonsils. 
 
 In the preceding species, the surface of the tonsils was in- 
 volved, but now we have to treat of inflammation of their 
 substance. The local disease is either preceded, or immedi- 
 ately followed, by febrile symptoms, or they are introduced 
 together. Rigors usually introduce the fever, which is 
 attended by headache and a strong and full pulse. 
 
 A difficulty in swallowing is the first announcement of local 
 disturbance by those who can make their condition known. 
 In severe cases, so painful is deglutition as to produce, appa- 
 rently, a spasmodic action of the muscles involved in the 
 function ; and if both sides are equally involved, the function 
 becomes almost impossible, so much so that it frequently hap- 
 pens, in attempts to swallow fluids, that they are thrown back 
 through the nares. 
 
 In consequence of a pressure of these bodies upon the eusta- 
 chian tubes, the hearing is frequently much impaired ; respi- 
 ration, however, is but little disturbed, except in very severe 
 cases when a sense of sufibcation is felt. The fauces, at first, 
 present redness, with tumefaction of one or both tonsils, and 
 when of both, the swelling may increase until they almost 
 meet. 
 
 A diffused whiteness may appear upon their surface, or it 
 may be in spots, and probably concreted — a morbid product 
 of the mucous follicles. The uvula is generally much swollen 
 and elongated, and the contiguous parts considerably inflamed. 
 
 The disease is not always unattended with external inflam- 
 mation, with tumefaction of the cervical glands and cellular 
 tissue, to such an extent as to render the inferior jaw almost 
 immovable. 
 
 This inflammation, when slight or successfully treated, will 
 end in resolution, but frequently it terminates in suppuration, 
 which, when established, will be announced by rigors, soft- 
 ness of the tumors, and probably by a pale spot, indicating 
 its nearest approach to the surface, and some fluctuation. The 
 sufferings, at this stage, are exceedingly great, but not greater 
 than is the relief which attends the rupture of the tumors. 
 
 Causes. — Improper exposure to atmospherical changes is, 
 
558 NON-INFLAMMATORY FORMS OF DISEASE 
 
 probably, the most usual cause — the atmosphere is sometimes 
 thought to contain an epidemic cause for it, which may be 
 similar to that of scarlatina and measles, as it frequently pre- 
 vails with them. 
 
 Treatment. — The course already named in the two preced- 
 ing forms of disease, may be pursued in this, with equal 
 benefit, the first indication being, as with them, the removal 
 or alleviation of inflammation. 
 
 In the early part of quinsy, an emetic will almost always 
 be found useful, often afibrding relief at once, after which the 
 previous treatment may be energetically pursued, that is, 
 stimulating gargles or washes, stimulating liniments to the 
 throat, and a warm fomentation of Hops and Mullen leaves, 
 together with frequent bathing of the surface of the body. 
 
 In adults, the inhalation of vapor from a decoction of bitter 
 herbs, repeated several times a day, and continued for ten or 
 fifteen minutes, gives relief, and materially assists in reducing 
 the inflammation. 
 
 When suppuration takes place, it must be watched to pre- 
 vent it from causing death from sufibcation ; and should this 
 be threatened, the tongue must be held down by a spoon or 
 tongue-holder, and the enlarged tonsils be punctured with a 
 lancet, carefully guarded to prevent it from wounding or injur- 
 ing any other portion of the mouth or tongue. 
 
 The diet and regimen must be the same as in the two pre- 
 ceding forms of angina. 
 
 OKDER 11. 
 
 NON-INFLAMMATORY FORMS OF DISEASE IN PARTS LOCATED ABOVE 
 THE DIAPHRAGM. 
 
 Genus I. — Stomatitis Gangrenous — Necrosis Infantilis — 
 Death of the Mouth from insuffiGient Vitality. 
 This form of disease is, by some, regarded as a variety of 
 stomatitis, and is consequently denominated gangrenous in- 
 fiammation of the mouth. We, too, consider this afiection 
 as a modification or variety of that which is called stomatitis, 
 
ABOVE THE DIAPHRAGM. 559 
 
 but, as we do not regard inflammation as being ever a cause 
 of gangrene, and as this form is not preceded by inflammation, 
 we could not treat of it as a member of an inflammatory 
 order. 
 
 In constitutions which are too feeble to maintain, success- 
 fully, an inflammatory action, gangrene may succeed thrush 
 or aphthae, and then be mistaken for what is known as gan- 
 grenous stomatitis, or in other words, gangrsena oris; the 
 mistake, however, would be but little in point of fact, because 
 it is very probable that a less degree of vital force in an assault 
 of thrush would have produced gangrsena oris. 
 
 We are informed by pathological anatomists, that this afiec- 
 tion never depends upon, or results from, any other form of 
 disease, consequently it must be the necessary result of defi- 
 cient vital action, and in confirmation of this result, we are 
 informed that the class of children in which it is idiopathi- 
 cally found, are not only feeble, physically, but manifest, men- 
 tally, a want of vital energy ; the respiration is feeble, the 
 circulation is sluggish, and the cellular tissue betrays a con- 
 stant tendency to become oedemalous, particularly in depen- 
 dent parts. 
 
 Under circumstances of such languor and feebleness, it is 
 not difficult to conceive that the capillary circulation may be 
 replaced by serous infiltrations, which may act almost as 
 eflectually in producing the death of a part, as a ligature. 
 The sluggishness which attends ulcers, in highly-lymphatic 
 persons, gives support, in our judgment, to these views ; and 
 as our practice must be in accordance with our pathological 
 opinions, it was necessary that we should briefly express 
 them, whether ill or well-founded. But, upon a question of 
 this kind, on which all confess their ignorance, all possible 
 suggestions are admissible. 
 
 Prof. Wood informs us that this aflfection occurs usually 
 between the first and second dentition, but, according to Bil- 
 lard, it occurs in early infancy, and all the cases he has cited 
 appeared within the first month. It is said, further, that it 
 may also attack adults. 
 
 Like the ulcerative variety, it may attack, indiflerently, any 
 part of the mouth, and, generally, when first observed, it pre- 
 Bents a whitish or ash-colored eschar, and as the deatli of the 
 
560 NON--INFLAMMATORY FORMS OF DISEASE 
 
 part advances, the slough spreads ; the breath is very offen- 
 sive, having a gangrenous odor, and the saliva flows copi- 
 ously. If the attack be upon the gums, it penetrates the 
 osseous structure, followed by necrosis of the alveolar pro- 
 cesses, and the teeth fall out. If the attack be in the cheek, 
 the outside will be marked with an ash-colored spot, which 
 soon becomes livid or black — enlarges rapidly, and speedily, 
 the cheek is destroyed ; the mischief however continues — the 
 superior jaw, the palatal and ethmoidal bones are invaded, 
 but rarely destroyed, before death arrests the process. 
 
 Sometimes a slight inflammation maybe observed to attend 
 this work of destruction, and occasionally a little febrile action 
 may spring up ; but it is thought that neither of them precedes 
 the gangrene, but are rather produced by it — in other words, 
 they indicate the feebleness of the system in an effort to arrest 
 the progress of death in the parts assailed. 
 
 Causes. — Gangrene ' may supervene inflammation of the 
 mouth, as of any other part of the system ; but, in this form, 
 it is not certain that it precedes the mortification at all. One 
 would, a priori^ suppose that an inflammation capable of 
 producing mortiflcation could not be attended with any doubt, 
 and if such were the fact, there would not be any. Dr. Wood 
 thinks it probable that it depends upon some peculiar morbid 
 condition of the system. Admit that it does, and what does 
 it avail ? He has not suggested the character of the -supposed 
 morbidity. In children of such extreme debility, we may 
 safely suppose the existence of very imperfect depuration, and 
 hence there is, very probably, " morbidity " enough to over- 
 come the resistance of the vital force, and death of the part, 
 and possibly of the patient, must be the result. 
 
 Treatment. — Our final success, in this form of disease, 
 must depend upon the use of proper food, stimulants, and 
 tonics ; but the local invasion will scarcely be arrested or 
 removed without the use of local means. 
 
 This affection, if promptly attended to in its early stage, is 
 generally curable, but that constitutional infirmity, of which 
 it may be esteemed an evidence, will scarcely allow the patient 
 to live more than a few years. If, however, the sloughing 
 has been considerable, a fatal termination may be expected. 
 
 The remedies demanded by the constitutional debility and 
 
ABOVE THE DIAPHRAGM. 5^1 
 
 depravity are the Compound Syrup of Stillingia, which should 
 be given in connection with the following : 
 ]^. S. Quinia, 
 Hydrastin, 
 
 Myricin. aa 3ss. Mix ; 
 divide into twenty powders, for a child of six months old, of 
 which three or four may be given daily. Where the child is 
 too young to take the powders, a solution of them or tincture, 
 may be used instead. 
 
 With this tonic, alterative, and nutritious course, similar 
 local means may be adopted as in cancrum oris. 
 
 Madeira wine or good brandy may be used as stimulants, 
 or still better, the Aromatic Spirit of Ammonia; and for diet, 
 the patient may use wine-whey, brandy milk-punch, yolk of 
 egg in wine, rich soups, animal jellies, and tender meats. 
 
 Genus II. — Irritations of Dentition — 
 Teething, 
 
 This subject is too frequently treated as though the teeth 
 were foreign bodies, having neither anatomical nor physio- 
 logical relations with the system in general, mechanically 
 forcing themselves through anatomical parts, and thereby pro- 
 ducing a long train of the most fearful pathological conse- 
 quences. 
 
 Normally, the process of dentition produces no more trouble 
 or suffering than any other one belonging to the system ; 
 nevertheless, we are aware that the period assigned to it, is, 
 in civil society, one of disease and death. But are these 
 results to be attributed to the process of dentition ? Will any 
 one assert that the several parts of all children, as a general 
 fact, are not in physiological harmony with each other ! As 
 very many children do not survive this period, is it not con- 
 clusive that they acquired, after birth, a constitutional in- 
 firmity, or that one was entailed upon them ? 
 
 If parents desire children so constituted as to be able to pass 
 through this period of their existence, they should not pro- 
 crastinate a preparation for it until the period arrives. Physi- 
 cians cannot save life in a constitution that is incompatible 
 with it. We do not know that any of the children who have 
 died, during this period, from the real or supposed disturbances 
 36 
 
562 1T0N--INFLAMMAT0RY FORMS OF DISEASE 
 
 of dentition, died, by a single hour, prematurely. If tliey had 
 lived, their lives might have been wretched to themselves and 
 useless to society. We certainly have a right, in a great de- 
 gree, to such an inference. If mothers do not like it, let them 
 live all the time, and particularly during gestation, in con- 
 formity with the institutions which were ordained for their 
 government. 
 
 Finally, in this place, we have to say to both sexes, if your 
 constitutions are gout}', scrofulous, or otherwise unsound, 
 deny to yourselves all the supposed advantages of matrimony; 
 and if you will not do this, then do not complain at the pre- 
 mature loss of your children. 
 
 We are pleased to see that medical writers are beginning 
 to attach more importance to the period of dentition, than to 
 this process, in the abstract — to view it as one in which many 
 important revolutions take place in both the habits and de- 
 velopments of the infantile economy. 
 
 A healthy child begins to cut its teeth at a certain time, and 
 in a certain order ; now, if this time and this order are not 
 punctually observed, is the fault in the teeth? is it in the jaws, 
 or both united ? Is it not rather in some constitutional in- 
 firmity, which might result in any one form of disease com- 
 mon to infancy, under the provocation of an adequate 
 excitant ? 
 
 We have said that this is a revolutionary period in the his- 
 tory of our existence, and, like other revolutions, it is preg- 
 nant with some mischief and always with much good — the 
 mischief falls upon those who are unable to contend with it, 
 and the good upon those who are, and they always constitute 
 a large majority in the end. As an illustration of this prin- 
 ciple, we will invite attention to a few examples. 
 
 It may be observed, that while the mother's milk is the 
 indispensable food for the child, that it does not slaver — that 
 its mouth is comparatively dry ; but as the time approaches 
 when it must be subjected to a change of food, the salivary 
 glands manifest an increased activity, and this happens in the 
 fourth or fifth month, long before the teeth prove a source of 
 irritation. No other change will be announced before the 
 beginning of the eighth month, when two teeth will appear in 
 the middle of the inferior jaw. All is quiet again for some 
 
ABOVE THE DIAPHRAGM. 563 
 
 time, when two more teeth appear in the middle of the supe- 
 rior jaw ; and thus of the others which are yet to appear. 
 
 While these changes are going on in the mouth, there are 
 others of equal importance, under a similar state of develop- 
 ment, in the stomach, intestines, liver, brain, etc. 
 
 Those capable of only a moderate share of reflection, must 
 now perceive that a cause which is capable of materially 
 affecting any one of these important movements must give to 
 the delicate constitution of an infant such a shock as may 
 result in very serious mischief, and more especially so must it 
 prove to the delicate and constitutionally infirm. Thus, it is 
 obvious that the dental process is only one, among many 
 others, which renders the period of dentition one of danger 
 and difficulty to the feeble. It would be, pathologically, just 
 as correct to speak of the various forms of disease of the osse- 
 ous, cerebral, gastric, intestinal, and hepatic development, 
 respectively, as of the dental. 
 
 The fact that physicians have too generally looked to the 
 dental process, during this period, as the source of its dangers, 
 has been attended with much mischief; it has caused them to 
 overlook the other important changes which are progressing, 
 and to neglect the interruptions to which they are incidentally 
 subjected. 
 
 Some children pass through all these changes without appa- 
 rent difficulty. And why should they not ? They are all 
 normal. We have heard nothing said by graziers and hunters 
 of dental disease among the inferior animals ; and if man had 
 lived, up to this time, as much in accordance with his organic 
 laws, as the inferior animals have, the so-called dental dis- 
 eases, would now be regarded as of very rare occurrence. 
 
 As the condition of the teeth with certain people, and of 
 the same people under different circumstances, may serve to 
 shed some light upon the difficulties of the first dentition, we 
 beg leave to invite attention to a few interesting facts upon 
 this subject. 
 
 In the south, the plantation negroes have, very generally, 
 fine, white, sound teeth, while those who live as family ser- 
 vants, and have descended, through several generations, from 
 family servants, have, very rarely, sound teeth. They present, 
 
564 N'OIT-II^FLAMMATORY FORMS OF DISEASE 
 
 also, other and equally remarkable differences — their heads 
 are larger and rounder. 
 
 The Osage Indians have, with scarcely an exception, sound 
 and beautiful teeth, and they are set in large and beautifully- 
 turned arches. 
 
 The Cherokee, Creek, Choctaw, and Chickasaw Indians may 
 be said to be as much distinguished for unsound teeth, as the 
 Osages are for sound ones. Of more than one hundred crania 
 of the former peoples, we do not remember one in which all 
 the teeth were sound, and in a majority of them they were 
 very unsound. 
 
 The lowest and most down-trodden portion of the Irish 
 population have cramped and irregularly- turned jaws, with 
 teeth tangled and irregularly planted — but they are generally 
 sound. 
 
 Now, a proper application of these facts must enlighten us 
 not only upon the subject of dentition, but also upon the 
 modes of life and of civil institutions ; but with the two latter 
 we have nothing to do, except so far as they may bear upon 
 the main question. 
 
 The plantation negroes have few or no responsibilities — 
 their lives are devoted to three great functions — feeding, work- 
 ing, and resting — their food is proper in quality and never 
 intemperately used in quantity, and among their children the 
 derangements of dentition are few and far between. 
 
 In family domestics, there is greater responsibility, and 
 their heads are larger — their duties are more varied, and 
 therefore they are rounder. In their food and beverages they 
 are frequently intemperate as to quantity, and as frequently 
 imprudent as to quality. Their teeth are frequently in a 
 worse condition than is common to the whites, because they 
 are guilty of more excesses. The dentition of their children, 
 to say the least, is such as is common to the whites. 
 
 The Osages, at the time of our acquaintance with them, 
 had had no intercourse with the whites, except occasional 
 interviews — their modes of life were simple and temperate and 
 their responsibilities few and light. Their jaws were not pre- 
 cociously ossified — they furnished ample room for all the 
 teeth, and consequently they existed as a useful and a healthy 
 
ABOVE THE DIAPHRAGM. 565 
 
 family to the latest periods of life. Now, we believe that an 
 intelligent, refined, and elevated civilization is just as com- 
 patible with sound and beautiful teeth, as the Osage simple 
 savagism. All that is requisite is obedience to the organic 
 laws. The obvious difference between American civilization 
 and Osage savagism is this : the latter have not the means 
 wherewith to infract the organic laws — their existence is in 
 that state of necessary conformity which is common to all of 
 the wild animals. The former, the Americans, have the 
 means to outrage these laws, but have not the necessary intel- 
 ligence and moral government to avoid it, in the use of them. 
 The only remedy is a wide diffusion of the natural sciences, 
 and until this is effected, we must be content to suffer an 
 abridgment of our own lives and the premature loss of our 
 children. From this fate, religion and church morality, though 
 proper and useful — even indispensable in their places, cannot 
 save us. 
 
 The Cherokee Indians, and the other tribes named in con- 
 nection with them, have, as peoples, homely jaws and mouths, 
 and rotten teeth. Has this always been the case with them ? 
 The contrary is very strongly to be presumed. 
 
 They have had an extensive intercourse with the most 
 depraved of the white races for more than a hundred years, 
 and wherever this class of white men place their feet, there 
 they plant their vices, and there is no soil so congenial as a 
 savage one. These tribes have succeeded remarkably well in 
 acquiring the vices of the white race, but their organizations 
 were, and are still, too low to imitate, and much less to 
 acquire, their virtues. 
 
 We have, for many years, discovered that between social 
 and mental troubles, on the one hand, and deformed jaws and 
 teeth, on the other, there exists the relation of cause and 
 effect, and the same relation exists between the abuses of the 
 appetite and decayed teeth. The Irish population, before- 
 named, very clearly illustrates the first, and so do the Indian 
 tribes last named — but they illustrate both. The second con- 
 clusion is illustrated also by our family servants. We have 
 never yet seen crooked jaws and tangled teeth unassociated 
 with mental obliquities. 
 
 The preceding facts justify these conclusions — healthy 
 
f^QQ NON-INFLAMMATORY FORMS OF DISEASE 
 
 digestion is attended with sound teeth, and a happily -balanced 
 mind with a harmonious face. 
 
 It must now be obvious that dentition, viewed as a separate 
 process, has but little agency in producing the affections usu- 
 ally denominated the " diseases of dentition," 
 
 It may be thought by some that we have digressed largely 
 from the intrinsic merits of the question, but if we succeed in 
 making the reader think — in enlarging his views of the sub- 
 ject, such criticism will give us no trouble. 
 
 While we do not believe that dentition producco a single 
 disease, yet it serves, under feeble conditions of the consti- 
 tution, as an exciting cause, occasionally, to some painful 
 attendants, which now claim our attention. 
 
 Among those children who are constitutionally necessitated 
 to suffer more or less from the process of dentition, we find 
 the gums tumid and tense, the mouth hot, and the precise 
 position of each tooth is distinguishable for some time before 
 its appearance. In another class, we find the appearance of 
 the teeth to have been preceded or attended by an intense 
 redness of the mucous membrane, a copious flow of saliva, 
 with aphthous ulcerations on the tongue, upon the outer sur- 
 face of the avolse, and in the duplications of the lips, while 
 the gums themselves may be neither swollen nor painful. 
 
 Some degree of febrile action may be looked for in both of 
 these states, with considerable fretfulness, peevishness, and 
 even more direct manifestations of pain. Another morbid 
 condition of the mouth, attended with considerable fever and 
 disorder of the chylopoetic viscera, will sometimes be met 
 with. In such cases the gums become very hot, tender, and 
 swollen, more particularly over some particular tooth, upon 
 which a tumor-like projection is formed. Little ulcerations, 
 having a sloughy appearance, frequently form on the gum, 
 and more particularly about some tooth that has just appeared 
 through it. This affection is painful and difficult to remove ; 
 it has been named odontitis infantura. 
 
 Many persons, acting upon mechanical principles — regard- 
 ing the teeth and gums as so many nails forced into a piece 
 of leather, and cutting holes upon the opposite side to aid 
 their egress, proceed with the gum-lancet to aid the teeth in 
 making their appearance. They seem not to reflect that this 
 
ABOVE THE DIAPHRAGM. 557 
 
 is a pliysiological process, and that a mechanical division of 
 the gum cannot advance the appearance of the tooth. The 
 projection of the tooth and the absorption of the gum are but 
 separate parts of the same process. All such mechanical 
 meddling with physiological processes only injures the child, 
 and proves the operator to be uninformed upon the subject. 
 
 If there be instances which legitimately call for the use of 
 the gum-lancet, they are exceedingly few — so few, that we 
 cannot reconcile with our pliysiological judgment in the pre- 
 mises, the idea that such a case ever existed. But if such 
 cases ever exist, they are those in which the operation can do 
 no mischief, and therefore, when we can do nothing else, we 
 may be justified in doing it, because of the possibility that it 
 may produce some relief. Such cases are easily defined — they 
 are those in which the tooth is so nearly through the gum as 
 to produce a conviction that it will be through in one or two 
 days. When the operation is performed, the instrument 
 should be carried to the tooth. 
 
 When the object is to relieve tumefaction and infiammation, 
 temporary relief may sometimes be had by scarrifying the 
 gums, and the importance of this operation is, in our opinion, 
 greatly overrated ; at all events, it is an operation that difiers 
 widely from the other, and is performed for a very difi'erent 
 purpose. 
 
 There are cases of constitutional disturbance, which may 
 continue for several days and even weeks, during which time 
 the dental process continues perfectly stationary. In such 
 cases, we are told that we might try the experiment of lancing 
 the gums. But why do a useless thing, especially as it will 
 inflict some pain ? Has not the morbid irritation, in other 
 parts of the system, suspended the process of dental protru- 
 sion and alveolar absorption ? We must restore the system to 
 its normal condition by such means as the constitutional dis- 
 turbance may indicate, then the lancet will not be required 
 nor indicated. 
 
 In cases of convulsions for which we can assign no probable 
 cause, the gum-lancet maybe used upon the principle that 
 calomel is generally administered — it may do good, although 
 we cannot tell how, or wherefore. It may relieve the convul 
 sions by causing the loss of a drop or two of blood, or it may 
 
568 NOIT-mFLAMMATORY FORMS OF DISEASE 
 
 do it by producing a change of local irritation, or it may do 
 it by producing a shock to the nervous system, or it may do 
 it by some means which we cannot anticipate — at all events, 
 it will do no harm, and after all, this is perhaps the best rea- 
 son that can be assigned. If as much could be said in favor 
 of the present indiscriminate use of calomel, we could better 
 tolerate its use. 
 
 As the period of dentition is one of revolutionary action, 
 we should be careful not to provoke evils which, by care, may 
 be avoided ; consequently, we should make no change in any 
 of the habits or customs of the child during this process, 
 except in the periods of repose — as between the shedding of 
 the two inferior and the two superior incisors, and so on. 
 
 In that severe affliction which sometimes happens to infants, 
 denominated odontitis^ the gum-lancet can do no good, but 
 may do much mischief. The operation would be very painful, 
 and then the morbid inflammation which accompanies the 
 inflammation of the gums, might seize upon the fresh wound 
 and increase the sufferings of the patient. 
 
 We are told by writers on infantile disease, that the old 
 prejudice concerning disease of the skin which appears at 
 this period, being salutary in its influence, is not without a 
 foundation in truth ; that instances of convulsions or other 
 cerebral signs of mischief have been known to succeed a sud- 
 den disappearance of cutaneous eruption. 
 
 "We admit the facts, and regret to say that we have nowhere 
 seen a rationale of them for the guidance of the student. 
 When this is once had, the student can never hesitate in his 
 course. 
 
 Let it be ever present in the mind of every physician, that 
 no organization can manifest, at one and the same moment, 
 two equal or supreme actions. Now, the application of this 
 law will explain the whole difficulty. It will do more — it will 
 sustain a conclusion which we advanced a short time since, 
 viz: the process of dentition produces no disease. 
 
 If nothing morbid be in the system, there will be no cuta- 
 neous eruption ; but the eruption exists, hence there is mor- 
 bidity in the system. If this eruption be dried up, the 
 constitutional morbidity will seek some other channel for its 
 manifestation. If the existing morbidity of the constitution 
 
ABOVE THE DIAPHRAGM. 509 
 
 be eradicated, then the removal of the eruption will not be 
 succeeded by convulsions or any other manifestation of dis- 
 ease, because there does not exist any disease or morbid 
 quality to manifest. In other words, it is not in the power of 
 the system to maintain a manifestation of an equally morbid 
 condition through the skin and the brain at the same time. 
 
 A circumstance in the physical history of the writer will do 
 more to illustrate the principle we have laid down, than any 
 language of definition we can command. When a medical 
 student, at Lexington, he sufiered much with dyspepsia — the 
 gastric derangement was manifested in various ways, and 
 sometimes by toothache, but never by any pain or sense of 
 ill being in the stomach. Upon one occasion it was through 
 a most violent toothache — he entertained fear that serious 
 consequences might result upon the extraction of it. After 
 bearing with it three or four days and nights without inter- 
 mission, he consulted Professors Drake and Dudley, and they 
 expressed the opinion, that he might venture to have it ex- 
 tracted ; but so strong were his apprehensions, that he 
 endured it four days more, and then ventured and had it 
 extracted. In less than an hour after the operation, he had a 
 violent attack of asthma, and all the rest he obtained, in 
 another week, was in a sitting posture. He had never had 
 this disease before, nor has he had it since. 
 
 The principle now being made clear, we can calculate the 
 chances for the little sufferer. If the brain be large and the 
 chest small, or if it be large and prominent in its circumfer- 
 ence at the parietal ridge, by all means suffer the eruption to 
 continue, but, if possible, not to increase. If the general 
 health of the child be feeble, the same course may be the 
 most advisable. With the patient before him, the physician 
 can decide better than we can at this distance from him ; but 
 of one thing he may be sure — if the cutaneous eruption be 
 cured, and there remains in the system any morbid quality, it 
 is very probable that it will be manifested through the dental 
 process. 
 
 But sometimes the eruption spontaneously dries up, and 
 this is because a stronger action is being generated in the 
 dental process. In such a case, it may be advisable to increase 
 
570 DISEASE ABOVE THE DIAPHRAGM. 
 
 the cutaneous irritation by other means. Finally, the physi- 
 cian must aim at the least of impending evils. 
 
 [Note. — If physicians really desire to be of service to this class of their 
 patients, they should make themselves thoroughly acquainted with the anato- 
 my, physiology, and pathology of the teeth. The ignorance that obtains in 
 the profession, on this subject, is shameful. We understand thoroughly the 
 import of the language we are using. How could it be otherwise? Mnety- 
 five per cent, of the students have no other advantages upon the subject than 
 works of general anatomy, and a half-hour's lecture from the anatomical pro- 
 fessor. It has been our full and thorough conviction that no medical school is 
 complete without a professor of dental anatomy, physiology, and pathology, 
 and he should have received a thorough medical education. We once heard 
 a graduate of an eastern college gravely remark that he had not shed all of his 
 jaw-teeth ! We do not know how often infants, suffering from dentition, had 
 been confided to his care ! ! ] 
 
CLASS II, 
 
 MANIFESTATIONS OP DISEASE IN THE DIGESTIVE APPAEATUS LOCATED BELOW 
 THE DIAPHRAGM. 
 
 ORDEE I. 
 
 INFLAMMATORY FORMS OF DISEASE IN THE DIGESTIVE APPAEATUS 
 LOCATED BELOW THE DIAPHRAGM. 
 
 Genus I. — PERiTONrns — 
 Inflammation of the Peritoneum. 
 
 This disease sometimes attacks the fetus, and the causes 
 must necessarily be peculiarly obscure, but the revelations of 
 post mortem examinations have discovered two cases that 
 were, very probably, occasioned by strangulation of the intes- 
 tines. — (Cy. Prac. Med.) The many examples of peritoneal 
 adhesions, which have been detected in infants that lived but 
 a few hours after birth, show that inflammation occurs fre- 
 quently to intra-uterine life. 
 
 The causes of this affection during lactation are, perhaps, 
 not much less obscure than during gestation. We can, in 
 some cases, readily suppose it to be occasioned by improper 
 food, and a few more cases by wet clothing. 
 
 Its early symptoms, or those of the first or inflammatory 
 stage are quite obscure, so much so, as to frequently pass 
 unnoticed ; and the first information that is had, in most 
 cases, consists of that tension and tumefaction w4iich have 
 resulted from effusion. The slight pains which had previously 
 been manifested were attributed to flatulence or some other 
 trivial afiection of the bowels. As in adult peritonitis, pres- 
 sure upon the abdomen occasions a sensation of soreness to be 
 revealed in some part of the abdomen, but most generally 
 
 (571) 
 
572 INTLAMMATORY FORMS OF DISEASE 
 
 about the umbilicus. Coughing and sneezing also awaken 
 this sensation. The cutaneous tissue upon all parts of the 
 surface is pale, and the pathognomy of the face indicates lan- 
 guor, suffering, and discontent. At night the child is restless, 
 its sleep is broken and unrefreshing ; the appetite is variable ; 
 the bowels are usually affected with constipation and diarrhea 
 alternately ; the tongue, along its middle, bears a white fur, 
 while the edges are clean and of a pale-red color ; the pulse 
 during the forenoon is normal, but toward evening it becomes 
 contracted, quick, and accelerated ; the skin, like the pulse, is 
 quite normal in its temperature, until the evening exacerba- 
 tion arrives, when it becomes abnormally elevated. It is pro- 
 per to add, that in some cases the abnormal pain is constant, 
 quite severe, and attended with vomiting, and a greater 
 severity of the previouslj^-enumerated symptoms. 
 
 The duration of this disease, as in adult life, is very various, 
 but at sometime between the fifth and twentieth day, effusion 
 into the peritoneal cavity takes place, and the abdomen con- 
 sequently becomes enlarged ; and that it is really effused 
 serum, percussion leaves no doubt. The effusion, however, 
 if not arrested, goes on still further to enlarge the abdomen, 
 the skin of the superior parts of the thighs hangs in folds, the 
 extremities become emaciated, and so does every other part 
 of the body, except the face and the parts before-named — and 
 in this extremely reduced and prostrated condition, the patient, 
 under a consuming febrile excitement, sinks into death. 
 
 Diagnosis. — It is all important, in some respects, that a 
 mistake in the premises should not be made. The pain of 
 colic is more severe, spasmodic, and intermitting, while that 
 of peritonitis is constant, rarely so severe with infants ; and 
 then, again, pressure gives relief in colic, and pain in the 
 other. 
 
 Parents, and the unprofessional in general, are apt to mis- 
 take this disease for that of worms, and to administer anthel- 
 mintics, which perhaps never fail to increase the mischief. 
 As there is no certain symptom for the presence of worms, we 
 must be guided by the presence or absence of those which 
 characterize peritonitis. 
 
 Pkognosis. — This is not necessarily a fatal disease — under 
 proper treatment, in its first stage, it yields quite readily; 
 
BELOW THE DIAPHRAGM. 573 
 
 and even in the second, when effusion has manifestly taken 
 place, it may still be arrested by judicious treatment. The 
 great difficulty to contend with is the obscurity of the early 
 symptoms — we cannot always discover the nature of the 
 malady with which we have to contend. 
 
 Treatment. — The patient should be kept in bed and not 
 allowed to change his position often, and not even the bed- 
 clothes should be allowed to press upon the abdomen. Not- 
 withstanding constipation is a frequent accompaniment, we do 
 not regard it proper to induce free catharsis, for this, in all 
 cases, would be attended by an increase otall the above-named 
 symptoms; and even where laxatives have to be used, they 
 should be regarded as secondary agents ; hence, so soon as 
 the disease has been fully diagnosticated, apply warm fomen- 
 tations over the stomach and bowels or cloths wrung out of 
 the decoction of bitter herbs, which should be as hot as the 
 patient can bear ; these should be repeated as often as they 
 become cool, until the active symptoms have subsided, which 
 may be from twenty-four to sixty hours. 
 
 To remove the constipation, injections of Starch-water, with 
 a small quantity of table salt and the Antispasmodic Tinc- 
 ture, should be given. 
 
 If this combination should not be sufficiently active, and 
 violent pain be present, the Sudorific Tincture may be added. 
 The Neutralizing Cordial may be administered in laxative 
 doses, until mild evacuations have been produced. 
 
 We do not regard it necessary to make use of counter- 
 irritation in this disease, but rely entirely upon the above 
 treatment, which, if adopted in the early stage of the disease, 
 there need be very little apprehension of effusions or deposi- 
 tions taking place. 
 
 Genus II. — Cholera Infantum — 
 Inflamw,ation or Mgh Irritation of the Stomach and 
 
 Boxoels. 
 This form of disease is unknown to European society, and 
 but little known in our own country, except in our middle and 
 southern states. 
 
 If to those conditions of the mucous membrane of the intes- 
 tines which constitute feculent and catarrhal diarrhea, we add 
 
574 INFLAMMATORY FORMS OF DISEASE 
 
 a derangement of the liver and an erythematic inflammation 
 of the mucous lining of the stomach, passing sometimes into 
 a state of congestion, we shall be able to form a pretty accu- 
 rate conception of cholera infantum. 
 
 The exciting causes correspond with this synthesis — impro- 
 per food and atmospheric exposures of the body, as by the use 
 of insujB&cient clothing. We shall find the evacuations from 
 the bowels and the condition of the stomach still further sus- 
 taining the above estimate of it. 
 
 The natural faeces are frequently greatly retained, while the 
 others are sometimes thin and serous or watery, sometimes 
 more consistent and consisting principally of mucus occasion- 
 ally containing some blood. The color is variable, being 
 green, yellow, white, or brown, inodorous or very ofiensive, 
 but generally having a sourish smell. Sometimes the alvine 
 irritability is such that the ingesta lienterically pass through 
 the intestines. 
 
 Although the intestinal actions, in the beginning, may only 
 indicate a diarrhea, yet the stomach is generally affected from 
 the start, and when the attack is violent, the vomitings and 
 purgings are attended with such spasmodic actions as to 
 resemble the cholera morbus of adult life. 
 
 The fever, which soon follows the first symptoms, is irregu- 
 larly remittent, having its highest exacerbations in the even- 
 ing. The brain is greatly involved, as is manifested by the 
 delirium and even frenzy which attend it. The eyes, by 
 their fierce or languid expression, when awake, and half-closed 
 condition, when asleep, are indicative of the same. 
 
 The pulse is generally small, quick, and feeble, or irritated 
 and corded, but rarely full or strong. The thirst is intense 
 and cold water is urgently demanded, and as soon as it is 
 swallowed it is rejected. With all this, there is an unequal 
 distribution of temperature, while the extremities are cold, 
 the body is very hot. 
 
 Emaciation progresses in this afiection with great rapidity — 
 the complexion becomes pallid, the flesh flabby, and such is 
 the demand of the respiratory function, that the fat becomes 
 entirely absorbed, livid spots appear which finally pass into 
 ulcerations. 
 
 The eyes and cheeks become sunken, the lips shriveled, the 
 
BELOW THE DIAPHRAGM. 575 
 
 integuments corrugated, except on the forehead, and nose 
 pointed. Now, such is the character of the disease, that at 
 this stage it is possible for the patient to recover, but still it is 
 probable that he will not. 
 
 In many instances, the vomiting, in connection with the 
 above symptoms, continues to the close of life ; but more 
 generally it ceases, leaving a diarrhea to wear out the patient. 
 In still more advanced stages of the disease, several other 
 fearful symptoms are generated — the abdomen becomes tumid 
 or sunken, the mouth becomes moist and aphthous, petechise 
 and a small, vesicular eruption appear on the breast, the skin 
 becomes of a dull and dirty hue, and the conjunctiva appears 
 bloodshot. The circulation has become exceedingly lan- 
 guid, the patient very restless and plaintively moaning, coma 
 comes on and terminates the sufiering, but not always without 
 symptoms of hydrocephalus. 
 
 The vesicular eruption on the breast, the discharge of living 
 worms, and the thrusting of the fingers into the back part of 
 the mouth, as though desirous of withdrawing something, are 
 regarded as invariably fatal symptoms : but the tenacity with 
 which the infantile system clings to life, in this form of dis- 
 ease, most generally, is truly remarkable : the struggle seems 
 to be one of time, and if the physician can stay, even to some 
 extent, the progress of the disease, to a more advanced sea- 
 son, the patient may recover, however improbable it might 
 appear from the exceedingly worn-out condition of the 
 patient. 
 
 In duration, the disease varies from a few hours to weeks, 
 and from weeks to months ; and in accordance with an old 
 adage, it may almost be truly said of it, that " while there is 
 life there is hope." 
 
 Causes. — Much has been said about the cause of this dis- 
 ease — it is maintained by very many that the process of den- 
 tition, the existence of worms, and exposure to cold have 
 much to do in producing a predisposition to it. But all of 
 these causes operate upon children in the second dentition, 
 and yet they do not have this disease. Again, all these 
 causes act upon children, under two years of age, during the 
 cold months, as well as the warm ones, and yet they are not 
 assailed by it. The children of other countries, and in the 
 
5Y6 INFLAMMATORY FOUMS OF DISEASE 
 
 same latitude, are operated upon as much, by the same causes, 
 as are the children of this country, and yet they do not have 
 the disease. Is it safe, then, to infer that these causes have 
 any agency in the production of it? As it occurs during the 
 process of first dentition, it is very convenient for those who 
 have not candor enough to confess their ignorance, to avail 
 themselves of the coincidence, as of a cloak with which to 
 hide their ignorance. 
 
 Prof. Wood, in treating of this disease, says, that the first 
 indication is to remove the causes, and that while these are 
 permitted to continue, the physician can do but little to pro- 
 mote a cure. Now, as we are sure that the causes have not 
 been discovered, we are equally sure that they are never 
 removed unless by accident, hence we may charitably suppose 
 that the astonishing fatality of the allopathic practice, in this 
 disease, is to be charged to the non -removal of the causes. 
 
 As the disease is confined to a certain district of country, 
 we hold it to be impossible to remove the causes, but it is 
 possible to remove the child out of the midst of them. 
 
 We are told that this disease prevails much more in small 
 courts, alleys, and narrow streets, than in other and better 
 ventilated parts of the city. If this be a fact, one step is 
 made toward a discovery of the conditions under which it is 
 produced. It is our conviction, that, in the south at least, the 
 alleys and narrow streets of the cities, and low situations of 
 the country, are much more exempt from summer and fall dis- 
 eases than the less crowded and better ventilated portions, 
 and the more elevated ones of the country, so far as regards 
 adult life. Our observations in the city of Baltimore, in Mis- 
 sissippi, Alabama, and Louisiana, but more especially in the 
 city of New Orleans, forced us to this conclusion. If this 
 statement be true, then, we have made another step in the 
 progress of this inquiry. 
 
 Again, it is an admitted fact that the disease is measurably 
 confined to our middle and southern states, and will it not be 
 admitted that these states produce a greater amount of evapo- 
 ration than any other district, of the same magnitude, in the 
 world ? If this be admitted, we have safely made a third step. 
 
 In the next and last place, it is already admitted that it 
 prevails more in our cities, than in the country, while the 
 
BELOW THE DIAPHRAGM. 577 
 
 disease of adults, during the same season, prevail much more 
 in the country. 
 
 Now, although we shall have safely taken these four steps, 
 it does not follow that we shall discover the precise cause of 
 cholera infantum ; but it does follow that we have made a 
 useful advance toward it, and that too, without pressing into 
 our surface that other cloak which was invented to cover igno- 
 rance — miasmata. 
 
 We will now venture another step : to chemists, we believe, 
 it is well understood, that where there is the greatest amount 
 of evaporation, there is the greatest reduction of temperature 
 and the greatest evolution of electricity. The predisposing 
 cause or causes now lie concealed in the preceding facts, for 
 assuredly it is not doubted that all children, during the first 
 two years of their existence, because of the peculiar condition 
 of their systems at this age, are susceptible (not predisposed) 
 to the influence of the cause of this disease, no matter in what 
 it may consist; and by its continued influence, for a time 
 longer or shorter, a predisposition to it will be produced, when 
 a slight exposure to cold, too much cold drink, or an improper 
 article of food may excite the predisposition into action, and 
 cholera infantum is the result. 
 
 Admitting that we have truly advanced thus far, it will be 
 admitted, although we have not discovered the entity that 
 causes or predisposes to the disease, and although we cannot 
 remove it, that we have shown, that by the removal of the 
 child, even fifty or a hundred yards, we may place it in a con- 
 dition very nearly the opposite of the one in which it con- 
 tracted the disease, and this can, most generally, be done. 
 
 Inasmuch as we have not got obvious facts to lead us 
 further, and inasmuch as we are entitled to the privilege of 
 indulging in such inferences, from the facts we have, as sug- 
 gestion may furnish, we will attempt a nearer approximation 
 to the predisposing cause of the disease before us. 
 
 The great amount of electricity evolved in ventilated and 
 evaporating situations may be assumed as the cause of the 
 various forms of summer disease in adults, for it is true, that 
 there is not a morass or swamp in our country, about which a 
 man may not live and have good health, provided he will live 
 in the woods, or even sleep in them. About the country 
 37 
 
578 INFLAMMATORY FORMS OF DISEASE 
 
 farms there is more evaporation than in our cities, and he is 
 more liable to sickness in the former than in the latter. 
 
 Now, with regard to children, it maybe assumed that their 
 cutaneous function is rendered imperfect by the surrounding 
 humidity— a humidity that could not injuriously contend with 
 the force of an adult skin. In the next place, may it not be 
 safely assumed that this humid state of the atmosphere im- 
 pedes, to an equal extent, the pulmonary function, preventing 
 a thorough elimination of the carbon of the venous blood — 
 and preventing such an absorption of oxygen as may be essen- 
 tial to the elimination of the metamorphosed tissues ? K 
 these two functions shall be embarrassed, it is obvious that 
 an excess of duty will be imposed upon the liver and kidneys 
 and cause them to fail. If we are justified in the preceding 
 conclusions, have we not found a sufficient cause for the 
 disease ? 
 
 But we have not yet done. Considering the soft, serous, 
 immature, and developing condition of infancy, may not its 
 organism require that electrical atmosphere which evaporation 
 produces in freely -ventilated situations ? To us, this seems to 
 be exceedingly probable. 
 
 It appears far more than probable that we shall never be 
 able to understand the modus operandi of any of the occult 
 causes in creating predispositions to disease ; but it is possi- 
 ble, by a careful observation and comparison of facts, to 
 obtain a knowledge of the conditions under which it is pro- 
 duced. When we shall have acquired this knowledge, although 
 we shall be no more able to change or modify them, we will 
 be able to deport ourselves wisely with reference to them. 
 
 Treatment. — Although, under Allopathic treatment, this 
 disease proves very fatal, yet, as far as our observation and 
 inquiries have extended, the treatment which we herein lay 
 down as Eclectic, has been almost uniformly successful — the 
 failures being mere exceptions to the general rule. 
 
 The agent on which we principally depend for the removal 
 of infantile summer complaint, is the Syrup of Ehubarb and 
 Potassa, which removes nausea and vomiting, when present, 
 acts mildly upon the stomach and bowels, and restores the 
 evacuations to a healthy condition. 
 
 K febrile symptoms are present, the whole surface of the 
 
BELOW THE DIAPHRAGM. 579 
 
 body and limbs should be sponged two or three times daily 
 with a weak alkaline solution rendered stimulant by the addi- 
 tion of a small quantity of whisky or spirits ; and in obstinate 
 cases, attended with high fever, the Compound Tincture of 
 Virginia Snakeroot may be added to the above syrup, in 
 the proportion of one part of the tincture to four of the syrup. 
 
 Where the discharges from the bowels are frequent, and 
 attended with pain, we employ the following injection, used 
 cold, to be administered immediately after each evacuation, 
 and retained in the rectum as long as possible. 
 ^. Ulmus Fulva, 
 
 Cort. Prunus Yirginiana, aa gss, 
 Aqua, octj. Mix, 
 let it stand two or three hours, and it is ready for use. The 
 quantity to be used as an injection must vary from one to two 
 drachms ; larger quantities increase the disposition to strain 
 or defecate, which should always be avoided. Usually, we 
 add a few drops of the Compound Tincture of Virginia Snake- 
 root to each enema, and in protracted cases, we add about 
 one-fourth part of the Saturated Tincture of Prickly-ash ber- 
 ries. This injection has a decided influence in moderating 
 inflammation and relieving pain. 
 
 Where vomiting is obstinate and frequent, a Mustard poul- 
 tice, applied over the epigastric region, will be found useful, 
 in connection w^ith the internal use of the syrup and tincture, 
 as above-named ; and if the patient at any time during the 
 disease becomes prostrated, stimulants must be administered, 
 as diluted Brandy, Wine-whey, or Aromatic Spirits of Am- 
 monia. 
 
 Cooling mucilaginous drinks should be frequently given 
 when irritability of stomach and accompanying nausea or 
 vomiting are absent. 
 
 After the inflammatory or febrile form of the disease has 
 been removed, should diarrhea remain, astringents, with tonics, 
 must be given ; as, 
 
 9^. Hydrastin, 
 
 S. Quinia, aagrs. ij, 
 Geraniin, grs.xvi. Mix, 
 Divide into sixteen powders, of which one must be given- 
 
580 :n'oi«'-inflammatory forms of disease 
 
 every hour or two, according to the urgency of the case, and 
 continued until the excessive evacuations have ceased. 
 
 Occasionally, very obstinate cases of cholera infantum occur, 
 in which the employment of Leptandrin, to overcome biliary 
 derangement, in conjunction with the other means already 
 recommended, will exert a highly-beneficial influence. 
 
 The child's clothing should be often changed, the diet should 
 be light, as boiled milk, with powdered Cinnamon added, or 
 milk thickened with Wheat or Rice flour ; and, if possible, it 
 should be removed from the city to the country, or at all 
 events, some distance from its home ; and, under all circum- 
 stances, it should not be confined within a closed room, but 
 should be exposed as much as possible to the air, but not to 
 the influence of the sun's immediate action. 
 
 ORDER II. 
 
 NON-INFLAMMATOET FORMS OF DISEASE IN THE DIGESTIVE APPA- 
 RATUS LOCATED BELOW THE DIAPHRAGM. 
 
 Genus I. — Gastric Indigestion — Dyspepsia. 
 
 This aflTection, in infants, as in adults, is marked by every 
 grade of importance, because attended by every possible 
 variety of gastric disturbance. Infants often throw up the 
 milk they have swallowed, which appears sometimes unaltered, 
 and at others, coagulated into masses of greater or less size. 
 Sometimes it amounts only to simple regurgitation, attended 
 with a little cough or hiccough. Sometimes, when it sucks 
 too much, the contractile irritability of the stomach forces a 
 portion of it up ; and, lastly, when true indigestion is present, 
 the matters thrown up show that such action has not been 
 had upon them as would indicate a normal digestive process. 
 
 While considering this subject, it should be recollected that 
 the form of this viscus, in infants, and its position in the 
 abdomen, are such as greatly to qualify it for the discharge 
 of its contents, and hence the great ease with which they 
 vomit. 
 
BELOW THE DIAPHRAGM. 581 
 
 The vomiting of infants, however, must not always be 
 regarded as indicative of disease in the organ itself. It is a 
 symptom of pleural or pulmonary inflammation, of the onset 
 of cerebral disease, and frequently a precursor of the various 
 forms of eruptive disease. It may also attend infantile diar- 
 rhea, and upon the use of improper food, it may attend signs 
 of intestinal disturbance. 
 
 The stomach, in this period of existence, frequently becomes 
 so irritable, as uniformly, almost, to reject its contents; but 
 this symptom is not always essential to the fact that this organ 
 is incapable of performing, with necessary ability, its proper 
 function, as attending circumstances will generally render very 
 obvious. 
 
 Sometimes, in infants, while no indications of intestinal 
 disturbance exist, they will be suddenly attacked with violent 
 vomiting, and although the stomach thus indicates an exceed- 
 ing irritability, its desire for the breast is unabated — it sucks 
 but to vomit, which may happen immediately or be procras- 
 tinated for a short time. 
 
 Causes. — When the child has been usually healthy, such 
 attacks as these may, very generally, be attributed to some 
 derangement in the health of the mother or to some indiscre- 
 tion. She has perhaps been absent and allowed it to be 
 absent from the breast longer than usual, and then allowed it 
 to indulge to excess, or the child has been fatigued, exposed 
 to the sun, or been roused, in an untimely manner, from its 
 sleep. 
 
 Treatment. — No matter what the cause has been, the child 
 should be taken from the breast, and a proper course of treat- 
 ment commenced, not only for the removal of the existing irri- 
 tability, but also as a prophylaxis. 
 
 A tea-spoonful of cold water may be given to it, which, if 
 retained, may be followed in thirty minutes by one or two 
 more ; and if these shall also be retained, then a little isinglass, 
 or something else equally simple, may be dissolved in water 
 and administered in the same way. 
 
 If the vomiting shall have ceased for eight or ten hours, it 
 may be allowed the breast or cow's milk diluted with water, 
 but they should be used with the same temperance. 
 
 If the stomach bear this course for ten, twelve, or more 
 
582 I^'ON'-INFLAMMATORY FORMS OF DISEASE 
 
 hours, de23ending upon the violence of the case, then it may 
 be restored to the breast, under the precaution to guard 
 against full indulgence. 
 
 But should the vomiting be preceded or attended by intes- 
 tinal disturbance or gastric symptoms of a more serious char- 
 acter, a resort to medicine is indispensable. 
 
 In connection with the treatment above prescribed, a very 
 mild aperient, as the Syrup of Khei and Potassa, or a small 
 portion of Leptandrin, may be given ; and if the vomiting 
 shall have continued for several hours, the application of a 
 Mustard or Cayenne Pepper poultice to the epigastrium will 
 be likely to aflbrd much relief. The physician must now rely 
 upon his acquaintance with the general principles of the pro- 
 fession . 
 
 l^ormally, the appetite is proportioned to the demands of 
 the system — if therefore, the process of development shall 
 measurably cease, the only obvious symptom may be anorexia. 
 The child seems to have no special disease, but it gradually 
 becomes paler and leaner. This state of the patient may 
 consist in an inability of the stomach to digest even the 
 smallest quantity of nourishment. But even this, under such 
 circumstances, only indicates a general pathological state, 
 which may be, as it often is, produced by a chamber too ele- 
 vated in temperature, and badly ventilated. 
 
 In dyspeptic conditions of the stomach, anorexia is more 
 an attendant symptom, than is a gormandizing desire to feed. 
 It often happens that the child never appears satisfied except 
 when sucking; and when it has indulged to repletion, it seems 
 very uncomfortable until it has disgorged it. The relief 
 which this process brings is immediately followed by a renewed 
 desire to suck again. 
 
 As regards the bowels, in these various phases of dyspep- 
 sia, nothing specific can be laid down ; but this much may 
 be said — anorexia is generally attended with constipation, 
 while diarrhea as commonly attends over and constant feed- 
 ing ; and yet the evacuations do not appear to indicate, to 
 even a remote extent, the amount of deranged gastric action 
 under which they are produced. 
 
 It is far better to remove constipation in infants, as well as 
 in adults, by soap suppositories, than by any internal admin- 
 
BELOW THE DIAPHRAGM. 583 
 
 istration of medicine. Frictions with some mild liniment, 
 often prove advantageous. 
 
 When the repeated vomitings have an acid exhalation, and 
 are attended with a ropy mucus, and this too in the absence 
 of evident signs of gastric inflammation, it will be proper 
 to administer an antacid. In this disease, medicine may 
 palliate or remove a symptom, but it is not wise to rely upon 
 it, to make a cure. This has to be effected by a proper atten- 
 tion to diet, rest, ventilation, and temperature. It will be the 
 duty of the mother to note the effect of every variety of infan- 
 tile diet upon the child, to discover the one that will best 
 agree with it. 
 
 This gastric irritability may be produced by poison, which 
 may have been associated with its food, from having been 
 prepared in improper vessels, or it may have handled and 
 placed in its mouth some metallic instrument coated with a 
 poisonous oxide ; but such occasions, while infants are at the 
 breast, must be extremely rare. 
 
 We should never omit to give particular attention to the 
 color of the matters vomited up, because they may indicate 
 their history ; when they result from indigestion, and their 
 seat is the stomach, they are very generally white, but some- 
 times a little yellow, and more frequently semi-fluid than 
 coagulated. 
 
 Mothers and nurses usually regard the regurgitations of 
 milk, by infants, as ominous of health — no doubt but that 
 it serves frequently as a prophylaxis, for in such instances, its 
 ingesta was too abundant for the demands of health. But 
 when the milk is retained, and then firmly coagulated and 
 rejected with pain, we cannot form a very flattering conclu- 
 sion. 
 
 The casein of the milk is the flrst to coagulate, but then its 
 coagula is never hard, like that which is vomited up. The 
 normal coagula, when formed, is speedily dissolved by the 
 gastric juices, and adapted to the purposes of assimilation ; 
 but this coagulation is a very different matter from that into 
 which milk spontaneously runs. This is a step in the process 
 of putrefaction, and generates a free acid which has none of 
 the solvent power of the gastric juice, but impedes digestion, 
 and hence the impropriety of feeding a child on sour milk. 
 
584 IS-QK-INFLAMMATORF FORMS OF DISEASE 
 
 Now, it is possible, indeed very probable, that the stomach 
 of an infant may be so deprived of its normal juices as to aid, 
 by its temperature, the spontaneous process of acetous fermen- 
 tation to the production of pain in the stomach and diarrhea — 
 for certainly, it can be a matter of no diflerence as to whether 
 this process is effected or commenced before or after its admis- 
 sion into the stomach. 
 
 The vomiting of coagulated milk is frequently thought to 
 indicate the existence of too much acid in the stomach ; but 
 this is not necessarily the case. It may only indicate such a 
 condition of the stomach as disqualifies it for producing its 
 juices in a sufficient quantity, or in a normal quality. In 
 either event, the milk passes into the acetous fermentation. 
 
 In all cases of this kind, the eructations are nauseous and 
 the breath offensive. In cases of this kind, and they are cer- 
 tainly distinguishable, the mineral acids will be highly ser- 
 viceable. Some of these cases are attended with diarrhea, 
 which consists of pale, light-yellow evacuations — indicating 
 a demand for an alterative medicine. 
 
 A majority of infantile forms of disease, happening before 
 the period of weaning, may generally be referred to some 
 cognizable or occult morbus in the mother. In the infant, 
 disease, beyond all question, exists, and it depends upon the 
 exciting cause, as to whether it will be manifested in the form 
 of dyspepsia, cutaneous eruption, or by disease of some other 
 character. 
 
 The various forms of disease which attack children, after 
 they are weaned, are not to be regarded, necessarily, as inde- 
 pendent of the same remote cause. 
 
 Genus II. — Intestinal Indigestion. 
 
 We frequently see children afflicted with diarrhea without 
 the presence of enteritis or inflammation of the intestines. 
 They are reduced to a state of marasmus and death by a want 
 of nourishment, and yet have had a full supply of food — they 
 die of hunger, with an insatiable appetite and plenty of food 
 that was agreeable to its taste. 
 
 This diarrhea consists of a thin white mucus, frequently 
 containing lumps of coagulated milk, unaltered by the stomach 
 or the intestines. After death, the mucous membrane of the 
 
BELOW THE DIAPHRAGM. 585 
 
 intestines is found to be without color throughout its whole 
 extent, unless there shall still exist, in various parts of its 
 surface, patches or streaks, retaining its normal color and 
 condition. 
 
 The causes of such defective nutrition may exist in the 
 nature of the milk, in the manner in which it is taken, or in 
 some great defect in the digestive system of the child. The 
 milk of one woman may agree very well with some children, 
 and be at the same time destructive to others ; if, therefore, 
 the quality of the milk be suspected to be the cause, some 
 other food should be tried, such as cow's milk and water, or 
 barley-water and milk. Such a change is sometimes found to 
 be successful. 
 
 If the milk flow very rapidly, the child may receive more 
 than a proper supply at each time the breast is given to it, 
 and as this practice would do more mischief than even a 
 slight insufficiency, it should be carefully attended to. If the 
 difficulty is inherent in the child, it may not be impossible to 
 find such food as will agree with and nourish it. At all 
 events, when the child manifests continual hunger, seizes the 
 breast with great eagerness, has a pale face, and withal is 
 becoming more and more emaciated, we should attend imme- 
 diately to both the quality and quantity of the food, because 
 medicine can do no permanent good so long as there shall be 
 a fault in either of these respects. 
 
 Genus III. — Colic. 
 
 This complaint, in young infants, is peculiarly distressing, 
 and, with many, it is an occurrence of every day. It is 
 divisible into two distinct varieties, one of which may be 
 occasioned by a considerable variety of causes, as badly- 
 digested food (which very frequently happens to those infants 
 who are artificially fed), or some morbid quality in the milk 
 of the mother, which may result from disease in her system, 
 or from outbreaks of temper ; and when this is the cause, the 
 consequence upon the child may be convulsions. 
 
 This form of disease may also arise from the neglect of the 
 nurse to keep the extremities warm. Flatulence is the result 
 of all these causes, except the last, which appears to afl'ect., 
 principally, the muciparous follicles, and to a degree that may 
 
586 NON-INFLAMMATORY FORMS OF DISEASE 
 
 result in inflammation. This variety of colic has been de- 
 nominated erratic. 
 
 The other form of this complaint is called the periodical^ 
 because it returns pretty regularly at a certain period of the 
 day, and usuall}^ in the afternoon. This variety of colic does 
 not appear incompatible with the health, as it usually quits 
 the child at the age of three months, and hence it gives old 
 women no concern — they call it the " three-months belly- 
 ache." 
 
 The cause of this colic is greatly concealed, but not more 
 so than are the adequate means for its removal. Constipa- 
 tion is a very constant attendant upon it. 
 
 Erratic colic may occur at any time of the day and without 
 being traceable to any probable, and much less certain, cause. 
 Its subjects are most generally, those of a feeble constitution. 
 The patient may take the breast with a good appetite, and the 
 mother may furnish an abundance of milk, but because of 
 some morbid quality in the latter, the stomach of the former 
 becomes filled with a fluid which it cannot digest, but which 
 becomes acid, producing in the child, probably, a diarrhea 
 with green stools, or they may consist of ill-digested food, 
 without any abnormal frequency. If the food be improper, 
 whether of milk or otherwise, the child will manifest unea- 
 siness as soon as it has done feeding. The abdomen becomes 
 tense with manifestations of much pain. From these symp- 
 toms the patient is frequently and suddenly relieved by an eruc- 
 tation of gas, or by its passage through the large intestines. 
 
 The treatment, of course, should commence with a removal 
 of the cause, if it can be discovered. If acidity attend the 
 disease, Magnesia will be indicated, more especially if a ten- 
 dency to constipation shall exist. 
 
 Sweet Oil, by the teaspoonful, three or four times a day, 
 often proves a valuable remedy. 
 
 Particular attention should be paid to the quality and quan- 
 tity of the food, and if the patient be fed entirely by the 
 breast then a suitable change should be made in the diet of 
 the nurse. If it be nourished by the spoon or bottle, an occa- 
 sional emetic will be useful to empty the stomach of indigesti- 
 ble crudities. 
 
 If the colic have been produced by cold or wet, it will be 
 
BELOW THE DIAPHRAGM. 587 
 
 advisable to use a pediluvium, and at the same time warm 
 fomentations with a flannel cloth with frictions with a warm 
 hand to the abdomen. These means usually produce a revul- 
 sion to the surface. This course, with antispasmodics, as 
 warm Mint teas, will generally suffice to remove the difficulty. 
 
 Upon the periodical form of colic, constipation is a very 
 common attendant, and yet purgative medicines do not prove 
 advantageous ; but when it has been more than usually pro- 
 tracted, it may be advisable to administer an injection of mo- 
 lasses and water, or try a suppository of soap. 
 
 The difficulty which is here intended to be removed, is con- 
 fined to the large intestines, and therefore it can never be 
 advisable to produce an increase of action in the stomach and 
 small intestines to reach it — mischief must be the result. As 
 this disease observes periodicity, it may be broken up by the 
 prompt use of antispasmodics ; but for the suffering of the 
 child, the disease should produce but little concern, as it is 
 not dangerous. 
 
 Genus IY. — Diaekhea. 
 
 This form of disease is peculiar to no age, yet it does, be- 
 yond all question, occur most frequently during infancy ; and 
 it is proper to remark, further, that it is liable, at this early 
 age, to assume a more dangerous character than at a more 
 advanced one. In it the discharges or evacuations are more 
 frequent and liquid, and sometimes more copious than is nor- 
 mal. Inasmuch as it is occasioned by very different causes, 
 and obtains under very different conditions of the system, it 
 has, for the purpose of elucidation, been divided into several 
 species, as the Feculent, Bilious, Mucous, Chylous, Lienteric, 
 and Chronic. 
 
 Species I. — Feoulent Diarrliea. 
 This is treated of as the most simple form of the disease — 
 in it the condition of the bowels appears, pathologically, to 
 consist in such an irritation as may be produced by the direct 
 action of offensive or acrid matters upon the mucous lining 
 of the intestinal canal. Even the ordinary contents of the 
 bowels may prove so irritating as to produce excessive peri- 
 staltic action, because of a pre-existing irritability of the mucous 
 membrane, occasioned by unknown or inappreciable causes. 
 
588 15'ON-INFLAMMATORY FORMS OF DISEASE 
 
 When it originates in the irritation caused by acrid or 
 otherwise offending causes, acting directly upon the mucous 
 membrane, it will most likely cure itself by the expulsion of 
 the offending substances ; but when it results from some mor- 
 bidly-irritable condition of the bowels — such as will not tole- 
 rate the presence of their most mild and ordinary contents, 
 then we must not expect a spontaneous cure. When, there- 
 fore, the disease has existed three or four days, we may con- 
 clude that it depends upon some pre-existing morbid irrita- 
 bility of the bowels, rather than upon the presence of acrid 
 substances. 
 
 In this form of the disease, the evacuations resemble those 
 which are usually produced by the action of cathartics — they 
 are feculent, but less so when the immediate cause is the 
 morbid, irritability of the bowels, and under such circum- 
 stance it is more difficult to manage, because the irritation 
 sometimes amounts to a subacute inflammation. 
 
 Causes. — The most frequent cause of this form of diarrhea 
 consists in improprieties of diet — the patient may have fed 
 too much, or the food may have been highly indigestible ; in 
 either event, some of the food may pass through the stomach 
 in a comparatively crude condition. From the presence of 
 such food, the bowels may become so highly irritable, as, after 
 its expulsion, to refuse to retain the most bland that can be 
 given ; when the cause depends upon an incompatibility be- 
 tween the child and the mother's milk, the diarrhea is feculent 
 throughout its course — depending upon a simple irritability 
 of the mucous lining of the bowels. That constitutional irri- 
 tation which attends dentition, not unfrequently occasions 
 this form of diarrhea. 
 
 Treatment. — In this form of diarrhea, the Syrup of Rhu- 
 barb and Potassa, given in doses suitable to the child's age, 
 will be all the therapeutic treatment generally required; it 
 should be given every hour until it has operated upon the 
 bowels, after which its repetition every three or four hours 
 will be sufficient. 
 
 The child's diet should be especially attended to, and should 
 consist principally of boiled milk, boiled milk-and-bread, 
 toast- water, boiled Rice, Sago, etc., but no meats or vegetables, 
 except the Rice. 
 
BELOW THE DIAPHRAGM. 589 
 
 If at the breast, the milk should be examined, and if found 
 unhealthy, the nurse must be changed, or the infant weaned ; 
 but if healthy, it should not be allowed to suck as much at a 
 time as generally. 
 
 Children sucking, should, as a general rule, be allowed no 
 other food than the breast milk. 
 
 Species II. — Bilious Diarrhea. 
 
 This form of the disease not unfrequently appears in the 
 feculent character, through that irritation which the presence 
 of bile produces upon the mucous membrane of the bowels ; 
 but the color of the evacuations will indicate the source of the 
 irritation. The appetite is frequently good, although the 
 digestive powers of the intestines are much enfeebled. 
 
 In this feculent form of diarrhea, nausea and vomiting 
 occur more frequently than in any other, and it generally 
 supervenes feeding, and rarely fails to end in colic pains and 
 brisk purging. 
 
 But the true bilious form of diarrhea betrays a much higher 
 grade of biliary action than is indicated by the preceding 
 symptoms. The bile is produced in an excessive quantity, 
 and it is reasonable to suppose that its quality is greatly 
 vitiated. The evacuations are mixed with much yellowish or 
 greenish -looking bile, and generally the urine is much stained 
 with it, and after having progressed a few days, the eyes and 
 skin assume a jaundiced appearance. 
 
 So far as can be inferred from the appearance of the bile, 
 it is entirely normal in quality but extremely copious in quan- 
 tity; but in other instances, its appearance is very unnatural 
 and its quality is so acrid as to occasion considerable burning 
 and irritation about the anus. When the evacuations are of 
 this character we should be prepared to apprehend a super- 
 vention of some inflammatory irritation of the mucous mem- 
 brane. 
 
 It is not uncommon for the bile, in the course of several 
 days, to become replaced, entirely, by an aqueous fluid or 
 secretion, which is attended with considerable irritation of the 
 stomach. This suspension of bilious secretion is, most pro- 
 bably, occasioned by a venous congestion of the liver. 
 
 Causes. — A modification of bilious diarrhea is frequently 
 
590 NON-INFLAMMATORY FORMS OF DISEASE 
 
 induced, among children of two or three months of age, by 
 such feeding as is calculated to tax heavily the digestive appa- 
 ratus, such as bad milk and other improper food. Attending 
 this variety there is apt to be much acidity of the intestinal 
 canal, which occasions griping. The evacuations are usually 
 of a bright-green color. 
 
 But bilious diarrhea, properly so considered, usually occurs 
 about the close of the hot season, and is occasioned, in our 
 opinion, by such a debility of the cutaneous system, as inca- 
 pacitates it for the discharge of its function, and consequently 
 the liver is vicariously called into action to depurate for the 
 skin ; and this cutaneous debility is occasioned by solar heat, 
 under circumstances of defective evaporation, as a humid 
 atmosphere. 
 
 Our observations in the south have brought us to the con- 
 clusion, that adults, in the hot season, do best in a humid 
 atmosphere, and children in a dry one. For the reason above 
 assigned, populous cities and marshy districts are more pro- 
 ductive of the disease than situations of a contrary character. 
 Under such circumstances, other etiologists consider malaria 
 to be the cause. In the first place, we deny the existence of 
 such a poison ; and in the second, nothing is gained by the 
 admission of it — it affords no pathological information. To 
 say that malaria caused it, is equivalent to saying that it had 
 a cause. 
 
 Treatment. — The treatment recommended for cholera in- 
 fantum is that which we have found the most successful in 
 this form of diarrhea. 
 
 Species 111. — Mucous or Catarrlial Diarrhea, 
 This form of diarrhea differs widely, in some respects, from 
 the two preceding — this is measurably confined to the large 
 intestines, while the two former more especially belong to the 
 small ones. 
 
 The evacuations are sometimes pure mucus, but in the 
 more severe forms of the disease, the mucus becomes opake 
 and whitish. With the mucous discharges, there is frequently 
 mixed feculent matter — sometimes mucus alone precedes the 
 feculent matter, and at other times succeeds it. 
 
 The discharges are occasionally, especially when they are 
 
BELOW THE DIAPHRAGM. 591 
 
 opake or streaked with blood, as is sometimes the case, pre- 
 ceded by tormina — they are very rarely copious, but some- 
 times not only frequent but attended by tenesmus and some 
 straining. So far as we know, it only becomes requisite to 
 aggravate it so far as to make inflammation requisite for its 
 removal. 
 
 Causes. — This form is regarded by some as a catarrhal 
 affection of the bowels, and, like other affections of the kind, 
 is produced by cold, acting upon an excited condition of the 
 cutaneous exhalants, whereby their function is suppressed. 
 "We do not, however, regard cold alone as the cause of this 
 variety of diarrhea. Any cause calculated to suspend the 
 function of the cutaneous exhalants may cause it; conse- 
 quently, under some modifying influence, it is produced by 
 the same general cause that occasions bilious diarrhea. When 
 thus occasioned, it is more liable to pass into dysentery, or to 
 become chronic. 
 
 Species TV. — C/tylous Diarrhea. 
 
 It would have been, in our opinion, much more intelligible 
 to have nominated this form of diarrhea, the anti-hilious, 
 because bile is as certainly absent in this form, as it is present 
 in the second. This is not all : it is evidently a misnomer to 
 call it chylous, because the immense quantity that is some- 
 times evacuated precludes the idea of its being chyle. 
 
 This form of diarrhea is indicated by light-colored evacua- 
 tions — such as are of a dirty white, sometimes almost of a 
 milky whiteness, and when very abundant, they considerably 
 resemble the rice-water discharges of cholera. With adults, 
 one of the symptoms is an uneasiness in the abdomen, with 
 very little acute pain, but with great depression of spirits. 
 Erom this symptom, we would infer a very positive congestion 
 of the liver and portal circle at large. The skin is more or 
 less shrunk, and a feeling of prostration is a very general 
 attendant. 
 
 There does not appear in the course of this form of disease, 
 a single symptom that indicates the existence of an intense 
 irritation. The hands and feet are cold — the process of nutri- 
 tion is greatly suspended, and hence the work of emaciation 
 
592 NON-IN-FLAMMATORY FORMS OF DISEASE 
 
 progresses with much rapidity, and when considerably pro- 
 crastinated, the skin becomes sallow. 
 
 In view of the above facts, the most probable conclusion 
 appears to be, that the mucous membrane of the small intes- 
 tines is highly congested, and that the chylous-looking evacua- 
 tions are effected for its removal. 
 
 In the character of the evacuations, in the feeling of dis 
 tress and prostration, in the shrunken condition of the skin, m 
 the absence of bile, in the rapid emaciation of the patient, 
 and its indisposition to terminate favorably, it has a conside- 
 rable resemblance to cholera. 
 
 Causes. — The immediate cause may be a suspension of 
 hepatic action, and consequently the chyme is not converted 
 into chyle — not adapted to nutrition, and it is rejected 
 with serous matter. But it seems to us more probable 
 that there is a failure of the liver to perform its function, and 
 possibly the lungs, also, more or less ; consequently, there is 
 too much carbon in the blood, which, in not being eliminated, 
 has become to act upon the system as a foreign body, produc- 
 ing catharsis or this particular form of diarrhea. 
 
 This would seem to be the most probable conclusion, if the 
 experiments of Tiedman and Gmelin are to be relied upon — 
 namely, that bile is not necessary to the production of chyle. 
 We think it very questionable whether the remote cause of 
 this form of diarrhea can be determined with much probability 
 of accuracy. The exciting causes may be cold and improper 
 food, and the remote may be the same as in bilious diarrhea, 
 in conjunction with some peculiarity of constitution, possibly 
 some debility of the pulmonary system — a question which our 
 observation has not settled. 
 
 Species Y. — Lienterio Diarrhea. 
 This form of diarrhea appears, in some measure, to be 
 allied to the preceding — such a modification of it as might be 
 supposed to follow a reduction of portal congestion, with an 
 increase of gastric irritation. As it consists in a rapid trans- 
 portation of alimentary matter through the bowels, almost un- 
 changed, it would seem to have its principal source in the 
 stomach, for as soon as food enters it, it is forced, by a rapid 
 
BELOW THE DIAPHRAGM. 593 
 
 peristaltic motion, into the intestines, which as speedily hurry 
 it through at their inferior extremity. The appearance of the 
 evacuations leaves scarcely any room to doubt that the gastric 
 secretions are suspended. 
 
 The evacuations, in this form of diarrhea, consist of the 
 food which was taken but a short time previously. At the 
 onset of the disease, however, the evacuations do not occur 
 until several hours after eating ; but as it advances, if unin- 
 terrupted, the intervals between the reception of the food and 
 its evacuations become more and more brief, until at last there 
 is no delay between its reception by the stomach and its rejec- 
 tion by the anus. 
 
 In this condition of the malady, the patient feels consider- 
 able uneasiness in the epigastric and umbilical regions soon 
 after eating, which, in a little time, is followed by severe tor- 
 mina, and to this succeeds, with much haste, a diarrheal 
 evacuation of offending matter. The griping, however, is 
 not a necessary symptom — it is frequently absent, in whole or 
 in part. 
 
 The appetite is variable, sometimes voracious, at others 
 capricious — loathing some articles of food, and desiring such 
 as may be very objectionable, from its crude, acrid, or exciting 
 nature. Pressure upon the abdomen but rarely produces a 
 sensation of pain or soreness; but jumping or jolting, cough- 
 ing or sneezing does. In some instances, the evacuations are 
 mixed with dark -green bilious matter, or with a fluid resem- 
 bling a solution of verdigris. 
 
 This form, like the preceding, indicates no disposition to 
 terminate favorably, and consequently it should never be 
 neglected. It is very apt to appear as a sequels to the other 
 varieties, but more frequently of dysentery, and this fact 
 would seem to strengthen the pathological views above ad- 
 vanced. When, under such circumstances, a single article of 
 diet is known to pass through the bowels, unchanged, the 
 commencement of this form may pretty safely be suspected; 
 and in a short time the suspicion will be found confirmed, by 
 a similar passage of other articles of food, until finally, all 
 the ingesta, indiscriminately, is rapidly passed through the 
 digestive apparatus, without the least indication of having 
 teen acted upon by them. 
 38 
 
594: Is'ON'-INFLAMMATORY FORMS OF DISEASE 
 
 In lienteric diarrhea, the stomach must be regarded as the 
 principal seat of the disease, and consequently it may be 
 esteemed as a violent attack of indigestion. 
 
 Causes. — When it appears as the sequelae of other forms 
 of disease, the exciting causes may be an improper exposure 
 to cold, or improper food, or a voracious use of such as may be 
 otherwise unexceptionable ; it is, however, more apt to appear, 
 under all circumstances, gradually — having its remote cause 
 in food of an irritating character, or in improperly managed 
 diarrhea in either of the preceding forms, or dysentery. 
 
 Species YI. — Chronio Diarrhea — Weaning Brash, 
 
 It is thought that either of the preceding forms of diarrhea 
 ma}^, in children, become chronic, but we are much inclined 
 to the opinion that the bilious variety, caused as it is by direct 
 and sympathetic impressions, is the one which most generally 
 runs into the chronic state, or may assume the chronic form. 
 The general character of the evacuations, in our judgment, 
 sustains this opinion. This conclusion is rendered very proba- 
 ble by the fact that every variety of vitiation in the function 
 of the liver would tend to the maintenance of the diarrhea. 
 
 An undue continuance or neglect of the feculent and 
 catarrhal species may so weaken and impair the mucous mem- 
 brane of the intestines, as to render it more obnoxious to the 
 vitiated secretions of the liver and all other sources of irrita- 
 tion. 
 
 It is usually announced by griping pain and purging, with 
 yellow or green evacuations, depending upon the violence of 
 the attack. If this introduction of it shall be neglected for a 
 few days, retching, and sometimes vomiting of bile -colored 
 dejections, will follow. These manifestations will soon be 
 succeeded by a loathing of all kinds of food — attended, as 
 might be expected, with restlessness, thirst, fever, emaciation, 
 and softness of the flesh. 
 
 After the existence of the disease for some weeks, peevish- 
 ness, griping pain, and a discontented expression of the face, 
 become the distinguishing features of it. In the progress of 
 the disease, great and many changes become manifest in the 
 evacuations ; their color is sometimes normal — at other times, 
 ash-colored and slimy, and sometimes, without knowing the 
 
BELOW THE DIAPHRAGM. 595 
 
 history of the affection, we would judge it to be llenteric. It 
 terminates fatally, sometimes, in two, three, or four weeks, but 
 in such instances, it is apt to be by convulsions, occasioned 
 by the intense irritation of the stomach and bowels ; but a 
 fatal termination rarely occurs under six or seven weeks ; and 
 then again, the disease may continue three or four months and 
 terminate in convalescence. 
 
 In consequence of the frequent coincidence in the appear- 
 ance of the teeth and this disease, and the prevalent impres- 
 sion that a diarrhea at such a time is salutary in its influence, 
 it is frequently neglected, until it results in the loss of the 
 child. 
 
 In this country, it mostly prevails in July, August, and 
 September, and it is more frequent and fatal in damp summers 
 and situations, than in dry oiaes. It is thought by some, that 
 in the beginning of this disease, the mucous membrane of the 
 small intestines is alone diseased, and that as it advances the 
 liver, through intestino-hepatic sympathy, becomes involved, 
 and by the increased quantity of its secretion, or the morbid 
 character of it, the disease becomes more permanently estab- 
 lished and much increased in violence. 
 
 We cannot indorse this view of the subject ; if the disease 
 commenced in the mucous membrane, what caused it? It has 
 not been shown, nor even contended, that it is either feculent 
 or catarrhal in the beginning, and if it be neither of these, 
 then it must be sympathetic, and if sympathetic, then the 
 morbid condition is really somewhere else than in the mucous 
 membrane of the intestines. These considerations, in connec- 
 tion with the season of the year in which it usually occurs, 
 induce us to believe that it is more probably a result of an 
 enfeebled condition of the skin acting through cutaneo-hepatic 
 and intestinal sympathy. 
 
 The difference between the two opinions, thus advanced, in 
 view of the treatment, is one of immense importance; the 
 latter indicates a course of practice which could not do mis- 
 chief, while tliat indicated by the former might reach the 
 symptom, but missing the cause, the disease would not be 
 removed. 
 
 Dr. Cheyne informs us that ;post mortem examinations 
 
596 I^ON-INFLAMMATORY FORMS OF DISEASE 
 
 reveal many contractions and intus-susceptions in the alimen- 
 tary canal, from the stomach downward — that they are of a 
 spasmodic kind, and they are without " adhesions or even the 
 marks of inflammation." In these facts we have one of the 
 reasons why we have treated of diarrheas as non-infl:'ammatory 
 forms of disease. 
 
 In this form, the liver, being highly excited, secretes much 
 bile, but the excess of this action sometimes exhausts it, and 
 then it produces but little, if any ; consequently, the evacua- 
 tions will sometimes have a clay color, and the disposition of 
 the patient will be more restless and gloomy in this respect. 
 As a prophylaxis, children should not be weaned during the 
 months in which this form of disease mostly prevails. 
 
 The conviction is very general, in the popular female mind, 
 and with many physicians, that the great danger of diarrhea, 
 to our infantile population, is in consequence of teething. 
 We have in several instances repudiated this idea, and we are 
 gratified to find that we are sustained by such authority as 
 that of Dr. Oheyne. He observes : 
 
 " Notwithstanding my most diligent inquiries, I have sel- 
 dom been able to deduce any of the derangements of the in- 
 fantile system from teething ; and 1 have been inclined to 
 think, that those physicians who have represented this func- 
 tion (dentition) as teeming with danger, have not accustomed 
 themselves to that careful investigation, without which these 
 diseases cannot be understood. The weaning-brash, I have 
 the strongest reason to believe, has no connection with teeth- 
 ing, farther than they sometimes meet in the same child. I 
 have known this disease, in many instances, where the gums 
 were neither swelled, indurated, nor inflamed, and where 
 there was no salivation, nor the least appearance of pain in 
 the mouth. I have seen it where children were cutting their 
 teeth easily ; and where many of them came without diffi- 
 culty before weaning ; still the disease has supervened. But, 
 perhaps, the strongest argument that can be used, would arise 
 from the observation, which I have frequently made, that this 
 disease occurs in children of three months ; and I have often 
 known it several months before teething came on." 
 
 Causes. — Fruit is very generally included among the 
 
BEL0A7 THE DIAPHRAGM. 597 
 
 exciting causes of diarrhea in the summer, consequently, we 
 feel that a few remarks, of a discriminating character, are 
 required of us. 
 
 We are of those who possess an abiding faith in the wisdom 
 of all the plans and purposes of nature. Now, inasmuch as 
 fruit is a product of the summer and fall only, and as it was 
 intended for food, rather than as a temptation for us to sin, 
 we believe that it is adapted to us during the season of its 
 maturity. Then, it cannot, in the abstract, be pregnant with 
 danger to those who use it properly and temperately. To use 
 it properly, it must be ripe, and being ripe, we should divest 
 it of the skin, which was intended for its protection and de- 
 velopment, and not for food. It should not, furthermore, be 
 used with our habitual food, particularly in its raw state. To 
 use it temperately, it should not be taken in such quantities 
 as to supersede, to any extent, the demand for the usual or 
 more nutritious food. Furthermore, it should be taken about 
 midtime between the regular meals. It is our conviction that 
 ripe fruit, thus used, would prove a prophylaxis against the 
 various forms of disease incidental to the season. 
 
 As to chronic diarrhea, it may be stated, that a procrastina- 
 tion of early attention, improper treatment, and a neglect of 
 the predisposing and exciting causes must be regarded as the 
 general sources of this form of disease. 
 
 The children most liable to it are those who have been pre- 
 maturely weaned, and after weaning, improperly fed, as to 
 both the quantity and quality of the food ; but it is not con- 
 fined to these, for it frequently obtains under widely diffe- 
 rent circumstances, and therefore, in many instances, atmo- 
 spherical. 
 
 Treatment. — The treatment of these various forms of 
 diarrhea is so nearly alike, that we will consider them under 
 one head. 
 
 In the early part of the attack, the Syrup of Khubarb and 
 Fotassa will generally be found fully sufficient to check the 
 excessive discharges, allay vomiting when present, and remove 
 the morbid condition on which the diarrhea depends ; it may 
 be given every hour or half hour, in doses suitable to the 
 child's age, and continued until it exerts a laxative effect, 
 when the intervals between the doses should be lengthened 
 
598 NOI^'-INFLMIMATORY FORMS OF DISEASE 
 
 to two, three, or four hours, according to the urgency of the 
 case. 
 
 In addition to this, especially when the symptoms are obsti- 
 nate, or have been of long duration, the whole system should 
 be bathed with a warm alkaline bath, two or three times a 
 day, and this should be pursued in all the forms of diarrhea, 
 whether acute or chronic. 
 
 If nausea or vomiting are present, and do not cease on the 
 continued use of the syrup, a Mustard poultice, applied over 
 the epigastrium, will be found advantageous, and a few drops 
 of Paregoric may be added to each dose of the syrup. 
 
 If there is much fever, with pain in the stomach or bowels, 
 the Compound Tincture of Virginia Snakeroot, in proper 
 doses, may be administered every hour or two, with the appli- 
 cation of warm fomentations to the bowels, of bitter herbs, or 
 even warm water. 
 
 When there is prostration, with cold extremities, increased 
 heat of the head, and restlessness, applications to the head, 
 as for instance, the Cooling Lotion, with rubefacients to the 
 extremities, and some stimulating liniment over the whole 
 length of the spine, will be beneficial, and their employment 
 should be persevered in. 
 
 When tenesmus is present, a few drops of the Compound 
 Tincture of Virginia Snakeroot, in one or two teaspoonfuls of 
 cold water injected into the rectum, immediately after each 
 alvine evacuation, and retained there as long as possible, will 
 speedily remove this disagreeable symptom. In some cases, 
 the wet-sheet around the lower part of the body, will prove a 
 valuable auxiliary. 
 
 The above course of treatment will generally be found 
 effectual in overcoming any of the forms of this disease, but, 
 should they run into the clironic form, other means will be 
 demanded. 
 
 Thus, in chronic diarrhea, the following has proved invari- 
 ably successful, as far as we have used it: 
 
 ^. Syrup of Ehubarb and Potassa, giv, 
 Hydras tin, grs. xii. Mix. 
 
 Of this, a teaspoonful may be given every hour, to a child 
 five years old, or proportionate to its age. K the discharges 
 
BELOW THE DIAPHRAOM. 599 
 
 are frequent, twenty grains of Geraniin, or even more, may 
 be added to the above compound. 
 
 Tonics should be administered whenever they can con- 
 veniently, and we prefer the following : 
 
 T^. S. Quinia, 
 Hydrastin, 
 Leptandrin, aa grs.v. Mix, 
 
 And divide into fifteen powders, of which one may be given 
 every two, three, or four hours, to a child four or five years 
 of age. 
 
 In the mucous form of diarrhea, as well as in the chylous, 
 alterative doses of Podophyllin and Leptandrin combined, or 
 of Leptandrin and Geraniin, or of Lupulin and Geraniin, 
 according to the indications present, will always be required 
 before permanency of cure can be expected. 
 
 In lienteric diarrhea, after the employment of the means 
 heretofore named, tonics and astringents will be required to 
 efifect a cure ; a combination of Quinia, Hydrastin, and Gera- 
 niin may be used, or Cornine and Geraniin. 
 
 But, notwithstanding the therapeutical treatment, if the 
 prophylactic is neglected, the disease may prove fatal. 
 
 Especial attention should be given to the diet of the child, 
 which must be mild, nourishing, and digestible, avoiding 
 everything calculated to irritate the stomach, or which the 
 child dislikes. All candies, preserves, and nick-nacks must 
 be imperatively prohibited. 
 
 The dress should be adapted to the season, and be kept as 
 clean as possible. 
 
 Exercise in the open air, if the condition of the child will 
 permit, is of the utmost importance, and if this is impossible, 
 the chamber in which the child is confined should be well 
 ventilated, allowing fresh air to circulate freely through it. 
 
 Genus Y. — Invekmination — 
 Worms. 
 It has been asserted and contradicted, that so long as chil- 
 dren are exclusively fed and nourished by the breast, they will 
 be exempt from worms. 
 
 Dr. Dewees says, that he never saw children under ten 
 
(500 I^roX-mrLAMMATORY FORMS OF DISEASE 
 
 months of age have worms, and only two so early as that, 
 and they were weaned at the age of four months. 
 
 The worms which have been most frequently found in the 
 human system have been divided into three genera: I. Hel- 
 minthia Alvi, alvine worms; II. Helminthia Podices, anal 
 worms ; III. Helminthia Erratica, erratic worms. 
 
 Of the first genus there are five species, and they inhabit 
 the stomach and the intestinal canal. The indications of their 
 presence are, foul breath, pale countenance, sore and irritable 
 nostrils, emaciated body, swollen abdomen, and a pungent 
 and gnawing pain in the stomach ; but it is proper to add, 
 that all of these symptoms are simulated by other causes of 
 irritation, and hence we have no certain diagnostic symptom. 
 The first species of the genus has been described by Dr. Good, 
 as follows : 
 
 Species I. — Ascaris Lumbricoides — Long Bound-Worm. 
 
 " The head of the lono^, round-worm is sli2;htlv incurvated, 
 with a transverse contraction beneath it; mouth triangular; 
 body transparent ; color, light yellow, with a faint line down 
 the side ; gregarious, vivacious ; from six to fifteen inches 
 long; inhabits principally the ilium, but sometimes ascends 
 into the stomach, and creeps out of the mouth and nostrils ; 
 occasionally travels to the rectum, and passes away at the 
 
 Species II. — TricocepJialus — Long Thread- Worm. 
 " The body of the long thread-worm is, above, slightly 
 crenate ; beneath smooth, finely striated on the forepart; the 
 head obtuse, and furnished with a slender retractile proboscis ; 
 tail, or thinner part, twice as long as the thicker, terminating 
 in a fine hair-like point, about two inches long ; in color, 
 resembles the preceding ; gregarious, and found chiefly in the 
 intestines of sickly children ; generally in the caecum." 
 
 Species III. — Toenia Solium — Long Tajpe- Worm. 
 " In the long tape-worm, the articulations are long and nar- 
 row, with marginal pores, by which it attaches itself to the 
 intestines, one on each joint, generally alternate ; ovaries 
 arborescent; head, with a terminal mouth, surrounded with 
 
BELOW THE DIAPHRAGM. 601 
 
 two rows of radiate hooks or holders ; and a little below, on 
 the flattened surface, four tuberculate orifices or suckers, two 
 on each side : it is from thirty to forty feet long, and has been 
 found sixty. Inhabits the intestines of mankind, generally at 
 the upper part, where it feeds on the chyle and juices already 
 animalized. Is sometimes solitary, but commonly in conside- 
 rable numbers ; and adheres so firmly to the intestines, that 
 it is removed with great difiiculty. It is said to have the 
 power of reproducing parts which have been broken ofi"; but 
 this assertion wants proof. The animal is oviparous, and dis- 
 charges its numerous eggs from the apertures on the joints. 
 The broken-ofi* joints have, when discharged, the appearance 
 of gourd seeds ; and it is hence denominated gourd-worm by 
 many medical writers." 
 
 Species IY. — Tcenia Vulgaris — Broad Tape -Worm. 
 The articulations of the broad tape-worm are short and 
 broad, with a pore in the center of each joint, and stellate 
 ovaries around them ; body broader in the middle, and taper- 
 ing toward both ends ; head resembling the last ; inhabits the 
 upper part of the intestines, and feeds on the chyle ; from 
 three to fifteen feet long ; usually in families of three or four. 
 
 Species Y. — Fasoiola — Fluke, 
 The body of the fluke is flattish, with an aperture or pore 
 at the head, and generally another beneath ; the intestines 
 fluxuous ; ovaries lateral ; hermaphrodite and oviparous." 
 
 Of the preceding five varieties, the first much more fre- 
 quently occurs, but they are all occasionally met with in 
 practice. 
 
 Genus II. — Helminthia Podicis — 
 Anal Worms. 
 Of this genus there are three species ; they live just within 
 the verge of the anus, and frequently prove exceedingly trou- 
 blesome, particularly by the itching they occasion at the anus. 
 The species are : 
 
^02 ]S^Ol^-INFLAMMATORY FORMS OF DISEASE 
 
 Species I. — Ascaris Vermicularis — Thread-Worm — Maw- 
 Worm. 
 '^ The head of the thread-worm is subolate nodose, and 
 divided into three vesicles, in the middle of which it receives 
 nourishment ; skin at the sides of the body firmly crenate or 
 wrinkled; tail finely tapering, and terminating in a point; 
 gregarious ; viviparous ; about half an inch long ; sometimes 
 it gets into the intestines, and occasionally as high as the 
 stomach." 
 
 Species II. — Scaralaous — Beetle-Grubs. 
 " This species has not been accurately described. The fol- 
 lowing seem to be the chief: gray larve, with yellow legs, and 
 ferruginous head ; have six feet ; are annulate, hairy, vesicular 
 at the end of the abdomen, and furnished with a horny 
 head. 
 
 Species III. — CEstrus — Bots. 
 
 " The larves of the oestrus, breeze, or gad-fly, are called 
 bots, and are of a round figure ; pale green ; tail obtusely 
 truncated ; head tapering ; mouth horny, with two lips, and 
 two re-curved black claws on each side of the mouth." 
 
 Genus III. — Helminthia Erkatica — 
 Erratic Worms. 
 
 Of this genus but little is known. According to Dr. Good, 
 they are, " the larves of insects, introduced by accident, and 
 without finding a proper habitation in the stomach and intes- 
 tines, producing spasmodic colic, with severe gripings, and 
 occasionally, vomiting or dejection of blood." 
 
 Worms have probably been the torment of children almost 
 ever since they commenced having an existence, and yet, we 
 are exceedingly ignorant upon the subject. We have thought 
 it proper to place the preceding descriptions before Eclectic 
 students, under a hope that they may be induced to observe 
 and to investigate the subject. It presents a large and pro- 
 mising field for professional labor, usefulness, and fame. If, 
 in nature, there be a symptom which indicates the existence 
 of either of the varieties of the first genus, to the exclusion 
 of others, it has not been discovered. Nay, more, if there be 
 
BELOW THE DIAPHRAGM. 603 
 
 a symptom whicli could certainly distinguish the existence of 
 any of the alvine worms from other sources of irritation, it 
 has not been discovered. The first and only certain indication 
 we can have of their existence, is the seeing of them. 
 
 Causes. — The source of intestinal worms has been for a 
 long time a subject of discussion ; it is maintained by one 
 party that their origin is external to the human body — that 
 they are from germs or ovse of preceding animals of the same 
 species ; the other party maintains that they are spontaneously 
 or equivocally produced by some species of afiinity in the 
 matter which exists in the system — that the first which ap- 
 pears in the system was produced by a living organic parent- 
 age. We have neither time nor space for the discussion of this 
 subject ; but we may remark that they exist — that the species 
 had a beginning, and no matter when this beginning was, it 
 was without organic parentage, and so far as we know, they 
 can now commence without organic parentage, as readily as 
 the first of the species did. Our investigations have satisfied 
 us that it is about as difiicult to change a species as it is to 
 produce one, and hence it is probable that we shall incline to 
 the opinion of their spontaneous origin until their representa- 
 tives shall be found outside of the human system. 
 
 Of the same nature is the inquiry into the origin of some 
 contagious forms of disease. We do not expect to witness a 
 case of small-pox or syphilis which did not have its cause in 
 some previous organization ; but how did the first case origi- 
 nate ? May not either or both of them still originate sponta- 
 neously, when or under the circumstances that first produced 
 them, which were certainly equivocal ? In water, at a tempe- 
 rature of 156° of Fah., at the Hot Springs, Arkansas, animals 
 live and manifest an active life, and yet, in this same spring, 
 fish, snakes, and toads instantly scald to death. Where were 
 these little animals before the appearance of these springs ? 
 
 A healthy condition of the system appears to be, in a very 
 great degree, incompatible with the existence of these para- 
 sites; it is reasonable to infer then, that they did not produce 
 all of that depravity of the system with wliich they are found 
 to be assocHted. Their existence, therefore, may be attri- 
 bi^t^d i(^ 9 ', generis depravity in the function of the mucous 
 
604 Ts^ON-INFLAMMATORY FORMS OF DISEASE 
 
 membrane of the intestinal canal ; and, although no age is 
 exempt from this depravity, yet it much more frequently 
 obtains with children above the age of infancy. Their exist- 
 ence is usually attributed to an accumulation of mucus, feeble 
 digestion, badly-regulated diet, a damp atmosphere, etc. 
 Much of this appears to be assumed — we find them under 
 such circumstances, generally, but it does not, therefore, fol- 
 low that they were produced under them — much of this de- 
 rangement may have been produced by them. 
 
 We have found worms under circumstances, where, a priori^ 
 we would not have expected them, and the reverse. It seems 
 to us that a helminthic diathesis just as certainly obtains in 
 society as a scrofulous one; but, at the same time, we do not 
 doubt that the causes above named, serve greatly to aggravate 
 this innate predisposition, more especially the anti-electrical 
 condition of the atmosphere, for this we regard as the most 
 fruitful source of juvenile disease. In such an atmosphere, 
 no amount of care as to diet, and no amount of medical atten- 
 tion can prevent the generation of these parasites, during the 
 proper age of the child for their existence, or during the in- 
 adaptation of the system to the atmosphere. 
 
 Treatment. — Many agents have been recommended for 
 the removal of worms, and the majority of them fulfill the 
 indications for which they are given, yet their mere expul- 
 sion is seldom followed by any permanent benefit, if the 
 condition of the intestines is not likewise especially attended 
 to, by the employment of tonics or other agents suited to their 
 particular condition. 
 
 Pinkroot is, perhaps, as much relied upon for the removal 
 of worms as any other simple agent. It is usually given 
 combined with Senna, or with the Compound Powder of 
 Jalap, in the proportion of from five to ten grains of the pow- 
 dered Pinkroot, to the same quantity of the cathartic, and 
 which may be given in molasses, or infusion, and repeated 
 two or three times a day, to a child three 3^ears old, for several 
 successive days. Infants several months old use it in the 
 form of infusion. 
 
 A very excellent vermifuge, which we are in the habit of 
 employing, is made as follows : 
 
BELOW THE DIAPHRAGM. 605 
 
 ^, Castor Oil, 3j, 
 
 Oil of Wormseed, 3J, 
 Oil of Anise, 3ss, 
 Tinct. of Myrrh, 3ss, 
 Spirits of Turpentine, gtts.x, 
 CrotonOil, gtt.j. Mix. 
 To a cliild three years old, a half teaspoonful may be given 
 every two hours, for ten or twelve hours, or until active pur- 
 gation has been produced. 
 
 Another vermifuge, w^hich has been used effectually, is : 
 5;. Oil of Wormwood, 
 Oil of Tansy, aa 3j, 
 Spirits of Turpentine, giss, 
 Castor Oil, 3Jj. Mix. 
 The dose for a child, three or four years old, is a teaspoonful 
 every hour until it operates. 
 
 A preparation, composed of a medley of agents has been 
 found very useful in the treatment of intestinal entozoa, but 
 on account of its complexity, we have never used it — it is pre- 
 pared as follows : 
 
 9r. Lime Water, oct. j, 
 Oil of Wormwood, 
 Spirits of Turpentine, aa 3j 
 Tinct of Myrrh, giij, 
 Essence of Anise, 3ij, 
 Molasses, oct.ss. 
 Oil of Tansy, 3ss, 
 Castor Oil, oct. ss, 
 Croton Oil, 3J. Mix. 
 
 The dose of this preparation is a teaspoonful two or three 
 times a day. 
 
 For the removal of the thread-worm, ascaris vermicularis, 
 in addition to the above internal remedies, infusions or decoc- 
 tions of bitter substances must be injected into the rectum, as 
 of Aloes, Bitter-root, etc., or an enema of Spirits of Turpen- 
 tine, one drachm, in milk, one gill. 
 
 But, although, as before said, these agents may expel the 
 worms, but small advantage will accrue to the patient, unless 
 others are employed to restore the impaired condition of the 
 
606 NON -INFLAMMATORY FORMS OF DISEASE 
 
 intestines to one of strength and health. For this purpose, 
 we prefer the following preparation : 
 
 ^. Hydrastis Canadensis, 
 Calumba, 
 
 Chamomile Flowers, 
 Prickly-Ash Berries, 
 Sassafras Bark, aa 3ss. Mix. 
 
 Upon these articles, coarsely bruised, pour one pint of boiling 
 water ; let them stand until cold ; then add one pint of Sherry 
 or Port Wine, and sweeten with loaf-sugar. The dose to a 
 child, one year old, is a teaspoonful three times a day; — and 
 with this, a proper attention should be paid to diet, allowing 
 no indigestible substances to be received into the stomach, or 
 such as acidify. 
 
 Genus YI. — Costiveness — 
 Ta rdy Action of the B owels. 
 
 Constipation of the bowels, in children, as well as in adults, 
 is frequently produced by certain varieties of ingesta, and it 
 may also be constitutional ; when, therefore, a physician is 
 consulted upon the subject, his first business is to ascertain 
 whether it is, and has been, habitual with the child, or only 
 occasional, and irregular. 
 
 With some persons, a certain kind of food invariably pro- 
 duces constipation. With many adults, sweet potatoes have 
 this effect ; and with many children, all the preparations of 
 rice and boiled milk will produce the same result. That 
 which will produce this effect in one child, may not do it in 
 another ; hence, it becomes the duty of the nurse or mother, 
 as the case may be, to notice the effect which the various 
 articles of a child's food produces upon its bowels, and when 
 the one is discovered which causes such a result, its use should 
 be discontinued. 
 
 Nurses who are defective in patience, and still more so in 
 honesty, frequently keep concealed about their persons, an 
 article far more mischievous than any article of food — we 
 allude to laudanum. Some mothers, not knowing the conse- 
 quences, are guilty of administering to the infant the same 
 
BELOW THE DIAPHRAGM. 607 
 
 dms:, or some preparation of it, and for the purpose of keep- 
 ing it quiet. Parents should exercise an unceasing vigilance 
 over their nurses with reference to this subject. 
 
 Suppositories and injections are much more applicable to 
 such accidental cases of constipation than medicine, because 
 they excite the inactive part, which is usually the rectum, 
 without preternaturally exciting the whole intestinal canal ; 
 but when these means fail, then it may be proper to adminis- 
 ter some mild purgative, as Olive Oil, Castor Oil, the Com- 
 pound Tincture of Jalap, or Syrup of Elderberries. 
 
 When the constipation is constitutional, and entirely com- 
 patible with the health and happiness of the child, it is 
 recommended to let it alone. 
 
 The constitutional habit is such, sometimes, as to produce 
 a stool but once in every eight or ten days ; we have seen 
 men of sound health whose bowels manifested the same pecu- 
 liar constitutionality, but we have always found an unplea- 
 sant circumstance connected with it — without a daily change 
 of linen, and a frequent washing of the skin, an unpleasant 
 odor was constantly emanating from the surface to the annoy- 
 ance of others. Now, in view of this circumstance, we would 
 not let the child alone which had such a constitutional pecu- 
 liarity. 
 
 As we believe that the vegetative organs can be trained or 
 educated, as well as the animal, we would attempt to train 
 the bowels of such infants to a more decent habit: and this 
 may be done by a proper attention to diet. The Graham 
 bran-bread principles, properly applied, might effect the de- 
 sired change. Eor the bread, substitute mush, which might 
 be variously seasoned to please the taste. 
 
 Genus YII. — Prolapsus of the Pectum. 
 
 The mucous lining of the rectum is attached to the next 
 outer membrane of the bowels by loose cellular tissue, and in 
 the affection, above denominated, this mucous membrane sepa- 
 rates so far from the one to which it is attached as to permit a 
 duplicature of it to protrude out of the body, forming what 
 may be called a thick red ring at the anus. 
 
 In a feeble child, it may be produced by crying or by 
 coughing, the large stools which sometimes attend purgative 
 
608 E"ON- INFLAMMATORY FORMS OF DISEASE 
 
 medicines, and also by any bowel disease which is attended- 
 with tenesmus. 
 
 The greatest danger that attends this affection is a liability, 
 through neglect, of its becoming a habit of the pftrt that may 
 continue through life. We, at one time had the acquaintance 
 of a gentleman, thirty years of age, whose memory could not 
 reach back to the time when he did not have a prolapsus of 
 the rectum every time he attempted to stool, and every time 
 before he arose, he had the prolapsus to reduce. In view of 
 such a consequence, it is obvious that the utmost attention 
 should be given to it when it occurs. 
 
 As the sphincter of the anus acts as a ligature upon the 
 protruded part, consequently, when it has been down for a 
 few hours, its appearance becomes truly alarming; the stric- 
 ture prevents the return of the venous blood, and then it soon 
 becomes swollen and inflamed — assuming a livid color, which 
 may pass to a black one. The stricture becomes so confirmed, 
 as to give rise to much trouble sometimes in the reduction of 
 thb protrusion. 
 
 When an attempt is to be made to reduce the prolapsed 
 bowel, the child should be placed across the lap of the nurse, 
 with the chest more depressed than the hips, the part should 
 be lubricated with Sweet Oil or fresh Lard, gentle pressure 
 should then be so conducted as to force a portion of blood 
 from it, and when it is sufficiently reduced it may then be 
 urged by pressure, made with the fingers, upward and back- 
 ward, until it passes within the anus. The tumor, when 
 reduced, may be retained in its normal position by the use of 
 a T bandage, and compresses wetted with cold water. If it 
 should manifest a tendency to descend or prolapse as often as 
 defecation shall be attempted, the circumference of the anus 
 should be supported during the discharge of this function. 
 
 Sometimes the prolapsed portion becomes so large, through 
 a failure to return it in proper time, that any attempt to 
 reduce it, before the blood contained in it is disgorged, would 
 prove not only mischievous but entirely unavailing. For this 
 purpose, the child should lie upon its back, with its kips 
 higher than its shoulders, and its knees drawn up, with the 
 part uncovered, and kept wet with lead-water. 
 
BOOK I Y. 
 
 TREATMENT OF THOSE FORMS OF DISEASE TO WHICH 
 ADULTS, MORE THAN CHILDREN, ARE LIABLE. 
 
PREFACE. 
 
 W[jE^ this work was commenced it was the purpose of 
 the authors to treat only of those forms of disease which 
 have been observed to afflict children rather than adults, 
 but such are the known wants of the Eclectic branch of the 
 profession, as regards works of practice, that they have 
 been induced to add a fourth book, to embrace those which 
 pertain to adult, rather than to infantile life. Some 
 of those which have been embraced, by the preceding- 
 Book, are common to adults as well as to children, and 
 consequently they have been so treated. This book will 
 also contain a few which have been known to assail chil- 
 dren, but the treatment is adapted to both ages. There 
 are also a few visceral affections which present very 
 different forms in the two ages respectively, and they of 
 course will be treated of again. 
 
 In this wise, so far as their abilities will permit, they 
 hope to give satisfaction to their professional brethren. 
 
 CLASSIFICATION OF THE VARIOUS FORMS OF DISEASE. 
 
 Although the forms or manifestations of disease are too 
 numerous to admit of computation, yet all may be arranged 
 under two heads or classes, the febrile and non-febrile. 
 
 There is no form of disease that will not readily fall 
 into one class or the other, and between those of the two 
 classes respectively, there is no repugnance of character. 
 It is true, that sometimes a form which is essentially, in its 
 
 (613) 
 
614 PREFACE. 
 
 general character, non-febrile, may become febrile, but this 
 is a mere circumstance, and as an objection, its magnitude is 
 not greater than will occur in any other division that may be 
 attempted ; at all events, it suits the circumstances of our 
 present purpose better than any other that has been sug- 
 gested to us. 
 
 As it is almost impossible for any physician, in the begin- 
 ning of any form of disease, to entertain a doubt as to which 
 class it belongs, so this division keeps constantly before his 
 mind the leading idea of his duty. The limits, further- 
 more, that bound the two classes, are, usually so clearly 
 defined, that the pulse alone will generally furnish a suffi- 
 cient diagnosis. 
 
 We shall begin with the febrile class, or that which is 
 distinguished by a special manifestation of the vital force — 
 such as will frequently, without the aid of medicine, 
 restore the patient to health. There is yet another reason 
 why we should begin with the febrile class — ^it is more 
 simple, because it is more easy to reduce force than in- 
 crease it. 
 
CLASS I. 
 
 PYREXIA OR FEBRILE FORMS OF DISEASE IN GEN- 
 ERAL. 
 
 PATHOLOGICAL AND ETIOLOGICAL CONSIDERATIONS. 
 
 The opinions upon the nature and character of fever are 
 about as various and as numerous as have been their many 
 writers, and if we commence their investigation with Hip- 
 pocrates, who lived 361 years before the Christian era, and 
 who was probably the first systematic writer on the subject, 
 we shall find them, as we travel down to the present time, 
 to depart more and more from our conceptions of the truth. 
 
 He regarded the human system as being under the direc- 
 tion of a conservative, and in some sense, intelligent prin- 
 ciple, which he denominated nature. Under such a con- 
 viction he must have believed that pathological manifesta- 
 tions were governed by laws as fixed and as determinate 
 as those of gravitation — that all pathological action is just 
 as legitimate and as normal, under the circumstances, as 
 any purely physiological one. This inference from the 
 preceding premise, is completely sustained by his opinion 
 of disease, as set forth by the Edinburg Practice, Yol. I, 
 page 6; viz: "He imagined disease to be only a disturb- 
 ance of the animal economy, with which nature was per- 
 petually at variance, and using her utmost endeavors to 
 expel the ofiending cause." 
 
 In this simple, consistent and beautiful faith, he appears 
 to have been well grounded; for Dr. Thatcher, page 4, 
 says, that " he studied and copied nature with the greatest 
 care and assiduity, as the only sure basis of medical science ; 
 and so extensive was his knowledge, and so accurate were 
 his observations, that he has been constantly held in vener- 
 ation through succeeding generations." From existing 
 
 (615) 
 
616 FEBRILE FORMS OF DISEASE 
 
 indications, it would seem, however, that " succeeding gen- 
 erations" venerated him, not because of his talents or the 
 accuracy of his observations and discriminations, but as 
 they generally do any old antiquated ruin — a proper vener- 
 ation would have dictated a closer conformity to the immu- 
 table and salutary laws which he was the first to discover 
 and proclaim. 
 
 We have remarked, in one of the preceding books, that 
 the animal system, as a machine or organization, does not 
 act intelligently, but in accordance with the laws of that 
 pre-existing intelligence which designed it. Between this 
 opinion and that of Hippocrates, there is not, practically, 
 a shade of difference, and it is to be presumed that no one 
 can be found who is so much of an accidentalist, as to deny 
 that the human organization, either in the abstract, or in 
 its relations with the external world, does indicate wisdom 
 or intelligence in its design. If this conclusion be admit- 
 ted as correct, then it follows that Hippocrates was in the 
 possession of a great discovery, when he remarked that 
 "Nature cures disease" — that is, disease is removed from 
 the system by the agency of those laws of the organization 
 which exist and act in conformity with a wise or an intel- 
 ligent design. It follows again, with equal conclusiveness, 
 that man has no power to cure disease — he can only aid * 
 " nature ^^ by acting in conformity with her laws, and when 
 he acts otherwise, he is sure to defeat her intentions. This 
 conviction should be ever present in the mind of every 
 physician, when at the bedside of the sick. 
 
 We have examined very many of our standard and most 
 distinguished authors on the pathology of fever, but our 
 taste, judgment, prejudice, partiality, or whatever else it 
 may be, is too fastidious to adopt or indorse any opinion 
 we have found, except that of John Hunter in the abstract, 
 and that of Tissot, in connection with its treatment. The 
 former says, that "fever, in all cases or of all kinds, is a 
 disturbed action, like inflammation itself." And " inflam- 
 mation," he says, "is not to be considered a disease, but as 
 a salutary operation either to some violence or some dis- 
 
FEBRILE FORMS OF DISEASE. 617 
 
 ease." He again remarks, that " pure inflammation is 
 rather an effort of nature than a disease." Then, accord- 
 ing to Hunter, we may say that " pure" fever " is rather 
 an effort than a disease ;" and consequently as fever is but 
 action, all fever must be pure. 
 
 The latter author, Tissot, says, that " a fever, therefore, 
 that has a quicker pulse than natural, and an increased 
 degree of heat, is always salutary with respect to the mor- 
 bific cause ; for the effect of the morbific cause is excellently 
 fitted to remove the cause itself.* Hence a fever is justly 
 defined by the celebrated Sydenham, to be a " vigorous 
 effort of nature to throw off the morbific matter, which is 
 extremely inimical to the human body, and thus recover 
 the patient." 
 
 " A fever, therefore, which is not too violent, but suited 
 to the morbific causes, ought not to be extinguished, if it 
 could be done, but rather kept up to promote their expul- 
 sion." 
 
 It would seem that there is no war between the Eclectics 
 and the Old School Allopathists of former days — the former 
 are actively engaged in repairing, enlarging and elevating 
 the original edifice ; while the modern Allopathists are not 
 only hostile to those who abide in the faith, but have dis- 
 owned their parentage, as will presently appear. 
 
 Thatcher, Gregory, Clutterbuck, Rush, "Watson, Eberle, 
 Wood, and Cheyne regard fever as a disease. Thatcher 
 calls it, ''HJie disease^''^' and the others though not so brief, 
 agreej with him. All of them have failed to find a defini- 
 tion of fever ; and why ? Simply because they have re- 
 garded it, as they have inflammation, to be a disease, and 
 therefore like the latter, in the language of Dr. John 
 Thompson, is in every case, either an " effect^ a concomi- 
 tant^ a cause, a symptom or a consequence.^^ We should 
 indeed think it difficult to define such a pro tens. 
 
 Under an abiding conviction that no one can be a good 
 or a safe practitioner who is directed by false principles, it 
 
 « This is to be understood according to the definition of Sydenham. 
 
618 FEBRILE FORMS OF DISEASE. 
 
 becomes our duty to dwell on this subject to such an extent 
 as we may deem necessary to an exposure of the prevailing 
 errors, and the defense of those which our convictions of 
 truth compel us to adopt. 
 
 As it has not been our good fortune to find such a defini- 
 tion, or conception of fever as we can adopt, we are called 
 upon to add one more to the long catalogue with which 
 our medical libraries are now burdened. We would there- 
 fore, define fever to be that amount of vital action, cceteris 
 paribus ^ which any given, but general, obstruction to the 
 yital functions can produce. It follows consequently that, 
 that amount of obstruction which would produce but a 
 slight fever in one of strong vital force, might produce 
 death in another of extremely feeble vital force. Conse- 
 quently there can be no grade of fever which can not be 
 thus readily understood, so far as regards its modes of 
 manifestation. 
 
 As to the location of fever and its proximate cause, or 
 as we would say, as to the nature of the disease that pro- 
 duces fever, there are many and widely difierent opinions. 
 
 Dr. Cheyne, Cyc. Prac. Med., in opposition to some of 
 the opinions we have quoted says, that " we find the early 
 medical writers entertaining the idea, that the system 
 waged war against something noxious within itself, and 
 that in the attempt to expel the ofiending agent, a violent 
 commotion was excited." By this plausible theory, the 
 duties of the physician were restricted to assisting nature 
 in her efibrts to get rid of what was deemed injurious to 
 the welfare of the body ; in fact, fever was imagined to be 
 a natural and salutary process, indispensably necessary to 
 throw ofi" whatever was noxious, whether generated within 
 the body or introduced by external causes." 
 
 This extract shows very clearly that the author considers 
 fever to be disease, and that the physician has something 
 more to do than to assist nature. This is particularly that 
 feature of the Old School practice which we lament — they 
 take it upon themselves to remove disease, and so far from 
 helping nature, they throw about one half of her out-door 
 
FEBRILE FORMS OF DISEASE. 619 
 
 in the form of blood, and the remaining half they poison 
 to death; but we, more humble in our pretensions, will feel 
 entirely satisfied with oux efforts, when we shall become 
 qualified to render the necessary aid. Beyond this humble 
 position we have no ambition. 
 
 We are very much mistaken, however, if the author has 
 not shown himself to be exceedingly inconsistent. In the 
 same paper he remarks : "It is more than probable that in 
 what is usually called idiopathic fever ^ there is alteration 
 either of the solids or fluids, although its precise local- 
 ity can not in every case be detected ; but without disease 
 in either the one system or the other, we maintain that 
 fever can not exist." This is precisely our position^when 
 there is no disease in the system there can be no demand 
 for fever. In the previous extract, the inference is clear 
 , that fever is disease, and that all those are in great error 
 who regard it as an effort of the vital force to cast out dis- 
 ease, and now he says, that unless there is disease fever 
 " can not exist." Fever, then, is an effect, and not a dis- 
 ease, nor is it the cause of the disease. Then it follows, 
 that the fever is a friend of the system — an effort of the vital 
 force, or rather an accumulation of it for the purpose of 
 removing disease, or else it is an enemy of the system, and 
 if so, then it is disease, and as such, it is superadded to 
 the disease that caused it. Verity, if this is the case we 
 need not to marvel at the difficulty of comprehending it. 
 No matter where we turn, we find nothing but confusion 
 as to what fever is, and when we inquire as to its proximate 
 origin, we obtain nothing more satisfactory. 
 
 Many have, some yet do contend, that the cause of fever 
 is to be sought in the fluids, while others are equally sure 
 that it is in the solids. Some have referred it to the nerv- 
 ous system, and some again have attributed it to some 
 mysterious or occult organic inflammation. Fever has been 
 hunted for more than two thousand years, and yet its hiding 
 places are as little known as when the search commenced. 
 
 Dr. Stevens is of opinion that a morbid condition of the 
 blood is the first link in the chain of morbid phenomena 
 
620 FEBRILE FORMS OF DISEASE. 
 
 that causes fever — that the aerial or miasmatic poison 
 reaches the blood through the respiratory function. He 
 seems to have founded this opinion upon such facts as this : 
 he states that on opening the heart in fatal cases of yellow 
 fever, he found, instead of blood, a dissolved fluid nearly 
 as thin as water and black as ink. In both sides of the 
 heart the fluid was equally black, and throughout the vas- 
 cular system all distinction between venous and arterial 
 blood was completely lost. 
 
 If this supposed aerial poison has the power to do all this 
 mischief by acting directly on the blood, it must be con- 
 sidered as exceedingly singular that human genius can 
 devise no means to detect its presence in the atmosphere, 
 or in the blood, or under any other possible circumstance. 
 To the doctrines of fever, we know of but one parallel, and 
 that is geology — with regard to both, many facts have been 
 accumulated, but the advocates of both seem to have 
 banished common sense from the field of their investiga- 
 tions, and given themselves up to the most extravagant 
 speculation concerning them — summoning to their aid the 
 most occult, hidden and extraordinary causes- — such as 
 would elucidate nothing if admitted. 
 
 As to the remote cause of fever, there is a pretty general 
 unanimity of opinion, it is an aerial poison, miasm, ma- 
 laria, an ignisfatuus, a something, a nothing, and yet it 
 produces the most fatal types of fever. It is not our pur- 
 pose to enter into a discussion of this subject, or to do 
 more than simply to record our own convictions of it. In 
 many years traveling through the United States, we have 
 observed enough to satisfy us that heat and moisture, with 
 the plus and minus electricity they occasion, and the 
 variously modified modes of life among the people, are 
 adequate to all the febrile results we have noticed in con- 
 nection with them. 
 
 With a few brief remarks upon the modus o^perrandi of 
 these causes in producing fever, we conclude this introduc- 
 tion to our subject. 
 
 We can not believe that any one will venture to contend 
 
FEBRILE FORMS OF DISEASE. 621 
 
 that fever ever did take place under a proper performance 
 of the depurating function. Inflammation results from 
 local obstructions or lesions. Now suppose such obstruc- 
 tion or lesion shall be general — universal in the system, 
 what else could or should be expected than such a reaction 
 as constitutes fever ? Every part and parcel of the solids 
 is so over excited, or under excited, that no one part, however 
 small or comparatively unimportant, is able to eliminate 
 its metamorphosed portions, the absorbents are as it were 
 dead. The glandular structures, too, are in a similar con- 
 dition, and hence all the impurities of the venous blood, 
 because of defective depuration, becomes mixed or blended 
 with the arterial, and this morbidly excites every part 
 and fever results. 
 
 It is well known that a hot dry season is measurably exempt 
 from febrile epedemics, but if rain be added to this heat, then 
 they appear.* We are told that it is because the two com- 
 bined promote vegetable decomposition. If this explana" 
 tion be adopted, how shall we account for some epidemics 
 in sandy deserts, far removed from any source of malaria? 
 It is well known that children and negroes are greatly 
 exempt from the malarious fevers of the South. If then, 
 these fevers are produced by a poison, how does it happen 
 that they are exempted ? If our position be correct, this 
 fact is easily explained. The black surface of the negro 
 radiates not only a large portion of his animal heat, but 
 also a large portion of that solar heat that falls upon him ; 
 and another large portion is removed by the evaporation of 
 his perspirable matter. With these advantages his skin 
 maintains its integrity, and as no morbid sympathy is engen- 
 dered between it and the liver, the kidneys and other 
 glandular structures, a proper depuration of the system 
 does not become suspended. And as to children, they are 
 confined mostly to the house. But they have another 
 
 *This is not the fact, with reference to the yellow fever of New Orleans — 
 a hot dry season is the most productive of it; we admit the statement, how- 
 ever, as regards interra'ittents. 
 
622 FEBRILE FORMS OF DISEASE. 
 
 means of protection — it is that thick coat of adeps which 
 is common to their age, and to some forms of these 
 epidemics such men are equally invulnerable. 
 
 No medical philosopher, we should think, could have 
 labored for many weeks, contrary to his custom, in a hot 
 sun, with the other epidemic requisite, and not compre- 
 hend how it was he contracted fever. He exhausted his 
 skin — many internal organs sympathized with it, particu- 
 larly the liver and the mucus membrane of the bowels, 
 and thus, without the prevalence of moisture, he may be 
 seized with Dysentery — but with the moisture he will have 
 some form of fever — his skin is too feeble to contend with 
 a greatly reduced electric condition of the atmosphere, 
 constriction of it ensues, then comes a chill, and then a 
 reaction which is denominated fever. As the obstruction 
 is universal, the result is fever, and can not be inflamma- 
 tion, and therefore, it appears about as consistent to talk 
 about a general or an universal congestion, as about an in- 
 flammatory fever. 
 
 These views of fever strike us as being the legitimate 
 results of common sense and common observation, and do, 
 with clearness and force, point out the necessary indications 
 of treatment. With a normal depuration, fever can not 
 obtain, and without it, it can not be cured, but it may be 
 replaced by a mercurial disease, or some other, or the 
 patient may be killed, or sufiered to die for the want of an 
 adequate treatment. 
 
 We are aware that very many apparently conclusive 
 facts can be brought to bear in favor of malarious poison, 
 but let it be remembered that laws or rules have no 
 exceptions, and therefore, the production of a single epi- 
 demic, of the same kind, under circumstances that posi- 
 tively contra-indicate the existence of such a poison, is 
 enough to destroy the doctrine — one affirmative fact is 
 worth any number of negative ones. 
 
 As being confirmatory and explanatory of the preceding 
 views, we beg leave to make a few extracts from " The East 
 Tennessee Record of Medicine and Surgery for May^ 
 
FEBRILE FORMS OF DISEASE. 623 
 
 1853." Dr. Deaderick, the writer, says, that " Jefferson 
 and the adjacent counties where by far the greatest part of 
 my desultory practice occurred, are remarkable for their sa- 
 lubrity ; the face of the country mountainous and hilly ; the 
 soil dry, rocky, and gravelly ; the water (a great portion 
 limestone), excellent, and the streams, large and small, 
 passing rapidly off over gravelly or rocky beds. Conse- 
 quently we were seldom or never assailed by the epidemics 
 incident to marshy and miasmatic countries. In a course 
 of more than twenty-two years, I do not believe that I met 
 with more than a dozen cases of intermittent fever. The 
 most frequent were the common remittent and continued . 
 (synocha) fevers, which seemed incidentally to be occa- 
 sioned by frequent rains, succeeded by bright sun and 
 sultry weather. In general, these fevers required free use 
 of the lancet, the proper application of which, in conjunc- 
 tion with other appropriate appliances, rarely failed in con- 
 ducting them to a favorable termination." 
 
 The doctor now states, that some twenty years since, 
 he moved some hundred miles southwest of his former 
 residence, " where the face of the country is by no means 
 so mountainous and broken. On the contrary, there is in 
 every direction considerable bodies of level land, upon 
 the uncultivated part of which, the water, in many places, 
 remains after copious rains, until dissipated by evaporation 
 and absorption. The water-courses pursue their sluggish 
 course over muddy bottoms, and during the winter and 
 spring seasons, innumerable wet-weather springs and rivu- 
 lets, which disappear in the summer, are everywhere seen. 
 With this dissimilarity in the local features of the two 
 sections under notice, there exists a corresponding differ- 
 ence in the characteristics of their febrile diseases. Inter- 
 mittents are vastly more frequent, and in the remittent and 
 continued fevers there is an unequivocal approximation of 
 the character of those in more decidedly paludal and mias- 
 matic regions. 
 
 '' In the fevers here, the force and excitement in the san- 
 guineous system are not exalted, the thirst and heat of body 
 
624 FEBRILE FORMS OF DISEASE. 
 
 less ; nevertheless a greater tendency to congestion and 
 inflammation in some of the viscera, especially in the 
 mucous membrane of the intestines, and convalescence 
 more tedious. In short, many of the cases might be, 
 perhaps, with propriety, termed typhoid ; consequently 
 more caution is requisite in the use of the lancet, which 
 is rarely admissible, excepting at an early period of the 
 attack." 
 
 Our observations in the south entirely confirm those of 
 Dr. Deaderick, so far as they were alike extended — we 
 noticed the particular constitution of the patient, and 
 found that in low and wet situations — such as possessed 
 a low caloric and electric condition, the patients gene- 
 rally possessed a comparatively feeble vital force, or Pro- 
 fessor Hall's high dynamis, and therefore could not bear 
 a greater reduction of these stimuli. In the cases of 
 continued or remittent (synocha) fever, to be confined to 
 constitutions of high vital force, or according to Professor 
 Hall's Zoonomia, high stimulus ; and therefore could not 
 bear more, as the high caloric and electric atmosphere, as 
 described in the first extract from Dr. Deaderick. 
 
 But, to conclude our considerations with reference to 
 fever in general, we remark, that it does not matter what 
 may be the number or the variety of the forms under which 
 it may appear, it is essentially a unit — it has an increased 
 action of all the fibrous tissues for the removal of disease 
 or obstruction ; nevertheless, for the convenience of study, 
 its forms may be divided, and with much propriety, into 
 two orders : first, those which result from general obstruc- 
 tion, and therefore attended with fever ; and secondly, those 
 that result from obstruction, and consequently attended 
 with inflammation. 
 
 During the prevalence of Asiatic cholera, it is, we 
 believe, pretty well ascertained, that the fact, which we 
 placed before the Medical Society of Cincinnati, in 1834, 
 and subsequently communicated through the press to the 
 public, namely, that the conflagration of the nitrate of 
 potash and sulphur could not be maintained, is now pretty 
 
FEBRILE FORMS OF DISEASE. 625 
 
 well established, and yet we have not learned that any one 
 has attempted to explain the fact by the supposed existence 
 of poison. Indeed, it may be clearly presumed that no 
 poison could be generated on the surface of the earth, and 
 so change the atmosphere as to disqualify it for the support 
 of combustion; and yet there never was a malarious at- 
 mosphere more fatal to human life than was this. 
 
 We have too much to learn about the atmosphere, as 
 regards caloric, electricity and humidity, to conclude, when 
 it is fatal to animal life, that there is in it some Ibreign 
 poison. The conclusion in this instance, has been as much 
 too hastily drawn, as that of the geologists in referring min- 
 eral coal to a vegetable origin, upon the flimsy evidence that 
 the coal shales contain vegetable impressions. Such hasty 
 generalization has, and now is doing much to retard the ad- 
 vancement of science. Of this, we have one flagrant exam- 
 ple : the whole medical world has admitted that some forms of 
 disease are hereditary, and this general admission has closed 
 the door to any useful investigation on the subject — and yet 
 the character of the error has but to be named to be clearly 
 perceived. 
 
 We have not dwelt upon this subject, to the least extent, 
 with any expectation or even a desire to convert any one to 
 our convictions of the truth, but for the purpose of awaking 
 fresh observation — for the purpose of breaking up or dis- 
 turbing that settled conviction of the truth of a conclusion 
 which may possibly be false. 
 
 Finally, when we come to treat of the special forms of 
 fever, special elucidations of this subject will occasionally 
 be introduced. 
 
 ORDER I. 
 
 This order, in the present book will embrace two genera : 
 continued fever and jperiodio fever, 
 
 INTRODUCTION. 
 
 Before proceeding to the consideration of these genera, 
 it may be profitable to dwell a while on the phenomena that 
 
626 FEBRILE FORMS OF DISEASE. 
 
 usually constitute the course, type, and stages of fever. 
 The course of a fever is determined by its phenomena being 
 continued, remitting or intermitting, and that series of 
 phenomena which characterize this course may be usefully 
 divided into the following periods or stages ; 1, the form- 
 ing ; 2, the cold ; 3, the hot ; 4, the sweating, and 5th 
 the final. There are so many interesting and useful phe- 
 nomena in the first, that we have preferred to embrace it, 
 though contrary to the custom of many. As the final 
 period, that of convalescence or dissolution is of equal 
 interest with the first, we have, in company with some 
 authors, thought it best to include it also. 
 
 It should be remembered, however, that we are not to 
 expect to find all of these stages clearly defined in any one 
 of the febrile forms, except the intermitting, nevertheless, 
 periodicity characterizes, more or less, every form of dis- 
 ease ; but this law is not particularly conspicuous in the 
 violent and continuous forms of fever, and yet, it but 
 rarely happens that the primary or oppressive, the febrile 
 or exciting, and the declining stages of all forms of fever are 
 not sufiiciently marked to be clearly observed. 
 
 1. Period of formation. — This is, in reality the period 
 in which the vital forces are preparing for the removal of 
 existing disease, or obstruction to the normal manifestation 
 of the physiological functions, it is that period which inter- 
 venes between the first morbid sensations, and the introduc- 
 tion of the febrile phenomena. Its duration varies exceed- 
 ingly, and this depends more upon the resisting character 
 of the invaded constitution than upon other contingencies. 
 In the highly vital, this period is occasionally so short as 
 not to be observed — the febrile attack is absolutely one of 
 surprise and astonishment. In such constitutions the fac- 
 ulty of animal sensibility is so strong, and therefore vigi- 
 lant, that upon the slightest invasion, the other vital powers 
 are immediately summoned to resistance. 
 
 In constitutions of a contrary character, this period may 
 be greatly prolonged. The obstruction is permitted to 
 increase and spread, until at length the physiological 
 
FEBRILE FORMS OF DISEASE. 627 
 
 functions become very much arrested — too much so for a 
 normal continuance of life, and then a struggle ensues 
 which is indicated by a rigor or a chill, which is succeeded 
 by fever. 
 
 The first indication of this prodromal stage is an indis- 
 position to attend to business ; a feeling of weariness, an 
 indefinable anxiety — the appetite still being good. Then 
 succeeds a sen se of lassitude ; disturbed sleep ; loss of 
 appetite ; yawning and stretching ; wandering pains in 
 the limbs and back ; and unpleasant sensations in the stom- 
 ach ; harsh and dry skin ; irregularity of the bowels, but 
 most generally constipated ; some headache ; flatulence ; 
 nausea ; the drying up of old sores ; giddiness ; tremors of 
 the extremeties; slight creeping sensations of cold, and 
 an indisposition to be satisfied with the usual modes of 
 existence. In reviewing these symptoms, as a group, we 
 are bound to perceive that the nervous system has become 
 greatly impaired, and that its susceptibility to normal 
 impressions has become blunted. 
 
 2. The period of rigor or chill. — The first indication of 
 the approach of this stage, is a sensation of chilliness 
 which may be confined to the loins, or to one or more of 
 the extremities, or to the spine, while the other portions of 
 the body feel to be comfortably warm. This state of the 
 system gradually passes into one of tremor, which first 
 becomes manifest in the inferior jaw, and thence extending 
 to the entire muscular system. In the firmer class of consti- 
 tutions it but rarely exceeds a chill and slight tremor ; but 
 in less resisting constitutions it is sometimes very severe, 
 so much so, that it has, according to authorities, produced 
 convulsions. 
 
 The patient has not only a sensation of cold, but his 
 skin does become cold, and Dr. Wilson Philip says, that its 
 temperature has been known to fall as low as 70° Fahren- 
 heit. This condition of the animal temperature becomes 
 indicated by the paleness of the lips, nails, fingers and 
 toes — sometimes they become of a purple or livid color. The 
 skin, on most parts of the body becomes greatly constricted 
 40 
 
628 FEBRILE FORMS OF DISEASE. 
 
 and drawn into little elevations or papules, like those of 
 the feathered tribe, when the feathers are removed. The 
 pulse, during this stage, is small and quick and frequently 
 irregular; the breathing, like the pulse, is hurried and 
 labors under a feeling of constriction in the prsecordia. 
 
