a^Jy/i^^a^^ , DR. MANSPERGER'S BOOK OF HYGIENE CONTAINING INSTRUCTIONS For the Cure of Diseases, TOGETHER WITH MANY VALUABLE AND USEFUL PRESCRIPTIONS, ADDED TO WHICH IS AN ACCURATE DESCRIPTION OF THE properties anb ^Implication of the (Eixratibe JJotoer* of Jioots anb SSerbs. INSTRUCTIONS FOE A DIAGNOSIS OF DISEASES FROM THE URINE AND PULSE. BY Dr. K. MANSPERGER, Practicing Female Physician, GARDENVILLE, ERIE CO., N. Y, TRANSLATED FROM THE GERMAN. BUFFALO: Nauert & Klein, Printers, 19G to 202 Main Street. 1880. lh Entered according to Act of Congress, in the year 1880, by Dr. K. Mansperger, In the office of the Librarian of Congress, at Washington. Stereotyped by Buffalo, N. Y. PREFACE TO FIRST EDITION. 'WjHE publication of this book is prompted by a desire to furnish (B^» to the public a plain, and, if possible, precise and complete compilation and explanation of the various diseases to which the human body is liable, to supply the necessary instruction and pre- scriptions for their treatment, and to furnish a diagnosis of diseases by the beating of the pulse, and from the condition of the urine. My practice, which has extended over fourteen years, during which time I have treated thousands of patients, has enabled me to gather a rich treasure of medical experience and knowledge, which I am prompted to lay before the public in this work, for the benefit of many patients, who often find themselves without advice, and in a helpless and oppressed condition. I have endeavored to write a searching treatise on every disease to which man is subject, at the same time offering the necessary medical advice. It will enable every family who possesses the "Book of Hygiene," to consult a true friend and adviser in all cases of distress, caused by disease. A diligent study of this work will be richly rewarded in time of need, and every head of a family should make himself thoroughly familiar with its contents. I do not desire to convey the idea, however, that the publication or the possession of the "Book of Hygiene " is to supercede all medical assistance ; on the contrary, in many cases it is most urgently recommended ; yet, it will frequently make the call of a physician unnecessary. IV PREFACE. The object of writing and publishing this book, is to furnish to the people generally an intelligible and safe medical teacher and adviser in all cases of sickness, whether the patient is an infant or an adult ; it will aid in recognizing the approaching danger in time, which, by the application of proper remedies, may frequently be easily pre- vented. It also has the advantage of exposing wrong and pernicious advise, and preventing bad results. If anyone should question the value of the book because it is written by a woman, let him examine it ; it speaks for itself. It is my wish that it be judged by its value ; it will then accomplish the object for which it is written. Dr. K. MANSPERGER. Gardenville, Erie Co., N. Y. x nsr id :e x. Aachen's (Aix la Chapel lc) Springs Abdominal Cavity, Ruptures of the " Glands " Swelling, Remedy for " Typhus Abscesses - - - - Page. 559 285 673 333 158 160 426 " Axillary, The Acid, Hydrocyanic - " Muriatic - - - - 625 11 Nitric - 627 " Prussic - - - - 426 »«-..-- 635 " Pyroligneous - - - 636 " Sulphuric - 619 Aconite ----- 5ii0 Acorn Coffee - - - - 580 Acrid Lettuce - 530 Adults, Regular Division and Doses of Medicine for - - 722 Agaric, White ... 657 Ague 329 " Cure for - 710 '■ Pills for the - - - 706 Air-expanded Abdomen - - 450 Air, Foul 421 Alba, Miliari ', and Rubra - 136 Albus, Tumor - - - - 195 Alexis Bath - - - - 6S6 Allspice ----- 562 Almonds ... - 561 Aloes - - - - 562 Alum ----- 562 Alvine Evacuations ... 450 Ambergis - 562 Ammonia ----- 563 " Acetate of - - 560 Carbonate of 563 " Caustic, Liquid, - 563 Ammonium, Chloride of 641 Amulet - - - - 564 Anasarca - - - - 377 Ani, Pruritus ... Animal Bath - - - - " Kingdom, Poisons of thi' Anisseed - Star Angelica Root Angina - - - - Anodyne Liquor, Hoffman's " Plaster '* Salve - " A Good " Good - Antarthritic Paper Ant-Bath - Antimony - 11 _ " Wine of Antimonial Wine Antispasmodic Salve - Aphthae - Page. - 152 692 - 429 565 - 505 5 14 - 5! 5 607 668 669 - 668 668 - 6S4 6ul - 6J7 686 - 429 51 5 - 700 591 668 249 " To Remove, in Small Chil- dren - _ . 702 Apoplexy - 409 " Serous ... 409 Apoplexia, Nervous - - - 410 Apothecaries' Weights and Measures 723 Apparently Dead Persons. General Remarks on the Recall of 437 Appetite, An Unusual Strong, for Certain Things - 449 " Immoderate - - 419 " Want of - - - 449 " " - - - 526 Apple-pulp Poultices - - 0d2 I Apple Salve - - - - 664 A pyretic Rheumatism of Receni Date 394 Arm-Bath - - - - 685 Arm, Rheum or Rheumatism in the 711 Arms, For Swelling of - - - 712 VI INDEX. Page. Page. Arnica, - - 566 Benzoin ... - 571 Arthritic Pains, 393 " Compound Tincture of - 713 Arthritis - - 404 Bergamot, Oil of - - 628 Arsenic _..--- 427 Beringer Springs - 689 " . . - - 566 Bestuschef's Nervine Tincture - 571 Artichoke - - - 567 Bibernel - - 571 Ascaris Lumbricoides - - 485 Bilberries - - 607 Ascites, _ . . 371 Bilious Fever - - 311 Ash-Bath - 685 '• " Inflammatory - 313 Asiatic Cholera - - - - 453 " " Nervous - 313 Asphyxia of Pregnant Women 86 " " Rheumatic - - 313 Assafoetida - 567 Birch Bark - - 572 Asthma - k - 472 Birth, Premature - 81 " A Powder for 7d6 Bismuth .... - 572 " Caused by Congestion - 477 Bitter Oranges - 572 « For ---- 710 Bitter Salt - 573 " of Hyporhondriacs and Hj s- Bittersweet - - 573 terical Persons - 474 Bitterwater ... - 573 Atrophy "-"."" 268 Black Lend - - - - 601 Auditory Organ, The - 12 " Plaster, Good - 674 Aurium, Tinnitus, - 226 " Salve, A Good - 676 Avens Root, - 5B7 Bladder, Spasm of the - - 277 Back, Rheumatism of the 399 " Stone in the - 282 Bad Breath, Remedy for - 710 Blankeim Tea - 615 Badger's Grease - 568 Blennorrhcea - 359 Balmmint, - - 568 " Acute, or Whites - 357 Balsam - 568 " of the Genitals - 360 Bandage. Suspensory - - 288 " Syi hilitic - 293 Bark - - - 661 Blennorhoeal Ophthalmia - - 219 Baley Water ... - 569 Blepharoplegia - - - - 481 Baths, .... 686 Blessed Thistle - 573 " Alexis ... - 686 Blood, The ... - 448 '* Animal 692 " Circulation, General Organs of " Ant - 686 the - - 22 " Arm - 635 " Circulation, of the - 26 " Ash - 6S5 Blood- Purifier, Golden - 695 " Douche 690 Blood-Purifying Herbs - 574 " Foot - 690 Blood Vesicles - - - - 214 " for Beautifying the Skin - 637 " Vessels, Inflammation of - 214 " Herb - 691 Body, The Human - J " Malt - 618 " Inner Organs of the Humau 31 it (t _ - 691 Bones, Diseases of the - - 200 " Plunge 692 " Fractured, - 206 " Sitz - - - 692 Borax - - 574 " Steam ... 689 Bothriocephalus Latus, The - 436 Bearberry ... - 569 Brachial Joint, Rheumatism in the 400 Bear's Grease 569 Brain, The - - 5 Beautifying Water, - 720 " Inflammation of the - - 220 Bed Sores .... 170 " Softening of ths - 411 U M ' • - 685 Bread Poultices - 663 Belladonna - - - - 425 " Water - 574 ... - 569 Breast, A Plaster for " Sore - - 676 INL )£J. VII Page. Page. Breast Diseases of Women 522 Caustic Potash - 579 44 For a Sore ... 675 Cavity, Abdominal Ruptures of the, 285 Breath, Bad, Remedy for - 710 Celandine Leaves - - - 579 Fetid ---- 477 Centaury Minor - 579 44 Spasmodic Shortness of - 475 Cerebritis, Exuding, or Inflamma- Bronchitis - 516 tory Hydrocephalus in Children - 120 Bryory Root, White 657 Cevadilla Seed ... 580 Bubo 284 Chalk, White - 580 44 Syphilitic ... 302 Cliancre - 299 Buckbean - 574 Change of Position of the Uterus - 79 Bumps - 162 Chapped Hands, A Good Salve for 672 Burdock Root - - - - 575 44 Lips, For - 674 Burns, For - 684 44 44 Grape Pomade for 675 « *« 685 Chapping of the Skin - 165 44 Ointment fol- 292 Charcoal - 580 ic *«"___ 665 Cherry Laurel Leaves 580 44 Salve for - 669 Chest, For Spasms in the - 710 Cajeput, Oil of - 628 44 Inflammation of the 230 Calisaya Bark - 575 44 Rheumatic Inflammation of 233 Calomel - 575 44 Spurious 44 44 - 234 Camphor 576 44 True " 44 233 Canal, The Intestinal - - - 28 Chilblains - 162 Canal- Worm, The - 486 Childbirth ... - 49 Cancer - 173 Child, The - 71 44 An approved Remedy for the 44 Care of the - 72 Cure of - 673 44 Death of the, in Delivery, and 44 Remedy - ' 703 Apparent Deatli of theNewly 44 Salve ... - 670 Born - 87 Cancrum Oris ... 250 Children, their Diseases, and Manner Cankered Mouth, Gargle for - 702 of Treatment 102 44 44 Remedy for 701 44 Catarrh and Obstructions Caraway Seed - 576 in the Nose 114 Cardamon ... - 577 44 Colic in - 102 Caries ----- 200 44 Difficult Breathing and 44 A Good Salve for 671 Catarrh - 112 Carmelite Water ... 577 44 Doses for ... 722 Carrots - - - - 577 44 Regular Division and Doses Carrot, Grated, Poultices 663 of Medicine for - 722 Cassia Bark - - - - 577 44 Spasms in Small 104 Castor --.---- 578 44 Summer Complaints in 701 44 Oil - 578 Chills, Pills for 706 Cataplasm - 662 Chloride of Ammonium 641 Cataract - 525 Chlorine - 581 Catarrh— Cold in the Head 180 Chlorosis - 362 44 in the Head without Fever 181 Choking, Death by - 420 Catarrhal Cough, Remedy for 704 Cholera, - - - - - 451 44 Fever - 308 44 Asiatic - 453 Catechu ------ 578 44 Morbus - - - 451 Catheter _-..-- 281 44 Nostras - 451 Cat Thyme ... - 589 Cinnamon - 581 Caustic - - - - 579 Circulation of the Blood - 26 Caustic, Lunar -.•-.-- 617 Cloves - - - - - 581 VIII INDEX. M Page. Page. Club-Foot - - - - 193 Cough Syrup - 704 Club Moss - - 581 " " 705 Clyster - 582 " Tincture - 705 Cod Liver Oil, - - 582 Court Plaster - 667 Coffee, Acorn - 560 Crabstones - - - - 587 " Bean - 583 Cream of Tartar - 587 " Laxative - 694 Creosote - 588 " Tincture - 584 Croton Oil ------ 588 Colchicum - 584 Croup _____ 118 Colic - - 246 Crying and Laughing 448 " Lead - - - - 248 Cubebs - - - - 588 " Painter's - - 248 Cucumber Juice - 589 Colocyntha - 584 " Pomade _ _ _ 589 Cologne, Cheap - - 716 Wild 658 Good 716 Cummin Seed - 589 Colombo - - - - - 624 Cupping _ _ _ _ 213 Colophony - - - - 584 Curvatures - 200 *•_____ - 666 Cutaneous Diseases 125 Colt/sfoot - 585 " Eruptions of the Scalp 138 Common Scurvy - 585 " " of every kind, Complexion, Excellent Wash for For - 682 Beautifying- the - 717 Cutaneus, Pruritus - 152 Compound Remedies 559 Cystitis - - - 277 " Tincture of Benzoin - 713 Dandelion - 589 Condyloma - - - - 303 Dead Persons, General Remarks on Congestion - - ' - - 214 the Recall of Apparently 437 Consumption - 255 Deadly Nightshade - - _ 525 " Purulent - - 259 Deafness - 227 " Quick - 264 Death by Freezing - 419 " Remedy for - 705 " by Strangulation, Suffocation Constipation - - - 464 and Choking 420 " in Pregnancy - 78 " of the Child in Delivery, and Contagious Matter - 529 Apparent Death of the Contusions - ... - 205 Newly Born 87 " A good Salve for 683 " of the Foetus during Preg- Copaiba Balsam - - 585 nancy -. . - 83 Copper .... 428 " of Pregnant Women 86 " _ - 585 Decoction - 590 Cordial for Palpitation of the Heart 709 Delirium Tremens _ _ - 439 Corneae, Macula - 480 Dental Diseases _ _ _ 17 Corns --■<--.- 165 Dentition - 108 " for - - 683 Derivatives - 590 " Plaster 668 Dermoid Tumor - - - 161 " " A Superior - 674 Development of the Ovum 43 Corrosive Sublimate - • - 575 Dextrine - 590 Cotton - - - - - 587 Diachylac Plaster - _ - 666 Coughs and Colds, Remedy for Ob- Diarrhoea - - - - 462 stinate - 703 " in Pregnancy 78 Cough, For a Dry - 704 Difficulties of Lactation - 92 " From Plethora - 186 " in Micturition 79 " Non-catarrhal 184 Digestion - 591 " Remedy - 706 Digestive Organs, The 26 INDEX. IX Page. P AGE. Digestive Salve - 667 Earth, Japan - - 578 Dill .... - 591 Eel Pout - - 592 Diluent Pills, Good - %- 707 Effervescing Powder - 592 Diphtheria - - 515 Elder Tree - - 502 " Remedy for - 708 Elecampane Root - - 593 Directions for the Collection, Drying " Salve - 664 and Preparation of Medi- '• Wine - - 593 cinal Herbs - 661 Electuary - - 594 Discontinuance of Menstruation 42 Embrocations for Rheumatism - 681 Discutient Liniment - - 681 Emetics - - 698 Salve - 669 Emetic Wine - 594 Diseases, Breast, of Women - - 522 « « . . - 700 " Cutaneous - 124 Emotions - - 447 Dental - 17 Emulsion - . - 594 " Ear - 225 Enteritis -• - 273 " General - 209 Epilepsy - - 497 " Instructions for the Recog- Epsom Salt - - 573 nition of all, to which the Ergot - - 426 Human Body is subject, " of Rye - - 594 by the Urine - 531 Eruptions, For Cutaneous, of every " Miscellaneous - 371 kind - - - - 682 " Nervous - 504 " of the Scalp, Cutaneous 138 " of the Bones - 200 Erysipelas - •" - 131 " of Children - - 102 ««____ - 137 " of the Joint - 195 Essence ... - 595 " " " Liniment for 681 Ether - - 596 " Sexual, of Women - 338 Euphorbium - - - - 596 " Venereal - 293 Excellent Stomachic - - 700 Dislocation - - 203 Excrescence, To Drive away an 674 Dispensary, House - 558 Exostosis - - 168 Diuretic Liniment - - 682 Expulsion of Worms - 489 Doggrass - - - - - 591 Extract - - 596 Dorsalis, Tabes - 254 Exuding Cerebritis - - 120 Doses for Children - 722 Eye, The - - 13 " of Medicine - - 722 " Injuries to the - 479 Dovers Powder - - 591 " Salve, Good - 680 Dragon's Blood - 592 " Stone - - 596 Dropsy - - 371 " Water, Excellent - - 712 " Abdominal - - 371 " " Strengthening - 712 " of the Heart and Chest - 374 Eyes, For Inflammation of the - 712 " Prevention of a Relapse in 379 l( l( l< (C . 713 Drowning - - 418 " Gouty " " - 219 Drunkenness - 509 " Rheumatic " " - 218 Dysentery - - 460 " Scrofulous " " - 218 Pills for - - 709 " Catarrhal " " - 219 Ear, The - - 12 Face, Excellent Wash for Beautify- " For Inflammation of the - 711 ing the Complexion on the 717 " Inflammation of the - 224 " For Pimples and Ulcers in the 717 " Diseases - 225 Facialis, Neuralgia - 398 " Ringing in the - 226 Fainting Fits - 414 Earache - - - 224 " of Pregnant Women - 86 (i - 226 Falling of the Uvula - 521 INDEX. Page. Falling Sickness - - - 497 Feet, Sweaty - 519 Fennel Seed - - - - 597 Fetid Breath ... 477 Fevers 306 Fever, Acute Nervous - - 316 " Good Syrup for Intermittent 711 " Bilious ... 3n " " Inflammatory - - 313 " " Nervous - - 313 44 " Rheumatic - - 313 " Catarrhal - 308 g t Cure for Intermittent - - 710 Heat, Pills for - - 706 44 Hectic - - - - 327 " Inflammatory - - 307 44 Intermittent - - - 329 Gastric - 310 44 Pituitary - - - - 314 44 Putrid or Spotted - - 324 41 Remedy - - - - 706 44 Rheumatic - 309 Scarlet - - - - 126 4 * Slow Nervous - - . 316 44 Wound - - - - 308 Figs ----- 597 Fistula 142 Flatulence - - - - 379 44 450 Flatulency - - - - 102 Flesh, Proud - - - - 143 44 " Remedy for - - 673 44 Treatment of Splinters in the 707 Flooding, Excessive Menses and 346 Flowers 661 Fluids, Measure for - - 724 Foetus, Death of the, During Preg- nancy - 83 Foot, For Rheum or Rheumatism in the - 711 Formic Oil ... - 597 44 Spirits ... 597 Foul Air ----- 421 Fractured Bones - - - 206 Freckles - - - - - 526 44 For - - - - 717 " « - 718 44 Remedies for - - 719 Freezing, Death hy - - - 419 Fumitory, Common - - 598 Fungi - - - - - 427 Galactirrhcea ... 555 Page. Gall 598 Gail-Bladder, The Liver and - 29 Gall, The - - - - - 30 Gall-Stones - 282 Gangrene and Mortification - - -.89 ' 4 of the Spleen - - 436 Garden-Spider, Oil of - - ) ,,629 Gargle - - - - 598 Garlic - - - - 600 Gases, Deleterious - - 421 Gastric Fever - 310 Gastritis - 238 44 Slow - - - - 240 Gastrodynia ... 241 General Blood Circulation, Organs of the - - - . 22 44 Diseases - - - 209 44 Remarks on the Recall of Apparently Dead Persons 437 44 Treatment - - - 304 Genitals, Blenorrhcea of the - 360 44 Hemorrhoids of the - - 391 44 The, of Woman - - 39 Gentian Root - - - - 600 Germander, Writer - -656 Ginger - - - - - 600 Glands, Abdominal - - 30 Glauber Salts - - - - 601 Glow-worm - 601 Glue ----- 601 Golden Blood-purifier - - 695 Golden Rod, Common, - - 645 Gonorrhoea - - - - 293 44 with Urethral Hemor- rhage - - - 301 Goulard's Extract - - - 601 Gout 404 44 Paper - - - - 601 Gouty Inflammation of the Eyes 219 Grape Pomade for Chapped Lips and Hands - - 675 Graphite - - - - 601 Greenough's Tincture - - 602 Green Salve, Good - - 679 Ground Ivy - 602 Growth of the Hair, to Promote the 713 Gum Ammoniac - 602 44 ' 4 ... 664 44 Arabic - - - - 602 44 Galbanum - - 602 44 " Plaster - - 667 44 Gamboge - - - 602 INDEX. XI Page. Gum Guiac - 602 " of Tragacanth 651 Hasmatemesis - - 188 Hematuria - 278 Hajmoptisis - - 187 Hair, The ... 38 " A]Good Remedy for the - - 715 " Liniment, Good 713 Hectic Fever ... - Helminthiasis ... HeMebor, White and Black - Hemlock - " Leaves - " Spotted, as a Medicine Z Hemorrhages - Hemorrhage, Gonorrhoea with Ure- thral - Hemorrhoids ... " Bleeding - - - Blind " of the Genitals and Uri- nary Organs " Salve for - " White or Mucous - Henbane - - - - - 714 526 716 715 716 715 " Loss of - 11 Oil, Good - " Pomade ... " '• for the " Remedy for Cleining the " To Promote its Growth, and to Prevent its Coming Out - 713 Hands (cracked) ... 603 Hands, For Chapped - - 674 " Chapped, Grape Pomade for 675 Hardening - 530 Hartshorn .... 603 " Oil (Ethereal) - - 605 " Salt of - - - 563 Head, Catarrh in the, Without Fever 181 " Cold in the ... 180 Headache - - - - 401 " Rheumatic - - 398 Heart, The 23 " Dropsy of the - - 374 " Palpitation of the - - 471 " Remedy for Palpitation of the, and Cordial - - 709 " Tumor ... 673 Heartburn - - 245 327 482 604 604 425 605 213 301 382 384 Page. Henbane .... 605 Hepatitis - - - - 269 Hepatic Substance, Inflammation of the - - - - - 270 Herb-Baths ... 691 Herb Salve, A Good - - - 679 Herbs, Blood-purifying - - 574 " Lieber's - - - - 615 " MedicinaL - - - 661 Herb Cushions - - - - 606 Herpes - - - - 1*8 Herring's Milt - - - - 606 Hiccough - - - - 249 Hip-Joint Ulcer - - 198 Hoarseness - 472 " Remedy for - - 705 Hoffmann's Anodyne Liquor - 607 Honey 607 Hops 607 Hop Poultices - - - - 663 Hordeolum - 481 Horehound, White - - - 608 Horse-chestnut Bark - - 608 Horseradish - - - - H08 House Dispensary - - - 558 Houselcek, Common - - - 609 Huckleberries ... 607 Human Body, The - - - 1 " " Inner Organs of the 34 Humor, Lymphatic, A Good Remedy for - - - - ■ 673 Hunger - - - - 449 Hydrocephalus in Children, Inflam- matory - - - 120 Hydrocyanic Acid - 426 Hydrophobia .... 432 Hypochondriasis - 442 Hyssop, Hedge - - - - 605 Hysterics - 445 Iceland Moss - - - - 609 Ictus Sanguinis - - - 411 Indian Liniment - - 681 " Blood-purifying Pills - 709 Indications of Pregnancy - - 47 Inflammations - 215 Inflammation, Atrabilious, of the Lungs - - 235 " Catarrhal, of the Eyes 217 " Gouty " " 219 44 of the Blood Vessels 214 Brain - 220 Chest - - 230 XII INDEX. Inflammation of the Ear " " Ear, For .1 u Eyeg .* Page. 224 .- 711 712 - 713 " " Kidneys - 275 " " Larynx - 516 " '-• Peritoneal Coat- ing of Liver 269 " " Spinal Cord and the Vertebra 251 " " Stomach - 238 " " Throat - 513 11 " Womb - - 369 " ' Rheumatic, of Chest 233 " " Eyes 218 Scrofulous, " " 218 " Slow, in the Liver - 272 " " of the Peritoneal Coating of Liver 271 " " of the Lungs - 235 " Spurious, of the Chest 234 " True, " " 233 Inflammatory Bilious Fever - - 313 " Fever - - 307 " Hydrocephalus in Children - - 120 Infusion - 610 Ingrown Nails - - - - 707 Injuries to the Eye - - 479 Inner Organs of the Human Body - 34 Innoxious Paint - '. 720 Insect Stings - - - - 431 Instructions for the Recognition of all Diseases to which the Human Body is Subject, by the Urine - 531 Intermittent Fever - - 329 " A Good Syrup for 711 " " Cure for - 710 Interruption of Pregnancy, Prema- ture - 81 Intestinal Canal, The 28 Iodine - 610 Ipecac - - - - - 610 " Boot - - - ■ - 700 Iron Preparations - - 611 Ischuria (Retention of Urine) - 279 Itch, The - - - - 144 " Another Species of - - 146 " Cure of the - - - 147 " For - 683 Ivy, Ground - - - - 602 Jalap - - - - - 612 Page. Japan Earth - - - - 578 Jaundice - 466 Joint, Diseases of the - - - 195 " " " Liniment for 681 " Rheumatism in the Shoulder 400 Juniper - 612 Karlsbad - - - - 690 Kidneys, The - 33 " Inflammation of the -' 275 Kino ----- 612 Kissingen - - - - 691 Lactation, Difficulties of - - 92 Lameness, Salve for - - - 669 " Liniment for - - 682 Larynx, The 36 " Inflammation of the - 516 Latus, The Bothriocephalic - - 486 Laughing and Crying - - 448 Laurel - - - - - 613 Lavender - 613 Laxatives - - - - 692 Lead and its Compounds - - 428 " Black - - - - 601 " Colic - - - - 248 " Ointment - - - - 613 " Salve - 665 " Vinegar - - - - 613 " Water - 614 Leaven Poultices - - - 664 Leeches - 211 Legs, For Swelling of - - 712 Lemon Balm ... 614 " Juice - - - - 614 Oil of - - 629 " Peel - - - - 614 Lentils - 614 Leucorrhcea - - - - 356 Levantic Wormseed - - 615 Lice - - - - - 528 Licorice Root - - 615 Lieber's Herbs - - - - 615 Ligation - 169 Lightning, Struck by - - - 423 Lily, White, Oil of - - - 629 Limbs, A Good Salve for Wasting - 678 Lime ----- 615 Liniment - 616 " A Good, for Severe Pains of any kind - - 680 '« A Good Hair - 713 " " - . 714 " Discutient - - 681 INDEX. XIII Page. Liniment, Diuretic ... 682 " Indian - 681 " Nervine - - - 680 " for Diseases of the Joint 681 " " Limencss - - 582 " " Eheumatism - 682 " "Spasms of the Stomach 82 Linseed - 616 Lips, For Chapped - - - 674 " " " Grape Pomade 675 Liver, The 29 " Inflammation of the Perito- neal Coating of the - - 269 " Pills - 709 " Slow Inflammation of the Peri- toneal Coating of the - 271 " Slow Inflammation in the - 272 " Spots - 273 " Spots and Moles, For - 717 " «' For - - - 716 " " - - - 71S " of Sulphur - - - 616 Location of the Genitals of Woman .'39 Lockjaw ----- 685 Lovage - - - - 616 Lumbago -'-".- 403 " and Sciatica - - 400 " Remedy for - - - 711 Lumbricoides, Ascaris - - 485 Lunar Caustic - - - - 617 Lungs, The - - - - 21 " Atrobilious Inflammation of 235 " Slow " " 235 Lycopodium - - - - 617 Lymphatic Humor, A Good Remedy for - 673 Macula Cornea? - - - 480 Magnesia - - - 617 Malignant Ulcers, Plaster for - 669 Mallow Flowers - 617 Malt Bath - 618 ""---- 691 " Potion - - - 618 " Poultice - - - 664 Manna - - - - - 618 Marienbad - 691 Marjoram, Sweet - - - 618 Wild - 619 Marshmallow Juice ... 620 " Paste - - 619 " Root - - - 619 '• Salve - - 668 Mai'shmallow Syrup - Marsh Tea - Marygold Flowers # - Ma- tic Masterwort - - - - Masturbation - May Worm - Meadow Anemone - Measles . - Measures, Apothecaries' - Measure for Fluids - Medicinal Herbs, Direction for the Collection, Drying and Prepar- ation of Medicinal Plants - - - " Prescription Medicine, Regular Division and Doses of, for Adults and Children " Doses of Medullary Sarcoma Membrane, The - - - Menkes, Excessive - ■ " Suppression of - Menstruation, Discontinuance of Non-appearance of at the time of Puberty Period, Rules for the Premature Appear- ance of ; Mercury - Mezereon Bark - Micturition, Difficulties in Milfoil, Leaves and Flowers Miliaria Alba and Rubra Milk Cure - - - - Milk-Scab --'_.. Milk-Scall - Mineral Poisons Miscarriage - Miscellaneous Diseases Monks Rhubarb - - - Monthly Courses, Painful Moles, For - Moon Seed - Mortification - Mother, Care of the Mugwort - . _ _ Mulberries - Mullein Leaves Muriatic Acid - Page. - 620 620 621 620 507 621 622 124 723 724 661 661 722 722 521 37 346 344 42 341 338 429 79 623 136 624 169 169 427 81 371 624 351 717 624 289 72 624 625 XIV INDEX. Page. Page. Musk - - - - 625 Olive Oil - - 629 Mustard Poultice - 664 Onanism - - 506 " Seed, Black *- 626 Ononis Spinosa - 637 Myrrh ... - - 626 Open Sores, Salve for - 677 Nails, Ingrown 707 Ophthalmia ... _- 219 Nasal Polypus - - 191 " Blennorrhoe.il - 219 Nausea and \ omiting 450 Opiate Salve - 66S Neck, Rheumatism of the - 399 Opium - - 425 Nephroliths - - . 282 " - 629 Nerves, The 9 Opodeldoc ... - 680 Nervine Liniment - 680 Organ of Smell - - - - 11 " Salve - - - - 675 Sight - 13 " Tincture, Bestuschef's 571 Organs, Digestive - 26 Nervous Apople ia - 410 " Inner, of the Human Body 34 " Bilious Fever 313 " of the Senses - - 11 '• Disease - 504 " " Vascular System - 34 " Fever, Acute 318 Oris, Cancrum - - 250 '■ " Slow - - 316 Orris Root, Florentine - 630 " Phthisis 258 Ovum, Development of the - - 43 Neuralgia Facialis - 398 Ox-Gall - 598 Nightmare - 500 Oxyuris Vermicularis - 485 Nightshade, Deadly - 425 Oyster Shells - 630 Nipples, The - 523 Painful Monthly Courses - 351 " Pomade for Sore - 683 Pains, Arthritic - 393 Nitrate of Putassa - 642 Paint - - 719 Nitre - 642 " Innoxious - 720 Nitric Acid - 627 Painter's Colic - - - 248 Nose, The - 11 Palpitation of the Heart - - 471 Obstructions in the, and Ca- " " " Remedy for 709 tarvh - - 114 Panaritium - - - - 171 " The Obstructions in the 112 Pansy - - - - - 630 Noxious Vapors - - 421 Paper, Antarthiitic - 601 Nutmeg - 627 » - 667 Nux Vomica - 628 11 Gout - 601 Oak Bark 628 Paralysis - - - 407 Obesity - - 470 Parahpimosis - - . - 301 Obstructions in the Nose, and Ca- Paronychia ... - 171 tarrh - - 114 Parsley - - 631 Obstructions in the Nose, The 112 Paste, Marshmallow - 619 " of Stool - - 464 Pectoral Tea - 631 Oil of Amber 628 Pellitory Root - - 631 " Bergamot - 628 Peony Flowers - 632 " Cajeput 628 Pepper, Black and White 632 " Garden-Spider - - 629 Peppermint - - 633 " Lemon 629 Peruvian Balsam - 633 Vitriol - - 649 Pessaries - - 369 " White Lily - - • 629 Petroleum - 638 Oil-cloth - - - - - 629 Phimosis - 300 Oiled Silk 629 Phlebectasia - - - - 209 Ointment for Burns - 665 Phlegmon, The - 143 " Sulphur - 668 Phosphorus - - 633 " White-lead - u5S Phthisis - - - 255 INDEX. XV Page. Page. Phthisis. Cure of - 264 Pomade for the Hair - 716 " Nervous - 258 " Grape, for Chapped Lips " Tuberculosa - - 260 and Hands - 675 Piles ----- 382 Poppy Flowers, Red - 637 Pills for the Ague - 706 Potash ... - 634 " " Dysentery 709 Potassa - - 634 " " Fever Heat and Chills - 706 " K itrate of - 642 " Good, Diluent - - - 707 " Tartrate of - - 659 " Indian Blood-purifying - - 709 Potion, Malt - - .618 " Liver - 709 Poultices - - 662 Pimento - - - - - 562 " Apple-pulp - - 662 Pimpernell, Scarlet - 643 Bread - 663 " " - 645 Grated Carrot - 663 Pimples - - 140 Hop - ■ 663 For - 717 Malt - - 664 Pitch 633 " Mustard - - 664 Pituitary Fever - - 314 " Potato - 663 Plants, Medicinal - 661 •' Soothing - - 663 Plaster, Anodyne - 668 " Yeast and Leaven - - 664 " A Superior Corn - 674 Powder, Effervescing - 592 " Corn - 668 " for Asthma - 706 " Court 667 " Plummer's - 634 " Diachylac - 666 " Sedative - 643 " for Malignant Ulcers 669 Pregnancy ... - 42 " '• a Sore Breast - 676 " and its Indications - 47 " '' Whitlow on the Fingr r 671 " Death of Foetus D nring 83 Good Black 674 " Outside of the Utei us - 77 " " for an Open Wound - 672 " Premature Interruption " Gum Galbanum - 667 of - 81 " Pain-killing - - 684 " Twin - - 75 " Stomach - 674 " Vomiting, Diarrhoea, 11 Tartar Emetic - 666 Constipation and White-Lead 658 Rupture in - 78 " " _ _ - 665 Pregnant Women, Fainting, As- Plebotomy - 210 phyxia and Death of - 86 Plethora, Cough from - - 186 Premature Birth - 81 Plumbago ... - 601 Presci'iptions, Medicinal - 722 Plummer's Powder - 634 Preservative Remedies - • 305 Plunge Bath - - - - 692 Prolapse - - - - - 366 Pneumonia - - 228 " of the Rectum - 370 Podagra - - - - 404 " " Womb - - 367 Poison, Mad - - 432 Prolapsus Vaginae - - 366 " Mineral - 427 Proud Flesh - 143 " of the Animal Kingdom - 429 " " Remedy for - - 673 " Sausage - 436 Pruritus Ani - - 152 " Vegetable - 425 *' Cutaneus - - 152 Poisoning - 424 Prussic Acid - - 426 Polypody - 634 « » . 635 i'olypus, Nasal - 191 Pterigium - - 480 Pomade, A Good Hair - 715 Puberty, Non-appearance of Men- " Cucumber 589 struation at the Time of - 341 " for Sore Nipples - 683 Pulp, Tamarind - 649 XVI INDEX. Page. Page. Pulse, The ... - 551 Remedy for Toothache - - 708 " Beating of the 552 " " Warts - - 671 " Influences Affecting a Change U t( (( - 707 in the - 554 Respiration, Significance of Certain " On Feeling the 553 Symptoms in - 555 Purgatives _.-_.-,_ 692 Rest Harrow Root - 637 Purulent Consumption 259 Rhatany Koot - 637 Pustules, Virulent, Salve for 670 Rheumatic Bilious Fever - 313 Putrid Fever 324 " Fever 309 Pyroligneous Acid 636 " Headache - - 398 Quassia - 636 " Inflammation of Chest 233 Quick Consumption ... 264 " " " Eyes - 218 Quince - - - - 636 Rheumatism - 393 Quinine ------ 636 " Acute - 393 Raspberries - 63 7 " A Good Salve for - 673 Rectum, Prolapse of the 370 " Apyretic, of Recent Date 394 Relapse in Dropsy, Prevention of a 379 " Embrocations for - 681 Remarks, General, on the Recall of " in the Arm or Fool , Pol- 711 Apparently Dead Persons 437 " " Brachial and Remedies - 416 Shoulder Joint - 400 " Compound - 559 " Liniment for - 682 " Preservative 305 " of the Back - 390 Simple 558 " of Old Standing - 394 " Styptic - - - 513 " of the Throat and Neck 399 Remedy, A Good, for Lymphatic Rhinorrhagia - 189 Humor 673 Rhododendron (Yellow-flowered) ■ 638 " A Good, for Snake Bite - 703 Rhubarb ... - 638 " Approved, for the Cure of " Monks - 624 Cancer and Whitlow - 673 Rickets - - 191 " Cancer 703 ... - - 406 " Good, for the Hair 715 For - - 710 " for a Weak Stomach - 700 Ringing in the Ear - 226 (t <( a (( _ 701 Rochelle Salts - 650 " " Bad Breath 710 Rock Oil --- - - 638 " " Cankered Mouth 701 Roots - - - - - 661 " " Catarrhal Cough 704 Rose - - 131 " " Cleaning the Hs.ir 715 " Honey - - - - 630 " " Consumption 705 Rosemary Leaves - 639 " " Diphtheria 708 Roseola - - 130 " " Freckles - 719 Rosin .... - 667 " " Hoarseness 705 Rubra, Miliaria Alba and - 136 " " Lumbago - 711 Rue - . . . - 639 " " Obstinate Coughs and Rules for the Menstruation Period 338 Colds - 703 Rupture in Pregnancy - 78 " " Palpitation of Heart 709 Ruptures of the Abdominal Cavity 285 " Proud Flesh - 673 Saffron, Garden - 640 " " Scald Head 709 " Genuine - 640 " " Sour Eructations 708 Sage .... - 640 " " Thoracic Tumor, Sago - - - - - 641 Heart Tumor, and Sal-ammoniac - - 641 Abdominal Swell- Salep -.'--'•- - 641 ing - 673 Sa ineSprings - - 641 INDEX. XVII Page. Page. Salt, Common - 641 Scalp, Cutaneous Eruptions of the 138 Saltpetre ------ 642 Scammony - 643 Salt Eheum - 523 Scarlet Fever - 126 " Salve for - 669 Schlangenbad - 692 Salve, A Good Anodyne 684 Sciatica and Lumbago 400 it ii «i _ 668 Scrofula (Gland) - 177 " Anodyne - 668 Scurvy - 156 " Antispasmodic - 668 Sea-sickness - 441 " Apple - 664 Sedative Powder - 643 " Cancer - 670 Seed 661 " Cancerous Tumors - 670 Self-pollution - 506 " Digestive - - - - 667 Seneca Root ... - 644 " Discutient - 669 Senna Leaves - 644 " Elecampane ... 664 Senses, Organs of the - 11 " Eye, Good - - 680 Serous Apoplexy ... 409 " for a Swelling - 672 Sexual Diseases of Women 338 " " Sore Breast 675 Shoulder Joint, Rheumatism in the Salve for an Ulcer which does not Brachial and ... 400 want to break 612 Sight, Organ of - 13 " " Burns ... 669 Simaruba Bark ... 644 " " Caries and other Sores 671 Simple Remedies - 558 " " Chapped Hands - 672 Sitz-bath - 692 " " Contusions, A Good 683 Skin, Baths for Beautifying the 687 %i " Corns - 683 " Chopping of the 165 " " Gout, Eheuuiutism,j and " For Beautifying the 718 other Pains - - . - 673 Sleep - 502 " " Hemorrhoids 675 Sleeplessness . - - 502 " " Itch, Salt-Rheum and Tetter 683 Small-pox - 152 " " Lameness 669 Smell, Organ of - 11 " " Open Sores - 677 Snakes - 430 " " Salt Rheum 669 Snake-bite, A Good Remedy for 703 ii ii ii it 683 Snake Root, Virginia 655 " " Scald Head, A Good - 670 Soap ----- 720 •' " Wasting Limbs, Good 678 Soapwort - 644 " Black, Good - 676 Soda 645 " Green, " ... 679 " Sulphate of 601 " Herb, " 679 Softening of the Brain 411 " Lead - . 665 Somnambulism - ■• - 451 " Marshmallow 668 Soothing Poultice - 663 " Nervine - 675 Spanish Flies - - [429 " Opiate - - - _ 668 ii i« _ _ 645 " Splinter - 669 Spasms - 448 " Tartar Emetic 666 " and Painful Monthly Courses 351 " Vrdnerary, Good - 677 " in the Chest 710 " White Lead - 665 " in Small Children 104 Sanguinis, Ictus - - - - 410 " of the Bladder 277 Sarcoma, Medullary 642 " " Stomach 241 Sarsaparilla - 521 « ii » For 682 Sassafras - 642 It II I' ii 701 Sausage Poison - 436 II II II CI 710 Scald Head - - - 138 « " " Liniment for 682 ii it _ 709 Speedwell - - - - 645 XVIII INDEX. Page. Spermaceti - - - 645 Spider ----- 646 " Web - - - - 646 Sleep 502 Sleeplessness - - - 502 Spiral Cord, The - " " Consumption of the - 258 " " Inflammation of the 254 Spinosa, Ononis - - - - 634 Spleen - 447 " The - 332 " Gangrene of the - - 436 Splenalgia - - - - 442 Splinter Salve - 669 Splinters in the Flesh, Treatment of 707 Sponges - 688 Spotted Fever - - - - 324 Spraining - 20 g Spruce Gum - - - - 646 " Sprouts _ - - 646 Spunk - - - - 646 Squill Root - 646 Squinting ----- 482 Starvation ... - 423 St. Ignatea Bean - - - 647 St. John's Wort - - - 647 St. Vitus' Dance - - - - 499 Stomach, Heartburn aud Aciditiy of 245 " Inflammation of the - 238 " Plaster - 674 " Remedy for a Weak - 700 " Spasms of the - - 241 Stomachic, An Excellent - - 700 " » " - - 701 Stone in the Bladder - - - 282 Stool, Obstruction of - - 464 Strabismus - - - - 482 Stramonium - 647 " Leaves and Seed - 426 Strangulation, Death by - - 420 Stratum, The Fat 37 Struma Venosus - 209 Stye - - - - - 481 Styptic Remedies - 513 Suffocation, Death by - - - 420 Sugar - - - - - 647 " of Milk - - - - 648 " of Oil - - - - 648 Sulphur - - - - - 648 " Liver of - 616 " Ointment - - - 668 Sulphuric Acid - 649 Page. Summer Complaint in Children - 701 Suppression of Menses - - 344 Sweaty Feet - - - - 519 Sweet Flag - 649 Syncope ----- 414 Synovia, A Good Remedy for - 673 Syphilis ----- 293 ,' Secondary - - - 302 Syphilitic Blennorrhea - - 293 Bubo - 302 " Caricous Tumor - - 303 " Ulcer - 299 Syrup, A very Good Blood-purifying 696 " Blood-purifying - - 696 " Cough - - - 704 " - - - 705 " for Intermittent Fever, A Good 711 Tabes Dorsalis ... 254 Tamarind Pulp - - - 649 Tansy ----- 649 Tape-Worm - - - - 485 Tar 650 Tartar Emetic Plaster - - 666 " " Salve . - - 666 Tartrate of Potassa - - - 650 Tea, Blood-purifying - - 698 Teeth, The 16 Tetters, - 148 " Salve for - - 660 " " 683 Thirst - - - - - 449 Thorn Apple - - - 647 Throat, Inflammation of the - 513 Thyme - 650 Tincture - - - - - 650 " Cough - 705 " Greenongh's - - - 602 " of Benzoin, Compound 713 Tin Filings - - - - 750 Tinnitus Aurium - - - 226 Toads 430 Tobacco - 651 Tongue, The 11 Toothache - 18 " Remedy for - 708 Tooth-powder, A Good - - 703 Tormentil Root - - 651 TraChitis ... - 255 Tragacanth, Gum of - - - 651 Treatment, General (Venereal Dis- eases) - - - 304 " of Splinters in the Flesh 707 INDEX. XIX Trembling - - - - - Trichinae --.-'"-- Trusses - Tuberculosa, Phthisis Tumor Albus " Cancerous, Salve for " Dermoid - " Syphilitic Caricous Turpentine - - - - Twin Pregnancy ... Typhus, Abdominal Ulcer, Hip-joint " in the Face, For " Syphilitic ... Urethral Hemorrhage, Gonorrhoea with ----- Urinary Organs, Hemorrhoids of the Urine, Black Color of - " Blood in " Branny Substances in " Circle in " Cloudiness of the " Coarse Substances in " Dusty " " Flocculent Matter " " Foam in - " Granules in - " Green ... - " Instruction for the Recogni- tion of all the Diseases to which the Human Body is subject, by the " Lead-colored ... " Natural Semen in - " Pearl Bubbles in " Pus in - " Bed - - - - " Retention of - " Sand in - " Scales in " Significance of Color in " Six Rules to be observed - " Substances contained in " presenting an Ap- pearance of Fog at the Bottom - '• The - " The Proper Collection of the, and Suitable Vessels for that Purpose - - " Water in " White - Page. 447 494 2S7 2ii0 195 670 161 303 651 75 333 198 717 299 301 391 537 544 547 542 f46 54S 547 546 543 546 539 531 538 545 545 518 540 279 544 547 536 533 541 549 542 550 549 Pa Urticaria - - - Ustion - - - - - Uterus, Change of Position of the " Pregnancy outside of the Uvula, Falling of the - Vagina?, Prolapsus Valerian Root - Vapors, Noxious - Variola - Varix - - - - - Vascular System, The - - - " " Organs of the - Vegetable Poisons - Veins, Swollen - Venereal Diseases Venison Tallow - Venosus, Struma Verdigris - - - - Vermicularis, Oxyuris Vertebra, Inflammation of the - Vertigo ------ Vesicants - - - - Vesicatory, A Good - Vinegar - Violets ------ " Syrup _ - - Viper, The European - Virgin's Milk Virginia Snake Root - - - Virulent Pustules, Salve for Vitriol, Oil of - Vomiting, Nausea and " in Pregnancy Voraciousness _ . _ - Vulnerary Salve, Good " " Another Good Walnuts _ - - - Warmbrunnen (Warm Springs) Warts - - - - " Remedy for - - - Wash, Excellent, for Beautifying the Complexion of the Face Wasting Limbs, A Good Salve for - Water, Beautifying " Fennel - - - - " Germander - Wax, Green - " White - - - - Weights and Measures, Apothecaries' Whey - - - - - GE. 135 290 79 77 521 366 652 421 152 209 22 34 425 209 293 652 209 652 485 251 412 653 676 653 654 654 430 654 655 670 649 450 7S 449 679 C77 655 655 167 167 671 707 717 678 720 656 656 656 656 723 657 XX INDEX. White Agaric " Bryory Root " Lead Oointrnent '« " Plaster Page. - 657 657 Whites ... . 357 Whitlow ----- 171 " An Approved Remedy for the Cure of - - 673 " on the Finger, Plaster for - 671 Whooping Cough - 114 Wiesbaden - - - - 692 Wild Cucumber - 658 " Patience Root - - - 658 Willow Bark - - - - 658 Wine of Antimony - - 700 " Vinegar - - - - 653 Page. Woman, The Genitals of - Womb, Inflammation of the - " Prolapse of the Women, Breat Diseases of " Fainting, Asphyxia Death of Pregnant 44 Sexual Diseases of - Wood Louse - Worms, Expulsion of - Worm Moss - - - Wormwood - Wormseed, Levantic Wounds - - Wound Fever Yeast Poultice - Zedrary Zinc - and 615 510 664 APPENDIX. Appendix BEEF. Baked Beefsteak - 44 English fashion Boiled and roasted Brain --*-"" 44 baked - Brisket, grilled English Roast - - - - 44 44 of another kind Larded - - - - - 44 differently prepared Palate, with anchovy sauce - Roast - - - - - Roasted ------ Rump Piece, boiled • 4 44 stewed Tongue, with Caper Sauce 44 pickled and smoked 44 roasted - - Tripe - BEVERAGES. Chocolate with Water - Coffee as a Beverage 44 the various kinds of— Wash- ing, roasting and grinding] of Coffee, and a few Surrogates - Milk Chocolate Tea 44 Reformed 725 BEVERAGES, WARM AND COLD. For Sick and Well Persons Almond Essence for the sick - 737 793 Milk " « 739 791 " » 737 792 Apple Water for the Sick - 737 789 Barley 4t " " - - 736 793 Beer, warm - 738 793 Bishop, fine - . 734 792 44 after the Russian style - 734 790 Burgundy Punch - 730 791 Cardinal -■_•'__ 735 791 44 with Pineapple 736 791 Champagne Punch - 732 793 Cherry Water 736 791 Currant 44 - - - 736 793 44 Wine - - - - 738 793 Egg Punch - - - - 733 790 44 Wine, cold (a refreshing bever- 792 age) 734 792 44 Wine, hot - 733 792 English Punch ----- 730 793 Excellent Beverage in cases of Di- arrhoea and Spasmodic Difficul- culties - 740 French Punch - 732 729 Grog - - _ - - 734 726 Holland Punch ... 732 Hunters' " - 732 Ice Water ... - 737 725 Iceland Moss (for Pectoral Diseases) 740 728 Imperial Punch - 730 727 Lemonade for the Sick (with Fever) 739 729 44 warm - 735 INDEX. XXI Page. Lemon Water (Lemonade) for the Sick - 736 May-bowl with Wood roof - - 739 " of a different composition 739 Mulled Wine - - - - 733 " " with Vanilla - 733 Nectar - 738 Negus - 738 Orange Punch - 729 " " of another kind - 729 " Water for the Sick - - 737 Polish Tea - 735 Punch Extract, Excellent - - 734 Raspberry Vinegar - - 737 " Water - - - 736 Rice Punch - 734 " Water for the Sick - - 736 Royal Punch ... 735 Slemp, a good winter beverage - 730 Spiced Wine - - - 735 Strawberry Punch - - 731 Toast Water for the Sick - - 736 Violet Vinegar - - - 740 Whey for Pulmonary diseases - 740 Whisky - - - - - 735 Wine Foam - 734 '• Punch - - - - 732 " " another - - 732 BROTHS. A Nourishing Soup Brown Soup - Chicken Broth - Game " Lenten Soup " " of Fish Solid Broth To clear Broth CORDIALS. Anis Cordial Black Currants, Cordial of Caraway Cordial Cinnamon Tincture Cream Cordial - Curacao ... Hip Cordial Lemon " - Nut Orange " - - Peppermint Cordial Quince " Stomach Bitter - Stomach, Cordial for the - Vanilla Cordial - 751 752 753 753 752 753 753 752 741 742 743 743 741 741 743 742 742 742 743 742 743 743 741 DUMPLINGS. Bacon Dumplings - General Remarks Grated Bread Dumplings - baked Groat Dumplings baked Liver " Marrow " Meat Potato " Roll Dumplinj Scalded another kind differently prepared s - - - baked plucked - stewed " " third kind Soup Biscuit - " " of another kind FRUIT SOUPS. Apple Soup - " " the same " " with Anis - " " " Currants Cherry, soup of dried " soup of fresh sour Hip soup, also for the Sick " «' " « ■ «• differently prepared - Lemon soup, also for the Sick Oatmeal and dried Prunes, also for the Sick - " with l'aisins and currants Prunes, soup of fresh " with milk (a very nice soup for supper) " soup of dried, also for the sick - - - . Prunello soup, also for the Sick - Strawberry soup - PRESERVED FRUIT. Apple Jelly - Cherries - Cheri*y Jelly - " Juice - Currants - - - - " candied - " red and white Currant Jelly - " " another kind " Juice - Gooseberries, green - Page. 774 773 776 776 776 776 777 777 774 777 774 775 775 ,775 775 775 776 776 774 774 771 771 771 771 771 770 773 773 770 772 773 771 772 772 772 770 750 745 749 750 745 746 746 749 749 750 748 XXII INDEX. Page. Page Hip 747 Lettuce - 806 Mulberry Juice - 751 " Head of - 807 Peaches, ripe - 746 Potato - 807 Pears 748 " warm - 807 Plums - 746 Radish - 807 Prunes ------- 746 Red Beets for salad 806 Quinces - 747 Succory - 806 Quince Jelly - 750 Water-cress - 806 Raspberries - - 744 Raspberry Jelly • - - 749 SAUCES AND BUTTER. " Juice 750 Remarks - 744 Brown Sauce - 794 Strawberries - 745 Butter " for asparagus 797 Strawberry Marmelade " . Jelly - 749 750 " " " cauliflower - Horseradish - 796 797 Violet Syrnp - 751 " with almonds . - " broth 796 795 POULTRY. " milk 795 " " oranges - 797 Chicken, roasted -.-.-" 804 Mixed Sauces - 796 Ducks ».-.-- 805 Mustard sauce, brown 795 Goose Liver, baked - 806 " " yellow 795 " stufl'ed with apples and raisins 805 Parsley " - 796 " young, roasted 805 Onion " brown 795 " " stuffed - 805 " " white 795 Partridge, roasted - 803 Sauces for Beef ... 794 Pigeons, " --...•- 804 Stock Sauces - - 794 Pigeons, " stuffed - 804 Tomato Sauce - 796 Turkey, roasted ... 803 White Sauce - 794 stuffed 803 SOUPS. RAGOUTS AND ROASTS. A good soup in cases of Dysentery Calf 's Brain with sauce 798 and Diarrhoea 769 " " " Anchovy sauce 799 Asparagus soup ... 764 '.' Breast, larded - 800 Barley Water ... 759 " " stuffed 801 " " in another way 759 " " differently prepared - 801 Beer soup - 757 " Ears, baked - 798 Boiled water soup ... 754 " Feet, with Malaga sauce 800 Brain soup - 767 " " " Piquant sauce - 800 Bread soup for the Sick 769 " Hend " Madeira " 797 " " strained 754 " " " Horseradish - 798 Bretzel soup - 759 " Heart, roasted - 800 Burnt " - 755 " stuffed 799 Calf's Head soup - 766 " Liver, grilled 799 Chervil soup - 763 " " with cream sauce - 790 Cotton " - 761 Hare, roasted --■-•- 802 Crab " - 765 Mutton, Leg of, with turnips 802 Drop " - - - - 762 " " roast - 802 Egg " - 759 Veal 797 Egg Cheese soup - 756 " roast Leg of - - - 802 Eggs, soup with poached 755 " stewed - - - - 802 Fish or Lent soup - 767 Hare soup - 764 SALADS. Hash " .... 768 Italian Vermicelli-paste soup 761 Bean - 807 Kernel soup, grain - 763 Celery - 808 Lark and Snipe soup 765 Garden-cress -'-■■.-- 806 Lemon soup - - 757 INDEX. XXIII Page. Page. Lentil soup, strained 764 Cabbage, Bavarian - 781 Liver " - - 766 " Red or blue 783 Maccaroni soup - 761 " white - 781 Meal-groats soup, browned - - 758 '■ " stewed 781 '• " with browned broth 757 Carrots - - 778 " " white - 758 " with green peas 778 Milch Bread soup - 756 Cauliflower with butter sauce - 782 Milk soup - 756 Cole, green rape 780 Oatmeal soup for the Sick 769 " rose - - . - - 783 " " another kind - - 769 Hops .... - 778 Onion " white 762 Lentils - 784 Oyster " - - - 767 Peas, crumbled - 779 " " with milk 767 " dried - 779 Panada - 755 Potato Chips ... - 784 " with wine 755 Potatoes, baked 781 Pea soup, green, with rice - 763 fried - - 784 " " yellow - - 763 Remarks - - 777 Pearl Barley soup for the Sick - 768 Savoy, curled - 780 Pheasant soup ... 765 " " stewed 781 Potatoes, soup of raw - - 756 Sourcrout and Smoked Pork - - 788 " " boiled, cold 756 Spinach .... 782 Red Wine soup - - - - 757 " prepared in another style - 782 Rice soup, brown - 758 Turnips .... 782 " " with eggs and cream - 758 Rice Water - 758 Root soup, another kind - 762 VEGETABLES, SIDE DISHES FOR. " " strained 762 Brains, baked - 785 Rusk " for the sick - - 769 Bread, baked slices of 788 Sago " brown ... 759 different - 789 " " white - 759 Calf's Feet, baked - 786 Sorrel soup - 763 " Harslet, " - 785 Soup a la Reine - 766 Head, •«'-•-. 785 " for small children 768 " Liver, " - 786 " prepared from Partridge or Field " " stewed 787 Fares - 765 " " " another form 787 Sour cream soup - 755 " Tongue - - 786 Spring or Root soup - 762 Eggs, or Ox-eyes, baked - 789 Sweet Bread soup - 768 Fish, baked - - 789 Thickening, baked fancy - 761 Frog Legs, baked ... 786 " chopped, soup 760 " " " different - - 786 " fancy - 760 Ham and Eggs - 789 " grated, soup - 760 Goose Liver, stewed - 788 " " " browned - 760 Mutton Chops - 787 Veal soup, brown - 764 " " broiled - - 787 " " white - 764 " " grilled 787 Vermicelli soup - 760 " " " breast of - 786 Wafer soup - - 761 Pancakes, ordinary 788 Water soup with melted butter - 754 " snow - 788 White Wine soup - 757 Pigeons, baked - 786 Pigs Feet and Ears, grilled - - 788 VEGETABLES. Pork Chops, broiled 788 " grilled - 788 Asparagus - - 778 Remarks - 784 Beans, string ... 780 Sweet Bread, grilled - - 785 " white ... - 780 " larded 785 Black Roots - 783 Veal Cutlets - 785 FIG. I . The Male Human Skeleton, fully developed. FIG. 2. The Female Human Skeleton, fully developed. THE HUMAN BODY. THE HUMAN BODY derives its shape principally from the bony- structure it encloses, the skeleton. The main part of the body is the spinal column, which extends in the back part of the body from the neck to the abdomen. It consists of the vertebrae, short bones placed one above the other and connected by movable joints and bone-disks; the upper seven, from the inside, are called the vertebrae of the neck. In the accompanying drawing (Fig. i) only the three lower ones are visible j the four upper ones are concealed by the lower part of the face. To these are joined the twelve dorsal, or back vertebrae, con- tinued by the five lumbar, or loin vertebrae, and finally by the chine- bone with the coccyx, or cuckoo-bone. The uppermost vertebral bone is connected by a movable joint with the skull, which is the bone foun- dation for the head. To each of the vertebrae of the back, to the right and left, a rib is attached, therefore twenty-four ribs, each connected with the spinal column by a movable joint. The right and left ribs are connected in front with the breastbone by a cartilage, and therefore to some extent also movable ; this forms the chest. From the upper end of the breastbone a collar-bone starts to the right and left, con- nected by a movable joint. To each of the collar-bones, toward the back, a shoulder-blade is attached, to which again are appended the bones of the arm. At the lower part of the vertebrae, at the chine- bone, are to be found the side-bones of the pelvis, the upper edge of which is called the crest of the hip-bone. Underneath this is a hip- joint ; from each of the side-bones of the pelvis spring the thighs. The bone-frame is covered with a soft substance, generally called flesh, which aids in forming and covering cavities containing the in- testines. The skin forms the surface of the body. The human body is divided into three parts : First, the bones of the head ; second, of the trunk ; and third, of the extremities The head consists of the 2 THE HUMAN BODY. face and the skull. The particular parts of the face are well known. They are designated as the region of the eyes, the nose, the cheeks, upper and lower jaw, lips and chin. The bones of the face are im- movably joined to each other, excepting the under jaw, the joints of which may be felt by the side of the cartilage of each ear. The ear is placed on the boundary between the face and the skull. The front part of the skull is called the forehead, the middle and highest part the crown, the rear part the occiput ; at the side, in front of and above each ear, are the temples. Under the skin of the head of an adult may be felt a continuous, smooth, bony surface. The single bones composing the skull, which in youth were movably united to each other, are immovably joined in the head of an adult, and are entirely blended in advanced life. This bony shell forms the brain- pan, which contains the brains. The trunk consists of the neck, the upper part of the. body, the abdomen, and the pelvis. The front of the part connecting the head with the trunk is called the throat, the back part the neck. In the upper part of the throat, under the lower jaw, may be felt the hyoid or tongue-bone, which forms the base of the tongue. A little further down is the larynx, or Adam's apple, from which the voice springs in speaking and singing. In the centre of the lower part of the throat, at the upper edge of the breast-bone, is a cavity, the pit of the throat. In corpulent persons it is filled with fat, while in slender people the windpipe may be felt through it. In the middle of the neck, close to the occiput, there is a cavity ; further down, also in the middle and under the skin, may be felt the back processes, or projections of the bones of the neck vertebrae It is called the vertebral part of the neck. Connected with the throat is the upper part of the body, the front and sides of which are called the breast, and the rear part the back. The boundary between the throat and breast is formed by the collar-bone, an S-shaped bone, which, running from the cavity of the throat to the shoulder-blade, may be plainly felt, and limits, in slender persons, upward and downward a cavity, the upper and lower collar-bone cavity. The anterior middle part of the breast, beginning at the cavity of the throat, is the breast-bone part, in adult women the bosom \ sideward lie the breast-glandule parts, the lacteal glands and the nipple ; still further sideward, under the arms, lie the arm- pits, and under them the side part of the breast. Under the skin THE HUMAN BODY. 3 may here be more distinctly felt the ribs, taking their oblique course. In the middle of the back is located, as in the neck, the vertebral region, where the processes may be felt under the skin. On the upper part of the back, and on each side of it, is the shoulder-blade region, where the shoulder-blade may be felt as a triangular movable bone ; a transverse branch of the same is the pit of the shoulder-blade, which runs with a process to the exterior end of the collar-bone, and with it forms the shoulder. Underneath the shoulder-blade region, and on each side of it, is the posterior rib region. The inside of the upper part of the body forms a cavity, and is called the cavity of the chest. The most important vital parts lying within that cavity are the lungs, which, with the windpipe (trachea) and the larynx, con- stitute the organs of respiration, and the heart, which by its regular pulsation forces the blood through the veins of the whole body. The veins, through which the blood is forced from the heart to all parts of the body, are called arteries ; and those through which the blood returns from all parts of the body to the heart, are called veins. The upper anterior central part of the abdomen, under the segment of the ribs, is called the pit of the stomach, and on each side of it is the rib-cartilage region. Below the pit of the stomach and the navel is the navel region, and at the side below the rib-cartilage region, be- tween the lower edge of the ribs and the hip-bone ridge, both of which may be felt under the skin, are the groins. Below the navel region, stretching down to the pelvis, lies the lower abdomen (hypo- gastric) region ; the parts on both sides of it, at the lower end of the abdomen, and alongside the crease of the thigh, is called the groin region. These regions are important, because here rupture of the bowels and other diseases of the abdomen occur At the back part of the abdomen is found again the spinal column, here called the lumbar or loin vertebrae, the processes of which can not be felt as readily as under the skin of the back. Alongside of the lumbar- vertebrae region, and between it and the groin region — as these lie between the ribs and the hip-bone ridge, but a little more to the rear — are the groin regions. The outside coverings of the abdomen, mostly composed of flesh, enclose the cavity of the abdomen, which is divided from the cavity of the chest by the diaphragm. The most important abdominal organs are : the liver, lying in the upper part, 4 THE HUMAN BODY. to the right and behind the lower edge of the ribs, which secretes the bile ; behind the last ribs, the spleen, the stomach, the colon ; the kidneys, which secrete the urine, lie on both sides of the lumbar region. The pelvis contains a solid bony ring, which will be described hereafter. The anterior side of the pelvis region is called the puden- dal region. Here lies the mons veneris, covered with hair, and underneath it the genitals : in man the penis, behind which is the scrotum with the testicles, and in woman the vagina with the two lips of the pudenda. The lower side of the pelvis, lying between the thighs, is called the rump, where are located the posteriors, the pos- terior inferior spinous process, and the perinseum, which lies between the posteriors and the genitals. The sides of the pelvis are called the pelvic regions, or hips, and change into the outer surface of the thigh- bone. The middle of the back side is called the lumbar region, where the chine-bone may be distinctly felt. By the side of the lumbar region are the buttocks. The space enclosed by the pelvis is called the cavity of the pelvis ; it is a continuation of the cavity of the abdomen. The intestines lying therein will be considered hereafter. The upper extremities, the arms, are connected with the shoulders by the shoulder-joint. The arm consists of the upper part to which the lower part is joined by the elbow-joint, with which again the hand is connected through the wrist. The upper arm contains a long bone, the humerus ; the forearm has two movable bones alongside of each other ; the ulna, the larger of the two, lies on the little finger side, and the radius on the thumb- side of the forearm. The hand consists of the wrist (carpus), containing eight small bones; the middle part having four long bones, and each of the fingers three joints. The first joint of the thumb is seated in the flesh of the hand. The inside of the hand is called the palm, and the outside the back. To the hip are jointed the lower extremities, the legs. The upper part of it is called the thigh, with its large, strong thigh-bone ; then follows the knee, with the hollow in the rear, and the round movable knee pan in front, joining the upper to the lower part of the thigh. Like the forearm, this has two bones, the strong shin-bone (tibia) in the front, and alongside and in the rear, the smaller bone (fibula). The thick, fleshy portion of the lower part of the leg is called the THE BRAIN. 5 calf of the leg. The ankle-joint connects the lower part of the leg with the foot ; at the inner and outer side of the ankle joint, knuckles are placed. The distinguishing parts of the foot are : the heel behind, the sole underneath, the instep on top, and in front the toes. The nails are thin layers of horn, which cover the ends of the back part of the fingers and toes. In the nail is distinguished the root and the body. The root is the lower, not visible, part of the nail, which is buried in a fold of the cuticle from which it grows ; it is very soft, and as fast as formed, is being constantly pushed outward. Each side of the body of the nail is also fastened to the cuticle, and consists throughout of very close layers of horny plates (dried cells), exactly like the epidermis The skin lying under the nail is very rich in minute tactile papillae, and therefore extremely sensitive. THE BRAIN. The brain is an organ consisting of a great volume of nervous tissues and blood vessels, and is lodged in the brain-pan. It has a flat basis, resting on the base of the skull ; the upper part of it is of an oval shape. The brain is divided into the great brain (cerebrum), the little brain (cerebellum), and the central brain. The brain proper occupies the upper and front portion of the skull. It is bisected by a fissure running through it lengthwise, into two equal parts called hemispheres. Each of these hemispheres is again subdivided into an anterior, middle and posterior part,, by clefts from the base ; they are called brain-lobes. The surface of the great brain is divided by irregular, deep and tortuous furrows into "convolutions," each of which has its particular relations. The interior portions of the great brain consist of a white tissue, or nerve-fibres. In the circumference, corresponding to the canvolutions, we find a thick stratum of gray nerve-cells. The interior of the great brain has four cavities, com- municating with each other ; two of them lay sideward in the hem- ispheres, and the other two are on the central line. The great brain is enclosed by three membranes overlying each other, the exterior and toughest is the dura mater ; the whole of the inner surface of the brain-pan is lined with it, and also the vertebral canal. It is of a bluish-white color, and, in the central line, forms a sickle-shaped 6 THE HUMAN BODY. fold, running from front to rear, which buries itself in the before- mentioned fissure of the two hemispheres. The same membrane forms in the posterior and lower part of the skull a cross-fold (the tentorium cerebri), which divides the great brain from the little brain. Several arterial vessels run into this tough membrane, but there are also found in it large arterial vessels^ in which the venous blood that has passed through the brain is collected, whence it passes through openings in* the cranial cavity into the great blood-vessels of the throat (jugular veins) and into the heart. The middle membrane, which is very thin and tender, consisting of two membranes lying close to each other, is called the spider-web. The exterior one is firmly connected with the interior surface of the hard and the interior one with the surface of the innermost soft brain membrane. The spider- web membrane secretes a small quantity of fluid or humid vapor, which keeps the surfaces of the membranes facing each other moist and lubricated. The spider-web membrane does not enter the fissure of the hemispheres, like the dura mater, but continues into the canal of the spinal column, and with it forms a protecting cover around the spinal cord. The soft membrane, pia mater, overlies directly the brain tissue, and penetrates between the convolutions into the brain cavity. This membrane is extremely thin, tender and vas- cular, and therefore very much inclined to inflammation. Four great arteries supply blood to the brain (the two interior carotid arteries and the two vertebral arteries). As before mentioned, the blood passes off principally through the jugular veins. The little brain is placed in the posterior, lower part of the brain- pan, almost altogether covered by the lower lobes of the great brain, and almost separated from it by the before-mentioned diagonal fold of the hard membrane of the dura mater. It has the shape of a three-sided body, somewhat higher in the anterior, and broader and lower toward the posterior part. The little brain also exhibits the two hemispheres, subdivided by many deep, concentric, parallel ridges, and in its periphery the centre (as in the great brain) contains the grey brain-tissue, the white or fibre-tissue, which is divided by fissures in numerous ridges, and in a cross-section has a somewhat branched appearance, called the tree of life (arbor vitse). The parts of the brain tissues, uniting the great and little brain with the spinal THE BRAIN. 7 cord, are called middle brain. It lies principally at the base of the brain, and embraces the elongated spinal cord, the bridge and the four projections. The elongated spinal cord is the uppermost, some- what swelled-out part of that cord; it is located at the lower surface of the little brain, and connected with it by two thick strands. The bridge, a thick cross-band consisting of nerve-fibres, is situated at the anterior, upper end of the elongated spinal cord, and is connected with it, and also with the great and little brains, by thick strands of nerves. The four projections are situated in the interior of the brain, and are also manifoldly connected with the great and little brain. The weight of the brain cannot be accurately given. Its weight in adults is from three to four pounds ; its size and weight frequently varies very much in different people. In my practice I have noted that the brain of women is lighter than that of men. A close in- vestigation has demonstrated that, on an average, the brain of a vigorous man weighs from four to five ounces more than that of a woman ; a woman, therefore, has from four to five ounces less brain than a man. In appearance the head of a live woman seems to be rather larger than that of the man ; this, however, is accounted for by the mode of wearing the hair. If, after death, we compare the two skeletons, Fig. i and 2, carefully copied from nature, the differ- ence becomes apparent at once. The skull of the woman is smaller, more round, and resembles more the shape of a ball, because it has fewer protuberances and a lower frontal bone; the face, also, is shorter and more round. The man's chest is larger in every direction, and, like all other bones, the structure of the chest shows a stronger, more bulky form, while the chest of the woman is conspicuous for a greater elasticity of the bones. The lumbar vertebrae of the woman are somewhat higher, therefore her shape is more slender ; but the bones of the pelvis are considerably broader, in consequence of which the thigh-bones are oblique with the knees. The arms of the woman are less adapted for work, because their shoulder-blades are smaller, the bones of the arm shorter, and the hands smaller, whilst their legs are less suited for running on account of the direction of the thigh- bones, of weaker knees, and smaller feet. But while a woman's brain, on an average, is somewhat smaller than that of a man, it is, never- theless, compared to the general weight of the body, or to the size 8 THE HUMAN BODY. of all nerve-tissues, comparatively heavier than that of man. As to weight, the brains of men and women must not be compared, inas- much as the proportions of the bodies of both show too great varia- tions, and a comparison of particular parts of the organism could not lead to a satisfactory result. THE SPINAL CORD. The spinal cord, or marrow, represents a cord consisting of nerve- fibres and nerve-cells of a cylindrical form, somewhat flattened on the inner side. It occupies a chamber, or tunnel, in the spinal column. > It extends from the cavity of the occiput to the second vertebra of the loin, and is encompassed by three membranes, cor- responding to those before mentioned in connection with the brain j they may be considered a continuation of the same. The spinal cord, which has a continuous connection with the brain, unites the functions of the nervous system, motion and sensation. These spinal nerves, thirty-one pairs in number, which originate in the brain and the spinal cord, branch off from each side of the spinal cord by two roots, an anterior root containing the nerve of motion, and a posterior one containing the nerve of sensation, and which supply the various parts of the body with nerves of motion and sensation. The posterior root of the spinal nerves enlarges, after piercing the membranes of the spinal cord, to a knot, or ganglion, of the size of a small pea. The spinal cord is composed of the same substances as the brain ; but the arrangement is reversed, the white matter encompassing the grey matter instead of being encompassed by it. A vertical fissure partly separates the cord into two lateral halves, similar to the separation of the brain. The lower part of the spinal cord is of a blunt, conical shape, the spinal cord cone, from which extends a strong thread, the spinal cord fibre, down into the canal of the coccyx, where it firmly adheres. The nerves originating in the lower part of the spinal cord, and running into the lower extremities, have very long roots, and branch, at an acute angle, from the main trunk, and lying together in large numbers in the lower part of the vertebrae chamber, they form bundles of nerve-cords. The spinal cord is not of the same thickness in all its parts. It has an enlargement at the neck and loins, in the places where the nerves branch off for the upper and lower extremities. THE NERVES. 