 During this stage, the patient makes no demand for food, 
 but his thirst is sometimes very considerable; the secre- 
 tions are not only in a great measure suspended, but much 
 deranged— the saliva is scanty and viscid ; in some instan- 
 ces much gastric derangement obtains, as frequent wretching 
 and vomiting ; and, occasionally this irritation is extended 
 to the bowels and liver, which is attended with a purging 
 of bilious matter. These symptoms, however, are mostly 
 confined to southern latitudes, but in all latitudes this stage 
 is so mild, that the patient himself, does not become con- 
 scious of it — it is indicated only by some paleness of the 
 lips and a little coolness of the hands and feet. 
 
 The length of time occupied by this stage is very varia- . 
 ble — continuing from a few minutes to four or Rye hours, 
 but one hour and a half may be assumed as the average 
 duration. It may be valuable to remark, however, that 
 this period is generally more protracted in southern than 
 temperate latitudes ; but in all latitudes it may be well to 
 add, that the more this stage is contracted, the more pro- 
 tracted and severe will the hot one be. "When we reflect 
 that the chill is always in the inverse ratio to the vital or 
 reactive force, the reason of this is readily understood; and 
 hence it is that when the vital resistance or reaction can 
 not be efiected the patient dies in the chill. 
 
 When the reaction has been effected and completed, 
 flushings of heat become blended with those of the chill — the 
 patient breathes with more ease, and gradually removes 
 piece after piece, the bed clothing off his body, and finally 
 from his extremities. The hot stage has commenced. 
 
 3. The period of increased temperature. — When the tem - 
 perature begins to rise out of the rigor, it is felt by the 
 patient to be a great relief, but when it reaches its maxi- 
 mum intensity, he finds himself as uncomfortable as when 
 
FEBRIDE FORMS OF DISEASE. 629 
 
 at the other extreme. He first becomes sensible to the 
 introduction of this stage about the face and eyes, and then 
 the thorax, the abdomen and finally the extremities. When 
 the reaction is rendered difficult, sensations of heat and 
 cold alternate, and frequently for some time, but finally, 
 in such cases, the former obtains the ascendency. The 
 patient finally begins to feel hot, and the sensation is not 
 delusive, for the condition of his surface produces the same 
 sensation to the tact of others, and further, it becomes 
 demonstrable by elevating the mercury to 105°, and in a 
 few instances to 107°, when the bulb of the thermometer is 
 placed under the tongue. 
 
 With this increase of temperature there is usually a very 
 considerable acceleration of the circulation, but in this 
 particular there is much variation. When the vital force 
 and the obstruction are so related as to render the reaction 
 easy, the pulse is full, strong, and quick, but without a 
 remarkable frequency, not much more, than is common to 
 health. But when the condition is reversed, the pulse, 
 in all respects, falls below the normal standard, except as to 
 its frequency, being sometimes increased to 110, and from 
 this to 160 beats in a minute ; but while there is good 
 velocity, there is indicated a great want of arterial power, for 
 it is soft and easily compressed. If inflammation be loca- 
 ted in any special part, it will be indicated by a tense, 
 small, and contracted pulse. 
 
 The brain, as a matter of course, participates with the 
 other parts of the system, and hence, in this stage, the 
 senses, except those of smelling and tasting, become more 
 acute, the brain is very frequently afflicted with pain, more 
 particularly with those who possess dense and fibrous consti- 
 tutions ; and, moreover, if the fever run very high, delirium 
 is a very general consequence. It is quite common in this 
 stage for the patient to complain much of pain in the 
 back, the extremeties and other portions of the body ; he is 
 also troubled with a morbid vigilance — an indefinable 
 uneasiness, and restlessness. 
 
 The digestive system is not without equal manifestations 
 
630 FEBRILE FORMS OF DISEASE. 
 
 of derangement. A loathing of food and warm drinks, 
 with a desire of cold drinks, are peculiarly characteristic of 
 this stage. Nausea and vomiting, constipation or diar- 
 rhea, but more frequently the former ; a disagreeable taste 
 in the mouth, a furred tongue with clean tip and edges, 
 are also yery common symptoms. 
 
 The secretions are generally very much arrested; the 
 urine is scanty and high colored ; the skin, tongue, and 
 mouth are usually dry, and, in the most favorable cases, 
 the bowels are dry and constipated. 
 
 The duration of this stage is as uncertain as that of the 
 preceding ; it sometimes ceases in a few hours, but in many 
 instances it continues for days and even weeks. Finally, 
 it should be remembered, that all of these symptoms 
 become very much modified, in different cases, by circum- 
 stances incidental to the cause, the constitution or the 
 peculiarities of the occasion. 
 
 4. The period of j)erspiration. — When the previous 
 stage has become so far reduced in temperature as to admit 
 of secretion, perspiration begins to break forth upon the 
 superior portions of the body and gradually extends over 
 the whole surface. It is sometimes, as to quantity, quite 
 moderate, but in many instances it becomes highly profuse. 
 When this period has continued for some time, it subsides, 
 leaving all the functions very much in their normal condi- 
 tion, except that they are much weakened. 
 
 The preceding four periods succeed each other in regular 
 order ; nevertheless, they present much diversity of charac 
 ter in the difierent forms of the disease, as may be noticed 
 when we come to treat of them individually. 
 
 5. The period of conclusion. — The disease, for the re- 
 moval of which the fever was instituted, was proximately 
 occasioned by an insufficient depuration, so when this 
 function begins to re-establish itself, and, this stage begins 
 in a favorable manner, the patient will recover, in the 
 event of no unfavorable interruption. On the other hand, 
 if the function of depuration be not re-established the chem- 
 ical agencies acquire an ascendency over the vital, thee 
 
FEBRILE FORMS OF DISEASE. 631 
 
 this period is occupied by the progress of dissolution. 
 Hence it is, that when the declination is favorable, its 
 begining is indicated frequently by the spontaneous occur- 
 rence of a profuse perspiration, urination, bilious or serous 
 discharges from the bowels, which have been denominated 
 critical. 
 
 We can not avoid, in this place, to notice a remark of 
 Dr. Wood's, who says, "It has been conjectured that these 
 evacuations were the means by which nature effected the 
 cure of the complaint ; and the idea at one time extensively 
 prevailed, that through their instrumentality, offensive 
 matter, which served to sustain the fever, were eliminated 
 from the system. Without attempting here to confute this 
 hypothetical notion, it is sufficient to say that the dis- 
 charges are the necessary results of a certain grade of irri- 
 tation in the organs, and, if they serve to relieve the dis- 
 order in which they originate, it is only one of the numer- 
 ous instances, in which nature has contrived to make 
 noxious influences subservient to their own removal." 
 
 If the bills of mortality could either speak or write, 
 they would publish a most lamentable account of those who 
 practice upon the doctrine here set forth by this distin- 
 guished Professor. It is too glaringly absurd to require of 
 us more than a very few common sense interrogatories and 
 comments. 
 
 Will the Doctor or any one else affirm that the patient, 
 would or could have recovered without the elimination 
 of the morbid and offensive matter which is now under 
 consideration? How did that " certain grade of irritation 
 in the organs" happen? Was this matter elaborated by 
 the irritation, or was it the cause of the irritation? If the 
 ^'instances" of such eliminations are "numerous," should 
 we attribute them to nature's bungling, or to a law of her 
 settled policy? If nature very frequently bungles in this 
 way, it would be a happy circumstance to society if the Doc- 
 tors would suffer her to manage all cases in her own way. 
 
 If secretion becomes arrested or deranged, by miasmatic 
 poison (?), heat, cold, minus or plus electricity, or any 
 
632 FEBRILE FORMS OF DISEASE. 
 
 other cause, and the matter which ought, norraallj, to have 
 been eliminated, is not, will it not act upon the irri- 
 tability of the system as foreign matter? And if the retention 
 of such matter did not produce a " certain grade of irrita- 
 tion, "and even fever, could the system be in a normal or 
 physiological condition? Is there not, sometimes, too much 
 carbon, urea, or lime, or phosphorus in both the fluids and 
 solids of the system? Has the system any other remedy 
 for this, its condition, than secretion and depuration by the 
 skin, kidneys, liver, the mucus membrane of the bowels, etc? 
 And are not those eliminations which take place in the crisis 
 of fever, of this character? Do they not absolutely pro- 
 duce it, and thus terminate the fever by removing its cause? 
 
 In such instances nature has effected the very result, 
 which should be the object of the physician from the 
 moment he visits a patient ; indeed, he was called for the 
 purpose of helping her to do in less time, that which she 
 may ultimately effect without help. 
 
 One of the most indubitable evidences of the commence- 
 ment of this period — of the re-establishment of secretion, 
 is the moistening and cleaning of the tongue. This clean- 
 ing process commences at the point and edges, and gradu- 
 ally progresses till the whole is clean and brought to a 
 normal appearance. These changes in the tongue indicate, 
 no doubt, that nature is " contriving" to do the same for the 
 whole gastro-intestinal canal, in connection with a general 
 secretory movement — the execution of the plan "which 
 nature has contrived to" remove a "certain grade of irrita- 
 tion in the organs," instead of being the result of it. 
 
 With the indications of returning health, above named, 
 may be expected a jpari passu movement of all the secre- 
 tions and a corresponding return of the senses, appetites 
 and propensities to their normal condition. 
 
 Before dismissing this subject it is proper that we add a 
 few remarks upon what is usually denominated the types 
 of fever, and as Dr. Eberle's descriptions are better ov 
 more clear than those of most of writers ^ we shall adopt 
 his, account of them. 
 
FEBRILE FORMS OF DISEASE. 633 
 
 He says, "The space of time occupied by one paroxysm 
 of a fever and its succeeding intermission, or which inter- 
 venes between the regular periodical exacerbations of par- 
 oxysmal fever, is called the revolution of a fever. The 
 revolutions of fevers are various in point of duration ; some 
 fevers completing theirs in twenty-four hours ; others in 
 forty-eight, while others require seventy-two, and some 
 even ninety-six hours . The form which a fever assumes, 
 in this respect, is called its type ; so that a fever which 
 occupies twenty-four hours, from the commencement of one 
 paroxysm to another, is said to be of the quotidian type ; 
 while one which revolves every forty-eight hours, is of the 
 tertian type ; and when this period is extended to seventy- 
 two hours, the fever is of the quartan type ; and a period 
 of ninety-six hours constitutes the quintan type. The 
 quotidian^ the tertian^ and the quartan types, constitute the 
 three principal and primary types of fever ; all of which 
 are, however, subject to modifications which may readily 
 mislead the careless observer, so as to confound them, or 
 mistake one for the other, especially the quotidian and the 
 tertian. 
 
 " It has been observed, that in fevers of the quotidian 
 type, the paroxysms generally come on in the morning — 
 a circumstance, which has been almost invariably verified 
 in my own experience, and which is, indeed, so constant, 
 that CuUen was induced to notice it in his definition of a 
 quotidian. Tertians commonly come on toward noon ; 
 but they are much less regular, in this respect than fevers 
 of the preceding type. Two simple tertians sometimes go 
 on cotemporaneously in the same patient ; so that, instead 
 of the paroxysms recurring only every other day, they 
 occur daily, as in a quotidian. These cases are called 
 douUe tertians^ and are distinguised from quotidians by 
 the paroxysms of the alternate days being similar in 
 relation to the precise time of their occurrence, grade of 
 violence, duration, and other circumstances. Thus the 
 paroxysms on the odd days, will perhaps recur at nine 
 o'clock in the forenoon, while those which happen on the 
 
634 FEBRILE FORMS OF DISEASE. 
 
 even days will come on at two or three o'clock in the after- 
 noon, so that, although each day has its paroxysms, the 
 fever can not be properly considered as a quotidian, but 
 the cotemporaneous progress of two simple tertians, the 
 one having commenced a day sooner than the other. 
 Fevers, however, rarely assume the double tertian type 
 from their commencement. They usually begin and con- 
 tinue for some time in the simple tertian type — the duplica- 
 tion occurring afterward ; and when the type thus becomes 
 doubled, the new or accessory paroxysms are in general 
 considerably milder than those of the original or simple 
 tertian. It is asserted, that a double tertian seldom ter- 
 minates without first assuming the single tertian type, 
 the accessory or weaker paroxysm disappearing first." 
 
 Genus. I. — Continued Fever. 
 
 Introduction. — It will be remembered that we divided the 
 various forms of fever into two orders, and the first of these 
 again into two genera — the continued and the periodic, and 
 although this arrangement has many practical advantages, 
 yet it is not strictly true. It appears so far as observation has 
 extended, that the functions, of every variety of organiza- 
 tion are subjected to a species of periodicity, and this law 
 is common to both health and disease. Consequently it is 
 exceedingly rare to witness any variety of febrile action 
 which does not, to some extent, indicate the presence of this 
 law. And yet the decrease or abatement of febrile action, 
 in this genus, is so inconsiderable, when compared with the 
 other, as to leave no room for a mistake in the diagnosis. 
 
 The modifications of this genus are so numerous and 
 prominent as to have led to considerable confusion among 
 writers, and the names which the several modifications 
 have received, are almost as numerous as have been the 
 writers. The two extremes of this genus, as relates to the 
 energy of their action, has caused it to be divided into two 
 species the sthenic and asthenic, or inflammatory and 
 typhous. That there is a very great difierence between the 
 highest grade of the sthenic and that of the asthenic no 
 
FEBRILE FORMS OF DISEASE. 635 
 
 one will question, but to regard a fever as inflammatory 
 that originates in general obstruction, is equivalent to con- 
 tending for an impossibility, nevertheless, as a name, it is 
 now understood, and hence we shall not depart from its ac- 
 cepted use. In order to convey some idea of the grades of 
 febrile manifestations, they have been divided into three 
 varieties: synocJia^ synocJius^ and typJious. The first is 
 intended to embrace those febrile forms which have been 
 denominated inflammatory; the third is intended to em- 
 brace those which exhibit the lowest degree of febrile 
 action, and the second those of an intermediate character. 
 The first has been again divided into two sub-varieties : the 
 idiopatMo and symptomatio. This division is another that 
 inculcates a false idea, because both are, in truth, symptom- 
 atic. The first is symptomatic of a reduction of nervous 
 irritability and a constriction of the capillary vessels, and 
 the second, of a pre-existing inflammation or local lesion 
 of the solids. To distinguish the former from the latter 
 after this explanation, we may use the word idiopathic. 
 
 Species I. — Pyrexia Bthenica — Simple In-flammatory Fe- 
 ver. — The Synochal grade of Idojpathio Fever; Fehris 
 vasorum. 
 
 This form of fever most generally seizes young persons 
 in the flower of their age, and full of blood, those who are 
 athletic and therefore fibrous and elastic, finally, those who 
 constitute the first class, (page 20.) It may occur at any 
 season of the year, but it is more liable to prevail during 
 the spring and summer. 
 
 It begins with a sense of lassitude, the body feeling as 
 if bruised ; with weakness ; cold and hot sensations which 
 alternately succeed each other ; with tremors and with 
 pains all over the body, but particularly in the shoulders, 
 back, knees, legs, and head. The bowels are constipated 
 and the secretions are suspended. As this stage passes off 
 the second is introduced with an intense and burning heat, 
 an unquenchable thirst ; a sufiusion of the eyes, aredness and 
 swelling of the face ; nausea ; vomiting ; restlessness ; anx- 
 
636 FEBRILE FORMS OF DISEASE. 
 
 iety ; a full, quick, and strong pulse ; a dryness of the skin ; 
 a scanty and high colored urine ; a rough and dry tongue, 
 frequently covered with a thick scurf; the respiration is 
 difficult and labored. Delirium is not very common to 
 this form of fever, but when it does supervene it is severe 
 and threatening ; the acuteness of the senses of seeing and 
 hearing are much increased, and finally, the blood, when 
 drawn, shows a buffy coat, cupped crassamentum and a 
 deficiency of serum ; but the introduction of this symptom 
 is measurably useless to Eclectics as they never see it, 
 except possibly, by some unexpected accident. 
 
 It is not uncommon for the preceding symptoms to man- 
 ifest remissions and exacerbations — the first appearing in 
 the morning and the second in the evening, until terminated 
 by some critical evacuation and a return to health ; or by 
 stupor, coma, tremors, twitchings of the muscles, hiccough 
 and death. 
 
 This form of fever, when its simple form is maintained, 
 very seldom continues beyond the ninth day, but it may be 
 extended to the fourteenth, and it may conclude on the fifth 
 or seventh. When the symptoms have continued to in- 
 crease in violence to the fourth or fifth, a crisis may be 
 looked for on the seventh, and when its crisis is procrastina- 
 ted to the fourteenth, it will be observed to increase in vio- 
 lence to the ninth or eleventh. 
 
 Prof. Eberle, says that revolution in this form of fever, 
 is almost invariably attended by general and free perspira- 
 tion, urination etc. As this is one of nature's contrivances, 
 he does not seem to think that the revolution is affected by 
 secretion, of which perspiration and urination are now two 
 of the most important. And here we would have the 
 reader remark that he and most other authors inform us 
 that a reddish or pale sediment in the urine, is a never- 
 failing concomitant in the crisis of this fever. Is the sub- 
 traction of this sediment from the blood a mere circum- 
 stance, and one of no particular importance? Did its re- 
 tention in the blood have no agency in the production of 
 the fever? 
 
FEBRILE FORMS OF DISEASE. 637 
 
 It should be remembered that in this form of fever the 
 chilly sensations, during the forming stage, do not appear 
 to be attended by any absolute reduction of temperature, 
 at all events, if such be the fact, it is not ascertainable by 
 the sense of others, or the thermometer. The only opinion 
 we can suggest to account for it is, that the cold and hot 
 sensations which are alternately produced, are occasioned 
 by alternate contractions and relaxations of the capillary 
 vessels; that in the former no caloric is evolved, and that 
 in the latter it is. In support of this view, it should be 
 remembered that the system is now struggling to remove 
 all constriction, and finally succeeds. 
 
 In many constitutions of even the firmer class, there is 
 some part more feeble than the balance of the system, and 
 hence, therefore, more liable to take on inflammatory action 
 in the progress of this fever, because of its inability to 
 resist an excessive invasion of the febrile action. Hence 
 it is that the simple and even tenor of this fever is fre- 
 quently complicated with topical inflammation. 
 
 Causes. — Of all the causes to this form of fever, an 
 undue or unguarded exposure to cold is confessedly much 
 the most frequent, and in a large majority of instances 
 this exposure results from an incapacity to anticipate atmos- 
 pherical vicisitudes or mutations, and hence its more fre- 
 quent prevalence in the spring and fall months, more par- 
 ticularly in cold and variable climates. When we consider 
 the fibrous and sensitive character of those who are most 
 organically liable to this form of fever, we should reckon 
 an electric condition of the atmosphere as a frequent cause, 
 hence the reason why northwest and northeast winds so 
 frequently occasion it. A sudden exposure to cold water 
 is said to cause it when the the person is heated by exercise. 
 This remark, standing as it does, unqualified, has been 
 productive of mischief.* 
 
 * The writer made it a rule of his life, never to take a cold bath until, by 
 exercise, he had his surface in a perspiring condition — a condition that indi- 
 cated an active and elevated condition of the vital forces — a condition tha 
 
638 FEBRILE FORMS OF DISEASE. 
 
 An exposure to solar heat, by those of this class who 
 have not been accustomed to it, frequently proves a suc- 
 cessful cause. The use of highly stimulating food and 
 drink, is also a frequent cause in old and affluent commu- 
 nities. But in all our reflections upon the etiology of fever, 
 it should be remembered that the various grades and modifi- 
 cations of it depend more, much more upon the inherent 
 organic conditions of the system, than upon either the re- 
 mote or exciting cause. Hence we may safely assert that 
 all the forms of fever which are incidental to any given 
 section of country, at the same season of the year, are 
 but so many varieties or modifications occasioned by the 
 existing difierences that organically exist between individ- 
 uals. Thus, while the athletic — those having large organs 
 of animal sensibility and muscular motion, will have pure 
 synocha ; another with less endowment of animal sensi- 
 bility, synochus ; and in a third, in whom both of those 
 vital forces are feeble, a typhoid, which, by neglect or im- 
 proper treatment may degenerate into a proper typhous. 
 
 best calculated to resist the constringing influence of a reduced temperature. 
 The great matter to be avoided is an exposure to cold when the system is 
 fatigued — when incapable of a prompt and efficient action. Furthermore, 
 we have never known any one to suffer from drinking ice-water un- 
 der a warm and perspiring condition of the skin, provided fatigue had not been 
 induced, and provided, further, that the person was not in the habit of using 
 ardent spirits. 
 
 Under the false impression that now exists in society without qualifica- 
 tion, that it is dangerous to go into cold water when the skin is heated, we 
 see both men and boys go to the river in a heated condition, undress and 
 fan themselves till the skin is cool and dry before entering it, the conse- 
 quence is that the most feeble class of them come out with a contracted 
 skin, and livid or purplish lips, which is sometimes followed by fever. 
 
 In 1827 and on July the 5th, the writer and three other gentlemen, one 
 of whom was athletic, another was less so, but in good health, the third 
 possessed a fibrous constitution, but with impaired general health, and the 
 fourth, the writer, had a constitution which at that time, though fibrous 
 was considerably anaemic — the vital forces feeble — and who had never pos- 
 sessed good health, determined upon visiting a cave, near Bowling-green 
 Kentucky, which was denominated the "Cold Cave." When they arrived 
 at it, they were in a perspiring condition, and all of them, except the writer, 
 refused to enter it until they should become cool, and to hasten this result 
 they took off their coats and seated themselves under a shade. During 
 
FEBRILE FORMS OF DISEASE. 639 
 
 A sight of the patient, therefore, should generally deter- 
 mine the grade of the fever. 
 
 Diagnosis. — It is distinguished from typhus fever by its 
 strong, high, full pulse, dry tongue, intense thirst and heat 
 and greater violence of the pains. The absence of clearly 
 defined periodicity, will distinguish it from those forms 
 which constitute the next genus, and from the succeeding 
 species by the diagnosis which will there be given. 
 
 Prognosis. — Such is the vital resistance in synochal 
 fevers that the prognosis should not be considered as 
 either uncertain or unfavorable. What the bleeding, purg- 
 ing, and mercurial practice may efiect upon it, is altogether 
 another question. This, so long as it has no complications 
 to contend with, is the least dangerous of all the forms of 
 continued fever, and for the simple reason that the vital 
 powers are adequate to the removal of the disease. 
 
 If the system though generally strong, should possess 
 feeble parts, inflammation, in some one of them, may 
 supervene, and in such case, the magnitude of the danger 
 will depend upon the functional importance of the invaded 
 part. If the breathing should become obstructed or pain- 
 ful, or attended with a cough, or with pain in the thorax; 
 or if the abdomen be tense and tender upon pressure, we 
 
 this time the writer employed himself, with his coat off, hunting fossils 
 among the exposed rocks in the vicinity of the cave, and in the open 
 blaze of a southern July sun. At length the three cooled gentlemen re- 
 placed their coats and announced that they were ready, and the writer, in 
 a perspiring condition, replaced his coat and adjusted it closely about his 
 person, and the party proceeded with their visit. 
 
 It will now be perceived that when the party returned to the surface of 
 the earth and into the presence of the sun, the writer was in about the 
 same condition that the other gentlemen were in at the moment of their 
 entrance into the cavern. Now for the consequences to this party individ- 
 ually. 
 
 The first had simple catarrh which did not incommode him much ; the 
 second was confined two or three days to his room, with a similar afFection; 
 the third had pneumonia, which apparently, came near costing him his life, 
 and the fourth, the writer, suffered no conscious change of health. 
 
 No one, and more especially a medical gentleman, can fail to understand 
 the rationale of the facts involved in the preceding history. 
 
640 FEBRILE FORMS OF DISEASE 
 
 may apprehend danger. The presence of mere delirium 
 should not be regarded as unfavorable, but should the ex- 
 istence of violent pain in the brain become indicated, en- 
 cephalitis may be suspected to exist and to greatly increase 
 the danger. 
 
 Favorable Signs. — A slight hemorrhage from the nose, 
 a general perspiration, urine pale when voided and turbid 
 when cool ; a reduction of the temperature and of the hard- 
 ness, quickness, and frequency of the pulse. 
 
 Species II. — SynooTius Fever — Common Continued Syno- 
 
 chus Fever — Enteric Fever — Typhoid Miteor — Typhoid 
 
 Fever — Entero — Mesenteric Fever ^ etc, 
 
 "We have thought it best to regard this form as a distinct 
 species, for the reason that it is confined to those regions of 
 the country in which the bilious or so-called miasmatic 
 forms of fever do not prevail. 
 
 It is very probable the several names, at the head of this 
 article, have been given to one and the same form of dis- 
 ease, modified probably by local and constitutional circum- 
 stances. The profession, it seems, have been brought to 
 this conclusion by the labors of Louis, who designated it by 
 the name of " typhoid fever," but its nomenclature is still 
 unsettled, and consequently we have preferred to call it by 
 a name which indicates a grade of action between the high- 
 est and the lowest that is known to the genus. Dr. Wood 
 calls it " enteritic fever," and probably for the reason which 
 we infer from the following remark of his : " The intestinal 
 afiection is as characteristic of this disease, as the eruption 
 is of small-pox." "We can not adopt this name, because it 
 only designates a specific form, instead of a general one. 
 "We conceive that fifty individuals may have the same grade 
 of continued fever, and yet no two of them will be attended 
 by the same local or special phenomena. The multiplica- 
 tion of names to include or express local or incidental cir- 
 cumstances, has done much violence to the profession. 
 
 We are disposed to suggest, in this place, that the pre- 
 sent form represents the general character of this genus, 
 
FEBRILE FORMS OF DISEASE. 641 
 
 and that the synochal form is an upward departure from it, 
 and that the typhous is a descending one ; and hence they 
 should be regarded as being merely varieties, and this con- 
 clusion is sustained by a corresponding condition of the 
 vital forces among men. Some men are much above the 
 average of society in vital force, and others are much below 
 it ; the average then, is the legitimate sphere of the syno- 
 chus grade of fever. Either of the ascending forms of con- 
 stitution, may have typhous fever, because their vital force 
 may be reduced to the typhous level by previously debilitat- 
 ing causes ; hence it is that every man, in a crowded and 
 filthy ship or prison may, finally, die of typhous fever. But 
 the reverse of this can not be efi'ected — a man of a low grade 
 of vital force will never have synochal fever. 
 
 Now, in that mass of society which determines the aver- 
 age of the vital force, there necessarily exists many modifi- 
 cations, and each epidemic may result from a modified con- 
 dition of the atmosphere. In one season, it may have a 
 particular pulmonic, nervous, or gastro-enteritic tendency. 
 Under these views, we think it best to generalize febrile 
 forms of disease, to the full extent of practical advantage. 
 
 This, or the synochus grade of fever, may have the usual 
 forming stage or period of fever, but it frequently gives very 
 little or no premonition of its approach, and abruptly an- 
 nounces itself by a chill, which may almost as abruptly ter- 
 minate by the introduction of the fever; but most frequently 
 it is imperceptibly merged or lost in the fever which so 
 gradually increases as to leave the patient unconcious of 
 the moment of beginning. 
 
 In some instances, again, the patient is scarcely con- 
 scious of the existing chill, and the fever that succeeds is 
 of a very mild grade ; the tongue becomes white, the pulse 
 more frequent and full, with a dry skin ; pain, more or less 
 severe, over the eyes; urine diminished and highly colored; 
 sleep disturbed, and bowels constipated. The appetite is 
 not always arrested. When the afiection is of this mild 
 grade, it passes ofi" in a few days by perspiration or 
 diarrhea. 
 
642 FEBRILE FORMS OF DISEASE. 
 
 In oiir cold and variable climates, the ordinary continued 
 forms of fever present various degrees of violence, from the 
 mild form above described, to those of cerebral oppression 
 and fatal collapse. Gastro-intestinal irritation may almost 
 be regarded as a pathognomonic symptom of this form of 
 fever, and it usually appears early in the seizure, by the 
 manifestation of nausea, vomiting, unpleasant gastric sen- 
 sations and foul tongue. 
 
 In that form which is most usually denominated continued 
 fever, the symptoms are, from the beginning, of a pretty 
 high grade of violence. Beside a distressing degree of the 
 symptoms of the forming stage, the exciting degree of the 
 hot is pregnant with threatened danger. The skin is hot 
 and covered with a pretty uniform, but slight, blush of red ; 
 the face is flushed, the pulse is active, full, and frequent; 
 the patient is restless, and probably peevish and apparently 
 incapable of fixing his attention upon anything, except a 
 dull, heavy, or throbbing pain in his head. The urine is 
 sometimes pale, but most frequently it is red and entirely 
 destitute of sediment. The tongue, being white in the be- 
 ginning of the fever, becomes, in its progress, dry, harsh, 
 and dark-brown; the bowels, as usual in fever, become tor- 
 X^id, but the faeces continue soft, but frequentlj^ contra-indi- 
 cate the presence of bile. 
 
 For six or seven days, these symptoms, with slight inter- 
 missions and exacerbations, continue about the same ; but, 
 in the further progress of the disease, cerebral symptoms are 
 apt to supervene, more particularly delirium at night. If the 
 vital energies are capable of effecting a favorable termina- 
 tion, it may be expected on the eighth or ninth day, other- 
 wise it will pass, with more or less rapidity, into the typhous 
 form or into collapse, when all the symptoms will become of 
 a very threatening character — such as delirium, more or less 
 stupor, dilated pupils, foul and dark-brown tongue, hurried 
 breathing, picking at the bed clothes, subsultus tendinum, 
 and a gradually sinking pulse to the close of life, which 
 may happen on the fifteenth day, but it may be procrastin- 
 ated two or three days longer. 
 
FEBRILE FORMS OF DISEASE. 643 
 
 When the cold stage has been protracted, and reaction 
 established with difficulty, we may infer the existence of a 
 feeble vital force, and therefore we should be prepared to 
 expect a rapid declension of the disease into the typhous 
 stage, attended with exhibitions of cerebral disorder of no 
 ordinary grade — such as an aversion to light and sound, a 
 disposition to watchfulness, confusion of ideas and delirium, 
 which may become continuous and violent. The head is 
 rolled from side to side ; the arms and feet are kept in fre- 
 quent motion ; all portions of the body are tender to the 
 touch , and evanescent pains are felt in various parts of it. 
 There is apt to exist, also, tenderness at the epigastrium, 
 flatulence and irritability of the stomach. In this modifi- 
 cation of the disease, the pulse never becomes remarkable 
 for tenseness or fullness, and the typhous condition of the 
 disease may be expected to supervene on the fourth or fifth 
 day, and then we have a reduction of some symptoms, and 
 an introduction of others of a less favorable import — the 
 delirium passes into a low and muttering raving — great 
 mental oppression, and a rapid destruction of the vital 
 powers. 
 
 When synochus fever occurs under circumstances of de- 
 bility arising from poverty and depravity of living, such 
 as may characterize life in a damp cellar, poorly ventilated 
 and warmed, with food poorly calculated to produce health, 
 then we have a fever in which the prodromal stage 
 is much protracted, and the hot one extended indefi- 
 nitely to five or six days, or probably to as many weeks. 
 The pulse, in activity, frequently continues at very nearly 
 the normal standard, but usually a little accelerated. The 
 appetite is absent or greatly impaired, the thirst is very 
 moderate, the eyes are dull and sufiused, and the patient 
 drowsy ; the tongue is white and slimy, the urine is small 
 in quantity and pale, containing, most generally, much 
 mucus. This form does not necessarily run into the typhous 
 state; but, as it progresses, the pulse becomes smaller, 
 weaker, and more frequent. It may terminate favorably 
 about the seventh or ninth day by a general diaphoresis 
 41 
 
64:4: FEBRILE FORMS OF DISEASE. 
 
 with a slow convalescence. In the case of a fatal termina- 
 tion, the event will be preceded by muttering, subsultns 
 tendinnm, hiccough, and coma. 
 
 When those persons who have been exposed so long to 
 those influences which are called miasmatic, as to have the 
 nervous system more or less enfeebled, and the secretions 
 more or less impaired, become exposed to the influence of 
 cold, a common cause of synochus, a modification of it will 
 be induced which demands special notice. Beside the 
 usual symptoms of the prodromal stage of fever in general, 
 we are required to add a sense of distention and weight in 
 the stomach, acid or bitter eructations, an icterode complex- 
 ion of the face, pains in the abdomen, constipation or a 
 bilious diarrhea, occasionally chilly sensations, and a silent 
 and gloomy disposition of mind. In the hot stage, the 
 pulse is but rarely over 112, during the first several days, 
 and for the same time it is full, active, and compressi- 
 ble ; the skin rarely becomes very hot — the tunica albu- 
 ginea and the whole surface of the body becomes of a jaun- 
 diced hue ; some moisture may be frequently observed, 
 during the course of the fever, about the region of the 
 heart, but a general perspiration is but rarely, if ever, wit- 
 nessed before the final resolution of the fever. The urine 
 is small in quantity and charged with bile ; the tongue is 
 bitter and covered with yellowish slime, which becomes 
 brown as the disease advances, and, though moist in the 
 beginning, it becomes dry, hard, and of a brown color. 
 Nausea, vomiting, and a loathing of food always attend, 
 with a desire of drinks, particularly of an acidulated char- 
 acter. In this modification there is an early tendency to 
 pass into the typhous form, consequently the most prompt 
 attention should never be withheld. The breathing is usu- 
 ally oppressed and attended with some cough ; the remis- 
 sions and exacerbations are quite apparent. If it shall 
 reach the typhous stage, then delirium and all the other 
 phenomena that usually characterize this form of fever will 
 be apt to make their appearance by the fifth, seventh, or 
 ninth day. 
 
FEBRILE FORMS OF DISEASE. 645 
 
 In the course of this malady there are certain symptoms, 
 that occasionally arise, which so unavoidably affect its gen- 
 eral character as to make it expedient that we should notice 
 them. 
 
 Diarrhea is a frequent attendant upon continued fever, 
 but, whether present or not, such is the gastro-enteritic irri- 
 tability that the bowels are much more easily operated upon 
 by cathartic medicines than in other forms of fever ; and 
 where a doubt exists as to the character of the fever, this 
 circumstance in the opinion of Dr. Wood, should have 
 weight in determining our opinion. He says, that diar- 
 rhea sometimes precedes the fever, but more frequently 
 comes on during the first twenty-four hours, and is often 
 procrastinated to a later period. The evacuations may be 
 only one or two per diem, and they may be extended to a 
 dozen or more ; and what is equally if not more, remark- 
 able, they have a normal or healthy appearance, except as 
 to consistency. As this peculiarity attends throughout the 
 disease, it becomes one among the best of the diagnostic 
 symptoms, and, furthermore, the liquidity of this excretion 
 being common to this form of fever, marks it as one of the 
 most obstinate, and therefore, dangerous forms of fever we 
 have to contend with. It prevents that concentration of the 
 vital force w^hich is indispensable to the re-establishment of 
 depuration. The disease is sometimes attended, particu- 
 larly in its advanced stages, by dark-colored or even black 
 stools — sometimes by such as indicate the presence of in- 
 flammation, and abdominal pains are not unfrequent 
 attendants. 
 
 Tymjpanites.-^T)v. Wood states that he has scarcely wit- 
 nessed a case of this fever in which this symptom did not 
 more or less prevail. It does not become very obvious until 
 about the seventh day, but sometimes it obtains as early as 
 the third. Its violence is usually proportioned to tliat of 
 the disease. Sometimes the abdominal distention occa- 
 sioned by it is very distressing — it greatly interferes with 
 the respiratory function. It appears to be mostly confined 
 to the large intestines. 
 
64:6 FEBRILE FORMS OF DISEASE. 
 
 Rose-colored erwption is said to be very characteristic of 
 this form of fever. It occurs most frequently between the 
 seventh and fifteenth day, and first appears on the abdomen, 
 from which it extends to the breast and inferior extremities. 
 It appears in small, red spots, either round or oval, and 
 about a line in diameter, more or less, and possess a slight 
 elevation which disappears upon pressure, and returns upon 
 its removal. Their number is sometimes only two or three, 
 but in many instances they are innumerable. By appear- 
 ing in successive crops, they occupy a period ranging from 
 three to fifteen days. They are said to be very rarely ab- 
 sent. They are easily distinguished from petecchiae, which 
 consists of extra vasated blood in the skin. 
 
 Sudamina. — This consists of vesicles not larger than a 
 pin's head, and in order of time their appearance is subse- 
 quent to that of the rose-colored eruption. They are more 
 readily felt than seen, unless viewed obliquely. They may 
 spread over the entire surface, except the face, but they are 
 more usually confined to the neck and the superior portions 
 of the chest. They have but little diagnostic weight, as 
 they occur in other forms of fever, and by no means con- 
 stant in any. 
 
 Cough and hronchial rales. — Dr. Wood says, that " this 
 is a very common complaint," and that the "cough is either 
 dry or attended with a slight mucous expectoration, with 
 very little or no soreness or sense of oppression in the chest. 
 The dry, sonorous, and sibilant rales may be heard more or 
 less extensively over the thorax, and are much greater in 
 proportion to the amount of oppression or dyspnoea than in 
 ordinary catarrhal afiections. They thus afibrd an impor- 
 tant diagnostic sign. They are not, however, present in 
 all cases. Sometimes they begin with the disease, but more 
 frequently not until the lapse of about a week. Occasion- 
 ally they give place to a crepitant or sub-crepitant rale, in- 
 dicating the occurrence of inflammation in the parenchyma 
 of the lungs." 
 
 Pulse. — This source of information to the vascular con- 
 dition of all forms of disease betrays much variety in this 
 
FEBRILE FORMS OF DISEASE. 647 
 
 form of fever. It presents great diversity of character in 
 difierent cases ; sometimes, in the early stages, it is full 
 and strong, and sometimes feeble from the outset, and 
 always becomes so in the progress of the malady. But that 
 average pulse, which is most characteristic of this fever, is 
 one of frequency, smallness, and feebleness, and is indica- 
 tive of nervous irritability and capillary congestion. Its 
 general range of beat is from 110 to 160 ; the former marks 
 the beginning and the latter its last stage. When the sys- 
 tem passes into a prostrate condition, its frequency is re- 
 duced below the standard of health. 
 
 HemorrJiage. — In the early stage of the disease epistaxis 
 is not an unfrequent phenomenon — the result, perhaps, of 
 an active determination to the head ; it is generally slight, 
 though sometimes requires attention. In the advanced pe- 
 riods of the disease, hemorrhage from the bowels is apt to 
 supervene, and as it is passive it may be always accounted 
 a dangerous indication. 
 
 Dullness or heletude. — In the early and probably most 
 congested period of the disease, the countenance of the pa- 
 tient becomes, as it were, a blank — he is apathetic and low- 
 spirited. This dullness may increase with the disease, 
 until stupor and even coma may supervene. 
 
 Delirium. — This usual attendant upon continued fever 
 may appear early in the disease, but it is usually procras- 
 tinated until about the seventh day. The manifestations 
 of this condition of the brain, embrace every possible con- 
 ception of which the mind is capable. They constitute a 
 field of much study and interest to the phrenological physi- 
 cian. The peculiarities of the delirium are always in har- 
 mony with the prevailing endowments of the brain. The 
 strongest feelings or most governing trains of thought are 
 pretty certain to be exhibited. When the vital and lower 
 animal faculties are strong, the delirium may be furious ; if 
 caution be strong and hope small, it will be of a despond- 
 ing character; if the social sentiments be well endowed, 
 the patient will betray great pleasure in his vivid concep- 
 tions of the beautiful and the agreeable ; and if he has 
 
648 FEBRILE FORMS OF DISEASE. 
 
 much language in connection therewith, he will probably 
 write poetry on the wall, or recite it to his attendants. We 
 once attended an unlettered but a very philosophical man — 
 who was organically a philosopher. During his fever, he 
 appeared to find exceeding pleasure in the solution of phi- 
 losophical questions. 
 
 But this state of mental exuberance is not of long con- 
 tinuance — it passes very frequently into a muttering of 
 broken sentences, and thence into stupor, and finally coma. 
 It is proper to add furthermore, that there are two varieties 
 of delirium in this fever — one results from an active cere- 
 bral circulation in fibrous constitutions, and the other from 
 cerebral irritation, resulting from an insuflScient circula- 
 tion — debility. It may be further remarked, that, with the 
 remissions and exacerbations, these two forms of delirium 
 may alternate each other. 
 
 Sloughing of the skin. — The physician should be con- 
 stantly on the watch to prevent this liability from running 
 into serious mischief. Vesicated portions of the skin and 
 those upon which the patient constantly reposes his weight, 
 are very apt to slough. The knowledge of this tendency 
 should greatly direct our indications of treatment — dimin- 
 ished vitality, and consequently a feeble capillary circula- 
 tion. 
 
 Retention of urine. — The accumulation of urine in the 
 bladder sometimes becomes very considerable — the disten- 
 tion occasioned in this way has sometimes been enormous. 
 The possibility of this occurrence should keep the physician 
 admonished of his duty in this respect. " M. Marten 
 Solon," says Dr. Wood, '^ has paid special attention to the 
 state of the urine in this disease. He has found it to be 
 more scanty, higher colored, and denser than in health, 
 equally acid, if not more so, much more abundant in urea, 
 and occasionally alluminous, especially in severe cases, in 
 which this character of secretion must be considered as an 
 xmfavorable sign." 
 
 We have now passed over those symptoms which more 
 or less frequently obtrude themselves upon this form of 
 
FEBRILE FORMS OF DISEASE. 649 
 
 disease, if not absolutely essential to it. As they are well 
 calculated to keep up the vigilance of the physiciau, we 
 could not consent to omit them. 
 
 Causes. — Upon this subject there prevails much more 
 speculation than knowledge. It is known that cities, pri- 
 sons, hospitals, camps, and ships are, perhaps, more fre- 
 quently visited by it than other situations ; but it is by no 
 means peculiar to them, for it has fatally prevailed, as an 
 epidemic, in the healthiest regions of our country. It is 
 known, furthermore, that those who are under the meridian 
 of life are much more liable to it than those who are above 
 it. Dr. "Wood says, that " of 255 cases observed by Louis 
 and by Chomel, 78 were from fifteen to twenty ; 95, from 
 twenty to twenty -five ; 54, from twenty-five to thirty ; 22, 
 from thirty to forty ; 5, from forty to fifty, and only one 
 above fifty." 
 
 These statistics have induced the general opinion that 
 the aged are less liable to it than the youthful ; but as to 
 the reason why this is the fact, no one seems ever to have 
 ventured an opinion. Having pretty fully explained such 
 facts in the second book, we will just remark here, for the 
 purpose of calling attention to it, that the least viable are 
 the most liable to be cut down first. !N"o one ever died at 
 twenty-five, who had the vitality of those who are now liv- 
 ing at the age of eighty-five years. We are willing to ad- 
 mit, however, that the two extremes of life are less liable 
 to it, than that period which is the most distinguished for 
 animal sensibility and vascular action. 
 
 It has been thought to be contagious, but the weight of 
 professional opinion is now opposed to such a conclusion. 
 Dr. Wood has advanced an opinion which gives direct sup- 
 port to those expressed by us, in defining the constitutional 
 difierence between this and other forms of continued fever ; 
 but the reader would scarcely notice the correspondence, 
 without a special call of his attention to it, because there is 
 eo similitude in the modes, respectively, of reaching the 
 eame fact. He says : 
 
 *'0n the whole, the most rational view of the etiology of 
 
650 FEBRILE FORMS OF DISEASE. 
 
 enteric fever, in the present state of our knowledge, seems 
 to be, that an inherent predisposition to this disease exists 
 in many persons, analogous, in some measure, to the tuber- 
 culous, the gouty, and the rheumatic predisposition, which 
 is liable to be called into action by various exciting causes, 
 perhaps by almost any cause capable of considerably dis- 
 turbing the vital functions, but that all persons do not have 
 the predisposition, and that it is generally exhausted by one 
 attack of the disease." 
 
 If, now, the word predisposition, in the preceding quota- 
 tion, be replaced by the word Uahility^ then the agree- 
 ment between us becomes obvious ; with this difference : 
 we have exposed the organic conditions upon which the 
 liability depends, while he has not and can not show upon 
 what a predisposition depends. We have shown that a 
 predisposition is, absolutely, disease — a conclusion which 
 he would not grant, and yet it is one which he can not 
 avoid. 
 
 Natuee. — Authors have given us nothing on this subject 
 which we are willing to honor with the epithet of res^pecta- 
 tie nonsense. Many have labored to find some sort of in- 
 flammation in some sort of a place in which to found it ; 
 but, as yet, they have so utterly failed, as to cause Dr. 
 Wood to conclude : "As to the real nature of the fever, we 
 are in the dark, as we are, in fact, in relation to all the 
 essential fevers." 
 
 We are of opinion that fever is as easily understood as 
 inflammation, and that it is as comprehensible as any 
 other vital action ; and as to the ultimate nature of any 
 one, we neither know nor can know anything. Fever, in 
 every instance, must hold a precise relation to the char- 
 acter of the disturbing obstruction and the organization it 
 acts upon, and the mode of its action. 
 
 Diagnosis. — It should always be remembered by the at- 
 tending physician, that all febrile forms have, in the begin- 
 ning, so strong a family likeness that it is exceedingly diffi- 
 cult, if not impossible, to distinguish one from another ; 
 consequently, no attempt should be made at diagnosis- for 
 
FEBRILE FORMS OF DISEASE. 651 
 
 the first three or four days. If an epidemic prevail, he will 
 be justified, in the beginning, in treating it as one of the 
 same form. After the lapse of three or four days, the soft, 
 or even the semi-fluid character of the faeces, the insidious 
 character of the attack, the gloomy expression of the coun- 
 tenance, the cough, the rose-colored eruption, the tympani- 
 tic abdomen, the sudomina, the retention of urine, and the 
 pulse will distinguish it from other forms of continued 
 fever. From remittent fever, it may be distinguished by 
 the less marked character of its remissions. When remit- 
 tent fever assumes the typhoid character, the diagnosis will 
 become obscure, and of but little importance if made. The 
 diagnosis between it and typhous will be presented when we 
 treat of the latter. 
 
 Peognosis. — When this form of fever is allowed to run 
 its course, without becoming complicated with local inflam- 
 mation, it should never be accounted dangerous, but as one, 
 particularly under a proper treatment, disposed to termin- 
 ate favorably by diaphoresis at some time within the period 
 of two weeks. But sometimes the constitutional infirmities 
 do not permit of such a result, and then we find the pulse 
 weak, small, and frequent, the muscular system greatly 
 prostrated, and a constant disposition in the patient to lie 
 upon his back, all of which denote a collapse, from which 
 recovery is scarcely ever to be expected, and more particu- 
 larly if complicated with inflammation, which is most 
 generally the case. Under such circumstances, the prog- 
 nosis is always unfavorable. 
 
 Indications. — In this form of fever, nothing more ap- 
 pears to be required than to remove the constriction, to 
 equalize the circulation, and to sustain these achievements 
 when gained by a proper alterative course. 
 
 Treatment. — At the commencement of this disease, we 
 prefer the use of anti-periodics, anodyne, and diaphoretics, 
 for the purpose of allaying nervous irritability, equalizing 
 the circulation, and thereby removing constriction. If, 
 however, diarrhea should be present, or an extreme suscep- 
 tibility to such condition, it will be proper to commence 
 
652 FEBRILE FORMS OF DISEASE 
 
 the treatment with mild evacuants, such as the Compound 
 Powder of Ehubarb and Potassa, or the syrup of the same, 
 in doses of five or ten grains of the powder, or a fluid 
 drachm of the syrup, to be repeated every two hours, and 
 continued until the bowels are thoroughly evacuated, and 
 the diarrheal disposition removed or lessened. Occasion- 
 ally, when hepatic fever is present to a considerable extent, 
 we prefer the following preparation : 
 R. Podophyllin, grs. ij, 
 
 Caulophyllin, 
 
 Leptandrin, da grs. vi, 
 
 Comp. Powder of Ipecac, and Opium, grs. xvi. Mix, 
 Divide into four powders, and administer one every four 
 hours, until catharsis of a bilious character is produced. 
 This compound may likewise be used in cases where the 
 diarrhea is accompanied with watery evacuations and much 
 pain. 
 
 After having accomplished the results to be desired from 
 the above agents, it becomes necessary to administer the 
 anti -periodic and diaphoretic agents at first referred to ; 
 the most efficacious combination we have found to be as 
 follows ; 
 
 R. Sulphate of Quinine, grs. xx, 
 
 Ferro-Cyanuret of Iron, grs. xv, 
 Cornin, grs. xviii, 
 Hydrastin, grs. xx. Mix, 
 Divide into ten powders, and give one every four hours, 
 in any convenient vehicle, and it may be continued 
 throughout the disease, if not subsequently contra-indi- 
 cated, even during the stage of convalescence. 
 
 In connection with this powder, and for the purpose of 
 promoting diaphoresis, the Compound Powder of Ipecac, 
 and Opium must be given in doses of from three to five 
 grains, three or four times a day ; this, however, must be 
 omitted should there be pain in the head or a determination 
 thereto. 
 
 In every case of this fever, throughout its whole course, 
 especial attention must be bestowed upon the surface. It 
 
FEBRILE FORMS OF DISEASE. 653 
 
 should be bathed as often as two or three times a day with 
 a cold alkaline wash, and even more frequently, should the 
 beat obstinately continue. The patient may drink freely 
 of cold water throughout the whole course of the disease, 
 and if he desires it, a piece of ice may be given him. By 
 a perseverance in this treatment, the disease will generally 
 yield in from three to eight days. 
 
 In the progress of this fever, many symptoms of a local 
 character may present themselves, demanding the prompt 
 interference of the practitioner. The diarrhea may not 
 give way to the above treatment, but may continue with 
 much severity, rapidly debilitating the patient; in this 
 case, astringents must be given, and we prefer the addition 
 of from five to eight grains of Geraniin to each dose of the 
 above Rhubarb and Potassa preparations to any other agent 
 with which we are acquainted. 
 
 Tympanites is a common occurrence and must always 
 be treated with warm fomentations, emollient cataplasms, 
 and counter-irritants, together with the means heretofore 
 named for this local difiiculty. If it should obstinately 
 continue, with constipation, the injections referred to in an- 
 other part of this work, must be often repeated with laxa- 
 tive doses of Seidlitz Powders. 
 
 Cough is sometimes present, and may be relieved by 
 the use of equal parts of the Syrup of Squills, Syrup of 
 Senega, and Camphorated Tincture of Opium, and of which 
 one or two fluid drachms may be administered every three 
 or four hours. If it proves severe and unyielding, Mustard 
 Poultices must be applied over the chest. 
 
 Hemorrhage frequently occurs in this disease ; w^hen 
 moderate it is not alarming, but becomes so when exces- 
 sive. It must be met by the continued use of tonics and 
 astringents ; and if it be excessive epistaxis, it may become 
 necessary to plug the nostrils with sponge, moistened and 
 dipped in pow^dered Tannin. 
 
 Under the old depletive system of medicine, the condi- 
 tion of the blood and of the nervous power becomes so 
 changed by the treatment, that this symptom is not an 
 
654: FEBRILE FORMS OF DISEASE. 
 
 unfrequent attendant; while, under Eclectic practice, in 
 which the integrity of the system is maintained throughout 
 the whole course of the disease, the corpuscles of the blood 
 being increased, and the nervous system invigorated, it is 
 seldom met with. 
 
 Should there be excessive determination to the head, as 
 manifested by pain, or delirium, or both, cold applications 
 must be applied to the head, with counter-irritation to the 
 back of the neck, as the application of Mustard Poultices ; 
 and the inferior extremities must be kept very warm by 
 bathing in hot water, application of bottles of hot water, 
 or other similar means. 
 
 When retention of urine occurs, warm fomentations of 
 bitter herbs applied over the pubes, with diuretics intern- 
 ally, will generally prove sufficient. The diuretic prepara- 
 tion which we most commonly employ is Spirits of Mtre, 
 given in half-drachm doses, every hour or two, in Spear- 
 mint tea, or decoctions of Marsh Mallows, or Uva Ursi. 
 This treatment is recommended where sensibility exists, as 
 evinced by pain ; but as this symptom frequently occurs 
 without pain, the practitioner must be watchful of it, and 
 in such instances introduce the catheter. 
 
 In the advanced stages of the disease, when there is de- 
 bility, with stupor and delirium, stimulants must be given, 
 and continued, until the solution of the disease, and until 
 convalescence has ensued; wine whey, Longworth's Cataw- 
 ba wine, porter, and even brandy may be administered at 
 intervals with excellent effect. Sulphuric Ether is often 
 efficacious in cases of sudden and great prostration. The 
 temperature of the system must also be regulated as much 
 as possible, by the application of sinapisms, hot bricks, or 
 bottles of hot water, etc., kept constantly to the feet and 
 legs, and cold or cooling washes applied to the head. Ex- 
 cessive stimulation to the lower extremities must be avoided, 
 lest sloughing should take place. If the coma or delirium 
 be obstinate, the hair may be cut or shaved off, and the 
 cooling washes continued. 
 
 The diet. of the patient, in the early part of the disease, 
 
FEBRILE FORMS OF DISEASE. 655 
 
 should be very light and usually of a liquid character, as 
 toast-water, solution of Gum Arabic, rice-water, weak 
 Indian-meal gruel, together with the juice of sweet grapes 
 and oranges. 
 
 As drinks, cold water, cold lemonade, or infusions of 
 bitter herbs may be allowed. In the stage of prostration, 
 animal broths, beef or mutton tea, milk punch, and other 
 stimulating nutriment must be given to sustain the patient's 
 strength. 
 
 The room should be frequently ventilated, and the cloth- 
 ing changed at least as often as every other day. 
 
 During convalescence, the diet should be mild, nutritious, 
 and easy of digestion — care being taken that the patient 
 does not indulge too freely, or use indigestible food, lest 
 sudden dissolution should happen. 
 
 Species III. — Typhous Fever — Typhus Gravior — Spotted 
 Fever — Petecchial Fever — Putrid Fever — Camp Fe- 
 ver — Ship Fever — Jail Fever — Hospital Fever. 
 In our treatment of febrile forms of disease, we shall ob- 
 serve the distinctions which have been made by Dr. Wood. 
 The words typhous and typhoid will be used as adjectives 
 to express that resemblance of typhous fever, which other 
 forms of fever sometimes assume ; while typhus will be 
 used as a substantive or as a name to designate a special 
 form of fever — that which has been denominated typhus 
 gravior, spotted fever, ship fever, etc. 
 
 When treating of synochus or typhoid fever, we gave it 
 as our opinion that synocha, synochus, and typhus were 
 but three varieties, but the differences between them are 
 such as to have caused them to be, by almost all writers, 
 treated of as three pretty distinctly-marked forms of febrile 
 disease. We have, therefore, arranged them as species, 
 more especially as there exists many intermediate shades of 
 difference between the three, which constitute varieties. 
 This arrangement, as we have before remarked, has its par- 
 allel in the three grades of vital strength that distinguishes 
 society. To the word predisposition^ we can attach no 
 
656 FEBRILE FORMS OF DISEASE. 
 
 idea independently of an obvious organic condition — as an 
 abstraction, it conveys no idea, except that of the fact — the 
 patient has a fever or is liable to it ; and of this liability it 
 conveys no instruction. But the liability of one to a par- 
 ticular form of disease is indicated by an observable pecu- 
 liarity of organization, and thus our idea is rendered intel- 
 ligible and instructive. 
 
 Dr. Wood says : " There are undoubtedly strong resem- 
 blances between certain cases of the enteritic (synochus) 
 and typhous fevers ; and though in most cases easily distin- 
 guished by the obvious symptoms, they were often con- 
 founded, until the work of Louis placed us in possession of 
 the means of a more accurate diagnosis." He continues : 
 " But it is highly probable that the two diseases are some- 
 times combined, in consequence of the simultaneous char- 
 acter of their causes." 
 
 This conclusion we very seriously doubt. It is very pro- 
 bable that the two causes could make two equally strong 
 impressions upon the same system at the same time; and it 
 is equally improbable that two forms of disease could pos- 
 sess the system at the same time ; but we can readily admit 
 that two causes capable of producing, by their joint action, 
 a modification of obstruction, might produce a modified 
 form of fever. 
 
 But, whatever may be the cause or causes of typhous 
 fever, we exceedingly doubt their capacity to produce it in 
 one of a vigorous vital force — a strongly-reactive force, 
 unless it has the power to strike with death, as it were, the 
 irritabitity of the nervous system. The history of the dis- 
 ease shows that persons in comparatively good health have 
 been suddenly stricken with the disease ; but of the condi- 
 tion of their vital force, normally, we have had no informa- 
 tion. 
 
 If, however, the cause has this power, then this form of 
 fever is distinct, and also independent, in a great measure, 
 of all vital conditions. It is probably well known that 
 when a typhous epidemic prevails, all other forms of dis- 
 ease betray a tendency to fall into the same type, just as 
 
FEBRILE FORMS OF DISEASE. 657 
 
 we have recently known, under an Asiatic cholera atmo- 
 sphere, all other forms of disease assumed more or less that 
 of cholera. With these speculations, which are always justi- 
 fiable in the absence of knowledge, we proceed to the symp- 
 toms of typhous fever. 
 
 Symptoms. — An intense, pungent, and remitting heat of 
 the surface ; a tense, low, quick, and unequal pulse ; ex- 
 treme weakness ; vast anxiety and dejection of mind, pre- 
 saging everything that is bad ; nausea, and, in malignant 
 cases, a vomiting of black bile ; pain in the temples and 
 over the brows, a deep-seated pain in the eyes, and a great 
 injection of them ; a sort of smoke-dried complexion ; ring- 
 ing in the ears ; a laborious respiration, interrupted with 
 sighs ; pain in the stomach, limbs, and back ; a difficulty 
 in lying down ; tremors ; delirium ; the tongue at first 
 white, afterward black and dry; the lips and teeth are lined 
 with a viscid sordes ; an unquenchable thirst ; a bitter taste 
 in the mouth ; the urine, at first, pale, but, as the disease 
 increases, extremely high-colored, and in some very putrid 
 cases, it assumes a blackish color and deposits a stool-like 
 sediment ; fetid sweats, which are sometimes tinged with 
 blood ; stools, highly offensive, livid, black, or bloody ; 
 small, livid spots on the skin, like flea-bites, called petec- 
 chise, or, if more extended, vibices, hemorrhages, aphthae, 
 ulceration of the fauces, and hiccoughs. 
 
 We have presented a dense group of fearful symptoms, 
 and for the purpose of their elucidation a few words of com- 
 ment and explanation will not be out of place. 
 
 The initial stage greatly varies in both degree and dura- 
 tion ; it is in some instances so slight as scarcely to be ob- 
 served, but in others it is severe and protracted ; the skin 
 is pale, cold, and shrunken ; the expression is peculiarly 
 anxious ; the pulse is very feeble ; and so great is the pros- 
 tration, that reaction does not become established; but this 
 extreme prostration is by no means a general feature of the 
 disease. The hot stage, in the beginning, manifests no 
 considerable departure from what is common to other forms 
 of fever. 
 
658 FEBRILE FORMS OF DISEASE. 
 
 We have named nausea and vomiting among the symp- 
 toms, nevertheless they are not common — frequently en- 
 tirely absent, and the bowels are generally costive. This 
 marks a diagnostic difference between this and the syno- 
 chus fever, and we regard it as a more favorable symptom. 
 The temperature of the skin ranges from 100° to 109°, and 
 the pulse from 100 to 160 beats in a minute ; the respira- 
 tion is also very hurried, and an exacerbation usually 
 becomes manifest toward night, with a remission in the 
 morning. 
 
 The disease having now been at its zenith for several 
 days, its characteristic eruption then appears — that which 
 originally gave to the disease the name of petecchial fever. 
 This eruption is confined to no particular portion of the 
 body — it may be quite local, and it may be so general as to 
 impart to the surface a measled appearance. It may or 
 may not be slightly elevated, and in color it may vary from 
 red to black, as the disease progresses toward a malignant 
 condition. The eruption appears usually from the fifth to 
 the eighth day, but it may anticipate two or three days, or 
 procrastinate four or five. Occasionally they disappear, and 
 then reappear, and sometimes they are complicated with 
 sudamina. 
 
 The tongue takes on a brownish color, is more or less 
 dry, particularly in the middle; in many cases a dark 
 sordes collects on the teeth, gums, and lips. It happens 
 sometimes, as in the typhous stage of other fevers, that the 
 tongue is clean and glossy, and finally comes to resemble 
 raw beef. The appetite, in many cases, is totally lost, but 
 the loathing of food is less than it usually is in more active 
 fevers. The color of the face becomes of a dark-red or of 
 a livid hue ; the eyes become turbid ; some hemorrhage is 
 apt to take place from the nose, and a peculiar odor exhales 
 from the skin. 
 
 As the disease advances its characteristic stupor increases, 
 so that the patient ceases to notice anything that is going 
 on about him, and not unfrequently delirium is compli- 
 cated with the stupor. So powerless is the circulatory sys- 
 
FEBRILE FORMS OF DISEASE. 659 
 
 tern, that the slightest exertion is attended with syncope ; 
 great thoracic oppression not unfrequently attends this ex- 
 cessive debility. The malady has now obtained that stage 
 in which a change must take place, and if it be toward 
 recovery, the frequency of the pulse becomes diminished ; 
 the skin becomes relaxed ; the tongue moist and cleaning ; 
 the eruption fades; stupor subsides, and consciousness 
 returns. This change toward convalescence is sometimes 
 distinguished, like synochus, by a copious perspiration or 
 urination, and the patient falls asleep, to awake, compara- 
 tively, a new or different being. 
 
 But should the change be for the worse, then the patient 
 lies upon his back, eyes half closed, mouth open, delirium 
 with subsultus tendinum, hiccough, picking at the bed- 
 clothes, difficult deglutition, involuntary discharge of urine, 
 extremities cold, features collapsed, pulse, perhaps, absent 
 at the wrist. The physician should not abandon the case 
 yet ; if he does, he may possibly learn on the next day, to his 
 shame, that the system of the patient rallied through the 
 night, and he is convalescent. When there is no necessa- 
 rily fatal lesion of some very important part, it may be said, 
 " where there is life, there is hope." 
 
 Convalescence from this form of disease, as might be ex- 
 pected, is slow, but it generally advances to good health 
 with very little liability to relapses. The time occupied by 
 this disease is very variable or very fatal ; it may, in mild 
 cases, conclude in recovery in a week, and in other forms 
 of violent cases it may consume four weeks ; but, gene- 
 rally, one week is consumed in its advancement, one to its 
 completed stage, and one to its decline. We should add, 
 that in those cases in which reaction can not be established, 
 death may supervene in twenty-four hours. 
 
 Causes. — About these we have some facts, but no philo- 
 sophy. The most common resort of this form of disease is 
 in camps, prisons, ships, hospitals, and, in private life, the 
 filthy abodes of the destitute and miserable. It is inferred, 
 therefore, that a poisonous effluvia is generated from the 
 bodies and excrements of those who are thus confined 
 42 
 
660 FEBRILE FORMS OF DISEASE. 
 
 together. Yery many facts have been collected to render 
 it very probable that the poison thus generated, may, 
 through the medium ol the atmosphere, visit the disease 
 upon those who have not had any part in the generation of 
 the poison. It is, furthermore, pretty generally believed 
 that the poison can be confined in clothing, etc., and thus 
 transported beyond the region of its generation, and re-pro- 
 duce the disease. 
 
 It is also believed to originate in epidemic influences. 
 This, to us, is a puzzle, that the human body, under certain 
 circumstances, and the atmosphere shall produce a cause, 
 which, in its results, shall be the same. Dr. Wood states, 
 that he has no doubt that the fatal epidemics that prevailed 
 in our country between 1807 and 1820 were of typhous 
 fever. Both sexes and all ages seem to be liable to it, and 
 the winter season, rather than any other, the time for its 
 most frequent appearance and greatest prevalence. 
 
 Diagnosis. — This form of fever can, in a great measure, 
 be distinguished from all others, by the sordes upon the 
 teeth, gums, lips, and tongue ; by the habitual stupor that 
 attends it ; the suffusion or injection of the eyes ; the dusky 
 or dark-red hue of the countenance, and great prostration 
 of strength. 
 
 The typhoid fever is most frequently confounded with it, 
 but from it, it may generally be distinguished by the diffe- 
 rence in the condition of the bowels, respectively. In 
 typhoid, they are very rarely habitually aperient ; while, 
 in typhous, they are habitually constipated. Again, alvine 
 hemorrhage is common to the former, but very rare in the 
 latter. The typhoid eruption differs from the typhous ; 
 tympanites is common to the former, but exceedingly rare 
 in the latter, and the same is true of the bronchial rales, 
 which generally attend the former. (See the article on 
 Typhoid and Typhous Fever, by Dr. W. Jenner, at the 
 end of this " Order.") 
 
 Prognosis. — This should be always regarded as uncer- 
 tain ; but the appearance of diarrhea or fetid perspiration, 
 in the declension of the disease, and a change of the petec- 
 
FEBRILE FORMS OF DISEASE. 661 
 
 cliise from a blackish aspect to a brighter color, may be 
 regarded as favorable. 
 
 Dr. Eberle says, that spontaneous vomiting during the 
 iirst and second day of the disease, more especially when 
 the unpleasant cephalic sensations are thereby abated ; 
 slight hemorrhage from the nose, about the sixth or seventh 
 day of the stage of excitement, is a good indication, and 
 so is a moderate diarrhea at an early period of the dis- 
 ease. 
 
 The unfavorable signs are, a vast number of livid spots, 
 a sudden disappearance of them, black aphthae, no thirst, 
 inflamed fauces, laborious respiration alter the eruption of 
 the petecchise, a swelling of the abdomen, with a concomi- 
 tant diarrhea, highly fetid and ichorous stools, coldness of 
 the extremities, and convulsions. To these Dr. Eberle has 
 added a still ^more certainly fatal class : as blindness, in- 
 voluntary flow of tears, difficult deglutition, paralysis of 
 the tongue, insensibility to active vesicatories, and involun- 
 tary colliquative stools and hemorrhages. After all, he 
 adds, patients do sometimes recover from this disease 
 after many of the most alarming of these symptoms have 
 made their appearance. 
 
 Indications. — The symptoms of this form of fever show 
 that that chemico- vital action upon which the calorific func- 
 tion depends, is greatly arrested and deranged ; that the 
 vital laws show a constant tendency to yield to the chemi- 
 cal ; that there exists a morbid tonicity of the nervous and 
 vascular systems; consequently the whob system should 
 be relaxed, heat should be applied, depuration should be 
 promoted, and the putrescent tendency of the system should 
 be counteracted. 
 
 Treatment. — In this form of fever, we pursue a similar 
 course of treatment to that recommended in typhoid fever, 
 with the exception that counter-irritants must be more ener- 
 getically applied to the extremities and the spinal column, 
 together with the use of antiseptics, when putrid symp- 
 toms are present, as Vinegar, diluted rjioligneous Acid, 
 Elixir Vitriol, etc. 
 
662 FEBRILE FORMS OF DISEASE. 
 
 Treatment of Simple Inflammatory Feyee. — We will 
 now proceed to lay down our treatment for this form of 
 fever (see page 635), which, we would here remark, is fre- 
 quently followed by typhoid symptoms, may occur inde- 
 pendently of any other abnormal condition, and often at- 
 tends as the early stage to several other forms of fever. 
 
 The treatment of this form of disease is very simple, as 
 a general rule, if there be no complication, as we before 
 remarked ; but it is not always possible for the practitioner 
 to determine immediately the existence of a complication, 
 hence the safer course will always be to adopt an early 
 treatment. 
 
 The first indication is to remove morbid accumulations 
 in the stomach and equalize the circulation and nervous 
 action. 
 
 To fulfill this, an emetic must be administered as early 
 as possible, to be followed by a cathartic ; after which, in- 
 stead of the futile attempts frequently made to produce 
 diaphoresis by vapor baths and internal sudorifics, refrige- 
 rant diuretics, as Spirits of Mtre with infusion of Marsh- 
 Mallow, must be given internally, and the surface bathed 
 frequently with cold or tepid water. The wet- sheet may 
 here be used with advantage. 
 
 As soon as the more active inflammatory symptoms have 
 become subdued, tonic febrifuges must be given ; and here, 
 we prefer our usual preparation of Sulphate of Quinine, 
 and Prussiate of Iron, which will generally overcome this 
 form of disease, except it be complicated, when a course 
 of treatment must be pursued which is adapted to the com- 
 plication. 
 
 It will occasionally occur, however, that the inflamma- 
 tory condition of the system wiU continue very severe and 
 obstinate, not readily yielding to the above treatment; in 
 such cases, the Tincture of Gelseminum must be employed 
 in doses of ten or twenty drops every hour, to be given 
 until the eyelids begin to feel heavy, with scarcely an abil- 
 ity on the part of the patient to control them, when its ad- 
 ministration must be omitted, and no more should be given 
 
FEBRILE FORMS OF DISEASE. 663 
 
 until the effect has entirely subsided. It should always be 
 used with care and caution, for the root possesses a resinous 
 principle, which is extracted by pure alcohol, that is very 
 poisonous, and doubtless would produce death, even if given 
 in small doses — hence the alcoholic extract or tincture 
 should never be used. The common tincture of the Eclec- 
 tic Dispensatory will not produce any injurious effect. 
 There is danger of producing too great a suspension of in- 
 voluntary muscular action ; this must, in all cases, be par- 
 ticularly guarded against, to prevent a degree of relaxation 
 which may not be overcome. If this should be produced, 
 however, active diffusible stimulus, such as Ammonia, 
 Spirits of Camphor, or good brandy, should at once be 
 made use of. 
 
 The symptoms will now be found completely removed, at 
 least such has been the case in our practice, and Quinine 
 may then be administered, as before, either with or without 
 the Prussiate of Iron. 
 
 The diet in this form of disease must be light, nutritious, 
 and of easy digestion. 
 
 During the fever, cold water or cold acidulated drinks 
 may be freely used by the patient. 
 
 It will be seen that we do not pursue nor recommend an 
 active depletive treatment in fever, and especially in this 
 form. Herein consists a great difference between Aila. 
 pathic and Eclectic practice ; the former, considering fever 
 to be an inflammatory disease, combat it with active deple- 
 tion, which we conceive to be a principal cause of the sub- 
 sequent typhoid symptoms or typhoid fever, and which, in 
 their hands, is such a common result — for it is an admitted 
 fact that all inflammatory fevers may be converted into 
 typhoid, by too active and debilitating modes of treatment; 
 while, on the other hand, the Eclectics, viewing fever as 
 an effort of the system to remove morbid action ani accu- 
 mulations, adopt a course which assists nature in her 
 efforts, invigorates the system, and prevents, as a general 
 thing, any of the subsequent typhoid conditions. 
 
QQ4: FEBRILE FORMS OF DISEASE. 
 
 Genus IL — Periodic Fever. 
 Introduction. — This genus embraces those febrile forms 
 which are usually attributed to miasmata; and though 
 some of them are not strictly periodical, yet their remis- 
 sions are more marked than those we have treated of as 
 being continued. The opinion is pretty generally enter- 
 tained that those of this genus are but varieties — essentially 
 the same — modified by the intensity of the cause and the 
 constitutional peculiarities of the assailed; nevertheless, as 
 it is common to treat of them separately, and as they admit 
 of well-defined diflferences, we shall treat of them as so 
 many species, and then ample room will be left for any 
 number of varieties. 
 
 Species I. — Intermittent Fever — Fever and Ague. 
 
 The symptoms which we detailed under the general name 
 of fever, as applicable to the forming stage of fever, ap- 
 plies very accurately to the same stage in this. We will 
 add one symptom, and so far as the writer has observed the 
 phenomena of this stage in himself, it precedes all others, 
 and frequently by a week or ten days ; it consists of a sort 
 of pungent or drawing pain, as though the epigastrium was 
 being drawn to the spine, and for the purpose of relief he 
 frequently took full inspirations. After he came to observe 
 this symptom, in connection with this form of fever, he 
 never failed to prevent its occurrence by the use of prophy- 
 lactic measures. The pain is located immediately at the 
 inferior extremity of the sternum. The writer has not found 
 this symptom recorded by any one else, nor does he know 
 whether it obtains generally or not ; but if it does, its ap- 
 pearance will give ample time for prophylactic measures. 
 
 We have before remarked, that a paroxysm consists of 
 three distinct periods in this form of fever : the cold, the 
 hot, and the sweating. 
 
 Cold period. — This begins with yawning, listlessness, 
 and a peculiar sensation in the back, or in the ends of the 
 fingers, which are not easily described. The patient is 
 
FEBRILE FORMS OF DISEASE. 665 
 
 then visited by a sense of horror ; a tremor of the muscles, 
 with a chattering of the teeth ; a sensation of extreme cold, 
 which commences at the extremities and travels to the 
 trunk ; it appears sometimes to be deeply seated, even to 
 the bones ; a pain in the joints, back and head ; difficulty 
 of breathing ; pellucid urine, and a quick, small, weak, 
 contracted pulse, which can scarcely be numbered on ac- 
 count of the tremor. It lasts from a few minutes to three 
 or four hours, and even longer, when reaction is not effected; 
 death frequently happens in this stage. 
 
 During the action of this period, the patient betrays a 
 constant disposition to yawn ; the skin becomes so power- 
 fully contracted that the finger rings will drop from the 
 hand ; the mind becomes unsteady, irritable, taciturn, and 
 morose ; the muscular tremor is sometimes so violent as to 
 resemble a paroxysm of convulsions ; these rigors, as they 
 are usually called, when long continued, leave the patient 
 greatly exhausted. A dry cough, deep sighing, and a feel- 
 ing of stricture across the chest are usually present. 
 
 Dr. Eberle says, that m debilitated persons a violent fit 
 of rigors often induces a complete state of stupor or coma ; 
 but in the south, w^e have seen these symptoms in the ath- 
 letic. In this period, the thirst is urgent, and although 
 cold water is desired, the patient fears to take a second 
 draught, because he found the first to increase the parox- 
 ysm. The chill is sometimes so slight as to escape the cog- 
 nition of the patient ; the finger nails, more than any other 
 part, exposes the fact. 
 
 As this period becomes merged in the next, a sensible 
 and a very unpleasant mixture of heat and cold travels over 
 the patient. About the time of this change, nausea and 
 vomiting supervene, but sometimes earlier, and continue 
 until the hot stage is formed. 
 
 Hot period — Pyrexia, — As the last stage passes off, an 
 intolerable heat succeeds. The arteries are dilated, and 
 strike forcibly against the finger ; the respiration is strong 
 and free. The head aches, and the patient frequently be- 
 comes delirious, or we should have said, perhaps, that when 
 
66Q FEBRILE FORMS OF DISEASE. 
 
 the patient is of a dense fibrous constitution, he is very apt 
 to become delirious. An intense thirst is complained of, 
 and a frequent demand is made for cold water ; the tongue 
 is white ; the urine is high colored ; much heat is com- 
 plained of about the prsecordia, and sometimes there is a 
 swelling of the epigastrium. The blood, when drawn, is 
 more dense than usual, red on the surface but dark colored 
 within, with only a small portion of serum, and less cohe- 
 sive than in health. 
 
 When this stage is being introduced, a warm and plea- 
 sant glow is felt about the face and temples, and from this 
 the whole surface becomes hot ; nevertheless, at this early 
 stage of the period, if a limb be moved, sudden sensations 
 of cold will be felt running, as it were, in divided rays 
 over the surface. But presently all traces of the former 
 period have passed oflf; the skin becomes distended with 
 blood, the cheeks are flushed, and the eyes become brilliant. 
 Dr. Wood says that Fordyce found the temperature of the 
 system to be 105° by the thermometer, and Mackintosh, he 
 says, has known it to be as high as 110° in Great Britain, 
 and 112° in warm climates. There is no desire for food, 
 and sometimes nausea and vomiting are present. 
 
 As to duration, this stage is as various as the preceding 
 one, but it is generally more lengthened, extending some- 
 times to eighteen hours. The febrile action is frequently 
 greater than in continued or remittent fever. The cerebral 
 suffering in this period differs from that of the cold stage in 
 this, it is more deeply seated and generally more severe. 
 At the commencement of this period in children, convul- 
 sions not unfrequently occur. 
 
 Sweating period. — The patient, at length, feeling as 
 though he was scorched to a crisp, is relieved by a copious 
 sweat all over his body. All the symptoms now remit, and 
 the perspiration, after continuing three or four hours, but 
 sometimes much longer, entirely disappear. The urine 
 deposits a lateritious sediment; the patient falls to sleep, 
 and an intermission succeeds. 
 
 Ajpyrexia. — This period embraces that time which trans- 
 
FEBRILE FORMS OF DISEASE. 667 
 
 pires between the close of the sweating stage and the com- 
 mencement of the forming one of the next paroxysm. 
 Dm-ing this period, the patient, though without fever, is 
 not usually entirely free from some sensations of ill-health. 
 He feels as though he had been sick ; he moves about as 
 though he sufiered from languor, and possibly he has some 
 obtuse pain in the back and loins ; his appetite is fastidi- 
 ous, and his complexion is more or less sallow. But, on 
 the contrary, it frequently happens that he feels entirely 
 clear of disease and has an appetite that is even less fas- 
 tidious than in health. 
 
 We shall now make an extract froni Dr. Wood, for the 
 purpose of showing how little is understood of the nature 
 and modus operandi of fever. We select him, not because 
 he is the most vulnerable, but because he is probably the 
 most esteemed authority in this country. He says: 
 
 " It has frequently been stated by writers that each stage 
 of the paroxysm, subsequent to the chill, is the immediate 
 efiect of the preceding stage ; in other words, that the cold 
 stage produces the hot, and the hot the sweating ; but this 
 is scarcely probable, at least with regard to the first two 
 stages, which bear no proportion to each other — a pro- 
 tracted and severe chill being frequently followed by less 
 fever than a very slight one, and the fever sometimes occur- 
 ring without any preceding chill whatever. The proba- 
 bility is, that while the depression attendant upon the cold 
 stage is naturally followed by some degree of febrile reac- 
 tion, as a necessary consequence, the morbific cause, what- 
 ever it may le^ is capable of producing the hot stage by a 
 direct influence." 
 
 We would like to know what sort of action this "direct 
 influence" is. We are utterly unable to conceive how any 
 one can pursue a sound practice in fever, whose views of 
 its pathology are so beclouded — the fact is, they do not, and 
 can not. 
 
 We do not expect to explain this matter to the satisfac- 
 tion of the lovers of the mysterious, but we are of the opin- 
 ion that it can be done for those who seek only for the truth, 
 
668 FEBRILE FORMS OF DISEASE. 
 
 and love it the more for its simplicity. Then, first, what is 
 fever ? We have answered this question several times, but 
 it will do no harm to do so again. It is vital action accu- 
 mulated for the removal of obstructions from the system. 
 Now, a proper application of the law contained in this an- 
 swer, will enlighten the whole subject. 
 
 When the vital force is great, and the obstruction is com- 
 paratively trifling, is it not obvious that the former may act 
 upon the latter without the patient or his physician having 
 any other cognizance of the fact than is rendered apparent 
 by the sequence, which is fever ?* It is not characteristic 
 of a great man to make much fuss over a little thing, then 
 why should we expect such a vital force to make a great 
 fuss — to shake the patient almost to pieces, to overcome a 
 little obstruction? A little obstruction may occasion a 
 more lasting fever than a great one, because the concentra- 
 tion of vital force will be less — its energies will not be 
 thoroughly aroused. 
 
 When the vital force is compared with the amount of the 
 obstruction, if feeble, the chill will be thorough and pro- 
 tracted, and in the event that it is overcome, it has been 
 effected by a thorough concentration of the force; and 
 whenever successful, there will be no great excess to become 
 manifested in the form of fever. 
 
 In the former case, though the fever may be considerably 
 protracted, the patient will recover without foreign aid ; 
 but, in the latter, two or three paroxysms may so exhaust 
 the vital force that death may result in the next struggle — 
 simply because it is overpowered by the obstruction. In 
 the latter case, furthermore, when successful, almost as soon 
 as the cold stage has passed, the sweating or secreting 
 stage will be introduced, simply because the force did not 
 and could not rise much above the secretory condition of 
 the system. 
 
 Upon this subject, we beg leave to refer Drs. Wood, 
 
 *Such a fever as this is quite common, in some districts, among young 
 people, under puberty, and it is usually called dumb ague to distinguish it 
 from shakivg ague. 
 
FEBRILE FORMS OF DISEASE. 669 
 
 Eberle, Cheyne, "Watson, and the whole Allopathic school, 
 to the '' Thesis," of Freeman Franklin, M. D., of the Ec- 
 lectic Medical Institute, of Cincinnati, which will be found 
 in the April number of the Eclectic Medical Journal of 
 that school for 1853. We say unhesitatingly, and under a 
 full sense of our responsibility, that he has conveyed, in 
 four or five pages, more sound and correct views of the pa- 
 thology of fever, than can now be found in every Old-School 
 book extant. The young gentleman merits this compli- 
 ment, and the Old School the rebuke. 
 
 As a difference of latitude, of topographical condition, 
 of constitution, and of modes of life, produce great depar- 
 tures from the general history we have given of this form 
 of fever, it becomes proper that we should notice a few of 
 them. The principal of these peculiarities Dr. Eberle has 
 reduced to the following: 1, the inflammatory; 2, the 
 congestive; 3, the gastric; 4, the malignant; to which 
 we add : 5, the masked intermittents . 
 
 1. Inflammatory intermittents. — According to the same 
 author, Richter is of the opinion that this form of intermit- 
 tent fever occurs most frequently during the winter and 
 spring, and that it occurs more frequently in quotidians 
 than in tertians, and in the latter more than quartans. 
 Those who constitute our first class are the most frequent 
 subjects of it.* 
 
 It is usually introduced with rigors, and in the hot stage 
 the temperature of the surface rises high and the pulse 
 
 *Why should this form of fever assail the strong rather than the feeble? 
 
 The writer in his winter travels, in the colder regions of this country, ob- 
 served that stout and athletic men suffered more — complained more, than 
 females and feeble men. For this fact, he was unable to assign a reason, 
 until he discovered the origin of animal sensibility. He now knows it to be 
 a fact that with this class the sUin more readily becomes constricted under 
 the influence of cold, and consequently, in such a state, it can not depurate, 
 and thus such obstructions are generated as to cause that stru^igle and re- 
 action which constitute the paroxysm. The writer, having a feeble organ 
 of animal sensibility, has, in very many instances, witnessed his superior 
 power in brooking exposure to cold air and water and the usual trials of a 
 camp life, in comparison with those of a contrary organization; and now, 
 as to the accuracy of his conclusion, he has not a doubt. 
 
670 FEBRILE FORMS OF DISEASE. 
 
 beats with fullness and strength. But the diagnostic symp- 
 tom of this form is the fact, that no matter how thoroughly- 
 marked the sweating stage may have been, a state of py- 
 rexia will still continue to the next paroxysm. Much of the 
 violence of the hot stage, to be sure, has subsided — the 
 pulse has lost its fullness, but much of its quickness and 
 tenseness remains; the thirst, too, is reduced, but still the 
 patient demands drink, and still complains of some pain in 
 the extremities and back. The discontented and fretful 
 condition of the patient indicates the existence of much irri- 
 tability in the system. Richter, says Dr. Eberle, teaches 
 that this variety of intermittents is but seldom attended 
 with gastric disturbances. 
 
 2. Congestive intermittents. — This form of the disease 
 does not occur often in this climate, nor very frequently 
 even in the south. Those who become the subjects of it 
 are of the third class, and who, in the north, would proba- 
 bly die of phthisis pulmonalis. 
 
 For the reason that we have before given, the cold stage 
 is greatly protracted, and all the symptoms indicate a highly 
 congested condition of all the viscera, such as pain in the 
 head, a sense of weight and oppression in the chest, faint- 
 ing, vertigo, a feeble pulse ; beside these symptoms of the 
 cold stage, the hot is never clearly developed — it does not 
 present a single feature of this period as it usually obtains. 
 It develops itself very slowly — the skin scarcely becomes 
 warm, the respiratory function continues oppressed, the 
 countenance continues to appear anxious, and the pulse, 
 though frequent, is small and tense — and probably the only 
 heat complained of appears to be internal, and but seldom 
 demanding drink. 
 
 3. Gastric intermittents. — This variety, as might be in- 
 ferred from its name, is attended by much gastro-enteritic 
 irritation, from the redundancy of bile, a hyper-secretion of 
 which is going on in the liver ; the skin wears a jaundiced 
 complexion ; the urine is charged with bilious matter ; nau- 
 sea and vomiting of bilious matter is common ; the tongue 
 appears to the taste to be bitter ; much pain is complained 
 
FEBRILE FORMS OF DISEASE. 671 
 
 of in the forehead. As the seqnela3 of this form of dis- 
 ease, we may anticipate much visceral derangement, as a 
 cachectic condition of the system, and induration of the 
 liver and spleen. 
 
 This form of the disease usually appears in the fall, and 
 has, in the opinion of the writer, no necessary connection 
 with the, so-called, miasmata. He has witnessed it only 
 in those who had been exposed to the preceding summer's 
 sun, whereby the cutaneous system became, not only de- 
 ranged, but greatly debilitated, and through a failure of its 
 function, the disease resulted. 
 
 4. Malignant intermittent — Congestive cJiill. — Dr. Eb- 
 erle says, that, according to Alibert, this form is of fre- 
 quent occurrence in the south, and is always of a dangerous 
 character. It is characterized, he says, " by a copious and 
 fetid perspiration in the third stage, together with colliqua- 
 tive hemorrhages from various parts of the body, sometimes 
 petecchise and other marks of malignity. They run their 
 course with great rapidity, death usually taking place in 
 the third paroxysm." 
 
 The writer has seen, and has had to contend with, many 
 cases of this form of disease, and he has never known it to 
 occur except in the first class of persons — the strong and 
 more or less athletic. The first and second paroxysms are, 
 so far as he has observed, uniformily mild, and the patient, 
 during the intervals, will employ himself as usual; but the 
 third parox^^sm is characterized by the above-narrated 
 symptoms. Alibert says that death takes place in the third 
 paroxysm; — to this remark we will add, and it always hap- 
 pens in the cold stage. 
 
 It is thought to be, and if neglected or inefiiciently 
 treated it certainly is, a dangerous disease. The writer 
 thinks it hardly probable that one per cent, of unaided pa- 
 tients recover ; nor has he ever known one to recover in the 
 Old School practice — and yet, in the main, its practice was 
 founded upon correct indications, but it wanted energy. 
 He is decidedly of the opinion that there is no form of dis- 
 ease more manageable than this; and this opinion he 
 
672 FEBRILE FORMS OF DISEASE. 
 
 founds upon his own uniform success. And why should it 
 not be ? It never assails the feeble, nor those of a broken- 
 down constitution ; but those who are otherwise sound, and 
 so strong as to require only proper and prompt aid to effect 
 a reaction.* 
 
 *As the writer, from his many years' residence in the south, has seen much 
 more of this form of disease than his co-laborer, the author of the practicej 
 he thinks it proper to add, in this place, his own uniformly successful treat- 
 ment of it. As his first case was the most malignant one he ever saw, he 
 will simply introduce it and his treatment. 
 
 In the valley of the Arkansas river, his person being generally known, 
 he was called from the road to render what assistance he could to save a 
 young man who was, as stated by the messenger, dying. The patient was 
 so far gone that his eyes had the fixed position of death, and the glebes were 
 covered with its gloss; his lips were contracted tightly over his teeth; his 
 body was covered with a cold and clammy sweat; his skin was insensible to 
 almost any violence; his mind was unconscious; his pulse had left his wrist, 
 and a copious but passive cero-sanguineous hemorrhage was going on from 
 his bowels. Such was his condition. 
 
 The only medicine the writer had was Quinine, which he always carried 
 for his own personal use; and the family had none of any kind, except the 
 common red pepper of their gardens. He ordered a strong decoction to be 
 made of it — a good fire to be n^ade and covered with stone, and a large ket- 
 tle of water to be hung over it to heat. All this was accomplished in a 
 short time. A tub was placed by the bedside; a few pieces of brush- wood 
 were placed about the patient to raise the blanket from his body, and the 
 tub and he were covered with the same. A few hot rocks placed in the 
 already boiling water, soon produced a scalding vapor or steam, which was 
 so managed as to envelop the body. He was too unconscious for voluntary- 
 deglutition, but when his mouth was filled with the pepper decoction, and 
 his nose closed, he swallowed. At first, and for some time, he made no com- 
 plaint of the scalding steam; but at length he complaiued — still its continu- 
 ance and the use of the tea were persisted in, until his eyes and lips assumed 
 a normal appearance and the hemorrhage ceased. Injections of the tea would 
 have been administered, but no means of doing so could be had. While the 
 preparations were making, four persons were kept rubbing him with hot 
 cloths. 
 
 Having pretty well equalized the circulation, twenty-grain doses of S. 
 Quina were administered every three hours, until he had taken a drachm, 
 and then smaller portions, until it was deemed unnecessary to give more. 
 This was done with a view of maintaining that equality of the circulation 
 which had been achieved. This was in the afternoon, and by the same time 
 the subsequent day, he was well, but not strong. 
 
 This practice succeeded so well, in so threatening a case, that, in his sub- 
 sequent practice, the writer has resorted to no other. On the day after the 
 
FEBRILE FORMS OF DISEASE. 673 
 
 5. Mas'ked intermittcnts . — Under this head, it is useless 
 for us to do more than to apprise the young physician that 
 amonsr those forms of disease which, in the normal mode 
 of manifesting themselves, are familiar to every practi 
 tioner, do frequently obtrude themselves upon our notice in 
 a masked form ; and v^hat is still more important to be 
 known, is the fact that they will yield to no other means of 
 cure than those which are applicable to the regularly -formed 
 intermittent fever. In other words, it appears that the dis- 
 ease or obstruction which generally results in what is known 
 as intermittent, does, in consequence of local or some gene- 
 ral variety of infirmity, appear in that form of disease in 
 which the said infirmity would most likely manifest itself. 
 As an illustration of our meaning, we remark that a tooth 
 is so decayed as to expose its nerve, which by aching indi- 
 cates the usual morbid actions of the system ; hence the 
 system, laboring under the usual cause of intermittent 
 fever, the reactive power expends itself in the form of odon- 
 talgia. This, we opine, is the true explanation of the fact, 
 just as gastric derangement is manifested in the same man- 
 ner, and for the other reason, that masked intermittcnts can 
 be cured only as pure intermittent is. 
 
 Of the masked forms of intermittent fever, Dr. Brown 
 (En. Prac. Med.) has given a catalogue, from which the fol- 
 lowing are extracted — but without his appended authorities: 
 Pleuritis, carditis, peritonitis, ophthalmia, swelling of the 
 head, urticaria, scarlatina, rheumatism, gout, epistaxis, 
 odontalgia, cephalalgy, encephalitis, meningitis, gastro- 
 enteritis, dysentery, asthma, hysteria, epilepsy, convul- 
 sions, blindness, dumbness, sneezing, eructation, leucor- 
 rhea ; but neuralgia, in some form, is the most frequent 
 that appears in this disguise. 
 
 Prognosis. — Simple or uncomplicated intermittent fever 
 can not, directly, be regarded as a dangerous form of dis- 
 
 paroxysm, his skin had very much the color of a boiled lobster — as red as it 
 could have been made without vesication. Such has been the writer's suc- 
 cess in this practice, that he believes ninety-nine per cent of cases may be 
 saved by it. 
 
674 FEBRILE FORMS OF DISEASE. 
 
 ease, but when long continued it is apt to lay the founda- 
 tion of a premature death. The feet and legs become 
 edematous, the spleen enlarged, the digestive function 
 greatly impaired, and finally dropsy terminates the case. 
 But the practice of irregular habits, and the use of trashy 
 and innutritions food, have as much to do in these results 
 as the disease — indeed, we have seen but few who possessed 
 a good constitution, and lived obediently to the organic 
 laws, who ever had the disease. 
 
 When the disease assails those who possess a highly en- 
 cephalic constitution, passive congestion of the brain, or 
 apoplexy, may be so far anticipated, as to place us on our 
 guard. Prof. Eberle says : "In general much less danger 
 is to be apprehended from this disease in the young and 
 vigorous, than in persons of feeble, nervous, and depraved 
 habits of body." "We should think so, as we have never 
 seen the disease, except in the malignant form, in persons 
 of that character. He further states : " Delirium seldom 
 occurs in intermittents, and when it does happen, it must 
 be viewed as unfavorable ; and even more so than mere 
 coma." We do not believe one word of this. Dense and 
 fibrous constitutions very rarely have febrile action without 
 delirium ; and yet they have the least danger from this dis- 
 ease. The writer, during five years, had more than twenty 
 paroxysms, and delirium attended them all ; and yet he 
 never had a threatening one. We have seen much of the 
 disease, and would greatly prefer to see delirium than 
 coma. 
 
 Before closing, it is proper to remark, that tertians are 
 more manageable than quotidians, and they again much 
 more so than quartans. It is our opinion that simple in- 
 termittent fever is always founded on debility — and hence 
 remittents are converted into intermittents by bleeding and 
 purging. 
 
 Causes. — In treating of the causes of fever in general, 
 that which pertained to this particular form was so far dis- 
 cussed, as to leave us but little to say at present. Our 
 readers have, no doubt, learned by this time, that we have 
 
FEBRILE FORMS OF DISEASE. 675 
 
 no more faith in the doctrine of Jcaino -miasmata or mala- 
 ria, than a man of common sense might be siipposed to 
 have in the so-called " spirit rappings." It is, we believe, 
 a settled principle in philosophy, that like causes will pro- 
 duce like results — hence like results should be referred to 
 like causes. Bear this in mind, while we attend to Prof. 
 Eberle. He says : " I have seen one instance, in a deli- 
 cate child, where a distinctly-formed ague was manifestly 
 produced by intestinal irritation, from too free an indul- 
 gence in irritating articles of food. An interesting case is 
 related by Mr. Earle, in which a regular intermittent was 
 produced by the irritation of a small piece of dead bone in 
 an old wound, and which was at once arrested on removing 
 the irritating substance." He further states, ''Richter ob- 
 serves, that worms and other causes of intestinal irritation 
 have been known to produce intermitting fever." 
 
 What a wonderful similitude there must be between irri- 
 tating articles of food, worms, and a small piece of dead 
 bone, and hamo-miasmata J 
 
 Let us notice him a little further. " Intermittents are 
 never more prevalent than when the days are very warm, 
 and the evenings and mornings are cool and damp." 
 
 "We are disposed to think that such mornings and even- 
 ings, acting upon a skin that had become exhausted from 
 previous long exposure to a hot sun, would be sufficient to 
 produce an adequate obstruction to call forth an action of 
 the system. 
 
 Proximate Cause. — Upon this subject, we have had 
 nothing but speculation, and hence a little more can do no 
 great mischief— therefore, we claim a brief indulgence. 
 
 Periodicity is a law of the animal economy, and there- 
 fore we shall attempt no explanation of it, but we may elu- 
 cidate it. A man sleeps to-day at a given hour, and there- 
 fore, on the morrow he will desire to sleep again, unless 
 his mind shall have been pre-excited. This is our experi- 
 ence. Application : A man has a febrile paroxysm to-day, 
 why, therefore, should not his system require one at the 
 same hour on the following day ? 
 43 
 
676 FEBRILE FORMS OF DISEASE. 
 
 But there is another view that may be taken of this sub- 
 ject. Obstruction to the performance of some essential 
 function has been produced ; vital force accumulates and 
 acts for its removal ; but the force accumulated in the vis- 
 cera and large vessels was at the expense of the surface and 
 extremities, and consequently, in them, the calorific func- 
 tion is greatly weakened for a time, or suspended, and a 
 chill is the result. Next, the force acts, and the action is 
 called fever, and in this action it is expended, and depura- 
 tion is the result ; but the obstruction is not all removed, 
 and therefore, as soon as preparation can be efiected for an- 
 other paroxysm, it returns; and thus a habit is finally 
 established which, sooner or later, under favorable circum- 
 stances, will spontaneously leave the system. Connected 
 with the subject there are many minor phenomena, for 
 which we have no explanation. 
 
 Indications. — As intermittent fever results from obstruc- 
 tions in debilitated constitutions, the indications must be to 
 assist the vital force to remove the former and to strengthen 
 the latter. 
 
 Treatment. — At the commencement of this disease, an 
 emetic must be administered, if possible, just previous to 
 the return of the cold stage, which may be followed by a 
 purgative, if the patient's strength will admit ; and in very 
 severe attacks, this course must be continued daily for seve- 
 ral days in succession. After the action of the first emetic, 
 anti-periodics must be given, and continued through the 
 whole course of the disease, without regard to any of its 
 particular stages. The anti-periodics which have proved 
 most efficacious in our hands, are Quinia, Prussiate of Iron, 
 Hydrastin, and Cornin, in the following combination: 
 K. Sulphate of Quinia, 
 
 Fero-cyanuret of Iron, 
 Hydrastin, 
 
 Cornin, da xv grs. Mix. 
 Divide this into ten powders, of which one may be given 
 every hour, until the disease is arrested. If much influ- 
 ence upon the head should ensue, the dose of Quinine may 
 
FEBRILE FORMS OF DISEASE. 677 
 
 be lessened or altogether omitted. If catharsis is required 
 during the treatment, a combination of Podophyllin and 
 Leptandrin, or the Compound Pill of Podophyllin, will be 
 preferable to all other cathartics, as they act both by freeing 
 the bowels and unloading the congested liver. 
 
 In cases where there is much gastric irritability, accom- 
 panied with nausea and vomiting, and an inability to retain 
 anything upon the stomach, sinapisms applied to the epi- 
 gastric region, hot applications to the feet, with Lupulin or 
 small portions of Opium carefully administered, will, if 
 persevered in, overcome the difficulty; when the curative 
 treatment may be pursued. 
 
 The Extract of Leptandrin Yirginica and Salicacese have 
 been employed by one of th'^. authors with much success in 
 this disease (Eclec. Med. Jour., 1852, vol. iv, p. 295). We 
 extract his remarks upon the use of the latter : 
 
 '"''Of the Salicacem. — We make no pretensions to botany, 
 and therefore, we can not designate the two varieties of the 
 tree of which we shall treat. They are, beyond doubt, in- 
 digenous. Our acquaintance with them was contracted in 
 Arkansas : one is common to the Arkansas and Mississippi 
 rivers, and probably to many other streams ; it grows into 
 a very tall tree, and, in some instances, obtains a diameter 
 of two feet. Its twigs or small branches are very brittle at 
 their junction with the stalk, of a darkish yellow, not 
 bright, like a foreign variety, which is common about Cin- 
 cinnati. The tree is straight, and grows near the edge of 
 the river, and frequently forms dense groves of small 
 growth on the sand beaches. 
 
 "The other variety , in Arkansas, grows scrubby, about the 
 size of a peach tree, on stony branches, where, in the sum- 
 mer season, there is scarcely any moisture. 
 
 "Knowing that some varieties of the willow had been used 
 as an anti-periodic, we were, during our first season in the 
 State, forced, for the want of a better, to use the extract of 
 the bark of the tall willow first above described. The 
 result was so satisfactory that we sought no other agent 
 while in the vicinage of the river. 
 
678 FEBRILE FORMS OF DISEASE. 
 
 "During our third summer in the State, we attended a 
 very large political gathering of the people of the valley o^ 
 the Arkansas river, upon which occasion we were called 
 upon for a political speech ; but as the opportunity did not 
 suit our politics, we gave them one upon the cure of inter- 
 mittent fever, which prevailed very extensively among 
 them. 
 
 "We instructed them to fill a ten-gallon kettle with the 
 twigs and bark of the Arkansas willow, and boil them 
 about thirty minutes, then re-fill the kettle with fresh mate- 
 rial, and thus proceed until they shall have a kettle full of 
 a strong decoction ; then strain it and boil it down to a 
 syrup ; and then, to avoid burning it, evaporate in the sun 
 to a proper consistence to make into from four to eight- 
 grain pills. 
 
 "In the use of these pills, we instructed them to resort to 
 no variety of preparatory medication, but to commence 
 six or seven hours before an expected paroxysm, and give 
 two of these pills every hour, until the chill came, or its 
 time for appearing should have passed. 
 
 "In the following winter, we again visited that portion of 
 the State, when a Mr. Barnets informed us that the pills he 
 made cured seventy -four or five cases ; that another gentle- 
 man, a few miles from him, had cured more than fifty; and 
 that, in all, he supposed one hundred and sixty cases, in his 
 acquaintance, had been cured by our address. 
 
 "In our practice, we never knew the chill to follow these 
 instructions, when thoroughly carried out. 
 
 "It is not our opinion that this willow has much, if any, 
 of the astringent principle ; these pills had, more frequently 
 than otherwise, an aperient efiect. 
 
 ^'Being, upon another occasion, in the southern and 
 mountainous portion of the State, we were called to an ob- 
 stinate case of intermittent fever, and had no medicine to 
 combat it with. The Leptandrin was not known to exist 
 about there, nor did the tall willow, but the scrubby willow 
 abounded. Supposing, as others have stated, that all the 
 willows possessed similar qualities, we had an extract made 
 
FEBRILE FORMS OF DISEASE. 679 
 
 of it, and administered it as above taught. It produced 
 no observable tonic or anti-periodic virtue, but so obsti- 
 nately locked up the bowels as to do more mischief than 
 could have been compensated by a destruction of the chill. 
 It is a powerful astringent, and appears to be as destitute 
 of tonic power as the other is of astringent. 
 
 "There is, in this vicinity (Cincinnati), a willow pre- 
 cisely resembling the Arkansas, except in size ; that their 
 virtues are the same, we can not answer. Among the forest 
 timber, there is another similitude equally striking: the 
 buckeye of this country is a tree, in that, it is a shrub ; in 
 all other respects the resemblance is perfect, even to the 
 effects upon the cattle which eat it." 
 
 The Tincture of Gelseminum is extensively used in this 
 disease by many of our physicians, and, as far as we can 
 learn, with much success ; our use of it, however, has been 
 limited, yet, as far as tested, we are much pleased with its 
 effect. 
 
 Although we have stated that an emetic will be advisa- 
 ble at the commencement of an attack of intermittent fever, 
 yet it will rarely be required after the first week of its ex- 
 istence. 
 
 ISTotwithstanding the immense amount of matter from 
 time to time presented to the profession for the treatment 
 of this disease, we have found the above simple plan fully 
 sufficient to meet the most obstinate and severe cases gene- 
 rally met with. 
 
 Species II. — Remittent Fever — Bilious Fever — Bilious 
 Remittent Fever. 
 In order that the reader may not be misled by names 
 when reading other works on fever, we deem it proper to 
 state, that this form has received many, in consideration of 
 the locations in which it has fatally prevailed, or from the 
 local circumstances which are supposed to give origin to 
 it, viz : miasmatic fever ; marsh fever ; country fever ; river 
 fever ; lake fever ; Bengal fever ; African fever ; Walche- 
 ren fever ; Mediterranean fever ; but it is, by the American 
 
680 FEBRILE FORMS OF DISEASE. 
 
 readers, most generally nnderstood by the names of bilious 
 fever, bilious remittent fever, and remittent fever; yet, 
 even these names are objectioDable, because all of them are 
 sometimes just as applicable to other varieties of febrile 
 action. Nevertheless, the term remittent conveys more 
 nearly the idea we wish to convey than any other by which 
 it has been designated, inasmuch as it really holds some- 
 what of an intermediate position between the continued 
 and intermittent forms of the disease ; and it may be taken 
 to represent, in respect to violence or grade, a mean degree 
 between intermittent and yellow fever. 
 
 Prof. Caldwell used to maintain that the principal diffe- 
 rence between these three forms of disease consisted, mainly 
 or altogether, in the violence or concentration of the cause; 
 and this opinion, we believe, is considerably prevalent in 
 the profession. To those who have not studied closely the 
 differences in human constitutions, this doctrine may ap- 
 pear almost or quite unexceptionable ; but our long ac- 
 quaintance with the latter subject causes us to entertain 
 some doubt, more especially as it affects the intermittent 
 and remittent forms. We are much disposed to regard 
 these forms as such varieties only as may result from diffe- 
 rences of constitution. 
 
 Under the head of remittent fever, writers embrace two 
 widely-differing varieties : the sthenic and the asthenio. In 
 the former, all the vital functions are vigorously performed; 
 while, in the latter, the vital system was either organically 
 feeble or had become so by previous disease or debilitating 
 habits. When treating of intermittent fever, we found that 
 the malignant variety never obtained with those of a feeble 
 constitution. In this form, then, the sthenic and asthenic 
 can only be reconciled as members of the same form, upon 
 the principle that intermittent and remittent forms of fever 
 are one and the same, modified by telluric, atmospheric, 
 and constitutional differences. 
 
 So far as our observation has extended, and it has not 
 been very limited, intermittent fever is produced by the ac- 
 tion of a humid atmosphere upon feeble constitutions — the 
 
FEBRILE FORMS OF DISEASE. 681 
 
 humidity preventing a proper cutaneous action ; and remit- 
 tent fever results from a less humid and a highly-heated 
 state of the atmosphere acting upon highly-vital constitu- 
 tions ; hence, in new countries, as we have seen, remittent 
 fever may prevail in the towns, and intermittent in the 
 country where forest and marsh abound. This explains 
 also, why it is that intermittent fever prevails in the south 
 at the river's edge, and remittent on the top of the bluff, 
 where ponds and marshes do not exist. 
 
 In the preceding book, we taught that narrow and damp 
 streets were fatal to children, and broad and hot ones to 
 men. From such facts as we have here introduced, it 
 would seem that strong vital force is best adapted to an un- 
 exciting atmosphere, and that a feeble one does best in an 
 exciting or electric one. We may further add, that we 
 have always found malignant intermittent to obtain under 
 remittent influences.* 
 
 Dr. Joseph Brown (Cy. Prac. Med.), treating of tlis 
 subject, says: ^'Remittent is the endemial of w^arm cli- 
 mates, especially of those of which the soil is marshy ; but 
 it is to be met with in the more temperate regions of the 
 earth, and is not unfrec^uently observed in our own country, 
 especially in seasons of universal heat^ and in those parts 
 of it where under ordinary temperatures agues are preva- 
 lent." This observation, as far as it goes, supports directly 
 the opinions we have advanced. 
 
 Dr. Wood says: " Remittent fever has the same types as 
 the intermittent. The most frequent is the quotidian, with 
 
 * The writer was early induced to observe closely the relations of au- 
 tumnal forms of disease to their causes, because he rejected the doctrine of 
 malarious poison when a student of medicine, and under the voice, too, of 
 its champion advocates, Professors Caldwell, Chapman, and Hossack. He 
 will not assert that the doctriae of malaria is false^ but that he believes it to 
 be, and expresses this conviction for the purpose of inducing his readers to 
 observe and investigate the matter for themselves. He would have them, as 
 Sie has endeavored to do, to take nothing for granted that has not been de- 
 monstrated, unless it be self-evident. This course is indispensable, if we 
 would escape imposition, for the most flagrant errors have received the 
 sanction of truth, by the universal consent of mankind. Ill.uslratiou ; 
 Mineral coal is of vegetable origin! 
 
682 FEBRILE FORMS OF DISEASE. 
 
 a paroxysm occurring at about the same time every day. 
 The tertian, with its every-other-day paroxysm, is not un- 
 common. The quartan is very rare. Next, perhaps, to 
 the quotidian, is the double tertian, having a daily parox- 
 ysm, but that of one day difiering from the next, and the 
 alternate paroxysms resembling each other both in charac- 
 ter and in time of occurrence." 
 
 The phenomena of the forming stage in this form of 
 fever are, in general, such as we have before detailed under 
 the head of "Order I;" but sometimes this period is re- 
 markably brief, for the second or cold stage, as indicated 
 by slight chills, is frequently the first manifestation of the 
 disease. For a time more or less definite, these chills 
 alternate with flashes of heat, until finally the latter acquires 
 an entire ascendency — the febrile action is fully established, 
 and with a highly-increased condition of many of the usual 
 prodromal symptoms ; such as, pain in the back, head, and 
 extremities. The pain of acute rheumatism is not more 
 severe than that of the extremities frequently is. The 
 tongue is covered with far ; a jaundiced complexion spreads 
 over the eyes ; nausea, which is sometimes attended with a 
 vomiting of bilious matter ; the right hypochondriac and 
 epigastric regions labor under a sensation of weight or ten» 
 sion ; the urine is scanty and charged with bile ; the skin 
 is generally dry and hot ; the respiration is oppressed \ the 
 pulse is but seldom hard or tense, but generally full and 
 frequent, although not to such an extent as to exceed 116 
 or 120 beats per minute ; the appetite is not gone, but 
 there is usually a loathing of food ; thirst is not a constant 
 though a frequent symptom. It is common for the eyes ta 
 be sufiused and the face flushed. 
 
 These symptoms, from having continued from six to eight 
 or ten hours, relax, and the stage of remission commences » 
 About the neck and face some moisture appears, which may 
 or may not extend itself over the whole surface — giving sa 
 much relief that the patient soon becomes lost in a quiet 
 and refreshing sleep. All of the febrile symptoms have 
 abated^ but a state of apyrexia does not supervene. The 
 
FEBRILE FORMS OF DISEASE. 683 
 
 duration of the abatement or remission is very indefinite — 
 extending from two to twenty hours, depending upon the 
 existing quotidian or tertian type, as the case may be, when 
 another febrile paroxysm supervenes, commencing in many 
 instances as the previous one did, with chilly sensations, 
 and subsiding in perspiration. This alternation of exacer- 
 bation and remission continues, with a gradual increase of 
 the former and diminution of the latter, until the zenith of 
 the disease is attained. But it is proper to remark, that 
 the remission, instead of being attended with perspiration, 
 will frequently give no other evidence of its existence than 
 some abatement of the symptoms. 
 
 In mild cases, the tongue is disposed to be moist through- 
 out the disease ; but, with the usual violence of the disease, 
 it becomes dry and frequently brown, or even blackish, par- 
 ticularly about the surface. In most cases, the epigas- 
 trium becomes particularly tender to pressure ; in some in- 
 stances, gastric oppression is complained of, and in others, 
 a sensation of burning pain which is very distressing. 
 During these symptoms there is apt to be much gastric irri- 
 tability. 
 
 One of the distinguishing symptoms of this form of dis- 
 ease is yellowishness of the skin and of the white of the 
 eyes, and though not always present in the beginning of 
 the malady, it rarely refuses to make its appearance by the 
 fifth day ; its tint of color sometimes becomes very intense, 
 even simulating that of yellow fever, and not unfrequently 
 quite uniform over the system; — it has even been known, 
 in some instances, to be so secreted upon the surface as to 
 stain white articles coming in contact with it. If bilious 
 diarrhea supervenes, this peculiar secretion of the skin will 
 not be produced. 
 
 At the beginning of the disease, nausea and possibly 
 vomiting may be among the symptoms ; they are rarely ab- 
 sent, however, when at its height. The ejections are, gene- 
 rally, in the latter case of a yellowish, greenish, grass-green, 
 bluish, or brownish color, and of a bitter taste. The force 
 of the symptoms are not unfrequently reduced by nausea. 
 
684 FEBRILE FORMS OF DISEASE 
 
 The bowels are not always constipated, but that they are, 
 may be assumed as a general fact ; and the fecal excretions 
 though sometimes anti-bilious, are generally the contrary 
 and probably mixed with some shade of green or black. 
 In the advanced stage, a bilious diarrhea sometimes super- 
 venes, and occasionally it is present at the beginning, and 
 when nausea happens to be present, also, the introduction 
 of the disease has somewhat the appearance of a cholera 
 morbus. As most generally obtains in fever, the urine is 
 small in quantity, high colored and turbid, and in an ad- 
 vanced condition of the disease, it is usually of a brownish 
 color. As might be expected, there is some increase of it 
 during the remissions. 
 
 There is, perhaps, no symptom that is more uniformly 
 present than headache, and along with it there is generally 
 one or more of the following symptoms : vertigo, intoler- 
 ance of light or sound, roaring or singing in the ears, red- 
 ness of the conjunctiva, flushing of the face, delirium, 
 drowsiness, tetanic spasms, paralytic symptoms, wakeful- 
 ness, hiccough, etc. 
 
 Finally, the reader is not expected to meet, in observa- 
 tions upon this form of disease, with all the symptoms we 
 have enumerated in any case; and he should remember, 
 furthermore, that there is perhaps no other form of fever 
 that presents so many modifications of type, grade, and 
 variety. We have therefore, only attempted to represent 
 that character which may be drawn by generalizing a ma- 
 jority of its visitations. 
 
 Dr. Joseph Brown says : '' Recovery may be expected if 
 the pulse becomes more full and expansive, the heat more 
 equalized over the surface, the pain of the head and epi- 
 gastrium less distressing, and if the countenance, though 
 still flushed, loses the purple hue which it previously pos- 
 sessed. A favorable inference may be drawn, too, from 
 the remissions becoming more distinct, the conjunctivas 
 being less vascular, the bowels more obedient to the action 
 of purgatives, the restoration of a more abundant urinary 
 secretion, and the appearance of bile in the matters vom- 
 
FEBRILE FORMS OF DISEASE. 685 
 
 ited. The mean duration of the disease, in cases of recov- 
 ery, is about fourteen days." 
 
 Dr. Wood makes the average duration to be about the 
 same period, but very properly adds, that it sometimes ter- 
 minates as early as \h^ fifth or seventh^ and often about the 
 ninth or eleventh ; but sometimes it is protracted to twenty- 
 eight days. 
 
 The writer never had a case to extend beyond nine days, 
 and frequently they terminated on the seventh ; yet, in the 
 practice of his neighbors, he has known cases to continue 
 twenty-seven days and never less than twenty. He alludes 
 to those cases only to which he was called in consultation 
 that had passed into the typhoid character — • which never 
 happened in his practice. He does not believe that the 
 disease has a prescribed course to run. An energetic and 
 proper practice will never suffer a case to run fourteen days. 
 
 Eemittent fever is considerably modified by the season 
 of the year in which it may appear. When it apyjears in 
 the spring, it is apt to produce thoracic symptoms of a dan- 
 gerous character; when in the summer, the brain and 
 the nervous system become the most vulnerable, and in the 
 autumn, the abdominal viscera will suffer the most. 
 
 Dr. J. Brown treats of one symptom which, it seems, 
 has been noticed only by Dr. R. Jackson and himself; it is 
 what we would denominate a suicidal monomania, instead 
 of general delirium. It seems to have puzzled him very 
 much, more particularly as ^ost-mortem examinations re- 
 vealed nothing ! If, in such cases, he had examined the 
 parietal ridge, immediately behind the coronal suture, he 
 would have found that part largely developed. Monoma- 
 nia of any kind, in all febrile cases, depends upon special 
 mental powers in a high state of endowment or excitement. 
 He speaks also of some who, while in the fever, predicted 
 that they would die — and die they always did, but the 
 secret cause and fulfillment of the prediction he could not 
 divine. If he had phrenologically examined them, he 
 would have found a large endowment of caution, and a 
 small one of hope. Even in cases of general delirium, it 
 
686 FEBRILE FORMS OF DISEASE. 
 
 is not uncommen for some particular idea to predominate. 
 As to the circumstance of their dying, there is nothing 
 strange — but it would be strange for men to recover from 
 under a constantly-abiding impression of fear, so common 
 and natural to such an organization, more especially when 
 submitted to, as an inevitable doom. 
 
 In the course of this fever, those of its subjects who pos- 
 sess a part so feeble that it can not resist invasion, inflam- 
 mation is apt to be induced, and upon this circumstance, 
 rather than upon the inherent character of the fever, does 
 its fatality depend. The most vulnerable parts are usually 
 the stomach, the spleen, the lungs, and the brain. When 
 inflammation thus supervenes, the treatment will be found 
 under the head of inflammation of these organs, respect- 
 ively. 
 
 It sometimes happens that this fever presents only a 
 typhous character from the beginning. This may depend 
 upon an inherently-feeble constitution, but we are of the 
 opinion that it originates more frequently in those who 
 have become enfeebled by previous disease or vicious hab- 
 its. Bilious fever of the ordinary character frequently de- 
 generates into the typhous through neglect, but more fre- 
 quently through mal-practice — the very common anti- 
 phlogistic. When the disease is of this character, the 
 treatment will be found under the head of typhous fever. 
 
 It frequently happens that individual parts share a greater 
 portion of the diseased action than others, and that, too, 
 without the existence of inflammation ; but it is proper to 
 add, that such local manifestations of disease should render 
 us vigilant lest inflammation should supervene. Upon 
 these local determinations, varieties of this fever have been 
 established ; hence we have gastric-bilious fever, hepatic- 
 bilious fever, and upon the same principle we have as many 
 as there are important parts in the system — nevertheless, 
 these local modifications should always command our ear- 
 liest attention. 
 
 Convalescence. — We have but rarely witnessed a case 
 of convalescence which was not more retarded by the mal- 
 
FEBRILE FORMS OF DISEASE. 687 
 
 practice that had been instituted, than by any pre-existing 
 peculiarity of the fever or of the constitution, and the prin- 
 cipal difficulty we always found to be referable to mercury 
 or the lancet. "We have known the latter to be used to 
 reduce the fever to an intermitting form — one that essen- 
 tially depends upon debility. Such practitioners must act 
 upon the principle that it is more easy to remove the sys- 
 tem from the disease, than it is to remove the disease from 
 it. In consequence of the use of the lancet and of mer- 
 cury, the convalescence is not only greatly protracted, but 
 attended with much suffering. 
 
 When the case is of a mild grade, the convalescence is 
 rapid and altogether favorable, and such is the case in 
 almost all of its modifications when the treatment has been 
 judicious. The troubles that are usually classed under this 
 head consist frequently of the manifestations of that dis- 
 ease which was instituted to remove the pre-existing one. 
 In originally frail constitutions, this stage may be attended 
 more or less with copious night-sweats, imperfect diges- 
 tion, constipation, enlarged spleen, and perverted action of 
 the liver. 
 
 Causes. — Upon this subject, we have perhaps said 
 enough, unless we had something more certainly true than 
 has yet been divulged. The profession generally attribute 
 it to miasma, but many think it may be produced by heat 
 and moisture. In answer to this hypothesis. Dr. Wood in- 
 quires why it does not occur among sailors at sea, and in 
 our cities. We answer: At sea, the temperature is never 
 so afflicting, and in our cities, in consequence of its hard, 
 paved, and shaded condition, there is comparatively but 
 little moisture. But, in this matter, all have overlooked an 
 important feature — the electricity evolved by evaporation. 
 One square foot of black, moist, and heated soil will throw 
 off more vapor and evolve more electricity than a square 
 rod at sea or in the city. Here, we are satisfied, lies con- 
 cealed the secret. Under the head of intermittent fever, 
 we delivered our opinion as to the cause of that and also 
 of this form of fever. 
 
688 FEBRILE FORMS OF DISEASE. 
 
 Diagnosis. — When we shall have treated of the two fol- 
 lowing species, the reader will have but little use for a spe- 
 cial treatise on the distinguishing differences between this 
 and other forms ; and yet, there is, perhaps, no single 
 symptom, taken separately, that may not occur in other 
 forms of fever. To judge of it at all, we must view it as a 
 whole. The most marked symptoms of this form are : 1st, 
 its paroxysmal character — but this is even more perfectly 
 possessed by the intermittent ; 2d, gastric irritability — this 
 symptom attends this form more habitually than it usually 
 does others, but others sometimes equally manifest it ; 3d, 
 constant pain in the head — this is like the preceding ; 4th, 
 bilious phenomena — although these are more generally pre- 
 sent, yet the same is true occasionally in other forms; 
 hence all effort to divide febrile forms of disease into well- 
 defined species, must fail. ¥ever, therefore, is essentially 
 the same in all of its modifications. 
 
 Prognosis. — Under this head, we have the same diffi- 
 culties to contend with. In taking a general view of bil- 
 ious fever, we are prepared to declare it to be favorable. 
 Under a prompt and judicious treatment, we consider it 
 (all circumstances considered) a less fatal and a more man- 
 ageable form than the intermittent, simply for the reason, 
 that, in it, there is more vital force, generally, to contend 
 with the disease. It should never be considered as dan- 
 gerous, except when it invades a diseased or broken-down 
 constitution. 
 
 Indications. — In this form of fever, these are very sim- 
 ple, but require an energy which shall be in harmony with 
 the vital force ; they consist iu equalizing the circulation 
 and the nervous irritability of the system, to remove ob- 
 structions and all sources of irritation, and to promote 
 depuration. 
 
 Treatment. — At the commencement of the febrile stage 
 of this form of fever, or during the first day or two of its 
 attack, one of the best agents that can be given is an 
 emetic, which not only removes the morbid matters accu- 
 mulated in the stomach, but, by giving a shock to the 
 
FEBRILE FORMS OF DISASE. 689 
 
 nervous system generally, causes more or less profuse dia- 
 phoresis, mitigating the subsequent severity of the disease, 
 and not unfrequently breaking it up at once. 
 
 The emetic operation should be followed by a cathartic, 
 for the purpose of removing congestion of the portal circle, 
 augmenting the secretory action of the liver, and unload- 
 in o- the bowels of fecal and bilious accumulations. To 
 efiect this, we know of no better agent than the Compound 
 Powder of Jalap of the U. S. Eclectic Dispensatory, which 
 in ordinary cases may be repeated every other day. In 
 cases where this agent can not be given, as w^ell as in in- 
 stances where there is excessive congestion of the portal cir- 
 cle, combinatioDS of Podophyllin and Leptandrin, may be 
 given in doses and at intervals suited to the urgency of the 
 case. 
 
 After the action of the cathartic has ceased, should there 
 still remain pain in various parts of the system, nausea, 
 or vomiting, or rapid pulse and high fever, active diapho- 
 resis must be produced and maintained for a few^ hours. 
 To effect this, the spirit vapor-bath is the best method; and 
 may be given while the patient is in bed ; or the Com- 
 pound Tincture of Yirginia Snakeroot may be administered 
 in suitable doses, and repeated at short intervals until the 
 patient perspires freely. 
 
 If these symptoms, however, should not be present, or 
 only slightly exist, the practitioner may commence at once 
 with anti-periodics, and continue them through the whole 
 course of the disease. The agents of this class and com- 
 binations which we prefer, have already been given under 
 the treatment of the preceding forms of fever. 
 
 For the determination to the head, which is almost 
 always present in this disease, the same course must be 
 pursued as already named in the treatment of continued 
 fever. 
 
 Hiccough may be relieved by Aqua Ammonia, Com- 
 pound Spirits of Lavender, Musk, or other anti-spasmodics. 
 Restlessness, wakefulness, and similar symptoms may be 
 relieved by Compound Powder of Ipecac, and Opium, Sul- 
 
690 FEBRILE FORMS OF DISEASE. 
 
 phuric Ether, or infusions of Valerian, Skullcap, or Black 
 Cohosh. 
 
 Convulsions, which usually take place with children, may- 
 be treated by the warm bath, sinapisms to the extremities, 
 and the internal exhibition of a dose or two of the Tinc- 
 ture of Lobelia and Capsicum. 
 
 The patient may drink freely of cold water, and the diet 
 should be light and fluid, with proper ventilation of the 
 room and changing of linen. If acidulous draughts are 
 craved, such as lemonade, tamarind water, or currant jelly, 
 apple-sauce, and similar digestible preparations of acid 
 fruits, they should be permitted. During convalescence, 
 the diet must be more nourishing, but strictly of a digesti- 
 ble character. 
 
 Species III. — Congestive Fever — Pernicious Fever — Per- 
 nicious Remittent — Pernicious Intermittent. 
 
 Dr. Wood thinks the name " pernicious fever " to be less 
 exceptionable than any other that has been selected to rep- 
 resent this form of fever. This, in the abstract, may be true, 
 but the one we have adopted has become so familiar from 
 long use, particularly to our western and south-western peo- 
 ple, to whom this work will be measurably confined, that 
 we prefer it. 
 
 If congestive fever was not so signally distinguished in 
 the popular mind from all others, we should have treated 
 of it as a mere variety of the preceding, which, in truth, is 
 the fact. Indeed, we may say that all the forms comprised 
 in this genus are but varieties — modifications, and they 
 should be so considered. 
 
 Dr. Wood says, that he does not apply the epithet per- 
 nicious to all fatal or dangerous cases of either intermittent 
 or remittent fever, but to those " in which there is great 
 and sudden prostration or depravation of the nervous 
 power, or to use a customary phrase, in which the innerva- 
 tion is extremely and most dangerously defective or de- 
 ranged." 
 
 This manner of defining his meaning amounts to about 
 
FEBRILE FORMS OF DISEASE. 691 
 
 nothing, because it applies with as much justice to those 
 forms of fever which are malignant or pernicious in conse- 
 quence of a depraved constitution. In such cases, there is 
 prostration — a want of innervation. Our idea of what he 
 intended to define is about this: A pernicious fever is one 
 in which the obstruction exceeds the resisting power of the 
 vital force — one which will readily recover when the force 
 is so aided as to overcome or remove the obstructions. By 
 this state of the system is commonly understood a conges- 
 tion from the magnitude of the invasion, and not from any 
 previous depravity of the constitution ; and one that is en- 
 tirely independent of any local inflammation. 
 
 The importance of this distinction is very considerable, 
 because, in the first, though the present congestion may be 
 relieved, the patient will probably die by reason of consti- 
 tutional depravity; but, in the second, if it be overcome — 
 if reaction be established, the patient is saved — dissolution 
 and recovery depend, respectively, upon the turning of a 
 single point and this point, to a malignant extent, rarely 
 recurs. 
 
 Between this form and the one of malignant fever, there 
 is one striking similitude, it never occurs in a depraved or 
 feeble constitution — but in the strong ; and there is also an 
 equally striking difference : the congestive chill is confined 
 to the usually miasmatic season of the year; but this has 
 been known to commence in the spring and to prevail 
 through the winter, though it generally obtains in the same 
 season with the preceding. 
 
 It is found to be difiicult to state what the type of this 
 fever will be, until after two or three days • — the period of 
 doubt and uncertainty to both the patient and physician — 
 that of congestion, or struggle or effort to overcome the 
 obstruction. If this period be survived the type may be 
 intermittent, remittent, or continued. But if the conges- 
 tive period be procrastinated for two or three days, it may 
 for this time appear as an intermittent or a remittent ; and 
 subsequently, instead of either of these types, it may ap- 
 pear, as before stated, in the continued form. 
 U 
 
692 FEBRILE FORMS OF DISEASE. 
 
 Observations from various parts of the country seem to 
 have determined, beyond doubt, that there are two leading 
 modifications or varieties of this malady : in one the cere- 
 bro-spinal or animal system seems to be almost exclusively 
 invaded ; and in the other, the ganglionic. Whatever may 
 be the character of the disease as subsequently developed, 
 it usually begins, as do the miasmatic fevers in general, and 
 betrays no pernicious phenomena until the arrival of the 
 second or third paroxysm ; or, as before intimated, at the 
 close of the prodromal stage a highly-congested condition 
 of the system may become manifest. 
 
 If the fever is to be of that modification which more 
 especially invades the cerebro-spinal system, the first indi- 
 cation will probably be drowsiness, which will be followed 
 by more or less of stupor. The patient's attention becomes 
 greatly impaired and his memory unfaithful. When asked 
 a question, he may be so far aroused by it as to attempt an 
 answer, but will probably stop before he has concluded, and 
 possibly in the middle of a word. 
 
 This cerebral condition may, and not unfrequently does, 
 pass into a complete coma, and from an impossibility to 
 arouse him, he will die in it. The circulation appears 
 labored, and though the pulse indicates fullness, the rapidity 
 is frequently even less than the normal standard; the respi- 
 ration is stertorous. It is said that epileptic convulsions 
 do sometimes attend this fever, and also tetanic spasms and 
 difficult deglutition. 
 
 These symptoms sometimes occur in the first paroxysm, 
 but more frequently they are procrastinated to the second, 
 or even the third. This form is consistent from the start, 
 for though the first paroxysm may be light, yet comatose 
 symptoms wdll prevail more or less. If the patient shall 
 rally from the first severe paroxysm, which is generally the 
 second, the following intermission will be attended by its 
 usual symptoms; indeed, he maybe exempt from all symp- 
 toms of disease, and thus go on to recovery ; but it is un- 
 safe to indulge, without the greatest precautionary means, 
 such a hope, for most frequently he will continue drowsy 
 
FEBRILE FORMS OF DISEASE. 693 
 
 and stupid until the next paroxysm, which usually proves 
 fatal. 
 
 The Medical and Surgical Journal of New Orleans, vol. 
 iii, p. 733, contains an article from Dr. Bowling, of Mont- 
 gomery, Ala., upon the subject of this fever, as he observed 
 it. He states, that the approach of the paroxysm, after a 
 few febrile exacerbations, was attended by spasms which 
 closely resembled an attack of tetanus, that, with exacerba- 
 tions and remissions of fever, continned with a correspond- 
 ing degree of violence. He further states, that after the 
 occurrence of the spasm, the patient in no instance lived 
 longer than five days, and most frequently, if not arrested, 
 death supervened at an earlier period. But the disease, as 
 he saw it, differed from its usual character in this : it was 
 attended with some intellectual capacity. 
 
 When it invades the ganglionic system, the sight of one 
 patient, in the forming stage, will so impress his general 
 pathognomy upon the memory of the physician that he will 
 never forget it. Language can convey no adequate idea of 
 it. His expression is one of alarm, of horror, and impend- 
 ing dissolution ; his features are shrunk, shriveled, and ap- 
 parently reduced within two-thirds of their former compass; 
 his eyes are sunken in their sockets, and the skin is of a 
 bloodless paleness. The extremities and the whole surface 
 are cold, but the patient does not appear to be conscious of 
 it, and a clammy perspiration covers the surface. Some- 
 times, as an exception to this general coldness, the chest 
 and abdomen are much heated. The tongue is occasionally 
 pale and cold, and the stomach greatly oppressed; and yet, 
 with these symptoms, the patient complains of an intense 
 internal heat, and of unquenchable thirst. 
 
 In many instances, the stomach is particularly irritable, 
 and all ingesta are rejected, and with it sometimes a little 
 bile or muco-serous fluid, and possibly a little blood ; and, 
 as in the case of congestive chill, the bowels may labor 
 under a sero-sanguineous hemorrhage, the discharges being 
 frequent and greatly prostrating. The respiration is diffi- 
 cult or labored, being quick and panting ; the pulse is fee- 
 
694 FEBRILE FORMS OF DISEASE. 
 
 ble, or it may be corded, and so frequent as to number 160 
 beats per minute. Those who have practiced in the chole- 
 ra, but have not seen this form of fever, would, upon see- 
 ing it, suppose it to be the former — it resembles it in very 
 many particulars. The preceding symptoms, with modifi- 
 cations, may continue two or three days, and unless relieved 
 will terminate in death ; or, if not too oppressive, they may 
 be followed by a remission, or even an intermission, when 
 the same symptoms will be repeated with increased and 
 fatal violence when the proper hour is brought about by 
 the revolution of its type. 
 
 In a majority of cases, however, these dreadful symp- 
 toms may continue but a few hours, before they are replaced 
 by a more favorable set, as returning warmth to the surface 
 and extremities — by a stronger and fuller pulse; in fine, by 
 a regularly-formed hot stage, which as to mildness w^ill be 
 in the ratio of the preceding severity. 
 
 Cause. — About this we absolutely know nothing ; but a 
 few facts have been observed in relation to it. It has been 
 observed in some places, that when bilious fever prevailed 
 on the table-lands, this form took place or was produced 
 in still lower situations near the river's edge. It has been 
 further observed, that when remittents and intermittents 
 have prevailed, this variety did not. 
 
 Dr. Wood is of the opinion that it is a miasmatic fever, 
 but it appears to us rather difficult to reconcile this idea 
 with the prevalence of the disease through the winter, as is 
 sometimes the case. 
 
 Natuee. — Dr. Wood asks : "What is it that imparts its 
 peculiar character to the pernicious fever ? Can it be in- 
 flammation ?" He appears to come to the conclusion that 
 it is not — and we think this conclusion is very correct. 
 He then asks ; " Is congestion the source of danger ? I 
 can not think so." 
 
 When we consider the cold and shriveled condition of 
 the extremities and surface generally, we can not doubt the 
 presence of congestion even to an alarming extent. We 
 care not whether the danger be attributed to congestion, or 
 
FEBRILE FORMS OF DISEASE. 695 
 
 to the obstruction, for the removal of which the congestion 
 was the first preparatory step, because, if we equalize the 
 circulation, and thereby re-establish depuration, we shall 
 remove the disease.* 
 
 Tkeatment. — The most reliable treatment is artificial 
 heat, together with counter-irritation, most energetically 
 applied. The most active and powerful means must be 
 adopted to procure a determination to the surface, and 
 thereby relieve the oppressed condition of the nervous sys- 
 tem, as well as the congestion of the internal viscera ; for 
 instance, if possible, the warm or vapor-bath may be used, 
 hot foot-bath, sinapisms to the whole surface of the inferior 
 extremities and spinal column, having previously applied 
 powerful, stimulating liniments with considerable friction. 
 
 As to internal treatment. Quinine may be administered 
 in very large doses, as soon as possible, without regard to 
 any particular stage or period of the disease; and its admin- 
 
 * In the treatment of this disease, the indications are, very generally, by 
 the Allopathic faculty, properly judged of, but their therapeutics are defective 
 in energy The writer has witnessed the death of many patients from this 
 and other congestive forms of disease, simply through a want of energy. 
 To melt a pig of iron it is necessary to apply heat, but to expect to melt it 
 in a pile of shavings or straw, would betray a remarkable degree of folly — 
 not more, however, than most physicians manifest with regard to conges- 
 tive forms of disease. To place around or about the patient a few bottles of 
 hot water, and to administer to him a little toddy and a little Ammonia, is 
 equivalent to melting a pig of iron with straw. 
 
 Through a similar want of energy, he has known death to result from 
 eoma. Through a fear of public opinion, physicians frequently omit to 
 discharge their own convictions of duty — such men should not practice 
 medicine. An illustration of this may not be out of place. A professional 
 acquaintance of the writer had a case of coma, and after having, with com- 
 mendable zeal, tried all the means to arouse his patient that had been recom- 
 mended by authorities, but to no effect, he sent for counsel. The consult- 
 ing physician suggested actual cautery to several inches square of the sur- 
 face on the lumbar region of the spine. The attending physician refused to 
 accede to it, on the ground that the patient would die anyhow, and if such 
 a measure were used, the people would say that they had killed him. The 
 consulting physician then requested the privilege, upon his own responsi- 
 bility, which, after consultation with the mother, was granted. Hence the 
 cautery, in the shape of a hot shovel, was applied — and the patient saved. 
 In this instance, but for the energy and decision which every physician 
 should possess, the patient would have been lost. 
 
696 FEBRILE FORMS OF DISEASE. 
 
 istration should be continued, at short intervals, until a de- 
 cidedly normal impression is effected. 
 
 We have found the tincture of Gelseminum given in con- 
 nection with Quinine, in these cases, to be without a par- 
 allel in efficacy ; it must be given, however, until its pecu- 
 liar effects are induced, which may be known by an inability 
 of the patient to raise his eyelids, or muscles generally, 
 although perfectl}^ conscious of all around him ; together 
 with a sense of increased temperature of the surface, a re- 
 turn of the skin to its normal condition, and a greater 
 degree of regularity and softness of the pulse. 
 
 In many instances, diarrhea is present, and the dis- 
 charges are sometimes hemorrhagic, for which Geranin 
 may be given in large doses in conjunction with the above 
 remedies; but if, on the contrary, there should be constipa- 
 tion, active doses of Podophyllin must be given ; and, in 
 either case, as soon as the condition of the patient will per- 
 mit, a combination of Podophyllin and Leptandrin should 
 be administered, at short intervals, for the purpose of re- 
 storing the bilious secretions to their normal standard. 
 
 When stupor or coma is present, ice-cold applications 
 must be made to the head, in connection with the above 
 counter-irritating means to the spine and extremities, and 
 stimulating enema may be frequently employed, together 
 with active doses of Podophyllin, if the patient can be 
 made to swallow them. 
 
 Cold water may be drank freely by the patient, and even 
 in large quantities if craved. We have used it with much 
 benefit in this disease. The patient is stripped of all cloth- 
 ing, and cold water is poured upon him, until a slight chill 
 is produced, or a sensation of coldness ; then dry the sur- 
 face with considerable friction, and place the patient in bed 
 well covered up ; reaction soon takes place, the surface be- 
 comes warm and moist, congestion is overcome, and the 
 patient's life is saved. This plan is recommended, how- 
 ever, more especially where the patient complains of a 
 peculiar burning heat in the skin. 
 
 After the disease has been subdued, the treatment dur- 
 
FEBRILE FORMS OF DISEASE. 697 
 
 ing convalescense must be similar to that already recom- 
 mended in other forms of fever. 
 
 Species IY. — Yelloio Femr — Typlius Icier odes — Remit- 
 ting Yellow Fever — Bidavi Fever. 
 
 This is another form of fever which seems to be produced 
 by a longer continuance or some modification of that cause 
 from which the other forms of this gen as result. In its in- 
 dividual character it presents many and considerable ex- 
 tremes of variety ; so much is this the case, that a physi- 
 cian introduced to it for the first time would be strongly 
 induced to suspect, in a number of hospital cases, that he 
 had almost as many independent forms of fever to contend 
 with. Although the several patients may have been 
 assailed at the same time, yet no two of them will have 
 the same symptoms, in the same order, or manifested 
 in the same manner. Much of this variety must be refer- 
 red to inherent differences of constitution ; and some of it, 
 no doubt, is referable to the magnitude of the cause of the 
 lesion inflicted. 
 
 The prodromal stage or period partakes largely of those 
 peculiarities which attend the other forms of fever. In the 
 period of chill, rigors very rarely obtain, and in some in- 
 stances, there is not even an appreciable sensation of cold 
 or chill — the hot stage being gradually merged out of the 
 incipient, which is greatly distinguished by the severity of 
 the pain in the back and extremities. The stage of excite- 
 ment is characterized by a dry and hot skin, frequent pulse, 
 a flashed face, red and suffused eyes, and a hurried respira- 
 tion. The stomach is disturbed by nausea, and possibly 
 by some vomiting, as both are not unfrequent attendants. 
 Deglutition is frequently rendered difficult by the soreness 
 of the fauces, and the tongue wears a white fur in conjunc- 
 tion with considerable moisture. Gastric disturbance is 
 often present from the beginning, but generally it does not 
 appear until after the lapse of twelve or eighteen hours, 
 when it becomes exceedingly troublesome — attended with 
 a sense of burning pain, tension, oppression, and soreness 
 
698 FEBRILE FORMS OF DISEASE. 
 
 upon pressure — all ingesta is retained, while, singular to 
 remark, its own morbid contents are retained. The bowels, 
 as is common to febrile action, are constipated ; flatulence 
 is often troublesome, and the desire for cold drinks is very 
 imperious. 
 
 Writers generally inform us that the tongue usually, if 
 not always, w^ears a pasty coat, but Dr. Gillkrist says, that 
 a perfectly clean tongue is not an unfrequent attendant 
 upon very severe cases. From our acquaintance with fever, 
 in general, we are disposed to regard the latter as a more 
 unfavorable symptom than the former. He adds, that the 
 most characteristic symptom of this fever is a pasty tongue, 
 with the tip and edges red. In young and vigorous sub- 
 jects, the skin may, and often does, have a pungent heat, 
 but we are not to suppose that this is a more dangerous 
 symptom than even a much low^er temperature. In the 
 latter case, the skin has a peculiar condition — one that can 
 best be represented by the idea of compression or impac- 
 tion, which is by no means to be regarded as favorable. 
 The patient is apt to suffer much from his incapacity to ob- 
 tain rest — he is restless — incessantly tossing his head and 
 limbs about — unable to sleep — he is deeply distressed — 
 draws deep inspirations ; in fine, all of his manifestations 
 indicate a state of congestion — one of imperfect reaction. 
 
 The nervous symptoms provoked by this fever are sur- 
 passed by no other class, in relation to the suffering they 
 produce. The severe pains in the back and extremities with 
 which the affection was introduced, increase and continue 
 even through the stage of excitement ; pains in the head 
 and eyes usually attend, are generally severe, and, like the 
 former, continue through this stage, and with it, all of them 
 so increase in violence as to cause the patient to moan and 
 even to scream. The mental functions are frequently de- 
 ranged ; sometimes it amounts only to confusion, but at 
 other times it is manifested by maniacal violence. 
 
 As the disease advances, the irritability of the stomach 
 becomes so excessive that it is perfectly useless to attempt 
 to do anything, through it, in the way of medication. Dr. 
 
FEBRILE FORMS OF DISEASE. 699' 
 
 Gillkrist (Cjc. Prac. Med.) says: " Our experience during 
 two epidemics, one in the West Indies, and of 1828 at Gib- 
 ralter, by no means bears out the statement of others as 
 to the hilious appearance of what is vomited in the pro- 
 gress of this fever ; after having paid the closest attention 
 possible to this point, we must, on the contrary, state, that 
 with the exception of the black-vomit stage, and at the 
 very commencement of the attack, what is thrown up con- 
 sists of the ingesta and a glairy fluid. Bile is also usually 
 absent on an inspection of the stools and urine." But he 
 goes on to remark, that it should be remembered that we 
 are treating of a disease which is so much like spasmodic 
 cholera as to furnish exceptions to almost every rule that 
 can be drawn from its diversified manifestations. 
 
 Dr. Eberle says, that after the first ejections, bile in abun- 
 dance is frequently brought up, which varies in color from 
 yellow to dark- green, and often of so acid a quality as to 
 excoriate the fauces. 
 
 The stage of excitement, with occasional rigors, may 
 vary, says Gillkrist, in its duration from forty-eight to 
 seventy-two hours ; the pulse begins to give way, after hav- 
 ing, up to this time, been full, rapid, and firm ; the eyes 
 lose their brilliancy, and the patient, in most instances, be- 
 comes exceedingly feeble — too much so to sit up without 
 aid. The skin becomes cooler and moister, the respiration 
 calm, and the stomach measurably easy ; the severity of the 
 headache and other pains have departed, and the patient 
 believes himself to be convalescent, and such may even be 
 the fact ; but in the majority of cases the struggle is yet to 
 be encountered. 
 
 During this calm, however, we are not without indica- 
 tions of the existing probability. If the worst is yet to be 
 expected, the epigastric tenderness, upon pressure, will be 
 found to have increased, and instead of the flushed face and 
 red conjunctiva, we will find an orange-yellow extending 
 from the face to the chest, and possibly it may invade the 
 entire surface ; the urine has also a yellowish tinge, though 
 in a deep quantity it may appear brown, and the pulse has 
 
700 FEBRILE FORMS OF DISEASE. 
 
 fallen below the normal standard. This intermission or 
 remission, as the case may be, may continue only a few 
 hours, or it may continue twenty-four. But, be it long or 
 short, it is succeeded by pain in the stomach and a burning 
 sensation, and to these succeed a most distressing vomit- 
 ing — the ejections are flocculent, and the desire of cool 
 drinks urgent, and which, as soon as swallowed, are re- 
 jected with a force that leaves no doubt as to the extreme 
 irritability of the stomach. These symptoms, having con- 
 tinued from twelve to thirty-six hours, introduce the last or 
 third stage. 
 
 The vomiting now becomes almost incessant, and the 
 matter thrown up resembles coffee-grounds suspended in a 
 glairy liquid, which is both dark and ropy ; the pulse sinks 
 in force, volume, and frequency ; the tongue is dark, ap- 
 proaching black in color ; the burning sensation in the 
 stomach is extremely distressing ; the extremities are cold 
 and clammy ; green or black discharges from the bowels 
 now ensue ; and then follow hiccough, hemorrhages, deli- 
 rium, coma, convulsions, and death. 
 
 This is perhaps the most general course of this fever, 
 when fatal; but it must be remembered, that it is fre- 
 quently still more overwhelming — the patient sometimes 
 falls at the seizure as though felled by a blow ; and in some 
 it commences with furious delirium. In such cases, it is 
 common for the disease to terminate fatally at the close of 
 the third day ; but even in these cases^ dissolution is pre- 
 ceded by an acrid or burning sensation in the stomach and 
 extending to the esophagus. The temperature of the sur- 
 face and extremities falls rapidly ; the features shrink ; the 
 urine is absent ; distressing singultus comes on, and finally 
 black vomit. 
 
 But it is much more common for the disease to be pro- 
 tracted to the fifth, sixth, or seventh day, and sometimes 
 fatal cases are continued to the twelfth or even the fifteenth 
 day. The yellowishness of the skin frequently appears as 
 early as the third day, but more frequently it does not ap- 
 pear until a more advanced period, and in a few instances. 
 
FEBRILE FORMS OF DISEASE. YOl 
 
 not at all. Hemorrhages from the nose, gums, decayed 
 teeth, and every other orifice of the body are apt to appear 
 about the fourth day. 
 
 The profession are generally of the opinion at this time 
 that the matter of black vomit consists of coagulated par- 
 ticles of blood suspended in gastric mucus — it is insipid, 
 "whereas the black vomit of bilious or typhous fever, when 
 it occurs, is bitter. 
 
 Causes. — The time has been when this subject was much 
 discussed, but it has measurably passed. During the stu- 
 dentship of the writer, it was strenuously maintained by 
 some to be contagious. Prof. Hossack told the writer, that 
 if he would hear him through his course on the subject, he 
 would convince him that it was contagious ; he did so at- 
 tend — but was not convinced. Prof. Caldwell maintained 
 that it was not contagious — and in this w^e are disposed to 
 believe that he was coriect — but he also maintained that it 
 was produced by a peculiar poison, which he denominated 
 malarious or miasmatic. This may be true, but the writer 
 has never believed it. It is, and has been, his opinion that 
 the various forms of fever embraced by this genus result 
 from various combinations of heat, humidity, and electric- 
 ity ; but, however this may be, the weight of the profes- 
 sion has concurred in the opinion that yellow fever is not 
 contagious, and in this we think an important point has 
 been gained. 
 
 "We do not intend to enter into any discussion of the 
 subject in this place, but will introduce some facts which 
 may possibly aid others to think for themselves upon the 
 subject: 
 
 1. Yellow fever does not prevail in the cold season. 
 
 2. It does not require a higher temperature than 79° or 
 80° of Fahrenheit. 
 
 3. It is arrested by cold, heavy rains and storms. 
 
 4. It appears simultaneously, and is intermixed with bil- 
 ious remittents. — Eherle. 
 
 5. Dr. Kamsey states, that during the prevalence of 
 the yellow fever at Charleston, in South Carolina, in the 
 
702 FEBRILE FORMS OF DISEASE. 
 
 year 1804, " neglected intermittents frequently terminated 
 in yellow iQYQxy—E'berle. 
 
 6. Dr. Rush also states, in relation to the yellow fever, 
 at Philadelphia, in 1802, " Intermittents, the mild remit- 
 tent, the inflammatory, bilious, and the malignant fever, 
 have, in many instances, all run into each other." — 
 Eherle. 
 
 7. Dr. Caldwell, in speaking of the yellow fever of Phil- 
 adelphia, in 1803, states : "As the fever receded from the 
 low ground and malignant atmosphere of Water street, it 
 became more and more manageable, until its evanescent 
 shades in Second street were, in many instances, much 
 lighter than the common remittent of the country." 
 
 8. In the city of Baltimore, "the bilious or vomiting 
 fever, in its ordinary form, prevailed in that town and con- 
 tinued until it was gradually lost in the severer form of 
 yellow fever as the season advanced." — (Dcmage) Elerle. 
 
 9. "In some epidemics, females have remained wonder- 
 fully exempt ; this was the case during a terrific epidemic 
 at Dominique and Martinique, in 1801." — Gillkrist. 
 
 10. In 1811, at Xeres, females "sufiered in a particular 
 manner." — Gillhnst. 
 
 11. I^egroes are known to be, generally, very insuscepti- 
 ble to the cause of this disease. 
 
 We have in another place shown why it is that women 
 and children are measurably exempt from any form of fever 
 to which the other sex is peculiarly liable. This fact can 
 not be explained by assuming any modification of the poi- 
 son, if such it be. We have also explained why it is that 
 negroes are but little liable to the southern fevers. 
 
 Yellow fever is sometimes produced under circumstances 
 entirely incompatible with the idea of a malarious poison. 
 Dr. Gillkrist, upon this subject, says: "In fairness, we can 
 not think that, like many other places which may be men- 
 tioned where yellow fever is known from time to time to ap- 
 pear, it can not be admitted that Gibralter furnishes sources 
 from which raalaria^ in the usual sense of that word^ arises, 
 sufficient to account for the appearance of a malignant 
 
FEBRILE FORMS OF DISEASE. 703 
 
 fever ; neither can we concede to authorities of great re- 
 spectability, that either there or in various other places the 
 solution of the question is to be found in a crowded popu- 
 lation, the filth of the town, or the state of the sewers. 
 
 "If we consider the soil and elevation, it must be ad- 
 mitted that here, too, no satisfactory conclusion can be 
 drawn ; for if we find evidence, especially in the West In- 
 dies, and on the American continent, of the influence of a 
 marshy soil, on several occasions, this does not hold good 
 in other instances ; and in those countries, as well as in 
 Spain, many places might be mentioned, where elevation, 
 soil, etc., would seem to guarantee immunity, but where, 
 nevertheless, the disease occasionally prevails to a devas- 
 tating extent." 
 
 If we had space to enter fully into this subject, it would 
 be discovered that all the facts which favor the doctrine of 
 malarious poison, equally favor our own views, and that 
 those which are fatal to that hypothesis, are entirely com- 
 patible with ours. 
 
 If yellow fever be caused by miasm, it is supposed that 
 it must in some way be associated with the decomposition 
 of animal matter, because the disease is confined to cities, 
 armies, ships, etc. The disease is never known in New 
 Orleans when the river keeps full during the hot season ; 
 and when it becomes low, there is exposed an immense 
 mud-bar through the whole extent of the city's front, in 
 which was deposited, during the business season, an im- 
 mense quantity of animal matter. Under such circum- 
 stances, is it not possible that the atmosphere may gene- 
 rate a species of animalculas which may be inhaled, and 
 thus produce the disease ? Or, in lieu of this, may it not 
 cause their generation in the human system ? Dr. Khees, 
 of Philadelphia, states : "When the matters fresh thrown 
 from the stomach were examined, the animalculse were 
 alive and in constant motion ; but that no such phenomena 
 could be detected in autumnal or bilious fevers." This cir- 
 cumstance demonstrates the existence of a very great difie- 
 rence between the two varieties of fever. 
 
704 FEBRILE FORMS OF DISEASE. 
 
 Diagnosis. — All fevers, in their initiatory stage, have so 
 many features in common, that it is difficult to distinguish 
 this from other febrile forms under two or three days, and 
 yet there are signs which may guide to a very probable con- 
 elusion, such as the turbid conjunctiva, the great severity 
 of the pain in the loins and inferior extremities, and, when 
 the malady has further advanced, the great epigastric ten- 
 derness and the gastric irritability, the regular continuance 
 of the fever for two or three days, and then succeeded by 
 an abatement — intermission or remission, the yellowishness 
 of the eyes and skin, and finally the appearance of the black 
 vomit. If yellow fever prevails at the time, or if the other 
 usually attending circumstances of the disease be present, 
 the preceding symptoms can scarcely leave a reasonable 
 doubt as to the character of the disease. 
 
 Prognosis. — This has hitherto most generally proved to 
 be a very fatal form of disease, having its fatality some- 
 times to run as high as ninety-five per centum. We feel 
 quite sure that such a fatality is, in a great measure, due 
 to the prevailing ignorance of its pathology and requisite 
 therapeutics. 
 
 It is now a well-settled fact, that the disease is attended 
 with a much more extensive mortality when it first appears 
 than at any subsequent period — that its fatality declines 
 from the beginning of the epidemic to its close ; and from 
 this circumstance it appears to be generally inferred, that 
 the cause, whatever it may be, is more concentrated or ca- 
 pable of inflicting disease than it becomes to be at a later 
 period. We regard this inference as being true only to a 
 small extent, if at all. Our conclusion is, that the cause, 
 when it becomes first introduced, cuts down all of the most 
 vulnerable to its influence, and as the vulnerability dimin- 
 ishes, so does its fatality and the number of its victims. 
 Dr. Wood says: " Perhaps the general average of deaths 
 from yellow fever, prevailing epidemically, may be stated 
 at one-third." 
 
 Among the unfavorable symptoms. Dr. Wood cites the 
 following: Excrutiating pains in the forehead, back, and 
 
 I 
 
FEBRILE FORMS OF DISEASE. 705 
 
 limbs ; great frequency and fullness of the pulse, a gaseous 
 state of it, or its entire absence at the wrist ; a blood-shot 
 appearance of the conjunctiva, and a bronzed or mahogany- 
 color of the skin; a short and violent febrile stage; coma 
 or convulsions; a slow respiration with deep sighs; hic- 
 cough ; excessive restlessness, and a disposition to get out 
 of bed and walk ; an unnatural apathy, or an expression 
 of dogged indifference in the advanced stages ; a voracious 
 appetite ; suppression of urine ; an universal hemorrhagic 
 tendency, with petecchise ; and finally, the occurrence of 
 black vomit. This last symptom is regarded as almost ne- 
 cessarily fatal, but occasional recoveries are mentioned by 
 authorities as having taken place after its appearance. 
 
 Indications.— Whatever the cause may be can matter 
 but little when we know the absolute condition of the sys- 
 tem, and that this is one of a high order of congestion there 
 can be entertained no reasonable doubt. The indications 
 then, must be to overcome all cutaneous stricture and stim- 
 ulate its surface, and by revulsives to produce a centrifugal 
 action in the circulation — in other words, our duty is to 
 equalize the circulation, and to establish and maintain de- 
 puration. 
 
 Treatment. — In the early stage of the disease, should 
 there be no irritability of the stomach, an emetic must be 
 given, to be followed by an active cathartic, for which the 
 Compound Powder of Jalap is admirably adapted ; after 
 the operation of the cathartic, the Compound Powder of 
 Ipecacuanha and Opium, combined with equal parts of 
 Quinine, may be given every hour or two in three or four- 
 grain doses ; and the bowels must be kept open dail}', in 
 every case, by small portions of Podophyllin and Leptan- 
 drin, frequently administered ; but in cases of irritability 
 of the stomach, in which everything is rejected from it. 
 Mustard must be applied over the epigastric region, and 
 energetic counter-irritation to the spinal column and infe- 
 rior extremities, together with active cathartic injections, 
 combined with pulverized Lobelia or a portion of Tincture 
 of Lobelia and Capsicum. The patient may also eat ice 
 
706 FEBRILE FORMS OF DISEASE. 
 
 in proper quantities, which will usually be found to assist 
 in overcoming the gastric irritability. 
 
 The surface of the body, in all instances of this disease, 
 and especially when gastric irritability is present, should 
 be closely attended to ; the whole surface should very fre- 
 quently be bathed with a cold alkaline wash, which should 
 be continued until the temperature is much diminished and 
 renewed whenever there is an increase of fever. In other 
 respects, pursue the same course as laid down for conges- 
 tive fever. Cold water may be allowed whenever the pa- 
 tient craves it, but should it be almost immediately rejected, 
 small portions of ice should be substituted. 
 
 Species Y. — Infantile Remittent Fever. 
 
 After having decided to publish a fourth book, we con- 
 cluded not to separate this form of fever from the general 
 subject — that nothing could be gained by so doing. 
 
 This species has been divided into three varieties : the 
 acute, slow, and low — and the differences between them 
 are sufficiently considerable to justify the distinction. 
 
 Yakiett I. — Acute Infantile Remittent. 
 
 This form is distinguished by pain in the head and abdo- 
 men, slimy stools, little thirst, loss of appetite, drowsy ex- 
 acerbations, and wakeful remissions ; it begins, usually by 
 several days, with marked symptoms of indisposition ; the 
 patient's color is changed ; its expression contra-indicates 
 health ; its breath is offensive ; it picks its nose and lips ; 
 has a dry cough, anorexia, swollen abdomen, and flatu- 
 lence ; it grates its teeth, moans and starts in its sleep ; its 
 urine is turbid, and upon cooling it deposits a whitish sedi- 
 ment ; and its bowels may be either loose or costive. In 
 the midst of these symptoms a chill is produced, which is 
 soon followed by fever ; but sometimes its beginning is 
 sudden, and no introductory stage becomes apparent. 
 
 Of the paroxysms there are frequently three in twenty- 
 four hours — one in the forenoon, one in the afternoon, and 
 one at night, which is usually the most intense. It is hot 
 
FEBRILE FORMS OF DISEASE. TOT 
 
 and of course restless at night, and the diurnal exacerba- 
 tions soon succeed. When the fever is severe, the remis- 
 sions are short and frequently not more than observable ; 
 it is attended bj troublesome flatulence, an increased cough, 
 a horrid respiration, and occasionally by nausea and vom- 
 iting. As the fever progresses, the exacerbations increase 
 and all of its attendant symptoms become aggravated, so 
 that the pulse runs from 140 to 160. 
 
 At length, all the symptoms during the remissions abate; 
 it begins to rest composedly ; the pulse is reduced to 120 or 
 130 per minute ; it is more wakeful, gives more attention 
 to passing events, and is not unfrequently playful. In the 
 exacerbations and remissions the skin is usually dry, and 
 when an exception occurs the moisture is usually confined 
 to the head, breast, or palms of the hands. As yet, neither 
 food nor drink is desired, and when either is taken it is 
 usually rejected as soon as swallowed. The urine has be- 
 come limpid and of a high color, and the stools never have 
 a normal appearance in smell, color, or consistence ; worms 
 are sometimes found in the stools and vomitings, and they 
 spontaneously appear through the anus or the mouth ; the 
 exacerbations become milder and more abridged as the py- 
 rexia declines ; moisture generally appears upon the sur- 
 face ; the pulse falls ; the appetite and refreshing sleep 
 return; a copious sediment deposits from the urine, and 
 the alvine excretions have become more healthy. The 
 complaint continues from one to three weeks and occasion- 
 ally longer. 
 
 Yakiety II. — Slow Infantile Remittent. 
 There is a variety of infantile remittent which makes its 
 assault more insidiously and imperceptibly, and by way of 
 distinction it is called the slow variety. In this form the 
 breath is offensive, the appetite is fastidious, the abdomen 
 frequently enlarged, and the flesh is gradually wasted ; it 
 has but one exacerbation, which comes on in the evening, 
 continues until morning, and is then succeeded by a pro- 
 fuse perspiration ; hectic flushings are frequent through the 
 45 
 
708 FEBRILE FORMS OF DISEASE. 
 
 day, the skin is dry and harsh, the pulse about 140 in the 
 exacerbation and about 100 in the remission. The patient 
 is rarely so much indisposed as to be confined to bed, never- 
 theless, it is not inclined to be active or playful, but is in- 
 dolent, listless, and complains of an aching of the limbs 
 when motion is attempted. It is often considerably dis- 
 posed to doze both day and night ; to pick its nose ; the 
 urine is of a deep orange color ; the thirst is but little ; the 
 appetite is absent ; the tongue is white and moist, and the 
 stools, as in the former, or acute variety, are unnatural. 
 At the commencement of a favorable termination, all the 
 symptoms abate, and health and cheerfulness return. The 
 continuance of this form of disease may be of two or 
 three months. 
 
 Variety III. — Low Infantile Remittent. 
 This form resembles very closely, for the first week, the 
 acute variety, except that it begins, pretty uniformly, in a 
 sudden manner, and afflicts the brain more severely, often 
 to the production of delirium. Its peculiar character now 
 commences by an exhibition of indifierence to all that sur- 
 rounds it; it calls for nothing, and yet refuses neither food 
 nor drink when presented to it ; the superior extremities 
 are usually, during its waking hours, kept in constant mo- 
 tion, while its inferior continue in a fixed posture. When 
 the disease has attained to its most oppressive stage, such 
 is the debility that the patient loses the power of speech, 
 and its jaws occasionally become fixed and immovable. 
 During the exacerbations it slumbers much ; the eyes are 
 dull, inattentive, and flushed when the stage begins ; the 
 tongue, teeth, and lips are covered with a blackish fur; 
 the facial expression betrays much distress, and during the 
 remissions much restlessness becomes apparent by the con- 
 stant motion of its arms. Before a discharge of faeces or 
 flatus, it becomes restless, and, though sensible, the cystic 
 and alvine excretions are passed involuntarily. In the re- 
 mission, the pulse is about 100, but in the exacerbation it 
 rises to 120. When the exacerbations become shorter and 
 
FEBRILE FORMS OF DISEASE. 709 
 
 milder, a favorable turn is supposed to have commenced, 
 and if so, the drowsiness will be reduced, the eyes will be- 
 come clearer, the expression more placid, the pulse more 
 calm, the tongue more clean, and the appetite improved; 
 it gradually becomes to betray some fretfulness, the speech 
 and voice return, but the urine is still passed involunta- 
 rily — weakness is the only matter of complaint, and this is 
 finally overcome. This form may continue six weeks, or 
 even longer. 
 
 Causes. — Upon this subject there has existed considera- 
 ble contrariety of opinion. At one time it was attributed 
 by many to the presence of worms ; so much so was this 
 the opinion that Hoffman was greatly surprised when he 
 did not find worms in connection with this disease. At 
 that day the disease was familiarly called " worm fever." 
 Something like a hundred years since, an Edinburgh phy- 
 sician questioned the doctrine, and showed that w^orms 
 were not always the cause of this fever. Dr. Butter, in 
 1782, in his work on this fever, attributed the disease to 
 debility, derangement, etc., of the digestive organs. He 
 was of the opinion, however, that worms were of advan- 
 tage to the system — and even Dr. Eush was much inclined 
 to the same view of the subject. At the present time, the 
 profession is generally of the opinion that Butter's views, 
 in the main, are correct. In France, it is considered as a 
 species of gastro- enteritis. It occurs both spasmodically 
 and epidemically. In the latter form, it is produced, pro- 
 bably, in organically liable constitutions, by some of the 
 usual causes of fever. Dr. Sims reports one epidemic of it 
 as prevailing simultaneously with a low grade of nervous 
 fever among adults (Cy. Prac. Med.). 
 
 Diagnosis. — Dr. Sims, above cited, was of the opinion 
 that it was impossible to distinguish this fever from hydro- 
 cephalus in patients under five years of age ; but Pember- 
 ton is of a contrary opinion. He thinks, that the scream- 
 ing of the patient during sleep, strabismus, tossing of the 
 hands over the head, intolerance of light, and the disturbed 
 condition of the intellectual faculties, which characterize 
 
710 FEBRILE FORMS OF DISEASE. 
 
 hydrocephalus, will distinguish it from this form of fever, 
 in which there is no strabismus, no derangement of the 
 intellectual faculties, and but very seldom any screaming 
 during sleep or any intolerance of light. Furthermore, says 
 Dr. Golis, hydrocephalus is attended by no distinct stages, 
 its pulse never falls below the normal standard, and never 
 extends from three to six weeks. 
 
 Peognosis. — Although this is a troublesome and tedious 
 disease, it can not be thought very liable to any unfavorable 
 termination, more particularly under a judicious practice. 
 In fatal cases the intestines have been found greatly dis- 
 tended and the mesenteric glands somewhat enlarged, but 
 neither inflammation nor efliision has been detected in the 
 abdominal cavity. The fact that this fever is somewhat 
 liable to pass into hydrocephalus, constitutes its most dan- 
 gerous feature. When such a tendency exists, it is usually 
 indicated by sickness and vomiting in the beginning. 
 
 Treatment. — At the commencement of the disease, when 
 the stomach is loaded with undigested food, or before gas- 
 tric irritation has taken place, a light emetic will usually be 
 found advantageous. This should be followed by an active 
 purgative, as the Compound Powder of Jalap, which is 
 probably the best agent that can be used, often exerting a 
 beneficial influence over the disease sufficient either to put 
 an end to it at once, or greatly mitigate its subsequent 
 severity. 
 
 After the bowels have been freely acted upon, should the 
 fever continue, small doses of Leptandrin, with or without 
 Podophyllin, or if there be gastric acidity, Leptandrin com- 
 bined with the Compound Powder of Rhubarb, or Syrup 
 of Rhubarb and Potassa, should be administered in doses 
 sufficient to cause one, but not to exceed two daily evacua- 
 tions from the bowels ; and in cases of excessive irritability 
 of the stomach, in which these agents are rejected, active 
 cathartic injections must be used. 
 
 Gastric irritability may be overcome by mild mucilagin- 
 ous draughts of a diuretic nature, as Marsh-Mallows, to be 
 aided by external applications, as sinapisms to the epigas- 
 
FEBRILE FORMS OF DISEASE- 711 
 
 trie region and spinal column. Spasmodic action will usu- 
 ally yield to the Tincture of Lobelia and Capsicum, aided 
 by warm baths, especially if it amounts to actual convul- 
 sions. Probably the Tincture of Gelseminum might be of 
 service when these symptoms are present. When great de- 
 termination to the head is manifest, cooling lotions must be 
 frequently applied, together with warmth and counter-irri- 
 tation to the inferior extremities and spinal column. 
 
 As soon as the stomach can retain medicine, anti- 
 periodics must be given continuously every few hours, until 
 the solution of the disease ; the following is perhaps equal, 
 if not superior, to any other for this purpose : 
 
 R. Powder of Ipecac, and Opium, bss, 
 S. Quinine, Bj. Mix, 
 Divide into ten powders, and, to a child two years old, give 
 one powder every four or five hours. 
 
 As soon as convalescence takes place, the mild bitter- 
 tonics, as Hydrastin, Cornin, etc., must be given, and 
 their use continued, until the strength and appetite are 
 restored. The diet must be very light and increased as the 
 restoration to health advances. Oftentimes, when this dis- 
 ease is very obstinate, a removal to the country or change 
 of climate will effect an immediate beneficial result. 
 
 TYPHOID AND TYPHOUS FEVEES. 
 
 We here present to our readers the investigations of Dr. 
 W. Jenner, in relation to these two febrile forms of disease, 
 which we regard as an excellent analysis, and of much 
 value to the practitioner : 
 
 On Typhoid and Typlious Fevers. An attempt to De- 
 termine the Question of the Identity or Non-Identity^ hy 
 an Ancdysis of the Symptoms^ and of the Appearances 
 found after Death, in Sixty-Six Fatal Oases of Oontiniied 
 Fever, ohserved at the london Fever Hospital, from Janu- 
 ary, 18^7, to February, 1849. By W. Jenner, M. D., 
 Professor of Pathological Anatomy in University College, 
 London. — This is the title of an extremely interesting paper 
 
712 FEBRILE FORMS OF DISEASE. 
 
 which has been published in successive numbers of the 
 Monthly Journal of Medical Science, commencing in the 
 number for April of last year, and concluded in the num- 
 ber for April of the present year. It constitutes one of the 
 most important contributions to the history of continued 
 fever that has yet been made, presenting, as it does, the 
 carefully-recorded histories of a very large number of cases, 
 admirably arranged and analyzed, by a highly-competent 
 and reliable observer. — Ame7\ Jour. Med. Sci., for 1850. 
 
 ^^Age. — Typhoid fever was limited, in the cases here 
 considered, to persons under 40 years of age ; nearly one- 
 third of the forty-three cases of typhous were more than 
 50 years of age. 
 
 ''Mode of attack. — As a general rule, the attack of 
 typhoid fever commenced more insidiously than that of 
 typhous fever. This observation, like all others in this 
 paper, applies, of course, only to fatal cases. 
 
 ''Duration. — The average duration of the fatal cases of 
 typhoid fever was 22 days. Of the fatal cases of typhous 
 fever, 14 days. Half the cases of typhoid fever survived 
 to the 20th day of the disease. Not a single case of typhous 
 fever survived the 20th day of disease. 
 
 "Erujption. — The difference in the appearance of the 
 eruption in the two diseases was as great as it well could 
 be, considering that both were of a reddish hue. 
 
 "Miliary vesicles and sudamina. — These vesicles were 
 present in an equal proportion of the cases of both diseases 
 under 40 years of age. But in no cases of typhous fever, 
 more than 40 years of age, were they detected . 
 
 "Subsequent experience leads me to believe that miliary 
 vesicles are rarely seen on individuals more than 40 years 
 of age ; and very rarely, indeed, if ever, on patients more 
 than 50 years old. I have, during the last year — i. e.^ 
 since my attention was directed to this point — seen these 
 bodies on no one of the many patients more than 50 years 
 of age, laboring under various diseases, that have come 
 under my observation. 
 
 "Expression., manner^ hue of face ^ etc. — As the rule, in 
 
FEBRILE FORMS OF DISEASE. 713 
 
 the cases of typhoid fever here analyzed, the expression 
 was much less indicative of prostration, and more anxious, 
 than in cases of the typhous fever. In the former disease, 
 the complexion was tolerably clear, and the flush, when 
 present, was of bright-pinkish color, limited to one or both 
 cheeks, and often distinctly circumscribed. In typhous 
 fever, on the contrary, the complexion was thick and mud- 
 dy, the flush of the face uniform, and of a dusky-red color. 
 
 ''^Headache was a constant symptom in all the cases of 
 typhoid and typhous fevers ; but it disappeared about the 
 10th or 12th day in the latter, and not until the termination 
 of the second, or the middle of the third week, in the 
 former. 
 
 ^''Delirium commenced in three only of ten cases of 
 typhoid fever before the 14th day; while it began in four- 
 teen out of fifteen cases of typhous fever before the 14:th 
 day. As a rule, the delirium was decidedly more active in 
 typhoid than in typhous. 
 
 ''''Somnolence. — In eight osit of nine cases of typhoid 
 fever, somnolence commenced after the 14th day of disease. 
 In seventeen out of eighteen cases of typhous, before the 
 termination of the second week. 
 
 ''''Coma-vigil. — One-fifth of the cases of typhous fever 
 experienced coma-vigil ; not a single case of typhoid fever 
 experienced that condition. 
 
 ''^Spasmodic movements were nearly equally frequent in 
 the two diseases. 
 
 ''''Retention of urine and involuntary discharge of urine 
 and stools OQQMYYQdi wii\\ equal frequency in the two dis- 
 eases ; but at a much earlier date in typhous than in typhoid 
 fever. 
 
 ''''Loss of muscular power. — Little more than a fourth of 
 the patients attacked with typhoid fever kept their beds en- 
 tirely before the seventh day of disease. All the patients 
 affected with typhous, whose cases are here considered, 
 took altogether to their beds before the seventh day of the 
 disease. 
 
 "The prostration was rarely so extreme in the cases of 
 
714 FEBRILE FORMS OF DISEASE. 
 
 typhoid fever as in those of typhous fever. Extreme pros- 
 tration, when it did occur in typhoid fever, was not ob- 
 served until from the 14:th to the 30th day, wdiile in a large 
 majority of the cases of typhous fever it was marked be- 
 tween the 9th and 12th day of disease. 
 
 ^^Epistaxis was present in five of fifteen cases of typhoid 
 fever — in not one of twenty-three cases of typhous fever. 
 
 ^^ Hearing was equally and similarly afiected in the two 
 diseases. 
 
 ''''Eyes. — The conjunctivse were very much more con- 
 stantly and intensely injected in the cases of typhous than 
 in those of typhoid fever ; the pupils were absolutely larger 
 than natural in a majority of the cases of the latter disease^ 
 while these were abnormally contracted in a large majority 
 of the cases of the former affection. 
 
 ^''Tongue. — Although individual cases of the two forms 
 of disease may have closely resembled each other in the 
 appearance of the tongue, yet, taking the whole of either 
 group of cases, this organ presented a singularly-different 
 aspect in the one from what it did in the other. It was 
 much more frequently moist throughout the disease in 
 typhoid than in typhous fever. When dry, it was often 
 red, glazed, and fissured, in the former ; but rarely so in 
 the latter. 
 
 "Again, in typhoid fever, when the tongue was brown, 
 its hue was much less deep— it was of a yellowish, instead 
 of a blackish brown. The small, dry tongue, with red tip 
 and edges, smooth, pale, brownish-yellow fur, fissured — 
 the surface seen between the fissures being red — may be 
 considered diflerentially as a diagnostic sign of tj^phoid 
 fever. One only of the twenty patients afiected with the 
 typhoid fever, but eight of the forty patients laboring under 
 typhous fever, were unable to obtrude the tongue when 
 bidden.* 
 
 '-''Intestinal' hemorvliage occurred in one-third of the 
 
 " * This clearly indicates the difference in the amount of prostration m 
 ihe tv;o diseases. 
 
FEBRILE FORMS OF DISEASE. 715 
 
 patients laboring under typhoid fever — in none of those 
 suffering from typhous fever.* 
 
 "The other abdominal symptoms and signs need no reca- 
 pitulation. 
 
 ''''Appetite andtJiirst. — No difference in the two diseases. 
 
 ''^ Pulse. — The frequency of the pulse fluctuated much 
 more, from day to day, in the cases of typhoid than in 
 those of typhous fever. 
 
 ^^ Cough and physical chest-signs. — Sonorous rale was 
 very much more Irequently present in the cases of typhoid 
 than in those of typhous fever — ^. 6., it was present in 
 eleven out of twelve cases of the former, and in seven only 
 of twenty-one cases of the latter. Dullness of the most 
 depending part of the chest, from intense congesting of the 
 lung, was observed in nine cases of typhous fever — in no 
 case of typhoid fever. 
 
 ''''Sloughing appeared to be nearly equally frequent in 
 the two diseases. 
 
 ''^Erysipelas occurred in seven of the twenty-three — i. e.^ 
 in nearly a third of the cases of typhoid fever; and in two 
 only of the forty- three cases of typhous fever — i. 6., less 
 than one- twentieth of them. 
 
 '''' D isGoloration of the walls of the ahdomen.^ and of the 
 skin covering the larger veins., was much more frequently 
 present in those dead from typhous than typhoid fever. 
 
 ''''Emaciation had made greater progress in the typhoid 
 than in the typhous subjects. 
 
 ''''Spots. — The spots observed during the progress of the 
 cases of typhous fever continued after death ; no trace of 
 the spots visible during life could be detected after death 
 from typhoid fever. 
 
 ''''Head. — After typhoid fever, the pia mater and arach- 
 noid separated from the convolutions with abnormal facility 
 
 *' • I may here remark, that in one case only of typhous fever, received 
 into the London Fever Hospital during the last three years, has blood passed 
 from the bowels. The case referred to was that of an old man who had 
 hemorrhoids, which occasionally bled when he was in health. During tha 
 time specified, notes of near two thousand cases have been taken. 
 
716 FEBRILE FORMS OF DISEASE. 
 
 in one only of nine cases examined with reference to the 
 point. The vessels of the pia mater were abnormally filled 
 with blood in one-third of the cases, but intensely congested 
 in one only of fifteen cases. After typhous fever, the pia 
 mater and arachnoid separated with abnormal facility in 
 nine of eleven cases of which notes on this point were 
 made. The vessels of the pia mater were congested in 
 nearly half, and intensely congested in one-fifth, of the 
 whole of the cases ; while the cerebral substance itself was 
 abnormally congested in half. 
 
 ^^ Hemorrhage into the cavity of the arachnoid^ which 
 was not found in a single case of typhoid fever, had occur- 
 red before death in one-eighth of the cases of typhous 
 fever. 
 
 "The amount of serosity found within the cranial cavity 
 was decidedly greater after typhous than typhoid fever. 
 
 ''''Pharynx. — After typhoid fever, this organ was found 
 ulcerated in one- third of the cases. After typhous fever, 
 ulceration of the pharynx was not to be detected in a single 
 ease. 
 
 '■''Larynx. — Ulceration of the larynx was found in one of 
 fifteen subjects dead from typhoid fever — in one of twenty- 
 six from typhous fever. 
 
 '•''Esophagus. — After typhoid fever, ulcerated in one of 
 fifteen cases in which it was examined. After typhous 
 fever, the esophagus was free from ulceration in all the 
 twenty-four cases in which it was examined. 
 
 "The epithelium separated from the esophagus sponta- 
 neously at an earlier period after death from the latter 
 than the former disease. 
 
 ''^Stomach. — In none of the fifteen cases examined after 
 death from typhoid fever was the mucous membrane of the 
 stomach softened throughout its whole extent ; in no case 
 did the softening of the cardiac extremity approach perfo- 
 ration. 
 
 "In four of thirty-seven cases of typhous fever, the whole 
 mucous membrane of the stomach was softened ; and in 
 four others, there was such extreme softening of the whole 
 
FEBRILE FORMS OF DISEASE. 717 
 
 of the coats of the great cul-de-saG that they were perfo- 
 rated by the slightest violence. 
 
 '''Small intestines and mesenteriG glands. — The presence 
 or absence of lesion of these organs was the ground on 
 which the cases of typhoid and typhous fever here analyzed 
 were divided from each other — consequently they were 
 invariably diseased in the one and normal in the other. 
 
 '''Large intestines, — After death from typhoid fever, the 
 mucous membrane of the large intestines was found ulce- 
 rated in rather more than a third of twenty cases. In no 
 instance after death from typhous fever. 
 
 ''Peritoneum. — As peritonitis was in typhoid fever 
 secondary to, and dependent on, the entero-mesenteric dis- 
 ease, it may here be excluded from consideration. 
 
 "Spleen. — This organ was enlarged in all the cases of 
 typhoid fever — softened in one-third of the cases only. 
 Before the age of 50, it was as large after typhous as 
 typhoid fever; after that age, it was decidedly smaller in 
 the former than in the latter affection. After the age of 
 50, it was as soft in typhous as in typhoid fever ; before 
 that age, it was less frequently softened. 
 
 "Gall-hladder. — There was ulceration of the linino: 
 membrane of the gall-bladder in one of fourteen cases of 
 typhoid fever ; in none of thirty-one cases of typhous fever. 
 In the latter disease, the bile was much thicker and of a 
 darker-green color than in the former.* 
 
 "Liver, pancreas., kidneys. — These organs were more 
 flabby in the cases of typhous than in those of typhoid 
 fever. 
 
 " Urinary -lladder. — This viscus was ulcerated in one of 
 the cases of typhoid fever — in none of the cases of typhous 
 fever. 
 
 "Pericardium. — This cavity contained a small amount 
 of yellowish, transparent serosity in all the cases of typhoid 
 fever examined. The contained serosity was red, from 
 
 «' *The condition of the bile, as found after death in these two diseases, 
 is worthy of more careful investigation. The difference in appearance is, 
 in a large nriajority of cases, well marked. 
 
718 FEBRILE FORMS OF DISEASE. 
 
 transii elation of a solution of lisematosin, in five of thirty- 
 one cases of typhous fever, in which the pericardium was 
 examined before the termination of the fever. 
 
 ^'' Heart. — The muscular tissue of this organ was much 
 more frequently and decidedly flabby, and its lining mem- 
 brane was much more frequently and deeply stained of a 
 dark-red color, in the cases of typhous fever than in those 
 of typhoid fever. 
 
 ''^ Lungs. — Granular and non-granular lobular consolida- 
 tion were very frequent in the subjects dead from typhoid 
 fever ; rare in those dead from typhous fever. The reverse 
 was the fact with reference to consolidation from congestion 
 of the most depending part of the lung. 
 
 ''''Pleura. — Recent lymph or turbid serosity was found 
 in six of fifteen cases of typhoid fever — i. g., between one- 
 half and one-third, or in the proportion of forty per cent. 
 The same lesions, but much less in amount, were found in 
 two only of thirty-six cases of typhous fever — i. e.^ one- 
 eighteenth, or in the proportion of 5.5 per cent. 
 
 " The particulars here briefly recapitulated, appear to 
 me to prove indisputably that the symptoms, course, dura- 
 tion, anatomico-pathological lesions, and the tendency to 
 cadaveric changes, are diflerent in typhoid fever to what 
 they are in typhous fever. 
 
 " To account for the diflerences in symptoms which exist 
 in continued fever, with or without entero-mesenteric dis- 
 ease, the following assertions have been put forward : 
 
 "1. That typhoid fever is merely typhous fever compli- 
 cated with lesions of a particular organ ; and, therefore, it 
 is to be expected that certain symptoms referable to, and 
 dependent on that lesion, will be present, and so far modify 
 the symptoms of the disease. If the symptoms and signs 
 referable to the intestinal disease as a cause — i. e., the con- 
 dition of the tongue, the diarrhea, increased resonance, and 
 fullness of the abdomen, gurgling in the iliac fossa, pain 
 and tenderness in the same region from the fluctuation of 
 the contents of the bowel — were the only symptoms by 
 which typhoid fever was separated from typhous fever, 
 
FEBRILE FORMS OF DISASE. 719 
 
 althongh the idea might cross the mind that they were two 
 diseases, no sufficient ground for their separation would be 
 present, unless the specific cause of the one was proved to 
 be different from that of the other. But, putting aside the 
 symptoms strictly referable to the abdominal lesion, the 
 general symptoms of the two diseases, in the cases here 
 analyzed, differed widely; such differences having no appa- 
 rent connection with the local affection, but being probably, 
 like it, dependent on some common cause acting on the 
 whole system simultaneously. 
 
 " Thus the remarkable differences in the kind, not sim- 
 ply amount, of the rash in the two diseases ; and the ten- 
 dency to local inflammations, to erysipelas, and to ulcera- 
 tion, observed in the cases of typhoid fever here analyzed, 
 can not, with any show of reason, be considered to have 
 been dependent on the disease of Peyer's patches — i. e.^ in 
 the same way as the abdominal signs undoubtedly were; 
 and it is to be carefully borne in mind that the external, 
 the hygienic conditions of either group of cases were pre- 
 cisely the same in all respects. They occupied the same 
 wards, partook of the same diet, slept on the same beds, 
 under the same amount of clothing, and had the same X->hy- 
 sicians to attend them, and the same nurses to wait on 
 them. 
 
 "Moreover, of the symptoms common to the two, the 
 headache continued longer, and the delirium and somno- 
 lence came on, as we have seen, much later, in typhoid 
 than in typhous fever ; and the delirium, too, possessed a 
 more active character. These differences, also, can not be 
 explained by the presence of intestinal disease in the 
 former, and its absence in the latter affection. 
 
 " The short comparative duration of the cases of typhous 
 fever here considered, is another remarkable point of difle- 
 rence, totally inexplicable by the hypothesis that typhoid 
 fever is typhous fever with intestinal ulceration. Had the 
 cases eventually recovered, it might have been said that the 
 intestinal lesion prolonged the disease in the cases of 
 typhoid fever ; but that all the fatal cases of fever, with a 
 
720 FEBRILE FORMS OF DISEASE 
 
 local lesion of so severe a nature as that recorded to have 
 been present in the cases of typhoid fever, should have had 
 a much longer course than all those other fatal cases of 
 fever in which no organic change of structure could be de- 
 tected after death, appears to me inexplicable, on the sup- 
 position that the former is simply the latter disease, with 
 this serious lesion superadded. Let me repeat, by this 
 hypothesis we are asked to imagine that death is retarded 
 in fever by extensive ulceration of the small intestines, and 
 enlargement, softening, and even suppuration of the mesen- 
 teric glands. Surely, it behooves the supporters of such a 
 statement to bring forward cogent proofs of the identity of 
 the specific cause of the two affections ere they ask us to 
 admit its truth. 
 
 " The same mode of reasoning appears to me equally 
 conclusive, when we consider the comparatively early 
 period of the disease at which the patients suffering from 
 fever lost the ability to make muscular exertion. For, to 
 suppose that the presence of abdominal complication in 
 fever invariably prevented the extremely early superven- 
 tion of debility is, aj>riori, still more absurd than to sup- 
 pose such lesions to have retarded death. How, again, are 
 we to explain, if we regard typhoid as typhous with ab- 
 dominal complication, the diflerences observed in the ages 
 of the patients ; in their general manner ; the muddy hue 
 of the skin and uniform flush of the face, the injected con- 
 junctivas and contracted pupils, in typhous fever ; and the 
 comparatively clear complexion, the pink flush limited to 
 the cheeks, the pale conjunctivas, and the large pupils, in 
 typhoid fever ? 
 
 " In what way, also, are we to account for the difl'erences 
 observed in the physical breath-signs, on the supposition 
 that the one is merely the other with abdominal compli- 
 cation ? 
 
 "Death itself, moreover, adds new proof to the non -iden- 
 tity of the general affection in the two diseases. The com- 
 paratively rapid loss of muscular rigidity, the discoloration 
 of the surface, the more flabby condition of the heart, 
 
FEBRILE FORMS OF DISEASE. 6*21 
 
 liver, and kidneys, the extreme softening of the stomach, 
 and the early separation of the epithelium, after typhous 
 fever, are all cadaveric changes, by which death makes us 
 cognizant of a condition of the system at large, which con- 
 dition must have existed anterior to the cessation of life 
 from that disease ; and which condition could not have 
 been present in the cases of typhoid fever, or death would 
 have made it manifest. 
 
 " I need not here more than advert to the dijfferences ob- 
 served in the lesions which death simply enabled us to lay 
 bare. The almost constantly-congested brain and mem- 
 branes in typhous fever; the frequent presence of the signs 
 of pre-existing serous inflammation in typhoid fever ; the 
 difference in the nature of the pulmonary lesions in the 
 two — are inexplicable on the supposition that the one dis- 
 ease is the same as the other, excepting so far as concerns 
 the abdominal affection. 
 
 '' Thus tried by facts — i. 6., by recorded symptoms and 
 lesions — the assertion that typhoid fever is merely typhous 
 with abdominal complication, is completely refuted. 
 
 " 2d. But another mode of explaining the differences 
 which exist between the two diseases have been given — ^. ^., 
 that the differences observed depend on variations in the 
 epidemic constitution. These cases afford a complete an- 
 swer to this assertion. For a majority of the cases here 
 analyzed of both diseases were observed during the same 
 epidemic constitution. If the reader will refer to vol. xix, 
 p. 668 Amer. Jour. Med. Sci., he will find that nineteen 
 of the cases of typhous fever I have used were collected 
 between May and November, 1848 ; and that thirteen of 
 the cases of typhoid fever were collected during the same 
 months of the same year. For such as prefer broad, gene- 
 ral assertions to the details of particular but more-limited 
 facts, I may remark, that during the three years' attentive 
 watching of nearly all the cases admitted to the London 
 Fever Hospital, in which time there have been epidemics 
 of relapsing fever, typhous fever, and cholera — and, conse- 
 quently, according to those whose opinions I am here exam- 
 
722 FEBRILE FORMS OF DISEASE. 
 
 ing, as many changes in epidemic constitution — I have 
 seen no alteration in the general or particular symptoms of 
 either typhous or typhoid fevers, or the lesions observed 
 after death from either — i. e.^ from November, 1846, to 
 November, 1849. The cases of typhoid fever — which dis- 
 ease is rarely absent for a fortnight from the wards of the 
 hospital — preserved their symptoms unchanged, and pre- 
 sented the same lesions, whatever the epidemic constitution 
 that prevailed ; the same is true of typhous fever. Cases 
 of the latter disease are also rarely absent from the wards 
 of the same institution. It is there common to see patients 
 occupying beds side by side, and presenting respectively 
 the well-marked characters of either disease. 
 
 "But to return to the particular cases here analyzed. 
 Allowing to epidemic constitution all the power of modify- 
 ing disease claimed for it by certain writers, it must be 
 granted that whatever influence this epidemic constitution 
 exercised over the group of cases without intestinal lesion, it 
 ought to have exercised over the group of cases with intes- 
 tinal lesion, because the cases of the two groups were scat- 
 tered indiscriminately over the space of two years only. If, 
 I repeat, the two affections were really the same disease, 
 then the same epidemic constitution ought to have im- 
 pressed on both the same general features, implanted in 
 both the same local lesions, and given to both the same 
 tendency to cadaveric changes, and this allowing for all 
 the modifying influence which the accidental presence of 
 the abdominal lesion in the one and its absence from the 
 other group might have occasioned. The analysis of every 
 symptom, and every lesion, shows that the two aflTections 
 were not thus assimilated by the prevalence of any partic- 
 ular epidemic constitution. But if this epidemic constitu- 
 tion, by any stretch of the imagination, could be supposed 
 to change from week to week, to cause the case attacked 
 to-day to have typhous fever, the individual who takes the 
 disease to-morrow to have typhoid fever, still, it could 
 not account for the fact — as well established as any fact 
 in medicine — that typhoid fever rarely, if ever, affects per- 
 
FEBRILE FORMS OF DISEASE. . 723 
 
 sons more than fifty years of age ; while age exerts little 
 influence in determining the occurrence of typhous fever. 
 
 " Thus, then, the assertion that typhoid fever is merely 
 typhous fever modified by the prevailing epidemic consti- 
 tution is as irreconcilable with facts as that the former dis- 
 ease is simply the latter with abdominal complication. 
 
 " To conclude — In a former paper, I proposed to examine 
 whether typhoid fever and typhous fever differed from each 
 other in the same way as small-pox and scarlet fever dif- 
 fered from each other ; and for the purpose of comparison, 
 I laid down certain grounds, as those on which we founded 
 our belief in the non-identity of the two last-named dis- 
 eases. Those grounds were : 
 
 "1st. In the vast majority of cases the general symptoms 
 differ — i. e.^ of small-pox and scarlet fever. 
 
 "[This holds equally true with respect to the general 
 symptoms of typhoid and typhous fevers.] 
 
 " 2d. The eruptions, the diagnostic characters, if jpre- 
 sent^ are never identical — i. ^., in small-pox and scarlet 
 fever. 
 
 "[The particulars detailed in the foregoing papers prove 
 that this is true of the eruptions of typhoid and typhous 
 fever as of those of small-pox and scarlet fever.] 
 
 "3d. The anatomical character of small-pox is never 
 seen in scarlet fever. 
 
 " [Just in the same way, the anatomical character of 
 typhoid fever — i. e., lesion of Peyer's patches and the me- 
 senteric glands — is never seen in typhous fever.] 
 
 " 4:th. Both — i. 6., small-pox and scarlet fever — being 
 contagious diseases, the one by no combination of individ- 
 ual peculiarities, atmospheric variations, epidemic consti- 
 tutions, or hygienic conditions, can give rise to the other 
 disease. 
 
 " [In this paper, I have not attempted to determine how 
 far this holds true with respect to the diseases here treated; 
 but I have considered it in a paper read before the Medico- 
 Chirurgical Society of London, December, 181:9 [Amer. 
 Jour. Med. Sci., vol. xx, p. 381:], the contents of which I 
 46 
 
724 FEBRILE FORMS OF DISEASE. 
 
 may anticipate so far as to state that, to my mind, the 
 origin of the two diseases from distinct specific causes is 
 as clearly proved as that scarlet fever and small-pox arise 
 from distinct specific causes.] 
 
 "5th. The epidemic constitution favorable to the origin, 
 spread, or peculiarity in form or severity of either — i. e., 
 small-pox and scarlet fever — has no influence over the 
 other excepting that which it exerts over disease in general. 
 
 " [The facts detailed in this paper prove that this holds 
 as true of typhoid as typhous fevers as of small-pox and 
 scarlet fever.] 
 
 " If, then, the above are the grounds — and, after mature 
 deliberation, I am able to assign no others — for the separa- 
 tion of small-pox from scarlet fever, I think it is indisput- 
 ably proved that typhoid fever and typhous fever are equally 
 distinct diseases ; not mere varieties of each other, but spe- 
 cifically distinct — specific distinction being shown in 
 typhoid and typhous fevers, as in small-pox and scarlet 
 fever, by the difierence of their symptoms, course, dura- 
 tion, lesions, and cause. 
 
 " Before closing this paper, I ought to observe that, with 
 respect to some secondary points — e. g., the chronological 
 relation between the laryngeal and pharyngeal afiections — 
 it may be considered that I have drawn general conclusions 
 from a too limited number of facts. But a few facts, im- 
 partially observed, minutely recorded, and carefully ana- 
 lyzed, are, I believe, more likely to give correct results than 
 a multitude of general observations ; and moreover, I be- 
 lieve most men would be astonished, if they had in num- 
 bers all the cases of any given disease they had ever seen, 
 yet concerning which they have generalized. The method 
 I have adopted, however prolix it may be, however difficult 
 to conform to, however tedious the details into which it 
 leads, has this advantage, that, if the observer be honest 
 and capable of noting what is before him, thinking men 
 may judge of the value of his facts, the force of his 
 reasoning, and the correctness of his conclusion ; whereas, 
 general observations, while they are incapable of prov- 
 
FEBRILE FORMS OF DISEASE. 725 
 
 ing anything, are exposed to all the fallacies of definite 
 statements, because the one, like the other, rests ulti- 
 mately on the accuracy of the facts observed. If the ob- 
 servations, on which any reasoning is founded, be erro- 
 neous, no cloaking of those observations, in general terms, 
 can render the conclusions correct. It has been objected to 
 definite numerical statements, that they mislead the reader 
 by an aj)pearance of accuracy, in cases where there has 
 been great inaccuracy in observation. This objection ap- 
 pears to me to lie against the condition of the reader's 
 mind, and not against the method. For if the reader fails 
 to examine, 1st, the trustworthiness of the author, and 2dly, 
 the legitimacy of his conclusions, the fault is, obviously, 
 mentally his own, and in noway to be ascribed to the 
 method. Because chemists have, by the imperfection of 
 their analysis, arrived at incorrect conclusions as to the 
 ultimate constitution of various organic bodies, we surely 
 would not have them henceforth confine themselves to the 
 general impressions produced on their minds by a series of 
 experiments or observations. The more complicated the 
 problem to be solved, the more careful ought we to be that 
 every step in its solution is made correctly. How complex 
 questions, such as arise in medicine, are to be determined 
 mentally- — i. 6., without the aid of figures — by ordinary 
 men, I am at a loss to conceive. Yet physicians think to 
 solve, by mental reveries, problems in comparison with 
 which the most difiicult that the most renowned mental cal- 
 culators ever answered were child's play ; and not only do 
 they think to solve these problems, but to carry in their 
 minds for years the complicated materials by which they 
 are to be solved. 
 
 " "Who can tell what general statements are worth, with- 
 out knowing on what evidence they rest ? One man's many 
 is another's few. Last month (Oct.) I saw thirty cases of 
 fever — ^to me these were few ; to men with smaller oppor- 
 tunities of observing that disease, they would have been 
 many. One man's frequent is another's seldom." 
 
726 INFLAMMATORY FORMS OF DISEASE. 
 
 ORDER II. 
 
 OR THOSE WHICH AEE 
 REMOVED BY INFLAMMATION. 
 
 General Remarks. — Professor Eberle calls inflamma- 
 tion a vascular form of disease. Our definition has already 
 been given. It is said to be characterized by pain, redness, 
 swelling, and increased heat ; and yet, it is conceded that 
 neither of these phenomena is essential to its existence. It 
 is said to terminate by resolution, suppuration, and gan- 
 grene. "We deny the two latter ; they are chemical processes, 
 and the last frequently happens without having been pre- 
 ceded by inflammation. 
 
 Inflammation, therefore, when properly considered, has 
 but one termination, and that is by resolution or the re- 
 establishment of health ; under some circumstances, no 
 accumulation of vital force can efiect this, and suppuration 
 is the result — the only means by which, under the circum- 
 stances, depuration can be effected. Gangrene is a chemi- 
 cal process which results from deficient vital power. 
 
 Genus I. — Cerebritis — 
 
 Softening of the Brain — RamoUissement du Cerveaii — 
 
 Inflammation of tJie Substance of the Brain. 
 
 In the early records of medicine but little can be found 
 upon this subject as an independent form of disease. We 
 are indebted, almost entirely, to modern investigation for 
 all that is now known with reference to it. 
 
 Its introductory stage is indicated by uneasiness and rest- 
 lessness, a sense of weight and fullness in the head, with 
 occasional attacks of pain in it, drowsiness and vertigo, 
 flushing of the face and increased heat of the head, acute- 
 ness of the external senses, optical illusions, contractions 
 of the pupils, intolerance of light, strabismus, imperfect 
 
CEREBRITIS. 727 
 
 vision, tinnitus aurium, confusion of thought, an obvious 
 departure from the previously-established character of men- 
 tal action in some respect, imperfection of the memory, 
 pains in the limbs, lassitude, muscular debility, disturbed 
 sleep, paroxysms of chilliness and flushings of heat or 
 feverishness, and sometimes obstinate vomiting. Many of 
 these symptoms, particularly those wliich pertain to the 
 head, may continue for several months. 
 
 At length, in what some have denominated the second 
 period, paralysis of some part or parts supervene ; and 
 such is the injury that has already fallen upon his nomina- 
 tive faculties, that he resorts to pantomime to make known 
 his wants. Occasionally coma and convulsions supervene. 
 In many instances convulsions first announce the existing 
 danger — sometimes they recur at short intervals, at other 
 times they continue for many hours, and occasionally are 
 succeeded by a contracted state of the flexor muscles and 
 coma. From this condition the patient may recover and 
 appear well for several days, and then, without the least 
 premonition, the convulsions return and pass into fatal 
 coma. 
 
 In some instances, the convulsive paroxysms entirely 
 subside, the muscular system becomes relaxed, and paraly- 
 sis, more or less complete, succeeds ; the eyes become 
 sunk, pale, and dim ; the pupils become dilated and mo- 
 tionless ; the pulse is rapid, small, and unequal ; rigors 
 become frequent ; the skin becomes cold and loaded with a 
 clammy sweat ; the respiration is slow and stertorous ; the 
 face is sunk and cadaverous ; the patient lies senseless on 
 his back ; deglutition is difficult, and a fatal issue is close 
 at hand. Paroxysms of excitement and collapse may recur 
 several times, or until in this way he finally sinks into 
 coma and death. 
 
 The symptoms, in no one case, can fairly represent any 
 other one case, because of the numerous modifications that 
 result from the difierence in the extent of the invasion, and 
 the part in which it may be particularly located ; this will 
 become obvious when we reflect that diflerent portions of 
 
728 INFLAMMATORY FORMS OF DISEASE. 
 
 the brain perform different functions. Post-mortem exam- 
 inations of the brain in this form of disease discover a soft- 
 ening of some of its parts — it consists, when complete, of 
 an entire disorganization, and of various shades of color. 
 This 7'amollissement may exist in distinct and compara- 
 tively-distant portions of the organ. 
 
 The nature of this disorganization continues a subject of 
 doubt in the profession. Some regard it as a result of in- 
 flammation, while others entertain the opinion that it 
 results in a manner similar to that which is effected in 
 tuberculous matter in the lungs. We are of the former 
 opinion. 
 
 Dr. Abercombie (Eberle) thinks it most probable that 
 there are two modifications of this affection ; one he thinks 
 is inflammation, and the other a cerebral gangrene, Irom 
 deficient circulation. If cerebritis was confined to the 
 third class of constitutions — the organically ensemic — we 
 might feel disposed to take this view of the subject ; never- 
 theless, there are some circumstances that yield counte- 
 nance to the opinion— its existence in those who had ex- 
 hausted their vital force by an immoderate use of ardent 
 spirits. 
 
 Causes. — Depressing mental emotions ; drunken habits; 
 blows on the head ; suppression of accustomed evacua- 
 tions. 
 
 Diagnosis. — There exists a possibility of confounding 
 this form of disea,se with tuberculous meningitis, apoplexy^ 
 and some varieties of hysteria. When the case is attended 
 by frequent pulse, headache, delirium, general convulsions,, 
 and ultimately coma, without rigid spasm or local paraly- 
 sis, we may presume the presence of meningitis (Wood) ; 
 but so intermingled are the symptoms of these two forms 
 of disease, that no certain diagnosis can be given, and for- 
 tunately no great mischief can result from the mistake if 
 made. 
 
 Pkognosis. — This must always be esteemed a dangerous 
 form of disease, and it is probably safe to conclude that all 
 severe cases prove fatal. 
 
PLEURITIS 729 
 
 Teeatment. — The treatment must be similar to that laid 
 down for meningitis, in a preceding part of the work, re- 
 membering, however, to employ it more actively and ener- 
 getically in the case of adults. 
 
 While most authors recommend depletion in this disease, 
 probably for the purpose of subduing inflammation, and 
 which must greatly diminish the normality and number of 
 the blood corpuscules, we consider it a much better mode 
 of treatment, and more properly adapted to this disease, to 
 employ agents which will enrich and invigorate the blood, 
 thereby furnishing the brain with healthy corpuscules, and 
 assisting nature to overcome or retard the progress of the 
 lesion ; for this purpose, chalybeate preparations, and alter- 
 ative tonics, with generous but not too-stimulating diet, 
 will be proper. 
 
 Genus II. — Pleuritis — 
 
 Pleurisy. 
 
 This name was used, in an early age of the profession, 
 to designate a pain in the side, without any reference to its 
 precise location ; but the idea it now conveys is that of in- 
 flammation of the pleura — the serous membrane that invests 
 the lungs and lines the cavity of the thorax. Inasmuch as 
 it is not known that adhesions are ever efiected without in- 
 flammation, and as they are very frequently found in some 
 portion of this membrane, we may reasonably conclude 
 that pleurisy is a very frequent disease — and frequently we 
 know it to be a fatal one. 
 
 So intimate is the connection between this membrane 
 and the lungs, that it was at one time supposed to be im- 
 possible for one to be invaded by inflammation without 
 involving the other ; but the contrary is now known to be 
 the fact, which was beautifully illustrated when treating of 
 this afi'ection in children. Nevertheless, it is true that the 
 complication is frequent. 
 
 This form of disease presents so many varieties as to 
 render it impossible, or at most, obscurely possible, to obtain 
 a general view of it from any one position. As Dr. Law 
 justly remarks, " It may be acute or chronic ; it may aflect 
 
730 INFLAMMATORY FORMS OF DISEASE. 
 
 one side of the chest or both sides ; it may be general, in- 
 volving the whole of one side, or partial, only involving a 
 part of one side ; it may be simple or complicated ; the 
 complication may be either accidental or essential, and in 
 the latter case the pleurisy and its complication stand to 
 each other in the relation of effect and cause." 
 
 The right pleura is more frequently the seat of the dis- 
 ease than the left, and it is not unfrequently influenced by 
 modifying causes ; hence it may be combined with bilious 
 or typhoid fever, and then the disease is known as bilious 
 pleurisy, typhoid pleurisy, etc. It may also be complicated 
 with pneumonia, in which case it is known as pleuro-pneu- 
 monia. 
 
 Species I. — Acute Pleuritis. 
 
 This is an acute pain in the side, accompanied with an 
 inflammatory fever, difiicult and painful respiration. 
 
 It begins with rigor and shivering, followed by heat, 
 thirst, inquietude, and an acute, pricking pain in the side, 
 verging toward the spine or clavicles ; the pulse is hard 
 and tense, like the vibrations of a cord ; the patient lies 
 without difficulty on the aflected side, and has a dry cough 
 which increases the pain ; the urine is high-colored ; the 
 blcod drawn by venesection coheres very strongly together, 
 and is covered with a tenacious, whitish coat, resembling 
 matted tallow ; the head aches ; respiration is performed 
 with much difficulty, and an expectoration of a thin, sani- 
 ous, and often bloody matter comes on after the third day 
 from the first attack. 
 
 The pain may be the first symptom, or it may come with 
 the chill, or not until it has passed ofi*. Most generally the 
 pain is in the mammary region, and yet it is often felt else- 
 where, depending measurably upon its location in the 
 pleura. It will be felt, for instance, in the inferior margin 
 of the chest, when the diaphragmatic pleura is the location 
 of the inflammation. When it is located in the lining 
 pleura of the chest the pain is increased by intercostal pres- 
 sure. Sometimes it is extensively diflfused, and then the 
 pain is less acute. Internal pressure, as suspended respi- 
 
ACUTE PLEURITIS. 731 
 
 ration, stops the pain. The violence of it is modified with 
 the exacerbations and remissions of the fever. The pain, 
 in some cases, is scarcely felt, except upon a full inspira- 
 tion, coughing, or pressure. 
 
 With reference to the breathing, the dyspnoea increases 
 as the disease advances, but it becomes to result from pres- 
 sure on the lung by the serous effusion which has dimin- 
 ished both the inflammation and the pain. In consequence 
 of the constricted condition of the lungs, the patient feels 
 a distressing want of breath all the time ; but this is much 
 increased by a sudden and copious effusion, which now 
 arises rather from pressure than constriction. It is proper 
 to add, however, that this symptom, in some cases, never 
 supervenes, although all the conditions that usually produce 
 it are present. 
 
 Dr. Watson says : " In some patients the dyspnea never 
 ceases to be urgent from first to last ; and these are apt to 
 prove fatal cases. In others the respiration is very much 
 impeded at first; then the difficulty of breathing dimin- 
 ishes ; and at length it ceases long before the fluid is re- 
 absorbed. In others again, by some unaccountable idio- 
 syncrasy, the respiration remains at all times very facile, 
 both at the outset and during the progress of the disease." 
 
 The attending cough is short and dry, and will measura- 
 bly continue so, unless some bronchial irritation or inflani- 
 mation should supervene, and then it maybe attended with 
 a mucous or frothy expectoration, which in a few instances 
 is streaked with blood. In some cases, not only the pain, 
 as we have remarked, but also the cough is absent — such 
 forms of the disease have been denominated latent pleiirisij . 
 The fever undergoes a daily exacerbation and remission ; 
 the latter occurs in the morning, and the former toward 
 evening ; the pulse is usually full and tense in the hot 
 stage, but, it is worthy of note, that when the pain is very 
 great, there is some reduction of the pulse. Delirium is 
 sometimes present in the course of the inflammatory stage. 
 
 Among the physical signs by which we are to determine 
 the presence of pleurisy, most reliance should be placed, 
 
732 I^^FLAMMATORY FORMS OF DISEASE. 
 
 perhaps, upon the results of auscultation. In the begin- 
 ning of the disease, before effusion has taken place, the 
 percussion is clear — giving no other auscultorj sign than 
 a diminished respiratory murmer — a result of a less pul- 
 monary expansion ; but after the effusion has commenced, 
 a comparison of the results of percussion upon the two 
 sides can leave no doubt. Instead of a healthy resonance 
 upon the diseased side, there is an unmistakable dullness, 
 which increases with the effusion until a complete flatness 
 is produced. 
 
 PosT-MORTEM APPEARANCES. — ^A thickened condition of 
 the pleura is but seldom a result of this inflammation ; but, 
 in fatal cases, an extravasation upon its interior surface, of 
 a pseudo- membranous substance, is an uniform result ; and 
 it usually contains fllaments of coagulable lymph or con- 
 crete pus, which may be nearly transparent, reddish, or of 
 a light-yellow color. Through the interposition of the 
 pseudo-membranous matter, adhesions between the costal 
 and pulmonary portions of the pleura are usually efiected. 
 
 Causes. — This form of disease most frequently attacks 
 persons of the first class — the feeble are but little liable to 
 it, except perhaps from metastasis. Of external causes, 
 cold, acting upon the body in a state of perspiration from 
 exercise, is the most common. It is not unfrequently occa- 
 sioned by metastasis of rheumatism, erysipelas, and gout — 
 affections, wdiich are emphatically of the same class. A 
 modification of this form of disease not unfrequently results 
 from surgical operations. 
 
 Prognosis. — Easy respiration and purulent expectoration 
 indicate a favorable termination ; but a great difiiculty of 
 respiration, a sense of imminent suffocation, a plentiful 
 discharge of aqueous urine, and a dry cough, after the close 
 of the third day, portend a fatal termination. A sudden 
 cessation of the expectoration, without sediment in the 
 urine, a violent diarrhea, and a hippocratic countenance 
 indicates a speedy dissolution. A relapse generally proves 
 fatal. 
 
 Although this is a yerj dangerous form of disease, yet it 
 
ACUTE PLEURITIS. T^d 
 
 is not, under a careful and judicious treatment, a frequently 
 fatal one. 
 
 Treatment. — This is one of the most unyielding forms 
 of disease to Allopathic practice, and its history and treat- 
 ment have afibrded a text for writers to consume pages 
 upon ; nevertheless it is perfectly tractable to a mild but 
 thorough and active course of medication. Ordinarily, we 
 are in the habit of producing copious perspiration by means 
 of the spirit vapor-bath, if the strength and condition of 
 the patient will admit. If, however, this can not be done, 
 we give the Compound Tincture of Virginia Snakeroot in 
 two or three-drachm doses, and repeat it at short intervals 
 until the patient perspires very freely, when instant relief 
 is afforded. 
 
 After the patient has been relieved, and can breathe 
 without pain, or at all events with but little pain, an emetic 
 should be administered, which is more especially indicated 
 in that form termed hilioiis jyleurisy ^ and which should be 
 followed by an active cathartic. Should more or less pain 
 still continue, the Compound Tincture of Yirginia Snake- 
 root may be given in half-drachm doses every two or three 
 hours for the purpose of keeping up a moisture of the sur- 
 face ; and to relieve cough and assist expectoration, some 
 nauseant-expectorant must be given, as the Compound 
 Tincture of Lobelia. 
 
 In cases where, from the condition of the patient, it was 
 impossible to use the spirit vapor-bath, and where the em- 
 ployment of the above tincture was forbidden — likewise in 
 instances where the disease has presented itself as a com- 
 plication with some other disease. Prof. J. King has met 
 with excellent success by covering the whole of the affected 
 chest with a fomentation of bitter-herbs, as hot as could be 
 borne, and which should be renewed every five minutes ; 
 in many instances relief was given in five minutes, and in 
 fifteen minutes from the first application the patient was 
 free from pain. 
 
 We have adopted this plan in similar cases, and with 
 debilitated patients, and fo«id it to be eflicacious, aflbrding 
 
73i INFLAMMATORY FORMS OF DISEASE. 
 
 prompt and immediate relief; and in very severe cases we 
 have conjoined it witli the internal use of the Compound 
 Tincture of Virginia Snakeroot. 
 
 Occasionally, the practitioner will meet with cases which 
 do not so readily yield to treatment ; that is, although the 
 pain is removed, yet it returns, or continues with less 
 severity than at first ; in such instances the use of the hot 
 foot-bath and counter-irritation over the chest and between 
 the shoulders by means of sinapisms, with draughts of a 
 warm infusion of the roots of Asclepias Tuberosa and 
 Althaea Officinalis, and the Compound Powder of Ipecacu- 
 anha and Opium, will be found to be very valuable aux- 
 iliaries. 
 
 After the above treatment, should the pulse continue full 
 and hard, with no mitigation of the symptoms, hemastasis 
 may be performed, and continued until approaching syn- 
 cope ; the ligatures must be applied with caution, being 
 careful not to check the arterial circulation, nor confine the 
 the venous circulation too long, lest mortification ensue. 
 However, under the treatment just given, such cases will 
 be very rare. 
 
 The diet should be low, consisting in the early stage of 
 mucilaginous liquids, with acidulated drinks if craved, and 
 during convalescence, toast-bread, stewed fruit, oranges, 
 etc. The temperature of the room should be kept uniform; 
 the patient may lie with his head and chest elevated some- 
 what, and should avoid speaking and coughing as much 
 
 as possible. 
 
 Species II. — Clironio Pleicritis. 
 
 By the chronic form of disease we usually understand 
 not only one in which the symptoms proceed slowly, but 
 one that was preceded by its antithesis — the acute. By 
 chronic pleurisy, therefore, we are to understand that there 
 occur two distinct varieties: one is a continuation of the 
 disease from its acute stage or form, and the other is chronic 
 from the beginning. 
 
 In treating of the acute form, we remarked that it was 
 mostly confined to persons of a full, strong, and athletic 
 
CHRONIC PLEURITIS. 735 
 
 habit, and now we have to state that the organically chronic 
 form obtains in those who constitute the most feeble of the 
 third class — those of a cachectic habit of body — those, pos- 
 sibly, in whom the vital force is incapable of manifesting 
 the acute form. It may also occur in those of the first 
 class whose constitutional vigor has been exhausted by pre- 
 vious disease or long-protracted habits of intemperance. 
 These two varieties, though very different in their origin 
 and in their respective subjects, will nevertheless be treated 
 of as one form, as no therapeutical advantage can be ob- 
 tained by a separate consideration of them. 
 
 In this form of the disease there is but little acceleration 
 of the pulse or of the cutaneous temperature, and the pain 
 in the side does not usually amount to more than a mere 
 soreness. The respiratory difficulty is but rarely such as 
 to attract the patient's attention ; yet his pallid and un- 
 healthy appearance is such as to arrest the attention of 
 every observer — to declare that mischief is progressing. 
 His appetite is gone, much languor is present, also a dry 
 cough, which may be attended with a scanty mucous expec- 
 toration and some febrile movement toward evening. When 
 we find the cough, without any indications of crude tuber- 
 cles in the lungs, or any gastro-intestinal irritation, we 
 can have but little reason to doubt the existence of chronic 
 inflammation of the pleura. 
 
 The anatomical peculiarities of this form do not differ 
 much from those of the acute, except in magnitude ; the 
 pseudo-membranes are generally more developed, and when 
 this form is but a continuance of the acute, this membrane 
 appears to consist of recently-deposited laminge upon those 
 of the acute stage — the latter being more firm and adherent 
 to the pleura. The effused fluid is generally more turbid — 
 containing fibrinous fiocculi, or it is purulent and of a dis- 
 agreeable odor, or it has the consistence of jelly. Some- 
 times the quantity is so enormous as to produce an enlarge- 
 ment of the chest and an equal compression of the lung. 
 When the disease has been of long continuance, the spine 
 is apt to become deformed — so curved that its concavity is 
 
T36 INFLAMMATORY FORMS OF DISEASE. 
 
 directed toward the disease, and if it be on the left side the 
 heart becomes also displaced. 
 
 Diagnosis. — This form of disease is usually so insidious 
 that it is apt to have made considerable progress before the 
 patient becomes admonished to seek medical aid ; hence at 
 this time it will generally be found that the diseased side is 
 rounder, and the intercostal spaces possess more than a 
 normal dilation and elevation ; possibly some flatulence 
 may be felt, and it is also possible that the integuments 
 may be oedematous, and it is further possible that some 
 displacement of the spine may exist. 
 
 Prognosis. — This is generally unfavorable — when un- 
 complicated a hectic fever usually supervenes which rapidly 
 destroys the patient. In some instances a cure is sponta- 
 neously efiected by absorption ; or when the fluid is puru- 
 lent, by making a passage through the pulmonary tissue 
 into the bronchial tube, when it is coughed up ; or through 
 the parietes of the thorax, when it is discharged externally. 
 
 Treatment. — Chronic pleurisy is often the termination 
 of the acute form, and though generally not so immedi- 
 ately dangerous, yet it is as certainly fatal in its results, if 
 not arrested. 
 
 The treatment, which we have pursued and found the 
 most successful, is the application of the Compound Tar 
 Plaster over the affected side, the use of which must be 
 continued until a free discharge of purulent matter takes 
 place; after which, remove the plaster and dress the ulce- 
 rated surface with the Compound Lead Ointment, continu- 
 ing its use, until the irritability of the part subsides, and 
 the soreness of the ulcer is somewhat removed. If, how- 
 ever, the pain in the chest should still continue, the irritat- 
 ing plaster should be re-applied, and the same process con- 
 tinued alternately and intermittently until the pain is com- 
 pletely dissipated. 
 
 In connection with this, should there be any febrile 
 symptoms, quick pulse, increased temperature of the sur- 
 face, or irritability of the nervous system, the Compound 
 Powder of Ipecac, and Opium should be given in doses of 
 
PULMONITIS. 737 
 
 about five grains every three or four hours, and continued 
 until such symptoms are alleviated. 
 
 In the absence of any symptoms of the above character, 
 the Compound Syrup of Stillingia and the Iodide of Potas- 
 sium, in the proportion of one drachm of the salt to six 
 fluid ounces of the syrup, must be given in doses of a fluid 
 drachm every three or four hours, to act as an alterative in 
 arresting organic changes which so frequently take place 
 in this disease, as well as to promote the absorption of 
 eflused serum. 
 
 For the dry cough which usually accompanies this form 
 of pleurisy, nauseant-expectorants may be given with ad- 
 vantage, as the Compound Tincture of Lobelia, or the pre- 
 paration of Senega, Scpills, and Paregoric, equal parts of 
 each, as heretofore referred to. 
 
 The diet should be of a nutritious and easily-digestible 
 character, consisting of farinaceous articles, cooked fruits, 
 and fresh vegetables, together with the addition of eggs, 
 oysters, boiled meats, etc., in cases of great debility. 
 
 Active exercise should be prohibited, and sudden changes 
 of temperature, or exposures to damp air, night air, or 
 noxious atmospheres, should be avoided. The surface of 
 the body should be often bathed, and the various excretory 
 functions properly attended to. 
 
 Genus III. — Pulmonitis — 
 
 Pneumonia — Peripneumonia — Pneumonitis — Inflam^na- 
 
 tion of the Lungs. 
 
 This afiection is defined by Dr. C. J. B. Williams (Cyc. 
 Prac. Med.) to be, " fever, with more or less pain in some 
 part of the chest; accelerated and sometimes oppressed 
 breathing ; cough, with viscid and rust-colored expectora- 
 tion ; at first the crepitant rhonchus, afterward bronchial 
 respiration, and bronchophony, with dullness of sound on 
 percussion in some part of the thorax." 
 
 We may remark, in so many words, that this form of 
 disease consists of an inflammation of the parenchyma of 
 the lungs. It may, or it may not involve the pleura, but 
 
738 IMFLAMMATORY FORMS OF DISEASE. 
 
 when it does, the complication is denominated pleuro- 
 pneumonia, or pleuro-pulmonitis. 
 
 The disease is divided by writers into two species — the 
 common or lobar, and the lobular. The latter, though not 
 entirely confined to children, we treated of in the preced- 
 ing Book, and the former will now engage our attention. 
 
 It begins with a sense of coldness, which sometimes 
 amounts to a decided chill, succeeded by heat or fever ; a 
 full and strong pulse, which is sometimes considerably ac- 
 celerated ; laborious, quick, and hot respiration ; an oppres- 
 sive, heavy, but not acute pain ; redness of the face 
 and eyes ; anxiety ; inquietude and weakness ; sometimes 
 vomiting ; a dry cough ; dryness of the mouth and tongue ; 
 pain in the shoulders ; high-colored urine, which becomes 
 turbid after cooling ; watchings, and sometimes delirium. 
 At length respiration is performed with a hissing noise ; 
 the pulse grows trembling and weak ; the sight becomes 
 dim ; the extremities cold ; a moisture appears on the supe- 
 rior parts of the body, and death ensues. 
 
 These are briefly the usual symptoms of pneumonia or 
 pulmonitis, but as they are attended with many modifica- 
 tions, a few remarks by way of explanation are demanded. 
 
 Although it is common for the chill and fever to precede 
 the other symptoms, yet it sometimes happens that the pain 
 and dyspnoea have precedence ; and, in those cases where 
 pneumonia supervenes upon bronchitis, the chill does not 
 happen at all ; and, in some cases where it is present, it 
 is preceded by a sense of depression and languor, a disor- 
 dered condition of the stomach and bowels, and pains in 
 the back and limbs. To these symptoms a shivering fit 
 and intense pyrexia may succeed, and yet precede any local 
 symptom even by a day or two. 
 
 When SiCute pain is present, it is probably occasioned by 
 some invasion of the pleura ; but it frequently happens that 
 there is no acute pain in the whole course of the disease, 
 and in a few instances no pain is complained of in any 
 stage. But most frequently pain is present, and its charac- 
 ter is one of stricture, soreness, oppression, or weight, and 
 
PULMONITIS. 739 
 
 it may be referred to the region of the sternum, epi- 
 gastrium, side, or even both sides. In some instances, 
 when the pain appears to be absent, it can be elicited by 
 a full inspiration, coughing, or pressure between the ribs. 
 
 The cougli^ though sometimes very severe, is in many in- 
 stances entirely absent to a late period of the disease. 
 Before or until some pulmonary secretion has been effected, 
 it will be dry, but at length it becomes viscid, of a rusty 
 color, or it may become yellow or green, or more or less 
 stained with blood. The rusty and viscid character of the 
 matter expectorated is perhaps the most diagnostic symp- 
 tom that attends the disease. The expectoration is never 
 very copious in pure pulmonitis, yet it does become so when 
 complicated with catarrhal symptoms. Toward the close 
 of the disease the expectoration, as in the beginning, be- 
 comes scanty, and passes into a purulent form. In the pro- 
 tracted stage of threatening cases the pulmonic secretion 
 becomes quite liquid, sometimes tinged with blood, and 
 finally of a very dark color, which observation has disco- 
 vered to be a very dangerous symptom. 
 
 In this form of disease the breathing becomes exceed- 
 ingly rapid — passing from the normal standard to as many 
 respirations in some cases as sixty per minute, and so dif- 
 ficult is it, sometimes, that the patient has to assume, more 
 or less, a vertical position. The dyspnoea is sometimes so 
 exceedingly urgent as to render it almost impossible for the 
 patient to speak, and when it becomes so violent as to pro- 
 duce a livid color of the face, the danger becomes extreme. 
 
 The fever is scarcely ever absent in this inflammation, 
 and in many instances it constitutes almost the only symp- 
 tom. For some days, in many cases, the headache it in- 
 duces constitutes ahnost the only trouble of which the 
 patient complains — being often so severe as to run into 
 delirium, and when thus severe it is an unfavorable symp- 
 tom. In most instances the pulse is only moderately accel- 
 erated, but it is always full and strong. When it becomes 
 very frequent, some complication may be suspected. The 
 skin is generally hot and dry, and the cheeks flushed ; the 
 47 
 
740 INFLAMMATORY FORMS OF DISEASE. 
 
 urine scanty and high-colored. In some instances the pros- 
 tration is extreme from the beginning — ^indicating perhaps 
 a high state of congestion and more or less of constitu- 
 tional debility. 
 
 The application of percussion and auscultation have been 
 brought to such an accuracy, that they now furnish the 
 most certain means of obtaining a knowledge of thoracic 
 conditions that the experienced physician can command ; 
 and hence their use should never be neglected when accu- 
 rate information is desired with reference to this form of 
 disease. 
 
 Dr. Williams says, that in the beginning of the inflam- 
 mation there is, in the respiratory function, "a crackling 
 or crepitating sound, like that produced when kitchen salt is 
 thrown on a heated iron," or like the sound emitted by rub- 
 bing hair between the fingers near to the ear. He adds, 
 that Leennec regarded this sound as " pathognomonic of 
 the first stage of pneumonia." He continues : " The parts 
 where it is most commonly heard are below the inferior 
 margin of the scapula, below the axilla, or about the lower 
 margin of the pectoral muscle, points corresponding with 
 the lower lobes of the lungs, which, as we have before no- 
 ticed, are the most frequent seats of the inflammation ; 
 but it is occasionally to be met with in other parts of the 
 chest." 
 
 In the second stage of the disease, percussion over the 
 hepatized portion of the lung yields a sound as dull as if it 
 was made over the liver — neither the respiratory murmur 
 nor the crepitant rhonchus of the first stage is heard. 
 When the hepatization reaches or approaches the middle 
 parts and root of the lobes, and extends to the surface, a 
 whiffling sound is heard, amounting sometimes to a whistle, 
 called, by Andral, the bronchial respiration. With these 
 sounds there is often mixed a mucous gurgling, but it is 
 circumscribed and obscure. 
 
 When the third stage arrives there is, with the dull 
 sound of the second stage, heard at the root of the lungs, 
 in many instances, a coarse mucous rhonchus ; but the 
 
PULMONITIS. 741 
 
 bronchial respiration and resonanc^e continue, in some in- 
 stances, and then we have no proof that the third or suppu- 
 rative stage has supervened. 
 
 In the event an abscess shall form in any part of the 
 luno;s, we obtain no evidence of its existence until an ex- 
 pectoration of matter shall have taken place, and then a 
 cavernous rhonchus will be heard at the corresponding 
 point. 
 
 Causes. — This form of disease is most generally confined 
 to those who constitute the first class, and more particularly 
 those in whom the organ of animal sensibility is highly de- 
 veloped — for it is usually occasioned by atmospheric causes. 
 Dr. Wood says : "Of the predisposing causes, cold may 
 be ranked among the most efiicient. HeDce the disease 
 prevails most in cold countries." In this opinion we agree 
 with him. Animal sensibility is more generally developed 
 in cold than warm latitudes, and this provision was indis- 
 pensable as an admonition against too much exposure. 
 The surface being very sensitive to the impression of cold, 
 it becomes constricted under an exposure to it, forcing the 
 fluids upon the internal organs. But this is not ordinarily 
 the cause of the disease ; it usually results from a sudden 
 exposure to cold when the surface is in a perspiring condi- 
 tion, and more especially when the reactive energies of the 
 system have become fatigued by previous exercise. The 
 depuration that was going on became suddenly arrested j 
 and the whole cutaneous system has, consequently, become 
 obstructed and pneumonia may be the result. 
 
 When those of feeble vital forces become similarly ope- 
 rated upon, the most frequent result is catarrh or bronchi- 
 tis, which may develop a pre-existing tubercular liability, 
 and consumption may be the result. We have somewhere 
 else remarked how much gross men suffer under the influ- 
 ence of cold more than lean men or spare women, and how 
 much more the latter can endure exposure to cold and wet 
 than the former, without provoking disease. 
 
 Some persons of the same class are much more liable to 
 this disease than others, the organ of animal sensibility 
 
742 INFLAMMATORY FORMS OF DISEASE. 
 
 being the same, which must be attributed to some local 
 condition, or to a difference of temperament ; and those 
 which partake most of the sanguine are, coeteris paribus^ 
 the most liable, and this constitution prevails more in the 
 north than in the south. 
 
 Beside the influence of cold, there are many other causes, 
 as poisonous inhalations, mechanical violence, very unu- 
 sual exertions of the muscles, violent emotions of the mind, 
 the retrocession of cutaneous eruptions, of gout, or rheu- 
 matism. To all of these causes, except mechanical vio- 
 lence, the first class of persons is the most liable, and the 
 most sanguineous period of their existence is more liable 
 than any other — as between twenty and thirty-five years. 
 Females are less liable than males, not because of their 
 less frequent exposure, as Dr. Wood thinks, but because of 
 their less- endowed animal sensibility. If men were gene- 
 rally as thinly clad as women, they would have the disease 
 more frequently than they do. Women can go to parties 
 with naked arms, neck, and breast, and with very thin 
 shoes, with comparative impunity ; but if men were to do 
 it, they would pay dearly for their enjoyment. 
 
 Diagnosis. — Those forms of disease, with which this is 
 most liable to be confounded, are bronchitis, pulmonary 
 oedema, pleurisy, and certain states of phthisis. In bron- 
 chitis, the pain is located in the anterior and superior por- 
 tion of the chest and posterior to the sternum ; the pain, 
 so called, is rather a feeling of soreness than the acute pain 
 which attends pulmonitis ; the expectoration in the latter is 
 viscid and of a rusty color, which is not the case in the 
 former ; but when the two are combined, as they some- 
 times are, then it is difficult to diagnose them. In oedema 
 of the lungs, the discharge, when copious, is thin, color- 
 less, and frothy; the face or the extremities are oedematous 
 in most cases, and frequently general anasarca prevails. 
 None of these symptoms attend pneumonitis. 
 
 In pleurisy, the pain is usually sharp, severe, and gene- 
 rally concentrated ; but in uncomplicated pneumonia it is 
 dull and moderate. In the former, the expectoration is 
 
PULMONITIS. 74:3 
 
 mucous and transparent or whitish, or possibly streaked 
 with blood ; it the latter, it is viscid and rusty. Percus- 
 sion produces no distinctive sound in pneumonia in its 
 early stage ; but in pleuritis it is obviously dull. In phthisis 
 the symptoms are so indefinite at first, and so various that 
 it can scarcely be said to possess a clearly-defined diagnos- 
 tic symptom ; but the viscid and rusty sputa of pneumonia 
 will be generally sufficient to distinguish the one from the 
 other. 
 
 Prognosis. — The indispensable necessity of the lungs to 
 the great function of life, renders pulmonitis a dangerous 
 disease. If the obstruction be small, and the fever only of 
 moderate violence, then a resolution of the disease may be 
 expected. A creaking noise of the lungs, and dimness of 
 sight, indicate much danger. When both lungs have been 
 invaded, death is almost certain to ensue ; and pleuro- 
 pneumonia is not much less dangerous. If the sputa shall 
 become white, yellowish, mixed with streaks of blood, and 
 expectorated without difficulty, a recovery may be hoped 
 for; if it be of florid blood, frothy, livid, and porous, like 
 a sponge, the most imminent danger exists. If the urine 
 becomes aqueous, or if diarrhea supervenes and arrests the 
 expectoration, a speedy dissolution may be looked for. 
 
 When the disease assails those who are organically lia- 
 ble to tubercle, tuberculous deposition may ensue, and 
 necessarily produce a fatal termination. If the inflamma- 
 tory symptoms continue to the fourth day, without abate- 
 ment, its termination by suppuration may be expected. 
 
 Treatment. — At the commencement of this disease, we 
 administer an emetic, as the Compound Powder of Lobelia, 
 to an adult, or the Compound Tincture of Lobelia, to a 
 child, and as soon as possible after emesis has ceased, fol- 
 low it with the spirit vapor-bath, if the circumstances of 
 the patient will permit. 
 
 If the pain be very severe after this course has been 
 pursued, fomentations of bitter-herbs must be placed over 
 the chest, as liot as can be borne ; and, internally, admin- 
 ister nauseant-expectorants, as a combination of Senega, 
 
T44: INFLAMMATORY FORMS OF DISEASE 
 
 Squills, and Lobelia, in tincture, of each equal parts, which 
 must be administered in sufficient doses to keep up nausea 
 and free expectoration. 
 
 In some instances, where the pulse keeps full, and there 
 is no cessation of pain, with a dry skin, the Compound 
 Tincture of Virginia Snakeroot may be added to the above, 
 or it may be given in connection with the Compound Pow- 
 der of Ipecac, and Opium. Ligatures may likewise be 
 placed around the extremities, as heretofore recommended 
 in other forms of disease, thereby retarding a too free return 
 of the venous blood into the trunk, and consequently 
 diminishing the pain and active condition of the inflamma- 
 tion. 
 
 The surface of the body should be often bathed with a 
 weak alkaline -solution, and sinapisms applied to the feet, 
 legs, and along the spinal column, employing them inter- 
 mittingly, but avoiding, as far as may be, the production of 
 vesication. 
 
 In many instances, where the pain remains obstinately 
 severe, immediate relief will follow the cathartic efiect of a 
 dose of Compound Powder of Jalap, and this should gene- 
 rally be given at an early period of the disease ; and sub- 
 sequently the bowels should be kept in an open condition 
 by small doses of Podophyllin and Leptandrin. 
 
 During the whole course of the disease, from its com- 
 mencement through to convalescence, mucilaginous drinks 
 must be used freely, as an infusion of Elm-bark, Flaxseed, 
 or Marsh-Mallow root ; and during the inflammatory stage. 
 Sweet Spirits of Nitre may be occasionally added to the 
 draught, as often as the circumstances of the case and the 
 condition of the patient may require. 
 
 As the inflammatory symptoms subside, the practitioner 
 will, according to their indications, gradually omit all other 
 means, and rely principally on the expectorants and muci- 
 laginous draughts, which at this time will most generally 
 be found very useful. 
 
 Should debility ensue as the disease advances, tonics and 
 stimulants will be necessary — wine- whey, Quinine, cold 
 
PULMONITIS. 74:5 
 
 infusion of Virginia Snakeroot, and in some instances even 
 milk-punch, may be used, more or less freely, until a resto- 
 ration to strength has taken place ; among those who have 
 been addicted to the use of alcoholic stimulus, it is better 
 to employ other stimulants, among which the Carbonate of 
 Ammonia will be found a superior remedy. 
 
 In the early part of our practice, we treated pneumonia 
 by bleeding, a method taught by our Allopathic professors 
 and our various text-books ; but observing the evil results 
 produced by this course, we speedily abandoned it for what 
 we consider a more rational practice — that which is recom- 
 mended in the preceding pages. 
 
 The following statistics, by Dr. Deitl (Eel. Med. Jour., 
 vol. iii, p. 114) present a fair illustration of the failure and 
 evil consequences attending bloodletting in this form of 
 disease. He gives us the results of 380 cases of pneumonia, 
 of which S5 were treated by bloodletting, 106 by large 
 doses of Tartar Emetic, and 189 by diet and rest alone. 
 He says : 
 
 " Of those treated by bloodletting, 17, or 20.4 per cent., 
 died ; of those treated by large doses of Tartar Emetic, 22, 
 or 20.7 per cent.; while of those treated by diet and rest 
 only, 15, or 7.4 per cent., terminated fatally. 
 
 " The fever continued from 5 to 9 days in 41 cases that 
 were bled, and from 14 to 21 days in 27. In those treated 
 with Tartar Emetic, it continued from 5 to 9 days in 66^ 
 and from 14 to 21 days in 18 ; and in those treated by diet 
 alone, in 140 it continued from 5 to 9 days, and in 35 from 
 14 to 21 days. 
 
 '' The period of convalescence was from 6 to 21 days in 
 30 of the cases that were bled, and from 22 to 60 days in 
 38. In those treated by Tartar Emetic, it lasted from 5 to 
 21 days in 62, and from 22 to 60 days in 22 ; while in those 
 treated by diet alone, it lasted from 5 to 21 days in 133, 
 and from 22 to 60 days in 42. Thus, the medium duration 
 of convalescence, in the first set of cases, was 28.9 ; in the 
 second, 20.3, and in the third, 19.7. 
 
 '^ The entire duration of the disease, from the first 
 
74:6 INFLAMMATORY FORMS OF DISEASE. 
 
 appearance of fever to tlie complete restoration of the pa- 
 tient, was, in 27 of the cases treated by bloodletting, from 
 10 to 30 days, and in 41 from 30 to 60 days ; in 54 of those 
 treated by large doses of Tartar Emetic, it was from 10 to 
 30 days, and in 30 from 30 to 60 days ; in those treated by 
 diet alone, it was from 10 to 30 days in 119, and from 30 
 to 60 days in 66 — showing that the medium duration of the 
 disease, in the first set of cases, was 35 days ; in the second, 
 28.9, and in the third, 28 days. 
 
 " In 27 of the cases, the inflammation was seated in both 
 lungs. Of these, 10 were bled, and 4 died ; 6 treated with 
 Tartar Emetic, and 1 died ; and 11 treated by diet alone, 
 and 2 died. 
 
 "In 142 of the cases, the inflammation was confined to 
 the right lung, and in 211 it was confined to the left lung — 
 making, in all 353 cases in which the inflammation was of 
 one lung only. Of these 75 were bled, and 13 died, or 
 17.4 per cent.; 100 were treated by Tartar Emetic, and 21 
 died, or 21 per cent.; and 178 were treated by diet alone, 
 and 12 died, or 5.1 per cent. 
 
 " In the stage of red hepatization, 23 died, namely, of 
 those who were bled, 5 ; those treated with Tartar Emetic 
 11, and by diet, 7. 
 
 '' In the stage of gray hepatization, 17 died, namely, of 
 those who were bled, 7 ; treated by Tartar Emetic, 7, and 
 by diet, 3. 
 
 " In the stage of purulent softening, 13 died, namely, of 
 those who were bled, 5; treated by Tartar Emetic, 4, and 
 by diet, 4. 
 
 " Of pneumonia, without complication of any kind, 9 
 patients died, namely, of those wlio were bled, 7, and those 
 treated by Tartar Emetic, 2. 
 
 "Of pneumonia, with complication, 44 died, namely, of 
 those who were bled, 10 ; treated with Tartar Emetic, 20, 
 and by diet alone, 14. 
 
 " So far as the evidence based upon the results of these 
 380 cases goes, it is decidedly in favor of a purely expecto- 
 rant treatment of pneumonia. It would seem to prove that 
 
PHTHISIS— CONSUMPTION. 74:7 
 
 inflammation of the lungs is a self-limited disease, and all 
 that is necessary to insm^e its passing favorably through its 
 several stages, is the withdrawal of those influences calcu- 
 lated to interfere with its regular course, all active treat- 
 ment being avoided as useless, if not injurious." 
 
 Genus IV. — Phthisis — 
 
 TiiberGuIar Phthisis — Phthisis Pulmonalis — Consumjp- 
 
 tion. 
 
 The term phthisis^ at one time, was employed to desig- 
 nate every variety of consumption, as well of the liver and 
 mesentery, as of the lungs — indeed, it was a sort of baptis- 
 mal name for all forms of disease — as, phthisis scorbutica, 
 phthisis syphilitica, phthisis rheumatica, etc.; but since the 
 investigations of Lsennec into the true character of pulmo- 
 nary forms of disease, it has become to be used exclusively 
 to designate that form of disease which consists of tuber- 
 cles in the lungs — and in this restricted sense we shall 
 use it. 
 
 We have placed phthisis, more through a regard for fash- 
 ion than for truth, under the general head of phlegmasia or 
 inflammation, when, in reality, it consisted of tubercles in 
 the lungs, which were present before the inflammation com- 
 menced ; and yet we may contend for the absolute accuracy 
 of the place we have assigned it, upon the truth of our 
 general principle, that inflammation exists only in conside- 
 ration of previous disease — that it is a mere result of dis- 
 ease — an accumulation of vital force to expel disease. 
 Upon this view of the subject, phthisis is as much a mem- 
 ber of the phlegmasia as pulmonitis — because both have 
 their origin in obstruction. 
 
 The difiiculty in the subject before us, is not as to the 
 cause of the inflammation — for this we know to be tuber- 
 cles in the lungs — but whence the tubercles ? In answer to 
 this question, there have been expressed, perhaps, as many 
 conflicting opinions as there have been writers ; and as to 
 the nature of the aflection, professional opinion has not 
 been less divided. 
 
748 INFLAMMATORY FORMS OF DISEASE. 
 
 Dr. James Clark, in treating of this subject (Cyc. Prac. 
 Mecl.), says, that his principal object in so doing is that of 
 taking a "comprehensive view of tuberculous phthisis, as 
 originating in a morbid state of the constitution." 
 
 It will be remembered, that when treating of this dis- 
 ease, as it relates to children, we attributed its origin to 
 certain existing relations between the medulla oblongata 
 and the cerebellum ; hence, if we are correct in this view, 
 the disease originates in a certain organic defect, and not 
 " a morbid state of the constitution." If we admit the dis- 
 ease to originate in a morbid state of the constitution, then 
 we must admit that that state exists in direct relation to the 
 form of disease which subsequently becomes developed, and 
 consequently, iliat Qnorhid state must be the incipient 
 stage of the disease — the disease itself. 
 
 It results then, that this reasoning explains nothing — it 
 is simply equivalent to the declaration that phthisis exists. 
 If we admit phthisis to originate in a morbid state of the 
 system, then two other pertinent questions arise : What 
 occasioned this state ? and why did it not result in some 
 other form of disease, as rheumatism or gout ? Neither of 
 these questions admits of more than an exceedingly hypo- 
 thetical answer ; but, under our view of the subject, it fol- 
 lows that the organic forms of the individual determine the 
 form of the disease, under certain geographical and topo- 
 graphical conditions, and any cause of excitement that can 
 produce a derangement of the secretions, which will be ex- 
 plained before we conclude, may occasion the disease, or it 
 may even spontaneously ensue. 
 
 Briquet, says Sweet, " states that thirty-three of his pa- 
 tients were of vigorous constitution, twenty-one were deli- 
 cate, the remainder, one hundred and twentj^-eight, pos- 
 sessed medium constitutions." This observation, standing 
 unqualified or explained, would seem to stand opposed to 
 the conclusions we arrived at upon this subject, in Book I ; 
 but let it be remembered, that an organic liability to phthisis 
 does not necessarily imply debility, but an inequality of 
 endowment between the medulla oblongata and the lateral 
 
PHTHISIS— CONSUMPTION. 749 
 
 portions of the cerebellum ; and of this inequality there 
 are two varieties : first, when the medulla oblongata pre- 
 ponderates ; and second, when the cerebellum preponde- 
 rates. In the first, however stout the subject may be, the 
 chest will exhibit, more or less, a phthisical form ; but in 
 the second, the chest may be large and round — highly capa- 
 cious, and yet the lungs will display but little expansibility, 
 as will be indicated by the contracted character of the nares. 
 Those of the first class Avill always be found to be lean, 
 though they may be muscular ; while those of the second 
 constantly indicate a tendency to obesity. 
 
 That phthisis may occur in vigorous constitutions we 
 have no doubt, but according to our understanding of the 
 word, the number, 35 in 184, is too great to consist of those 
 who possessed no organic necessity to take on this form of 
 disease. 
 
 Pathologists have generally agreed upon a certain set of 
 external signs or marks as indicating a tuberculous consti- 
 tution, including that form which is known as phthisis. 
 We confess, however, that after a patient and particular 
 observation of more than twenty j^ears, we have not found 
 these signs to be of general application to the phthisical 
 form of disease. 
 
 "Dr. Clark (Cyc. Prac. Med.) says: " The tuberculous 
 constitution, when of hereditary origin, is manifested by 
 a peculiar appearance of the countenance, by the form 
 and development of the body, by the abnormal state of 
 various important functions, and by a peculiar disposition 
 to certain diseased actions. The aspect of the countenance 
 generally aflfords decisive indications of the presence of the 
 affection ; in early childhood, it has a pale, pasty appear- 
 ance, the cheeks are generally full, and the upper lip and 
 alee nasi large. If the complexion be dark, the color of 
 the skin is generally sallow ; if fair, it has an unnatural, 
 white appearance, resembling blanched wax rather than 
 healthy integument ; and the veins are large and conspicu- 
 ous. At a more advanced period of youth, the indications 
 exhibited in the countenance are cleaily marked. The 
 
750 INFLAMMATORY FORMS OF DISEASE. 
 
 eyes, particularly the pupils, are generally large, the eye- 
 lashes long, and there is usually a placid expression, often 
 great beauty of countenance, especially in persons of a fair, 
 florid complexion ; on the other hand, the features are less 
 regular in those of a dark complexion, and the skin is com- 
 monly coarse and of a sallow, dingy color, although there 
 are many exceptions to this — in the fine dark eye, regular 
 features and delicate skin of such persons." 
 
 We have seen all this in tuberculous constitutions, but 
 we have seen incomparably more cases of phthisis, even 
 in those upon whom it was entailed, without these external 
 signs, than with them. 
 
 The writer has discovered this peculiarity in his own 
 mind, viz: that his capacity for detecting differences greatly 
 exceeds his ability to discover resemblances ; therefore, he 
 is not surprised that most persons discover resemblances 
 where he can not ; nevertheless, scientific accuracy depends 
 much more upon the former capacity. Thus it is that he 
 has been compelled to believe that a broad distinction ex- 
 ists organically between those who have tabes mesenterica 
 and phthisis, respectively. 
 
 The description given by Dr. Clark of the tuberculous 
 constitution applies to those who may have any form of 
 tuberculous disease, except the pulmonary. In some in- 
 stances, they may also have it, because the two organic 
 conditions may be blended. When we speak of the scrofu- 
 lous constitution, we exclude the phthisical. In the former, 
 the organ of animal sensibility is generally w^ell developed, 
 while in the latter it is as generally feeble. We would sug- 
 gest, for the investigation of those who have hospital ad- 
 vantages of observation, that scrofula depends upon a pre- 
 dominance of the cerebellum over the medulla oblongata, 
 and that phthisis originates in the contrary condition ; but 
 the former may not occasion an exemption from a modifica- 
 tion of phthisis, such as we might denominate scrofulous 
 phthisis. In conclusion, we would infer from the language 
 he uses, that he entertains some doubts as to the identity of 
 phthisis and scrofula. He says: "Phthisis does not con- 
 
PHTHISIS-CONSUMPTION. 751 
 
 sist merely in the deposition of tubercles in the lungs and 
 its consequences. There is beside, a morbid state of the 
 system, which precedes and attends the deposition, and 
 upon which it probably depends. This state of system is 
 commonly denominated the tuberculous diathesis or predis- 
 position. It is either identical with scrofulous diathesis, 
 or closely analogous to it." 
 
 We regard the views contained in this extract, except the 
 single idea for which we have made it, as a most flimsy 
 speculation. Our statistical observations sustain the affirm- 
 ative of this suggestion ; but before introducing these ob- 
 servations, we will make a reference to Dr. Sweet. He 
 says : 
 
 " When you are told that constant exposure to watery 
 vapor exerts a favorable influence (on phthisis), you may 
 well question the fact." He now proceeds to qualify this 
 statement, and says, " that a warm and moist atmosphere 
 may exert a favorable influence upon the lungs, will be 
 readily admitted." We think it very probable that no one 
 ever contended for the contrary. He continues : "Animal 
 and vegetable emanations are also regarded by Lombard as 
 exerting a favorable influence upon this disease. Butchers, 
 tanners, leather-dressers, are remarkably exempt from 
 phthisis. But with regard to vegetable emanations, the 
 truth of Lombard's statement may well be doubted. In 
 certain regions, the healthful influence of vegetable ema- 
 nations may be true enough ; but if the various forms of 
 malarious disease are dependent upon this cause, then we 
 must class these emanations among the most unfavorable 
 influences in the production of phthisis. There is, indeed, 
 a popular opinion in this country, that a residence in a 
 malarious region is favorable to phthisical patients ; but 
 this opinion is the very reverse of the truth. Malarious 
 diseases, by impairing the general health, favor the develop- 
 ment of phthisis, and much increase its mortality." 
 
 Dr. Sweet, we think, has traveled considerably in ad- 
 vance of his well-ascertained facts. It has not been proved 
 that the so-called malaria is a poison, or even mischievous 
 
752 INFLAMMATORY FORMS OF DISEASE. 
 
 to all constitutions. The writer has had an extensive field 
 of observation in the south, during a period of seventeen 
 years, and his conclusions are these : Scrofula obtains in 
 both the white and the black inhabitants of low, humid, 
 and marshy districts, but phthisis never ; nor do we believe 
 it to be possible that a child of phthisical parents, in the 
 north, or of any dry and elevated situation, and normally 
 constituted to live to the twenty-fifth year of his age in the 
 locality of his birth, could ever have phthisis in a southern 
 marsh. Now, the question arises, why is not a humid 
 atmosphere as favorable to scrofula as to phthisis ? We 
 have remarked that a high endowment of animal sensi- 
 bility is associated with the organization which occasions a 
 liability to that form of disease, and where this organ is 
 large the skin becomes the most important of the depurat- 
 ing apparatuses, to which a hnmid atmosphere is opposed. 
 In phthisis, this organ is small, and the kidneys constitute 
 the most important depm^ators, and a humid atmosphere 
 aids them. 
 
 Our military surgeons, not being acquainted with the 
 organic conditions npon which scrofula and phthisis respect- 
 ively depend, have not been able to construct such statis- 
 tical tables, with reference to the influence of southern lati- 
 tudes upon phthisis, as could be desired, or even such as to 
 reflect much light upon the subject. It is stated that sailors 
 are much less liable to phthisis than soldiers, and this diflfe- 
 rence is attributed to the respective conditions of the atmo- 
 sphere, that of the former being the more salubrious. We 
 are inclined to attribute the diflerence to the greater devel- 
 opment of the respiratory apparatus of the former. The 
 statistical tables which are presented to determine the 
 greatest sexual liability, enable us to state that, in the ab- 
 stract, one sex is about as liable as the other, and that where 
 a diflerence does obtain, it is altogether relative. In those 
 countries where the women labor much in the open air, as 
 in many parts of Germany, they are less liable than where 
 they do not, and even less than the other sex, and we have 
 only to examine their brawny muscles and masculine chests 
 
PHTHISIS-CONSUMPTION. 753 
 
 to be convinced that a greater development of the base of 
 the head is the source of this exemption. 
 
 Symptoms of Phthisis. — Although this form of disease 
 is characterized by a certain group of symptoms, yet, in 
 consideration of the great diiference that obtains in its 
 duration, in different individuals, much difficulty is pre- 
 sented to giving a lucid description of them, independently 
 of the existence of a multitude of other circumstances, as 
 a difference of age, of organic conditions, of previous health, 
 and present complications. As to the length of time that 
 tuberculous matter may be depositing before its presence in 
 the lungs is indicated, is a question which can not be clearly 
 answered. In some cases, in consequence of a sudden 
 arrest of some important depuration, it may generate very 
 rapidly, but in other instances the depuration may be defi- 
 cient by a very small fraction, consequently, a long time 
 may elapse before any apparent disturbance of the general 
 health becomes manifest, and when it does, its progress 
 may be so very slow as to occasion no alarm for months — 
 possibly years. The first admonition the patient has is 
 probably a dry, hacking cough, with some emaciation of 
 his person and some loss of strength ; these three symp- 
 toms indicate that all is not right, but they may progress 
 very slowly or rapidly. In the former case, though appa- 
 rent, yet they are too slight to command that concern which 
 they deserve, from the uneducated ; but at length some 
 dyspnoea, wandering pains in the chest, and hemoptysis 
 thoroughly arouse the patient, and if a physician has not 
 been consulted, one will now be — for these symptoms are 
 too suspicious to be further neglected even by the ignorant. 
 If, in addition to these symptoms, we shall find dullness 
 under one of the clavicles by percussion, more particularly 
 if, at the same time, there is a feeble murmur under a pro- 
 longed expiration, or if the murmur be harsh or jerking, 
 we are scarcely permitted to doubt the existence of tuber- 
 cles in the lungs. 
 
 The cough, being the first symptom that is manifested, 
 should claim, in a special manner, our vigilance. In the 
 
754 INFLAMMATORY FORMS OF DISEASE. 
 
 beginning of the disease, so far as we can judge, it at first 
 appears upon getting out of bed in the morning, and then 
 it may consist of only one, two, or three dry hacks ; as the 
 afi:ection advances it will recur two or three times a day, 
 particularly after exercising, and upon undressing for, or 
 upon getting into, bed at night. After a while, expectora- 
 tion from the fauces of a limpid and viscid fluid will appear 
 in the mornino; couorh, and at leno;th it will attend the 
 cough as frequently as it may recur. 
 
 The preceding s^anptoms are those which are generally 
 regarded as constituting the first stage of the malady ; and 
 morbid anatomy informs us that they have been occasioned 
 by tuberculous matter in the lungs. 
 
 Physical Signs. — In this stage of this form of disease 
 much information may be derived, in some cases, by aus- 
 cultation, but in many instances the contrary is the fact. 
 In these w^e must be guided by the symptoms we have in- 
 troduced to the best of our judgment. If the tuberculous 
 matter be pretty generally dififused we can obtain no reli- 
 able information from auscultation; but if it be considera- 
 ble in quantity, and deposited, as it most frequently is, in 
 the superior or clavicular regions, then we may find assist- 
 ance to our diagnosis. Under such circumstances the sound 
 will be discovered to be much more clear under one clavicle 
 than the other. Where the duller or more obtuse sound 
 is heard, the murmur, as heard through a stethoscope, will 
 be less soft and free, and the resonance of the voice greater; 
 but unless the difierence between the two sides be very 
 obvious, the information thus obtained, at this stage of the 
 disease, will not be very reliable ; on the contrary, when 
 the two sides yield very difierent sounds or murmurs, the 
 information obtained by this means is the most unequivocal. 
 It is frequently possible at this time to make profitable dis- 
 coveries in the motions of the superior portions of the chest 
 during inspiration ; the tuberculous side will exhibit less 
 expansion than the other. 
 
 Second Stage. — The beginning of this stage is indi- 
 cated by the appearance of opake and yellowish-colored 
 
PHTHISIS— CONSUMPTION. "i^^ 
 
 particles of matter in the previously-colorless and frothy 
 expectoration, which, as the disease advances, increase in 
 quantity so as to form patches, that are found, when ex- 
 pectorated, to be floating in the limpid sputa which is some- 
 times streaked with blood. Pari pasu, with this change 
 in the matter expectorated, the other symptoms progress in 
 the strength and importance of the consequences to be in- 
 ferred from them ; the evening chills are more severe and 
 uniform, and more regularly succeeded by febrile symp- 
 toms, as a hot skin through the night, and perspiration on 
 the following morning; the cough also increases in fre- 
 quency and in the trouble it gives the patient. Tolerably 
 early in this stage the hectic fever becomes established — in- 
 dicated by a uniformly -frequent pulse and hurried respira- 
 tion. The em.aciation of the patient increases in a very 
 observable manner, and he is entirely conscious that his 
 muscular strength and mental capacity, as regards their 
 power of action, are daily wasting. He complains of pain 
 of a rheumatic character in his side or about his shoulders; 
 hemoptysis, too, is now, in many instances, of frequent 
 occurrence, which in extent may only streak the matter ex- 
 pectorated, or it may consist of pure blood. Through the 
 day the patient is usually pale, but toward evening a cir- 
 cumscribed blush appears upon the cheek.* 
 
 * During this stage, a patient, under the observation of one of the au- 
 thors, discharged from his lungs, during one continued effort, not less than 
 a pint of frothy mucus; and so great was the quantity and so sudden its 
 flow, that his life was endangered from suffocation. In the course of two 
 weeks the patient had three of these paroxysms. Before the occurrence of 
 these events, he was unconscious of any particular change in his pulmo- 
 nary condition — they were preceded by no premonitoi-y symptoms. The 
 patient was an able physician, and had fought the disease in the first and 
 second stages for fifteen years ; and whatever may be the opinion of others 
 as to the salutary influence of a southern latitude upon this form of disease, 
 even after its commencement has been unmistakably indicated, he was 
 thoroughly of the opinion that his removal from Massachusetts to Arkan- 
 sas had secured to him not less than twelve years' of existence. He was 
 satisfied that the disease had made considerable advancement before he left 
 the north. Both he and the writer frequently speculated about the copious- 
 ness of the mucous discharges above described, but they could arrive at no 
 explanation that satisfied themselves. 
 
 48 
 
756 INFLAMMATORY FORMS OF DISEASE. 
 
 During this stage, the tuberculous matter becomes soft- 
 ened, and possibly diluted with morbid secretions from the 
 substance of the organ. The certainty that this softening 
 has taken place, is clearly to be inferred from the character 
 of the expectoration; but during this process that portion 
 of the pleura which covers the diseased part of the lung 
 becomes attached to the costa through the agency of effused 
 lymph, which finally passes into cellular tissue. The pleu- 
 ritic inflammation essential to the production of this lymph 
 is, no doubt, the cause of the pain of which the patient 
 complains. The tuberculous softening as it progresses, 
 which is determined by the quantity of the expectoration, 
 forms caverns of greater or less magnitude in the superior 
 portions of the lungs — the parts in which the disease usu- 
 ally begins, and from which it travels downward. 
 
 When the malady has become thus far advanced, the 
 sound or murmur occasioned by inspiration amounts to une- 
 quivocal evidence of the true pulmonary condition ; the 
 sound under both clavicles, on percussion, is dull, and the 
 ear or stethoscope discovers a cracking noise ; and when 
 coughing, there is a gurgling sound, and the voice has be- 
 come more resonant, amounting frequently to broncho- 
 phony. The peculiarities above-named are more apparent 
 usually upon one side than the other. If attention be now 
 given to the pectoral movements, it will be clearly per- 
 ceived that the superior portions of the chest are raised 
 less freely and fully during an inspiration than when in a 
 healthy state. 
 
 Up to this period of the disease, tubercles may not ob- 
 tain in any other part than the lungs, and yet, in its pro- 
 gress before the close of life, scarcely any part of the sys- 
 tem may be clear of them. 
 
 As to the duration of the disease, up to the close of this 
 stage, no very definite opinion can be given. In some 
 cases, it may progress rapidly ; in others, the progress 
 may be so far retarded, by a proper treatment, as greatly 
 to extend the patient's existence. The disease has been 
 know to run its course in a few weeks, and the preceding 
 
PHTHISIS-CONSUMPTION. 757 
 
 note of one of the authors shows that it has been known to 
 continue for fifteen years. 
 
 During this stage the purulent expectoration becomes 
 "very copious, which, with the night-sweats, rapidly ex- 
 hausts the patient ; and it is proper to add that these night- 
 sweats are not necessarily dependent upon febrile parox- 
 ysms. Hemorrhage during this stage is not so frequent as 
 during the preceding. It sometimes happens that all the 
 above symptoms disappear, or at least to a great extent, 
 nutrition becomes evident, and the patient flatters himself 
 with the idea of a convalescence, when in truth, there is 
 very probably no prospect of the kind for him — the symp- 
 toms which so much distressed him, return again, and 
 sometimes with even more than the former violence. The 
 delusive intermission was probably occasioned by the com- 
 plete discharge of a vomica, and a fresh crop of tubercles 
 is announced by the returning symptoms. 
 
 Thikd Stage. — "This has been," says Dr. James Clark, 
 "termed the colliquative stage, from the copious perspira- 
 tions, the frequent attacks of diarrhea, and the abundant 
 expectoration by which it is usually attended." During 
 this stage all the symptoms seem to conspire to reduce, de- 
 bilitate, and prostrate the patient. Nutrition has become 
 greatly suspended, and the emaciation of the system the 
 most extreme — every particle of it that can be rendered 
 subservient to the function of respiration and the produc- 
 tion of animal heat has been consumed. Frequent attacks 
 of diarrhea now supervene and alternate with copious 
 night-sweats, or occur, as they frequently do, simultane- 
 ously. The expectoration is copious and the cough is pe- 
 culiarly distressing ; nausea and vomiting are not unfre- 
 quently added to the other sufferings of the patient— the 
 dyspnoea is great, and frequently attended by such extreme 
 hoarseness as to reduce the voice to a whisper. In a large 
 majority of instances, the fatal termination approaches very 
 gradually, so much so that the back slouohs in consequence 
 of the long-continued pressure of the weight of the body 
 upon its osseous projections. ;N"ear the close of life, the 
 
758 INFLAMMATORY FORMS OF DISEASE. 
 
 tongue becomes red, loses its papillary appearance, and 
 takes on an aphthous one ; oedema seizes upon the feet and 
 legs ; the appetite disappears ; diarrhea becomes constant, 
 and such becomes the degree of debility, that expectoration 
 becomes impossible, the air vessels become engorged with 
 pus, and of course death ensues, because respiration has 
 been arrested. It must not be supposed that death always 
 approaches thus leisurely, for life is sometimes extinguished 
 by the supervention of pulmonary hemorrhage, the erup- 
 tion of a large vomica which inundates the air-passages, or 
 possibly by peritoneal inflammation. 
 
 We have now pursued this form of disease, as it usually 
 appears, from its commencement to its termination — we 
 have presented a general view of it ; and yet, outside of 
 this view, there are not unfrequently presented such modifi- 
 cations of it as may be thought to constitute varieties, and 
 as such to claim a special consideration. 
 
 Those forms of phthisis which writers have regarded as 
 constituting varieties have been designated by the following 
 names : 1st, acute phthisis ; 2d, chronic phthisis ; 3d, in- 
 fantile phthisis, of which we have treated ; 4th, febrile 
 phthisis ; 5th, latent phthisis. 
 
 Yaeiety I. — Acute PhtJiisis. 
 When we state that the mean duration of phthisis, as it 
 usually appears, is about thirteen months, and that the 
 mean duration of this variety is about two and a half 
 months, the reader will be able to understand what is 
 meant by acute phthisis. The brevity of existence after 
 an attack of this form may depend upon either of two 
 causes : first, an absolute want of viability — an exceedingly 
 defective vital system, and hence it is a form that is usually 
 confined to youth, and from the nature of its cause it must 
 be regarded as necessarily fatal. Those who become the 
 subjects of this variety constitute extreme illustrations of 
 the third class. Book I, page 20. The second cause of this 
 variety is said to consist in the " activity of the morbid 
 process." If this be true, then it does not depend upon a 
 
PHTHISIS-CONSUMPTION. 759 
 
 want of vital power, but upon some unbalanced condition 
 of it. We are therefore permitted to suggest, for the pur- 
 pose of future observation, that they belong to the second 
 class. Book I, page 20. In this, the medulla oblongata is 
 comparatively feeble, while the lateral departments of the 
 cerebellum are fully endowed. In these subjects tuber- 
 culous matter and adeps may both accumulate at the same 
 time, and the former may exist for a long time before its 
 presence becomes to be suspected — the tuberculous matter 
 exists in a state as perfectly latent as do the adeps, and 
 when excited into activity, no matter by what cause, the 
 work of mischief is exceedingly active. Much has been 
 said upon both of these sub-varieties of phthisis, but it is 
 so foreign to our conceptions of the truth, that we must 
 pass it over, trusting that the explanation we have given 
 will prove sufficient to enable the reader to connect them 
 with the general form of phthisis. 
 