9 THE NERVES. The nerves are composed, as before remarked, of single fibres, and are divided into brain and spinal nerves, and into sympathetic nerves or ganglionic nerves. The brain and spinal nerves are either nerves of sensation or motion, and spring from the brain (brain nerves) or spinal nerves. The farther they extend from their place of origin, the more they ramify, without, however, dividing into threads, or blending together, until they finally end in the finest nerve fibres. The single fibres, according to the kind of nerves, differ in their mode of conveying. The motor nerves convey from the brain to the muscles (from the centre to the periphery), the sensory nerves from the skin to the brain (from the periphery to the centre). The motor nerves are the means by which the commands of the mind are com- municated to the voluntary muscles, and the latter are caused to contract. The sensory nerves, on the other hand, transmit the re- ceived impressions, perceptions and excitements of all kinds, to the brain. A larger nerve generally contains mixed fibres, motor and sensory fibres, rarely only one of them. Very few of the organs and parts of the body are without nerves ; for instance, the nails, hair, outer skin and cartilage. In the central organs of the nervous sys- tem the nerve -fibres are connected with the nerve-cells. The fibres running to the periphery lead mostly to a complicated apparatus, as, for instance, the nerves of the senses, eye, ear, skin ; the mode of the peripheric termination of many nerves is still unknown. The brain- nerves appear at the basis of the brain, and connect, through partic- ular openings in the base of the skull, with the outward organs of the senses, the various parts and organs, muscles, skin, face, and partly also with the throat and the chest. The spinal nerves (thirty-one pairs) spring from each side of the spinal cord by two roots, as before mentioned, and provide the skin and muscles of the trunk and ex- tremities with nerve-fibres. The great trunk nerves, after leaving the brain and the spinal cord are mostly more or less stout, white, round cords, protected by the muscles ; they branch off in every direction, until they finally run out into innumerable threads. If, for instance, a heated object is touched with the finger., the pain created thereby is communicated to the brain by the sensory nerves. There the motor-nerves receive the order, so to say, to cause the 10 THE HUMAN BODY. corresponding muscles to contract, and then only are we enabled to withdraw the finger on which we feel the pain. These occurrences, however, are the work of a moment only. If a motor nerve is injured or destroyed, it results in a loss of power of motion ; if irritated, convulsive action of the muscles occur. The irritation of a sensory nerve causes pain ; if cut or destroyed, it results in a loss of sensation, or, in other words, it is paralyzed. The following are the twelve pairs of brain nerves : the olfactory nerve, or nerve of smell, located in the mucous membrane which lines the interior of the nose ; the optic nerve ; the nervus oculo-muscularis communis, the pathetic nerve {trochle -ares); the nervus abducens ; the three last supply nerve-fibres to the eye muscles ; the nervus trigeminus contains the motory nerves for the masseters, and furnishes the face and forehead with sensory nerves ; the facial nerve is the motor for most of the muscles of the face ; the auditory nerve, the glosso- pharyngeal nerve, extends into the mucous surface of the fauces, tongue, tonsils and mucous glands of the mouth ; the nervus vagus sends its fibres to the vocal and respiratory organs, to the stomach ; the accessory nerve extends to the various cervical muscles ; the nervus hypoglossus moves the tongue and the muscles of the larynx; the spinal nerves, originating in the spinal cord, derive their names from the region in which they branch out ; they are divided into cervical, dorsal, lumbar, sacral and coccygeal nerves. The exterior skin, and the cutaneous papilla, which must be considered as the principal seat of the sense of touch, because the sensory nerves end there, have been previously considered. The muscular sense gives rise to the sensations of the form and size of objects brought in contact with it, and of the direction of a pressure or thrust to which the organs of touch are subjected. In the lower part of the oral cavity is a curved fold, which separates downwardly to the right and left into two plates, an anterior and posterior. This arch, spanning over the root of the tongue, con- sisting of mucous membrane and a muscular stratum, is called the velum palatinum. From its centre, over the dorsum linguce, depends a small conical process, called the uvula. Between the two plates of the velum palatinum the tonsils are situated. When the cells of the mucous membrane of the tongue's surface are shed in larger quantities than usual, and more phlegm is secreted, it is called a coated tongue. THE ORGANS OF THE SENSES. II Sometimes the tongue has grown together too closely with the mucous membrane at the bottom of the oral cavity; in that case the frcenulum must be bisected, that is to say, the ligament of the tongue must be cut. THE ORGANS OF THE SENSES. THE TONGUE. The most important organ of taste is the tongue, particularly the posterior part of it ; the soft and hard palate, and the interior surface of the cheeks, have perceptions of taste. The tongue rep- resents a very movable body, consisting of a musculous substance, and is situated at the bottom of the mouth. The muscles ot the tongue originate partly at the hyoid bone, and partly at the inner surface of the inferior maxilla, and give it the freedom and variety of motion which it possesses. The upper surface of the tongue is covered with innumerable fine papilla of a variety of shapes, which may be considered partly organs of touch, and partly organs of taste, as the gastatory nerves terminate therein. At the lower surface of the tongue is placed a small perpendicular ligament, called the frcenulum, connecting the tongue with the bottom of the cavity of the mouth. The tongue has three parts: the front part, the tip of the tongue, which is particularly sensitive to taste ; the upper part, the dorsum lingua, and the posterior part, the root of the tongue. As soon as food or soluble substances touch the ends and end-appara- tus of the gastatory nerves, the sensation is conveyed to and perceived by the brain. THE ORGAN OF SMELL— THE NOSE. The external nose is formed in its lower portion by several cartilag- inous pieces, the posterior part, by the processes of the superior maxilla, and by the nasal bones. The skin is stretched over the cartilaginous and bony frame. The nasal cavity is divided into two parts, the lower part by a cartilaginous, and the posterior part by a thin plate of bone (the vomer'), and the vertical plate of the ethmoid bone, which are connected with the lower cavity of the mouth by two openings. The nasal cavity, like the cavity of the mouth, is materially concerned in the formation of voice and speech. Upon the outer sides of the cavities of the nostrils are found the turbinated bones, and a similar 12 THE HUMAN BODY. scroll-like portion from the ethmoid bone. The whole cavity of the nostrils is lined with mucous membrane, and in the part which lines the turbinal bones and the upper part of the vertical wall are branches of the olfactory nerves, which descend from the brain through the ethmoid bone into the nostrils. The finest filaments are connected with certain end-apparatus, where the irritation created by smell- emitting substances are communicated to the nerves and transmitted to the brain. THE AUDITORY ORGAN— THE EAR. The auditory organ serves to receive sound, and transmits the im- pressions created by sound-waves; it is divided into external and internal parts. The external parts are the pinna (auricle) and the auditory canal ; the internal, the tympanic cavity with the membrana tympani, the auditory ossicles, and the labyrinth. The foundation for the external ear consists of a cartilaginous plate with numerous irreg- ularities upon its surface, and from its resemblance to a shell has been called concha. It serves to collect sounds, and to give them greater intensity. Over this cartilage the skin is stretched, which continues inwardly to the external portion of the auditory canal, and downward to the lobe of the ear at the lower part of the pinna. The lobe of the ear is free from cartilage, but has more or less streaks of fat run- ning through it. At the point where the external ear is attached to the pericraniu?7i, it is supplied with several weak muscles, which enable it to be moved slightly forward or backward. The external auditory canal runs horizontally directed forward, and is slightly curved. The anterior part of the auditory organ is cartilaginous; the posterior part, a bony partition formed by the petrous bone. This canal is lined by the exterior membrane, where, particularly towards the pos- terior end of it, are found some stiff hairs and glands ; the former prevent the entrance of hard bodies, and the latter secrete the wax of the ear. At the point where the auditory canal joins the tympanum, the membrana tyjnpani is found, which is an impervious membrane stretched between the two cavities, dipping inward at an angle of forty-five degrees ; it is of a bluish-red shade, transparent, thin, and elastic. Behind the tympanum lies the tympanic cavity with the auditory ossicles, forming a cavity in the petrous bone, with bony THE ORGAN OF THE SENSES. 13 sides, with the Eustachian tube, which represents an open canal between the pharyngeal cavity and the tympanic cavity. The auditory ossicles are exceedingly small ; they are called the mallet (malleus), anvil {incus), and the stirrup (stapes). The hammer, showing several processes, of which the smallest grows together with the ?nembrana tympani, lies furthest to the front ; the anvil is connected with the hammer by a joint, and also has two thin processes, one of which is connected with the stapes, a small bone having the appearance of an exceedingly small stirrup, the base of which is somewhat movably placed in an oval opening in the interior wall of the tympanic cavity. Whenever the membrana tympani vibrates under the influence of the sound-wave, the three little ossicles are also set in motion, and the base of the stirrup is drawn slightly out of its opening or pressed in. By this named opening, entrance is gained to the auricle, a very small cavity, enclosed by osseous walls, and situated in the interior of the petrous bone ; this little cavity is filled with a fluid. From this part runs in a forward direction the so-called snail shell (cochlea), a canal fashioned after a snail's shell, and posterior to it, and in an upward direction, are three semi -circular canals. In the cavity and the canals the auditory nerve with its complicated fibres are spread out, and as soon as a sound-wave has set in motion the membrana tympani, and with it the auditory ossicles, the vibration is communicated through the oval window (fenestra ovalis) to the limpid fluid, and thence to the termination of the auditory nerves in the auditory canals, and in the snail shell (cochlea). The sonorous impression is conducted to the brain, or, as we say, a sound is heard. THE ORGAN OF SIGHT— THE EYE. The most important part of the eye is the eyeball, lying in the orbital cavity ; it is of a globular form and most ingenious construc- tion, receives the rays of light emitted by luminous bodies, and contains the most important parts of the whole optic apparatus. In proximity to the eyeballs are found so-called accessory organs, by which they are moved and protected from injury. Among these accessory organs are the eye-muscles, the cushion of fat in the orbital cavities, the lachrymal glands, the eyelids, and the eyebrows. There are six muscles of the eye, four straight and two oblique. They move and 14 THE HUMAN BODY. turn the eyeballs in various directions, and, originating principally in the posterior part of the orbital cavity, terminate in the anterior part of the eyeball in short tendons. The muscles of the eye and the whole eyeball, as far as it lies within the orbital cavity, are surrounded by a cushion of fat, which protects it from concussion, keeps it warm, and facilitates its motions. The lachrymal gland is about the size of a bean, of yellowish-red tint, and lies in the anterior part of the orbital cavity, a little above the external angle of the eye. It con- sists of several gland lobules, and each of them, having a narrow excretory duct, pierces the conductiva of the eye near its external angle. The lachrymal glands segregate the tears (a clear, watery, saline fluid), which flows on the under side of the lower eyelid to the inner angles of the eye, and is received there by the two lachrymal points. The lachrymal points are two very small openings, lying in the upper and lower eyelid, near the inner side of the angle of the eye, and form the entrance of the lachrymal canals. The lachrymal canals are two fine ducts, conveying the lachrymal fluid into the lachrymal sac. The lachrymal sac is situated between the inner eye- angles and the nose, limited in front by the skin and behind by the lachrymal bones ; a larger tube leads into the nostrils lying below the lower concha. Tears, therefore, segregated by the lachrymal gland in the exterior part of the orbital cavity, are sucked up by the lach- rymal points at the inner side of the angle of the eye, and conducted by the lachrymal ducts into the nostrils. The outside of the eyelids (upper and lower) are movable membranous coverings, the inner side lined with a mucous membrane. In the outer border of the free edges of the eyelids, fine short hairs are inserted, called eye-lashes, which, like the eyebrows, protect the eyes from injury. In the tarsal cartilages are a number of small glands, placed alongside of each other ; the excretory ducts discharge on the edges of the eyelids, where they segregate the sebum palpebrale, a heavy, yellowish sub- stance, which keeps the eye lubricated and generally prevents the overflow of the lachrymal fluid. The eyeball has a globular form, the anterior portion of which, the cornea, has a more circular form than the sides or posterior part. The largest part of the eyeball is con- cealed by the orbital cavity, and only that part which can be covered by the eyelids is visible. The eyeball is composed of three investing THE ORGANS OF THE SENSES. 15 • coats ; the exterior coat is called the sclerotic, the middle one the chloroid, with the iris, and the inner one the retina. The sclerotic is composed of dense, white fibrous tissue ; the middle coat, the chloroid, is closely attached to the inner surface of the sclejolic, and the retina, the innermost of the three coats, occasions the brown, blue, or gray color of the eye. The white of the eyeball, to which the muscles of the eye adhere, is of a bluish-white color, and surrounds the largest part of it. It represents a very firm tendinous film, and in its centre is pierced by a small round opening to permit the passage of the optic nerve. The white coat which, as heretofore mentioned, covers the outer surface of the eyeball, affords by its toughness a certain amount of protection to the inner tender parts of it, and, being opaque, pre- vents at the same time too great an influx of light to the interior of the eye. The cornea forms the anterior sixth part of the eyeball, and is connected all around with the white film. It is perfectly trans- parent, and its anterior part is also covered by the conductiva of the eye, which, however, is here very thin and soft. The inner surface of the white film is lined with the vascular membrane ; its abundance of blood vessels form a well-connected network ; it is covered, particu- larly on the inner surface, with numerous cells, containing a black coloring matter. The chloroid is connected with the iris in the front part of the globe of the eye. The inner and most important coat of the eyeball is the retina ; it is transparent, of a whitish color, and consists mostly of nervous membrane formed by the expansion of the ultimate filaments of the optic nerve. It is sensitive to light alone. Towards the front, the retina is connected with the capsule of the lens. Between the lens and the cornea is a small space containing the aqueous humor. This humor consists of a few drops of a trans- parent liquid. By anterior chamber is meant the space between the cornea and the iris ; by posterior chamber, the space between the iris and the lens. The crystalline lens is the most important light- refracting apparatus, of double convex shape, and perfectly trans- parent ; it has a firm, but elastic texture, lies immediately behind the iris, and is enclosed by an extremely delicate transparent filament, the lens capsule. The posterior surface of the lens lies in a plate-shaped cavity of the humor. The humor, the third light-refracting appar- atus, fills the posterior two-thirds of the eyeball, and consists of a 16 THE HUMAN BODY. * completely transparent, colorless, jelly-like mass. The humor is enclosed in a thin transparent membrane (the vitreous membrane), separating its posterior part from the retina, and its anterior part from the lens. Whenever luminous rays strike the eye, their transmission is refracted by the liquid of the eye ; they do not go forward in a straight line, but are diverted inwardly and brought nearer to each other. Further on, the rays meec the crystalline lens, and beyond that the humor ; in both of the light-refracting apparatus occurs a like refraction of the rays. It is thus that the rays, emanating from a luminous point outside of the eye, meet again upon the retina, form- ing an exact representation of the object emitting the rays. The impressions made by the light upon the retina are transmitted by the nerve-fibres to the brain, where the mind forms a conception of the visible things and phenomena of the outer world. If the rays emitted by a luminous point are not again united to a point on the retina, but if the point of union lies before or behind it, the object cannot be clearly seen at certain distances ; eyes of that kind are either short or long-sighted. The short-sighted eye can see sharply close by, but in the distance only indistinctly; with the long-sighted, the reverse is the case. In the first named case the union of the rays occurs pre- vious to reaching the retina, and concave glasses are required to extend the point of union to the retina. In the long-sighted eye the point of union lies behind the retina, and therefore convex glasses are required to advance the point, so that objects near by may be per- ceived with tolerable clearness. THE TEETH. The number of teeth of the human adult are thirty-two, which are equally divided between the upper and lower jaws There are eight incisors, four eye or canine teeth, and twenty molar teeth. The sub- stance of which teeth are principally composed is the so-called dentine, which encloses one or more cavities or small canals, containing the nerves and vessels. The enamel, which covers all the teeth above the gums, is an exceedingly hard, brittle, white substance, which frequently breaks off, when hot food or liquids are brought in contact with it, or when hard substances (metal tooth-picks, pins) are forced between the teeth. These broken-off parts of the enamel are never replaced. THE TEETH. 17 The upper part of the teeth is called the crown ; it is the visible part covered by the enamel ; the root is situated in the jaws, and is covered by the gums. The crown of the incisors has the shape of a chisel ; in the eye-teeth it is pointed, and knobby and broad in the molar teeth. According to these different shapes, the teeth serve for cut- ting, holding, and chewing or grinding food. The part of the tooth lying between the crown and the root is called the collum dentis (neck of the tooth). The roots of the teeth have a conical shape, and are firmly set in the jaws. The incisors, eye and most anterior molar teeth have only one root ; the balance of the molars have from two to four roots. At the lower points of the roots, the nerves and vessels find their entrance. In their healthy state teeth do not ache, but such is the case when the nerves and the soft parts in the inner tooth become inflamed and swell. If, furthermore, the teeth become hollow, and the inner soft part is laid bare, a change of temperature, air and food cause great pain. Children, one or two years old, have about twenty teeth, the so-called milk teeth, which have either a very small root or none at all. From the seventh year these teeth fall out, and are replaced by new and permanent ones. Between the twen- tieth and twenty-fifth year the four last molar teeth make their appear- ance ; they are usually called wisdom teeth. From that time the adult has his full set, thirty-two teeth. It is rare for teeth to make their appearance in very aged people. DENTAL DISEASES. The calculus dentalis is a firm yellowish substance, adhering to the lower part of the crown, which crowds back the gums. It results from chalky ingredients, gradually collecting there from the food consumed. To protect the teeth from injury, the greatest care should be bestowed upon them ; they should be cleaned daily ; charcoal pre- pared from the wood of the linden-tree is preferable for that purpose to many complicated preparations. Hollow teeth should be filled in time, in order to check the progress of destruction. Caries, caries dentium, manifests itself as a disease of the teeth, which com- mences either on the external surface by a discoloration of the enamel, or in the internal part of the crown, until the tooth is totally destroyed. 18 THE HUMAN BODY. TOOTHACHE. The caries is either moist or dry, and manifests itself in the internal or external part of the tooth. The inner caries is always moist, while the external is always dry. The so-called milk-teeth and the first four molars are affected mostly by the moist caries, the next are the upper incisors and the eye-teeth. The so-called wisdom teeth, however, are more exposed to the caries than any other ; they often have the mark of it when they break through the gums ; at first a small point only is visible in the crown of the attacked tooth, which becomes discolored, soft, and turns black ; then the disease extends into the cavity and gradually disintegrates the bony substance, when the shell readily crumbles off. The odor caused by the moist caries is much more offensive than that of the dry caries. The interior moist caries begins without any great pain and proceeds somewhat rapidly ; finally, an opening is discernible, through which air, moisture, food and change of temperature have an unfavorable effect, and then the aching of the tooth begins. The disease also extends to the roots, and finally nothing remains of the tooth except the stump. The dry caries always begins in the exterior part of the tooth, and more frequently appears in aged persons, while young people are more liable to moist caries ; frequently swelling and inflammation of the gums are caused, and also fistula at the point of the margin of the maxillary bone, cor- responding to the attacked root of the tooth. Aside from this, the caries dentium may spread not only from one tooth to another, but also from the tooth to the tooth cavity, and if in the upper jaw, to the maxillary sinus ; it then becomes a serious matter. The caries dentium is produced by external and internal causes ; among the former is the too free use of acid food, neglect of cleansing the teeth, sudden change from very hot to very cold food, the smoking of tobacco, and injuries of the gums. Generally, however, this disease originates from internal causes, particulary, if the caries dentium begins in the internal part of the tooth ; because, frequently bad teeth are hereditary ; often it is caused by the rickets, scrofula, scurvy, syphilis, and many other diseases. And for that reason, the drawing of these teeth to prevent the infection of adjoining teeth, is in many cases useless. Thus far, treatment is no sure means of arresting the progress, or of curing the caries dentium, because teeth have not the TOOTHACHE. 19 vitality of other bones, aiding in the cure of incipient disease. The greatest care should be taken of the teeth and gums from early youth. If a tooth is affected, rinse the mouth after every meal with water, not too cold, and remove with a toothpick all particles lodging be- tween the teeth Aside from that, the teeth should be cleaned every morning with powdered Peruvian bark and a moderately stiff tooth brush. To purify the offensive breath produced by decayed teeth, strict cleanliness is required; the rinsing of the mouth with an infusion of sage, the filling of the hollow tooth with cotton, saturated with essence of myrrh, spirits of camphor, or oil of rose, is recommended. Fistula of the cavity of the tooth is called ulceration, which has found an outlet through the tooth ; it is either the result of a preceding inflammatiori of the inner lining of the cavity, or is produced and maintained by caries dentium of the tooth, or of the jaw itself. If the cutting of the gums, or a softening mouth-wash have had no effect, it is best, in both cases, to extract the tooth. By this means the disease, if of an inflammable nature, is more readily removed, because it may then be seen whether the disease is in the concealed caries dentium, or if the trouble is in the upper jaw, whether it is in the maxillary sinus, swelling of the gums, accompanied by a dull pain, is, in some cases, only external ; in other cases, however, it results from a decayed root of a tooth. The cause is generally a cold, or rheumatic pain. If no suppuration has taken place, one or two leeches, or a few incisions with a fine blade, will moderate the pain. If suppuration has begun, assist it by a warm softening mouth-wash, prepared from a decoction of poppy-heads, red poppy flowers, with rose honey, or warm milk in which figs have been boiled, or a piece of a fig may be placed on it ; poultices may also be used on the out- side. If the swelling is broken, the blood and matter is squeezed out, and the mouth rinsed for some time with the above named decoc- tions, or with warm milk, or camomile. If the trouble recurs fre- quently in consequence of a decayed tooth, the best plan is to have it extracted. Inflammatory toothache occurs particularly in young and vigorous people. In people who suffer from hemorrhoids, giddiness, headache, also in hysterical persons, in women during the first months of their pregnancy and in consequence of surpressed menstru- ation, heat is noticed ; particularly, however, a sudden transition of 20 THE HUMAN BODY. heat and cold. Toothache sometimes lasts for weeks, with partial abatement or with a few painless intermissions ; it is tearing and throbbing and connected with tensions in the jaw. The cavity of the mouth is hot, the gum is red and slightly swollen ; the cheek of the affected side is hot and red, the seemingly elongated tooth pains with every touch ; the aching, commencing slowly, increases very rapidly, and becomes intolerable in a short time. The attacks generally occur after meals or in the warmth of the bed. After a longer duration, it results in fistula of the tooth, when it dies. For a cure, outside poul- tices are required ; put in a pint of boiling water three ounces of linseed meal, take it from the fire as soon as it has become a slimy, jellied mass ; add about one drachm spirits of camphor and three tablespoonsful sedative water, stir the whole with a spoon and spread on cloth. In place of the above, salt poultices, prepared as follows, may be used : take three ounces of salt, six ounces of linseed meal and three ounces of wheaten bread, boiled in sweet milk, and make a fresh application every hour, until the pain relaxes. Inwardly give the following powder : Saltpetre four grains ; tartrate of potash fifteen grains ; divide into ten powders, and take a powder three times a day, twenty minutes after meals; a mustard plaster applied on the upper arms, near the shoulder, relieves the pain ; a mustard foot- bath can be recommended. It lessens the rush of blood to the head and removes the pain ; nervous toothache, which frequently becomes very violent, may be felt in sound as well as in de- cayed teeth; women inclined to spasms, sometimes also those in the last months of pregnancy, are frequently subject to it ; more rarely men and children. The pain is very violent, particularly at night ; excitement of the mind and other disturbances may bring it on. The pulling of the tooth transmits the pain to the adjoining teeth. If the tooth is very much decayed, however, and the pain continues, it should be pulled. Rheumatic toothaches will affect teeth that are not decayed ; generally a number of teeth will be affected at the same time. But where there is a hollow tooth, the whole side of the jaw, head and throat will ache ; the pain is very violent and of a tearing, quivering and boring character. Rheumatic toothache is treated in the same way. As a general rule, it is not well to be in too much of a hurry to have a tooth drawn, as an artificial THE LUNGS. 21 tooth never fully replaces a natural one ; therefore some of the pain- killing remedies, of which this work gives a large number, should be tried. To deaden pain produced by hollow teeth, the following tinctures are recommended : tincture of opium, a few drops on cot- ton, placed in the hollow tooth ; tincture of henbane, applied in the same manner ; a good pain-killing remedy is the tincture of stramo- nium. Ethereal oils, such as oil of cloves, are useful, also camphor, which is to be applied with cotton. Where the pain is very severe and there is no hollow tooth, these remedies may be introduced in the ear. The following prescriptions have proved to be very successful in some cases : Extract of henbane, belladonna, pulverized opium, each five grains ; powdered German pellitory root ten grains, oil of cloves ten drops ; make into pills of one grain each, roll in powdered pellitory root and introduce one pill at a time in the hollow tooth. Another remedy is to moisten a little cotton with one drop of creosote and put in the hollow tooth ; the pain disappears, but soon returns, when a fresh application must be made ; rubbing both cheeks with a magnet frequently stops the most violent toothache. Another remedy : powdered camphor three grains, powdered opium fifteen grains, extract belladonna three grains, boiled oil of henbane one- half grain, oil of cajeput, tincture of Spanish fly, each four drops ; mix into a mass and put a pill of the size of a pea into the hollow tooth, and the pain disappears ; a mustard plaster, a plaster of Spanish fly, or grated horseradish placed behind the ear, is beneficial in rheu- matic toothache ; spirits of wine one pint, chloroform one-half ounce, spirits of camphor one-half ounce, oil of cloves one-half ounce, tincture of arnica one-half ounce, mix well, saturate cotton with it and apply to the painful spot ; the cheeks may also be rubbed with it, if the pain is violent. THE LUNGS. The lungs consist, first, of numberless small canals in which the branches of the trachea widely ramify ; the terminal branches have on their ends small air-cells, consisting almost entirely of membranous mucous surrounded by an extremely fine net of blood vessels. With every inspiration, the last named innumerable small formations are expanded by the air inhaled ; and the latter, therefore, comes in im- 22 THE HUMAN BODY. mediate contact with the delicate air vessels. At this time an exchange of certain materials occurs between the blood and the air ; the blood transfers the air parts, which have become unfit for the support of the body, to the air in the lungs (particularly carbonic acid), and, in return, absorbs material necessary for the support of the body (particularly oxygen). Besides that, a great deal of watery vapor is continually secreted in the lungs. The lungs consist of two large, sponge-like, grayish-red or bluish-black bodies, weighing from two to two and one-half pounds (lobes of the lungs), having the form of a cone pointing upward, which fill the cavity of the chest on both sides of the spinal column. The right lobe of the lungs is divided into three different sized flaps, coherent to each other, and the left into two. There are distinguished two upper, two lower and one middle flap. The heart is partly covered by the edges of the left lobe of the lungs. The lungs contain no sensory nerves, but number- less blood vessels. The pulmonary artery, proceeding from the right ventricle of the heart, supplies them with blood ; the vessels carrying the blood back, of which there are four, having their mouths in the left auricle of the heart, are called pulmonary veins. In breathing, the chest expands, the ribs being raised by various muscles (respira- tory muscles), and the diaphragm flattens down to a plane. Corres- ponding with this expansion, the lungs expand. Atmospheric air, containing oxygen, rushes in, inflates them, and fills the minutest pulmonary vesicles. In turn, the muscles relax, the lungs and also the chest contract, "and the inhaled air is expelled, having surrendered its oxygen in exchange for the carbonic acid. In healthy adults the number of respirations are from fifteen to twenty in a minute ; babies breathe about forty times, and children about twenty-four times. The nerves, maintaining the breathing process, originate in the uppermost part of the spinal cord, in the elongated cord. Injury to these parts produces instantaneous death, because the process of breathing is interrupted. THE VASCULAR SYSTEM, AND ORGANS OF THE GENERAL BLOOD CIRCULATLON. Blood is a glutinous fluid, its color varying from bright scarlet to dark purple, which, circulating through the veins, spreads through the whole body, and whilst supplying all organs with nutricious matter on THE VASCULAR SYSTEM THE HEART. 23 the one hand, it removes on the other hand matter no longer nutri- tious (gall, perspiration). The quantity of blood in the body of an adult varies very much, and is estimated to weigh from ten to twenty pounds, one-seventh part of the weight of the body. When examined under the microscope, it presents a multitude of minute solid bodies, or corpuscles, that float in a yellowish-green fluid, called the watery plasma (blood-globules, blood-cells, blood-corpuscles). The blood of the arteries is rich in oxygen, and therefore light red and nutritious ; the veinous blood, rich in carbonic acid, is dark red, and therefore no longer nutritious. The blood corpuscles are red and white ; the former exceed the latter greatly in number (three to four hundred red to one of white). The red corpuscles, magnified two or three hun- dred times, appear reddish-yellow, not globular or spherical, but flat, circular and disk-like. A single drop of blood contains millions of them. They contain the blood-coloring material proper, which is caused principally by an admixture of iron. The white blood cor- puscles appear under the microscope as round globules or cells, which are conveyed to the blood in the lymph and chyle. The white blood corpuscles originate in the spleen, and in the lymphatic glands assume in the blood-veins a red color, and are mostly destroyed again in the liver. The blood circulates in numberless canals connected with each other, which are called blood vessels or veins. The centre of the vascular system, from which the blood is distributed to all parts of the body, and to which it must turn again, is THE HEART. The shape of the heart is conical, with the apex or point pointing downward and toward the left. It is a hollow muscle placed in the cavity of the left breast, and in an adult has about the size of a man's fist ; its weight is about three hundred and fifty grains. It consists of numberless interlaced, muscular fibres running length and crosswise, and is surrounded by the pericardium. The pericardium is a kind of a membrane sac, which, like the peritoneum and the pleura, belongs to the serous membranes, which on their surface segregate a moist vapor or fluid. The base of the heart, which is upward, is attached so as to hold it securely in its place, while the apex is freely movable. The 24 THE HUMAN BODY. sac is attached outwardly to the pleura and the diaphragm. The heart is the central organ of the circulation of the blood, and to maintain this, it must keep up a continuous motion. In an adult it contracts sixty or seventy times in a minute, and by it forces the blood into the arteries. After each contraction, it expands again to receive the blood returning from the body through the arteries or veins. We perceive the con- tractions of the heart at the arteries in the beat of the pulse, and near the breast-bone, between the fifth and sixth rib, the heart-beat may be heard and felt. The heart is partitioned into two symmetri- cal halves, lying alongside of each other, but firmly united by a muscular diaphragm ; these halves are also sometimes called the right and left heart. The left half receives the blood * returning from the lungs, having there received its supply of nutritious matter, and sup- plies the whole body with it, while the right half receives the blood returning from the body possessing no longer that quality, and forcing it into the lungs. Each of the two halves of the heart is again sub- divided into two parts, into the auricle and ventricle, which commu- nicate with each other, but not with the cavities of the other half of the heart. There are, therefore, four chambers or cavities in the heart, two auricles, and two ventricles. The auricles are the two upper chambers, and the partitions are much thinner than those of the ventricles. In the left auricle, the four arteries discharge the blood which they reconduct from the lungs into the right auricle. The two great blood vessels reconduct the whole blood of the body to the heart. The ventricles occupy the lower two-thirds of the heart, and their walls are much thicker than that of the right. Both cham- bers are separated by a thick muscular partition. The partition wall of the auricles is considerably thinner. Each auricle is connected by a pretty wide opening with the ventricle lying underneath, which, however, can be closed by a valve in such a way that when the auricles contract, the blood may flow back from the ventricles, and from them into the auricles. From the left ventricle springs the aorta, from the right the pulmonary artery. The retrogression of the blood from these two vessels into the ventricle is prevented by mitre-shaped valves. The mechanism of the action of the heart is as follows : first, the two auricles, filled with blood, contract simultaneously and drive the blood into the ventricles; while the former expand to THE HEART. 25 receive a fresh supply of blood, the ventricles contract and drive the blood into the aorta, and into the pulmonary artery. The channels in which the blood flows from and to the heart, are the arteries or blood vessels. There are two kinds, arteries and veins. All blood vessels represent membranaceous canals, which generally consist of several (three soft and elastic) strata, of the external connective tissue, of the muscular stratum, and of an inner very thin cellular layer. The walls of the arteries are much thicker than those of the veins. The arteries lay generally protected and deep, covered by muscles ; they contain light red, oxygenized blood, which they lead from the heart to all parts of the body ; at the same time separating fork-like into inner smaller branches, similar to the manner in which the trunk of a tree branches off into boughs and twigs. The veins lay mostly on the surface, frequently right under the skin, when they are visible from the outside, or in pairs alongside of the arteries. They contain the dark, cherry-red, carbonaceous blood. The veins origi- nate in extremely fine branches in the same parts of the body in which the small arteries ramify. These fine branches unite into larger veins, and finally two large veins only reconduct the blood of the whole body to the heart. Between the finest ramifications of the arteries and the finest roots of the veins are the so-called capillaries, which complete an uninterrupted communication between arteries and veins. The capillaries, which form an exceedingly close net of minutest canals in nearly all organs of the body, are not visible to the naked eye, and consist of a single, exceedingly thin, transparent membrane, corresponding to the innermost membrane of the other blood vessels. In the capillaries occurs the change of matter to effect nourishment in such a way that the nourishing parts, which have passed through the arteries into the capillaries, are transferred through the thin walls of the latter into the various organs of the body. On the other hand, the matter from which the nourishing part has been absorbed, is again taken up by the capillaries and conducted into the veins. 26 THE HUMAN BODY. THE CIRCULATION OF THE BLOOD. It has been already remarked that the blood, in the capillaries, sur- renders a part of its nourishing qualities to the surrounding parts of the body, and that the latter constantly need the part of the surren- dered matter for their preservation and nourishment. In order that fresh nourishment, containing blood, may be supplied to the capillaries, a continuous circulation is maintained, which is called the circulation of the blood. The motive power of this circulation is the heart. The course pursued by the blood in its circulation is as follows : first, the light red (arterial, nourishing) blood pours rapidly from the left ventricle through the great artery, which divides constantly into finer branches the farther it is removed from the heart (into the finest arteries); then the blood, flowing slowly, enters from these last and finest branches of the arteries into the capil.aries, in which it surrenders a part of its nourishing qualities, particularly oxygen. From the capil- laries it makes its way as dark red blood to the entrances of the veins ; the veins, as they approach the heart, unite into larger ones, until finally the blood enters the right auricle by the vena cava superior and the vena cava inferior. The circulation which has been thus far described, is called the greater or systemic circulation. Each contraction of the right auricle sends the blood into the right ventricle, and from there into the lungs through the pulmonary artery. In the lungs, as already stated, it flows through numerous branches and capillaries, which surround the pulmonary vessels, and where it absorbs the oxygen from the inhaled air. From the lungs, where the blood has become light red, oxygenaceous and impregnated with nourishing matter, it is recon- ducted through the four pulmonary veins to the left auricle. By the contraction of the latter, it again reaches the left ventricle, and thence the artery, and, consequently, again the greater or systemic cir- culation. This second part of the circulation of the blood, the course of which must be looked for particularly in the lungs, is called the lesser or pulmonic circulation. THE DIGESTIVE ORGANS. The digestive apparatus, from its begining to its ending, from the mouth and the gullet {oesophagus) to the rectum, represents a connected, now contracted, and now expanded, membranaceous THE DIGESTIVE ORGANS. 27 canal. The oesophagus is from eighteen to twenty-one inches in length, and consists, as is generally the case with all sections of the digestive apparatus, of an exterior (cellular) membrane, a middle (muscular) membrane, and an interior (mucous) membrane. It lies folded immediately behind the larynx and trachea, and can expand itself considerably. In swallowing solid food, the oesophagus contracts wave- like behind the food, and forces it downward into the stomach. Its funnel-shaped entrance, commencing in the upper posterior part of the cavity of the mouth, is called the pharynx. In the cavity of the chest lies the oesophagus, and farther down, a trifle to the left of the vertebral column, it passes through an opening of the diaphragm, and discharges into the stomach. The point where the oesophagus enters the stomach, is called the orifice of the stomach. The stomach re- presents a wide, pear-shaped pouch, lying in the upper left part of the abdominal cavity (immediately below the diaphragm), and runs from left to right. It consists, as before mentioned, of three principal layers, of which the muscular membrane produces motion, by means of which the food is mixed with the gastric juice, and subsequently conducted lower down into the intestinal canal. The food, mixed with the gastric juices, is called chy?jie. The stomach, therefore, has two openings : the orifice, which is situated on the left upper side of the stomach, is the entrance point of the oesophagus ; the pylorus, (gate-keeper) is the op .osite opening and leads into the duodenwn. Through the orifice of the stomach the food enters and passes out through the pylorics ; both of these are provided with ring-shaped muscular fibres, and by their contraction the stomach may be closed above and below. Towards the left, the stomach forms a pouch-like enlargement, which is called the stomach region. The mucous mem- brane of the stomach is very closely covered with glands (peptic gas- tric glands); they are small, pouch-shaped indentations. In these the gastric juice is separated from the blood. This is particularly the case when the mucous membrane is excited by the entering food. The gastric juice is a transparent, clear, fluid, of a strongly acid taste, and is intended to dissolve and digest the albuminous food (particularly meat and albuminous substances), and to prepare them for the con- dition in which they can be received by the blood vessels. 28 THE HUMAN BODY. THE INTESTINAL CANAL. Immediately attached to the stomach is the intestinal canal, which again is divided into various sections, the duodenum, intestinum tenue (small intestine), and the intestinum crassum (large intestine). The duodenum is that part of the intestinal canal in which is received the chyme direct from the stomach through the gate-keeper. It has the shape of a horseshoe, surrounds the pancreatic glands, and is about nine inches long. In it enters the excretory duct of the gall-bladder and the pancreas. From time to time, gall and the juice of the mentioned glands is mixed with the chyme to aid digestion. The small intestine, which is annexed to the duodenum, has in adults the length of five metres, and is the winding intestine which presents itself to view when the abdominal cavity of a larger mammal is opened. The upper part of the small intestine is called the jejunum ; the lower part the ileum. The small intestine is also very closely covered on its inner side (the mucous membrane side) with small glands, which in many places are closely piled together. Besides that they are lined with innumerable short, fine, thread-like prolongations, called villi, (intestinal villi), which reach, like fine roots, by the million into the chyme, where they absorb its nourishing parts and surrender it to the blood. Each of these villi has a fine canal, in which collects and moves forward the nourishing part, drawn from the chyme, which is called chyle (chylus~). These fine canals widen and forward the chyle to the mesenteric gland, and thence into the blood. The intestinum crassum, which is joined to the intestinum te7iue, is about half a metre long and contains no villi. At the juncture of these intestines is found a fold of mucous membrane, the valvula coli, which projects into the inner part of the intestine and leaves an opening for the passage of the chyme. The uppermost part of the intestinum crassum is called the ccecum. It represents a caecal pouch, which lies in the right under side of the abdominal cavity ; to this caecal pouch is attached a long, thick, hollow process, which is directly connected with the cavity of the ccecum, and which is called the vermiform process. The middle long part of the large intestine is called the colon ; its walls are thick and laced abundantly by diagonal folds ; according to its position it is divided into the ascending, transverse and descending colon. It leads THE LIVER AND GALL-BLADDER. 29 into the right side of the abdominal cavity in an upward direction, forms a curve under the liver, runs along the lower part of it, and below the stomach transversely to the left, descends on the left side of the abdominal cavity, and passes in the third part of the intestinum crassum into the rectum. The rectum has a very strong muscular stratum, and runs on the inner surface of the sacrum, downward and out. The further down the chyme descends the intestinal canal, the more is it deprived of fluidity and nourishing substances. In the intestinum crassum it has become firm and dry, and consists almost altogether of indigestible, insoluble and useless materials. The time for the passage of food through the whole of the digestive canal is fifteen hours. The intestinum tenue is not sensitive, the intestinum crassum, on the other hand, very sensitive (colic pains). THE LIVER AND GALL-BLADDER. The principal function of the liver is the preparation of the gall, a fluid highly important for the digestion of food. It is partly kept in position by a particularly strong sinewy ligament, the suspensory ligament of the liver, which is grown together with the diaphragm. The liver lies in the upper right side of the abdominal cavity, and that of an adult weighs about five pounds To the left the liver touches the stomach ; its upper surface lies on the diaphragm, its lower on the intestinum tenue, and particularly on the transverse colon. The liver is divided into several lobes by three furrows, two running to the left and one diagonal, which form the shape of the letter H. The diago- nal furrow is called the porta hepatica, because here enter the hepatic artery and the so-called portal vein. In the right longitudinal furrow the gall-bladder is situated ; in the left is a firm ligament, leading toward the navel. The right lobe of the liver is much larger than the left. The substance of which the liver is composed, is of a brown- ish-red color, very rich in blood vessels, and, in a transverse cut, appears divided into numberless lobules. In these small lobules, which consist of single smaller cells, hepatic cells, the gall is separated from the blood and conducted through small biliary ducts, which unite into larger and finally into one canal, the hepatic duct, to the gall-bladder or directly into the intestine. 30 THE HUMAN BODY. (I desire here to make a particular remark. I have already men- tioned that all blood, after having passed through the capillaries of an organ, where it has surrendered its nutritious qualities, is recon- ducted through the veins to the right auricle of the heart as venous, carbonaceous blood. This rule has but one exception. The blood which has afforded nourishment to most of the digestive organs, and particularly to those of the stomach, and partly also to those of the intestine, the pancreas, and the spleen, does not return directly to the heart, but collects in a large vein, which is called the portal vein, and which, entering through the porta hepatica into the liver, divides into fine branches. After they have diminished into capillaries and sur- round the hepatic lobules and cells as a close network, and after the gall has been segregated from them in the finest biliary ducts, the purified blood again collects in the hepatic vein, and is then recon- ducted to the heart. The blood of the hepatic vein has, therefore, to pass the capillaries twice ere it reaches the heart.) THE GALL. The gall-bladder of an adult, about eight or nine centimetres in length, is a pear-shaped membranous pouch, situated in the right longitudinal furrow on the under side of the liver, and serves as the reservoir of the gall. After the bile has been segregated in the liver, it is conducted through the so-called hepatic duct, a membranaceous canal into which the fine gall-ducts from all parts of the liver dis- charge, partly into the gall-blader, partly also directly through the ductus communis choledochus into the duodenum. The wall of the gall-bladder has smooth muscular fibres, which enable it (particularly during digestion) to contract, in order to effuse at least a part of the fluid into the duodenum and admix it with the gastric juice for diges- tive purposes. Bile is a very bitter, more or less thickish, green or brownish-yeliow fluid, particularly intended to digest fat and fatty substances, and to change them to such a condition that they may be assimilated with the blood. ABDOMINAL GLANDS. By the term glands generally it is intended to denote the formations, which, varying greatly in their structure as well as their function, have but few characteristics in common. They are distributed nearly all ABDOMINAL GLANDS. 31 over the body, are rich in blood, but possess few or no sensory nerves at all. Generally, glands represent various large oval formations, consisting of a great many blood-vessels and canals. The glands are intended to prepare certain humors and lead them by excretory ducts to the outside or into the cavity of the body, or to create in the blood or humors generally certain changes of admixture by an activity peculiar to them. The latter kind of glands have no excre- tory ducts. The glands are, therefore, divided into secretory and non-secretory. To the secretory glands (glands with excretory ducts) belong the mucous gland, sudoriparous gland, the sebaceous gland, the lachrymal glands, salivary glands, abdominal glands, also the hepatic glands, renal glands. To the non-secretory glands (glands without excretory ducts) belong the lymphatic glands, mesen- teric gland, the spleen, the suprarenal gland, thyroid gland, and tonsils. Glands are also divided into simple and composite glands. The simple glands consist of small, bottle-shaped depressions with few branches in the skin or mucous membrane, or in depressions with few branches, the wall of which is lined with small globules; they were mentioned already as mucous glands and sebaceous glands. The composite glands are larger than the before named, and have a dif- ferent and very complicated construction. Of these numerous glands we mention only the pancreas ; it is located in the upper posterior part of the abdominal cavity, diagonally on the posterior side of the stomach ; to the left it touches the spleen ; to the right it is sur- rounded, in the shape of a horseshoe, by the duodenum. The pan- creas consists of numberless reddish-yellow lobules, gland lobules, through the middle of which runs a canal (excretory duct of the pancreas), which receives the fluid, secreted in the single lobules, (gland juice), and conducts it into the duodenum. The juice of the pancreas mixes here with the chyme and bile and has no inconsider- able part to perform in digestion, having conjointly withj the juice of the salivary glands the task of digesting the starch and prepare it suitably for the food. The lachrymal glands, located at the external side of the cavities of the eyes, are about the size of a bean, and separate the lachrymal fluid, which is absorbed by the so-called lach- rymal points. The salivary glands prepare the saliva, of such great importance for the digestion of starch-containing food. Of these are 32 THE HUMAN BODY. distinguished, on each side, the two parotid glands, two sub-maxillary glands, and two lingual glands. The parotid glands are the largest ; they are placed flat under the skin (beneath the ear), at the posterior part of the cheek. The saliva prepared by them, is emptied through a thick excretory duct piercing the cheek into the cavity of the mouth. The sub-maxillary glands are about half the size of the parotid glands, and lie at the inner surface of the inferior maxilla. These, as well as the sub-lingual glands, which are of similar construction, effuse saliva by excretory ducts into the cavity of the mouth. Of the glands in the abdominal cavity, besides the salivary glands, the mesenteric glands should be particularly mentioned. They lie, enveloped in fat, in the mesentery, between the two laminae of the peritoneum, which attach the intestines to the posterior surface of the abdominal cavity. These glands are very vascular, oval in shape, of about the size of a lentil, and have an adducent and an excretory duct. The first admits the chyle absorbed by the intestinal villi from the chyme, and which has the color and consistency of milk, into the gland where it comes in intimate contact with the blood. An exchange of certain substances occurs here between the blood and the chyle, or milky juice ; and this refined milky juice is then forwarded through the excretory duct. A very similar system of fine ducts (canals) like those with which we have become acquainted in the intestine and mesentery, are found distributed over the whole body in nearly all organs. These fine canals are called lymphatic vessels, and the glands con- nected with them, lymphatic glands. It is for these lymphatic vessels to absorb the surplus of the nourishing juice, no longer necessary for the respective parts, which has been surrendered in the capillaries to the surrounding parts of the body, and to turn it over to the blood. The clear, pale-yellow juice in these lymphatic vessels is called lymph. The lymphatic glands, which are about the size of the mesenteric glands, also have an adducent and an excretory lymphatic duct. The whole of the lymphatic, milk and chyle vessels, through which the lymph and chyle flows toward the heart, similar to the blood in the veins, finally unite into two large canals of unequal size, the thoracic duct, which discharges into the subclavian vein, and the little lymphatic tube, which discharges to the right into the vein of the same name. Thus the blood is constantly Turbinated bon Septum narium partly cut through Ealx cerebri a fold of the dura mater through which tha right cerebral hemi- sphere "13 perceptible. Cerebrum Cerebellum Medulla ablongata 1 Cervical vertebra 2 Cervical vertebra (The spinous processes of the cervical vertebrae lie behind,and the body of th/ 1 vertebrae before;the spinal cord.) Spinal Cord 7 Cervical vertebra 1 Thoracic vertebra .(Esophagus Trachea (Esophagus (on passing through the) Diaphragm 12 Thoracic vertebrae (Art.renalis dextra) -t v Yena ren.' sinistra) Pelvic vertebra (Art.pancreatico duod) (Art.iliaca derrra) (Vena iliaca sinistra) 5 Pelvic vertebra Sacrum posterior, pelvic bona THE SPLEEN THE KIDNEYS. 33 supplied with nourishing juices. There exists a certain similarity between the lymphatic glands and the thyroid glands and tonsils. The former lie on both sides of the larynx; the latter, in the posterior part of the oval cavity, in two hollows of the soft palate. The ton- sils are two roundish glands of the size of a cherry ; they are without excretory ducts and very frequently the seat of inflammations. They, as well as the thyroid glands, appear to have certain functions in sanguification. THE SPLEEN. The spleen is one of the glands having no excretory ducts, lies in the upper side of the abdominal cavity at the outer side of the stomach, and is covered by the last four false ribs, and partly also by the diaphragm. The spleen weighs from one-half to three-quarters of a pound, and is of oblong-round shape. Its surface, facing outward, is smooth and convex, while that turned inward and lying against the stomach is concave. On this side enter and leave the blood and lymphatic vessels. The color of the spleen is dark violet ; it is some- what soft, and consists of numberless blood and lymphatic vessels. The external firm coating of the spleen is called capsule of the spleen. The spleen also is an important organ for the purification and prepar- ation of the blood, and it is highly probable that the red blood corpuscles are principally formed in the spleen, and are conveyed through the vein into the mass of the blood. THE KIDNEYS. The kidneys are two bodies lying on both sides of the upper lum- bar vertebrae, to the right beneath the liver, and to the left beneath the spleen. They are bean-shaped and of brownish-red color; enveloped in masses of fat, they are enclosed in a tight fibrous mem- brane, the renal capsule, which coalesces with the surface of the kidneys. The surface of the kidneys is smooth ; the edge lying out- wardly is convex, and that lying inwardly concave. The substance of the kidneys is very sanguineous, and is divided into the peripheric cortical substance, and the inner medullary substance. The medul- lary substance consists of a number of pyramidical cones of rays, having their broad base outwardly (toward the cortical substance^. 3 34 THE HUMAN BODY. and their point inwardly (toward the concave edge), which are composed of straight, stretched, uriniferous tubule and blood vessels. The uriniferous tubule are somewhat thicker than the capillaries, and form partly straight, partly serpentine, little canals, the inside of which is lined with a thin layer of delicate cells. The cortical substance is formed of numerous fine meandrous blood vessels and uriniferous tubule. In many places of the cortical substance the blood vessels and uriniferous tubule are interwoven, and form small round bodies (little canals) scarcely visible to the naked eye, in which the secretion of the urine progresses. The latter is then received by the winding capillaries of the cortex, conducted through the straight capillaries of the renal pyramids into the pelvis of the kidneys, a membranaceous, funnel-shaped pouch, lying on the con- cave side of the kidneys. Into this pelvis of the kidneys the urine flows by drops at the point of the pyramids, and descends from here through the ureters, two membranaceous tubes of about the size of a quill, into the urinary bladder. The latter represents a pear-shaped bladder, lying in the front part of the little pelvis, and consists of an exterior cellular membrane, a middle muscular membrane, and an interior mucous membrane. THE INNER ORGANS OF THE HUMAN BODY. THE DIGESTIVE ORGANS AND THE ORGANS OF THE VASCULAR SYSTEM. The interior of the trunk has two large cavities, the cavity of the chest and that of the abdomen. They are completely separated from each other by the diaphragm. The diaphragm is inwardly a flat sinewy muscle, firmly grown to the inner surface of the lower ribs and the vertebral column, and therefore forms a diagonal partition wall. Upwardly, toward the cavity of the chest, this muscle is dome shaped. By inhalation it flattens down, and the cavity of the chest is ex- panded. To prevent the creation of a vacuum, air must pass from the outside through the larynx and trachea into the lungs. In the neigh- borhood of the vertebral column there are several openings in the diaphragm for the passage of blood vessels and the (Esophagus. The cavity of the chest, as well as the cavity of the abdomen, is thoroughly THE INNER ORGANS OF THE HUMAN BODY. 35 lined with a thin, delicate, bluish-white, sinewy, firmly adhering membrane, which is called pleura in the cavity of the chest, and peri- toneum in the cavity of the abdomen. These membranes, which be- long to the so-callCd serous membranes, secrete on their surface a small quantity of moisture, or serum, for the purpose of keeping the surface of the organs enclosed in the cavities pliant and to prevent friction. The pleura covers the inner surface of the cavity of the chest, and at the roots of the lungs turns over to the lungs themselves ; it is firmly grown together with the surface of these organs. Both pleura and peritoneum are greatly inclined to inflammation (peritoneal inflam- mation and pleurisy) ; in the same manner all the abdominal viscera (stomach, intestine, spleen, kidneys, liver) are wholly or partly covered with the peritoneum. It furthermore forms two great folds, consisting of several layers lying on the intestine ; these folds are interjected with fat, and constitute a projecting and warming cover- ing for the abdominal viscera. These flat, protecting folds of the peri- toneum are called the great and small net. The peritoneum next covers the inner surface of the abdominal walls, continues in a side- ward direction toward the vertebral column, passing there from the posterior abdominal walls to the surface of the intestines, forms there two peritoneal duplicatures of different lengths, a sort of pedicle, con- sisting of two peritoneal laminae, by means of which, on the one hand, a moderate locomotion is permitted to the bowels, while, on the other hand, an invagination of the same is prevented, which, without this arrangement, would necessarily follow. This peritoneal duplica- ture, which has numerous glands (mesenteric glands), is called mesen- tery. In a diseased state this fluidity is segregated in large quantities, and the result is dropsy of the chest or bowels. Another, no less important kind of membrane, found very extensively in the human body, is the mucous membrane. They are thin, vascular, membrana- cous layers, consisting of several long, small cells, which line the inner surface of most of the canals and cavities, excepting the blood vessels, and secrete a mucous substance (mucus) on their surface. The mu- cous membranes are provided everywhere with small indentations, scarcely visible to the naked eye, called mucous glands, and which must be particularly considered as the organs for the secretion of mu- cus. The mucous membranes are intended to keep the inner surface 36 THE HUMAN BODY. of the canals moist and lubricated. The slime, secreted by the gas- tric mucous membrane, and the intestinal mucous membrane, has an important function to perform in the digestion of food. THE LARYNX. The larynx lies behind and under the tongue in the middle and anterior part of the throat, before the cervical vertebrae, and consists of a cartilagenous substance, and forms the enlarged entrance to the trachea. All the air inhaled or exhaled must enter or make its exit through the larynx. It has a funnel-shaped ring form, and consists of different cartilages, connected with each other through mucous membrane and tissues. The largest piece of cartilage it contains, which is the so-called Adam's apple, and may be felt under the skin of the throat, and which visibly moves in swallowing, is called the thyroid cartilage ; under this is the cricoid cartilage. On the upper posterior edge of the latter are the arytenoid cartilages, and on the anterior upper edge of the thyroid cartilage the larynx is fastened with a small stem, representing a thin, heart-shaped plate, cartilagi- nous on its inside, which closes the entrance to the larynx as soon as food and drink has passed over the larynx into the oesophagus lying immediately behind it. In the interior of the larynx, in its wall, lie horizontally, from the anterior to the posterior part, vocal cords, of which there are two upper ones, and closely under them two lower ones. They represent folds of mucous membrane, stretched from the anterior surface of the thyroid cartilage to the arytenoid cartilage. The vocal cords of the right and left side have between them a trian- gular, oblong slit, which is called the glottis. The larynx serves the purpose of producing the voice, the height or depth of which is the result of the number of vibrations of the vocal cords. To pro- duce a sound, the glottis is contracted, the vocal cords expand and receive vibrating motions from the air pressing against them. The mucous membranes are found in the digestive canals (in the mouth, oesophagus, stomach, intestine), in all air passages (larynx, trachea, lungs), in the excretory ducts of the glands, in the gall-bladder. If, in a diseased state, this fluid is secreted in unusually large quantities, as is the case in inflammations of the mucous membrane, it is called THE FAT STRATUM THE MEMBRANE. 