 Yariety I. — Chronic PMJiisis. 
 
 The acute form is measurably confined to young people, 
 and the disease continues only a few weeks ; but this va- 
 riety never assails the young, and when developed it may 
 continue for several years more than the other did weeks. 
 
 Dr. Jas. Clark supposes that in these subjects the heredi- 
 tary predisposition is not strong, or if so, it has been kept 
 in check by favorable circumstances. It is known that we 
 deny the whole of the doctrine of hereditary predisposi- 
 tion — the whole doctrine, in our opinion, conveys but one 
 idea, and that one is negative, namely, our ignorance. We 
 contend that all forms of disease are referable to certain 
 organic conditions and exciting causes, and they can be 
 investigated. If we shall classify those who become the 
 subjects of these several varieties of phthisis, we shall soon 
 discover that the special liabilities have resulted from cer- 
 tain organic conditions, and that these by a timely interpo- 
 sition may be changed or greatly modified. 
 
 Like the acute, this variety is divisible into two sub- 
 varieties. In the first, the medulla oblongata and the cere- 
 
760 INFLAMMATORY FORMS OF DISEASE. 
 
 belliim are both small or raoclerate, the cerebrum and 
 finally the whole head is below the average size of heads — 
 all of the animal functions are active but feeble — the mental 
 are also peculiarly active, even to the manifestation of 
 genius, but never powerful or forcible, and the vegetative 
 functions are but feebly discharged. This being the normal 
 condition of the system, we can certainly have but little diffi- 
 culty in comprehending either the origin or cause of phthi- 
 sis, when once developed. In this peculiarity of constitu- 
 tion, tubercles never commence their development until the 
 vital forces begin to sink under the accumulation of mental 
 toil and responsibility — the depuration is not equal to the 
 metamorphosis, and tubercle results, but it must progress 
 as slowly as does the declension of the vital force or the 
 depurative processes. Persons thus constituted may have 
 the disease and die before the meridian of life, or they may 
 live to be threescore and ten years old . 
 
 In the second sub- variety, we have in many respects a 
 reversed condition of the constitution. The brain is again 
 rather below the average size — it has measurably the ath- 
 letic size and form. In the earlier part of life, the muscles 
 are large and strong, but not active — the cerebellum and 
 medulla oblongata are nearly balanced — the nostrils and 
 nose are of medium size ; and if he live a life of active 
 and muscular habits, he will probably never have phthisis, 
 but he may probably have rheumatism. If his pursuits be 
 mental, and he be overtaken by care and responsibility, 
 difficulty and trouble, he will probably become intemperate 
 in the use of ardent spirits, and more or less obese, and so 
 continue until the powers of nutrition become exhausted 
 and then phthisis will supervene. If his life be one of 
 ease and pleasure his cerebral forces will acquire an ascen- 
 dency over the medulla oblongata, and then obesity will 
 ensue (if he has escaped pulmonary hemorrhage), and 
 then, any cause that can disturb the nutritive process may 
 develop tubercle, which may derange his health for years. 
 We have witnessed both of these forms of phthisis, and we 
 believe that we have given an accurate description of those 
 
PHTHISIS— CONSUMPTION. 761 
 
 who are, respectively, liable to them ; hence the so-called 
 acute and chronic varieties happen to be nothing more 
 than such modifications as result from peculiar organic 
 conditions. 
 
 As we have before remarked, we have treated of infantile 
 phthisis in Book III, and therefore we will now proceed to 
 the consideration of the so-called, 
 
 Yariety IY. — Febrile PJitliisis. 
 With this modification of phthisis we have no acquaint- 
 ance, and therefore will give Dr. Clark's opinion of it, 
 and a mere suggestion of our own. He says: ''It occurs 
 suddenly and difiers in its symptoms from all other forms 
 of the disease, and also in its pathological results. It 
 occurs in a state of apparent health, after exposure to cold, 
 or even without any evident cause. It commences with 
 shivering, followed by heat of skin, quick pulse, and other 
 symptoms of fever, which often continue for several days 
 with little or no indications of pulmonary disease. In some 
 cases, it puts on the characters of bilious fever, and in 
 others of catarrhal fever, for both of which it is sometimes 
 mistaken ; indeed it would have been such in a healthy 
 constitution, but occurring in a person laboring under 
 tuberculous cachexia, the rapid deposition of tuberculous 
 matter in the lungs is the consequence of the disturbance 
 created in the system by the febrile attack. Cough, how- 
 ever, soon appears, and the breathing is noticed to be par- 
 ticularly rapid, which is one of the most marked and con- 
 stant symptoms of this form of phthisis. The cough, when 
 it has once occurred, becomes speedily more frequent, and 
 is soon accompanied with some expectoration, which is at 
 first colorless, afterward assuming a yellowish or greenish 
 hue, and occasionally being streaked with blood ; but it 
 rarely puts on the character of the expectoration in the ad- 
 vanced stages of ordinary phthisis. Pain of one or both 
 sides frequently occurs, and occasionally diarrhea is pre- 
 sent. The fever, in the meanwhile, continues without 
 abatement, and is so much out of proportion to the other 
 
762 INFLAMMATORY FORMS OF DISEASE. 
 
 symptoms of pulmonary affection, that tlie true character 
 of the disease is liable to be overlooked. In the course of 
 from six or seven weeks the patient sinks." 
 
 He has stated that this form of disease "occurs in a state 
 of apparent health; and he repeats, "we say apparent 
 health, because we believe that the disease never occurs in 
 a healthy constitution." If the constitution upon which 
 phthisis becomes ingrafted is never healthy, what is the 
 pre-existing disease ? By the same rule of reasoning, may 
 we not say that no constitution is healthy upon which dis- 
 eased action supervenes ? Kheumatism attacks constitu- 
 tions which were apparently healthy, and we now inquire, 
 were they not as really so as can possibly happen ? There 
 is, organically, as strongly-marked signs of this constitu- 
 tion as there are of the phthisical ; and we are of the opin- 
 ion that we have seen persons of the "tubercular diathe- 
 sis," as he calls it, having as good health and being as free 
 from disease as we have ever seen the rheumatic. He con- 
 tinues, " the most marked cases " of this variety of phthi- 
 sis, "which we have seen, occurred in persons having a 
 strong hereditary disposition to phthisis." The strength 
 of all the symptoms which he has given, as being charac- 
 teristic of all the symptoms oi febrile ^pJitMsis^ induce us 
 to doubt the existence of a truly phthisical organization in 
 the premises ; and to suspect that of the rheumatic, and 
 that instead of phthisis — the disease, normally, should have 
 been rheumatism. If it be possible for the remote and ex- 
 citing causes of rheumatism, under any modifying influ- 
 ences, to produce phthisis, we would cite febrile phthisis 
 as illustrations of it. 
 
 Yariett Y. — Latent Phthisis. 
 Under this head we shall again extract from Dr. Clark, 
 who says : " The presence of tuberculous matter in the 
 lungs gives rise, in a large proportion of cases, to those 
 symptoms which are usually considered to indicate the 
 commencement of phthisis ; there are, however, cases in 
 which this accidental product may exist for a long time^ 
 
PHTHISIS— CONSUMPTION. 763 
 
 and even to a considerable extent in the lungs, without giv- 
 ing rise to any local symptoms indicative of its presence, 
 such as cough, expectoration, or hemoptysis, but neverthe- 
 less effecting its silent work of destruction. It is to cases 
 of this kind that we apply the term latentP 
 
 Latent phthisis presents itself in two different forms. In 
 one, we have constitutional symptoms, such as fever, night- 
 sweats, emaciation, diarrhea, etc., without any local indi- 
 cations of the pulmonary disease ; or if they be present, 
 they are of so slight a character as to pass unnoticed. The 
 other form of latent disease is still more important, because 
 it is more insidious ; being attended neither by constitu- 
 tional nor local symptoms, until the tuberculous disease has 
 made extensive progress. This form of latent phthisis, 
 therefore, claims our closest attention ; because, from the 
 slowness of its course, and the more limited extent of the 
 tuberculous disease for a long period, w^e may possibly be 
 able, in many cases, to check its further progress entirely, 
 should we detect it at an early stage." 
 
 We shall not pursue Dr. Clark's treatise on this variety 
 of phthisis any further, because it must already have be- 
 come apparent to the reader that it is nothing more or less 
 than a modification of the chronic form or variety. 
 
 Inasmuch as we are required to determine the character 
 and condition of disease by its signs and symptoms, we 
 deem it proper to pass briefly in review a fevv^ of the latter, 
 for the purpose of determining how far they are to be con- 
 sidered as indicative and diagnostic of this disease. 
 
 CocGH ^ND ExPECTOKATioN. — These symptoms may be 
 dependent upon several forms of disease, and although 
 generally present in phthisis, it is not unifoimly the case 
 except at or near the close of it. It is not the cough, in 
 the abstract, that so mucli demands our attention at pre- 
 sent, as the character or peculiarity of it. When it is 
 laryngeal, it is known to be loud and barking; when bron- 
 chial, loud and ringing ; when occasioned by pleuritis, it is 
 feeble and suppressed ; when symptomatic, as of dyspepsia, 
 it is generally dry, and in degree, a matter of small moment. 
 
T64: INFLAMMATORY FORMS OF DISEASE. 
 
 In broncliitis^ it is sometimes dry and continues so for a 
 time, but sooner or later it will be attended with expectora- 
 tion, which will be thin and frothy, opake and thick, puru- 
 lent or muco-purulent, streaked with blood or mixed with 
 it. In pneumonia, the expectoration has a rusty appear- 
 ance, and thus becomes diagnostic ; so likewise is a grayish 
 and fetid one of pulmonary gangrene. When the cough is 
 occasioned by pulmonary tubercles, it is slight and hacking, 
 but if complicated with nervous irritation, it may occur in 
 irregular and distressing paroxysms. In the general course 
 of phthisis, the cough is very much as we have before 
 described it, but toward the close of the complaint it some- 
 times becomes deep and hollow, which is thought to indi- 
 cate a fatal termination. 
 
 Dyspnoea. — Any cause that can impair the action of the 
 air upon the capillary circulation will produce this distress- 
 ing symptom. It is very frequently produced in health by 
 rapid exercise, which occasions a too rapid circulation of 
 the blood through the lungs — it results also in fever from 
 the same proximate cause. It may, furthermore, be occa- 
 sioned by a retardation of the blood through the lungs, as 
 in mitral disease of the heart. It may also result from 
 pulmonary compression, as in pleuritic alfections ; hydro- 
 thorax ; destruction of the air cells, as in pneumonia ; and 
 from many other causes, beside tubercles, in which it is not 
 so prominent a symptom, as it is in some other forms of 
 disease. 
 
 In many instances this disease progresses to the verge 
 of the grave before this symptom becomes particularly or 
 even observably troublesome. This circumstance may pos- 
 sibly be explained by the fact, that in this disease the ema- 
 ciation and reduction of the patient maintain the circula- 
 tion in harmony with the pulmonary function. 
 
 The unpleasant and painful sensation arising from dys- 
 pnoea arises from the insufficient oxygenation of the blood; 
 if, therefore, the lungs have sufficient capacity for this pur- 
 pose, and the velocity of the blood is in harmony with this 
 capacity, then the symptom will not obtain. When phthi- 
 
PHTHISIS— CONSUMPTION. 765 
 
 sis becomes complicated with pleuritic effusion of pneumo- 
 thorax, as it frequently does toward the close of the disease, 
 then dyspnoea becomes peculiarly distressing. 
 
 Pain. — This is not usually a prominent symptom — fre- 
 quently it is very considerable, and often it is very severe ; 
 in a majority of cases, however, it may be said to be either 
 , pleuritic or neuralgic, fugitive and occasionally severe. 
 
 Hemorrhage. — We can not, perhaps, state that this symp- 
 tom invariably attends phthisis, but it does very generally. 
 Sometimes it is the first observed symptom, but it more 
 generally occurs in the course of the disease and more fre- 
 quently in the second, than in the other stages. In a few 
 instances, it is copious, but generally it is very slight. 
 When the patient has had for sometime a cough, the occur- 
 rence of this symptom becomes more clearly diagnostic 
 than any other. Louis, says Dr. Wood, "goes much further 
 than this, and states that since his attention had been 
 directed to the subject, he had seen hemoptysis in no other 
 afiection than phthisis, except in females attacked suddenly 
 with amenorrhea, and in cases of external violence." To 
 this statement. Dr. Wood makes objections, and we indorse 
 them. He says that he has known many cases of pulmo- 
 nary hemorrhage that were never associated with phthisis, 
 and he concludes by stating : " I have insisted more than 
 I otherwise should have done on this point, because I be- 
 lieve that the impression of the almost certainly-fatal sig- 
 nificancy of hemorrhage from the lungs is calculated to do 
 much harm, by alarming patients, and discouraging their 
 medical advisers." 
 
 Nervous Symptoms. — Dr. Wood says, that when the 
 liver and stomach are sound, the patient is cheerful and 
 hopeful, and disposed to believe to the last, or at least, to 
 so late a stage as to preclude all rational hope, and yet, he 
 says, even intelligent physicians, who understand the value 
 of the symptoms, are thus self-deceived. The writer had 
 a medical friend wdio was throughout his sufierings a better 
 judge of his own condition, than any of his medical friends 
 were ; but it must be observed, that his stomach was 
 
766 INFLAMMATORY FORMS OF DISEASE. 
 
 SO diseased as to occasion the greatest amount of his suf- 
 ferings. 
 
 Sexual Symptoms. — Nothing worthy of remark obtains 
 in this relation with the male sex, but the opinion is very 
 prevalent that with the other sex pregnancy and lactation 
 have a decided tendency to arrest the disease. We are 
 aware that the contrary has been maintained, or admitted 
 no further than amounts to a mere suspension. When the 
 constitution is organically phthisical, and the climate is 
 favorable to the development of the disease, we have no 
 faith in the potency of any remedy ; but when the disease 
 exists under contrary circumstances, we as much believe it 
 to be curable as many others ; and it is under such cir- 
 cumstances that we believe gestation and lactation promo- 
 tive of recovery, and it is because of the extensive depura- 
 tion which these processes provide ; and, under contrary 
 circumstances we would never advise their introduction. 
 
 Nature and Causes. — Upon these subjects we have but 
 little to add to what we introduced in Book III. To talk 
 about a morbid state of the system — tubercular diathesis, 
 laxity of the tissues — hereditary predisposition, etc., is 
 equivalent, in our opinion, to an acknowledgment of our 
 ignorance or a mere statement of the fact, that the disease 
 occurs. We know of no organic condition that may not, 
 under appropriate circumstances, become tuberculous, but 
 when it is essentially liable — necessarily so very frequently 
 in a cold climate, no hope can or should be indulged as to 
 recovery, and we are very sanguine in the opinion that no 
 such case of phthisis was ever cured. On the contrary, we 
 are equally sanguine that many cases even spontaneously 
 recover. Why not ? Suppose the suppression or impair- 
 ment of some essential depuration should occasion it in a 
 rheumatic constitution, why should not recovery follow the 
 restoration of the depuration ? Post-mortem examinations 
 of many, who had died of other forms of disease, have 
 furnished the most unequivocal evidence that the subjects 
 had had phthisis, and had been well and clear of it for 
 many years. 
 
PHTHISIS-CONSUMPTION. 767 
 
 Much has been said about the predisposing and exciting 
 causes of phthisis, and it may be applicable to those cases 
 in which there does not obtain an organic necessity for the 
 disease, under circumstances necessary to its development, 
 instead of some other form of disease. In such cases, it is 
 spontaneously developed, and as necessarily so as the beard 
 on a man's face. Among the predisposing causes, care or 
 mental responsibility and sedentary habits are the greatest, 
 and among the exciting, an improper exposure to cold is of 
 the greatest consideration. 
 
 Diagnosis.— It is only during the first, or initial stage, 
 that any difficulty can exist on this subject, and even in 
 this no uncertainty need to exist, with a close observer, in 
 a vast majority of the cases. The short, dry cough, or 
 cough with slight expectoration, continuing as it does for 
 weeks or months, and attended with more emaciation than 
 can be attributed to observable causes, should awaken a 
 very strong suspicion that phthisis is generating ; but when 
 with these symptoms we have an increased frequency of the 
 pulse and fugitive pains between the shoulders or in the 
 breast, all previous doubt yields to a probable certainty, 
 and when blood appears with the expectoration, we may 
 conclude that we have absolute certainty. But these symp- 
 toms do not appear and progress in the above order in those 
 cases that do not depend upon an absolute organic liability 
 as the cause. It is true, that the exceptions are not nume- 
 rous, but they exist, and their manner of commencing is 
 so Protean that no reliable diagnostic symptom can be 
 given. In such case, we must fall back upon our general 
 acquaintance with pathology and calculate the chances. 
 "When the disease is occasioned by the suspension of a de- 
 puration that holds an intimate relation with the perfection 
 of the pulmonary function, the first symptoms may be of 
 alarming character. 
 
 That form of disease which bears the greatest similitude 
 to phthisis, is bronchitis, and yet the difierence between 
 them is sufiiciently striking, in extreme cases, to admit of 
 no mistake. In the latter, there is an observable agree- 
 
768 
 
 INFLAMMATORY FORMS OF DISEASE. 
 
 ment between the indications of disease and the conse- 
 quences upon the system. It is usually attended with more 
 fever, more copious expectoration, advances more rapidly, 
 is attended with a louder cough, and lastly, the auscultatory 
 signs of phthisis are absent. 
 
 Prognosis. — If the patient has always had lean, small, 
 and flaccid muscles ; a flattened chest ; a small neck, and 
 more particularly if it be thiu, then we may regard the 
 case as incurable, because it depends upon an organization 
 that can not longer exist without it, for it is now supposed to 
 be too far advanced for a resort to any prophylactic mea- 
 sures. If the patient has been obese from his youth to 
 the time of the attack — has small and contracted nares — 
 small muscles, although the chest may be large, the case 
 may be esteemed as hopeless, because it resulted from an 
 organic necessity of adeps or tubercles, and it is now too 
 late to change the action from the latter to the former. 
 Lastly,. if the nares, neck, chest, and muscles be those of 
 a man — so well developed that circumstances could possi- 
 bly have inflicted upon him rheumatism, gout, or a high 
 stage of any form of inflammation, we may, by judicious 
 treatment, indulge a hope of his recovery, because his dis- 
 ease did not result from an organic necessity, but from a 
 tardy or interrupted action of some important depurator. 
 
 Many writers now believe that phthisis is sometimes cura- 
 ble, and that it has been cured ; but none of them appear 
 to know anything about the conditions under which the 
 possibility exists. Dr. Wood says, that such cases " are 
 undistinguishable from symptoms which in other cases 
 are the forerunners of confirmed phthisis," and he might 
 have added — of death. We admit all this, but it does not 
 prove that there is not an organic difference of such magni- 
 tude as to account for the difference of the results. He 
 says : "It occasionally happens that consumptive symp- 
 toms disappear entirely, even in the second stage of the 
 disease, after the formation of a cavity. This event, it is 
 true, is comparatively rare." We admit it, and we believe 
 it on the grounds that very few persons have phthisis who 
 
PHTHISIS— CONSUMPTION. T69 
 
 are not organized, under some circumstances, with reference 
 to it. The mental pursuits and sedentary habits incidental 
 to civil society produce the organization that is favorable 
 to it ; and under such influences no organization is neces- 
 sarily secure against it. 
 
 Treatment. — In the treatment of this disease, little else 
 can be done than to make use of means which will enrich 
 the fibrinous portions of the blood, strengthen the nervous 
 and muscular system of the patient, and relieve trouble- 
 some and dangerous symptoms as they may appear. 
 
 For the accomplishment of the first indication, various 
 agents have been recommended, none of which can be said 
 to have proved even generally successful, at least, so far as 
 regards a cure of the disease, yet which, at the same time, 
 will always be proper for the practitioner to employ, with 
 the hope that either transient or permanent benefit may 
 follow. Among the agents recommended for this purpose, 
 we will select those which we have employed ourselves, as 
 well as those which, from their nature, we would suppose 
 the best calculated to meet the indication. Iron, in various 
 forms, is one of the articles which has a more general ap- 
 plication than any other. The precipitated carbonate of 
 this metal will be found well adapted to most cases. We 
 have derived much advantage in several instances from the 
 Prussiate of Iron, combined with Sulphate of Quinia and 
 Hyoscyamus. Equal parts of common salt and the pre- 
 cipitated Carbonate of Iron, combined together, and admin- 
 istered in such quantities as the stomach will bear, to the 
 extent of two or three drachms a day, have in several in- 
 stances apparently aided in efiecting a permanent cure. 
 
 In addition to these, many of the vegetable alterative 
 tonics have seemed to produce beneficial results, as vari- 
 ous combinations of Stillingia Sylvatica, Eumex Crispus, 
 Inula Helenium, Solanum Dulcamara, Ptelea Trifolata, 
 Cimicifuga Racemosa, Prunus Yirginiana, etc., and these 
 will always prove more useful when given in the form of 
 cordial, or in that of syrup or decoction, with some alco- 
 holic liquid added, as good French Brandy, Jamaica Spi- 
 
YTO INFLAMMATORY FORMS OF DISEASE. 
 
 nts, or HollaDd Gin. The next indication is to mitigate 
 urgent symptoms, among which cougli stands most promi- 
 nent and distressing, though occasionally absent nntil in 
 the latter stages ; and whatever remedies are used, or how- 
 ever beneficial thev may at first appear, it must be remem- 
 bered that all of them speedily lose their influence over this 
 harrassing symptom, and consequently the practitioner 
 must be prepared with a knowledge of several means for 
 checking or arresting it. 
 
 If the cough be occasioned by elongation of the palate, 
 as we find frequently to be the case, and w^ill not yield to 
 the action of astringents, a sufiicient portion of the uvula 
 must be excised. If the cough still continues, or is not 
 connected with any elongation, demulcent mucilaginous 
 draughts may be drank, either with or without narcotics, 
 as each particular case may require ; and it will generally 
 be found that sooner or later this class of agents must be 
 employed. Among these, Opium and the Salts of Mor- 
 phine, in small doses, repeated as often as the urgency of 
 the case may require, are most esteemed among practition- 
 ers ; however, there are many others which may be advan- 
 tageously administered, as Hyoscyamus, Stramonium, and 
 Conium Maculatum. We have used a syrup of Helian- 
 thus in severe cases of cough with the most marked efiect. 
 Hemoptysis is likewise a symptom generally present to a 
 greater or less extent, requiring prompt attention. It may 
 be treated with an infusion of Lycopus Virgin icus and 
 Liquorice-root, or an infusion of a combination of Lycopus, 
 Beth, and Geranium. 
 
 In very severe cases of hemoptysis, we have found Ge- 
 ranin, in doses of ten grains every half hour, to exert a 
 very beneficial influence upon the hemorrhage. If there 
 should be pain attending this symptom, Opium or some of 
 its preparations may be administered in small doses. Oil 
 of Turpentine has been highly recommended by various 
 practitioners as an excellent agent to check the above 
 symptom. 
 
 Diarrhea is a symptom almost always present in this 
 
PHTHISIS-CONSUMPTION. 771 
 
 disease, and more generally occurs in the latter stages ; it 
 is often very difficult to overcome by any means that have 
 been recommended. We have met with more advantage 
 from the use of a powder composed of two drachms of 
 Myricin and one of Geranin, than any other preparation 
 we have employed. Opium, so universally recommended 
 by authors, we have never found to exert the least influence 
 in palliating this symptom. 
 
 The rapid pulse so common to phthisis is seldom the 
 result of inflammatory action, except perhaps at the com- 
 mencement of the disease; but, in our estimation, it is 
 almost invariably the result of debility, a striking example 
 of which may be seen in the quick pulse attending the 
 stage of prostration in typhoid fever. The result of our 
 treatment, based upon this view, w^ould seem to indicate its 
 correctness. We are in the habit of administering stimu- 
 lants and tonics, which are generally followed by the reduc- 
 tion of the pulse, and a decrease of the temperature of the 
 surface. 
 
 With regard to dyspnoea, and bronchial inflammation, 
 but little can be done by the administration of internal 
 remedies ; palliation is all that can be expected, and to 
 effect this, we have found the most advantage from inhala- 
 tion of vapor of vinegar, or vinegar in which Lobelia or 
 Stramonium has been tinctured. 
 
 Night-sweats are nearly always attendant upon the latter 
 stages of this disease, and notwithstanding the many arti- 
 cles which have been recommended for their removal, it is 
 seldom accomplished. Elixir Yitriol seems to exert a more 
 marked influence over them than any other means we have 
 used. When the disease is to terminate fatally, night" 
 sweats can not be controled, at least, for only a few nights 
 at most; if a cure is to be the result, or a suspension of the 
 disease, of course they will cease. 
 
 The diet, in phthisis, must be of a stimulating, nutri- 
 tious character ; beef, veal, mutton, oysters, etc., may be 
 used as freely as the stomach of the patient will permit. 
 Pork, in any shape, is inadmissible. Wine, beer, porter, 
 49 
 
772 INFLAMMATORY FORMS OF DISEASE. 
 
 ale, or even the more stimulating alcoholic liquids, may be 
 likewise employed in moderate quantities with advantage. 
 The patient must take gentle exercise daily, and practice 
 long inhalation and exhalation, especially in the earlier 
 stage. Depletive agents, as emetics, cathartics, diapho- 
 retics, and the like, must positively be prohibited — the 
 seeming advantage from their use is but transient, and fol- 
 lowed by serious consequences. 
 
 Genus Y. — Parotitis — 
 Cynanche Pai'otidoea — Mumps. 
 
 This disease may attack adults, but it is generally con- 
 fined to childhood, and it is sometimes a very simple mat- 
 ter — too unimportant to command medical attention ; at 
 other times, it proves to be very troublesome, painful, and 
 serious in its consequences ; but it is perhaps never, or at 
 most very rarely, fatal. It consists of inflammation and 
 tumefaction of the parotid glands, but sometimes the sub- 
 maxillary and sub-lingual glands are either implicated at 
 the outset, or in the course of the disease. Sometimes it 
 is confined to one side ; at other times it seizes upon both 
 sides at once — but most frequently, after seizing one side it 
 then attacks the other. 
 
 When all the glands above-named are involved in the 
 infiammation, the swelling extends from the ear to the chin. 
 Soreness at the angle of the jaw, or soreness in attempts 
 to open the mouth, is usually the first indication of its ap- 
 proach. Slight fever usually attends these local symptoms. 
 Under proper treatment, it usually terminates in resolution 
 in a few days, having given but little trouble, further than 
 a material interruption to the function of the lower jaw. 
 
 Through the joint influence of atmospheric and constitu- 
 tional causes, it is sometimes productive of severe suflfer- 
 ing — the inflammation running high, and the gland becom- 
 ing so enlarged as to render the opening of the mouth and 
 deglutition particularly difficult and painful. It happens 
 in a few instances that nausea, vomiting, fever, and deli- 
 rium are all attendant upon the disease ; but, however mild 
 
PAROTITIS-MUMPS. 773 
 
 the complaint may be, much care and vigilance are advisa- 
 ble, because of a peculiar and very remarkable metastasis 
 to which it is obnoxious. 
 
 We can readily understand why a translation of disease 
 may take place from the skin to the mucous lining of the 
 bowels — from the scalp to the cerebral meninges — from the 
 stomach to the teeth, etc., — but why there should be a fixed 
 tendency to a translation of disease from the parotid glands 
 to the mamma in females, and the testes in males, which 
 observation has proved to be the fact in this disease, is 
 more than the present state of physiological science can 
 explain. 
 
 When this translation takes place in the male, the testes 
 become sometimes enormously enlarged, producing much 
 fever, occasionally delirium, always severe suffering, and 
 very considerable hazard — such, indeed, as to require per- 
 severance in the use of potent and active remedies . In the 
 female, the mamma become inflamed and enlarged, but we 
 have not learned that suppuration ever supervenes. Some- 
 times another translation is made, and the disease returns 
 to the glands — it has been known to take place to the brain, 
 and then death may be the result. This possibility affords 
 another reason why care should always be rendered to this 
 disease. 
 
 The inflammation usually rises to its highest point in two 
 days, continues without abatement two days more, and then 
 declines — the whole course of the disease, ordinarily, con- 
 suming only a week. The glands very rarely suppurate. 
 
 Causes. — Like some of the contagious diseases, it but 
 rarely attacks the same person a second time. Drs. Watson 
 and Wood say that it is undoubtedly contagious, and it is 
 acknowledged by all to appear frequently as an epidemic. 
 
 Treatment. — Usually mumps require but little treatment; 
 a diet of toast and tea, toast-water, thin gruel, and similar 
 articles, with an especial attention to an avoidance of cold 
 by exposure to wet, sudden changes of temperature, or 
 other causes of cold, will generally be found sufficient. 
 
 Should the bowels be constipated, a Seidlitz-Powder or 
 
774: INFLAMMATORY FORMS OF DISEASE. 
 
 two may be administered. There will be no necessity for 
 the application of any liniments or washes to the affected 
 parts, as they may act as repellants, and probably cause a 
 metastasis to take place ; a piece of soft flannel may, how- 
 ever, be applied, to keep them warm and favor perspira- 
 tion. 
 
 Should much fever accompany the disease, small doses 
 of the Compound Powder of Ipecacuanha and Opium may 
 be administered, together with a purgative dose or two of 
 the Compound Powder of Jalap, to which five or ten grains 
 of Cream of Tartar have been added. 
 
 In cases where the inflammation becomes translated to 
 the testicle, the patient should be confined to his bed in a 
 horizontal position, the testes enveloped in an Elm-poultice, 
 and supported by a suspensory bandage- — the poultice must 
 be changed two or three times a day. 
 
 In addition to the above, efforts should be made to recall 
 the inflammation to the parotid glands by the application 
 of a sinapism or blister over the gland, and the Compound 
 Powder of Ipecacuanha and Opium should be administered 
 internally. A somewhat similar course may be pursued 
 when the mamma become affected. 
 
 In cases where the brain, or some other vital organ, be- 
 comes affected, blisters must be applied as in ordinary, 
 severe inflammations of such organs. 
 
 Should a chronic inflammation of the gland remain, 
 which, however, will very rarely be the case by the above 
 course, an irritating plaster applied over the tumor, and 
 kept discharging from time to time, intermittingly with 
 the internal use of Compound Syrup of Stillingia and Hy- 
 droidate of Potassa, will be found sufficient to remove the 
 difficulty. 
 
 Genus YI. — Gastritis. 
 
 This term is commonly used to express an inflammation 
 of all the tunics of the stomach, with the exception of its 
 serous covering ; but, as it is now generally believed that 
 this diseased action commences in the mucous membrane 
 and glands, the term is employed to designate an inflam- 
 
ACUTE GASTRITIS. 7Y5 
 
 mation of the internal tunic, which may or may not affect 
 the remaining tissues from the violence or chronicity of the 
 disease, the habit of the patient, etc. — Cyo. Prac. Med. 
 
 1. Acute Gastritis. 
 
 That the mucous membrane of the stomach is liable to 
 as many varieties of inflammation as that of the fauces or 
 mouth, we do not entertain a doubt ; but as we can not 
 distinguish these varieties (and if we could, we do not 
 readily perceive a therapeutic advantage in it), therefore we 
 shall treat of gastritis as a simple inflammation—acute and 
 chronic. 
 
 Gastritis is a rare disease of infancy, and to find it un- 
 associated with inflammation of a portion of the intestinal 
 tube, is still more rare. Such are the sympathies of the 
 stomach, that the symptoms of gastritis scarcely ever ap- 
 pear clear and indisputable. It requires close attention 
 and accurate discrimination to sift the truly gastric symp- 
 toms from the adventitious ; but this difiiculty can not be 
 said to exist to much extent, except so long as it may con- 
 tinue in a simple erythematic form. When the inflamma- 
 tion shall have thoroughly invaded the mucous membrane, 
 or inflicted upon it a well-marked lesion, nearly all doubt 
 is dispelled as to the character of the complaint. 
 
 When the attack is attended by vomiting, tension, and 
 pain of the epigastrium, by cries when this organ is sub- 
 jected to pressure, by alterations of the countenance, ex- 
 pressive of severe pain or suffering, we can scarcely doubt 
 as to the character of the disease, in infancy. In adults, 
 it may be known by severely-acute pain in the prascordia ; 
 a sensation of heat in the stomach ; a pulse more or less 
 hard, contracted, and weak ; great mental anxiety ; contir 
 ually-painful vomiting ; excessive thirst ; watch ings ; in- 
 quietude; tossing of the body; coldness of the extremi- 
 ties ; exquisite pain upon belching ; fainting fits or a stroi.g 
 disposition to syncope ; an increase of pain when degluti- 
 tion is attempted, or a deep inspiration. 
 
 Gastritis is not alwavs confined to the mucous liuiuo; of 
 
776 INFLAMMATORY FORMS OF DISEASE. 
 
 the stomach and the sub- mucous cellular tissue, but extends 
 sometimes to the other coats, and may involve the whole 
 organ. To the symptoms which have been detailed, we 
 may add, that the vomitings at the onset bring up the food 
 or chyme, and henceforward bile, or mucus, and whatever 
 else may have been swallowed, which is tinctured some- 
 times with blood. The pulse is frequent, and usually small 
 and corded, respiration short and hurried, skin hot and 
 dry, and the urine highly colored. 
 
 These symptoms are liable to considerable modification, 
 depending upon the more or less violent character of the 
 attack. If it has been produced by a corrosive poison, the 
 disease may run its course in twenty-four hours, but when 
 ordinarily produ€»ed, it may continue from two to four or 
 five weeks, and then terminate fatally, or in a slow conva- 
 lescence, or lastly in a chronic form. However mild the 
 attack, it should be attended with no neglect or indifie- 
 rence, because it may continue in such a state for weeks, 
 and then assume the chronic form. 
 
 Whatever may be the variety of this disease, it is liable 
 to run into a true disorganization of tissue, inasmuch as all 
 its varieties are sometimes followed by ulceration or gan- 
 grene. Such consequences, however, very rarely hap- 
 pen in infancy, but are not unfrequent occurrences with 
 adults. 
 
 Causeb. — Irritating food, strong acid, cold, and poisons. 
 Pretty extensive observation has decided that the Tartrate 
 of Antimony and Potassa is much more apt to produce 
 gastritis in the south than the north. During the time the 
 writer was in Arkansas, some five years, he was informed 
 of many deaths that were occasioned by the use of this 
 article as an emetic. From such fatality in the south we 
 may v/ell question its safety in the north — indeed, in every 
 modification of latitude. 
 
 Diagnosis.— It is barely possible that a young and inex- 
 perienced physician might mistake' colic or flatulence of 
 the stomach for gastritis, therefore a few diagnostic symp- 
 toms will be sufficient. In the former, the pulse con- 
 
ACUTE GASTRITIS. 777 
 
 tiiiues normal, or nearly so ; vomiting is usually absent ; 
 the pain is intermittent, and it is relieved by pressure ; the 
 pain is heavy, aching, and twisting, and the skin is rather 
 cool and moist — while the reverse of all this attends 
 gastritis. 
 
 Prognosis. — A fatal termination is indicated by a rest- 
 less tossing about, a vomiting up of whatever is taken into 
 the stomach, hiccoughs, fainting fits, an intermitting pulse, 
 disturbed mind, and convulsive movements of the extremi- 
 ties. This form of disease is always dangerous, but when 
 the pain and vomiting gradually subside, attended with a 
 lateritious sediment in the urine, feculent discharges from 
 the bowels, a compressible pulse, and a gentle moisture of 
 the skin, a favorable termination may be expected. 
 
 Teeatment. — If the gastritis be the effect of poison, and 
 the poisonous substance remains in the stomach, it will be 
 necessary to remove it by giving a mild emetic, using at 
 the same time, as well as subsequent to the evacuation of 
 the stomach, the proper antidote to the poison. If the in- 
 flammation should still continue, the usual means to subdue 
 it may be employed. 
 
 In all cases of gastric inflammation, the treatment must 
 be commenced by the application of fomentations over the 
 epigastric region, as hot as the patient can bear, which 
 should be often changed, not allowing them to become cool. 
 The feet and legs must be frequently bathed in hot water, 
 and sinapisms placed on the soles, and even around the 
 ankles in severe cases. Perspiration must be induced either 
 by the use of the spirit vapor-bath or injection of the Com- 
 pound Tincture of Virginia Snakeroot, one to three drachms 
 of which may be placed in about a half-gill of warm starch- 
 water, and injected at one time into the rectum. Professor 
 King is in the habit of applying sinapisms over the epigas- 
 tric region, in connection with the hot fomentations, and 
 also sinapisms the whole length of the spinal column. 
 
 Internally but little active medication can be employed ; 
 the best preparation with which we are acquainted, how- 
 every to overcome the tendency to vomit, by reduciug the 
 
778 INFLAMMATORY FORMS OF DISEASE. 
 
 inflammation, is an infusion of peach-leaves and elm-bark, 
 which may be given in teaspoonful doses to the patient 
 ^verj fifteen minutes, with one drop of the Tincture of Aco- 
 nitum added to it ; and as soon as the more active symp- 
 toms become lessened, the Aconitum may be omitted. 
 
 Should the patient crave cold water, or cold lemonade, it 
 may be given, provided it does not increase the tendency to 
 vomit, otherwise no other drink must be given than the 
 above infusion. 
 
 As soon as the patient becomes able to retain anything 
 upon the stomach, the Compound Powder of Ipecacuanha 
 and Opium in very small doses, combined with half to a 
 grain of Hydrastin, may be given at intervals of two or 
 three hours, still continuing the peach-leaf infusion. Con- 
 stipation must be overcome by purgative injections. 
 
 As to diet, but little can be taken during the active stage 
 of the inflammation ; but after this has subsided, Gum- 
 Arabic water, barley-water, rice-water, or toast-water, may 
 be given, and when the inflammation has enth'ely subsided, 
 a cautious use, at first, of chicken-broth or beef-tea, gradu- 
 ally accustoming the stomach to the usual food of the 
 patient. 
 
 2. Chronic Gastritis. 
 
 It is not always possible to distinguish between that 
 functional derangement of the stomach which constitutes 
 dyspepsia and chronic gastritis, and therefore the error of 
 confounding the two is readily fallen into. In verj^ many 
 instances, as is well known, dyspepsia is occasioned by a 
 too-free use of stimulating or highly-seasoned food ; and it 
 is also well known, that no variety of functioual derange- 
 ment can exist without passing ultimately into one of struc- 
 ture; in cases of long-standiag dyspepsia, therefore, it is 
 much more than probable that it consists of both functional 
 and structural derangement, and the difliculty of arriving 
 at a diagnostic difierence between the two forms of disease, 
 and more especially when existing conjointl}^, has occa- 
 sioned much error and disappointment in the practice foy 
 dyspepsia ; and yet, as humiliating as it really is, the pro- 
 
CHRONIC GASTRITIS. 779 
 
 fession has it not in its power to indicate a single symptom 
 that seems to distinguish the two forms of disease from 
 each other, until the inflammatory shall have so far ad- 
 vanced as to render its complaints more imperious than 
 those which are usual to the other. 
 
 There is probably no other form of disease that is more 
 insidious in its assault and initiatory stage than this ; so 
 much so is this the case, that the earliest indications of its 
 existence are allowed to pass unobserved, and therefore we 
 are compelled to begin the history of it with those which 
 are sufficiently troublesome to force their observance, and 
 of these the most frequent and appreciable are pain and 
 vomiting — the first is the usual companion of the patient 
 during the process of digestion, while vomiting not unfre- 
 quently supervenes to relieve him of it. 
 
 In many cases, before any particular pain is felt, the pa- 
 tient feels some uneasiness in the epigastrium shortly after 
 eating, and discovers that his appetite has become irregular 
 and fastidious. He is also troubled more frequently than 
 formerly with headache, feels fatigued — complains of pains 
 and soreness in his limbs. The symptoms gradually in- 
 crease in variety and severity ; the epigastric uneasiness 
 has passed into absolute pain, but it is exceedingly varia- 
 ble, being sometimes acute, spasmodic, slight, dull, and 
 even lancinating. Instead of, and sometimes conjointly 
 with, the preceding varieties of pain, there is a tormenting 
 sensation of heat or burning which may even extend to the 
 chest. At other times, instead of the pain, there is a sense 
 of fullness, weight, distention, or constriction. The pain 
 is occasionally exceedingly severe, but subsides as the 
 stomach becomes empty ; it may extend to the back, or ap- 
 pear under the margins of the ribs or sternum, but gene- 
 rally it is in the epigastrium or hypochondrium. Vomit- 
 ing is not an unfrequent occurrence and generally occa- 
 sions much relief; the injesta alone is usually rejected, and 
 its supervention is generally proportioned to the irritating 
 character of the food ; but sometimes the most bland ingesta 
 will produce it ; and indeed, it occurs sometimes when no 
 
780 INFLAMMATORY FORMS OF DISEASE. 
 
 food has been taken. In the matter ejected, there is some- 
 times much variety — at one time it may resemble the white 
 of eggs ; at another, insipid and watery ; it may also be 
 intensely acid, dark-colored, bilious, or bloody. Hema- 
 temesis is not an uDcommon attendant — indeed, it even 
 begins the disease, in some instances ; it may result from 
 exhalation in some cases, and in others, from the ulceration 
 of the gastric vessels. Without the ulcerative form, it is in 
 some cases so nearly allied with the disease under conside- 
 ration, that inflammation can immediately succeed to it, 
 and in such cases the proper remedy for the one is also the 
 best for the other. 
 
 It happens sometimes that the digestive process goes 
 on very well until it reaches a certain stage, or probably 
 arrives at a certain part of the organ, and then pain is occa- 
 sioned and the food is rejected. Sometimes the presence of 
 food gives temporary relief, by allaying a gnawing sensa- 
 tion in the epigastrium, which the writer knows to be pecu- 
 liarly distressing. It occurs usually a little time before the 
 regular period of taking food ; in some instances the desire 
 for food is entirely lost, but this only occurs in the most 
 violent cases. The tongue, in this disease, is generally an 
 untrustworthy guide as to the condition of the stomach. 
 The bowels, in many cases, a^e habitually costive, which 
 so much increases the suflering that purgatives are greatly 
 demanded by the sufferer — indeed, he is strongly disposed 
 to regard this as his disease, and by its treatment renders 
 his condition worse ; he becomes usually emaciated, and 
 the abdomen, by its accumulation of fasces and flatus, be- 
 comes distended — the shoulders more or less droop, through 
 the extension of the abdominal muscles.* This abdominal 
 
 * Tlie writer was compelled, at an earlier period of his life, when afflicted 
 with this disease, to take cathartic medicine every night to remove con- 
 stipation. To avoid this necessity, he determined to try abdominal com- 
 pression, and for this purpose he buckled around his waist a Russian riding 
 belt, in the morning, after the evacuation of his bowels, and determined not 
 to loosen it. On the next day, the compression was remarkably uncomfort- 
 able, and on the third day peristaltic action commenced ; and by the use of 
 •-he belt he avoided the further necessity of taking cathartic medicine. The 
 
CHRONIC GASTRITIS. 781 
 
 distention is not a conspiciions symptom in all cases, but it 
 is always presented, more or less frequently, in those cases 
 in which gas is evolved in the stomach. 
 
 There is apt to be an aphthous exudation on the tongue, 
 in the advanced stages of this disease, which is thought to 
 indicate an ulcerated condition of the stomach ; at all 
 events, it is held to be an unfavorable symptom. The 
 pulse, in general, makes but little departure from that of 
 health — sometimes it is a little more frequent and others a 
 little slower, and perhaps intermittent. A slight febrile 
 paroxysm after dining is a common symptom in the con- 
 firmed condition of the disease. Some patients complain 
 of much heat in the soles of the feet and palms of the 
 hands, but with the most of them the extremities are cold. 
 The secretions are generally much deranged, but nutrition 
 is not always so defective as might be supposed. In some 
 cases the disease continues for a long time without an appa- 
 rent loss of flesh, but in others the emaciation is tolerably 
 rapid and runs to a great extreme. 
 
 The influence of this disease upon the nervous system, 
 in producing nervous affections, can not be expressed by 
 any use of language, and it is very probable that no two 
 patients ever sufiered in the same manner. From this dis- 
 ease the writer has sufiered partial blindness, deafness, 
 baldness, also palpitations, asthma, heartburn, headache, 
 toothache, rheumatism, gout, bronchitis, fugitive pains, 
 lithiasis, and mental dejection. 
 
 Causes. — Dr. Wood says that this disease occasionally 
 follows the acute, but that a large majority of the cases are 
 independent of it. The use of alcoholic liquors is said to 
 produce it, but of this w^e have some doubt. We have seen 
 many cases of it among those who had never used such 
 liquors, and we have observed remarkably few^ even among 
 
 belt lias been his remedy ever since when his bowels manifested a tendency 
 to a habit of constipation. He has applied it with equal success in perhaps 
 fifty other cases. He recommends it to the profession as a useful applica- 
 tion, in all cases of habitual constipation, but particularly when it is 
 attended by abdominal enlargement. 
 
782 INFLAMMATORY FORMS OF DISEASE. 
 
 habitual drunkards. This is not all — we have known the 
 disease to yield to the nse of them. The writer attributes 
 his recovery to brandy and traveling. He is of opinion 
 that the use of mustard, as a condiment, is worse than alco- 
 hol, and next to this is excessive eating. But a more fruit- 
 ful cause than either, and one that we have found noticed 
 by no writer, is excessive venery, but it acts indirectly by 
 first producing dyspepsia. 
 
 Diagnosis. — The maladies with which chronic gastritis 
 may possibly be confounded, are cancer of the stomach, 
 dyspepsia, and gastralgia, to which we refer. 
 
 Prognosis. — This disease exists almost uniformly in a 
 peculiar organic liability — a deficiency of the organ of ali- 
 mentiveness — for the power of the stomach depends upon 
 the endowment of this organ ; consequently, although the 
 patient may recover, he has no security, during life, against 
 as many returns of the disease as he shall be guilty, for 
 indefinite periods, of violating the laws which are indis- 
 pensable to his own health. When the disease becomes 
 confirmed, no hope need to be indulged of a recovery under 
 a year or two, and it may continue for four or five — for 
 much depends upon the constitutional liability. It does not 
 move steadily on to its final termination, but is attended 
 with irregular intermissions, the patient appearing quite 
 well even for weeks or months, and suddenlj^, because of 
 some imprudence in diet, or some atmospheric change, it 
 becomes manifested again. If it should not become com- 
 plicated, it will very probably terminate favorably, for it is 
 rarely fatal. The stomach may become ulcerated — adhe- 
 sions may form, and perforations may be efiected, commu- 
 nicating with the bowels, and still the patient may recover. 
 
 Treatment. — In this disease, the mucous coat of the 
 stomach only is afiected, and the treatment must be directed 
 to it, using such agents as exert a more especial influence 
 on the mucous tissues. When the inflammation is rather 
 active, bordering on the acute, it will be necessary to give 
 the patient, internally, the Compound Powder of Ipecacu- 
 anha and Opium, combined with Hydrastin, together with 
 
CHRONIC GASTRITIS. 783 
 
 mild, unirritating, and mucilaginous drinks. The diet must 
 also be especially attended to, and should consist of nutri- 
 tious but easily-digested articles of food, as Gum- Arabic 
 water, barley-water, rice-water. Sago, Tapioca, soft-boiled 
 eggs, toast and tea, and similar preparations. 
 
 The surface of the body should be bathed daily with a 
 weak alkaline-solution ; an irritating plaster may also, if 
 the case proves obstinate, be applied over the region of the 
 stomach, and continued intermittingly as the case may 
 require, and the patient should be kept quiet, and free from 
 any exposures. 
 
 If, however, the inflammation be purely of a chronic 
 character, and attended with much debility, a more nutri- 
 tious diet will be required, as animal jellies, oysters, poul- 
 try, venison, tender beefsteaks, birds, or other meats easy 
 of digestion. 
 
 Should there be any particular craving of the patient, 
 however much it may be in opposition to the views of the 
 physician, it will generally be found better to grant the use 
 of the desired food, commencing with it gradually and 
 carefully ; many instances have occurred where this course 
 has resulted in permanent benefit to the patient. 
 
 The agents to be used internally must be given with a 
 view to the promotion of absorption and stimulation of 
 the secretions to a normal standard. We prefer, for this 
 purpose, combinations of Hydrastin, Cornin, Supercarbo- 
 nate of Soda, Myricin, Caulophyllin, and Macro tin. The 
 combination to be employed must be adapted to the emer- 
 gencies of the case, and may be composed of two or more 
 of the above articles. The following is a favorite formula 
 with us : 
 
 K. Hydrastin, 
 Cornin, 
 
 Myricin, da grs. x. Mix. 
 Divide this into ten powders, one of which may be given 
 every three or four hours. 
 
 Should constipation be present, it will most generally be 
 found connected with acidity of the stomach, or rather, in 
 
784 INFLAMMATORY FORMS OF DISEASE. 
 
 cases of constipation, the acidity will be found present 
 likewise, and to overcome both of which symptoms the fol- 
 lowing compound will be found fully sufficient : 
 R. Pulv. Rhei, grs. xx, 
 Podophyllin, grs. ij, 
 Supercarb. Soda, grs. xx, 
 Pulv. Carbo Ligni, grs. xx. Mix, 
 Divide into ten powders, of w^hich from one to three may 
 be given daily, to produce not over two alvine evacuations; 
 or, if the medicine proves very active a still smaller dose 
 of it may be administered, sufficient to effect the desired 
 result ; if acidity of the stomach be prominent, a solution 
 of Supercarbonate of Soda may be given in tablespoonful 
 doses, daily — repeated every one, two, or three hours. 
 
 Other laxative agents may be employed, as Apocynum 
 Cannabirum, Asclepias Incarnata, Iris Versicolor, Juglans 
 Cinerea, etc., which may be given alone or in combination, 
 as the practitioner may deem best. The skin must be 
 attended to, bathing daily with cold or tepid water, as may 
 be found more suited to the casCj and using considerable 
 friction in drying. Too much exercise of any kind must 
 be prohibited. 
 
 In that form of dyspepsia in which chronic inflammation 
 of the stomach exists, with constipation, we have derived 
 the greatest benefit from the following course of treatment : 
 R. Pulv. Prinos Yerticillatus, 
 
 Pulv. Hydrastis Can., da 3ss, 
 Myricin, Bj. Mix. 
 Divide this into four powders ; one of these powders is to 
 be placed in half a pint of boiling water, infused for a few 
 minutes, and the whole taken in the course of twenty- 
 four hours, and thus continue daily with each powder. 
 
 The irritating plaster must likewise be placed over the 
 epigastric region, and a free discharge kept up during the 
 continuance of the disease. For the constipation, injec- 
 tions of cold water may be used, or the above-named laxa- 
 tive powder. Occasionally cases will occur in which coun- 
 ter-irritation applied the whole length of the spinal column 
 
DUODENITIS. 785 
 
 will be of advantage. The diet should be nutritions, of 
 
 easy digestion, avoiding fats, acids, and all agents which 
 
 may induce flatulency or constipation. Moderate exercise 
 
 in the open air, and frequent bathing with cold water should 
 
 be advised. 
 
 Genus YII. — Deodinitus — ■ 
 
 Inflammation of the Duodenum, 
 From continuity of structure, as well as an intimate 
 affinity in function, it is but seldom that this viscus is in- 
 flamed or otherwise diseased without involving its neigh- 
 bors. If its inflammation extends upward, the stomach 
 may become implicated, and gastritis, more or less evident, 
 may be the result ; if it extends downward, the jejunum 
 may become involved, and an enteritis may thus, also, be- 
 come .manifest. In its various forms of disease, the liver 
 and pancreas may become involved ; hence it is, that be- 
 cause of its intimate functional and pathological relations, 
 rather than through any therapeutic considerations, does it 
 become proper or important to note its most striking patho- 
 logical and diagnostic symptoms. 
 
 The most striking circumstance in the history of duo- 
 denitis is its tendency to derange the function of the 
 liver, and the most obvious instance of this kind is 
 a jaundiced condition of the skin. But the pathological 
 sympathy between the duodenum and liver is not more 
 striking than the physiological. Chyme received into the 
 duodenum so excites the liver that its bile is immediately 
 discharged into the former. This intimate relation shows 
 that a morbid condition of the duodenum cannot fail to in- 
 crease, or diminish, or otherwise affect the function of the 
 liver. If its action, through this mean, be increased, such 
 may be the quantity of bile thrown into the bowels, that 
 by absorption, enough may be taken up to produce jaun- 
 dice ; and on the other hand, if its secretion be diminished, 
 jaundice may result from an accumulation of bile in the 
 blood; and, again, if the secretion be vitiated, it may pro- 
 duce diarrhea, for we think it very questionable whether 
 healthy bile is ever an exciting cause to diarrhea. Some 
 
786 INFLAMMATORY FORMS OF DISEASE. 
 
 writers attribute jaundice to an obstruction of the common 
 duct of the liver, bj an inflammatory thickening of its 
 coats, in duodenitis, or by mucus. It may possibly be 
 sometimes effected in this way, but it is rendered certain 
 that this is not always the case. 
 
 Prof. Dunglison, we believe it is, teaches that mercury 
 promotes the secretory action of the liver, by its impression 
 upon the duodenum or the mouth of the hepatic duct. If 
 this be true, and it strikes us as being probable, we have 
 another source of uncertainty as to the action of this drug. 
 The functional sympathy that exists between the liver and 
 duodenum affords us an explanation of an important phe- 
 nomenon in the digestive process. In a dyspeptic condi- 
 tion of the organ, the chyme, its normal stimulus, is inca- 
 pable of making such an impression as would be received 
 by it, if it was in a healthy state ; and consequently it can 
 not communicate to the liver a normal impression — hence 
 it is made to secrete too much or too little bile, or bile of 
 a vitiated quality. JSTotwithstanding that duodenal derange- 
 ments may produce others in the liver, we are not prepared 
 to believe that they are the most fruitful source of them. 
 
 Diagnosis. — When we have no evidence that the liver is 
 inflamed or enlarged, and pressure produces pain immedi- 
 ately to the left of the right hypochoudrium ; when the skin 
 is jaundiced and the urine bilious ; when pain is felt deep- 
 seated about the pylorus, reaching below and leftwardly of 
 the stomach — then we may suspect the existence, of 
 duodenitis. 
 
 Treatment. — In this form of disease, the treatment 
 recommended under gastritis will be indicated — or if any 
 variation is made, it may be in the administration of more 
 active laxative measures, with an especial attention to the 
 biliary secretions, for which Podophyllin and Leptandrin 
 will be found of particular eflScacy. 
 
 Genus YIII. — Enteeitis. 
 The name enteritis is, strictly speaking, applicable to in- 
 flammation of any portion of the bowels ; yet, as this 
 
ACUTE ENTERITIS. 787 
 
 affection, in the upper and lower extremities of the intes- 
 tinal tube, has received the designations of duodenitis and 
 dysentery, and as the symptoms of these two complaints are 
 in a certain degree strikingly peculiar, it becomes con- 
 venient to ffive a distinct name to inflammation of the 
 intervening portion, and enteritis may, perhaps without 
 impropriety, receive this restricted meaning. — Wood. 
 
 1. Acicte Enteritis. 
 
 Enteritis, as an idiopathic affection, is of rare occurrence, 
 but as a symptomatic one, it is not nnfrequent — particu- 
 larly with reference to scarlatina, rubeola, and low nervous 
 fevers ; and when it does occur, it is more generally of the 
 sub- acute or chronic form. When it is acute, and involves 
 the sub-mucous tissue, the mucous membrane, and the peri- 
 toneal coat, the symptoms generally are intensely pungent, 
 consisting of a burning pain in some particular spot, usu- 
 ally in the umbilical region, increased by the slightest pres- 
 sure ; also a sense of tightness, heat, and abdominal dis- 
 tention, attended with mental anxiety, and violent thirst 
 (which is generally aggravated by cold drinks), constipa- 
 tion, vomiting of slime and bile, and sometimes excremen- 
 titious matter, inflammatory fever, flatulence, obstruction 
 of nrine, occasionally, and a small, contracted pulse. 
 
 When the disease appears in its simple ov siib-acute io\:xn.^ 
 but little pain is felt, compared with what obtains when the 
 peritoneal coat is involved ; it consists rather of a difiused 
 soreness over the abdominal region, which may, or may 
 not, be increased by pressure ; but the symptoms are always 
 increased by indigestible food and cold drinks. Indiges- 
 tion, nausea, and vomiting are more or less present, de- 
 pending upon the portion of the intestinal canal which is 
 principally afiected. If it shall so descend as to involve 
 the colon, diarrhea, with mucacious and bloody stools, will 
 be produced, and if the rectum be invaded by it, pure blood 
 may be expected, with straining efibrts to stool. The 
 tongue is more or less red on its tip and margins, whatever 
 may be the condition of its center ; sometimes, however, 
 50 
 
788 INFLAMMATORY FORMS OF DISEASE. 
 
 the whole of it is red and smooth. The pulse is quick, the 
 thirst is considerable, and the languor extreme. 
 
 Usually, when the bowels are neither diarrheal nor ape- 
 rient, they will be easily moved by cathartic medicine. 
 "When diarrhea obtains, it is not unfrequent that it becomes 
 suspended and then re-appears. Sometimes the stools are 
 highly serous, and mixed with fecal matter, bile, mucus, 
 undigested food, and even blood ; and again, they are 
 sometimes of a dark, or green, or clay-color. The evacu- 
 ations usually happen immediately after griping pains, 
 which they greatly relieve, and several of these discharges 
 may happen in the course of the day. 
 
 When the inflammation particularly involves the muscu- 
 lar and peritoneal coats, and when it has been occasioned 
 by obstructions, the bowels will be constipated. When the 
 inflammation is attended with intense pain and tenderness, 
 obstinate constipation, a frequent and contracted pulse and 
 tympanites, it may be safely concluded that the disease is 
 complicated with peritonitis. If these severe symptoms 
 occur suddenly in the progress of the disease, it may be 
 safely inferred that a perforation has been efiected. 
 
 Dr. Stokes (Cyc. Prac. Med.) teaches, that the symptoms 
 occasioned by sympathetic irritation vary with the idiosyn- 
 crasy of the patient and the violence of the disease. There 
 may be, he says, a continued, remittent, or hectic fever, or 
 an apyrexial state. It sometimes happens that the most 
 prominent symptom is a violent excitement of the heart, 
 such as characterizes pericarditis and hypertrophy of the 
 organ. He thinks, that the excited condition of the abdomi- 
 nal aorta, as a symptom, has not been sufficiently attended 
 to. This excitement, he says, is similar to that of the 
 radial artery in cases of paronychia, and may be detected in 
 an uncollapsed condition of the abdomen. 
 
 Cerebral excitement is less apt to attend this disease in 
 the adult than in the child, and is less liable to result in 
 structural disease of the brain ; and it is not unfrequently 
 difficult to determine whether the cerebral irritation in 
 these cases does or not indicate inflammation of the brain. 
 
ACUTE ENTERITIS. 789 
 
 Andral cites a case in which the patient manifested much 
 cerebral excitement — became lively and loquacious, and 
 finally passed into furious delirium, and yet post-mortem 
 investio^ation discovered no indications about the brain of 
 pre-existing inflammation. 
 
 The fever, in this form of disease, sometimes becomes 
 the simple continued form, without any local symptoms, 
 while at the same time the most serious local mischief is 
 progressing ; but this condition should be suspected if 
 there be much thirst, tympanites, and irregularity of the 
 bowels. 
 
 Diagnosis. — If enteritis should be mistaken for colic, and 
 it has been, the consequences may be fatal, because of the 
 difference of treatment which the two forms of disease, 
 respectively, require. In all cases where doubt may exist, 
 it is better to treat the case as one of enteritis ; for in this 
 event no mischief is done, but the reverse would probably 
 result very differently. The pains of colic and enteritis 
 may be equally severe, but between them there is this diffe- 
 rence : in those of the former there are complete intermis- 
 sions, which is not the case in the latter. Again, in colic, 
 the patient is apt to be constantly twisting, turning, and 
 rolling his body, whereas, in enteritis and peritonitis, the 
 body is kept still, however much the arms may be thrown 
 about. Furthermore, colic is decidedly a spasmodic affec- 
 tion. Pressure affords relief in colic, but increases the 
 pain in enteritis; and again, fever is usually absent in 
 colic, and present in enteritis. Simple enteritis may 
 be distinguished from peritonitis by the absence, in the 
 former, of that intensity of pain which attends the latter. 
 
 Causes. — This is a disease which attacks both sexes and 
 all ages, but children are the most liable to it, because pro- 
 bably of the more delicate and vascular condition of the 
 mucous membrane at this age. Like catarrhal diarrhea, it 
 may be produced by a sudden suppression of accustomed 
 drains upon the surface or elsewhere; like sympathetic 
 diarrhea, it may result from a suppressed irritation in dis- 
 tant parts, as of gout and rheumatism ; and like feculent 
 
690 INFLAMMATORY FORMS OF DISEASE. 
 
 diarrhea, by the contact of irritating substances upon the 
 mucous membrane of the diseased part, as by drastic 
 purges, worms, mercury, antimony, etc. 
 
 Prognosis. — If this disease does not terminate in resolu- 
 tion, induration of the intestines may be the result, and 
 thus the foundation of chronic "constipation, suppuration, 
 or gangrene may be laid. It is al-v^ays to be regarded 
 as a dangerous disease. Cold hands and feet, an extensive 
 diffusion of pain in the abdomen, a scarcely-perceptible 
 pulse, a tense and tumid condition of the abdomen, exceed- 
 ingly tender to pressure, must be regarded as indicating 
 great danger ; but uncertainty attends all the symptoms of 
 this morbus as regards the final result. 
 
 Treatment. — The treatment of this disease will be simi- 
 lar to that named in gastritis : fomentations and sinapisms 
 over the abdomen, counter-irritation to the extremities, and 
 in obstinate cases to the spinal column, alkaline-bath, in 
 some cases the vapor-bath, and emollient and mucilaginous 
 drinks, with Tincture of Aconite or Belladonna. 
 
 Active catharsis must always be avoided, but where there 
 is torpor of the liver, it may be overcome by small doses 
 of Podophyllin, Leptandrin, and Caulophyllin, say one- 
 third of a grain each, combined, and administered three or 
 four times a day. 
 
 To relieve pain, and keep up a determination to the sur- 
 face, it may sometimes become necessary to administer the 
 Compound Tincture of Yirginia Snakeroot. 
 
 When the discharges from the bowels are very copious, 
 or of a mucous character, either with or without blood, and 
 which generally occur after a subsidence of the more 
 active symptoms, the employment of tonics and mild astrin- 
 gents will be found beneficial, as Hydrastin combined with 
 Geranin. 
 
 As to the treatment in other respects, and as to diet, etc., 
 the same course must be pursued as laid down in acute 
 gastritis. 
 
CHRONIC ENTERITIS. 791 
 
 2. Chronic Enteritis — Chronio Inflammation of the 
 Small Intestines. 
 
 This is one of the most troublesome, depressing, and 
 prostrating forms of disease that afflict humanity, more 
 particularly when it constitutes obstinate diarrhea. We 
 are much inclined to.the opinion that long-continued and 
 obstinate diarrhea and chronic enteritis are truly one and 
 the same form of disease, and so it will inevitably appear 
 before we conclude. The evacuations do not materially 
 differ from those of acute enteritis, but as to the quantity 
 and frequency of them no rule can be determined ; in fre- 
 quency they may not extend beyond two or three in twenty- 
 four hours, and they may be two or three times as many, 
 and the quantity is equally various. It has been some- 
 times observed that a false membrane is discharged, 
 showing that plastic inflammation existed. The attending 
 pain is perhaps never acute, rather dull and obtuse, but 
 pressure will always detect the existence of soreness, and 
 so will jars and jolts. If the inflammation passes into the 
 acute state, which is occasionally the case, the pain will be 
 quite severe, but it is relieved by the evacuations it occa- 
 sions, which are sometimes so frequent as to distress the 
 patient very much. 
 
 It sometimes happens that no pain is felt until a definite 
 time after eating ; in such cases we may infer that the in- 
 flammation is local, and that no sufiering is produced until 
 the ingesta reaches it. In some instances, again, the only 
 function that appears to be disturbed is that of nutrition — 
 the patient becomes feeble and emaciated, but scarcely com- 
 plains of any local symptom. The abdomen is occasion- 
 ally distended, but it is frequently flat or gaunt, the skin 
 dry and harsh, the pulse more than normally frequent, and 
 the tongue is somewhat furred, or it is red and dry, or it 
 may be aphthous. 
 
 As might be expected, the stomach sometimes becomes 
 implicated, and to the preceding symptoms are added those 
 of chronic gastritis. The remarks we made upon the 
 
Y92 INFLAMMATORY FORIMS OF DISEASE. 
 
 duration and mutability of gastritis equally apply in the 
 case before us — it may be cured in a few weeks, or it may 
 continue for years, appearing sometimes quite well, and 
 then re-appearing, and frequently without any obvious 
 cause. When it is severe, has been of long standing, and 
 of very doubtful recovery, the patient loses all hope, de- 
 sponds, becomes fretful, and sometimes even insane. 
 
 Causes. — It is said sometimes to oris^inate in the acute 
 form, but most generally it obtains in those of a phthisical 
 organization who have been much exposed to fatigue in a 
 hot sun. Yery many of those who served in Mexico died 
 of this disease — some in Mexico, some while journeying 
 home, and many after their arrival there. 
 
 Treatment. — The treatment in this form of enteritis will 
 be the same as described for chronic gastritis, with an espe- 
 cial attention to diet. See chronic gastritis. 
 
 Genus IX. — -CoLOKEcrms — 
 
 Dysentery — Bloody-Fhix^ or Acute Inflammation of the 
 
 Large Intestines. 
 
 " Dysentery," says Dr. Wood, '' is inflammation of the 
 m_ucous membrane of the colon and rectum, characterized 
 by small mucous or bloody evacuations, griping pains in 
 the abdomen, straining at stools, and tenesmus. Inflam- 
 mation in the colon, without these phenomena, would rank, 
 under enteritis." 
 
 This form of disease very rarely attacks children under 
 two years of age — before this period, the liability, in this 
 country, is to cholera infantum. Dysentery as rarelj^ ob- 
 tains under this period, as cholera infantum does after it. 
 
 Dysentery and bloody-flux are names selected to repre- 
 sent an inflammation of the mucous membrane of the large 
 intestiues — the colon and rectum. When the evacuations 
 are unattended with blood, the disease is called simple dys- 
 entery — the inflammation, if present, is but slight; but 
 when it is dysentery proper, there is a constant urgency to 
 evacuate the bowels, tenesmus, violent pains in the abdo- 
 men, a greater or less degree of fever, and the evacuations 
 
COLOREGTITIS-DYSENTERY. 793 
 
 consist, measurably, of mucus and blood. It sometimes 
 appears suddenly, but it is perhaps most generally pre- 
 ceded, by a few days, with loss of appetite, nausea, or 
 slight vomiting, costiveness, flatulence, chills succeeded by 
 a hot skin, accelerated pulse, abdominal pains, tormina, 
 and increased evacuations, containing usually some natural 
 faeces, particularly scybala. In a short time more, the 
 evacuations consist of mucus and blood, frequently fetid, 
 and, if at this stage the disease is not speedily arrested, it 
 may terminate in ulceration or gangrene. This is briefly a 
 description of this form of disease. 
 
 In simple dysentery, the symptoms may be so mild that 
 the disease may run its course without exciting the particu- 
 lar attention of even the patient ; at other times, the fever, 
 tormina, and tenesmus, appear, as it were, simultaneously, 
 and thus progressing for two or three days, it becomes one 
 of the most formidable forms of disease to which humanity 
 is liable. 
 
 In violent cases, the whole pain consequent upon the in- 
 flammation appears to be concentrated about or in the rec- 
 tum, and the feeling of tenesmus becomes the most impor- 
 tant and distinguishing feature of the disease. The calls 
 to stool are very urgent and frequent, from a dozen to a 
 hundred in twenty-four hours, and the straining is so great 
 as to produce prompsus ani, more especially with children. 
 The writer once witnessed, in an old negro laboring under 
 this disease, a protrusion of the rectum to the extent of 
 nearly three inches.* The fseces are sometimes so scalding 
 or piercing that the patient so dreads the consequences of 
 an evacuation as to resist, to the utmost of his power, the 
 call to stool. 
 
 In a very large majority of cases, under proper medica- 
 tion, the disease takes a favorable turn between the sixth 
 and tenth days. In some cases, however, such is the 
 
 * Tlie old man, in looking as nearly as lie could to the location of tlie 
 protruded gut, concluded that it was a useless stranger, called for a knife to 
 cut it off, but his wife thought it best to consult the writer about it first, and 
 refused to obej him. 
 
794 INFLAMMATORY FORMS OF DISEASE. 
 
 violence of the assault, that the system never reacts; a 
 small, feeble, and frequent pulse, anxious and sunken fea- 
 tures, a livid appearance about the nails, lips, and eyes, a 
 pale, cool, and clammy skin, with an extraordinary vio- 
 lence of all the symptoms before named, mark the case 
 from its commencement. Such cases continue but a few 
 days — they are extremely rare — and this is exceedingly 
 fortunate. 
 
 When the disease has continued as long as ten days 
 without a favorable change, it is very common for the 
 above-described symptoms to become more violent, with an 
 addition of others of a more alarming character. The ab- 
 domen becomes swollen and tender, the pulse weaker and 
 more frequent — the tongue becomes dryish and brownish, 
 or it becomes clean, red, and smooth, and to these are 
 added increased restlessness and feebleness. 
 
 Authors have treated of several varieties of dysentery, 
 as the bilious, adynamic, intermittent, remittent, and 
 typhous, but as they do not particularly interest us in this 
 connection, being mere modifications, we refer our readers 
 to other works for information concerning them. But there 
 is a variety too remarkable in its features to be passed over 
 without some notice. It is a variety in which calomel can 
 exert no more influence than brick clust. It appeared as 
 an epidemic in a few of the counties above Cincinnati, on 
 the Ohio, in 1826, and yet it did not attack very many per- 
 sons, but those it did attack were of a stout and healthy ap- 
 pearance, and between second dentition and middle age. 
 It was almost certainl}^ fatal — the writer does not remember 
 to have heard of a single recovery, except those which hap- 
 pened in his own practice — and he lost his first two cases. 
 His preceptors, Messrs. Ramsey and Pearson, had a few 
 cases in the vicinity of Cincinnati. The writer prepared a 
 report upon the disease and his treatment of it, and gave 
 it to Dr. Drake, but what became of it he knows not. 
 
 Dr. Thomas, in his Practice, describes a variety of dys- 
 entery which occurs, or had occurred, in the West-India 
 Islands, that precisely corresponded to the one under con- 
 
COLORECTITIS-DYSENTERY. 795 
 
 sideration. The writer does not intend, in this place, to 
 treat of this particular form in full, but simply to mention 
 some of its peculiarities. 
 
 The patients at no time, scarcely, complained of any- 
 thing but a feeling of extreme wretchedness, which was 
 attended with great restlessness — it produced considerable 
 tormina and tenesmus, but of these symptoms little com- 
 plaint was made — the feeling first named prevailed over ail 
 others. The evacuations at first consisted of mucus and 
 blood, but after the lapse of three or four days, they con- 
 sisted of mucus and a verdigris-green matter, and the same 
 appeared in the vomitings. To his first patient, who did 
 not fall into his hands until the ninth day of the disease, he 
 gave seventy-four grains of calomel, without the least ob- 
 servable influence. On the seventeenth day of the disease 
 the patient died. The evacuations and the other symptoms 
 continued, in kind, about the same to the last. 
 
 Two days before the death of this lady, he commenced to 
 treat her brother, a likely and healthy youth of about six- 
 teen years of age, who w^as seized with the same disease. 
 The symptoms were the same — he died on the eighteenth 
 day of the disease. During his illness he gave him one 
 hundred and seventy -four grains of calomel, beside such 
 other agents as the case seemed to indicate, and with about 
 as much efiect as might have been expected from an equal 
 quantity of chalk. 
 
 During the prevalence of this epidemic there was con- 
 siderable difference of opinion in the profession so far as 
 the writer had intercourse with it, as regarded the charac- 
 ter of the green evacuations — some contending that they 
 were acid, and others that they were bilious. To settle the 
 question, he resorted to a large variety of chemical re- 
 agents, to all of which the matter proved insensible. To 
 ascertain the fact, if possible, he tasted the vomitings, and 
 the stools, and in a post-mortem examination of the second 
 patient, he tasted the green contents of the colon — but in 
 all his efforts he found them to be inodorous and insipid. 
 His conclusion then was, and now is, that they consisted of 
 
796 INFLAMMATORY FORMS OF DISEASE. 
 
 blood changed bj some bidden cause. This conclusion 
 was strengthened by the fact that after the appearance of 
 the green matter, anything like blood ceased to appear in 
 the stools. 
 
 Of the second patient, as already stated, he made a post- 
 mortem examination — the liver was much enlarged, very 
 firm, and about the color of a newly-dressed cherry-tree 
 board ; the gall-bladder contained a little black, tar-looking 
 bile ; stomach and small intestines measurably sound ; the 
 coats of the large intestines about the fourth of an inch in 
 thickness, the caliber reduced to the size of a half inch, and 
 exhibiting no lesion of structure — except in the mucous 
 membrane. 
 
 As soon as he saw the liver, he became satisfied that he 
 had been incorrectly taught as to the merits of calomel in 
 congestive forms of disease — for he had been taught to 
 make it the sheet-anchor of his hope in such cases. The 
 reflection of a moment satisfied him as to why it should be 
 insuflicient in such cases. Calomel is an insoluble salt, 
 and the congestion was too great to permit the stomach to 
 provide anything that could render it a soluble one. 
 
 Two sisters of this patient were taken with the same 
 disease, three days before his death, and the instant 
 he concluded his reflections about calomel, the writer 
 changed his practice, saved them, and all the subsequent 
 patients in this form of disease, to whom he was called. 
 He has not relied upon calomel since in congestive forms of 
 disease, and the physician who does will be greatly de- 
 ceived in his expectations. But even in such cases, the 
 calomel has sometimes the credit of effecting a cure, be- 
 cause after secretion becomes re-established it has salivated 
 the patient. How long will it be before the profession 
 generally will lea?n to do better by doing without calomel ? 
 
 The writer did not hear of a single case of this disease 
 that was saved by those of his professional brethren who 
 had it to contend with, and he thinks it more than proba- 
 ble that they failed, as he at first did, in placing their reli- 
 ance upon calomel. Furthermore, he thinks it reasonable 
 
COLORECTITIS-DYSENTERY 797 
 
 to suppose that a misplaced confidence in calomel is the 
 canse of a Jarge proportion of the fatality which now 
 attends the Old-School practice, particularly in congestive 
 fever, dysentery, cholera, and cholera infantum. That a 
 fatality, in these forms of disease, does attend their prac- 
 tice, which is unknown to any other, admits, at this time, 
 of no debate. He has failed as they do, and therefore he 
 can appreciate the full force of what he says. 
 
 The rule that governed his practice was this : never to 
 lose two patients by the same practice in the same disease, 
 when he had a fair chance with the first. He recommends 
 this course to all young practitioners. 
 
 Causes. — In relation to the cause of dysentery, we have 
 many facts which do not appear to have been properly ap- 
 preciated. In the 17th century, London, in some seasons, 
 produced a bill of dysenteric mortality of six thousand, but 
 in the 18th century, this mortality became reduced to 
 twenty. What an exceeding change to be effected in one 
 century. The advancement of the arts and sciences, and 
 their application to the advancement of society, are entitled 
 to some of the credit for this reduction of a specific mor- 
 tality, and the balance can be explained by the principles 
 which we introduced when treating of the cause of cholera 
 infantum. 
 
 In the 17th century, a large portion of the area which 
 constituted London, in the 18th, was not occupied by pave- 
 ments, sewers, and dwellings, nor was the immediate 
 vicinity as little calculated to furnish evaporation as it was 
 in the 18th century ; hence it is obvious, that as London 
 decreased in its evaporation, so it decreased in dysentery. 
 Prof. Watson, in his Practice, says : "In tropical climates 
 it is observed to be more common and more severe when 
 rains succeed to long-continued drought. " Here again, we 
 have the same principle illustrated. After a long drought 
 of hot weather, the earth becomes greatly heated, and con- 
 sequently great evaporation ensues after rain. 
 
 It may be answered, that the mischief is referable to the 
 sudden chilling of the atmosphere, in accordance with 
 
798 INFLAMMATORY FORMS OF DISEASE. 
 
 another remark of the professor, which is, "a high diurnal 
 temperature of the air appears to be the predisposing, and 
 exposure to cold the exciting cause." Now, let it be re- 
 membered here, that it is characteristic of a tropical cli- 
 mate to be hot through the day and cold at night, so cold 
 .that one or two blankets may be required before morning ; 
 and yet, without rain or a copious evaporation there will be 
 no dysentery. He asks : " Wherefore is dysentery, which 
 was so familiar to our ancestors, so happily rare among 
 .us ?" And here we desire to inquire : " Has the climate of 
 London changed? Are not the days as hot and the nights 
 as cold as they were in the 17th century ? If the disease 
 depends upon these atmospheric mutations, how does it 
 happen that London is not afflicted now as it was then ? 
 Does the earth, at London and in its vicinity, and we might 
 include the whole island, absorb less water than it did 
 then ? Does the rain that falls find its way to the great 
 channels sooner and more directly than then ? It is impos- 
 sible to answer these questions in the negative, and there- 
 fore, they have hotter summers there now, than then, and 
 cooler nights; consequently, hot days and cool nights can 
 not be the cause of this form of disease, for it was the 
 plague of that time, and now it is scarcely ever seen. The 
 difference between London, at the two above-named peri- 
 ods, respectively, amounts to about this : In the former, 
 she had less heat and active electricity, and vice versa ^ in 
 the latter. 
 
 Those who lived in Ohio and Kentucky thirty-five or 
 forty years ago, recollect, no doubt, that dysentery was 
 more prevalent and fatal than now, particularly in the 
 older-settled portions of them ; and yet, our summers now 
 are hotter, and our weather, upon an average, more muta- 
 ble than then. If, therefore, with an increase of tempera- 
 ture, here and in England, there is a diminution of dysen- 
 tery, how can we consistently attribute the disease to the 
 temperature in cold climates ? 
 
 We are not going to point out the predisposing cause of 
 dysentery, but by a philosophical examination of the facts 
 
COLORECTITIS-DYSENTERY. 799 
 
 we have, to open that door to observation vrhich has long 
 been almost closed, and is almost closed yet, by that 
 ignis fahms^ professionally called malaria. It can do no 
 mischief, however, to state the conclusion to which we have 
 been forced, namely, that an electric dryness of the atmo- 
 sphere predisposes adults to summer and autumnal forms 
 of disease, and that the reverse condition of it has a similar 
 influence upon children. A rain, therefore, by changing 
 this condition of the atmosphere, may be an exciting cause 
 among adults ; and so may all other departures from the 
 accustomed condition of the system. We do not assert 
 these conclusions to be facts, but simply that they are ours 
 and the best we have. 
 
 It is the opinion of some writers that dysentery is some- 
 times contagious — it may be so, but we hesitate to indorse 
 the opinion. 
 
 Pkognosis. — When, in dysentery, the pains, by degrees, 
 become less severe and frequent, the stools more copious 
 and fecal, and less frequent, the tenesmus diminished, we 
 may infer that a favorable change is being effected ; but on 
 the contrary, should these symptoms suddenly subside, the 
 extremities become cool, the feeling of the skin clammy, 
 the abdomen swollen, the nails livid, and the pulse feeble 
 and irregular, with passive stools, stupor, delirium, hic- 
 cough, and subsultus tendinum, we may safely predict a 
 fatal termination. 
 
 Treatment. — This is one of the forms of disease, which, 
 from its excessive mortality in the hands of Allopathic 
 practitioners, has rendered it an " opprobrium" to the pro- 
 fession ; but, as Prof. J. King remarked, in the Eclec. Med. 
 Jour., vol. iii, p. 370: " The discovery of the active prin- 
 ciples of many of our most valuable medicinal plants, has 
 resulted in a new era for Eclectic practice, and numerous 
 forms of disease, which at one time required days, or even 
 weeks, for recovery, are now cured with unparalleled safety 
 and rapidity ; and the addition of these new agents to our 
 Materia Medica, has given an impulse, character, and ex- 
 tension to Eclecticism, beyond the most sanguine hopes of 
 
800 INFLAMMATORY FORMS OF DISEASE. 
 
 its many zealous adherents. In no form of disease, per- 
 haps, have the beneficial effects of these recent discoveries 
 been so well marked, as in the one under consideration, 
 and so constant have been these happy results, that in all 
 places where Eclectic practitioners are located, we find them 
 taking the precedence of all others." 
 
 The treatment of Prof. J. King is so much in accordance 
 with our own views and practice, that we can not do the 
 subject more justice than by extracting the following : 
 
 "Whatever may be the immediate or remote cause of dys- 
 entery, we invariably find the functions of both the liver 
 and skin very much deranged, and the removal of which is 
 necessarily the first indication to fulfill ; consequently, 
 when called to a patient suffering under this disease*, with 
 bloody discharges, tenesmus, etc., whether it be of one 
 day's duration or a week's, our only prescription, thus far, 
 has invariably been as follows : 
 
 R. Podophyllin, grs. vi, 
 Leptandrin, grs. iv, 
 Lactin, 3ss. 
 Mix, et div., in chart, No. iv. One powder to be given 
 every three hours, until free catharsis is produced. In 
 many cases, we prefer the common diaphoretic powders to 
 the Lactin, and which has a tendency to correct much of 
 the harshness of action of the medicine. 
 
 The above combination, though at the first sight appear- 
 ing heroic, will yet be found most efiectual in removing the 
 disease, often within twenty-four hours from the commence- 
 ment of its use ; it exerts a most powerful influence on the 
 liver and skin, restoring their functions to a normal condi- 
 tion, and causing a free biliary and cutaneous discharge; 
 and in addition to this, as both the Podophyllin and Lep- 
 tandrin act with energy on mucous tissues, beside possess- 
 ing an undisputed antiperiodic agency, this fourfold power 
 naturally indicates them as the proper remedies, and the 
 successful results following their administration conclu- 
 sively demonstrate the correctness of the indication. 
 
 It will generally be found, after the third dose, and some- 
 
COLORECTITIS— DYSENTERY. 801 
 
 times not until after the fourth, that the patient will experi- 
 ence for a time very unpleasant and distressing symptoms, 
 but this is not universall}^ the case — there will be present 
 nausea and vomiting, griping pains in the abdomen, cold 
 sweat, coldness of extremities, great prostration, and copi- 
 ous discharges. These symptoms need create no alarm or 
 uneasiness, and we usually prepare the friends of the pa- 
 tient by informing them of the anticipated effects, directing 
 them, in case of much prostration, to support the patient 
 with brandy-sling, or other grateful stimulant, until the 
 purgative operation has ceased. It must be remembered, 
 that it is only necessary to administer the above powders 
 until their decided effect is produced, when they are to be 
 laid aside. With but few exceptions, the termination of 
 the catharsis is followed by the immediate cessation of 
 tenesmus and the dysenteric discharges. 
 
 The patient will now be found in a condition in which it 
 will be necessary to maintain, for a few days, a hepatic and 
 cutaneous influence, to restore tone to the debilitated state 
 of the intestines, prevent further discharges, and preserve 
 the antiperiodic disposition already established ; for this 
 purpose, we usually administer the following : 
 R. Sulph. Quinia, grs. viii, 
 Sulph. Morphine, gr. ss, 
 Pulv. Ipecac, grs. ij. 
 Mix, et div., in chart, No. viii. One powder to be admin- 
 istered every two or three hours, gradually lengthening the 
 intervals between the doses, and continuing their use for 
 two or three days. 
 
 In by far the greater part of cases, this treatment will be 
 found all that is necessary, as in a day or two the patient 
 will be cured and able to attend to his business. Some- 
 times, however, and especially among those patients to 
 whom we have not been called until they have suffered 
 under the dysenteric attack for several days, there wdll be 
 found, after the operation of the cathartics, light muco- 
 sanguineous discharges, with some tenesmus, for which, in 
 connection with the above Quinine powders, it will be 
 
802 INFLAMMATORY FORMS OF DISEASE. 
 
 necessary to administer injections, composed as follows, and 
 one Oi whicli should be administered immediately after 
 each discharge, requesting the patient to retain it as long 
 
 as possible : 
 
 B. Infus. Hj^drastis Can., (cold), 2i, 
 Tinct. Opii, gtt. x., vel. xx. Mix. 
 
 Large injections counteract the ends aimed at, viz.: to 
 allay inflammation and check the discharges. 
 
 If this does not readily remove the symptoms, and the 
 patient's strength will admit, the cathartic must be repeated, 
 but in smaller doses, and if it removes the pain and dis- 
 charges, to be followed by the Quinine powders as before ; 
 but if he be very weak, the administration of port wine, 
 one or two drachms, in which is dissolved Tannin, two to 
 four grains, and repeated every hour or two, according to 
 the urgency of the case, with the above injection, will gene- 
 rally elFect the cure. Sometimes we have found much ad- 
 vantage from the following prescription : 
 
 K. Tinct. Catechu, 3iij, 
 Tinct. Camphor, 
 Tinct. Leptandrin, dd 3j, 
 Syr. Zingiber, vel. Cinnamon, 3j. Mix. 
 
 Dose — a teaspoonful every one, two, or three hours. 
 
 Some practitioners continue the administration of the 
 Podophyllin and Leptandrin, in minute doses, triturated 
 with Lactin, and with excellent results. 
 
 Where the disease manifests a disposition to be obsti- 
 nate — which is seldom the case where Eclectic treatment 
 has been adopted from the first — the stools continuing 
 bloody and becoming fetid, with or without tenesmus, ina- 
 bility to retain anything on the stomach, or, if retained, 
 followed shortly after by a desire to stool, with much pros- 
 tration, and indisposition to move or talk, it will be highly 
 important, in addition to the other treatment, to frequently 
 bathe the surface of the body and limbs with an alkaline 
 wash, warm or cold, to suit the nature of the case and the 
 
COLORECTITIS-D^SENTERY. 803 
 
 patient's feelings, also to apply over the bowels and spine, 
 intermittinglj, mustard-poultices. The tongue must like- 
 wise be observed, if it be coated yellow, brown, or dark, 
 acidulous draughts must be given, as they will in this in- 
 stance, prove useful, but will be injurious if given when the' 
 coat is white. 
 
 Oatmeal made into a cake with water, then baked and 
 finally browned, similar to coffee, and made into a cofiee, 
 will be found not only nourishing, but will often check the 
 nausea and irritability of the stomach when all other means 
 fail. It must be given without milk or sugar, in table-spoon- 
 ful doses, and repeated sufficiently often. Some practitioners 
 speak highly of a tea of parched corn for this purpose, but I 
 have never employed it. If demanded, acids or sedatives 
 may be combined with it. 
 
 During the whole course of treatment, the patient must 
 remain as much as possible in a recumbent position — the 
 erect posture, or much motion, seems to aggravate the 
 disease. 
 
 In the case of delicate females, or patients of not very 
 strong constitution, the dose of the cathartic powders may 
 be somewhat diminished, according to the practitioner's 
 judgment. 
 
 Such, in brief, is the treatment which I have pursued 
 both in Memphis and Cincinnati, during the last two years, 
 and thus far without the loss of a single patient ; and a 
 similar course is now, I believe, generally adopted by Eclec- 
 tic physicians. 
 
 In years past, I have met with considerable success in 
 dysentery, by the use of the white liquid or saline jphysic^ 
 which has in many instances effected a recovery where dis- 
 solution seemed inevitable, but I have not used it for 
 some three or four years, though I believe it will be found 
 a very efficient remedy. The formula for its prepara- 
 tion is given in the United States Eclectic Dispensatory, 
 page 18. 
 
 The following will be found an useful preparation for 
 children, suffering under dysentery : 
 51 
 
804: INFLAMMATORY FORMS OF DISEASE 
 
 R. Pulv. Leptandrin. 
 
 Pulv. Zingiber, (Jamaica) aa grs. v. 
 
 Pulv. Podophyllin, gr. iss. 
 
 Pulv. Creta, Preparat. grs. x. 
 
 Pulv. Sacch, alb. 3i. 
 Mix, triturate well together, and divide into ten powders. 
 For a child from 1 to 3 years old, give one powder every 
 three hours." 
 
 In addition to the above treatment, and where the evacua- 
 tions continue very copious, we have often found that the 
 neutralizing cordial, geranine, tinct. opi camphorati, as in 
 the following prescription, will give almost instant relief. 
 R. Syr. Rhei et Potassa, 3iij. 
 
 Geranine, grs. xxx. 
 
 Tinct. Opi Camph. 2iss. Mix. 
 Of this, give a table-spoonful every two hours. This com- 
 bination neutralizes acidity when present, gives strength to 
 the debilitated capillary vessels, and allays the pain. In 
 many cases, if taken at the start, this prescription, with the 
 external applications recommended by Prof. J. King, will 
 be sufficient to break up the disease in from two to four 
 days, and never allow it to progress so far as to be attended 
 with any inconvenience to the patient. 
 
 In cases where the disease has continued until it has as- 
 sumed a typhoid character, with increased thirst, dryness 
 and redness of the tongue, much heat of the stomach, and 
 an apparent increased heat of the whole surface of the 
 body, we have found, a wet sheet applied around the body, 
 as often as it becomes warm, to have the most soothing and 
 beneficial effect of any application which can be made ; this 
 should be continued as an auxiliary until those symptoms 
 subside. This is a remedial agent which has not received 
 that attention from general practitioners which it merits ; 
 in our opinion, ice or cold water can not be used too exten- 
 sively, either internally or externally, in all cases of this 
 disease, so long as there is an increased temperature and an 
 accelerated pulse. 
 Yet, we have not confidence enough in water to rely upon 
 
ACUTE PERITONITIS. 805 
 
 it to the exclusion of the above treatment, or similar plans 
 which may be adopted. 
 
 Genus X. — Peritonitis. 
 
 This is the term now universally used to express an in- 
 flammatory state of the serous membrane, which lines the 
 interior of the abdominal cavity, and invests all the viscera 
 contained therein. Cy. Prac. Med. 
 
 1. Acute Peritonitis. 
 
 When treating of acute enteritis, we included the in- 
 flamed condition of the peritoneum when present, as it fre- 
 quently is in that form of disease, but we propose to treat 
 of it, independently of any implication of the intestines. 
 The extraordinary severity that sometimes attends this in- 
 flammation, demands this special consideration, for, in the 
 catalogue of human maladies, there is not one which is 
 attended with more extreme pain and suffering. 
 
 It is generally introduced by a sense of lassitude, an ob- 
 tuse pain or aching in the knees and back, which is suc- 
 ceeded by a sensation of creeping chills and alternate 
 flushes of heat ; uneasiness in the epigastrium, and head- 
 ache. Sooner or later, depending upon the power of the 
 vital force, reaction takes place, which is attended with a 
 pungent heat of the surface, constriction of the epigastrium, 
 a sense of heat and pain in the abdomen, tenderness upon 
 pressure, and a frequent, hard and concentrated pulse. 
 When the disease becomes thoroughly developed, the pain 
 becomes the all absorbing symptom — the patient appears 
 scarcely conscious of any other ; and here, it is proper to 
 remark, that this pain' even precedes, in a few cases, any 
 febrile symptoms ; and of all that we know of pain, as aris- 
 ing from inflammation, there is no other that presents so 
 many and strong indications of reaching the highest possi- 
 ble severity. A patient of the writer likened it to a cutting 
 screw twisted in a highly inflamed part. In some cases 
 the pain presents a paroxysmal character, which may pos- 
 sibly result from the presence of flatus ; in other instances 
 
806 INFLAMMATORY FORMS OF DISEASE. 
 
 it is continuous and confined to a very limited extent, and 
 then again it is migratory, and lastly, in a few instances, is 
 difiused. The patient lies on his back, with his knees 
 slightly elevated, and can repose in no other position. The 
 pain is increased by any motion of the body, and particu- 
 larly by an erect posture. It is worthy of remark that in 
 some cases, no pain is complained of, unless pressure be 
 used. As the respiratory motion of the diaphragm in- 
 creases the pain, the respiratory function is mainly per- 
 formed by the pectoral muscles, and hence it is hurried, 
 short, and interrupted. 
 
 The existence and degree of this inflammation are mainly 
 to be known by the sensibility of the abdomen to pressure, 
 which is sometimes so acute and delicate, that the weight of 
 the lightest bed-clothing becomes insupportable. Tension 
 and tumefaction of the abdomen are very nearly as charac- 
 teristic of this inflammation, as the extreme sensibility to 
 pressure. It should be remembered, however, that this 
 tension and tumefaction are never very remarkable in those 
 who have a lean, dense, and firm muscular system ; but 
 with men of flabby muscles, and women after child-birth. 
 It is not unfrequent that nausea and vomiting attend the 
 disease, at least in some part of its cause, and the ejections 
 consist of mucus and bile, after the usual contents of the 
 stomach are thrown up. The urine is scanty and high- 
 colored, a whitish fur coats the tongue, the pulse running, 
 perhaps, as high as 130 beats per minute, and exceedingly 
 small and contracted ; with these symptoms there is a 
 great desire for cold drink, which, if taken, is speedily 
 ejected. 
 
 The course of this inflammation is one of great rapidity, 
 and of very frequent mortality — it may conclude by resolu- 
 tion, by efiusion, by gangrene, or by the introduction of 
 the chronic form. It rarely continues beyond the sixth or 
 seventh day without terminating in some way ; it frequently 
 terminates fatally in three days, occasionally in twenty-four 
 hours, and Andral says that it has terminated fatally in a 
 few hours. 
 
ACUTE PERITONITIS. 807 
 
 Causes. — Acute peritonitis may result from mechanical 
 violence,* long continued muscular exertions, perforation 
 of the stomach and bowels by ulceration, and the passage 
 of ingesta or feces into the abdominal cavity ; extravasa- 
 tion of blood, urine, or bile, into the peritoneal cavity ; a 
 sudden arrest of perspiration by the agency of cold ; the 
 drinking of cold water when in a state of perspiration, is 
 said to produce it. We think that this statement requires 
 much qualification. We admit the statement w^ith those 
 who habitually use ardent spirits, and those who have be- 
 come exhausted by fatigue, but we have never known an 
 instance of one being injured by the drinking of iced- 
 water, who did not use ardent spirits, and who was only 
 heated and perspiring without fatigue. We have made 
 these remarks for the benefit of those who use ardent spir- 
 its, and those who may be greatly fatigued. Parturition is 
 not an unfrequent cause ; suppressed hemorrhoids and the 
 menses ; metastasis of scarlatina and rheumatism. 
 
 Diagnosis. — This subject, with the inexperienced, is fre- 
 quently attended with much difficulty, but w^e think that 
 the experienced can scarcely make a mistake that shall be 
 attended with mischievous consequences. To mistake it 
 for gastritis, enteritis, splenitis, or entero-peritonitis, could 
 lead to no mischief. As pressure afibrds relief in colic, it 
 need not to be mistaken for it, but if it should be mistaken 
 for a paroxysm of hysteria, death might be the result. The 
 writer when young, once mistook hysteria for peritonitis, but 
 in such a case, but little if any mischief could probably re- 
 sult. Between these two forms of disease we know of no one 
 diagnostic symptom, but when we take the signs and symp- 
 toms of either of them, we shall find them to be completely 
 incongruous with the existence of the other. If the physi- 
 
 *A young negro man, belonging to the writer, was kicked in the abdomen 
 by another domestic, immediately after breakfast. He lived twenty-four 
 hours. Post-mortem examination discovered that the coats of the ileum had 
 been ruptured, and that some fecal matter had passed into the peritoneal 
 cavity. The contents of the abdominal cavity were, by adhesions, united, 
 apparently into one mass. The inflammation appeared to have been con- 
 fined to the peritoneum. 
 
808 INFLAMMATORY FORMS OF DISEASE. 
 
 cian know the hysterical character of his patient, he need 
 to commit no error. 
 
 Prognosis. — When we find the pain, tension, and ten- 
 derness of the abdomen to gradually decline, the pulse to 
 become more full and less frequent, the skin to become soft 
 and moist, the countenance more easy and relaxed, we may 
 expect a favorable termination ; but when the pain suddenly 
 ceases, the pulse becoming quicker and more feeble, the ex- 
 tremities becoming cold, the abdomen more tense, the coun- 
 tenance sunken, we may expect delirium, coma and death. 
 
 Treatment. — In this disease we must, as with other in- 
 flammatory diseases, equalize the circulation, and which we 
 accomplish by the spirit-vapor bath, provided, the strength 
 and condition of the patient will admit; if not, it will then 
 become necessary to apply fomentations over the abdomen, 
 as hot as the patient can bear, and change them every five 
 or ten minutes, and this course must be pursued until the 
 pain has considerably subsided. The feet and lower ex- 
 tremities should likewise be bathed often in hot water, after 
 which sinapisms may be applied to them ; these should also 
 be applied along the whole length of the spinal column, 
 for the purpose of counter-irritation and revulsion, and 
 should be employed intermittingly. The body and limbs 
 should be bathed several times a day with a warm, weak 
 alkaline wash, and this should by no means be omitted. 
 Internally, the Compound Powder of Jalap, or Podophyl- 
 lin, may be given in doses sufficient to produce a mild pur- 
 gative effect, for the purpose of removing any accumulations 
 which may cause intestinal irritation ; or in case these can 
 not be retained upon the stomach, purgative enema may be 
 substituted. After the action of the purgative, the Com- 
 pound Tincture of Virginia Snakeroot must be given, both 
 on account of its anodyne and diaphoretic efiect. Some- 
 times it will be found advantageous to apply a mustard- 
 poultice over the whole abdomen, in connection with the 
 hot fomentations. Where much debility is present, and 
 especially when attended with a tympanitic condition of the 
 abdomen, the saturated tincture of Prickly Ash berries^ 
 
CHRONIC PERITONITIS. 809 
 
 given internally, when the stomach will bear it, and also 
 administered by injection will be found to have a most ex- 
 cellent influence as a stimulant and diaphoretic. The 
 bowels should be kept regular, using mild laxatives for the 
 purpose of causing one evacuation daily, as the Compound 
 Powder of Khubarb, or a combination of Leptandrin, Podo- 
 phyllin, and Caulophyllin, in small doses. 
 
 The patient should be kept as quiet as possible, both du- 
 ring the disease and convalescence, and the diet should con- 
 sist merely of mucilaginous drinks, toast-water, and even 
 ice or iced water may be allowed should the patient crave it. 
 
 2. CJironio Peritonitis. 
 
 If it had not been observed that the acute form of this 
 disease passes into the chronic, it is possible that we should 
 not, even at this day, have known that such a disease as 
 the one under consideration, ever existed ; at all events we 
 should have had but little information concerning it, be- 
 cause when it obtains independently of the acute form, its 
 manner of invasion- is so insidious and imperceptible as to 
 escape notice, until it has wrought very serious mischief. 
 When it has become established, more or less of uneasiness 
 and tenderness are felt in the abdomen, and under-pressure 
 or sudden motion of the body, as that produced by cough- 
 ing, some soreness is perceived to exist about the um- 
 bilicus. 
 
 When it is primitive, or not the offspring of the acute 
 form, it may, in no part of its course, give rise to pain, 
 and in many instances we can discover no indications of its 
 existence during life, except, perhaps, in a few cases we 
 may find the appearance of some ascites ; but as we have 
 stated, it is generally attended with some abdominal pain, 
 but it is dull, and deep, and very rarely permanent, but 
 some soreness will always be detected upon pressure. Vom- 
 iting is sometimes observed, and more or less abdominal 
 distention, and even tympanitis. In some instances indu- 
 rated spots can be detected, which under pressure are found 
 to be sore. In some cases the appetite and the digestion 
 
810 INFLAMMATORY FORMS OF DISEASE. 
 
 continue pretty good ; in such cases it is possible that the 
 peritoneum of the stomach is not so seriously affected as 
 other portions of it. In other cases the nutritive function is 
 greatly impaired, and emaciation, increasing distension of 
 the abdomen, and increasing tenderness to pressure, irregu- 
 larity of the bowels — exhibiting alternate diarrhea and con- 
 stipation, and various symptoms common to dyspepsia, 
 attend the general course of the disease. 
 
 "When we view the symptoms as a whole, and the modes 
 of their manifestation — for they do not appear to have any 
 order — we are compelled to pronounce them singularly ob- 
 scure. The pulse frequently continues unchanged, unless 
 it be in the evening, when it becomes quick, and the skin 
 more than normally heated, but in some instances these 
 symptoms are measurably absent. With such symptoms 
 as we have endeavored to portray, the malady slowly ad- 
 vances with intermissions that may continue for months, 
 till it terminates fatally, in acute enteritis, or peritonitis, or 
 from exhaustion, a result of diarrhea. Frequently before 
 the close of life, ascites supervenes. 
 
 Diagnosis. — No rules, of a diagnostic character, can be 
 drawn to guide the physician with reference to this disease, 
 because each case requires a separate study. He must, 
 therefore, rely upon his acquaintance with pathology, and 
 practical acquaintance with disease. 
 
 Prognosis. — This, in the general, must be considered 
 unfavorable — a few cases are said to have been cured. 
 
 Treatment. — In the chronic form of peritonitis, mild 
 cathartics should be administered every two or three days, 
 unless there be diarrhea, in which case astringents must be 
 given. The irritating plaster should be applied interrait- 
 tingly over the abdomen, keeping up a discharge each time 
 of application, as long as the patient can bear it. If pain 
 be present, a combination of one part of Sulphate of Qui- 
 nia and two of Compound Powder of Ipecacuanha and 
 Opium, may be administered every three or four hours, in 
 doses of four or five grains. If the pain be not very severe, 
 the powders may be given only at night. The patient 
 
ACUTE HEPATITIS. 811 
 
 should be kept still, and placed upon a nutritious but easily 
 digestible diet. And if the case be complicated with a tu- 
 berculous diathesis, some of the preparations of iron will 
 be found advantageous. The surface of the body should in 
 this, as well as in the acute form, be frequently bathed with 
 an alkaline wash. 
 
 Genus XL — Hepatitis. 
 
 Inflammation may affect the substance of the liver, its 
 investing peritoneal membrane, or both, or may involve 
 the whole organ or only a part ; and in each of these cases 
 presents certain characteristic symptoms which may lead to 
 a more or less accurate diagnosis. Hepatitis vanes also 
 greatly in its degree of violence and rapidity, being some- 
 times acute, sometimes chronic, and not unfrequently of 
 intermediate grades ; so that it is not always easy to clas- 
 sify its diversities in these respects correctly. — Wood. 
 
 Under the two heads of Acute and Chronic, we shall 
 endeavor to present all that is of practical importance con- 
 cerning the whole subject. 
 
 1. Acute Hepatitis. 
 
 The symptoms of this form of disease, as they are gen- 
 erally described by practical writers, have not been suffi- 
 ciently qualified to save the young physician from error ; 
 because no one symptom has yet been discovered which 
 may not be absent, and all of them, individually, may result 
 from other causes than hepatitis. In judging, therefore, of 
 the presence of this inflammation, we must judge of the 
 bearing which all the symptoms, which may be present, 
 have upon the morbus under consideration. In the com- 
 mencement, the symptoms indicative of this local inflam- 
 mation, may differ in no essential respect, from those 
 which may be said to be common to an inflammation of 
 any portion of the digestive system. In the forming stage, 
 it is, perhaps, impossible to say whether the patient is 
 about contracting gastric or bilious fever, or hepatic inflam- 
 mation. The pulse will have less of the typhoid character 
 
812 INFLAMMATORY FORl^IS OF DISEASE. 
 
 than is common to gastro-enteritis, the fever may run high, 
 the tongue may be covered with a yellowish fur, the thirst 
 may be urgent, and there may be a frequent vomiting of 
 bilious matter. The condition of the bowels will depend 
 very much upon the number and extent of the existing im- 
 plications — they may be irregular, but most frequently 
 constipated ; and the urine is scanty and high-colored, as 
 in febrile affections generally. 
 
 The local symptoms indicative of hepatitis, which claim 
 the greatest reliance, are pain, soreness and tumefaction, 
 and the first is greatly influenced by the particular location 
 of the inflammation. When fixed upon the convex surface, 
 the pain considerably resembles that of pleurisy — it is in 
 the right hypochondrium, often violent, sometimes appear- 
 ing as stitches, at other times it is associated with a burn- 
 ing sensation ; in some instances it is directed toward the 
 sternum, and at others, toward the right scapular ; in a 
 few instances the right foot is impressed with a sense of 
 numbness, and the right arm with one of tingling ; deep 
 inspirations increase the pain, and not unfrequently the 
 patient is harrassed by a dry, short cough. 
 
 When the disease is located in the concave side of the 
 organ, the biliary derangement is much greater, the pain 
 much less — the principal complaint is a sensation of pres- 
 sure or stricture, and not unfrequently attended by a jaun- 
 diced discoloration of the eyes, skin, and urine. The gastric 
 irritability frequently occasions much distressing vomiting ; 
 the fasces are generally hard and of a whitish or gray color. 
 It is most common to find the pain, heat, and tumefaction, 
 in the right hj^pochondrium, or about the cartilages of the 
 lower ribs, or possibly in the lumbar region. It has been 
 frequently stated, that pain in the right shoulder is quite 
 pathagnomonic of hepatitis in the acute form. We hold 
 this to be a mistake — we are of opinion that this pain is 
 more indicative of chronic and functional affections of the 
 organ, than in the disease before us. The next S3^mptom, 
 in point of importance to the pain, is the tumefaction of 
 the organ. When the abdominal muscles are flaccid, and 
 
ACUTE HEPATITIS. 813 
 
 the intestines are empty, there is bnt little difficulty in de- 
 tecting the hepatic enlargement. Jaundice has been named 
 as a symptom, but its occurrence is too rare to give it im- 
 portance, and then, again, facts enough have not been ac- 
 cumulated to enable us to determine why it should be either 
 present or absent in any case. When the peritoneal coat 
 is involved, the pain is sharp, and usually much more 
 severe than when the organ alone is the seat of the disease. 
 We may add, also, that the pain of inspiration and the dif- 
 ficulty of breathing, are also much greater. Inflammatory 
 fever attends both locations of the disease. 
 
 Those who have a gouty or rheumatic organization, are 
 frequently troubled with neuralgic pains in the region of 
 the liver, and care must be observed that they are not mis- 
 taken for those of inflammation — in the event of the latter 
 the other indications of acute hepatitis will constitute a 
 safe guide. The attendant fever, in the advanced stage, 
 sometimes takes on a typhoid character. Hepatitis, it is 
 said, has been known to run its wdiole course, and termi- 
 nate in suppuration, without any attending fever. To 
 account for such a fact, we feel ourselves entirely unable, 
 without supposing the existence of some organic defect in 
 the nervous system. 
 
 Hepatitis may terminate by resolution, suppuration, or 
 pass into the chronic form. When w^e find the fever, the 
 gastric symptoms, the pain, and tumefaction, to subside 
 gradually, w^e may conclude that resolution is going on. 
 But in the event it terminates by suppuration, the tumefac- 
 tion increases, and the fever passes into the hectic type. 
 This event is further indicated by shiverings, small and 
 rapid pulse, pale countenance, and a sour smell of the sur- 
 face. When an abscess has formed, the organ will be 
 found to have increased in size ; a distinct tumefaction may 
 be felt below the margin of the ribs ; a bulging of the f\ilse 
 ribs ; possibly a tumor may be felt in the epigastrium ; and 
 lastly, the intercostal spaces will be found more full than 
 natural. By adhesions, the contents of the abscess have 
 been known to pass through the paricties of the abdomen — 
 
814 INFLAMMATORY FORMS OF DISEASE. 
 
 through the diaphragm, and into the lungs, and finally 
 into the stomach; and further, the same case has been 
 known to do all three, and yet recover. 
 
 Causes. — It is quite a current opinion that malaria in 
 hot climates is, probably, a very frequent cause — possibly, 
 the most frequent. We do not feel that we are hazarding 
 much in asserting that it never does any such thing. If 
 the inhabitants of the south will live in the shade, and 
 thereby avoid an exhaustion of the cutaneous tissue, they 
 will not have acute hepatitis. This view of the subject has 
 been explained by Dr. James Johnson, but Dr. Eberle calls 
 it a " novel and a verj plausible " view of it. Besides a 
 long continued exposure to a high temperature, as a cause 
 of hepatitis, we may add mechanical contusions, metasta- 
 sis of gout or rheumatism, atmospheric vicissitudes, with 
 fatiguing exercise — the drinking of cold water when the 
 body is heated and exhausted — biliary concretion in the 
 gall ducts, etc. 
 
 Diagnosis. — Hepatitis, most frequently, may be distin 
 guished from pleuritis, by the greater severity of the cough, 
 and thoracic oppression in the latter. In hepatitis, the pa- 
 tient can rest better on the affected side, but in pleuritis, he 
 can not ; pressure on the intercostal spaces gives but little or 
 no pain in hepatitis, but it produces much in pleuritis ; in 
 pulmonitis the difiiculty of breathing and the pain are aggra- 
 vated by resting on the affected side. In gastritis, all in- 
 gesta is commonly ejected as soon as taken, but in hepatitis, 
 though vomiting is present, the stomach does not so promptly 
 reject the ingesta. In gastritis, pressure on the epigastrium 
 increases the pain, but in hepatitis, it is required to be 
 made on the right hypochondrium. 
 
 Prognosis. — In general this can not be regarded as unfa- 
 vorable, more especially under a judicious course of treat- 
 ment ; its most frequent fatality attends those who have for 
 a long time been habitually intemperate in the use of 
 ardent spirits. When the treatment has been inefficient, 
 the recovery is apt to be exceedingly troublesome and 
 protracted. 
 
CHRONIC HEPATITIS. 815 
 
 Treatment. — In this disease, tlie treatment may be com- 
 menced by the use of the spirit-vapor bath, for the purpose 
 of equalizing the circulation, and thereby lessening the in- 
 flammation ; and during the period of perspiration, a ca- 
 thartic must be administered, for the purpose of unloading 
 the congested vessels of the liver, as well as for its revul- 
 sive action, for which the Compound Powder of Jalap may 
 be used at first, and subsequently followed by laxative do- 
 ses of Podophyllin and Leptandrin, which ha^e an especial 
 influence upon the liver, increasing its secretions, and 
 thereby relieving the congested condition of the portal sys- 
 tem. After the operation of the cathartic, and in some 
 instances, even during the period in which perspiration is 
 going on, a large mustard-poultice should be placed over 
 the region of the liver, to be removed only when its full 
 rubefacient efiect has been obtained, and then the parts are 
 to be covered by fomentations of bitter herbs, as hot as can 
 be borne, and which should be changed often ; and these 
 should be used until the pain and inflammation have sub- 
 sided. The surface should be bathed as in other inflam- 
 matory diseases. 
 
 For the purpose of allaying pain, calming any irritation 
 which may be present, and producing a tendency toward 
 the surface, the Compound Powder of Ipecacuanha and 
 Opium may be given in four or five grain doses every three 
 or four hours ; and toward the termination of the disease, 
 should there be any prostration of strength, or evidences of 
 suppuration. Sulphate of Quinia should be combined with 
 it in quantities of half a grain or one grain to each dose. In 
 other respects, both the treatment and diet will be similar 
 to that given for acute gastritis, except in the latter stage, 
 when suppuration is present, in which nutritious food, as 
 soft boiled eggs, oysters, etc., should be given, and if there 
 be much debility, stimulants, as wine, ale, etc. 
 
 2. ChroiiiG Hepatitis. 
 
 The liver is liable to many lingering modifications of 
 disease, and it has been common to speak of them under 
 
816 INFLAMMATORY FORMS OF DISEASE. 
 
 the appellation of clirSnic hepatitis, and among these may 
 be named atrophy, hypertrophy, induration, tubercle, and 
 schirrhus. This is certainly an error, and yet it may be 
 deemed a fair expression of the little that we know, cer- 
 tainly, of the organic condition of this organ, after it has 
 existed, for a long time, in a state of chronic irritation. 
 We know that it may have suffered, apparently, a very im- 
 portant lesion of structure without a corresponding one of 
 function, and we know that the contrary does as frequently 
 obtain. The most that we can do, then, is to give those 
 symptoms which have been found associated with certain 
 functional conditions of the organ ; and even in this, we 
 may so far mistake, as to implicate, more or less, some of 
 its neighboring viscera. However all this may be, the 
 malady of which we shall now treat, will generally be re- 
 cognized by the history which has been obtained of it. 
 
 When the disease has existed but for a short time, we 
 have but to see the patient, to be satisfied that the functions 
 of digestion, nutrition, and biliary secretion, have become 
 deranged, and upon a closer investigation of the patient's 
 condition, we expect to find our first impression confirmed, 
 and accordingly we learn that he is troubled with flatulent 
 colic, gastric acidity, a sense of fullness in the epigastrium, 
 and occasional nausea and vomiting. He has, or he has 
 not, felt any pain in the region of the liver, except under 
 the influence of pressure. He has a sensation of stricture, 
 and uneasiness in the right hypochondrium, and upon a 
 personal examination there is found more or less of tume- 
 faction in this region. His bowels are generally costive, 
 but sometimes this condition of them alternates with diar- 
 rhea, and the discharges are scanty, slimy, fetid, greenish, 
 dark-colored, or watery and muddy. The tongue is most 
 generally white, and only moderately moist ; the taste is 
 bitter or disagreeable, and the urine is highly of a bilious 
 tinge. The countenance is sallow or jaundiced ; the shoul- 
 ders are elevated ; the body is wasted ; the skin is harsh, 
 dry, and constricted, and so much so, as to render it next 
 to impossible to produce moisture upon it. Slight febrile 
 
CHRONIC HEPATITIS. 817 
 
 exacerbations, with a burning sensation in the soles of the 
 feet and pahns, take place towards evening. It is stated 
 that in the advanced stages of this disease, the gums have 
 a singular and a very unnatural firmness. 
 
 It is confidently said that when the convex surface of the 
 organ is the principal seat of the disease, the pain is re_ 
 ferred to the chest, and when located in the concave, it is 
 referred to the stomach and bowels. 
 
 The termination of this form of hepatitis is represented as 
 being exceeding various, and that all of the known organic 
 lesions of the liver have been known to occur in the midst 
 of symptoms of this disease ; and various are the circum- 
 stances under which death takes place in fatal cases, but in 
 a majority of cases, it is effected through a disease of some 
 other organ, as that of the peritoneum, small or large intes- 
 tines, the brain, the lungs, etc. 
 
 Causes. — In the south, acute hepatitis is mostly confined 
 to dry and heated situations ; in this respect it appears to 
 have some affinity with the remittent forms of fever ; but 
 this form, partaking more or less of the character of inter- 
 mittent fever, occurs most generally in low and humid sit- 
 uations. The first originates in an exhausted condition of 
 the skin, and the latter in a constriction of it. It some- 
 times arises directly from intermittent fever, intemperate 
 use of ardent spirits. The acute form is more confined to 
 the first class of constitutions, and the chronic to the third 
 class, or those who would, in a northern climate, most 
 probably die of phthisis. 
 
 There is no part of this continent, nor, perhaps, of any 
 other, where chronic hepatitis is so prevalent as in Mexico, 
 and the obvious cause there, is the very extensive use of 
 animal food. The same remark applies to our Anglo- 
 Americans, in some of the southern States — particularly 
 those who are not natives. It is also an extensive cause of 
 mortality in the slave population. During the winter, 
 when animal food would be the best for them, they have an 
 abundance of vegetables, w^hich are generally consumed by 
 the first of June, and then they have to live measurably on 
 
818 INFLAMMATORY FORMS OF DISEASE. 
 
 bacon and bread, till vegetables are again produced, and by 
 that time tlie fat bacon has produced a pretty extensive crop 
 of disease.* 
 
 Diagnosis. — In this disease the diagnosis is peculiarly 
 difficult, if not impossible, and yet we think it scarcely pos- 
 sible for an experienced physician to mistake its pathogno- 
 my for that of any other. Indeed, with those who possess, 
 naturally, a capacity for seizing and judging of pathognomy, 
 it is of more worth than namable diagnostic symptoms. It 
 is said to be frequently confounded with gastro-enteritis 
 and chronic pleuritis. As we shall not attempt that which 
 is considered so nearly impossible, as to define the diagnos- 
 tic symptoms between this and those above named, we shall 
 conclude our remarks upon it, by referring the reader to a 
 patient study of the natural history of the diseases with 
 which it has been confounded. 
 
 Prognosis. — The prognosis of this affection can not be 
 considered as favorable, when we consider its influence 
 upon the prospects of recovery, both directly and indirectly. 
 It can not be regarded as being frequently fatal of itself, 
 but it generally induces some other form of disease that will 
 terminate fatally. In fact, the usual subjects of it are not 
 so endowed with vital force, as to render existence possible 
 for a long time, or for the term of threescore years. 
 
 Treatment. — In the chronic form of hepatitis, our usual 
 course is to apply intermittingly an irritating plaster over 
 the region of the liver, and administer internally the fol- 
 lowing compound : 
 
 R. • Compound SjTup of Stillingia, 3iv. 
 Iodide of Potassum, 3i. 
 Tincture of Aconite, 5ij. Mix. 
 
 *It is a very general opinion that ttie southern soil can not be cultivated 
 hj white labor. The writer's acquaintance with the south induces him to 
 entertain a very different opinion. But he admits that it could not be done 
 without a great waste of life, so long as the present unnatural modes of 
 feeding and drinking continue. A large portion of the southern population are 
 of the opinion that the climate renders the use of ardent spirits indispen- 
 sable ; and yet physiology declares that there would be as much good sense 
 in keeping up a coal fire in their parlors, when the temperature is at 
 100 deg. Fah., as in using ardent spirits under a similar circumstance. 
 
SPLEi^ITIS . 819 
 
 Of this, a teaspoonful may be given three times a day, in 
 a wine-glass of water, and the use of which should be con- 
 tinued for some time. In addition to this, the bowels 
 should be acted upon once or twice daily, by a mixture 
 composed of one part of Fodophyllin, and four of Leptan- 
 drin, which should be given in sufficient doses, three times 
 a day, to cause the desired ejSect ; this combination exerts 
 a most favorable influence upon the liver, and is surpassed 
 by no other medicine in the Materia Medica. Powerful 
 cathartic action in this complaint should always be avoided, 
 the disease requires time for its removal, and no hurried, 
 energetic measures will be able to effect any immediate ten- 
 dency toward a cure. 
 
 The patient should exercise moderately, but not to fatigue, 
 and the diet should be nourishing and easy of digestion, 
 avoiding alcoholic stimulants, tea, coffee, and fats. 
 
 Where an abscess of the liver is forming, it should be 
 facilitated by the application of emollient poultices. 
 
 Errata. — In the R, on page 818, 3, in place of 3, of 
 the Iodide of Potassum and Tinct. of Aconite should be 
 used. 
 
 Genus XII. — Splenitis. 
 
 Inflammation of this viscus, in the acute form, is rather 
 a rare afiection, but in the chronic it occurs frequently in 
 the lowland marshy districts of southern latitudes. Because 
 of the fact that its function has not been determined, its 
 morbid states have not been so thoroughly investigated as 
 those of other viscera ; and yet when we contemplate the ex- 
 traordinary provision that has been made for its circulation, 
 the importance of its function should have been so far in- 
 ferred, as to command a full share of professional investi- 
 gation. The conviction of the writer, that it holds, in a 
 great measure, the same relation to the vegetative sys- 
 tem of nerves, that the brain and spinal marrow do to the 
 animal, has induced him for many years to observe closely 
 the influence of its morbid conditions upon the functions of 
 the other abdominal viscera, and he feels quite confident 
 52 
 
820 INFLAMMATORY FORMS OF DISEASE. 
 
 that if physicians generally will pursue for a few years the 
 same course of observation, they will soon cease to enter- 
 tain any doubt as to its paramount importance. 
 
 1. Acute Splenitis, 
 Acute splenitis is introduced to the attention of the pa- 
 tient, very much in the manner of the phlegmasia in gen- 
 eral — beginning with a chilly sensation, which sometimes 
 amounts to a rigor, with a feeling of pain, weight and full- 
 ness in the left hypochondrium, frequently extending to 
 the left shoulder, and as in hepatitis and pleuritis, the pain 
 is increased by pressure and a deep and full inspiration. 
 The reaction brings with it thirst, more or less nausea, 
 cough, and the usual symptoms of fever. "When the peri- 
 toneal coat of this organ is implicated, the pain is more 
 deeply acute ; and if with inflammation of the organ there 
 be much congestion, rendering reaction difficult, the pain 
 under the false ribs is deep, full, and obtuse, having at the 
 same time a sense of weight and downward dragging. The 
 left hypochondrium becomes, usually, more or less enlarged, 
 the skin becomes dry, with the eyes more or less jaun- 
 diced, and the urine participates in the same peculiarity. 
 The nausea is frequently attended with vertigo, and a very 
 oppressive and burning sensation in the stomach, particu- 
 larly when the head and shoulders are elevated in the bed. 
 Sometimes the patient complains of darting pains directed 
 from the left hypochondrium through the bowels, and at 
 other times through the left shoulder ; but the greatest pain 
 is experienced upon any twisting motion of the body, as in 
 an attempt to turn over. A horizontal posture on either 
 side is uncomfortable, but particularly on the affected one. 
 "We are informed that in some instances no pain becomes 
 manifest except when occasioned by pressure ; in such cases 
 there is a sense of weight and fullness ; and in some cases 
 even this is wanting, and then the only indications of exist- 
 ing inflammation are pain upon pressure, and an enlarge- 
 ment of the organ. These remarks may be true, but we 
 are much disposed to refer them to the chronic form. Those 
 
ACUTE SPLENITIS. 821 
 
 who have had the acute disease, in its usual form, will not 
 readily believe them. 
 
 Acute splenitis is sometimes attended with a remittent 
 or intermittent form of fever, but this may be only a 
 complication. Through some tissue or functional de- 
 pendence, the stomach may become implicated, in which 
 case the nausea and vomiting become so violent some- 
 times as to constitute a spleno -gastritis. Palpitation of the 
 heart, cough, dyspnoea, and hiccough, are sometimes pres- 
 ent, occasioned, as the writer believes, by a dependence of 
 all the organs of automatic life upon the spleen for power 
 or nervous innervation. In harmony with this view, we 
 may remark that, however well the liver may be performing 
 its function at the time of the splenitic invasion, it gener- 
 ally suspends its function upon the occurrence of this event, 
 and that too, without yielding a single symptom of hepatic 
 disturbance, except the jaundiced condition of the eyes, 
 skin, and urine, and the absence of bile in the faeces. 
 
 In splenitis there is a sui generis feeling which no one 
 acquainted with the anatomy of the abdominal viscera could, 
 in his own person, mistake as to its source ; but the phy- 
 sician attending upon another person, especially if that 
 person be very ignorant, or a child, may readily make a 
 mistake, because of the immediate neighborhoodship of 
 many important organs, as of the left lobe of the liver, the 
 pleura, the colon, and the stomach, but more especially if 
 the organ should not be in its normal position. If any of 
 these contiguous parts should participate in the inflamma- 
 tion, the diagnosis will be rendered still more difl[icult. 
 
 Causes. — Splenitis, in its acute form, is occasioned by 
 the same causes that produce acute hepatitis, and it occurs 
 in the same variety of constitution. 
 
 Diagnosis. — When the reader shall make himself well 
 acquainted with the symptoms of splenitis, gastritis, hepa- 
 titis, and colorectitis, he will not find much difficulty, gen- 
 erally, in diagnosing this disease. 
 
 Prognosis. — Under a proper and prompt treatment, sple-- 
 nitis may generally be caused to terminate by resolution ; 
 
822 INFLAMMATORY FORMS OF DISEASE. 
 
 but under neglect, a contrary treatment, or a broken-down 
 constitution, a fatal result may be expected. Under such 
 circumstances, violent cases may terminate fatally in from 
 five to ten days, preceded by hiccough, tympanitis, diar- 
 rhea, delirium, and collapse. Sometimes it terminates in 
 suppuration in the course of ten days, which is indicated by 
 a diminution of the pain, or some marked alteration of it, 
 by rigors, relaxation of the skin, and probably night-sweats. 
 In this event the pus may be absorbed, or it may be dis- 
 charged upon the peritoneum, and be absorbed,* or produce 
 fatal peritonitis, or death may ensue before the pus is 
 discharged, or, through the agency of adhesions, it may 
 pass through the abdominal parietes, or into the stomach and 
 bowels, and even into the lungs, and thus make its exit out 
 of the body, and thus the patient may be restored to health. 
 Treatment. — 'Acute splenitis is to be treated in all res- 
 pects the same as acute hepatitis, substituting for the local 
 applications, the region of the spleen for that of the liver. 
 
 2. CJironiG Splenitis, 
 
 There is no form of disease which is, perhaps, better cal- 
 culated to harass and finally to destroy life, than this — 
 phthisis pulmonalis not excepted. Judging of it, as the 
 writer has seen it, in marshy districts in the south, he would 
 prefer the latter ; and those who had it, if they migrated 
 from the north, did not make a profitable speculation in ex- 
 changing their prospect of phthisis for that of chronic sple- 
 nitis, for they were organized to die, either of a thoracic or 
 an abdominal disease of an anemic character. It is as in- 
 curable as phthisis, and it is so from the same organic ne- 
 cessity — a want of vital force to maintain an equilibrium 
 of the functions which are essential to a normal continu- 
 ance of existence. 
 
 It is sometimes difficult to decide upon the presence of 
 chronic splenitis, until the enlargement of the organ declares 
 
 * Pus may be absorbed by the peritoneum. See the report of a case of 
 strangulation and amputation of a portion of the spleen, by the writer, 
 American Journal of the Medical Sciences, Vol. I. 
 
CHRONIC SPLENITIS. 823 
 
 the fact for itself, but it will, sooner or later, become apparent 
 to every observer. But previous to any observable enlarge- 
 ment the patient will complain of weight, tension, or some 
 other variety of uneasiness in the left hypochondrium; he fur- 
 thermore discovers that when pressure is made on the part, 
 he has a feeling of soreness, and when he turns over, he feels 
 a hurting in the location of the organ. When the disease 
 has so far progressed as to give evidence of its enlargement, 
 the patient, upon interrogation, will say that he has a " feel- 
 ing of deadness throughout the contents of his abdomen." 
 The writer found this to be the most pathognomonic symp- 
 tom in the south. But when the disease has been produced 
 by mechanical injury, this feeling of deadness is still more 
 strongly expressed by the patient. When the organ has 
 become considerably enlarged, its magnitude alone becomes 
 a source of mischief, by its pressure upon or against its 
 neighboring viscera, and in this wise, deranges their func- 
 tions, as the stomach, lungs, heart, intestines, etc. This 
 circumstance, to some extent, accounts for the attending in- 
 digestion, cough, dyspnoea, and palpitations. But the great 
 disturbance of the hepatic and renal functions which at- 
 tends this disease, can not be thus explained to the full ex- 
 tent of their existence. In some instances these organs 
 appear to exist in a state of paralysis. The skin, if not 
 sallow, is of a dusky greenish color — that is, it is of a light 
 dusky yellow, with barely a greenish tinge added to it. 
 The bowels are irregular, but most frequently the faeces are 
 soft and of a light yellow-clay color and appearance. In 
 some cases, indeed in all cases at sometimes, there is a fe- 
 brile tendency of the system ; wandering pains are some- 
 times complained of in the extremities, which not unfre- 
 quently terminate in collections of pus under the integu- 
 ments. In the advanced stages of the disease, the debility 
 and emaciation become very great, the complexion dark- 
 ens, and the appetite fails. Hectic, diarrhea, or vomiting 
 will, in the course of the disease, come on with unconquer- 
 able violence, discharging blood upwardly and downwardly; 
 at some other period, aching pains will be complained of 
 
824 INFLAMMATORY FORMS OF DISEASE. 
 
 in almost every part of the body, with anxiety, vertigo, 
 restlessness and sleeplessness. 
 
 The reader is not to suppose that in every case he will 
 find all the symptoms, and all the pain and discomfort, 
 which we have described, nor must he conclude that he will 
 find none which we have not named, for if he do, he will 
 be disappointed, if his practice should be in the low coun- 
 tries of the south. 
 
 The disease may exist for many years, becoming trouble- 
 some as often as the patient may take cold or have the ague, 
 otherwise he will appear to suffer but little from it, unless 
 an indisposition to do anything but lounge about, can be 
 regarded as suffering. Thus, in some cases, it continues 
 almost the length of an ordinary lifetime. But in many 
 instances, this form of splenitis induces other forms of dis- 
 ease, w^hich speedily prove fatal, as hemorrhage, diarrhea, 
 dropsy, or the supervention of acute splenitis. 
 
 The terminations of this form of disease are numerous ; 
 it may terminate by resolution, but this is a rare event, 
 particularly in the south, unless the patient leave the coun- 
 try ; it also terminates by a softeniug of the organ, in which 
 case it becomes a cyst, filled with a dark-colored sanies, by 
 induration, when its substance becomes hard and resembles 
 liver, or it may become brown and hard with cartilaginous 
 coats ; in this state it has been called scirrhus ; by ossifica- 
 tion, for it has been seen ossified, and in one instance had 
 a cancellated structure surrounded by an osseous shell, (Cy, 
 Prao. Med,) by gangrene — this can only happen in the most 
 feeble of constitutions ; and by hypertrophy, in this case 
 the spleen may so enlarge, as to weigh twenty or thirty 
 pounds, and with it the patient may live as many years, 
 and then die of some other disease. — {Cy. Prao. Med.) 
 
 There are several minor forms of disease which may be- 
 come located in the spleen during its chronic continuance, 
 as hydatides, tubercles, melanosis, calculous deposits, rup- 
 ture, atrophy, etc. 
 
 Causes. — Chronic splenitis occasionally succeeds to the 
 acute, but this is very rarely the case. Its most common 
 
NEPHRITIS. 825 
 
 cause is long-continued intermittent fever. In feeble con- 
 stitutions — the most feeble of those who have it — it might 
 be caused by a residence in a humid atmosphere, keeping 
 up a constant engorgement of the portal circle. 
 
 TREATMENT. — In the chronic form of splenitis, we pursue 
 the same treatment as laid down for chronic hepatitis, 
 merely substituting the region of the spleen for that of the 
 liver, where local measures are applied. 
 
 Genus XIII. — NEPHErns. 
 
 Dr. Cullen defines nephritis to be "Pyrexia, pain in the 
 region of the kidney, after following the course of the ure- 
 ter ; frequent desire to pass urine, which is either limpid 
 and colorless, or very red ; vomiting, numbness of the 
 leg, retraction or pain of the testicle of the same side." 
 
 When we come to treat of the diagnosis of this disease, 
 it will be all -important to have this definition well impressed 
 upon the memory, because a failure in this respect might 
 not only prove humiliating to the physician, but absolutely 
 injurious, if not fatal to the patient. 
 
 Nephritis may, like many of the other phlegmasia, intro- 
 duce itself by chilly sensations and flashes of heat, and the 
 pyrexia may become established before any indication is 
 given of local disease, as when occasioned by cold, or a re- 
 pulsion of cutaneous action. Or its first announcement 
 may be severe pain in either or both lumbar regions, as 
 when occasioned by strains, urinary calculi, contusions, me- 
 tastasis of rheumatism, or any other affection, or by irrita- 
 ting substances acting through the circulation, as canthar- 
 ides, etc. The pain is remarkable for its severity, and being 
 deep-seated, is very little influenced by external pressure, 
 but it is by all sudden motions of the body. It has been 
 asserted that this affection is not always attended with pain, 
 but this statement is certainly contrary to the general expe- 
 rience of the profession. 
 
 It is stated in the definition, that pain often follows the 
 course of the ureters, and to this we may add, that it lias a 
 darting motion, rather than one of quiet travel ; at least, 
 
826 INFLAMMATORY FORMS OF DISEASE. 
 
 it is SO in many instances. It may, also, be acute, or ob- 
 tuse, sharp or burning, and it not unfrequently extends to 
 the neck of the bladder, the scrotum, and even down the 
 inside of the thigh, and in the latter position it is attended 
 with a feeling of numbness. 
 
 As in most of the phlegmasia, indeed, all of them, under 
 favorable indications, the bowels are costive, the urine is 
 high-colored, occasionally tinged wdth blood, and always 
 scanty in quantity, almost absent sometimes, more particu- 
 larly when both kidneys are inflamed ; and however small 
 the quantity, its presence creates a desire to urinate ; and 
 hence the desire is nearly all the time present — the reverse 
 being the fact in only a very few cases. K^ausea and vom- 
 iting attend upon most cases, and colic pains are present in 
 a few. The pulse is generally hard and frequent during 
 the first three or four days, and then it becomes increased 
 in frequency and reduced in volume, particularly during 
 the periods of nausea and vomiting. The skin is generally 
 very dry, and more than normally elevated in temperature. 
 When the patient aims to rest or to be comfortable, he in- 
 clines his body to the inflamed side, or lies on it, or else on 
 his back. 
 
 Causes. — These are indicated in our opening remarks. 
 
 Diagnosis. — There is a possibilit}^ of confounding nephri- 
 tis with inflammation of the psoas muscle, lumbago, ne- 
 phralgia, partial peritonitis, colic, and hysteria. 
 
 When in the psoas muscles, there is neither nausea, a re- 
 traction of the testicle, nor alteration in the flow or cjuality 
 of the urine; in lumbago the pain is more superficial and is 
 increased in an attempt to rise from the sitting posture ; in 
 nephralgia there is no inflammatory fever or indications ot 
 inflammation ; in peritonitis, it is true that inflammation 
 and vomiting are present, but the urinary symptoms and 
 peculiar course of the pain are wanting, to create a like- 
 ness between it and nephritis ; in colic the pain is paroxys- 
 mal, and located about the umbilicus, and not in the loins ; 
 to distinguish nephritis from hysteria is not so easy as from 
 the other afiections above named — in hysteria there may bo 
 
NEPHRITIS. 827 
 
 a vomiting of green matter and an absence of the urinary 
 symptoms ; beyond these, if further evidence is wanted, the 
 history of the case may enable the physician to decide. 
 
 IN'ephritis is a rapid disease, rarely continuing longer 
 than the seventh day, when it may terminate in resolution, 
 suppuration, very rarely in gangrene, and occasionally in 
 induration. When a termination in resolution is about to 
 take place, all the symptoms become more favorable ; but if 
 in suppuration, it will be indicated by chills and shiverings, 
 a dull throbbing pain. When the abscess opens into the pel- 
 vis of the kidneys, the pus will be discharged with the urine, 
 and this may be continued for months, or even years, and 
 finally terminate in hectic and death, or it may only con- 
 tinue for a short time, and end in health. But we must not 
 regard the presence of pus in urine as conclusive evidence 
 of renal abscess, because calculous irritation sometimes oc- 
 casions the secretion of pus. Renal abscess sometimes 
 points externally, and by an incision it may be thus dis- 
 charged ; but it too frequently happens that a fistulous open- 
 ing is formed, and hectic finally follows. 
 
 Prognosis. — This is always doubtful, until it is known 
 that a termination by resolution has been effected. 
 
 Treatment. — During the whole course of the disease the 
 surface of the body must be bathed frequently with an alka- 
 line wash, and the Compound Tincture of Virginia Snake- 
 root should be given to allay pain, soothe nervous irrita- 
 bility, and keep up a tendency to the surface. The patient 
 should be kept quiet, and free from mental excitement. 
 
 In the early stage of the disease, when the inflammation 
 runs high, but little diet should be used — cold water, or in- 
 fusion of simple herbs, flaxseed tea, barley-water, Gum 
 Arabic water, etc., will be all-sufficient. On the decline of 
 the disease, chicken or mutton broth, beef tea, calf s-foot 
 jelly, etc., may be safely allowed. But if it assumes a chronic 
 form, the treatment must be somewhat modified, according 
 to circumstances. In long-standing and obstinate cases, 
 more active counter-irritation to the lumbar region may be 
 required, and we have frequently obtained the most grati- 
 
^4. 
 
 828 INFLAMMATORY FORMS OF DISEASE. 
 
 fjing results from the intermittent application of an irrita- 
 ting plaster. The diet should be similar to that recom- 
 mended in the preceding chronic inflammation of different 
 organs. 
 
 Genus XIY. — Cystitis — 
 
 Inflammation of the Bladder, 
 Although this inflammation is divided into two forms, 
 the acute and chronic, yet it may exist in various degrees, 
 from that which is attended wdth a slight secretion of mu- 
 cus from the internal membrane, to that of such intensity 
 as to terminate in gangrene. These several degrees of vio- 
 lence may intermingle or pass into each other by gradual 
 advance, which, to be understood, they must be contem- 
 plated in close connection. 
 
 1. Acute Cystitis. 
 When a burning pain is found to obtain in the region of 
 the urinary bladder, and at the terminus of the urethra, 
 hypogastric tenderness, urgent and frequent calls to urinate, 
 and in the exercise of the function the urine appears iu 
 small quantities, and attended with painful spasms, the 
 conclusion may be quite safel}^ drawn , acute cystitis is pres- 
 ent. When pressure is made above the pubis, it is com- 
 mon for the pain to be much increased, and upon examina- 
 tion, soreness will be discovered to exist in the perineum. 
 It is not uncommon for stillicidium to be a constant and a 
 very troublesome symptom, and the urine that is dis- 
 charged, is of a deep-red color, and sometimes tinged with 
 blood. The bowels are usually, as is common to the phleg- 
 masia, constipated, and if the inflammation shall extend to 
 the inferior extremity of the rectum, which is frequently the 
 case, there will be some tenesmus. It is quite common for 
 the patient to complain of such sensations about the prae- 
 cordia, as to produce an expression of anxiety in the coun- 
 tenance, which is but seldom unattended with nausea and 
 vomiting. The thirst is urgent, the skin is hot and dry, 
 the pulse is full, hard, and frequent, and the patient is anx- 
 ious and restless. 
 
ACUTE CYSTITIS. 829 
 
 This inflammation is usually introduced with chilly sen- 
 sations, or even some shivering, and as it advances, pains 
 appear to dart from the bladder to the anus, the loins, down 
 the thighs, and even to the epigastrium. Sometimes there 
 is a complete retention of the urine, and in such cases the 
 bladder rises like an oval tumor above the pubis ; and the 
 soreness or tenderness, instead of being confined to the hy- 
 pogastrium, becomes diffused over the abdomen. Hiccough 
 and a vomiting of bilious matter may now be expected, 
 and then delirium, coma, convulsions, and death. 
 
 A total retention of the urine but rarely becomes effected 
 except when the inflammation is more especially located 
 about the neck of the bladder, and in such cases the pain in 
 the perineum becomes exceedingly severe. Or in the event 
 there is not a complete retention of the urine, a dysuria or 
 feelings of strangury become incessant and tormenting. 
 When, under such circumstances, it becomes indis])ensable 
 to introduce the catheter, it is attended with great difliculty 
 and extreme pain. In the course of the disease, it is com- 
 mon for the urine to undergo several changes : at first it is 
 red, or greatly so, ^s in other inflammations — it then be- 
 comes blended with coagulable lymph or blood. If the dis- 
 ease has been occasioned by cantharides, then the urine is 
 especially bloody. In a still more advanced stage of the 
 disease the urine becomes highly putrescent and ammonia- 
 cal, and resembles, more or less, the washings of putrid 
 flesh. 
 
 This inflammation may extend to the muscular tunic, and 
 thence to the peritoneal. When the disease originated in an 
 inflammation of some neighboring organ, as the uterus, or 
 the rectum, its course will be of a reversed order — it will 
 begin in the peritoneal and terminate in the mucous coat. 
 Under no circumstances is it common for either of the tunics 
 to be wholly inflamed at one time. When it shall happen 
 to invade the mouths of the ureters, they become distended 
 — make pressure upon the kidneys, and death speedily 
 follows. 
 
 Like inflammations in general, this may terminate by 
 
830 INFLAMMATORY FORMS OF DISEASE. 
 
 resolution, suppuration, or gangrene; or it may terminate 
 in induration and a thickened condition of the cystic coats. 
 When it closes its career by resolution, beside a general 
 abatement of the symptoms, it presents, or is attended with 
 a general and copious diaphoresis, and a copious and turbid 
 secretion of urine. A termination by suppuration is not 
 common, but when it does happen, chills or rigors super- 
 vene upon a subsidence of pain and fever, and speedily fol- 
 lowing will be the appearance of pus in the urine. If the 
 abscess forms between the coats of the organ, it may point 
 inwardly and discharge its pus into the bladder, or it may 
 point outwardly and penetrate to the interior of the uterus, 
 rectum, or vagina, etc. It is said to terminate frequently in 
 gangrene, and this is the case in most of those instances in 
 which the disease terminated fatally in six or seven days. 
 This event is announced by a sudden cessation of pain, 
 prostration of strength, cold extremities, and a clammy 
 perspiration, and then hiccough becomes introduced to close 
 the scene. 
 
 Causes. — This affection may be occasioned by a painful 
 retention of the mine ; by mechanical violence upon the 
 hypogastric region, by acid ingesta through the stomach, as 
 turpentine, cantharides, etc., irritating injections into the 
 bladder, violence in the use of the catheter, a suddenly-sup- 
 pressed perspiration, metastasis of gout or rheumatism, 
 gonorrhea, etc. 
 
 Treatment. — The treatment recommended in acute ne- 
 phritis is applicable to this ; the local applications, however, 
 are to be applied over the pubes instead of the lumbar 
 region. 
 
 2. CJiToniG Cystitis, 
 
 This affection is sometimes described under the name of 
 cystirrhaea — it is not an unfrequent affection. This form of 
 cystitis, in many instances, seizes upon the patient without 
 any premonitory indications, but more frequently its onset 
 is so remarkably gradual, that the patient has no knowledge 
 of the precise period of invasion. When treating of the 
 acute form, we noticed the fact that the urine was some- 
 
CHRONIC CYSTITIS. 831 
 
 times loaded with mucus, it now becomes proper to observe 
 that such an event more generally belongs to this form, and 
 hence, the closing stage, in many instances, of the acute, is 
 but the introduction of the chronic. It is this circumstance, 
 the flow of mucus from the internal membrane of the organ, 
 that has caused this chronic form of cystitis to be called 
 catarrh of the bladder. It generally appears sporadically, 
 but like catarrh, and other affections of the mucous mem- 
 branes, it may prevail epidemically. It is generally attended 
 by a slight febrile state of the system, or it may exist only 
 in a simple irritation of the mucous membrane. 
 
 The existence of this aflection becomes known by fre- 
 quent calls to urinate, with pain in the region of the blad- 
 der and at the extremity of the urethra. There is generally 
 some tension of the hypogastrium, caused most probably by 
 distention of the bladder or cystic irritation. Even in 
 health, it is common for a slight mucous cloud to deposit 
 from the urine, upon cooling, but in this disease the urine 
 bears a large quantity of mucus, which, perhaps, has never 
 an entirely normal color. Upon the cooling of the urine, 
 the mucus subsides into a jelly-like mass, which tenaciously 
 adheres to the bottom of the vessel. Most generally, as we 
 have remarked, the mucus is suspended in the urine, but 
 occasionally it appears unassociated with the urine, and in 
 considerable quantities, and so thick sometimes as scarcely 
 to be voided. In the advanced stage of the disease, this 
 mucus inclines to yellow, and it may then become greenish, 
 or finally streaked with blood. Should the inflammation 
 run on to the formation of abscesses, the mucus will then 
 be found mixed with pus. The quantity of the mucus is 
 occasionally astonishingly great, amounting to several pints 
 per diem. The urine is frequently much changed in char- 
 acter — containing large quantities of the phosphates, which, 
 by alkaline qualities secreted by the bladder, are precipi- 
 tated in crystals, particularly the phosphate of magnesia and 
 ammonia. When ulceration has taken place, hemorrhage 
 from the bladder is not unfrequent. 
 
 This disease, in its progress to a violent stage, may be- 
 
832 INFLAMMATORY FORMS OF DISEASE. 
 
 come extended to the surrounding parts, and all its symp- 
 toms may become greatly aggravated ; the mucus may be 
 replaced by pus ; the dysuria may become more distressing ; 
 emaciation may rapidly ensue, and a hectic condition of 
 the system may, and most frequently does, supervene to 
 close the scene. 
 
 Causes. — The most usual causes of acute cystitis, in first 
 class constitutions, produce the chronic in the third class; 
 but there are many causes of it in feeble constitutions, which 
 would never produce the acute in the strong ; such as vene- 
 real indulgence — a residence in damp situations — sedentary 
 habits. There are, furthermore, some persons who appear 
 to possess an organic liability to it under slight exciting 
 causes. 
 
 Prognosis. — Under proper treatment, the prognosis may 
 be regarded as favorable, except with those who are feeble, 
 more especially, if they are particularly liable to it. But 
 though not fatal, it may continue even many years, alterna- 
 ting with better or worse conditions of it. 
 
 Treatment. — In the chronic form of cystitis, the internal 
 treatment may be the same as named for chronic nephritis. 
 But in connection with this, in cases where there is a mu- 
 cous discharge, or a tendency to ulceration of the bladder, 
 we use the following injection : 
 
 R. Hydrastis Canadensis, 3j, 
 
 Boiling Water, octj. Mix ; 
 "When cool, strain, and by means of a catheter inject one- 
 third of the infusion into the bladder, and repeat it three 
 times a day, and continue it daily until the symptoms have 
 subsided. It may be proper to state here, that at first, the 
 use of this injection will increase the discharge ; and should 
 it cause too much irritability of the organ, its use must be 
 omitted for a few days, and then recommenced, using it at 
 first but once a day. 
 
 Genus XY. — Hysteritis. 
 The uterus, in its unimpregnated state, is liable to inflam- 
 mation, and although, as might be supposed, it is attended 
 
ACUTE HYSTERITIS. 833 
 
 with less danger than when it occurs in the gravid state, or 
 shortly after parturition, yet it is attended with much pain 
 and considerable danger. That inflammation of the uterus 
 which is attended with puerperal convulsions, will not be 
 considered in this place. 
 
 1. Acute Hysteritis. 
 
 In this affection, the inflammation is sometimes so slight 
 as only to increase the normal secretion of the organ, but in 
 other instances, as in inflammation of the mucous mem- 
 brane of other organs, it runs on to suppuration. As in 
 the phlegmasia in general, it is not unfrequently introduced 
 by rigors which are followed by fever ; but it does happen 
 that pain, in the region of the uterus, is the first announce- 
 ment that is had of the disease. The pain is fixed in the 
 pelvis, and if the organ be much congested, it will be dull, 
 aching, and increased by pressure, and attended by a sen- 
 sation of weight or pressure toward the perineum. If the 
 inflammation be located in the posterior part of the organ, 
 with severe pain in the region of the sacrum, there will be 
 tenesmus in efforts to stool. The pain will be felt in the 
 iliac regions, to the hips, and down the inferior extremities 
 even to the feet, when the affection extends to the lateral 
 portions of the organ. If the affection be located ante- 
 riorly, there will be severe pain and difficulty in urinating, 
 if not a complete retention of the urine. An examination 
 of the pubic region will generally find the uterus enlarged, 
 firm, and painful upon pressure, but the abdomen is very 
 rarely swollen before an advanced stage of the disease. 
 
 With reference to the condition of the bowels, in this 
 affection, the general law as regards inflammations is not 
 violated — the bowels are usually inactive and the urine is 
 small in quantity and highly colored. In some instances, 
 too, the patient is very irritable, which is manifested by 
 nausea and vomiting, and the head is afflicted with pain. 
 
 This affection progresses with more than common celerity, 
 and hence, if a termination is not had in four or five days 
 by resolution, suppuration and possibly gangrene may be 
 
834 INFLAMMATORY FORMS OF DISEASE. 
 
 apprehended. In the event of suppuration, the case may 
 be regarded as dangerous, more particularly if the pus shall 
 work its way between the peritoneum and the exterior of 
 the uterus into the cellular tissue in the inferior portion of 
 the pelvis. If the abscess shall point to the interior of the 
 organ, expectations of recovery may be indulged. The 
 pus may be discharged into the rectum or the bladder, 
 through the interposition of adhesions, and still the pa- 
 tient may recover. 
 
 Treatment. — This, like the preceding forms of disease, 
 will yield to almost a similar treatment, as the vapor-bath, 
 warm foot-bath, and warm fomentations over the region 
 of the womb ; these means, in most cases, we have found 
 to be of more service than tepid or cold applications, and 
 they should be continued with the other treatment referred 
 to as long as the inflammation lasts. 
 
 As constipation of the bowels is a frequent attendant 
 upon this disease, it is very important and indispensably 
 necessary to effect its removal before much can be done, so 
 far as the administration of internal remedies is concerned ; 
 hence, in such cases, we use stimulating enemas, which 
 should be continued until a laxative condition of the bowels 
 is produced — this is more important on account of the in- 
 flammation which, in most cases, extends to the rectum 
 and bladder, and is increased to some extent when cathar- 
 tics are used before enemas — after which the bowels should 
 be kept in a relaxed condition by the use of Compound 
 Powder of Jalap. If there be much febrile action or nerv- 
 ous irritability present, the Compound Powder of Ipecacu- 
 anha, in flve-grain doses, should be given, and repeated 
 sufficiently often to allay these conditions and favor dia- 
 phoresis. The patient, under all circumstances, should be 
 conflned to her bed. 
 
 If there be a retention, or even scanty and high-colored 
 urine, use the decoction of Althea Officinalis and Ulmus 
 Fulvis, of which the patient should drink freely. If there 
 be much gastric derangement, sinipisms should be applied 
 over the stomach. In addition to the local applications 
 
CHRONIC HYSTERITIS. 835 
 
 directed to be made, we have often found much benefit from 
 the use of the tepid hip-bath, which should be taken twice 
 a day ; however, we meet with some cases which will not 
 bear any of the warm applications referred to, in conse- 
 quence of producing a constant sensation of syncope, with 
 much distress or difficulty of breathing, under which cir- 
 cumstances we would advise a similar use of cold water — 
 that is, towels wrung out of cold water and applied in the 
 same way as recommended for the warm fomentations. 
 Use the cold sitz-bath and frequent injections of cold water 
 into the vagina. 
 
 If ulceration should occur, the Susqui. Carb. Potassa 
 should be used as follows : 
 
 R. Susq. Carb. Potassa, 3ii, 
 Aqua, 5iv. Mix. 
 
 This should be injected or thrown upon the ulcerated 
 surface every day, increasing or diminishing the strength 
 of the preparation according to circumstances. It will be 
 well to alternate this with a decoction of Hydrastis Cana- 
 densis, two drachms to half a pint of water, which we have 
 found sufficient for the cure of ordinary ulceration of the 
 womb. 
 
 2. Chronic Hysteritis. 
 
 It is conceded that this inflammation is but little under- 
 stood ; and, furthermore, it is regarded as not being easily 
 controlled — indeed, it is so very local in many instances 
 as to produce but little constitutional disturbance — so little 
 that it happens sometimes the patient is irrecoverably lost, 
 through the extent of the local mischief, before the incon- 
 venience it occasioned made it appear necessary to do any- 
 thing. 
 
 Most generally the disease is seated about the neck or 
 mouth of the organ ; but it may, and in a few instances 
 does, invade the entire organ — hence w^e can understand 
 why the fact is, that the uterine secretion continues in very 
 many cases of a purely normal character — its quantity only 
 is increased ; but in some cases pus is produced as in simi- 
 lar inflammations of other mucous membranes. Some pa- 
 53 
 
836 INFLAMMATORY FORMS OF DISEASE. 
 
 tients complain only of a sensation of heat and some sore- 
 ness in the inferior portion of the pelvis ; others have dull 
 or lancinating pains, with occasional intermissions and 
 exacerbations, and a few complain of a sensation of weight 
 and occasional pains in the superior part of the vagina, 
 which are much increased during the venereal embrace. 
 The OS uteri is usually diverted from its normal position 
 and peculiarly tender to the touch, at least some portion of 
 it. A leucorrheal discharge is a very general attendant 
 upon this disease, and it becomes white or purulent as fre- 
 quently as the inflammation shall become aggravated. In 
 cases of long standing there is apt to be considerable swell- 
 ing of the cervix uteri. In a few instances it forms a large 
 tumor, which is embraced by the vagina. Pain in the 
 back and loins, and a variety of dyspeptic symptoms are 
 common attendants upon this chronic form of inflammation. 
 
 When a physician is called to treat leucorrhea, and the 
 patient complains of heat, pain, or weight in the superior 
 portion of the vagina, he would do well to suspect the ex- 
 istence of inflammation about the os or cervix uteri, and 
 to institute an examination per vaginum. 
 
 As may have been inferred from our opening remarks, 
 this aflection may continue for years to harass the patient 
 without efiecting any serious lesion of the organ ; but, on 
 the other hand, the result of it may be scirrhous and ulti- 
 mately cancerous ulceration. 
 
 In those females who menstruate with pain, there is apt 
 to be inflammation enough during the intervals of the 
 monthly periods to produce a deciduous membrane, which 
 is expelled during those periods, either as a closed sack 
 filled with a fluid, or in the form of flakes, which have 
 been known to be as large as the finger nail. 
 
 During the menstrual intervals there is usually, in such 
 cases, considerable uneasiness in the region of the uterus. 
 Such women are said to be barren. It is supposed by some 
 that the pain in menstruation, when severe, is occasioned 
 by the presence of, or the obstruction which, this membrane 
 creates. 
 
CHRONIC HYSTERITIS. 837 
 
 For the pain attendant npon this form of the disease, 
 Prof. Dewees recommends the following prescription : 
 
 R. Gum Camphor, Bi, 
 
 Spir. Yin. Eectif., q. s.. Fiat Pulvis, add, 
 
 Pulv. G. Arab., 3i, 
 
 Sacch. Alb., q. s.. 
 
 Aqua Cinnam. SimpL, 3i. Mix. 
 
 When the patient experiences the pain, one-half of this 
 draught is to be administered, and unless relief should 
 supervene in one or two hours, the other half should be 
 given. After a trial of many agents, he found nothing to 
 succeed so well as Camphor, but in some cases more will 
 be required than above prescribed. 
 
 Il; may be stated, as a general rule, that the digestive 
 functions are deranged, the appetite is variable and uncer- 
 tain, the bowels are inactive, the urine is discharged with 
 pain, the anus is retracted, and menstruation disturbed. 
 
 Causes. — Among the causes, difficult or instrumental 
 labors, excessive venereal indulgence, metastasis of erysipe- 
 las, and suppressed menstruation have been cited. 
 
 Treatment. — In the treatment of this form of disease, it 
 is necessary to regulate the gastric derangement with the 
 means heretofore recommended. As most cases of this 
 disease are accompanied with, or produced by, a retention 
 of the menstrual discharge, we advise the use of emena- 
 gogues, and perhaps the Materia Medica does not afford 
 another agent of so great a value as Macrotin ; this should 
 be given in doses of from three to four grains three times 
 a day increasing or diminishing the dose so as to produce 
 its specific constitutional effect, which consists of aching in 
 the joints, dull, full heaviness of the head, accompanied 
 with m.ore or less dizziness. 
 
 The foregoing treatment should be continued, in connec- 
 tion with the warm hip-bath, until the suspended function 
 of the womb is restored. 
 
 The patient should at all times be careful to avoid active 
 exercise, and constantly wear a properly-adjusted abdomi- 
 nal supporter. 
 
838 INFLAMMATORY FORMS OF DISEASE. 
 
 Genus XYI. — Kheumatism. 
 
 Dunglison's Dictionary defines this to be, "A kind of 
 shifting phlegmasia, sometimes seated in the muscles, some- 
 times in parts surrounding the joints, and at others within 
 them." We cannot adopt this definition — our observation 
 has forced us to the conclusion that the obstruction is of a 
 general character — that the matter producing the obstruc- 
 tion (a result of some defective or suspended depuration) 
 has only the power to injure certain tissues, as the fibrous, 
 and that the local invasions, which constitute the preceding 
 definition, are mere results of the disease or constitutional 
 disturbance. 
 
 Upon this subject. Dr. Jas. Bird (Braithwaite's Eetro- 
 spect) says : " Though rheumatism appears with all the 
 phenomena of (the phlegmasia), its local inflammation still 
 possesses a specific character more symptomatic than idio- 
 pathic in nature, and manifesting in progress that the 
 symptoms proceed from a particular constitutional taint, 
 which gives to them a character distinct from simple in- 
 flammation. He further adds : "Rheumatic inflammation, 
 difiers from simple inflammation, inasmuch as it proceeds 
 from a specific cause and is associated with greater abnor- 
 aial sensibility of the nerves." 
 
 What proof have we that the proximate cause of all other 
 forms of disease is not as specific as that of rheumatism ? 
 What proof have we that the " greater sensibility of the 
 nerves " is not referable to some constitutional peculiarity, 
 rather than to any specifically morbid one ? In what does 
 the " constitutional taint," in this form of disease, consist ? 
 But, to our author again : 
 
 " Eegarding the origin of the rheumatic diathesis, rheu- 
 matism is considered as the result of that pre-existing lesion 
 of the assimilating and excretory organs of the body, 
 which, on the application of cold, errors of diet, intoxica- 
 tion, malaria, and like exciting causes, gives rise to that 
 abnormal change of the blood which constitutes the rheu- 
 matic diathesis." 
 
ACUTE RHEUMATISM. 839 
 
 If our readers can obtain an idea from this sentence that 
 is not applicable to every other form of disease, they will 
 accomplish more than we can. We hold that the language 
 here used is applicable to all forms of disease, and abso- 
 lutely fails to explain anything, with reference to any one, 
 and yet, in the abstract, it may constitute a truism. 
 
 M. Andral, says Dr. Barlow (Cyc. Prac. Med.), main- 
 tains that the cause of rheumatism is in the blood, and that 
 this cause consists of an excess of fibrin or sanguineous 
 plethora. With reference to this opinion, we have to say, 
 that if such a plethora exists, then it is really the disease, 
 and the subsequent manifestations only indicate that the 
 system is struggling to remove or remedy the evil. To 
 assert that the disease has its cause in the blood, is only 
 removing the difficulty one step further off. 
 
 But there exists another difficulty, which the admission 
 of this doctrine can not enable us to answer. It is this : 
 all constitutions are liable to plethora, but all are not liable 
 to rheumatism. This objection is answered by the intro- 
 duction of a "constitutional taint" in favor of, or dispos- 
 ing to, rheumatism. Yerygood; but in what does this 
 " taint" consist? If nothing is known to indicate its exist- 
 ence, then it is a mere assumption — an unmeaning abstrac- 
 tion. 
 
 Having exposed how little is known about rheumatic 
 constitutions, we proceed to the consideration of the sub- 
 ject, and will begin by dividing it into two entirely distinct 
 varieties — the acute and the chronic. 
 
 1. Aeute Rheumatism. 
 This form or variety of rheumatism is confined to those 
 who possess a pretty nearly -balanced or equal development 
 of the medulla oblongata and the lateral portions the cere- 
 bellum (the organs of muscular motion and animal sensi- 
 bility), and both in a high degree — so much so as to occa- 
 sion a large neck, one that is particularly full and broad 
 posteriorly. This organization is slightly liable to obesity 
 under favorable circumstances, but it is always stout and 
 
7-iO INFLAMMATORY FORMS OF DISEASE. 
 
 muscular. The subjects of gout, pericarditis, inflammatory 
 fever, and epilepsy, in their idiopathic forms, are very much 
 of the same organization. We do not know anything 
 about a rheumatic diathesis — but the above is a description 
 of a rheumatic organization. The most vigorous portion 
 of life is the general period of liability ; and as it is insep- 
 arably associated with a vigorous muscular system, and 
 high animal sensibility, it follows that females are but little 
 liable to it. 
 
 Dr. Barlow regards the description given of this form of 
 disease, by Sydenham, to be the most accurate he has seen, 
 and therefore he adopts it. If this be true, we can not do 
 better than to do the same. 
 
 "This disease happens at any time, but especially in 
 autumn, and chiefly aflects such as are in the prime of life. 
 It is generally occasioned by exposing the body to the cold 
 air after having heated it by violent exercise or some other 
 way. It begins with chilliness and shivering, which are 
 soon succeeded by heat, restlessness, and thirst, and the 
 other concomitants of fever. In a day or two, and some- 
 times sooner, there arises an acute pain in some one or 
 other of the limbs, especially in the wrists, shoulders, 
 knees, which, shifting between whiles, aflects these parts 
 alternately, leaving a redness and swelling in the part last 
 aflected. In the beginning of the illness, the fever and 
 the above-mentioned symptoms do sometimes come to- 
 gether, but the fever goes ofi*, generally, while the pain 
 continues, and sometimes increases." 
 
 Professor Wood says : " Very soon after the local seizure, 
 rigors and symptoms of commencing fever are experienced, 
 followed by increased frequency of the pulse, heat of the 
 skin, furred tongue, anorexia, thirst, and occasional head- 
 ache." We do not esteem these remarks to be exactly 
 accurate, for, in a majority of instances, the constitutional 
 disturbance precedes the local determination. He regards 
 rheumatism as a constitutional disease, and if this be the 
 fact, then its announcement should be by constitutional 
 symptoms, and not local ones. With reference to the 
 
ACUTE RHEUMATISM. 84:1 
 
 general symptoms, it should be observed, that the pulse, 
 though never remarkable for frequency, is always full and 
 strong ; the respiratory function, in the simple form of the 
 disease, is never greatly disturbed ; the temperature of the 
 skin, very rarely, perhaps never, becomes as much elevated 
 as is common to most fevers, but it is more frequently 
 moist, often amounting to a copious perspiration, which is 
 attended with that sour and offensive smell that may be 
 frequently observed in intermittent fever, but it does not 
 reduce either the inflammation or the pain. 
 
 As is common to the phlegmasia, the bowels are consti- 
 pated, and the urine is scanty and high colored. The 
 tongue is covered, generally, with a moist and whitish fur, 
 but nausea and vomiting are only occasionally present. 
 Cerebral suffering is very rarely present, but occasionally 
 it amounts to delirium. The fever is generally of the 
 remitting character, and most frequently runs its course 
 without invading, in an essential manner, either of the 
 splanchnic cavities. 
 
 In some instances, although they are rare, the local affec- 
 tion precedes the constitutional, and in such cases the latter 
 appears to be symptomatic of the former, and thus the gen- 
 eral conclusion, as regards this form of disease, is reversed. 
 The parts locally affected are swollen, red, and very pain- 
 ful — the least motion of the part produces the excruciating 
 pain. Through the day the patient may acquire some rest, 
 by keeping himself still, but such are the nocturnal exacer- 
 bations, that there is no rest for him — at most, but little. 
 
 This form of fever, like all others, is liable to become com- 
 plicated with other forms of disease, or to awaken a liabil- 
 ity to some other form, as in the case of bilious rheumatism. 
 In this case, the previously-acting causes have produced a 
 liability to hepatic or gastric derangement, and possibly 
 both, which, by the rheumatic invasion, is developed into 
 action. The various important organs of the body are liable 
 to become implicated by metastasis or extension. Endo- 
 carditis and pericarditis are, perhaps, the most frequent re- 
 sults which happen of this character. While treating rlieu- 
 
842 INFLAMMATORY FORMS OF DISEASE. 
 
 matism, the physician should have this possible event con- 
 stantly before his mind. 
 
 The duration of this disease is very variable, but under a 
 prompt and judicious treatment, it should not continue 
 longer than two weeks, though it often continues for two or 
 three months. In such cases it consists of a succession of 
 local attacks, each of which runs a similar course ; conse- 
 quently, during such a period, scarcely a single important 
 articulation will escape. It invariably leaves the invaded 
 articulations more feeble and stiff, which generally contin- 
 ues for a long time after the disease has been conquered. 
 
 Causes. — The remote cause is to be souo^ht in the oro'ani- 
 zation, upon which we commented in the outset. We may 
 here acid, that in acute rheumatic subjects, there is a high 
 endowment of the cerebello-spinal and ganglionic systems — 
 the dynamic and active forces both exist in high degree. 
 Professor Wood, after speaking of cold as the most fre- 
 quent exciting cause, adds : " But something more is requi- 
 site than cold. There must also be a peculiar state of the 
 system predisposing to this form of disease. There must 
 be a rheumatic diathesis. In what this diathesis consists, 
 has not been discovered . There are no signs by which its 
 existence can be detected with an approach to certainty." 
 Whatever our readers may think of our opinions on this 
 subject, it is certain that they can not charge us with being 
 more ignorant than our brethren. We admit that cold is 
 the most frequent exciting cause, aud so it is of phthisis, 
 chronic rheumatism, and of many other forms of disease, 
 but not in similar organizatious. The same exciting cause, 
 in our opinion, may develop phthisis in one, acute rheuma- 
 tism in a second, chronic rheumatism in a third, and peri- 
 carditis in a fourth ; and we are far from being sure that 
 all of these forms of disease may not, like the presence of 
 adeps, become spontaneously developed. Between fat, 
 fibrin, and tubercle, there is sufficient analogy to justify 
 the inference. 
 
 Diagnosis. — It is next to impossible to confound acute 
 rheumatism with any other form of disease except the gout, 
 
ACUTE RHEUMATISM. 843 It 
 
 and in well-marked cases there need to be no difficulty in 
 this case ; but it is true, that cases are sometimes seen in 
 which it is very nearly impossible to diagnose them. Gout 
 is most generally associated with digestive derangement, 
 and confined to the small joints — in neither respect is this 
 the case with rheumatism. Gout is furthermore, more par- 
 oxysmal, periodic, and remittent, and attended by a more 
 severe pain, a greater redness and tumefaction of the 
 part. 
 
 Prognosis. — So long as rheumatism maintains its simple 
 form, its prognosis must be regarded as favorable ; but 
 when it implicates the brain or the heart, it becomes asso- 
 ciated with danger. It usually terminates favorably by 
 resolution, yet in a few instances, where the constitution is 
 more remarkable for its active than its dynamic forces, it 
 terminates in suppuration, forming abscesses in the inter- 
 muscular tissues. 
 
 Treatment. — Perhaps there is no disease or condition of 
 the system which more clearly indicates the use of the 
 spirit vapor-bath, than the one under consideration, and 
 which should be employed on the first appearance of the 
 disease ; and here let me impress upon the mind of the 
 practitioner the necessity for prompt action in this matter. 
 The patient should be advised to inhale the vapor as it rises 
 under the blanket, until free and copious perspiration is 
 produced, and in fact, until complete relaxation of the sys- 
 tem takes place, which will be manifested by diflSculty of 
 breathing, or a sensation of syncope. At this stage of the 
 treatment, provided the above conditions have been pro- 
 duced, the covering may be removed from the head of the 
 patient, who may be allowed to inhale the natural atmo- 
 sphere. If the symptoms of relaxation should then pass 
 oflf, without having to place him in a recumbent position, 
 the vapor-bath may be continued for at least half an hour 
 longer. The patient should be subjected to this kind of 
 treatment twice a day so long as the disease continues ; and 
 if this is carried out according to the above directions, and 
 the patient is made to perspire as freely as possible, by the 
 
844 INFLAMMATORY FORMS OF DISEASE. 
 
 treatment, continued until the above relaxing effects are 
 produced, all constriction of the system is removed, and the 
 disease is thrown off by establishing a healthy depuration. 
 
 The above treatment will, in most cases, remove the dis- 
 ease in from two to five days, especially when adopted in 
 its early stage. If there be much pain and irritability of 
 the nervous system, it will be necessary to make use of ano- 
 dynes and antiperiodics, as follows : 
 
 R. Sulphate of Quinine, 
 
 Com. Pow. Ipecac, and Opium, da grs. xx. 
 Mix, and divide into ^yq powders, one of whio,h should be 
 given every three, four, or five hours, increasing or dimin- 
 ishing the quantity or dose according to the circumstances 
 of the case ; and, as a general thing, they should be used 
 until the febrile symptoms are removed. 
 
 We regard venesection or active purgation unnecessary ; 
 but, inasmuch as we frequently find more or less gastric 
 derangement, accompanied with hepatic torpor, we would 
 advise the use of the Podophyllin, Leptandrin, and Caulo- 
 phyllin, in alterative doses, and so soon as the bowels be- 
 come in a relaxed condition, their use should be discon- 
 tinued. 
 
 As regards local measures, we think all that is necessary 
 in this disease, is to make use of flannel bandages, as w^ell 
 as to dress the patient with flannel, and keep him in bed. 
 We do not believe that the various liniments and cata- 
 plasms recommended, are of much use ; but where the dis- 
 ease assumes rather a sub-acute form, even the hot-bath 
 will be found very useful ; yet we doubt whether its utility 
 is so great as the vapor-bath. In this form of the disease, 
 it may require more anodynes and diaphoretics, than in the 
 more active form, as the Conium Maculatum, Macrotin, 
 Aconite, Belladonna, etc. 
 
 Upon examination, if there be found much tenderness of 
 any part of the spinal column, it will be well to make use 
 of active stimulating liniments ; if this be not sufficient to 
 remove the tenderness, it may be well to produce pustula- 
 tion with Croton Oil. Should there be any symptoms of a 
 
CHRONIC RHEUxMATISM. 845 
 
 metastasis to the heart or lungs, active means should be 
 used to prevent it, such as immersing the feet and hands in 
 hot water, and vesication over the part originally affected, 
 with Aqua Ammonia, Turpentine, or Granville's Lotion, 
 with the free nse of Quinine and diaphoretic powders. If 
 the patient desires acid drinks, such as lemonade, etc., he 
 should be indulged. The diet should be generous, avoid- 
 ing all exercise and exposures to sudden changes of the 
 atmosphere, until the disease is entirely removed. 
 
 2. diToniG Rheumatism. 
 
 The subjects of this form of rheumatism have lean and 
 dense muscles — their necks are rather small, and pos- 
 teriorly narrow or thin — muscular motion and animal sen- 
 sibility being more feeble — forming, with the subject of the 
 acute form, a bold contrast. They most frequently consist 
 of the sanguine-bilious and the sanguine encephalo-bilious 
 constitutions. In fine, their dynamic force is much greater 
 than their active. According to our organic distinction 
 between those who are liable to the two forms respectively, 
 it would follow that neither of the organic conditions could 
 have both forms of the disease. Upon this point we are 
 pleased to find our opinion sustained by that of Professor 
 Dunglison. 
 
 He says (Cy. Prac. Med.): "The chronic form of rheu- 
 matism is often described as being frequently the sequel to 
 the acute. This does not accord, however, with the expe- 
 rience of the writer. So far as his observation has gone, 
 the subjects of acute rheumatism rarely suffer from the 
 chronic form," (we think never, when the character is de- 
 cided), " and on the other hand, persons who are constantly 
 more or less crippled by chronic rheumatism, may pass 
 through life without suffering from the acute." 
 
 Dr. Barlow (same reference), treating of this disease, 
 says that, "It is a prevailing impression that a chronic 
 disease can not be inflammatory. How this originated, it 
 is needless to conjecture ; but, however the misconception 
 arose, it is a familiar truth, that the term chronic conveys 
 
84:6 INFLAMMATORY FORMS OF DISEASE. 
 
 to most minds, not the simple idea of duration, whicli alone 
 it expresses, but something the opposite of inflammatory." 
 We admit this to be the fact, and certainly we can not be 
 surprised that such is the case, since no reason has been as- 
 signed why the two different forms should exist upon any 
 other principle. What reason can Professor Dunglison, or 
 any one else give why a patient may have the chronic form, 
 and attended, too, with inflammation, yet never have the 
 acute ? InTo pathologist can well reflect upon the organic 
 difference that attends between the acute and the chronic 
 forms respectively, and not perceive their rationale. In the 
 first, the greatly -active forces will cast off or eliminate the 
 proximate cause or obstruction ; while in the second, under 
 a strong dynamic influence, the active forces are too feeble 
 to effect, entirely, such an elimination. It should not be 
 overlooked, furthermore, that as these forces are both com- 
 paratively strong or feeble, as they approach in strength or 
 recede, so must the manifestations of the morbid actions 
 become diversified ; consequently no description of the 
 affection can be given that shall equally apply to all cases. 
 To obviate this difficulty, two other forms have, by some, 
 been added to the rheumatic catalogue, as the sub-acute and 
 the nervous. But, holding it to be true, that the physician 
 who clearly understands the nature of the disease in its 
 acute and chronic forms, will be able to contend with all 
 the intermediate and modified forms, we deem it to be un- 
 necessary for us to attempt to treat of them. 
 
 This form of the disease, like the preceding, is attended 
 by more or less of fever, which gradually reduces the resist- 
 ing power of the constitution, and with pain and swelling 
 of the invaded tissues or articulations ; and as the affection 
 advances, the febrile symptoms become so far obliterated, 
 as to appear only toward evening and during the night, and 
 then they may simply consist of quickness, tension, and 
 contraction of the pulse, and the affected parts may either 
 cease to be red or swollen. During this period of establish- 
 ment, the pain may be greatly migratory, invading in suc- 
 cession almost every muscle or articulation in the sys- 
 
CHRONIC RHEUMATISM. 847 
 
 tern ; but at length it becomes seated in some particular 
 part. 
 
 The preceding symptoms may be repeated, in part or in 
 whole, as frequently as the liability shall be excited into 
 action by fresh exposure to cold, watching, fatigue, or any 
 other cause that can derange the secretions. 
 
 Cullen says : " The limits between the acute and chronic 
 rheumatism are not always exactly marked." This we 
 admit to be the fact, in all cases where the active forces 
 are such as to admit of a low grade of the acute form, or a 
 high one of the chronic ; and, in such cases, to mistake the 
 one for the other, can do no mischief. He continues : 
 " "When the pains are still ready to shift their place — when 
 they are especially severe in the night time — when, at the 
 same time, they are attended with some degree of pyrexia, 
 and with some swelling, and especially with some redness 
 of the joints, the disease is to be considered as still partak- 
 ing the nature of acute rheumatism. But when there is no 
 degree of pyrexia remaining — when the pained joints are 
 without redness, when they are cold and stifi^— when they 
 can not easily be made to sweat, or when, while a free and 
 warm sweat is brought out on the rest of the body, it is only 
 clammy and cold on the joints — and when, especially, the 
 pains of these joints are increased by cold and relieved by 
 heat applied to them, the case is to be considered as that of 
 purely chronic rheumatism." 
 
 The preceding extract sustains the remark of Dr. Bar- 
 low, that the opinion is prevalent, that the chronicity of a 
 disease is incompatible with inflammation ; and the opinion 
 betrays an utter ignorance of the constitutional diversity of 
 power to manifest the presence of disease. That condition 
 of the system which Cullen regards as chronic rheumatism, 
 we regard as local disorganization — a mere sequel a3 of 
 rheumatism, as opthalmia may be of small-pox. If rheu- 
 matism be a constitutional disease, it must be conceded 
 that in the absence of every constitutional symptom, there 
 must also be an absence of the disease. It is important to 
 distinguish between a result of rheumatism, and rheuma- 
 
848 INFLAMMATORY FORMS OF DISEASE. 
 
 tism itself, because the former will require, perhaps, only 
 local treatment, while the latter must be combatted with 
 that which addresses constitutional . 
 
 We have neither time nor space to review many of the 
 opinions which have been advanced concerning the pathol- 
 ogy of this disease. Those who desire further information, 
 may consult Eberle, "Wood, and particularly the Cyclopedia 
 of Practical Medicine. To talk about predisposition, diathe- 
 sis, relative plethora, etc., avails nothing, because there are 
 no visible signs by which such conditions can be recog- 
 nized; but if it be true that pathological differences depend 
 upon the anatomical, then something of real value is 
 gained, because they can be so described as to be perceived, 
 the desired desiderata become tangible and comprehensible, 
 and this service to the profession we have endeavored to 
 render. 
 
 Causes. — Beside exposure to cold, or, which is worse, a 
 cold, damp air, there are many other causes, and some of 
 them impart a specific name to the disease, as the mercu- 
 real and syphilitic ; but no matter what may be the cause, 
 the disease is confined to that organic condition which we 
 have described. 
 
 Diagnosis. — Gout is the only form of disease with which 
 this can be confounded, and under that head the diagnosis 
 will be treated of. 
 
 Prognosis. — This disease, in its simple form, is, perhaps, 
 never fatal, but it disqualifies the patient for the enjoyment 
 of life, either by the pain it infiicts, or the crippled condi- 
 tion of the extremities which it produces. At the Hot 
 Springs, of Arkansas, the writer has witnessed almost every 
 possible variety of rheumatic decrepitude and deformity ; 
 and while a majority of them are either benefitted or en- 
 tirely cured by the vapor-bathing in these springs, there is 
 one which we have never known to yield, and it is that 
 which is produced by the external use of sulphur. We 
 suppose this to partake of the nature of chronic rheuma- 
 tism, because we have always observed it to be associated 
 with the same organic conditions. 
 
CHRONIC RHEUMATISM. 849 
 
 Treatment.* — In this, like the other form of the dis- 
 ease, the affected parts should be bandaged with flannel. 
 The Tincture of Aster JEstivus in doses of one-half drachm, 
 may be given every three or four hours, and during the ab- 
 sence of constitutional symptoms, the part affected may be 
 frequently bathed with the same tincture. We would also 
 recommend the following as an alterative and stimulant : 
 K. Compound Syrup Stillingia, 3ii, 
 
 Syrup Ginger, 3iiij, 
 
 Iodide Potassa, 3ii. Mix. 
 Of this, give a tablespoonful from every three to five hours, 
 unless it should produce nausea or severe pain in the head, 
 when the quantity should be lessened or proportioned to 
 suit the circumstances of the case. We have found, in this 
 disease, that the Iodide of Potassium, either alone, or in the 
 above combination, will produce a powerful effect, and in 
 many cases arrest it at once. It may also be used in the 
 same way in the acute stages. 
 
 The frequent use of the vapor-bath and alkaline wash, 
 should not be neglected, but should be used daily through- 
 out the disease. The diet should be generous, and the 
 bowels kept in a relaxed condition. If the disease should 
 become located, and produce much enlargement of the joints, 
 it may be necessary to use the warm fomentations and 
 irritating plaster. 
 
 * The advantage of the Hot Springs, of Arkansas, in the treatment of 
 chronic rheumatism, depends upon their convenience, the patient's hope or 
 expectation of being cured by them, the influence upon him of society, and 
 that of traveling to get to them, rather than upon any intrinsic quality of 
 the water, which contains rather more than a large quantity of the bicar- 
 bonate of lime. While bathing in the vapor, the hot water is drank, and 
 consequently this bicarbonate of lime may exert some medicinal effect. 
 Certain it is, veiy many are permanently relieved by them — even those who 
 had been compelled to use crutches, in walking, for many years. 
 
 The observation and experience of the writer have induced him to believe 
 that, with the use of proper relaxents, vapor-bathing is the best possible 
 remedy in both forms of the disease. As remedial agents, he has no con- 
 fidence in local applications during the presence of constitutional symp- 
 toms. 
 
850 INFLAMMATORY FORMS OF DISEASE. 
 
 Genus XYII. — Arthritis — 
 
 Gout, 
 " Gout," says Dunglison's Dictionary, " is an inflamma- 
 tion of the fibrous and ligamentous parts of the joints ;" 
 and Dr. Eberle says, that it is a " constitutional affection, 
 depending upon a peculiar diathesis, and manifesting itself 
 in its regular form by external local inflammation of the 
 fibrous structures, and fever of the synochal grade." The 
 first of these definitions is well calculated to mislead the 
 student, by causing him to regard the afiection as a local 
 one ; and the second is exceedingly faulty, and yet perhaps 
 it is as good as can be at present framed. 
 
 Dr. Barlow regards a plethoric condition of the blood — 
 that is, blood which contains, either absolutely or rela- 
 tively, too much fibrin, as in the case of rheumatism, to be 
 the cause. If such a state of the blood absolutely exists, 
 then this condition of it is the disease, which was remotely 
 caused by the arthritic " diathesis," and the exciting was 
 that which impaired some important depuration. The fever 
 indicates that the system is making an efibrt to eliminate 
 the obstruction, and the local afiection, instead of being the 
 disease, is merely its crisis ; and, as such, no local remedy 
 should be used to either mitigate or abridge its violence. 
 The physician who visits this form of disease, with these 
 views thoroughly impressed upon his mind, will not make 
 a blunder in its treatment. 
 
 Between the organic conditions which are essential to 
 the existence of rheumatism, and those which are in like 
 manner related to the gout, there is but a shade of difier- 
 ence. Having seen but little of gout, and having been 
 compelled to rely much upon the history and description of 
 this form of disease which others have given, we can not 
 be so confident of the accuracy of the opinions we shall 
 express concerning it. But with even these limited means 
 of acquiring knowledge of the subject, we do not expect to 
 betray more ignorance of its true nature than our predeces- 
 sors have done. 
 
ARTHRITIS. 851 
 
 The distinction we are disposed to draw between the 
 rheumatic and the arthritic organizations, with reference to 
 their acute forms, is this : in the latter the active forces 
 much more considerably preponderate over the dynamic, 
 and this may have been occasioned by a greater indulgence 
 in idleness and luxury. In the chronic foj-ms of these affec- 
 tions, the active forces in that of gout descend much below 
 the dynamic, and it is f sble when compared with the 
 chronic condition of the rheumatic. 
 
 By way of objection, we may be told, that many persons 
 have gout who are industrious in their habits and tempe- 
 rate in their modes of living. We chc TfuUy grant all this. 
 We are again told, by every writer, that gout is hereditary. 
 To this doctrine, it is known, that we object, and in lieu 
 of it contend for the entailment of organic conditions, with 
 which are associated organic liabilities to certain forms of 
 morbid action under certain circumstances. Now, let it be 
 remembered, while treating of arthritit^ and indeed of all 
 other forms of disease, that organic form and magnitude 
 are not alone transmitted, but also organic modes of action. 
 
 For the purpose of securing a full comprehension of this 
 principle, it may be well for us to present a few illustra- 
 tions. Those who know anything of Rembrant Peal's 
 family, must know that every one of his descendants have 
 an inclination and a talent for painting. It is also well 
 known among the growers of horses, chat the colts of pac- 
 ing horses, if they resemble in anywise their sires, are 
 more disposed to pace than to trot. Finally, it is well 
 known to hunters ol* the bear, that the pups of an old bear 
 dog trail the bear spontaneously, and yet can scarcely be 
 taught to trail any other animal. It can not be objected 
 that this law applies only to mental or muscular action, be- 
 cause the facts in cases of phthisis, and other forms of dis- 
 ease which are Gaid to be hereditary, prove the contrary. 
 
 The preceding facts and reasoning must render it obvi- 
 ous, that a man may be seized with gout, because of a 
 transmitted or entailed mode of action of his system under 
 such exciting causes as would produce, under other cir- 
 54 
 
852 INFLAMMATORY FORMS OF DISEASE. 
 
 cnmstances, some other form belonging to the same family 
 of disease ; and we are disposed to regard phrenitis, pul- 
 monitis, pleuritis, pericarditis, rheumatism, gout, and can- 
 cer as belonging to the same organic family — and yet we 
 consider them to be distinct forms, because of distinct 
 modifications of the dynamic and active forces. 
 
 We shall treat of arthritis, as we have of rheumatism, 
 under two forms, the acute and chronic, although nosolo- 
 gists have divided it into many more varieties — as regular 
 and irregular, tonic and atonic, misplaced and retrocedent. 
 Much has been written upon this subject — ■ theory after 
 theory, to an incalculable number, has been announced and 
 denounced, and, therefore, in the little we have said about 
 it, we entertain no fear of a worse reception than has been 
 awarded to our predecessors. 
 
 1. Acute Arthritis, 
 
 This is a paroxysmal form of disease, which, like fever 
 and ague, allows the patient to feel comparatively well 
 during the paroxysmal intervals. We stated that the affec- 
 tion of the joints, though defined to be the joints, is nothing 
 less nor more than the crisis, yet this crisis is an immense 
 evil to old age, when the strength is so wasted and the 
 limbs so weakened that locomotion is nearly lost ; it is 
 also a heavy tax to pay for sensual indulgence, more espe- 
 cially when it is imposed upon us as an inheritance. 
 
 A paroxysm of the gout is generally preceded by indi- 
 gestion, drowsiness, wind, a slight headache, sickness, and 
 sometimes vomiting. The patient complains of weariness 
 and dejection of spirits, and has often a pain in the limbs, 
 with a sensation as if wind or cold water was passing 
 down the thigh. The appetite is remarkably keen a day 
 or two before the fit, and there is a slight pain in passing 
 urine, and sometimes an involuntary shedding of tears. It 
 frequently happens, that as the paroxysm approaches these 
 symptoms become more violent. 
 
 When the attack is of the regular character, it is most 
 apt to appear in the spring or beginning of winter, and at 
 
ACUTE ARTHRITIS. 853 
 
 some two or three o'clock in the morning. It begins by 
 the location of a severe pain in the great toe, the heel, the 
 ankle, or calf of the leg, but the first position is generally 
 the one selected. This pain is associated with a sensation 
 as if cold water was poured upon the part, which is suc- 
 ceeded by shivering, with some degree of fever. The pain 
 then increases, and fixing itself among the small bones of 
 the foot, the patient feels all the difierent kinds of torture, 
 as if the parts were stretched, burnt, squeezed, gnawed, 
 twisted, or torn in pieces. 
 
 The severity of the pain causes the patient to be exceed- 
 ingly restless, the pulse becomes full, hard, and frequent, 
 and the skin dry and hot. These symptoms may continue 
 with unabated violence twenty-one or two hours, when they 
 will begin to decline, and finally terminate in a profuse per- 
 spiration ; but it is more common for the symptoms to 
 abate and a perspiration to supervene in three or four hours 
 after the seizure. In the most violent cases, it but rarely 
 happens that there is any abatement in the symptoms before 
 the third or fourth morning — and, as a common circum- 
 stance in disease, the patient sufiers more through the night 
 than through the day. 
 
 This afiection appears to have a strong partiality for the 
 metatarsal joint of the big toe. Dr. Scudmore, says Dr. 
 "Wood, found that of 193 cases, 130 began in the big toe, 
 but it may attack any of the small joints of the hand or 
 foot — it may do even more than this after it shall have fre- 
 quently recurred, for then it may invade any joint in the 
 body, or any organ in the large cavities. 
 
 It is common for an exacerbation of the fever and inflam- 
 mation to occur toward evening, daily, and to continue 
 measurably through the night and abate in or toward the 
 morning ; and thus it may continue for a longer or shorter 
 period, rarely longer than twenty days, and frequently less 
 than a week. Upon the declination of the pain and fever, 
 the perspiration or the urine may become copious, or the 
 bowels may become laxative ; but the tumefaction, which 
 is edematous, continues until the disappearance of the pre- 
 
864 INFLAMMATORY FORMS OF DISEASE. 
 
 ceding symptoms, when it also begins to subside, and 
 passes off with a desquamation of the cuticle. During the 
 inflammation, the tenderness of the affected joint is so 
 great that the weight of the bed-clothes can not be borne 
 upon it, the digestive functions are invariably deranged, 
 and, during the paroxysm, the patient is irritable and 
 fretful. 
 
 Dr. Wood says, that sometimes before the beginning of 
 the regular paroxysm, there may be, at distant intervals, 
 slight attacks of pain and soreness in some part of the foot 
 or hand, which, not being violent, the patient is disposed 
 to attribute to a sprain or to some other accident. Among 
 the premonitory symptoms. Dr. Cullen enumerates the fol- 
 lowing: "The ceasing of a sweating which the feet had 
 been commonly affected with before ; an unusual coldness 
 of the feet and legs ; a frequent numbness, alternating with 
 a sense of prickling along the whole of the lower extremi- 
 ties ; frequent cramps of the muscles of the legs, and an 
 unusual turgescence of the veins." 
 
 Two or more assaults of the gout depend much upon 
 the habits of the patient — very few escape with one — and 
 the intervals may be comparatively short or extended to 
 two or three years, but most frequently they recur annually; 
 yet, as the disease advances, the paroxysms become length- 
 ened in duration, and may re-appear twice or four times a 
 year, and each invasion may last so long as to allow the 
 patient but a short exemption, which usually happens in 
 the middle of the summer. This extension of the disease 
 is, in a very great degree, compensated by the. greatly re- 
 duced severity of all the symptoms ; but this mitigation of 
 the symptoms, however, proves an increase of the danger, 
 because it has resulted from a corresponding reduction of 
 the active forces — the centrifugal action — consequently, the 
 internal viscera has become liable to invasion. This is 
 sometimes denominated misplaced gout. Under the weak- 
 ened condition of the active forces, a retrocession of the 
 disease may be effected by even an inconsiderable cause 
 acting upon the exterior surface, or even a part of it. In 
 
ACUTE ARTHRITIS. 855 
 
 this wise gout has frequently proved fatal. It may assail 
 the stomach in the form of acute gastritis — when it invades 
 the brain, apoplexy or palsy may result — but the stomach 
 and kidneys are the most frequent subjects of arthritic me- 
 tastasis. 
 
 As in the case of rheumatism, women are much less 
 liable to gout than men. Dr. Gregory states, that in Eng- 
 land the proportion is as 1 to 50, and in Scotland it is as 1 
 to 100 ; and he thinks they are indebted for this relative 
 immunity to their greater temperance. This, no doubt, 
 should be included in the estimate, but a greater cause of 
 their exemption, in our opinion, is to be sought in the rela- 
 tive development of their vital or active forces. They are, 
 as a very general fact, less developed in them than in men, 
 and from what we have seen and learned, we infer that the 
 English women have them larger than the Scotch — that 
 they are more gross — that they exercise more in the labo- 
 rious pursuits of life — that is, nationally, and thus, these 
 forces have become more developed. 
 
 Causes. — Dr. Wood says : '' The most frequent cause of 
 gout is inheritance. This not only gives a predisposition, 
 but is sufficient of itself, wholly without aid from, other 
 causes, and even in opposition to whatever influences can 
 be brought against it, to give rise to the disease." If gout 
 do, so necessarily, succeed to the inheritance, what useful 
 purpose did he, or could he, suppose to result from his ad- 
 monition to those who have descended from gouty parents — ■ 
 they should " use every possible preventive measure ?" 
 How can we prevent the consequences of an inheritance ? 
 We have used words long enough to conceal our want of 
 ideas — it is time that we had done with the practice of it. 
 
 We admit that a child may inherit a capacity for music — 
 but no one ever inherited music, and this capacity has its 
 organic sign — it exists in organization. No predisposition 
 to make music inheres in the organization, but a predispo- 
 sition may arise, though not in those who have no capacity, 
 and when produced, it may readily be excited into action, 
 and music is the result. Application: — No one ever inher- 
 
856 INFLAMxMATORY FORMS OF DISEASE. 
 
 ited gout, nor a predisposition to it — but an organization 
 having the power, under circumstances, to produce it. 
 Under this organization a predisposition may be developed, 
 which may be sanguineous plethora, and then it becomes 
 absolutely the disease, but in a comparatively latent state. 
 Furthermore, we believe that an active development of gout 
 may be prevented in those who are organized with a capa- 
 city for it, by a change of climate and special modes of life 
 We may be mistaken, but if the kidneys are as much in- 
 volved in the production of this disease, as we think they 
 are, it could not be produced from any strength of gouty 
 organization, in the city of New Orleans, or its vicinity. 
 
 As to other causes of gout, dwelt upon by writers in gen- 
 eral, we have not much to say ; we may remark, however, 
 that gout never obtains outside of an adequate organiza- 
 tion. We have no doubt that idleness and luxury, in some 
 atmospheric conditions, may convert a rheumatic or a can- 
 cerous organization into an arthritic one. All causes cal- 
 culated to develop active forces, favor the production of an 
 arthritic or rheumatic organization, but to elevate a dyna- 
 mic into an active constitution, is not the work of one life- 
 time. 
 
 Treatment. — During a paroxysm of gout, the sufferer 
 may receive some relief by placing the foot in an alkaline 
 bath, as hot as can be borne, and retaining it there for some 
 ten or fifteen minutes, after which a fomeutation of Stra- 
 monium leaves should be applied around the foot and pain- 
 ful joint ; at the same time, powders of Sulphate of Quinine 
 and Sulphate of Morphine may be given every half hour or 
 hour, in doses of about half a grain or a grain of the for- 
 mer, and from one-eighth to half a grain of the latter, ac- 
 cording to circumstances. The same course may be pursued 
 when the disease attacks any other part where local appli- 
 cations can be made. 
 
 As to subsequent treatment, but little can be dene toward 
 a cure, as the disease is owing to defective organization ; 
 yet it may be suspended, or its attacks entirely prevented, by 
 avoiding the exciting causes. Thus, moderate exercise, a 
 
CHRONIC ARTHRITIS. 857 
 
 healthy, nutritious, easily-digestible diet, regular hours, and 
 an avoidance of acids, wines, liquors, stimulating condi- 
 ments, and what is known as high-living. Yet, as the dis- 
 ease is usually prized by those laboring under it, as an aris- 
 tocratic one, such a course is rarely adopted, notwithstand- 
 ing the severe penalty resulting from its omission. 
 
 As to internal measures, the greatest benefit is afforded 
 by a preparation composed of equal parts of the saturated 
 tinctures of Macro tys root and Colchicum seed, which may 
 be taken in half-drachm or drachm doses, three or four 
 times a day, and continued for some time. The bowels 
 should be kept regular, and the surface of the body should 
 be frequently bathed with an alkaline solution, using con- 
 siderable friction in drying. 
 
 Diuretics and alkalies will also be found a very efficient 
 part of the treatment, and should be frequently adminis- 
 tered, especially when acidity of stomach or flying pains 
 are present, as well as when the urine is scanty or contains 
 an undue amount of uric acid. If torpidity of the liver is 
 present, Podophyllin and Leptandrin may be used in small 
 doses with advantage. 
 
 When the gout attacks internal organs, the Compound 
 Tincture of Virginia Snakeroot must be given in half- 
 ounce or ounce doses, or sufficient to produce a powerful 
 and immediate determination to the surface, as manifested 
 by profuse perspiration ; and at the same time, sinapisms 
 must be applied to the foot and leg originally attacked, at 
 least as high up as to the knees — after which an active 
 cathartic injection should be administered. When the pa- 
 tient has recovered, Quinia and Morphine, with solutions 
 of Bicarbonate of Potassa or Soda, may be given to prevent 
 a return of the attack. 
 
 2. CJiToniG Arthritis. 
 
 Dr. Wood says: "Chronic gout is generally the result 
 of a long continuance of the acute, though sometimes the 
 disease is of the chronic grade from its commencement." 
 We do not doubt that a comparatively dynamic form of the 
 
858 INFLAMMATORY FORMS OF DISEASE. 
 
 acute variety may sometimes be met with ; and on the 
 other hand, there may occnr a pretty active form of the dy- 
 namic or chronic variety, but that the active or acute ever 
 did pass into the dynamic or chronic, we are not prepared 
 to admit. The fact, that the active forces, in the acute form, 
 do, in obstinate cases, become so exhausted as to be inca- 
 pable of maintaining a successful centrifugal action, is not 
 enough to constitute it chronic. Even in this exhausted 
 stage of the acute form, acute pain and suffering will still 
 recur, although they may be of short duration. The purely 
 chronic form is so from the beginning, and it is so because 
 the active forces are not adequate to the expulsion of the ob- 
 struction or disease. 
 
 Those who are inherently or organically liable to acute 
 arthritis possess very active forces, and less of the dynamic 
 than those who are subject to chronic rheumatism. They 
 have a strong resemblance to those who are liable to tuber- 
 cular phthisis, with this difference — the former possess a 
 more efficient pulmonary system. 
 
 '' In this condition of gout," says Dr. Wood, '' the par- 
 oxysms are more frequent than in the acute^ but much less 
 severe. There is often little pain, unless upon motion of 
 the joint. There is also little increase of heat, and the 
 redness is either entirely absent or of a purplish hue. 
 When there is swelling, it is usually edematous. Not un- 
 frequently, the synovial liquid of the joints, and the fluid 
 of the neighboring bursas are so much increased as to pro- 
 duce a considerable appearance of tumefaction, and to fluc- 
 tuate obviously under pressure. This is particularly the 
 case in the knee and the elbow." 
 
 This inflammation may fix itself upon certain joints, or 
 it may travel from joint to joint, like migratory rheumatism, 
 and it may also leave the joints entirely, «nd fix itself upon 
 some one of the internal organs. When it shall assume a 
 more established character, the joints may become so greatly 
 altered, as to be measurably useless, in consequence of their 
 inflexibility, which is occasioned by a thickened and rigid 
 condition of the capsules and ligaments, and the deposition 
 
CHRONIC ARTHRITIS. 859 
 
 of chalky matter into the synovial cavity, or in its adjacent 
 cellular tissue. This chalky substance frequently accumu- 
 lates in large quantities in the joints of the lingers. In old 
 subjects they are frequently so well formed and near the 
 surface, that the knuckle can be used like a piece of chalk, 
 to write upon a wall. When they become thus developed, 
 they are called clialk stones. In some instances they occa- 
 sion considerable swelling, that consists of a serous fluid, 
 and which, finally, may pass into suppurating ulcers. The 
 chalky matter appears to be contained in the areola tissue, 
 and is removed with difficulty, but finally it is disposed of, 
 and the part recovers. This chalky substance has been dis- 
 covered to consist of the urate and the phosphate of soda 
 and lime ; and this fact is rendered still more interesting, 
 by the discovery that there is, under the circumstances, a 
 deficiency of uric acid in the urine, and too much of it in 
 the blood. We are much more disposed to attribute the 
 proximate cause of gout to defective renal depuration, than 
 to the presence of too much fibrin in the blood, and the 
 chemical facts above stated would seem to sustain the opin- 
 ion ; but it is possible that both conditions may obtain. 
 
 In this form of disease, the paroxysms are less painful 
 and less regular in their occurrence than in the acute — 
 the intervals, in some instances, amount to two or three 
 months, but they continue much longer. Sometimes the 
 paroxysms so run into each other, that a fresh attack 
 supervenes upon the closing portion of the preceding, and 
 the patient has but little respite from pain and suffering. 
 
 Against the doctrine that regards an excess of fibrin in 
 the blood — a state of plethora of the system — as being the 
 proximate cause, we can not conclude this subject without 
 admonishing our readers to be on their guard. Dr. Barlow 
 teaches, that in " weakly habits, and where the constitution 
 has been sufiered to struggle long under unrelieved plethora, 
 these derangements (extraneous symptoms, etc.) are nume- 
 rous and proteiform, harassing the patient, and confounding 
 the physician." 
 
 We have seen cases of chronic gout where there was no 
 
860 INFLAMMATORY FORMS OF DISEASE. 
 
 plethora, and any treatment that might have been founded 
 upon such an hypothesis, would have proved mischievous. 
 We do not assert that plethora is not the proximate cause, 
 but simply that we are inclined to refer the disease to im- 
 perfect renal depuration, and think it therefore more safe 
 to excite secretion than to reduce plethora. 
 
 As regards the cause of gout, if we admit any form of 
 disease to be hereditary, we can not admit this to be more 
 so than phthisis, and a very large proportion of phthisical 
 cases are not of this character ; but, as we have before 
 shown, we regard the doctrine to be erroneous in principle 
 and mischievous in practice. 
 
 Diagnosis. — To distinguish between chronic rheumatism 
 and chronic gout, is admitted to be exceedingly diflBcult — 
 we must be governed, measurably, by the history of the 
 case, as no certain diagnostic can be had in the introduc- 
 tory stage. 
 
 Treatment. — In this variety of gout, the same means 
 are recommended as in the acute form. Notwithstanding 
 volumes have been written upon this disease, yet, save a 
 change of habits, no cure has ever been effected, which is 
 owing to the defective organization heretofore named, a 
 fact not mentioned by any other writer, as far as we are 
 aware. 
 
 Genus XYIII. — Pericarditis — 
 
 Inflammation of the Pericardium.. 
 
 As the symptoms and diagnosis of pericarditis, endo- 
 carditis, and carditis are particularly obscure — so much so 
 as to render it exceedingly uncertain whether disease really 
 exists, in either of the organs, although highly inflamed, 
 and as our treatment must necessarily be the same in 
 all three, we shall only treat of pericarditis. 
 
 " Laennec states, (Cy. Prac. Med.), that he has often, on 
 dissection, discovered the disease, in a severe form, when 
 nothing had afforded a suspicion of its existence ; and on 
 the other hand, that he had frequently witnessed all its 
 signs without finding a vestige of the malady." 
 
 The symptoms of endocarditis " are very nearly the same 
 
ACUTE PERICARDITIS. 861 
 
 as those enumerated under pericarditis, and, as in this affec- 
 tion they are insufficient for the positive diagnosis of the dis- 
 ease, though they may lead to the suspicion of its existence, 
 and thus induce an examination by tiie stethoscope. 
 
 "Whenever inflammation of the substance of the heart 
 has been observed, it has, thus far, been almost always asso- 
 ciated vs^ith some morbid condition either of the investing 
 or the lining membrane, or both together. Such an affec- 
 tion as independent carditis, of any considerable extent, 
 has not yet been proved to exist. The symptoms of cardi- 
 tis are, therefore, necessarily intermingled with those of 
 pericarditis and endocarditis. Nor can they be discrimin- 
 ated."— ]Fb(?6?. 
 
 The preceding extracts render it clear that nothing can 
 be gained in a practical point of view, by the separate con- 
 sideration of inflammation of the three structures above 
 named. 
 
 1. Acute Pericarditis. 
 
 The symptoms of acute pericarditis consist of acute in- 
 flammatory fever, a pungent, burning, lancinating pain in 
 the region of the heart, shooting to the left scapula, shoul- 
 der, and upper-arm, but rarely descending below the elbow, 
 or even quite to it. The pain is increased by full inspira- 
 tion, by stretching the left side, and especially by pres- 
 sure between the praecordial ribs, and by forcing the epi- 
 gastrium upward underneath the left hypochondrium. 
 Palpitation of the heart and oppressive dyspnoea are some- 
 times present. In those cases in which the symptoms are 
 direct, it most frequently happens that the patient can not 
 lie down, more especially on the left side. He is con- 
 strained, by the severity of the pain that motion occasions, 
 to maintain a static and quiet position, and that is gene- 
 rally required to be in a sitting posture. 
 
 The pulse, whether feeble or strong, for it is sometimes 
 the one and sometimes the other, is very irregular and in- 
 termitting. In the course of the disease, it is not uncom- 
 mon for the eyes, temples, and extremities to become more 
 or less edematous ; though it is common for the face to be 
 
862 INFLAMMATORY FORMS OF DISEASE. 
 
 pale, yet a flush upon one cheek is not uncommon. The 
 epigastrium is generally tender, and the soreness is usually 
 attended with some headache and tenderness, or even posi- 
 tive pain in the stomach. 
 
 In our prefatory remarks we treated of the exceeding un- 
 certainty of the symptoms of this affection ; the student, 
 therefore, must not expect to find, in all cases, the symp- 
 toms we have given, or, if they, or many of them, shall 
 be present, they may be so complicated with pleuritis, 
 pneumonitis, carditis, or even gastritis, as to be too com- 
 plex for any one to arrive at a clear discrimination — and if 
 he could, but little perhaps would be gained by it, as the 
 general treatment would be much the same. 
 
 Diagnosis. — M. Louis is of the opinion, that in those 
 cases which are independent of complications, the diagno- 
 sis is not so difficult as has generally been supposed. He 
 says, that when in the region of the heart, there is lancina- 
 ting pains, which, at intervals, extend to the back and epi- 
 gastrium, with unusual smallness and irregularity of the 
 pulse and palpitation of the heart, an inability to rest in a 
 recumbent posture, occasional faintness, and possibly syn- 
 cope, and oedema of the extremities, we may pretty safely 
 conclude that pericarditis is present. These remarks or di- 
 agnosis may be very true, in many cases, yet it must be 
 confessed that fatal cases occur without exhibiting a single 
 indicative symptom ; and in other cases, again, all the usual 
 symptoms exist in the absence of the disease. 
 
 Causes. — In this respect there is nothing singular, ex- 
 cept, like acute rheumatism, the disease is confined, per- 
 haps entirely, to what we have denominated the first class 
 of constitutions — those w^hich are distinguished by the most 
 active vital forces. Those exciting causes that produce vis- 
 ceral inflammation, in general, produce pericarditis. 
 
 Prognosis. — Though not necessarily fatal, pericarditis is 
 justly classed with the most dangerous forms of disease, 
 and the danger is increased by its liability to become com- 
 plicated with pleuritis and pneumonia. 
 
 Teeatment. — Undoubtedly, the most important indica- 
 
ACUTE PERICARDITIS. . 863 
 
 tion in acute pericarditis is to produce a powerful determin- 
 ation to the surface, by means of the spirit vapor-bath, or 
 by the use of the Compound Tincture of Yirginia Snake- 
 root, either of which must be used sufficiently to cause pro- 
 fuse perspiration, and which should be maintained for sev- 
 eral hours ; after which the Compound Powder of Ipecac, 
 and Opium may be given, in doses of four or five grains 
 every two or three hours, for the purpose of keeping up 
 considerable moisture upon the skin, and to allay pain and 
 nervous irritability. At an early period the bowels should 
 be thoroughly evacuated by some active cathartic, as the 
 Compound Powder of Jalap, to which ten or twelve grains 
 of Bitartrate of Potassa may be added, or one or two grains 
 of Podophyllin, with the same quantity of the bitartrate, 
 may be administered. Afterward, it will be necessary to 
 obtain one or two evacuations daily, by mild laxative doses. 
 The patient should drink freely of diuretic infusions ; one 
 composed of equal parts of Asclepias Tuberosa and Altheea 
 Officinalis will be found very beneficial, with which, espe- 
 cially in cases of rheumatic origin, when the more severe 
 inflammatory symptoms have subsided, ten or twenty drops 
 of Tincture of Colchicum seed may be taken, and repeated 
 every four or five hours. 
 
 Should the pain be very severe, sinapisms maybe applied 
 over the affected part, and afterward hot emollient poultices; 
 sinapisms may also be placed along the upper part of the 
 vertebral column, and in rheumatic cases over the original 
 points of the rheumatic attack. The surface should be 
 bathed once or twice daily, with a warm alkaline solu- 
 tion. 
 
 The diet of the patient should consist of farinaceous or 
 mucilaginous liquids ; the mind should be kept quiet, as 
 well as the body, and all causes of excitement should be 
 avoided, and the presence of unnecessary persons should be 
 positively prohibited from the sick room. Animal food 
 should not be allowed until perfect convalescence has taken 
 place. 
 
864: INFLAMMATORY FORMS OF DISEASE. 
 
 2. GTironic Pericarditis. 
 
 This form of the disease is thought to be more common 
 than the preceding, and of less doubtful diagnosis. It is 
 mostly, if not entirely, confined to those whose vital forces 
 are of rather a low grade, but as the condition of these is 
 of every grade between their extremes, it must sometimes 
 happen that the fever, in this form, may run so high, as to 
 present a low grade of the preceding variety — but most 
 generally the fever is of the hectic character, and attended 
 by occasional exacerbations. In most cases there is a fixed 
 pain in the cardiac region, and the patient most frequently 
 complains of a sensation of iullness and weight in the same 
 region, with some degree of pectoral oppression and dysp- 
 noea ; he is less constrained in his motions than in the 
 acute, but usually prefers a sitting posture, with the body 
 inclined forward. Yiolent palpitations of the heart are apt 
 to succeed either mental or muscular action, when of more 
 than ordinary strength. As in the acute, the pulse is small, 
 intermittent, and irregular. There is no marked difference 
 between the symptoms of the acute and chronic forms, ex- 
 cept in the degree of their violence, which is to be attri- 
 buted entirely to a physiological difierence of constitution — ■ 
 for when the normal physiological forces are of a low 
 grade, we can not expect high inflammatory action. 
 
 Causes. — Mechanical violence upon the chest is thought 
 to be the most frequent cause of this form of the disease, 
 but like chronic rheumatism, it may occur without any very 
 obvious cause. It may also originate in, or be complicated 
 with, pleurisy or pneumonia. 
 
 Diagnosis. — When occasioned by violent blows or pres- 
 sure upon the prsecordial region, the history of the case will 
 furnish the most reliable diagnosis, as when the patient, 
 previously exempt from disease, suddenly complains of its 
 symptoms, we can scarcely have a doubt as to the cause ; 
 so likewise, when it supervenes an attack of rheumatism. 
 But in many instances no reliable diagnosis can be 
 had. 
 
CATARRHAL OPTHALMIA 865 
 
 Prognosis. — This form of disease has been thought to be 
 necessarily fatal, but it is now known to have been cured ; 
 nevertheless, it is to be regarded as one of the most formid- 
 able and dangerous. 
 
 Treatment. — In the chronic form of pericarditis, the 
 bowels should be kept open by laxative doses of Podophyl- 
 lin and Leptandrin ; the surface should be bathed frequently, 
 and the Compound Syrup of Stillingia with Iodide of Po- 
 tassium must be given to promote absorption. If the pain 
 be severe, or if the patient be wakeful, the Compound Pow- 
 der of Ipecac, and Opium may be given to overcome these 
 conditions. In some instances, counter-irritation over the 
 chest and the upper part of the spinal column, will be found 
 beneficial. The diet should be nourishing but easy of di- 
 gestion, and, in patients much debilitated, wine or ale may 
 be allowed. 
 
 Genus XIX. — Opthalmia — 
 
 Inflammation of the Conjunctiva. 
 In conformity with the strict meaning of the above name, 
 we should confine our treatise of the organ so far only as 
 concerns vision, and yet it is more frequently employed to 
 express inflammation of the conjunctiva. It has been, fur- 
 thermore, divided into many varieties under names which 
 are so arbitrary as to be, in many instances, more expres- 
 sive of different stages and constitutional modifications of 
 the same form, than of distinct varieties. But as it is pro- 
 bable that a more scientific arrangement would scarcely 
 compensate for a departure from the one usually adopted, 
 and with which the profession is generally acquainted, we 
 shall pursue it. 
 
 1. Mild or CatarrTial OjptTialmia. 
 The conjunctiva, the membrane in which this disease is 
 located, should not, perhaps, be regarded as being purely 
 mucous, but as partaking of the nature of the cutis, and 
 also of a mucous structure, and therefore subject to those 
 changes which inflammation is known to produce in both 
 of them ; such as increased vascularity, swelling, and al- 
 
866 INFLAMMATORY FORMS OF DISEASE. 
 
 tered sacretion. In mild cases, these changes are not very 
 remarkable — -the conjunctiva merely becoming red and 
 more or less tumefied, and terminating by resolution. But 
 in other instances, as in purulent opthalmia, it runs into a 
 most destructive process. 
 
 Catarrhal opthalmia is the mildest form of the disease 
 and of much more frequent occurrence than any other. It 
 becomes introduced to the notice of the patient by pain, 
 intolerance of light, and a sensation that can not be com- 
 pared with anything else than the presence of sand, or an 
 inverted eyelash between the palpebrse and the globe of the 
 eye. But it should be remembered that this sensation is 
 common to all the varieties of conjunctivitis, and is consid- 
 ered by some to be diagnostic of it ; and as it is occasioned 
 by the turgescence of the vessels of the conjunctiva, the 
 opinion is doubtless correct. The patient has no other idea 
 than that sand or some other foreign matter is causing the 
 irritation for which he rubs his eyes, and thereby aggra- 
 vates the disease. Succeeding to this sensation is one of 
 heat, as though the part had been scalded. 
 
 The inflammation, in this variety, usually terminates by 
 resolution, but sometimes a purulent discharge is observed, 
 which is by no means copious — never so violent as to occa- 
 sion chemosis or sloughing of the cornea. 
 
 Gacjses. — In adults, it is most frequently produced by 
 cold and damp air; but it is sometimes occasioned by an 
 intemperate exposure of the eyes to a strong light, Jong- 
 waking by candle-light, intemperance in the use of ardent 
 spirits, and occasionally by gastric and intestinal irritation. 
 Finally, the liability of this membrane to inflammation is 
 that which is common to other mucous surfaces, and from 
 similar causes. 
 
 It is endemic, and appears sometimes to be epidemic but 
 it is not known to be contagious — and yet it frequently runs 
 through a family, and not unfrequently so invades a school, 
 that but few of the pupils escape it. It may be remarked, 
 in conclusion, that young subjects are more liable to it than 
 adults. 
 
CATARRHAL OPTHALMIA. 867 
 
 Diagnosis. — As it is possible for the inexperienced to 
 confound catarrhal opthalmia with the rheumatic or sclero- 
 titis, it becomes proper to indicate the difference. In con- 
 junctivitis, the vessels are tortuous, and the color a scarlet- 
 red ; in sclerotitis, the vessels are fine or hair like, straight, 
 and radiated, and the color, which is seen through the con- 
 junctiva, is of a pink, or possibly of a violet hue. The 
 pain of catarrhal opthalmia is slight, and the intoler- 
 ance of light is but little, while in the rheumatic the pain 
 is severe, dull, and aching, throbbing, and felt with as much 
 severity, if not with more, in the surrounding parts than in 
 the eye — there is, furthermore, great intolerance of light. 
 Frequently through the day the pain is not much, but as 
 night approaches it increases and continues to do so until 
 after midnight. When attention is given to these diagnos- 
 tic differences, a mistake can not be made. 
 
 Prognosis. — Unless the constitution be depraved, there 
 is no serious danger to be apprehended from catarrhal 
 opthalmia. 
 
 Treatment. — In catarrhal opthalmia, the feet should be 
 bathed in hot water for some fifteen or twenty minutes ; 
 after which sinapisms should be applied to them, and if the 
 inflammation be severe, likewise to the back of the neck. 
 The bowels should be purged, and the patient placed upon 
 a light diet. 
 
 Local applications should also be made over the eyes, as 
 warm fomentations of Elm and Hops, or other narcotic 
 herbs, and the eyes should be frequently bathed with an 
 infusion of Hydrastis, or the following preparation : 
 R. Tincture of Aconite, 3j, 
 Hydrastin, grs .xx, 
 Aqua, f5ij. Mix. 
 In some severe instances, Professor King has derived al- 
 most immediate benefit by the application of cold water 
 over the eye. on cloths, which must be changed every lew 
 minutes. If much pain, watchfulness, or nervous irrita- 
 bility, be present, the Compound Powder of Ipecac, and 
 Opium may be given, or Tincture of Aconite. 
 55 
 
868 INFLAMMATORY FORMS OF DISEASE. 
 
 When the more active symptoms have subsided, stimula- 
 ting applications will usually be found necessary, for the 
 purpose of increasing the activity of the absorbent vessels, 
 for which we prefer the above combination, with the addi- 
 tion of half a drachm of Capsicum. In some cases the 
 Compound Colly rium of Golden Seal, the Compound 
 Myrrh Collyrium, or the Compound Soda Collyrium, may 
 be used with advantage. 
 
 The patient, both during the disease, and for some time 
 after convalescence, should avoid ex])osures, as well as ex- 
 cesses in eating, drinking, exercise, etc. 
 
 2. Severe or P^irident Ojpthalmia — Severe Inflammation 
 of the Conjunctiva. 
 
 This variety of opthalmia is sometimes called Egyptian, 
 and sometimes contagious opthalmia ; it differs from the 
 preceding, mainly, in being more severe, and in being 
 occasioned by different causes. Gonorrheal opthalmia, and 
 the purulent opthalmia of infants, of which we treated in 
 Book III, are regarded as varieties of it. The only nota- 
 ble difference, of consequence, between purulent and gon- 
 orrheal opthalmia, consists in the difference between their 
 respective causes. It is stated, however, that the gonor- 
 rheal frequently attacks but one eye, while the purulent 
 most generally invades both. 
 
 As Dr. Yitch has had more favorable opportunities for 
 obtaining an accurate acquaintance with this form of op- 
 thalmia, we can not do better than to give his description 
 of it. lie says : 
 
 " The first appearance of inflammation, after the appli- 
 cation of the virus, is observed in the lining of the lower 
 eyelid. It assumes first a mottled appearance, and then a 
 fleshy redness. A little mucus is generally present at the 
 doubling of the conjunctiva at its lower part. The disease, 
 I know from observation, may remain in this state for 
 twelve hours before it invades the conjunctiva covering the 
 eye ; sometimes it may be longer, and in some cases, where 
 the contact of the virus has been slight, or removed by im- 
 
PURULENT OPTHALMIA. 
 
 869 
 
 mediate washing, the disease never went farther than pro- 
 ducing the redness of the lining of the palpebra. In scle- 
 rotic inflammation, the lining of the eyelids preserves, in 
 some degree, its natural whiteness, especially just under 
 the tarsi, for days and weeks. The progress of the inflam- 
 mation, when it extends from the conjunctiva of the ej^elids 
 to that covering the globe of the eye, is often so rapid as 
 to elude any distinct observation; but frequently it ad- 
 vances more graduall}^, preserving a defined line, until it 
 extends over the whole membrane as far as the cornea. ISTo 
 part can be said to be more vascular than another, as the 
 whole seems equally injected, and no space unoccupied. 
 The disease is often thus far advanced before the attention 
 of the patient is so much excited as to make him complain, 
 a certain degree of stifiiiess being sometimes the only sen- 
 sation which accompanies it. 
 
 " The first and chief uneasiness, in this stage of the dis- 
 ease, is described as arising from the feeling of sand or dirt 
 rolling in the eye. This sensation is not constant, as it 
 comes on suddenly, and as suddenly departs, confirming to 
 the patient the idea of something extraneous being lodged 
 in the eye. I have always observed that its attacks are in 
 the evening, about the time of going to bed, or very early 
 in the morning. Their duration varies ; sometimes an 
 attack abates in an hour, and sometimes continues during 
 the whole night — those coming on in the evening being 
 always the most severe. This symptom requires particu- 
 lar attention, as its accession is a certain index of the dis- 
 ease being on the increase." 
 
 So violent is this disease, that a yellow, thick pus is soon 
 made to issue from between the greatly tumefied lids, and 
 it is frequently so acrid that it excoriates the cheeks as it 
 flows over them. It is common, too, for the matter to be- 
 come eflused between the conjunctiva and the sclerotica, 
 causing the former to become elevated around the cornea, 
 giving the idea of a ring — the cornea thus appears at the 
 bottom of a pit, and so deeply is it invested, in this wise, 
 in some instances, as scarcely to be seen. For the clear 
 
870 INFLAMMATORY FORMS OF DISEASE- 
 
 understaudiDg of this phenomenon, it is proper to remark, 
 that the nnion between the conjunctiva and the cornea is 
 too close and intimate to admit an effusion of pus between 
 them, which is not the case between the former and the 
 sclerotica. 
 
 Effusion of matter, also, in many instances, is effected in 
 the sub-conjunctival tissue, producing tumefaction of a 
 fleshy-red color, which is frequently attended with patches 
 of extravasated blood. It is also worthy of remark, that 
 this matter not unfrequently becomes effused into the cellu- 
 lar tissue which unites the conjunctiva to the palpebra, 
 thereby causing such extensive swelling as to conceal en- 
 tirely from our view the globe of the eye. But, it is pro- 
 per to add, that so long as the disease is confined to the 
 conjunctival lining of the eyelids, no very serious conse- 
 quences need to be apprehended, yet it has a tendency to 
 extend itself to the cornea and occasion in it ulceration and 
 sloughing — a rupture of the cornea, an escape of the aque- 
 ous humor, a protrusion of the iris, and finally a total loss 
 of vision. 
 
 As an illustration of its mischievous character, we may 
 cite a statement made by Dr. Watson, viz: in the "mili- 
 tary hospitals, at Chelsea and Kilmainham, there were, on 
 the 1st of December, 1810, no fewer than 2317 soldiers a 
 burden upon the public from blindness in consequence of 
 (purulent or Egyptian) opthalmia." 
 
 The question is still debated as to whether it is or not 
 contagious ; from an investigation of the argument, we have 
 concluded that the affirmative is the more ably maintained ; 
 at all events, when we have it to contend w^ith, prudence 
 would dictate that we should act as though the affirmative 
 was established. 
 
 Causes. — That purulent opthalmia, under sorhe peculiari- 
 ties of constitution, may be produced by the same causes 
 that produce the catarrhal, or by such as produce violent 
 inflammation of other mucous membranes, may, we think, 
 be admitted — namely, currents of cold air, the introduction 
 of acrid, or indeed, of almost any foreign matter, sudden 
 
PURULENT OPTHALMIA. , 871 
 
 transitioDS of heat and cold, and finally, those atmospheric 
 conditions which produce other forms of inflammatory dis. 
 ease. From this last cause, we may even suppose the 
 disease to become epidemic. 
 
 We are not yet able to determine why it is that one sea- 
 son produces dysentery and another continued fever, nor 
 can we be sure that some modification of such an atmo- 
 sphere might not produce purulent opthalmia. Thoso who 
 deny its contagious nature, contend that it is an atmo- 
 spheric disease. Assalina says (Watson's Practice) : ''The 
 atmospheric conditions wdiich are known to occasion ca- 
 tarrhal affections, are very frequent and powerful in Egypt: 
 the days are very hot, the nights chilly and attended with 
 heavy dews ; and men's eyes are perpetually exposed in 
 the day time to a dazzling glare of light from the white 
 and arid surface, while the air is full of floating particles 
 of hot sand which are raised from the ground by the 
 slightest breeze." 
 
 We may admit all this, and still contend for the conta- 
 gious nature of the disease. Whatever the abstract fact 
 may be, it is now well known that the matter of purulent 
 opthalmia will produce the same disease when introduced 
 into the eye of a well person, and that when the disease 
 invades a ship, a school, or an army, a large proportion of 
 the individuals composing the crowd, respectively, will 
 have the disease. 
 
 After a few remarks upon the subject of gonorrheal op- 
 thalmia, we close what we have to say about purulent opthal- 
 mia. As its nature imports, this modification of opthalmia 
 results from gonorrhea, most frequently, if not always, by 
 direct inoculation or introduction of gonorrheal matter from 
 the urethra. It has been contended that it may result from 
 a metastasis of the urethral inflammation to the eye — it is 
 also supposed that purulent opthalmia may result from gon- 
 orrhea, just as sore-throat may result from syphilis. While 
 we admit the two latter, as causes of purulent opthalmia, 
 as being perhaps possible, we confess that we have very 
 little MfAi in the probability. 
 
872 INFLAMMATORY FORMS OF DISEASE. 
 
 In all casual or isolated cases of purulent opthalmia, we 
 ■ should endeavor to ascertain whether it be not of gonorrheal 
 origin. This information may not avail us an^^thing, in 
 the treatment, but, beside affording some satisfaction, it 
 might induce us, under some circumstances, to establish 
 prudential measures with reference to those who may be 
 associated with the patient. 
 
 If the disease be confined to one eye, we may, in the 
 proportion of one to a hundred or so, suspect it to be gonor- 
 rheal. Contagious opthalmia, according to Dr. Yitch, will 
 occur in one eye one time in a thousand cases, and, accord- 
 ing to Mr. Lawrence, gonorrheal opthalmia will invade both 
 eyes once in every seven cases and a fraction. 
 
 As there is no other disease with which purulent opthal- 
 mia can be confounded, and as the prognosis can be infer- 
 red from what vre have said, we pass to the. 
 
 Treatment. — In newly-born infants, this disease will 
 generally yield to local infusions of Hydrastis, or Hydrastis 
 and Witch-Hazle leaves, or the Tincture of Myrrh, which 
 should be applied several times a day. 
 
 In the early stage of purulent opthalmia, should in- 
 flammatory symptoms be present, they must be treated in 
 the same manner as named for the early stage of the catar- 
 rhal form. After which the treatment must consist of con- 
 stitutional as well as local remedies. The local remedies 
 may be the same as referred to in the latter stages of catar- 
 rhal opthalmia ; or the eyes may be frequently bathed with 
 infusions of Hydrastis and Geranium, or Hydrastis and 
 Statice Limonium. The Compound Syrup of Stillingia 
 with the Iodide of Potassium, is undoubtedly the best con- 
 stitutional remedy that can be given ; and if the disease 
 proves very obstinate, an irritating plaster may be applied 
 to the nape of the neck, extending round and up behind the 
 ears. It must be borne in mind, that if these stimulating 
 applications irritate the eyes, rendering them worse, they 
 must be omitted for a time, and more soothing measures 
 employed. 
 The treatment of gonorrheal opthalmia m_ore properly 
 
RHEUMATIC OPTHALMIA. 873 
 
 belongs to the department of surgery — we will merely sug- 
 gest that we employ the above constitutional treatment, 
 with local applications to the eye of Nitrate of Silver, or a 
 solution of the Sesquicarbonate of Potassa. For more de- 
 tailed treatment, see Eclectic Surgery, pages 254 to 256. 
 
 Genus XX. — Iritis — Rheumatic Opthalmia — 
 Lijiamination of 'tJte Iris. 
 
 This portion of the eye is frequently the subject of in- 
 flammation, independently of any other structure ; but the 
 choroid, retina, and sclerotica are frequently involved with 
 it. The iris is stretched across the anterior chamber of the 
 eye, which is lined by a closed sack, having all the pecu- 
 liarities of a serous membrane, in both health and disease, 
 and under the influence of inflammation, it is liable to form 
 adhesions which may change the size and shape of the pupil, 
 and the movements of the iris; it is also liable to throw 
 out coagulable lymph, which may entirely close the pupil. 
 
 The presence of this disease is announced to the patient 
 by some intolerance of light, impairment of vision, and 
 circum-orbital pain ; and, to the physician, by a vascular 
 redness around the cornea, in the sclerotica, which consists 
 of fine, straight lines tliat converge toward, and stop ab- 
 ruptly at, or nearly at, the cornea, and appear to penetrate 
 and pass through the sclerotica, to obtain the iris. In severe 
 cases, the conjunctiva may be more or less involved, and 
 when it is, then its red and vascular peculiarities are blend- 
 ed with those of iritis. The color of the iris will depend, 
 in a great measure, upon the color it had in health. Blue 
 or gray eyes become yellowish or greenish, and dark-col- 
 ored eyes are changed into a tinge of red. This change is 
 efiected by an admixture of lymph with the original color 
 of the iris. 
 
 During the existence of this inflammation, there is not 
 only circum-orbital pain, but pain in the globe of the eye, 
 and also in the temple, and it is generally more severe at 
 night. This pain and the attendant fever are quite varia- 
 ble, and in many instances not proportioned to the mischief 
 
874 INFLAMMATORY FORMS OF DISEASE. 
 
 that is going on. In some cases the pain is severe and un- 
 ceasing ; while in others, but little is complained of. These 
 remarks are true of the attending fever. When the disease 
 is acute, it is common for the febrile manifestations to be 
 very considerable — such as white tongue, full and hard 
 pulse, pain in the head, and broken rest. 
 
 The efiusion of lymph very frequently becomes visible 
 upon the surface of the iris, but its character varies much 
 in different cases. In some cases, it appears in little spots 
 or specks of a rusty color ; in others, in a thin sheet or layer 
 of the same color, and in others, in the form of tubercles 
 some of which may be as large as a squirrel shot. In se- 
 vere or neglected cases, suppuration takes place, the pus is 
 discharged into the anterior chamber, and in sinking to the 
 bottom of it, presents that appearance which has been 
 called Jiypojpyon. 
 
 Whatever may be the grade of the inflammation, vision 
 is always impaired by it, in consequence of the injury inflict- 
 ed upon the iris, the tunics posterior to the eye, and most 
 obviously to the cornea, which is rendered more or less 
 opake. 
 
 Cacses. — In arthritic and rheumatic constitutions or or- 
 ganizations, this disease may occur from causes similar to 
 those which produce gout and rheumatism, respectively. 
 Those causes which produce opthalmia in general, are said 
 to produce iritis ; but we are disposed to believe that they 
 will do so only in the constitutions above named. It is said 
 to occur in secondary syphilis, and is then called syphilitic 
 opthalmia, or iritis ; it is also maintained by some to result 
 from the use of mercury — which we regard as probable — 
 but in both instances, we are disposed to confine it to the 
 organizations before named. It is also said to originate in 
 a scrofulous constitution ; and hence authors treat of stru- 
 mous opthalmia, meaning iritis. About this we are scepti- 
 cal — there is too much diflference between the rheumatic 
 and the strumous organizations for both to be liable to the 
 same forms of disease. 
 
 That form of disease known as the strumous opthalmia 
 
RHEUMATIC OPTHALMIA 875 
 
 of children, is treated of as being confined to strumous 
 constitutions, but this the writer hnovas to be an error. He 
 has seen one well-marked case in a boy, in whose family 
 nothing of a scrofulous tendency was ever known — and 
 now, as a man, he is very muscular and of a decidedly 
 rheumatic organization. He admits that the so-called stru- 
 mous opthalmia is associated with some depravity of the 
 constitution, but it does not follow that it must be a stru- 
 mous one.* 
 
 Treatment. — In the treatment of iritis, the bowels must 
 be actively purged, the purge being followed by a spirit 
 vapor-bath ; the perspiration must be kept up for several 
 hours by nauseants and diaphoretics ; sinapisms must be 
 applied to the feet and nape of the neck. Cold water may 
 be kept applied constantly to the eyes, on cloths, which 
 should be changed every few minutes. Sometimes cold 
 applications increase the pain ; under such circumstances, 
 warm water maybe substituted, or fomentations of Hops, or 
 Stramonium leaves. This treatment should be energetic- 
 ally pursued and persevered in. The bowels should be kept 
 regular during the treatment. 
 
 If the disease should run into the chronic form, stimula- 
 ting applications must be made to the eye, the same as men- 
 tioned in the previous opthalmic affections, and the above 
 treatment continued. In debilitated patients, tonics must 
 be administered, as Iron, Hydrastin, Cornin, Compound 
 Wine of Comfrey, etc., and in very obstinate cases an irri- 
 tating plaster may be applied, as in the previous forms, 
 with advantage. 
 
 In the active form the diet should be light — in the chron- 
 ic, nutritious, digestible, avoiding fats, acids, and the use 
 of alcoholic liquors. 
 
 ^Inflammation of the other structures of the eye do not often occur inde- 
 pendently of conjunctivitis and iritis, and as the treatment of these two 
 forms will necessarily embrace the others, a special description becomes use- 
 less, more especially, as much yet remains to be learned about them, as iii- 
 dependent forms of inflammation. 
 
876 INFLAMMATORY FORMS OF DISEASE. 
 
 Genus XXI. — Eczema"^ — 
 Humid Tetter or So all. 
 
 This is considered by some to be a non-contagious form 
 of eruptive disease ; but others think it to be contagious 
 under very favorable circumstances. It is usually treated 
 of under three divisions or varieties, as eczema simplex, 
 rubrum, aud impetigin odes'; but as all three may exist at 
 one and the same time, it appears more consistent to regard 
 them as so many well defined stages or degrees of violence 
 of the same form of disease. 
 
 It consists of a great number of very small vesicles, dis- 
 posed of, sometimes confluently, upon an irregularly formed 
 surface of considerable extent. When it is regarded as 
 eczema simplex, the vesicles are exceedingly numerous, 
 confluent, and disposed of in clusters, and attended with so 
 little increase of color or inflammation and fever, as scarcely 
 to be noticed. The contained serum is at first limpid, but 
 it gradually changes to a turbid, and then to a milky color. 
 By degrees this fluid is absorbed, the epidermis dessicates 
 into a thin pellicle, and is then removed by desquamation. 
 
 It is generally confined to some particular portion of the 
 cutaneous surface, and hence the many local names which 
 it has received, as eczema capitis, eczema faciei, etc. Nev 
 ertheless, it is sometimes distributed generally over the 
 body, but its most usual locations are the arms, forearms, 
 hands, and between the fingers. 
 
 In consequence of its tendency to produce a succession 
 of eruptions, the disease is frequently continued for several 
 weeks, but as it is, in a great measure, w^ithout danger and 
 without constitutional symptoms, and leaves on the skin no 
 evidence that it ever existed, the only annoyance it is to the 
 patient, arises from the itching it occasions, which is con- 
 siderable. To this simple form of the disease, a slight 
 
 *In Book III, we treated of so many forms of cutaneous disease, that but 
 two remain which we deem it essential to consider, and thej are vesicular, 
 namelj, Eczema and Miliaria. 
 
HUMID TETTER. 877 
 
 itching is the only premonitory symptom, and during its 
 coarse it never, spontaneously, produces inflamed surfaces. 
 It is said to be sometimes associated with itch, and to be 
 occasionally produced by some of the remedies which are 
 used in the treatment of it. 
 
 When the disease is of such violence as to be entitled to 
 the appellation of eczema riihrum^ the surface becomes 
 much inflamed, and of a vividly-red color, and covered 
 with small pointed pimples of a white, shining luster. 
 After some days, small vesicles appear on the inflamed 
 surface, w^hich are bounded by a well-defined red areola. 
 When the aflection is of moderate or usual violence, the 
 vesicular fluid, in the course of a week, is absorbed, and 
 the vesicles disappear by absorption, leaving .the surface of 
 a pale-red color, having scattered over it many small, 
 round papulse, based in a whitish disc. 
 
 But should the inflammation fail to terminate thus favor- 
 ably, and continue to increase, and the vesicles should so 
 increase in number as to become confluent, then it is that 
 their contents, at first limpid and transparent, become tur- 
 bid and milky, and then burst, leaving inflamed and exco- 
 riated surfaces which furnish a large quantity of matter 
 that is so irritating, as to increase the magnitude of the 
 excoriations. The exposed derma is highly inflamed — of a 
 crimson color, having patches of a whitish, membraneous 
 film ; and the secretion from it forms scabs of varying ex- 
 tent and thickness. When the disease is of this severe 
 character, it is apt to continue two or three weeks, and by 
 neglect, or the continued presence of causes calculated to 
 irritate, it may become chronic. A tingling sensation in 
 the skin, with some heat and stiflTness, are the only symp- 
 toms that precede the eruption. 
 
 Eczema imjpetiginodes is another variety or form of the 
 disease, which is as much more violent than the preceding, 
 as it was more so than the one that preceded it. It is char- 
 acterized by violent inflammation, more or less of swelling, 
 vesicles, which are greatly crowded or confluent, and filled 
 with a sero-purulent matter, which, upon a rupture of the 
 
878 INFLAMMATORY FORMS OF DISEASE. 
 
 vesicles, a circumstance that soon follows their formation, 
 forms, upon dessication, extensive scabs or crusts, exposing, 
 when detached, red surfaces that secrete an abundance of 
 ichorous fluid of a reddish tinge, w^hich hardens, by expo- 
 sure, into a thin, dark-colored scab, that continues nntd the 
 part is healed. By successive crops of the eruption, the 
 disease may be continued for several weeks. When it is 
 local, as it most generally is, the constitutional symptoms 
 are very light, or else entirely absent ; but when it is gen- 
 eral, all the symptoms that usually attend inflammation are 
 present. The local symptoms always indicate the vio- 
 lence of the disease, by the burning, smarting, and throb- 
 bing pain it occasions, which is so much increased by the 
 warmth of a bed as to prevent sleep. 
 
 Like other acute forms of disease, eczema sometimes 
 appears in the chronic form, more particularly w^hen it has 
 been severe, protracted, and aggravated. It is marked by 
 extensive excoriations and fissures in the derma, more espe- 
 cially in the flectures of the joints and axillse. They exude 
 a serous fluid, which, upon dessication, causes an adhesion 
 of the dressings or clothing to them. Sometimes when the 
 disease appears nearly well, it w^ill, without any known 
 cause, re-appear with still greater violence ; and thus, by a 
 repetition of the same course, it may continue for years. 
 The cracked and fissured derma sometimes continues dry 
 with a firm adhesion of the crusts, and when they finally 
 become detached the surface appears of a slightly red color ; 
 but in some cases it is very red and so continues for a long 
 time. The itching in this affection is frequently distress- 
 ing, no matter on what part of the surface it be located ; 
 but when it is the pubes, the arm-pits, scrotum, groin, and 
 pudendum, the annoyance is not less than the distress, and 
 both are very great. Eczema is said to occur more fre- 
 quently in women than men, and in summer rather than 
 winter. 
 
 Causes. — Upon this subject but little is certainly known. 
 It is thought that irritating applications to the skin, as 
 blisters, sinapisms, irritating ointments, dry frictions, ex- 
 
HUMID TETTER. 879 
 
 posnre to the sun, lime, sugar, and the use of mercury, will 
 produce it. We think it possible that these causes may be 
 sufficient to produce the disease in constitutions that are 
 organically liable to it. 
 
 Diagnosis. — Eczema has been mistaken for the itch, and 
 sometimes it resembles it ; but in the former the vesicles 
 are flat and crowded together, while in the latter they are 
 pointed and separated. Eczema impetiginode has been 
 confounded with impetigo ; but the former is vesicular, and 
 the latter is pustular ; furthermore, the former occupies 
 large spaces, and the latter small ones. Chronic eczema 
 has been confounded with lichen, particularly with lichen 
 agrius, which it most resembles ; in this, the scabs are 
 thick, small, and yellow, and when they drop off, the sur- 
 face they left is papular ; but in that, the scabs consist of 
 thin lamina and their detachment leaves the surface red, 
 smooth, and shining, and probably some little excoriated. 
 
 Treatment. — In the inflammatory condition of this dis- 
 ease, the Compound Powder of Ipecac, and Opium may be 
 given, to allay pain and inflammation, as well as to keep up 
 a moisture of the surface. The bowels should be kept 
 regular by laxative doses of the Compound Power of Rhei 
 and Potassa, and the surface should be frequently bathed 
 with a warm alkaline solution. The diet should be light, 
 but as nutritious as the condition of the patient will allow. 
 Mucilaginous diuretics will also be found beneficial. 
 
 When the more active inflammatory symptoms have sub- 
 sided, as well as in the chronic form of the disease, chaly- 
 beate tonics must be given, for the purpose of improving 
 the vigor of the constitution, and especially the capillary 
 system, which is nearly always debilitated or torpid. Equal 
 parts of Sulphate of Quinia and Prussiate of Iron may be 
 given, in does suitable to the age of the patient, and repeated 
 three or four times a day, in connection with a nourishing 
 but digestible diet, avoiding fats and acids, or articles dis- 
 posed to produce acidity of stomach. 
 
 The bowels must be kept regular, and the surflice of the 
 body attended to ; and if the eruption be very painful, or 
 
880 INFLAMMATORY FORMS OF DISEASE. 
 
 cause much itching, soothiDg applications must be applied, 
 as Tallow or Sweet Oil, to either of which a small proportion 
 of Glycerin may be added ; sometimes powdered Stramo- 
 nium or Belladonna leaves may be added to the local remedy, 
 with advantage, as far as mere palliation of disagreeable 
 symptoms is concerned. This is the only treatment we 
 have found available in these afiections. 
 
 Genus XXII. — Miliaria — 
 Sicdamina. — 3£iliary Vesicles. — MUiary Enijption. 
 
 Miliaria is characterized by prominent vesicles, of a 
 rounded form and of about the size of millet-seeds. When 
 they first appear they have a reddish hue, and are then 
 denominated miliaria rubra ; but, in the course of twenty- 
 four hours, they become milky or opake, and are then known 
 as miliaria alba. They are very generally, if not alwa3"s, 
 discreet, though frequently very numerous. They may 
 appear on any part of the body, but most frequently they 
 select the trunk of the body. It is common for them to 
 give no premonition of their appearance, or if any, it con- 
 sists of a little irritation and redness of the skin. 
 
 It was named miliaria from the resemblance of its vesicles 
 to millet-seed, and it was called sudamina, because it is 
 always, or very generally, attended with a high cutaneous 
 temperature and a copious perspiration. It occurs more 
 frequently in summer than during the other months, and 
 more commonly attacks those who possess a thin and deli- 
 cate skin. Miliaria is sometimes met with durino- the 
 course of the eruptive fevers ; and it also occurs occasionally 
 as an attendant upon typhoid and some other fevers, as the 
 remittent, and many of those forms of inflamraation which 
 are attended by copious perspiration. 
 
 Causes. — Upon this subject there has been much contra- 
 riety of opinion, and some still exists. Before the time of 
 Sydenham, when a highly-heating and perspiring state of 
 the skin was aimed at, in the treatment of fevers, it was 
 regarded as a dangerous form of disease — one of a specific 
 character and of frequent occurrence. This frequency, as 
 
PHLEBITIS. 881 
 
 well as the attendant danger, is now thought to have re- 
 sulted from the practice in the treatment of febrile forms of 
 disease which then prevailed. Considerable probability is 
 due to this opinion, inasmuch as it is now a rare disease — 
 and has been since that mode of practice was abandoned. 
 
 It is thought to be, by some, uniformly symptomatic, 
 more particularly of those forms of disease which we have 
 before named ; nevertheless, it is contended, by others, to 
 be occasionally idiopathic. Violent exercise, in the heat 
 of summer, it is said, by those who maintain that it may 
 obtain idiopathically, will produce it. It is thought that it 
 may be occasioned by a heating practice in almost any form 
 of febrile disease, and occasionally when the best treatment 
 has been adopted. From the discussion which has been 
 had about this form of disease, we are disposed to believe 
 that it would never appear in any form of febrile disease, if 
 the hest treatment should he adojpted. 
 
 Treatment. — No attention is required by this exantheme 
 when it is symptomatic ; upon the cure of the disease to 
 which it is an attendant, it will disappear; and when 
 it is idiopathic, it is usually so mild as to require but 
 little or no treatment. An infusion of Elder flowers. Maid- 
 enhair, and Asclepias Tuberosa, will be found generally 
 sufiScient to meet all cases, the bowels being kept regular. 
 Unfavorable symptoms usually attend its recession — such 
 as demand nauseants, diaphoretics, and in some instances 
 counter-irritation. 
 
 Genus XXIII. — Phlebitis— - 
 Infl ammatio 71 of tlie Veins, 
 This is an inflammation of the lining membrane of the 
 veins. It sometimes attends common venesection, also 
 the ligature or excision of varices, amputation, gun-shot 
 wounds, the ligature of the umbilical cord, etc. When it 
 is consequent upon a local injury^ the first symptom is 
 inflammation of the injured part, and then a tense, knotty, 
 and painful cord may be traced along the direction of the 
 inflamed vessel, which is attended with febrile symptoms, 
 
882 INFLAMMATORY FORMS OF DISKASK. 
 
 proportioned to the extent and violence of the inflamma- 
 tion. It has been known to terminate by resolution, sup- 
 puration, ulceration, and gangrene. 
 
 Pathologically considered, the first effect of inflamma- 
 tion of the lining membrane of a vein is the efi'usion and 
 adhesion of the coagulum upon the interior of the inflamed 
 surface, which may be to such an extent as to dam up the 
 venous channel, or it may only exist to such an extent as to 
 fur it over. The danger of this form of inflammation does 
 not depend upon its abstract severity, but upon the magni- 
 tude of the invaded vein — as it must be obvious that the 
 destruction of a small vein could be attended with no very 
 serious consequences, but the severest sufiering, and even 
 death, may readily be supposed to follow the obstruction or 
 obliteration of one of the large venous trunks — and yet the 
 absolute intensity of the local inflammation may be as great 
 in the one case as in the other. 
 
 Most generally, phlebitis does not run beyond the adhe- 
 sive stage, and the mischief, therefore, that may ensue 
 must be regarded as resulting from the mechanical obstruc- 
 tion of a portion of the venous circulation — but such an 
 arrest in the cerebral sinuses would necessarily prove fatal. 
 If the organ in which such an obstruction takes place be 
 not highly essential to life, the patient may recover through 
 the establishment of a collateral circulation. Recovery is 
 sometimes effected by a softening of the coagula to such 
 an extent that the blood forces a channel through it. 
 
 Even in the suppurative stage, the disease may be con- 
 lined — continued as a local one, by the adhesive process 
 bounding the accumulated pus, and thus establishing a 
 local abscess ; but the greater probability is that the pus, 
 or some of it, will enter the circulation, and become the 
 agent to establish or cause abscesses in distant and indis- 
 pensably-important organs, more particularly the liver and 
 lungs, inasmuch as part of the blood must pass through the 
 former and all of it through the latter ; because the capil- 
 lary vessels of these viscera will arrest whatever foreign 
 matter the blood may contain, or should any escape, it may 
 
PHLEBITIS. 883 
 
 produce miscliief in some other part of the system, after 
 being transmitted to the left side of the heart. It is now, 
 pretty generally we believe, thought that particles of pus 
 become thus transmitted to distant parts, and excite in- 
 flammation and suppuration. The experiments that have 
 been made with mercury would seem to render this hypothe- 
 sis much more than probable. 
 
 Upon this principle, suppurative phlebitis may be occa- 
 sioned by very trifliug injuries, as well as those of the 
 gravest character. It may also arise Avithout a mechanical 
 lesion of any part ; that is, it may produce other inflamma- 
 tory affections. It is not contended that the pus which 
 produces dangerous, and very often fatal, abscesses, in dis- 
 tant parts of the system, found its way into the circulation 
 by absorption, but mechanically, as pus, unchanged or 
 modified by absorption. Its entrance into the blood may 
 sometimes happen thus mechanically — therefore, it is pro- 
 bable that in a majority of instances the pus is formed in 
 suppurative phlebitis. 
 
 Phlebitis is sometimes quite prevalent, so much so as to 
 bear the character of an epidemic. It appears, therefore, 
 that some peculiar condition of the atmosphere prevails at 
 the time, which so modifies the susceptibilities of the sys- 
 tem as to increase its liability to this form of disease. 
 
 When the joints or parts near them are selected as the 
 seats of suppuration, much pain and soreness are com 
 plained of and for a time they may be supposed to be rheu- 
 matic ; and when it takes place in the serous cavities the 
 pain is even more severe than wdien located about the 
 joints. 
 
 Chills or sliiverings, profuse sweats, usually attend this 
 form of phlebitis, and sometimes the bov/els are greatly de- 
 ranged — producing copious and very abnormal discharges. 
 To be more particular in presenting the phenomena of this 
 dangerous malady, we can not do better than to give from 
 the Medical Cyclopedia, Mr. Arnott's account of it : 
 
 " In from two to ten days after the receipt of the injury, 
 the secondary or constitutional symptoms of phlebitis mani- 
 66 
 
884 D^FLAMMATORY FORMS OF DISEASE- 
 
 fest themselves, and they may be thus briefly characterized : 
 Great restlessness and anxiety, prostration of strength and 
 depression of spirits, sense of weight at the prsecordia, fre- 
 quent sighing or rather moaning, with paroxysms of op- 
 pressed and hurried breathing, the patient at the same time 
 being unable to refer his sufferings to any specific source. 
 The common symptoms of fever are present ; the pulse is 
 rapid, reaching to 130 or 140 in a minute, but is, in other 
 respects, extremely variable. There is often sickness and 
 violent vomiting, especially of bilious matter. Frequent 
 and severe rigors almost invariably occur, sometimes to the 
 number of three or four in the course of a few hours. The 
 general irritability and deep anxiety of countenance in- 
 crease ; the manner is quick, and the look occasionally wild 
 and distracted. When left to himself, the patient is apt to 
 mutter incoherently, but on being directly addressed, is 
 found clear and collected. The features are pinched, and 
 the skin of the whole body becomes of a sallow or even 
 yellow color. 
 
 *' Under symptoms of increasing debility, and at a time 
 when the local affection may appear to be in a great degree 
 subsiding, secondary inflammations of violent character, 
 and quickly terminating in effusions of pus or lymph, 
 very frequently take place in situations remote from the 
 original injury ; the cellular substance, the joints, and the 
 eye have been affected ; but it is more particularly under a 
 rapidly-developed attack of inflammation of the viscera of 
 the chest, that the fatal issue usually occurs. Whether this 
 is observed or not, death is always preceded by symptoms 
 of extreme exhaustion, such as those of a rapid, feeble 
 pulse, dry, brown, or black tongue, teeth and lips covered 
 with sordes, haggard countenance, low delirium." 
 
 Phlegmasia dolens or crural phlebitis is a modification 
 or a variety of this disease, which requires from us a spe- 
 cial notice. For a long time the true pathology of this 
 malady was entirely unknown, as may be inferred without 
 further evidence, from the names by which it was desig- 
 nated. It was, furthermore, supposed to be confined to puer- 
 
PHLEBITIS, 885 
 
 peral or lying-in women, as may also be inferred from the 
 same evidence, viz : oedema, lactium, metastasis lactis, 
 hysteralgia lactea, phlegmasia lactea, phlegmasia dolens, 
 etc. But now, that its pathology is better understood, 
 and observation is more extended, it is known as not being 
 confined to puerperal women, but may occur in those who 
 have never been pregnant, and also to the other sex ; it 
 does, however, occur much more frequently to the first class 
 of persons. It is now, furthermore, pretty well ascertained 
 that it does not consist in a metastasis of the lacteous secre- 
 tion, nor to an obstruction of the lymphatic vessels, nor to 
 lymphatic inflammation, commencing in the glands or else- 
 where, nor is it an inflammation of all the tissues of the 
 limb, as maintained by Professor Hossack ; and yet there 
 are a number of circumstances of a prima facie character, 
 which militate against the idea that it is a pure phlebitis, 
 as the white and edematous appearance of the limb, the 
 hectic character of the fever, and its more uniform and less 
 fatal termination than usually characterizes phlebitis. Nev- 
 ertheless, if we are to be guided by legitimate inferences 
 from the apparent results and the facts disclosed by post- 
 mortem investigations, we must conclude that phlegmasia 
 dolens is phlebitis, modified, possibly, by some prevailing 
 condition of the system. 
 
 When this is a puerperal affection it appears, according 
 to some observers, between the fifth and the ninth day after 
 parturition ; others state that it most generally appears 
 about the twelfth, but it may supervene at a period as late 
 as six weeks. It may occur in the superior extremities, but 
 it very generally selects the inferior extremities, and one 
 rather than both. 
 
 For the purpose of doing the greater justice to our read- 
 ers, we will extract from the Cyclopedia of Practical Medi- 
 cine, a description of two cases, furnished by Dr. Lee, and 
 for another reason, namely, the one which the author him- 
 self gives, which is, that " they afford good examples of 
 this affection in its most mild and most severe forms, and 
 illustrate, better than any general description could do, the 
 
886 INFLAMMATORY FORMS OF DISEASE. 
 
 phenomena of the disease, and the alterations of structure 
 produced by inflammation in the hypogastric and crural 
 veins." 
 
 " A patient of the British Lying-in Hospital, who had 
 been suffering for some weeks before delivery (May 8, 
 1829), from the usual symptoms of tubercular phthisis, ex- 
 perienced, on the 4th June, a sense of soreness in the left 
 groin, which gradually extended along the inner surface of 
 the thigh to the ham, and from thence along the posterior 
 surface of the leg to the foot. She stated that for two days 
 before the occurrence of pain in the groin, she had lelt 
 great uneasiness in the region of the uterus, that this sud- 
 denly quitted the hypogastrium, and passed into the groin, 
 and that from thence it extended downward along the inner 
 surface of the thigh to the leg. The limb became swollen 
 twenty-four hours after the invasion of the disease. 
 
 "The whole left inferior extremity is now affected with a 
 hot, painful, colorless swelling, no where pitting on pres- 
 sure, except over the foot. The thigh is fully double the 
 size of the other, and any attempt to move the limb pro- 
 duces excruciating pain along the inner surface of the 
 thigh; and the pain excited by pressure along the tract of 
 the femoral vein is so acute, that the condition of the vessel 
 can not be ascertained. Several branches of the saphena 
 major, above the knee, are distended and hard ; pulse 120; 
 respiration quick and laborious ; tongue peculiarly red and 
 glossy; diarrhea continues. IQth. Pulmonary affection 
 aggravated. The limb continues extremely painful, and is 
 still more swollen. The groin is so tender that she can not 
 bear the slightest pressure over it. The same is the case 
 with the inner surface of the thigh. The branches of the 
 saphena arc still hard and painful. lltJi. The femoral vein 
 under Foupart's ligament can now be felt indurated and 
 enlarged, and it is exquisitely painful when pressed, as is 
 the inner surface of the thigh, the ham, and the calf of the 
 leg. There is comparatively little tenderness along the 
 outer surface of the limb. 11 th. Diarrhea, emaciation, 
 colliquative sweats, and difficulty of respiration increasing. 
 
PHLEBITIS. 887 
 
 The left inferior extremity is still much swollen ; but there 
 is less pain in the groin and in the course of the femoral 
 vessels. Died on the ^Uh^ 
 
 ''^ Dissection. — Thorax. — Adhesions between the pleura 
 on both sides. Scarcely a portion of lung could be ob- 
 served which did not contain tubercles in various stages of 
 their growth. The right and left superior lobes contained 
 several large tuberculous excavations. The vena cava and 
 right common and external iliac veins were in a sound state. 
 The left common external and internal iliac veins were 
 all impervious, and had undergone various alterations of 
 structure. The common iliac, at its termination, was re- 
 duced to a slender tube, about a line in diameter, which 
 was lined with a blueish, slate-colored, adventitious mem- 
 brane. The remainder of the common and the external 
 iliac veins were coated also w^ith a dark-colored membrane, 
 and their center filled with a brownish, ochery -colored, te- 
 nacious substance, rather more consistent than the crassa- 
 mcntum of the blood. 
 
 " The left hypogastric or internal iliac vein was in the 
 same condition, but in some places reduced to a cord-like 
 substance, and its cavity throughout completely obliterated. 
 The branches of this vein, taking their origin in the uterus, 
 and usually termed the uterine plexus, were found com- 
 pletely plugged up with firm, red coagula. From the com- 
 mencement of the branches of this plexus of the hypogas- 
 tric vein, to the termination of this vein in the iliac, the 
 whole had become thickened, contracted, and plugged up 
 with coagula and adventitious membrane of a dark-blue 
 color. 
 
 " The same changes had taken place in the uterine plex- 
 us, and trunk of the right hypogastric vein, from the uterus 
 to its unusual termination in the left common iliac vein. 
 The coats of the left femoral vein were thickened, and 
 closely adherent to the artery and surrounding cellular sub- 
 stance, its whole interior lined with adventitious mem- 
 brane, and distended with a reddish-colored coagulum. 
 The same morbid changes presented themselves in the 
 
888 INFLAMMATORY FORMS OF DISEASE. 
 
 deep and superficial branches, as far as they were exam- 
 ined down the thigh. 
 
 " A woman, aged 40, who had been delivered of twins 
 a month before, and had nearly perished from flooding, 
 and subsequently from an attack of uterine inflammation, 
 was seized on the 27th August, 1829, with a violent fit of 
 cold shivering, followed by pyrexia and pain in the right 
 iliac region and groin. In the course of the two following 
 days, the pain increased in severity, and extended down in 
 the inner surface of the thigh toward the ham, and the 
 whole leg and thigh became much swollen. 29^^A. The 
 whole right inferior extremity afiected with a general intu- 
 mescence, and completely deprived of ail power of motion. 
 The temperature of the limb, particularly along the inner 
 surface, much higher than that of the other ; but the integu- 
 ments retain their natural color, and do not pit on pres- 
 sure. The femoral vein for several inches under Poupart's 
 ligament, is very distinctly felt enlarged, and is very pain- 
 ful when pressed. Out of the course of the crural vessels, 
 little uneasiness is produced by pressure. In the right side 
 of the hypogastrium there is also great tenderness ; pulse 
 120 ; tongue furred. She appears pale and depressed, and 
 complains of deep-seated, acute pain in the lower part of 
 the back when slie attempts to move. From this period 
 until the 22d September, when she died, she suflTered from 
 repeated fits of shivering, which occasionally assumed a 
 regular intermittent form ; there was diarrhea, with brown 
 tongue ; the glands in the right groin became much en- 
 larged, and the left inferior extremity became afiected in a 
 manner similar to the right. 
 
 " Dissection. — The veins presented nearly similar ap- 
 pearances to those observed in the preceding case. The 
 divisions of the vena cava were, in this instance, both af- 
 fected. On the left side, the cavities of the iliac and femo- 
 ral veins were filled with a dark-purple coagulum, their 
 coats being not much thicker than natural ; while on the 
 right side, the coats of these veins were dense and liga- 
 mentous, and the cavities blocked up by adventitious mem- 
 
FHI^EBITIS. 889 
 
 braces, or lymph, of a dull-yellow color. Tlie lower part 
 of the vena cava, for the space of two inches, as well as 
 the right common iliac, was obstructed by a tough mem- 
 brane of lymph surrounding a soft, semi-fluid, yellowish 
 matter. The right common, external, and internal iliac 
 veins were imbedded in a mass of suppurating glands, the 
 purulent fluid of which had escaped into the adjacent cel- 
 lular membrane, and forced its way downward in the course 
 of the psoas muscle as low as Poupart's ligament. The 
 right hypogastric vein was reduced to a small impervious 
 ,<3ord, and its branches were distended with coagula of lymph 
 of a bright-red color. The right femoral vein and its 
 branches we^e in like manner impervious, their coats being 
 greatly thickened, and their interior occupied by coagula. 
 The cavities of the left common external iliac and hypo- 
 _gastric veins contained soft coagula, disposed in layers 
 which adhered to the inner tunic of the vessel. 
 
 " The trunk of the left hypogastric vein was .contracted, 
 its coats somewhat thickened, and its branches filled with 
 worm -like coagula. The spermatic veins were healthy. 
 The cellular membrane of both lower extremities was infil- 
 trated with serum." 
 
 The facts detailed in these two cases shoajld scarcely leave 
 ja doubt upon the mind of any one as to the true pathology 
 of this disease, however difficult it may be to arrive at a 
 satisfactory conclusion as to its etiology. 
 
 The description given of this disease by Dr. Hull (Cy.. 
 Frac. Med.), is so interesting, that we can not refrain from 
 placing it before our readers, although it will render our 
 ^article longer than we had intended. He says ; 
 
 " It has in many instances attacked women who were re- 
 icovering from puerperal fever, and in some cases has su- 
 pervened or succeeded to thoracic inflammation. It not 
 uncommonly begins with coldness and rigors. These are 
 succeeded by heat, thirst, and other symptoms of pyrexia .; 
 jand then pain and stifihess, and other symptoms of topical 
 inflammation supervene. Sometimes the local aflection is 
 fxomth& first accompanied with, but is not preceded by, 
 
890 INFLAMMATORY FORMS OF DISEASE. 
 
 febrile symptoms. Upon other occasioDS, the topical affec- 
 tion is neither preceded by puerperal fever, nor rigors, etc., 
 but soon after it has taken place, the pulse becomes more 
 frequent, the heat of the body is increased, and the patient 
 is affected with thirst, headache, etc. The pyrexia is very 
 various in degree in different patients, and sometimes as- 
 sumes an irregular remittent or intermittent type. 
 
 " The complaint generally takes place on one side only 
 at first, and the part where it commences is various ; but it 
 most commonly begins in the lumbar, hypogastric, or in- 
 guinal region, on one side, or in the hip or top of the thigh, 
 and corresponding labium pudendi. In this case, the pa- 
 tient first perceives a sense of pain, weight, and stiffness in 
 some of the above-mentioned parts, which are increased by 
 every attempt to move the pelvis or lower limb. If the 
 part be carefully examined, it generally is found rather 
 fuller or hotter than natural, and tender to the touch, but 
 not discolored. The pain increases, always becomes very 
 severe, and in some cases is of the most excruciating kind. 
 It extends along the thigh, and when it has subsisted for 
 sometime, longer or shorter in different patients, the top 
 of the thigh and the labium pudendi become greatly swol- 
 len, and the pain is then sometimes alleviated and accom- 
 panied with a greater sense of distention. The pain next 
 extends down to the knee, and is generally the most severe 
 on the inside and back of the thigh, in the direction of the 
 internal cutaneous and crural nerves ; when it has continued 
 for some time, the whole of the thigh becomes swollen, and 
 the pain is somewhat relieved ; the pain then extends down 
 the leg to the foot, and is commonly most severe in the di- 
 rection cf the posterior tibial nerve; after some time the 
 parts last attacked begin to swell, and the pain abates in 
 violence, but is still very considerable, especially on any 
 attempt to move the limb. The extremity being now swol- 
 len throughout its whole extent, appears perfectly or nearly 
 uniform, and it is not perceptibly lessened by a horizontal 
 position, like an edematous limb. It is of the natural color, 
 or even whiter ; is hotter than natural ; excessively tense-^ 
 
PHLEBITIS. 891 
 
 and exquisitely tender when touched ; when pressed by 
 the finger in different parts, it is found to be e]astic, little 
 if any impression remaining, and that only for a very short 
 time." 
 
 He further remarks, that it sometimes happens, when 
 the disease has abated in one limb, the other is attacked in 
 a similar way ; and that instead of terminating by resolu- 
 tion, it sometimes terminates by suppuration in one or both 
 legs, and occasions ulcers which are difficult to cure. In a 
 few instances, he says, gangrene has supervened, and in 
 others, the patient is destroyed by the violence of the dis- 
 ease before the supervention of either suppuration or gan- 
 grene. 
 