37 catarrh (catarrh of the lungs, nose, head, larynx, eyes). In croup an inflammation of the mucous membrane of the larynx occurs, in con- sequence of which a coagulating fluid is secreted, and not mucous, as is the case in catarrh of the larynx. The membranes which form in consequence thereof (croup membranes), contract the glottis and cause the dangerous attacks of suffocation and croup in children. A similar action occurs in diphtheria. The trachea lies in the middle of the throat and runs downward. ■ It consists of from seventeen to twenty cartilagenous rings, connected by a membrane, lying over each other, and open in the posterior part ; the back part of the wall is formed by a muscular membrane. Towards the lower part the trachea divides into two great branches, of which one ramifies in the right and the other in the left lobe of the lungs. THE FAT STRATUM. Between the skin and the muscles of even moderately fed people is found a stratum of fat of more or less thickness. It is formed of small globules, which can be seen only by the aid of the microscope. These globules are embedded again in a connective tissue (a network of fine sinewy threads), which connects the skin with the muscles lying on the surface. Fat differs from the substance of the muscles and the other component parts of the body, inasmuch as it contains no nitrogen. The stratum of fat serves as a cushion for the underly- ing parts, rounds off the limbs and gives them shape, and being a poor conductor of heat, it protects the body from catching cold. If the body cannot receive the necessary nourishment by food and drink, as is the case, for instance, in severe sickness, the fat undergoes a process of liquefaction, which is absorbed by the blood, and thus the body is nourished. THE MEMBRANE. The external membrane, which forms a protecting cover to the body, and is also the seat of the sense of touch, and which mediates the secretion and absorption of certain matter, is formed of three layers from the exterior to the interior surface ; they are the epider- mis, the mucous layer, and the corium. Underneath the last is the fat stratum, which, as before mentioned, connects the external mem- 38 THE HUMAN BODY. brane with the muscles. The epidermis consists of dried-up, trans- parent, horny laminae, piled in close layers ; the uppermost layer of which is easily removed in washing by rubbing. It has neither vessels nor nerves, and shows on its outer surface fine openings, the excretory ducts of the sudoriparous and sebaceous glands. The mucous layer lies under the epidermis, between the latter and the corium. It forms a thin layer and consists of soft, extremely delicate and small globules. The corium varies in strength in different parts of the body, and is very vascular, and very full of nerves. It forms on its outer surface, facing the mucous layer, numerous small protuberances, tactile papillce. In these end the sensitive nerves, and they must therefore be con- sidered important organs for the sense of touch. The tactile papillce and the indentations lying between them are covered everywhere by the mucous layer. In the deeper layers of the corium are located the sudoriparous and sebaceous glands, the excretory ducts of which lead outward. The sebaceous glands secrete a suety substance, which keeps the skin soft and pliable ; they lie nearer to the surface than the sudoriparous glands. The sudoriparous glands secrete the perspiration; they are ball-like tubes lying in the lower strata of the corium. A corkscrew-shaped duct leads the secreted fluid or perspiration to the surface of the skin. THE HAIR. The hair represents fine threads of various colors and lengths ; it is divided into the hair-shaft (scapus), which is the part growing above the level of the skin, and the hair-root (radix pili), the lower part of which expands into the bulbus pili. The two last parts are inserted in a canal, extending into the corium, in which the excretory ducts of sebaceous glands have their outlet. The external stratifications of the hair-shaft consist of honey, transparent lamince, or cells grown to each other. The interior contains a layer of succulent, colored cells, which impart to the hair its various colors. If these dry up (die), the hair turns gray and white. The nourishing of the hair proceeds from the lowest part of the bulb, where there is a small vascular knob full of nerves, which supplies the cells, lying in the interior, with food. THE GENITALS OF WOMAN, THEIR CONSTRUCTION AND LOCATION. The vagina is a tubular cavity extending to a finger's length from the entrance of the vagina to the pelvis. The vagina is lined with a process of the mucous membrane. Its anterior and posterior walls are lined with tight folds, running diagonally, which, however, become smooth from copulation and parturition. In a reposing posi- tion the anterior wall lies close up to the posterior. The vagina cf a virgin is pretty tight ; copulation, and still more parturition, expands it considerably. The uppermost part of the vagina is ca\\t(form x vagina; the lower section of the womb reaches down into it trom above, in a conical shape, and which therefore is called the vagina] portion of the womb. The womb lies over the vagina in the process of the guiding line of the pelvis, in connection with the vagina and the other parts to be described hereafter. In form it is a somewhat pear-shaped, firm, fleshy body, flattened from the front to the rear part, three inches long, two inches wide on the upper side ; that of a virgin weighs from one to one-and-one-half ounces. It has an anterior and posterior face, two side edges and the upper edge, the base of the womb. The womb is hollow. The canal of the neck of the uterus leads through the neck of the uterus ; in the corpus uteri lies the cavity of the uterus. The canal of the neck of the uterus opens into the transverse fissure between the anterior and posterior labium ovis uteri, through the exterior mouth of the womb into the vagina, and above through the inner mouth of the womb into the cavity of the uterus. The cavity of the uterus is curved, triangular ; the lower e'dge of it lies on the interior os uteri, and the two upper ones at the sides of the fundus uteri. The mucous membrane of the vagina continues over the vaginal portion of the womb, through the os uteri and neck canal, into the cavity of the uterus. On both sides of the fundus uteri the (39) 40 THE GENITALS OF WOMAN. oviducts (fallopian tubes) branch off to the right and left, two slender, long tubes, four inches long, which are pierced by a fine process of the cavity of the uterus, and lined by a process of the mucous membrane ; its ends enlarge in the shape of a trumpet. At the trumpet-shaped en larged end, the wall of the oviducts ends in fringes ; its cavity here opens into the abdominal cavity. On both sides of the womb, a little further to the rear and downward, also lie the two ovaries, almond- shaped bodies, containing numerous small globules, some as large as a pea, which contain the ova. The ovary ligament runs on each side and towards the rear of the ovary and the womb; the round uterine ligament runs on each side in a curve toward the inguinal region. These ligaments, ovaries, and also the oviducts, are enclosed in the broad ligaments, which run, one on each side, from the side edge of the corpus uteri to the inner side of the wall of the pelvis. The womb is fastened in its position, without, however, becoming immovable, partly by means of these ligaments, partly by being affixed to the fornix vagince, particularly, however, by a strong, sinewy membrane, which lines the whole inside of the pelvis. Beside the previously described sexual organs, the pelvis of the woman contains, of important parts, the rectum and the urinary bladder. The rectum, the terminal part of the intestine, through which passes the excrement, lies behind the vagina and the womb ; its upper section does not lie in the middle, but passes mostly to the left near the promontory. The urinary bladder into which the urine, prepared by the kidneys, flows through the urethra, lies before the vagina and the womb. The position of the womb varies in accordance with the expansion of the rectum, the vagina and the bladder, and also in accordance with the variation of the downward pressure of the other intestines. In childhood the sexual organs have no per- ceptible occupation ; they are nourished and grow, slowly, how- ever, with the other parts of the body. Although the whole of the sexual organs are lined inside with mucous membrane, the secretions on the same at that age, and in a healthy state, are so small that no humidity passes outside. At the time when the body has nearly attained its full growth, generally in the fifteenth year, the sexual organs attain maturity rapidly. Externally it is observable by the enlargement and fullness of the great lips of the pudenda, the growth THE GENITALS OF WOMAN. 41 of hair on the mons veneris, and the enlargement of the bosom. The interior parts develop correspondingly to greater fullness ; they attain the size of those of an adult woman. In the ovary the heretofore undeveloped ovse become ripe. When the first ovum in the ovary has become ripe, the first hemorrhage from the sexual organs occurs, which menstruation repeats itself in most girls and women at regular intervals, every three or four weeks, usually every twenty-eight days. The first hemorrhage transforms the child into a maiden ; she has reached the age of puberty. With most women and girls some pains precede or accompany the commencement of the hemorrhage ; they experience a general feeling of weariness, and pain in the lumbar region and the thighs ; the genitals grow warmer and softer ; mucous secretion increases, to which hemorrhage is added. The hemorrhage, which proceeds from the mucous membrane of the womb, lasts gener- ally from four to five days ; in some persons the duration of the hemorrhage is only from one to two days, whilst in others it may extend even to seven, eight or nine days. The quantity of the dis- charged blood is estimated at from three to five ounces. The hemor- rhage ceases gradually as the blood becomes watery again and some mucous admixes with it, and then the secretion ceases. The quantity of blood, the duration of the hemorrhage, and also the intervals of time, and the time of its first manifestation, vary very much in different women. These variations from the rule, if women feel well, do not indicate disease. If, however, the hemorrhage does not appear at the regular time in a girl, although the pains and weariness have manifested themselves, or fails when it has previously already shown itself, or if the weariness and pains are greater and of longer duration than usual, if urinary difficulties and constipation are added to it, or if the blood passing away is cloggy instead of being liquid, or if the hemorrhage is much more violent, or is more frequent than usual in the same person, or if a woman has, out of the regular period, uncomfortable feelings in the pelvis, and she is not free of dis- charges from the sexual organs, then disease is the cause of it. At the time of menstruation, women must be more careful than usual ; they must beware of colds, overheating, and violent emotions ; they are more susceptible of sickness at that time. The periodical returns last, with the interruptions from pregnancy and child-nursing, gen- 42 THE GENITALS OF WOMAN. erally to the forty-fifth year, sometimes less, sometimes more. There- fore, during that time only, that is for about thirty years, a woman may become pregnant, because during this time only ovce capable of being impregnated can be developed in the ovary. As a rule, gener- ally about the time of the monthly period an ovum leaves the ovary, passes through the oviduct into the womb, and if not impregnated, makes its exit imperceptibly through the vagina. DISCONTINUANCE OF MENSTRUATION. In most women menstruation ceases without resulting in sickness. Sometimes, however, the previously mentioned diseases make their appearance at about the time when the change of life occurs, or the hemorrhages are renewed, after having been discontinued for a longer period. Even at that time permanent diseases may be developed from that condition, if medical aid is not sought for in season. With the discontinuance of menstruation from age, the activity of the ovary ceases, and the genitals return to a condition similar to that of child- hood. PREGNANCY. Pregnancy is the condition of the woman produced by the impreg- nation of the ovum, and continues to the time when the foetus, result- ing from the ovum, leaves the womb, that is until delivery. Through cohabition of man and woman, copulation, the semen of the man is injected into the genitals of the woman ; if it mee,ts in the womb or oviduct a ripe ovum which has been released from the ovary, it is impregnated by it, the woman has conceived, and from that moment pregnancy commences. This is more apt to be the case soon after menstruation, because at that time it is more likely that the semen will impregnate a descending ovum. It is also possible, however, that the semen, injected previous to menstruation, retains its generative power until the next ovum leaves the ovary, when it may become impreg- nated. . The duration of pregnancy is about two hundred and eighty days, that is nine calendar months and from four to seven days, according to the number of days in each month ; two hundred and eighty days are equal to ten times twenty-eight days, or ten times four weeks, or forty weeks. The two hundred and eighty days of preg- nancy have been divided into ten periods of four weeks each, because a DEVELOPMENT OF THE OVUM. 43 better record can be kept of incidents. Some call these four-weekly periods of time months ; the duration of pregnancy, according to that, would be ten months. Physicians and midwives should possess this information, in order not to be misled by calculations. Ten cal- endar months are three hundred and three to three hundred and six days ; ten lunar months (from full moon to full moon ) are two hundred and ninety-five days. The duration of pregnancy of a woman is two hundred and eighty days. DEVELOPMENT OF THE OVUM. At the time when menstruation is to occur, the mucous membrane of the womb becomes much thicker than usual, more sponge-like. If the ovum does not become impregnated, this quality of the mucous membrane of the womb disappears again. If the ovum is impreg- nated, however, it affixes itself to the sponge-like mucous membrane, which grows over it altogether. The ovum now grows, taking its nourishment from the mucous membrane ; the mucous membrane be- comes thicker and more enlarged, the cavity of the uterus widens and its wall becomes thicker. In the ovum itself the new being springs into existence (foetus). The impregnated ovum has passed through the oviduct into the cavity of the uterus, the thickened mucous membrane has grown over it ; the ovum is now four lines long ; the walls of the uterus have become thicker ; the canal of the cervix uteri contains a viscid, clear mucus, segregated by the mucous membrane. At the expiration of four weeks, the ovum, which in the ovary measured only the tenth part of a line, has grown to the size of ten lines (two-thirds of an inch). Its external membrane is covered all over with soft flakes, which bury themselves in the mucous membrane of the uterus, which, for that reason, is called the flake membrane, subsequently the corium. The mucous membrane of the uterus, which henceforth remains attached to the ovum until it is delivered with it, is called sieve membrane, on account of its perforated appearance. It sur- rounds the ovum in two layers, of which one lies against the wall of the uterus, while the other has grown around the ovum. In the interior of the flake membrane, or corium, is a second delicate membrane, the hyaloid membrane ; it is filled with the liquor amnii, and floating in it adhering to the hyaloid membrane, is the foetus, which, being at this time 44 THE GENITALS OF WOMAN. one-third of an inch in length, has not the shape of a human being, recognizable with the naked eye. The foetus has grown to the length of one-half of one inch at the end of six weeks. It has assumed human shape ; it no longer adheres, as at first, closely to the hyaloid membrane, and from its abdomen extends the umbilical cord (navel string), through the hyaloid membrane to the corhcm. The umbilical cord, which remains only until birth, consists of three blood vessels ; of these, two lead the blood from the heart of the foetus into the flakes of the corium, therefore to the wall of the uterus ; they are the two arteries of the umbilical cord. In the wall of the uterus flows the blood of the mother. From the blood of the mother nourishment passes through the coats of the veins into the blood of the foetus. The third tube of the umbilical cord conducts the blood with its nourishment back to the foetus ; that is the blood vessel of the umbili- cal cord. In this manner the foetus receives nourishment during • pregnancy. Menstruation ceases during pregnancy. In eight weeks the ovum has grown to the size of two inches. The uterus is also enlarged, and. its triangular-shaped cavity has rounded off. After twelve weeks the uterus and the foetus have grown considerably ; in the spot where the ovum lies, up to the original mucous membrane of the uterus, the flakes continue to increase both in number and size, and the vessels of the umbilical cord ramify in them. In the mucous membrane of the uterus of this spot, larger vessels develop themselves from the mother, with which the vessels of the foetus in the flakes ramify, in such a manner, however, that the blood of the mother and child cannot flow together. This formation of ramified vessels, which lies against the wall of the uterus, and in which the umbilical cord buries itself, is the source from which the foetus draws its nourishment ; it is called placenta uterinoz, also placenta fmtalis ; from the placenta the umbilical cord extends to the foetus. The hyaloid membrane lines the corium internally. Where the umbilical cord goes to the placenta, it passes over the vagina funiculi umbiiicalis. The hyaloid membrane is filled with the liquor amnii, and in it lies the foetus by the umbilical cord. In sixteen weeks the foetus, with outstretched legs, is five inches long and weighs three and one-half ounces. The umbilical cord has twice to three times the length of the foetus; the liquor amnii is abundant ; the sex of the foetus is scarcely dis- DEVELOPMENT OF THE OVUM. 45 tinguishable, because in the male foetus the scrotum has closed. After twenty weeks the foetus has attained the length of ten inches, and weighs about ten ounces ; little fine hair covers its mem- brane, which secretes a white mucilaginous substance, and with which it is covered ; the liquor amnii has again considerably increased ; the foetus had already previously made motions in this water, but only now is it enabled to move its grown limbs with sufficient force to en- able the mother to perceive it. After twenty- four weeks the foetus is twelve inches long and its weight is one pound ; the woolly hair has become much more abundant. In twenty-eight weeks the foetus is fourteen inches long, and weighs from two to two and one-half pounds ; its limbs have greater rotundity, and are fatter than hereto- fore j the scrotum of the male foetus is generally still empty. Its vital parts have developed to such an extent, that, if born at this time, it is sometimes possible to keep it alive, which would have been impos- sible previously. In thirty-two weeks the foetus is at least seventeen inches long, and it weighs up to five pounds ; the woolly hair is less abundant than before, while the hair of the head has grown larger and has become colored ; both testicles are generally in the scrotum. Pregnancy terminates in forty weeks, and the foetus has its full growth; it is now called mature. Its length is now at least eighteen inches, and it weighs, on an average, from five to seven pounds, frequently, however, more. The color of the skin of the mature child is light red, a trifle redder than that of an adult ; the skin of the child not matured is of a very red color, with a bluish tint. The woolly hair of the mature child has mostly fallen out, only on the shoulders it is still to be seen ; the hair of the head is abundant and colored ; it has eye- brows and eyelashes. The child not matured has a great deal of woolly hair on its body ; the hair of the head is thin, and the same is the case with the eyebrows and eyelashes. The nails of the mature child are pretty firm and extend generally over the points of the last joints ; in the one not mature the nails are softer, more transparent and shorter. The scrotum of the mature child is somewhat redder than the other parts of the skin, corrugated diagonally, and contains in its bottom the testicles ; in the one that is not mature it is redder, less corrugated, nearly smooth, and does not as yet contain the testi- cles, or they lie at the root near the inguinal region. The great lips 46 THE GENITALS OF WOMAN. of the pudenda in the mature child are mostly large enough to cover the small ones and also the clitoris ; in the one not mature the little lips of the pudenda, with the clitoris, frequently project from the large ones. The body and limbs of the mature child are round and plump ; its motions, particularly its stretching motions, vigorous ; in the one not mature, body and limbs are thin, motions weaker, and the child keeps its lower limbs drawn up to the abdomen. The voice of the mature child is clear and strong ; the not mature child whines with a weak voice. The chest of the mature child rises uniformly in breath- ing a ad remains round; that of a not mature one remains small and projects in a forward direction. Ears and nose of the mature child are firmly cartilaginous, although softer than those of an adult ; in the one not mature they are soft. The face of the mature child is in proportion to the skull, as in the adult ; that of the one not mature appears smaller, the skull larger, and the former often has a wrinkled and crabbed look. The seams in the skull of a mature child are close together, the great fontanel stands open quadrangularly several lines ; the three bones of the small fontanel lock together closely, so that no opening, except the three joining seams, can be felt ; in the child not mature the seams are broader, the great fontanel larger, and the small one may be distinctly felt as an opening between the bones. The weight of children greatly varies, and is an unimportant evidence of their maturity. There are mature children of four pounds weight, others weigh ten or twelve pounds, and sometimes a little over that. Children weighing ten pounds when mature, were already heavier before maturity than others ; children born before maturity may, therefore, also be of considerable weight. The tallness of children also shows considerable variation ; there are mature children of eighteen to twenty-two inches, or more, in height, and yet the height of the child is not only the surest indicator at previous periods of the age of the foetus, but it is of all signs also the most important as to maturity. A child measuring eighteen inches or more is mature, if it does not at the same time lack several of the mentioned signs of maturity ; a child measuring less than eighteen inches is not mature, unless it possesses all previously mentioned indications of maturity. PREGNANCY AND ITS INDICATIONS. 47 PREGNANCY AND ITS INDICATIONS. The indications produced by pregnancy are divided, according to the value which they have for the recognition of pregnancy, into positive and doubtful symptoms. The uncertain symptoms are deduced partly from the general state of the health of the woman, partly from those changes in the genitals which permit an early pre- sumption of pregnancy. The positive symptoms arise from the child itself, and are added to the other indications only about the middle period of pregnancy. Very frequently a general weakness (nausea) manifests itself already at the time of the conception, or rather a few hours or days thereafter, which sometimes increases to vomiting, par- ticularly in the morning before breakfast, when water and mucus are thrown off. An aversion to the customary food, and an appetite for unusual things manifest themselves; contrary to the habits of the woman, she becomes costive or suffers from diarrhoea. With some the urine shows a darker color, and again with others it is yellow and muddy ; with some the discharge of the urine is connected with great difficulties, and a very painful and frequent bearing-down pressure. The following must be set down among the doubtful evidences of pregnancy : a change in the lineaments, dark spots in the face and other places of the skin, dark rings around the eyes, eruptions of the skin, change of temper, headaches, debility, palpitation of the heart, toothache, bleeding of the nose, swelling of the legs, varix on the same, swelling of the abdomen (with raising of the navel and dark lines on the abdomen), enlargement and tightening of the breasts, particularly with a darkening of the brownish areola mamoe, and a swelling of its glands, perception and consequences of the pressure of the enlarged uterus on the urinary bladder and rectum, difficulty in breathing, restlessness, particularly at night, cramp in the calves of the legs and thighs, difficulty in retaining the urine, hemorrhoidal difficulties, heart-burn, and many other symptoms. All these symptoms, however, may be the result of some other cause, and the woman need not be pregnant ; and again these symptoms may all be wanting, and yet the woman be pregnant. So long as the presumption of pregnancy is unsupported by clearer indications, there is reason to suspect that the named symptoms are caused by disease. If the woman has been 48 THE GENITALS OF WOMAN. pregnant before, and the beginning of pregnancy has previously been accompanied by the same disturbances of health which again manifest themselves, the presumption of pregnancy gains strength. The dis- continuance of the periodical menstruation may result from concep- tion, or from cessation of virility by age, or from other diseases ; but if the periodical menstruation ceases in a perfectly healthy woman, in her virile years, it is probable that she is pregnant. The changes of the breasts, as described, also make it probable that the woman is pregnant. This indication is of greater significance in a woman who has never been pregnant, than in one who has already nursed a child. All the changes of the abdomen, as remarked, even the uterine sound, may be the result of pregnancy, but also of a diseased condition. Some of the indications, such as the elevation of the navel, or the lines on the abdomen, may not show themselves until the regular close of pregnancy. The uterus or some other part may, by disease, swell in the abdomen, and have all the appearance of an uterus in a pregnant state. The changes in the vaginal portion of the uterus may be produced in a similar way, as in pregnancy, by a filling and enlargement of the uterus. Therefore, all the mentioned indications that may be felt, seen or heard around the abdomen of the woman, are not sure indications ; they point to a probability of pregnancy, because all those diseases are of rarer occurrence than pregnancy, and it increases the probability, if other evidences of disease, such as pain, bleeding, emaciation, do not make their appearance. They become almost a certainty, if a continued observation demonstrates, that all the named changes in the uterus appear in the same order and succession of time as in regular pregnancy. Diseased conditions, not easily dis- tinguished from pregnancy, seeming pregnancy, and strange forma- tions contained in the uterus, have been called false pregnancy, which is not the correct expression, however. The woman is either preg- nant or sick. If the woman complains of pains indicating disease, or if the midwife, on examination, discovers that all parts are not in regular condition, it is her duty to direct the woman immediately to an accoucheur. The woman may perhaps have a disease which is still curable, but which in a few weeks may be past cure ; or if the woman is perhaps pregnant and sick at the same time, and if her dis- ease does not at once receive proper treatment, an interruption of CHILDBIRTH. 49 pregnancy, the certain death of the child, and great danger and long suffering for the mother is impending. CHILDBIRTH. Birth is the event when the fcetus leaves the mother and pregnancy ceases, and is also called confinement or delivery. Delivery may occur at any time of pregnancy; it may not occur at all, of which we will speak hereafter. According to the time of delivery, it is called miscarriage or an untimely birth, which occur with the first twenty- eight weeks of pregnancy. The child at such time cannot live out- side of the mother's womb. Premature births are those where the child may be able to live, but has not arrived at maturity, that is, from the twenty-ninth to the thirty-ninth week of pregnancy. Seasonable births are those where the mature child is born at the expiration of forty weeks. Rarely a birth occurs after the expiration of forty weeks ; it is generally a miscalculation on the part of the woman, or she may have deceived herself or has been deceived. The natural expulsion of the fcetus is effected principally by pains, that is, by contractions of the uterus; they are involuntary and generally connected with violent pains, hence the name. Besides the pains, expulsion may be aided by abdominal pressure, straining, or the diges- tion of the pains, a compression of the abdomen with restrained breath, as in the case of severe costiveness ; aiding by the means indi- cated, depends partly on the will of the woman. The vagina is, like the uterus, also subjected to involuntary contractions ; the effect is of little consideration in seasonable births. The pains are intermissive, and the period between two pains is called the pain-rest. The labor causes a violent pain, extending from the loins to the region of the pubis. This pain is light at first, increases gradually until it becomes very violent, and then ceases by degrees. In the same manner the contractions of the uterus are light at first, they then become very powerful, and again decrease gradually. These contractions can be felt through the hardening of the uterus by laying on the hands. When the uterus contracts, it assumes a rounder shape, and as it can- not expand to the rear on account of the lying-down position of the woman, it, so to say, raises up in the front part of the abdomen with 50 THE GENITALS OF WOMAM. every contraction, as may be distinctly felt. During the pain the pulse of the woman is generally more rapid, and when the pain ceases, it beats more slowly again. The pains at the commencement of the labor are not so frequent, of short duration, and not severe ; but as the labor progresses, they become more frequent and more severe and violent. As the labor, towards the close of the delivery, is of the greatest severity, the pain accompanying it does not confine itself any longer to the regions of the loins and pubis, but extends to the hips, thighs, and frequently to the legs. To this is added a feeling of pressure, as if for evacuation and urinating, the straining becomes involuntary, the woman reaches a great state of excitement, her face becomes red and hot, she perspires, trembles, moans or screams from pain, and not unfrequently vomiting sets in. Corresponding with the pains and the result of the progress of the labor, the latter is divided into three periods, from which the pains have received their names. The delivery is divided into three periods : first, the opening of the mouth of the womb ; second, the ejection of the child ; third, the ejec- tion of the after-birth, and in accordance with this the labor pains are of three different kinds. Aside from this, there are pains previous to birth and other pains after birth, so that in fact there are five kinds of labor pains. The first are premonitory pains, they occur at the time when the uterus lowers itself, that is during the last three or four weeks of pregnancy ; at first, at rare intervals and very moderately, and in the last days more frequently and harder. There are intervals of one or more days. Women with their first child feel them more severely than those who have already borne children ; in the latter they almost disappear. During this time, and by means of the premonitory pains, the last part of the vaginal portion in women with their first child passes away; in those who have been repeatedly pregnant, the already opened canal of the cervix uteri shortens. With both, the vagina becomes soft, wide, hot and slippery through the increased secre- tion of mucus ; the external genitals also become generally softer and wider. The second kind of pains are the preparatory or opening pains, also called water pains. Their commencement marks the beginning of birth, it is the parturition of labor. These pains, as well as the con- tractions of the uterus, are more violent and of longer duration than those of the premonitory pains, they come at less intervals and more CHILDBIRTH. 51 regularly, the rests are also shorter, mostly not extending over a quar- ter of an hour. In rare cases there is an absence of pain at the com- mencement of labor, or it is insignificant. As the contraction in the fundus uteri during the regular pains is always greatest, so every part of the uterus is drawn thereby in the direction of the wall of the uterus to the basis. By the opening of the mouth of the womb, an always larger part of the ovum in the mouth of the womb becomes uncovered ; a still larger part of the ovum becomes loosened from the wall of the uterus, because the latter, in drawing upward, moves away from the ovum. But as the sieve membrane, which is the mucous membrane of the uterus, remains attached to the ovum, a little bleed- ing must occur by this loosening from the uterus ; the blood is ad- mixed in fine stripes with secreted mucus. This little bleeding which accompanies the opening of the mouth of the womb is called " the commencement of the delivery," as by the contraction the space of the uterus diminishes itself, the amnion enters the mouth of the womb with each pain, and thus assists in its enlargement. The projection into the womb of the membranes ovi filled with the liquor amnii, which occurs with each pain, is spoken of as " the amnion arranges itself." When the pain has passed, the womb again expands, and the amnion relaxes ; but when the mouth of the womb is completely opened so that a small edge may be felt in the anterior part and sideward on the walls of the pelvis, then the womb remains smaller when the pain has passed, and the amnion remains expanded and is ready to burst. With the next severe pain the amnion bursts, and the first liquor amnii is discharged. This closes the first and opening period of delivery ; it must be noticed, however, that it is not the discharge of the liquor amnii, but the complete opening of the mouth of the womb, that marks the close of the first period of delivery. If the progress is irregular, the amnion may burst sooner or later. The pains either 'manifest themselves immediately with increased severity, or after a lapse of one-quarter to an hour's time ; this is the second period of delivery, and are called the forcing pains, because they force the child in and through the pelvis. These pains contract the womb just like the opening pains, strongest at the base, and as the lower edge of the womb, after a complete opening of the mouth of the womb, cannot be drawn up any higher because it adheres to the pelvis, the fundus utert 52 THE GENITALS OF WOMAN. and with it the child, must move downward. The forcing pains ex- cite still more than the opening pains did that feeling of straining which inexperienced mothers consider to be a strong desire for alvine evacuation, this feeling of straining incites the woman in labor to assist ; she seeks firm supports for her arms and legs, suppresses her breath ; she works up the pains. When the child's head, in its greatest cir- cumference, is embraced by the lips of the uterus, it is said to be " in the crowning;" when it has reached the bottom of the pelvis, it presses the perinceum frequently with each pain in the anterior part and below; it is said, " it presses down;" it then makes its appearance between the distended lips of the pudenda. To the labor pain is added the violent pain of the distention and tugging of the external genitals by the pressure of the head. This pain increases the labor pain, and induces the woman to increased efforts and involuntary straining, which sometimes causes the limbs and the whole body to tremble ; for that reason these forced pains are also called tremulous labor pains. Each of these tremulous labor pains forces the head with more violent pain further into the rima pudendi. During the pause in the labor pain, it recedes at first to a greater extent, which, however, lessens by degrees, into the amnion, until it finally remains in its large circumference in the rima pitdendi ; it is cutting through. The follow- ing labor pain forces it, with violent pain, past the perineum, it has cut through. A short pause of pain and labor ensues, when the rest of the body is forced out by one, or, at most, a few labor pains, followed by the rest of the liquor amnii, the so-called second water. With this the second term of delivery, the ejecting period, closes. The whole uterus has become smaller by contraction, the place where the placenta was fastened, becomes also smaller. The placenta can no longer contract, and for that reason it was now partly separated by the contraction of the uterus from the wall of the latter. This is necessarily connected with bleeding. Bleeding, therefore, generally immediately follows the ejection of the child. The third term of de- livery now begins, the period of after-birth. The uterus may now be felt as a hard, roundish body through the relaxed abdominal cover- ings, above the os pubis, and extending to the neighborhood of the navel. The placenta, the membranes ovi, and the uterine end of the umbilical cord, the whole being called the after-birth, still remain in CHILDBIRTH. 53 the uterus The ejection of these things from the uterus is effected by new contractions of the same, the after-birth pains, which, like the former, may be plainly perceived by the midwife, but which often are not at all felt by many in labor, particularly, however, by those who are delivered for the first time. During each of these after-birth pains some blood is discharged ; this blood comes from the great blood vessels of the uterus, which must tear. While the placenta is entirely separated by these labor pains from the wall of the uterus, which ejects the loosened placenta with the rest of the membrancz ovi, and the collected blood, mostly in a state of coagulation, the uterus wall becomes smaller. The walls of the great blood vessels are pressed together by these means, and their openings closed, so that the bleed- ing generally discontinues of itself, or at most it is but very little. When the after-birth has left the genitals of the mother, the delivery is finished. The woman is now said to be "lying in." The uterus continues to contract from time to time for several days, and diminishes thereby; these contractions are particularly felt by women who have been in childbed before ; they are called after-pains. The woman should continue in the room in which she was confined until her complete recovery. The room should therefore be high, dry, light, and removed from the noises of the street and the house. The sunlight must be excluded ; it must be properly lighted at night, and in cool weather the temperature should be main- tained at fifteen degrees (R). The air must be pure, and all strong scents, both pleasant and unpleasant, must be removed. The con- finement bed should be the same bed in which the woman usually rests. The bed upon which she lays should possess a certain firm- ness ; a mattress, or straw mattress, is suitable ; soft, yielding feather beds are unsuitable. The foot-board of the bed should be arranged so as to afford support to the feet. To afford a hold for her hands, which will be a relief during the subsequent stages of her labor pains, a cord, or towels, should be tied firmly to the under part of the head- board, the ends of which she may take hold of. The bed must be prepared in such a way that her body may comfortably rest upon it in her customary way ; in what cases a certain position of the woman to be confined may become necessary, will be given hereafter. Over the bed-sheet an oil-cloth, or other water-proof sheet, should be 54 THE GENITALS OF WOMAN. spread, to prevent the bed from being wet by the discharging fluid. The bed should be accessible from both sides, and must not stand too near a stove, a window, or door, or it must be protected by a screen from draught. The clothing should be loose, but warm. Drawers should be removed. For covering, a woolen blanket or quilt over a sheet is preferable. The midwife should be particular to enclose the hair of the head of the woman to be confined, in a cap or other con- trivance, as the hair must not be combed out for a few days ; hot and cold water should be always accessible. A tub in which the child can be bathed should be at hand. The clothing and crib for the child must be ready and the bandages for the navel of the child (as hereafter to be described) must be prepared. The midwife should have her im- plements, to be enumerated hereafter, in proper order for use; she must also have water, soap and towels ready, that she may wash her- self after each internal examination ; for, if the midwife does not in her own person manifest the most scrupulous cleanliness, she cannot demand it from those placed in her care. Bed -pans for urinary and other purposes should be ready for use. Vinegar and a little wine should be kept in the house. If the woman, during the time of labor, should call for food or drink, it may be given her, but care should be taken not to give too much at one time, because it would be thrown up again ; all indigestible and heating food should be avoided. Fruit, vegetables, fat and smoked meat are most decidedly to be avoided ; the same with wine, beer, whiskey, strong coffee, and every kind of tea ; a swallow of fresh water is sufficient. Food becomes necessary only when the delivery is a protracted one. Milk and water, a cup of broth, a water soup, made with rice or oatmeal, will suffice in most cases. At the beginning of the delivery, the midwife should be careful to cause the woman to be confined to urinate properly, and to have alvine evacuations. Frequently the request to perform the first will be complied with. If it does not pass off while standing or squatting, it will be performed easier in a lying-down position. The midwife may also move the head a trifle with her finger from the fornix vagince, if it should press heavily on the bladder, so that the urine can pass. By an external examination, the midwife can ascertain at any time whether the urinary bladder is full or empty. If the filled blad- der does not empty itself in the manner described, the midwife must CHILDBIRTH. 55 clear it by the use of the catheter. To effect a movement of the bowels, a syringe is required. Even if a natural movement has taken place, the syringe must be called in requisition, because it contributes to the regularity of the labor pains. The injection consists of warm water with a couple of spoonsful of oil, and in case of costiveness, a little soap, or a tablespoon ful of common salt. If the midwife arrives after the first period of ejection has commenced, and the head has already entered the pelvis, the urinating cannot be performed until after the child is born, because the urethra is squeezed together by the head, and in that case an injection is also useless, because neither the syringe nor the faeces can pass the head of the child. At the beginning, if everything passes off regularly, the woman may at pleasure walk about, stand up, or lie down, just as she may find it to be most convenient to herself; she may also sleep, if she can find rest for it. When a labor pain comes on, she will endeavor to support herself; a sofa or the bed will afford her the sought-for support. If she prefers to lie down or walk about, she may sit down during the pain, or she may place herself with her back against the wall, and support herself by the back of a chair placed before her, or she may grasp the hands of the midwife. All these comforts the woman may be indulged in, but she must not use the supports for the purpose of straining. All voluntary straining in the beginning is very injurious, it causes premature rupture of the bladder, spasmodic labor pains, and delays delivery in that way, makes it more painful, and may even create danger. The examination made by the midwife after arrival, she must continue from time to time during the opening period ; she must make an external and internal investigation, according to the general rules. She has to exercise particular caution in this examina- tion, and to observe the following directions : she must be careful not to pull the mouth of the womb, as it results in spasmodic labor pains ; she must avoid pressing her finger hard against the amnion, to avoid a premature bursting; she must avoid pressing away from the pelvic aperture the head of the child, which perhaps is very movable, as it may result in an unnatural presentation ; she must avoid unnecessary examinations. Examinations are only necessary to obtain positive knowledge on the following points : first of all, she must know whether it is a head presentation ; if not, she must sena for the 56 THE GENITALS OF WOMAN. accoucheur. The midwife knows how a head presentation is ascer- tained ; she can feel the head through the fornix vaginceaX the anterior pelvic wall ; she feels it, when the opening has already made con- siderable progress, through the mouth of the womb. If she is unable to decide by an internal examination what part is presenting itself, an external examination will furnish certainty whether it is ahead presen- tation. If the presentation is normal, the womb retains its regular egg-shape; in the fundus uteri, the round, soft buttock is felt, and, alongside of it, most generally to the right, small parts, the feet. The cardia sound are heard more distinctly at the side, generally to the left, and a little below the navel. Above the pubic symphisis, the firm, round head may sometimes be more distinctly felt through the skin than through the fornix vagince. If the midwife wants to ascer- tain the position of the child and the part presenting itself, she must not make the internal or external examination except at an interval in the labor pains. Whether the amnion still stands, she will know with some probability from the declaration of the woman, whether the liquor amnii has passed away or not ; she discovers it with greater cer- tainty by an examination; The amnion feels smooth, and the touch of the finger tells whether the water is still in it ; the hair on the head is also felt. How rapidly the opening is progressing, the midwife will perceive by repeated examination of the mouth of the womb. If she finds that the progress is rather slow, she must make an examination after three or four labor pains have passed ; if the progress is rapid, she must examine after every pain. Even if an interval of several hours should occur between the labor pains, it is of no disadvantage to either mother or child ; the midwife has only to urge upon the mother to make good use of that time for rest. Whether the pains are regular, the midwife will know by the effect which they have on the opening, and even if it is only moderate, from the completely painless pause between the labor pain. If, however, the midwife has doubts as to the regularity of the labor pains, she may examine inwardly and outwardly during the labor pain. The mouth of the womb is more expanded in a regular labor pain, but not tighter, the bladder is forced out. On an external examination the womb is found firm everywhere, and more round than before ; when the labor pain ceases, the womb again becomes slack and soft, and so does the corpus CHILDBIRTH. 57 uteri. When the midwife makes this examination, she has to observe whether much urine has collected in the urinary bladder, and if that is the case, she must draw it off. If the mouth of the womb has opened so far that a small edge may be felt only toward the anterior part and on the sides, then the bursting of the bladder is near at hand. The woman must lay down on her back, and the midwife must place a bed-pan under her, to receive the liquor amnii. Immediately after the discharge of the liquor amnii, therefore, with the commence- ment of the ejecting period, the midwife must make a close internal examination. The midwife must know by this time that it is a head presentation, and through external examinations she has also become acquainted with the position of the child ; she must now convince herself by internal examination of the particular position of the head, and whether it presents itself alone. A hand, a foot, or the umbilical cord might lie alongside of it ; it is, therefore, necessary for the mid- wife to carefully feel all around between the head and the pelvis. The particular position of the head is discovered through a close examina- tion. The position of the head might have been changed by the dis- charge from the pelvic aperture. As such may be the case, strong pressure against the head must not be used in the examination, because just that very change might result therefrom. The woman must not leave the bed after this. When the midwife has become convinced through examination that the position of the child is quite regular, she may permit the woman in labor to rest at her con- venience on her back, or on either side, but a restless throwing about, bending of the back, in which some like to indulge, is strictly pro- hibited. If lying on her side, it will be a relief to her if her back is supported by the midwife during the labor pain. She now needs support during the pains more than she did before, and by affording it to her, a restless woman can be induced to lay quiet. If the woman is lying on her back, it is best for her to press her feet with moder- ately bent limbs against the foot-board of the bed, and take hold with her hands of the cord or towels fastened to the head of the bed. In this manner she can assist herself best in the straining which she is called upon to do, and in which she must be indulged. Her head is best supported in a bent position either by a pillow, or the hand of the midwife ; she holds her breath, and bears down as if for an evac- 58 THE GENITALS OF WOMAN. uation ; this may be permitted only during a labor pain, at any other time it would be injurious. This working up of the pains is useful, even if the result of the pains is small. The result of the labor pain is judged of, if an internal examination is made either during, or im- mediately thereafter ; the advance of the head is thus noticed. Par- ticular attention must be paid at the time when the head begins to press, whereby anus and perinczum are pressed out, and great attention must be paid to it that the rima pudendi and particularly the perinczum remain whole when the child passes through. At the time when the head enters the pelvis, a supporting position, or a position with raised posterior, was not required with a regular pelvis ; it is not at all injurious, however. But at the time when the head has reached the bottom of the pelvis, a position of that kind would be extremely injurious. That position would have the effect of bending the lumbar vertebral column, and the inclination of the pelvis to the trunk would be thereby materially changed. The midwife must know in advance that the lumbar vertebral column is capable of being considerably bent ; she may at any time perceive its flexibility in her own person, or in the woman she is examining. As the position of the womb, particularly in the position of lying on the back, is, to a great extent, depending on the posterior wall of the abdomen, the direction of the womb, and with it the direction of the ejecting force toward the con- ducting line of the pelvis by this bending and stretching of the lum- bar vertebral column, is changed. Therefore the woman, at the time when the head reaches the bottom of the pelvis, should lie in a position to have the lumbar region well stretched. If the woman lies on her back, a pillow should be placed under the lumbar region, and not under the buttocks, as is usually done. A position with raised buttocks is just as injurious to women, as the half-reclining one in the old obstetric chairs; and even if the woman lies on her side, it should be attended to that the lumbar region is well stretched and strongly bent in. There are three points to be attended to, to prevent the tearing of the perinczum when the head passes through. First, the occiput must have passed completely under the pubic arch, before the frontal region rolls over the perinczum ; secondly, this rolling over of the frontal region must proceed slowly enough to enable the soft parts at the bottom of the pelvis to extend properly ; thirdly, the CHILDBIRTH. 59 head must remain in the conducting line until it has entirely passed out ; therefore, the hollow of the child's neck must remain closely pressed to the pubic arch of the mother ; therefore, the midwife has to observe three points in succession whilst the head is passing through. The larger the circumference of the head at the time of its exit into the pudenda, the more will the soft parts at the bottom of the pelvis expand, and the quicker will the peri 'ncsum tear when the skull comes to cut in and remains under the pubic arch, while the crown, fore- head and face are rolled out over the perinceum and the latter is very firm. It is more frequently the case that the head begins to roll out over the perinceum when it has arrived under the pubic arch, particu- larly with the first-born of women of advanced age. If the midwife would then attempt, according to an old custom, to press her hand against the perinceum, because the latter has so great a tension, she would most certainly prevent the head from passing out further, and by her attempt to support the. perinceum, she would be the very means to cause a perineal rent. The midwife must, therefore, proceed as follows : under all circumstances, as soon as the head begins to rol over towards the front, she must examine with her index and middle fingers whether the whole of the, occiput has already passed under the pubic arch. If such is not the case, she must, after each labor-pain, or even during the same, lay the two named fingers firmly on the occiput, and press it down against the perinmim, so that the whole occiput passes under the pubic arch. The great extension to which the perinceum is subjected in permitting the head to pass, will be accomplished without the rent, if done slowly rather than suddenly. To enlarge the perinceum, or anoint it with oil, does not make it more extensible ; the midwife must look to it that the head passes out slowly. For this purpose she must interdict all straining, remove from the woman all support which she may have at her feet or head, prohibit the holding of her breath, but rather have her cry out freely, if she feels inclined to do so, and instead of letting her lie on her back, have her assume a position on her right or left side ; the legs and knees are to be bent moderately, and the knees kept apart by a cushion placed between them, so that free access may be had to the perinceum and genitals. It has already been stated that the woman about to be confined should be well clad and covered. In the posi- 60 THE GENITALS OF WOMAN. tion on her side she is less able to strain, and the midwife can observe the perinczum much better than in the position on her back If the woman lies on her left side, the midwife takes her seat near the head of the bed on its right edge, or on a chair placed alongside of it, at the back of the woman, observing the tension of the perinceum with her eyes, but more particularly with the index and middle fingers of the right hand, which she, feeling carefully, places across the coccy- geal region on the anterior edge of the perinceum. If the tension of the same, during a labor pain, becomes so great as to threaten a rent, she must not permit the head to advance any further during this pain ; she then places the two fingers of the other hand, which she extends over the abdomen, firmly against the head until the pain abates. During the intermission of the labor pains the perinceum. has time to expand, and with the succeeding pain, the head can move out further without danger to the perinceum ; if the tension becomes too great again, the head must be prevented from passing through entirely with the next labor pain. In this way the head passes through so slowly that a perineal rent does not occur. Toward the anterior part, the head cannot deviate from the conducting line. If the roots of the occiput lie closely up to the pubic arch, the head is in the conducting line of the pelvic aperture. In almost all cases the perinceum itself, by its great tension, takes care that the head remains in the conduct- ing line ; only when the perinceum is very flaccid, or from extreme labor-pain, or immoderate aid in straining, can the head deviate from the conducting line against the perinceum. By an examination with her finger the midwife may discover this, if there is a space left between the head and the pe?inceum. As soon, therefore, as the head is about to pass through, she must feel with the fingers of the hand that are ready to restrain it from passing out, and during a pain, whether the head lies close up to the pubic arch. In the rare instance, where the occiput does not lie close up to the pubic arch, it is neces- sary to support the perinceum as the head cuts through. The midwife must place her thumb on the right, and the index finger on the left edge of the perinceum ; in this position she executes a gentle pressure in the direction of the pubic arch, so that the occiput cannot deviate from it, while the forehead and face of the child pass forward between the thumb and index finger of the midwife. If the midwife makes CHILDBIRTH. 61 her observation with the woman lying on her back, she sits on the right or left edge of the bed, at the feet of the woman, and facing her. If the midwife sits on the right edge of the bed, she notices under the bed-cover, with the finger of her right hand, the advance of the occiput ; she also feels the tension of the pubic arch with the fingers of her right hand. To restrain the head, the left hand of the midwife lies across the right side, ready for manipulation. If the latter should become necessary in the position on the back, the hand is to be placed on the pubic arch in such a way that its anterior edge lies before the ball of the thumb, while the hand and distended fingers lie backward over the coccygeal region. All three of these manipu- lations must not be practiced at every confinement, but the midwife has always to notice all three points. If the occiput has already fully passed under the pubic arch, an attempt to press it further down would be useless. If the skull passes of its own accord slowly through the pubic arch without too much tension, it would be injurious to keep it from cutting through. It would also be injurious if the occiput lies, as usual, against the pubic arch, to press the same still more against it. The pressing down of the occiput, the retarding of the passage of the head, and the support of the perinceum on cutting through, are rarely necessary. The midwife would, however, do the greatest injury if she resorted to the third manipulation, the support of the perinceum, pre- vious to the entrance of the head under the pubic arch. If she did that, the head would enter the rima pudendi at its largest diameter, instead, as usual, at the small diagonal one, and the perineal rent, which the midwife endeavored to prevent, would be sure to occur. When the passing head presses the faeces out of the rectum, it must be received in a cloth kept in readiness for that purpose. To cover the hand used in the examination of the perinaum with a towel or cloth, is injudicious, because it prevents the perception of the tension of the perinceum. Neither a physician or midwife must hesitate to touch any part of the human body ; soap and water will cleanse it. After the head is born, the midwife should feel around the throat of the child for the purpose of discovering whether there is a loop of the umbilical cord lying around it ; if such is the case, it must be loosened to permit the shoulders to pass through. The midwife must support the head that it may not sink down, but the mouth and nose must 62 THE GENITALS OF WOMAN. not be covered up, as sometimes the child breathes already. When the next labor pain, which ejects the shoulders, sets in, the hand lying at the perinceum must take care that the shoulder lying in front in passing through is firmly kept against the pubic arch ; if such is not the case, the perinceum tears sometimes from the passage of the shoulders. It depends on the skill of the midwife to preserve the perinceum from injury; a careful pressure prevents it. When the shoulders have passed through, the hand having heretofore lain at the perinceum, follows the child, which is usually entirely delivered with the same labor pain. The child must be received and placed in a position to enable it to breathe freely through mouth and nose ; the umbilical cord must remain slack, and must not be pulled under any circumstances, because it might injure both mother and child. During the after-birth period the midwife must divide her attention and occu- pation properly between mother and child. The new-born child, which generally now only begins to breathe and cry, must remain lying, connected with its mother, for a few minutes ; during that time the midwife must feel for the womb, whether it is firmly contracted, so that a bleeding need not be feared, and whether it has become so small that a second child cannot be contained therein. If the mid- wife finds the womb firm and small, with its base a little beneath the navel or even deeper, and if the child breathes and cries regularly, she proceeds to the division of the umbilical cord. At about the width of four fingers from the navel she ties- the umbilical cord with a strong ribbon of the width of about one or two straws, by knotting it firmly with a double knot. At the width of three fingers from that point she cuts the umbilical cord with the umbilical scissors, turns the free end back upon the tied-up end and laces over that the ends of the little ribbon, which is again firmly tied by a double knot. In tying the umbilical cord, the midwife has to take particular care not to pull the end of the mother or child. The pulling of the mother's end might result in bleeding, and that of the child's in inflammation of the navel. In drawing the ribbon together tightly, she must place the knuckles of her hands firmly against each other, so that if the ribbon should break her hands would not fly asunder. Many follow the cus- tom of tying the umbilical cord in two places a little apart from each other, and then cut it between those two places. There is no objection CHILDBIRTH. 63 to this. The double tying has even the advantage of less blood running on the bed-clothes, and perhaps also the other advantage that the placenta remains larger through the restrained blood, and that it excites the womb to more vigorous labor pains for the after-birth. The midwife should know, however, that the tying of the mother's end of the umbilical cord is unnecessary ; that if the division of the umbilical cord must be done speedily, she must not loose time with a double tying. The woman will not loose one drop of blood from the umbilical cord remaining untied. After the umbilical cord of the child has been tied, the mother will again require her attention. The child is wrapped up in a warm cloth and placed in charge of another person, or laid down in a secure place ; the midwife again examines whether the womb is still drawn together tightly, and whether the bleeding from the genitals is light. She inquires of the confined whether she is without pain, and whether she feels otherwise comfortable, and pays particular attention whether the general feelings of the woman do not indicate bleeding. In the internal investigation she must pay attention whether the bladder lying before the womb is full or empty. Sometimes, during the delivery, a good deal of urine has collected, and a full bladder is an obstacle to the ejection of the after-birth. If the midwife finds the bladder full, she must introduce the catheter with particular care, because the parts are at that time very sensitive, and draw off the water. With her hand lying under the bed cover, on the abdomen of the woman, the midwife must keep a constant watch for the after-birth. When an after-birth occurs, the womb becomes harder and more round, and generally more blood passes. As soon as an after-birth pain occurs, the midwife must, from the edge of the right side of the bed, lay hold of the womb with her left spread hand in such a way that the thumb-side of the palm of her hand is around the anterior, the little finger side around the base and the posterior part of the womb. With her hand in this position, the midwife must press moderately the anterior against the posterior wall of the womb, without, however, pressing the womb down into the pelvis or giving the woman pain. By this pressure the pain is properly increased, and with the first or second after-birth pain, aided in the described manner, the after-birth enters the vagina, or even the external genitals, whence they are removed in the manner to be 64 THE GENITALS OF WOMAN. described. If the after-birth does not enter the external parts, the midwife may presume, from the continued diminution of the womb, that the after-birth has entered the vagina ; she must convince herself of this by internal examination. If she stands or sits at the right side of the bed, she takes hold of the umbilical cord with two fingers of the left hand, reaching under the right thigh of the woman, and moves the index and middle finger of the right hand along the umbil- ical cord into the vagina, until she reaches the placenta or the mouth of the womb. If she can proceed to the edge of the mouth of the womb, the after-birth is still in the womb ; in that case she withdraws her hand, covers up the woman, and observes the womb with her hand laid on as before. If she does not reach any part of the mouth of the womb because the whole of the pubic arch is already filled with the placenta, or if the latter lies already far down in the vagina, she will have to remove the same. For that purpose she winds the umbil- ical cord, which she has taken hold of with the fingers of her left hand, around these fingers, and grasps it more firmly than previously required for an examination, and lays the index and middle finger of the right hand, moving along by the umbilical cord, on the place where it imbeds itself in the placenta ; pressing back vigorously the after-birth with the two fingers of her right hand, she draws it out by the umbilical cord. The midwife must take notice that it requires a vigorous pressure with one hand and a pull with the other for the removal of the after-birth from the vagina. It is therefore absolutely necessary to know whether the after-birth lies in the womb or in the vagina. If it still lies in the womb, even a gentle pull is injurious ; but if it lies in the vagina, a vigorous pressure and a pull are required, because unnecessary delay of the after-birth in the vagina may lead to renewed bleeding from the womb. As soon as the placenta makes its appearance at the external parts of the genitals, the midwife takes it with the fingers of her right hand, turns it a few times around itself, in order that the metnbranoz ovi may form a stronger cord, and draws out the whole after-birth slowly by the placenta. If the membranoz ovi following out should still resist a gentle pull, the midwife must once more enter the vagina with the index and middle fingers of her right hand, and with them press the strand of the membrane ovi gently, so that it may come out without being torn asunder in the con- CHILDBIRTH. 65 ducting line from the mouth of the womb. The removed after- birth is placed in a clean basin. The after-birth must now be closely examined whether any considerable portion of the membrance ovi or some of the placenta is wanting. In that case the midwife must send for the accoucheur, and keep the after-birth. The midwife must also convince herself, by an examination of the abdomen, whether the womb is now small and firmly drawn together, and whether the bleeding, however regular, is very trifling ; she must then wash the genitals and surroundings carefully with a sponge and clean lukewarm water ; this should be done very carefully, because the parts are at that time very sensitive. At the genitals, the sponge must be moved from the pubic arch towards the anterior part, else it would give much pain, and the midwife must examine whether, in spite of all care, a perineal rent has not taken place. If the woman remains on the same bed on which she was confined, which would be preferable, the cushions which have been placed under her to elevate the coccygeal or lumbar regions, are to be removed, to make her more comfortable. The clothes and bed linen, which may have become bloody and wet, should be changed ; the fresh linen must be entirely dry and well warmed, and a continued uncovering and any active motion on the part of the woman must be avoided. If it should be unavoidable to change beds, the new bed must be placed alongside of the one on which she lies, and she must be lifted into it without raising herself or moving. A soft, white cloth, a so-called stop-cloth, is to be placed before the genitals between the thighs, which at any time will show to the mid- wife the state of the bleeding. To put a body bandage around the confined woman can do no injury, provided it is not drawn too tight. It is useful only in cases of a very rapid delivery. The midwife then attends to the child. She has to examine the water in which the child is to be bathed, as to temperature, which should be about twenty- five degrees R. If a thermometer is not at hand, she may test it by dipping her elbow into it ; if it creates a pleasant warm feeling, it may be deemed satisfactory. The child is put in the bath, resting upon the hand of the midwife, face upward, while she cleanses with a soft sponge the whole body of the child of slime. If the latter adheres too tightly, it will come off more readily if the skin of the child is anoin- ted with a little fine oil, unsalted butter, or with the yolk of an egg ; 5 66 THE GENITALS OF WOMAN. all hard rubbing of the tender skin of the child must be avoided, and it does no harm if the slime does not come off with the first bath. The child is then dried with a warm cloth, on a pillow or the lap of the midwife, who at the same time examines it whether it is regularly- formed in all its parts, and particularly whether the genitals and anus have their regular form and openings. If that is not the case, she has to inform the friends, and not the mother, of the fact, and a physi- cian should be consulted. The midwife must also again examine the tied umbilical cord, and if it shows any bleeding, it must be tied again with a second small ribbon. A square cloth of the size of a hand, upon which clean fat has been spread, has in the meantime been prepared ; this cloth is cut from one of the edges to the middle. This cloth she places around the navel and lays it loosely in an up- ward position, on the left side of the abdomen. In this position the umbilical cord is fastened by a bandage of the width of about three fingers and one and one-half yards in length, wound moderately tight around the abdomen of the child. The child is then dressed. A double diaper is placed around the child, the inner one being of linen, and the outer of flannel. It is then loosely tied up in a quilt or blanket, but should have room for the free use of its legs ; its arms remain entirely outside. The dress of the child varies in different localities ; tying it up in feather beds, and rolling long bandages tight around it, is injurious. After the mother and child have been attended to as above stated, the midwife remains at least two hours longer. During this time she closely watches the woman, whether bleeding or other trouble in her condition shows itself. Even if such should not be the case, the midwife must from time to time feel for the womb on the outside of the abdomen, and ascertain whether it remains well drawn together ; she must enquire of the woman whether she feels blood passing away, and must from time to time examine the white cloth placed before the genitals, in order to convince herself whether more than the usual quantity of blood is passing off. Pre- vious to leaving, the midwife has to examine the urinary bladder, whether it is filled or empty. If full, she has to place a vessel under the woman and ask her to urine. If she is unable to do so without changing her position, the midwife must take it from her with the catheter, because a full bladder interferes with the restoration of the CHILDBIRTH. 61 womb, and every motion is detrimental to the newly-confined woman. Equally injurious is the bursting of the bladder in regular confine- ments, because the bladder assists in opening the mouth of the womb, the delivery is generally retarded by it. If, however, the head is forced through the insufficiently opened mouth of the womb, this premature ejection may lead to great injuries. In the ejection period, a good deal of faulty manipulation is used with the apparent intention of protecting the perinceum. Many stretch and pull at the perinceum, and believe by these means they are enlarging the rima pudendi. The surroundings of the rima pudendi swell by this treatment, and is more apt to tear asunder while the head passes through. Poulticing, and oily embrocations of the perinaum can do neither harm nor good. Some inexperienced midwives put their finger in the anus, or even between the head and the perinaum in the rima pudendi, to lift in that way the head over the perinceum. If the rima pudendi is rent by the head alone, it would be rent much farther, when head and finger are placed in it at the same time. Some deem it necessary to put their finger in the child's mouth immediately after birth, in order to remove mucus. Most children have, immediately after birth, no more mucus in their mouths than is good for them ; it is, therefore, wrong to trouble them with this manipulation. What course to pursue when a child is seemingly dead -born, will be mentioned hereafter. Previous to the ligation of the umbilical cord, some press the blood either toward or from the child. Both can only interfere with the circula- tion of the blood, and are, therefore, strictly interdicted. To expedite the removal of the after-birth, many objectionable practices are resorted to. All pulling and tugging of the umbilical cord to discover whether the after-birth is loosened, all requests to the woman to favor the ejection by- pressing, coughing, blowing into the hand, may produce incurable, life-long sufferings, displacement of the uterus, &c, or even fatal bleeding, and must therefore all be rejected. The treatment of late adopted by some, to press the after-birth out of the genitals, by shoving the now very movable womb into the pelvis, is also to be rejected. The midwife must proceed in the way only pointed out in this chapter. 68 THE GENITALS OF WOMAN. The implements which the midwife will have to take with her to the place where she is called to attend, are : i. A syringe. 2. A pair of umbilical scissors. 3. Several strings to tie the umbilical cord. 4. A jar of pure oil, or other grease. 5. Two sponges. These five articles are used in every case ; but as the midwife is not sure that the delivery will be a regular one, she must also supply her- self with : 6. The catheter. 7. The uterine tube with the button pierced once, and another but- ton pierced more than once. 8. A small bottle of spirits of nitre, and another of ether. It is also well for the midwife to bring with her a cuneiform pillow case, which may be quickly stuffed with hay or straw. It is frequently very important to have a pillow of that kind at hand, particularly if the accoucheur has to perform an operation, for which the transverse board is required. She should also bring with her a few yards of oil or rubber cloth ; she is not likely to find it in the house of poor people, and it is just in those places where keeping the bed clean will be doubly necessary, because they perhaps have not more than suffi- cient to make the most necessary change. All these things she must place in proper order in the confinement room ; in her own house they should also be always kept in their proper place, and in good condition, so that, when she receives a call, she will forget nothing, nor lose time in hunting for them. When the midwife returns to her home, she must clean everything she has used most scrupulously, and put it in its proper place, as she may be called out again at any moment. She should also carry with her to the place where she is going to attend, her manual ; it is her best counsellor, and affords her most appropriate reading, if she has to wait for a regular delivery sometimes for hours ; for she must not disturb the woman to be con- fined with idle talk, and not employ her time in eating, drinking or sleeping ; this is not good for the woman to be confined, and improper for the midwife. After the woman has been delivered, she is spoken of as "lying-in," and the condition in which she is, is called the CHILDBIRTH. 69 childbed. At this time two functions occur : first, the return of all the parts, particularly the genitals of the mother, that have been changed by pregnancy and delivery, to almost the same condition in which they were prior to pregnancy; and, secondly, the secretion of the milk which is to furnish nourishment to the new-born child. It is of the greatest importance for the life and health of mother and child, that both functions should be regularly performed. The nursing of the child will generally last from nine to ten months ; the return of the genitals to their normal state requires over three months. The woman who has been delivered feels weak ; frequently she has a short, light chill, which is soon followed by a feeling of comfortable warmth, a desire to sleep, and a general gentle perspiration ; after her sleep she feels better. Her pulse, which, up to the time when the child was born, became more rapid, has now quieted down. The skin of healthy women in childbed is regularly moist and warm ; during the first week the whole skin is covered from one to three times a day with perspiration. This great evaporation of moisture increases her thirst. Her appetite usually returns only after a few days. The urinal secretion is sometimes lessened ; the quantity depends, how- ever, on the quantity of drink taken, on the copiousness of her per- spiration, and other circumstances. Sometimes the urinal secretion is greatly increased at first; frequently the pressure for urinating is wanting, although there is an abundance of it in the bladder ; it is a great drawback to its discharge. A movement of the bowels generally does not occur for three or four days. The external genitals and the perinczum, which, immediately after delivery, are usually very tender, and frequently somewhat swollen, are generally reduced to their usual size during the first twenty-four hours, and also lose their unwonted sensitiveness. Trifling injuries to the mucous membrane of the liga- ment of the pudenda lip, and in front at the side of the urethra, which are not rare, heal in a few days by proper cleanliness. The fornix vagina remains wide and slack for some time, and sometimes lastingly. During the regular childbed, an increased flow from the womb takes place, which is called lochia. On the first day the lochia consists of blood ; it is fluid, perhaps somewhat watery, sometimes mixed with smaller or larger clogs, and sometimes with pieces of the ethmoidal TO THE GENITALS OF WOMAN. membrane. The admixed blood keeps the color of lochia a brownish- red from one to four days ; it is then reduced to a very small quantity for a few hours, becomes watery, and gradually increasing again, turns to a thick fluid of a whitish-yellow color. It consists of mucus and matter, because the injured inner surface of the womb suppurates regularly while it is healing. This condition the lochia retains, but it ceases entirely in three or four weeks in women who nurse their child. The quantity and smell of the lochia varies in different women at different periods of the childbed. On the second and third day, where it is brownish and abundant, it generally smells worst, but that of a healthy woman in childbed never has a putrid smell. The secretion of the milk has been preparing already during pregnancy ; frequently an abundance of milk has filled the breasts even at the time of delivery ; frequently, however, the secretion of milk becomes abundant on the second or third day. At this time the breasts swell out more, and often painful stitches are felt, which cease as soon as the milk is drawn off freely. The oftener the child is put to the breast, the. more vigorously it sucks, the sooner the milk secretion begins, and the more abundant it will be. The first milk is a mixture of w r atery fluid, with thick yellowish- white streaks in it ; it is discharged in large drops from the breast under pressure. As soon as the milk flows more abundantly, it appears as a uniform bluish-white fluid, squirting from the breast when pressed ; if squirted into a glass of water, it dissolves at first in a cloudy manner, but afterwards becomes uniform. In most women menstruation does not generally occur during the duration of the milk secretion. When the child has been weaned, the breasts sometimes swell up again. With proper care the swelling and secretion of the milk ceases, and the breasts become soft again. Four or six weeks after that menstruation sets in again. But not all the changes effected by the pregnancy and delivery of the mother are obliterated by the regeneration taking place during child- bed, and the time following it. There are permanent changes, by which, after many years and even through life, an examination will reveal whether a woman has given birth to a child. Among the most important indications may be mentioned the scars on the womb, which are never absent after the birth of a mature child. The scarry stripes of the flabby skin of the abdomen, and scars from injuries to the THE CHILD. 11 perinozum, which luckily are generally wanting, are infallible indica- tions. The indications pointing to a recent delivery may become of importance to the midwife ; there may still be found milk in the breasts of women who have given birth to a child years ago ; there may frequently be found milk in the breasts of women who have never given birth to a child, but who may be pregnant at the time; but there is scarcely ever milk in the breasts of a woman who has never been pregnant. THE CHILD. The first need of the healthy, new-born child, after it has been bathed and dressed, and which generally has urinated already at that time, is sleep. It has no need of food, because up to the time of final delivery, it has taken sufficient nourishment through the umbili- cal cord from the mother. Generally after the lapse of from four to twelve hours, the child awakens from its gentle slumber, and indicates by its cries that it needs nourishment, which it receives from the mother's breast. The first milk it takes from the mother, while furnishing it with food, has also the important effect of acting as a purgative. It effects the evacuation of the faeces, collected in the child's intestine in the womb, a blackish-green mass, the so-called meconium. These evacuations cease in from two to four days ; after that they have a golden or sulphur-colored appearance ; they are pappy, and take place from two to four times during twenty-four hours. The skin of the new-born child frequently turns to a yellowish color, sometimes even to a dark yellow after a few days, giving it the appearance of an adult having the jaundice ; after that the cuticula peals off. The more delicate and red the color of the child's skin after birth, the deeper is the yellow color and the more abundant the peeling. If, however, the child sleeps well, nurses well, and has regular evacuations, and only cries when it is hungry or has wet itself, it must be considered in good health, the changes in the color of the skin to the contrary notwith- standing. The end of the umbilical cord attached to the child is cast off with suppuration at the edge of the abdominal membrane. This casting-off occurs on an average on the fifth day after birth, rarely, however, after two days, but in some cases only after eight days ; the child showing no sickness during that time. In a few days thereafter 72 THE GENITALS OF WOMAN. the navel becomes cicatrized and assumes the shape which it retains through life. As long as the end of the umbilical cord remains on the child, it is called new-born. THE CARE OF MOTHER AND CHILD. The lying-in room must have a constant supply of fresh air ; this is accomplished by cleanliness in every respect, and by the admission of fresh air, and not by fumigation. The woman must never be exposed to draught, and a sudden cooling of the room by airing must not be permitted ; the temperature must be sustained as near as possible at 15 degrees (R.) Sunlight must be excluded, but under no circum- stances must the room be darkened. Above all things the lying-in woman must be kept quiet, if she is to retain her health. She must not leave her bed during the first week of her confinement, and must recline constantly. If it is required that the bed should be made, because it has become uncomfortable, she must not get up during that time, but must be lifted out of and into it again. Where it is possible, two beds should be kept for a change, so that the lying-in woman may be lifted from the bed she is occupying into the one that has been freshly prepared for her. The making-up of the bed is best to be done about noon, and not evenings, when the lying-in woman would be much more excitable. As rest of mind is as indispensable as rest of body for a recovery, a full week must elapse ere visitors are admitted to the room. For the same reason all causes for violent emotions of the mind, particularly anger, fright or fear, as well as pleasant emo- tions, must be scrupulously avoided. Lochia will become very offen- sive, if the midwife does not observe the utmost cleanliness. If the flow is great, the bed should be changed at least every two hours. An oil-cloth should be placed under the sheet to prevent a saturation of the bed itself. It is well for the midwife to own a pair of these water- poof cloths and lend them to poor people, for without them the mat- tress or straw of the bed will rot, which will cause sickness. At the time of the renewal of the sheets, the outer genitals must be washed with a sponge and clear warm water, and for the first few days an in- jection of warm water should be made in the vagina to prevent an accumulation of lochia. If the flow has a very strong smell, luke- warm camomile tea may be used for sponging and injections. To THE CARE OF MOTHER AND CHILD. 13 avoid taking cold, all this must be done without any unnecessary uncovering and wetting. The fresh sheets must be thoroughly warmed. For the first week the midwife should visit the lying-in woman twice a day, mornings and evenings. Visits after that depend upon the condition and the wish of the lying-in woman, and frequently on the orders of the physician. In her visits the midwife must ascertain whether the principal events of childbed above mentioned are pro- gressing regularly, and she must satisfy herself that the exudations are regular, and give instructions to await them properly. In changing the sheets, she must satisfy herself of the regular condition of lochia, and in washing the genitals, of their healthy state. She must examine the abdomen, and investigate whether the womb remains contracted, and whether it diminishes from day to day in size as it should do. If troublesome after-pains occur, she must inform the lying-in woman of their usefulness, admonish her to have patience, and look to it par- ticularly that she is not prevented by these after-pains from nursing the child at the proper time. She must give her instructions as to her breasts and nipples, and the necessary directions as to nursing. Should the breasts swell during the first few days and become painful, which is not unusual, it is advisable to anoint them with warm oil and cover them with wadding. This does not interfere, as some seem to think, with the secretion of the milk ; the nursing of the child must not be neglected thereby, however. The midwife must inquire of the lying-in woman how she feels, whether she sleeps well, and has a great deal of thirst. She may satisfy her thirst, but must not drink too much at a time. If, for a change, she wants something else than fresh water, which is always the most suitable for her, she may drink a thin decoction of oatmeal, or barley water, or water in which some bread, slices of apples, or dried prunes have been boiled, or milk and water, or almond milk. After the fifth day she may make use of a thin broth, weak coffee and milk, water soup with rice, groats, sago, &c. All these things must be well cooked and contain no spices. She may also eat soup, soft boiled eggs, and roasted meat, if she has any appetite for them, but must eat little only at a time ; all heavy food must be avoided. It is not necessary that the lying-in woman should have an alvine evacuation for the first three days. Rest to the intestines is beneficial ?4 THE GENITALS OF WOMAN. for the restoration of the genitals. If a natural evacuation has not occurred up to the fourth day, the midwife must give an injection of warm water, or milk and water, or a decoction of linseed, or weak camomile tea, to each of these is to be added one or two tablespoons- ful of good oil. If a movement does not follow, another injection must be given with the addition of a little good soap, or of one table- spoonful of common kitchen salt. If at subsequent times the woman has not a natural alvine evacuation, the midwife must repeat the in- jection every second day only. Internal remedies to open the bowels must under no circumstances be ordered by the midwife. For the first eight days the lying-in woman must not get up to go to stool ; a bed-pan must be used. The midwife must dress the child at every visit and bathe it once a day, preferably in the morning. All severe rubbing of the child, and every cause for a cold must be avoided. The use of soap in bathing the child is injurious. After every bath the midwife must dress the child's navel with a new cloth in the same manner that she did in the first instance ; she must carefully avoid all tugging. When the end of the umbilical cord has dropped off, the navel wound must be dressed after each bath with a fresh oiled cloth, until it has en- tirely healed. If pure, fresh oil is not to be had, the dressing may be put on dry. The child must be changed dry in clean diapers every time it has wet itself. To rouse it suddenly out of its sleep is not good for it ; the awakening of its own accord should be awaited. The child, however, will soon get used to a regular time. During the whole time of nursing the child, the woman must carefully protect her breasts against pressure or cold, and keep them very clean. She must support them with a well fitting, but not tight boddice, so that they may not hang down. A flannel cloth enveloped in a soft cotton cloth, which must be changed frequently, will protect her from taking cold, and at the same time absorb the milk that may flow from her breasts. Every time the child has nursed, she must wash her nipples with fresh water. In food and drink the woman must observe the utmost regularity ; she must use food only which has agreed with her in her days of health. Digestible, nourishing food is the best for her. If the woman has been roused to violent anger, or has had a great fright, her milk must be sucked out, because it would be in- TWIN PREGNANCY. 75 jurious to the child's health. If menstruation should set in with the woman nursing the child, she may, if otherwise in good health, con- tinue the nursing ; but if she becomes pregnant again, without having had any menstruation, which is often the case, she must wean the child. The best time for weaning the child is after it has cut all its incisor teeth, which it usually does when it is ten months old. The child is given the breast less frequently for a few days, and then it must be stopped altogether. To extend the time to weeks or months, is not good, because when the milk begins to dry up in the breasts, it deteriorates in quality and injures the child. If, on weaning the child, the breasts of the mother swell much, they must be covered with oil and wadding, and be well supported ; during that time she must diet strictly, and see that she has daily full alvine evacuations. An irregular presentation is discovered by an internal and external examination. When, during the last months of pregnancy, it is intended to ascertain, by an examination, the precise duration of the pregnancy, the midwife must take into consideration the position of the child. In transverse and oblique positions the manifestations are not the same. The womb does not extend to the length it should do ; the midwife must take the breadth of the womb into consideration, in order to judge of its size. The manifestations of the lowering of the womb during the last weeks are less distinct, because no presenting part can descend into the pelvic aperture. For the same reason the dilatation of the fornix vagina, and the passing away of the vaginal portion, do not take place with the same regularity and certainty as in a regular presentation. In cases where an anterior laying-over, or an oblique position of the womb, and an irregular presentation of the child exists, the midwife may make herself already useful during pregnancy. She may support the abdomen by a proper bandage, and advise the woman to lay at night on the side where the fundus uteri does not stand. TWIN PREGNANCY. In exceptional cases several embryos may develop in pregnancy. Twin pregnancy happens twelve to sixteen times in a thousand cases ; triplet pregnancy one among five thousand, and quadruple and quin- tuple pregnancy are of still rarer occurrence. While there are a little 76 THE GENITALS OF WOMAN. more than one hundred thousand children born daily, it has never been discovered that one mother has carried simultaneously six embryos to her full time. Pregnancy with more than one embryo is more liable to be interrupted on account of the greater expansion of the womb. Twin pregnancy goes to the end of the regular time oftener, but triplet pregnancy never. Quadruple and quintuple preg- nancy never produce mature children. Neither are mature twin children always as large as single children, because space and nourishment had to be shared ; sometimes, however, one is larger and more vigorous than the other. If one of the twins has remained considerably behind the other in development, if, perhaps, an interval of several weeks has elapsed between the birth of the first and second child, the argument has been advanced by some that the children were procreated at different times. Twin children are always of the same age. Twin children are mostly in a cranial position ; just as often, however, the one is in the cranial, and the other in a coccygeal or in a foot position ; rarely are both in the coccygeal or in the foot position. The two last mentioned irregular positions, particularly the oblique and transverse positions, occur more frequently in preg- nancies with more than one. Two children may originate in one ovum. In that case they have at their birth only one corium, gener- ally, however, there are as many embryos as there are ovae, of which each has its hyaloid membrane and its corium ; only the thick, external layer of the ethmoidal membrane is always wanting in places where the ovae touch, because there is only one mucous membrane of the womb. In the place where the ovae touch each other, their external surfaces are pretty firmly cemented to each other. The two placenta are either separated or they represent a coherent mass. If the latter is the case, and if the children have been lying in two ovse, the septum of these two ovae is lacking between the entrance places of the two umbilical cords. Twin children are generally of the same gender. The midwife can only discover a twin pregnancy if she distinctly feels two heads or two posteriors, for instance, the one at the mouth of the womb, and the other at the fundus uteri, or if she and another midwife or a physician, can hear simultaneously cardiac sounds of different measure at the abdomen of the pregnant woman. The more rapid growth, larger expansion of the abdomen, its diagonal shape, 9 PREGNANCY OUTSIDE OF THE UTERUS. 77 a middle furrow over it, the simultaneous feeling of child-motion in different places, may also occur in single pregnancy ; generally, how- ever, the midwife will with certainty discover that there is a second child, after the first has been born. PREGNANCY OUTSIDE OF THE UTERUS. A midwife should possess knowledge of the rare occurrence, pro- duced when the impregnated ovum does not reach the uterus of the mother, but remains in the ovary or in the oviduct, or gets into the abdominal cavity, and is developed in either of these places. At first the manifestations resulting from either of these occurrences do not differ from regular pregnancy. The doubtful signs of pregnancy show themselves more or less clearly, and as the changes in the empty uterus take place the same as in regular pregnancy, menstruation also ceases. After a few months, however, bleeding begins, carrying with it at times pieces of ethmoid membrane. Pains are felt in the abdomen, and on examination the midwife discovers sometimes behind or alongside of the uterus a swelling through the fornix vaginez. These manifestations, which may, however, also resuk from other conditions, only prove to the midwife that a diseased condition exists. Preg- nancy outside of the uterus continues, in most cases, for a few months only. In from six to twelve weeks the woman dies, most generally, suddenly from internal bleeding. Only in cases of pregnancy in the abdominal cavity can the child develop further ; in those cases the indications of undoubted pregnancy present themselves after half of the period of pregnancy has elapsed, while the vaginal portion of the uterus does not show the regular changes. When the time for delivery has arrived, a kind of labor pain sets in, but it can not result in giving birth. Frequently the mother dies, but under the most favorable cir- cumstances the child only dies. It may remain in the abdomen of the mother during her life time, and is then called lithopaedion. It frequently is the cause of inflammations and suppurations, of which the woman has to die. Even with the last named occurrences, the midwife is never able to recognize pregnancy outside of the uterus with certainty. And this is another reason that the advice of an accoucheur should be taken, when irregularities manifest themselves. However great the danger in situations of that kind may be, in many •78 THE GENITALS OF WOMAN. cases the mother, and perhaps even the child, may be saved with timely asssistance. VOMITING, DIARRHCEA, CONSTIPATION, AND RUPTURE IN PREGNANCY. Vomiting is so common in pregnant women that it must be enu- merated among the uncertain signs. The vomiting during pregnancy generally ceases about its twelfth or fourteenth week. But if it becomes very troublesome, an effervescing powder, a glass of selters, or soda water, a swallow of good wine, a cup of tea made of lemon balm or spearmint, or a warm poultice applied to the gastric region, may prove beneficial. Vomiting occurring toward the end of preg- nancy, is frequently stopped by an injection and a proper evacuation. There are cases, however, where vomiting still continues in spite of the above prescribed remedies, and where little or no food is retained on the stomach. Women suffering in that way lose strength, become emaciated, and, for want of nourishment, their own as well as the child's life is endangered. The midwife must not permit the matter to go to that extreme ; in obstinate and long continued cases of vomiting, she must call in a physician. If to vomiting, chills and heat or pain in the abdomen are added, she must call in a physician without any delay whatever. A pregnant woman must particularly guard against diarrhoea, because it is connected with great danger to her. The continued bearing-down on the anus causes contractions of the uterus, which may lead to miscarriage or premature delivery. The moment a pregnant woman is attacked with diarrhoea, she must go to bed immediately, must not eat heavy food or drink cold water, but use only lukewarm drinks, such as oatmeal gruel, rice, grits, &c. In case the diarrhoea does not discontinue soon under this treatment, and, if down-bearing pains, pain in the bowels, chills and heat are superadded to it, a physician should be called in. Constipation is also accompanied by severe sickness, for instance, strangulation of abdominal hernia. Abdominal hernia are swellings beneath the healthy skin, mostly in the inguinal region (inguinal hernia), or close under the femoral fold (hernia femoralis), more rarely at the navel, or in other parts of the abdomen. They are produced by the protrusion of the bowels through an interstice in the abdominal wall near to the skin. DIFFICULTIES IN MICTURITION. 79 These swellings are large or small, soft or hard, and usually painless, and not sensitive to pressure. By resting quietly on the back, they mostly disappear ; the protruding bowels go back to their proper place. By means of a properly applied pressure with the fingers, they can generally be pressed back with a peculiar sound ; they are forced out by coughing, sneezing, and other motions connected with straining. If a woman who is troubled with hernia becomes pregnant, it gener- ally reduces itself without aid during the middle term of her preg- nancy, because the uterus then presses back the intestines and occupies the space itself. But if the rupture remains lying outside during pregnancy, because it has grown to it, it may be easily strangulated ; the fasces cannot pass through, and the result is constipation, which is connected with great danger. A woman with a rupture remaining outside past the middle term of her pregnancy, must go to a physi- cian for advice to avoid danger. If strangulation has already occurred, the hernial tumor becomes very painful, and vomiting, pain, chills and heat follow. The sooner medical assistance is called in, the greater the probability of a recovery. If a change in the position of the uterus is the cause of the constipation, it is generally at the same time accompanied by ishuria ; in that case also the physician should be called in at once. DIFFICULTIES IN MICTURITION AND THE CHANGE OF POSITION OF THE UTERUS. The difficulties in micturition are of a threefold nature. First, strangury, a painful, frequent, or even continual inclination to void urine, when only a small quantity is discharged with a cutting pain ; second, an involuntary discharge of urine, when, without the will of the woman, and without a call from nature, the urine is voided by starts; for instance, in coughing, sneezing, &c, or even continually; third, ischuria, the condition when the urine cannot be voided, although the bladder is fall, and the woman has the desire to do so. With this may exist the natural, or even an increased desire for mic- turition, or the desire may be entirely wanting. A frequent desire for micturition is usual in women during the first and subsequent stages of pregnancy, and they should satisfy the desire, because the cause of it 80 THE GENITALS OF WOMAN. lies in their regular condition. But this desire may become painful, and the pain frequently increases by urinating. It then assumes the form of stranguary, and frequently it is painful to touch the urethra and also the vagina. In stranguary the pregnant woman must go to bed and cover her- self up well, drink thin gruel, linseed tea, almond milk, &c, but must abstain from the use of all exciting drinks, such as wine, beer, coffee, tea, and all sour and salty food. A warm, moist poultice across the region of the pubis, warm injections of camomile tea-water, or milk and water, can be recommended for the alleviation of pain, or for a cure. A constant attempt to urinate only increases the de- sire ; it is sufficient if the patient obeys the call every half hour or hour. If the condition does not soon change for the better, or if the midwife finds, on an examination not to be neglected, that inner parts are very painful, or the uterus not in proper position, the accoucheur should be called in. Because stranguary and also full ishuria are the accompanying symptoms of one of the worst changes in the position of the pregnant uterus, that is to say : its retroflexion and strangula- tion. Strangulation develops itself either slowly, if the uterus does not, as it should, rise between the tenth and twelfth week from the little pelvis, but remains under the promontory, and grows there ; or, it begins suddenly, if from severe straining, coughing or vomiting, or by a fall on the posterior, through violent bodily exertion, particularly in a bent or squatting position, the uterus, which had already risen past the promontory, is pressed down again, and cannot re-ascend to its regular position. The firmer the incarceration of the retroflexed uterus, the more it grows by gradual increase, or by inflammatory swelling, the more fully will it bar the passages of the rectum and the urethra, so that neither alvine evacuation or urinating can take place, The inclination causes straining, and that, as well as the increased accumulations in the rectum and bladder, constantly press the uterus down deeper and deeper, and the incarceration becomes more firm. The accoucheur should be called in at once ; if relief is not afforded immediately, either the immature child is delivered, or the woman may die in consequence of the strangulation. The midwife can do but little until the arrival of the accoucheur, except to keep the woman quiet, and to cause her to lie on her side. Pressing and lift- PREMATURE INTERRUPTION OF PREGNANCY. 81 ing the uterus would only increase the difficulty, and so would injec- tions. If the midwife is skillful in the use of the catheter, she may, with great care, make an attempt to draw off the urine ; if successful in it, she will afford great relief. A rare disease in pregnant women is the discharge from the uterus of a watery fluid, occasionally of a reddish color. This water gradually accumulates between the two laminae of the ethmoidal membrane, therefore on the mucous mem- brane of the uterus, and is discharged all at once with labor pains, sometimes in a quantity amounting to several pounds. The statements made by pregnant women are insufficient for a diagnosis of this dis- ease. A copious discharge from the vagina, involuntary flow of urine, both of which can be distinguished from each other, give rise to mis- takes. The midwife can not distinguish this dropsical flow from the liquor amnii. A discharge of water from the uterus she must always consider as the beginning of an untimely birth. PREMATURE INTERRUPTION OF PREGNANCY, MISCARRIAGE AND PREMATURE BIRTH. Every considerable bleeding, in whatever part of the body, has an effect on the general health of the bleeding person, which, on account of its danger, is of great importance. A feeling of weariness, followed by oppression, great fear and asphyxia manifest themselves ; the sick person becomes dizzy and imagines that she is falling, although she lies quietly in bed. She has a buzzing and ringing noise in her ears , some have a violent headache, others suffer from great nausea and vomiting ; it gets dark before her open eyes, and she becomes uncon- scious. The lips even lose their color, and the skin assumes a greenish, waxy color. The eyes look dull and heavy, and sink in their sockets. The pulse beats slower and fainter, sometimes however, more rapidly, and finally fails altogether. Hand and feet become cold, and the skin is covered with a cold perspiration. If consciousness does not return soon, frequently with a deep-drawn sigh, violent convulsive motions of the whole body set in, and the woman dies. The whole of this may last only a few minutes. In a rapid bleeding some of these symptoms may not appear, because death comes quickly. The bleeding woman may occasionally come to for a time, until, with 6 82 THE GENITALS OF WOMAN. renewed bleeding, the symptoms return with greater violence, or the bleeding stops and the person is fully restored. During slow and long continued bleeding, which may appear to be less dangerous, dizziness and fainting occur later ; but the loss of blood has at that time been so great already, that even if it should stop then, death could not be prevented. There are internal and external bleedings. External bleedings are those where the blood makes its exit at the outside ; internal bleedings, those where the blood flows into an inter- nal cavity of the body, as, for instance, into the cavity of the uterus or of the abdomen, and which does not become visible outwardly. Internal bleedings may occur at the time of pregnancy in all internal parts of the body. The midwife may presume their presence, when, without any appearance of external bleeding, the just mentioned symptoms of ance?nia manifest themselves. If internal bleeding is caused by the rending of the uterus, or by an internal rending, outside of the uterus, on account of pregnancy, the pregnant woman is generally taken with sudden pain in her abdomen, and feels as if something warm was effusing in her abdomen, which at the same time distends and may become painful. The midwife, if she suspects an internal bleeding, must send for the accoucheur without delay, and until his arrival must apply ice cold poultices. External bleedings are much more frequent in pregnancy; unim- portant bleeding from other parts than the genitals, as from the nose, are not serious and frequently even beneficial. A physician should be called in, however, at each bleeding. The most frequent and most important bleedings during pregnancy are from the uterus. As a rule, no bleeding from the uterus should take place during the whole period of pregnancy, until the regular time for confinement ; bleedings occur- ring previous to that time are irregularities. If, at about the time when the woman has her regular menstruation, when she is not preg- nant, bleedings from the pregnant uterus set in, the woman will most generally imagine that she is not pregnant, and the midwife is not consulted. If the woman, however, suspects that she is pregnant, perhaps because the time for menstruation has passed once or twice, or for other reasons, or, if the midwife suspects it, then these bleed- ings occurring at the period of regular menstruation must be treated in the same manner as prescribed for bleedings from the uterus during DEATH OF THE FCETUS DURING PREGNANCY. 83 pregnancy. Bleeding from the uterus during pregnancy may, as at other times, be caused by a disease of the uterus ; for instance, ulcers on the vaginal portion, or cancer ; most of those bleedings come from the internal surface of the corpus uteri. But as it is closely connected with the ovum in every part by the mucous membrane, the ethmoidal membrane, and subsequently particularly by the placenta, and as the nourishment of the ovum is derived from this source, every bleeding creates the danger of the ovum not receiving its nourishment, and that pregnancy will suffer an interruption. The woman who has miscarried, should be treated as a woman lying-in, just as if she had been delivered at the regular time. Women are inclined to consider a miscarriage an unimportant event, requiring no attention, and which is best kept secret. The midwife should know better. The uterus and whole body of such a woman have to undergo similar changes as those in a regular confinement, if she is to be restored to perfect health. In addition to this, miscarriage is gen- erally caused by a disease of the uterus, which, if no remedies are applied, continues, grows worse, and frequently undermines the health of the woman. And even if the woman should perhaps feel quite well again after it, the danger of a miscarriage will be renewed during her next pregnancy in consequence of that disease. A conscientious midwife (even should she arrive after all has passed), will urgently advise every woman who has suffered miscarriage to call ( in an ac- coucheur, or to take his advice after she has passed through it, DEATH OF THE FCETUS DURING PREGNANCY. Death of foetus in the uterus may be the result, first, of an original defect in its own development, or in that of the ovum. A deceased foetus is therefore generally of malformation. Second. — All attacks of fever in the mother generally result in the death of the foetus ; the same is the case with small-pox, measles, scarlet fever, cholera, nervous fever, etc. Third. — Contagious diseases of the mother, for instance, venereal diseases, may be transmitted to the child and kill it. Fourth. — Deficient nourishment of the mother on account of sick- ness or famine may kill the child. 84 THE GENITALS OF WOMAN. Fifth. — Disease or bleeding of the uterus may result in the death of the child. Sixth. — In rare instances the foetus may die through violent emotions of the mother. Seventh. — Unknown causes may lead to the disease and death of the child. Premature birth generally soon follows the death of the foetus ; sometimes, however, weeks and even months may pass before it occurs. If the foetus dies during the first weeks of pregnancy, the ovum may continue to develop itself in a morbid condition ; the uterus also increases as if pregnancy was regularly progressing. The morbid development of the ovum after the death of the child is called a mole. There are racemose moles and molce thrombatica. Racemose moles consist of numerous clear, water-colored or brownish globules, to the number of thousands, varying in size from a good-sized grain of sand to that of a pea, and adhering to each other like a cluster of grapes ; they are morbidly degenerated villi of the corium. Racemose moles grow more rapidly than the healthy ovum, and may reach the size of a child's head, and over. The uterus of a woman advanced only four months in pregnancy, may, therefore, be of a size as if she was really advanced to six months. Molcc thrombatica represent a firmer mass, and are somewhat larger than a fist. They consist of red, brown, and frequently also of whitish masses, and have about the consistency of dried meat. Sometimes interstices are found filled with a muddy fluid. The molaz thrombatica grow slower than the healthy ovum, and may remain in the uterus without growing at all. The membranse ovi may still be discovered in both kinds of moles. Sometimes the small foetus may be found in the interior of the moles, and in other cases they are no longer to be found. The midwife may distinguish a mole-pregnancy. Mole-pregnancy is of shorter duration than regular pregnancy. The delivery of a mole generally commences with violent bleedings, endangering the life of the woman, and requir- ing the immediate assistance of an accoucheur. If one foetus of twins dies, the other may keep alive and come to maturity. After delivery, the small twin, squeezed together, is found enveloped in the tunic of the matured child. During the first weeks of pregnancy the dead foetus may dissolve in the ovum, so that it can- DEATH OF THE FGETUS DURING PREGNANCY. 85 not be found at all. A foetus that has died prior to the seventeenth week of pregnancy, frequently presents the appearance of being dried up, although it is surrounded by the liquor amnii. An older foetus, if remaining dead in the uterus of the mother for some time, becomes soft, puffed up, and the skin peals. The dead foetus can putrify in the womb only after the liquor amnii is discharged. The indications pointing to the death of the foetus in the uterus are not always clear. The change of the conditions created by pregnancy frequently dis- appears suddenly after the foetus has died. But that is not always the case ; sometimes the breasts swell considerably after the death of the foetus ; a heavy chill, not produced by external causes, and a putrid taste in the mouth, sometimes manifest themselves after the death of the foetus. If the foetus has already grown to some size, the mother, after its death, has a feeling of coldness in her abdomen. The ex- panded uterus, when changing position, creates the feeling in her as if a foreign body was tumbling about in the abdomen. If the motions of the foetus have been felt already, they, of course, cease after its death. Sometimes these motions were very vigorous, particularly if the foetus died of spasms. The heart-beat can no longer be heard. If the foetus has already assumed its regular attitude and position, it is not very unusual for it to leave it after death ; therefore the cranial position changes from the pelvis aperture sideward. If there exists a single indication of life, it certainly cannot be dead, and all mentioned indications do not furnish positive certainty, but only a reasonably sure presumption of its death. If the midwife did not know from previous examinations that the woman is pregnant, it may be difficult for her, if the foetus is dead, to determine with certainty whether she was in that condition at all. The feeling of parts of the child's body by external and internal examination, does not furnish certainty on the point. If the midwife supposes that the foetus has died in the pregnant woman, she must never frighten her by communicating the fact to her, but may suggest the possibility of a miscarriage, or a pre- mature birth. The accoucheur, who will have to be called in the latter case, may be informed of the circumstances by the midwife. 80 THE GENITALS OF WOMAN. FAINTING, ASPHYXIA, AND DEATH OF PREGNANT WOMEN. Fainting is a condition of unconsciousness, and the person attacked sinks down motionless ; the pulse is feeble, sometimes it stops alto- gether, and breathing becomes almost imperceptible. A deep fainting fit and asphyxia are very nearly related to each other ; the condition when the pulse stops and breathing ceases altogether, is called asphyxia ; when the beating of the pulse and breathig have ceased forever, it is called death. The causes which produce these condi- tions in pregnant women are, as in other people, so numerous that they cannot all be enumerated here. One of the most common causes is bleeding. The first thing to be done by the midwife in case Of fainting or asphyxia, is the removal of the producing cause ; there- fore, treatment for bleeding, admission of fresh air, the removal of tight clothing, &c. In light fainting fits, where consciousness has not entirely disappeared, the person is often recalled by a swallow of fresh water, or of a tablespoonful of good wine, or by being sprinkled with cold water or sulphuric ether, or by inhalation of spirits of sal- ammoniac. The limbs of the woman becoming cold, must be warmed by being rubbed with woolen cloths, and by brushing. Hot mustard poultices must be applied at the pit of the stomach, between the breasts, and on the arms. Under no circumstances must hot bottles be applied to the feet, as that would increase the bleeding. The head must not be elevated above the rest of the body, and a physician nearest at hand, or an accoucheur, must be sent for at once. If in the meantime the midwife has succeeded in overcoming the attack by the remedies above named, the physician will order further treatment to prevent a recurrence. In case she was not successful, the physi- cian has more effective remedies at command. But if death seems to have taken place already, and if it is not in the power of the physician to recall the mother to life, his presence is required on account of the foetus. If pregnancy has existed for over twenty-eight weeks, the life of the unborn child may possibly be saved. In all cases where the uterus of the pregnant woman has arisen almost to or exceeding the height of the navel, the immediate calling in of a physician, surgeon or accoucheur is required ; because a woman far advanced in preg- nancy should and must not be buried without being opened. DEATH OF THE CHILD IN DELIVERY, ETC. 8? DEATH OF THE CHILD IN DELIVERY AND APPARENT DEATH OF THE NEWLY BORN. In the absence of all signs of life in the child, the midwife pre- sumes that it is dead-born; and if the liquor amnii discharged is green, bloody, and has a fetid smell, it confirms her in her opinion. If, on a further examination, she finds that the scalp is flaggy and loose, and the bones of the head only loosely connected with each other, or if the anus of the posterior is wide open, the probability that the child is dead increases. But as the midwife is not cer- tain whether the child might not be saved, and as the death of the child might bring danger to the mother, she must, as soon as she suspects that the child will be dead-born, send for a phy- sician. The dangers surrounding the child at its birth, are known to the midwife. If the child is in danger, the pulsations of its heart become slower and irregular, they grow weaker and finally cease altogether; the midwife can hear that. Frequently the motions of the child become very suddenly much more brisk, almost spasmodic, and then cease ; that the midwife can feel. During this the child discharges its mecomium, and if anything can pass out of the uterus alongside of the head, it will be meconium, mixed, per- haps, with a small quantity of the liquor amnii ; this the midwife can see on the cloth, on the genitals, and particularly on the finger used in the examination. If she notices even one of these signs, from which she may conclude that there is danger to the child, although she does not perceive one of the symptoms before mentioned, she must call in the nearest physician, so that the child may be saved, if possible. If danger has had any effect upon the child either previous to, or during birth, it is either dead-born, or only apparently dead. A midwife can only consider the child dead which has been regularly born, if it shows signs of putrefaction; the first of these signs is when the skin peels off in shreds on being lightly touched. If the child is born without any indication of putrefaction, and without showing any of the known signs of life, it must be considered as being only an apparent death. The midwife must, in such cases, make the attempt to bring it to life ; unsuccessful attempts alone should satisfy her that death has taken place. The midwife should adopt the rule, before she lays down the child as being dead, to tie its 88 THE GENITALS OF WOMAN. umbilical cord under all circumstances, except it is in an undoubted state of putrefaction. The blood oozing from the open umbilical cord of even the dead child might create doubts whether the child was really dead. Apparent dead children are either without any motion whatever, or the only perceivable signs are pulsation of the heart and convulsive gapping for breath. The color of apparently dead children is either bluish-red or pale ; those of a bluish-red color have the appearance as if somewhat bloated ; their limbs are without motion, but possess, nevertheless, some firmness and do not hang down entirely unbent. Pulsation may also generally be felt in the umbilical cord ; frequently it is slow but full. The pale children show a flaggy skin and loose limbs ; even the inferior maxilla hangs down ; mouth and anus are open ; the umbilical cord shows no signs of pulsation, or, if such is the case, it is small. The blue color is the lesser and pale color, the higher degree of the appar- ently dead. The longer the child remains away from its connection with the mother's blood and does not breathe, the nearer its transition from apparent to real death. Many children come to of their own accord from the blue apparent death, although at first not fully, and with subsequent sickness. Children who do not come to from the blue apparent death, sink into the pale apparent death before dying. Vivification from pale apparent death is possible, but only by very circumspect treatment. The conditions under which the child lived in the uterus cannot be restored. The connection of the born child with the placenta, even if the latter remains still in the uterus, is of no consequence to the child. The reason of it is known to the mid- wife ; outside of the uterus, life can only be continued by breathing. To make breathing possible, to start it, or to imitate it temporarily, is the principal problem of every treatment of apparent dead. The first obstruction existing which prevents the breathing of a majority of apparent dead children is mucus, frequently mixed with mecoin:um\y'mg in their mouths and throats. The midwife must place her index or little finger in the mouth of the child, pushing it away down below the tongue, crook her finger a little, and draw out the mucus accumulated there. If the child was only in the bluish- red apparent death, it frequently attempts already then to breathe. She then slaps it gently, and at intervals, with the palm of her hand on DEATH OF THE CHILD IN DELIVERY, ETC. 89 the back and posterior, rubs her hand, dipped in cold water, several times over the child's face and breast, and with her hand vigorously sprinkles cold water on it. If the child begins to breathe regularly, opens its eyes, makes a wry face as if it was going to cry, draws up its arms and legs, and if the bluish-red color of the skin changes to a lively red, the midwife may continue the named remedies, until the child cries aloud and continuously. If the pulse has disappeared in the umbilical cord, she may divide it. But if the mentioned mani- festations of life do not show themselves soon, she must not lose toe much time, but proceed to a division of the umbilical cord, and try some more exciting means. In dividing the umbilical cord, permit a tablespoonful of blood tc flow from the end of the navel. First of all, the child must be placed in a warm bath for a short time, and moved backward and forward in the water. Then let the midwife take it by its shoulders and dip it quickly up to its throat in a vessel of quite cold water, and take it out again at once ; put it back in the bath again, and after a short time renew the dipping. The pulsations of the child's heart generally become very rapid and grow stronger, the skin changes to a red, the limbs gain firmness, the head no longer falls limber to one side, and the child begins to breathe. Frequently the child draws its legs up immediately with vigor, opens its eyes, and begins to cry aloud. But, should the child not soon come to life under this treat- ment, but become more limber and pale, then proceed in the same way as with children born in pale apparent death. The umbilical cord of the pale, apparently dead child must be divided without delay ; the mucus in its mouth must also be removed. The drawing of blood from the umbilical cord migtu be also useful in this case, for the deathly pale child is not deficient in blood. Generally, however, blood will not flow from the divided umbilical cord, because the heart, surcharged with blood, does not pulsate. To excite the pale, apparently dead child to voluntary breathing, is generally a useless loss of time; the breathing must be imitated arti- ficially. The blowing of air down its throat will remain without any success, but no harm can result from it. The midwife must imme- diately after the division of the umbilical cord, pursue one of the two courses now prescribed. She must in the meantime place the 90 THE GENITALS OF WOMAN. child for a short time in a warm bath, to prevent its getting too cold. She must also from time to time again remove the mucus from the mouth and throat in the manner previously described, pressing down each time the root of the tongue in a forward direction, which opens a passage for the air. In swinging the child, the air passes in and out audibly, and the mucus previously drawn into the lungs flows out through the nose. A further effect of the artificial breathing is, that the pulsations of the heart become more lively, and the child begins to breathe voluntarily. To infuse proper vigor into this superficial breathing, it becomes necessary again to return to artificial breathing and to dip the child in cold water. If the effect is not very marked, the midwife will, for a change, squirt a stream of cold water on the cardiac region, or drop ether on the same place and rub it in with her hand, tickle the child's nose with a feather, give it an injection of very cold water, drop a few drops of very strong wine on its tongue, as far down as possible, rub its breast and abdomen with the flat of her hand, and have cold water poured over its head and neck, whilst in the warm bath. It is of the highest importance, however, to con- tinue artificial inflation, which is best done by swinging the child. Sometimes success is only attained after several hours of work, and the child is recalled from apparent death and restored to regular and deep respiration. As often as the child makes attempts to breathe, it must not be interrupted therein by a hasty continuation of the arti- ficial means. The remedies should, under all circumstances, be applied with caution, keeping a careful watch over the child. The remedy which seems to have the best effect should be often repeated. As long as the midwife sees the pulsations of the child's heart, or can hear them by placing her ear closely to it, she must continue her efforts for vivification ; only when the heart ceases to beat entirely, may she consider the child really dead. The child may be considered fully revivified only after it has cried in a loud voice for some time. If left to itself sooner, it may relapse again into its former condition. The danger which is threatening the child, does not escape the attention of the midwife, even at its birth. Generally an accoucheur is present when apparently dead children are born, and she must then act accord- ing to his orders. Should it, however, happen, contrary to every ex- pectation, that an apparently dead child is born by an easy and rapid DEATH OF THE CHILD IN DELIVERY, ETC. 91 delivery, which is possible, the midwife must nevertheless send for an accoucheur, and in the meantime she must proceed according to the rules laid down. Children who were in apparent death, and who were revivified only with much trouble, are nevertheless sick, even if the revivification was successful, and they frequently die in a few hours. For this reason the midwife must always insist upon the calling in of the family physician, even after she has been successful of recalling to life an apparently dead child, else the success attained by her exertions may be of short duration only. DIFFICULTIES OF LACTATION The difficulties of lactation are of particular importance to mother and nurse. One of the first difficulties presenting itself is when the child feels the first necessity for nourishment, and finds no milk in the mother's breast. In a case of that kind it would be best to place the child to the breast of a nursing woman. If that cannot be done, the child must be fed from a sucking-bottle, with fresh cow's milk, to which an equal quantity of hot water and a little sugar has been added. The temperature of the mixture must be that of the mother's milk, therefore thirty degrees. Each time the child requires nursing, it should be put to the mother's breast, and the attempt to make it suck must be persistently persevered in, ere it is placed at another woman's breast, or fed from the sucking-bottle. There is a twofold reason why the child should not be fed from the sucking-bottle. First, the child does not thereafter accomodate itself readily to nursing from the mother's breast, and, secondly, the sucking of the child causes the secretion ot milk in the breast. If the child cannot be induced to nurse, because it does not find nourishment, the sucking of the mother's breast must be effected in some other way, in order to create a secretion of the milk. This may be brought about by the aid of an older and more vigorous child, or by means of a warmed sucking-bottle. Appropriate appar- atus for that purpose are now manufactured of rubber ; less appropriate ones are the so-called nipple glasses, made of glass or metal. In other cases, again, the trouble arises from too much milk in the breast, and therefore the child cannot take hold of the nipple, it being buried too deep in the breast. In that case some of the milk must also be drawn off, to enable the child to get hold of the whole nipple. A defective shape of the nipple is also sometimes the cause of producing a difficulty in nursing. The nipples may be too broad or too short, or they do not at all project above the surface of the breasts. This might be mostly prevented already during pregnancy. If, however, (92) DIFFICULTIES OF LACTATION. 