 Causes. — In the course of our remarks upon simple and 
 undisputed phlebitis, we indicated its usual causes ; and as 
 to the cause of crural phlebitis, or phlegmasia dolens, we 
 had as well, perhaps, have nothing to say, because we 
 really know nothing, further than the attending phenomena. 
 Dr. Lee says: ''In uterine phlebitis the inflammation can 
 not, it is true, be traced in all cases to the semi-lunar shaped 
 orifices in the lining membrane of the uterus which com- 
 municates with the sinuses where the placenta had adhered; 
 yet it scarcely admits of a doubt that the frequent occur- 
 rence of the disease arises from the orifices of these veins, 
 in the lining membrane of the uterus, being left open after 
 the separation of the placenta, by which a direct communi- 
 cation is established between the cavities of these veins 
 and the atmospheric air, in a manner somewhat analogous 
 to what takes place in amputation and extensive wounds." 
 
 This, at best, is mere speculation, but it is as good as can 
 be offered, and therefore it is useless lor us to pursue this 
 branch of the subject further. 
 
 When this form of disease takes place in women who 
 have not been recently delivered, it is under the circum- 
 stances of suppressed menstruation, malignant ulceration of 
 the OS and cervix uteri, and other organic diseases of the 
 uterine organs— so says Dr. Lee. When the disease hap- 
 pens to men, it may have originated in " hemorrhoidal. 
 
892 INFLAMMATORY FORMS OF DISEASE. 
 
 vesical, or in some of the other branches of the internal iliac 
 veins, in consequence of inflammation or organic changes 
 of structure in one or more of the pelvic viscera. Crural 
 phlebitis in men, arises much more frequently, however, 
 from inflammation being excited in the superficial veins of 
 the leg, extending upward, and involving the great venous 
 trunks of the thigh and pelvis." — Gy. Prao. Med. 
 
 Treatment. — In the early stages of phlebitis, mild ca- 
 thartics may be given, after which the bowels should be 
 kept regular daily. The afiected limb should be exposed 
 to a vapor-bath until perspiration has been induced, after 
 which an anodyne poultice must be applied, and the whole 
 limb enveloped in it — we prefer a poultice of bran and 
 hops. This should be continued, alternating the use of the 
 vapor-bath and poultices, until the inflammation has sub- 
 sided. 
 
 Internally, the Compound Tincture of Virginia Snake- 
 root, or Compound Powder of Ipecac, and Opium, should be 
 given in suflacient doses to keep up moisture of the skin, as 
 well as to relieve the pain which is present. In very ob- 
 stinate cases the addition of nauseants and relaxants will 
 be found advantageous. 
 
 The patient should be kept in a recumbent position, and 
 allowed a light diet ; and after the inflammation has been 
 reduced, if any edema remains, the limb should be ban- 
 daged, but not too tightly, and cooling diuretics given. 
 
 In cases of debility or prostration, arising from whatever 
 cause, stimulants and tonics must be given to sustain the 
 strength , of the patient, such as wine-whey-wine, Quinia^ 
 Cornine, Hydrastin, preparations of Iron, etc. ; and in 
 chronic cases, to favor absorption, the Compound Syrup of 
 Stillingia with Iodide of Potassium should be given. 
 
CLASS 11. 
 NON-FEBRILE FORMS OF DISEASE. 
 
 In this class of morbid actions, neither fever or inflam- 
 mation is ever to be regarded as an essential element of the 
 disease, and yet, it is not to be taken for granted that nei- 
 ther of them will ever be present; but when it occurs, it 
 may be pretty safely affirmed that the type or character of 
 the disease has changed — has become to belong more or 
 less to the first class. 
 
 This class is clearly divisible into two orders. The mor- 
 bid actions comprised by the first, proximately at least, 
 appear to inhere in the vascular system — these are hemor- 
 rhages. Those of the second appear as clearly to inhere in 
 the nervous system, and are usually denominated nervous 
 or chronic diseases. Their pathology, as yet, is but imper- 
 fectly understood, aud their treatment is tedious, uncertain, 
 and too generally unsuccessful ; and both for the reason 
 that cerebral organization has not been sufficiently investi- 
 gated in relation to its functions. Hitherto, so far as the 
 writer has learned, no one has thought of referring phthisis, 
 asthma, apoplexy, epilepsy, catalepsy, etc., to defective or 
 peculiar cerebral organization. 
 
 This order is obviously divisible into three genera ; the 
 first consists of the morbid actions of the organs of internal 
 relation — those which affect directly, the existence and 
 well-being of the individual. 
 
 The second embraces the morbid or deranged actions of 
 the organs of external relation — those which adapt us to 
 the surrounding world ; and. 
 
 The third consists of morbid actions of those organs 
 which have for their functions, the perpetuity of the species. 
 Their relations are of a mixed character. 
 
 (893) 
 
894 NON-FEBRILE FORMS OF DISEASE. 
 
 ORDEE I. 
 
 MORBID ACTIONS FROM VASCULAR IRRITATION. 
 
 Hemorrhages have been divided into traumatiG and 
 spontaneous^ and the latter into idiopatJiio and symptom- 
 atic. The idiopathic alone will now engage our attention. 
 "We propose to group together into one order, the usual 
 forms of hemorrhage, not through any conviction of pro- 
 priety, but through obedience to fashion or custom, and un- 
 der this custom for the sake of convenience. We can not 
 conceive of an idiopathic hemorrhage, nor of a hemorrhagic 
 form of disease ; but custom has decreed that certain he- 
 morrhages shall be treated of as so many forms of idio- 
 pathic disease, and we obey. In this place it is proper to 
 say so much of hemorrhage as is common to all of the so- 
 called idiopathic forms of it. 
 
 At one time, and naturally enough, it was supposed that 
 all hemorrhages depended upon a rupture of blood-vessels, 
 and this opinion is not, even now, without its advocates ; 
 but since the investigations and expositions of Bichat, they 
 have continued to become reduced in number, so that, at 
 this time, they are indeed few. 
 
 That hemorrhages do occasionally result from lesions of 
 the vessels, will probably be denied by no one, but such in- 
 stances must be so few in number, comparatively, as barely 
 to constitute an exception to what may be safely regarded 
 as a general fact, that they result from a transudation, or 
 exhalation ; for Bichat maintained that it was effected 
 through the exhalants. But it may pass the vascular ex- 
 tremities, either through a local absence of normal resist- 
 ance, or an increased propelling force. 
 
 Hemorrhages have been again divided into active and 
 passive ; the former is said to obtain when there is in the 
 system an increased vascular excitement, and consequently 
 a preternatural flow of blood to the part. The general cir- 
 
MORBID ACTIONS. 895 
 
 dilation does not, however, always manifest an increased 
 momentum in active hemorrhages ; on the contrary, the 
 activity of the heart and arteries is sometimes depressed, 
 but in such cases there is a strong hemorrhagic excitement 
 in the organ itself. Thus, we sometimes have active pul- 
 monary and uterine hemorrhages in persons who are feeble, 
 and whose pulse is small, weak, and frequent. Neverthe- 
 less, active hemorrhages usually occur in the young and 
 plethoric — in those who have an excess of stimulus — those 
 in whom the vital forces are largely developed, and whose 
 temperament possesses a high admixture of the sanguine. 
 This species of hemorrhage is sometimes preceded by a 
 full and rebounding pulse, redness, and fullness of the skin, 
 alternating flushes of heat and chills, with a sense of weight 
 and pressure in the part ; but frequently it is attended by 
 no premonitory symptoms — suddenly breaking forth in a 
 full stream. 
 
 In the passive variety of hemorrhage there is decreased 
 vascular activity in both the general circulation and in that 
 organ or part in which the hemorrhage occurs. The fact 
 that this hemorrhage is passive, is strongly to be inferred 
 from the circumstance that stimulants are the most effective 
 remedies. It is thought to depend upon mere relaxation or 
 inactivity of the vessels, and not upon any morbid quality 
 of the blood. It generally results from the exhaustion that 
 is effected by chronic forms of disease, particularly scurvy 
 and the typhous forms of fever. It is contended by some 
 that all hemorrhages are active. This is true, if we con- 
 template the phenomena merely in its mechanical relations, 
 but when we regard it as a vital one, it does not appear dif- 
 ficult to conceive of such a deficiency of vital tonicity in 
 the small vessels as to render them incapable of resisting a 
 hemorrhagic flow of blood. This very fact is sometimes 
 witnessed after death, when there is no other propelling 
 force than that of gravitation. A state of debility very 
 nearly approaching death often happens in cases of extreme 
 debility from disease. In many cases of such debility 
 there seems to bo a pretty general tendency to hemorrhage, 
 
896 NON-FEBRILE FORMS OF DISEASE. 
 
 more especially in those parts which offer the least re- 
 sistance. 
 
 Microscopists, however, deny that any pores exist in the 
 capillaries large enough to admit the egress of blood cor- 
 puscles, but we can more easily believe that they have not 
 discovered all of the minutiae of the human system, than to 
 conclude that so many ruptures have taken place, in close 
 contiguity, as will account for many of the hemorrhages 
 which have been and are frequently witnessed, more espe- 
 cially as the ruptures, as well as the supposed existence of 
 pores, have not been discovered. We might speculate upon 
 supposable changes in the blood or in the tonicity of the 
 capillary vessels, through the agency of supposable causes, 
 and thus entertain the reader without instructing him. We 
 prefer to be useful, and not being able to perceive the ad- 
 vantage to the practitioner of knowing how hemorrhages 
 take place, we shall enter into no particular investigation 
 of it. 
 
 The consequences produced upon the system by an exten- 
 sive loss of blood, are too well known to require that much 
 should be said about them ; we may remark, however, that 
 the sensible phenomena produced by it, are paleness of the 
 face, coldness of the extremities, feebleness of the pulse, 
 nausea, vertigo, convulsions, syncope, and death. But 
 such fearful results as convulsions, etc., do not frequently 
 occur, because, when it has been so copious as to produce 
 an obvious depression of the circulation, it spontaneously 
 stops. The apprehensions of the patient greatly aid in 
 bringing about this result. So long as the cause of the 
 hemorrhage continues to exist, there will be much liability 
 of its return. Sometimes it is of a periodic character, and 
 when it returns annually, it is most generally in the spring, 
 and the subjects are those who have a thin and delicate 
 skin, and large organs of animal sensibility and muscular 
 motion. It frequently recurs monthly with those females 
 who have suppressed menstruation. 
 
 Professor Wood treats of " constitutional hemorrhage ! " 
 Could we not with the same propriety speak of constitu- 
 
MORBID ACTIONS. 897 
 
 tional intermittent fever or catarrh? He says: **In some 
 persons, a strong constitutional tendency to hemorrhage ex- 
 ists, so much so, that the slightest causes will often bring on 
 an attack, and, when the blood begins to flow, it is exceed- 
 ingly difficult to arrest it. A slight wound, even the scratch 
 of a pin, will sometimes occasion a serious and even alarm- 
 ing hemorrhage." Is not the same true of many persons 
 with reference to intermittent fever and catarrh ? This 
 hemorrhagic " tendency," amounts at last to nothing more 
 than a liability which is stronger in some persons than in 
 others — merely an organic peculiarity. 
 
 " The constitutional jpredisjposition^'' {?) he says, " is 
 sometimes a family peculiarity." He further adds, that it 
 is " not unfrequently hereditary ^'''^ and then cites some in- 
 teresting examples of it, and notes a remarkable peculiarity 
 in connection with it, viz : that this family predisposition 
 was almost entirely confined to the males ; and lastly, he 
 says : " Nothing has been noticed in the habits or previous 
 health of the individuals affected, sufficient to account for 
 the peculiarity." 
 
 The writer has witnessed some phenomena in human so- 
 ciety as strange and unaccountable as the preceding. He 
 once saw a family of seven children, consisting of four sons 
 and three daughters, all of whom, like the father, had red 
 heads ; but between the sons and daughters there was this 
 peculiar difference: the boys, as they reached puberty, 
 commenced having a beard ; there was, furthermore, cer- 
 tain sexual differences. Nothing had been noticed in the 
 habits or previous health of the individuals sufficient to Ac- 
 count for their peculiarities I 
 
 To be serious, is there anything in either of these cases 
 more strange than the fact that apple-trees bear apples, and 
 not peaches or plums ? Would it be proper to call the or- 
 ganic constitution of the apple-tree, to bear apples, a ^^pre- 
 disposition V But the females did not have the hemorrha- 
 gic liability to the same extent that males had, and for the 
 reason that females, as a class, have not the high stimulus 
 (according to Hall), or the vital forces so largely developed 
 
898 NON-FEBRILE FORMS OF DISEASE. 
 
 as the males. Professor Wood, in the same connection, 
 states that this hemorrhagic "predisposition " was, in ma- 
 ture age, replaced by rheumatism. Have we not shown, 
 under the head of rheumatism, and under some other heads, 
 iucid entail J, that acute rheumatism is always associated with 
 a high endowment of the vital forces ? In the cases cited 
 by Professor Wood, not a single fact is given to show that 
 the smallest degree of predisposition existed in either case ; 
 there was merely a greater liability to hemorrhage under 
 the usual causes of it, than is common to the race, just as 
 some persons are, under temptation, more liable to steal 
 than others. 
 
 Professor Wood, however, is not the only one who has 
 manifested surprise at the peculiarities above referred to ; 
 Eberle and others speak of the same as being unaccounta- 
 bly singular, and yet there is nothing about the subject 
 that can be regarded as strange, for we witness a manifesta- 
 tion of the cause in a hundred other forms every day, and 
 there is nothing in them that is mysterious, except the in- 
 tegrity of the laws of procreation, that secures to progeny, 
 as apart of their inheritance, ancestral peculiarities of or- 
 ganization, whether favorable or unfavorable. 
 
 With these remarks upon hemorrhage in general, we pro- 
 ceed to notice some of its special forms. 
 
 Genus I. — Epistaxis — 
 Hemorrhage from the ]Vost7'ils. 
 
 Of all the special hemorrhages, this is, perhaps, of the 
 most frequent occurrence ; and it may be either active or 
 passive — so the writer supposes, for he uever witnessed a 
 nasal hemorrhage of the passive variety, nor has he ever 
 witnessed one of the active, when spontaneous, except in 
 young persons who possessed a high endowment of the vital 
 forces, such as would occasion a strong liability to rheuma- 
 tism at a more advanced age. But, according to authority, 
 it may occur even to those who are advanced in years. 
 
 The approach of epistaxis is sometimes indicated by a 
 sense of fullness, heat, and itching in the nares, or by a 
 
EPISTAXIS. 899 
 
 feeling of fullness, and a dull pain in the forehead, or by 
 giddiness, or bj dizziness, or deranged vision, or coldness 
 of the extremities; but the most uniform sign of its approach 
 is redness of the eyes and flushing of the face. Though it 
 is common for it to be preceded by some of the above symp- 
 toms, as premonitory, yet it frequently occurs without any 
 observable or conscious introduction. 
 
 It may appear in drops, or it may flow in an unbroken 
 stream, and the quantity may consist of only a few drops, 
 or it may continue to flow until enough is not left to 
 sustain existence. The color of the blood is florid, and its 
 character coagulable. 
 
 This hemorrhage is irregular — that is, it is very rarely 
 strictly periodic in its recurrence ; and it is equally irregu- 
 lar in its course and duration. When it occurs in the ple- 
 thoric, and in those who are so organized as to be liable to 
 active congestion of the brain, it is, when not excessive, 
 highly useful ; it is frequently useful, also, when it occurs 
 vicariously. It is not generally to be considered as of much 
 moment ; still it is sometimes very alarming, and possibly 
 in a very few instances fatal ; the writer is of the opinion 
 that he has twice prevented a fatal termination. 
 
 The passive variety is said to be the most dangerous, but 
 this, perhaps, never happens, except with those who have 
 become so prostrated by previous disease, that the hemor- 
 rhage appeared only as a preferable mode of death. 
 
 Causes. — Professor Wood says : •' Where no predisposi- 
 tion to epistaxis exists, it is seldom produced except by 
 direct violence ; but, with such a predisposition, very slight 
 causes are sufficient to induce an attack." How can we 
 know those who are predisposed ? This is a very important 
 point to the physician. Professor Eberle says: '^ What- 
 ever has a tendency to produce a preternatural determina- 
 tion of blood to the head, may give rise to this variety of 
 hemorrhage, such as insolation, stimulating ingesta, pro- 
 tracted study, the warm-batli, sneezing, coughing, playing 
 on wind instruments, violent parturient efforts, straining in 
 evacuating the bowels, a depending position of the head 
 57 * 
 
900 NON-FEBRILE FORMS OF DISEASE. 
 
 violent aflections of the mind, strong blushing, intestinal 
 irritation, heavy lifting," etc. Now, it has so happened 
 that the writer has been subjected to all of these producing 
 causes, except the parturient efforts, and has never had 
 epistaxis but once, and then it was occasioned by a severe 
 blow on the nose, and he is fulty satisfied that more than a 
 half of the community, in this respect, are constituted like 
 himself — absclutelv not liable to this hemorrhage from the 
 causes above assigned. It appears, then, that the teachings 
 of the professor will not apply to at least one-half of the 
 community, consequently, it is evident that some further 
 information is requisite to render them available. The flow 
 of blood to the head, under the circumstances named, is not 
 preternatural, but entirely natural — and not to happen would 
 be preternatural — and y et epistaxis will not result from it, 
 except in a very few. If the professor had said, insolation, 
 stimulating ingesta, etc., are calculated to produce epistaxis 
 in those who possess highly-endowed vital systems, those 
 who possess so much stimulus that any increase proves mis- 
 chievous, he would have been instructive. 
 
 Professor Eberle adds, as causes of this hemorrhage ; 
 " Chronic visceral disorders, particularly indurations of the 
 spleen and liver ;" also, " suppression of the menstrual 
 and hemorrhoidal evacuations," and concludes by stating 
 that it " is of no uncommon occurrence in dropsical patients, 
 and in the latter stage of cachectic diseases, particularly 
 scurvy." 
 
 Diagnosis. — In some cases of epistaxis the blood flows 
 posteriorly, and in such instances it is sometimes swallowed 
 and occasions nausea and vomiting, and sometimes a little 
 of it enters the glottis and produces coughing, and hence 
 fears sometime arise that the patient has hematemesis or 
 hemoptysis. This is more especially the case when the 
 hemorrhage occurs during sleep. But all doubts may be 
 solved by causing the patient to blow his nose and clean 
 the posterior narcs, for by so doing some remains of epis- 
 taxis will be brought to view. 
 
 Treatment. — In those cases of epistaxis where no con- 
 
EPISTAXIS 901 
 
 stitutional symptoms are present, and no plethora or fullness 
 abcut the head, if it does not soon cease spontaneously, 
 means may be used to check it ; ordinarily, bathing the 
 nostril in cold water will sufnce, but where this does not 
 answer, various other means may be used. The patient 
 should be placed in a sitting posture, with the neck free from 
 compression by cravats or otherwise, and cold water, snow, 
 etc., may be applied to the nostril and to the back of the 
 neck ; but the best means are astringent applications ; thus 
 a mixture of equal parts of Alum, Gum Arabic, and Ge- 
 ranin, may be passed into the nostril upon a piece of moist- 
 ened lint or cotton, and retained there for some time ; or 
 other astringents may be applied, either in solution or by 
 snuffing up the dried powder, as of Kino^ Catechu, Galls, 
 Extract of Ehatania, Matico, etc. Dried beef, grated tine, 
 and the nostril filled with it, has proved very serviceable ; 
 also pressure on the outside of the nose over the artery. 
 
 If the extremities become cold, hot pediluvia with sina- 
 pisms to the feet may be employed ; and where the pulse is 
 full, strong, and excited, with symptoms of determination 
 to the head, a brisk cathartic will be found very beneficial. 
 If both arms are raised suddenly and perpendicularly while 
 the patient is standing, and retained in this position for 
 some time, it is very apt to give permanent relief. Various 
 other means have been advised, but we have always suc- 
 ceeded with the above. 
 
 Where there is a tendency to a return of the hemorrhage, 
 with an irritable state of the nasal membrane, it may be 
 removed by applying an infusion of Hydrastis, with Ses- 
 quicarbonate of Potassa dissolved in it, on a piece of lint 
 or by means of a camel's hair pencil, to the afiected mem- 
 brane ; from eight to twenty grains, or more, of the salt 
 may be added to an ounce of the infusion. 
 
 Should the epistaxis be owing to some constitutional 
 difficulties, or be vicarious, the proper means must be used 
 in connection with the above, to remove the difficulties, 
 before much relief can be expected to follow. The nostril 
 may be plugged with sponge, with Beloc's nasal instrument. 
 
902 NON -FEBRILE FORMS OF DISEASE. 
 
 This, perhaps, will not be as effectual as the following treat- 
 ment by Professor Powell, who says : 
 
 In the treatment of epistaxis, the writer is of the opinion 
 that he has a certain, a never-failing remedy, which is not 
 in the possession of the profession, and although the duty 
 of adding the treatment does not devolve upon him, yet he 
 feels it to be his duty to lay it before the public, more 
 especially as he feels sure that Professor Newton will have 
 no objection. 
 
 Upon being called to a case of expistaxis, in which every 
 means known to the proiession have been tried without 
 apparent advantage, and the dissolution of the patient is 
 strongly threatened, for he has never had an opportunity 
 of trying the remedy under any other circumstances, he 
 immediately orders the procurement of a portion of the 
 small intestine of a pig (in the country a pig can always be 
 had, and in the city every physician should be provided 
 with some of it,) and orders it to be cleaned and scraped 
 as though it was intended for sausage meat. He ligatures 
 one end, and with a curved wire or probe introduces it into 
 the posterior nares ; another ligature is placed around it 
 immediately in front of the anterior nares and placed under 
 the care of an assistant who is instructed to draw it as soon 
 as he finds that the operator has that portion which is in 
 the nose completely inflated, which he does by blowing into 
 it through a goose's quill. This intestinal membrane being 
 very thin, insinuates itself into every little inequality, 
 coagula form upon it, and hemorrhage is instantly arrested. 
 When arrested in one nostril, it will frequently commence 
 in the other, and when it does, apply to it the same remedy. 
 After a proper time has elapsed, cut the anterior ligature 
 and cause the patient to blow through his nose, and the 
 membrane will be dislodged. The writer does not believe 
 that this application will ever fail, and he believes that he 
 has saved several patients by its use. 
 
HEMATEMESIS. >903 
 
 Genus II. — Hematemesis — 
 Hemorrhage from the Stomach. 
 
 This affection may be active or passive, acute or chronic* 
 It consists generally of a sanguineous exhalation from the 
 mucous lining of the stomach. The hemorrhagic matter is 
 generally thrown up by vomiting, but occasionally it finds 
 egress by stool, and has very generally a grumous aspect, 
 of a very dark color, and sometimes in coagulated clots. 
 In the active variety, it is sometimes florid and liquid. 
 Sometimes it is black and tar-like, but in such cases the 
 true seat of the affection is thought to be in the liver. 
 When hematemesis is symptomatic its character of course 
 will be modified by the reigning disease ; but with its symp- 
 tomatic peculiarities we have nothing to do in this place. 
 
 The premonitory symptoms of hematemesis consist of a 
 feeling of weight and pressure in the epigastrium ; foul 
 breath ; loss of appetite, or else it is voracious ; tenderness 
 in the hypochondria, possibly pain ; acid eructations ; alter- 
 nating flushes of heat and cold ; a tendency to syncope ; 
 cold extremities ; a shriveled countenance ; a contracted 
 and irritated pulse ; great anxiety ; a feeling of constriction 
 about the breast ; extreme sickness at the stomach ; a con- 
 fusion of the senses, and lastly, ejections of blood, by vomit- 
 ing, make their appearance. 
 
 Causes. — The most frequent of these are said to be 
 indurations of the liver and spleen. It is sometimes occa- 
 sioned by a suppression of hemorrhoids ; menstrual irregu- 
 larities in young females, frequently produce it ; and it is 
 sometimes occasioned by the final cessation of the menses ; 
 it api^ears sometimes to be occasioned by pregnancy. To 
 these and similar causes may be added such as are chemi- 
 cal, as acrid substances, and such as are mechanical, as blows 
 on the epigastrium. 
 
 Prognosis. — The danger of hematemesis does not depend 
 upon the quantity of the hemorrhage, but upon the func- 
 tional derangement it may occasion to the stomach, which 
 may eventually end in dropsy, hysteria, dyspepsia, great 
 
904: NON -FEBRILE FORMS OF DISEASE. 
 
 relaxation, debility, and death. When occasioned by vis- 
 ceral obstructions, and more especially with the intemper- 
 ate, the most danger is to be apprehended. When it super- 
 venes suppressed hemorrhoids, or the menses, the danger is 
 not considerable ; indeed, it has been known to occur 
 monthly instead of the menses without any mischievous 
 results. 
 
 Treatment. — It is only in the uncomplicated condition 
 of this species of hemorrhage that we can expect to accom- 
 plish much permanent benefit ; if it be dependent upon 
 softening of the liver or of the stomach, cancer of the 
 stomach, or other organic affections, but little can be done. 
 In the treatment of it, we pursue a similar course to that 
 named for hemoptysis, with the exception of the addition of 
 of Geranium Maculatum, or Geranin, to the astringents 
 administered. Geranium, added to the Compound Powder of 
 Ipecac, and Opium, may be given with advantage, and sina- 
 pisms over the epigastric region will often afford rapid relief. 
 In cases attended with constipation, or where catharsis is 
 indicated, stimulating purgative enema should be used in 
 preference to the administration of this class of agents by 
 mouth. 
 
 When complicated with other organic diseases, these 
 must be treated, as recommended under their respective 
 heads. 
 
 Genus III. — Hematuria — 
 
 HemorrJiage from the Urinary Organs, 
 This hemorrhage may be from the kidneys, the ureters, 
 the bladder, or urethra, and like other hemorrhages it may 
 be active or passive, and like hemorrhage in other mucous 
 membranes it must take place by exhalation, for in these 
 membranes ruptures are exceedingly uncommon. This 
 variety of hemorrhage sometimes occurs periodically, more 
 especially when its source is the neck of the bladder and is 
 associated with a hemorrhoidal condition of the system. 
 
 The aged are more liable to this form of disease than the 
 young, more especially when of a rheumatic organization, 
 and those of this class are still the most liable to it who 
 
HEMATURIA. 905 
 
 have been troubled with hemorrhois. It is said to occur 
 frequently with young children during the process of denti- 
 tion. 
 
 The essential symptom is the evacuation of blood by 
 the urethra, preceded by pain in the region of the bladder, 
 or kidneys, and attended by a feeling of faintness. 
 
 Diagnosis. — There are but a few instances in which a 
 correct diagnosis is more essential to the practitioner than 
 in this ; not. in the way of distinguishing this hemorrhage 
 from others, but in the discovery of its particular seat ; 
 because it can not be a matter of indifference whether it 
 proceeds from the bladder, ureters, kidneys, or urethra. If, 
 therefore, the blood be unmixed with urine, and evacuated 
 without an effort, the very probable inference must be that 
 it proceeds from some portion of the urethra. If the hem- 
 orrhage be from the bladder, it will be attended with a dull 
 or stinging pain about the neck of the bladder, with much 
 uneasiness, and probably a feeling of pressure or fullness in 
 the perineum, painful erections of the penis, and sensation 
 of burning in the glans penis and about the anus. The 
 blood will appear with small flocculi and coagula suspended 
 in it. The coaguli, sometimes, is too large to pass the neck 
 of the bladder, and consequently produces a suppression of 
 the urine and a demand for the catheter. 
 
 When the hemorrhage is from the kidneys or ureter it is 
 without flocculi or coagula, but so intimately blended with 
 the urine as to give it a bloody appearance, but upon stand- 
 ing sometime the blood settles to the bottom of the vessel, 
 leaving the urine clear. 
 
 Causes. — These are numerous, particularly with those 
 who possess a strong hemorrhagic liability ; but, as we 
 remarked in treating of hemoptysis, those who possess a 
 lean and dense fibrous system are scarcely vulnerable to it 
 Euder any circumstances, except from calculous concretions 
 and gonorrhea. With its proper subjects it may be occa- 
 Bioned by acrid diuretics ; scirrhus ; ulcerations ; tumors 
 in the ureter, kidneys, or bladder ; mechanical agitation of 
 the body 5 as rough carriage riding, by any cause, indeed. 
 
906 NON-FEBRILE FORMS OF DISEASE. 
 
 that increases the momentum of the arterial circulation, or 
 very greatly relaxes the capillary. With the aged, a sup- 
 pression of hemorrhois is not an unfrequent cause. It is 
 sometimes occasioned by a suppression of the menses ; in 
 such instances it may be considered vicarious. 
 
 Peognosis. — Hematuria is never attended with danger 
 from the loss of blood ; but when it is of frequent recur- 
 rence and copious, as it sometimes is with the aged, it 
 results in dropsical effusions. Its vicarious appearance is 
 never attended with danger. The passive variety of it in 
 the last stage of a severe form portends the utmost danger- 
 
 Treatment. — When uncomplicated, hematuria is to be 
 treated similar to the other hemorrhages, by astringents, 
 rest, abstinence, and cooling mncilaginous drinks, with other 
 auxiliary means, as indicated by the symptoms. When it 
 is of a passive .character, the Oil of Turpentine may be used 
 with benefit, and which agent will be found of much service 
 in all passive hemorrhages not connected with conditions 
 which would contra -indicate its use. Inffusions of Lycopus 
 Yirginicus, Geranium Maculatum, Althea Officinalis, or 
 Uva Ursi, may be used alternately, in obstinate cases. 
 
 Genus IY. — Hemoptysis — 
 Hemorrhage from the Lungs. 
 Professor Eberle says : " This term is applied to hemor- 
 rhages from the respiratory passages, whether they proceed 
 from the larynx, the trachea, or the bronchia." Why not 
 add the nostrils I — they too, are respiratory passages. Dr. 
 Kobert Law says, that if this term was taken in the full 
 latitude of its etymology it would include " every discharge 
 of blood from the mouth, but nse," he says, " has annexed 
 to the term a more limited signification, restricting it to 
 eoiypeGtoratioii of hlood^ or that which originally issues from 
 the respiratory organs." The first part of this clause is a 
 correct definition, but the second part is erroneous, because^ 
 as in that of Professor Eberle, it embraces the nares, and 
 at best, the definition is far from being definite — neverthe- 
 less, it is generally understood. 
 
HEMOPTYSIS. 907 
 
 There is no period of life that is entirely exempt from 
 this hemorrhage, although its most frequent appearance is 
 between the ages of fifteen and thirty-five years — the period 
 in which the organization is most actively merging toward 
 an equilibrium ; and there is no other hemorrhage that ex- 
 cites in the mind of the- patient so much alarm, and for the 
 reason, no doubt, that it is a frequent indication of a very 
 incurable malady, phthisis pulmonalis. 
 
 The quantity of blood discharged by this hemorrhage 
 varies, very greatly, in difierent cases ; sometimes it 
 amounts to a mere tinge of a single sputum, while in other 
 cases, and possibly in the same at other times, the quantity 
 is truly alarming and equally surprising that so much can 
 be expended without an extinction of life ; yet the waste of 
 this large quantity is frequently repeated at comparatively 
 short intervals for months and even years, and still leaves in 
 the organization a possibility of its return to good health. 
 
 When we contemplate the similarity that exists between 
 the effects of both fear and hemorrhage, it will sometimes 
 be difficult to determine how much of the constitutional 
 symptoms, in any given case, is to be attributed to the lat- 
 ter. In a person of firmness and fortitude, the symptoms 
 measurably may indicate the disease ; but in the nervous, 
 timid, and fearful, the greater number may have been oc- 
 casioned by the fright which the hemorrhage produced. 
 
 This morbid action, like that of epistaxis, is sometimes 
 introduced without any premonitory symptom, but most 
 generally it is preceded by some of the following symptoms, 
 viz : a feeling of lassitude in the extremities, particularly 
 in the inferior ones ; a short or hacking cough ; palpitation 
 of the heart ; a stricture across the breast ; anxiety and 
 frequent sighing ; a chilly sensation which may amount to 
 a moderate chill ; a deep-seated and burning pain under 
 the sternum, much like that which sometimes precedes an 
 attack of intermittent fever ; irritability of disposition ; a 
 quick, frequent, and small pulse, and flushings of the face. 
 
 After the continuance of these symptoms, or many of 
 them, for some time, there occurs some evidence of, appa- 
 
908 NON-FEBRILE FORMS OF DISEASE. 
 
 rent, reaction in the system, such as a sensation of warmth 
 in the chest, which is felt to rise toward the larynx, and 
 appears to provoke some hawking, or possibly coughing, 
 which is followed by the hemorrhage. When premonitory 
 symptoms are absent, the hemorrhage is apt to be slight ; 
 but whatever may be its character in this respect, when this 
 hemorrhage has appeared, it is apt to recur frequently for 
 sometime afterward. 
 
 When this hemorrhage is of that kind which we propose 
 to consider — the idiopathic — the blood is florid and frothy ; 
 but when symptomatic, or a mere attendant upon some 
 other form of disease, as scurvy, fevers, etc., the blood is 
 dark, and even very dark. In determining the precise lo- 
 cality of the hemorrhage, considerable difiiculty is some- 
 times experienced. When the blood runs passively out of 
 the mouth, or is spit out, without coughing or hawking, we 
 may rest assured that its source is not below the fauces ; 
 but it does not certainly follow that when it is coughed up, 
 its source is below the fauces, because more or less of it 
 may reach the glottis, and occasion such irritation as to 
 produce coughing and even vomiting. 
 
 When hemoptysis has once occurred, a strong probability 
 exists that it will, at irregular periods, recur again. It has 
 been known to recur periodically, as at a particular hour 
 every day or every other day, and continue for months. It 
 has also been known to occur every month instead of the 
 catamenia. The writer once had a case of this kind which 
 had been treated as a case of undisguised hemoptysis. 
 
 It is said that some persons 2,vQjpredisposedio this hemor- 
 rhage. This position we deny ; but we admit that some 
 persons are, normally, much more liable to it than others. 
 A predisposition to it, however, does sometimes exist, but 
 it is an attendant upon some other form of disease. To 
 idiopathic hemoptysis, or any other hemorrhage, a predis- 
 position can not exist. In such cases the fault is organic 
 and not pathologic. 
 
 Causes. — With some constitutions, as the lean and 
 fibrous, scarcely any cause, except mechanical violence, can 
 
HEMOPTYSIS. 909 
 
 produce it, and hence those in whom it occurs from other 
 causes, may be regarded as being organically liable to 
 it. With such it may be caused by violent muscular exer- 
 tions ; atmospheric changes ; the sudden suppression of 
 ulcers ; the repulsion of cutaneous eruptions ; a sudden re- 
 duction of atmospheric pressure ; costiveness ; mental ex- 
 citement, ; loud speaking ; the inhalation of acrid matter ; 
 organic disease of the heart; functional derangement of 
 the liver; interruptions to the circulation of the blood; and 
 in muscular men, the abandonment of accustomed muscu- 
 lar labor, proves a more frequent cause than has hitherto 
 been imagined. 
 
 Tkognosis. — This affection is, in all cases, calculated to 
 excite fearful apprehensions, and yet it is never fatal through 
 a loss of blood, nor particularly dangerous except to those 
 who have a phthisical organization. Most generally, the 
 danger is but moderate when the hemorrhage is copious, as 
 this usually happens to those of a rheumatic organization ; 
 and yet, it is with them sometimes fatal. When the he- 
 morrhage is so slight as merely to stain or streak the mat- 
 ter expectorated, much danger should be apprehended, be- 
 cause such cases are generally confined to a phthisical 
 organization. But, whatever may be the character of the 
 hemorrhage, if it be associated with a phthisical organiza- 
 tion, danger should be apprehended. If it has occurred in 
 a contrary organization, and from such causes as are calcu- 
 lated to produce pulmonic congestion, as great muscular 
 exertion, particularly in a stooping posture, no very serious 
 consequences need to be expected. 
 
 Treatment. — In the treatment of hemoptysis, we place 
 our principal reliance, as far as medicinal means are con- 
 cerned, upon astringents, tonics, and sedatives, and have 
 found the greatest benefit to accrue from the following pre- 
 paration : 
 
 R. Lycopus Virginicus, 3ss, 
 
 Boiling Water, O. ss. Mix, 
 Infuse for fifteen or twenty minutes, and when cold, about 
 two fluid ounces may be given two or three times a day ; 
 
910 NON-FEBRILE FORMS OF DISEASE. 
 
 and if the hemorrhage be very copious, it should be given 
 every fifteen or twenty minutes, and continued until it is 
 checked. This agent exerts both a powerfully sedative and 
 astringent influence. 
 
 After the hemorrhage is arrested, to prevent a return of 
 the attack, as well as to impart tone to the general system, 
 the following tonic compound will prove beneficial : 
 R. Pulv. Hydrastis Canadensis, 
 
 Pulv. Prinos Yerticellatus, da 5j. Mix. 
 One-fourth of this is to be added to one pint of boiling 
 water, and when cold, the infusion is to be taken in the course 
 of the twenty-four hours, and thus repeated daily. Or the 
 following may be substituted : 
 
 R. Sulphate of Quinine, 
 
 Hydrastin, da grs. xx. Mix, 
 Divide into ten powders, and administer three powders 
 a day. 
 
 In connection with this treatment, the patient must be 
 kept still, lying in bed, on his back, the body being com- 
 fortably warm, and the room properly ventilated. He should 
 be enjoined to keep as still as possible, and any mental ex- 
 citement must be avoided. 
 
 In cases attended with febrile or inflammatory symptoms, 
 the feet may be bathed in warm water and sinapisms ap- 
 plied to them ; and diaphoresis should be produced either 
 by the spirit vapor-bath, or by the agents usually given 
 internally for that purpose. In very severe cases, ligatures 
 may be applied to the limbs. If cough be present and 
 proves very troublesome, it must be allayed by expecto- 
 rants, for so long as this exists the hemorrhage will 
 continue. 
 
 To convey an idea of our treatment in hemoptysis, we 
 select the following case from our clinical reports for March 
 29,1853: 
 
 "Case ix. — H. R., set. 20, Hemopt^^sis. — The hemor- 
 rhage from the lungs has been very bad. He was first at- 
 tacked about two weeks since, and then he bled nearly 
 a pint. 
 
MENORRHAGIA. 911 
 
 He had suffered severely from pain and soreness of the 
 chest for four weeks previous to the attack. He is a printer, 
 and thinks much of the difficulty was produced by working 
 too hard at the press. He has a very flat chest; can dis- 
 cover no organic derangement of the lungs. Two of his 
 sisters have died of consumption. There appears to be 
 much debility of the respiratory action ; has frequent par- 
 oxysms of coughing, but unattended with much expectora- 
 tion. This hemorrhage may have been produced by a de- 
 bilitated condition of the lungs, and not the result of any 
 acute or inflammatory condition of the lungs. He has 
 bled several times from one to three ounces. 
 R. Lycopus Virginicus, 3ss., 
 
 Aqua, O. ss. 
 
 Make a decoction. Take from two to four ounces at a time, 
 and repeat four or five times a day ; and at the same time 
 give the following expectorant : 
 R. Syr. Squills, 5ij, 
 
 Syr. Ipecac, 5i, 
 
 Syr. Senega, 3i, 
 
 Tr. Sanguinaria, 3ij, 
 
 Simple Syrup, 3ss, 
 
 Tr. Opi. Camphor, 3ss. 
 Mix, and give one drachm every hour. For a tonic give 
 R. Pulv. Hydrastis, 
 
 Pulv. Prinos Yerticellatus, da 2i, 
 One-fourth of which is to be added to one pint of boiling 
 water, and this quantity to be used daily." 
 
 This course was continued for about two weeks, and the 
 young man was discharged cured, and has had no return 
 of the hemorrhage since, though still pursuing his occupa- 
 tion as a printer. 
 
 Genus Y. — Menorrhagia — 
 
 Ilemorrhag 6 from the Uterus. 
 
 This hemorrhage, like the preceding, is from a mucous 
 
 surface, and like them results from exhalation, much more 
 
 probably than by a rupture of small vessels. Of menor- 
 
912 NON-FEBRILE FORMS OF DISEASE. 
 
 rhagia there are many modifications, but for the present, 
 our remarks will be confined to those which claim an idio- 
 pathic character. Like those hemorrhages which we have 
 considered, it may be either active or jpassive. This dis- 
 tinction, to some, is exceptionable. Broussais maintained 
 that all hemorrhages are active, and we admit that such is 
 mechanically the fact ; but the idea we intend to convey by 
 the two terms, respectively, is this : the former is attended 
 by a high endowment of vital force, and the second by a 
 great diminution of it — depends upon a state of great de- 
 bility or prostration. 
 
 There is more liability to a great waste of blood from this 
 hemorrhage than is common to any other, and its occurrence 
 is, perhaps, more frequent. Sometimes it occurs so sud- 
 denly, that the patient has no warning of its approach, but 
 more generally it is produced by a sense of weight and full- 
 ness in the uterus, and a frequent desire to urinate. If it 
 be of the active character, the pulse will be full and re- 
 bounding, but if of the passive, then it will be small, fre- 
 quent, and contracted. In females of a full habit, it may be 
 very copious, but of short continuance — only a few hours ; 
 but according to its general character it continues from sev- 
 eral days to as many weeks. It occasions, sometimes, in 
 delicate and prostrated women, amaurosis, and probably a 
 pain in the head over one of the orbits, such as is com- 
 monly produced by gastric derangement. There is no form 
 of hemorrhage so destructive to health as this ; those who 
 are afflicted with a frequent recurrence of it, become dys- 
 peptic, feeble, and anasarcous. The most prostrating at- 
 tendant upon this hemorrhage is leuchorrea, which fills up 
 the hemorrhagic intervals. 
 
 Diagnosis. — Menorrhagia has been confounded with co- 
 pious menstruation — the former is strictly a hemorrhage, 
 while the latter is as certainly a secretion, and as such, it 
 may be very copious, and yet compatible with good health. 
 It is true, that copious menstruation is sometimes very pros- 
 trating, but in such cases it is not normal, and yet it does 
 not become a hemorrhage. A proper attention to the 
 
MENORRHAGIA 913 
 
 evacuation will always furnish the means of diagnosis ; in 
 hemorrhage the blood either coagulates or betrays such a 
 tendency, but the menstrual evacuation continues fluid and 
 exhibits no tendency to coagulation. 
 
 Causes. — With those who possess a hemorrhagic organi- 
 zation, the active form of this affection may be produced by 
 any cause that would produce epistaxis or hemoptysis with 
 the same class of persons of the other sex, as wines, cor- 
 dials, high-seasoned food, an intemperate use of the warm- 
 bath, and also of sexual indulgence ; with these may be 
 named a tardy or costive condition of the large intestines. 
 Passive menorrhagia may be produced by all the causes 
 which are calculated to produce general debility ; as defi- 
 cient nourishment, defective ventilation, a residence in a 
 humid atmosphere, etc. But it should be remembered that 
 these causes will never produce it in those who have a he- 
 morrhagic constitution, until the general stamina of the 
 constitution is destroyed. Those who are especially liable 
 to this variety, are the organically feeble. 
 
 Treatment. — In the treatment of this form of hemor- 
 rhage, the patient should be kept in a recumbent position, 
 and everything calculated to induce a determination of blood 
 to the pelvic region, must be avoided ; if constipation exists, 
 it must be obviated by laxative enema, and if there be con- 
 gestion of the portal circle, owing to hepatic torpor, Lep- 
 tandrin, or some other agent which exerts an influence on 
 the liver, without causing active catharsis, may be given, 
 
 Applications of cold water or vinegar should be made 
 over the abdomen and genital organs in connection with 
 warm or cold astringent vaginal injections, as appear to be 
 most suitable to the case, together with astringents admin- 
 istered internally. Should much nervous irritability be 
 present, the Compound Powder of Ipecac, and Opium will 
 be found serviceable, and in some cases Camphor, Vale- 
 rian, Assafetida, or other antispasmodics. The following 
 extract from Ashwell on Females, is in accordance with our 
 views, and we give it in addition to the above : 
 
 " Sexual intercourse and^ stimulants, mental excitement, 
 
914 
 
 NON-FEBRILE FORMS OF DISEASE. 
 
 aDd physical effort, must be avoided for ten or twelve days 
 before the periodic returns. When there is increasing 
 pallor, edema, threatened dropsies, softening of the cervix, 
 and aggravated debility — sea air, a mild but nutritious diet, 
 consisting of animal food and milk, or malt liquor, must be 
 enjoined. Where there is universal coldness of surface, es- 
 pecially of the extremities, frictions, by stimulating embro- 
 cations, the tiesh-brush, and horse-hair gloves, the v^eaiing 
 of flannel, and worsted stockings, are indicated. The salt 
 hip-bath, the local salt shower-bath, applied night and 
 morning, by a common garden watering-pot, over the hypo- 
 gastric and lumbar regions, are often advantageous. Nor 
 is the injection of cold water, once or twice a day, into the 
 rectum, to be forgotten. Astringent vaginal injections are 
 deservedly relied on, especially if carefully administered 
 during the intervals. Still there are cases, and occasionally 
 I meet with a good many, where cold injections can not be 
 borne. Local fullness, excitement, and pain, follow their 
 use, and sometimes I have attributed to their employment 
 an earlier and larger return of the hemorrhage. They are 
 most beneficial where there is copious leuchorrhea, and 
 from the cure of this morbid secretion, good may be inva- 
 riably anticipated. It is to be remembered that the unmar- 
 ried are liable to congestive menorrhagia, and I have often 
 thought that their cure was more difiicult aud protracted, 
 and their hemorrhages larger, than where many children 
 had been borne ; but I am not prepared to give a positive 
 opinion. During an attack, the patient should lie on a 
 hard mattress, be kept perfectly quiet, covered lightly with 
 bed-clothes, and have warmth applied to the feet and legs ; 
 hot bottles or mustard-poultices, may be used for this pur- 
 pose. Her drink must be unstimulating and cold, except 
 where there is syncope, and then wine in small quantities 
 may be given." 
 
I^ERVOUS FORMS OF DISEASE. 915 
 
 OEDEE II. 
 
 NERVOUS OR FUNCTIONAL FORMS OF DISEASE. 
 
 Introductory Remarks. — The forms of disease em- 
 braced by this order are very numerous, and are distin- 
 guished by the circumstance that they are measurably con- 
 fined to those who possess an imperfect organization — some 
 portion of the encephalon is in excess or deficient. This 
 principle may be illustrated by a reference to apoplexy — in 
 the active form the cerebellum is in excess, and in the pas- 
 sive it is not only small, but the cerebrum is decidedly 
 large. 
 
 The difiiculty of treating this order of morbid actions, is 
 universally admitted, but so far as we have learned, it has 
 never been attributed, directly and necessarily, to imperfect 
 organization. That we are correct in this declaration, every 
 physician may satisfy himself in a few years, by well-di- 
 rected observation. There is no fact more certain than that 
 some persons can not have acute rheumatism— that some 
 can not have apoplexy, either active or passive. 
 
 Finally, we do not hesitate to aflSrm that all forms of dis- 
 ease have their primary source — an organic liability, in the 
 imperfections of the cerebral organization, and the time will 
 come when the form and the size of the brain will as cer- 
 tainly reveal the morbid liability, as it now does the mental 
 and physical character. 
 
 Genus I. — Morbid Actions in the Organs of Internal 
 Relation. 
 
 As the functions of the organs of internal relation have 
 for their object the well-being and perpetuity of the indi- 
 vidual, their disease constitutes an. assault upon life ; and 
 but for the connection that exists between the ganglionic 
 system or that of vegetative life, and the cerebello spinal 
 68 
 
916 NERVOUS FORMS OF DISEASE. 
 
 system, no animal function would necessarily be involved. 
 The ganglionic system, then, primarily and in reality, con- 
 stitutes the organs of internal relation — their functions be- 
 coming manifest only through their instruments, the vari- 
 ous viscera and tissues of the body. This system may be 
 deranged or diseased to any extent compatible with life, 
 without a necessary invasion of the mental and sexual 
 functions. Hence the cerebral hemispheres, the posterior 
 and anterior lobes, and a large portion of the cerebellum, 
 if not the whole, have no necessary participation in this 
 genus of morbid actions ; the medulla oblongata or the 
 mesocephale constitutes the only portion of the enceph- 
 alon that is connected with the ganglionic system, and 
 this for the purpose only of producing or securing an animal 
 or mental consciousness of the condition of the vegetative 
 system. 
 
 Species I. — Asthma. 
 
 This form of disease is characterized by great difficulty 
 of breathing, usually occurring in paroxysms ; it is seldom 
 attended with fever or organic derangement of the heart or 
 lungs, but is evidently a nervous disease, and is entitled to 
 the same classification as angina pectoris. Upon this 
 point, we copy the following extracts by Dr. Kneeland, 
 from the "American Journal of Medical Science." He 
 says : 
 
 " Both come on by sudden paroxysms, at irregular inter- 
 vals. In both there is a sense of painful constriction and 
 suffocation, of epigastric tension, with eructations, yawn- 
 ings, coldness and paleness of the face, tlfe pulse compara- 
 tively unaffected, difficulty of speaking, the health good in 
 the intervals, until the arrival of secondary causes of dysp- 
 noea (usually emphysema, or other symptomatic asthma). 
 Both are alike brought on and influenced by atmospheric 
 changes ; by the action of a cold, dry wind ; by mental 
 emotions — perhaps also by hereditary predisposition. Both 
 have been ascribed to the same lesions of the respiratory 
 and circulating systems, even to ossification of the costal 
 cartilages, coronary arteries, and cardiac valves ; both are 
 
ASTHMA. 917 
 
 relieved by the same treatment — narcotics, antispasmodics, 
 and revulsives. 
 
 Many cases of angina are recorded in which symp- 
 toms of asthma first appeared and disappeared in the 
 course of the disease, viz : fits of nightly sufibcation, 
 after the first sleep, which compelled the patient to fly to 
 an open window for relief. 
 
 '' The difierence between angina and asthma may be 
 explained by the different functions of the filaments of sen- 
 sation and motion in the par vagum. In asthma, the dysp- 
 noea is more characteristic than pain ; every muscular 
 power is brought into action to introduce air into the lungs ; 
 the diaphragm and pectorals contract convulsively ; the 
 desire for air is extreme, and the patient seems continually 
 on the point of sufibcation. During the paroxysm there is 
 more or less absence of the respiratory sounds, from the 
 difficulty the air finds in entering the pulmonary vessels ; 
 hence the violent and noisy laryngeal respirations. When 
 the fit ceases there is copious expectoration, with mucous 
 rales and cough. The muscular fibers of the bronchi and 
 their ramifications are animated by the spinal accessory 
 nerve ; the dyspnoea of asthma depends on the spasmodic 
 contraction of these fibers, the partial obliteration of the 
 air-passages requiring violent respiratory efibrts to secure 
 the necessary introduction of air ; in this constriction the 
 larynx is involved, as evinced by the whistling of the 
 inspirations — the non -introduction of air into the pulmo- 
 nary vesicles accounts also for the diminution or even 
 absence of the respiratory murmur." 
 
 Prognosis. — When this disease is uncomplicated, it may 
 be considered curable, notwithstanding the paroxysms are 
 very alarming ; but when there is complication, with organic 
 derangement of the heart or lungs, it should be considered 
 as a fatal disease, and the treatment under such circum- 
 stances can be only palliative. 
 
 Treatment. — During the paroxysm of asthma, relaxants 
 and antispasmodics arc to be used, in connection with the 
 following liniment, which appears to exert almost a specific 
 
918 NERVOUS FORMS OF DISEASE. 
 
 influence over the spasm, as well as to assist in preventing 
 a subsequent attack : 
 
 R. Oil of Stillingia, 3j, 
 Oil of Lobelia, 3ij, 
 Alcohol, fSiij. Mix. 
 
 The throat, neck, chest, and vertebral column, as far 
 down as the fifth or sixth dorsal, must be bathed with this 
 three or four times a day. With this, the following may be 
 used internally : 
 
 R. Syrup of Ipecac, 
 Syrup of Senega, 
 Syrup of Squills, dd 3j, 
 Tinct. Lobelia, 5ss. Mix. 
 
 Of this, give about a fluid drachm every fifteen minutes, 
 until nausea is produced. This course has always, in our 
 practice, promptly removed the paroxysm, and if pursued 
 for some time, giving the last preparation in nauseating 
 doses three or four times a day, will efiect a permanent 
 cure. 
 
 When asthma is complicated with gastric, hepatic, or 
 other derangements, in addition to the above treatment, 
 measures should also be directed toward the removal of the 
 complication by the means recommended under their re- 
 spective heads. 
 
 Species IL — AspTtyxia. 
 
 By this term is understood an interruption of the respi- 
 ratory functions, and consequently of the vitalizing eflfects 
 of the air on the blood. Death soon follows the interrup- 
 tion of respiration, in man and the warm-blooded animals, 
 resulting from asphyxia. Recovery is possible only after 
 a short continuance in the asphyxiated state. In syncope 
 there is a suspension of respiration, and also of the pulse, 
 as in asphyxia, but we would not say of a female who had 
 
ASPHYXIA. 919 
 
 fainted that she was in a state of asphyxia. The sudden 
 interruption to breathing that would be occasioned by a 
 plaster being stuck over the mouth and nose would produce 
 asphyxia. This was the mode employed by the notorious 
 murderer, Burke, of Edinburgh, for providing the schools 
 with anatomical subjects some years ago, and which re- 
 ceived the appellation of Burhing. This summary mode 
 of preventing the ingress of air into the lungs by closure 
 of the air-passages, and thus producing death by asphyxia, 
 is termed suffocation. Foreign bodies lodged in the trachea, 
 croup, etc., produce death in this way. Death produced 
 by compression of the larynx from without, as by hanging, 
 is called strangulation. Another cause often producing 
 asphyxia is svhmersion or drowning.^ the organization of 
 the lungs of animals breathing atmospheric air not being 
 adapted to appropriate the oxygen in water to the renova- 
 tion of the blood. Another set of causes is the respiration 
 of the gases, as hydrogen, carbonic, etc. The strong 
 gases, as chlorine, etc., produce spasmodic closure of the 
 glottis. Chloroform proves fatal now and then. External 
 compression of the thorax and abdomen, from violence, or 
 internal distention by air or water, as in pneumothorax 
 and drops}^, may produce death by asphyxia. Spasmodic 
 closure of the glottis and tonic contraction of the diaphragm 
 and other muscles concerned in respiration, as in tetanus, 
 may cause death by asphyxia. Division of the eighth pair 
 or pneumogastric nerves, or other cause paralyzing the 
 muscles of respiration, will cause death by asphyxia. Opium 
 seems to produce death in this way — hence the indication of 
 keeping up artificial respiration under poisoning by this 
 drug. The phenomena and appearances vary more or less 
 under the various causes by which asphyxia is produced, 
 and the indications in the treatment will vary accord- 
 ingly. 
 
 Phenomena. — The distress which every one may feel by 
 voluntarily holding the breath unto the longest moment 
 possible, is the first symptom. The feelings of distress are 
 attended with involuntary spasmodic efforts of the dia- 
 
920 NERVOUS FORMS OF DISEASE. 
 
 phragm and the associated muscles of respiration, betoken- 
 ing the most urgent desire for fresh air. The writer once 
 succeeded in voluntarily suspending respiration for the 
 space of sixty seconds by the ticking of the clock, lying 
 upon the sofa. This was only accomplished after repeated 
 efforts, and so distressing was the feeling referable to the 
 lungs and diaphragm that the effort was never repeated. 
 It is said that divers engaged in the pearl-fishery remain 
 submerged two, three, and even five minutes ; but this 
 seems incredible, though it is probable that repeated and 
 practiced trials, under a state of presence of mind, bodily 
 training, and the hope of gain in this perilous employment, 
 may enable the adventurers to remain submerged a few 
 minutes. The exact time, therefore, that respiration may 
 be suspended without jeopardizing life depends upon cir- 
 cumstances ; and the longest period at which it is proper 
 to desist from efforts to recover persons from a state of sus- 
 pended animation, or asphyxia, is by no means a settled 
 point. It depends upon age, and the circumstances and 
 mode of production. The writer has succeeded in restor- 
 ing infants to life born in the asphyxiated state, after an 
 hour and some minutes' persevering efforts. But let us pro- 
 ceed with the more striking phenomena of sudden asphyxia. 
 
 The distress for breath rapidly becomes agony ; deep and 
 violent spasmodic efibrts of the diaphragm, intercostal and 
 other muscles concerned in the respiratory act, ensue; the face 
 becomes turgid or livid ; the eyes protrude from the sockets ; 
 torpor ensues, and quickly loss of consciousness, and then 
 succeed irregular, convulsive movements of the trunk and 
 extremities. A moment or two, and a state of perfect 
 relaxation of all the muscles ensues, even to the sphincters, 
 and involuntary discharges of urine and faeces often occur. 
 
 When slowly produced, as under some forms of disease 
 gradually impeding respiration, the sufferings will be more 
 protracted, and beside the painful anxiety for fresh air, 
 there is vertigo, with other symptoms indicating oppression 
 of the brain, such as fiery sparks, ring-sounds, and tend- 
 ency to coma. The skin gradually becomes cold and livid 
 
ASPHYXIA. 921 
 
 in patches, and the lips blue. Spasms or convulsions sel- 
 dom appear, and death is gradual. 
 
 TTie cause of death^ in asphyxia, is ascribed to the dele- 
 terious effects of vicious blood sent to the brain ; for loss 
 of sense and consciousness ensues before the heart ceases 
 to beat. In recovery from asphyxia, the heart may be 
 brought to beat for an hour before the other phenomena of 
 life faintly begin to be manifested, first by a sigh, then b^^ 
 an audible expiratory moan, etc. 
 
 The loss of sense, and the convulsions that ensue, points 
 to the brain and spinal cord as the seat of the mischief, pro- 
 duced by the circulation through these nervous textures of 
 carbonaceous or unoxj^genized bloody and the patient dies, 
 as has been strongly but quaintly expressed, _^6>/6'6'w^<^ hy 
 his own hlood. The correctness of this theory is corrobo- 
 rated by the suddenly-poisonous effects produced by the 
 inhalation of carburetted hydrogen, and other gases into 
 which carbon enters largely ; whereas, simple hydrogen and 
 nitrogen gases operate only negatively by usurping the 
 place of atmospheric air. The theory of the anesthetic 
 effect of ether and chloroform inhaled, is, that they enter 
 the circulation, and through it reach the brain and nervous 
 system. Accounts are recorded of grave-diggers having 
 fallen suddenly from the inhalation of the effluvia bursting 
 from corpses dug upon. The rapid poisoning of the brain 
 and nervous system by gases, through the blood, is unde- 
 niable. 
 
 Treatmejtt. — In the treatment of asphyxia, the first indi- 
 cation is to remove the cause, if it can be discovered, which 
 will often be the only means required. In other cases, the 
 body should be stripped of clothing and WTapped in a warm 
 blanket, with the head and shoulders somewhat elevated, 
 and the patient should have free access to air. AVhen the 
 temperature of the body has not been diminished, cold 
 water may be dashed over the face, shoulders, and even the 
 spine, and artificial respiration should be at once resorted 
 to, and persevered in for some time. 
 
 If the body be wet or moist, it should be wiped perfectly 
 
922 NERVOUS FORMS OF DISEASE. 
 
 dry before placing it in warm flannel ; and should water 
 have entered the air-passages, the mouth should be care- 
 fully cleansed of frothy mucosities, by means of the finger 
 or the feathered part of a quill, a catheter introduced into 
 the larynx, and a syringe or the mouth applied to its outer 
 extremity for the purpose of withdrawing the liquid ; and 
 when this is accomplished, artificial respiration should be 
 had recourse to. 
 
 In addition to these means, stimulants must be applied 
 to various parts of the surface for the purpose of influenc- 
 ing in this manner the nervous centers, but care must be 
 had not to carry it to too great an extent, lest, when restora- 
 tion ensues, violent inflammation may occur, followed by 
 ulceration and perhaps sloughing. Stimulating enema will 
 be found valuable in nearly every case, and frequently stimu- 
 lants, introduced into the stomach by means of a tube and 
 syringe, have proved advantageous. 
 
 Electro-magnetism has been found a valuable auxiliary 
 in the treatment of asphyxia ; a current passed from the 
 epigastrium to the back part of the head, has restored sen- 
 sibility and vital action, when life was supposed to have 
 become extinct. 
 
 After restoration has taken place, it must be remembered 
 that danger may still exist from disorder of the brain, owing 
 to the previous congestion, or there may be inflammation of 
 one or more organs, with more or less functional derange- 
 ment, all of which require careful watching, and in the 
 treatment of which, the practitioner should be governed by 
 the character of the presenting symptoms. 
 
 Species III. — Aneurism of tite Aorta. 
 The arteries are liable to various morbid conditions, as 
 inflammation, and the deposition of osseous, cartilaginous, 
 fibrous, and other formations, rendering their coats inelas- 
 tic, thickened, and fragile, in portions and patches. These 
 morbid conditions are the causes of aneurisms, or pulsat- 
 ing, bloody tumors and enlargements of arteries, of which 
 the aorta is more frequently the seat than any other ; and 
 
ANEURISM OF THE AORTA. 923 
 
 aneurism of the aorta will therefore suffice as a type of this 
 form of disease. 
 
 Anatomical Yakieties. — 1. Complete dilatation^ or 
 enlargement of a portion of the aorta on all sides. This 
 is most apt to occur in the ascending portion and at the 
 arch, but is met with also in the descending aorta. Some- 
 times there are several of these dilatations in the same 
 case. The dilatation is not 'generally very great — not often 
 over twice or thrice the natural size. If these weakened, 
 inelastic, or diseased portions be distended much beyond 
 this size, they generally burst ; that is, the internal and 
 middle coats give way at the weakest point, and the exter- 
 nal or cellular coat is expanded into a sack, constituting a 
 compound or mixed form of aneurism. 
 
 2. Partial dilatation arises from a weakened or dis- 
 eased patch on the side of the aorta, which, by the pressure 
 of the blood, is expanded into a tumor, narrowest at the 
 neck or opening from the aorta into the pouch. This form, 
 for distinction's sake, or because the three coats are all ex- 
 panded and surround the tumor, is called true aneurism. 
 Aneurisms of the ascending aorta and arch, are, in the 
 first stage, mostly of this variety ; but generally become of 
 the mixed variety at a later period of their growth. Irreg- 
 ular coagula, adhering by peduncles to the walls of the 
 sack, and fluid blood fill these pouches. 
 
 3. Rupture of the internal and middle coats of the 
 aorta^ arising from ulceration or any of the before-men- 
 tioned diseased conditions, produces what is called false 
 aneurism. The blood passing through the rent or fissure, 
 distends the outer or cellular coat into a pouch. This is by 
 far the most frequent form of aneurism, and frequently in- 
 grafts itself on the two preceding varieties. Finally, the 
 outer coat gives way, and the sack is bounded and formed 
 by the contiguous structures and organs pressed upon be- 
 coming thicker and denser from the agglutination of sur- 
 rounding cellular tissue. No structure can resist the pro- 
 gress of the growth of aneurism. Pressure and attrition 
 annihilate every opposing organ and obstacle ; even the 
 
924: NERVOUS FORMS OF DISEASE. 
 
 solid bones and cartilages are worn down and absorbed, and 
 the tumor appears at last, externally. Concentric coagula 
 are generally formed in these tumors. They sometimes 
 burst into internal cavities, and sometimes externally. 
 
 4. Mixed aneurism of the aorta is formed when false 
 aneurism becomes ingrafted upon complete or partial dila- 
 tation. The aorta first becomes dilated, as in the first, or 
 second variety, and then the inner and middle coats give 
 way at the weakest point, and aneurism of the third variety 
 is superadded. This form constitutes a large proportion of 
 cases. 
 
 Symptoms, Signs, and Diagnosis. — Aneurism of the 
 aorta, as has been observed, occurs more frequently in the 
 ascending portion or arch, than in the descending aorta ; 
 hence thoracic aneurism is more common than abdominal, 
 and also much more difiicult of detection. There is no 
 pathognomonic symptom or general sign for detecting a 
 thoracic aneurism before it becomes so superficial as either 
 to be seen or felt. Sometimes aneurism exists for years 
 without any disturbance of the general health, and burst- 
 ing, causes instant death. Generally there is functional 
 disturbance, becoming progressively more and more severe 
 and urgent, but of the character met with in organic afiec- 
 tions of the heart, or severe lesions of other viscera, denot- 
 ing obstruction in the circulation, such as dyspnoea, cough, 
 livid countenance, palpitation, sudden starting from sleep, 
 horrid dreams, oppression of the chest, as if crowded too 
 full ; the radial pulses may be dissimilar as to force, and 
 not synchronous in beat ; there may be wheezing respira- 
 tion or hemoptysis, and a great variety of other symptoms, 
 such as are met with in nervous affections, scirrhus of the 
 stomach or liver, etc. 
 
 It is only by uniting the auscultatory signs with the train 
 of symptoms present, that a clear diagnosis can be made. 
 The distinctive characteristic sound in aneurism, is a deep, 
 hoarse tone, like that heard in rasping a board, of abrupt 
 commencement and termination, and lasting but for a mo- 
 ment, following each beat of the heart or contraction of the 
 
ANGINA PECTORIS. 925 
 
 ventricles. This is most audible just above or just below 
 the clavicles in thoracic aneurism, and decreases toward the 
 heart. It is heard distinctly toward the right of the ster- 
 num, in aneurism of the ascending aorta, and a little to the 
 left, in aneurism of the arch, and more distinctly on the 
 back when the descending aorta is the seat. Pulsation is 
 strong both above and below the clavicles, and when the 
 tumor makes its way to the surface, the skin on the pulsat- 
 ing tumor becomes livid-red. When the abdominal aorta 
 is the seat of aneurism, the j)ulsating tumor may be felt by 
 the grasp, and diagnosed by the stethoscope. 
 
 Peognosis. — Aneurism of the aorta is generally fatal, 
 yet much may be done to prolong life, palliate suffering, 
 and assist the efforts of nature in forming coagulation of 
 the blood in the sack, by means of which a permanent cure 
 is now and then effected. 
 
 Treatment. — We would say, in regard to the treatment 
 of this disease, very little is to be expected, and its intro- 
 duction is given more to explain the peculiar phenomena 
 which are presented, than for any other purpose. The indi- 
 cations are plain, but our knowledge to fulfill them is lim- 
 ited ; the only hope we can have is to form a fibrinous 
 coagula in the sack, and thereby it may be obliterated. 
 With the hope of accomplishing this, the patient should be 
 confined to a recumbent position, avoid all stimulants and 
 excitement, and confine himself to such diet as will not in- 
 crease the quantity of the blood. 
 
 Various mechanical means have been recommended, but 
 as they have resulted in little or no benefit to the patient, 
 WG do not consider it necessary to introduce their descrip- 
 tion and application here. 
 
 Species TV. — Angina Pectoris. 
 This name was given by Dr. Heberden about seventy 
 years ago to a paroxysmal and painful affection of the 
 breast, deep in the throat, and shooting to the left axilla and 
 arm. Perhaps one hundred well-marked cases have been 
 reported through the journals since, many of which proved 
 
926 NERVOUS FORMS OF DISEASE. 
 
 fatal, and dissections have, in the majority of them, re- 
 vealed disease of the heart or contiguous arteries. The 
 subjects were generally males, over fifty years of age, occa- 
 sionally under. But few females are found in the list. 
 
 Symptoms. — Paroxysms of peculiar distress, with inter- 
 vals, longer or shorter, of comfort or perfect health, mark 
 the course of the complaint. The paroxysm comes on sud- 
 denly while the person is under exertion. The sudden dis- 
 tress is referable to the region of the heart, and may be an 
 acute, dagger-like pain, or corded stricture, and seems to 
 threaten immediate death. The sufferer pauses^ seizes any- 
 thing he can reach for support, is afraid to move, and sinks 
 down pale and covered with a cold sweat. The paroxysm 
 may last only a few minutes, and the patient recover, or 
 the sufferings may be protracted to even an hour. The 
 pain shoots upward from the heart, or to the right, but 
 generally to the left shoulder axilla and arm, where it is 
 often extremely acute. Respiration seems more disturbed 
 from \k\.Qifear to hreaihe^ than from inability ; the arms are 
 thrown up to aid respiration ; the pulse is very variable, 
 quick, full, slow, or suppressed, and often regular ; flatus is 
 generally belched, which affords great relief. 
 
 The attacks are usually mild at first, and progressively 
 increase in severity. Sometimes only a transient, shooting 
 pain in the heart is first noticed ; sometimes there is pain 
 radiating to the left arm ; at others, there is a sense of dis- 
 tention at the heart, more permanently fixed, with stoppage 
 of its beat, and violent palpitation. 
 
 Causes. — The exciting causes may be anything that for- 
 cibly hurries the circulation, as prolonged, or sudden, violent 
 exercise. The remote causes will be found to depend on 
 either organic or functional derangement of the heart and 
 arteries, or sympathetic functional derangements of the 
 stomach and nervous system, brought on by dyspepsia or 
 other depressing causes — the habit of the subject and his- 
 tory of the case will determine. 
 
 Treatment. — During the paroxysm, administer the Com- 
 pound Tincture of Lobelia and Capsicum, in tablespoonful 
 
HEMORRHOIDS. 927 
 
 doses, which must be repeated every ten or fifteen minutes, 
 until relief has been afforded ; if the paroxysm is not com- 
 pletely relieved by this, an emetic should be given as soon 
 as the patient can swallow, for which the Common Emetic 
 Powder will be found the most useful. This has, in all the 
 cases which we have treated, given prompt and permanent 
 relief. From its known relaxing influence over the nerves 
 and muscles, the Tincture of Gelseminum might probably 
 be used with advantage in this disease. 
 
 In addition to this, when the paroxysms are severe, and 
 there is coldness of the surface and extremities, external 
 stimulants, as Ammonia, or Granville's Lotion, must be 
 applied, especially over the epigastrium and along the 
 spine, with warmth and friction to the extremities. 
 
 In order to prevent a return of the disease, the treatment 
 should be especially directed to the nervous system, as well 
 as to any other disease which may be present, as gout, 
 rheumatism, dyspepsia, etc. The condition of the stomach 
 should be particularly watched ; acidity may be removed by 
 Carbonate of Ammonia, and flatulence and constipation by 
 their appropriate remedies. Moderate exercise should be 
 advised, together with a healthy, nutritious, digestible diet, 
 an avoidance of acids, fats, and alcoholic liquors, as well 
 as of all excesses, and the mind should be kept perfectly 
 free from excitement or alarm. 
 
 Species Y. — Hemorrhoids, 
 
 Hemorrhoids, or piles, comprehend several forms of dis- 
 ease of the rectum, in which bleeding may or may not be 
 an attendant symptom, as the name imports. 
 
 1. The commonest form of hemorrhoidal tumors is pro- 
 duced by an eversion of a portion of the verge of the anus 
 from standing, walking, or other long-continued exertion 
 in the upright posture, in persons of lax constitution and 
 fiber. The sphincter ani is incompetent to prevent this 
 eversion of a portion of the mucous membrane, and its 
 efibrts only serve to strangulate the portion extended, which 
 soon swells and becomes inflamed and painful . Early re- 
 
928 NERVOUS FORMS OF DISEASE. 
 
 ductionof the extended portion of the gut and its retention, 
 by lying in bed, suffice to remedy the difficulty ; but often 
 some hours of neglect prevent reduction, or if reduced, the 
 tumor again protrudes of itself, though the patient assumes 
 the horizontal posture, becomes painful, livid, and inflamed, 
 and constitutes an acute attack of hemorrhoids. 
 
 2. Another form of hemorrhoidal tumor arises from va- 
 ricose veins, or infiltration of blood into the cellular tissue 
 between the muscular portion or walls of the rectum and 
 its mucous membrane just within the anus, which, becoming 
 extended, are often a source of constant irritation and dis- 
 comfort, and sometimes of great suflfering. They some- 
 times bleed, giving rise to the term, bloody piles, in contra- 
 distinction to the former variety, which is often called blind 
 piles. These varicose sarculated tumors or cysts, in some 
 cases, increase to a large size, and appear lobulated, are 
 ordinarily kept reduced, but are liable to become extended 
 at every exoneration of the bowels, and call for surgical 
 operation. 
 
 3. A third variety of hemorrhoids is bleeding from the 
 rectum. This is not a very uncommon affection, and often 
 gives no uneasiness, recurring only occasionally, and while 
 the patient is at stool. Varicose tumors may be the source 
 of the flux, or it may be an exudation of blood from the 
 mucous surface. We occasionally find the discharge ha- 
 bitual in free-livers. When it becomes profuse and fre- 
 quent, the hemorrhoidal flux is a matter of much solicitude, 
 and occasionally brings on an anemic condition, and finally 
 terminates fatally, unless arrested by medical treatment. 
 
 Treatment. — The following treatment from "Eclectic 
 Surgery," pages 369, 370-71, is that which is usually pur- 
 sued by Eclectics, and which we extract from that work : 
 
 " In the treatment of this disease, almost everything de- 
 pends upon the general health. A torpid condition of the 
 liver and derangement of the whole digestive system is a 
 very general attendant. Hardened faeces, impeding the re- 
 turn of blood from the part, have been regarded as the 
 cause. 
 
HEMORRHOIDS 929 
 
 "At times the tumors and whole anus will become exter- 
 nally inflamed. In such a case, evacuate the bowels freely. 
 This is generally best done by some medicine that has a 
 specific action on the liver, in combination with a hydra- 
 gogue, so as to produce effective but thin discharges that 
 will not irritate the rectum. Small doses of Podophyllin, 
 from one-eighth to a quarter of a grain, taken every two 
 hours for six or eight hours, and then followed up with from 
 3ss to 3j of our common cathartic powder will generally 
 have the desired effect. 
 
 " After the evacuation, or even before, if the pain and 
 inflammation be severe, the local application of Tobacco will 
 have a good effect. Take a piece of the pressed article 
 finely cut, or a cigar, moisten it in warm water, and let it 
 be pressed up the rectum in contact with the tumors, and 
 confined there by a ' T ' bandage. This measure will al- 
 most invariably give temporary relief. In some instances, 
 the application may cause a little nausea. This is not gen- 
 erally of much consequence. Should it, however, go to the 
 extent of vomiting, or much nervous depression, the ' plug ' 
 should be at once removed. 
 
 " For constant use, let a salve be made of the Extracts of 
 Stramonium and Tobacco, ad 3j, and Tannin, gr. v. Let 
 this be applied three or four times a day so as to come in 
 contact with every tumor. It is well also to have it spread 
 and kept on permanently during the night. Should there 
 be much tendency to hemorrhage, increase the proportion 
 of Tannin." 
 
 " Cold water is generally a good palliative. 
 
 " The patient should be directed to take regularly of the 
 Alterative Syrup, with from one-eighth to one-half of a grain 
 of Podophyllin every night. 
 
 " This simple treatment will remove all recent cases. 
 But in some instances of long-standing, the piles have be- 
 come hardened and callous. In this stage they are nearly 
 insensible unless when inflamed. I have been called on to 
 treat many such chronic cases in which the tumors wore a 
 very malignant appearance, and had already occasioned ul- 
 
9 30 NERVOUS FORMS OF DISEASE. 
 
 ceration to a very considerable extent. The course of 
 treatment which has been successful in every such case, is 
 this : 
 
 " Place a ligature round the tumor, or round two or three 
 if there are many, passing it through a cork, as recom- 
 mended in the case of fistula in ano, and tightening^t every 
 day, until the strangulated tumors slough oK The patient 
 meantime should constantly keep on a Slippery-Elm poul- 
 tice, and rest as still as possible — the bowels being loosened 
 by small portions of hydragogue physic. 
 
 " The ligature, as a means of removing large hemor- 
 rhoidal tumors, is far preferable to the knife. It is not so 
 alarming to the patient and gives him no pain except on the 
 first application, and for a few moments after each tighten- 
 ing. It avoids all the danger of inflammation, and the still 
 greater danger of hemorrhage. The books are full of in- 
 stances where patients have sunk under or immediately 
 after the operation. 
 
 " The disease rarely returns after removal by ligature, 
 even though the patient should neglect himself and become 
 costive. But I wish you to bear in mind that no mode of 
 local treatment — at least none short of this operation by 
 ligature — will efiect more than temporary relief, unless pro- 
 per constitutional remedies are at the same time ap- 
 plied." 
 
 In addition to the above, we make use of the Hydrastis 
 and Prinos Yerticellatus, as recommended in the treatment 
 of dyspepsia ; and where there is much hemorrhage, we 
 combine with this Geranin in sufficient quantities to 
 arrest it. 
 
 Species YI. — Diabetes Mellitus 
 
 This term is applied to an excessive secretion and evacu- 
 ation of sweetish-tasted urine. It occurs more often in the 
 middle ages of life than in childhood or old age, and is the 
 true diabetes of authors. 
 
 History. — Hippocrates makes no mention of this form 
 of disease. Celsus and Galen treat of it ; and Areteaeus 
 gives a clear and minute description of it. He considered 
 
DIABETES MELLITUS. 931 
 
 it a liquefaction of the body into nrine. Willis first called 
 attention to the saccharine taste of the urine, and noticed 
 the fact that more urine was sometimes voided than the 
 whole amount of fluids drank. Sydenham has left an ac- 
 curate account of diabetes, its causes and indications of 
 cure, but has made no niention of the saccharine quality of 
 the urine. Cullen, and also Heberden, treat of this form 
 of disease, since which time it has received the attention of 
 many able men in the profession. More-extended observa- 
 tions prove that in some cases more urine is discharged than 
 the whole amount of both solid and liquid aliments taken 
 into the stomach, though generally less than the liquids 
 taken. The urine has in some cases amounted to four or 
 five gallons a day, always sweet to the taste, and ferment- 
 ing quickly if yeast be added. 
 
 Symptoms. — Along with an increased flow of urine, first 
 noticed, perhaps, by being called to rise at night, thirst and 
 a dry and clammy state of the mouth and throat are no- 
 ticed. Accident may discover to the person a sweet taste 
 in the urine. Sometimes a mawkish-sweet taste in the mouth 
 is early complained of. The appetite, as well as desire 
 for fluids, is craving. The tongue becomes furred with red 
 edges. The skin is dry and rough. The bowels become 
 costive; there is a gnawing, craving feeling in the stomach; 
 lassitude and weariness under the least exertion ; constant 
 aching across the loins ; uneasiness and redness of the 
 meatus urinarius ; sometimes after the passage of urine the 
 semen flows involuntarily ; serious disturbance of the gen- 
 eral health ensues; the pulse, at first quicker, becomes 
 slower than natural and without force ; the feet and ankles 
 swell ; emaciation becomes extreme ; hectic fever ensues ; 
 the gums soften as in scurvy, and shooting pains and cough 
 mark the last stage of the complaint, with a peevish, irrita- 
 ble state of mind and great depression of spirits. 
 
 Nature and Cause. — Despite all the investigations of 
 
 able inquirers, the pathology of diabetes is still involved 
 
 in great obscurity. Post-mortem examinations generally 
 
 reveal structural changes in some important organ, and 
 
 69 
 
932 NERVOUS FORMS OF DISEASE. 
 
 more frequently, perhaps, of the kidney, than any other 
 abdominal viscus ; but the changes of structure are so dis- 
 similar, that it is impossible to say what is the nature 
 and primary cause of this extraordinary affection. The 
 stomach, liver, spleen, lungs, mesenteric glands, etc., have 
 all in turn been found deeply implicated, and the kidneys 
 occasionally nearly natural. Some physiologists have come 
 to the conclusion that the stomach is the seat of the first 
 morbid action, converting vegetable food into sugar, which 
 the kidneys were taxed to eliminate as a foreign substance ; 
 while others have ascribed its origin to a morbid state of the 
 liver and bile ; and others again to a morbid state of the 
 assimilatory and nutrient functions; while others have 
 reasoned that an irritable state of the kidneys was sufficient 
 to account for all the phenomena presented. Analysis of 
 the urine shows that, while the solid constituents of healthy 
 urine are nearly maintained, there is the additional intro- 
 duction into the urine of the foreign substance of grape 
 sugar in considerable quantity, by some unaccountable per- 
 version of function. For a long time analysis of the blood 
 of diabetic patients did not reveal the presence of sugar, 
 but of late several respectable chemists have detected it ; 
 and Mr. McGregor has found that the dried serum of dia- 
 betic blood, re-dissolved in a small quantity of warm water, 
 underwent fermentation on the addition of yeast, proving 
 that the sugar is formed before it reaches the kidneys. The 
 most rational conclusion, therefore, is, that the digestion 
 and assimilative functions are first deranged, and that the 
 morbid phenomena presented are the result of the grape 
 sugar formed and thrown constantly upon the blood. 
 
 Prognosis. — Diabetes mellitus is a very fatal form of dis- 
 ease. It often comes on insidiously, and has become well- 
 established before advice is sought. Still, the mild forms 
 of this formidable afiection may, with unerring attention 
 on the part of the patient to the regimen and treatment, be 
 so governed as to enable the patient to pass through life in 
 a comfortable condition. It is very difficult, however, for 
 patients to control their appetites and follow the necessary 
 
DIABETES INSIPIDUS. 933 
 
 rules of living, and hence it is difficult to establish a perfect 
 cure after the disease has been once fully developed. Dr. 
 Prout says, of twenty cases treated, he never saw but one 
 where the urine became natural again. Dr. Bardsley asserts 
 that, of twenty-nine cases treated, eight recovered per- 
 fectly. But it is asserted that a disposition to its return re- 
 mains in cases reported cured, and that ultimately these 
 cases fall victims to its return. Fortunately it is not a com- 
 mon form of disease ; the writer of this never met with but 
 one case of diabetes mellitus. 
 
 Treatment.— This is a disease, well known by all classes 
 of medical men, to be very difficult of successful treatment. 
 "We have, however, succeeded in effecting permanent cures 
 in several cases by the following method : 
 
 Podophyllin and Leptandrin, to be given in doses suffi- 
 cient to arouse the hepatic functions, without active cathar- 
 sis being at the same time induced. Subsequently to this, 
 when the liver and biliary organs have been excited, dia- 
 phoretics and tonics to be given, as the Compound Powder 
 of Ipecac, and Opium, with Hydrastin and Prussiate of 
 Iron, and an irritating plaster over the region of the kid- 
 neys, which course is to be pursued until the excessive dis- 
 charge of urine has abated. In connection with this, the 
 spirit vapor-bath must be employed at least twice a week, 
 and the body should often be thoroughly rubbed all over the 
 surface. When the discharge of urine has lessened, the 
 above means may be omitted, with the exception of the 
 spirit vapor-bath, and the Compound Syrup of Stillingia 
 with Iodide of Potassium, given in the usual doses, and 
 continued until the cure is permanent. 
 
 The diet of the patient should be exclusively of an animal 
 character. 
 
 Species YII. — Diabetes Insipidus. 
 The term diuresis is usually employed to designate co- 
 pious urinary discharges, other than that of saccharine 
 character, which is the true diabetes of authors ; but where 
 these forms of diuresis become confirmed, or of permanent 
 
934: NERVOUS FORMS OF DISEASE. 
 
 character, they are usually treated of as diabetes insipidus. 
 The urine, however, though not sweet, is not always taste- 
 less as the term imports. 
 
 The sirrvple forms of diabetes insipidus are of frequent 
 occurrence in nervous, hysterical, and dyspeptic subjects, 
 of lean habit and irritable fiber, induced by anything that 
 disturbs their equanimity, as changes of weather, articles 
 of food or drink, mental agitation, etc. The urine is 
 copious, pale, and watery, but its solid constituents are 
 unaltered. 
 
 TJie comjpliGated forms of this afiection are not only 
 marked by copiousness in quantity of urine daily passed, 
 but the solid constituents held in solution are altered in 
 their proportions, and thus differ from healthy urine. This 
 state of things should also be marked by a degree of per- 
 sistency of the affection in order to constitute the disease. 
 In some cases the urea is greatly in excess, the urine hea- 
 vier than natural, and characterized by acid reaction ; in 
 others the urea is greatly deficient ; sometimes the urine is 
 of albuminous character, indicative of Bright's disease of 
 the kidney, now and then contains extractive matter, and 
 sometimes chyle. These forms of diabetes insipidus are 
 often marked with gnawing or morbid feelings of the stom- 
 ach, debility, thirst, dull pain in the back, and an anxious 
 expression of countenance. The causes producing the de- 
 rangements under consideration are not known. The sub- 
 jects are more usually men of middle age, whose constitu- 
 tions have become broken by disease, intemperance, or ve- 
 nereal and other excesses, though all ages and both sexes 
 are liable. If taken early the majority of cases are re- 
 mediable. 
 
 Treatment. — Diabetes insipidus may be cured by the 
 means advised for diabetes mellitus. It is generally more 
 easily influenced by remedial agents, does not require such 
 active and energetic treatment, and has frequently yielded 
 to diaphoretics alone. 
 
ISCHURIA RENALIS. 935 
 
 Species YIII. — Ischuria Renalis. 
 
 Ischuria renalis, or suppression of urine, is either a total 
 abolition of the secretory function of the kidneys, or so 
 marked a diminution as to be clearly morbid. In the form 
 of total suppression, it probably depends on paralysis of the 
 kidneys from disease in the nervous centers, atrophy, indu- 
 ration, or other structural change of the kidneys being the 
 result. In the form of partial suppression, it is symptom- 
 atic of other forms of disease, and is much more frequently 
 met with than total suppression. 
 
 Symptoms. — Suspension of the passage of urine first 
 attracts observation, or notice is taken of the very minute 
 quantity passed. It is proper to remark in this place, that 
 retention of urine is a very different matter from suppres- 
 sion, and care must be taken to examine the state of the 
 bladder, by percussion and the introduction of the catheter. 
 The writer has seen retention of urine, resulting from pa- 
 ralysis of the bladder, where the urine would not flow even 
 after the introduction of the catheter until adequate pressure 
 was made upon the abdomen, when several quarts of urine 
 were drawn off. This condition might be mistaken for 
 ischuria. Obstructions to the flow of urine in the pelvis, or 
 the kidney, or in the ureters, are not likely to be mistaken 
 for suppression, owing to the pain and suffering in nephritic 
 and gravelly affections. In idiopathic suppression, little or 
 no uneasiness may be felt for the first few days, save anxiety 
 as to the suspension of the flow of urine, or perhaps slight 
 pains in the lumbar region, which is all the history the 
 patient can give on applying for advice. Nausea and per- 
 haps vomiting come on in a day or two, with torpor and 
 sleepiness. The pulse is slower than natural. When 
 roused, the patient seems surprised that any concern should 
 be manifested in his case. In five or six days coma super- 
 venes, and convulsions usually set in before death, which 
 happens within the week after total suppression is estab- 
 lished. The case may run longer if small quantities of 
 urine are from time to time passed. 
 
936 NERVOUS FORMS OF DISEASE. 
 
 Ischuria may occur at any age or period of life from 
 infancy to old age. It has been asci'ibed to dentition in 
 children, and to gouty habits in elderly people. It is per- 
 haps more often seen in the corpulent and well-fed, who 
 have passed the meridian of life. It is not a very common 
 form of disease. The writer has met with two cases only 
 of well-marked idiopathic ischuria, one in a gourmand of 
 forty-seven years of age, and the other in a lad of seven ; 
 both terminated fatally. 
 
 As a symptomatic affection ischuria is often met with 
 under various forms of acute disease, such as fevers, in- 
 flammations, dropsies, Asiatic cholera, etc., and in many 
 cases, no doubt, greatly aggravates the primary affection 
 by throwing the urine back upon the blood, and conse- 
 quently upon the brain, inducing coma by the poisoning 
 influence of urea upon the nervous centers — the cause of 
 death, doubtless, in the idiopathic form. The depuration 
 of the blood by the renal secretion is so important that it 
 can not long be dispensed with, and hence it becomes the 
 prominent indication in numerous forms of disease, espe- 
 cially in the exanthematous affections where elimination 
 from the skin is interrupted. Symptomatic ischuria, there- 
 fore, will never escape the attention of the vigilant prac- 
 titioner. Nature, it is affirmed, sometimes sets up a vica- 
 rious secretion of urine from either the stomach, bowels, 
 skin, umbilicus, mammse, or elsewhere, in order to preserve 
 life under a state of total suppression. The hint thus 
 derived from nature should be acted upon, and the emunc- 
 tories of the system be addressed by remedies where the 
 kidneys are unable to maintain their function. 
 
 Tkeatment. — The first indication in this disease is to 
 restore the functions of the kidneys and the consequent 
 secretion of urine, and secondly, to prevent a return of the 
 attack in patients who are subject to it. To fulfil the first 
 indication, the patient must be placed in a bath as warm 
 as can be borne, in which he should remain until approach- 
 ing syncope ; he should likewise be made to drink freely of 
 an infusion of equal parts of Queen of the Meadow root, 
 
ENURESIS. 937 
 
 Marsh-Mallow root, and Peach leaves, or an infusion of 
 Uva Ursi and Spirits of l^itre ; and this drink should be 
 continued for several days after the return of the urinary 
 discharge. Should constipation be present, the Compound 
 Powder of Jalap, with Bitartrate of Potassa, may be given. 
 To prevent a return of the attack, an irritating plaster 
 should be applied intermittingly over the region of the 
 kidneys, and the following pill given internally: 
 R« Eupurpurin, 9ij, 
 
 Xanthoxylin, BJ, 
 
 Strychnia, grs.j. Mix, 
 Divide into twenty pills, of which one may be given 
 three or four times a day. Should the disease be compli- 
 cated with any other, the complication must be treated 
 according to its peculiar character. "When the disease is 
 owing to a disorganized condition of the kidneys, palliative 
 measures are all that can be of service. 
 
 Species IX. — Enuresis. 
 
 Enuresis, or incontinence of urine, may be the result of 
 an irritable condition of the urinary bladder, or of a partial 
 or complete paralysis of the sphincter muscle by which the 
 discharge is usually governed. In the former case, the 
 bladder may be either in a state of inflammation or so 
 highly irritable that it can not tolerate the presence of even 
 healthy urine, or suffer the least distention without painful 
 contraction of its muscular coat ensuing, bringing on the 
 most urgent and irresistible desire to micturate. There 
 may exist every degree of this urgency, from the slightest 
 nocturnal incontinence of childhood to the extreme condi- 
 tion presented in cystitis and strangury. In the latter case, 
 the bladder may be perfectly healthy, but the sphincter so 
 paralyzed as to be inoperative, and the urine therefore 
 passes off involuntarily. 
 
 Incontinence^ as a symptom of acute or chronic inflam- 
 mation or strangury, arising from the absorption of cau- 
 tharides, or from other vesical irritation, as acrid urine, 
 etCj is the offspring of totally different pathological con- 
 
938 NERVOUS FORMS OF DISEASE. 
 
 ditions from that arising from weakness or paralysis of the 
 sphincter of the bladder, and in the investigation of these 
 cases the curative means must be directed with reference to 
 the causes and their removal. The causes may in some 
 cases be obscure, as in the nocturnal incontinence of chil- 
 dren, that sometimes- seem to be perpetuated by the law of 
 habit. In many instances, the discharge occurs only in 
 dreams, but in the most inveterate cases of this form the 
 patient is entirely unconscious. The habit usually ceases 
 at puberty, but sometimes it does not, and though not 
 seriously implicating the physical health, becomes highly 
 important in its moral influences, and calls for the sympathy 
 and ablest skill of the practitioner. 
 
 Where it arises fro'm paralysis of the muscles governing 
 micturition, the case is often deplorable and quite beyond 
 the resources of our art, except in a palliative point of view, 
 or rendering the condition as comfortable as possible. This 
 unhappy condition sometimes occurs after childbirth, in 
 consequence of mechanical injury, or after distention of the 
 urethra in extracting calculi from the bladder. This form 
 of incontinence is often met with in aged persons, and 
 frequently supervenes in various forms of disease before 
 death. It is not unfrequently associated with paralysis of 
 other parts depending on cerebral or spinal disease. 
 
 Treatment. — In this disease the bowels should be kept 
 in a soluble condition by mild laxatives ; an irritating plaster 
 should be applied to the sacrum, and the spinal column 
 should be douched with cold water, twice a day. Inter- 
 nally, we have derived the greatest benefit, in adults, from 
 the following mixture : 
 
 K. Comp. Syr. Stillingia, 5iv, 
 Iodide Potassium, 3j, 
 Tinct. Cantharides, 3j. Mix. 
 
 Of this, give one drachm in about a wineglassful of 
 water, three times a day, until it produces the specific effect 
 of the Iodide upon the head, and also strangury. If the 
 above quantity of Cantharides should not produce this efiect 
 within a proper time, it may be necessary to increase its 
 
ENURESIS. 939 
 
 quantity. We have usually succeeded in curing this com- 
 plaint by the above course. 
 
 We extract the following, from the Eclectic Medical 
 Journal, Yol. I, 1853, third series, by Professor J. King, 
 relative to this affection, more especially when it is present 
 in children. 
 
 " It is only for those cases in children and adults, arising 
 from a debility of the urinary organs, produced by impro- 
 per food or drink, or over exercise, straining or relaxing 
 the parts, that I wish to lay down a mode of treatment 
 which has been almost invariable successful. 
 
 In a majority of cases to which I have attended, the isin- 
 glass mixture has proved effectual ; it is a pleasant remedy, 
 and well worthy a trial in every instance. It will likewise 
 be found very beneficial in incontinence following severe 
 rheumatic or gouty affections. 
 
 R. Take of isinglass two drachms ; boil it in one pint 
 of water until it is dissolved ; then strain, and add one pint 
 of sweet milk, put it again over the fire, and let it 
 ^ just boil up ;' then sweeten with loaf sugar, and grate 
 nutmeg upon it. When it is made, it very much resembles 
 custard. 
 
 Dose. — For an adult, a half-pint or a tumblerful three or 
 four times a day. I have known this mixture to prove 
 serviceable in many cases where all other medicines had 
 produced no good effect whatever. 
 
 Should the above fail, which, by the bye, will be found 
 a very rare circumstance, the following diuretic convpound 
 will be of efficacy ; 
 
 R. Fulvis Eupatorium Pnrpureum, 
 " Aralia Hispida, 
 " Althaea Officinalis, 
 " Epigma Repens, da 3j. 
 
 Steep the compound in four pints of water for about four 
 hours, then add four pints of good Holland Gin, heat it 
 until it boils, and when cold sweeten with honey. 
 
 This compound will also be found useful in all urinary 
 
940 NERVOUS FORMS OF DISEASE. 
 
 difficulties, as suppression, heat, high color, difficulty in 
 urinating, gravel, urethritis, etc. 
 
 Dose. — In severe cases a wineglassful every hour until 
 relief is obtained, after which, and also in mild cases, a 
 wineglassful three or four times a day. 
 
 In connection with the above compound, a strong tea of 
 the following articles should be drank freely : 
 R. Trillium Latifolium, 
 Myrica Cerifera, 
 Prunus Yirginiana ; 
 Of each, equal parts. If, as is sometimes the case, the com- 
 plaint is occasioned by a check of perspiration, a spirit 
 vapor-bath in addition, will be found beneficial. 
 
 In children, this symptom is often the result of habit or 
 carelessness, in not being made to urinate immediately 
 before going to bed ; it will, therefore, be necessary to 
 attend to this, and also to awaken the child at stated inter- 
 vals through the night, for the purpose of evacuating the 
 bladder. In some cases it may be found that the urine is 
 passed during sleep while in one particular position, as, for 
 instance, on the back ; by changing this position, some 
 benefit may at times result. 
 
 Where children are in the habit of taking suppers, very 
 little fluid should be allowed them, and tea and coffee must 
 be abstained from, even for some time after a cure has been 
 effected. The diet should be principally of boiled milk and 
 wheat flour, with a little nutmeg and cinnamon sprinkled 
 on it. In some cases a stimulating adhesive plaster applied 
 from the small of the back to the sacrum, will be found a 
 valuable auxiliary." 
 
 Species X. — Scorbutus — Sourvy. 
 The term scorbutus is said to be derived from the Danish 
 word scorbech^ sore-mouth. There seems to be no doubt 
 that this form of disease was known to the ancients, although 
 the particular phenomena constituting it have not descended 
 under a name. Writers of the sixteenth century — Krantz, 
 Olaus, Magnus, and others — treat of it under the name of 
 
SCORBUTUS— SCURVY. 941 
 
 scurvy, as a destructive disease affecting the northern 
 nations of Europe ; and from that period until about the 
 commencement of the eighteenth century, when its proper 
 treatment and prevention became understood, it destroyed 
 more sailors than the accidents of a sea-faring life and 
 naval warfare united. On land it was formerly as fatal as 
 an epidemic. It has sometimes been treated of under two 
 forms, as appearing on land, and on board ships, or as 
 land-scurvy and sea-scurvy, but there is no essential diffe- 
 rence in the symptoms. The manner of living induces it, 
 viz., an exemption from succulent fruits and vegetables. 
 Before the arts of horticulture and orcharding had made 
 much progress it was very destructive on land, and after 
 the impulse given to navigation by the discovery of Amer- 
 ica, when long voyages at sea became common, it appeared 
 more distructive on ship-board. It is not uncommonly met 
 with now-a-days in the frontier settlements of the West. 
 The writer has often encountered it toward the close of 
 winter or during the spring season, in the frontier settle- 
 ments of the western States, and has no doubt that a scor- 
 butic tendency greatly prevails in the border settlements 
 generally, greatly aggravating all the vernal attacks of 
 malarious and other forms of disease. 
 
 Symptoms. — The first notable symptom is paleness of the 
 countenance. Slight scratches and bruises become trouble- 
 some sores. The patient complains of lassitude, is indis- 
 posed to make exertion, and slight efforts produce fatigue. 
 There is feebleness, and trembling of the knees ; depression 
 of spirits ; fetid breath ; sponginess of the gums, which 
 often bleed ; the teeth become loose ; livid specks appear 
 in patches on the arms and legs ; the mouth is complained 
 of as sore, and frequently bleeding ulcers appear on the 
 tongue. The constitution becomes more and more enfee- 
 bled ; hemorrhage takes place from some of the natural 
 openings ; edema of the feet and ankles takes place ; old 
 wounds become painful and re-open ; there are tearing pains 
 in the belly; pains in the bones and other parts, sometimes 
 pleuritic pains with cough ; there is often syncope on rising to 
 
942 NERVOUS FORMS OF DISEASE. 
 
 the erect posture, and not unfrequently death occurs suddenly- 
 after the exertion of walking across the room. The pulse 
 is slower than natural and feeble throughout the course of 
 the attack ; the ulcers do not secrete healthy pus, but a thin 
 sanious ; the appetite is generally good and a great desire 
 for vegetable and acid food prevails. 
 
 Such is the usual character of scorbutus, but there is 
 every phase of complication of it with other fcrms of disease 
 presented, which inexperienced practitioners are apt to 
 overlook. For instance, women in the puerperal state, 
 restricted in their diet and exhausted by lactation,. become 
 frequent suffers from a tendency to scorbutus. The writer 
 has encountered many anomalous conditions at the bedside 
 of puerperal patients that had withstood the treatment of 
 reputable practitioners three or four months, and which 
 yielded at once to the appropriate treatment for scurvy. 
 
 Causes. — An altered and depraved state of the blood, 
 occasioned by stale, salted animal diet to the exclusion of 
 succulent vegetables, we are told by many authorities, con- 
 stitutes the main or principal cause of this form of disease. 
 But we beg leave to ask whether the condition of the blood 
 is not, in reality, the disease ? This is our opinion ; but 
 there are other causes that favor the production of this con- 
 dition of the blood — that is, the disease ; such as, cold and 
 humidity, an inactive life, and any debilitating circum- 
 stances to which individuals may be exposed. Hence preg- 
 nancy is a predisposing cause, and united with the almost ex- 
 clusive " hog-and-hominy " fare of the frontier settlements, 
 often induces the scorbutic diathesis. The writer has wit- 
 nessed the sudden death of several delicate women, under 
 such circumstances, after delivery, not traceable to any other 
 cause. No hemorrhage, or other difficulty, but death 
 ensued. This suddenly expiring after a shock of the sys- 
 tem, is strongly characteristic of scurvy. A drooping sailor 
 will suddenly lie down and die after the unusual exertion 
 required of hands during a storm at sea. Of course, many 
 diseased conditions of the system favor the production of 
 the scorbutic diathesis, as well as the remedies in ordinary 
 
SCORBUTUS— SCURVY 943 
 
 use by the Allopathic school for their removal. A state of 
 mercurialization is akin to the scorbutic condition. The 
 condition brought on by an inordinate use of alkalies is 
 also similar to that presented in scurvy. 
 
 Diagnosis. — Purpura is the only form of disease likely to 
 be confounded with scurvy. This is considered by some 
 authors as a variety of scurvy. But it generally appears 
 in autumn, when fruits and vegetables abound, and the 
 purple patches or petecchiee are brighter when they first 
 appear, fade away and are succeeded by another crop, 
 whereas, in scurvy, they are dark-colored at first and per- 
 sistent. There is not the same tendency to softening of the 
 gums and soreness of the mouth in purpura as in scurvy, 
 nor do the remedies, lemon-juice and fresh vegetables, 
 which cure scurvy, effect a cure of purpura. 
 
 Prognosis. — Since the nature of scurvy has been under- 
 stood, it has ceased to be considered alarming, where the 
 remedies for its relief are to be had. It is only where the 
 proper recourse to suitable diet and remedies can not be 
 obtained, as in long voyages at sea, or where incurable 
 diseases have set in, that a fatal termination may be antici- 
 pated. 
 
 Tkeatment. — This disease requires but little medical 
 attention, the principal thing being a change of diet, and 
 a removal from the causes producing it. The patient 
 should be placed upon a fresh vegetable diet, especially of 
 acid fruits, oranges, lemons, limes, sour-krout, and similar 
 articles. 
 
 As a local application, whether it be attended with 
 hemorrhage or ulceration, notwithstanding the great variety 
 of remedies which have been recommended, in our opinion, 
 nothing equals the strong decoction of Hydrastis Canadensis, 
 very frequently applied to the parts, and at the same time, 
 taken internally several times a day. We have succeeded 
 m curing several cases with the Hydrastis alone, having 
 previously removed the producing causes. 
 
94:4 NERVOUS FORMS OF DISEASE. 
 
 Species XI. — Chlorosis. 
 
 This form of disease may be said to be identical with 
 chronic anemia. From the peculiar paleness of counte- 
 nance characterizing it, being of a waxen transparency, or 
 yellowish-green hue, it has been called chlorosis or green- 
 sickness. It is most usually met with in young females, 
 between puberty and maturity, accompanied with retention 
 of the menses, but occasionally is met with in married 
 women, and sometimes is seen in male youths of delicate 
 constitution, and also workmen employed in mines.. 
 
 The idiopathic form of chlorosis is generally seen in girls 
 of lymphatic temperament, arrived at the age of puberty, 
 of depraved constitution and weak vital forces, insufficient 
 to carry out and establish harmony of function, under the 
 developments of sex. For an account of the symptoms and 
 causes of chlorosis, or the green-sickness of girls, see "Ee- 
 tention of the Menses," under the head of Amenorrhea. 
 
 Chlorosis may supervene as a consequence of repeated 
 losses of blood, and frequently does in married females, as 
 after frequent miscarriages, or hemorrhage incident to child- 
 birth. It sometimes makes its appearance in delicate male 
 youths, and is to be attributed to the same causes that give 
 rise to it in girls. It has been known also to attack miners, 
 confined in an impure atmosphere, deprived of the vivify- 
 ing influences of insolation and fresh air. 
 
 Nature. — The chlorotic condition may be compared to 
 that blanched or etiolated condition of a vegetable growing 
 in a cellar. The blood is impoverished, being nearly de- 
 prived of its red corpuscles. The indication for its removal 
 appears to be the same from whatever cause or causes pro- 
 duced. 
 
 Treatment. — The first thing to be done in this form of 
 disease, is to remove the cause ; for so long as this con- 
 tinues, you can expect but little from any form of treat- 
 ment — hence, it becomes necessary to make use of such 
 means as will assist nature to remove the obstruction. AU 
 the difierent functional or organic derangements which are 
 
HYDROPS. 945 
 
 present, producing this peculiar condition, should be treated 
 as referred to under their respective heads. Perhaps no 
 class of agents possess a greater power than tonics and 
 alteratives, the various forms of Iron, Quinine, Cornine, 
 and Hydrastin, in such proportions as agree well with the 
 condition of the system, avoiding such as produce irritation 
 of the stomach. If this precaution is not strictly adhered 
 to, the Iron will not be conveyed into the circulation, and 
 thereby our object will be thwarted. We have, also, de- 
 rived much benefit from the alkaline-bath, externally, and 
 the Compound Syrup of Stillingia and Iodide of Patassium, 
 in proportions as heretofore recommended. 
 
 If there be much pain, or neuralgic symptoms, present, 
 the Compound Powder of Ipecac, and Opium, or Quinine, 
 should be used. The patient should be allowed moderate 
 exercise in the open air, and avoid every cause which pro- 
 duces excitement of any kind. 
 
 Species XII. — Hydrops, 
 
 Hydrops, or dropsy, is an effusion of serum into the cel- 
 lular tissue and serous cavities of the system. When the 
 morbid accumulation is confined to a particular part, cavity, 
 or shut sack, it is treated of as a form of local dropsy ; thus 
 we have anasarca^ an infiltration of serum into the cellular 
 tissue ; hydroGepJialus^ dropsy of the brain ; hydrothorax^ 
 dropsy of the chest ; ascites^ dropsy of the belly, etc.; and 
 when most of these parts of the system are at the same 
 time invaded, it is called a general dropsy. 
 
 Symptoms. — General dropsy may supervene rather sud- 
 denly under a somewhat febrile condition, marked by in- 
 creased frequency and force in the circulation and heat of 
 the skin, with furred tongue and high-colored, scanty urine; 
 or it may come on very gradually, under an opposite and 
 broken-down, and debilitated state, characterized by de- 
 pressed vascular and vital energy. Frequently its approach 
 is not attended with marked evidences of either excitement 
 or depression. There is often tenderness of the belly, and 
 also of the cellular structure, indicating a low grade of 
 
946 NERVOUS FORMS OF DISEASE. 
 
 inflammator}" action, but more generally the symptoms are 
 characteristic of local irritation rather than inflammation. 
 The appearance of the patient indicates a depraved state of 
 system dependent on some obscure, remote, pathological 
 condition, of which the dropsical effusion is but a symptom 
 or effect. The face is generally pale, and a state of anemia 
 frequently present, in which the w^hite corpuscles of the 
 blood prevail in undue proportion. 
 
 As the disease progresses, the thirst becomes a promi- 
 nent symptom, while the urine is always scanty, but of vari- 
 able character and appearance. Sometimes it is brown, at 
 other times, bloody, opalescent, lateritious, or bilious. In 
 acute or febrile forms of dropsy, it is mostly of a dark and 
 turbid appearance, containing albumen, which will be de- 
 posited in the form of curdy flakes on application of heat 
 or tested with nitric acid. 
 
 Perspiration is greatly deficient also in dropsy. Consti- 
 pation generally attends it. The effused fluid is the serum 
 of the blood, and consists of water mostly, but contains 
 albumen, urea, sometimes fibrin, and the salts of soda, pot- 
 ash, iron, lime, etc. 
 
 Dropsy is common to all ages and both sexes, but is more 
 often met with in the decline of life. The most distressing 
 symptoms of the complaint arise from obstruction to respi- 
 ration and other functions, caused by pressure from the 
 accumulations of water in the body. 
 
 Causes. — Dropsy is caused by irritation, active conges- 
 tion, and inflammation of the serous and cellular tissues 
 which secrete serum for their lubrication in health, there 
 existing a balance and harmony of function in health, be- 
 tween deposition and absorption, which harmony is de- 
 stioyed by the causes producing dropsy. Debility and 
 relaxation in the capillaries of these tissues, and conse- 
 quently passive congestion, may also cause dropsy, by pro- 
 ducing excessive exhalation and deficient absorption. An 
 altered or diseased condition of the blood may also prove 
 a cause of dropsy, and is probably the most common or 
 primitive one. Scarlet fever is often a cause of dropsy 
 
HYDROPS. 947 
 
 in some form, more generally anasarca or ascites; — also 
 measles and other eruptive forms of disease. This may be 
 owing to neglect or inattention to depurate the blood, by 
 diuretics in cutaneous affections, where the functions of the 
 skin are interrupted. ''Malarious fever" is frequently a cause 
 of dropsy, as well, perhaps, by impoverishing the blood as 
 by causing obstructions in the portal circle from enlarge 
 ments of the liver and spleen. Diseases of the heart, liver, 
 and kidneys, are among the most fruitful causes of dropsy, 
 in one or another form. Indeed, Bright's disease, as it is 
 called, of the kidneys, has been supposed to be the real or 
 essential cause of dropsy in most cases, but the inference is 
 unwarranted. 
 
 Prognosis. — Dropsy is a form of disease that occasion- 
 ally abates spontaneously. This might happen if the path- 
 ological condition on which it depended, was removed by 
 the efforts of nature. Nothing is easier than to draw off 
 the water by hydragogues and diuretics, and a portion of 
 the cases recovers entirely, there being no return of the 
 effusion. It often, however, returns again and again, and 
 finally destroys the patient. The acute forms of the disease 
 are often entirely or permanently cured, as those arising 
 from scarlatina. In all cases arising from organic affec- 
 tions and irremediable obstructions, the cases admit of but 
 palliative prospects from any course of treatment, still 
 much may be done to soothe the passage to the grave. 
 
 Treatment. — ^In all the forms of dropsy, just referred to, 
 the general treatment will be the same, though auxiliary 
 measures may be required somewhat varying in each. The 
 indications are to arouse the action of the absorbent sys- 
 tem, evacuate the fluid, and endeavor to prevent its re-ac- 
 cumulation. To fulfill the first of these indications, the 
 spirit vapor-bath should be used once or twice a day, as the 
 strength of the patient will permit, and which should be 
 continued daily, until the removal of the fluid. Internally, 
 hydragogue cathartics should be given, among which the 
 Compound Powder of Jalap and Senna, with Cream of Tar- 
 tar, will be found very valuable ; these may be adminis- 
 60 
 
948 KERVOUS FORMS OF DISEASE. 
 
 tered for the first two or three days, in sufficient quantities 
 to produce an active hydragogue efiect, after which, they 
 should be employed only in laxative doses. Should much 
 gastroenteriti cinflammation be present, hydragogues can 
 not be employed, and milder agents must be given, such as 
 Leptandrin, Caulophyllin, and Fodophyllin in small doses. 
 It is also proper to administer diuretics, especially in those 
 cases where they produce a perceptible diuretic influence ; 
 it will be found, however, that these will frequently fail in 
 producing any effect. 
 
 When these means have removed the effused fluid, 
 measures must then be adopted to prevent its further return. 
 The system must be invigorated by tonics, such as Quinine 
 and Iron, Cornine, Hydrastin, etc., and any constitutional 
 or local difficulties must be treated according to their re- 
 spective indications. A generous, nutritious diet must be 
 allowed, together with the use of wine, porter, or ale. 
 
 Yariety. I. — Ascites. 
 
 An effusion of serum within the peritoneum or shut sack, 
 lining the abdomen, is called ascites, or abdominal dropsy. 
 The color of the serum varies from a light yellow to a deep 
 brown, is occasionally mixed with pus, and not unfrequently 
 contains flakes of coagulable lymph, denoting that there 
 has been inflammation of the peritoneum. Encysted col- 
 lections of serum in the abdomen, such as are often seen 
 attached to the liver, spleen, ovaria, and omentum, are 
 termed encysted dropsy, ovarian dropsy, or hydatids, and 
 are to be distinguished from true ascites by the history of 
 the cases, and the situation and progress of the tumors. 
 Fibrous tumors of the womb, also, as well as watery col- 
 lections within its walls, polypus, and even pregnancy, 
 may be mistaken for ascites without a careful investigation 
 into the history of the case and skillful examination. 
 
 Should pregnancy and ascites be combined, as sometimes 
 happens, a case might be involved in a good deal of obscu- 
 rity. Tympanites, or a collection of air in the intestines, 
 can hardly be mistaken for a case of dropsy. Ascites may 
 
ASCITES. 949 
 
 occur under either an inflammatory or non-inflammatory 
 condition. 
 
 Ascites resulting from inflammation of the peritoneum, 
 is accompanied with fever, pain, and tenderness of the 
 belly, increased by pressure. In some instances the efiu- 
 sion is quite gradual, with little disturbance of the general 
 health, and in others quite rapid, the abdomen becoming 
 largely distended in a few days. Ascites, following scarla- 
 tina, is of the inflammatory type, and is generally more or 
 less accompanied with anasarca ; the face being swollen in 
 the morning and the feet and ankles at night. There is 
 generally a small, wiry pulse in these acute forms of ascites, 
 high-colored, scanty urine, furred tongue, thirst, constipa- 
 tion, and either clay-colored or very offensive stools. In 
 many cases, the effusion might, perhaps, be better or more 
 properly ascribed to a special irritation of the peritoneum 
 than to inflammation, such a pathological condition as has 
 received the name of congestion. Congestion of the portal 
 circulation, from deranged conditions of the liver ^ retards 
 the venous circulation in the abdomen, and throws a special 
 irritation upon the peritoneum — ascites is the consequence. 
 Or the special irritation may originate in the kidney, spleen, 
 or other viscus. 
 
 Ascites resulting from indirect debility is a consequence 
 of previous disease, generally of some important organ. 
 It is gradual in its development, and is usually preceded 
 by edematous feet and ankles, and the accumulation in the 
 abdomen is from below upward, until the diaphragm is so 
 impeded that respiration is next to impossible. The opera- 
 tion of paracentesis abdominis is usually resorted to in this 
 emergency, with, however, very variable results. As a 
 means of affording tempor.ary relief, and gaining time and 
 opportunity for the administration of curative measures, it 
 is unquestionably a proper palliative resource of the heal- 
 ing art. Instances are cited where it has been resorted to 
 over two hundred times in the same case, and a permanent 
 cure effected at last. 
 
 This form of dropsy not unfrequently follows a broken- 
 
950 NERVOUS FORMS OF DISEASE 
 
 down condition of the constitution, resulting from malarious 
 fever. It may follow any prostrating inroad upon the vital 
 powers, but is most apt to succeed to those forms of disease 
 that weaken, retard, and obstruct the portal circulation, 
 damming up, as it were, the return of venous blood. 
 
 Diagnosis. — In true ascites, the distention is first at the 
 lower portion of the abdomen, and as it progresses the 
 lateral portions widen equally, and at last the epigastrium 
 becomes distended. This is much the case with the pro- 
 gress of pregnancy, and ovarian dropsy also. In preg- 
 nancy, however, an examination per vaginum will reveal a 
 development of the neck of the womb in the latter months, 
 or ballottement will suffice ; or holding the hand for some 
 time in cold water and then laying it on the abdomen, will 
 provoke movements of the child. In ovarian dropsy the 
 tumor will roll or gravitate from side to side, as the woman 
 changes position. The more lively thrill, or tremulous im- 
 pulse under percussion, in true ascites, w^ill assist in diag- 
 nosing difficult or obscure cases. One hand should be laid 
 flat on one side of the abdomen, and a sudden tap or fillip 
 made on the other. Tumors are generally detected by their 
 inequalities under the grasp. Hydatids usually progress 
 from above downward. In all obscure cases, the history 
 and progress of the enlargement and attending symptoms, 
 must be carefully inquired into. It may be fatal to the repu- 
 tation of a physician to mistake a case of pregnancy for 
 ascites, and the operation of tapping under the mistake, 
 might be fatal to both mother and child. 
 
 Prognosis. — Ascites resulting from functional derange- 
 ments, as checked perspiration, repelled eruptions, engorge- 
 ments of the liver and spleen, etc., are generally remedia- 
 ble. It is more often, however, dependent on changes of 
 structure, that render it unmanageable and finally fatal. It 
 not unfrequently disappears under the administration of 
 remedies, and returns again and again, until the constitu- 
 tion finally succumbs. Where it exists very distinctly by 
 itself, without efiusion elsewhere, it is said to be more un- 
 manageable than when accompanied with evidences of a 
 
ASCITES. 951 
 
 general dropsical tendency. The prognosis will, therefore, 
 vary according to the cause, age, constitution, etc. Yery 
 rarely a spontaneous cure has taken place by the water being 
 drained off through the urinary organs, or by the bowels. 
 
 Treatment. — In ascites, the general treatment recom- 
 mended under dropsy may be pursued, and as the water 
 becomes evacuated, the abdomen must be supported by the 
 use of a broad bandage, applied as tightly as the patient 
 can bear without inconvenience. In the early stages of this 
 disease, the use of the bandage alone, w^ill frequently effect 
 a cure. 
 
 It is sometimes the case that ascites proves very obstin- 
 ate, resisting all our remedial measures ; in such instances, 
 in order to afford relief to the patient, as well as to postpone 
 for a period the fatal termination, it will be necessary to 
 resort to the operation of paracentesis abdominis — for a full 
 explanation of which, see Eclectic Surgery. Notwithstand- 
 ing, as a general rule, tapping only affords temporary re- 
 lief, yet it sometimes happens that patients ultimately re- 
 cover, even when they have undergone the operation a 
 number of times — of which many instances are recorded. 
 Dr. Griffith, of Virginia, reports a case in which the pa- 
 tient was tapped one hundred and eighty-six times in ten 
 years, and had seven hundred and fifty-one and three- 
 fourths gallons of water removed in that time, and yet re- 
 covered. He says : 
 
 " On the 22d of November, 1830, she was first tapped 
 (by Dr. Dawson), when six and a half gallons of water were 
 drawn off. She was not again tapped until the 8th of Oc- 
 tober of the following year. After this, the water continued 
 to accumulate rapidly. In 1832 she was tapped ten times, 
 in 1833 twenty-six times, in 1834 twenty-five times, in 1835 
 twenty-six times, in 1836 twenty-seven times, in 1837 twen- 
 ty-six times, in 1838 twenty-six times, in 1839 seventeen 
 times, and in March, 1840, she was tapped for the last 
 time — in all, one hundred and eighty -six times (186), and 
 seven hundred and fifty -one and three-fourths (751f) gal- 
 lons of water, of a clear, straw color, w^ere drawn ofl". The 
 
952 NERVOUS FORMS OF DISEASE. 
 
 size of the tumors gradually diminished, until they finally 
 disappeared, but could be distinctly felt, on either side of 
 the pelvis, for some time after the last tapping ; since which 
 time she has enjoyed almost uninterrupted good health. 
 Indeed, during the entire period, her general health con- 
 tinued good, and she suffered but little except the inconve- 
 nience caused by the accumulation of water. She is now 
 able to walk several miles without fatigue, which I have 
 frequently within the last few weeks, known her to do, in 
 her benevolent attentions to the sick of her neighbor- 
 hood. 
 
 " I am aware that a number of cases have been reported, 
 in which the operation of tapping has been borne a great 
 number of times, and that in some, an almost incredible 
 quantity of water has been drawn off. In the April num- 
 ber of this Journal, a case is referred to by Professor Feas- 
 lee, of Dartmouth College, mentioned by Burard, in which 
 the patient was tapped 665 twies in 13 years. In the case 
 reported in the Philosophical Transactions for 1784, by 
 Martineau, referred to by Watson, the patient, in twenty- 
 six years was tapped eighty times, and 6631 jpts,^ or upward 
 of 13 hogsheads of fluid, drawn off." — Am. Jour. Medical 
 Sciences, 
 
 Yakiety II. — Hydrothorax, 
 
 Hydrothorax, or water in the chest, is treated of by some 
 authors under three varieties, to-wit : when it occurs in the 
 pleural cavities, when in the pericardium, and when in the 
 substance of the lungs ; but by the most modern patholo- 
 gists it is restricted to water or serum in the pleural sack, 
 and, like most forms of dropsy, is but a symptom of dis- 
 ease — a result of pre-existing morbid action. Pulmonary 
 edema, or water in the substance of the lungs and hydro- 
 pericardium, or dropsy of the heart-case, are also results of 
 previous morbid action, generally of inflammation of those 
 immediate structures ; and though these organs are situated 
 in the thorax, there is no propriety in considering serous 
 effusions into their structures, forms of hydrothorax ; we 
 
HYDROTHORAX. 953 
 
 shall, therefore, restrict the term hydrothorax, to the effu- 
 sion of serum within the pleural cavities. 
 
 Symptoms. — Viewing hydrothorax as a symptomatic form 
 of disease, and never, strictly speaking, idiopathic, it may 
 supervene upon almost any form of disease, either general 
 or local, but affections of the heart, lungs, and pleura, are 
 those that most frequently give rise to it. It has been con- 
 sidered by some authors as idiopathic, when it arises from 
 such an inflamed condition of the pleura as speedily results 
 in the effusion of serum into its cavity. This is, doubtless, 
 its most simple or acute form ; but in this ca,se the effusion 
 is a sequent as clearly as when it results from organic dis- 
 ease of the heart or other viscera. 
 
 There is no one symptom that clearly marks hydrothorax, 
 because the effusion of serum into the cavities of the pleura 
 occasions a train of symptoms common to other affections 
 that greatly impede respiration and obstruct the circu- 
 lation. 
 
 The most distinctive symptom, perhaps, is difficulty 
 of breathing — oppressive dyspnoea. But we have seen a 
 case of hepatization of the lungs mistaken for hydrothorax 
 hj the best mediciil counsel, when a post-mortem examina- 
 tion revealed the pleural cavities entirely destitute of 
 serum. 
 
 One of the earliest symptoms of effusion, no matter what 
 the primary affection, is edema of the eyelids in the 
 morning. The progress of hydrothorax depends upon the 
 nature of the affection causing it. In some cases it will 
 advance slowly, as in organic affections of the heart ; but 
 from whatever cause produced, the symptoms become ag- 
 gravated by the presence of the efiusion, until the patient 
 is unable to breathe, except in the sitting posture, with his 
 arms resting on the back of a eliair, and his face to an open 
 windo^. The face becomes sallow and bloated; the lips 
 livid ; the ankles edematous ; the surface and extremities 
 €old ; the pulse feeble and fluttering. Death sometimes 
 terminates the scene suddenly, within a few days after well- 
 marked symptoms of effusion have supervened; and at 
 
954 NERVOUS FORMS OF DISEASE. 
 
 other times, the sufferings are protracted for two or three 
 weeks. 
 
 Physical Signs. — Percussion gives a dull sound upon 
 all parts of the chest where there is effusion. Auscultation 
 also reveals little respiratory murmur, except at the apex of 
 the lungs. Admeasurement frequently discloses one side of 
 the chest larger than the other. The intercostal spaces 
 bulge out, or at least, do not sink in as in health. 
 
 Diagnosis. — It is not always easy to distinguish hydro- 
 thorax from other affections of the chest, such as hepatiza- 
 tion of the lungs, empyema, etc. The most careful atten- 
 tion to the general history of the case is requisite as a first 
 step. 
 
 In hydrothorax, there will generally appear a serous dia- 
 thesis or watery look in the constitution, and the puffy face 
 in the morning and swelled ankles at evening, appear early 
 in the stage of effusion ; whereas, in empyema, the}^ only 
 supervene very late. In empyema, the effusion is generally 
 confined to one side. The early symptoms and history will 
 generally serve to distinguish hepatization from hydro- 
 thorax. 
 
 Prognosis. — The prognosis, in hydrothorax, is very un- 
 favorable, because it most generally is but a symptom of 
 some incurable malady. The effusion may be removed by 
 appropriate treatment, and cases have occurred where the 
 effusion has not returned ; but they are exceedingly rare. 
 
 Treatment. — In the treatment of this form of dropsy, 
 the practitioner will be guided by the rules laid down in the 
 general treatment. Paracentesis thoracis is sometimes per- 
 formed in this affection, but we much doubt its utility, 
 [For an explanation of the operation, see Eclectic Sur- 
 gery, page 623.] 
 
 Yaeiety III. — Anasarca. 
 Anasarca, or an infiltration of serum into the sub-cuta- 
 neous cellular tissue, may take place under various condi- 
 tions of the system, symptomatic of different forms of dis- 
 ease. It can hardly be said to be idiopathic, though it 
 
ANASARCA. 955 
 
 sometimes constitutes the most prominent symptom, and is 
 treated of by some authors as a distinct form of dropsy. 
 
 When it occurs suddenly, and seemingly as an acute 
 form of disease, attacking persons in the vigor of life, 
 arising, as it mostly does, in those cases from exposure to 
 cold after being overheated, it will generally be found to be 
 accompanied with inflammation of some internal organ, as 
 the lungs. There will generally be pain, increased by deep 
 inspiration, and not unfrequently a troublesome cough. In 
 some cases there may exist great oppression in the breath- 
 ing without pain or cough, and the pulse not indicate 
 inflammatory action, but auscultation will reveal it. The 
 difficulty of breathing in some cases becomes very urgent, 
 preventing the patient from lying down. The hce becomes 
 pufiy and a general anasarca soon steals over the whole 
 body. The urine is scanty and high-colored, in some 
 cases coagulable ; and if the urgent symptoms be suffered 
 to go on, death may occur in a week. 
 
 When it occurs after scarlatina, or the retrocession of 
 other eruptive forms of disease, acute or chronic, it is very 
 analagous in character to the acute form above described, 
 and post-mortem examinations often reveal not only the 
 lungs, but also pleura, diaphragm, kidneys, and intestines, 
 the seat of inflammation — clearly showing that the ana- 
 sarca is the consequence of the internal disease. We always 
 look upon anasarca from retrocession of scarlatina or mea- 
 sles as highly dangerous. Frequently it does not come on 
 until three weeks subsequently to the little patient's getting 
 about, and then insidiously steals upon the child in the 
 form of a dry, troublesome cough at night, and puffiness of 
 the face in the morning. 
 
 Symptoms of extreme danger — anasarca, dyspna:a, and 
 a distressing cough — often appear within three days after 
 this edema of the face occurs, and, unless a vigorous 
 treatment be instituted, death often results within a week. 
 Sometimes convulsions close the scene, and at other times, 
 effusion into the chest appears to be the immediate cause 
 of death. Anasarca from retrocession of chronic pus- 
 
956 NERVOUS FORMS OF DISEASE. 
 
 tular eruptions is no less acute or formidable in its char- 
 acter. When it occurs from disordered menstruation, or 
 suppressed hemorrhoidal discharge, the pathology is more 
 obscure, the urgency of symptoms less acute, and the in- 
 filtration often much more gradual. It sometimes forms 
 rapidly from suppression of the menses ; often gradually at 
 the period of cessation ; and not unfrequently is an attend- 
 ant on debility from menorrhagia in young women, espe- 
 cially edema of the feet and ankles. 
 
 When it results from organic disease of the heart, liver, 
 uterus, enlargements of the spleen, etc., the cause of ob- 
 struction to the circulation is generally evident, and the 
 resulting anasarca only an index of the progress of disease. 
 It usually appears late or toward the close of life, but some- 
 times early in organic affections. 
 
 When local, as in phlegmasia dolens, it depends on in- 
 flammation of the trunks of the large veins, or phlebitis. 
 The whole matter, therefore, resolves itself into this, that 
 anasarca is only a symptom or evidence of functional dis- 
 turbance, or structural change of some important organ. 
 
 Treatment. — In anasarca, in addition to the treatment 
 named for general dropsy, bandages should be applied to 
 the extremities, and kept moistened with cold water; they 
 should be applied as tightly as the patient can bear. These 
 will be necessary, in all cases, where there is much swelling 
 of the limbs. 
 
 Species XIII. — Colica Pictonum. 
 
 This form of disease attacks persons employed in the 
 production of lead from its ores, white-lead manufacturers, 
 painters, etc., and arises from the poisonous action of this 
 metal on the system. The writer has witnessed it in a 
 female who had been injudiciously treated with acetate of 
 lead for bleeding piles. 
 
 Symptoms. — A peculiar bluish tinge of the gums, some- 
 times showing itself in a well-marked line, a little distance 
 from the teeth ; a sweetish styptic taste, fetid breath, sallow 
 skinj and conjunctiva, are objective symptoms, showing 
 
COLICA PICTONUM. 957 
 
 themselves where the poison of lead has been slowly intro- 
 duced into the system. Proper treatment in this stage will 
 ward off an attack. 
 
 The first symptoms the patient complains of, are, a loss 
 of appetite, increased flow of saliva, restless nights, and a 
 variety of nervous feelings. Vomiting supervenes and re- 
 curs more or less often throughout the attack. Obstinate 
 constipation sets in, attended with pain in the belly, at first 
 remitting, but becoming more and more constant, usually 
 most acute at night, and not increased by pressure. The 
 abdomen is flat and knotted, and the faeces, when discharged, 
 dry and lumpy. Pains in the head and limbs set in, more 
 especially in the knees, calves, ankles, and soles of the feet, 
 and paralysis often follows. There is generally no fever, 
 and the pulse is slower than natural. The urine is unaf- 
 fected. In rare instances, peritoneal inflammation ensues 
 late in the attack. The prostration and emaciation become 
 extreme in cases where there is a tendency to death, but the 
 great majority of cases recover. Subsequent torpor of the 
 bowels, indicating a partial paralysis of their muscular coat 
 is a common result, which may be attended by paralysis of 
 one or more of the limbs. 
 
 Where proper treatment is instituted, the disorder seldom 
 proves fatal. Of five hundred cases treated in a Parisian 
 hospital, only five terminated fatally, so that a favorable 
 prognosis may in general be pronounced. 
 
 Treatment. — This disease will always be spontaneously 
 cured, if the patient will avoid further contact wdth the 
 cause which produces it ; yet, while the paroxysm is pres- 
 ent, it is necessary to make use of means to allay the 
 violent suffering. In the first place, give the patient stim- 
 ulating enemas until free and copious evacuations of the 
 bowels are produced ; as soon as this is accomplished, make 
 use of the warm -bath or vapor-bath, then rub the patient 
 until he is perfectly dry, and place him in bed. If, after 
 this the pains should continue, apply hot bitter-herb fomen- 
 tations over the whole abdomen, which should be as warm 
 as the patient can bear, during the paroxysm. Apply 
 
958 iVERVOUS FORMS OF DISEASE. 
 
 bottles of warm water to his feet, and give internally from 
 one to three drachms of the Compound Tincture of Capsi- 
 cum and Lobelia. 
 