93 it occurs in childbed, the nipples must be drawn out by means of sucking-bottles, and the child put to the breast immediately thereafter. It is also very judicious to closely cover the deep-lying nipples with a properly shaped nipple cap, made of wood, horn, or hard rubber ; it must have a fine opening exactly over the nipple. Over this cap is placed the mentioned rubber sucking-bottle. It draws the nipple into the form of the nipple cap, so that the child is able to take it without trouble. The midwife must not tire, and must also urge the mother to have patience. The rawness and chapping of the nipples is very painful, and frequently interferes with the nursing of the child. By observing the mentioned rules of cleanliness, this suffering is generally prevented. But if the nipples have to be drawn out with trouble, then their be- coming raw cannot often be avoided, even with the greatest care. If the nipples have become raw, then it is necessary, if it has been neglected heretofore, that they are washed off in clean water after each nursing of the child. During the interval between nursing, a fine linen cloth, kept constantly moist with water, must lay over them. Should this cloth become dry by accident, it must not be taken off by force, but it should be carefully removed by wetting it with water. In nursing the child, the pain will be less acute if the nipple is pro- tected by a nipple cap of black rubber, in the preparation of which sulphur has not been employed ; one or more of these the midwife should always have on hand. The midwife pours warm milk in the nipple cap, places it deftly over the nipple, and puts the child to it. In this way the child nurses very well, the mother will be spared at least some of the pain, and the raw nipples will heal. The midwife should not permit herself to be persuaded into the use of a solution of sugar of lead, or of ointments ; all of which are very apt to inter- fere with the nursing. If the nipples do not heal with the prescribed treatment, a physician should be consulted. The midwife should see to it that the milk does not accumulate in the breast, on account of the discontinuation of nursing. It manifests itself by a pressing, straining pain, a swelling of the whole breast, sensitiveness to touch, and a formation of hard lumps in some places, the so-called milk-knots. Repeated accumulation of milk does not only stop its secretion, but also leads to tedious, painful, and even 94 DIFFICULTIES OF LACTATION. dangerous inflammation of the breasts. Inflammation and suppuration of the breasts result mostly from a neglect of attending to nursing ; rarely does it result from other causes. Accompanied by violent pain, a hard spot is formed in the breast ; subsequently the skin over it turns red, and frequently only after weeks of torture suppuration takes place. In more rare instances the whole breast swells at once and becomes hard, red and hot. As soon as the midwife arrives at the conclusion that it is inflam- mation of the breast, she must insist on having the accoucheur called in, and must refrain from using plasters, salves and internal remedies. She must in the meantime keep the bowels of the woman open by injections, prescribe a strict diet and support the breast by a bandage across the opposite shoulder, and guard against an accumulation of milk in the breast. The nursing of the child would increase the inflammation, and as the milk of the inflamed breast would not be good for the child, the flow of milk must be promoted by repeated applications of warm cloths. The pain may be ameliorated by gently rubbing the breast with fine warm oil, and by enveloping it in a thin layer of soft wadding. The last remedy is beneficial in all cases ; for instance, if the child, by advice of the physician, must not nurse, or because it has died. Sometimes the child cannot nurse because it is not strong enough for it, or because it cannot bring its tongue to the outer edge of its lips, the franum lingiuz being too short. In both cases the advice of the accoucheur is absolutely necessary. An obser- vation of the preceding rules, and the use of a nursing cap having a longer mouthpiece reaching into the child's mouth, facilitates nursing in the meantime. Sometimes a case occurs when the mother does not want to nurse her child. Good physicians and midwives will continue to limit these cases more and more. Women generally have outside inducements which make the nursing of their offspring appear to them injudicious. The midwife must combat these false considerations, and represent the usefulness and necessity of nursing for both mother and child. Women who have to work for their daily bread away from home, as soon as they recover from their confinement, cannot nurse their child for as long a period of time as would be really necessary. But for that reason a woman should not attempt to wean the child at once. It is of the greatest importance to herself, as well as to the child, DIFFICULTIES OF LACTATION. 95 that it should receive the mother's milk, if only for a few weeks. In most cases it might be arranged that the child could have the mother's milk for months, at least once a day ; while during the rest of the time it could have other nourishment. Both are of immense advantage to the child, and the mother need not fear that it will have a bad effect on her breasts ; with proper care breasts remain healthy. If the child, for any of the reasons given, does not receive suf- ficient nourishment from the mother's breast, it must be provided with it from other sources in the most judicious manner possible. This is done either by means of the milk of another woman, a wet- nurse, or by artificial means. If the mother, or another careful woman, attends to the bringing up of the child in the manner to be hereafter described, it will, with a vigorus constitution and good care, thrive excellently. But if the child is weak, small and thin from its birth, then it requires the greatest and most prompt care and a great deal of more time than it would require if nursing at the breast, to carry it through ; a wet-nurse would in that case be preferable. A prejudice against wet-nurses, the result of correct feeling, is based upon the ground that if another woman is engaged to nurse the child, that the mother's child will be deprived of the nourishment to which it is entitled. This prejudice disappears, if it is taken into consideration that those mothers who would engage as wet nurses are compelled, by their condition in life, to wean their child in a few weeks after birth. If they find no place as wet nurse, they must get some other employ- ment as soon as they have gained sufficient strength. A place as wet nurse is much better for the young mother than a situation with hard work. The selection of a healthy, suitable wet nurse can only be made by the physician ; by a close examination he is able to ascer- tain whether the person is in full health. The midwife must ascertain whether the person has again had her menstruation, or whether she has other diseases of a peculiar nature, as, for instance, hysteria, salt- rheum, cancerous tetter or scrofula, itch, the whites, hemorrhoids, pulmonary disease, nervous phthisis, epilepsy, rheumatism, and rheum, or whether she suffers from disease of the liver ; nurses afflicted with any of these diseases ought not to be employed. A nurse must be in good health, else the child cannot prosper. The same rules as to mode of living, laid down for nursin g mothers, hold good for wet- 96 DIFFICULTIES OF LACTATION. nurses. The difference in the digestive organs of the nursing child and the adult is just as great, because milk is the proper food for the nurse- child ; if the child cannot have a mother's milk, it must be supplied with other milk. All food consisting of flour, or any other food, furnished to the nurse-child, except milk, it cannot digest. Cow's milk resembles a woman's milk to some extent, if diluted with an equal quantity of water and sweetened with a little surgar. Country milk is preferable to city milk ; but people should be satisfied that the cows furnishing the milk are kept cleanly and well fed. The milk given to the child should be one cow's milk, if possible ; it must be fresh, not skimmed or boiled ; if there is any doubt about the freshness of the milk, boiling it is preferable. The milk is given to the child from a sucking-bottle, obtainable in all apothecary shops. The milk must be of the same temperature as mother's milk, it may be even a trifle cooler, rather than hotter. The milk is warmed by adding the necessary quantity of hot water, with which it is to be reduced ; or by placing the sucking-bottle containing the diluted milk in hot water, until it attains a temperature of thirty degrees. If, as is now- a-days the case, the milk is already abundantly diluted when bought, an addition of sugar and warming it, are a sufficient preparation to give it to the child. For the purpose of sweetening the milk, a tea- spoonful of sugar of milk to a cup of milk is used. The sugar of milk can be had in all apothecary shops. If fresh milk cannot be had, concentrated milk had better be used. It is prepared in Ger- many, but particularly in Switzerland, and also in America, from the best milk that can be procured. A tablespoonful of this condensed milk, dissolved in twelve tablespoonsful of hot water, yields a good strengthening mixture for the child ; for children of more advanced age, a little less water is used. An addition of sugar is not required. The condensed milk contains already a sufficient quantity of sugar. The child may be fed with it as often as it would be placed at the mother's breast, and this depends upon the necessities of the child. As soon as it is discovered that the wants of the child are satisfied, the bottle should be removed. Healthy children easily throw up again any surplus which they may have drank, but after a while the stomach becomes accustomed to the excess, and it weakens digestion. People are apt to say that children who eat a good deal grow well ; DIFFICULTIES OF LACTATION. 97 this is true ; as long as the child's stomach defends itself against the surplus, digestion is not altogether destroyed ; but it is certainly better not to cram the stomach until it rejects the food. The mother or nurse must feed the child repeatedly, but must not give it too much at a time. What is left in the bottle is thrown away, the bottle must be cleaned at once, and the mouth-piece placed in fresh water. The milk must be prepared fresh each time, and after each feeding the mouth of the child should be cleaned with a soft cloth and fresh water. When the child gets to be three or four months old, the milk is gradually less diluted ; one quarter of water may then be added to it. After the fourth month, the dilution of the milk with water may be entirely discontinued. In addition to the milk which the child sucks from the bottle, it may be fed once or twice a day with milk in which a small quantity of farinaceous substance has been boiled, when it reaches the age of six months. Best adapted for that purpose are a thin meal pap, biscuits boiled in milk, soda crackers, rice and bar- ley water, or meal groats boiled in milk. It is hard for prematurely born children, and for twins and , triplets, to be deprived of the mother's milk. Frequently these children cannot digest cow's milk ; in that case other artificially prepared food must be resorted to, and the digestive organs must be strengthened with wine or medicines. A disarrangement of the digestive organs manifests itself in the child in the first place by vomiting, diarrhoea, costiveness, and also by spongy excrescences in the mouth ; they may either die soon, or after a long sickness. In most instances the disarrangement is brought about by a disagreement with food ; the child is either over or under-fed, or nourishment of the most unsuitable kind is administered. I consider it almost superfluous to enter into an enumeration of the causes. I must mention, however, the so-called sugar-tits, which will destroy the digestion of the healthiest child, and still more so that of one already sick, in whose mouth it is placed to keep it quiet. The mid- wife must, therefore, combat this abuse wherever she finds it with her utmost power. Beside the trouble the sugar-tits create for diges- tion, it makes bad teeth and enlarges the mouth. Nursing children vomit without any premonitory signs of indispo- sition, and without any of the choking or violent straining of the body which accompanies it in the adult. In the child it is, therefore, 98 DIFFICULTIES OF LACTATION. generally called spewing. But even healthy children spew up the curdled milk, which has a slightly acid smell. The midwife must, therefore, closely investigate the matter, and discover what part of the food causes the disagreement, and remove it. If the child is fed through the sucking-bottle, she must particularly investigate whether the milk used is perhaps sour already when the child gets it. Sour milk must be most strictly prohibited. If the child still vomits after the removal of this cause, or if no cause can be discovered, it is some- times very beneficial if the milk is diluted with weak fennel, or cam- omile tea instead of water. If, in spite of this, the child continues to spew up its food, or if it shows pain or restlessness, a physician should be called at once. If a nursing child has diarrhoea, the mother or midwife will readily know it, by its having more than four move- ments of 'the bowels in a day. The evacuations have, mostly, a greenish color ; or they are watery, slimy, or resemble chopped eggs, or perhaps they are even mixed with blood. Frequently these evacu- ations smell sour, and frequently also give much pain to the children. Diarrhoea in nursing children is very significant, and requires the attention of the physician as soon as possible. To relieve the child from pain for the time being, give it an injection of warm linseed tea, place warm flannel around its abdomen, and investigate immediately whether a mistake has been made in its food, and prevent a repetition of the same. Children fed on cow's milk are frequently costive ; their evacuations are drier and not so frequent, because it takes a longer time to digest cow's milk. If a child fed on cow's milk has one movement of the bowels in a day, and is otherwise well, it is satisfac- tory; one movement a day it must have, however. Children who are deprived from the beginning of the mother's milk, are also thereby deprived of the laxative furnished by nature, the mecomium. If a child does not discharge mecomium on the first day, or if subsequently no evacuation takes place until evening, or if the evacuations are dry and hard, causing pain to the child, the mid- wife must give it a lukewarm injection, consisting of milk and water, or water with a teaspoonful of syrup or honey added to it, or an in- jection of camomile tea. The midwife must entirely abstain from the administration of internal remedies. If the costive child shows rest- lessness or heat, or if it had no evacuation at all during the first DIFFICULTIES OF LACTATION. 99 twenty-four hours, the physician must be consulted without delay. In regard to the last mentioned case, the midwife must not forget that although she has satisfied herself, immediately after the child was born, of the regular condition of the anus, that it may be possible that the rectum may be closed farther up, a condition which requires medical aid just as urgently as does atresia ani. The spongy excrescence in the mouth of the nursing child is a kind of mould, which forms if proper cleanliness is not attended to. Improper food, containing flour, and the mentioned sugar-tits, are frequently the cause of these spongy excrescences. The strictest cleanliness of the mouth must now be observed, and they frequently disappear again in a few days. Should they, however, extend over the whole mouth, or should the child show signs of other diseases, when they first appear, as for instance diarrhoea, the physician should be at once con- sulted. The usual swelling of the new-born child soon disappears of its own accord. If it continues to a considerable extent after a protracted delivery, warm, moist poultices, prepared of camomile or elder blos- soms, or mullein flowers, will have a beneficial effect ; they should be well pressed out, however, so that none of the juice can flow in the child's face. If the swelling of the head increases after birth, or if a new swelling commences on the head, the midwife may presume that it is cephalsematome, and a physician must be at once called. Bleedings of the navel may be caused in newly-born children by an unskillful manipulation of the end of the umbilical cord, or by an original disease in these parts. The midwife may proceed in accord- ance with the rules given in the case of a tearing off of the umbilical cord, but must call in a physician without delay. The injury to the navel may, instead of healing, turn into an ulcer, and here also the attendance of a physician is required. Hernia umbilicalis may develop itself in children who cry a great deal while the navel is healing. If the midwife or the mother of the child should notice that a navel rupture has taken place, it should be attended by a physician, so that the rupture may be cured at once by proper treatment. Cutaneous eruptions are in children who are nursing somewhat more frequent than has been heretofore stated ; in most children, however, they are prevented. If, however, bullous dermatosis should 100 DIFFICULTIES OF LACTATION. make its appearance on the child's skin, or abscesses form, or milk- scall, erysipelas, or a white swelling of the skin show itself, or if the jaundice of the child should increase, when disturbances of the diges- tive organs and other signs of disease will not fail to manifest them- selves in these cases, the midwife must insist upon the attendance of a physician, and she herself should abstain from the application of all internal and external remedies. Chafe is a disease with which new-born children are generally afflicted. It shows itself in the folds of the skin in wellfed children at the thighs, under the arm-pits, around the throat, &c. Great cleanliness and a careful manipulation of the child in being, bathed and washed are often sufficient to prevent the chafing, or to remove it. If that should not prove to be sufficient, sprinkle, after carefully washing and drying the chafed places, a little lycopodium, obtainable in an apothecary's shop, in the folds of the skin, which may be done by means of a small piece of fine linen. More efficacious in obstinate cases is a mixture of equal parts of lycopodium and flowers of zink. This mixture is prepared in the apothecary's shop. Other prepara- tions in use, such as rose leaves or ointments, frequently do more injury than good. If the chafed places are hard and swollen, or if there are little ulcers on them, a physician should be consulted. Sometimes a swelling of the breasts occurs in new-born children ; sometimes even a little milk exudes from them. This swelling gener- ally passes away of its own accord, if the little breasts are protected from pressure, or awkward handling in bathing and dressing ; because some superstitious women are imbued with the idea that the milk must be pressed out of the children's breasts. This pressing sometimes causes an inflammation of the little breasts, which may be followed by suppur- ation. If inflammation has set in, gently rub the breasts with warm oil of almonds and place a little wadding over them. If that does not dissipate the inflammation, if the swelling increases and the skin becomes red, the child should be shown to the physician. Inflammation of the eyes is also a dangerous disease in new-born children. A few days' neglect may result in incurable blindness. A good occulist should be consulted at once. The greatest cleanliness is also required in this disease, and the eyes should be treated with cold-water applications. The nurse or mother of the child will fold DIFFICULTIES OF LACTATION. 101 a linen handkerchief into four or six folds, wet it with cold water, and repeat the application on the eyes until the arrival of the occulist. New-born children, and also those somewhat more advanced, are frequently subject to spasms. They are very dangerous, and require the immediate attendance of a physician. A cold or defective nour- ishment, and also imprudence committed by the mother or wet nurse in their own diet, &c. , are frequently the cause of these spasms. A particularly dangerous spasm in new-born children is lock-jaw, which consists in the inability of the child to open its jaws ; this is easily overlooked at first, when it could be more readily relieved. Until the arrival of the physician, an injection of camomile tea should be given, and a hot bath kept ready in case it should be ordered. There are many other diseases to which nursing children are liable ; the midwife and the mother can tell the difference between a well and a sick child. If a child cries constantly, not caused by either hun- ger, thirst or the defilement of its clothes, if it constantly refuses nourishment, if its skin is hot, if its breathing is rapid or irregular, if it does not gain, but rather loses, and if there are no indications of any of the diseases previously mentioned, in all these cases it is sick, and the aid of the physician should be called in. At the time of teething, when the teeth are either cutting through, or are on the point of doing so, children are most generally taken sick. Injudicious women suppose that diarrhoea or another disease are the necessary accompaniments of cutting teeth. That, however, is not always the case. Some children do not show any sickness during dentition ; others again are subject to very severe sickness ; many of these chil- dren do not die of teething, but of the diseases which manifest them- selves during the period when the teeth are cutting through, and of the many mistakes made in the nourishment of the children during that time. If, during the time of dentition, a child is taken sick, the mother must without loss of time call in a physician. CHILDREN, THEIR DISEASES, AND THE MANNER OF TREATMENT. FLATULENCY AND COLIC IN CHILDREN. The restlessness of children, their continual crying and kicking, demonstrates that they are suffering from flatulency and colic ; it is further indicated by a rumbling in, and the distension of, the abdomen. They make wry faces in their sleep, throw themselves restlessly about, attempt to take the breast, but soon let go again. Only if they are held up in a more erect position before the breast, will they take the nipple and suck until they are satisfied. Usually the attack is con- nected with costiveness, but in some with diarrhoea. The causes of it are various. It mostly results from cold taken by the mother or child, heating milk, anger, vexation, fright, costiveness of the nursing child, and sometimes from too rich milk, or milk which does not agree with it. The nursing mother or wet-nurse must therefore abstain from the use of too rich or highly seasoned food, and also from heating drinks. If these attacks continue for any length of time, iliac passion, enteritis or a contracting spasm of the bowels, may result from it. If the colic pains are very severe, administer to the child the following mixture : juice of manna four grains, fennel water eighteen grains, and diluted tincture of rhubarb four grains, one teaspoonful every three hours ; shake it up well before giving it to the child. If the pains should continue, however, administer of vervain and peppermint, equal parts ; take one-half ounce of each to a cupful of water, and give the child one tablespoonful every hour. Another prescription : Carbonate of magnesia four grains, fennel- oil sugar seven grains, powdered rhubarb four grains, valerian root one and one-half grains ; give of this twice a day as much as will lay on the point of a small knife, put in sweetened water. (102) FLATULENCY AND COLIC IN CHILDREN. 103 Another prescription : One-quarter of an ounce of balm mint, one ounce of syrup of poppy seed, one-quarter of one ounce of syrup of blue violet flowers, two grains extract of valerian root, and two ounces of white sugar ; dose, one teaspoonful three times a day ; to a child from two to three months old, one-half of a teaspoonful. Another prescription : Fennel syrup six grains, balmmint water thirty- two grains, carbonate of magnesia one and one-half grains ; dose, one- half of a teaspoonful every three hours ; nursing children from three to four months old, one teaspoonful every two- hours. A good ointment for colic in sr?iall children : Expressed oil of mace sixteen grains, tincture of opium one and one-quarter grains, and rose ointment fifteen grains ; warm the ointment in your hand and rub the abdomen of the child with it twice a day. Another prescription : Genuine bear's grease, rubbed in, is good against colic and cramps. It is difficult to obtain this article in the apothecary shops; dog fat or lard are generally sold in its place. Care should be taken to obtain the genuine article, for bear's grease has become quite celebrated. It is used for swellings, erysipelas, gout, and scrofula. The painful place must be rubbed with it four times a day. If it is flatulency only, and not colic, give aniseed tea, not too strong, fennel, star aniseed, peppermint or sweet flag tea ; put warm cloths or poultices around the abdomen. Another prescription : Ginger syrup is highly to be recommended against flatulency and colic ; dose for a child under six months, one- half drachm ; for children from six to twelve months, one drachm ; for children two years old, two to three drachms, and larger children from four to five drachms. Another prescription : Mastic is excellent against flatulency. Dose for children under one year old, one grain ; under two years old, two grains ; for a child from three to four years old, from three to five grains. Another prescription : Essence of peppermint is good against flatu- lency. Dose for a child under six months, one drop, diluted with the mother's milk, or it may be given* in a tablespoonful of weak camo- 'mile tea ; to a child between one and two years old, give from two to three drops in sweetened water. 104 CHILDREN AND THEIR DISEASES. SPASMS IN SMALL CHILDREN. An attack of spasms is always very significant in small children, and the mother and nurse must be very careful in such cases. Fright to the woman whose milk the child sucks, creates great danger ; instead of trying to relieve the child, the mother frequently troubles it with her lamentations or caresses, but that must not be ; she must go to work carefully, and labor quietly and patiently. Give the child a lukewarm bath and an injection of camomile or linseed tea, which will relieve it soon. The mother must abstain from nursing the child in her then state of mind, for her fright and anxiety has made the milk in her breast in reality poisonous ; it would of itself be sufficient to produce the most violent spasms in the child. It is therefore necessary that her milk should be drawn from her breast by means of the nipple glass, or it must be sucked out by a person. The child should only be nursed by the mother again after she has recovered her tranquility of mind, and her breasts have filled up with fresh milk. Should it be the case, however, that the child has sucked that milk, and that it has resulted in spasms, then the milk must be removed from the stomach as quickly as possible. The most advisable course to pursue is to give it antimonial wine as a mild emetic, or a teaspoonful of juice of squill root in two teaspoonsful of luke- warm water, and an injection of camomile tea, and a table- spoonful of sweet oil. Great caution should be observed not to make the injection too hot. In all cases where the spasms in children origi- nate in the abdomen, warm poultices over that part of the body and the stomach are very beneficial. For a poultice, boil meal-pap with milk and place it over the abdomen; or take camomile, mallow flowers and linseed boiled in milk. Internally administer a quieting powder, prepared by mixing carbonate of magnesia and powdered valerian root, one and one-half ounces of each ; dose, the quantity which will cover the point of a small knife, three times a day. There are various kinds of spasms. In some children they manifest themselves very suddenly ; sometimes, however, they are preceded by spasmodic twitchings of feet and hands during sleep. The child occa- sionally rolls its eyes upward and downward, which its friends gener- ally consider as smiling in its sleep. This is a sad mistake, however, because children never laugh until they are thirty-two or forty days SPASMS IN SMALL CHILDREN. 105 old. This seeming smile is only a forerunner of spasms. When a child rolls or fixes its eyes, if it makes a wry face so that its features lose the expression of calmness, which is very peculiar to children, it is afflicted with spasms. It sometimes happens that children, who are deprived of their mother's milk, and fed on cow's milk, are furnished with a milk obtained from several cows. A change of that kind will frequently effect them seriously. They are taken with colic pain, and spasmodic diarrhoea sets in, which is either watery, foamy, greenish or of a bloody color. An attack of that kind is generally not considered as being very serious, and the mother has no idea that the child is in great danger. A diarrhoea of that kind in nursing children must not be looked upon with indifference ; it carries off many children. It is surprising how quickly delicate children lose flesh with a diarrhoea, and after a sickness of a few days die in spasms. Every attack of diarrhoea in children must be attended to at once, but the sudden checking of the same is always strictly forbidden, as it is very hazardous. The cause of it should be removed first. A diarrhoea in children is generally caused by defective food, and if the trouble is to be removed in a proper way, the greatest caution is necessary. Frequently the diarrhoea is very obstinate and the children run down with it ; the cause of this is sometimes in the mother's milk. Frequently the milk is too rich or too fat, too old, too cheesy, or too salty, or it has some other pernicious quality. In many cases the milk was apparently good and wholesome, and yet the children, with the best care and attention, could not get rid of the spongy excres- cences, of vomiting and diarrhoea. The milk was thereupon examined and tasted, when it was discovered that it was very salty and had an offensive smell, and that it was the sole cause of the child's suffering. It is therefore necessary that the milk should be thoroughly tested in such cases. If it is found upon investigation that the milk is not of a good quality, a wet-nurse must take the mother's place. If that cannot be done, it must receive its nourishment through the sucking- bottle, in the manner already described. Frequently the milk of women who have their menstruations does not agree with the children, and causes diarrhoea and sometimes vomiting. Under such circum- stances a change of nurses becomes necessary. If a woman nursing a child takes cold from any cause, or has diarrhoea, she also gives 106 CHILDREN AND THEIR DISEASES. them to the child. Most frequently nursing women spoil their other- wise healthy milk by eating sour or strongly salted food, cabbage, onions, fruits, and sometimes also by sour beer, or by anger and other emotions of the mind. If diarrhoea is the consequence of these causes, it cannot be cured until the woman nursing the child corrects her mistakes. No mother or wet-nurse must permit the child to suck her milk, if she has undergone emotions of the mind, as it would be sufficient to produce spasms in the child. If a child has been lately weaned, and a severe or obstinate diarrhoea sets in, it is sometimes caused by the food which it cannot digest. The mother sometimes thinks that she is giving to her child the best and most wholesome food, while in fact it is too fat or too rich for digestion. This should be changed at once, if the mother wants to preserve her child. The best, most nourishing and easily digested food is chicken or veal broth, in which the yolk of an egg, barley or rice has been boiled, or lamb's broth in which rice has been boiled. Costiveness is never as dangerous to children as is an inclin ation for diarrhoea; children who are inclined to costiveness prosper better than those inclined to diarrhoea. And yet there lurks as much danger in persistent costiveness as there is in diarrhoea, particularly spasms, abdominal hernia, fever, and many other diseases. It must be observed, however, that if children are costive, who have received no other food but their mother's milk, it is sufficient if they have a limited evacuation of the bowels every other day ; under such circumstances they should not be troubled with laxatives. If, however, they are not very costive when using other food, laxatives, frequently administered, would only increase the trouble. Should they be very costive, and it is necessary that they should have a movement of the bowels, admin- ister an injection consisting of a cup of lukewarm camomile or linseed tea with a tablespoonful of sweet oil, or a cup of lukewarm milk with a tablespoonful of honey, or of water gruel with a tablespoonful of sweet butter. Inclination to costiveness is removed only with the cause thereof, which most generally is the result of a faulty diet. With children who receive their food from the breast alone, there is reason to believe that the milk is too rich for digestion. For that reason the mother must live on less rich food. She must also avoid SPASMS IN SMALL CHILDREN. 10T drinking beer, wine, whiskey, and even sweet milk, and drink fennel, aniseed or caraway seed tea. If the child is brought up on diluted cow's milk, it should receive daily weak veal or chicken broth, and its abdomen should be rubbed twice a day with goose or chicken fat, or sweet oil. Mashmallow ointment is also very good for that purpose. The most dangerous spasms are tetanus, and spasms with rigidity. The inability of the child to open its jaws is called lockjaw ; this is scarcely noticed at the commencement, when help would be a possi- bility. If tetanus gets its full sway, the lower maxilla can no longer be pressed down, it is fixed and rigid, the lips are firmly closed, and the mouth immovable. The rest of the body also becomes stiff ; arms and feet become rigid ; the voice ceases ; there is a gasping for breath ; the color of the face changes from pale to a bloated red and blue ; the eyes remain immovably in their sockets, and finally, life becomes ex- tinct in a few hours ; generally, however, after an abatement and a renewal of the attack, the child dies in from two to four days ; in rarer instances it is carried off by suffocation or apoplexy. Another kind are the internal spasms. The face and eyes becomes distorted ; the nose pointed ; the alee nasi sink in ; the nostrils are obstructed ; the forehead is in wrinkles ; the cheeks become hollow ; the jugular and cerebral arteries beat violently ; the child starts suddenly, throws its head about restlessly, and moans pitifully ; breathing is oppressed ; a white foam is on its lips, and it becomes insensible. Spasms are generally indications of other diseases, because every- thing that irritates and excites the nerves may produce spasms. It is for that reason that spasms occur more frequently in childhood, because the nerves are at that age more irritable ; in weak children almost every severe sickness is connected with spasms. Frequently children die of spasms in the mother's womb, or have an attack of them half an hour after birth. A violent, passionate temper of the pregnant woman, for instance, anger, vexation, care, melancholy and fright, and also labor beyond her strength, are inducing causes for spasms in children. It has been frequently observed that mothers who were greatly afflicted with grief, or a depressed mind, often lose their children by spasms or cramps. Derangement of the stomach, or the intestinal canal, are often the cause of spasms. Fre- quently children thrown into spasms have been troubled with cos- 108 CHILDREN AND THEIR DISEASES. tiveness for several days, or did not have a movement of the bowels for three or four days. If that is the case, give an injection of a cup- ful of linseed tea, with a tablespoon ful of sweet oil, or a cup of luke- warm milk with three teaspoonsful of honey, or water-gruel with two tablespoonsful of sweet butter. If this does not remove the trouble, or if the spasms return again in the same way, rub the abdomen, spine, and also both sides of the child's ribs, twice a day with oil of amber ; internally, give two to four drops to nursing children, and to those two months old, one to two drops in a tablespoonful of fennel tea. Particularly recommended for children are warm baths with two handsful of mugwort root, and one handful of camomile tea, boil in three gallons of water for half an hour, strain and heat it to luke- warmness. If the child is taken with the spasms, the above may be used as a bath. It has been tried and has relieved many children of spasms. Valerian root tea may be given internally. Take half an ounce of valerian root to a cup of water, boil for half an hour, and administer a tablespoonful every four hours. Another prescription for spasms : For a child under six months, give one-quarter to one-half of a drachm, and to older children one drachm of prepared amber. Another prescription: Tincture of castoreum six grains, tincture of henbane twenty drops, well mixed. To a child under six months, give two to three drops; to one over one year old, three to four drops; and to one over that age, from five to eight drops ; to be taken in water or milk. Another prescription : Assafcetida is highly recommended for spasms. Take twelve grains assafoztida, and syrup of poppy heads three drachms ; mix well, and give to a child under twelve months, from one-half to one drachm ; to one of two years, from two to three drachms ; to one from two to four years old, from four to six drachms. DENTITION, The first indications of teething in the child should occur between the sixth and eighth month of its age. There are, however, excep- tions to this, for it is known that children had a tooth at the time of their birth. Some children begin cutting teeth already in their third month ; others with the fifth and eighth month. It is exceptional if DENTITION. 109 children commence cutting their teeth when they are one year old. In many children it is hardly perceivable ; they discharge a good deal of saliva, and put their fingers in the mouth, and attempt to put some- thing into it on which they may bite. The mouth feels hot, they do not like to have it touched, and begin to cry suddenly. The gums are red and swollen, particularly where the tooth is cutting through. The cavity of the mouth of some children is very painful, they take the nipple of the breast in attempting to nurse, but let go again imme- diately and cry out. Dentition is always more or less connected with disorders of the stomach and the intestinal canal. Most children are troubled with diarrhoea at that time, although some of them are costive. A moderate diarrhoea can not do much harm, but in hot weather there is always danger that it will become severe. If it is very severe, it must not be checked at once. If the child has pain in the bowels, and the evac- uations are of a greenish color, and contain undigested food, or are thin and watery, or slimy and mixed with blood, it must be taken as an indication of a disease, requiring medical treatment. In some children dentition causes fever, redness in the face, diarrhoea, some- times difficulties in urinating, cough, difficulty in breathing, sleepless- ness or uninterrupted sleep, sore eyes, cutaneous eruptions, spasms and cramps. These diseases are not frequent, and hundreds of children are not at all troubled with them. Some children cut their teeth so easily that it is only noticed after the teeth have already cut through. Weakly children and those of a nervous, irritable consti- tution, are more subject to the diseases mentioned. If the teeth cut through slowly and irregularly, it indicates physical weakness ; neither is the early teething a favorable indication. Gen- erally children remain healthy during dentition, but any child may be taken sick at that as at any other time. It is a great mistake with some mothers, as is frequently the case, to imagine that during that time every indisposition of the child is caused by dentition, and that, therefore, not much can be done for it. It is foolish, however, as is frequently the case, to console oneself with the belief that it ought not to be different. A belief of that kind may result in serious con- sequences, and it is frequently the case that severe sickness may be added to dentition. Sometimes the rush of blood to the brain is so 110 CHILDREN AND THEIR DISEASES. great that it results in spasms, to which the child falls a sacrifice. As before stated, a difficult dentition is always caused by too great a rush of blood to the head, and it may become just as dangerous to vigorous, well-fed children, as to those that are very weakly. Violent fever, obstinate constipation, torpor, somnolence and spasms are among the most dangerous symptoms, threatening the child's life, or it may result in epilepsy and paralysis. If during dentition the child has thirst, if its mouth is hot, has a heated, and frequently an offensive breath, and if the forehead is very hot, it suffers from teething fever. As long as these feverish symptoms are moderate, no medicines are required. The child must not be kept too warm ; the head should be kept cool, but this must not be understood that it should be kept cool by moistening it. The head should be kept dry during the teething fever ; strong draughts of air must be avoided, and during this time the child should not be exposed to cold weather. The teething child should be carefully sup- plied with suitable food, and it requires pure air, and cleanliness in clothing, and in all other respects. Animal food should be entirely avoided by the woman nursing the child; she should also abstain from all heavy food, and particularly from all pungent, heating nourishment or spirituous drink. Children always suffer more at night than at any other time ; more attention should be paid to them, therefore, at that time. If the fever is very severe, put poultices of leaven, mixed with vinegar, to the calves of the legs and soles of the feet. Internally administer marshmallow tea twenty grains, extract of common yarrow two drachms (^ ounce), mix, and to a child six months old, give half a teaspoonful three times a day ; to one twelve months old, one teaspoonful twice a day; and to children from two to three years old, three to four teaspoonsful a day. If the rush to the head should increase, a leech should be applied behind the ear, if possible behind the right ear. If the child is very costive, give an injection of a cup of camomile tea, to which a tablespoonful of honey has been added. If all this is done at the right time, or in season, the danger may be averted. But if the application of these remedies has been delayed too long, and the fever and heat be on the increase, the head becoming hotter, so that it is almost impossible to count the beating of the pulse, and if the child constantly raises its hands to DENTITION. Ill the head, throwing it about from side to side, falls into somnolence, squints its eyes, and loses the expression in the face, then the danger is very great, and medical attendance is required. But in case the latter cannot be obtained, apply cold poultices and administer calomel six grains, divided into ten powders, of which give one every three hours. If, during dentition, spasms occur without fever, heat and redness of the face, there still exists great danger, because these spasms are caused by irritation or inflammation of the brain. The child is in that case pale and seems fallen away, and while some parts of its body feel burning hot to the touch, others are cold. In other children signs of great exhaustion manifest themselves after a heavy diarrhoea ; they look pale, their eyes are half open, and they lay quiet, rarely ever crying. Under these circumstances leeches should be applied to the head ; the administering of strengthening and useless remedies would infallibly result in death. Very little can be done to the gums ; if they are very much swollen and inflamed, small incisions may be made in them with a sharp penknife. This simple operation will afford much relief; it is neither painful nor injurious. To let the child bite on hard substances is not desirable, particularly when the teeth are just coming through, as they may be easily injured thereby. The best material to let them bite on is either leather or violet roots. A full set of the first teeth of a child consists of twenty, although generally only sixteen of them make ther appearance during the first two years. The upper and lower jaw each have four incisor teeth ; they derive their name from the sharp edge, which adapts them for the cutting of food. There are four canine teeth, two in the upper and two in the lower jaw. The two in the upper jaw are called eye-teeth. A child has two molar teeth on each side ; some children have four ; they are also called double teeth, because they have two sharp edges with an indentation between them, and resemble two incisor teeth placed alongside of each other ; they are also called grinding teeth, because they grind the food, which has been cut by the incisor, or torn asunder by the canine teeth. The molar teeth of the lower jaw have two roots and those of the upper jaw three, except- ing those next to the canine teeth, which have only two roots. The first to break through the gums of the child are the two middle incisors of the lower jaw, followed by the middle ones of the upper 112 CHILDREN AND THEIR DISEASES. jaw. Nature, however, does not closely adhere to that rule, for some children get the upper middle teeth first. Girls generally cut their teeth sooner than boys. THE OBSTRUCTIONS IN THE NOSE. CA TARRH AND DIFFICUL T BREA THING. It occasionally happens that children are exposed to attacks of suffo- cation a few days after birth, and many of them fall a sacrifice to it only because the danger is not recognized in time and proper remedies applied. These attacks result from various causes. They are either the result of an accumulation of mucus on the chest, of spasm of the same producing it, or of membranaceous exudations in the larynx or trachea. Mucus accumulates quickly in the chest of new-born children without any external cause or fever. Mucus accumulates often so rapidly in the trachea, as to create danger of suffocation, in which it may result, unless quickly attended to. A quiet slumber generally succeeds the attack, the child feels more comfortable, light mucus flowing constantly from its mouth, until some hours afterwards the attack returns with a strong rattling in the throat ; the face being bloated and of a bluish color. This accumulation of mucus may, however, take place later in consequence of a catarrh, which children readily contract from no perceivable cause. Most generally, however, it is the result of a cold, produced by taking the children out of bed while in a state of perspiration, or by a sudden change of temperature in the atmosphere, or having been left lying too long in their wet diapers. Night air is particularly hurtful to children ; cold baths may also produce this disease. A child may also absorb a cold from the woman whose milk it sucks, and this also may result in a catarrhal mucous obstruction of the chest. As long as this stringy mucus keeps filling them up, they should be carefully watched, so that they may receive immediate assistance in an attack, because it can easily result in a suffocative catarrh. If the child is threatened with suffocation from the mucus, put it immediately in an upright position, remove the mucus from its mouth with a fine cloth, and at once give an emetic consisting of ipecac one and one-half grains, juice of squill root fifteen grains, dis- tilled water thirty grains ; dose, one teaspoonful every hour until the child vomits. THE OBSTRUCTIONS IN THE NOSE. 113 The danger of spasmodic suffocation in children is the result of spasms of the glottis or the lungs. Children are generally attacked with it who are weak and inclined to scrofula and catarrhal difficulties, or who are the offspring of debilitated women. This spasm must be considered among the most dangerous, for the spasmodic closing of the glottis quickly deprives the child of its breath ; it makes an effort to recover it, and regains it with a scream. It will be frequently noticed that at first the child will hold its breath whilst taking the breast, or in screaming, or in awakening from or during its sleep. These attacks become more frequent, until the child has a sudden attack of suffocation. It then makes great efforts to recover its breath ; it throws back its head and body, the face assumes a bluish- red color, the eyes become fixed, nostrils expanded, and feet and hands cold, when with a scream it recovers its breath. Frequently several days pass by before a new attack occurs, and the child is well again. At first these attacks occur only when the child awakens from sleep, but subsequently when it becomes irritated and wants to cry. If the disease is neglected or wrongfully treated, the attacks increase in violence, the breath frequently does not return for several minutes, and it may in addition have general spasms. These may, after it has recovered its breath, continue for some time, with squinting and roll- ing of the eyes, rigidity of limbs and a contraction of the hands. The child remains pale, is tired, but breathes freely ; it becomes quite bright again, and then falls into a slumber. But if the attack recurs, it is usually fatal ; the child suffocates during the attack. Sometimes the child dies unexpectedly in the arms of its mother or nurse. Death comes quickly, and it dies without an effort for breath. But this dis- ease does not always end fatally ; sometimes the severity of the attacks are lessened, and finally cease altogether ; they leave the child very irritable, however. The disease sometimes lasts for months ; the danger, however, is not diminished thereby, but rather increased. Treatment of this disease is very difficult. The child must be guarded against all causes for an attack of spasms, for instance, against laughing, crying, violent motions, &c. Frequently spasms of the glottis are caused by inflammable irritability of the spinal marrow ; a careful examination of the spine should therefore be made. If, by touching the cervical vertebrae the child screams, it may be safely 114 CHILDREN AND THEIR DISEASES. assumed that the cause of the spasms is in that place. A few leeches applied to the spot have a magic effect, and remove the disease at once. But should the attacks not discontinue after it, an experienced physician should be consulted, previous to a return of the attack. A temporary removal of the sick child to the country might be very beneficial. OBSTSRUCTIONS IN THE NOSE, AND CATARRH. Some children are subject to catarrhal affections or colds, and in consequence breathing through the nose becomes very difficult to them. Sometimes while nursing they lose their breath, throw their heads backward and forward, and are scarcely able to get their breath again. This is a very common affection ; the simplest remedies will remove the trouble. First of all, clean the nostrils with lukewarm camomile tea or water, and grease the nose with goose fat or cam- phorated oil. Care should be taken, however, that none of it gets into the child's eyes. These inunctions may be repeated as often as required. As a medicine, give warm catnip, mullein flower, or yarrow flower tea. WHOOPING COUGH. Whooping cough is almost altogether confined to children ; it is a malignant disease. It may be divided into three periods, com- mences like an ordinary catarrh, and is accompanied by fever. The cough at first is dry, particularly in the evening, and connected with but slight secretions from mouth and nose. Wlien this condition has lasted several days, or for a longer period, the real nervous period of the disease sets in. It is then that the characteristic features of the whooping cough are discernible. It begins suddenly with a deep, wheezing or whizzing inhalation, followed by several short, shrill exhalations, after which the child again draws a deep breath ; and this is repeated several times in the same manner. An anxious feeling usually precedes this spasmodic attack of coughing, the child seeks a place to which it may hold on ; it supports its head, the face has a swelled appearance, feet and hands are usually cold, and sometimes the forehead is covered with perspiration. Sometimes mucus is expectorated, and at times the child vomits. The child is greatly WHOOPING COUGH. 115 exhausted by the attack, but soon continues its interrupted play until a fresh attack produces similar symptoms. At first the attacks are infrequent, but soon continue to increase, and between the intervals the children are very much exhausted. In from fourteen to eighteen days the whooping cough becomes violent. This second period is always the most important, and usually lasts from four to six weeks. There are cases, however, when it has extended from eight weeks to four months. The longer it lasts, the more does it injure the child's constitution. The child loses flesh, becomes pale and at the same time bloated, and is very irritable ; it becomes feverish again, which sometimes carries it off slowly. The third period of the dis- ease is when it is on the decrease, that is when the cough loses its peculiar sound, and when it is no longer quite so choking or exhaust- ing. By degrees the cough begins to resemble more and more an ordinary catarrhal cough ; finally a yellowish mucus is easily expect- orated, and the child soon recovers its health. Whooping cough is peculiar, and whoever has once heard it, will readily recognize it again. Some children die of it, but a great majority of them enjoy good health when they get over it. It becomes dangerous to children who take it during dentition ; at that time it becomes easily fatal through apoplexy and inflammation of the brain. The attack of the cough itself, even should it almost reach the point of choking, or force blood from nose, mouth and ears, is rarely fatal ; but the diseases resulting from it deprive children of health and life. Among the diseases resulting from whooping cough are phthisis puhno- nalis, consumption, hernia, curvature of the spine, dropsy, diaphrag- matis, aneurism, &c. It is quite certain that whooping cough makes its appearance only under the influence of a peculiar state of the atmosphere, and children should therefore be protected against its pernicious effects as much as possible. The surest protection is to move away from the neighbor- hood where whooping cough prevails. But if that is impossible, care must be taken that the child does not take cold. A sudden change of heat and cold must be particularly avoided. In cool weather children must be dressed comfortably warm; they must not be exposed to draughts and night air, nor be carried suddenly out of the hot sun to a cool, damp and shady place. In every case of whooping cough the 116 CHILDREN AND THEIR DISEASES. first indication of catarrhal symptoms should be attended to, for it is then possible to combat the malady in its incipient state and to pre- vent its further development. First of all, medicines should be administered to promote expectoration ; for that purpose give a weak infusion of ipecac, emetic wine or syrup of squill root and salammo- niac. These mucilaginous decoctions are excellent. If the throat shows signs of inflammation, several leeches should be applied. During the first and third periods, if no inflammatory symptoms have manifested themselves, an emetic, composed of the following ingredients, may be given : tartar emetic three centigrammes, distilled water thirty grains, juice of squill root fifteen grains, powdered ipecac one and one-half grains ; dose, every half hour one teaspoonful until vomiting sets in. If emetics prove to be useless, place a plaster of Spanish fly on the chest, and let it remain for a few days. Frequent warm baths should not be omitted during the first period, and mus- tard poultices placed on the calves of the legs, or on the soles of the feet. Internally administer extract of henbane five drops every three hours to small nursing children ; to those from one and one-half to three years old, give from ten to fifteen drops every three hours, or tincture of castoreum from one to two drachms ; to smaller children under one year, one to two drops every four hours, or two drops of extract of hemlock every three hours to nursing children ; an extract of foxglove is also very good. A useful domestic remedy is the juice of onions and garlic rubbed in the sole of the foot. Remedies should be used that promote the expectoration of mucus ; among these is syrup of squill root, of which give to a nursing child half a teaspoonful every three hours, and to a child two years old, one teaspoonful every four hours. The syrup may be reduced with sweet milk or water, when it is administered. Another remedy : Violet syrup is a very light, laxative remedy, loosening the mucus, and adapted for little children ; dose for a nursing child, half a drachm ; for a child from one to two years old, one drachm ; to older children, two drachms three or four times a day. Another remedy : Gum ammoniac also is a good domestic remedy to loosen mucus, and has become well known as a remedy against WHOOPING COUGH. 11 7 whooping cough. It not only loosens the mucus, but also soothes the cough. Dose for a nursing child, three to four grains every three hours in a little milk ; to a child from one to two years old, administer six to eight grains every three hours ; to older children, give from ten to sixteen grains. Another remedy : Dovers powders is a good, pain-soothing and sudorific remedy. To a nursing child under one year, give two grains three times a day in a little yarrow tea ; to children of from one to two years, four to five grains three times a day ; to children from three to ten years, according to the number of years, from six to twenty grains three times a day. Another remedy : Tincture of lobelia is a very good, efficient remedy ; it loosens the mucus, is excellent against spasms, clears the trachea, and keeps the lungs and liver in good condition. Dose for a child under one year, two to three drops four times a day ; to one from one to three years, eight to twelve drops four times a day ; to older children, from twenty to fifty drops, according to age. If vomiting is to be produced, give a little larger dose. If too much is administered of this medicine, it acts as a light emetic. Another remedy : Another approved remedy is black bistort root ; it has demonstrated its efficiency whenever used. It is particularly soothing in severe attacks of coughing ; it strengthens the brain and chest, promotes a very easy expectoration, and creates a fine, healthy perspiration. Dose for a child one year old, eight to ten drops three times a day ; for children from two to four years, from fifteen to thirty drops, according to age. It is best administered in sweetened water. As a drink, give fennel, anisseed, lemon balm or linden flower tea ; as nourishment give sago, rice or other farinaceous substances boiled in veal broth. The strength of the little patient must be kept up ; this is done by wholesome, and not by fat or heating food. Par- ticular care should be taken that the child does not take cold. If the remedies prescribed do not prevent a further development of the dis- ease, then consider above all that the fully developed whooping cough must run its course, and must never be suddenly stopped. The foolish attempt to suppress the cough quickly has created danger, and fre- quently the death of the child is produced by imprudence and poison- 118 CHILDREN AND THEIR DISEASES. ous medicines. The treatment of mild cases of this disease is very simple, and generally terminates favorably without medicines or medical aid. If, however, the child is attacked by some other dis- ease, such as have already been mentioned, for instance, inflammation of the brain, phthisis pulmonalis, pneumonia, consumption, hernia, curvature of the spine and chest, &c, a physician should be called in. CROUP. Croup is an inflammation of the trachea. It is a very dangerous and painful disease which attacks children very easily, and which requires immediate aid. Children are attacked by it at all seasons of the year, but particularly during cold and damp springs and autumns. In some instances the attack is so sudden, and develops itself so rapidly, that there is scarcely time to call in medical assistance. In most cases, however, the attack is preceded for several days by symptoms resembling an ordinary cold, hoarseness and coughing, or by catarrh, which makes the child hoarse, and imparts to' its voice a harsh, grat- ing sound. In that case there is reason to fear an attack of mem- branaceous croup. If the child complains of a feeling as if something was sticking in its throat, or shows signs of pain when pressure is applied to the larynx ; if breathing is depressed and very rapid, and particularly if there is added to all this a peculiar, dry, whistling and barking cough, it is quite certain that it is an attack of croup. Children between the ages of two and eight years are more liable to attacks of croup than those who have reached their tenth year. The attack may occur at any time of the year, but, as mentioned, more frequently during the raw parts of spring and autumn, and during a continuance of north and east winds. This very serious disease requires the immediate attendance of a physician, and until he has arrived, every effort should be made to relieve the child, as delay increases the danger. The attack itself comes very suddenly, or is preceded by fever, forming by exudation of a membrane in the trachea. It forms in the larynx during the first days, and in favorable instances is ejected, when coughing, in pieces in connection with a thick, yellow, stringy mucus. In severe cases the anxiety and difficulties of breathing increase in the patient ; the danger of suffocation increases, until finally death closes the terrible CROUP. 119 scene. In treating this disease, everything depends how quickly remedies are applied to prevent the exudation of the membrane. The remedies to be applied should be anti-phlogistic. The patient should be kept in a room of moderate temperature, and be carefully protected against taking cold. Leeches should be applied to the throat. The bleeding, after the leeches have dropped off, should be kept up in larger children for a time ; warm meal-poultices are then applied around the throat, and an injection of a decoction of linseed, to which a tablespoonful of oil is added, is then given. Internally administer liquid goose grease ; take a tablespoonful of goose grease and add three or four drops of spirits of hartshorn, stir well ; to a child two years old, give a small teaspoonful every two hours, and in- crease the dose proportionately for larger children. The best remedy is an emetic. Take tartar emetic three centigrammes, distilled water thirty grains, squill root and syrup each fifteen grains, ipecac one and one-half grains ; dose, a teaspoonful every quarter of an hour, until vomiting sets in. Another emetic : Tartar emetic five grains, squill root twenty grains, water one ounce, white sugar two drachms ; dose for a child from one to three years, one teaspoonful every five minutes, and to older children two teaspoonsful, until vomiting sets in. This is repeated as often as difficulties in breathing manifest themselves. No uneasiness need be felt, even should the child vomit from ten to twenty-five times in twenty-four hours. To facilitate vomiting in a child, tickle its throat with the oiled feathery part of a quill. Where there are small children in a family, the above emetic should be kept in the house, when, if required, it will be ready at hand for mixing with water. Never lose sight of the fact that in croup an emetic is of the highest importance. At the beginning of an attack, a piece of wad- ding moistened with warm spirits of camphor, whisky or vinegar, and placed around the throat, is excellent ; or take one pint of genuine brandy, put into it three tablespoonsful of finely powdered cooking salt, previously dried in an oven, warm the mixture, dip a piece of flannel into it, and place it around the throat ; as soon as dry, moisten it anew ; or mix for an embrocation, spirits of camphor, turpentine and olive oil, of each one and one-half ounces, and half an ounce of laudanum ; shake well, and anoint the throat with it repeatedly. 120 CHILDREN AND THEIR DISEASES. Sometimes the attack is checked in a short time. But if the attack can not be checked, the last remedy from which relief may be obtained is tracheotomy, performed by the physician. This operation has repeatedly given instantaneous and surprising relief, so that the patient was soon convalescing. Tracheotomy must not be performed too late, or on a dying child, as has been sometimes foolishly done. The convalescing croup-patient requires careful treatment. The child must at first be kept from inhaling cold air, and must be pro- tected by warm clothing and head covering. Flannel underclothing worn next to the skin, and a flannel or silk necktie can be recom- mended. Everything that tends to the overheating of the child, and also all running against the wind, particularly against a sharp north or east wind, must be avoided. Non-attention to these rules is one of the most common causes for croup, and also very readily causes a relapse. EXUDING CEREBRITIS, OR INFLAMMATORY HYDROCEPHALUS IN CHILDREN. This brain disease belongs to the most dangerous diseases of chil- dren. It develops very rapidly, and frequently terminates fatally on the third or fourth day. If the first period of its development is permitted to pass by unheeded, it is in all cases incurable and fatal. This dangerous disease usually attacks children up to their seventh year. Children most usually attacked with inflammatory hydrocephalus are those whose [cranial bone-seams have remained open for a long time, or who have remarkably large heads, particularly large brows and frontal regions, or who have cut their teeth too soon or too late, or are frequently sleepless and very irritable and lively ; whose mental abilities develop too 'early ; and also those who show a certain indo- lence of mind, and learn to walk and talk late. The reason why children are so much inclined to this dangerous disease during the second year of their existence, arises from the great rush of blood to the head and the irritability of the brain, which does not occur again to the same extent during the balance of their lives. It needs but little, therefore, to excite the brain to an inflammable condition, and it is easy to be comprehended that everything which tends to increase the rush of blood to the head, will readily induce this disease. Among the most frequent causes are injuries to the head, by pressure, knock- EXUDING CEREBRITIS, ETC. 121 ing or falling; also concussion of the brain, by too much rocking or tossing, narcotic remedies, stupefying scents, heating beverages, too sudden checking of diarrhoea, driving back of cutaneous eruptions, as for instance, smallpox, measles, scarlet fever, and generally any other inflammable disease, if connected with severe fever ; also a severe cold in the head and too early exertion of the mind. If attention is paid to the child, the approach of danger may be learned from various symptoms. If children become restless, captious, sigh frequently, suffer from sleeplessness, or sleep unusually much, or even fall asleep during play, if they sleep lying on their abdomen and fore- head, startle frequently during their sleep, don't like to get out of bed, dislike exercise, stumble in their walk so as to fall frequently, partic- ularly over their own feet, if they suffer from costiveness, or their mouth is dry and the head is very hot, it is high time to consult a good physician ; for all these symptoms point to a surcharge of the brain with blood, which, during a continuance, or on the least provo- cation, may result in inflammation of the brain. Above all, the men- tioned causes for inflammatory hydrocephalus must be most carefully avoided, and the consequences of preceding detrimental influences must be made as little hurtful as possible, which, however, is for the physician to attend to. In general the position of the head should always be elevated and cool ; the child should be kept from falling or striking, and rocking must be prohibited. All noxious vapors and scents, such as coal gas, tobacco smoke, steam arising from ironing clothes, &c, should be kept out of the nursery; a moderate and uni- form temperature should be maintained in it, and too much light, particularly the rays of the sun, should be avoided. Nourishing and constipating food, and all heating beverages, must be avoided, for instance, broth, thick meal-pap, in fact any kind of farinaceous food, beer, coffee, wine, &c; the child should be kept on light fare, or very easily digested vegetables. If the bowels are constipated, the follow- ing recipe should be prepared : jalap root one and one-half grains, calomel'twenty-four centigrammes, sugar twelve grains, mix and divide into sixteen powders; dose, one powder three times a day, until the movements of the bowels become regular. Afterward, keep the bowels open by an injection of camomile tea and a tablespoonful of honey. 122 CHILDREN AND THEIR DISEASES. If the face is very red, and the head very hot, leeches must be applied behind the ears, and on the neck, and mustard plasters on the calves of the legs. If the child is taken with chills, which afterward change to considerable heat, and which continues for some time, and if during this heat the head becomes burning hot, if the blood in the veins of the temples and throat pulsates rapidly and violently, if the child is already able to talk, and complains of constant violent head- ache, if its eyes are extremely sensitive to light, and its ears to sound, if the pupils of its eyes are contracted, the eyes red, if it cries and rolls about constantly, if it cannot raise its head, and if, by having it raised, or by placing the body suddenly in an upright position, it vomits, if the skin is dry, if it is constipated, and urinates but little, then with these symptoms exuding cerebritis has fully developed itself, and if medical assistance is not called in, the danger will increase with every minute. All that can be done, as has already been stated gen- erally, is to apply leeches behind the ears and on the temples, and administer of sweetened calomel powder half a grain every two or three hours, to produce abundant evacuations ; tincture of jalap is also frequently administered for the same purpose ; dose, from two to four drachms. If the head is very hot, apply cold poultices to it. If, however, it is not very hot, which is frequently the case, and the child still has an attack of exuding hydrocephalus, not cold, but luke- warm poultices should be applied, and mustard poultices repeatedly placed on the calves of the legs and the soles of the feet. Diuretic medicines should also be administered ; powdered digitalis, one-half to one or two grains, according to the child's age; or accidulated honey of squill root, one-half to one drachm ; or sweet spirits of nitre, five, ten, fifteen or twenty drops daily, according to age. All these remedies are beneficial. The same remedies, in connection with the inunction of the neck with vinegar of squill root and mercurial ointment, are equally applicable to chronic dropsy of the cerebral cavity. Entirely hopeless is the case, if the patient lies in a constant stupor, and his head is constantly drawn back, if incessantly moving the same hand to the occiput, if he is delirious, squints with his eyes, grates his teeth, has cramps and spasms, and finally, if single members become paralyzed. If the spasms or cramps get to their height, the patient strikes out with his hands and kicks with his feet, beginning EXUDING CEREBRITIS, ETC. 123 with one foot and one arm. This is succeeded for a time by paralysis of these limbs. The child falls into a lethargic sleep, and on awaken- ing, his eyes have a staring, squinting look, the eyeballs keep rolling from the right to the left, and the limbs begin to move again to the same measure. If this is followed again by paralysis of the limbs, death will result from apoplexy. The duration of the disease is from eight to twenty-one days, and after full development, it is ex- ceedingly difficult to cure even by the most skillful physician ; it is often just as difficult to discover the first period of its^commencement. Thousands of little children die annually of brain diseases, without any suspicion or knowledge of the cause of their death. CUTANEOUS DISEASES. THE MEASLES. Measles are contagious, and generally connected with fever- They rarely attack more than once, most generally children, sometimes, however, also adults. The disease begins with a catarrhal affection. In children it generally begins with a cold in the head, connected with alternating attacks of chills and heat ; their eyes begin to water, and are somewhat inflamed and red ; they are very cross, sometimes hoarse, and suffer from a troublesome cough. After a lapse of several days, an eruption shows itself. At first they resemble flea bites, but gradually develop into irregular, half-moon-shaped, carmine-colored spots, which show themselves generally first on the forehead, and under the chin ; they then extend to the nose and other parts of the face ; then to the throat and chest, and finally to the rest of the body. After the eruption has culminated, the fever attacks abate and cease entirely with the disappearance of the eruption ; the skin bleaches and peels with severe itching. Perspiration and heavy voiding of urine sets in at the same time ; in some cases also diarrhoea, and a discharge of mucus from the lungs, and generally the disease disappears altogether in from fourteen to twenty-one days. The measles are usually not a dangerous disease, and in their regular ordinary course scarcely need medical treatment. It must be observed, however, that in some children the measles assume a malignant form, and it is there- fore advisable to consult a physician, particularly as in some cases diseases incidental to measles, such as diseases of the chest and inflam- mation of the eyes, often absolutely require quick and energetic treat- ment. In treating measles, the following rules should be observed : The patient should be confined to a somewhat cool, rather than to a too hot room, which should be darkened to a limited extent, particu- larly if inflammation of the eyes has set in to some extent. The patient should keep the bed only lightly covered, but must be protected (124) THE MEASLES. 125 from taking cold, and from any sudden change of air. Diluted, accidulated drinks may be used, such as weak lemonade, sweetened water, raspberry juice, toast water, almond milk, and if troubled with a cough, linden and elder flower tea. A strict diet must be observed, which is to consist of vegetable food, such as oatmeal, rice soup, &c, and if the patient has no diarrhoea, the eating of fruit, cooked or otherwise, is permitted. The rnind of the patient, which is always irritable during this disease, must not be excited or irritated. A moderate looseness of the bowels must not be checked ; if, however, the patient is costive, give an injection of camomile tea, and a table- spoonful of sweet oil. Internal remedies are only required if there is a violent fever. In some cases this fever is of an inflam- mable nature, and should be treated, if of a mild type, as a simple irritative fever, but if severe, as an inflammatory fever. If the fever has subsided, and the skin begins to feel soft and moist, a mild sudorific medicine would be of service. Give to a child a decoction of St. John's wort and elder blossom tea, or Spanish saffron tea. The use of meat and heating beverages must be avoided. Only after the skin begins to peel, perspiration may be promoted by drinking fennel tea. During the time when the skin peels off, the danger of taking cold is greatest, and therefore the patient needs the closest attention ; during that time his linen should not be changed. If, by imprudence, the rash is driven in, the patient should take a warm bath, be dried with warm cloths, and placed in a warmed bed. Inflammation of the eyes must be treated, as explained under the headings "Inflammation; Catarrhal Inflammation of the Eyes;" "Thoracic Complaints," and under " Coughs, Catarrh, and Croup." The person restored to health must keep the house for at least several weeks after his recovery, ere he ventures into the fresh air. This dis- ease is very dangerous to children who are subject to thoracic diseases ; they are generally attacked by it during the time of dentition ; it also attacks with violence adults, pregnant women, those in childbed, and also drunkards. The fever increases daily until the eruption of the measles takes place, and is frequently accompanied by headache, sometimes vomiting, and in some cases by delirium, and in small children by spasms. 126 CUTANEOUS DISEASES. SCARLET FEVER. Scarlet fever is a contagious, cutaneous disease, generally connected with fever, and inflammation of the throat. Children are much more liable to take it than grown persons, and generally only once in a life time. After more or less severe indisposition, and a feverish feeling for two or three days, innumerable red dots show themselves in the face and on the throat, which, in the course of twenty-four hours, extend over the whole body, when they become confluent into small spots. On the inside of joints the scarlet color is generally brightest ; it is perceivable also in the mouth, the oral cavity, and in the nostrils. On the fourth day the eruption is at its height, and from that time it decreases gradually, so that it disappears almost entirely with the seventh day. The tongue usually has a white coating, yet the red spongy excrescences are prominently above it, the face is bloated, fever more or less high, and the restlessness of the patient accordingly. After the eighth day the skin usually peels off in large flakes, and the patient is convalescing. It is not always the case, however, that this disease subsides so quietly. Frequently the fever sets in violently at once ; the inflammation of the throat makes its appearance simulta- neously with, or perhaps before the eruption, the patient feels a stiff- ness and pain of the throat, the throat is very raw, swallowing painful, the voice deep and hoarse, and the heat of the skin varies considerable. The patient is troubled with nausea, headache, and sometimes also with vomiting, great restlessness, and becomes delirious ; the pulse is frequent, and the tongue has a deep red color. The eruption does not always spread over the whole body, but appears sometimes in scattered spots. The peeling of the skin is sometimes inconsiderable and hardly perceivable ; at other times again it lasts for weeks, and large flakes peel off from hands and feet. Sometimes suppuration in the throat, or ulceration of the tonsils, and the velum palatinum, &c, takes place. The scarlet fever patient is liable to the same diseases which may result from the measles, and in addition thereto to dropsy of the face, feet, abdomen and other cavities, which are particularly produced by taking cold, and are sometimes fatal. Sometimes diseases of the head manifest themselves, which may also result in death. Not infrequently an offensive, purulent flow occurs from the ear, which sometimes results in total deafness. The patient should be kept in a rather cool SCARLET FEVER. 127 than warm room, the bed covering should be light, but all draughts and colds must be guarded against. Upon the whole, the eruption should neither be forced nor retarded. Non-malignant cases scarcely re- quire medicines; mucilaginous cooling decoctions and forbearance of all heating food and beverages, are generally sufficient. In such a case the same course may be pursued as is provided under the head- ing of " Croup." Croup requires proper treatment. Scarlet fever requires the greatest attention during desquamation, because taking cold at that period is serious, and dangerous maladies may result from it. If the eruption should have been driven in by accident, the patient should take a warm bath and be poulticed with mustard and Spanish fly plaster ; administer internally sudorific remedies, such as tea made of camomile or elder flowers, lemon balm, guiac wood, St. John's wort, or bistort root. All these herbs are sudorific remedies, and may be given to children without any risk whatever, where it is necessary to throw them into perspiration. The decoction must be made according to the age of the child. For young children the tea should not be made too strong, but for older ones it must be made stronger. Sometimes the poison of scarlet fever attacks the eyes and glands. Among all eruptive diseases, scarlet fever is the most malignant and deceptive. Frequently it runs very light, is innocuous, and a death is of rare occurence. At other times it appears so malignant, and is so poisonous that it becomes exceedingly pestilential and fatal, and the sick person succumbs sometimes on the second day, and from that time to the sixth day. It sometimes invades homes, and claims from one to three persons as its victims. In single cases it may even appear light at first, and yet become suddenly fatal by entering the brain, or by running into dropsy. Inflammation of the brain, gangrenous quinsy, spasms or cramps, asthma, apoplexy, lung diseases, consump- tion, and dropsy of the heart, are the sequel of scarlet fever, and mostly result fatally. Generally it is the violence of the fever that produces the danger. All fevers which continue with a high, rapid pulse, dry, burning heat of the skin, and a strong rush. of blood to the head, are under all circumstances dangerous, and where such a fever lasts with uninter- mitted violence, a change for the worse is possible, and therefore 128 CUTANEOUS DISEASES. danger always exists. Particular attention should be paid whether any changes occur in the sick person, particularly in his features, an unusal trembling of his limbs, quick and violent motions, and great thirst and dryness of the whole body. In a case like that, place no confidence in seeming improvements ; they are very deceptive, and the danger very great, and unless a physician is called in at once, the saving of the patient frequently is impossible. The extent of the inflammation of the throat can be judged by the danger from the scarlet fever. If the redness of the throat extends far down, if swallowing is almost an impossibility, and the swelling of the tonsils is so great that they almost touch each other, then the danger is very great, and diphteric inflammation of the throat sets in. If the red- ness of the skin has spread very much, and is connected with a burning heat, or if the reddened skin shows small spots, or what is worse still, if the skin becomes pale quickly or at once, then the disease has reached the brain, and the danger is very great. The first thing to be done in treating scarlet fever patients is, as soon as the first symptoms manifest themselves, to immediately anoint the whole body with cam- phor ointment, spirits of camphor, or salted bacon. The whole body, including the throat, should be rubbed with it, and a piece of it con- stantly kept around the throat. In a mild case of scarlet fever, the same treatment may be followed as that prescribed for measles. But in more severe cases, which are readily recognized by greater heat, higher fever, and a general deeper redness of the eruption, danger is imminent, and not a moment should be lost in obtaining medical assistance. But if the latter cannot be immediately obtained, leeches should be applied as soon as it is noticed that the fever is very high ; the number of leeches depending on the age of the patient. They should be applied on the neck or behind the ears. For a child twelve months old, one leech is sufficient, to be placed on the neck ; for children from two to four years, three leeches are necessary, one on the neck and one behind each ear ; adults require four or five leeches. Internally administer chlorine water ; for adults, from thirty to forty grains, with two hundred grains distilled water ; for children from one to four years, from four to eight grains, with twenty to sixty grains distilled water and three ounces of sugar ; it should be well mixed. Dose for an adult, a tablespoonful every two or three hours ; SCARLET EEVER. 129 for a child one year old, half a teaspoonful every two or three hours, and to older children, one teaspoonful every four hours. The patient may drink liberally of linseed tea; all other cooling drinks that may contribute to his comfort are permitted, but solid, heavy food is inter- dicted. The diet must always be very light. If his thirst should be very great, the drinking of an excessive quantity of water must not be permitted. The inflammation of the throat must be very closely watched as soon as great difficulty in swallowing manifests itself, and the redness in the throat has greatly extended. In mild cases, gargle with sage or mallow tea, with a little milk, or lukewarm sweetened water ; in more serious cases it is best to apply leeches, but if the throat is ulcerated, gargling must be resorted to, for which purpose use four grains of borax, mixed with twenty-five grains of honey, and two hundred and fifty grains of water ; use four or five times a day. For children, prepare sugar syrup twenty-four grains, chlorate of potassa one grain, distilled water eight grains. Dose, for children up to one year old, half a teaspoonful every three hours ; from two to four years old, one teaspoonful every three hours; and for older children, a tea- spoonful every two hours. For adults, mix marshmallow juice thirty grains, chlorate of potassa three grains, distilled water one hundred and sixty grains; dose, a teaspoonful every three hours. If the patient is attacked with dropsy, so that first the face, then the abdomen, then the legs, and then the scrotum becomes bloated, the following must be administered : balsam fir, to children from four to six grains, to adults from fifteen to thirty grains. The juice of expressed dandelion is also very good for dropsy. Dose for children one year old, half a teaspoonful ; from two to six years old, from one to four teaspoonsful daily. Spirits of nitre thirty drops, and accidu- lated honey of squill root from half to one drachm, mix ; dose, for a child one year old, one-quarter of a drachm, and to older children, according to age, from one-half to two drachms three times a day. The patient may drink linseed tea at pleasure. With this treatment dropsy may be prevented. The patient must be most carefully guarded against taking cold. During the time of desquamation the patient must keep the bed, and must be confined to his room during the summer for four weeks, and during the winter for six weeks. The room may be kept somewhat less warm towards the close than it was 130 CUTANEOUS DISEASES. at the beginning of the disease. A change of linen must be made with the greatest caution, and not too often. The patient may be washed with weak camomile tea, or with lukewarm milk and water. Care should be taken, however, that his change of linen is well aired and warmed, and not damp. Strict diet should be observed for some time. Even under the most favorable circumstances, the patient should be kept on low diet until after the fourteenth day after recovery, and after that time he may be indulged in light vegetables and thin broth ; meat he may eat after the twenty-first day. After the fortieth day he may return to his usual diet, but must continue to be careful not to take cold. The scarlet fever derives its name from the peculiar red color of the skin. ROSEOLA. Roseola is a disease occupying a place between measles and scarlet fever, but bears a nearer relationship to the latter, and some even insist that they are able to discover the peculiar scent emitted by scarlet fever patients. It appears almost altogether as an epidemic, but with so many different modifications that it is scarcely possible to give a positive definition of it. The premonitory symptoms are of a catarrhal-rheumatic nature, but rarely reach the intensity developed in scarlet fever or measles. It appears in the shape of small, red and distinctly defined spots on the skin, not rising, however, above its surface. These spots show themselves in different parts of the body, particularly on the throat and chest, whence they spread over the whole body; inflammatory fever is usually connected with their appearance. Throat diseases are connected with roseola, and the tonsils suffer especially. It begins with a loss of appetite, lassitude sets in, accompanied by pain in the limbs. The eyes are sometimes red, and the lachrymal fluid overflows ; in other cases they are dry and itch very much. Frequently the patient suffers from severe head- ache, especially from a severe pressure in the forehead, which is con- nected with nausea, and frequently also with vomiting. The attack is often accompanied by a violent cough, which continues until the disease has reached the culminating point. The skin is very hot and dry. The eruption, from which children and women suffer particu- larly, appears in from twelve to twenty-four hours, but in some ROSEOLA ERYSIPELAS. 131 instances only after a lapse of forty-eight hours, and remains visible for several days. The eruption does not appear with any kind of regularity ; sometimes it shows itself first on the face, and at other times on other parts of the body, or even over the whole body at once. The red color is of different degrees of depth. The desqua- mation is not quite as great as in scarlet fever, but greater than in measles, and occurs over the whole body at once, or in very rapid succession. The itching accompanying it is not severe. The symptoms disappear gradually, perspiration and urinating increase, and a muddy, heavy deposit occurs in the urine, when left to settle. If the spots which appear on the surface of the skin remain isolated, they bear the greatest resemblance to the measles ; but if they become confluent, the color of the skin becomes a uniform red, and the dis- ease then resembles scarlet fever. Sometimes groups of little nodules or blisters of the size of a mustard seed, raise in the middle of the spots. The eruption remains at its height from five to six days, and does not disappear before the ninth day, when the disease terminates with a light desquamation. Roseola is generally non-malignant, and only requires nursing for about four weeks, similar to the manner pre- scribed in measles. The movements of the bowels should be gentle, and tincture of jalap and calomel, of each eight grains, should be administered to the patient. Dose, for a small child, from one-half to one grain ; for larger children, from two to four grains, according to age j and for adults, from six to ten grains. ERYSIPELAS-ROSE. Erysipelas is a superficial inflammation, which generally attacks the lymphatic vessels, but sometimes also the glands and the mucous reticulum of the skin. According to the cause which produces the disease, it is divided into erysipelas and erysipelas spurium. Erysipelas is recognized by the yellowish red color of the skin, gradually shading down to the healthy color of the same. Some of the symptoms of the disease are nausea, disorders of the digestive organs, loss of appe- tite, a coated tongue, and pressure in the head. The patient feels wearied, and the nausea with which he is troubled, sometimes ends in vomiting. 132 CUTANEOUS DISEASES. Erysipelas is generally connected with fever and great heat, which disappears under the pressure of the finger ; but as soon as the pres- sure is removed, it returns and moves from one place to another. It is usually connected with burning, itching, and violent stinging. Frequently it is accompanied by fever, blisters on the skin, and is marked by an inclination for sleep. Erysipelas is liable to attack any part of the body, but usually makes its appearance in the face, where it is apt to give much trouble. Erysipelas of the head and face always commences with fever, head- ache, earache, and sore throat. It generally commences in one of the cheeks, in one ear, or on the nose, and spreads thence rapidly over the whole face, even over the part of the head covered with hair. On the cheeks, forehead and ears, little pustules frequently make their appearance, which, on breaking, form thin, yellow, or hard, black and brown scabs. In less severe cases the outer skin peels off, but in severe cases it separates in large flakes. The desquamation and dropping off of the scabs is frequently completed in a few days ; but as a rule it does not occur before the seventh, tenth, and even not before the eighteenth day. Erysipelas of the face sometimes starts from the chin, and extends itself over the forepart of the chest, and even over the breasts ; it is accompanied by fever. With erysipelas in the breasts they swell up immensely, become hard, the pain is violent, and suppuration readily sets in. Often the pain extends to the axillary of the side where the pain has its seat, and there forms an abscess. The inflamed breast of the woman nursing a child is often of an erysipelatous nature, which is distinguished from the inflamma- tion of the mammary gland by its being more extensively spread in the skin. Erysipelas of the abdomen sometimes assumes a very peculiar form. It encompasses in the navel region exactly one-half of the body, from the spine to the middle of the abdomen, as a zone, closely defined and separated from the healthy skin, and for that reason it is also called herpes zoster. Erysipelas of the arm is almost usually a continuation of erysipelas of the head, if not brought on by wounds or other surgical injuries. More frequently erysipelas attacks old, sickly people in the feet, where it causes painful ulcers, which usually continue for a long time. ERYSIPELAS. 133 Not to be confounded with erysipelas, is the so-called erysipelas spurium, which consists of an inflammation of the cellular tissue lying deeper under the skin. It is not very painful and of a deeper red color. It belongs to the so-called external surgical diseases, and is mentioned here only to avoid a misunderstanding. Erysipelas is produced by changeable, damp and cold weather, by taking cold, particularly in a heated portion of the body, by various emotions of the mind, such as anger, vexation and fright, and by a peculiar irritability of the stomach. Some people get erysipelas immediately by becoming quickly overheated, or from tainted food, particularly rancid fish, by a defective secretion of bile, from sup- pressed menstruation, from hemorrhoids, and from old ulcers, which have been prematurely healed. Erysipelas must not be looked upon with indifference, on account of its moving from one part to another, as well as for the reason that it may easily fly to some internal part. Erysipelas facei, even should it appear insignificant, if connected with headache, somnolence or deliriousness, always threatens great danger. Erysipelas generally ceases on the seventh or ninth day with desquam- ation and dispersion. Desquamation is absolutely necessary for this disease ; if it does not occur, it soon reappears again. On the hairy part of the head the effect, besides desquamation, is a loss of the hair. If erysipelas is not dispersed, it results in induration, suppuration and mortification. In treating erysipelas, first of all, quietness is necessary, colds, draughts, dampness, and intense stove-heat should be avoided. The patient must be put on low diet, but may be allowed rich, cool, accidulated drinks, particularly sweetened water with raspberry vine- gar, or lemon juice. In light cases, prepare a beverage by taking fifteen grains of cream of tartar, boil it with fourteen ounces of water until the powder is dissolved, and after having cooled off, add a sliced lemon and a sufficient quantity of sugar, and drink at pleasure. But if there is a high fever and signs of inflammation of the brain, or a great rush of blood to the head manifests itself, no time must be lost in procuring a physician. Emetics are always very essential in attacks of erysipelas, particularly in erysipelas facei. Prepare the following emetic : Ipecac root twenty grains, tartar emetic two grains, honey of squill root a tablespoonful, raspberry syrup fifteen grains, 134 CUTANEOUS DISEASES. well water forty grains ; dose, to adults, a tablespoonful, to children, a teaspoonful, until vomiting sets it. If, for particular reasons, this emetic cannot be administered, give as a purgative, manna and tama- rind bark, of each three drachms ; boil in three hundred and eighty grains of water until the liquid is evaporated to two hundred and fifty grains, strain and add forty grains of raspberry juice ; dose, a tablespoonful until it has desired effect. Treatment of erysipelas must be directed principally against the seat of the disease, and the driving in of it must be prevented under all circumstances, as it is fraught with the greatest danger. Cold and moist applications, so beneficial in other inflammable diseases, must be strictly prohibited ; the same with ointments and plasters, inasmuch as they may easily drive the disease to a more vital part of the body. Dry heat is best adapted for it, but the application of bags, filled with camomile and elder flower blossoms, or of cat or hare skins, wadding, &c, and also the sprinkling on of absorbing remedies, such as chalk, white lead, butter, &c, is to be entirely avoided. These remedies are hurtful, because they readily promote a hardening to which there is an inclination from the beginning. Internally administer, as stated before, good purgatives, according to the high or low state of fever the patient may be in. In case of severe gastric derangements, administer the before pescribed emetic, and endeavor to produce after- ward a gentle perspiration by proper remedies, such as elder blossoms and tartar emetic in small doses ; dose, one or two grains of the latter, to a decoction of four ounces of elder blossoms ; administer ipecac in small doses in the same way. If the erysipelas has been driven in, order the emetics before mentioned, and use the same sudorific reme- dies to a larger extent ; adminster from five to six grains of Dover's powder, or a decoction of guiac wood, three grains of guiac wood to a pint of water ; give the patient half a pint of it mornings and evenings. The extract of guiac wood may also be given, as it is an excellent sudorific ; dose, according to age, from four to twenty grains. On the particular spot where erysipelas has its seat, apply irritating remedies, such as mustard and Spanish fly plasters. Inunction with tincture of Spanish fly is very good ; but of particular benefit is the application of a dough, prepared of ginger, which has been fired with spirits of wine. Baths also have sometimes a very good effect. URTICARIA. 135 Bleeding should not be resorted to, except a very severe rush of blood to the head should require it. Should erysipelas become gangrenous, then, besides the remedies prescribed for internal use, treatment for mortification should be resorted to. Erysipelas spurium is an inflammation of the skin or of the cellular tissue ; except in its outer form, it has nothing in common with erysipelas. It may result from local irritations, such as a blow, push, burning by fire or caustic, &c, either operating directly on the spot and there creating the disease, or the inflammation is only an external indication of a deeper-seated disorder. The treatment of such a case must be antiphlogistic, as given under the head of " In- flammation." The painting of the surface of the skin as far as it is red with collodion, can be highly recommended ; to make the collo- dion more flexible, a little castor oil may be added to it. It soon dries and forms a tegument protecting the affected part from the air, dampness, and other external harmful influences. If in a few hours the tegument becomes cracked, a new application of the collodion must be made. Aside of that the collodion also effects a contraction of the blood vessels of the external skin, and counteracts congestion. URTICARIA. Urticaria shows itself in large red spots, with white centres. In regard to itching and burning sensations, it has the greatest resemblance to a nettle burn. The eruption disappears in a warm place, but reappears in the cold. This rash makes its appearance very suddenly, with or without a feverish feeling, and disappears in a few days. In some persons it is caused by indigestible food ; but one of the most common causes is an overheating by violent exertion, followed by a too sudden cooling off, suppressing perspiration. This disease can have bad effects only in cases of very great neglect. Treat it by giving a light purgative : extract of jalap from four to ten grains, and if necessary twenty grains, until a complete evacuation has taken place. This will be sufficient to remove the difficulty. Only in rare cases does urticaria result in a wearisome disease ; but if it returns on the least provocation, it becomes a troublesome sickness. Frequently the cause of it is to be found in a peculiarly diseased condition, and in other cases in a defect of the humors, a corruption of which pro- 136 CUTANEOUS DISEASES. duces it ; ais a remedy, give the following blood-purifying tea : sarsa- parilla, bittersweet stems, guiac wood, liquorice root, centaury minor, of each two ounces, boil in a quart of water, and take daily forty grains, a cupful at a time. If hemorrhoids are connected with it, take thirty grains of cream of tartar, flowers of sulphur fifteen grains ; dose, from one to two teaspoonsful twice a day, which will cause one or two gentle movements. This is to be followed up for a few days. The spots may also be rubbed with wheaten flour. MILIARIA ALBA AND RUBRA. Miliaria appears in small, pointed, red or white pustules, resembling millet seed. It is a cutaneous eruption, frequently accompanied by fever, when it is not entirely free of danger, being mostly of a nervous nature. Miliaria is sometimes accompanied by great weak- ness and an extraordinary inclination to perspiration. The eruption is likely to be preceded by great irritability, a restless sleep, itching and scratching around the throat and chest, and in some cases also by dyspnoea. Frequently it appears in combination with other dis- eases, and is not infrequently produced by keeping too warm, and by the abuse of sudorific remedies ; hence, it frequently makes its appear- ance during childbed and hydropathic treatment, when excessive perspiration is produced. It may also be produced by pungent sub- stances, dissolved by heat, or by the retention of the faeces. Miliaria spreads sometimes over the whole body, and frequently it appears in connection with other diseases. If, however, miliaria appears alone, and not incidentally connected with other inflammatory diseases, and if the eruption is inconsiderable, it usually passess off gently, and sometimes without being noticed at all ; the fever which accompanies it at that time is entirely innoxious ; this is usually the case with miliaria rubra. But, if miliaria is added to some other serious, inflammable disease, which is always the case when the latter threatens to become dangerous, then it must be considered a bad symptom, as it rather increases than diminishes the disease, and excites very dangerous nervous attacks. The eruption is driven in very easily ; it is caused on the least provocation, such as a light cold, overloading the stomach, or a light fright. This occurs much more readily, if ERYSIPELAS. 137 the patient is in a weak condition, when the consequences are all the more serious. The patient suffers from fear and disquietude, with constant violent fever and delirium, and if the eruption does not soon reappear, death follows. If miliaria attacks several persons at the same time, it is caused by a peculiar, unknown state of the atmos- phere. Weakly persons with a soft, tender skin, greatly inclined to perspiration, are usually attacked by it. The following blood-purify- ing tea should be administered : sassafras, burdock root, soapwort, gum guiac and liquorice root, of each two ounces, cut up small, mixed up and boiled. Take half an ounce of the cut-up ingredients and boil in a pint of water. The use of this tea must be continued for some time. It is particularly beneficial in miliaria, all eruptions of the skin, fevers, gouty and rheumatic attacks. ERYSIPELAS. Erysipelas is a very bad disease, and in some cases its appearance is connected with great danger. It usually commences with sore throat. Very soon the tongue, throat and neck begin to swell ; the tongue and palate assume a blackish or bluish color, externally the throat turns a reddish-blue color, produced by the reddish-blue spots which appear closely to each other, and which change into a dark green or black. If remedies are not applied at once, mortification ensues and the patient dies. The disease must be stopped as quickly as possible. First of all, an emetic should be administered ; take ipecac root one grain, tartar emetic five centigrammes, squill root honey and raspberry juice, fifteen grains of each, well water thirty grains; dose, every quarter of an hour one tablespoonful to adults, and one teaspoonful every half hour to children, until vomiting sets in ; to older children administer one teaspoonful every quarter of an hour, until the same result is produced. The throat must be rubbed with a liniment con- sisting of castor oil, oil of turpentine, oil of sassafras and tincture of Spanish fly, three ounces of each. Hot poultices prepared from vervain, mullein leaves and flowers, should be applied ; take a large handful of each, boil in water, place in a thin cloth, and wrap it around hot. When the poultice cools off, warm it up again, and apply it as hot as the patient can endure it. Let the patient drink a tea 138 CUTANEOUS DISEASES. prepared from two ounces linseed, thirty grains of calomel and two ounces of lemon balm ; mix the ingredients, take one ounce of it and put in one and one-half quarts of water, let it boil down to one quart ; dose, one half of a teacupful every three hours. If gangrenous indications should appear, apply to the throat, or to any other part where they may appear, warm poultices prepared from an infusion of camomile flowers, spearmint or savin. If required, more stimulating remedies, such as spirits of camphor, oil of turpentine, &c, maybe connected with it. The poultices should be frequently renewed. Erysipelas does not always appear in a malignant form ; with some persons it passes off lightly, while in others it proves fatal. Neither is it always stationary, but extends sometimes over the chest and arms. The disease is not confined to a particular season, but appears more frequently in winter than in summer. SCALD HEAD AND CUTANEOUS ERUPTIONS OF THE SCALP. Scald head consists generally of small ulcers on the hairy part of the head, which secrete matter of a very offensive smell, creating an irritating, violent itching, and forming scabs. If scald head is not malignant and connected with other diseases, it is not only not dan- gerous, but it is even considered healthful, as may be judged from children during the continuance of the disease. They become quiet, cross, impatient, and feel unwell as soon as the secretion stops, and the crusts dry up ; while, if the secretion is active, they feel well, are lively and pleasant, and appear to be in excellent condition. Scald head is never dangerous, unless prematurely dispersed. And if it is healed under such circumstances, no matter by what remedies it may be affected, it may result in dangerous diseases, and even in death. It generally results in inflammation of the brain, dropsy in the chest, insanity, inflammation of the lungs or eyes, convulsions and cramps. It is different with a malignant, poisonous scald head. In that case the disease may make such progress as to throw the child into a kind of emaciation, and severe fever. If in such a case the disease is neg- lected, it may become dangerous. Everything which causes a con- gestion of blood to the head may also produce scald head ; in a com- SCALD HEAD, ETC. 139 prehensive term it is called scald head, because cutaneous eruptions of the scalp are of great variety. Scald head is a congestion of the external stratum of the scalp membrane, connected with itching and the formation of rumerous very fine, white, dry scales, which scale off in large quantities, but are renewed with great rapidity. The hair drops out of itself, or is combed or scratched out. There is often an intermission in this disease lasting for years ; the scales disappear and the hair grows again. A relapse takes place, succeeded again by a new attack, &c. The moist scald head is an inflammation of the skin, and a forma- tion of pustules, which burst open and form the scab ; they usually come from a preceding diseased condition. The tinea vera appears in children at the age between six and ten, and is contageous; the head covering should be kept very clean, and be often changed. The tinea vera appears in the form of a small yellow corpuscle, resembling a millet seed, and originates in the hair follicle. It enlarges gradually, and forms a sulphur-colored dry crust on the scalp. Attention must be directed particularly to the so-called scald head. As before stated, scald head changes into ulcers and offensively smell- ing matter. For that reason everything which increases the flow of the blood to the head can produce scald head. Among these causes are dentition, warm head covering, gluttony, suppressed perspi- ration, &c. Frequently the condition of the milk causes the trouble, as has happened with nursing women, who during that time had their monthly menstruation. Food of too great pungency and spirituous beverages may produce the disease. But where the eruption makes its appearance, no external remedies should be applied under any con- dition, for the purpose of driving it back. In this disease the health of the child should be considered first of all ; if it remains healthy, medical assistance is not required. The greatest cleanliness must be observed, however ; evacuations must be regular, and production of insects prevented. If any exist, they must be exterminated, which is best done by an ointment of fresh butter and cavadilla seed, equal parts of each. The hair must be cut off previous to the application of the ointment ; after it has been applied, the head must be tied up tight with a cloth, so that the insects cannot make their escape. The application must be repeated until they are all destroyed. 140 CUTANEOUS DISEASES. If the disease is of recent date, the cutaneous irritation consider- able, scab on the head spreading largely, and the child thrives and becomes vigorous, put one or two leeches behind the ears. As a medicine, give pulp of lamarind six drachms, boil in one pint of water, add four drachms of epsom salt and ten drachms of manna juice ; dose, one teaspoonful every three hours. If the scald head is fully developed, the hard scab must be softened by anointing it with sweet butter or goose grease. If the scabs are very hard, which is frequently the case, so that the butter cannot permeate, the hardest part should be first removed with a sharp knife. When the head is fully cleaned of the scabs, the parts which have been covered by it should be washed several times a day with a decoction of mallow, bran water, or elder blossom tea, and rubbed with a softening oint- ment. Take finely powderd charcoal, mix in equal parts of lard, and rub the scab with it twice a day. Another ointment for scald head and scabs : Two ounces of unsalted butter, one-eighth of an ounce of ginger, half an ounce of copperas, and half an ounce of charcoal, mix, and anoint the head with it twice a day. For internal use, bittersweer stems, juniper wood and china root, of each three ounces, boil in one quart of water until reduced to one- half; dose, four tablespoonsful three times a day; for grown children, a quarter to half a tea cup three times a day. PIMPLES. Pimples are nodules on the surface of the skin, more or less in- flammable. They appear particularly in the face, sometimes on the throat and on the back, generally suppurate, and leave small bluish-red spots behind. This species of pimples most usually appears on youth- ful people, more frequently in the male than in the female sex. Fre- quently the whole face is covered with them, so that scarcely a particle of the natural skin is discoverable. But no matter how numerous they are, they never interfere with the general health ; on the contrary, they are rather an indication of good health Sometimes they suddenly make their appearance after a heavy meal, frequently after the use of strong wine, and generally in consequence of a disordered digestion. PIMPLES. 141 The best treatment of this simple species of the disease consists in the application of remedies, creating a gentle irritation of the skin, which may be gradually increased For this purpose mostly fluids, containing spirits of wine, are employed, which, according to the inflammability of the pimples, are diluted with more or less dis- tilled water. As a wash is recommended, for instance, a mixture of one part of spirits of wine and two parts of rose or elder flower water. The more the inflammable condition of the pimples decreases, the stronger can the wash be made, and even some spirits of sal- ammoniac or muriatic ether may be added. The pimples must only be touched with these preparations. Sometimes other volatile fluids prove to be beneficial, such as acetic acid. Another good domestic remedy : Pour one quart of boiling water on one ounce of crushed sulphur, let it macerate from ten to twelve hours, pour off, and use the liquid for washing. If the pustules are very much irritated and inflamed, wash with a decoction of bran, almond milk, and other mucilaginous remedies. With the pimples, some- times so-called comedones make their appearance, which in common life, are believed to be worms. They are nothing but a thick mucous in the little sebaceous glands of the skin, the outer point of which has been colored by the air or dirt, and which, when squeezed'out, has the appearance of a worm with a black head. Internally use chlorine water or a solution of carbonate of potassa. The bowels must be kept regular, and the skin washed with soap and water, or a solution of potash, and rubbed down hard with a towel. Besides the pimples above described, there are two other kinds of a much more obstinate character, and unusually indicating an internal disease. One of these manifests itself by a more serious condition than that heretofore described. The pimples are larger, at first very hard, they finally become inflamed and suppurate, and cause no incon- siderable pain to the patient. Another kind appear in people who use large quantities of pungent and spirituous drinks, and have arrived at man's estate. They usually appear on the face, particularly on the nose, and in connection with the peculiar coloring of the skin impart to persons the appearance known by the name of gutta rosea, generally called copper face. Concerning the first kind, endeavor to promote suppuration by the application of meal poultices in con- 142 CUTANEOUS DISEASES. nection with poppy heads. After the removal of the pus, the irritating remedies before mentioned may be applied. Particular attention must be paid that the bowels are regular. Very useful is the applica- tion of a lotion, consisting of equal parts of water and spirits of wine, to which calomel has been added in the proportion of half a grain of the latter to one ounce of the former. For internal use the following prescription has proved beneficial : carbonate of potassa in connection with a decoction of cascarill bark, in the proportion of one to twelve parts ; dose, a tablespoonful several times a day. The patient must abstain from eating heavy food. A cure of the last named disease is rarely fully effected, as it is either inherited or acquired by intemperance. The application of all strong external remedies are detrimental, and therefore must be avoided. At most, remedies containing very weak attenuations of spirits or acids may be employed, to which a little subacetate of lead has been added. Strict diet must be adhered to. The following remedy is highly recommended as being very efficient : liquid antimonial soap two drachms, mixed with one ounce of colo- cynths ; dose, from twenty to thirty drops in oatmeal gruel. A foot bath, accidulated with nitric and muriatic acid to the extent of giving it the strength of weak wine vinegar, taken lukewarm in the evening for half an hour, frequently has a good effect. A complete cure is scarcely ever effected, and even should the eruption disappear, the natural condition of the skin is never recovered. Generally the dis- ease is not serious, only troublesome and disfiguring. The cause for gutta rosea is most frequently an immoderate use of spirituous liquors, but it also attacks people who are not drunkards, but who suffer from plethora of the abdomen, hemorrhoids, gout, or liver complaint, and also women in consequence of a derangement of menstruation. FISTULA. By the term fistula an unnatural, old opening of larger or smaller size is understood, through which fluids from internal cavities, excretory ducts, and other vessels are emptied either to the outside or into internal cavities. Fistula require the aid of a physician to effect a cure. Nothing can be recommended here but an observance of the utmost cleanliness. PROUD FLESH THE PHLEGMON. 148 PROUD FLESH. Proud flesh is called the spongy and readily bleeding granulation in suppurating wounds or ulcers, which prevents their healing. It is caused partly by general debility and a poor constitution, particularly in pale, bloated people, and partly by the abuse of emolient poultices and relaxing ointments with which the sores were dressed. To pre- vent the extension of the proud flesh, a more vigorous diet must be adopted, and the extravagant flow of humor to the ulcer or wound diminished. This object is usually attained by tying the ulcer up dry and close. If no benefit is derived from that, stimulating remedies must be applied. Sprinkle on the sore burnt alum or red precipitate, and dress with a solution of chloride of lime, or of sublimate, and touch the projecting proud flesh with lunar caustic, &c. The most prominent projecting growth the physician will remove with the knife or scissors. THE PHLEGMON. A phlegmon is a raised, hard, very painful, dark red, generally highly inflamed swelling of the skin ; it is of different sizes, and appears in all parts of the body, most frequently in places that have a great deal of fat. The phlegmon, when it first appears, is not very tender ; it increases in size, however, and assumes a conical shape, of a deep red color, and finally becomes inflamed and painful. When it is ready to open, which is usually the case between the fourth and seventh day, a little white postule forms on the cone, which breaks open and discharges puss mixed with blood. At the same time, or soon thereafter, a shaggy or compressed mass of mortified cellular tissue is discharged, which is called core. If the latter is not entirely expelled, the wound closes, and another nodule is formed, which becomes again inflamed, and usually runs the same course which the preceding one did. The causes for phlegmons can not be clearly shown, as they sometimes appear in persons of vigorous health ; they are generally based upon an inflammation of a cutaneous gland. In small children they show themselves in consequence of the mother's poor milk, and in adults they originate often from too stimulating and rich food. The treatment of the phlegmon does not materially differ from that of an abscess. There is rarely any fever with phlegmon, 144 CUTANEOUS DISEASES. unless the patient suffers from several of them at the same time. If such is the case, it is accompanied by sleeplessness, lack of appetite, and in children sometimes by spasms. Each phlegmon should be ad- vanced to a state of suppuration as rapidly as possible. If the swelling is highly inflamed and painful, this is done by ordinary warm poultices, consisting of wheaten bread, rye flour, milk and honey. If the pain is severe, use linseed meal two ounces, hemlock leaves one ounce, hen- bane hall an ounce, boil with water into a moderately thick pulp, then add half an ounce of oil of henbane, and apply the poultice when in a lukewarm state. Another softening poultice consists of two ounces of elder blossoms, one ounce of henbane and two ounces of linseed, boiled in milk to a pulp; apply while in a lukewarm condition. If the inflammation and the pain become easier, but the hardness and swelling greater, and if the suppuration proceeds slowly, apply roasted onions or a poultice of white bread, milk, saffron and mullein flowers, each one ounce, milk a sufficient quantity to boil it in ; apply lukewarm. By applying softening remedies, the phlegmon generally opens of its own accord; but should this not be the case, it must be opened by an incision. As long as the swelling remains hard, it must be kept poulticed constantly. THE ITCH. The itch is a cutaneous disease, caused by a mite. The little insect burrows under the skin and causes an intolerable itching. Wherever it deposits an egg, conical nodules and pustules, surrounded by a red circle, are formed. There are two kinds of itch, dry and moist. The first is principally located on the sides between the fingers, at the wrists, the brachial joint, and the bend of the knee. It is called the moist itch, when it discharges some humidity in the joints. The itch-mite, therefore, takes to the small furrows of the skin, bores into them and makes under the outer skin fine, threadlike, serpentine canals of several lines in length, which on the outside are indicated by an elevation ; the entrance appears as a dark, sometimes redish point, while the end of the canal, where the mite has located itself and deposits its eggs is distinguished by whitish small point. If this point is pierced with THE ITCH, 145 a needle, and the elevation followed, the mite, sitting under the small point, may be lifted out, and may be even seen with the naked eye. The itch, therefore, requires treatment which will kill the mite and its brood. A cure can be effected with gunpowder and sulphur, one ounce of each, red precipitate half an ounce, and butter half a pound ; mix for half an hour and rub it in twice a day. This is a sure remedy ; it destroys the mite's canal and stops the itching and biting. The male itch-mite, differing from the female only slightly, is on the whole more scarce than the latter ; the duration of its life is shorter, and it is only half the size of the female. The latter lives from three to four months, and during that time lays over fifty eggs, but only one at a time. In this egg, containing numberless granules, the young mite develops in a few days, and slips out as a mite larva It may be distinguished from the full grown mite by its size, it not being so long, and not having its full growth. After a week the young mite strips its skin and creeps out of its cover a perfect mite. The described mite is only found in the skin of the human body, and lives on the humors of the epidermis, into which it bores, and for that purpose prefers certain soft, warm spots on the skin. The mite, as stated, being lively in warm, and numb in cold places, shows a disinclination for the cooler parts of the body. It travels about, principally at night, while in a warm bed, which causes a troublesome itching. The itch is not at all a dangerous disease, and, if not of too old a date, easily cured. But if neglected too long, the consequences of the chronic interruption of the action of the skin, and of the nerve irritation maintained by the itching, together with sleeplessness, may cause a waste of the skin and of the whole system of nutrition, which may result in a general disorder. The disease is of particular signifi- cance, if other acrimonies of the blood are connected therewith, as it may defer the cure for a long time. If the itch is of recent origin, say from eight to fourteen days old, and the person attacked is other- wise in a healthy condition, the first thing to be done is to clean the patient by washing or bathing in good lye or bran water and soap, change his clothes and then proceed at once to the external applica- tion of sulphur. In ordinary cases, use the sulphur ointment usually found already prepared in apothecary's shops, of which rub in lightly in the evening. The patient must get into a free perspiration, and 146 CUTANEOUS DISEASES. remain in a warm bed during treatment. He must sleep every night in his night shirt, drawers, and with a head covering, and his night clothes, and also the clothing he wears during the day, should be moistened with spirits of camphor. Everything he wears should be sprinkled with powdered camphor. The clothes worn by the patient when he took the disease, should be particularly well powdered, and kept in a close place. If proper caution is exercised, a little sulphur may be burned on a coal pan, first closing all openings to prevent the escape of the smell, and thus kill the insect, the cause of the disease. If the old itch-mite combines with the corrupt humors of the body, an obstinate disease maybe the result. If the itch has been driven in, and obstinate and troublesome diseases have resulted from it, the greatest caution has to be used. If the patient is suffering from acrimony, the itch pustules finally lose their simple character and assume either scorbutic, arthritical or consumptive tendencies, which may lead to years of suffering. The transfer of the itch-mite from one person to another (which is the contagion), is generally done by sleeping in the same bed with a person who has the itch, or by sleep- ing in the bed in which one who is afflicted with the disease has lately slept, or by the use of clothing lately worn by one. In some houses and prisons the mite seems to have fully taken up its domicile, and in some parts of the country the itch is among some classes a domestic dis- ease. Uncleanliness, and a lack of care of the skin favors its origin. One may protect himself from the itch when traveling, by not sleep- ing in dirty beds, or sleeping in the same bed with strangers, and by not touching old clothes. The liberal sprinkling of camphor or of am- monia, and also of spirits of turpentine, on your clothes while travel- ing, will protect to a certain extent from an attack of the mite. ANOTHER SPECIES OF ITCH. The so-called barber's itch makes its appearance generally in the face, on the chin, and in the hair of the beard. It is supposed that contagion occurs by being shaved in the barbers' shop. This may be the case, because the itch known by that name is only found in the male sex, and mostly only in persons who get shaved. It appears first on one lip, the chin, or other spot of the beard of the lower part of the face. At first there appear only a few redish pustules, causing THE CURE OF THE ITCH. 147 much itching and burning. In five or six days they dry, and peel off in thin white scales. In the meantime, the eruption increases and other pustules appear. They again peel off in the same way, until a large, raw and inflamed place has been formed, the itching of which is very troublesome. If the disease is not checked, it becomes very obstinate, extends more and more, spreads over a larger surface, and penetrates deeper into the skin. The affected parts are very tender, very hot, inflamed and red. The treatment is the same in all kinds of itch ; the same ' remedies apply to all of them. THE CURE OF THE ITCH. Sulphur ointment is the principal and surest remedy, and is pre- pared in the following manner : take two ounces of grease and one ounce of sulphur, make it into a salve and rub the sore place with it. The greatest care should be observed, however, if it is required to anoint a large part of the body with this salve, as it has given stiff joints to some people, besides contracting serious diseases. There is no danger connected with the use of the sulphur ointment, if the patient is not exposed to taking cold ; it is therefore prudent not to expose one's self to cold or damp weather during the application of the ointment. The same rule holds good with the use of all oint- ments against the itch. Every time the patient has been rubbed, he must wrap himself in flannel sheets and perspire. Every evening a warm bath must betaken, consisting of five gallons of water, one quart of spirits of camphor and two ounces of soft soap. This is a sure remedy, kills the mites at once, and in a few days the pustules dis- appear. The use of sulphur and soft green soap is also recommended. Another approved remedy : One ounce of powdered sulphur, one ounce of turpentine, half an ounce of pulverized chalk, two ounces of soft soap, and two ounces of lard, rub in twice a day and immedi- ately retire to a warm bed. Take a warm bath every day until restored. Another remedy : Flowers of sulphur and balsam of Peru, ten grains of each, four ounces of grease and one ounce of yellow wax. Melt the grease and wax together, stir until cold, then mix the other ingredients with it, and rub it in mornings and evenings. 148 CUTANEOUS DISEASES. Another good remedy frequently used by adults and children : Flowers of sulphur, oil of bergamot, camphor soap, one ounce of each. The camphor soap is cut up fine, beaten into foam, with two ounces of unwashed butter, the other ingredients are then added, and the whole of it well stirred ; rubbed in twice a day. The rubbing in on children must not be made too strong at once, and a soap bath must be taken at the same time. Elecampane ointment is also an excellent, innocuous remedy for children. It often has a better effect than all other remedies. To be used twice a day, as the other ointments. Another re?nedy : Four ounces lard, two ounces sulphur, two drachms finely powdered salammomac and thirty drops of oil of anis ; mix up well and rub the affected places twice a day, having washed them previously with soft soap Another remedy : Muriatic acid, baryta, sulphuric acid, sublimate of zinc or calomel ; for two drachms take three ounces of lard, and rub in mornings and evenings. In old cases of itch the internal remedies are used at the same time with the external applications, particularly sulphur; for instance, flower of sulphur and cream of tartar, two drachms of each, magnesia and fennel, one drachm of each, the whole well powdered ; dose, half a teaspoonful three times a day, to be taken in milk or water. This powder may be taken in every case of itch, to prevent its being driven in. Patients with whom sulphur does not agree, may try internally and externally the acids which are obtainable in the apothecary shops, for instance the Haller acid. TETTERS OR HERPES. Tetter is a tedious and troublesome skin disease, and first manifests itself by small pustules, grouped together, and surrounded by a red train, causing great itching or pricking. They mostly heal first in the centre, but spread at the same time from the outer edge, becoming very moist, or scaling or peeling off, or forming scabs. Sometimes the moisture effused by tetters is so sharp as to eat into the flesh and to cause deep and spreading ulcers. In this way the disease lasts sometimes for a long time, changes for the better and again becomes worse, or disappears altogether and returns again at stated times, usually in the spring, summer or fall. TETTERS OR HERPES. 