 If the above should not be sufficient to allay the pain, 
 make use of the Compound Powder of Ipecac, and Opium. 
 It will be well to use Podophyllin and Leptandrin, daily, 
 until catharsis is produced. 
 
 The above treatment has been sufficient, in our hands, 
 to break up the disease in a short time. As there is not 
 much tendency to a recurrence of the disease, unless the 
 patient subjects himself to the same cause, we do not con- 
 sider any further treatment necessary than — the avoidance 
 of the cause which produces it. 
 
 Species XIY. — Delirium Tremens — Mania a Potii. 
 
 Dr. "Watson treats of this disease in company with the 
 inflammatory forms of cerebral disease. Drs. Wood and 
 Eberle treat of it in association with the functional diseases 
 of the brain ; and we include it in the class of functional 
 forms of disease of the vegetative or ganglionic system, and 
 our motives for so doing will be discovered in the course 
 of this treatise. 
 
 Delirium tremens, even now, is very imperfectly under- 
 stood, and hence it becomes the duty of every investigator 
 of it to make known his conclusions about it ; for, although 
 they may be erroneous, yet they may suggest to some one 
 of his readers, a train of thought that may lead to the 
 truth. 
 
 This is our apology for the novel views we shall present — 
 novel, in regarding this form of disease as existing in close 
 alliance with cholera in both its cause and character. 
 Whether right or wrong, if we shall succeed in causing 
 others to observe and to think, we shall be amply rewarded 
 for our labor. 
 
 All the writers whom we have consulted describe this 
 form of disease much in the language of Professor Eberle, 
 as being "characterized by general inquietude, tremor, con- 
 tinued watchfulness, cool skin, perspiration, delirious loqua- 
 
DELIRIUM TREMENS 959 
 
 citj, and seDSorial illusions." It is said to occur only in 
 habitual drunkards and inordinate opium-eaters ; but as a 
 fact, we dispute this, because we have known it to occur in 
 those who never drank to intoxication, but only so far as to 
 maintain a high state of excitement. Dr. Coates, Dr. 
 Blake, and all others, so far as we have discovered, teach 
 that delirium tremens does not result from the use of stim- 
 uli, but from the sudden disuse or abandonment of them ; 
 and hence its beginning is manifested by '' lassitude, gen- 
 eral indisposition, a feeling of distress in the epigastrium, 
 anorexia, nausea and vomiting, giddiness, a sense of confu- 
 sion in the head, want of sleep, an anxious expression of 
 the countenance, and tremor of the hands." — Eherle. Or, 
 as taught by Dr. Blake, it commences with symptoms of 
 general debility ; the pulse is invariably slow, soft, and 
 compressible, often feeble and unsteady ; the hands and 
 feet are cold and clammy. 
 
 To the preceding account of this disease, when abstractly 
 applied to it, we most positively object ; because we have 
 witnessed the disease under very opposite circumstances. 
 We shall therefore contend for the existence of two dis- 
 tinctly-marked varieties of the disease. In those who have 
 so long indulged in drunkenness as to have greatly crippled 
 or broken down their vital energies, it begins as above 
 taught — with symptoms of general debility. The other 
 variety, to which we have alluded, takes place in the strong 
 and vigorous — those in whom the vital energies have not 
 been prostrated by absolute drunkenness — those who drank 
 enough to maintain a continuous high state of nervous and 
 vascular excitement — finally, those who continued and in- 
 creased this preternatural excitement, until it became 
 merged or lost in delirium. Of this kind of delirium, the 
 writer has had two cases, and his friends. Professor Knapp, 
 and Dr. Major, of Covington, Ky., assure him that they 
 have treated similar cases, and his co-laborer. Professor 
 K. S. Newto-n, informs him that he has had more cases of 
 this kind than of the other. 
 
 So far as the writer has observed, however, it is not de- 
 
960 NERVOUS FORMS OF DISEASE. 
 
 lirium tremens, for he has not witnessed any tremor in the 
 hands of such patients ;* nevertheless it is, in his opinion, 
 the same disease manifested in a different class of con- 
 stitutions — the difference is just that which obtains between 
 passive and active apoplexy or congestion of the brain. 
 
 The approach of this variety of delirium is indicated by 
 restlessness, a wildness of expression, or one of much ap- 
 prehension ; the face is flushed, and the pulse is full and 
 strong. The patient is impatient of restraint and capable 
 of maniiesting more than his ordinary muscular strength. 
 It is attended by no stage of lassitude, and the delirium, at 
 this stage, can only be inferred from the improbability of 
 the patient's statements, and the incompatibility of his 
 premises and conclusions. 
 
 In dividing the disease, according to Dr. Blake, into 
 three stages, we may say that there is but very little simi- 
 larity between the two varieties in either of the stages ; the 
 subjects, respectively, differ organically, and they differ in 
 all the manifestations. 
 
 It would appear, from some remarks of Dr. Carter (Cy. 
 Prac. Med.), that the variety or modification of which we 
 have been treating, had not entirely escaped his notice. He 
 says : " In young and robust subjects, whose excesses have 
 not been of long standing, the stage of reaction or excite- 
 ment will come on much more rapidly than in persons ad- 
 vanced in years, and whose constitutions have been broken 
 down by long intemperance. It is during this stage that 
 the medical attendant is most liable to fall into error. The 
 symptoms, many cf them, are so similar to those of inflam- 
 mation of the brain or its membranes, that, if he is not 
 especially upon his guard — if he allows the pathognomonic 
 signs of the disease to escape him, his diagnosis will be in- 
 correct and his practice unsuccessful." 
 
 Now, except for the description which he has given of 
 the first stage, the preceding remarks might be a satisfac- 
 
 * Since writing these lines, the writer has learned that some tremor has 
 been observed. 
 
DELIRIUM TREMENS. 961 
 
 tory explanation of the whole difiiculty ; but to tell us that 
 in the first stage the patient's " countenance is dejected and 
 anxious; his spirits are depressed; there is frequent sigh- 
 ing and oppression of the prsscordia;" when not one of 
 these symptoms attends the cases embraced by his qualifica- 
 tion, it becomes conclusive that the two forms are not one 
 and the same — that they are as far from it, as the two forms 
 of apoplexy before named. 
 
 Since making the preceding extract, we have fallen upon 
 another case, in Dr. Watson's Practice, that is more directly 
 to our purpose. He says : " So frequently does the deli- 
 rium manifest itself upon the cessation of the accustomed 
 spree, that the continually-recurring stimulus has been re- 
 garded as the jpredisposing^ and the privation of that stim- 
 ulus the exciting cause of the affection. Sometimes, how- 
 ever, it comes on in men who are perpetually fuddled, even 
 although they have not intermitted their usual indulgence 
 in drink." 
 
 This extract contains all that we contend for — and 
 certainly no reasonable mind will conclude that both 
 the use and disuse of an article — a poison, will pro- 
 duce the same variety of disease, after the contrary has been 
 suggested. 
 
 Before proceeding to give the symptoms of the second 
 and third stages, we feel called to settle upon a conclusion 
 as to whether the disease is really and usefully divisible 
 into two varieties or not. By a reference to our treatise 
 upon apoplexy and rheumatism, respectively, it will be ob- 
 served we have clearly shown that apoplexy may be, and 
 has been, entirely of a passive character ; and that those 
 who are organically liable to it, are organically exempt 
 from the active form — and we described the organizations 
 that occasion, respectively, the two kinds of liability. In 
 reference to rheumatism, we made it, we think, perfectly 
 clear, that all organizations are not, indiscriminately, liable 
 to either form, the acute or the chronic, under any possible 
 combination of causes — that those who have the acute can 
 never have the chronic form, and vice versa, No\v, from 
 
962 NERVOUS FORMS OF DISEASE. 
 
 what the writer has seen, and from what he has learned 
 through his professional brethren, before named, he ventures 
 to lay it down as a rule, that that variety of this disease, 
 which commences with signs of debility or prostration, 
 and in which the tongue and hands become tremulous, is 
 confined to those of a more or less low order of vital force ; 
 or, according to Dr. Hall's Zoonomia, they possess a high 
 dynamis — or, finally, they might have chronic rheumatism 
 or passive apoplexy; and on the other hand, those who 
 have the disease without a stage of prostration and without 
 tremors, possess high vital force, or, according to Dr. Hall, 
 high stimulus or low dynamis. The diagnosis between 
 these two classes, organically, can be rendered obvious to 
 the most ordinary observer. Those of the first class have 
 thin necks, or feeble organs of muscular motion and animal 
 sensibility ; while those of the second are precisely the re- 
 verse in all respects. Those seen by the writer were fit 
 subjects, under other circumstances, for acute rheumatism 
 and active congestion of the brain. 
 
 If, in the preceding remarks, we are correct (and in ac- 
 cordance with the laws of analogy, they would seem to 
 commend themselves to the careful observation of every 
 physician), then it follows, that delirium tremens is as much 
 and as obviously entitled to a division as rheumatism or 
 cerebral congestion. For reasons that will appear when we 
 come to treat of its pathology, we shall divide it into acute 
 and clironic, and each of these into three stages — the incip- 
 ient, delirious, and prostrated. The symptoms of the first 
 stage, in both varieties, have been sufficiently indicated in 
 the preceding remarks. 
 
 2. Symj)toms of the second stage in tlie acute variety. — 
 In this variety, there is none of the business, bustle, and 
 anxiety which is so peculiar to this stage in the chronic 
 variety. When the delirium becomes confirmed, which 
 rapidly follows the incipient stage, all the manifestations 
 are of a passionate character — that is, they indicate that aU 
 of the acting mental organs are powerfully excited; and 
 as it is common for the subjects of this variety to be strong 
 
DELIRIUM TREMENS. 963 
 
 men, they are, restrained and managed with great difficulty. 
 In one case the writer had, it was necessary to bind him 
 with ropes. The most pathognomonic manifestation of this 
 variety is a most tormenting dread of danger, and a dispo- 
 sition, in some cases, to suicide to avoid it. This was par- 
 ticuhirly the case in the subject above alluded to. In an- 
 other case, which the writer witnessed, the whole dread of 
 the patient was of future torment — he, in wild and frantic 
 calls for help, declared that the devil was dragging his soul 
 out of him. The expression of the countenance is fright- 
 fully wild, and either desponding with pitiable lamenta- 
 tions, or of defiance and battle, depending entirely upon 
 the imagined character and power of the enemy. 
 
 The pulse is full and strong, but not remarkably fre- 
 quent ; the face is flushed ; the voluntary muscles have more 
 than their normal strength; the hands are steady, and 
 sometimes an occasional moisture appears on the surface, 
 particularly after muscular efforts. The patient recognizes 
 his acquaintances, and will answer correctly, in monosyl- 
 lables, any question that is asked him, except with refer- 
 ence to the subjects of his hallucinations. 
 
 From the beginning of the incipient stage, the patient 
 sleeps none until he begins to mend, be the number of the 
 days few or many — a morbid vigilance occupies his whole 
 time. It is necessary to keep a constant watch upon such 
 patients, for, under the impression that they are pursued 
 by an enemy, they may quit the house and ramble off, or 
 possibly commit suicide. The patient of the writer, before 
 alluded to, escaped from his keeper or nurse and ran twenty- 
 five miles in one night, without hat, coat, vest, or shoes, 
 and when about to be arrested, he attempted suicide. 
 
 After one or two days this stage is terminated by a sound 
 sleep and a return to health, or else in the stage of pros- 
 tration. 
 
 The delirium of the last stage passes into incoherency — 
 
 the vigilance into stupor — the pulse comes down — the skin 
 
 is covered with a copious and clammy perspiration — the 
 
 bowels become diarrheal, and the discharges are made 
 
 61 
 
964 NERVOUS FORMS OF DISEASE. 
 
 involuntarily ; coma succeeds, and then death, which is fre- 
 quently of an apoplectic character. 
 
 3. Second stage of the chronic form of delirium tremens. 
 The second stage in this variety is introduced by an increase 
 of the vertigo and mental confusion, or in other words, it 
 may be said to commence with delirium, which is succeeded 
 by a wild aspect of the patient's countenance, and distrust 
 and suspicion of the nearest relatives and most sincere 
 friends. 
 
 In this variety there is a constant disposition to be busy — 
 to act as though he had business of pressing importance to 
 require his constant attention, and this leading idea of busi- 
 ness necessity renders him exceedingly impatient under re- 
 straint. The most pathognomonic symptom of both forms 
 of the disease is insomnia, but in this no time is squan- 
 dered, for the patient is exceedingly busy — very restless, 
 and considers it a great outrage to be prevented from dis- 
 charging his obligations. 
 
 The character of his disposition and of his illusions de- 
 pends upon the structure of his mental organization ; in 
 general, however, the patient is peaceful — not even dis- 
 posed to fight for his liberty, and yet he will use his utmost 
 strength to become free, urging important business as his 
 motive. If caution be large, and this stage well established, 
 he will manifest the utmost dread of assassins, robbers, or 
 other dangers, and if he be courageous, he will battle with 
 them, otherwise he shows the utmost alarm. If marvelous- 
 ness and hope are well-developed, the peculiarity of his il- 
 lusions will be whimsical and laughable — he is in the midst 
 of a swarm of insects, or he is invaded by an army of mice, 
 and he makes battle upon them with his feet, the tongs, or 
 broom ; or he is full of ribbons, and he draws them out of 
 his mouth, nose, or fingers. 
 
 About this time some acceleration of his pulse may be 
 observed — his body has become warmer, but his extremities 
 are still cold. If no relief by this time is had, he passes 
 into the third stage, which is indicated by a profuse and 
 clammy perspiration, with an increase of all the other 
 
DELIRIUM TREME>JS- 965 
 
 * 
 symptoms. The tremor of the hands and tongue has 
 
 greatly increased ; the tongue is still moist, but more furred; 
 
 the pulse is swollen, but more frequent ; the countenance 
 
 expresses great anxiety ; the urine is pale and scanty. 
 
 Thus these symptoms progress until the patient expires in 
 
 convulsions ; or possibly, his delirium increases, with sub 
 
 sultus tendinum, and thence he becomes quiet, and dies 
 
 without a struggle. 
 
 When the disease terminates favorably, the patient passes 
 into a sound sleep during the incipient or delirious stage, 
 and from the latter, he usually awakes between twelve and 
 eighteen hours in a state of convalescence, but he is pale, 
 exceedingly feeble and tremulous. 
 
 Cause. — The cause of the acute form of delirium tre- 
 mens is the constant and unremitting use of some material 
 stimulus upon a highly-vital organization, or, according to 
 Hall's Zoonomia, one cf such high stimulus, that more can 
 not be borne without injury to the health. This stimulus 
 usually consists of spirituous liquors, but it may be produced 
 by the narcotic poisons, particularly by opium. 
 
 In the chronic form, the cause consists of a suspension 
 of a stimulus to which the nervous system had become ac- 
 customed, in a constitution of low stimulus, and therefore 
 one which is constantly seeking stimulus of some kind ; and 
 when the brain becomes accustomed to any one, it can not 
 act normally without it. Every one who uses tobacco is a 
 witness of the truth of this statement. But in this case, 
 the stimulus is of the kind named, as directly producing 
 the acute form of this disease. 
 
 We are aware that it is taught by some that delirium 
 tremens is not confined to tipplers and drunkards — that it 
 may be produced in some constitutions by mental anxiety 
 long continued. That a disease resembling the one under 
 consideration may be thus produced, we admit to be proba- 
 ble, upon the authority of others, but we have some strong 
 facts to induce us to believe that it is not and can not be the 
 same disease. 
 
 The writer has probably examined critically more human 
 
966 JNERVOUS FORMS OF DISEASE. 
 
 crania than any other individual ever did, and in the course 
 of his investigations he has seen the crania of many men 
 who had been intemperate to the close of life. In those of 
 high stimulus, intemperance in the use of ardent spirits 
 produces a hypertrophy of the brain, atrophy of the cra- 
 nium, and unmistakable marks of pericranial inflammation. 
 He has the cranium of one unparalleled tippler and drunk- 
 ard, which is remarkably thin, and in which even the tem- 
 poral sutures are obliterated. Under the process of hyper- 
 trophy, the native angularity of the head is greatly rounded. 
 He has the skull of an Indian which, by hypertrophy, wears 
 the form of high civilization. In men of high stimulus, 
 intemperance improves the beauty of the head, particularly 
 in its social or coronal aspect ; but it is certainly at the ex- 
 pense of the social and moral character. 
 
 In those of low stimulus, intemperance produces atrophy 
 of the brain and hypertrophy of the skull — that is, the lat- 
 ter becomes more dense and thick. 
 
 The inference to be drawn from the preceding facts is, 
 that the action of the brain, by stimulus of the kind alluded 
 to, is increased with those of high stimulus, and decreased 
 with those of low. 
 
 Having now stated the cerebral condition of the two 
 kinds of subjects of this form of disease at the time of 
 its invasion, no one can be surprised that we are unwil- 
 ling to admit that merely mental anxiety can produce it. 
 
 Pathology of Delirium Tremens. — Dr. Armstrong, in 
 his Lectures, sui)poses this disease principally depends upon 
 some condition of the nervous system, and of this condition 
 he acknowledges that he knows nothing. Dr. Gregory is 
 of opinion that it depends upon '' exhaustion of the nervous 
 power." Dr. Eberle regards it as " a morbid activity of 
 the brain, from the sudden abstraction of a habitual stimu- 
 lus, by which its excitability had been long repressed or 
 blunted ; " Dr. Coates considers it as consisting in " a 
 hightened activity of the sensorium, from the generation, 
 as it would seem, of an inordinate degree of vital activity 
 in the brain." Dr. Klapp thinks that it is seated in the 
 
DELIRIUM TREMENS. 967 
 
 stomach. Dr. Watson thinks that the essential nature of 
 this disease consists in '' nervous irritation ^''^ and Dr. Car- 
 ter virtually confesses that he knows nothing about it, and 
 Dr. Watson has in reality done the same. 
 
 It must now be remembered that the preceding opinions 
 have reference alone to what we denominate chronic deli- 
 rium tremens, because no other variety has become known 
 to the profession. With this explanation, we have a few 
 passing remarks to make upon some of these opinions. 
 Dr. Eberle's opinion is, to us, exceedingly inconsistent. A 
 morbid activity from an abstraction of stimulus ! This is 
 like making a very hot fire by abstracting its fuel. When 
 men become drunk, and are noisy and troublesome, is it not 
 because of a morbid activity of the brain from an excess 
 of stimulus ? If this interrogatory be answered affirm- 
 atively, then his opinion is erroneous — absolutely in- 
 consistent with the most acceptable doctrines of phy- 
 siology. 
 
 When a man has formed a habit of drinking, he can bear 
 comparatively a large dose, but after having been habitually 
 intemperate for manj^ years, a wine-glass full inebriates 
 him. Does this fact not prove that he has exhausted the 
 resisting power of his system or brain ? Is it not univer- 
 sally conceded that a habit of intemperance long indulged, 
 breaks down and shatters the constitution ? If this ques- 
 tion be answered in the affirmative, then compare with it 
 the opinion of Dr. Coates. Has drunkenness, to the ex- 
 tent of delirium tremens, ever been known to generate 
 vital activity ? We leave our readers to answer this ques- 
 tion for them.selves. 
 
 Of the preceding opinions, those of Gregory, Klapp, and 
 Watson, are entitled to respect — each of them contains a 
 few grains of truth. There is, in the chronic form of the 
 disease, an " exhaustion of nervous power," and there is, 
 also, "nervous irritability," but when admitted, what do 
 they explain, with reference to the pathology of the dis- 
 ease? They do very little more than indicate that it is not 
 an inflammatory one. Klapp ingeniously supports the 
 
968 NERVOUS FORMS OF DISEASE. 
 
 hypothesis that the disease is of the stomach, but still, upon 
 this conclusion, the phenomena of the disease can not be 
 explained. 
 
 Before proceeding to advance our opinions upon this 
 very puzzling subject, we beg leave to premise, by placing 
 before our readers a few facts which we esteem as having a 
 vital bearing upon the subject. 
 
 In commencing this treatise, it will be remembered, that 
 we remarked that delirium tremens bore a stronger simili- 
 tude to cholera, than could possibly, at first, be sus- 
 pected. 
 
 In treating of the specific cause of cholera, we considered 
 it to consist of an abnormal quantity of carbon in the 
 blood, which, acting like other foreign matter in the san- 
 guiferous circulation, produced emesis and other gastro-en- 
 teritic disturbances, l^ow, take into consideration two facts : 
 ardent spirits consist of carbon as their basis, and the sub- 
 jects of this disease are constantly drinking them ; and now 
 for some other facts : It is well known that intemperate men 
 are frequently afiiicted with nausea and vomiting, and that 
 more cases of cholera morbus occur among them than 
 among any other classes of society. It is furthermore true, 
 that when gastric disturbances are interrupted, whether 
 spontaneously or by improper treatment, in drunkards, that 
 delirium tremens is the result. 
 
 Do not these facts show a coincidence between it and 
 cholera, of a character too remarkable for either of them to 
 occur independently of the same cause ? But we have not 
 yet expressed the whole extent of the similitude. In all 
 cases of cholera there is copious perspiration, and occasion- 
 ally, in the absence of both puking and purging, the excess 
 of this function alone runs the patient into fatal collapse; 
 and one of the most marked symptoms of delirium tremens 
 is the copiousness of the perspiration. Again, in cholera, 
 there is a violet or leaden-color of the skin. Is not this 
 also the case in the last stage of delirium tremens ? 
 
 We are now prepared to come to a conclusion as to the 
 nature of delirium tremens. 
 
DELIRIUM TREMENS. 969 
 
 In tke acute form, the remote cause is a high state of 
 cerebral action long maintained by the use of stimula- 
 ting potations, and the exciting cause is such an accumula- 
 tion of carbon, or what is equivalent, in this class of sub- 
 jects, an interruption of the fat-producing process, whereby 
 the carbon in the blood becomes excessive, and conse- 
 quently acts as foreign matter. 
 
 In the chronic form of this disease, the remote cause 
 consists in that shattered or enfeebled condition of the sys- 
 tem which makes the use of an unnatural stimulus essential 
 to the normal discharge of its functions. The exciting 
 cause consists of an abstraction of this stimulus, in conse- 
 quence of which the depurating functions are not properly 
 oor sufficiently canied on. Moreover, carbon has already 
 accumulated to an excess beyond the ability of the respira- 
 tory function, which is the most essential to life. 
 
 If an excess of carbon be the cause of delirium tremens, 
 as it is of cholera, it may be asked why, instead of delirium, 
 there is not cholera. We answer : this is sometimes the 
 case, and when it is not, the condition of the brain deter- 
 mines otherwise. In the first class, the brain is preternat- 
 arally active, and in the second, it is much enfeebled and 
 preternaturally irritable. But in neither case is the assault 
 made upon the organs of external relation, or those of ani- 
 mal life, as every writer has maintained it to be, except Dr. 
 Klapp ; but it is upon the ganglionic system — the organs 
 or apparatuses of internal relation. The reflection of a 
 moment will make this conclusion apparent. 
 
 When the organs of external relation become function- 
 ally deranged, vegetative life and health are, compara- 
 tively, but little disturbed ; as for example, in mania, mono- 
 mania, catalepsy, etc. But when the functions of tiie vege- 
 tative or ganglionic system become deranged, the citadel 
 of life, in the abstract, becomes endangered, as in func- 
 tional derangement of the heart, lungs, stomach, etc. 
 
 Now, inasmuch as delirium tremens is as fatal as 
 most of the functional derangements of the vegetative 
 system, and inasmuch as we think that we have absQ- 
 
970 NERVOUS FORMS OF DISEASE. 
 
 lutely shown that it originates in it, we must give it a place 
 among them. 
 
 In the production of this disease, there are two causes in 
 operation — the action of the stimulus upon, or its with- 
 drawal from, the apparatus of animal life, and the accumu- 
 lation of carbon in the sanguiferous system. Hence, the 
 true seat of the disease is in the ganglionic system, and 
 when the result is not delirium, in consequence of the 
 breach made upon the nerves of animal life, it will be chol- 
 era, or some other gastro-enteritic disturbance. The cere- 
 bral disturbance, therefore, is as much symptomatic as 
 that of fever. Now, we have another question to solve — 
 which portion of the nervous mass of animal life, sym- 
 pathizes with the vegetative ? So far as concerns the 
 mental manifestations, we believe that it is the mesoce- 
 phalse, and with reference to the spasms, it is the medulla 
 and the cerebello-spinal system. For a further view of this, 
 subject, see pathology of insanity. 
 
 There is one circumstance that occui's to us as favorable 
 to the doctrine, that long- continued mental anxiety will 
 produce delirium tremens, w^iich is this : mental anxiety 
 produces mental abstraction, and consequently some neglect 
 of the pulmonary function. The liver, too, soon becomes 
 deranged, and this partial failure in both the lungs and 
 liver may possibly result in a defective depuration of the 
 venous blood. But still, there is wanting those pre-existing 
 conditions of the brain which we have described as con- 
 stant attendants upon the intemperate. 
 
 Long-continued mental anxiety produces in the writer 
 gastro-enteritic disturbances, which are attended with a 
 pain in the head, that has, several times in his life, run into 
 a high state of delirium ; and yet, every other symptom of 
 delirium tremens was absent. These paroxysms with him 
 have never continued longer than twenty -four hours. 
 
 Diagnosis, — Those who are not acquainted with the man- 
 ifestations of cerebral derangement, may, possibly, without 
 some special instruction, confound this disease with men» 
 ingitisj mania^ or febrile delirium. The resemblance 
 
DELIRIUM TREMENS. 971 
 
 between the acute form of this disease and meningitis, is 
 sometimes very strong, so much so, as to render the diag- 
 nosis, in many cases, very difficult ; but in the latter, there 
 is more febrile disturbance and an absence of imaginary 
 dangers or enemies. Sometimes it'is, however, conjoined 
 with meningites, when, of course, there will be a com- 
 plication of the symptoms. Indeed, we have sometimes sus- 
 pected that this form is generally more or less meningitic ; 
 but our suspicion has been produced by the marks of inflam- 
 mation upon the crania of this class of patients, who lived 
 intemperate to the close of life. 
 
 From the chronic form, mania may be distinguished by 
 its greater incoherence, by its more gradual approach, by 
 its less concern for business matters, and its being less tor- 
 mented by imaginary enemies and dangers — tremor, too, is 
 a much less frequent attendant upon it. 
 
 The presence of fever, in lebrile delirium, will distinguish 
 it from the chronic form of this, more particularly when 
 considered in connection with a much greater independence 
 of the fantastic hallucination of the latter. As febrile ma- 
 nia is without that wild and frantic dread of enemies, which 
 distinguishes acute delirium tremens, they need not to be 
 confounded. 
 
 But in all cases where there is a shadow of doubt, the 
 previous habits of the patient should be ascertained if pos- 
 sible. 
 
 Prognosis. — The acute form of this disease is attended 
 with much danger, and it consists in its strong liability to 
 run into coma or apoplexy. Another danger that attends 
 it is suicide ; and yet, when properly met in the incipient 
 or the earlier part of the delirious stage, it is quite man- 
 ageable when simple or uncomplicated. 
 
 The chronic form of this, like the same form of other 
 maladies, is not immediately dangerous ; but ultimately it 
 generally proves fatal — indirectly, at least, by producing 
 great debility, or a preparation of the system for an attack 
 of some other disease that suddenly proves fatal. Yery few 
 cases of this form have many returns of the disease without 
 
972 NERVOUS FORMS OF DISEASE. 
 
 a great impairment of some important viscus, and the 
 liver is the one that is most likely to suffer by the vicarious 
 labor imposed upon it from a failure of the lungs in its de- 
 purating function. 
 
 Treatment. — When called in the early stage of the at- 
 tack, there will usually be found delirium, or more or less 
 spasmodic action. Should delirium only be present, ad- 
 minister a cathartic, place the patient in a recumbent posi- 
 tion, and make cold applications to the head, with warmth 
 and friction to the feet. If gastric derangement be present, 
 treat it as heretofore referred to. 
 
 After the operation of the cathartic, agents must be ad- 
 ministered to quiet the nervous system, produce a deter- 
 mination to the surface, and cause sleep. For this purpose 
 antispasmodics and sedatives must be given, among which 
 we have derived much benefit from equal parts of Tincture 
 of Valerian, Tincture of Castor, Laudanum, and Spirits of 
 Nitre, from one to two drachms of which maybe given 
 every hour, and continued until sleep is produced. 
 
 Should the attack commence with convulsions, give fif- 
 teen drops of the Tincture of Gelseminum every fifteen 
 minutes or half hour, lengthening the intervals between 
 each dose, and continue its use until spasmodic action be- 
 gins to subside, when its use must be omitted, and resumed 
 again only when the spasms re-appear or increase in sever- 
 ity. As soon as possible after the removal of the spasms, 
 administer a cathartic, and subsequently pursue the same 
 treatment as above. 
 
 In cases where patients, after having been for some time 
 under the influence of sedatives, or even after having slept, 
 strongly crave liquors, it will be prudent to cautiously allow 
 them the moderate use of some stimulants to which they 
 have been unaccustomed, at regular intervals, which should 
 be lengthened as far as possible, or as the case will admit. 
 After the more active symptoms have been overcome, the 
 patient should be placed upon tonics, among which we 
 prefer an infusion of Hydrastis. 
 
 It must be remembered that when sleep has been 
 
LITHIASIS. 973 
 
 produced, the patient must, for no purpose whatever, be dis- 
 turbed, unless it partake of the nature of coma, as indicated 
 by heavy breathing, weak pulse, cold, clammy sweat, etc. ; 
 in which case he may be aroused for a few minutes at a 
 time, and stimulants administered. 
 
 Species XY. — Lithiasis — Gravel — Calculous Disease. 
 
 Those morbid conditions of the system which are em- 
 braced by the above title, are indicated by the deposition of 
 an insoluble stony matter from the urine within the body — - 
 the most usual and important of which are the three fol- 
 lowing varieties : the pulverulent, crystaline, and concre- 
 tionary. 
 
 The pulverulent or sedimentary is found adhering to the 
 sides and bottom of the pot, after the urine has had time to 
 cool. TJusually it is divisible into two classes ; the sedi- 
 ments of the first are called pink-colored or lateritious, and 
 consist of the lithates of soda, ammonia, and lime — they 
 vary in color, having sometimes a brown or a yellow hue. 
 The second class consists of the phosphates of lime, magne- 
 sia, and ammonia, and are denominated the white sedi- 
 ments. 
 
 The crystalized sediments are suspended in the urine, 
 but when it comes to rest in the vessel they sink. They are 
 called gravel or sand — they consist of small, irregular grains 
 of nearly pure lithic or uric acid, or a triple salt of phos- 
 phoric acid, magnesia, and ammonia, or of the oxalate of 
 lime. The first are red, the second white, and the last are 
 of a dark -green color. All of these varieties are not to be 
 looked for in the same urine. 
 
 The concretionary form results from the agglomeration 
 of the two preceding varieties, and constitutes what is popu- 
 larly understood by urinary calculi. Of these concretions, 
 there are many varieties, which it is not necessary to con- 
 sider in this place. All urinary deposits, however, may be 
 reduced, for practical purposes, to three classes : the urates, 
 the oxalate of lime, and the phosphates. As each of these 
 indicate a state of disease difiering from that of each of the 
 
974 NERVOUS FORMS OF DISEASE. 
 
 others, it becomes essential to give them a separate con- 
 sideration 
 
 The urates or litJiiG gravel — Lithuria. — This variety of 
 gravel is said to be the most common, and constitutes the 
 most frequent cause of urinary calculi. It consists of uric 
 acid and urate of ammonia, either separate or united, and 
 in a few instances, it is said that the urate of soda becomes 
 an element. These substances being associated with the 
 coloring matter of the urine, have a salmon or brick-dust 
 color, but they are sometimes yellow, and occasionally of a 
 pink hue. Some tinge of red is always indicative of this 
 diathesis. 
 
 During that morbid condition of the system upon which 
 this deposit depends, the urine is, to some extent, scanty, 
 and generally high-colored. As a test of this diathesis, 
 Dr. Kees states, that the deposit is dissolved by nitric acid 
 with eflervescence. When uric acid obtains in the kidneys 
 or bladder, it is not impossible that muriatic or acetic acid, 
 both of which are occasionally in the stomach, may obtain 
 access to it and occasion a deposit of calculous matter. 
 Uric or lithic acid calculi are generally of a brown or ma- 
 hogany color, and the surface may be smooth or tuber- 
 culated. 
 
 Calculi of the urate of ammonia, though of rare occur- 
 rence, do nevertheless, occur — they have a clay-color, and 
 are made up of concentric layers — generally smooth, but 
 occasionally tuberculated — the fracture is fine and earthy. 
 Infants are more liable than adults to this variety. 
 
 Oxalate of lime calculi. — This is frequently known as 
 the mulberry calculus, and has very much the color of the 
 ripe mulberry — and its surface is somewhat like that of this 
 fruit, being tuberculated. This variety does not occur so 
 frequently as the preceding ; but in many cases of it, this 
 variety constitutes the nucleus. As oxalic acid does not 
 obtain in healthy urine, it is imagined by some to be more 
 difficult to account for the production of the disease ; but 
 recurring to the fact that we take into our systems, proba- 
 bly at every meal, all the elements of it, we should give 
 
LITHIASIS. 975 
 
 ourselves no trouble about it until we know more about the 
 chemical operations of the living system. 
 
 PhosjpJiatiG Calculi. — These consist of the phosphate of 
 lime singly, or in combination with the double phosphate 
 of magnesia and ammonia. The first is of rare occurrence, 
 and the second is still less frequently met with. The two 
 forms combined occur more frequently than either of them 
 alone ; and this less frequently than either of the preceding 
 varieties. In connection with this diathesis the urine is 
 generally of a yellowish-white color. The texture of these 
 calculi is but imperfectly laminated, and the color is of a 
 whitish character. They are usually, but not always, soft. 
 The surface has a crystaline appearance, and frequently 
 this calculus is founded upon a laminated, dark-colored 
 uric acid nucleus. 
 
 Symptoms in Genera^l. — An aching sensation or obtuse 
 pain in the region of the kidneys ; a burning and irritating 
 feeling in the urethra and about the neck of the bladder ; a 
 frequent desire to micturate, and when done a sensation 
 remains that all is not voided. Sometimes the mucous 
 lining of the urethra becomes irritable by the passage of 
 small gravel, and then there is an acute smarting, and some- 
 times there is an acute pain in the perineum, but it is only 
 of a momentary duration. 
 
 Causes. — Of the uric or lithic acid diathesis. Dr. Wood 
 thinks that the use of high-seasoned animal food, with wine 
 or alcoholic drink combined with indolence, constitutes 
 the most "powerful'' cause. It is his opinion, further- 
 more, that a liability to this form of disease is sometimes 
 hereditary and apparently associated with gout. As fur- 
 ther causes of this diathesis, he assigns sthenic fevers, and 
 such inflammations as occasion fever ; also inflammation 
 or high irritation of the kidneys ; and he says that Dr. 
 Prout thinks inflammations of the liver and the heart are 
 peculiarly apt to occasion a uric acid sediment. 
 
 All this may be just and correct, but the writer has to 
 add that there is no hereditary taint in his constitution — • 
 that he has never been a high-liver, but on the contrary he 
 
976 NERVOUS FORMS OF DISEASE. 
 
 has been most wretchedly dyspeptic, and that he has suf- 
 fered considerably from this diathesis. 
 
 Oxalic Diathesis. — This form of the disease is thought 
 to be occasioned by derangement of the digestive apparatus, 
 as dyspepsia, etc. It is confessed that but little is known 
 on this subject. 
 
 Phosphatio Diathesis. — Upon the cause of this form of 
 the disease. Dr. Wood says : " It has been observed that a 
 disposition to an over-production of the phosphates is apt 
 to accompany a nervous and irritable condition of the sys- 
 tem, marked by general debility, paleness of complexion, 
 impaired digestion, and a frequent, irritated, and easily 
 excited pulse." In fine, it may attend dyspepsia, debauch- 
 ery, and almost all forms of a ruined constitution. 
 
 Pathology. — The writer is of the opinion that every va- 
 riety of lithic diathesis is but symptomatic of some other 
 form of disease, modified, more or less, by the existing 
 constitution ; and he is surprised that lithiasis, at this day, 
 should be treated of as an independent form of disease. 
 
 Dr. Joy (Cy. Prac. Med.) says that " urinary calculi are 
 formed by the diseased action of the vessels which secrete 
 the urine, or by a deposition from urine in a morbid 
 state." 
 
 Are we to regard the urates which appear in the urine at 
 the close of sthenic fevers, as a result of " diseased action " 
 of the renal vessels ? When the other depurators of the 
 system fail to perform their function, and calculous matter 
 appears in the urine, are we to attribute it to renal disease ? 
 If such calculous matter did not appear in the urine under 
 such circumstances, then we should conclude the renal ves- 
 sels were diseased ; nay, more ; we should conclude that 
 the patient could not live long. 
 
 We do not doubt but that a long continuance of lithiasis 
 will finally produce renal disease, just as a vicarious func- 
 tion imposed upon any other organ will finally enfeeble and 
 derange its function ; but it does not follow that when the 
 kidneys become diseased, from this cause, that theii* secre- 
 tion will still produce lithic deposits. 
 
LITHIASIS 
 
 977 
 
 Under the head ot causes of lithiasis, we are told that 
 blows over the region of the kidneys will occasion lithic 
 deposits in the urine. But does this prove that they were 
 so injured as to occasion them ? Is it not equally probable 
 that other depurators were deranged by the blow ? The 
 writer has frequently noticed that after a few days of men- 
 tal anxiety, a copious deposition of the urates take place 
 from his urine. Were the kidneys at fault ? 
 
 Among the causes of the uric acid diathesis, Dr. "Wood 
 enumerates "damp places." Now we very much doubt 
 whether a case of stone in the bladder ever obtained in the 
 city of New Orleans, where the atmosphere is forever 
 charged heavily with humidity. And why ? Because the 
 bladder is always kept well washed out, and at short inter- 
 vals, by a very copious secretion of urine. During many 
 years' residence in the south , the writer was exempted from 
 all tendency to lithiasis, but in a year after his return to 
 this latitude, the complaint returned upon him. With 
 these remarks we close what we have to say about the path- 
 ology of a symptom, {f) 
 
 Treatment. — The indications in this disease are to change 
 the character of the urine and prevent the deposition from 
 taking place. The treatment will depend, also, upon the 
 character of the deposit ; when there is uric acid, we must 
 endeavor to change the secretion by increasing the quantity 
 and quality of the urine, so as to make it soluble ; for this, 
 the alkalies may be used freely. The Iodide of Potassium, 
 the Bicarbonate of Soda, or the Bicarbonate of Fotassa, 
 should be used and continued in moderate doses until the 
 desired effect is produced. This class of agents increases 
 very considerably the quantity of urine. We use in 
 connection with these the various mucilages, such as 
 Slippery Elm, Gum- Arabic, Flaxseed, Althea Officinalis, 
 Uva Ursi, etc. 
 
 In order to prevent a recurrence of this disease, the 
 patient should use freely of the different combinations of 
 Iron, Iodide of Potassium, and Compound Syrup of Stil- 
 lingia, with the additional use of the alkaline and vapor- 
 
^'«^S NERVOUS FORMS OF DISEASE. 
 
 bath, used alternately each day, and confine the patient 
 entirely upon meat diet. If the phosphatic variety be pres- 
 ent, and complicated v/ith dyspepsia, as we usually find it, 
 we would treat that complication as heretofore recommended 
 under its proper head, making use, at the same time, of the 
 same treatment referred to for uric acid, with the exception 
 of the Bicarbonate of Soda or Potassium. The Nitro- 
 Muriatic Acid may be used in this form of disease with 
 advantage, by adopting both its internal and external use, 
 according to the usual application of this remedy. 
 
 We recommend a similar treatment in the oxalic form, 
 with the exception of the acid application. We would ad- 
 vise the internal use of very little fluids of any kind, con- 
 tinuing the same local applications referred to in the 
 other forms. 
 
 Professor Powell states that during his citizenship in 
 Baltimore, he sufiered considerably from the uric acid dia- 
 thesis, and became relieved by a visit of two years to the 
 Sulphur Springs of Virginia. Thence he went south, and 
 during many years he had no return of the disease. In 
 connection with these circumstances he adds, that while in 
 Baltimore his general health was much depraved — that it 
 improved in Virginia, and became generally good in the 
 south. Since his return to Covington his urine was fre- 
 quently loaded with uric acid deposits, until he changed 
 his residence, which was to a place that bore plenty of 
 grapes — the eating of which arrested the diathesis. He has 
 since experimented on the subject, and finds that the pure 
 wine or juice of the grape made in this neighborhood, and 
 also pickled grapes, will almost immediately arrest it, and 
 render his urine peculiarly pure or clear. 
 
 The remedy is simple and palatable, and those who are 
 similarly troubled would do well to repeat his experiments. 
 
 Species XVI. — Scrofula. 
 In the catalogue of human maladies there is, perhaps, 
 not another that is so distingushed for its capacity of ap- 
 pearing in so many forms and of as many grades of 
 
SCROFULA. 979 
 
 violence as scrofula. It is a tubercular form of disease, and 
 has its location in the lymphatic system. 
 
 Dr. Eberle says that " the most common forms of scrof- 
 ula are tubercular phthisis piilmonalis, white swelling, or 
 disease of the hip and knee joints, and opthalmia." Be- 
 tween phthisis pulmonalis and the other forms of tubercu- 
 lous disease we are aware that writers have made no dis- 
 tinction. We are so far of a contrary opinion as to venture 
 to suggest a difference. Phthisical subjects are marked 
 with a liability to phthisis through life, but the scrofulous 
 ones are not necessaril}^ so marked. It as frequently occurs 
 in persons who have not in the least a phthisical form as in 
 those who have — if not more frequently. 
 
 We are of opinion that children may be scrofulous and 
 yet, in manhood, have nothing of a scrofulous character 
 about them, and vice versa. If the liver, and even the 
 muscles of a hog, or a rabbit, can be filled with tubercles 
 by feeding, why may they not in children ? As a general 
 fact, we have not been able to discover anything like a fam- 
 ily likeness between the heads and chests of scofulous and 
 phthisical people. When a child is the only one of the 
 same sex in a family, it may generally be considered as 
 liable to scrofula, and upon this principle it was, very prob- 
 ably, called the " King's-Evil " — too much feeding. 
 
 We do not contend that it can be produced in all persons, 
 and for the reason that all persons have not a cerebral or- 
 ganization adapted to it ; and that which we have found, 
 most frequently, to be associated with it, is the reverse of 
 that which most generally attends phthisis. 
 
 Writers have indulged in a very minute description of 
 those whom they regard as being " predisposed " to it, but 
 they do not agree among themselves in many important 
 particulars. We have never seen one who was " predis- 
 posed " to it, but we have seen many whom we regarded as 
 being organically liable to it, and we have seen many who 
 had it, and yet in the circumstance of eyes, hair, complex- 
 ion, etc., there existed scarcely a shade of family r3sem- 
 blance. We admit that there is a set of features which 
 62 
 
980 NERVOUS FORMS OF DISEASE. 
 
 have a strumous indication ; but we hold them to be like 
 the signs of rain in dry weather — ^.they pretty generally 
 fail. Some people say that they can always distinguish 
 a Jew from the other classes of society, but the writer con- 
 fesses that he can not, and yet he can discriminate between 
 Whigs, Democrats, Presbyterians, Methodists, and Episco- 
 palians, but not without a few failures — possibly live in a 
 hundred. 
 
 If we had found the signs of a scrofulous liability as well 
 established as we have the sectarian, we would venture to 
 name them. The truth is, as we believe, there is a large 
 class of persons, particularly of children, in whose ancestry 
 the disease never existed, who may be fed into scrofula, as 
 certainly as a hog or a rabbit, but such is not the case with 
 phthisis. The difference is possibly this : the 'former is 
 dietetic and the latter is atmospheric. For further informa- 
 tion, consult the introduction to the third book and the 
 article phthisis. 
 
 The deposition of tuberculous matter in this form of dis- 
 ease is of two characters ; it occurs in the form of an infil- 
 tration in the tissues, or in the form of little isolated bodies, 
 which in both cases is gray and semi-transparent, but in 
 time becomes opake, possibly yellow, and it may become 
 hard or merely rather soft. The matter is found, some- 
 times, in both conditions as to translucency and opacity ; 
 and it has not been determined whether the difference is 
 original, or that the former passed into the latter. 
 
 When the tubercles are of the isolated character, and not 
 larger than millet-seed at first, they are known as tubercu- 
 lous granulations or miliary tubercles. From this diminu- 
 tive size they become to be as large as a garden pea. A 
 change at length begins — they become softer, and finally 
 pass into a pus- like matter. Frequently these tubercles 
 are aggregated together and form a considerably large mass. 
 Upon this pus-like condition inflammation ensues, and 
 consequent ulceration. The infiltrated variety develops 
 into large, irregular masses, and then runs the same course 
 with the other. These tubercles may be formed in alnii©st 
 
SCROFULA. 981 
 
 any part of the system — the writer has seen them in the 
 liiDgs, liver, spleen, kidneys, muscles, mesentery, and the 
 glans penis. No age is entirely exempt from this form of 
 disease, but the two extremes of life are the most liable. 
 In this respect scrofula and phthisis are similar, and no 
 doubt the rationale we have given of the latter applies 
 equally to the former. 
 
 Exciting Causes. — Climate has as much to do in the 
 production of scrofula as it has in phthisis, and in confirm- 
 ation of this statement. Dr. Alison says, " that a great 
 majority of the inhabitants of the West and East Indies, 
 both negroes and Hindoos, are unusually prone to scrofula 
 when they come to temperate climates." — Eherle. The 
 reason of this is explained in the reference before made. 
 Among the affluent we consider over feeding and the use 
 of too much carbonaceous food as the most common cause ; 
 and among the poor, insufficient clothing, and consequently 
 too frequent exposure to cold and dampness. The negroes 
 of this country, in consequence of their natural inability to 
 endure cold as well as the whites, are much more liable. 
 In very many instances, in parts of our country, it is due 
 to the double influence — exposure to cold and feeding on 
 fats. 
 
 It is said to be much more unmanageable when heredi- 
 tary ; this should be expected, because to a tubercular or- 
 ganization is added suitable modes of organic action. 
 
 Prognosis. — When the patient is either young or old, the 
 prognosis is unfavorable ; in the first, because the existence 
 of the disease indicates an insufficient viability, and in the 
 old, because it indicates a declining viability. When the 
 patient's residence is in a cold and humid atmosphere, 
 the chance of a cure is improbable. When the patient is 
 an adult, or beyond puberty, with a tolerable share of 
 strength, a cure is rendered probable. A southern planter 
 assured the writer that he would not insist upon a reduction 
 of more than one hundred dollars in the price of a scrofu- 
 lous negro under the circumstances last named, because he 
 could cure him in a few weeks by the use of Burdock. 
 
982 NERVOUS FORMS OF DISEASE. 
 
 This may be true in the south and utterly fail in this 
 c.imate. 
 
 Treatment. — If this occurs after the organization becomes 
 complete, we can not expect to accomplish as much in the 
 treatment as we can previous to this period. And whatever 
 is accomplished, must be done by changing the quantity 
 and quality of the Food. 
 
 When this occurs in children and is located in the gland- 
 ular system, especially about the neck, there is great liability 
 to its passing into a stage of suppuration ; this may be pre- 
 vented, however, by covering the neck, where a predisposi- 
 tion exists, with flannel or some similar article. The fluid 
 extract of the Walnut leaf has been used pretty extensively 
 in the treatment of this disease. The treatment which 
 we pursue is so similar to that which is recommended 
 in the Eclectic Surgery, that we extract pretty fully from 
 that work, as follows : 
 
 '' The treatment must have reference to four considera- 
 tions : 1st, The constitution ; 2d, The inflammatory con- 
 dition or tendency in any part ; 3d, The abscesses ; and 4th, 
 The ulcerated or, perhaps, scirrhus complication. 
 
 '' To correct as much as possible the constitutional taint, 
 give the Alterative or Scrofulous Syrup; or one I have 
 often made for this purpose, a compound of equal parts of 
 the Eumex Crispus, Ampelopsis Quinquefolia, and Solanum 
 Dulcamara. This preparation, taken alternately with the 
 Scrofulous Syrup, seems to have a better efiect than the con- 
 tinued use of either of them alone. In connection with one 
 or both of these, a beer may be directed as a common drink, 
 strongly charged with the Sassafras, Burdock, and Spice- 
 bush. The Menispermum Canadense and Aralia Nudi- 
 caullis in a strong syrup, is excellent ; the Scrofnlaria may 
 be added to either of the foregoing or used alone, with ex- 
 cellent efiect. So also may the Corydalis Formosa. 
 
 " A mild emetic, followed up with a mild cathartic, 
 should be occasionally given during the alterative course. 
 If the patient is inclined to acidity of the stomach, the 
 emetic should be repeated once a week or often er. If there 
 
SCROFULA. 983 
 
 is derangement of the liver, as there Ireqiiently will be, 
 especially if the patient has been previously treated with 
 Mercury, use an alterative portion of Podophyllin in con- 
 nection with Leptandrin, when there is much debility ; or 
 if the bowels are already too loose, the Leptandrin alone. 
 
 "From late experience of my own and others, I am fully 
 convinced that no alterative or combination of alteratives 
 that we possess, is equal to the Stillingia S} Ivatica, either 
 for the relief of scrofulous disease when developed, or the 
 correction of the constitutional predisposition. 1 have re- 
 cently eflected cures with this article, as the only constitu- 
 tional remedy, when the ulceration was very extensive, 
 affecting even the spongy bones of the face and nose. The 
 article may be used as infusion, decoction, or syrup, taken 
 three or four times a day, as much as the stomach can bear. 
 
 " The saline and alkaline baths should be used all the 
 time in alternation, one or the other every day. 
 
 " The diet must always be nutritious and easy of diges- 
 tion — all stimulating condiments to be avoided. Never 
 think of restricting to ' vegetable diet.' 
 
 " To discuss any hardened tumors or enlarged glands 
 before active inflammation or soreness is manifested, apply 
 a poultice wet with the Comp. Tine, of Myrrh, and cloths 
 wet with the same applied and covered with Slippery-Elm. 
 In some cases the Discutient Ointment may be more con- 
 venient. Strong alkaline lotions aid much in bringing 
 about resolution. 
 
 " In threatening or incipient inflammation, make a poul- 
 tice of the Arum Triphyllum, by mixing the dry powder in 
 warm w^ater, and apply, changing it three times a day. 
 The fresh root finely grated is still better. This article 
 seems to have something quite specific in its influence, 
 speedily removing scrofulous tumors when very large and 
 highly inflamed. Whatever external means are applied in 
 such cases must be of a stimulating character, if you expect 
 them to aid at all in bringing about resolution. 
 
 ''If, however, your means for bringing about resolution 
 should fail, or it is already too late for their appliciitiou — • 
 
984 NERVOUS FORMS OF DISEASE. 
 
 if suppuratioD has already taken place, the sooner the mat- 
 ter points to the surface and breaks out, the better for the 
 patient. In order, then, to facilitate this result, apply 
 emollient fomentations and poultices. But it is not best 
 to wait for a spontaneous breaking. As soon, therefore, 
 as any point becomes purple or discolored, and you can 
 perceive by the fluctuation that the tumor contains matter, 
 though it may be deep-seated, open an issue with caustic 
 potash, pressing it in until it makes its way deep into the 
 tumor. Let it enter the cavity if possible, the very first 
 application. It causes little pain after passing through the 
 skin. At all events, leave a sufficient quantity of the caustic 
 to work its way through. Re-apply the poultices as before, 
 continuing them so long as there is any inflammation. 
 
 ''After this, wash out the abscess once or twice a day 
 with vegetable caustic, very weak at first, by means of a 
 syringe, keeping the external orifice open until it fills up 
 from below. After a few days of this alkaline washing 
 the discharge will assume a healthy character. It should 
 still, however, be kept up for a while, in order to prevent 
 the fungous growths and aid the healing process. 
 
 "If you find that the abscess contains a lymphatic gland, 
 loose and surrounded by pus, enlarge the orifice in order 
 that it may escape, or you may cautiously aid its expulsion 
 by pressure, or even remove it yourself with forceps. After 
 the removal of the gland, the sore will generally 'heal 
 kindly.' It may, however, still need stimulating alternated 
 with caustic applications. If the sore assume the character 
 of a malignant ulcer, persevere with the constitutional 
 measures before recommended, and let your local applica- 
 tions for a while be only such emollients and other antiphlo- 
 ffistics as are calculated to reduce inflammation and irrita- 
 tion. Against the latter a good article is a poultice of the 
 Scrofularia Marylandica, with Stramonium and the Lobelia 
 herb. 
 
 " After allaying irritation, if there be any callous growth, 
 which resists the vegetable caustic, use the caustic potash. 
 Place over the ulcer also a salve composed of the roots of 
 
EPIDEMIC CflOLERA. 985 
 
 Chelidonium or the common Irritating Plaster. This may 
 be occasionally removed, if necessary, and the emollients 
 re-applied. Under these means the ulcer will soon heal, 
 all induration disappearing. 
 
 " If the ulcer has sinuses communicating with each 
 other, they should be joined, if possible, by ligature or the 
 cautery, and may require injections and tents of mild caus- 
 tic. These or similar means, in connection with the con- 
 stitutional regimen before recommended, have succeeded in 
 numerous instances, many of which had baffled the skill 
 of the most celebrated practitioners. It is, no doubt, to 
 the constitutional remedies that we are chiefly indebted, 
 the local means being, after all, merely palliative, and never 
 amounting to a removal of the cause. 
 
 " In no cases of scrofula do we meet with half as much 
 difficulty, as in those, where, beside the disease, we have 
 to contend with the effects of previous medication. The 
 worst influences are induced in this form of cachexia by 
 Mercury and Sulphur. The injurious influence of this 
 latter article is not, perhaps, as well known as the former." 
 
 In addition to the above we have often derived much 
 benefit from the use of Iodide of Potassium in combination 
 with the Syrup of Still ingia, in proportion of one drachm 
 of the former to four ounces of the latter, of which, for an 
 adult, one drachm may be given three times a day. The 
 different combinations of Iron should be used freely ; allow 
 the patient plenty of exercise and. a generous meat diet. 
 
 Species XYII. — ^Epidjsmig Crolera — 
 Asiatic Cholera — Spasmodic CJiolera — Cholera Asphyxia. 
 We have no very certain historical evidence that this 
 form of disease was ever known before its appearance in 
 Hindostan, in 1817 ; yet there is history enough to show 
 that this was not, probably, its first visitation. In one year 
 after its first appearance, which was at Jessore, in Hindos- 
 tan, it appeared at Bombay; in 1821, it invaded Arabia, 
 and thence, passing through Persia, it appeared at the 
 month of the Volga in 1823, and nearly at the same time 
 
9S6 NERVOUS FORMS OF DISEASE- 
 
 it also visited Tripoli. In 1830, it re-visited the mouth of 
 the Yolga ; thence, passing through Russia, Poland, and 
 Germany, it appeared on the coast of the Baltic in 1831, 
 and shortly after it made its appearance in England, and 
 thence, in 1832, it visited the United States. 
 
 Some discussion has been had as to the name that should 
 be adopted to designate the true nature of the disease. It 
 is questioned whether it really belongs to the genus chol- 
 era — it is thought by some to hold a nearer relation to that 
 of fever, and hence the appellation of efpidemie cholera 
 fever has been suggested for it. But as fever is not disease, 
 but merely a mode of vital action to remove obstruction, 
 we can discover no propriety in changing the name, more 
 especially as the one it now has is universally understood. 
 When we come to treat of its pathology it will be discovered 
 that neither of the names expresses its true character — the 
 one it now bears is, perhaps, the more significant. It may 
 be defined to be a form of disease which is characterized 
 by vomiting and purging of a colorless fluid, severe spasms 
 of the voluntary muscles, great prostration of strength, 
 succeeded by collapse and death or recovery. Now, except 
 the character of the discharges, the writer has known all of 
 these features to attend a congestive chill of an intermittent 
 fever. It frequently happens that recovery from this dis- 
 ease takes place without a stage of excitement, as has been 
 contended for, and the writer has witnessed the san:e in 
 congestive chilL Under a proper mode of treatment we 
 are not sure that a stage of excitement is essential to either 
 form of disease. 
 
 For the purpose of greater explieitness in giving the 
 natural history of this form of disease, we shall divide it 
 into four stages, viz : the premonitory, the choleric, the 
 collapsed, and the convalescent. 
 
 1. Premonitory stage. — During the prevalence of the 
 epidemic, almost every member of the commuuity feels 
 some of the eflfects of the specific cause of the malady — - 
 one complains of lassitude ; another of costiveness ; ano- 
 ther of diarrhea \ another of anorexia \ another of djseiaterj; 
 
EPIDEMIC CHOLERA- 987 
 
 another of colic pains, etc. In confining our remarks to 
 those who become the subjects of the disease, we may say, 
 that in a great majority of the instances, diarrhea has been 
 the most distinguished symptom of this stage. In the be- 
 ginning, the diarrhea is fecal and bilious, but ultimately it 
 takes on the peculiar or serous character of the choleric 
 stage. This diarrhea may continue many days and greatly 
 enfeeble the patient, and from it he may spontaneously 
 recovery but this is not usual ; most generally it passes into 
 the next stage. In other instances the diarrhea is only a 
 few hours in advance of the second stage, but its average 
 duration is about forty-eight hours. In most instances the 
 transition from the first to the second stage is occasioned 
 by some error or imprudence at the table. In many in- 
 stances it is occasioned by fear. This premonitory stage, 
 when prostrating from the extent of the purging, but unat- 
 tended by spasms, has been denominated Gliolerine. Con- 
 stipation very frequently precedes, and is premonitory of 
 cholera, and the use of medicine to excite alvine action is 
 very apt to induce the disease. Dysenteric symptoms, and 
 more or less stricture of the large intestines, though com- 
 mon to society during the prevalence of the epidemic, are, 
 by no means, so apt to be followed by an attack of the 
 disease as diarrhea. 
 
 2. Choleric stage. — This stage comprises those phenom- 
 ena which have given character to the disease, and therefore 
 it might be appropriately denominated the stage of action. 
 It commences with a feeling of uneasiness in the stomach — 
 in some instances it amounts to pain, which, in either 
 event, is speedily succeeded by a vomiting of a white Oy 
 colorless fluid, resembling ricQ- water, and also a purging 
 of the same kind of fluid ; the purging, however, may 
 have continued from the premonitory stage, and therefore, 
 necessarily have preceded the vomiting. The latter is very 
 rarely so eifectual as the purging — in many instances it 
 consists of mere efforts at emesis, but in others the contents 
 of the stomach are ejected with great force. The muscular 
 spasms or cramps usually commence with the vomiting. 
 
988 NERVOUS FORMS OF DISEASE. 
 
 but sometimes they precede, and they constitute the great- 
 est portion of the suffering or positive pain which the dis- 
 ease occasions. T^he alvine discharges are sometimes 
 scanty, but generally they are copious ; and the urinary 
 secretion is suspended or very nearly so. The pulse is 
 feeble, most generally, and frequent ; the cutaneous tem- 
 perature is much below the normal standard ; the features 
 are shrunk and of a livid or pallid hue ; the respiration is 
 hurried, and frequently interrupted by spasms of the dia- 
 phragm and other muscles. 
 
 Most of the reports that have come to our notice state 
 that this stage most generally makes its assault between 
 midnight and sunrise. As it advances the circulation 
 sinks, the pulse becomes feeble and fluttering, and finally, 
 in many cases, imperceptible. The tongue is pale and 
 moist, but in other respects more or less normal. At length 
 the skin becomes cold and of a violet or leaden-color, and 
 so inelastic that when drawn into duplicatures, it so con- 
 tinues. The patient complains violently of the spasmodic 
 contractions of the muscles, and begs to have friction ap- 
 plied to them. In the course of this stage he becomes very 
 restless and complains of distress about the praecordia, and 
 betrays much difficulty in respiration. The mean duration 
 of this stage varies from eight to twelve hours, but be it 
 long or short, all the symptoms, unless arrested, increase 
 in violence to the introduction of the stage of collapse. 
 
 3. Stage of Collapse. — The patient has now passed the 
 period of much suffering, but feels oppression about the 
 prsecordia and betrays that restlessness which is character- 
 istic of high degrees of congestion. The pulse at the wrist 
 is absent, or so nearly so as to be barely perceptible ; the 
 skin has, to the feeling of others, an icy coldness, and is of 
 a bluish complexion, particularly on the hands and face. 
 The tongue is moist and of less than a normal temperature, 
 and the stomach has, so far as the fact can be ascertained, 
 lost the whole of its irritability, for the most powerful stim- 
 ulants do not seem to affect it. The urine is now entirely 
 suspended. Spasms are not now so frequent, and when 
 
EPIDEMIC CHOLERA. 989 
 
 they do occur, they are too feeble to give much pain ; the 
 respiration is particularly slow ; the eyes are sunken in their 
 orbits ; the conjuctivse are dry, glary, and in the inferi or 
 hemisphere injected with a dark-colored blood. The breath 
 is but little more elevated in temperature than the atmo- 
 sphere ; the voice is very feeble — frequently it becomes 
 lost ; the evacuations, if any, are passed involuntarily. If 
 death is to close the scene, the spasms, if they have been 
 absent, return, and after death the muscles are sometimes 
 found in a state of rigid contraction. The intellect usually 
 maintains its integrity to the close of life, but this does not 
 appear to be the case with the affective faculties, for the pa- 
 tient appears to be incapable of any variety of emotion. 
 Although he appears cold to those who observe his condi- 
 tion, yet he complains of great heat and an insupportable 
 thirst ; the respiration continues to sink until it becomes 
 imperceptible, but finally a few gasping efforts are observed 
 which are readily understood to announce the moment of 
 dissolution. This is the general result of collapse, but not 
 the uniform, for a few do recover from this low and appa- 
 rently lest condition. 
 
 4. Convalescent stage.— -Wh^ihOiY this commences in the 
 choleric or the collapsed stage, it begins by a return of heat 
 to the surface ; the pulse becomes less frequent, but mpre 
 full and forcible ; the sense of oppression about the prae- 
 cordia abates ; the spasms become less frequent and violent; 
 the discharges cease ; the skin assumes a normal appear- 
 ance, and the patient passes into a quiet and refreshing 
 sleep. The glandular system now returns to its duty, and 
 the patient, when he awakes, feels that he is comparatively 
 well — and, in many instances, he is, but so feeble and deli- 
 cate is his condition, that he may readily relapse. 
 
 If the efforts of the system and of the physician have 
 succeeded in removing the proximate cause — obstruction — 
 then is the patient really well when secretion has become 
 re-established. In such cases there is no stage of febrile 
 excitement — it is simply one of nutrition ; but in some cases 
 the obstruction has not become removed, and the system 
 
990 NERVOUS FORMS OF DISEASE. 
 
 sets up a febrile action to remove it, but in many cases this 
 last effort fails, and death is the consequence. After reac- 
 tion has been established, the patient, by imprudence or 
 otherwise, may have a return of the disease and death may 
 be the result; and in the event that the depuration was 
 not rendered complete during the active stage of the dis- 
 ease, that obstruction which remains may ultimately pro- 
 duce death, notwithstanding the utmost febrile efforts the 
 system is capable of making. 
 
 Dr. Brown (Cy. Frac. Med.) will have a febrile stage 
 whether the facts warrant it or not, and it is possible that 
 in Europe such a stage did always attend the reaction, be- 
 cause of some peculiarity incidental to the country, or to 
 the treatment, which w^e deem the most probable. We can 
 not conceive it to be possible that after venesection and 
 large doses ol* calomel, febrile action could be dispensed with 
 in any case of reaction in this form of disease. 
 
 In the event the reaction should be of a febrile character 
 the patient will complain of pain in his head, the vessels of 
 the conjunctiva become distended with blood, and light be- 
 comes distressing to the eyes, the tongue is dry and red, and 
 the fever is of a typhous character. As the disease pro- 
 gresses the patient betrays stupor and possibly a muttering 
 delirium. In this condition, more or less, he may continue 
 a week or ten days, and then sink into coma and death, or 
 finally recover, but his convalescence will be long and tedious. 
 
 When the patient has been so fortunate as to escape the 
 febrile attack, which frequently happens even in violent 
 cases, under a judicious or a depurating treatment, he re- 
 turns to good health in a few days. But in the other event 
 he will be afflicted with gastro-intestinal derangements for 
 months. 
 
 Like intermittent fever, cholera sometimes appears in 
 what may be called a masked form — that is, the attack may 
 not be attended by either nausea or vomiting, or possibly 
 no diarrhea attends it ; or the cramps or spasms may be 
 very light, or possibly, entirely absent, and yet, in all 
 other respects, it is epidemic cholera. 
 
EPIDEMIC CHOLERA. 991 
 
 Diagnosis. — Some cases of common cholera are so vio- 
 lent, that were they to occur during the prevalence of the 
 epidemic, which is not possible, they would certainly be 
 regarded as instances of it. As the treatment must be the 
 same in both, and as both can never happen at the same 
 time, it is useless to labor at an accurate diagnosis. The 
 only other form of disease with which it is possible to con- 
 found epidemic cholera, is congestive chill, as it is some- 
 times seen in the south. But in the latter the alvine dis- 
 charges consist of serum and blood, which, so far as we have 
 learned, is never the case with cholera. 
 
 Prognosis. — As the writer never lost a case of congestive 
 chill, nor one of cholera, when called to it before the stage 
 of collapse, he is forced to regard the latter as a very man- 
 ageable disease to the end of the choleric stage. That of 
 collapse is confessedly one of danger, and so is the febrile, 
 when it happens, for it is entirely incidental. The fact of 
 its occurrence proves that the specific cause, more or less, 
 is still present in the system, and it is too feeble to produce 
 such a grade of febrile action as may be requisite for its 
 removal. 
 
 Causes. — Upon the subject of- the exciting causes of this 
 disease, there is a pretty general unanimity of opinion ; 
 but with reference to the specific or remote, there exists 
 much diversity. 
 
 The specific cause has been very extensively attributed 
 to contagion ; some have regarded the lime that is in the 
 water we drink as being the cause ; some refer it to elec- 
 trical changes in the atmosphere, others to planetary in- 
 fluence ; some to malaria, and others to atmospheric ani- 
 malcules. As no one of these supposed causes has been 
 so explained as to account in any wise for the manifest- 
 ations of the disease, they have made no impression upon 
 the judgment of the writer. If either of these opinions 
 has any merit, as it has been defended, he has not been 
 able to discover it. 
 
 At the time the disease first appeared in England the 
 writer resided in Baltimore, and was a member of its 
 
992 NERVOUS FORMS OF DISEASE. 
 
 medical society, in which the disease was discussed at al- 
 most every meeting, during a year prior to its appearance 
 in New York. The writer was the only member of the 
 society who did not believe it to be contagious up to the 
 time it appeared in that city. So firmly was he convinced 
 that it was not contagious, that he offered himself as a sub- 
 ject for any experiment, by inoculation or otherwise, which 
 the society might decide to institute. His opposition to 
 the idea of its being contagious, was founded on the single 
 fact that the disease did not provide, like small-pox and 
 other contagious forms of disease, an apparatus for the elab- 
 oration of a poison. Up to the time of its appearance in 
 Baltimore, he had formed no idea as to what the cause was, 
 except that it was in some way atmospherical. 
 
 Upon the appearance of the disease in that cit}^, Mr. Baer 
 called the writer's attention to the astonishing fact that he 
 could not make sulphuric acid in his laboratory with suffi- 
 cient success to meet the cost of materials — the chamber, as 
 the manufacturers termed it, smoked. The writer visited 
 with him the laboratory, and smoke it did, at every chink 
 and crevice — a circumstance that never happens when com- 
 bustion is well sustained. This phenomenon continued 
 during the presence of the cholera. 
 
 To conclude from this circumstance — this single coinci- 
 dence, that the disease was occasioned by an atmospheric 
 cause, may be considered as rather hazardous ; but so care- 
 fully did the writer observe the coincidence and all its de- 
 tails, and so satisfactorily did such an atmospheric condi- 
 tion, admitting it to exist, account for the production of the 
 disease, that he could not refrain from regarding the feeble 
 combustion and the cholera as results of the same cause. 
 
 In 1835, the writer made this coincidence and his conclu- 
 sions from it, with reference to cholera, known to the med- 
 ical society of the Cincinnati Medical College, and they 
 met a very able support from Prof. Drake. Subsequently 
 he published the tact of the coincidence in one of the Cin- 
 cinnati papers, which he supposes occasioned other observ- 
 ers to give attention to the subject upon the next return of 
 
EPIDEMIC CHOLERA. 
 
 993 
 
 of the cholera to the city, when the same phenomenon was 
 observed and published ; he has forgotten the authority. 
 
 The modus operandi of this atmospheric condition in the 
 production of cholera, will be given when we come to treat 
 of the pathology of the disease. As to what that atmo- 
 spheric condition was, we shall not inquire ; for our present 
 purpose it is enough for us to know that it was such as to 
 afford, comparatively, but a feeble support to combustion. 
 
 That some persons are more liable to be assailed by chol- 
 era than others, we do not doubt; and yet, in this respect, 
 this form of disease is less influenced by differences of con- 
 stitution than any other now recollected. Some organiza- 
 tions are entirely exempt from acute rheumatism, others 
 from the chronic, and so with other forms of disease, the 
 cholera excepted. We have known it to assail some of the 
 best and most resisting constitutions that ever distinguished 
 the race — constitutions that had resisted every other form 
 of epidemic, and those too, who, through life, had con- 
 formed as closely to the natural laws as man well can. Yet, 
 as we have remarked, some organizations, particularly 
 when under the influence of certain habits, are more liable 
 than others ; and the most liable are the most cowardly. 
 "We do not mean by this remark, that none but cowards 
 have the disease, but simply that more cowards have it and 
 die of it, than of any other class, particularly among those 
 who are able to command the essential comforts of life. In 
 the opinion of the writer, there is, however, one organiza- 
 tion which appears to be more exempt from cholera inva- 
 sion than any other, and that is the obese. The writer has 
 never known a fat man to have the cholera, and by inquiry 
 of his professional brethren, he has heard of but very few. 
 This exemption should, a priori^ be expected, and for rea- 
 sons that will be found under the next head. 
 
 The exciting causes are, mostly, such as are known to 
 develop other forms of disease. Dr. Eberle says that " the 
 natural or constitutional predisposition to (the) disease con- 
 sists, probably, in a naturally -delicate and irritable state of 
 the mucous membrane of the alimentary canal — a condition 
 
994: NERVOUS FORMS OF DISEASE 
 
 ' which may have show itself, on a former occasion, in a pe- 
 culiar liability to disorders of the stomach and bowels, from 
 slight causes, or by a habitual tendency to diarrhea and 
 dyspepsia.' " 
 
 We regard this opinion very much in the light of a mere 
 supposition, and it is a very natural one to those who en- 
 tertain the opinion that the mucous surface of the intestinal 
 canal is the primary seat of the morbid impression. But 
 the writer has known men who had, comparatively, the di- 
 gestive apparatus of an ostrich, to have the disease. "We 
 do not doubt that those who have a feeble or an unsound 
 digestive apparatus are, cceteris paribus^ the most liable to 
 die of the disease. The doctor adds, that " Exposure to 
 a cold and humid atmosphere, particularly at night ; exces- 
 sive fatigue of the body ; inordinate mental excitement — 
 the abuse of spiritous liquors, and crude, indigestible, and 
 irritating articles of food, are particularly, calculated to favor 
 the development of cholera, in persons exposed to the in- 
 fluence of its cause." He goes on to name those articles 
 which have been found the most provoking in this respect, 
 but such a detail we do not think profitable, because articles 
 which are greatly indigestible with one person are particu- 
 larly the reverse with others. It will be safe, however, to 
 proscribe, during the prevalence of this epidemic, green 
 peas and corn, cucumbers and watermelons ; but even these 
 may prove very harmless with some people. The lather of 
 the writer, in the eighty-second year of his age, had a severe 
 attack of this disease, and yet, during the choleric stage he 
 drank sour buttermilk and ate pickled cucumb3rs, and he 
 would have them, in defiance of the remonstrance of his 
 physician and friends. Suffice it to add — he is still living. 
 
 ISTatuee or Pathology of Epidemic Choleka. — Hahne- 
 man, Neal, and others maintain that it is occasioned by the 
 introduction of animalculae into the sanguiferous circula- 
 tion through the medium of the lungs and the alimentary 
 canal. We name this hypothesis, to the exclusion of others, 
 because we conceive it to be the one that is most generally 
 adopted. But upon this hypothesis we fall very far short 
 
EPIDEMIC CHOLERA. 995 
 
 of accounting for many of the most obvious phenomena 
 that distinguish the disease ; as the peculiarly dark color 
 of the blood — even the arterial, the dark-blue or violet 
 color of the skin of the hands and face, and of the teeth 
 and nails. 
 
 In treating of the specific causes of cholera, we stated that 
 during its first visit to Baltimore, the atmosphere was inca- 
 pable of sustaining a normal combustion, and that upon a 
 subsequent occasion the same fact was observed in Cincin- 
 nati. The accuracy of this observation being admitted, it 
 follows that the pulmonary function could not have been 
 any better sustained than was combustion. Under such a 
 circumstance much of the carbon that ous^ht to have been 
 oxydized and eliminated from the lungs, continued in 
 the blood, and therefore in the course of some days the 
 arterial blood would partake of the venous character, be- 
 come dark, and through a want of oxygen, unfit for a nor- 
 mal support of any of the vital functions. This carbon, 
 then, in not having been eliminated, becomes in the blood 
 absolutely a foreign body, and must have, more or less, 
 the effect of foreign matter introduced into the venous 
 system. 
 
 Experimental physiologists have discovered that olive 
 oil and other bland fluids injected into the venous system 
 occasion emesis, and we think it probable that if these ex- 
 periments had been pushed to the same extent of repletion 
 of the foreign matter thus injected, which takes place with 
 the carbon in cholera, catharsis would also have resulted. 
 In the experiments of Drs. Manzolini and Quaglino, of 
 Milan {Brit, and For. Med. Chir. Rev.., from Gaz. Med- 
 ica di Milano)^ it was discovered that the injection of the 
 mineral poisons into the venous circulation occasioned gas- 
 tro-enteritis, and that such an injection of pus of any kind, 
 produced very similar results. In this circumstance we 
 have an explanation of the fact that diarrhea and gastro- 
 enteritic disturbances very generally attend suppurating 
 forms of disease. 
 
 It is, furthermore, shown by these experiments, that the 
 63 
 
996 NERVOUS FORMS OF DISEASE. 
 
 mineral and animal poisons produce derangement in tlie 
 organs of internal relation — the ganglionic system, and 
 that the vegetable exert their influence upon those of exter- 
 nal relation. We find very similar results from the admin- 
 istration of these substances respectively ; opium, alcohol, 
 strychnia, etc., produce delirium, a loss of consciousness 
 and of volition over the locomotive movements, and that 
 such an administration of the mineral poisons manifests 
 their morbid influence upon the mucous lining of the ali- 
 mentary canal. 
 
 As regards the animalculse hypothesis, we have no proof 
 of their existence in the atmosphere during the prevalence 
 of cholera, and if we admit that they do, it can not follow 
 that they are of the same genera and species with those 
 discovered by post-mortem investigations ; one is atmo- 
 spheric, and the other is parasitic and aquatic. Again, we 
 regard it as an indisputable fact that the choleric atmosphere 
 is unfriendly to combustion, and it will scarcely be con- 
 tended, we think, that this condition of it was occasioned 
 by animalculse. 
 
 In 1S49, and on the day that the cholera was the most 
 fatal in Cincinnati, Frof. Newton, who was confined to his 
 chamber at the time, has assured the writer, that all the 
 house flies about his house died on that day. They first 
 betrayed more or less stupor and an incapacity to fly, and 
 then presently dropped dead. This mortality among the 
 flies may have been occasioned by atmospheric animalculse, 
 but we think that they died of asphyxia. 
 
 In treating of the causes of cholera, we gave it as our 
 opinion that fat or obese people are less liable than other 
 persons to this disease ; and the reason is now obvious. 
 They require less oxygen than other persons, and whatever 
 of carbon there may be in the venous blood unoxydized and 
 eliminated, unites with hydrogen and is stored away in the 
 form of adeps. 
 
 Finally, our opinion is, that the first morbid impression 
 is made upon the nerves of organic life by the abnormal 
 condition of the blood, from the presence of foreign matter — 
 
EPIDEMIC CFxOLERA. 997 
 
 that the nerves of external relation become affected no fur- 
 ther than is essential to maintain the normal relation be- 
 tween the two systems, and that the action of the mucous 
 membrane of the alimentary canal can no more be said to 
 be disease or derangement, than is the action of the skin 
 in copious diaphoresis, for the purpose of removing febrile 
 or other obstructions. That its action is in obedience to a 
 law of the system to get clear of the foreign carbon that is 
 in the blood ; and when this is eliminated the patient re- 
 turns to health. The disease is not the carbon, but the con- 
 sequence of its influence upon the ganglionic centers. 
 
 Prophylaxis. — When an epidemic of this disease is an- 
 nounced to the community, almost everybody commence 
 some course of life which they intend shall save them from 
 its assaults, and more frequently than otherw^ise more is 
 done that is calculated to bring it on than to repel it. 
 While we contend that a change should be made in the 
 habits of life, yet we teach that it should not be of a charac- 
 ter calculated to make a strong impression upon the sys- 
 tem. All such impressions have a direct tendency to de- 
 velop the disease. 
 
 Because intemperate, but obese men usuall}^ escape the 
 disease, the use of brandy, whisky, etc., has become to be 
 considered by very many as an excellent prophylactic. No 
 notice appears to be taken of the many intemperate men 
 who die of the disease, but only of those who escape it. 
 We admit that it would be dangerous for the intemperate 
 to become suddenly temperate, and to those who are en- 
 tirely temperate, any use of those stimuli would create, 
 necessarily, a liability to the disease. The intemperate 
 should continue to take his grog, and the temperate should 
 as certainly continue so. We mean by temperance, abso- 
 lute abstinence, because it is impossible to use anything 
 temperably that is not required by the wants of the 
 system. 
 
 From the views we have presented concerning the nature 
 of cholera, it follows, as a necessary inference, that all per- 
 sons in cholera times should, as far as possible, abstain 
 
998 NERVOUS FORMS OF DISEASE. 
 
 from carbonaceous food and drinks, and by their pursuits 
 avoid as far as possible an}^ increase . of demand for atmo- 
 spheric air, for every inspiration but increases the danger. 
 In obedience to these views farinaceous vegetables, sugar, 
 butter, and all manner of fats should be, as far as practica- 
 ble, avoided ; because they furnish very little if any nourish- 
 ment ; but being carbonaceous they increase the demand 
 for vrhat can not be sufficiently had — oxygen. Succulent 
 vegetables of a digestible character, as cooked fruits, aspar- 
 agus, etc., and the fresh muscle of beef and mutton and of 
 other animals, should constitute the principal diet. These 
 instructions are not designed for the obese, but for all 
 others. The best prophylactics, however, are cheerfulness, 
 patience, submission — a mind constantly occupied with its 
 duties, and not with remote and possible danger. 
 
 Treatment. — When called upon to treat a patient in the 
 early stage of the disease, he should at once be placed in a 
 recumbent position, and everything should be avoided 
 which will have a tendency to disturb the mind, as well as 
 the stomach and bowels. In the greater part of cases, I 
 have found that in connection with this the administration 
 of the Compound Pills of Camphor, introduced to the pro- 
 fession by myself, in 1849, is sufficient to prevent a further 
 development of tlie disease. They are made as ioUows : 
 R. Camphor, 
 
 Opium, 
 
 Kino, da grs. xxxv, 
 
 Capsicum, grs. v. 
 
 Conserve of Eoses, q. s. Mix, 
 Divide into thirty pills, and give one after each discharge 
 from the bowels, or oftener if the urgency of the case re- 
 quires it. Occasionally, however, I have likewise applied a 
 large sinapism over the whole abdomen with advantage. 
 Greenhow's aromatized brandy, the Aromatic Tincture of 
 Guaiacum of the Eclectic Dispensatory, may sometimes be 
 beneficially alternated with this pill. Should there be an 
 overloaded condition of the alimentary canal, the Fluid 
 Extract of Ehubarb and Potassa three parts, with Saturated 
 
EPIDEMIC CHOLERA 999 
 
 Tincture of Prickly -Ash berries, one part, may be admin- 
 istered in tablespoonful doses every hour, and continued 
 until the bowels are properly evacuated, after Vv^hich the 
 above astringents may be given ; but where the diarrhea is 
 excessive, it would be imprudent to wait for catharsis, as 
 the discharge should be checked as speedily as possible. 
 
 In the second stage, when nausea, vomiting, and cramps 
 are present, more active means should be pursued. To 
 overcome the nausea or vomiting, the preparation of Dr. 
 O. E. Newton, termed in the Eclectic Dispensatory, Com- 
 pound Mixture of Camphor, may be used with excellent 
 effect ; it is prepared as follows : 
 R. Camphor Water, 
 
 Peppermint Water, 
 
 Spearmint Water, da f3j, 
 
 Paregoric, f3ij. Mix. 
 From a teaspoonful to a tablespoonful may be given every 
 five or ten minutes, and in cases where this does not act 
 sufiiciently prompt, the following may be administered : 
 R. Common Salt, 3j, 
 
 Black Pepper, 3j, 
 
 Vinegar, f3v. 
 
 Hot Water, fSiv. Mix. 
 Of this a tablespoonful may be given every ten or twenty 
 minutes, and continued until the nausea ceases. 
 
 To remove the cramps, hot bricks or bottles of hot water, 
 etc., should be kept applied to the feet, legs, and arms, and 
 cloths wet with water as hot as can be borne, must be ap- 
 plied over the abdomen, and changed every few minutes ; 
 this should be perseveringly pursued until relief is obtained. 
 Sometimes advantage will ensue from stimulant applica- 
 tions along the whole length of the spine. Cramps of the 
 muscles of the limbs may be overcome by bathing with the 
 Compound Cajuput Mixture, either alone or in combination 
 with Chloroform, and applying friction at the same time. 
 This course usually checks the further progress of the dis- 
 ease, and the patient is saved ; however, should it fail, and 
 the stage of collapse come on, in addition to the above 
 
1000 NERVOUS FORMS OF DISEASE. 
 
 treatment, energetically pursued, the patient should be en- 
 veloped in blankets, wet with water as hot as can be borne, 
 w^hich should be renewed every ten or twenty minutes ; and 
 stimulants may likewise be given — the Saturated Tincture 
 of Prickly-Ash berries will here be found beneficial, both 
 by mouth and by enema. 
 
 To convey an idea of Eclectic practice in this' disease, as 
 well as its great mortality, we extract from the Eclectic 
 Medical Journal the following report of the Eclectic Medi- 
 cal Society, made in 1849, and the subsequent statistics : 
 
 " At a special meeting of the Eclectic Medical Society, 
 held on Monday evening, September 17th, for the purpose of 
 discussing the treatment of cholera, the following remarks 
 were made by the members, which were reported by the sec- 
 retary, for the Eclectic Medical Journal : 
 
 " Dr. Morrow remarked, in regard to the treatment, he 
 considered the most prominent indication to be the produc- 
 tion of an equilibrium in the circulation and excitability. 
 This, beyond all question, was the most important and ur- 
 gent indication to be fulfilled, and the most successful re- 
 sults followed its production. To fulfill this, he had found 
 no other single preparation to have a better influence in 
 most cases, than the Compound Tr. Guaiac, prepared by 
 adding Gum Guaiacum, Cinnamon, and Cloves, of each 
 pulverized one ounce to a quart of best brandy, and given 
 in doses of from a teaspoonful to a tablespoonful in hot, 
 sweetened water and brandy every fifteen or twenty minutes 
 until relieved. This had been found to be an excellent 
 stimulant and astringent, closing the mouths of the absorb- 
 ents, and checking the discharges. In a few instances this 
 preparation did not appear to answer, but as a general 
 remedy he considered it the most useful with which he was 
 acquainted. In some cases, where excessive nausea was 
 the most prominent symptom, he had found it advisable to 
 commence the treatment by giving an emetic ; the opera- 
 tion of the emetic relieved the gastric irritability, equalized 
 the circulation, and checked the spasms. As an emetic he 
 preferred the Acetous Tincture of Lobelia and Sanguinaria, 
 
EPIDEMIC CHOLERA. 1001 
 
 with the addition of one-third Spiritous Tr. Aralia Spinosa. 
 This was given in doses of from a teaspoonful to a table- 
 spoonful every ten minutes in warm Catnip tea, sw.eetened. 
 In urgent cases it was given in larger doses and frequently 
 repeated. 
 
 " The Saturated Tincture Xanthoxylum Fraxinifolium 
 jBac. has been used with great benefit ; he had found 
 it an excellent and prompt remedy. When given in the 
 early stages, it would frequently relieve in from ten to 
 twenty minutes. He had used it in doses of from two to 
 three tablespoonfuls. In cases of severe spasms, vomiting, 
 prostration, and profuse rice-water discharges, he had given 
 a tumbler half full at a dose with benefit. Of late he had 
 used the Tr. Xanthox. Frax. Bac, and the Neutralizing 
 Extract, equal parts of each, and had found this combina- 
 tion prompt and efficient. In the earlier stages of the dis- 
 ease, would consider it a most suitable medicine. Bottles 
 of hot water, hot bricks, etc., were used, and if much pain 
 or spasm, extensive sinapisms. In the advanced periods he 
 had found it necessary to produce full, free, and copious 
 perspiration, which would relieve in a majority of cases, 
 say nineteen out of twenty, ^He thought that those who 
 lost sight of the necessity of producing this determination 
 to the surface, would fail in obtaining the successful results 
 attending the practice of those who regarded it as the most 
 important indication to he fulfilled in the treatment. 
 
 "• In cases of partial collapse, when the patients were 
 Bufiering from severe spasms, he had found Hunn's Anti- 
 spasmodic Mixture an excellent remedy. It is prepared 
 by dissolving one ounce each of the oils of Cajuput, Cloves, 
 Peppermint, and Anise, in four ounces of Alcohol. He 
 had given this preparation in cases of violent spasms, in 
 doses of from one to two tablespoonfuls, in hot brandy and 
 water, sweetened, every ten minutes, with great advantage 
 and considered it peculiarly applicable to such cases, but 
 found that it did not succeed so well where there was great 
 irritability of the stomach. 
 
 " The hot blankets, notwitlistanding the foolish notions 
 
1002 NERVOUS FORMS OF DISEASE. 
 
 of some who regard their use as barbarous aud improper, 
 had been employed frequently with the most decided bene- 
 ficial effect. In one case the patient was supposed to be 
 dead — he used the blankets wrung out of scalding water, 
 she recovered, and he got the credit of restoring one from 
 the dead ! 
 
 " Camphor was used beneficially in many cases. Dr. 
 M. had succeeded in restoring patients who were pulseless, 
 by the use of Camphor water, prepared by adding one 
 drachm of Camphorated Spirits to half a pint of cold 
 water. This was given in doses of a teaspoonful every 
 three or four minutes. The external applications were al- 
 ways well attended to during the time of administering the 
 Camphor. 
 
 "Dr. J. King stated that he had used the following prepa- 
 ration very extensively in the treatment of cholera in the 
 early stage. It had also been prescribed frequently by 
 other Eclectic practitioners with advantage in cholera and 
 dysentery. 
 
 B. Ox Gall, 3j, 
 
 Capsicum, 
 
 Gm. Guaiac, aa ^iv, 
 
 Leptandrin, 3iv. 
 This was given in doses of one grain, and repeated two or 
 three times a day. He had also succeeded in many cases 
 with a mixture composed as follows : 
 R. Sulphur sub., grs. iv, 
 
 Gm. Guaiac, grs. ij, 
 
 Charcoal, grs. ij, 
 
 Camphor, gr. j. 
 
 Opium, grs. ss. 
 Dose, one to ten grains, repeated every ten minutes, until 
 relief is obtained. In some cases, however, this compound 
 did not appear to exert any beneficial influence. 
 
 " He had used the spirit vapor-bath in two cases ; free 
 perspiration was produced, and the patients expressed a 
 great desire to sleep. Brandy and aromatics were admia- 
 istered, and the patients both recovered. 
 
EPIDEMIC CHOLERA. 1003 
 
 " In cases of excessive irritability of the stomach, oat- 
 meal cake coflee was given for the purpose of allaying, and 
 it answered the purpose admirably. 
 
 '' The Saturated Tr. Prickly- Ash berries combined 
 with Tr. Opium, was used in some cases as an injection 
 with very good eifect. 
 
 R. Saturated Tr. Xanthox. Frax. Bac, 3ss, 
 Water, 3j, 
 Tr. Opium, gtt. xx. 
 Used as an injection after every alvine discharge. Sina- 
 pisms over the bowels and spine, as well as bottles of hot 
 water, hot bricks, etc., were used with benefit. The pre- 
 paration, made by adding one teaspoonful of fine black 
 pepper, one teaspoonful of fine table salt, and five tea- 
 spoonfuls of vinegar to a tumbler half full of hot water, 
 was used in the case of a young lady who was menstruat- 
 ing at the time, and who was rapidly approaching the 
 stage of collapse. The injection above referred to was also 
 used, and she recovered. This was also found beneficial 
 in those cases, attended with stupor from the commence- 
 ment of the disease, and in which cases he had always 
 found Opium inadmissible. 
 
 " He bad also found Hunn's Antispasmodic Mixture of 
 almost universal benefit in the spasms, pain, etc. In the 
 incipient stage of the disease, in a number of patients, a 
 mixture composed of Elixir Vitriol, one ounce, Tinct. Xan- 
 thox. Bac, two ounces, Ess. Lemon, one drachm, in doses 
 of a teaspoonful in a gill of sweetened cold water, and re- 
 peated every two or three hours, removed the symptoms 
 speedily, without any other treatment. In the more ad- 
 vanced stages he would not rely on it. 
 
 " Dr. R. S. Newton observed that as to the general ap- 
 plication of remedies, there was but little difference in his 
 practice from other Eclectics, but he might hold different 
 views as to the cause of the disease. He did not doubt 
 but that there was present a redundance of acid, but thought 
 this to be rather an effect than the cause of the disease ; he 
 believed that the cause acted primarily on the nervous 
 
1004 NERVOUS FORMS OF DISEASE. 
 
 s^^stem, that its influence passed through the circulation, 
 causing a weakened action of the parts, relaxation, and con- 
 sequent escape of the serum. He had observed symptoms 
 in cholera patients similar to those exhibited in diseases 
 where the exciting cause acted directly on the brain nerves, 
 the same drowsiness, numbness, and soreness throughout the 
 system. The symptoms were allied to those produced by 
 Opium or some other narcotic stimulant ; the patients were 
 very generally careless about death, and had little or no 
 apprehension of dying. Such mental derangement as this 
 was not produced by a cause acting directly on the alimen- 
 tary canal. Narcotic stimulants should, therefore, be 
 avoided in the treatment, they had a direct tendency to in- 
 crease the difficulty ; hence the fatality of the Opium prac- 
 tice in cholera. 
 
 "Dr. N. tested the treatment of Dr. Hawthorne as re- 
 gards Opium and brandy, to the full extent at the commence- 
 ment of the epidemic. He gave one man ten grains of Opium, 
 three pints of brandy, and Dr. Hawthorne's Stimulating Mix- 
 ture. The external applications recommended were also used 
 as well as some other powerful stimulants and astringents, 
 but the man died. This patient had had rice-water discharges 
 four hours before he was prescribed for. He succeeded in get- 
 ting up a reaction at one time, but the Opium produced a 
 narcotic influence subsequently, and he could neither keep 
 up the circulation nor the perspiration. Dr. IST. adopted 
 about the same course in the treatment of another case, and 
 he recovered. 
 
 " He had also used a preparation composed of equal 
 parts — Tannin, Capsicum, Camphor, and Kino, with con- 
 siderable success ; to be given in doses ot four grains, and 
 repeated at short intervals * until the discharges were 
 checked. 
 
 '' He considered the Saturated Tincture Xanthoxylum 
 Fraxinifoiium Bac, the most valuable of all the remedies 
 for cholera which he had tested. When the stomach would 
 not retain it, he gave it as an injection. It had a pC' 
 culiar influence on the system, and having taken the 
 
EPIDEMIC CHOLERA. 1005 
 
 remedy he could speak from experience of its effects. When 
 given as an injection the effect produced was almost instan- 
 taneous : the sensation was as if he had received an electric 
 shock ; its use was very soon followed by copious perspira- 
 tion. He had more confidence in this than any other one 
 remedy with which he was acquainted. 
 
 ''Dr. N. further stated that he had treated one man 
 who died without vomiting or purging. The patient was 
 working on a boat ; in the alternoon he felt a little 
 sick ; at four o'clock he had two operations, no pain, 
 the discharges were of a natural appearance ; in the night 
 he was feverish and restless ; at four o'clock in the morn- 
 ing he experienced a little nausea ; at nine o'clock he was 
 in a collapsed condition, pulseless, eyes sunken, and he 
 appeared to be as much wasted as if he had had copious 
 discharges from his bowels. He tried in vain to raise his 
 pulse or produce perspiration, and the patient died that 
 night at nine o'clock. 
 
 "- Dr. T. J. Wright remarked that he had been more suc- 
 cessful in the treatment of cholera toward the close of the 
 epidemic than previously. He was not aware, when he 
 commenced treating the disease, of the importance of 
 removing morbid accumulations from the stomach. He 
 afterward used emetics more frequently and with great suc- 
 cess. He also used the Neutralizing Extract, Saturated Tr. 
 Xanthox. Frax. Bac, and the Compound Tr. Guaiac. He 
 succeeded best with a mixture of equal parts Tinct. Prickly- 
 Ash berries and Neutralizing Extract. He had always 
 found it necessary to attend strictly to the surface. The 
 best external application he found was equal parts of Cap- 
 sicum, Salt, and Mustard. In the spasmodic stage he used 
 Thompson's third preparation of Lobelia with advantage. 
 He used injections of Neutralizing Cordial, Tinct. Opium, 
 and Tinct. Prickly -Ash berries. He was fully convinced 
 of the necessity of getting up a copious perspiration. In 
 typhoid cases he pursued an entirely different course. In 
 these cases he first gave stimulants, and failed. He after- 
 ward used mucilage of Gum-Arabic, ice and ice-water ; ho 
 
1006 NERVOUS FORMS OF DISEASE. 
 
 applied externally cloths dipped in ice-water, and with 
 these applications succeeded in bringing about reaction, 
 after failing with ordinary hot applications. Dr. W. also 
 remarked that many cholera cases presented symptoms 
 similar to those described in Wood's Practice, as belonging 
 to pernicious fever. 
 
 " Dr. S. H. Chase stated that the general outlines of the 
 treatment he had pursued resembled that of other Eclectic 
 practitioners. In the early periods of the disease he had 
 used the Leptandrin, combined with ^Neutralizing Extract, 
 very successfully. He thinks Opium can be dispensed with 
 in the treatment of cholera altogether. He employed Lep- 
 tandrin very generally in mild cases — he gave two to three 
 grains dissolved in Camphorated Spirits of Alcohol, and 
 then triturated with sugar, and repeated once in six hours. 
 
 " Dr. Hunt stated that his experience was in the main the 
 same as that of those who had preceded him ; especially 
 was he impressed with the importance of emetics in all 
 cases where there was any evidence of morbid accumula- 
 tions in the stomach or bowels, and the patients not too 
 much prostrated to forbid their use. He had commenced 
 their administration in the treatment of cholera upon its 
 first appearance, and continued to employ theni until its 
 subsidence, and always with the happiest efi'ect. A good 
 thorough emetic seemed to change the whole features of the 
 case, removing all the unfavorable symptoms, and placing 
 the patient in a state of rapid convalescence ; he used the 
 emetic spoken of by Dr. Morrow, composed of Acetous 
 Emetic, three parts, Tr. Aralia, or Tr. Xanthox., one part. 
 He was accustomed in the commencement of its adminis- 
 tration to immerse the feet in water as hot as the patient 
 could possibly bear, the temperature being maintained by 
 the constant addition of more hot water. With this and 
 the use of bottles filled with boiling water, and sinapisms, 
 he succeeded in allaying the irritability of the stomach, 
 removing the cramps, checking the discharges, and produc- 
 ing free, healthy perspiration, which was afterward main- 
 tained for eight or ten hours by using alternately a warm 
 
EPIDEMIC CHOLERA. 1007 
 
 tea of Neutralizing Mixture and Guaiac. Compound about 
 every twenty minutes, or Tr. Xanthoxylon, Sudorific Tr., 
 Hunn's preparation, or Tr. Camphor, as he thought most 
 applicable. Afterward he directed the patient to be washed 
 off with hot salt and water or weak ley and spirits, the wet 
 clothing to be removed, the patient to be kept warm and 
 comfortable, and the use of diuretics and mild tonics. He 
 had found the use of tonics an important part of the treat- 
 ment ; their use frequently preventing relapse. He had 
 found much benefit result from the use of Tinct. Camphor 
 in allaying extreme irritability * of the stomach, removing 
 nervous depression, and promoting perspiration. When 
 there was great irritability of stomach, no evidence of mor- 
 bid accumulation and a sense of sinking or weight and 
 oppression about the heart, he used with advantage Com- 
 pound Spirits of Lavender, Tincture Camphor da one 
 ounce, Hoffman's Anodyne, half an ounce ; dose half to a 
 teaspoonfnl every fifteen or thirty minutes in warm tea. 
 
 " He would also commend to the attention of his pro- 
 fessional brethren, the Plantago Cordata ; he obtained a 
 small portion of the extract, and for the purpose of ascer- 
 taining as accurately as possible its properties, had used it 
 alone, and seemingly with benefit. Did not know whether 
 a more extended use would justify the same conclusion ; but 
 from its action in those cases where he had exhibited it, 
 would judge it to be antiemetic, anodyne, and antispas- 
 modic, and beneficial in checking diarrhea. In extreme 
 cases, he used hot blankets or ice-bath, and has seen 
 patients relieved by them when it seemed hoping against 
 hope to suppose they might recover. 
 
 "Dr. J. Milot stated, along with the various remedies 
 that have been spoken of by Dr. Morrow and others, he 
 had used to a very good advantage, dry cups placed along 
 the spine, where there was a great deal of internal conges- 
 tion, as well as a great determination of blood to the head. 
 
 " * In cases of irritable stomach during the early state of the disease the 
 Compound Mixture of Camphor (see Eclec. Dispensatory, p. 510) has been 
 found lately, of much greater efficacy, and adapted to more cases than any 
 other preparation. 
 
1008 NERVOUS FORMS OF DISEASE. 
 
 " Dr. J. E. Buchanan had relied upon the Tincture of 
 Xanthoxylon and Compound Tincture Guaiacum, in equal 
 parts, with a small portion of the Sudorific Tincture, and 
 Tincture of Kino. He was pleased to observe so great a 
 coincidence of sentiments among Eclectic practitioners, in 
 regard to the treatment of the disease. He wished to call 
 the attention of the members to the question, as to what 
 extent evacuations should be attempted. The liver was 
 commonly supposed to be involved, and Old-School physi- 
 cians were in the habit of giving large doses of Calomel to 
 their patients, and when tljey had brought away dark or 
 bilious evacuations, thought that they had accomplished an 
 important part of the treatment. Yet the subject had been 
 discussed in the society, and not a word had yet been said 
 about evacuation by any one of the class pf physicians who 
 had been most successful in the treatment of the disease. 
 This proved that the notion of evacuations was a tremen- 
 dous humbug. Dr. B. thought, however, that the old doc- 
 trine was not entirely destitute of truth, that there might 
 be necessity for purgation in some cases. He believed that 
 some of our practitioners were in the habit of giving an 
 efficient cholagogue after reaction had been produced ; 
 others did not deem it important. He would consider a 
 mild cholagogue, such as Leptandrin, desirable in a majority 
 of cases, after efficient reaction was obtained. The kid- 
 neys were often more involved than the liver, and he 
 believed that much of the efficacy of the alkaline treatment 
 of cholera depended upon the diuretic properties of the 
 alkalies employed. He thought that the cholera remedies 
 used should combine stimulant, diaphoretic, diuretic, and 
 cholagogue properties. These could be found in a great 
 variety of remedies which might be successfully used. 
 The Neutralizing Mixture used so abundantly, was gently 
 laxative. In a large number of slight attacks, a mild 
 aperient, or even a mild cathartic, might remove the dis- 
 ease, but where a decided cholera epidemic existed, the 
 most powerful stimulants would be required. There were 
 several valuable remedies which had not been mentioned 
 
EPIDEMIC CHOLERA 
 
 1009 
 
 this evening. Turpentine was important in cholera as an 
 internal as well as an external remedy ; it was valuable in 
 bowel complaints generally. He regretted that its value 
 had not been more thoroughly tested. The simple pre- 
 scription, pepper, salt, and vinegar, had been fairly tested, 
 and might be regarded as an efficient, prompt, and excel- 
 lent remedy. It is an agreeable medicine to the patient ; 
 it is similar to his every-day diet, and its use appears to 
 restore the stomach and bowels to a natural action ; it 
 checks the nausea and vomiting, as well as the purging, 
 most effectually. 
 
 " Dr. B. referred to the fact that cold applications ap. 
 peared to succeed better than warm in many cases ; he 
 thought we should have some distinct idea or principle to 
 regulate their use. In cases where the patients sunk 
 rapidly under the use of warm applications, cold was 
 applied, and their revived. Stimulants and external heat 
 were used in the case of our deceased friend, Dr. barker, 
 without any benefit ; they did not appear to rouse him, but 
 cold applications did. Dr. P. had lived very temperately, 
 indeed too abstemiously, and it appeared that his system had 
 obtained such a tone, it would not bear stimulants. Stimu- 
 lants to excess become sedatives to the feeble and debili- 
 tated, and he supposed that patients destitute of any consid- 
 erable amount of vital power, would be injured by ordinary 
 stimulants, in large doses, and benefited by cold applica- 
 tions. The use of Chloroform had been recommended in 
 cholera, and he wished to know what experience the mem- 
 bers had had in its use. 
 
 '' Dr. Newton further remarked that he would consider 
 the ordinary reliance upon cathartics in cholera, truly a 
 humbug. After reaction he might use a slight laxative as 
 Neutralizing Cordial and anti-bilious physic ; when reaction 
 had been established, he would not fear a cathartic. He 
 had treated one case where the disease had been reproduced 
 four times, and was not fully relieved until after the use of 
 a cathartic. The cases requiring laxatives he should sup- 
 pose were rare, as he had given them in but three cases. 
 
1010 NERVOUS FORMS OF DISEASE. 
 
 '^ Dr. Morrow stated that in the early part of the epi- 
 demic he did not give any cathartic worth speaking of. In 
 the last ten cases of cholera he treated, he gave evacuants, 
 and they operated well. As far, however, as his experience 
 had gone, he was convinced of the necessity of using them 
 to any extent. Since the subsidence of the epidemic, he 
 had used very large doses of active cathartics in dysentery, 
 etc., with signal advantage. He had met with some cases 
 that would not bear stimulation ; they were persons of weak 
 constitution, who had lived poorly. Where there had been 
 much irritability of the stomach, he found the use of ice- 
 water, in small quantities, advantageous. 
 
 " Dr. S. H. Chase mentioned that he had met with cases 
 of cholera in persons who were suffering from mercurial 
 salivation, the statements of certain medical men that sali- 
 vation was a preventive notwithstanding. 
 
 " Dr. Newton informed the meeting that he had used 
 Chloroform in one case which terminated fatally, and in 
 three which survived. He could not rely upon it or recom • 
 mend it ; it never arrested ' the discharges, but acted as a 
 gentle stimulus, increasing the circulation. 
 
 " Dr. T. J. Wright used the Chloroform in the case of a 
 boy, the only surviving member of a large family who died 
 of cholera. The boy was thought to be dead ; he was cold 
 and pulseless. After inhaling the Chloroform a short time, 
 and taking a teaspoonful, he had several muscular con- 
 tractions, his eyes rolled, the pupils dilated ; he became 
 maniacal, and was sent to the hospital, where he remained 
 some time. He is now going about nearly well." 
 
 The following statistics show the number of deaths in 
 Cincinnati, during the epidemic, in 1849 and 1850, from 
 cholera and other disease : 
 
 Year, Cholera. Other Diseases. Total. 
 
 1849 4114 2345 6459 
 
 1850 1400 1355 2755 
 
 Total, 5514 3700 9214 
 
TETANUS. 1011 
 
 Species XYIII. — Tetanus, 
 
 A state of tonic spasm, or prolonged, rigid contraction 
 of certain muscles, is called tetanus. When nearly all the 
 muscles of the body are affected, the body is stiffened and 
 the extremities extended, statue-like, and the muscles feel 
 hardened like marble. This is the true tetanic state. 
 
 When the muscles of the jaw are the chief seat of rigid- 
 ity, it is called trisnius^^ or locked-jaw ; when the muscles 
 of the back, throwing the body into the form of an arch, 
 opistJiotonos j when the muscles of the belly and front of 
 body, drawing the head and knees together, em^rosthoto- 
 nos ; and when the muscles of one side, incurvating the 
 body side wise, pleurotJiotonos. These are but symptomatic 
 conditions of the tetanic state. 
 
 Superadded to this t07iiG rigidity, clonio or convulsive 
 spasms, alternated with more or less complete relaxation, 
 supervene to give poignancy to the patient's sufferings, 
 there being neither coma nor any essential disturbance of 
 the mental faculties. Thus life is exhausted, in a majority 
 of cases, as by torture upon the rack, with the mind clear 
 and conscious to the last. 
 
 Tetanus is usually treated of as idiojpatJiic^ arising with- 
 out any evident cause or from common causes, and trau- 
 matio^ as supervening wounds or injuries. It has also been 
 considered as acute, sub-acute, and chronic, a refinement of 
 but little importance. The idiopathic form is often recov- 
 ered from, the traumatic variety seldom — not more than 
 one-fourth or one-fifth of the cases probably recover. It is 
 said to be more common or more frequently met with in 
 hot climates. 
 
 Symptoms. — A state of vigilance, uneasiness, languor, 
 loss of appetite, headache, and an unusual disposition to 
 lie with the limbs extended straight during sleep, have been 
 noticed as precursory symptoms. Stiffness in the back of 
 the neck, with dry and sore throat, is the first well-marked 
 symptom. Sudden or slow contraction of the temporal 
 muscles, locking the jaw so firmly that the teeth are sorne- 
 64 
 
1012 NERVOUS FORMS OF DISEASE. 
 
 times broken, is generally the next phenomenon. If the 
 patient attempts to suck in fluids, spasms of the throat take 
 place forbidding the intention, so that there is generally a 
 hydrophobic dread of repeating the attempt. This con- 
 stitutes trismus, and the tetanic spasm may not extend any 
 further, still it is equally formidable or fatal, though proba- 
 bly there is less sutfering. 
 
 As the disorder progresses, violent, stabbing ;f ains seize 
 upon the diaphragm, and the trunk and extremities become 
 paroxysmally distorted. Respiration becomes difficult or 
 nearly interrupted ; anguish and distortion of countenance 
 ensue ; the face is turgid ; sometimes the horrid laugh 
 called risiis sardonicus becomes a symptom ; relaxation of 
 the jaws, thrusting out of the tongue and its laceration by 
 the teeth sometimes occur ; the pupil is not particularly 
 altered ; the eyes are more generally rigidly fixed ; the 
 trunk may be distorted backward, or doubled forward, or 
 sidewise, or rigidly straightened ; the limbs are generally 
 firmly extended; the sphincters are usually contracted, but 
 sometimes the urine and faeces are discharged with great 
 impetus by the force of the abdominal muscles. Complete 
 intervals of repose and relaxation are extremely rare, but 
 remissions to be followed by more and more violent con- 
 tractions are common. 
 
 The mind is clear and sometimes cheerful ; Mr. Aber- 
 nathy says he has often known patients to express them- 
 selves as feeling better to the last ; the circulation is only 
 hurried by the muscular contractions, the animal heat, how- 
 ever, is higher than natural ; the perspiration is generally 
 profuse, urine not remarkable, and the bowels constipated. 
 
 Generally at the end of twenty-four hours the patient is 
 unable to take food or drink ; emaciation ensues rapidly ; 
 the face becomes more and more frightfully distorted ; a 
 clammy perspiration covers the skin ; there is less and less 
 remission of the spasms ; greater difficulty in breathing ; 
 the pulse becomes thread-like or imperceptible, and death 
 more often occurs on the second day, though an average 
 course is said by Andral to be four days. The cause of 
 
TETANUS. 1013 
 
 * 
 
 death is ascribed to asphyxia. So great is the suffering 
 and so awful the spectacle that death is hailed as a blessing 
 usually by the friends. 
 
 Causes. — Tropical heat and transitions to cold and damp- 
 ness, and wounds and injuries of any description, are the 
 most common causes of tetanus. Peculiar organization 
 doubtless increases liability. Negroes are said to be more 
 liable to it than whites. A form of tetanus attacking in- 
 fants, called trismus nascentium^ is very common in the 
 West Indies, much more so than among infants of white 
 parentage, though this variety is occasionally met with in 
 white infants of the temperate latitudes. Endemic causes 
 favor its development, though these may be only heat, cold, 
 and moisture. Upon this subject our views, at more length, 
 will be found in Book III. 
 
 By far the most frequent cause of tetanus is mechanical 
 injuries — no matter what. According to Sir James Mc- 
 Grigor, " it occurs in every description and in every stage 
 of wounds, from the slightest to the most formidable, from 
 the healthy and the sloughing, from the incised and lacer- 
 ated, from the most simple and the most complicated." 
 The locality of the injury is of almost no importance — still 
 lacerated and punctured wounds, when of the hands, fin- 
 gers, soles of the feet, and joints, are probably regarded as 
 most apt to produce it. 
 
 Diagnosis.' — There will be no difficulty in the diagnosis 
 in general. Hysteria sometimes partially counterfeits it, 
 but the fickleness of spasm and warped state of mind de- 
 tect it. Occasionally rheumatic afiections of the muscles 
 of the neck and jaw may similate trismus, but the history 
 of the cases, if not their febrile condition, will distinguish 
 them from it. Poisoning by strychnine produces the same 
 tonio character of spasm, and the same clearness of mind, 
 but the history of the case and attending circumstances 
 will generally lead to a correct diagnosis. 
 
 Accession. — Idiopathic tetanus is generally sooner de- 
 veloped after the exciting cause has been received, than 
 traumatic, not unfrequently supervening the next morning 
 
1014 NERVOUS FORMS OF DISEASE. 
 
 after exposure to the cold and dampness of night. Some- 
 times it immediately follows bathing or falling in the water 
 when the body is in a state of heat and perspiration. The 
 development of the symptoms after injuries is most com- 
 monly during the second w^eek, There is record, however, 
 of tetanus occurring instantaneously after slight injury, and 
 terminating fatally in fifteen minutes. It is believed 
 never to have resulted later than a month after the injury. 
 
 Nature. — Reasoning from the data afibrded by physi- 
 ology and the symptoms, in the absence of any uniformity 
 in the post-mortem appearances, we infer that the seat of 
 derangement is in the cerebellum and medulla oblongata. 
 The early symptoms of stiffness about the throat and 
 spasms of the muscles supplied with nerves from the me- 
 dulla oblongata indicate it as the seat of trismus. The 
 muscular spasms in general we are disposed to refer to the 
 organ of muscular motion. Our observation has not been 
 so extensive as to justify a general inference, but so far as 
 the writer knows, tetanus has been confined to a high en- 
 dowment of the above-named organ. The clearness of in- 
 tellect proves that the cerebrum is not implicated. In the 
 present state of pathological science, it is impossible to say 
 what the nature of the morbid change may be, any more 
 than we can tell why strychnia should produce similar phe- 
 nomena, or ergot tonic contraction of the womb. 
 
 Prognosis. — We have already remarked the greater mor- 
 tality of the disease when originating from mechanical in- 
 jury. Dr. O'Beirne witnessed two hundred cases in the 
 peninsula, and not one recovered. Of forty-six traumatic 
 cases, mentioned by Curling, ten recovered. The slower 
 the incursion or development, the better the chance of re- 
 covery, and vice versa. Wood thinks the milder cases may 
 terminate favorably spontaneously, which is to be borne in 
 mind in judging of remedies. The more perfect the inter- 
 missions, the more favorable is the case to be looked upon. 
 If the patient survives the fourth day, hopes may be enter- 
 tained of his recovery. Eapid development of the symp- 
 toms, increased severity of the paroxysms, uninterrupted 
 
TETANUS. 1015 
 
 rigidity of many muscles, violent spasms of the glottis and 
 diaphragm interrupting respiration, augur an unfavorable 
 termination. 
 
 Treatment. — For the treatment of this disease almost 
 every class of remedies has been used, by different practi- 
 tioners, and recommended by different authors, without 
 producing many cures ; so much so, that, at this time, the 
 treatment for this disease is as much empirical as any we 
 are called to treat. This being the case, every practitioner 
 must be governed by the attending circumstances and the 
 pathological view which he takes of the disease. 
 
 The general indications are, to remove the exciting cause 
 and change the condition of the nervous system, so as to 
 prevent its recurrence, or to remove an}^ depressing influ- 
 ence of the nervous system, as well as to support the vital 
 force and enable it to resist the exhaustion produced by the 
 muscular action during the paroxysms. 
 
 As tetanus is frequently the result of wounds, it is neces- 
 sary, in all such cases, to make use of soothing, emollient, 
 and anodyne applications, the local use of Morphine, bath- 
 ing the parts in a decoction of Stramonium leaves. Hops, 
 and Tansy ; and as it is not a muscular disease, we are of 
 opinion that that class of agents which produces the most 
 immediate and permanent impression upon the brain should 
 be used — and having failed with the treatment ordinarily 
 recommended, we have been induced to try the virtue of 
 one of the new remedies — the Gelseminum — in the recent 
 cases we have had under treatment, and from the success 
 which we have had with this agent, in almost immediately 
 relieving the paroxysms, are fully of belief that there is not 
 in the Materia Medica another article which possesses the 
 same peculiar virtues. We commence its use b}^ giving 
 from fifteen to twenty-five drops of the tincture e\rery fifteen 
 to thirty minutes until the convulsions are arrested. 
 
 Digitalis exerts a powerful influence upon the action of 
 the heart and arteries, without producing any material 
 change of vital action ; but Gelseminum affects the whole 
 organism, and produces a more powerful relaxant eflect 
 
1016 NERVOUS FORMS OF DISEASE 
 
 than we have ever obtained from any other ao-ent — and 
 since tetanus has been found to be located in the brain, and 
 this agent acts powerfully upon that organ, we can compre- 
 hend at once its utility in that disease. 
 
 To sustain the nervous system, and to prevent a recur- 
 rence after the exciting cause has been removed, we use 
 Gelseminum and Quinine, in the proportion of three grains 
 of the latter to fifteen drops of the tincture of the former, 
 which should be given three or four times a day. 
 
 If there be any indication of the powers of the system 
 giving way, it will be well to omit the Gelseminum and 
 use the Quinine, Prussiate of Iron, and Hydrastin in as 
 large doses as the circumstances will admit. 
 
 As this is regarded as a surgical disease, we would refer 
 the reader for additional treatment to " Eclectic Surgery,'" 
 "We will here say, however, that since we have adopted the 
 above treatment, we have found little difficulty in arresting 
 the malady, whether idiopathic or symptomatic, after the 
 exciting cause had been removed. 
 
 Species XIX. — Puerperal Convulsions. 
 
 The consideration of this form of disease properly belongs 
 to a work exclusively devoted to obstetric practice ; our 
 observations will therefore be brief. 
 
 Symptoms. — General convulsions coming on in the latter 
 period of pregnancy, during parturition, or within a few 
 days after delivery, characterize this form of disease, which 
 is unmistakable. The incursion of the convulsions may be 
 sudden, coming on during a parturient effort to expel the 
 child or placenta ; or after the woman is put to bed and 
 seemingly every way comfortable. Generally, however, 
 there is the premonition of headache, drowsiness, flushed 
 countenance, full, slow pulse, and partial failure of sight. 
 Succeeding to these there may occur piercing pains in the 
 head, fiery objects dancing before the eyes, ringing in the 
 ears, general oppression, and sickness at the stomach. 
 Twitching of the muscles of the face and eyes, locking of 
 the jaws, and universal spasms and jerking of the volun- 
 
PUERPERAL CONVULSIONS. lOlT 
 
 tary muscles immediately ensue with complete loss of all 
 eonsciousness, and thus resembling a fit of epilepsy. There 
 is foaming at the mouth, and while the teeth are firmly 
 closed there is hissing inspiration and expiration. ]N"ot un- 
 frequently the jaw is worked as in the act of grinding food, 
 the tongue spasniodically protruded, dreadfully bitten, and 
 bloody foaming the consequence. The countenance is hor- 
 ribly distorted, the eyes roll, jerk, or are fixed, the pupils 
 are dilated, the limbs are violently agitated, and the whole 
 body exercised as with a prolonged, universal shudder. 
 The paroxysm, sooner or later, ends in stupor, generally 
 after a few minutes, though repetition after repetition of 
 the convulsions, with intervals of quiet stupor and sterter- 
 ous breathing for hours and even days, are common. The 
 patient may wake suddenly from this stupor, be perfectly 
 rational, unconscious of anything that has passed, remain 
 rational a shorter or longer time, and then be thrown sud- 
 denly into convulsions again, or there may be no further 
 recurrence of spasms and the case terminate in perfect re- 
 covery, A large proportion of cases terminates fatally, 
 however, and some of these in the apoplectic or comatose 
 gtage. According to Churchill, who has collected statistics 
 from different observers, it appears that about one-fourth 
 of all the cases has terminated fatally, though we are in- 
 clined to think this an over estimate of the fatality. 
 
 Causes. — There is difficulty in the present state of patho- 
 logic science in determining the precise condition of the 
 nervous system and centers in the convulsive forms of dis- 
 ease. It appears that the two opposite conditions of the 
 sanguiferous system, viz : plethora and anemia, may give 
 rise to convulsions. 
 
 The immediate cause of puerperal convulsions may be 
 either of these conditions, or it may depend on distant irri- 
 tation in the womb or digestive organs. That the uterine 
 organs are concerned in its development, is manifest, from 
 tihe convulsions being peculiar to the pregnant or parturient 
 state. Peculiar organization may be necessary. Those 
 who have suffered one attack are more liable to another 
 
1018 NERVOUS FORMS OF DISEASE. 
 
 in subsequent confinements. The writer knew three sisters 
 who were successively carried off in first pregnancy from 
 the accession of puerperal convulsions at the period of par- 
 turition, which deterred a fourth and younger sister from 
 contracting marriage. 
 
 A disordered stomach ; improper food ; sudden terror, 
 or depressing emotions and passions may excite a paroxysm. 
 Women brought to bed illegitimately are said to be more 
 liable to attacks, owing to shame and mortification of feel- 
 ing. Improper straining in parturient efforts, causing a 
 rush of blood to the head, has been thought to produce an 
 attack. It has also supervened after excessive uterine 
 hemorrhage, and these cases are looked upon as attended 
 with more danger. 
 
 Treatment. — In this disease, we recommend the same 
 treatment as referred to in peritonitis, which should be 
 faithfully and energetically pursued. For the spasm which 
 is present, we administer the Compound Tincture of Lobe- 
 lia and Capsicum. 
 
 In addition to this, it will be necessary to commence giv- 
 ing the patient, from the start, large doses of Quinine and 
 Iron, which support and increase the vital force ; and, if 
 convulsions should continue after this treatment has been 
 pursued, we use the Tincture of Gelseminum, in combina- 
 tion with the Quinine, as recommended in tetanus and hy- 
 drophobia, to accomplish the same object. 
 
 As there is danger of the patient dying in from twenty- 
 four to forty-eight hours, in consequence of debility pro- 
 duced by the exciting cause acting upon the general system, 
 the importance of active and energetic treatment will be 
 seen at once. So far as our own observation extends, we 
 have found that any depletive course of treatment increases 
 debility by destroying the power by which the system 
 resists the action of the disease — which being the case, the 
 reader will at once see the necessity for adopting the treat- 
 ment which we have recommended, in preference to the 
 antiphlogistic plan ordinarily pursued. 
 
HYDROPHOBIA. 1019 
 
 Species XX. — HydTojphdbia. 
 
 Hydrophobia is a specific form of disease arising from 
 the bite of a mad animal, generally the dog, and hence 
 it may not be out of place for us to briefly notice its 
 symptoms in the dog, the better to guard the human 
 species. 
 
 "When a dog is observed to become shy and irritable,^ to 
 avoid his friends, neglect his food, droop his ears and tail, 
 seek solitude and look sullen, it is time to confine him on 
 suspicion of madness. Should there appear a viscid 'froth- 
 ing at the mouth, and panting respiration, his case is still 
 more suspicious. If he snaps at objects, and refuses his 
 usual obedience to control, but is thrown into anger and 
 rage at threat of the whip, he may be pronounced rabid. 
 Some dogs only snap and bite what crosses their path, 
 while others fly indiscriminately at every living thing, and 
 even gnaw and tear inanimate objects. No animals escape 
 their fui-y ; cats, dogs, sheep, bullocks, horses, and persons, 
 are indiscriminately attacked. Yomiting is often one of 
 the earliest symptoms, and frequently recurs throughout the 
 course of the disease. Respiration becomes laborious, 
 spasms ensue, and the animal is subdued, and dies under 
 tremors and violent convulsions. 
 
 Not all persons w^ho may be bitten by a rabid animal 
 necessarily take hydrophobia — not more than one, per- 
 haps, in a dozen. The poison is conveyed in the saliva, 
 and clothing is a great protection by wiping the teeth. 
 Persons bitten on the hands, or a part not protected by 
 clothing, are much more liable to an attack. 
 
 The time at w^hich an attack may supervene after being 
 bitten by a rabid animal is very various. It may come on 
 in a short time after the healing, but seldom does in a less 
 period than a month or six weeks^ and a longer period than 
 two years. The time during which the poison lies dor- 
 mant in the system is called the stage of delitescence ; the 
 incipient symptoms of an attack, such as pain and swelling 
 of the scar or cicatrix, the stage of recrudesGenGe ; and the 
 
1020 NERVOUS FORMS OF DISEASE. 
 
 fully developed attack, the stage of sjiyasm. It is convenient 
 to follow this arrangement. 
 
 Stage ofdeUtescenoe. — In general the wound heals kindly, 
 leaving nothing peculiar in the scar, though pains in these 
 wounds after healing are said to be pathognomonic, but 
 probably this may be the effect of the excited imagination. 
 Sometimes gloomy forebodings and melancholy apprehen- 
 sions weigh down the patient's mind and nearly incapaci- 
 tate him for his ordinary occupation. All this is mental, 
 however ; no outward symptoms appear, and he may never 
 be seized with an attack. Should two years elapse, all 
 fears may generally be dispelled. The stage of delitescence 
 is seldom shorter than a month or six weeks, and the 
 rationale or theory is, that the poison is absorbed into the 
 system, and remains dormant for a longer or shorter period, 
 analogous to other specific animal poisons, as that produc- 
 ing syphilis, but finally develops its efiects on the nervous 
 apparatus, according to its own peculiar laws of morbid 
 action and tendencies. 
 
 Stage of reGrudescenoe. — This stage generally lasts three 
 or four days, and is ushered in by tenderness, pain, swell- 
 ing, and perhaps opening of the wound. Sometimes a 
 sense of coldness first affects the parts, with stiffness extend- 
 ing up the limb. The glands of the axilla or groin have 
 never been observed to swell. By far the greatest number 
 of cases of hydrophobia occurs from the thirtieth to the 
 fiftieth day after the bite, and after the wound, which was 
 perhaps considerably enlarged by the surgeon, has healed, 
 though yet tender and irritable. The exciting cause of the 
 recrudescent stage has sometimes appeared to be a debauch, 
 and one case is mentioned in which a pain shot into the 
 part at the news of another person, bitten by the same dog, 
 having died of hydrophobia. 
 
 Stage of sj^asm. — The greatest anxiety prevails, of course, 
 throughout the stage of recrudescence, and febrile symp- 
 toms not unfrequently manifest themselves prior to spasms 
 setting in, while the symptoms of recrudescence go on in- 
 creasing in the wound. Kigors may usher in the attack 
 
HYDROPHOBIA. 1021 
 
 with alternate flushings, or there may be oppression, sigh- 
 ing, loathing of food, or sudden nausea on sitting down to 
 a meal, with efforts to vomit. A sense of stiffness in the 
 back of the neck, becoming painful, and extending to the 
 tongue and larynx supervenes. The patient soon finds it 
 impossible to swallow, owing to spasms seizing the muscles 
 of deglutition. Soon after, the sight of water will produce 
 these spasms. Laborious respiration, sighing, vomiting, 
 urgent thirst, pressure in the throat, and a burning pain 
 down the spine from the neck, mark the progress of the 
 alarming symptoms. The disease is now fully formed. 
 Every attempt to allay the burning thirst brings on the 
 most violent spasms, which at length seem to involve every 
 muscle of the entire body and extremities. The pulse is 
 often excited during these paroxysms to one hundred and 
 fifty beats in the minute. There soon takes place, after the 
 disease is fully established, a peculiar frenzied look or ex- 
 pression of countenance ; and all writers and observers 
 agree that there is an alienation of the mind. It is not 
 uncommon for the sufferer to become loquacious, and sen- 
 sitively circumspect and suspicious. High delirium is sel- 
 dom present. Death generally comes to the relief of the 
 sufferer on the second or third day. The urine is natural, 
 and the blood is not buffy. The muscles remain rigid long 
 after death — the victim generally dying suddenly in a vio- 
 lent, universal spasm. 
 
 Treatment. — This disease, like tetanus, has exhausted, 
 in the language of Professor Wood, " the whole magazine 
 of therapeutics," and yet the profession occupies about the 
 same position as heretofore. During the last year, we have 
 treated three persons who had been bitten by dogs while 
 attacked with hydrophobia ; we know this to be the case 
 from the fact that otlier persons bitten by the same dogs 
 died of the disease. On being called to each of the cases, 
 which was immediately after the accident occurred, we cau- 
 terized the wounds which were very extensive, with a strong 
 solution of the Chloride of Zinc, the liquid condition of 
 which allowed it to permeate every tissue that was involved 
 
1022 NERVOUS FORMS OF DISEASE. 
 
 by being brought in contact witli the teeth of the rabid ani- 
 mal. So soon as the parts had been thoroughly cauterized, 
 we at once applied an Elm-poultice to facilitate the suppu- 
 ration, and then administered the following : 
 H. Aqua Monia, 3ij, 
 
 Tincture Scutellaria, 3j, 
 Syrup Ginger, 3ij. Mix. 
 Of this, we gave one drachm every two hours, which was 
 continued until the parts that had been cauterized sloughed 
 out, with such changes of the quantity as the circumstances 
 demanded. We subjected the patient to the daily use of 
 the vapor-bath, and continued the suppurative action from 
 the wound by the daily application of the Sesquicarbonate 
 of Potassa for six weeks, and recommended the occasional 
 use of the above prescription. Up to the present time 
 neither of the persons have manifested any symptoms of 
 hydrophobia. 
 
 As the disease is so assimilated to tetanus, we would ad- 
 vise a similar treatment during the paroxysm. We extract 
 the following from the " Western Medical Keformer," Vol. 
 vi, 1846, page 83, as the treatment pursued by Professor 
 J. King, at that time a resident of the city of Isew York. 
 He says : 
 
 " Several years since we were led to institute a series of 
 experiments on cats and dogs, which resulted in a firm 
 conviction that the disease depended entirely upon the ab- 
 sorption of a poisonous acid into the system. From this 
 conviction we were led to employ an alkaline preparation, 
 very diffusible and stimulating in its action, and which 
 used in the manner we shall presently relate, has cured six 
 persons, two in the commencement of the second stage, 
 and four in the first stage. One of the former was Mr. 
 John Sharpe, 'No. 110, Elizabeth street, !Nfew York city, 
 who was cured in the summer of 1836, and who, we be- 
 lieve, is still living at said location. 
 
 " As soon as bitten, the surest method, we conceive, 
 would be to wash the part immediately with the alkaline 
 liquid mentioned below, or for want of it, water will an- 
 
HYDROPHOBIA. 1023 
 
 swer, so as to remove all the saliva of the animal, and then 
 cut out the whole wound ; after which, apply the vegetable 
 caustic, and keep up a discharge from it for several days. 
 In all the cases cured by us the wounds had healed, pre- 
 senting a scar of a dark purplish appearance. 
 
 " When the symptoms of hydrophobia begin to manifest 
 themselves, or during any stage of the disease, the follow- 
 ing is the course we invariably pursue : Take of the strong- 
 est Aqua Ammonia, one teaspoonful ; finely powdered 
 Skullcap leaves, one teaspoonful ; put into a tin cup, to 
 which add half a gill of cold water. Then holding the 
 patient's nose, to prevent the ammoniacal vapor from being 
 inspired therein, cause him to make as full an exhalation 
 as possible, and immediately drink the mixture, well stirred 
 together, while inspiring ; if this can not be done at once, 
 the operation must be repeated until the whole is taken. 
 If from spasms, the patient is unable to swallow, then 
 blindfold the eyes, and use all the persuasion that can be 
 employed to induce him to force it down. Perhaps a stom- 
 ach tube might be employed, covering that part of it which 
 comes in contact with the teeth, with some strong metal ; 
 we have always succeeded without it. If the patient is 
 attacked severely, it may be necessary to fasten his legs and 
 arms to prevent him from injuring others. Bandaging the 
 eyes will be found to have a soothing efiect, particularly if 
 cotton or some soft non-conducting substance is placed over 
 them so that the patient can certainly see no light. 
 
 " The Ammonia used by me was prepared by Dr. Chilton, 
 a well known chemist in New York city, and was put up in 
 glass-stoppered vials, holding two ounces each, and covered 
 with bladder. I prefer this size, as in larger vials there is 
 too much of the strength of the Ammonia lost while using. 
 The only reason why we used the Skullcap was, that it had 
 been highly recommended by others in whom, in this in- 
 stance, we blindly placed confidence. 
 