149 Dry tetter announces itself by an itching, burning, and tight sen- sation of the skin, on which red and frequently also yellow nodules make their appearance. If the skin between the little nodules, which subsequently peel off and disappear for a time, is not inflamed, the tetter is not settled in one place, but flies about and usually makes its appearance in the face, behind the ears, on the chin, on the eye- brows, on the hairy parts of the head, on the throat, arms, and par- ticularly on the elbows and knee-pans. Miliaria tetter usually breaks out with a red color and swelling, being preceded by headache, pain in the chest, indigestion, violent itching and burning. The pustules also appear in groups and resemble millet seed in appearance. They break of their own accord, or are scratched open, and discharge an acrid, yellow fluid, which dries into scales and peels off. This malady frequently lasts for years, some- times during the whole life, the eruptions renewing from time to time. Herpes exedens makes its appearance with itching, in the same way the miliaria tetter does, and when the pustules break open, or are scratched open, they exude a fluid which attacks the surrounding parts, makes them very sore, and eats all around and deep. Frequently scales form, and also ashy-colored scabs, which, however, are not of long duration, drop off and soon renew again. This malady usually commences in the face, which it frequently covers like a mask. Frequently it attacks the chin only, and it breaks out on the arms, legs, pudenda, scrotum, perinaeum, genitals, nipples, and the spine, and in time it may even spread over the whole body. When it breaks out on the genitals, it causes the patient to scratch, until blood flows, which is followed by a burning sensation. Tetters are produced by various diseases, for instance, by indiges- tion, which sends bad humors to the skin, by the frequent use of spiced, sharp, fat, salted and smoked food, by the use of old, tainted meat, heating drinks, by a sedentary life, damp dwellings, checked perspiration, suppressed hemorrhoids, irregular menstruation, sup- pressed leucorrhea, suppressed sweaty feet, retention of urine, liver and kidney complaints, and by gouty and glandular diseases. How- ever beneficial the eruption of tetter may be, it may be followed by bad consequences, if it goes in of its own accord, or is driven in by diseases, or by taking cold, or by vapor ; it may be assumed that the 150 CUTANEOUS DISEASES. more aged the patient is, the more difficult will it be to effect a cure. Frequently, after its disappearance, itrreturns after months and years. If the eruption is removed, there still frequently remains a disagreeable feeling in the skin. Before an attempt is made to cure a tetter, the question presents itself, shall it be cured or not? A quick, inconsiderate cure must never be attempted. Investigation should be made whether there are not severe internal diseases connected with the tetter, and whether these diseases did not disappear with the breaking out of the tetter. If on investigation it appears that with the appearance of tetter the other diseases disappeared, then the former must and cannot be cured, as the first and most important point in curing tetters, or any other disease, is to discover and remove the cause that has produced it. Above all, the use of rich, pungent and heating food and beverages should be discarded, and a moderate diet adhered to ; sleep in clean beds, and keep the air pure. If no other diseases exist, and tetters make their appearance without any connection with other diseases, a cure may be attempted without fear of danger. If the malady is not of too long standing, the simplest remedies frequently are the most efficient. Touch the effected part every other day with lunar caustic, until well. To purify the blood, take inter- nally, burdock root, manna, wood sorrel and sassafras, two ounces of each, mix ; take half an ounce of these ingredients, boil in a pint of water ; dose, a teaspoonful three times a day. If the skin is very red and inflamed, apply a leech near the tetter. In the face, however, leeches must not be applied in this disease. The affected part should be frequently washed with camomile, linden and mallow flower tea, and lukewarm soap baths used. For internal use for an adult, take repeatedly a laxative, consisting of calomel and jalap root, four grains of the former and sixteen of the latter made into a powder ; a. part of it should be taken in the morning, and the other in the evening. For children, a tea is prepared from the same ingredients ; take three grains calomel and fourteen grains of jalap root, boil in one pint of water in the way tea is usually made ; dose for children, from two teaspoonsful to three tablespoonsful a day, according to age. If this remedy has not the desired effect, others must be tried. An approved remedy is extract of bittersweet stems and hydrargyrum stibiato-sul- TETTERS OR HERPES. 151 phuratinn, twelve grains of each, made into two hundred pills ; dose, one pill every three hours. Neither is this remedy always successful, as the nature of the disease varies in different people. Tetters of long standing require longer treatment. It has happened in my practice that a remedy which in several cases did excellent service, was of no effect in others. It is therefore necessary that a remedy should be tried for a time, and if no benefit is derived therefrom, it must be exchanged for another. An excellent remedy is graphite, two ounces, made into a mass with one drachm of honey, of which take a teaspoonful mornings and evenings ; for children it cannot be recommended. As a wash, use a decoction of linseed and arbor vitce leaves ; soft soap (green soap) is also very good as a wash, and min- eral water can also be recommended. In obstinate cases of tetter the following powder has acquired a great reputation : Hydrargyrum sulphur atum nigrum Aethiops miner -a/is forty -five centigrammes, and two grains sugar ; dose, one powder twice a day. An ointment may be used, composed of nettle juice, squill root, honey and nut oil, each one part, mixed, and the affected part washed with it twice a day. Calamus oil soap is highly recommended to wash with, also the anoint- ing with lime water, almond oil, and elder bark juice, one part of each, mixed and thoroughly applied three times a day. A mixture of equal parts of vinegar and spirits of camphor as a wash, is very good. Old cases cannot be cured so readily, and it sometimes takes years before the patient has been fully restored to health. Another good remedy for tetters is powdered charcoal one ounce, one ounce of flowers of sulphur, two ounces of spirits of camphor and half a pound of lard, mix thoroughly, and apply three times a day. For internal use give a blood and skin purifier, consisting of manna eight drachms, sarsaparilla two ounces, centaury minor two ounces, wormwood half an ounce. These herbs are to be cut up fine and mixed ; take two ounces of the mixed herbs and boil in two quarts of water, until boiled down to one quart; dose, half a tea- cupful twice a day; to children give a tablespoonful, according to age. Another remedy : Take three ounces wild patience root, boil in twenty-five ounces of water ; dose, half a teacupful mornings and 152 CUTANEOUS DISEASES. evenings. It also answers for an external application ; wash the affected part with it mornings and evenings, but it must be used inter- nally and externally at the same time. It is an easy and cheap domestic remedy, and has cured many people who have been troubled with tetter and also with itch. PRURITUS CUTANEUS. Itching of the skin is caused by small, scarcely visible nodules in the skin ; it is sometimes very troublesome, and causes the sufferer to rub and scratch himself constantly. It usually attacks old people, but younger persons are not always exempt from it. It is often con- nected with gout, hemorrhoids and debility. The principal remedy is a strict diet ; avoid all sharp and stimulating food and beverages ; take lukewarm emollient baths, and observe the most scrupulous clean- liness. Mild laxatives are very beneficial in many cases. PRURITUS ANI. Pruritus ani shows itself sometimes in aged people, and also in those who lead a sedentary life. An acrid secretion discharges from the posterior, and the person suffers from general debility. Sometimes the malady results from hemorrhoids. In old people it sometimes moves into the scrotum, and there also causes severe itching, as well as a burning sensation. If it is caused by hemorrhoids, it disappears with the removal of the cause. An application of a little quince juice soothes the itching. The application of leeches to the anus is preferable for aged people. As a wash, use lime water two ounces, and calomel four grains, rub in twice a day. Internally take as a blood purifier, tincture of myrrh, two drachms, juice of marshmallow root three ounces, shake up well ; dose, one teaspoonful three times a day. SMALL-POX- VARIOLA. This pustulous disease attacks a person usually only once in a life- time ; it is accompanied by high fever, is contagious, and everyone is more or less inclined to take the disease. The attack is generally preceded by weariness, loss of appetite, fever, headache, pains in the back, nausea, choking, vomiting, lachrymation, restlessness, sleepless- SMALL-POX. 153 ness, a peculiar putrid smell, &c. All these symptoms subside as soon as the eruption makes its appearance, which is generally the case on the fourth day ; and when the eruption is at its height, they gener- ally disappear altogether. The eruption shows itself at first in red spots, which develop into nodules, and subsequently into pustules, in the centre of which is an umbilical depression. They appear first in the face, on the throat, chest, and thence spread over the whole body. The pustules finally fill with matter, are inflamed at the base, and break open about the eleventh day, when the contents discharge. Scabs form, which subsequently drop off of their own accord, and leave dark spots and scars. This is the mild type of the disease. In some cases the above symptoms are very violent, and the whole body is covered with pustules, which become confluent ; they even cover the mucous membrane of the mouth and intestinal canal, the nose and eyes, which is a bad symptom. After the disease has come to the surface, an attempt to remove it would be injudicious ; it would not succeed, and would interrupt its regular course. Close attention should be paid to any other diseases which might spring up at the same time, and which require the supervision of a physician. Par- ticularly is this the case with inflammation of the brain, which should be treated as laid down under the heading " Inflammations ;" the patient should be kept rather cool than warm, but must be protected from drafts. The bowels must be kept regular, which may be effected by injections or purgatives ; calomel is preferable for the latter. The diet must be of a cooling nature. The secondary diseases resulting from small-pox are diseases of the eye, ear, flatulency, &c. , which require medical attendance. The best protection against small-pox is vaccination. It is ques- tioned by some whether vaccination affords the proper protection against small-pox, because there are instances when persons who have been vaccinated are attacked by small-pox. This, however, is a great mistake, which must be combatted all the more because it weakens the confidence in vaccination, which after all is the safest protection against small-pox. The reason why people claim their opinion to be justifiable, lies in the fact that besides the regular small-pox there are spurious small-pox, which greatly resemble the" genuine ones. They appear after a shorter or longer period of time, after the symp- 154 CUTANEOUS DISEASES. toms have manifested themselves, the distinguishing features of which were mistaken for the regular small-pox. This has happened,, but a person is rarely attacked twice with the disease. Few persons only- are particularly susceptible to this poison. Genuine small-pox never occur after proper vaccination, but the so-called spurious small-pox do. The latter may be taken by a person who has had the regular small-pox, just as readily as by one who has been properly vaccinated. The other kind of small-pox are the so-called modified small-pox, which, however, appear only when vaccination has weakend the suscep- tibility of the body against the poison of the genuine small-pox, but has not entirely removed it. The characteristics distinguishing the different kinds of small-pox from each other, lie less in the external form than in the whole course of the disease. The non-malignant, regular small-pox run their regular course in about fourteen days. Until vaccination was resorted to as a preventative, small-pox was one of the most fearful diseases, particularly for children. The fever accompanying the disease would turn into typhoid and putrid fever, and result in all kinds of inflammations, such as inflammation of the lungs and brain, which would carry off its victims. The strength of the attacked people would be consumed by the general suppuration of the skin, and incurable diseases, blindness, deafness, and other infirmities, was the lot of those who escaped with their lives. Chicken-pox. — Chicken-pox is an eruption of semi-transparent, smooth pustules, which rarely suppurate ; they are accompanied by a light fever. They pass off usually without any trouble, and do not require the administering of any medicines. The resemblance which some kinds of spurious small-pox bear to the genuine disease, requires a close observation of their character. There are usually three kinds of small-pox distinguished, among which are the water-pox or wind- pox. This kind appears at first in small, red, oblong protuberances, which soon turn into transparent pustules, without, however, creating little or any fever. These pustules soon fill with a whitish lymph, which in a short time turns straw-color ; they shrink without breaking open, form small scabs, drop off, and leave a small red spot, but rarely a scar. Fre- quently the fluid in the pustules is absorbed again, which then appear to be hollow, and for that reason they are also called wind-pox. They usually make their appearance single and scattered, and less frequent SMALL-POX. 155 in the face, while the real small-pox are crowded together, and come principally in the face. The Swine-Pox. — This kind is more violent than the last described, and the fever which frequently accompanies them, becomes almost unbearable. The pointed pustules are raised suddenly, and have a somewhat hard, inflammable border. In a few days they partly shrivel up, and partly break open, suppurate, form a scab, which finally drops off, and leaves a permanent scar. The Sheep-Pox. — The pustules are pointed, inflamed around the circumference, contain already on the second day a fluid resembling whey P sink, become wrinkled, of a yellowish color, dry up, and turn into thin blackish scabs, which drop after some days. This kind is often connected with severe itching. Children who take them, scratch off the points, and this inflames them, and converts the fluid into a thick yellow pus, which lasts several days. They then dry up, drop off, and leave a scar. The patient must be kept from taking cold ; he should not eat meat, or use heating beverages. At the time when the eruption is drying off, a mild laxative should be administered. Treatment of the genuine small-pox : In all acute, eruptive dis- eases, and therefore also in small-pox, fever is the principal feature. Wherever the fever is of a mild form, there is never any danger, and with proper care the cure of the disease may be left to nature. But if the fever accompanying the disease is of a severe type from the start, it must be considered and treated as inflammatory. . Nothing, how- ever, is more injurious and apt to convert the mildest type of small- pox into one of the greatest danger, than keeping the patient too warm, particularly in heated rooms and beds, and especially in per- mitting the use of heating and sudorific beverages and medicines. The disease requires a constant supply of cool, fresh air; but the patient must nevertheless be guarded against taking cold and draughts. It is always advisable in a case of small-pox, to turn the patient over to a physician for treatment. 156 CUTANEOUS DISEASES. SCURVY. Scurvy is a disease having its seat in the gums and other parts of of the mouth, and to which particularly seamen and such other persons are liable who make long sea voyages, live on salt provisions, and are deprived of vegetables. Yet, scurvy sometimes attacks people who live on land; it is then produced by bad air and poor food. The malady begins with weariness and peevishness ; the gums show indica- tions of being loosened, and bleed on the slightest provocation ; the teeth become loose, the breath becomes putrid ; the patient longs for fresh and acid vegetables ; the skin has a bluish-red tint, and large greenish-black spots make their appearance. Sometimes the skin, swollen with the ill-conditioned blood, peels off, and frequently a considerable effusion of this blood occurs. Similar bleedings occur occasionally in the interior of the body. The body becomes weak, the patient has violent pains in the joints and bones ; frequently short- ness of breath sets in, and scorbutic ulcers break out in different parts of the body, and if relief does not come soon, the patient dies. This diseased state is more or less the result of a deteriorated con- dition of the blood ; it manifests itself by the following symptoms : debility and great aversion for exercise, spungy gums of a dirty, red color, which easily bleed, putrid breath and teeth which turn black, become loose and drop out ; the least exercise or motion produces a short and oppressed breath ; frequent bleeding from mouth, nose and other parts occurs, which can with difficulty be arrested ; debility increases, fainting fits set in, &c. As stated, scurvy can be prevented or cured only, if the causes producing it are avoided, and existing ones removed ; for light attacks this would be all sufficient. Even if the debility is very great, strengthening remedies, like horseradish, sorrel, radishes, mustard-whey, operate very beneficially. Mustard -whey is prepared by adding forty grains pounded mustard seed to one quart of hot cow's milk, let it boil gently until the cheese separates, strain off the whey, of which take two tablespoonsful three times a day. The patient should have an ample supply of healthy air and proper food, particularly fresh vegetables. He should be supplied with sorrel, scurvy grass, cress, onions, mustard, lettuce, horseradish, garlic, radishes, acid fruits and lemons. Besides that, he should partake of good nourishing food and beverages, such as soups, eggs, poultry, and SCURVY. 15 1 good beer and wine. For an ordinary drink, lemonade is particularly adapted, and to stop the bleeding of the gums, astringent and strength- ening gargles and tooth-powder should be used. As a dentrifice use the following : powdered red bark fifteen grains, powdered scurvy grass, orris root, eight grains of each ; mulberry juice sufficient to make it into a mass ; with this anoint the gums mornings and even- ings. If ulcers should form on the gums or in the mouth, moisten them with citric acid several times a day. If this does not give relief, use the following mouth-wash : barley-water two hundred and eighty grains, muriatic acid three grains, mulberry juice forty grains, apply four times a day. For sore and suppurating gums, use a com- pound of the tinctures of aloes and myrrh, with which rinse the mouth. Anothe? remedy : Take myrrh, aloes and licorice, half an ounce of each, pulverize, and pour a teaspoonful of hot water on the mixture, stir up thoroughly, and when cold, put it in a bottle, and add half a joint of good whisky to it, let it stand four or five days, shaking it occasionally, filter through a flannel cloth, and use it for rinsing your mouth as well as gargling four times a day. Another remedy : Rinse your mouth with brandy, to which one grain camphor has been added for each four tablespoonsful of the brandy ; the camphor must be well dissolved before it is added to the brandy. Internally use juice of water cress three tablespoonsful a day. For the improvement of the blood may be used ethereal oils and invigorating plants, such as sage, peppermint, balmmint, sweet flag, cassia, ginger and other spices ; pimpineli, sarsaparilla and juni- per berries ; also bitter and invigorating remedies, as gentian root, buckbean, centaury minor, wormwood, &c. All the herbs may be used separately and a tea made of them, of which take half a cupful a day. If costive, take compound tincture of aloes, one or two drachms a day. To heal external scorbutic ulcers, use fresh grated yellow carrots, or a decoction of loxa, or oak bark as a poultice, which must be renewed often. There are two kinds of scurvy, pur- pura hemorrhagica and sea scurvy, the last is the most important of the two. The reason for it is probably to be found in the fact that in long sea voyages many of the named injurious features cannot be avoided, and that these operate continuously and with great violence. 158 CUTANEOUS DISEASES. ABSCESSES. By abscess is understood a larger or smaller swelling of the cellular tissue, containing pus, or a matter resembling it. They may form in almost any part of the body, on the surface as well as in the most im- portant internal organs ; their formation differs, therefore, according to the place where they have their seat. They nearly all have one indication in common, which is the preceding inflammation. We will first consider the abscesses according to their general relation, and will keep in view particularly those forming on the surface of the body, and which we can examine with our eyes. They start with redness, heat, swelling and pain, to which sometimes a more or less high fever is added. After the inflammation has reached the highest point, the redness diminishes, a throbbing pain, accompanied by chills, sets in ; a feeling of cold manifests itself in the swelling, which becomes softer, assumes on its highest surface a somewhat pointed shape, and shows a yellowish coloring. From this central point the swelling softens toward the circumference, which is more yielding to pressure, and in abscesses of larger dimensions a movement of the fluid in the interior may be distinctly felt. With these symptoms the abscess is considered as being ripe. The time required for the ripen- ing of an abscess is, under favorable circumstances, from six to nine days. If left to itself, the abscess will break in a few days, because the integuments become gradually thinner, and the pus is discharged through one or more openings. The swelling goes down rapidly, pain disappears, the cavity fills up with flesh, and in a short time the whole is healed up. But the progress of an abscess is not always equally favorable. Nature does not come to the aid of people who suffer from gout, scrofula, tetter, &c, and instead of filling the abscess with innocuous matter, a thin, sharp, badly smelling ichor and fistulous ducts are formed, and the walls of the abscess cavity become hard. Instead of becoming covered with caruncles, the abscess is gradually transformed into an ulcer, which frequently resists for months all treatment, and carries the patient to the brink of the grave by a slow (hectic) fever. In other instances the abscess becomes gangre- nous, which may be recognized by the change of color from a lively red to a dark blue. Instead of pus, a mortified mass of cellular tissue mixed with blood is discharged, which frequently causes con- ABSCESSES. 159 siderable trouble in the surrounding parts, and sometimes develops itself in a nervous putrid fever, particularly if the abscess is of a larger kind. It is self-evident that the treatment of the latter cannot be discussed here, as from the danger which is sometimes attached to them, they require the attendance of a competent physician. The cause for the formation of abscesses lies, in most cases, on cer- tain long continued, chronic diseases, such as gout, rheumatism, scrofula and tetter, or they result from local irritations, such as pres- sure, thrusts or bruises. An abscess may be treated in different ways, that is by dispersion, suppuration, or by an artificial opening. In regard to dispersion, it is successful only in extremely rare cases, and only when the abscess is in course of formation. If the spot is highly inflamed, apply leeches to it, and afterwards cold water poultices, and internally laxatives, if required. If the inflammation is not too great, stimulating plasters, such as mercurial, ammoniacal, hemlock or melilot plasters, are appropriate, and so are also embrocations of liquid and stimulating remedies, such as camphor liniment. It is, however, best to let the abscess come to maturity, by aiding the suppuration. For that purpose apply poultices of oatmeal, linseed meal, rye bread, mullein flowers and leaves, or any other softening substance, which is to be boiled in milk, spread on a cloth to the thickness of a finger, and placed on the gathering as hot as it can be endured. The poultice is renewed as often as it becomes cold. At night apply in place of the poultice an irritating plaster, for instance, plasters of melilot, mercurial, galbanum, or the composite plaster of diachylac or saffron. This is continued until the abscess opens of its own accord, or requires but little aid by the lancet or any other instrument. If the abscess is not at all irritated, apply roasted onions (if possible the white speciesj, or leaven, or mustard, or a mixture of rye flour and honey. The following is a still stronger remedy: stir one ounce of mustard in one ounce of ashes of burnt onions, and mix to a pap, with a quarter of an ounce soft (black) soap and boiling water ; place it warm on the abscess to the thickness of an inch, and cover it with a plain oatmeal poultice ; the latter must be change d so as to keep the strong poultice underneath warm. At night an ammoniac plaster must be applied. If the abscess is small, or if it is in a place where a scar would not be desirable, the opening of it must be left to nature. The same is the 160 CUTANEOUS DISEASES. case with abscesses which have their seat in the glands, for instance, the cervical and parotid glands, on the female breast, &c. Other not so important abscesses may be opened, after they have become fully ripe, with a lancet or needle. To prevent the pressure of the pus, or its sinking, all abscesses in the neighborhood of important parts should be opened as soon as possible. For the treatment of larger abscesses, particularly when they are beneath tendons, or in the neighborhood of bones, or if the patient is debilitated, a good physi- cian should be called in. If an abscess has opened, either of its own accord or by some other means, the matter should be squeezed out gently, and the warm poultices continued for some time ; it will heal then of itself. The healing may be promoted, if the open abscess is protected from air and other impurities, which is best done by a plas- ter of litharge or of soap. An abscess must not be healed too soon, for in that case the trouble may begin anew again ; all hardness in and around the abscess must have disappeared. To prevent a too early healing, a little lint, moistened by olive or almond oil, may be placed in the abscess opening. During the treatment the patient must keep a light diet, and carefully avoid all heating food and beverages. The affected part should always be kept in a position to allow a free exit for the pus. * THE AXILLARY ABSCESS. The axillary abscess is a swelling of the glands under the shoulder, which is either the result of an irritation from local disease, the hand, arm, chest, &c, and which usually disappears with the removal of the cause, or the axillary glands themselves are the seat of the existing trouble to which they are limited. In the latter case they require our particular attention. The swelling in this case is either of an inflammable, cancerous, or of a scrofulous nature. The first is generally the result of very severe exertion of the arms, of external pressure on the particular part, and of other mechanical influences, to which is usually added a cold, and therefore suppression of perspiration. For that reason the swelling becomes hard and red, and is sometimes accompanied by rheumatic and catarrhal fevers. It is treated by administering sudorific remedies, particularly tartar emetic, of which DERMOID TUMOR. 161 give one and a half grains in four ounces of water. The swelling should be covered with herb poultices, and the arm kept perfectly quiet. If the swelling is hard, inflamed or red, a few leeches should be applied, and after that rub it with grey mercurial ointment; if a hardness remains, apply a mercurial plaster. If the swelling is of a cancerous nature, which sometimes is the case, it should be treated as prescribed for cancer. Scrofulous swellings of the axillary glands are of more frequent occurrence, which in general must be treated in accordance with the method laid down under the heading of " Cachexia scrofulosa." The following excellent blood-purifying remedy for internal use is in that case particularly applicable : white chicory root one ounce, sloe blossoms half an ounce, rhubarb one- quarter of an ounce, and one ounce of manna ; mix the ingredients well, boil one ounce of the mixture twenty minutes in three pints of water, and take three tablespoonsful at a time, twice a day. Externally apply a salve prepared from six grains of iodide of potassa and two drachms of grease, or four grains to a drachm of plaster. Aside of that, rub with grey mercurial ointment, and apply the grey mercurial plaster in connection with the hemlock plaster ; also use a soft mass of soap, which is to remain on the place until the skin red- dens, when its use must be stopped for one day, but after that it is to be applied again ; or the following plaster may be used : four ounces of lard, one ounce of rosin, one ounce of yellow wax, one ounce of linseed oil, and one ounce of saffron ; let the whole boil together, strain through a fine strainer, and preserve it for use. Of this three plasters are to be applied daily. DERMOID TUMOR. The dermoid tumor is not sensitive to touch, neither is it inflamed, and generally does not differ from the rest of the skin in color. It is a swelling which may appear in different parts of the body, and con- sists of a sack containing a fluid or semi-fluid substance. Several methods are employed for the removal of dermoid tumors, such as embrocation with a volatile liniment (camphor liniment), mercurial or galbanum ointment, or one pint of brandy, in which one ounce of salt and two ounces of camphor are dissolved ; to be rubbed in three or four times daily. ii 162 CUTANEOUS DISEASES. Another remedy : Take spirits of hartshorn and camphor oil, of each two ounces, one ounce oil of anis, mix well, and rub in three times a day. Another refnedy : Spirits of sal-ammoniac, oil of turpentine, oil of camphor and laudanum, two ounces each ; rub in three times a day. Dispersing plasters are also very beneficial. Prepare by melting with moderate heat, equal parts of Venetian turpentine, mutton tallow and lard, strain. The salve is of a pale yellow color. Another remedy : White castile soap, oil of turpentine, of each half a pound, carbonate of potash one ounce, well mixed and applied as a plaster on the tumor three times a day. There are also recom- mended ligation, caustic remedies, a seton and excision, which, how- ever, must all be left to the physician. BUMPS. A bump is a protuberance raised in consequence of external violence, by a blow, thrust, fall, &c, generally leaving the skin intact, but breaking the small underlying vessels, the fluid which they contain is emptied, effecting a discoloration of the skin. Light cases of that kind usually pass off by means of the absorbing process provided by nature. To expedite this process, cold poultices may be applied at first, which are to be followed by stimulating ones ; tincture of arnica is particularly adapted for that purpose. A domestic remedy is the application of bran, boiled down with salt and vinegar, and applied when cold. CHILBLAINS. Chilblains are bluish-red swellings, which itch very much when in a warm room. They particularly appear on the hands and feet, but sometimes also on other parts of the body, the tip of the nose, lobes of the ear, for instance. They result from a sudden change from cold to heat. The cause of chilblains is a too sudden change of tempera- ture, particularly one from extreme cold to heat. Besides that some persons have a certain susceptibility for chilblains ; where they have appeared once, they will most likely return again. As is the case with burns, with which freezing has the greatest similarity, there are several degrees which require a change in the mode of treatment. CHILBLAINS. 163 The first stage of chilblains consists of swelling with considerable redness and itching ; the second stage shows the same symptoms in an intensified degree ; in the third stage, pustules are formed, which open and result in obstinate ulcers, which in the fourth stage result in a discharge of the mortified parts. Treatment : This depends upon the condition of the malady. The first stage requires generally mild, astringent, stimulating, spirituous, resinous and ethereal remedies, in order to stimulate the weakened activity. The above emmolient remedies must be applied, however, on very spare people only ; to the former belong the bathing of the affected part with a solution of subacetate of lead, with or without camphor, embrocation with aromatic, spirituous remedies, such as oil of lavender, thyme, rosemary, juniper, anis, or with formiate. These oils must not be mixed, however, in using. One of the oils may be selected, to which various tinctures may be added, such as tincture of benzoin, amber, myrrh, 'opium, or cantharides ; also camphorated remedies, as spirits of camphor, ethereal ointment, with the addition of camphor and opodeldoc. Balsamic remedies may also be em- ployed, such as balsam of Peru, copaiba balsam, turpentine and oil of turpentine, rock oil, &c; finally, also diluted mineral acids, particularly muriatic acid, and also a solution of chloride of lime. Of the latter, take one ounce to six ounces of water and wash the frosted part with it five or six times a day. All these remedies may be applied singly, or in manifold combinations. The application of various plasters is also beneficial ; among the number are particularly mercurial plaster, in combination with opium and camphor. If very much swollen or inflamed, apply some leeches before using the plaster. The following domestic remedies are well known : the application of rotten apples, grated vegetables, or crushed squill root ; the spreading of warm glue on the frosted part, or Venetian turpentine, poultices of a decoction of camomile and elder flowers, &c. It would lead too far to enumerate all the rest of the known remedies against chilblains, and I will only add the so-called snow cure, which consists in covering the affected part with snow, and keep it in that state for about one hour. The pain will be very severe at first, but disappears subsequently ; the patient experiences a violent burning sensation in the frozen limb after the removal of the snow. 164 CUTANEOUS DISEASES. If snow can not be had, ice-cold water may be used ; the part to which it is applied must be carefully dried after the bath, and pro- tected from the effects of the air by a proper wrapper. Experience recommends the following formula as being very excel- lent : nitric acid, cinnamon water, of each half an ounce, mix ; apply by painting the affected part with a hair pencil once a day, or once every other day. This energetic remedy causes at first violent pains, which, however, soon subside. The skin turns yellow, shrinks, and peels entirely off. The following ointment may be used : tincture of cantharides one drachm, soap-salve six drachms, mix, and rub the affected parts with it three or four times a day. As an ointment for non-irritable chilblains, use rock oil one-quarter of an ounce, lave'nder spirits half an ounce, and simple tincture of opium one ounce, mix, and rub in three times a day. For the second advanced stage, after an application of leeches, use the following emolient remedies to allay pain : cocoa butter and venison suet or almond oil as an ointment, or a decoction of hemlock, with camomile and elder flowers, for poultices. Only after an alleviation of pain, the milder, to be followed by the severer, stimulating remedies, as before mentioned, are to be applied. If in the third stage ulceration has taken place, it should be treated with exsiccative remedies, such as ointment of carbonate of lead, with camphor and opium, or a salve prepared from the yolk of eggs and balsam of Peru, equal parts of each. In these ulcers proud flesh grows very readily, which requires the application of a salve prepared of red precipitate, and touching with lunar caustic. If, finally, in the fourth stage the chilblains have become gangrenous, they must be treated as stated under " Gangrene." Electricity is highly praised for the first three stages of chilblains. Finally, I will mention a few remedies which may be used in sup- purating and gangrenous chilblains : litharge plaster half an ounce, Peruvian balsam two scruples, and pure opium fifteen grains, mix, and apply fresh from three to five times a day. A plaster for suppurated chilblains : Rock oil three drachms, cam- phor one scruple, wax salve one and one-half ounces, mix, and apply three times a day. CHAPPING OF THE SKIN — CORNS. 165 Another remedy : Powdered alum one drachm, camphor half a drachm, and rose salve one ounce, mix thoroughly, and apply four times a day. A salve against chilb 7 ains : Subacetate of lead one drachm, extract of opium one scruple, and rose water six drachms, cover the applica- tion with a cloth, CHAPPING OF THE SKIN. Chapping occurs in a dry, inflexible skin, in very cold or very hot weather. It generally takes place in parts where the skin is very tender, as for instance on the lips, cheeks, hands, &c. To remove the cause, emollient substances should be applied, such as cocoa but- ter, unsalted butter, venison tallow, or lip salve. The following pre- paration is also serviceable : one-quarter of an ounce of spermaceti, one drachm of white wax, half an ounce of oil of almonds, melted together ; in place of wax, cocoa-butter may be taken. An addition of essential oils cannot be recommended. In cases of chapped skin, washing with two drachms of watery extract of myrrh, mixed with four ounces of water, is beneficial ; also anointing with a salve pre- pared as follows : rose-pomade half an ounce, Armenian bole half a drachm, myrrh half a drachm, all powdered fine and mixed with the rose pomade. The salve is to be applied at night before going to bed, and is washed off on the following morning. The sore parts must be protected from the effects of raw air. CORNS. A corn is an elevation formed by callous, dry layers of the epider- mis, having in its centre a small, white, horny point, which extends further down than the other parts. Corns occur principally in such places where the skin rests directly upon the bone, and is therefore sub- jected to a constant pressure, and consequently generally between and upon the toes, on the heels and under the sole of the foot where they originate in consequence of too tight boots and even of too tight stock- ings. They rarely occur on the hands. Women have them sometimes on their hips, produced by too tight lacing. They generally have a broad base, and grow from the size of a lentil to that of a split pea and 166 CUTANEOUS DISEASES. even larger. In themselves they are not sensitive to touch, and therefore exist sometimes for years without giving any trouble, if not subjected to pressure. Frequently, however, they cause by the pressure which they produce on the surrounding parts, considerable inflammation' and pain, particularly if tight boots or shoes are worn. During warm weather the irritation and pain becomes almost unbearable, which is still more increased by walking or standing ; a change of weather also seems to have a peculiar effect on corns ; many people are able to predict by that means the approach of rain and storm, &c. In attempting a cure, every pressure by means of tight boots and shoes must be avoided ; this sometimes effects a cure itself; the corns disappear. For the purpose of removing them, take a warm foot-bath, which softens the corn ; it is then removed or shaved down with a suitable instrument; all bleeding must be carefully avoided, however. Sub- sequently, and for some time, apply plasters like mercurial, soap, hem- lock, galbanum and diachylon plasters. Select one of these plasters, and if it does not have the desired effect, try another. This is par- ticularly the case with hemlock and diachylon plasters, equal parts. All these plasters are spread on cloth or soft leather. Great relief is obtained by placing on the corn a thick covering of soft material like felt, in the centre of which an opening has been cut to fit the size of the corn ; the pressure of the boot or shoe on the corn is thereby prevented. This course may be renewed from time to time, after taking a warm foot-bath and shaving down the corn. If the corn is under the sole of the foot, place in the boot a felt sole, in which a hole of the size of the corn is cut, which will free it from all pressure ; for the latter must be most carefully avoided under all circumstances. The following plasters, to be spread on leather, have been partic- ularly recommended : camphor one scruple, ammoniac plaster, gal- banum plaster, litharge plaster, of each two drachms, mix for a plaster and place on the corn. Another : Verdigris one and one-half drachms, gum ammoniac and yellow wax, half an ounce of each, mix for a plaster, and use at pleasure. Another: Salt, nitric acid and pulverized blue vitriol, one ounce of each ; mix the three ingredients in a bottle, add syrup and rain water, WARTS. 167 of each two ounces, to which add half an ounce of lemon juice, shake up well, cork up tight and set aside for use. Cut the corn down to the quick, paint with a fine camels' hair brush a little of the fluid on it, and tie up with a greased cloth. Repeat this twice a day for a few days. It effects a cure generally in from three to four days. Another : Take one ounce of gum ammoniac, two ounces of dis- solved wax and three grains verdigris, mix, spread it on a cloth and place on the corn. WARTS, Warts are hard, and generally painless formations of the skin, with a rough surface, varying in size from a millet seed to that of a pea, and upward. They appear on all parts of the body in places that are not covered by clothing, but more particularly on the back of the hand. They appear on the fingers more than on any other part of the body, and are not unusual in the face, on the lips, neck and throat. Most warts have a flat base and a conical form, or hang by a thin stem. The first are frequently grown together with the skin upon which they are located ; sometimes, however, they are movable with the skin, and frequently they have long and deep roots, which may become somewhat painful occasionally. In treating warts, it has to be ascertained, first of all, to what kind they belong, particularly whether they are connected with any internal disease, in which case there appear generally many warts on the body. It is self-evident that under such circumstances the disease must be removed, when the warts will disappear of their own accord. Among the medicines prescribed for internal use in that case, purgatives have been particularly successful. If an internal disease cannot be dis- coverd, local applications must be resorted to, which warts can rarely withstand. Among these are ligation, excision with a sharp instru- ment, and the application of caustic remedies. Where the warts have stems, ligation is the favorite process for their removal. Excision accomplishes the result quickly, particularly when the opening made by it is touched with caustic, as for instance lunar caustic. By this operation the root is entirely destroyed, which prevents a reappearance of the wart. The removal by caustic treatment, although a little slower, leads to the same result with equal certainty. For that pur- 168 CUTANEOUS DISEASES. pose concentrated acids are best adapted, such as sulphuric and muri- atic acid and aquafortis. It is best done by taking a small drop of the acid on a little stick, and touch the wart with it, and then rub it in. Repeat this once or twice a day until the wart is removed. Pre- vious to the application of the acid, the part destroyed by the previous application can be cut off with a knife. Previous to its entire disap- pearance, inflammation of the base of the wart generally sets in, which is eliminated by suppuration. Besides acids, there may be used for that purpose butter of antimony, a solution of calomel, tincture of cantharides, caustic spirits of sal-ammoniac, caustic potash (must be used with great caution), and lunar caustic, the latter, how- ever, has a very moderate effect. With the sharp juices of certain plants, such as celandine leaves, euphorbium, hemlock, &c, a result would be obtained only very slowly. EXOSTOSIS. Exostosis is a somewhat round, more or less hard, small, gradually increasing swelling, consisting usually of a thick-coated sack, lying in proximity of joints and tendons ; and which forms in consequence of an injury to a tendon, or by inflammation and subsequent induration of a mucous follicle. The interior of the exostosis is usually filled with a glutinous, albuminous mass, generally movable, but sometimes firmly adhering to tendon. They result either from external violence, pressure and tugging, or from internal causes, like gout. As long as they are small, they cause little trouble, but are often very much in the way when they grow. Sometimes they become inflamed and turn into malignant, wearisome ulcers. Treatment : Small exostosis, of recent date, may be dispersed by embrocations of ox-gall and honey, spirits of soap, cantherides, oil of turpentine, spirits of sal-ammoniac, and discutient plasters or salves. If these remedies produce no result, cause a pressure with a sheet of lead, drawn tight by a bandage. Sometimes it is possible to scatter the exostosis by a sudden strong pressure, produced either by the two thumbs of another person, or by a tool, for instance, a mallet, after which the coats of the sack coalesce, and the fluid is absorbed by the cellular tissue. Occasionally, however, the swelling commences anew, LIGATION MILK SCAB. \QQ and the exostosis grows to its former size. The following remedy should then be applied : spread black soap thickly on sheepskin, and tie it on the exostosis ; or anoint daily three times with an ointment prepared of equal parts of camphor, earth-worm oil, and spirit of sal-ammoniac. LIGATION, .For the ligation of an excrescence, like a war^ a small sac, &c, use a waxed thread ; place it around the excrescence, tie and knot, and draw it tighter each day, or at greater intervals, until the excrescence drops off. If severe inflammation sets in, the thread must be loosened, and applied again only after the inflammation has been removed. M I LK-SCAB— M I LK-SC ALL. This malady is peculiar only to little children, and particularly to those who have gold-colored hair. At first there appear on the fore- head and cheek many small, white pustules in groups, the underlying skin being red. These soon break and discharge a clear mucilaginous fluid, which coagulates into thin, greenish or yellow parts, continually increasing in thickness, and spreading until they cover the whole face like a mask, so that the eyes alone remain free. Sometimes the scabs also extend to the throat and the haired part of the head. The exhal- ation of the scab smells rancid, but the general health does not seem to suffer much, except in very young children, where the irritation and itching causes sleeplessness and indigestion. Only if it con- tinues for a long time, can it become serious and end in consumption and death. The scabs never leave a scar or other disfigurement. In vigorous and polychylic children, they are caused by improper food, which produces acidity of the stomach and indigestion. Treatment: The main thing required is a change of diet ; a tea prepared from pansies may be administered, a tablespoonful at a time ; take two drachms of that plant, and pour upon it four ounces of boil- ing water. If the child is very young, administer one teaspoonful three times a day, and the disease will disappear gradually. The scabs may be softened and loosened by mucilaginous remedies, such as a decoction of bran, milk and water, oatmeal gruel, &c; the raw spots 170 CUTANEOUS DISEASES. may be covered by a cloth saturated with oil of almonds, or one on which rose salve has been spread. For internal use, give a mild laxa- tive, preferably calomel in small doses. Sea-bathing is an excellent remedy ; it can be artificially prepared by dissolving a quarter of a pound of sea-salt in warm water, with which the scabs and raw spots may be washed. The mother who still nurses the child, must also observe the strictest diet, and abstain from all irritating and pungent food and drink. If the scabs are very moist, apply lime-water, mixed with milk or oil. BED SORES. This malady results if the patient is obliged, by a tedious disease, to keep the bed for a long time, or if he is to keep a certain position to effect the healing of an injured part. They occur in places only that are subjected to constant pressure by the weight of the body, particularly where, naturally or by emaciation, the bones are covered with but little flesh ; and for that reason, principally on the sacrum, the hips, elbows, shoulders, knees and heels. In healing them, par- ticular attention should be paid that the parts where the sore begins to shows itself, should be as little as possible exposed to pressure. The greatest cleanliness should be observed, the bed should be made several times a day, and great care taken that there are no creases in the sheets, which cause pressure. Place the patient on a deer-skin, with the hair upward, or on an oil-cloth, thinly coated with oil ; wash the places frequently that are already sore, or threaten to become so, with cold water, lead-water, or spirits of camphor, or a decoction of oak or willow bark, or touch thern with lemon juice. A salve made of the white of an egg and whisky is recommended ; lead plaster, mixed with camphor, or soap plaster, may also be applied. If painful ulcers appear, use lead or zink ointment, with a little opium. If the places have become gangrenous, apply the lead or zink ointment, to which a good portion of turpentine has been added ; or apply the pulp of grated carrots, or apply to the ulcer a powder prepared from charcoal, loxa bark, myrrh and camphor. The domestic remedy of placing a small basin of water under the bed is well spoken of. WHITLOW PARONYCHIA PANARITIUM. Ill WHITLOW-PARONYCHIA. Paronychia is a violent inflammation of the fleshy parts of the finger, which at first limits itself to one finger, but which may extend to the hand and forepart of the arm. The disease appears less fre- quently on the toes and feet. Most exposed to the attack are the thumb, index and middle finger ; they may be attacked simultaneously, or one by one, on both hands. There are several kinds of this dis- ease. The treatment of paronychia varies with the different degrees and period of the malady. As long as they are only in the inflammable stage, dispersion should be attempted by cold applications and local bleedings of the attacked and surrounding spots; after that apply emollient poultices, which may be mixed with tincture of opium, if the pain is very great. If suppuration takes place, it must be removed, so as not to destroy the root of the nail, or the vagina tendinum. If the nail is already loosened from its inosculation, it is partly removed with the scissors, and an effort must be made to prevent the extension of the irritation to the fleshy part of the finger by the application of a small piece of cloth or lint pads. The pus collected under the nail may be removed by incisions in the nail, previously thinned by shaving it down. The new nail which grows out should be protected by a wax capsule, to prevent its becoming disfigured by external influences. In severe cases of attack, local or general bleeding, cold applications and rubbing in of mercury are resorted to, according to the violence of the inflammation. If a splinter or other noxious object is the cause and continuation of the inflammation, it should be removed. If on the third day a dispersion does not take place, a sufficient number of incisions must be made in the attacked spot, and emollient poultices applied. Watery swelling- of the hand may be removed by wrapping it up with powdered aromatic herbs in wool or wadding. PANARITIUM. The cause of panaritium is a splinter or other foreign body, an insect or worm, lodged between the nail, under the root of the nail, or in the finger joint. It manifests itself by stinging pains, connected with fever and insomnolence, inflammation and swelling of the 172 CUTANEOUS DISEASES. affected finger, which, if treated according to the old method, leaves more or less deep scars, and not infrequently a disfigured finger. There are even cases where the finger had to be amputated. Treatment : The suffering finger is wrapped up in a bandage steeped in spirits of camphor, and the whole covered with a fingerstall, made of leather or hog's bladder, which is tied with a string over the back of the hand, around the wrist ; the finger will soon be relieved of pain. Whenever the bandage has become dry, and the pain returns, fresh spirits of camphor must be poured into the fingerstall. After a lapse of two or three days the skin breaks, dries and peals off from the suffering spot ; this is ascertained from the smarting created by the spirits of camphor. The bandage is removed, and the finger washed with lukewarm tea. Instead of spirits of camphor, camphor ointment is applied, and the finger dressed with lint, which is thoroughly impregnated with the camphor salve, and the bandages and fingerstall replaced. As soon as the lint has become dry, which manifests itself by itching, camphor oil is poured into the fingerstall. The bandage is removed in the same manner once in twenty-four hours. If the skin covering the pus does not open of its own accord, it should be cut with a penknife ; relief will follow as soon as the pus has found an outlet. The finger should be frequently washed with camomile tea or tar-water ; the dead skin must be removed with the scissors. Another remedy : Place the finger, in hot lye, as hot as you can ' bear it, or in hot ox-gall, as long as the finger can stand it, repeat twice or three times a day, and apply a plaster prepared of salt, soap and oil of turpentine; this disperses it, if applied in season. If matter forms, the ulcer should be opened, and poultices applied, con- sisting of lye and powdered elm bark ; heal it with a good salve. Apply a salve, consisting of the yolk of an egg, ten drops of oil of turpentine, a small quantity of hard soap, a teaspoonful of burnt salt, and the same quantity of corn-meal. This salve is always healing, if applied in time. Or take a small quantity of Venetian turpentine, thicken with wheaten flour, and apply as a thin plaster. CANCER. 173 CANCER. Cancer is a peculiar softening and ulcerating of previously hard and degenerated parts, the result of dyscrasia, marked by its exuber- ant, spongy character, inclined to be destructive, and which, left to itself, never heals, but threatens to permeate the whole system with its peculiar poison. All genuine cancers spring from a scirrhus, a peculiar hardening of a gland, or of a part of the skin (also of the mucous membrane). Hardenings of that kind form knobs of various sizes in the skin, and wart-like inspissations, which, without creating any general trouble or pain (unless they annoy the surrounding parts by pressure), grow slowly. They either remain stationary and do not change after arriving at a certain point, or, if a new irritation should be added, become inflamed, grow in hardness and size, and cause a tearing, burning pain, as if a live coal was lying on the spot (a hidden cancer). Finally they break open under aggravated circum- stances, discharge a badly mixed, bloody fluid, and change into can- cerous ulcer, or into a decided cancer. Other swellings and ulcers, when they break open, may also turn into cancerous ulcers, such as medullary sarcoma, osteosteatoma, sarcoma, polypus, and neuroma. The cancerous ulcer is usually very painful, its basis is hard, uneven and lined with spongy, flesh-like and readily bleeding excrescences, which frequently rise above the border. The secretion which is usually very abundant, is a peculiar, fetid, thin, corroding, bloody or greenish-black ichor. The edges are bent over outwardly or inwardly, mostly hard, painful, pale and bluish, and the surroundings are red, inflamed, painful and generally swollen. The ulcer eats around and downward, and the destruction of the organs proceeds from within outwardly; the adjoining glands are usually swollen and hard. Can- cer most usually attacks the lips, cheeks, eyelids, nose, breasts, arm- pit, uterus, and the external genital organs. It is the outgrowth of a general and peculiar dyscrasia, which forms in people of sedentary habits, or who have much trouble and care, where the regular men- struations have been suppressed or are irregular, or where the period for them has passed, in gout of old standing, and in scrofula diseases, &c. Cancer of the breasts and uterus attacks more frequenty unmar- ried or childless women, after they have passed the middle age of life. 174 CUTANEOUS DISEASES. In general, prognostications in cancer must be unfavorable. If trie malady is still in a state of scirrhous hardening, a favorable result, at least no aggravation, may be anticipated from dispersion, particularly if the patient is still young, and the hardened part is of slow growth, and not very hard. The hidden cancer is more dangerous, however, because in that case the whole system begins to be imbued already with the cancerous poison. The open cancer is incurable ; although it may have been destroyed by caustic remedies, or removed with the knife, sooner or later a new cancerous ulcer breaks out, which by degress destroys vital power. Cancer is one of the most terrible and dangerous diseases to which the human race is subjected, and its dangerous character requires that it receive medical treatment on its first appearance. A knowledge of the symptoms by which it announces itself, is therefore of the highest importance, as the patient may then still be within the reach of human aid. The pain increases gradually, the patient runs down. With some kinds of cancers, as the cancer of the breast, for instance, the glands of the body sympathize. The skin and muscles within a reasonable distance of it become stiff and shriveled ; the axillary glands and arms frequently swell and become stiff, and in a short time the whole body sympathizes with the disease. Occasionally I found in patients an entire loss of appetite, while in others again it became perfectly ravenous. In some persons the progress of the malady is slow and limited to one spot ; in others again it is extremely rapid, and it may be noticed day by day how rapidly their health is being undermined. As has been already remarked, it is of the highest importance that hard and watery swellings on the body, particularly on the face and throat, should neither be cut open or injured, as many a hard node under the skin, caused by warts and other objects, have turned into a cancer by irritation, where, had they not been meddled with, they never would have broken out. The treatment of the maladies above described must be considered very unsatisfactory upon the whole, and only at first, where the indura- tion has not turned into an ulcer, there remains some prospect of saving the patient from certain death. No time should be lost, there- fore, if indurations of the kind above described show themselves in CANCER. 175 the mentioned parts, to call a physician at once, and not spend the time in trying useless remedies, which will after all afford no relief. The medical treatment to be pursued will be about as follows : If the malady, is still a scirrhus, attempts should be made to disperse it, par- ticularly if it is purely local, and the health of the patient still remains good. To attain this object, local stimulating remedies, dry or moist heat, should be applied. The part should be covered with a cat's skin, and recource had to dispersing salves and plasters of mercury, hemlock, gum ammoniac, or poultices of belladonna, fox-glove flowers, and other remedies. Sometimes electricity has been of service. If these efforts do not produce the desired result, the knife must be resorted to, and the scirrhus extirpated, if its location and other circumstances will permit it. If the malady has already passed into the stage of concealed or decided cancer, general and local remedies are useless, because its pro- gress is irresistible, if not removed or destroyed by the knife,or still better by caustic. The cautery iron is used if the cancer lies on the surface, and the knife is not sufficient for its extirpation, and secondary hem- orrhage is feared. Arsenic is one of the chief caustic remedies, used only as an embrocation, from four to eight grains to one pound of water, or as an internal remedy, in the form of a powder, on the pre- scription of a physician only. The powder is made into a soft mass with saliva or water, and applied to the surface of the ulcer with a camel's hair brush, where it remains for some time. The application is renewed, according to circumstances, until the ulcer has a smooth crust. At first this causes violent pain, swelling and inflammation, but in from eight to fourteen days the crust begins to loosen from the edge, and the new ulcer appears to be more innoxious. The slower this proceeds, the better. The new ulcer is treated simply with styrax salve, for instance ; if it does not heal up, the remedy has not operated to a sufficient depth, and must be repeated according to circumstances. Arsenic must also be prescribed for internal use. At first the patient is to take one-eighth of a grain, which is gradually increased to one-quarter, or one-half of a grain. Other remedies, aside from this, both for internal or external use, have been recom- mended : Extract of hemlock, in combination with mercury, in pills ; belladonna in the form of powder or extract ; fox glove ; cherry 176 CUTANEOUS DISEASES. laurel water, internally and externally ; lime water, extract of the common marygold flower, carbonate of iron, animal charcoal, muri- ate of gold, and finally, a continuous pressure with sheet-lead, have sometimes had a good effect. Excision as well as caustic remedies can only be tried with any kind of confidence, if the malady seems to have been stationary for some time, and if no fear need be entertained that the operation will effect the general organism to any considerable extent. A principal point is, that previous and after the extirpation of an old cancer, a seton should be applied. To keep up the strength of the patient during the disease, a healthy, nourishing diet should be ordered, also a decoction of loxa bark, or of plants of a similar character. The ulcer should be cleaned and the dressing renewed as often as required. Pains are quieted by the internal and external use of opiates and other antispasmodic and anodyne remedies. The odor and secretion is improved by an application of scraped carrots, powdered charcoal, wood vinegar, creosote, &c. Another very valuable remedy : Apply poultices of red bilberries to the ulcer; the berries are crushed and applied fresh three or four times a day. Another remedy : Take an egg, break it, pour off the white, so that the yolk part only remains in the shell, add half a teaspoonful of salt, half a teaspoonful of powdered camphor, and mix until it forms into a salve. Take a part of this, spread it upon a piece of adhesive plaster, and apply twice a day to the cancer. It is a very good, effective remedy, and has helped many people, but must be applied in the beginning. Another remedy : Take equal parts of chloride of zink, gold, and antimony, mix with a sufficient quantity of flour and some water, so as to form a tough mass, and apply fresh as a plaster four times a day. Another remedy : Take one ounce of red oak bark, and two ounces of the small-leaved, yellow sorrel root, boil in two quarts of water until reduced to one quart, wash the ulcer with the decoction as hot as endurable, fill the cavity with the fluid for two minutes, then scrape the root and rub fine, spread upon a cloth and cover the ulcer with it. This has to be repeated often. SCROFULA. ITT Another remedy : Take white oak root, dig out the pith and burn the chips to ashes, of which take half an ounce, nitrate of silver, lunar caustic, calomel and powdered cinnamon, of each half an ounce, powder fine, mix with one pound of lard, spread it thinly upon white leather, and place it twice a day upon the ulcer. In a few days the ulcer is killed, which is plainly indicated by its appearance. After that, apply a plaster of house-leek and squill root, equal parts. Another remedy : Take powdered Solomon's seal, bark of black thorn and wood sorrel, one ounce of each, powdered blackberry root two ounces, house-leek juice and squill root juice, one ounce of each, lard one pound, yellow wax and mutton tallow, one ounce of each ; rnelt the lard, wax and mutton tallow together, let it cool, add the rest of the ingredients, stir it up for one hour, and apply once a day. This remedy has cured many people of this dangerous disease. For internal use prepare a pill, composed of aloes and sulphate of iron, of each three grains, make into forty-five pills ; dose, one every even- ing. Sometimes the patient is costive during his sickness, which should be removed by giving a light laxative. Another remedy : Extract of hemlock ten grains, chloride of brom- ine two drops, powdered water fennel seed twenty-five grains, mix, divide into twenty-four pills ; dose, one a day. SCROFULA (GLANDS). Scrofula is a disease of the glandular system, which being in a defective and irregular state, secretes ill-conditioned lymph. The consequence of it is that the body is badly nourished, and the result is an inspissation, hardening and suppuration of the glands, and sub- sequently of the intestines and bones. All secretions deteriorate, and the whole body declines gradually, if the disease is not removed. The disease is divided into two classes, the inherited and the developed. The germ for the disease is presumably in the child, if it is the off- spring of scrofulous parents ; if it has a large head, short, thick throat, pressed-in temples, broad jaws, and if its face, particularly the nose and upper lip, are turgid. These children generally have flaxen hair, a white tender skin, blue eyes, with long, dark-colored eye- lashes, a full, corpulent, but spongy body, bloated abdomen, inclina- 178 CUTANEOUS DISEASES. tion to nose-bleeding, profuse secretion of phlegm and worms, irregular evacuations, and a precocious development of mind, but not of body. Developed scrofula is accompanied by the following symptoms : swelled glands and induration, first on the throat, under the jaw, on the neck ; then under the shoulders and around the groins ; at first they are soft and movable ; by degrees they become enlarged, grow harder and sensitive, and sometimes become inflamed, suppurate, and are transformed into scrofulous Ulcers ; or the disease goes to the internal glandular parts, such as the mesentery, lungs, brains, and bones. Usually there are no external swellings of the glands observable, but the abdomen is hard and bloated, the breathing is troubled, and the children forget how to walk. In consequence of this poisonous dis- ease, not unfrequently tedious inflammations of glandulous parts result, for instance, of the eyes, or blennorrhea of the nose and ears, eruptions of the skin, scald head, and milk scall. In many cases the bones are particularly attacked, which usually results in the rickets. If the disease obstinately continues for some time, tabes glandularis sets in, because by the obstruction of the mesenteric glands, the chyle is prevented from passing into the blood, the abdomen becomes bloated and hard, and frequently hard knots can be felt, while the limbs waste away. At the same time the most insatiable appetite sets in, constipation, alternating with diarrhoea, pain in the bowels and cramps ; the face looks old and wrinkled, and the skin withered and inanimate. In cases like that the disease sometimes becomes fatal. Cachexia scrofulosa is most generally a disease peculiar to children, and usually ceases with the developing period. Usually it appears in the second and third year, and is brought out by accidental or morbid irritability, such as dentition, fever, skin diseases, vaccination, &c. The main causes for scrofula are lack of light, pure air, cleanliness, and proper food. The germ for scrofula is either transferred from parents to children, because scrofulous parents almost always beget scrofulous children, or the germ is innate in consequence of a very weakened state of health of the parents. For that reason parents who are suffering from syphilis, and who have taken a good deal of mercury, may almost always count upon scrofulous offspring ; finally, it is also acquired by neglect and defective nursing in childhood. No SCROFULA. 