 " The above dose must be repeated every half hour for two 
 hours. In many severe cases, the doses for the first hour, 
 must be repeated as often as once in every fifteen minutes. 
 
1024 NERVOUS FORMS OF DISEASE. 
 
 '^ In an hour and a half or two hours, the more severe 
 and distressing symptoms will generally disappear, the face 
 and whole body will present a fiery-red appearance, and a 
 heat nearly amounting to a sensation of burning will be expe- 
 rienced. The alkali has now diffused itself throughout the 
 whole system ; but as we view it, it must at this crisis be 
 forced, as it were, to pass even further, to the surface of the 
 hodj. To accomplish this properly, we considered that an 
 acid, between which and the alkali a great affinity or attrac- 
 tion exists, must be employed, and for this purpose, the fol- 
 lowing acetous vapor-bath must have been prepared, to use 
 at the expiration of two hours: Stramonium leaves, Cicuta 
 leaves. Hops, Skullcap, of each half a pound; good strong 
 vinegar, four or five gallons. Boil all together for ten or 
 fifteen minutes. Likewise, have several large stones well- 
 heated. 
 
 "Half an hour after the last dose, undress the patient, 
 place him on an open-bottom chair, and completely cover 
 and envelop him with blankets, leaving however an oppor- 
 tunity for him to inhale fresh atmospheric air now and 
 then during the bath. Then place the above acetous decoc- 
 tion under him, and keep him there until he perspires 
 freely and copiously. As the steam lessens, the gradual 
 addition of the hot stones will increase it again. 
 
 " After this vapor-bath, which must always be carried to 
 a powerful extent, the patient must be well dried, and ano- 
 ther dose of the Ammonia and Skullcap given, and which 
 must be repeated every three hours for fourteen days 
 in succession, omitting it only during the action of pur- 
 gative medicine. 
 
 " On the first night of treatment, a full dose of antibilious 
 physic must be given, and repeated every other night for 
 six nights, and afterward every third night, and as soon as 
 it has operated, commence again with the Ammonia every 
 three hours. The acetous vapor -bath must be repeated on 
 the second, fourth, eighth, and twelfth days of treatment. 
 I would mention here that this active treatment, espe- 
 cially during the first and second days, reduces the pa- 
 
HYDROPHOBIA. 
 
 1025 
 
 tient's flesli most astonishiDgly. Skullcap tea must be 
 drank freely through the whole treatmeat, and the diet 
 must be light, but very nourishiDg, avoidiog all acids, 
 greasy or fat food, milk and liquors. 
 
 " The bitten part must be kept constantly diGcharging 
 after the first vapor-bath, by the application of vegetable 
 caustic. Stramonium ointment may also be applied on 
 lint. 
 
 " In case the person is very much convulsed in the first 
 part of the treatment, the best course to adopt is to apply 
 the acetous vapor-bath immediately, and administer the 
 Ammonia as soon as it can be swallowed ; in other respects 
 pursue the same course as above. 
 
 " This treatment should be persevered in for fourteen 
 days, when the patient may be discharged as permanently 
 cured.* 
 
 " With regard to the six persons cured by the above rem- 
 edy, I would remark, that they had all been recently bitten 
 by dogs, and manifested all the phenomena of hydrophobia 
 as it generally appears — two of the dogs were killed before 
 it was positively known that they were rabid ; the others 
 were w^ell ascertained cases, particularly in the case men- 
 tioned of Mr. Sharpe, as his dog w^as chained at the time 
 of the bite, and died rabid." 
 
 " * It has been suggested that when the patient is unable to swallow the 
 alkaline preparation, that in addition to blindfolding, the following anti- 
 spasmodic tincture be given in teaspoonful doses every few minutes (by 
 pouring it into the corners of the mouth), until the Ammonia can be taken. 
 Also, that during the treatment the Extract of Belladonna should be given 
 in doses and at intervals sufficient to keep up a gentle influence upon the 
 system constantly. Of these I know nothing, but mention them for the 
 benefit of your readers. 
 
 Antispasmodic Tincture. — Mix together equal parts of the Saturated Tinc- 
 tures of Lobelia seed, Capsicum, and Skunk Cabbage. I have cured three 
 cases of lock-jaw with this preparation." 
 
1026 
 
 NERVOUS FORMS OF DISEASE. 
 
 Genus IL — Morbid Actions in the Organs of External 
 Relation. 
 
 This set of apparatuses, in a state of health, adapt man, 
 and all other animals, to the world in which they live, and by 
 modifications of these apparatuses all of the various modes 
 of animal life are provided for. In some of the inferior 
 departments of this system of organs, some of the inferior 
 animals are superior to man ; and yet by the superior 
 development of them as a whole he is constituted the 
 master, the governor, the autocrat of the animal world. All 
 the other departments of it are subject to his will. 
 
 By the organic arrangements that distinguish him, he is, 
 in a state of health, capable of a variety and an extent of 
 enjoyment which does not admit of any comparison with 
 the most gifted of the inferior classes. By his sentiments 
 he has the power of communicating happiness to others, 
 and by his genius he harnesses caloric, electricity, air, and 
 w^ater, and forces them to labor for the command of his 
 comforts or the aggrandizement of his ambition. 
 
 But when these organic arrangements become deranged 
 in their functions, he may becom.e the most miserable, or 
 the most helpless, or the most abject and pitiable object in 
 the world. 
 
 The remarkable feature of this genus consists in the fact, 
 that however severe the attending pain may be, those func- 
 tions upon which life depends, are comparatively but little 
 disturbed. 
 
 Species I. — Catalej)sy. 
 
 This strange form of disease of the motor system, char- 
 acterized by 'rigidity of the muscles^ either of the whole or 
 a part of those usually designated as voluntary, has been 
 deemed apocryphal by some of the most eminent physi- 
 cians. So many well authenticated cases, however, are 
 recorded, that, at this day, no one doubts that a state of 
 cataleptic rigidity may seize upon a nervous subject, and 
 fix the person statue-like for a longer or shorter period of 
 time. The fit may last from a few minutes to many days. 
 
 { 
 
CATALEPSY. • 1027 
 
 Cases are recorded to have continued twenty days in this 
 condition, without food or evacuation. The attacks are 
 mostly recovered from generally suddenly; a portion, how- 
 ever, passes from this state of trance to that of death. 
 
 This condition of the muscular system is similar or 
 identical with that which may be induced by mesmerism. 
 The limbs can be molded to any attitude, and remain fixed, 
 as placed by another ; the rigidity of the muscles of the 
 shoulder, for instance, preventing the law of gravitation 
 from bringing the hand down when the arm has been placed 
 horizontally. 
 
 Catalepsy is paroxysmal or intermittent, without regular 
 periodicity ; the length of the paroxysms and intervals 
 being extremely variable. The attacks are usually sudden, 
 though sometimes premonitory feelings, as headache, palpi- 
 tation, confusion of ideas and slight spasms, usher in the 
 paroxysms. There is usually loss of consciousness, but 
 occasionally patients are conscious of passing events, and 
 some are said to have witnessed the preparations for their 
 interment in this condition, without the power to remon- 
 strate. The countenance is in general natural and com- 
 posed, the pupils dilated, the circulation feeble, the respira- 
 tion scarcely preceptible, and the animal heat low. 
 
 Causes. — Allied to the comatose forms of disease, and 
 passing sometimes into apoplexy, mania, epilepsy, and 
 more frequently hysteria, the causes are a great cerebral sus- 
 ceptibility and delicacy ot the nervous system in general, 
 a weakened state of the system, strong emotions, depress- 
 ing passions and the like. Frequent miscarriages have 
 been known to produce it. Females of hysteric liability 
 are the most frequent subjects of it. 
 
 Diagnosis. — To distinguish catcde^sy from death is a 
 matter of the highest moment. If the pulse be imprecepti- 
 ble, and the breathing too gentle for observation, recourse 
 should be had to auscultation for evidence of the heart's 
 action. A small mirror held at the nose will condense any 
 vapor from the lungs. In apoplexy the breathing is ster- 
 terous ; in asphyxia the breathing and circulation are entirely 
 
1028 NERVOUS FORMS OF DISEASE. 
 
 suspended, in syncope, also, with deadly paleness added, 
 while in all three there is flexibility of the limbs. 
 
 Treatment. — If the cause of catalepsy can be determined, 
 it must be treated according to the indications ; and if the 
 disease be periodical in its attacks, antiperiodics must be 
 be given, such as Quinia and Iron. In other cases, the 
 disease must be treated on general principles, according to 
 the symptoms present. As regards any positive or specific 
 treatment in catalepsy, but little is known. 
 
 Species II. — Hysteria. 
 
 The assemblage of morbid phenomena constituting hys- 
 teria, though not absolutely confined to the female sex, is 
 so generally seen in women from the age of puberty to that 
 of the cessation of the menses, that the exceptions are of 
 little comparative importance. So diversified are its symp- 
 toms, so alarming its paroxysms to the uninitiated, and yet 
 so seldom is there a tendency to fatal results that it has been 
 described as " a mere ebullition on the surface of life, 
 while its depths were undisturbed." It may similate almost 
 every form of disease, modify and render alarming and 
 perplexing very simple cases, thus greatly misleading inex- 
 perienced practitioners, but can hardly be said to be ever 
 fatal of itself. Secondary forms of disease that may be 
 induced, or which may supervene, may prove fatal. Cases 
 have been known to terminate fatally in apoplexy. Yery 
 rarely males of great nervous susceptibility have exhibited 
 the diversified and rapidly changeable groups of symptoms 
 characterizing this disordered condition of the nervous 
 system. 
 
 SiMPTOMS. — Most of the disquieting feelings, strange and. 
 wayward fancies of nervous females arise from hysteria. A 
 paroxysm is usually preceded by general uneasiness, anxi- 
 ety, and oppression ; a sensation of choking, or as if a ball 
 were rising up from the abdomen into the throat, to which 
 sensation the appellation of globus hystericus has been 
 given ; stifiness about the larynx, headache, and cramps. 
 M. Georget says : " Hysteric patients in the hcspitd of the 
 
HYSTERIA. 1029 
 
 Salpetriere are so well accustomed to take warning by these 
 precursory symptoms, as never to be seized unexpectedly ; 
 they go to bed, and are tied down until the fit is over." 
 Sometimes the paroxysm ends here ; but more generally 
 the anxiety and sufferings increase, extreme depression of 
 spirits, often weeping, ensues ; there is a painful sense of 
 stiffness and coldness of the limbs ; noise in the ears ; ver- 
 tigo ; confusion, and to these rapidly succeed temporary 
 loss of sense and consciousness, and of command over the 
 voluntary muscles, during which the most vehement strug- 
 gles are alternated with moments of repose. Occasionally 
 there is a tetanic rigidity of the muscles of the trunk or 
 back, and the body is thrown up in the form of an arch, but 
 the limbs are more generally contorted ; the patient often 
 beats her breast, tears her hair, grinds the teeth, bites the 
 tongue or lips, or otherwise injures herself. The assistants 
 are often struck, bitten, or scratched, and liave vociferous 
 epithets heaped on them ; terrific screaming, sobbing, 
 laughing, and vacant staring may rapidly succeed each 
 other. During the struggling the heart beats tumultuously, 
 the countenance becomes flushed and swollen, and the 
 breathing laborious. After a variable continuance of from 
 a few minutes to some hours or even days, of repeated in- 
 tervals of struggling and repose, as here described, the pa- 
 tient either falls asleep or gradually returns to a state of 
 consciousness and her ordinary condition, save feelings of 
 fatigue and soreness, which disappear in a few days. Such 
 are the prominent ieatures of the hysteric paroxysm ; but 
 it varies greatly in intensity and duration. The convul- 
 sions may be severe, with lucid intervals, and of frequent 
 occurrence for days, or a deep, quiet sleep or coma may fill 
 up the intervals, from which nothing can arouse the patient. 
 In some women the paroxysms return monthly or at the 
 menstrual flow ; in others at variable intervals dependent 
 on disturbances of the physical or mental equability. It is 
 remarkable that plumpness of person, roseate hue of coun- 
 tenance, and general appearances of good liealth are not 
 incompatible, but often attend the worst of sufferers from 
 
1030 NERVOUS FORMS OF DISEASE. 
 
 this affection through life, so faithfully is the nutritive func- 
 tion preserved amid the many and frequent storms of nerv- 
 ous functional derangement. 
 
 So variable are the protean shapes which hysteria may 
 assume, that there is scarcely an organ or its function that 
 may not be invaded and the gravest maladies counterfeited, 
 calculated to lead to errors in diagnosis and prognosis, 
 compromising, if not the life and welfare of the patient, at 
 least the reputation for close discernment of the practi- 
 tioner. 
 
 Sudden, extreme, and anomalous symptoms should not 
 be hastily pronounced upon at the bedside of the patient. 
 Hysteric distention of the intestines by flatus has been 
 mistaken for pregnancy ; hysteric hiccup, for that of ap- 
 proaching death ; hysteric colic, for acute peritonitis ; hys- 
 teric stridulous breathing, for croup ; hysteric cough, for 
 hooping-cough; hysteric limpid urine, for diabetes ; intense 
 urinary irritation, for nephritis ; interior irritation, for in- 
 flammation ; hysteric headache, for encephalitis ; hysteric 
 tenderness and swelling of the knee-joint, for white-swell- 
 ing ; hysteric coma, for apoplexy ; hysteric w^ay wardness, 
 for mania, etc. 
 
 Diagnosis. — The suddenness of an attack of epilepsy, 
 the cry, the fall, the distortion of the features, frothing at 
 the mouth, livid turgescence of the face, small quantity of 
 air admitted in inspiration, and the profound coma are suf- 
 ficient to distinguish it from the hysteric paroxysm which 
 certainly similates epilepsy more than any other affection. 
 The want of correspondence between the violence of func- 
 tional disturbance and the symptoms of organic disease 
 will generally guide in distinguishing hysteric imitations 
 or counterfeits. The history of the individual will aid ; 
 examination of the spine also. 
 
 Causes. — Whatever impairs the constitution and in- 
 creases the excitability of the nervous system, may become 
 an exciting cause of hysteria. The anemic state favors its 
 incursion ; an irritable habit produced by errors in early 
 physical training ; early vicious practices ; emotional and 
 
NEURALGIA. 1031 
 
 imaginative reading ; spinal, uterine, or gastric irritation ; 
 strong and impassioned feelings ; startling sights, sounds, 
 or intelligence ; grief, jealousy, or unrequited love. The 
 ancient doctrine was that the uterus was the seat of the dis- 
 ease, but modern physicians regard it as seated in the nerv- 
 ous system or centers. 
 
 Treatment. — In the treatment of hysteria, our principal 
 reliance is on antispasmodics, as Yalerian, Castor, Assafe- 
 tida, Scutellaria, or Tincture of Lobelia and Capsicum. 
 These means should be persevered in, and if the paroxysms 
 are very severe the patient should be bathed in warm water, 
 and hot fomentations applied over the region of the uterus, 
 with sinapisms to the lumbo-sacral region. In this affec- 
 tion it must be remembered that although the symptoms 
 may, apparently, be very alarming, yet serious consequences 
 seldom ensue ; and as it is generally dependent upon some 
 other disease, as amenorrhea, dysmenorrhea, etc., these 
 should be treated as named under their various heads. 
 
 Species III. — Neurcilgia. 
 Neuralgia is a term used to designate painful local affec- 
 tions unattended by the evidences of inflammation or struc- 
 tural lesion. Literally, the term means pain in a nerve. 
 Formerly, the term tic douloureux^ literally signifying 
 painful twitchings or twinging, was applied to this form of 
 disease. Its most frequent seat is, perhaps, the face, sup- 
 plied by the fifth nerve and its branches, but it may im- 
 pinge upon any part or organ, external or internal, and its 
 true character only become manifest from the inutility of 
 remedies for inflammation or other forms of disease. Its 
 seat, in a mild and familiar ibrm, is some spot upon the 
 skin or scalp, exquisitely sensible to slight tough, but not 
 to firm pressure, in which electric-like twinges of intense 
 momentary pain occur, at intervals more or less remote. 
 Frequently the slightest touch or movement induces the 
 painful shock or lightning-like, acute pain. When its seat 
 is in the face, snuffing, blowing the nose, etc., may induce 
 the agony, and the writer has noticed a copious flow of 
 
1032 NERVOUS FORMS OF DISEASE. 
 
 tears, nasal mucus, and saliva often to result. Spasms of 
 the muscles, and sometimes permanent distortion of fea- 
 tures occur. The current of the shooting pain is often in 
 the course of a nerve, and in such cases the diagnosis is 
 plain ; but the pain is not unfrequentlj of more permanent 
 and aching character and situated in an organ, as for in- 
 stance, the stomach. The writer has met with a few 
 instances of well-marked neuralgia of this organ that none 
 of the ordinary character of remedies, opiates, carmina- 
 tives, alteratives, and counter-irritation, would remove, but 
 which yielded instantaneously to a full dose of tris-nitrate 
 of bismuth — also, more-prolonged and agonizing neuralgia 
 of the supra-orbital and frontal sinus regions instantane- 
 ously cured by electricity ; the patient being placed in the 
 electric bath by insulation and a current drawn ofl' by points 
 held near the part affected. 
 
 The character of the pain and history of the case, to- 
 gether with the absence of the evidences of inflammatory 
 action, will generall}^ suffice to guide the practitioner in 
 distinguishing this form of disease from all others and lead 
 to correct treatment. 
 
 It is to be borne in mind, in the absence of any settled 
 convictions as to the true pathology of neuralgia, that local 
 lesions in the branches and extremities of nerves, particu- 
 larly of those distributed to the teeth, may keep up a per- 
 manent neuralgia of the face for years. The writer has 
 known a case of great severity, and of ten years' standing, 
 perfectly cured by the extraction of all the teeth, sound and 
 unsound, the patient parting with fourteen sound teeth at 
 one sitting; and from that moment to this, some twelve 
 years, has not felt a solitary twinge of her former distress- 
 ing malady. Sometimes the extrr ction of a single offend- 
 ing tooth has cured a facial neuralgia. 
 
 Occasionally neuralgia assumes a periodic form, the par- 
 oxysms recurring at a certain hour every day or every 
 other day. Sometimes it assumes the rheumatic form, 
 supervening on exposure to cold, having its seat in the 
 fibrous and dermoid tissues. Sciatica and dermalgia are 
 
NEURALGIA. 1033 
 
 of this form. The pain experienced in organic forms of 
 disease is often nem-algic in its character, shooting along 
 the course of the nerves. Indeed all pain may be said to 
 be neuralgic, or to be in the nerves, but pain arising from 
 ordinary and obvious causes is not neuralgia in the tech- 
 nical sense we have defined it. Intensity of pain dispro- 
 portioned to the danger, and entire obscurity of the cause, 
 we call neuralgia, let it be seated where it may. The 
 writer has met with three or four instances of neuralgia of 
 the rectum, the paroxysms of which were described by each 
 sufferer as of the most intense character. 
 
 TREATMENT. — Ncuralgia is most generally dependant upon 
 some already existing disease in the system, which it is 
 absolutely necessary for the physician to determine and 
 treat, before any progress toward a cure can be anticipated. 
 During the treatment for the complication, and even when 
 none exists, the patient should be placed upon the use of 
 antiperiodics, among which we prefer the following : 
 H. Sulphate of Qulnia, 
 Prussiate of Iron, 
 Hydrastin, dd. Mix, 
 Of this powder, about four grains may be given every four 
 hours, in conjunction with the Compound Powder of Ipecac, 
 and Opii, given in the same doses, three or four times a day. 
 
 In cases where there is no other apparent disease present, 
 we have derived considerable advantage from the use of the 
 Compound Syrup of Stillingia and Iodide of Potassium, in 
 connection with the above means. 
 
 The use of the electro-magnetic battery, as a local means, 
 has proved a powerful auxiliary in the treatment ; if pos- 
 sible, the current should be made to pass along the course 
 of the affected nerve. Pubefacients are sometimes used 
 with advantage, and the local application of Chloroform 
 has frequently been attended with the happiest results, as 
 well as the Compound Cajuput Mixture. The bowels 
 should be kept regular, and in many cases the occasional 
 use of the spirit vapor-bath will be found beneficial. Bel- 
 ladonna, Arnica, and Aconite have been recommended, and 
 
1034 NERVOUS FORMS OF DISEASE. 
 
 we have derived much good effect from a saturated tinc- 
 ture of the latter article, in the proportion of one fluid 
 drachm to eight ounces of water, of which a tablespoonful 
 was given every hour. 
 
 Species IV. — Mania. 
 
 "We have treated of certain forms of disease that involved 
 the brain as a living substance, as cerebritis, hydrocepha- 
 lus, etc. We have now to treat of its functional delin- 
 quency — of certain derangements — the results of disease, 
 which become known to us through its manifestations. 
 
 When we make the cerebral manifestations of the mass 
 of society the standard of sanity, there are many, even the 
 most gifted among the minority, whose manifestations in- 
 duce the majority to consider them more or less insane. 
 But in this variety of insanity, if such we may call it, for 
 the present, there is a sane method about it, which has been 
 characteristic of the individual through life. Cases of this 
 kind depend upon peculiarities of organization, and are not 
 to be confounded with those that result from disease. This 
 distinction may require some illustration. We do not con- 
 sider our savage tribes insane because of their mode of life, 
 but if one of our distinguished citizens was to join them, 
 and to adopt all their modes of life, he would certainly and 
 very justly be regarded as more or less insane. Then why 
 do we not regard the savages as insane ? Simply for the 
 reason that there is a uniformity and a method in their 
 modes of existence which is, and has been, so far as we can 
 know, the practice of all its individuals. When we come 
 to investigate these savages anatomically, we discover that 
 their manifestations are physiologically normal. These 
 remarks apply, similarly, to individuals. Nero was, con- 
 fessedly, a moral monster, and yet between him and a man 
 who should faint at seeing a fly killed, there is, in point of 
 science, no more diflerence than existed between Eaplace 
 and Mr. George Combe — the first a mathematician and the 
 second the first moral philosopher of the age, and yet does 
 not know the multiplication table. 
 
MANIA. 1035 
 
 The insanity, or departure from the standard of society, 
 of such men as Nero and Caligula is normal, purely phy- 
 siological, while that of which we have to treat is purely 
 pathological, and yet, it will be seen, before we conclude, 
 that they have been confounded. 
 
 All imperfectly-constructed machines possess an inherent 
 liability to functional derangement, and to this law the 
 brain offers no exception. Some individuals have a brain 
 so happily constructed that no amount, in both number and 
 strength, of the vicissitudes of life can produce in it func- 
 tional derangement, but a very large proportion of society 
 is, more or less, differently or less perfectly constituted. 
 Both the physiologically and the pathologicall}^ insane have 
 had entailed upon them unfortunate organizations, which, 
 through the aid or direction of education, the first becomes, 
 too frequently, the inmates of our prisons, and the second, 
 of our lunatic asylums ; and, therefore, in a legal point of 
 view, they should be held equally responsible — the safety of 
 society requires it, and nothing more. 
 
 Many have been the writers who have attempted to de- 
 fine insanity, and all have failed, and for the reason that 
 they attempted an impossibility. The human mind mani- 
 fests, we hiow^ about forty-seven independent functions, and 
 it is not presumable that all of them have been discovered ; 
 we may therefore safely assume that there are fifty — the 
 brain, then, consists of fil'ty organs, each of which acts and 
 ceases to act independently of all the others. Now, suppose 
 the agent by which harmony of action is maintained among 
 them, in a state of sanity, should become dethroned, would 
 it be possible to define the confusion ? The difiiculty is not 
 yet fully expressed. No two individuals are precisely simi- 
 larly organized, and hence no two cases of insanity can be 
 exactly similar in their manifestations. 
 
 Now suppose we define insanity to be a departure, in 
 mental manifestation, from the standard of society — taking 
 the majority as a standard. This definition is correct, but 
 it is not sufficiently exclusive, because it equally applies to 
 the normal condition of the minority of society — to those 
 
1036 NERVOUS FORMS OF DISEASE. 
 
 who are so organized as to form exceptions to the great ma- 
 jority. Such individuals have absolutely been medico-le- 
 gally dealt with as lunatics. We have incidentally named 
 this fact before — that some, with a healthy organization, 
 act insanely, while others do so from disease acting upon 
 an unfortunately constituted one. 
 
 Insanity has been defined by some one (Cy. Prac. Med.) 
 to be a "disordered state of the functions of the brain, 
 which gives rise to disturbances in the operations of the 
 mind." In this definition, " the functions of the brain," 
 and ''the operations of the mind," seem to be regarded as 
 two distinct entities, holding a relation of some kind to each 
 other, while in truth, the functions of the brain are really 
 the operations of the mind. No possible distinction can be 
 drawn between them ; the first clause of the sentence there- 
 fore contains the whole definition, and it is as good or per- 
 fect as can be conceived of; but, as the writer. Dr. J. C. 
 Prichard, of the article containing the definition above 
 quoted, says '4t includes a variety of other diseases, and 
 hence it becomes necessary to render the description more 
 particular by exclusions and restiictions." After naming 
 some of these exclusions and restrictions, he concludes that 
 "it is obvious a definition loses all its utility when it is 
 found necessary to encumber it with so many particular re- 
 strictions, and it is therefore better to give up the attempt 
 to define insanity in general terms." His article shows 
 that he has been no more successful in the use of special 
 ones. 
 
 He now proceeds to notice some of the varieties of insan- 
 ity for the purpose of giving us some idea of a disease 
 which he could not define, and begins with "Moral Insan- 
 it}^," which he says, consists in a " morbid perversion of 
 the feelings, aflections, habits, without any hallucination or 
 erroneous conviction impressed upon the understanding." 
 This is moral insanity, and yet, although dogs have feel- 
 ings, aflfections, and habits, no one regards them as moral 
 beings. Dogs, as well as men, have this identical form of 
 insanity ; is it therefore moral insanity ? By a reference 
 
MANIA 1037 
 
 to his article it will be discovered that his moral insanity 
 consists of the normal actions of an unfortunately organized 
 brain. 
 
 If this was the place for illustrations of cerebral physi- 
 ology, the writer could introduce a much more astonishing 
 character. Every phrenologist of much experience has met 
 with parallels of the preceding history, and he was able 
 without any knowledge of his character, to describe accu- 
 rately the peculiarities of his insanity (f). He would not 
 confound his condition with one of disease, but as the legit- 
 imate result of organization. 
 
 In such cases of insanity (?) as the preceding, we admit 
 that the intellect may be sound in the absence of passion; 
 but we deny that the intellect, in any case of insanity from 
 disease of the afiective faculties, is ever uninvolved. 
 
 Dr. Prichard says, that when there is hallucination or 
 erroneous judgment present, then the case is not one of 
 moral insanity ; and we add, that when no error of judg 
 ment attends the case, it is one of organization, and not of 
 disease. In a further efibrt to define moral insanity, the 
 doctor says, that '' when the morbid phenomena include 
 merely expressions of intense malevolence, excited without 
 grou7id or provocation, actual or supposed, the case is strictly 
 one of moral insanity." We fearlessly assert that no such 
 case was ever witnessed, and we do it upon the principle 
 that insane people do not and can not act without motives 
 or causes, any more than the sane. The highest mark of 
 insanity is shown in a want of fitness or compatibleness 
 between the causes and the efiects — the motives and the 
 consequent actions. 
 
 In fact, the writer, Dr. Prichard, has given us nothing 
 on the subject of moral insanity, of a doctrinal character, 
 which does not go to show that he has mistaken the func- 
 tions of an unfortunate organization for those of a diseased 
 one. Finally, his paper on this subject may interest those 
 whose opportunities for becoming acquainted with mental 
 science have been exclusively metaphysical, but in our 
 judgment it contains scarcely a ray of scientific light. To 
 
1038 NERVOUS FORMS OF DISEASE. 
 
 treat of the functions of destructiveness, acquisitiveness, 
 etc., as moral faculties, can not be considered as less than a 
 most flagrant abuse of language. Moral insanity should 
 be understood to mean an abnormal manifestation of the 
 moral sentiments. The same want of precision in the use 
 of language characterizes his whole paper, thus showing 
 that he has no clear conception of his subject. For medico- 
 legal purposes, like other popular works of the day, it may 
 be valuable, but not to the physiological student of medi- 
 cine. 
 
 It is customary for writers to divide functional derange- 
 ment of the brain into many varieties, but as these mostly 
 or entirely depend upon mere organic differences, we shall 
 treat of it under two heads only, viz : mania and monoma- 
 nia. By the first, we mean an impairment of the cerebral 
 functions of external relation in general; and by the second, 
 a derangement of some one of these functions or several of 
 them, upon one subject. 
 
 It is usual to treat of idiotism as a variety of mental de- 
 rangement, but as we consider this condition to depend upon 
 an absolute deficiency of brain, and not upon disease, it can 
 really have no place in a work of this kind. We are aware 
 that some regard it us resulting sometimes from disease, 
 but we hold it to be, in all instances, congenital. 
 
 Dementia and fatuity are sometimes treated of as varie- 
 ties, but we regard them as merely severe stages or condi- 
 tions of insanity or mania. 
 
 Imbecility is another form of mental imperfection which 
 is frequently met with in works on this subject, and it is re- 
 garded as a modification of, or an afiection that holds a 
 close alliance with idiotism. We understand by the word 
 an unexceptionable development of the afiective portions of 
 the brain, with more or less deficiency of the intellectual — 
 such persons are said to be weak-minded. It is an or- 
 ganic condition, and therefore not a subject for present in- 
 vestigation. 
 
 Our space will not permit us to pursue these introduc- 
 tory considerations further, nor should we have trespassed 
 
MANIA. 1039 
 
 upon the reader's attention as far as we have, but for 
 the purpose of guarding him against the metaphysical 
 learning of the day. 
 
 An abnormal manifestation of all the mental faculties 
 constitutes mania ; to distinguish this form from that of 
 monomania, it is usually denominated general mental 
 derangement. The manifestations of maniacal patients are 
 exceedingly various, in consequence of a diiference of tem- 
 perament and of cerebral organization. Our description 
 of mania must, therefore, be esteemed as only general. 
 
 The premonitory signs of approaching mania are usually 
 such as to be readily observed by the family associates of 
 the patient, inasmuch as they generally consist of a very 
 great or even a total change of such of his mental mani- 
 festations as mostly constituted his character or mental 
 individuality. Normally, he was confiding in his family 
 and friends, but now he is suspicious and jealous ; he was 
 self-governed and forbearing in his temper, but now he is 
 irritable and easily thrown into a violent rage ; formerly 
 rather slow in his habit or mode of thinking, but now quick 
 and rapid ; formerly he was exceedingly frugal and circum- 
 spect, but now he is prodigal and ready to hazard under all 
 chances of speculation ; if, normally, he was selfish, he is 
 now liberal and philanthropic. 
 
 When mania has become so developed as to admit of no 
 doubt as to its existence, there are certain symptoms which 
 are very generally present, such as sleeplessness, frightful 
 dreams, vertigo, cephalalgia, costiveness, an inordinate 
 appetite, a feeling of tension and throbbing in the brain, 
 and a dull or a wild and animated expression of the coun- 
 tenance. In a more confirmed stage, the patient, depend- 
 ing upon the peculiarities of his cerebral organization, is 
 haughty, affable, kind, or savage. When alone, he will 
 occupy his time in singing, whistling, swearing, praying, 
 preaching, hallooing, walking, with rapid and wild gesticu- 
 lations, or possibly he does nothing but gloomily sit still. 
 His power to sleep leaves him for a week, or even for 
 weeks, his appetite has become irregular, his urine is high 
 
1040 NERVOUS FORMS OF DISEASE. 
 
 colored and scanty, the bowels are constipated. The cir- 
 culation appears to participate in the cerebral derangement, 
 for it is exceedingly variable — sometimes feeble and irregu- 
 lar, sometimes strong and full, and at other times it is tense, 
 or slow, or frequent and quick, and lastly it is sometimes 
 normal. 
 
 As an attendant upon violent grades of insanity, there is 
 one symptom which, more than any other, claims our atten- 
 tion, as will more clearly appear when we come to treat of 
 the nature or character of the disease — it is a remarkable 
 impairment of consciousness. Every other mental faculty 
 continues to manifest its function, though in an abnormal 
 manner, so long as there remains evidence of mental exist- 
 ence, or until mania is lost in fatuity. So truly is this the 
 case, that the patient loses all idea of his location, of his 
 family, social, and political place, of time, and of his own 
 personal existence. He recognizes some of the impressions 
 that are made upon his external senses, yet even here his 
 consciousness is exceedingly feeble — so much so that he dis- 
 tinguishes nothing, confounds visiters with his friends, and 
 strangers with his relations. His affective and intellectual 
 faculties may continue active, but they have become isolated 
 with reference to the external senses, as is evidenced by his 
 imagining that he hears persons talking or singing, that he 
 sees spirits and angels, and even holds conversations with 
 them. Among the physical phenomena that attend mania, 
 there is a disagreeable odor, of an indefinable character, 
 which emanates from the body and excretions of the patient 
 (Esquiral). A suggestion : — May not this odor result from 
 an abnormal escape of sulphur and phosphorus, two ele- 
 ments which are essential to sound cerebral action ? 
 
 In the lighter shades of mania it is frequently impossible 
 for a stranger, during a few minutes of observation and 
 conversation, to detect any indications of its existence, and 
 when it is detected, it is most frequently through some 
 faulty manifestation of consciousness ; and this faculty fre- 
 quently appears defective in those who are greatly liable to 
 mania, long before the existence of the disease is suspected. 
 
MANIA. 
 
 1041 
 
 The writer has particularly noted that it is about as impos- 
 sible to make such persons feel conscious of error, as well 
 before as after the maniacal invasion. 
 
 This form of disease may appear suddenly and continue 
 a day, a week, a month or longer, and then remit, intermit, 
 or end fatally ; or it may appear slowly and as it were by 
 stealth and prove continuous, or it may appear in parox- 
 ysms and observe exact periodicity, yet the intervals are 
 not attended with sanity, but by depression or an absence 
 of excitement. Mania may, furthermore, appear in the 
 chronic form and continue unattended by obviously-distinct 
 exacerbations. As this form obtains in those who have a 
 high endowment of the organs of external relation, and a 
 feeble one of those of internal relation, it is marked by a 
 great absence Of animation or excitement ; existence seems 
 to be one of indifference, one of neglect to every want and 
 to every decency. 
 
 Causes.— There are two remote causes, and without the 
 presence of one or the other no other cause can produce 
 mania, except mechanical violence, and they are these, viz: 
 an unbalanced or badly-adjusted cerebral organization, and 
 qualitative modes of cerebral action which may have been 
 either transmitted or acquired. 
 
 Upon this subject. Dr. Pri chard (Cyc. Frac. Med.) re- 
 marks : "Among the circumstances in the previous condi- 
 tion of an individual which prepare him for sustaining the 
 attack of this disease, the most important is a certain pecu- 
 liarity of natural constitution. This consists chiefly, as it 
 is probable, in a particular organization of the brain and 
 nervous system, rendering those individuals so constituted 
 liable to become insane when exposed to the influence of 
 certain agencies, which in other persons either give rise to a 
 different train of morbid phenomena, or are, perhaps devoid 
 of any injurious effects. The constitutional peculiarity 
 which predisposes to madness is not distingidslied hy any 
 remarhable external characters?^ More than seventy years 
 since. Dr. Gall taught and demonstrated that those who 
 are particularly liable to insanity can be " distinguished 
 
1012 NERVOUS FORMS OF DISEASE. 
 
 bj" many "remarkable external characters," and every 
 tyro among his disciples can make the distinction. Dr. 
 Prichard, with all his learning and talent, through bigotry, 
 writing upon a subject in both matter and manner seventy 
 years behind his time ! Should we not in this year, 1854, 
 suspect an intelligent man to be of unsound mind, who 
 should assert that there are no " remarkable external char- 
 acters " by which the head of a liomocidal maniac can be 
 distinguished from that of the benevolent one, who has 
 divided a large estate, in small portions, among the poor ? 
 
 In happily balanced brains it is impossible for any one 
 faculty or group of faculties, whether of internal or exter- 
 nal relation, to become so excited as to endanger their in- 
 tegrity ; but with the unbalanced — the very impressible, 
 the case is very different. We will here add an illustration, 
 as it will not be out of place. 
 
 During the connection of the writer with the Medical 
 College of Louisiana, he was called to the Charity Hospital 
 by Professor Stone, to see a raving female maniac, who had 
 just been removed from the streets of the city to the hos- 
 pital. She had about her all the indications of having held 
 a very respectable position in society, and this circumstance 
 caused the professor to be more than ordinarily solicitous 
 about her. 
 
 He desired the writer to examine her head and to give 
 him such information touching her condition as he might 
 thus obtain. She was Irish, and had a remarkably fine 
 head — beautifully developed with reference to intellect and 
 the social sentiments, but preponderating over every other 
 compartment was the domestic. 
 
 The examination being made, the writer informed the 
 professor that her insanity must be attributed to some pow- 
 erful shock given to her domestic affections, and suggested 
 the immediate use of a hot pediluvium, ice to the social 
 sentiments, and many leeches to the domestic region. This, 
 and possibly more, but not now remembered, was done, 
 and in the space of an hour she detailed to us much of 
 her history relating to her mania, and as it is, in this con- 
 
MANIA. . 1043 
 
 nection, particularly interesting, we will be excused forgiv- 
 ing it. 
 
 Three years previous to this event, her husband, in search 
 of prosperity, left her with her friends in Ireland, and went 
 to New York, and during the first two years he sent her re. 
 mittances of money, but during the third year she received 
 no money nor any information of him. She then left her 
 friends and went to ]^ew York to search for him ; there she 
 learned that he was in ISTew Orleans ; she then went to I^ew 
 Orleans, and by the instructions she had she readily found 
 him ; but, sad to relate, he disowned her — he denied ever 
 having been married, and of ever having seen her before. 
 This was her history, and though brief, it was enough to 
 drive to madness so devoted a wife. 
 
 The reader is r^equired to remember this case, as we will 
 have occasion to refer to it before we conclude the subject 
 of insanity. We regret to add that she became a confirmed 
 maniac. 
 
 The reader has, by this time, no doubt, discovered that a 
 little more certainty is now had upon this subject than Dr. 
 Prichard, Esquiral, Pinel, and many other copious writers 
 upon it ever dreamed of. 
 
 This unbalanced condition of the brain is the most fruit- 
 ful source of insanity ; but anterior to it is another ques- 
 tion : — what rendered such a brain common to civil society ? 
 We answer — one of the first causes of it exists in a division 
 of labor, and another is the revolutionary movements of the 
 world — religious sectarianism has been a fruitful source, 
 and so have politics. The enthusiasm that distinguished 
 the Whig party during the struggle that made General 
 Harrison, President, did an immense amount of mischief. 
 Yery many of the children begotten during that struggle 
 possess scarcely anything in common with the other mem- 
 bers of their respective families — very many of them will 
 be brighter ornaments of society than their sisters and broth- 
 ers, if they happen to fall into a favorable current of circum- 
 stances, otherwise they will become drunkards, gamblers, 
 suicides, or maniacs. The writer has, with astonishment, 
 
1044 NERVOUS FORMS OF DISEASE. 
 
 contemplated many of these children. Such excitement 
 and enthusiasm, in church or state, though they may occa- 
 sionally produce a great man, are of incalculable mischief 
 to society as a ^hole. We have said that a division of la- 
 bor has been instrumental in producing unbalanced cerebral 
 organizations. This we have inferred from two circum- 
 stances : first, each pursuit calls into requisition only a 
 part of the mental faculties, and secondly, in the several 
 Indian tribes the history of an individual is that of his tribe, 
 in kind, and all the heads of a tribe have a strong family 
 resemblance. 
 
 The exciting causes of mania have generally been divided 
 into physical and moral, and yet it has neither truth, utility, 
 nor common sense to recommend it. In the first place, we 
 neither do nor can know anything of non-physical causes 
 or agents ; and secondly, the case of the Irish lady, above 
 referred to, would, by those who have adopted the division, 
 be attributed to a moral cause, when in truth tlie moral fac- 
 ulties had nothing to do with it. An outrage inflicted upon 
 her domestic faculties or afiections caused her insanity, and 
 these faculties are as common to geese, pigeons, partridges, 
 foxes, and some other anim.als, as they are to man, and cer- 
 tainly no one will admit that any of the inferior animals 
 are moral beings. A more consistent division would be, 
 into internal and external — internal, when efi'ected through 
 the agency of the organs of internal relation, and external, 
 when efiected through the medium of the organs of external 
 relation. 
 
 As internal causes of mania, we name the following, and 
 those that most frequently produce it stand first in the cata- 
 logue, viz: apoplexy, old age, suppressed menstruation, 
 puerperal state, worms, use of mercury, congenital injuries 
 of the head, fever, epilepsy, pregnancy, suppressed cuta- 
 neous forms of disease, intoxication, syphilis, narcotic poi- 
 sons, atmospheric influences, hemorrhage, or insufiScient 
 food, onanism, excessive indulgence of amativeness, and 
 its unsatisfied desire. 
 
 Of the external causes of mania, we may name the fol- 
 
MANIA. 1045 
 
 lowing, viz : want and its consequent misery ; grief, no 
 matter how produced ; unrequited love ; fright ; jealousy ; 
 fanaticism ; long-cherished hatred ; political disappoint- 
 ments; injured character ; intense and protracted study of 
 subjects that do not admit of certainty or demonstration ; 
 loss of property, and disappointed ambition in general. 
 
 We should add, in this place, that those who are liable 
 to mania from an unbalanced cerebral organization may, 
 very properly, be divided into two classes. Those who 
 have had entailed upon them peculiar modes of cerebral 
 action favorable to the production of the disease. This is 
 the class in which mania is said to be hereditary. The 
 second class comprises those who have not had entailed 
 upon them such modes of cerebral action, but such an or- 
 ganization as is calculated to favor the production of the 
 disease. In conclusion, we will merely add that the entail- 
 ment of peculiar modes of cerebral action has become too 
 well settled, both in relation to men and many of our do- 
 mestic animals, for it to become a question in the mind of 
 any one. Our hunters are perfectly convinced of it with 
 reference to the dog. The progeny of a dog that was 
 trained to set at game will spontaneously do the same. 
 
 Nature of Mania. — There has been considerable con- 
 trariety of opinion as to the primary source or seat of 
 insanity. Finel has given it as his opinion that it is in or 
 about the stomach and intestines. With as much pro- 
 priety, in our opinion, it might be contended that the true 
 seat of gastric derangements is in or about the brain. It is 
 true, as should be supposed, that when insanity is caused 
 by the morbid condition of the organs of internal relation, 
 that the general health is greatly impaired, as well preced- 
 ing the insanity as afterward. But from this circumstance 
 we are by no means entitled to the inference that when 
 insanity results from influences exerted upon the organs of 
 external relation, that there should exist at the time a mor- 
 bid condition of the stomach, the intestines, or of any of the 
 other viscera of the two inferior great cavities. In very many 
 instances we know the contrary to have been the fact. The 
 
1046 NERVOUS FORMS OF DISEASE. 
 
 Irisli lady, whose case we have introduced, was, apparently 
 at least, a model of good health at the time she was stricken 
 with insanity. This is not all. The shock upon an im- 
 pressible organization may be so violent, even in a state of 
 good general health, as to occasion the worst grade of 
 insanity — that of amentia or fatuity. Of this kind the 
 writer has seen one example. 
 
 We know" that visceral derangement will produce cere- 
 bral derangement, and vice versa; now, where is the 
 point, and what is the function of it that holds the two sys- 
 tems in such relation to each other ? When we shall have 
 discovered this point and its function, then, in our opinion, 
 we shall have discovered the true seat and nature of 
 insanity. A little further prosecution of this inquiry will 
 probably bring us a little nearer to the object at w^hich we 
 aim. When the stomach, liver, intestines, etc., are sound 
 or healthy we do not know them to exist ; but when they 
 become possessed of inflammation, then w^e become une- 
 quivocally informed of their being. Equally true is it, 
 that we do not know that the brain is the organ of thought 
 and feeling so long as it continues in a state of well-being ; 
 but a structural disease of it soon gives us to understand 
 that these are its probable functions. Now to the question. 
 Through what medium is it that we receive our information 
 in both cases? Is it not through consciousness f To us it 
 appears that physiology and pathology both answer in the 
 affirmative, and the testimony of anatomy bears w^ith great 
 force upon the same question, by showing that there is a 
 particular portion of the brain which so clearly performs 
 the function of consciousness that Mr. Grimes, of IN^ew 
 York, an able phrenologian, has nominated it the organ of 
 consciousness. Yivesectionists state that in slicing down 
 the brain, commencing with the superior surface of the 
 hemispheres, no consciousness of the operation is mani- 
 fested until the base of the brain is very nearly approached, 
 and it is at the base of the brain we find those organs 
 which connect consciousness with the ganglionic system, 
 such as vitativeness, pneumativeness, gustativeness, hydra- 
 
MANIA. 1047 
 
 tiveness, etc. The independence of sucli a faculty as con- 
 sciousness might be inferred, it would seem, from its con- 
 tinuing to be the only acting power of the mind in some 
 modifications of catalepsy. Its function appears to be that 
 of informing us as to the results of the actions of all of the 
 organs of external relation, and to constitute the sense of 
 ill or well-being to the organs of internal relation. 
 
 If the preceding conclusions be well founded, it is obvi- 
 ous that all the phenomena of insanity are explained. In 
 this disease the organs of external relation do not appear 
 to be deranged, in cases of moderate violence, in their 
 individual capacity, but in their relative actions as a whole. 
 
 In the case of the Irish woman, before treated of, the 
 cause of insanity was no doubt communicated through the 
 domestic faculties, but they, in the abstract, were not 
 injured, for if they had been, she would have displayed 
 monomania ; but as the result was insanity, the force of 
 the shock fell upon some part, the morbid manifestations of 
 which would le a derangement in the relations of all the 
 organs connected with, or dependent upon it. She was 
 conscious of having found her husband, of his having dis- 
 owned her, of being three thousand miles from her friends, 
 in the midst of a nation of strangers and without the 
 means of providing for her necessities. If all this, in a 
 highly refined order of organization, could not overpower 
 and derange the organ that was the witness of it, then it 
 must be proof against all causes. 
 
 We have now delivered our convictions upon the seat 
 and nature of insanity, and leave it for our readers to 
 judge of their value. But before dismissing this division 
 of our subject, we beg leave to make a few remarks upon 
 microscopical investigations as they have been conducted. 
 A few pathological anatomists deny having discovered 
 morbid changes in brains of those who have died of 
 insanity; but a large and preponderating majority have 
 asserted and recorded the contrary, and with great and 
 interesting minuteness; but, so far as we can discover, they 
 avail nothing, because they were conducted without par- 
 
1048 NERVOUS FORMS Of DISEASE. 
 
 ticular reference to the character of the disease in each 
 particular instance. Can it be a matter of no moment as 
 to whether the insanity was produced through the agency 
 of the organs of internal or external relation ? In making 
 a record of post-mortem appearances, should we not be 
 informed whether the case was one of insanity^ dementia^ 
 or amentia? M. Georget informs us that he found many 
 crania among those who died of insanity to possess an 
 irregular conformation, and most generally the right side 
 was^ more capacious than the left; in some, the lateral 
 diameter was equal to the antero-posterior ; in some, the 
 cavities of the base were irregular; in some, the skull was 
 partially thickened, and in others generally; some were 
 hard and white, and w^ithout diploe; and lastly, some were 
 very light. 
 
 ]S"ow the medical student, and the profession at large, 
 upon the high authority of M. Georget, must infer that all 
 these cranial peculiarities resulted from insanity; and yet 
 the writer can, at any moment, show all of them in the 
 crania of individuals who never had insanity or any other 
 form of cerebral disease. But admit them to have been 
 occasioned by insanity, how can we render them inservient 
 to any pathologic or therapeutic purpose, as we are left 
 uninformed of those peculiarities under which they were 
 severally produced ? It will be remembered that W3 named 
 an unbalanced head, which means an irregularly formed 
 one, to be the principal remote cause of insanity — one 
 without which insanity could not exist, except by mechan- 
 ical violence ; and therefore M. Georget has mistaken the 
 most important remote cause of insanity for an effect of it; 
 but he is not alone, for others have done the same. 
 
 It is true, that the cranium may become thin or thick in 
 a state of health or disease, nevertheless they are so dis- 
 tinguished by other marks that they can not be confounded. 
 A state of healthy mental activity and a state of active 
 insanity will both be attended with a light and thin skull ; 
 and a state of mental inactivity through a want of ambi- 
 tion or adequate motives to, or opportunities for action, 
 
MANIA. 1049 
 
 and a state of amentia succeeding to active insanity, will 
 be associated with a thick skull ; but a thin skull from dis- 
 ease gives evidence that inflammation existed in the dura- 
 mater and pericranium at death, and the thick skull from 
 disease discovers that these membranes had been diseased. 
 A thin skull from insanity, and a thin one from a too full 
 and frequent use of ardent spirits can not be certainly dis- 
 tinguished, but in both cases there is a preternatural excite- 
 ment of the brain and its membranes — in both cases the 
 skull becomes thin, and in both cases its normal angulari- 
 ties become replaced by a more full and rounded condition. 
 Dementia. — The signification of this word is remarkably 
 indefinite. It applies with equal force to tl;at decay or 
 absorption of the brain, and particularly of its intellectual 
 portion, consequent upon old age, and which is in no wise 
 allied to insanity, and also to that absorption of the brain 
 which supervenes upon inactive insanity — with reference 
 to both it is a mere sequent. The dementia of old age is 
 frequently attended with a strong recollection of the events 
 of early life, hence the aged often re-enjoy the tricks and 
 amusements of their youth, and re-fight its battles, and 
 yet be exceedingly forgetful of present impressions and 
 events. The reason of all this, to us, is very obvious. In 
 early life all the mental organs were active and vigorous, 
 and hence all the impressions made upon consciousness 
 were thoroughly made, and therefore enduring ; but in old 
 age the mental organs have become reduced in size and 
 enfeebled in action — in consequence of the absorption of 
 the perceptive convolutions and the continuous adaptation 
 of the internal table of the cranium to it, the frontal sinuses 
 become of enormous magnitude, and all at the expense of 
 the perceptive organs. In this condition of these faculties 
 a strong perceptive impression can not be made upon the 
 organ of consciousness, and consequently no impression is 
 distinctly retained, and frequently not even made. From 
 the causes now stated, old people sit for days and ev^en 
 weeks without speaking a word, and without giving any 
 evidence that they are in the least impressed by external 
 
1050 NERVOUS FORMS OF DISEASE. 
 
 nature ; and yet consciousness is not in the same exhausted 
 condition, for they will smile, even laugh and possibly 
 speak from the still existing early impressions. 
 
 With the dementia of old people, or senile dementia, we 
 have nothing to do further than to define it, because it is 
 not a state of disease ; but between it and that which de- 
 pends upon disease there are some points of resemblance. 
 There is in both the same disposition to taciturnity, and 
 non-observance of passing exents. In both there is an 
 atrophy of the brain, and a hypertrophy of the cranium; 
 but in senile dementia the cranium gives no evidence of 
 pre-existing inflammation of its membranes, while that of 
 the other always does. In the former the mental organs 
 are worn out, not deranged, and consciousness, as an inde- 
 pendent faculty, still preserves its integrity; but in the 
 latter, the cerebral atrophy is attended with insanity and a 
 greatly impaired condition of consciousness. There is 
 another very important difference between these two forms 
 of dementia. In the senile there is no recovery,^ but from 
 the other form the patient may recover, and the brain may 
 recover its normal size, and the cranium its normal 
 thinness. 
 
 In dementia, as a sequent of insanity, the patient may 
 enjoy or ratlier possess good health, the appetite, the diges- 
 tion, the secretions, and the excretions may all be healthy — a 
 condition of the system that did not attend the active stage 
 of insanity. Among patients of this denomination there 
 are a few who have occasionally a higher state of cerebral 
 excitement, and with it a correspondingly active state of 
 insanity. 
 
 Amentia or fatuity — the last stage of insanity. This 
 appears to consist in a complete vegetative condition of the 
 patient — those who are thus afflicted manifest no volition 
 nor consciousness. They never call for food, and they 
 would never eat if food was not put into their mouths. If 
 in bed, they would never get up, and when up, they would 
 never lie down, and neither is ever effected except by attend- 
 ants. Of their excretions thev take no notice. As we have 
 
MONOMANIA. 1051 
 
 remarl-recl, they merely vegetate, and this they may do for 
 many years, and have a pretty good state of health. 
 
 This is regarded as the last or final stage of madness or 
 insanity ; nevertheless, it is occasionally the first and only 
 stage. We knew a highly-talented lawyer, who had con- 
 tracted a marriage engagement with a lady, who married 
 another gentleman very nearly about the time she had con- 
 tracted to marry the other, and when he was informed of 
 her marriage he became suddenly amen ted, and so con- 
 tinued many years and to the end of life, and yet the vege- 
 tative functions were not materially disturbed. It was this 
 case that first induced the writer to reflect about the true 
 seat of insanity. The idea of his forty or more mental 
 faculties all becoming suddenly amented, is, to the writer, 
 preposterous, because very many of those faculties had no 
 more to do with the circumstance than had his external 
 senses. But a sudden amentia or paralysis of his organ of 
 consciousness, fully accounts for the sum total of his case. 
 
 With these views, we have no difficulty in comprehend- 
 ing how it is that the vegetative functions, and some of the 
 animal, or those which are essential to the vegetative, as 
 the external senses, locomotion, etc., should continue, com- 
 paratively, in a normal state, when reason and conscious- 
 ness are measurably dethroned. 
 
 Species Y. — Monomania. 
 
 This is a derangement of a single mental faculty or of so 
 many of them as may be essential to the formation of a 
 single idea or mental conviction, while all of the other 
 faculties continue in a normal state. The varieties of this 
 form of disease may be as numerous as are the aflective 
 faculties and their combinations. It is more frequently to 
 be met with than any other species of functional derange- 
 ment of the organs of external relation. 
 
 From the most careful investigation we have been able 
 to give this subject, we have been forced to the conclusion 
 that it is pathologically the antithesis of insanity. It will 
 be remembered that while treating of insanity we main- 
 
1052 NERVOUS FORMS OF DISEASE. 
 
 tained that it was primarily and essentially located, in con- 
 scionsness, and that it might be produced through the 
 medium of either the organs of internal or of external rela- 
 tion ; but in the form of mental derangement now under 
 consideration, the seat is in the mental organs, or organs 
 that manifest the deranged function, that consciousness 
 maintains its full integrity throughout the existence of the 
 disease, and lastly, that it is never occasioned through the 
 medium of the organs of internal relation. Furthermore, 
 the existing liability to this form of disease is most gene- 
 rally indicated by the external configuration of the brain. 
 Thus, a homicidal monomaniac has a large organ of de- 
 structiveness, and a suicidal one has watchfulness large. If 
 we knew all the mental faculties and their modes of mani- 
 festation it is very probable that we could in all cases refer 
 the existing delusion to its proper source. We can better 
 teach how far w^e are, in a great measure, capable of cer- 
 tainty, and how far we are not, by the introduction of 
 cases. 
 
 In Tuscumbia, Alabama, there was, at the close of a 
 phenological lecture by the writer, introduced upon the 
 stage for public examination an old gentleman from the 
 country. His organs of hope, reverence, marvelousness, 
 and self-esteem were all peculiarly large, with an intellect 
 much below mediocrity except for the plainest common- 
 sense. The writer informed the audience that if the sub- 
 ject under examination should be exposed to occasions of 
 high religious excitement, he would be liable to become a 
 religious monomaniac, and that his self-esteem would give 
 direction for fancying himself to be an apostle, the Savior, 
 or the Deity ; and further, that he was even liable to such 
 a hallucination spontaneously. At the close of the ex- 
 amination the lecturer and audience were informed that the 
 old gentleman whose head had just been examined, believed 
 himself to be the Almighty. On the day after the lecture, 
 a member of the Tuscumbia bar informed the writer that 
 the old gentleman above alluded to really did believe that 
 he was God, the Governor of the universe ; but that he was 
 
MONOMANIA. 
 
 1053 
 
 entirely sane upon all other subjects — managed his business 
 and farm with much prudence. 
 
 Some years since the writer was acquainted with an old 
 gentleman who was deranged with reference to children — 
 he had the organ of philoprogenitiveness decidedly large. 
 When visited by his acquaintances of both sexes, he never 
 failed to inform them that his wife had been pregnant nine 
 years, and then he would ask them if they did not think 
 the child w^ould be a " thopper " when it came. 
 
 Dr. Spurzheim mentions the case of a young lady of good 
 standing, who ran into a party of ladies and gentlemen, 
 and with much seeming satisfaction informed them that she 
 was with child. The writer knew a black woman, some 
 fifty years of age, who, as frequently as she got drunk, in- 
 formed her mistress that her master was going to have 
 another negro — that she was again with child. A derange- 
 ment of this faculty, to some extent, is quite common to the 
 maternal part of society. 
 
 Thus, when the monomania is of the kind above illus- 
 trated — that is, of an affective power or faculty, the cerebral 
 organization always indicates the liability ; but in the fol- 
 lowing instances it is impossible, in the present state of 
 mental science, to determine the source of the delusive 
 idea. 
 
 The writer once had a female patient, who had the ap- 
 pearance of being in good health, but who imagined that 
 she shook or trembled so badly that she did not, and had 
 not for seven years, ventured to feed herself He cured her 
 by having five or six of her neighbor- women to visit her 
 frequently, and assure her that she was mending, and that 
 her physician had probably no equal in the world. By this 
 course and bread-pills she was well in six weeks. 
 
 ^' Tissot mentions an instance, in which the patient be- 
 lieved himself to be a lump of butter, and would not suffer 
 any fire near him, lest he should melt. An eminent painter 
 imagined himself made of wax, and avoided all contact 
 wath hard substances — (Tulpius). Zacutus Lusitanus men- 
 tions a person who believed that his posteriors were com- 
 
1054 NERVOUS FORMS OF DISEASE. 
 
 posed of glass, and would on no account sit on anything 
 but the softest pillows. Some hypochondriacs have thought 
 themselves dead ; others imagined that their souls formerly 
 resided in some inferior animal, or in some fellow-creature; 
 in short, almost every imaginable hallucination of this kind 
 has been known to occur in this variety of mental disease.' 
 — Eherle. 
 
 As that variety of monomania which is known as melan- 
 choly, depends upon a deranged condition of the prudential 
 faculties, we are much inclined to attribute all of the 
 preceding singular varieties of monomania to these facul- 
 ties, and that false perception and reflection which they oc- 
 casion. 
 
 It should be strongly impressed u})on the mind of every - 
 body, that monomaniacs are entirely sane, and as capable 
 as they ever were of transacting all kinds of business that 
 does not infringe the subject of their hallucination, and 
 that for all acts outside of this they should be held legally 
 responsible ; but for acts which come within the sphere of 
 their special mania, they should be treated as lunatics. 
 When a man is discovered to labor under a homicidal or a 
 suicidal monomania, he should be constantly guarded, how- 
 ever sane he may be upon all other subjects. As to suicide, 
 the writer has had the most ample evidence that it invaria- 
 bly results from a suicidal monomania. 
 
 In a medico-legal point of view, the whole subject of men- 
 tal derangement is one of great delicacy and importance, 
 more especially as the whole of our criminal jurisprudence 
 is founded in false views of human nature ; so much so that 
 a man's life sometimes hangs upon a definition framed upon 
 a foundation as false as that of the jurisprudence. For in- 
 stance, Dr. F. Willis says, that ''a sound mind is one 
 wholly free from delusion." Is there a member of society 
 whom some other member does not suspect of existing at 
 times under a delusion ? But he continues : '' The man of 
 insane mind from disease, having been once compos mentis, 
 pertinaciously adheres to some delusive idea in opposition 
 to the plainest evidence of its falsity, and endeavors by the 
 
MONOMANIA. 1055 
 
 most ingenioxTS arguments, however fallacious they may be, 
 to support his opinion." 
 
 Under this description of sanity and insanity, the most 
 sane and gifted of the human race could be convicted of in- 
 sanity by an American jury. To illustrate this : Did not 
 the pope and cardinals of Rome regard Galileo as hiboring 
 under a mental delusion in contending that the s:m was the 
 center of our solar system ? If they did not, why did they 
 imprison him ? Are not all discoverers and their advo- 
 cates regarded by the mass as being deluded ? We saw, 
 recen*^ly, a newspaper statement of a man, btdbre the time 
 of Watts and Fulton, who was imprisoned in France, under 
 a supposition that he was insane, because he contended that 
 steam could be converted into a motive power. Be the 
 statement true or false, it is in accordance with hiwnan 
 nature. 
 
 We have traveled out of our legitimate sphere, but our 
 apology is a desire to make medical students think upon 
 the subject, because they do not know how soon they may 
 be called upon to hazard an opinion which may jeopardize 
 the reputation, the liberty, or the life of a fellow-being. 
 
 Tkeatment. — Under this head w^e intend to have refer- 
 ence not only to mania, but monomania, and those mental 
 conditions known as amentia and dementia. 
 
 It is common for writers to divide this treatment into 
 two kinds : therapeutic and moral. Under the first, various 
 writers have treated of various plans of medical treatment 
 which, they, respectively, supposed to be efiicacious. Some 
 have placed much stress upon bleeding ; others upon ca- 
 thartics ; some upon emetics ; some upon the various appli- 
 cations of the bath ; some upon counter irritants, etc. But 
 as we deem it to be possible for insanity to exist with an 
 entirely healthy condition of the organs of internal relation, 
 we see nothing to justify the hazard of deranging them by 
 any course of therapeutics, through a hope of eflcctlng a 
 salutary change in the action of those of external relation. 
 
 When the insanity has resulted from a diseased or a de- 
 ranged action in the organs of internal relation, then it be- 
 
1056 NERVOUS FORMS OF DISEASE. 
 
 comes the first duty of the physician to restore these organs 
 to health or to a normal mode of action, as the case may re. 
 quire. But with this admission, it does not follow that we 
 should, in this place, prescribe a course of treatment for 
 merely supposable forms of organic disease or derangement. 
 When the organs of internal relation cease to manifest their 
 functions properly, it is the business of the physician, guided 
 by the general principles of the profession, to treat them 
 accordingly. As we can reach the organs of external rela- 
 tion, therapeutically, only through those of the internal ; 
 and as, upon the subject before us, we neither have, nor 
 can have, any prescribed form of disease that has invaded 
 the fountain of life, to guide our prescriptions, it follows 
 very clearly that we should make none. 
 
 We are told that the second variety of treatment embraces 
 those " means supposed likely to exercise a beneficial influ- 
 ence on the mind," and which, by a most ridiculous abuse 
 of language, is called the " moral," instead of the mental.* 
 
 Before proceeding further with the treatment, it becomes 
 essential that we should first place the person of the maniac 
 in a proper condition to be treated, and this is frequently a 
 task of great difficulty ; but as the physician is consulted 
 on behalf of the maniac, he should decide exclusively with 
 reference to his good — his recovery. 
 
 Relatives and friends are usually anxious to retain the 
 care and management of the patient; at all events they are 
 unwilling that he should be sent to a lunatic asylum ; and 
 yet, as a very general fact, it is far preferable that he 
 should, because, it is not to be supposed that he is going to 
 obey those whom, probably, he formerly commanded. Fur- 
 thermore, relatives who do not flatter his caprices, are sure 
 to obtain his aversion and suspicion. In view of these 
 considerations, a public institution is much to be preferred.. 
 These public establishments, furthermore, are specially pro- 
 
 * The word mind, says Prof. Powell, embraces the whole mind — the in^ 
 tellect and the affections ; and in the latter is included the moral faculties. 
 As the adjective mental refers to the whole mind, it is the proper term 
 to use. 
 
MONOMANIA. 1057 
 
 vided for all the contingencies that may arise — his person 
 can be secured without harshness — the domestics have been 
 trained to the peculiar duties of the institution, and the at- 
 tending physician must be more familiar with his duty to 
 such patients, than physicians who are engaged in general 
 practice can be supposed to be. 
 
 Mental treatment of insanity. — The opinions we shall 
 advance under this head will apply to all species and vari- 
 eties of the subject, unless otherwise indicated. 
 
 Maniacs are not those who can not think and reason, but 
 they think and reason in an unconformable manner with 
 the laws of mind. They have not, furthermore, ceased to 
 feel — an attachment to wife, children, and home, may still 
 exist, and so may a proper regard for personal rights and 
 for the good opinion of society. They may still have a 
 proper sense of justice, of submission to authority, of hope, 
 fear, and of kindness. The same may be true of their pro- 
 pensities or inferior desires ; but they are all, perhaps, man- 
 ifested in a manner, such as to indicate a departure from 
 normality or the laws of mind. 
 
 The truth of these opinions being admitted, it follows 
 that our intercourse wdth them should be governed by the 
 same laws that regulate our intercourse with society at 
 large — discriminating the true social or official position re- 
 spectively. We do not command our equals — we solicit 
 them — induce them by motives. We should do the same 
 with the insane, as far at least as it is practicable. To com- 
 mand a lunatic, who, before his misfortune, commanded 
 others, is to insult him, and insult can not restore his facul- 
 ties to a normal mode of action. We should ply the insane 
 as we do the sane, with solicitations and motives in securing 
 our control of them. We should neither ridicule nor laugh 
 at their hallucinations — to do so would wound their vanity 
 or their pride, and possibly both, and consequently lessen 
 their regard for us. There are, in society, many sane per- 
 sons whose conduct is not regulated by their moral capabil- 
 ities, but by their knowledge of the consequences of violated 
 law, and this law need not to be statutory, but consisting 
 
1058 
 
 NERVOUS FORMS OF DISEASE. 
 
 alone of social or public opinion. Such persons, in a state 
 of insanity, can not, perhaps, be entirely governed by the 
 usages or address that proves sufficient with gentlemen. 
 They must know the law, and the penalty of its violation. 
 
 If it has been decided to place the lunatic in a public 
 institution, then it becomes a matter of the first importance 
 that his insane companions shall consist of those who were 
 about his equals in society in point of gentility and intelli- 
 gence. The importance of this requisition can be appre- 
 ciated by every gentleman, whom circumstances may have 
 compelled, occasionally, to be associated with the rabble — 
 the vulgar. It is of equal importance, furthermore, that 
 his associates should not be afflicted with the same or analo- 
 gous hallucinations ; the more diversity there is among 
 them in this respect, observation has proved to be the 
 better. 
 
 Hitherto, in the mental treatment of insanity, many 
 schemes have been invented to surprise or shock the mind 
 of the patient with a view of exposing to him the error of 
 his hallucination, or of changing the action of his affective 
 or intellectual faculties, as the case may have seemed to 
 require. Such experiment can only promise possible suc- 
 cess with monomaniacs — with the maniac none, we think. 
 Dr. Prichard expresses some surprise that Finel and Esqui- 
 ral should give any countenance to such attempts. Our 
 opinion is, that in many instances they would do neither 
 good nor harm ; that in some, mischief would result, and 
 in a few, much benefit, possibly a cure, might be the result. 
 1:^0 w, in order that we may do good without much hazard 
 of doing mischief, we must be able to discriminate the 
 cases. The rule laid down by Professor Powell, in his 
 lectures, is this : when the hallucination is such that it can 
 be shown to be false or unfounded by a demonstration, or 
 even true, apparently, and in such a manner as to be fol- 
 lowed by relief, then it may be attempted. He illustrates, 
 that a gentleman in Lexington, Kentucky, was insane upon 
 the subject of his monetary liabilities, and was cured, by 
 Professor Brown, by showing him b}^ figures that his estate. 
 
MONOMANIA. 1059 
 
 amounted to a greatly larger sum than his liabilities. Dr. 
 Pritchard says that he was told that a monomaniac, who 
 fancied that he had a serpent in his stomach, was cured by 
 an emetic and the dropping of one in the pot, so adroitly 
 that he believed that it came from his stomach. 
 
 The following case, known to some of our citizens, 
 we extract from Professor Powell's note-book, as an illus- 
 tration of a form that could not be met by a demonstra- 
 tion. 
 
 Cowan, who murdered his wife and children in the early 
 part of the year 1835, was regarded by the professor as 
 a monomaniac — his mania was jealousy, a very frequent 
 variety, according to his observations. But to Cowan's 
 case : the professor called on him when in prison, and 
 after examining his head, and finding an organic liability 
 to such a disease, asked him what evidence he had of his 
 wife's infidelity. He turned up his eyes, looked wildly, 
 as though much puzzled, and answered, " I have none 
 that I can communicate to you, but I have a consciousness 
 of it." Now, it is obvious that such a case could not be 
 met by a demonstration. 
 
 There are cases that may be cured by a little address, 
 which do not admit of a demonstration, and at the same 
 time without any possibility of mischief of any kind. Such 
 a case we find in Professor Powell's notes. 
 
 In 1827, he was called to see a lady who had been con- 
 fined to her armed-chair seven years, under a conviction 
 that she shook too badly to venture to get up, walk, or feed 
 herself. She had been attended by several physicians, who 
 endeavored to convince her that she did not shake. Her 
 system of internal relation was in good health. 
 
 The professor confirmed, to her mind, the reality of her 
 hallucination, and thus secured her confidence. He then 
 induced several of her neighbors to call upon her at pre- 
 concerted times, to congratulate her upon her constantly 
 improving appearance, to assure her that she would now 
 soon be well, that her physician was the greatest doctor in 
 the world. By these means and the use of bread-pills, she 
 67 
 
1060 NERVOUS FORMS OF DISEASE. 
 
 was well in six weeks, and made the professor a visit at the 
 distance of seven miles. 
 
 Notwithstanding the low estimation in which Dr. Prich- 
 ard holds such attempts, one per centum of success justifies 
 their use in the hands of an intelligent and discreet phy- 
 sician. An adroit application of such means as the above 
 would make many well persons sick, therefore it would be 
 strange if they could not cure a sick one, occasionally. 
 
 With reference to jealousy among men (how it is in the 
 other sex he does not know), it is the opinion of the pro- 
 fessor, that in a vast majority of the cases, it is monomania. 
 He has crania of several men who were executed for wife 
 murder, and all of them indicate the same mental liability 
 in this respect, and in each instance it was the opinion of 
 society that the wife was as pure as a flake of snow. 
 
 Upon this subject, he has given this caution to society : 
 When the wife detects the husband watching her, at the 
 door of her chamber, from a closet, through a key-hole, or 
 in any other sly and secret manner, the safety of her life 
 depends upon her immediate separation from him. These, 
 he says, are not the manifestations of a sane husband upon 
 just causes of suspicion. 
 
 There are yet two varieties of monomania, which through 
 prudential considerations, require of us a passing notice. 
 They are the homicidal and the suicidal. The first con- 
 sists in a desire to kill, and without any other motive than 
 the gratification of the desire. If space was allowed us, 
 we could present some exceedingly interesting and instruc- 
 tive examples of these two forms of monomania. These two, 
 and that of jealousy, are difficult to manage. The subjects 
 are sane upon all other subjects, and very frequently upon 
 these ; but overtaken by desire in the form of a paroxysm, 
 they rush to the deed. To keep men constantly confined 
 who are capable of usefulness, and who frequently view 
 with horror their own desire, is what we can not very 
 readily have done, and yet without it there is no certain 
 safety. 
 
 Upon such forms of mania the public mind is not snffi- 
 
MONOMANIA. IO6I 
 
 ciently informed as to hold a man to be irresponsible to the 
 laws when he is generally sane and betrays much cunning 
 and adroitness in both the commission of, and defense 
 against the accusation of crime. Cowan was hung as a 
 murderer, although Professor Powell did not entertain a 
 doubt as to his mental unsoundness. Luke Manning, for- 
 merly of South Carolina, was hung in Alabama for mur- 
 der, although, as the report of the case by Professor Powell 
 shows, he had been a homicidal monomaniac nearly all his 
 life, and the killing, for which he was executed, was com- 
 mitted without any other possible motive than the gratifi- 
 cation of his destructive desire to kill. 
 
 In such cases, it is obvious that the life of a man and the 
 reputation of a family are made to depend upon the deter- 
 mination of a fact that lies at an immeasurable distance 
 beyond the ability of the ablest mental philosopher who ever 
 lived, viz : is the mind sound ? how unsound must it be to re- 
 move responsibility ? No thinking man can desire a stronger 
 commentary upon our criminal legislation than this, or a 
 stronger proof that it is not adapted to the nature of man. 
 
 When the soundness of a steam engine becomes a ques- 
 tion, the most competent engineers are appointed to inves- 
 tigate it ; but when mental unsoundness is suspected, 
 twelve hod-carriers and day-laborers are appointed to 
 investigate and determine the fact. 
 
 In these remarks, we admit that we have traveled out of 
 our legitimate sphere ; but our apology is our desire to set 
 our young readers to thinking upon the grave and responsi- 
 ble character of this subject. 
 
 Genus III. — Morbid Actions of the Organs of Mixed 
 Relation. 
 The organs of internal and external relation can, and 
 do, in emasculated animals, maintain their integrity inde- 
 pendently of those of the mixed ; but the latter holds such 
 a relation to the two former as to modify all their actions 
 in both health and disease ; and whether we contemplate 
 them in relation to their function — the perpetuity of the 
 
1062 NERVOUS FORMS OF DISEASE. 
 
 race, or in relation to their influence over the mental and 
 natural history of the race — we are forced to regard them 
 as of paramount importance. Such is their influence over 
 the various forms of disease to which the other two genera 
 are liable, that they should claim of the physician a 
 thorough, a special, and a profound investigation. 
 
 Species I. — Exoneirosis — Nocturnal Pollution. 
 
 This malady is very common among boys when ap- 
 proaching puberty, and exceedingly ruinous to health ; but 
 no age is necessarily exempt from it. It is more common 
 to those who sleep in warm feather beds than to others. 
 
 It consists of dreams of sexual intercourse, attended with 
 stronger or more impassioned sensations of enjoyment than 
 will ever be experienced when awake, and for the reason 
 that all the nervous power of the system is concentrated 
 upon this function. The desire, depending upon amative- 
 ness, is powerful ; the muscular exertion is equal to the 
 whole strength of the muscular system, stimulated to its 
 highest capacity, and animal sensibility is so excited as to 
 render the imagined enjoyment almost painfully exquisite. 
 INo one can now doubt that such paroxysms, concentrating 
 all the power of the system, if frequently repeated, must 
 prove very destructive to health ; and such is really the 
 truth, causing blindness, paralysis, apoplexy, epilepsy, and 
 death. 
 
 Treatment. — This, in most cases, is exceedingly sim- 
 ple — all that is usually requisite is to replace his bed with 
 a matress, and his feather pillow with one made of rags or 
 of any material that may be hard enough to force him to 
 lie upon his side. These paroxysms never take place 
 except when the patient is lying on his back. Break up 
 this habit, and the disease is cured. The reason is this: 
 when lying on the back, blood by its own gravity, accumu- 
 lates in the cerebellum, which excites, not only the amatory 
 organ, but those which co-operate with it. It may be well 
 to accompany this treatment with light suppers for a while, 
 and some wakeful person to sleep with him to keep him on 
 
MASTURPATIO. 1063 
 
 his side. If the case be too obstinate to yield to these 
 means, elevate his head a little more, use cold applica- 
 tions to the back of it, let his diet be sufficient and nutri- 
 cious, but not stimulating, keep his bowels in a normal 
 condition by cold-water injections, and if he be already 
 enfeebled, tone up his system with a union of some bitter 
 tonic and iron. 
 
 Some writers have advised that much good may be pro- 
 duced by exciting in his mind disgust against females. As 
 we have never known anything but evil to result from the 
 violation of the organic laws, we can not indorse this doc- 
 trine. The organic laws ordain that the sexes shall love 
 each other, and therefore it is right that they should, and 
 that too without any disgust for each other. 
 
 This is not all — such a com-se can do no possible good, 
 nor can any advice do him good, so far as regards the 
 training of his thoughts and feelings during his waking 
 hours. He may indulge in female society all day, and fos- 
 ter in his bosom the most solacious imaginings, and still 
 he will have no sleeping dreams about them, nor emissions 
 of semen in his sleep, if he lies upon his side. The affec- 
 tion is one over which he can exert no voluntary control. 
 
 If the waking mind could prevent these paroxysms, 
 married men would certainly be exempt from them ; but 
 this is not the case. A husband may love his wife and in 
 an hour pollute himself, by sleeping on his back, with a 
 soft pillow under his head. 
 
 Species II. — Masturpatio. — Masturbation. — Voluntary 
 Self -pollution. 
 The practice of masturbation among boys over puberty, 
 young men, and even among those of riper years, is much 
 more common than is generally supposed by even the most 
 of the profession. We but rarely take a walk through the 
 city without meeting one or more of them. 
 
 As there is, probably, no manifestation of irritation that 
 is generally less understood, even by the profession, or one 
 that is more mischievous in its results, it becomes our duty 
 
1064 NERVOUS FORMS OF DISEASE. 
 
 to shed upon it such light as our peculiar advantages may 
 enable us. 
 
 We are pleased to find that some of our journals have 
 commenced treating of this subject, and this makes it more 
 imperious that we should present those anatomical and 
 physiological conditions that produce the pathological 
 manifestation usually known as self-pollution. If, in our 
 expositions of the cerebellum, we are correct, then it fol- 
 lows that we alone are qualified to enlighten the profession 
 upon the true character of this morbus, for such it is. 
 
 Those who know nothing of Gall's doctrines, know 
 nothing of those organic conditions which produce this 
 form of disease ; and those who understand those doctrines 
 have been very little better provided for, inasmuch as the 
 whole of the cerebellum has been appropriated to the sexual 
 function. Self-pollution has not, therefore, been referred 
 to a special organization, but to an abuse of one existing 
 in common, except in degree, in all individuals. 
 
 We have shown that the cerebellum comprises three 
 organs, performs three distinct functions, and it will be 
 discovered before we conclude that the onanic disposition 
 results from a certain relative condition between these three 
 organs, just as phthisis pulmonalis results from a certain 
 relation between the medulla oblongata and the cerebellum. 
 
 A certain equality of development between the medulla 
 oblongata and the cerebellum is indispensable to such a 
 balance of organization as can insure general good health, 
 long life, and an equal exemption from all forms of disease. 
 Precisely so it is, with reference to the cerebellum, in the 
 great and important function of procreation. Animal 
 sensibility, muscular motion, and amativeness are indis- 
 pensable to the function. The last is a sine qua non ; but 
 suppose the animal to be insusceptible of irritation, or 
 incapable of motion — muscular power and the animal 
 would be as incapable of the procreative function, though 
 enormously amative, as if it was emasculated. 
 
 The cerebellum is the great elaborator of nervous power 
 for the animal systjem, and when all of its parts are well 
 
MASTURPATIO 1065 
 
 developed, its power can be expended upon the industrial 
 pursuits of life without any call or demand for the opposite 
 sex ; hence it is, that a properly constituted man can live 
 upon the ocean, year after year, if engaged in such respon- 
 sibilities as will consume or demand his powers, without 
 scarcely thinking of the other sex. This is not all — such 
 men constitute the most chaste and temperate men, as 
 regards the opposite sex, which society contains. 
 
 The thoroughly constituted onanist does not want a 
 woman — he knows that she can not relieve him, or that 
 with her he can not relieve himself — his animal sensibility 
 is too feeble — he will and does leave the bed of his wife for 
 a more satisfactory indulgence with his hand — with it he 
 can apply more pressure, produce more irritation, which is 
 indispensable to his comparatively absent animal sensi- 
 bility. Some are even forced to greater extremities — the 
 titillation of the urethra and even its laceration, for the 
 purpose of inducing seminal emission. Such a condition 
 illustrates the lowest possible degree of existence in the 
 organ or power of animal sensibility. 
 
 There are many degrees in this capacity of animal sensi- 
 bility among onanists, and it is as impossible to cure the 
 most inveterate as it is to save a child of a non-viable 
 organization, or as it is impossible for the physician to 
 create in the brain of the patient an organ of animal sensi- 
 bility, or to reduce the size of the amatory — emasculation 
 is the only remedy. 
 
 When the cerebellum is narrow, and the central or ama- 
 tory portion much developed in a downward direction, giv- 
 ing to the posterior cervical muscles a sharp and backward 
 direction, we may feel sure that there exists a correspond- 
 ing importunity in the sexual desire. The vital forces, as 
 we have denominated them, are of two kinds — one exists 
 in relation to the perpetuity of the race, and the other, con- 
 sisting of^two parts, in relation to the existence of the 
 individual, and in onanists they are always feeble. 
 
 A few cases, out of the many we have, will fully illumi- 
 gsiBte this subject. 
 
1066 NERVOUS FORMS OF DISEASE. 
 
 1 . "We have the skull of a boy who died in New Orleans 
 at the age of sixteen years, of the consequences of onan- 
 ism. He commenced the practice in the seventh year of 
 his age. Toward the close of his life he had anesthesia of 
 one side and acinesia of the other. The space between the 
 mastoid processes was three and a half inches, and the 
 amatory portion oi* the cerebellum was developed, down- 
 wardly, one and a quarter inch ; his cerebrum was large, 
 neck and chest small. In the substance of the cerebellum, 
 on one side, was an encysted mass of pus as large as a pea, 
 and in the other a tubercle of the same size. 
 
 2. The skull of Kennedy (Table, page 20), presents the 
 same peculiarities of organization, but not quite to the 
 same extent. That he was an onanist before he married 
 we have not a doubt, and according to his own confession, 
 he had always entertained a strong desire for intercourse 
 with female children, from which may be inferred an animal 
 sensibility as feeble as it is indicated by his skull. 
 
 Of illustrations difiering in degree and modified in char- 
 acter, we have enough to make a small volume; but as we 
 aim only at a lucid exposition of our subject, the two we 
 have given are sufficient. 
 
 The general opinion upon this subject is, that the prac- 
 tice, no matter how induced, occasions all the forms of dis- 
 ease that supervene. This is certainly an error. The boy 
 above treated of would have become diseased if his hands 
 had been tied behind him at the age of five years, and kept 
 tied — the fault was in his organization, just as it is in cases 
 of consumption. 
 
 We are av/are that onanism is frequently introduced into 
 schools; but we are equally aware that those bovs who are 
 not organically constituted for onanists, will, while they 
 may practice it at school as a matter of 3^outliful sport, 
 abandon it spontaneously when they quit the school ; but 
 those who are impelled to it by organization ara cured with 
 great difficulty — we may add, that some of them are 
 incurable, except by emasculation. 
 
 There are other causes of onanism, beside an indispen- 
 
MASTURPATIO. 1067 
 
 sable or necessary development. A slight preponderance 
 of the amatory propensity over the other organs of the vitel 
 force, which otherwise would never have led to masturba- 
 tion, may force the subject into the practice, in defiance of 
 all his powers of resistence. We allude to irritation in the 
 large intestines, more especially when chronic. Disease 
 in this viscus can not exist long without producing irritation 
 in the inferior extremity of the spinal cord, which will, in 
 the event the amatory organ predominates over the others, 
 no matter how slightly, react upon the testes, and these 
 upon the amatory organ in the brain ; and thus the prac- 
 tice may remotely originate in intestinal worms or other 
 causes of intestinal irritation. 
 
 In some constitutions no known cause can produce 
 phthisis pulmonalis — ^and so it is with reference to onanism; 
 it can not be produced in very many men or boys who 
 possess the strongest procreative ability, for in such persons 
 muscular motion and animal sensibility preponderate. 
 
 From our physiological exposition of this subject, it 
 follows that the treatment must be physiological also, so 
 far as regards a recovery. Therapeutics can only find a 
 place so far as causes of local irritation may become to 
 exist and to aggravate the symptom — which is masturba- 
 tion. Onanists may be said to constitute a part of that 
 family of constitutions which we denominate the angeniic. 
 If the onanic propensity with them, had been no stronger 
 than the other elements of the vital force, they would die 
 of passive congestion of the brain, phthisis pulmonalis, or 
 some other form of tuberculosis. 
 
 When the lateral portions of the cerebellum are fully 
 developed, the expenditure of excitement, or irritation, in 
 motion and sensation, prevents such an accumulation in 
 the sexual portion, as to produce abnormal consequences. 
 Hence the reason why we frequently see men with thin necks 
 and small chests, who have ruined their constitutions, or 
 are dying by inches of phthisis, or arc afflicted with para- 
 l5'sis, or great feebleness of the spine, or amaurosis, from 
 excessive venereal indulgence. On the other hand, we can 
 
1068 
 
 NERVOUS FORMS OF DISEASE. 
 
 see men every day, and in every walk of life, with broad 
 necks, and large chests, with a highly developed cerebel- 
 lum, whose venereal desires are never importunate, who 
 enjoy the opposite sex as it was intended they should, as 
 one of God's provisions for progeny and happiness. 
 
 Indications. — These appear to be two-fold : the first is a 
 prevention of the practice, by overcoming a desire for it, 
 and the second is to restore a balance between the several 
 parts of the cerebellum. 
 
 The first can be efiected by a revulsion of the irritation 
 by laborious exercise, continued so long as to allow barely 
 time enough for repair through rest. The labor should be 
 such, and so long continued, as to make rest, for the pur- 
 pose of repair, absolutely imperious, and for the time allot- 
 ted to it. This rest should be had upon a hard matress, 
 with the head upon a pillow so hard that the patient will 
 be compelled to lie upon his side. The food should be 
 nutritious, but not stimulating. These means will affect- 
 ually secure the first indication, and, to a considerable 
 extent, if not entirely, the second, which must consist in a 
 higher development of muscular motion and animal sensi- 
 bility. 
 
 The best mean we know for effecting a greater develop- 
 ment of the chest, or, in other words, the lateral portions 
 of the cerebellum, in children or young people, is dancing ; 
 for this, we know of no substitute. For adults who are 
 capable of it, public extemporaneous speaking, under the 
 excitement of an audience is better, provided it be repeated 
 every day, or every other day. 
 
 But with reference to the affection under examination, it 
 matters not what its cause may have been, derangement of 
 the alimentary canal is certain to be associated with it ; 
 consequently, this must be strictly attended to in the whole 
 treatment of the affection. 
 
 The preceding course of treatment is only adapted to 
 inveterate cases in lunatic asylums ; but it can be modi- 
 fied. Those parents who are able, can keep their boys at 
 the dancing and fencing schools, and labor, during the 
 
LEUCORRHEA. 1069 
 
 intervals, and, also, from any more rest tlian may be indis- 
 pensably demanded. They can also keep with the patient 
 some one whose presence will prevent any manifestation of 
 the onanic excitement. This training will not only over* 
 come the vice, but render the patient more secure against 
 consumption, and more efficient and useful. 
 
 Those in whom the complaint is not so inveterate as to 
 cause their separation from society, can manage their own 
 case from the hints above given. Those of this class who 
 are married, or have the monetary ability to indulge where- 
 ever they can, frequently become impotent, or die of some 
 form of disease which the excess occasioned. The writer 
 has had many examples of this kind. 
 
 Species III. — Leucorrhea. 
 
 By this term is generally understood increased or abnor- 
 mal discharges from the vagina, not menstrual or bloody. 
 It is not our purpose to consider in this work those forms 
 of uterine disease that give rise to leucorrheal discharges, 
 but to confine our remarks to vaginal leucorrhea. The 
 vagina being the common conduit for conveying off all the 
 discharges from the neck and cavity of the womb, as well 
 as the abnormal and increased secretions from its own 
 walls, the diagnosis between uterine and vaginal discharges 
 is only to be made by means of the speculum. Dr. Jewell 
 has assumed that the discharges from the cavity of the 
 womb are suspended at night, while the patient is in bed, and 
 that a diagnosis may be made by introducing a sponge into 
 the vagina, at bed-time, and removing it before rising. If 
 it comes out dry, the discharge is from the womb. But it 
 is to be borne in mind that the leucorrheal discharge some- 
 times amounts to a pint or more in a day, and it is not very 
 philosophical to assume that half a pint, or even half a gill 
 of secretion would be retained in the cavity of the uterus 
 over night. The uterus does not tamely tolerate distention 
 of its parietes. 
 
 Our experience coincides with Bennet and other modern 
 pathologists in ascribing to the neck of the womb the seat 
 
1070 NERVOUS FORMS OF DISEASE. 
 
 of the mischief in a large proportion of cases applying for 
 advice, where leucorrhea is one of the symptoms com- 
 plained of. IN'othing but occular demonstration by means 
 of the speculum will reveal these structural lesions. We 
 have over and over again satisfied ourself that the touch is 
 not sufficiently acute and delicate to detect ulceration of the 
 OS, nor even a rope of mucus hanging like apples from 
 the OS — a condition often met with in inspecting leucorrheal 
 cases arising from uterine irritation and lesions of the 
 glandular structure of the neck. Still we are far from 
 undervaluing the sense of touch as a means of diagnosis in 
 leucorrhea. The relaxed and flaccid walls of the vagina, 
 the pasty, slimy feel of its mucous tissue, void of the 
 rugse and tonicity that betoken health, the prolapsed neck 
 of the uterus loosely pendulous near the floor of the 
 pelvis, are unmistakable proofs of that abnormal condition 
 of the vagina, accompanied by such a derangement of its 
 secretory function as is met with in true vaginal leu- 
 corrhea. 
 
 The discharge is, at first, but an increase of the natural 
 lubricating mucus, of a watery appearance, that in chronic 
 and inveterate cases becomes opake, creamy, and some- 
 times muco -purulent, and of very oflensive odor. The dis- 
 charge is generally increased by the debility incident to the 
 menstrual periods. The general health greatly sufiers. 
 There is dragging pain in the back, heaviness and inertia 
 of the body, and languor and indisposition of mind, pallor 
 of countenance, feeble pulse, and irritable temper ; the 
 appetite fails, emaciation ensues, the feet become anasar- 
 cous, night-sweats set in, and the patient, after dragging 
 out a miserable existence for years, finally sinks into the 
 grave, unless remedial measures prevent. 
 
 Causes. — The acute form of leucorrhea may be occa- 
 sioned by vicissitudes of weather, taking cold, etc., any- 
 thing that may accidentally throw an irritation amounting 
 to, perhaps, a sub-acute form of inflammation upon the 
 vaginal tissues, in which case there will be profuse dis- 
 charge early, accompanied with heat and soreness of the 
 
DYSMENORRHEA. 1071 
 
 parts. This may end in the chronic form of the disease. 
 Anything that debilitates the sexual system may bring on 
 leucorrhea, miscarriages, child-bearing, excessive venereal 
 commerce, or anything tending to break down the constitu- 
 tion. 
 
 Treatment. — In this disease the treatment will have to 
 vary according to circumstances ; in those cases where 
 there is only hyperemia or vascular injection of the mem- 
 branes, attended with increased quantity of the discharge, 
 but maintaining its characteristic transparency, abstinence 
 from intercourse, rest, and vaginal injection, composed of 
 an infusion of Alum, Hydrastin, and Tannin, one drachm 
 of each, water, one pint, are recommended. Of the infu- 
 sion, one or two fluid ounces may be injected into the va- 
 gina, and repeated three times a day. 
 
 If there is much inflammation, and attended with a 
 green, purulent discharge, in addition to the above, we 
 would advise the use of the cold hip-bath twice a day, with 
 tonics and astringents internally, as infusion of Hydrastin 
 or Macrotys, Carbonate of Iron, Quinine, Cornin, Tannin, 
 Geranin, etc. In cases where cold local applications do not 
 diminish the discharge, changing them to tepid will often 
 efiect immediate benefit. 
 
 In those cases where the leucorrhea is dependent upon, 
 or maintained by, a prolapsus of the uterus, this organ must 
 be first permanently reduced to its proper position before 
 the leucorrhea can be cured. 
 
 Species TV. — Dys7nenorrhea. 
 
 Painful or difficult menstruation is the characteristic of 
 this afiection. Ordinarily, or in most w^omen, the men- 
 strual flow takes place without warning, or with only slight 
 feelings of disturbance or discomfort,''such as a sensation of 
 fullness in the pelvis , pain in the back, of a dragging or 
 bearing-down character ; but in dysmenorrhea the monthly 
 periods are often attended with so much sufiering, as to be 
 the perpetual dread of the woman's life. 
 
 Symptoms. — The pain, in general, comes on a few days 
 
1072 NERVOUS FORMS OF DISEASE. 
 
 before the menstrual discharge takes place, and ceases after 
 the flow is established, which is usually scanty. 
 
 In other cases the pain continues throughout the dis- 
 charge, the flow being abundant, if not profuse, the pains 
 like labor-pains, and gushes of coagula follow the pains. 
 There is, not unfrequently, a formidable array of hysteric 
 symptoms, belching of wind, gastric distress, and rumbling 
 of the bowels. The pain is usually paroxysmal, resembling 
 the grinding pains of the first stage of labor, or dilatation 
 of the mouth of the womb, although in the intervals there 
 is a constant aching, dragging pain from the back down to 
 the thighs. Occasionally the suffering seems greater than 
 the throes of child-birth, the woman rolling in agony over 
 the bed and floor ; and even tetanic convulsions have been 
 witnessed. Now and then a membranous bag, of the shape 
 of the cavity of the uterus, is expelled. Dr. Draman was 
 of opinion that this membrane was always expelled in dys- 
 menorrhea, but his opinion is not founded in fact ; the. 
 writer has attended cases of extreme severity, but has 
 never encountered this deciduous membrane. 
 
 This severe afiection may arise at any period of a wo- 
 man's menstrual life. It may exist from puberty and cease 
 on child-bearing, or it may supervene after the first preg- 
 nancy. It is often an attendant on barren women, and is 
 supposed to be a cause of barrenness, but the exceptions are 
 too numerous to justify the conclusion. 
 
 The cause of dysmenorrhea appears to be an irritability 
 of the uterus, that in some cases seems to border on a state 
 of local inflammation. 
 
 Treatment. — In the treatment of dysmenorrhea, the in- 
 dications are to relieve sufiering at the monthly period, and 
 to make use of such means in the intervals, as will restore 
 the uterus to its normal condition. To fulfill the first indi- 
 cation, the patient should use a warm foot-bath, or, if con- 
 venient, a general bath, after which fomentations should be 
 applied upon the abdomen, over the region of the womb, 
 as hot as can be borne, and continued until relief is afforded; 
 and internally, the Compound Tincture of Virginia Snake- 
 
AMENORRHEA. 1073 
 
 root should be given in doses of from one to two fluid 
 drachms, every hour or two. If the bowels are constipated, 
 laxative agents must be given at an early period in the 
 treatment. This course will be found beneficial in the neu- 
 ralgic, congestive, or inflammatory varieties of the disease. 
 Small doses of some nauseant, as Ipecacuanha, Lobelia, 
 etc., may be given to maintain a degree of nausea and relax- 
 ation, which will be found to exert a favorable influence in 
 relieving the suflering. To fulfill the second indication, the 
 Compound Pill of Black Cohosh, may be given in doses of 
 one or two pills, three times a day, and its use continued 
 during the catamenial intervals, in connection with the use 
 of the Compound Wine of Comfrey. In the severe and 
 inveterate forms of the disease, the Compound Syrup of 
 Stillingia with Iodide of Potassium, may be beneficially 
 substituted for the above medicated wine. The patient 
 should avoid all those causes favorable to the maintenance 
 of that peculiar condition of the system assumed by the dis- 
 ease, as inflammatory, nervous, etc., and should use a nu- 
 tritious but easily digestible diet. We would state here, 
 that in some cases of the neuralgic form, we have derived 
 much success from the use of Quinia and Prussiate of 
 Iron. 
 
 Species Y. — Amenorrhea. 
 
 When upon arriving at the age of puberty the menstrual 
 secretion does not make its appearance in the human fe- 
 male, or if after having menstruated, this perodical dis- 
 charge ceases to recur, amenorrhea exists. The former is 
 called retention^ and the latter suppression^ of the menses. 
 
 It is to be borne in mind that there is considerable differ- 
 ence as to the period or age at which the menstrual dis- 
 charge makes its appearance, depending on climate, consti- 
 tution, etc., and that every case of retention beyond the 
 the usual developments of womanhood, does not necessarily 
 constitute a pathological condition. The writer has known 
 sundry instances of retention for three or four years after 
 puberty, unattended by any derangement of the general 
 health, and has witnessed this in families where the sisters, 
 
1074 NER-VOUS FORMS OF DISEASE. 
 
 two, three, or four in number, though arriving at puberty 
 at fourteen, did not menstruate until eighteen. In tropical 
 regions menstruation usually occurs at ten or twelve years 
 of age, while in northern latitudes it does not take place 
 until the age of eighteen or twenty, and Linnseus asserts, 
 that in Lapland, the women frequently menstruate only in 
 the summer. 
 
 Retention of the menses. — There is generally solicitude 
 manifested on the part of mothers where retention exists 
 after the usual characteristics of puberty present themselves, 
 and medical advice is often sought where nature would 
 prove the best resource. The writer has often been con- 
 sulted in cases where the only impediment seemed to be, if 
 he may be allowed the expression, too high a state of 
 health, or rather one of plethora, and where bleeding and 
 purgatives would doubtless have been resorted to by many 
 practitioners, but in which he has had the satisfaction to 
 see all come right by the '' let alone" practice, or simply 
 interdicting animal food. 
 
 When, however, at puberty, there is marked derangement 
 of the general health, together with retention^ the case calls 
 for treatment. In these cases there is evidently a want of 
 the vital forces ; the girl has been growing rapidly ; is gen- 
 erally thin and delicate-looking ; the face and lij: s pale ; 
 the hands and feet cold ; there is languor, lassitude, and 
 listlessness in her look ; a little effort fatigues ; the pulse 
 shows a feebleness in the circulation ; the appetite is capri- 
 cious ; the mind becomes irritable ; the bowels, costive ; the 
 tongue, foul and imprinted with the teeth; the breath, fetid; 
 foul eructations, and such a craving of chalk, slate-pencils, 
 and even dirt, that they are greedily devoured when ob- 
 tained ; depression of spirits and hysterical weeping occur, 
 or decided melancholy sets in ; the feet, edematous at night 
 and the face puffy in the morning ; there are palpitation and 
 dyspnoea on the slightest exertion, and not unfrequently a 
 troublesome cough supervenes, and the girl is said to be 
 going iAto a decline. This is the '^ green sickness^'''' or 
 chlorotic condition of female youth ; the result of a defec- 
 
AMENORRHEA. 1075 
 
 tive organization, or original stamina; unhealthy childhood; 
 confinement in manufactories or at school, and other de- 
 pressing causes. Of course, every case is not as distinctly 
 marked as the features here drawn, but are generally so 
 well defined that there is no difiSculty in drawing a line be- 
 tween retention from a want of the vital forces, and reten- 
 tion irom plethora, where the vital forces seem to be above 
 the secreting point. 
 
 Suj)pression of the m,enses. — Suppression of the menses 
 may occur at &ny period of a woman's life after she has 
 menstruated, and is either acute or chronic. The acute 
 form generally ensues from some cause acting on the sys- 
 tem just before or during the monthly flow, as fever, expo- 
 sure to wet and cold, dancing, and night air, improper food 
 and mental agitation. Hysteria often follows acute sup- 
 pressioil, and mania and catalepsy have been known to re- 
 sult. 
 
 Chronic suppression either follows the acute form, or is a 
 consequence of impairment of the general health. Women 
 generally count the suppression as the cause, but it is ob- 
 viously the efiect, generally speaking, for we see it gradu- 
 ally interrupted, or become less and less in quantity, until 
 total suppression ensues. In all cases of chronic suppres- 
 sion not traceable to an impaired state of the general health, 
 the possibility of pregnancy should not be lost sight of. 
 
 Treatment. — In amenorrhea, the treatment will vary ac- 
 cording to the condition of the patient, that is, w^hether she 
 be plethoric or debilitated. In the former condition, a de- 
 pletive treatment will be required, as purgatives, diuretics, 
 and diaphoretics, and which should be continued both 
 during the catamenial efibrt and the intervals. After pro- 
 per depletion by these means, the patient should be placed 
 upon the use of Macrotin, Caulophyllin, Senecin, etc., for 
 the purpose of acting more especially upon the reproductive 
 organs, and imparting to them tone and energy, and which 
 course should be persevered in until the uterus has recov- 
 ered its proper condition. But after a proper time has 
 elapsed, if no beneficial change is efiected, it may then be- 
 6S 
 
1076 NERVOUS FORMS OF DISEASE. 
 
 come necessary to employ some of tlie more active emmeii- 
 agogue or forcing remedies. 
 
 With debilitated patients, a diflerent course must be pur- 
 sued. Tonics and stimulants will here be required, and 
 Quinia and Iron, some one of the various preparations of 
 Iron, the Compound Wine of Comfrey, etc., may be used 
 in connection with the agents above named, to especially 
 influence the generative organs ; and should these fail, it 
 will then become necessary, as in the previous instance, to 
 resort to the active emmenagogues. In this latter case, the 
 diet should be nutritious and generous, Vvhile, in the former, 
 it should be light, and of easily -digested articles. 
 
INDEX 
 
 A 
 
 Adhesion of tlie labia pudendi,. 531 
 
 Alterations of color in the skin, 422 
 
 Amativeness, organ of, 20 
 
 Amenorrhea, 1073 
 
 treatment, 1075 
 
 Amentia, . . 1050 
 
 Anasarca, 954 
 
 treatment, 956 
 
 Anal worms, GOl 
 
 Aneurism of the aorta, 922 
 
 anatomical varieties, . . . 923 
 symptoms and diagno- 
 sis, 924 
 
 prognosis, treatment, . . . 925 
 
 Angina pectoris, 925 
 
 symptoms, causes, and 
 
 treatment, 926 
 
 *' simplex, 552 
 
 causes, 553 
 
 treatment, 554 
 
 " membranacea,. 555 
 
 causes and treat- 
 ment, 556 
 
 " tonsillaris, 557 
 
 causes, ib 
 
 treatment, 558 
 
 Animal sensibility, organ of, . . . 22 
 
 Aorta, aneurism of, 922 
 
 Apoplexj^ of the brain, 255 
 
 bmgs, 389 
 
 Appendix to Book I, 192 
 
 II, 199 
 
 Anthritis, 850 
 
 acute, 852 
 
 causes, 855 
 
 treatment, ■ 856 
 
 " clironic, 857 
 
 causes, 859 
 
 diagnos. and treat- 
 ment, 860 
 
 Ascaris lumbricoides, 600 
 
 " vermicularis, 602 
 
 Ascitis, 948 
 
 causes, 949 
 
 diagnosis and prognosis, 950 
 
 treatment, 951 
 
 Asiatic cholera, 985 
 
 Asphyxia, 918 
 
 phenomena, 919 
 
 causes of death, 921 
 
 treatment, ib 
 
 A 
 Asthma, 916 
 
 prognosis and treatment, 917 
 
 B 
 
 Beetle grubs, 602 
 
 Bilious temperament, 49 
 
 lymphatic do, 66 
 
 encephalic do, • 67 
 
 encephalo-lymphatic do, 73 
 
 fever, 679 
 
 remittent fever, . ib 
 
 Bloody flux,. . . ._ 792 
 
 Blue disease of infancy, 410 
 
 Book I, 15 
 
 " II,.., 85 
 
 " III, 200 
 
 " IV, 611 
 
 Bots, 602 
 
 Brain, congestion of, acute, 256 
 
 " " passive,. . . 261 
 
 " dropsy of, 266 
 
 " inflammation of, 245-726 
 
 complicated, 250 
 
 " hypertrophy of, 272 
 
 " debility of, 285 
 
 Broad tape-worm, 601 
 
 Bronchitis, acute, 361 
 
 cau. and diag., 362 
 prog, and treat., 363 
 
 " chronic, 364 
 
 cau., treat.,. 365 
 
 Bulam fever, 697 
 
 BuUffi, 436 
 
 Camp fever, 655 
 
 Catalepsy, 1026 
 
 causes and diagnosis, . 1027 
 
 treatment, 1028 
 
 Calculous disease, 973 
 
 Catarrh, 3.37 
 
 Catarrhal croup, 358 
 
 " ophthalmia, 865 
 
 " diarrhea, 590 
 
 Cholera infantum, 573 
 
 causes, 575 
 
 treatment, 578 
 
 " spasmodic, 985 
 
 causes, 991 
 
 pathology, . . . 994 
 treatment, . . . 998 
 
1078 
 
 INDEX. 
 
 C 
 
 Cholera asplijxia, 985 
 
 Cerebellum, opinions concern- 
 ing 17 
 
 " physiological infer- 
 ences from, 23 
 
 " pathological relation 
 
 of the, 25 
 
 " table of measure- 
 ments of, 30 
 
 Cerebritis, 245-726 
 
 causes, 247-728 
 
 diag. and prog . , . . ib ib 
 
 treatment, ib 729 
 
 Chicken-pox, 461 
 
 Child's necessities,inattention to, 136 
 
 Child, mental injury of, 138 
 
 " vital do ib 
 
 " washing of, 149 
 
 " dress of, 152 
 
 " physical training of,.... 172 
 
 " mental do 175 
 
 Chlorosis, 944 
 
 nature and treatment,, ib 
 
 Chorea, 294 
 
 causes and treatment,.. . 297 
 
 " sancti viti, 294 
 
 Circulation, independent estab- 
 
 mentof 403 
 
 Cold, 337 
 
 " in the head, 339 
 
 chest, 344 
 
 Colic,... 585 
 
 Colica pictonum, symptoms,. . . . 956 
 treatment,.. . . 957 
 
 Colorectitis, 792 
 
 causes, 797 
 
 prognosis and treat., 799 
 Common continued synochus,.. . 640 
 
 Congestive fever, . 690 
 
 causes and nature, 694 
 
 treatment, 695 
 
 Conjimctivitis, 865 
 
 Consumption, infantile, 375 
 
 adult, 747 
 
 Convulsions, puerperal, I0l6 
 
 infantile, 313 
 
 Coryza, 339 
 
 treatment, 342 
 
 Costiveness, 606 
 
 Cough, nervous, 395 
 
 treatment, 397 
 
 " hooping, 398 
 
 treatment, 401 
 
 Cow-pox, 464 
 
 Croup, 349 
 
 Crowing disease, 390 
 
 Crusta lactse, 473 
 
 Cyanosis, 410 
 
 Cyanopathy, ib 
 
 Cynanche parotidsea, 769 
 
 j Cystitis, acute, 828 
 
 j causes and treat., 830 
 
 I " chronic, lb 
 
 j cans., diag., and 
 
 I treatment, ... ib 
 
 ! ^ 
 
 1 Death of the mouth, 558 
 
 Debility of the brain, 285 
 
 ' Defensive faculties, training of,. 141 
 
 I Delirium tremens 959 
 
 j divided into two varie- 
 
 I ties, acute and chron., 962 
 
 \ causes, 965 
 
 I pathology, 966 
 
 I diagnosis, 970 
 
 j prognosis, 971 
 
 I treatment, 972 
 
 \ Dementia, 1049 
 
 [ Dentition, irritations of, 561 
 
 ' Derma, remarks on, 414 
 
 i *' disease of, 422 
 
 I " alterations of color in,.. . ib 
 
 " excrescences on, ib 
 
 , Diabetes mellitus, 930 
 
 symptoms, and 
 
 I "' nature, 931 
 
 prognosis, 932 
 
 treatment, 933 
 
 " insipidus, ib 
 
 j simple and compli- 
 cated forms, 934 
 
 treatment, ib 
 
 Diarrhea, feculent, 587 
 
 causes and treat.,.. . 588 
 
 I " bilious, 589 
 
 causes, ib 
 
 treatment, 590 
 
 " mucous or catarrhal,, ib 
 
 ; causes, 591 
 
 " chylous, ib 
 
 causes, 592 
 
 ' " lienteric, ib 
 
 ' causes, 594 
 
 j " chroniCj ib 
 
 1 causes, 596 
 
 treatment, 597 
 
 Dilation of the ventricles, 000 
 
 Discharges from infant vagina, . . 532 
 
 Disease, never hereditary^ 216 
 
 " classification of, 240 
 
 " infectious of nurses,.. . 135 
 '• of the cellular tissue, 
 
 introduction to, 519 
 
 Dress of the child, 152 
 
 Dropsy of the brain, 266 
 
 chest, 952 
 
 " " abdomen, 948 
 
 " " cellular tissue,... 954 
 i " " scrotum, 533 
 
IFDEX. 
 
 1079 
 
 D I F 
 
 Dysentery, 792 Faculties, vital, training of, 138 
 
 Dysmenorrhea, 1071 i " defensive, do .... 141 
 
 symptoms, ib ! " moral, do 142 
 
 treatment, 1072 j " social, do 144 
 
 Dyspepsia, 580 i " intellectual, do 147 
 
 j False croup, 358 
 
 ^ iFavus 478 
 
 Ecthyma, 471 Fetal openings, how obliterated, 407 
 
 causes, ib Fever, what is it? 203-616 
 
 diagnosis, progno., and 
 
 treatment, 472 
 
 Eczema, 876 
 
 " impetiginodes, 877 
 
 causes, 878 
 
 diagnosis and treat- 
 ment, 879 
 
 Egyptian ophthalmia, 868 
 
 Encephalitis, infantile, 245 
 
 adult, 726 
 
 causes, . ... 249-728 
 diag., prog.,, .ib-ib 
 
 treatment, ib-729 
 
 Encephalic temperament, 62 
 
 Encephalo-bilious do, 67 
 
 Encephalo-lymphatic do, 69 
 
 Enteritis, 786 
 
 " acute, 787 
 
 causes and diagnosis, 789 
 prognosis and treat- 
 ment, 790 
 
 '* chronic, 791 
 
 causes and treatment, 792 
 
 Enteritic fever, 640 
 
 Entero mesenteric fever, ib 
 
 Enuresis, 937 
 
 treatment, 938 
 
 Epidemic cholera, 985 
 
 causes and progno- 
 sis, 991 
 
 pathology, 994 
 
 prophylaxis, 997 
 
 treatment, 998 
 
 Epilepsy, 288 
 
 causes and diagnosis,, ib 
 prognosis and treatm't, 290 
 Epistaxis, 898 
 
 " phenomena of, 625 
 
 " continued, 634 
 
 " simple inflammatory,. . . . 635 
 
 " periodic, 664 
 
 " intermittent, ib 
 
 " congestive, 670 
 
 " gastric, ib 
 
 " malignant, 671 
 
 " bilious, 679 
 
 " do remittent, ib 
 
 " infantile remittent, 706 
 
 " petecchial, 655 
 
 " putrid, ib 
 
 " scarlet, ' 493 
 
 spotted, 655 
 
 " synochus, 640 
 
 typhoid, 711 
 
 " typhous, ib 
 
 " yellow, 697 
 
 " and ague, 664 
 
 Fits, infantile, 313 
 
 " puerperal, 313 
 
 Flour albus, 1071 
 
 Fluke worm, 601 
 
 Foster-mother, necessity of when, 131 
 
 Frightful dreams, 303 
 
 Functional forms of disease, 915 
 
 Gangrene of infants, 521 
 
 i Gastric indigestion, 580 
 
 j " fever, 670 
 
 'Gastritis, 770 
 
 I " acute, 775 
 
 ! causes and diagnosis, 776 
 
 j prog, and treatment, . 777 
 
 I " chronic, 778 
 
 causes,.. byy | causes, diagno., and 
 
 diag. and treatment,.. 900 j treatment, 781 
 
 Erratic worms, 602 Glottis, infantile spasm of, ... . 390 
 
 Erysipelas, . 438 j Gonorrheal ophthalmia, 871 
 
 Gravel* '.'."..'.'.'.'..'. . . . .' 973 
 
 causes, diagnosis and 
 
 prognosis 440 
 
 treatment, 441 
 
 Erythema, 486 
 
 causes, diagno., prog., 
 
 and treatment, 487 
 
 Exanthema, 483 
 
 Excrescences on the skin, 422 
 
 Exoneirosis, 48.3-1062 
 
 treatment, ib 
 
 H 
 
 Heart, inflammation of its en- 
 velopes, 412 
 
 Helminthia alva, 600 
 
 " podicis, 601 
 
 " erratica, 602 
 
1080 
 
 INDEX. 
 
 H 
 
 Hemateraesis, 903 
 
 causes and prog.,, ib 
 
 treatment, 904 
 
 Hematuria, ib 
 
 causes and diagnosis, 905 
 prog, and treatment,. 906 
 
 Hemorrhage from nose, 898 
 
 " stomach, 903 
 
 " lungs, 906 
 
 " " urinaiy organs, 904 
 
 " womb, 911 
 
 Hemorrhoids, 927 
 
 treatment, 928 
 
 Hemoptysis, 906 
 
 causes, 908 
 
 prog, and treat., 909 
 
 Hepatitis, 811 
 
 " acute, ib 
 
 cau., diag., and prog. 814 
 
 treatment, 815 
 
 " chronic, ib 
 
 causes, 817 
 
 diag., prog., treat., . 878 
 
 Herpes, 428 
 
 zoster, 429 
 
 " circinatus, 430 
 
 " preeputialis, 431 
 
 causes, ib 
 
 diag., prog., treat.,.. . 432 
 
 Hives, 464 
 
 Hooping-cough,... 398 
 
 Humid tetter, or scall, 876 
 
 Hydrocele, 533 
 
 diagnosis, ib 
 
 treatment, 534 
 
 Hydrocephalus, acute, 250 
 
 causes, 253 
 
 diagnosis,. . . . 254 
 prognosis and 
 treatment, . 255 
 
 " chronic, 266 
 
 causes, 270 
 
 diagno., prog, 
 and treat.,. 271 
 
 Hydrops, 945 
 
 symptoms, ib 
 
 causes, 946 
 
 prognosis and treat- 
 ment, 947 
 
 Hydrothorax, 952 
 
 symptoms, 953 
 
 diagno., prog., and 
 
 treatment, 954 
 
 Hydrophobia, 1019 
 
 treatment, 1021 
 
 Hypertrophy of the brain, ...... 272 
 
 Hysteria, 1028 
 
 symptoms, ib 
 
 diagnosis and causes,. .1030 
 treatment, 1031 
 
 H 
 
 Hysteritis, 832 
 
 acute, 833 
 
 treatment, 834 
 
 chronic, 835 
 
 causes and treat., . . . 837 
 
 I 
 
 Ichthyosis, 517 
 
 Idiotism, 000 
 
 causes, 874 
 
 treatment, 875 
 
 Imperfect cicatrization of the 
 
 umbilicus, 411 
 
 Impetigo larvalis, 474 
 
 causes, 474 
 
 diag., prog., and 
 treatment,. . . . 476 
 
 Incontinence of urine, 937 
 
 Induration of the cellular tissue, 
 
 introduction to, 519 
 
 Infantile mortality, cause of, ... . 179 
 " " necessity and 
 
 utility of,.. 185 
 
 " tetanus, 305 
 
 fits, 313 
 
 " remote causes, 319 
 
 " exciting causes, .... 320 
 
 " prognosis, 321 
 
 " treatment, 322 
 
 " remittent fever, 706 
 
 " " acute,, ib 
 
 " " slow, . 707 
 
 low,.. 708 
 
 Inflammation, what is it? . . . .203-616 
 
 " of the brain, inf't 245 
 
 " adult, 726 
 
 " " complica., . 250 
 
 " " bronchia,. . 361 
 
 " larynx, 344 
 
 " lungs, inf't 366 
 adl't 737 
 " pleura, .... 371 
 " " heart's en- 
 
 velope,. . . 412 
 " " tunics of the 
 
 cord, 326 
 
 " " stomach, . . 774 
 " parot.gld's, 769 
 " kidneys,... 825 
 " uri. bladder 828 
 " " duodenum,. 785 
 " " large intes- 
 tines, 792 
 
 " small do... 786 
 
 " " peritoneum, 571 
 
 " mouth,.... 538 
 
 " ears, 528 
 
 " eyes, 873 
 
 " fauces, 552 
 
 " tonsils, 557 
 
INDEX. 
 
 lOSl 
 
 I 
 
 Inflammation of the womb, 832 
 
 " iiver, 811 
 
 " « spleen, 819 
 
 " " veins, 881 
 
 Inflammatorj forms of disease, . 726 
 general remarks on, ib 
 Influence of maternal condi- 
 tions, introduction to, 105 
 
 Intellect, development of, 147 
 
 Intestinal indigestion, 584 
 
 " worms, ... 591) 
 
 Introduction to disease of the di- 
 gestive system, 535 
 
 Invermination, 599 
 
 causes, 603 
 
 treatment, 604 
 
 Irritations of dentition, 561 
 
 Iritis, 873 
 
 Ischuria renalis, 935 
 
 symptoms, ib 
 
 treatment, 936 
 
 J 
 Jail fever, 655 
 
 L 
 
 Laryngitis, mucous, 344 
 
 " sub-mucous, 345 
 
 diagnosis and 
 treatment, 348 
 " pseudo-membranous ■ 349 
 
 causes, 354 
 
 diag., prog., 
 and treat., . 355 
 
 " spasmodic, 358 
 
 predis. causes, 359 
 exciting do. . 360 
 diag. and prog, ib 
 treatment,. ... 361 
 
 Leucorrhea, 1069 
 
 causes, 1070 
 
 treatment, 1071 
 
 Lichen,.. 508 
 
 " simplex, ib 
 
 " agrius, 509 
 
 " urticatus, 510 
 
 diagnosis, prog., 
 ind. and treat., 511 
 
 Lithiasis, 973 
 
 symptoms and causes, . 975 
 
 treatment, 977 
 
 Long round worms, 600 
 
 Long thread do ib 
 
 Lymphatic temperament, 52 
 
 Liver, inflammation of, 811 
 
 Lungs, do do 366,737 
 
 Larynx, 344 
 
 M 
 
 Madness, 1034 
 
 Malignant intermittent fever,. . . 671 
 
 M 
 
 Mania, , '..1034 
 
 causes, 1041 
 
 nature of, 1045 
 
 treatment, 1055 
 
 Mania a potu, 959 
 
 Marriage, eligibility of, 87 
 
 improper, wiien, 95 
 
 Masturbation, ....-- 1063 
 
 indications of, 1068 
 
 Maternal conditlons,introduc. to, 105 
 " impressions, influence 
 
 of, on child, 106 
 
 " duties to child, 127 
 
 Maw-worm, 602 
 
 Measles, 488 
 
 Menorrhagia, 911 
 
 causes, 913 
 
 diagnosis, 912 
 
 treatment, 913 
 
 Menses, retention of, 1074 
 
 suppression of, 1075 
 
 Menstruation, painful, 1071 
 
 Mental derangement, 1034 
 
 M<intal training of children, 175 
 
 Miliaria, 880 
 
 Miliary eruption,. . . ib 
 
 " vedcles, ib 
 
 Milk, poison in, 134 
 
 Monomania, 1051 
 
 treatment, 1055 
 
 Moral facultiesj training of, 142 
 
 Morbid actions from vascular ir- 
 ritation, 894 
 
 " of inter '1 relation, 915 
 Mortality, infantile causes of,. . . 179 
 " necessity and utility of 185 
 Mother, influence on, of child- 
 bearing, 119 
 
 of, on children,... 106 
 " fester, necessity of, when, 131 
 
 Mother's mark, 423 
 
 Mucous laryngitis,, 344 
 
 Mumps, 769 
 
 Muscular motion, organ of, 21 
 
 Wsevi materni, 423 
 
 N'ephritis, 825 
 
 causes and diagnosis, 826 
 prognosis and treat.,. . 827 
 
 N'ervous cough, 395 
 
 Neuralgia, 1031 
 
 treatiBent, 1033 
 
 Nettle-rash, 485 
 
 Night terrors, 303 
 
 Nocturnal pollution, 1062 
 
 Non-febrile forms of disease,. . 893 
 
 Nourishment, improper, 132 
 
 Nursery, introduction to, 164 
 
 " location and constr'n of, 165 
 
10S2 
 
 IXDEX. 
 
 ^ ! 
 
 Nursery, temperature of, 1 70 i 
 
 " physical training in,., 173 | 
 
 " mental do . . . , 175 
 
 x^urses, infections disease of,. . . 135 ' 
 
 Necrosis infantilis, 558 
 
 i 
 
 Onanism, 1063 
 
 Organic, action, principle of,. 211, 616 ' 
 
 Ophthalmia, 865 
 
 " catarrhal, ib 
 
 causes,.... 866 
 diagnosis, . 865 
 progn's and 
 treat.,., ib 
 
 purulent, 524,868 
 
 " rheumatic, 873 
 
 " scrofulous, 526 
 
 (Edema, 520 
 
 Otitis, 528 
 
 Old man's itch, 512 
 
 (Estrus, 602 
 
 P 
 
 Palsy, 298 
 
 Painter's colic, 956 
 
 Paralysis, ib 
 
 Parental constitution, 92 
 
 " resemblance to, how told 80 
 " conditions, introduc. to, 85 
 
 Parents, present health of, 1'>1 
 
 Parotitis, 772 
 
 causes and treatment, . . 773 
 
 Papulas, 503 
 
 Passive congestion of the brain, . 261 
 
 interesting case of, . . . 263 
 
 Pathological considerations,. 203, 615 
 
 Pathology, what, 208 
 
 Pemph} gus, • . . 436 
 
 causes, diag., prog, 
 and treatment, . . . 437 
 
 Pericarditis, 412, 860 
 
 acute, 861 
 
 cau., diag., prog, 
 and treatment, 862 
 
 ** chronic, 864 
 
 causes and diag., . ib 
 prog, and treat., . . 865 
 
 Periodic fever, 664 
 
 Peripneumony, 737 
 
 Petecchice.. 426 
 
 treatment, 427 
 
 Petecchial fever, 655 
 
 Peritonitis, 571 
 
 diagnosis and prognos., 572 
 
 treatment, 573 
 
 Phlegmasia dolens, 881 
 
 Pityriasis, 514 
 
 cruses, diag., prog, and 
 
 treatment, 515 
 
 Phlebitis, 881 
 
 P 
 
 Piles, 927 
 
 cases of, 8S6 
 
 causes, 891 
 
 treatment, 892 
 
 Physical training of child, 106 
 
 Physiology, what, 2')8 
 
 Phthisis pulmonalis, 375, 747 
 
 symptoms, 753 
 
 physical signs, 754 
 
 " " acute, 758 
 
 " chronic, 759 
 
 " " febrile, 761 
 
 " latent, 762 
 
 nat. andcau. 379,766 
 
 diagnosis, 767 
 
 prognosis, 768 
 
 treatment,. .364, 769 
 
 Pleurisy, infantile, 371 
 
 Pleuritis do ib 
 
 chronic 373 
 
 treatment,. 374 
 
 adult, 729 
 
 acute, 730 
 
 cau. and prog., 732 
 
 treatment, 733 
 
 " " chronic, 734 
 
 diag., prog, and 
 treatment, . . . 736 
 
 Pneumonia, 366, 737 
 
 Pneumonitis, ib 
 
 Poison, what is it ? note,. ...... 204 
 
 Pollution, nocturnal, 1063 
 
 Porrigo, 478 
 
 " lupinosa, 479 
 
 treatment, .... 480 
 
 " scutulata, 481 
 
 causes, ib 
 
 diag., pro. and 
 treatment,. . 482 
 
 Preface to Book IV, 611 
 
 " by the authors, ill 
 
 " by Prof . Powell, vi 
 
 " by Prof. Newton, viii 
 
 Prurigo, 512 
 
 Pruritus, ib 
 
 Pseudo-membranous laryngitis,. 349 
 
 Psora, 433 
 
 Psychological influence of mother 
 
 on fetus,. 106 
 
 Puei-peral convulsions, 1016 
 
 causes,. ..1017 
 treatment.1018 
 
 Pulmonitis, 366, 737 
 
 causes, 741 
 
 diagnosis, 742 
 
 prognosis, 743 
 
 treatment, 369, ib 
 
 Purulent ophthalmia, 868, 524 
 
 causes, 870, 525 
 
 prog, treat.,... 872, 526 
 
IN^DEX. 
 
 1083 
 
 Putrid fever, 655 
 
 Pyrexia sthenica, 635 
 
 causes, 637 
 
 diag. and prog., 639 
 
 treatment, 662 
 
 Q 
 Quinsy, 557 
 
 R 
 
 , Ramollissement du Cerreau, 726 
 
 Red gum, 504 
 
 Remittent fever, 679 
 
 causes, 687 
 
 diag., prog, and 
 
 treatment, 688 
 
 Remitting yellow fever, 697 
 
 Respiration, imperfect, or absent, 386 
 Respiratory function in infants, 
 
 remarks on, 333 
 
 Ring- worm, 430 
 
 Rheumatic ophthalmia, 873 
 
 Rheumatism, 838 
 
 acute, = 839 
 
 cau. and diag. 842 
 prog, and trea. 843 
 
 *' chronic, 845 
 
 cau., diag. 
 
 and prog. 848 
 treatment,. 849 
 
 Roseola, . 483 
 
 causes, diag., prog, and 
 
 treatment, 484 
 
 Rose-rash, 483 
 
 Rubeola, 488 
 
 causes and diagnosis, . . 489 
 prognosis and treatment 490 
 
 Rupia, 442 
 
 causes, diagnosis, progno- 
 sis, indicat'n and treat., 443 
 
 Sanguine temperament, 44 
 
 ♦' bilious temperament,. 49 
 
 " lymphatic do 64 
 
 " encephalic do 65 
 
 " bilious lymphatic do. 69 
 " encephalo-bilious do. 70 
 " encephaio-lymphatic, 72 
 " bilious encephaio-lym- 
 phatic temperament. . 74 
 
 Scabies, 433 
 
 causes and diagnosis, . . . 434 
 
 treatment, 435 
 
 Scald-head, 479 
 
 Scalp, tumor of, 426 
 
 Scarabacus, 602 
 
 Scarlatina, 493 
 
 " simplex, 495 
 
 " aiio-incsa, A^"^^^) 
 
 S 
 
 Scarlatina maligna, 497 
 
 causes, diag. 
 
 and prog., 499 
 treatment, . . . 500 
 
 Scarlet fever, 493 
 
 Scorbutus, 940 
 
 symptoms, 941 
 
 causes, 942 
 
 diag., prog, and treat.,. 943 
 
 Scrofula, 978 
 
 causes and prognosis, . . 981 
 
 treatment, 982 
 
 Scrofulous ophthalmia, 526 
 
 treatment,. 527 
 
 Scurvy, 940 
 
 Shingles, 429 
 
 Skin, remarks on, 414 
 
 " absence of, 425 
 
 " change of color in, 422 
 
 " excrescences on, ib 
 
 Small-pox, 444 
 
 *' spurious, 459 
 
 Social faculties, training of, ... . 144 
 
 Softening of the brain, 726 
 
 Spasmodic laryngitis, 445 
 
 Spinal meningitis, 326 
 
 post-mortem appear- 
 ances of, 328 
 
 treatment, 329 
 
 Splenitis, 819 
 
 " acute, 820 
 
 causes, diag. and 
 prognosis, .... 821 
 
 treatment, 822 
 
 " chronic, ib 
 
 causes, 824 
 
 treatment, 825 
 
 Spotted fever, 655 
 
 Squamae, 514 
 
 Stomatitis, 538 
 
 " erythematic, ib 
 
 causes, treat. 539 
 
 " with altered secretion, 540 
 
 causes,. . 541 
 
 treatment 542 
 
 " follicular, 543 
 
 *' vesicular, 545 
 
 cau. and trea. 546 
 
 " mercurial, 549 
 
 treatment, ... 551 
 
 " gangrenous, 558 
 
 cau.andtre. 560 
 
 Strofulus, 504 
 
 *< intertinctus, ib 
 
 " confertus, ib 
 
 " volatic:?., 505 
 
 " albidus 50o 
 
 « car.didi:^., ib 
 
 c iv.-os i ."> 
 
 d'::ij- pro., irj., 5J7 
 
1084 
 
 INDEX. 
 
 S 
 
 St. Vitus' dance, 394 
 
 Sub-mucous laryngitis, 345 
 
 Sudamina, 880 
 
 Suppression of urine, 935 
 
 Swine-pox, 463 
 
 Symptomatology, 233 
 
 Synochus fever, 640 
 
 causes, 649 
 
 nature and diag., 650 
 
 prog., ind. and tre. 651 
 
 Spasmodic cholera, 985 
 
 Table of contents i-r 
 
 Temperament, 
 
 prevailing opin- 
 
 
 ions on, 33 
 
 ts 
 
 elementary, 41 
 
 <( 
 
 binary comb, of 62 
 
 C( 
 
 ternary do 69 
 
 a 
 
 quarternary do 74 
 
 C( 
 
 concluding re- 
 
 
 marks on, 75 
 
 Temperature of the nursery, 170 
 
 Tetanus, adult, 1011 
 
 
 causes anddiag.,1013 
 
 nature and prog. ,1014 
 
 treatment, 1015 
 
 " infantile, 305 
 
 Thread-worm, 602 
 
 Tic douloureux, 1031 
 
 Tinea capitis, 479 
 
 " anularis, 401 
 
 Tooth-rash, 504 
 
 Trismus nascentium, 305 
 
 cau. and tre. 306 
 
 Tubercular phthisis, 375 747 
 
 Typhoid fever, 640 
 
 " mitior, ib 
 
 Typhus gravior, 655 
 
 Typhous fever, ib 
 
 symptoms, 657 
 
 causes, 659 
 
 diag., and prog., 660 
 ind. and treat., . . 661 
 
 Urticaria, 485 
 
 cau., diag., pro. and tre. ib 
 
 Urine, suppression of, 935 
 
 " incontinence of, 937 
 
 Uterus, inflammation of, 832 
 
 Vaccination, 466 
 
 " what does it imply ? 468 
 
 *« tests of, ib 
 
 Vaccine protection, re-establish- 
 ment of, 469 
 
 Varicella, vesicula, 461 
 
 " lenticular, 462 
 
 " conoidal, 463 
 
 " globate, ib 
 
 Variola, 444 
 
 " complications of, 450 
 
 " anatomy of the pock, .... 451 
 
 cau. and diag., 452 
 
 treatment, 453 
 
 *' vaccina, 464 
 
 causes, 465 
 
 " " inoculated, 466 
 
 Varioloid, 459 
 
 causes 460 
 
 diag., prog, and treat., 461 
 
 Vital forces, training of, 138 
 
 " power, source of, 242 
 
 W 
 
 Washing the child, 149 
 
 Weaning-brash, 594 
 
 Woi-ms, intestinal, 599 
 
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 Yellow fever, 697 
 
 causes, 701 
 
 diagnosis, 704 
 
 prognosis, , ib 
 
 mdicat. and treat., 705 
 
 Zona, 429 
 
 ■Zoster, ib 
 
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