179 one becomes scrofulous during a later period of life, who has not had the germ in him from childhood, as previously stated. The scrofulous nodules are not only perceivable on the surface of the body, but they also attack internal parts, particularly the mesentery, later the lungs and other organs ; the mesenteric glands are particularly liable to be attacked. The abdomen becomes bloated, larger and harder, and finally it feels very knotty, the indurated glands often growing to the size of a hazel-nut. Scrofulous diseases sometimes appear during the first year, but usually during the second and third year. They are generally brought out by accidental causes which operate with particu- lar violence on the tender body of the child, among which are exter- nal injuries, dentition, high fever, particularly eruptive diseases, in- appropriate nutrition of children during early childhood by the mother's milk being either too fat, old or unwholesome. Disagreeing with the child, it suffers in consequence constantly from diarrhoea, costiveness, colic, and acidity of the stomach ; it also results from an overfeeding with even wholesome mother's milk, particularly as some mothers are in the habit of letting the child sleep at the breast. All this may lead to a scrofulous condition of the child. The treatment of scrofula is very tedious and difficult. The func- tions of the glandular system should be improved and regulated, which is best done by proper diet. The so-called anti-scrofula remedies may also be profitably applied. Wholesome nourishing food, adapted to the digestive powers of the child, should be given ; it should have a constant supply of fresh air, be kept cleanly, a restoration of a healthy action of the skin should be effected by bathing, which may be made still more effectual by the addition of soap, malt, &c, and a proper exercise in the open air. As a usual beverage, give the child acorn coffee, if it is already used to coffee. Internal remedies to be applied, must be in the shape of solving, strengthening remedies, such as the following : hydrargyrum slibiato-sulphuratum half a drachm, mag- nesia two drachms, rhubarb ^ drachm, fennel seed one and one-half drachms, mix and powder ; dose, what can lie on the point of a knife, two or three times a day. Muriate of baryta is very efficacious ; dissolve half a drachm in two ounces of distilled water ; dose, from five to fifteen drops three times a day ; dose for adults, from twenty to thirty drops three or four times a day. Furthermore, the dissolving extracts, 180 CUTANEOUS DISEASES. carbonate of soda, lime water, iodine, and occasionally a mild laxa- tive. In cases of great weakness, besides aromatic baths, china root and mild preparations of iron are serviceable. To heal glandular swellings quickly, rub with grey mercurial salve, fox-glove salve, a solution of muriate of lime, iodide salve, or put on a dissolving plaster. In cases of scrofulous bone swelling, the internal use of cod liver oil, in connection with the application of external remedies, is of excellent service ; dose, about half an ounce, once a day. Embrocating remedy : Wash the suffering parts frequently with spirits of camphor, or rub in camphor salve several times a day. Another remedy: If the glands and joints are swollen, take of iodide eighteen grains, purified oil of amber three drachms, and spirits of wine two ounces. When the oil of amber is poured over the iodide, it inflames or burns, and when that has ceased, the spirits of wine is poured off ; saturate a cloth with it, and apply four or five times a day ; wash it frequently with a decoction of bran. CATARRH-COLD IN THE HEAD. Catarrh usually begins with a light inflammable fever (catarrhal fever). In consequence of an inflammation, a local irritation of the mucous membrane of the trachea and nose takes place, which at first secretes a very thin, watery, and subsequently a thick, slimy fluid. The catarrhal fever begins at the same time with the local irritation ; chills alternate with heat, the head, but particularly the frontal region feels heavy, the chest is oppressed, sleep restless, and digestion disturbed. The fever lasts from five to ten days, and winds up with a discharge of tough, thick, greenish-yellow mucus from the nose or air passages by expectoration, accompanied by perspiration and voidance of a redish urine, with heavy sediment. The cause of this malady is the taking of a cold, which is not effected so much by the cold state of the atmosphere, as by the sudden change from heat to cold. With many, a particular inclination for catarrh prevails after a time, while a much severer cold, preceded shortly previous by catarrh, passes off without injury. In itself a catarrh is not dangerous, if there does not exist at the same time an inflammation of the organs of the chest and throat, or some old pectoral complaint, which frequently CATARRH IN THE HEAD WITHOUT FEVER. 181 manifests itself by severe pain in the larynx or throat, by a rapid, short breath, stitches in the breast, oppression, &c. The malady becomes serious if it continues for a long time, if heavy perspirations occur without giving relief, and the patient grows weak. In that case a physician should be consulted. CATARRH IN THE HEAD WITHOUT FEVER. Every catarrh is a rheumatic, light inflammation of the mucous membrane of the nose and trachea and their branches. It is the result of a cold, and sometimes causes pain and a heaviness in the head. Sometimes catarrh causes a light fever, and frequently it is not accompanied by it all. Every attack of catarrh, unaccompanied by fever, passes through two different stages. During the first stage the mucous membrane is in a state of irritation, accompanied by a cough which is either dry, or the expectoration is watery, thin and acrid. It is connected with hoarseness, and, if of a severer character, by pain in the chest. During the second stage, the irritation has some- what subsided, which is indicated by a moist, non-straining cough, when the expectoration is considerable, but thick and mild. This stage is of uncertain duration, sometimes very short, and at other times very long. However unimportant this disease is in itself, it may endanger life by neglect. It may result either in inflammation of the lungs, or in phthisis ; and it may be safely assumed that the largest number of cases of phthisis have originated in that way. Treatment : A fresh cold must be avoided under all circumstances, and for that reason proper, warm clothing should be worn ; throat, chest and feet must be kept warm. The room occupied should neither be kept cold, nor excessively warm. Perspiration should be excited by drinking strong elder flower tea, to each cup of which from ten to twenty drops of spirits of hartshorn is to be added. For people who can not be brought into a state of perspiration, a solution of tartar emetic may be added to the elder flower tea ; one grain to six ounces of the tea. In case of sore throat, gargle with an infusion of mallow, camomile or sage tea, to which has been added from one to two teaspoonsful of oxymel. In addition thereto, mucilaginous drinks may be taken moderately warm, such as an infusion of linseed, 182 CUTANEOUS DISEASES. mallow, mullein flowers, and marshmallow root ; the two last may be combined with anis or fennel in equal parts. All heating and sharp beverages, such as beer, whisky, wine, coffee, &c, and also meat, fat and sour dishes, must be avoided ; in place of which use mucilaginous soups prepared from sago, rice, oatmeal, groats, pearl barley, &c. The free use of sweets is not advisable, as they interfere somewhat with digestion ; some kinds, however, may not prove injurious, as for instance, jujube paste, marshmallow juice, more particularly squill root juice or honey. At stated periods take a good laxative. A similar course may be pursued with children. To children between the first and fourth year, administer from six to twelve drops of emetic wine in half a cup of mucilaginous tea, or in a teaspoonful of marsh- mallow juice ; for older children, increase the dose. To facilitate the throwing up of phlegm, in which children do not very readily aid themselves, administer emetic wine in doses of ten, fifteen, twenty or thirty drops, and if vomiting does not occur, the quantity should be increased. In case of severe pain in the chest, it is proper to apply a plaster of of Spanish fly of the size of a dollar to the chest ; for women and children a mustard plaster may be substituted, which should remain until it has drawn a red spot. A large piece of flannel, on which drop from forty to sixty drops of volatile salve (obtainable in the apothecary shops), may be placed over the breast. In cases of very obstinate dry coughs, place a warm poultice around the throat, prepared from two ounces linseed meal, a quarter of an ounce pure pulverized opium, boiled in water to a thick mass, and applied as hot as it can be endured. Steam, conducted through a funnel, or drawn into the mouth, will also give relief. The following mixture is beneficial : gum arabic, fresh pressed almond oil, marsh- mallow syrup, half an ounce of each ; dose, a teaspoonful every two hours. The following remedy is adapted to facilitate the expectora- tion of phlegm: coltsfoot leaves, sweet marjoram, marshmallow root (finely cut up), two ounces of each, licorice root one ounce, powdered fennel seed one drachm, mix well, and boil one tablespoonful of it in a quart of water, drink this tea warm three times a day. The follow- ing is an excellent domestic remedy : take two drachms of licorice, boil in a cupful of bitter beer, and drink at night when going to bed. CATARRH IN THE HEAD WITHOUT FEVER. 183 Incases of chronic nasal catarrh, where the nose seems to be entirely stopped up, it is beneficial to snuff up powdered white sugar. For old chronic cases, keep as much as possible in the open dry air, use foot-baths during the summer, and snuff up fresh well water, or snuff up through the nostrils the juice of sweet marjoram, diluted with three parts of water, twice a day. A cure of catarrh fever is usually effected by nature, in which it should be aided by frequently drinking water gruel, elder, linden flower and pectoral tea. Another remedy, well recommended, is orris root, fennel seed, marshmallow and licorice root, two ounces of each, cut up and well mixed ; take forty grains of it, and boil for half an hour in one and one-half quarts of water, strain, and drink the decoction during the day, a cupful at a time. If a dry cough and hoarseness is superadded thereto, take the following : emetic wine six grains, bitter almond water eight grains, distilled water sixty grains, sugar two ounces ; dose, one teaspoonful four times a day. If accompanied by pain in the chest, apply a mustard plaster. If, in otherwise healthy persons, the irritation of an ordinary, apyretic catarrh continues for any length of time, if the cough remains dry, or the expectoration watery, thin and acrid, administer sal- ammoniac and licorice juice, of each six grains, emetic wine four grains, dissolved in one hundred and forty grains of linden flour water ; dose, a tablespoonful every three hours. If the cough threatens to continue for a long time, administer the following powder : pure thebaic extract three centigrammes, gum arabic one grain ; dose, one powder three times a day. For a tickling cough, administer twice a day twenty drops of oil of anis, or from fifteen to twenty drops of tincture of pimpinell sugar. If expectoration is started, it is an indication that the catarrh is about to cease, and usually everything passes off regularly, so that no further medicine will be required. Taking fresh cold must be avoided, and the patient must keep warm. Precaution requires, in case of a long continuation of the cough, that tartar emetic ointment should be rubbed in on the chest, in order to keep up an eruption. 184 CUTANEOUS DISEASES. NON-CATARRHAL COUGH. Cough very frequently appears only as a symptom of other particu- larly inflammatory diseases. If the cough is to be thoroughly stopped, these particular diseases must be removed, aside of catarrh, because there are several other causes producing cough, and, without taking this into consideration, a successful selection of the means for its removal cannot be made. If, for instance, in a case of profuse secretion of mucous, which not very rarely causes an obstinate cough, sweet, mucilaginous remedies were to be applied, it would only increase the trouble. The stomach and abdominal cough must be counted to the non-catarrhal coughs ; although every cough is based upon a morbid expulsion of air from the lungs, yet it is not absolutely necessary that the morbid irritation causing this spasm of the lungs, should have its seat only in the lungs or the other respiratory organs. It frequently originates in some more remote parts, particularly in the abdomen or spinal cord, and only extends to the chest by means of the nervous system. Causes producing such a cough are impurities like phlegm, gall, worms, &c, in the abdomen, and more particularly in the stomach, or gasterasthemia, and sometimes various other morbid con- ditions of the liver. The Catarrhal Cough which is usually dry at first, is subsequently accompanied by mucous expectorations, causing relief. (This has been fully discussed above). The Cough accompanying Pleurisy is a short, hacking cough, with little or no mucous evacuation. It is accompanied by fever and other usual symptoms. The patient breathes uneasily, and has sting- ing pains toward the surface of the chest, and cannot draw a deep breath. Cough with Inflammation of the Lungs. — The cough in that case is very painful, accompanied by small mucous expectorations? streaked with blood ; the mucous expectorations increase subsequently, however; violent inflammatory fever, with all attending troubles, accompanies it. This cough appears also with other diseases, such as dropsy, consumption, &c. If the cough is accompanied by stinging pains, bleeding or expectoration, very careful treatment is required, particularly in patients between the sixteenth and thirtieth year, who NON-CATARRHAL COUGH. 185 are of slender form, fine and frequently florid complexion, who have grown very rapidly, and suffer from palpitation of the heart and short breath on ascending stairs and other elevations. Under such circum- stances the condition is critical, and the attack may easily turn into consumption. It is therefore advisable to call in a physician at an early stage. Persons who have passed the middle age, are frequently attacked by a constant cough, ending sometimes in consumption, but who nevertheless live to an advanced age. Frequently the cough is increased by faulty diet, colds and labor, particularly in rough weather, when it requires the application of emollient remedies, though there is very little prospect for a radical cure. The greatest caution should be observed with a cough in small children, particularly if they cry hard previous to and after coughing. This always points to pain, and not infrequently to an inflammatory state of the organs of the chest or respiration, particularly if connected with great restlessness and rapid breathing. Medical aid should be called in at once. In treating a Cough, the primary cause should be particularly con- sidered. When this has been removed or ameliorated, and if the cough still continues, then proper remedies should be applied. It must not be forgotten, however, that the easier the expectorations are thrown off, the less straining is the cough. As an aleviation, and to facilitate expectoration from the air passages, sweet and mucilaginous remedies are required. Among the former are rock candy, carrot sugar, sugar stirred in the yolk of an egg, marshmallow syrup, licorice, &c; among the latter, particularly decoctions of oatmeal, arrow root, linseed, marshmallow root, mullein flowers, &c. Light, stimulating remedies, particularly in severe coughs without any expectoration, are : anis, fennel, flowers of sulphur, and particularly the following mixture : sulphur four grains, powdered fennel seed and powdered licorice one drachm of each, mix, divide into twelve parts, and take one powder every four hours. To this class of remedies also belongs the pectoral elixir and pectoral powder, also tartar emetic, in small doses, mustard plaster, maniluvise, &c. If the attack is unaccompanied by violent inflammation, and if from great irritablity of the air passages or other trifling causes, violent coughing and pains are produced, antispasmodic and quieting remedies may be given, among which are diacdium syrup, a teaspoonful at a time, cherry laurel water from ten to twelve drops 186 CUTANEOUS DISEASES. every three or four hours, henbane and Dover's powders. In coughs of long duration in old people, when not accompanied by inflamma- tion, pectoral pills are beneficial ; they are prepared as follows : pow- dered squill root, ipecac, lobelia seed and powdered gum arabic, thirty grains of each, make into forty pills with extract of henbane ; dose, one pill three or four times a day. These pills are good for every kind of cough, particularly for those connected with bronchial affection and with consumptive tendencies. COUGH FROM PLETHORA. Generally young or robust people, who live on rich food and have a blooming complexion, are attacked, by this cough. The pulse is large, excitement and excercise increase the cough, which is usually connected with shortness of breath and pain in the breast. It requires the same treatment and mode of living as does an insipient inflammation of the lungs, in which it may easily result by neglect. There is also danger of haemoptysis. But also others than very plethoric people may be attacked with congestion in the chest, and which may cause a tedious cough. Very frequently this occurs more particularly in cases of suppressed hemorrhoids, in irregular or suppressed menstruation, during pregnancy, or suppression of other habitual hemorrhages, such as bleed- ing at the nose, &c. It is frequently difficult to discover the exact condi- tion, particularly if, without hemorrhoids and menstruations, no indica- tions have manifested themselves that nature requires these hemorrhages. Cough is a deposit of morbid matter, particularly of rheumatism, gout, cramps, scrofula, skin eruptions, phthisis pulmonalis, &c, which goes to the chest and causes an obstinate cough. A very disquieting cough of that kind does not only accompany gout in some cases, but fre- quently precedes it. In that case it is necessary that the attack of the gout should occur as soon as possible. The patient must therefore keep his feet very warm, drink frequently good warm tea, preferably pectoral tea, and take lukewarm mustard baths. A cough caused by elongated uvula, is frequently very obstinate ; it has sometimes been mistaken for phthisis pulmonalis, in which it may result, however, if the cause of it is not discovered and removed. The easily performed and entirely safe operation of having the elon- HiEMOPTISIS. 187 gated uvula cut off, is a sure and instantaneous remedy. It is there- fore advisable to have the oral cavity examined by an intelligent phy- sician, in every case of a long continued cough. HyEMOPTISIS. This is an effusion of blood from the lui gs, which by coughing is forced through the trachea and larynx into the mo.uth. Sometimes the matter coughed up is only streaked with blood, at other times it con- tains larger lumps of it, and occasionally it pours out in larger quan- tities, when it is called hsemoptisis. It is mostly produced by external violent sensations, such as a thrust or blow on the chest, violent screaming, blowing, dancing, running, and violent concussion in cough- ing. It is also caused by certain suppressed morbid conditions, such as skin diseases, hemorrhoids, menstruations, sweaty feet, destruction of blood vessels in consumption, &c. Hsemoptisis is always very critical, and requires strict attention. The prospect for a complete removal of the malady is more favorable if it occurs only in place of hemorrhages in other places, such as hemorrhoids, menstruation, &c. In such cases great care should be exercised not to suppress the attack by the application of cold or other haemostatic remedies ; the patient, however, should live very regularly, and preserve equanimity of mind and body. If the hemorrhages become stronger, attempts should be made to restore by proper remedies the malady originally suppressed, which, if necessary, may be aided by phlebotomy, leeches or cupping. In all cases the patient must be kept very quiet ; he must remove all garments pressing against the chest, avoid talking, or, at most, speak very softly, avoid the inhalation of cough-inciting matter, such as smoke and dust, and abstain from all stimulating and heating bever- ages, such as coffee, wine and whisky; he is to use mucilaginous, cooling and soothing beverages, for instance, milk of almonds, sweet- ened oat or barley water, and as a revulsive remedy, stimulating foot- baths, maniluviae, and endeavor to remove costiveness by injections. For women who have been attacked in consequence of suppressed menstruation, bleeding at the foot would be serviceable. In cases of sudden, violent hemorrhages, take a solution of salt, a spoonful at a time, or repeated doses of dry salt, as much as will lie on the point of a knife. 188 CUTANEOUS DISEASES. A remedy operating much quicker and surer, is spirits of turpen- tine. Give the patient from twenty to twenty-five drops in a tumbler of water, which at once causes a contraction of the vessels. H^EMATEMESIS. The blood vomited up in this case comes principally from the stomach, sometimes from the upper part of the intestinal canal, or from the liver and spleen. The attack is generally preceded by a sweetish taste of blood, and also by a griping pain in the bowels. Frequently it is at the same time accompanied by hiccough, fainting, cold hands and feet, and cold perspiration, particularly if considerable injuries have occurred to the parts mentioned. In such a case a skill- ful physician should be called in at once. Sometimes the attack passes off without doing any harm, particularly if the bleeding oc- curred in place of menstruation in women, and bleeding hemorrhoids in men. General treatment in such cases consists in keeping cool, in the use of cooling, accidulated drinks, such as cold water with cream of tartar, or with a small quantity of sulphuric acid, sufficient to give to the water an acid taste, alum-whey and lemonade. The patient must lie quietly in a horizontal position. If the attack arises from congestion, bleeding may be necessary. Blood-vomiting occurs in some persons under a feeling of great dread, nausea, inflation of the stomach, with and sometimes without pain, occasionally with fever, great lassitude, cold sweat and fainting. The vomiting is repeated sometimes three or four times a day for some days ; sometimes it is repeated only at an interval of some days, and again it appears in the shape of intermittent fever. If the vom- iting of blood proceeds from an irritation of the spinal chord, sup- pressed menstruation, hemorrhoids, or a hidden intermittent fever, it is always followed by a discharge of clogged blood with a movement of the bowels. Treatment. Apply vinegar poultices to which a little salt has been added, to the region of the stomach, or apply soothing poultices, prepared by taking linseed four ounces, hemlock leaves two ounces, henbane one and a half ounces, boil in water to a moderately soft mass, then add one and one-half ounces of henbane, and apply it in a lukewarm state. If the vomiting of blood do.-s not cease then, RHINORRHAGIA. 189 alum-whey is to be administered. It is prepared as follows : Take milk thirty-six ounces, alum two drachms, prepare from whey-sugar two ounces, dose half a cupful every three hours. The following powders are also highly recommended : Acetate of lead one decigramme, opium one centigramme, acetate of soda one deci- gramme, sugar of milk six decigrammes ; dose, a powder every two hours. This powder, when tried, has proved successful in all cases of hemorrhage. When the hemorrhage is stopped, tamarind water should be drank for some days ; it is prepared in the following manner : Pulp of tama- rind three ounces, tartrate of potassa two and one-half drachms, water one quart ; dose, half a cupful every three hours. Give an injection of camomile tea and sweet oil to clean the bowels of blood* For some days afterwards abstain from the use of all solid food, be- cause even a small piece of bread may open the wound in the stomach again. RHINORRHAGIA. In general bleeding of the nose is not only harmless, but in some cases even beneficial, particularly in congestion of the head, dizziness, pressure on the forehead, tinnitus aureum, blackness before the eyes, &c. Only in case bleeding is severe and lasts too long, should it be stopped, which is done by an application of cold water poultices to the forehead and nose. The snuffing up of cold water and vinegar through the nostrils has a very good effect, and finally the stopping up of the nostrils with a sponge, paper or lint, which collects and coagulates the blood before the pierced arteries, produces the desired result, and for that reason it must never be torn off by force. Tne most important question to be decided is, what course to pursue in regard to nose-bleeding, and under what circumstances external rem- edies should be applied to stanch the blood. The bleeding must not be suppressed in every instance, and particularly not, where it is moderate and affords relief under existing difficulties, in plethoric persons, in violent congestions, inflammatory fevers, and rush of blood to the head. Neither should it be stopped if it occurs after the sup- pression of other customary blood- discharges, as for instance, from bleed- ing hemorrhoids, or menstruation. In cases like that a premature sup- pression may produce dangerous results, such as inflammation of the 190 CUTANEOUS DISEASES. brain, deafness, blindness, and epilepsy. Only in case the face be- comes pale, hands and feet become cold, to which dizziness and faint- ing are added, is it proper to apply the remedies before mentioned to stop the bleeding. It should not be understood, however, that noth- ing should be done in a case of nose-bleeding, until the danger is pressing, for that would inflict on the patient needlessly an excessive loss of blood. If, therefore, the bleeding of the nose is very great, an attempt should be made to remove it by internal diverting reme- dies, because by such means all danger is averted. But, in order to proceed judiciously, the following circumstances should be taken into consideration : If the bleeding of the nose is caused by external violence, cold water may be applied at once with safety across the forehead and nose ; if the bleeding becomes very violent, proceed as before stated. Bleeding of the nose is caused by an obstruction to the free cir- culation of the blood in the brain, chest or abdomen. If proceeding from the brain, the blood will either flow from both nostrils at the same time, or alternately from one or the other. Blood-letting from the foot to a moderate extent would be proper. If, when taking a cold in the head, nose-bleeding appears in connection with pain and cold in the head, or if the patient suffers from gout, cold reme- dies must not be applied, but stimulating foot-baths, and applications of mustard plasters to the calves of the legs, and Spanish fly plasters between the shoulders. If, after the bleeding has been stopped, in- sensibility, somnolency and other signs of a violent rush of blood to the head should set in, an attempt must be made to renew the bleed- ing, and if it is found that this causes an abatement of the dangerous symptoms, then choose of two evils the least, and keep up a moderate bleeding of the nose. To renew the bleeding of the nose, it generally suffices to inhale the vapor arising from hot water, or causing the patient to sneeze, or a couple of leeches may be applied to the nos- trils. Strict investigation should be made whether the nose-bleeding is of a scorbutic character. In case of a more than usual violent bleeding, the body should be examined. If the bleeding has been violent, blue spots appear on the body, which is an indication of its scorbutic nature. NASAL POLYPUS — RICKETS. 191 NASAL POLYPUS. The nasal polypus is a spongy growth, a soft excrescence forming in the nose, which sometimes causes trouble by its size. There are two kinds ; one is called the sponge, and the other the cartilaginous poly- pus. The last named occurs very rarely. The common nose polypus is soft, spongy and of a light red color, sometimes, however, dark red. The spongy polypus is void of sensibility, and connected with the inner surface of the nose by a thin root. It sometimes grows to such an extent as to entirely fill one of the nostrils, and to even pro- trude from it. Sometimes, instead of growing in a forward direction, it grows backward, reaching into the oral cavity, and creating a diffi- culty in swallowing. The nose frequently swells, or increases in cir- cumference. The sense of smell is partly or wholly lost, breathing through the nose is an impossibility, hearing is obstructed, and other troublesome symptoms show themselves. Treatment: Touch the polypus frequently by means of a twisted cloth, saturated with spirits of camphor, and cover the nose with the same fluid. After that has been done, snuff up salt water, or in place of salt water snuff a powder, prepared as follows : finely powdered laurel bark and mandrake root, of each two ounces, powdered blood root, one and one-half ounces, mix well and snuff four or five times a day, on the side where the polypus is located. If by snuffing it does not reach the swelling, it must be introduced into the nose by other means. The principal point is to bring it in contact with the whole surface of the growth in the nose, by means of which it is gradually destroyed. It may also be accomplished by winding a small piece oi moistened cloth around a little stick, then dip it in the powder and shove it into the nose. It is also advisable to pierce the polypus or parts that can be reached with a small instrument, or crush it with a fine small pair of nippers, or pinch off parts of it, and then apply the powder. This will gradually kill the excrescence ; it grows dark and drops off. This must be frequently repeated. RICKETS. Rickets, or double members, is the disease generally called which appears in children from their first to the seventh year, and which is 192 CUTANEOUS DISEASES. caused by a defective sanguification. The visible signs of the disease are softening and curvature of the bones, and swelling of the joints. Children thus afflicted are frequently marked by large heads, par- ticularly broad on top, laxness of the whole body, an old-looking face, and a certain precociousness of manner. Their aversion against meat and liking for farinaceous food is remarkable. Their abdomen is hard and bloated, with occasional costiveness, and at other times with diarrhoea of a yellow watery substance. The children perspire very much, and the perspiration is sometimes glutinous with a nauseous, acid smell. The malady is frequently connected with an aggravated condition of glandular disease, or it changes into consumption. Frequently it is hereditary; children of enfeebled parents are par- ticularly subject to it, or it is the result from uncleanliness, unhealthy habitations, overfeeding, &c. Treatment : First of all, the greatest cleanliness and care of the child is necessary. The dwelling must be airy and free from all offensive exhalations. If the child is able to walk, it should be made to run out in the fresh air, smaller children must ride or be carried. Their diet requires the most particular attention. Children suffering from that disease must eat but very little farinaceous food, particularly no potatoes and leguminous vegetables, such as beans, peas, &c, neither must they eat rye bread, very little butter or greasy pastry, or food to which a great deal of sugar has been added. The food best adapted for them is broth, tea, infusions of anis, fennel, carraway, lemon balm, &c. For a common drink water should be used, to which a little good wine might be added. The whole body of the child should be rubbed down with flannel, which is fumigated with juniper berries or ordinary incense powder thrown on live coal. The abdomen must be rubbed with a volatile or nervous ointment. Bath- ing, however, is a chief remedy for a cure, but particularly baths pre- pared from aromatic herbs, such as sweet flag, peppermint, balm- mint, lavender, wild thyme, &c; furthermore, sponging with spirits of wine, and wine to which wine vinegar may be added. Diet, together with the treatment prescribed, is frequently sufficient to restore the child to health. A light emetic, consisting of two drachms of emetic wine, and, if necessary, a laxative of two drachms of tinc- ture of rhubarb, administered at first, would be useful in cleansing CLUB-FOOT. 193 the digestive organs. Very beneficial will be found bitter, aromatic ingredients, such as sweet flag, orange peel, extracts of doggrass, dan- delion root, soapwort, gentian root, and quassia ; they will produce a better digestion and strengthen the organs ; subsequently china root and tincture of iron should be administered. Cod liver oil may be given from the start ; dose, three teaspoonsful a day. It has always proved an excellent remedy. The treatment does not vary, however, from that of scrofula, for an attack of the bones by scrofula results in this disease. The following are the first symptoms : The child is late in learning to stand up or walk, distention of the bones around the joints, par- ticularly the wrist, followed by curvature of the bones, particularly the shin bones, breast bone, ribs (hence shortness of breath), spinal column, distention and deformity of the bones frequently of the whole body, particularly of the pelvis, and therefore a limping, wad- dling gait. This disease frequently disappears with the development and growth of the body. In more severe attacks, the curvature of the spinal column, feet, breast bone and ribs, remains sometimes through life. The cure of rickets is the same as that of scrofula, particularly in regard to diet. Besides that, salt and malt baths, with the addition of sweet flag root, should be taken, and the back and limbs rubbed with brandy, formic spirits or earth-worm oil. For internal use, take preparations of iron : iron filings two grains, cinnamon one grain, sugar two grains, prepared oyster shell one grain, mix and divide into four powders; dose, one powder mornings and evenings. Or admin- ister malate tincture of iron, from ten to twenty drops twice a day. If the child is costive, add one decigramme of rhubarb to the powder. The rubbing with camphor ointment is beneficial* CLUB-FOOT. Club-foot is a deformity by which the inner edge of the foot is turned upward, and its outer edge downward, whereby the sole and back of the foot assume a more or less perpendicular position. The toes are also strongly bent and turned upward toward the inner edge of the foot, the back of the foot appears more arched and deformed *3 194 CUTANEOUS DISEASES. by the protuberance of the astragalus. The heal is drawn up by the continuous strain of the tendon of Achilles, and does not touch the ground in walking. The weight of the body, therefore, rests on the outer edge of the foot, contracted into an arch, so that the inner part of the ankle scarcely projects at all, while the outer part stands out very prominently. The patient is only able to walk with a great deal of exertion, constantly swaying from side to side. Both feet may be affected by this deformity to different degrees. Whether born with it or acquired, it is caused by a preponderating activity of the addu- cent muscles and flexors of the foot, whereby the muscles of the opposite side relax and are elongated. A cure is based upon the restoration and preservation of the equi- librium of the muscles. Place the feet twice a day up to the knees in a warm bath, during which an attempt should be made to give the feet a natural position by a gentle tug, turning the heel outward, and pressing the back of the foot downward. At the expiration of half an hour, take the foot out of the bath, dry it, rub the inner and back part of the leg and inner surface of the sole of the foot with a salve consisting of lard and goose grease, and the front and exterior side of the leg and foot with a spirituous fluid ; draw the foot into its proper position by a bandage placed below the calf of the leg around the two ankle bones, from the outside to the inside, and from the exterior edge of the foot diagonally upward against the upper one. A sure cure of club-foot in a new-born child can be affected only by a physi- cian, or at least his instruction is needed. DISEASES OF THE JOINT. In a broad sense of the word, a large number of maladies are em- braced in the expression " diseases of the joint." They are produced partly by mechanical violence, and partly by irritable disorders in the body, but frequently by a coincidence of both internal and external causes. We, however, use the expression, diseases of the joint, with a less comprehensive meaning, denoting only by it those organic degen- erations of the joints, known by the appellation of tumor albus and spontaneous limping. TUMOR ALBUS. This disease is caused by a chronic inflammation of the articular ligaments and the adjoining soft parts, connected with an effusion oi a watery fluid ; in the severer forms of the disease, the inflammation extends even to the end of the bone. It shows itself as a swelling, colorless, soft, doughy, elastic, and apparently fluctuating, and extends uniformly over the whole joint, or on one side of it. If an attempt to disperse it is unsuccessful, it turns into pyarthrosis, fistula of the joint, stiff joint, and caries of the articular extremity. White swelling may occur in all joints, but it appears most generally on the knee-joint. Adhering to the purpose of this article, I will limit my- self to a more particular statement of the white swelling of the knee- joint, passing by all other forms without further notice. The disease commences sometimes with a sudden, more or less acute pain in the knee-joint, increasing by motion or outward pressure, and generally attacking the whole joint, frequently, however, only one side of it, and generally .extending to the tendons connected with the joint on the left. A few hours, or at most a few days, after the com- mencement of the pain, the knee begins to swell considerable in its entire circumference, or perhaps only on one side of it. The swelling (i95) 196 DISEASES OF THE JOINT. is white, glossy, soft and elastic, a little warmer than the surrounding parts, to which it gradually slopes down. The patient is unable to stretch out his legs or bend them at right angles, and finds a slightly bent position the easiest. The pain increases in time, the capsular ligaments and the tendons covering them, as well as the surrounding cellular tissues, gradually incrassate, the swelling increases consider- ably, appears very tight, and through it pass enlarged bluish blood vessels. The stiffness and immobility of the whole limb increases from week to week, and it begins to emaciate above as well as below the joint. The further the malady progresses, the harder becomes the swelling ; the lymphatic glands in the neighborhood of the inguinal region also begin to swell. After this condition has lasted for months or even years, with occasional changes for better or worse, the swell- ing becomes red in some places, and oedema shows itself on the foot ; under severe, pulsating pains, accompanied by frequent chills, and quicker pulse, particularly in the evening, the soft parts surrounding the diseased joints begin to suppurate, the existence of which, the fluctuation, now clearly perceptible, can no longer be doubted. Finally the swelling breaks in one or more places, and discharges a great deal of thin puss mixed with flakes, resembling the white of egg. This, however, does not reduce the swelling at all, or at most but very little. In time, one or the other of these abscesses close up, but others open in other places instead. Some of these abscesses degen- erate into fistulous ulcers. The general health of the patient suffers more and more, and not rarely he finally succumbs to hectic fever. If timely and proper assistance has not been accorded, or the dis- charge of the matter effected too late, it perhaps makes its way into the articular capsule, which finally leads to the destruction of the articular extremities by caries. Scrofulous, gouty and rheumatic per- sons seem to be predisposed to white swelling of the joints. Causes for it are a settling of rheumatism and gout in the knee, suppressed skin diseases, also contusions of the knee ; and for that reason the disease has been noticed in stone cutters. In treating this disease, the first thing to be done is to subdue the inflammation. If it is of a rheumatic nature, the wrapping up of the knee in wool or fur, and the causing of a general thorough perspira- tion by means of elder-blossom tea, or small doses of tartar emetic is TUMOR ALBUS. 191 in lighter cases, sufficient to remove the disease. If the inflammation is severer, leeches are indispensable, and must be applied to the knee in greater or smaller numbers. The application of leeches must be often repeated. Sometimes cold poultices are beneficial ; they must not be continued, however, if pain and heat do not diminish after application ; warm, moist poultices usually agree very well with the patient. When the inflammation has been reduced, a blistering or mustard plaster has an excellent effect. Internally administer salt- petre, sal-ammoniac, Riever's potion, and other cooling remedies. If the inflammation is of a gouty character, proceed in a similar way; care must be observed, however, in the application of leeches, and cold poultices must be entirely omitted. Much benefit may be derived from the internal use of cod liver oil. If white swelling is caused by suppressed skin diseases, attempts should be made to induce the reappearance of the same by rubbing in tartar emetic ointment, or the application of a tartar emetic plaster in the places where it formerly had its seat. Suppressed sweaty feet may be restored by wrapping them in wool, by the application of oil- cloth, foot-baths of hot sand, or birch or alder leaves, covering of the soles of the feet with assa fcetida plaster, by the rubbing of stimulating remedies, &c. If the white swelling is produced by external violence, leeches and cold poultices are necessary. Entire rest to the diseased limb is indispensable for its restoration. After reducing or entirely removing the inflammation, the most important part is to further the absorption of the lymphatic fluid effused into the cellular tissue. This is attained partly by astringent, and partly by stimulating and dispersing remedies. Among the first may be counted a solution of alum, decoction of oak bark and alum, decoction of loxa bark, and rosemary in red wine, and similar remedies ; they are particularly well adapted in case of a considerable softness of the swelling. But to produce a stimulating and dispersing effect on the swelling, the follow- ing remedies should be applied : grey mercurial ointment, rub in daily from ten to thirty grains in one or two applications ; the mercurial plaster ; the ammoniac plaster, prepared with squill root vinegar ; compression ; the cauterizing cylinders, and cautery iron. If the mentioned ointment is applied, it is of material importance that the diseased part should be perseveringly rubbed in order to cause an 198 DISEASES OF THE JOINT. absorption. The plasters are very properly tied up with the compress, for which purpose circular bandages, sticking-plaster or paste-board splints are used, but the pressure applied must not be sufficiently severe to increase the pain. The cautery iron often diminishes the pain very quickly ; it must be operated, however, on the surface only, to pre- vent the opening of the articular capsule, when the scab produced by the burning has dropped off, as under such circumstances it might cause the loss of the limb, or even endanger the life of the patient. The opening of the swelling by an incision or puncture would be quite as dangerous ; practitioners of less experience might be led to it by the fluctuation. For internal use, medicines inducing absorption are suitable ; among them is calomel, sal-ammoniac, red fox-glove, seneca root, and tartar emetic in small doses. In chronic cases use calomel, iodide, or Zittmann's preparation. If abscesses form in the cellular tissue, outside of the articular capsule, they must be opened by medicines. It is self-evident that the treatment last recommended should be carried out by a physician, who should be called in, in critical cases. HIP-JOINT ULCER. VOL UNTAR Y LIMPING AND VOL UNTAR Y DISL OCA TION OF THE HIP-JOINT The course of these diseases is divided into three stages. The commencement of the first stage is in most cases so inexplicable, that the malady is frequently overlooked, or at least disregarded. The patient complains of light, painful sensations in the hip-joint, which cease from time to time ; occasionally they increase towards evening, accompanied by light fever, and resemble rheumatic pains very much. After a night's rest, a stiffness in the hip-joint is observable, which, however, passes away during the day. Walking is not interfered with, the patient, however, tires soon, and after a while the walk is somewhat dragging, and the foot is more than usually turned upward. An examination of the hip-joint reveals neither swelling nor symptoms of disease ; only under severer pressure does the paiu seem a little more perceptible. These symptoms may continue for months and even years, ere the disease passes into the second stage. But there HIP-JOINT ULCER. 199 are also cases where the pain is very severe and connected with swell- ing and fever. The patient is unable to walk, or even to move the thigh, and the passing into the second stage occurs in a few days or weeks. The most apparent change in the second stage is the elongation of the diseased limb. This can be more readily perceived if the patient is undressed and stretched out upon a table or on the floor, and a comparison instituted in the higher and lower position of the knees and joints of the two limbs. It will be discovered at the same time that the buttock of the affected side appears to be more flattened, the vascular fold stands deeper, and the diseased thigh is more emaciated and flabbier than the healthy one. The elongation of the thigh, which in some cases may be from two to three inches, is the natural sequel of the relaxation of the articular capsule of the ligaments and muscles, and also of the beginning elongation of the condyle from the socket. Every motion of the diseased limb, particularly if it is turned inward, is exceedingly painful ; the patient limps very much in walking, at the same time bending the knee of the elongated thigh, and only touching the ground with the toe of the foot turned outwardly. To this is gradually added a sharp pain in the knee, par- ticularly on the inner side of it, which is disproportionally more violent than in the hip-joint. The knee is neither swollen, nor is its shape otherwise changed. Very gradually, and only after a long lapse of time, does the disease pass into its third stage. The third stage is characterized principally by a shortening of the thigh and the indications of the beginning of caries in the joint. Under an increase of pain and swelling, a dislocation of the head of the femur takes place either gradually or suddenly ; if the latter, it is in consequence of a sudden movement of the thigh ; the dislocation is to the rear and upward, more rarely to the front and downward. The immediate cause of this diseased state is an inflammation of the parts forming the hip joint, which rarely advances rapidly, but in most cases makes slow progress. There seems to be a predisposition for this disease in childhood, as children are much more frequently attacked by it than adults. Those suffering from scrofulous diseases or rickets, are more apt to succumb to it. Accidental causes for the disease are a change of the seat of gout and rheumatism to the hip joint, careless 200 DISEASES OF THE JOINT. treatment of itch, tetter and other chronic skin eruptions, suppression of habitual sweaty feet, rapid healing of old sores, &c. DISEASE OF THE BONES-CARIES. In a limited signification of the word, diseases of the bone are called all irregular conditions of the bone, not produced by mechanical causes, but those resulting directly in consequence of internal and more general derangements. We propose to treat first of secondary disea:es, or those resulting from a preceding inflammation. First. — Inflammation of the bone bears the same relations in the hard parts which any other inflammation bears in the soft parts, only that it is not quite as acute and rapidly progressing (see " Inflamma- tion "). Its results are the same, and it ends by dispersion, suppuration, mortification, induration, &c. Second. — Exostosis is called the disease of the bone, by which, in consequence of an excessive diseased plastic force, one or more bones swell, and form more or less large protuberances. Third. — Necrosis is that disease called where the substance of the bone has become mortified and dried, and operates as a foreign body, and is thrust out. Fourth. — Osteosarcoma. In this is embraced swellings of the bone, more or less similar to each other. Fifth. — Caries is a malignant bone ulcer, where the bone, bared of the soft parts covering it, presents an uneven, softened, spongy, ill-colored surface, from which secretes a bad, thin, blackish, foetid ichor. Sixth. — Osteosteatoma is called a diseased swelling, mostly appear- ing in spongy, ligamentous parts of the bone, caused by the deposit of a lardaceous substance between the laminae of the bone or the adhering ligaments. The treatment of all bone diseases should be transferred to a skillful physician. CURVATURES. Curvature is called a lasting deviation of the trunk or of limbs of the body from their straight line, whereby the natural curvatures of the vertebral column, or other of the longer limbs, have become CURVATURES. 201 excessive, or where other entirely new curvatures have been formed. The seat of the curvatures must be looked for either in the bones or muscles. The cause of the curvature lies in the bones ; if they have been softened or partly destroyed by a faulty mixture of the humors, particularly by scrofula, rickets, suppuration, caries, &c, so that they cannot properly withstand the muscles adhering to them, but are drawn off in the direction of the operating force. Even the weight of the body may be sufficient in such cases to curve the lower part of the vertebral column and the thigh bones. Curvatures most generally occur during the first years of life, when scrofula and rickets almost exclusively appear. Sometimes children are born with curvatures. Besides that old people are frequently subjected to these deformities, because the muscles are generally weakened to such an extent as to be unable to support the body in a straight position. The following are the most important curvatures : Torticollis, a distortion of the neck, limiting the motion of the head, which is carried either in a forward direction or sideways. The seat of this curvature is either in the skin and muscles, or in the bones ; sometimes in both. The treatment of this disease, which is sometimes tedious and difficult to cure, must be at once left in the hands of a skillful physician. Acromion. — The condition in which one shoulder is higher than the other, is either a symptom of a curvature sideways, or of an un- equal action of the muscles. It generally begins in the third or fourth year of life, in consequence of the unfortunate habit of exerting the right side of the body to a greater extent than the left. The best remedy for it is to compel the children to exert for a time their left side exclusively, during which time embrocations, shoulder-belts, &c, may be used. Sometimes the shoulders of both sides are higher than they ought to be ; the back is more arched, and the patient becomes thick-set. This malady sometimes results from the objectionable use of leading-strings, or the untimely support of children under the shoulder-joints in teaching them to walk. These objectionable customs must be discontinued in time, and if it should result in bad consequences, they can be removed by proper gymnastic exercises. 202 DISEASES OF THE JOINT. Curvature of the Vertebral Column. — This curvature may pro. ceed in three different directions, sideward, backward or forward. There are distinguished, therefore, the sideward curvature, the back- ward curvature and the forward curvature. The sideward curvature is more common, and appears with every age, but more particularly in children, and mostly in girls, from the first to the third year. It results from the habit of standing on one leg, from assuming a bent position in sitting and sleeping, and from greater use of one side of the body. In cases of that kind the verte- bral column is usually of the shape of the letter S, the dorsal vertebra being bent one way, and the lumbar vertebra another way. Usually there is a slight backward curvature connected with it. The ribs spread asunder on the convex side, while those on the concave side are pressed together and grow nearer to each other. One shoulder becomes elevated above the other, and subsequently breathing difficulties develop themselves. If the disease began during youth, the body did not develop properly, nervous irritability increased, the vertebras finally grew into each other, resulting in aneurism, dropsy in the chest, &c. Sometimes these curvatures make their appearance pretty quickly in consequence of caries, which, with the germ of scrofulous rickets in the body, resulted from scarlet fever or the measles. All other pre- viously enumerated causes for the origin of this kind of curvature are also here in place. The malady is only curable in its lighter stages, and if not of too old a date. The backward curvature has its convexity backward, and is almost exclusively limited to the vertebral column. The vertebrae gradually losing in thickness in front, cause the spinous processes to separate, which produces the curvature. The ribs are thereby drawn into a horizontal position, and for that reason the breast bone protuberates more than it does in a normal state, while the shoulder-blades are less deformed or displaced. In this curvature, as well as in the one pre- viously described, the pelvis is usually changed. The pectoral and abdominal viscerae are pressed together, nutrition suffers, gradually paralysis of the lower limbs sets in, and an early death always follows. The backward curvature is generally easier to cure than the sideward curvature, if the vertebrae have not grown into each other, or have otherwise degenerated. Strengthening, stimulating embrocations DISLOCATION SPRAINING. 203 should be frequently applied to the vertebral column ; the patient should lie stretched out and tied down on his back for some time, and the remedies applicable to the condition of the patient should be applied, as ordered by the physician. The forward curvature is not as common as the others spoken of. It is never very important ; its seat is mostly in the lumbar vertebrae, and it appears only as an arch. It sometimes originates during pregnancy, and then produces the so- called pendulous abdomen. It is generally easily removed by rubbing in henbane oil, the use of warm baths, gymnastic exercises, proper position, &c. DISLOCATION. Dislocation is an interrupted or entirely severed connection of two or more bones or cartilages, from accidental, internal or external causes, which, in their normal state, were united to each other in a manner permitting them to move more or less freely. There are two kinds of dislocation, the voluntary, the result of internal diseases of the joints, bones, cartilages or ligaments, and the violent dislocation, produced by external force applied to any of the joints of the body. A more particular description of the last mentioned condition cannot be given here. Speedy assistance from a physician is required. Some remarks will be made hereafter upon the subject under " Sprain- ing." SPRAINING. By spraining is understood an incomplete dislocation, or the con- dition where the externally applied force was not sufficiently powerful to accomplish a complete dislocation ; but where, nevertheless, the joint was badly squeezed, the articular ligaments and sinews pulled or stretched, the muscles twisted out of their sheaths, the articular ex- tremities of bones squeezed from each other or rubbed over each other, and frequently carried out of their position. It receives its name from the injured joint. If the injury is on the foot, we say. I have wrenched my foot ; if on the spine, I have twisted my back; and if on the wrist, I have sprained my wrist. An accident of that kind is not very uncommon, and is frequently aggravated by improper treat- ment. According to the old method, spirituous, stimulating cam- 20tt DISEASES OF THE JOINT. phorated remedies are at once applied, a treatment which should be particularly reproved as being inconsiderate. It is in common use, and the result may become very serious. They are generally caused by external violence, by a fall, push, or a jump, by lifting or carrying heavy weights, &c. However unimportant the accident may appear at first, it should never be treated with indifference, because in many cases, and particularly in persons who surfer from a mixture of bad humors, gout, scrofula, syphilitic diseases, &c, it may result in bad consequences, and sometimes even in death. But even without any mixture of bad humors, a tedious inflammation of the sinewy, fibrous parts of the joints is apt to set in. If it is considered how complex and ingeniously constructed a joint is, the ease with which it may be injured will not surprise anyone. Treatment : If you see the patient soon after the injury has hap- pened, endeavor to reduce the joint, if dislocated, to its proper place, by carefully manipulating, pressing and gently stretching it. Then poultice it immediately with cloths dipped in ice-cold water, or place the joint in cold water, provided there are no other objections to these applications, such for instance, in dislocation of the foot, sweaty feet, and in women their regular menstruation. This cold water treatment must be continued until the severest pain has passed off, and no fear of inflammation or swelling is apprehended. Afterward the joint is bandaged, and if no pain is felt, the bandage may be moistened with camphor or spirits of soap. The patient must keep the injured limb perfectly quiet. If, however, the injury has occurred for some little time, when you reach the patient, and if inflammation and swelling has already set in, apply leeches, followed by cold-water poultices, which may be afterward changed to fomentations with warmed lead water. At the same time grey mercurial ointment may be rubbed in around the joint as near as possible to the injured part ; wash with infusions of aromatic herbs, and at the same time apply spirituous and camphorous remedies, to strengthen the limb. For some time after the limb must be carried in a sling ; motions must be tried only very gradually, but the joint must not be used. Salt poultices are very serviceable. Put two ounces of kitchen salt in one pint of boiling water, let it boil for three minutes, take it or! the fire, and when it has become cold, mix with one pint of the lees CONTUSIONS. 205 of wine, two ounces of liquid ammonia and one ounce of spirits of camphor, saturate a piece of cloth with the mixture, and lay or bind it over the injured place. Repeat the application every two hours until the pain has subsided. If the inflammation and swelling are very great, care should be taken to reduce the inflammation first. Apply warm water poultices, or foment the limb in the vapors of bitter herbs. A warm poultice of wheat bran and hops, with a little vinegar, is of excellent service. When the inflammation and swell- ing have been somewhat alleviated, a decoction of wormwood leaves and hops in good vinegar is an excellent remedy, of which apply a poultice every hour. Poultices of juniper berries have also proved efficacious. Take eight ounces of juniper berries, crush them, add two ounces of hay-flowers, ripening at the time of hay-making, boil in good old wine, and use as a poultice ; a handful of salt may be added to it. This is excellent for sprains and dislocations. An embrocation with formate spirits four times a day, has also proved of excellent service. CONTUSIONS. A contusion is the effect of external violence produced on a certain part of the body by an obtuse body, without leaving any considerable perceptible laceration. A contusion manifests itself by a more or less severe swelling, with a dark, bluish-red discoloration, produced by the laceration of numerous small vessels, and the extravascation of a fluid from the same. The pain is inconsiderable ; yet there is a pecu- liar pressure and a little coldness felt in the injured part. At first the injured part feels very numb, particularly if larger nerves have been touched; subsequently, however, inflammation sets in, which, accord- ing to the importance of the injury, may end in paralysis, suppuration, and even in mortification of the injured part. The object of treatment is to prevent an inflammation, which usually sets in subsequently, or, if it has already occurred, to remove it ; also to overcome the remaining weakness and paralysis, and to further the absorption of the extravascated fluid. The first object is attained by an application of antiphlogistic remedies, such as poultices of ice-cold water, of vinegar and water, or of water in which sal-ammoniac has been dissolved, &c. If the injury is severe, the application of leeches would be beneficial. 206 DISEASES OF THE JOINT. The second object is attained by gentle fomentations through the infusion of aromatic herbs, with or without the addition of spirituous remedies, subsequently by rubbing in volatile and stimulating iniments and waters, such as camphor liniment, opodeldoc, spirits of soap and camphor, &c. If this has not the effect of absorbing the extravascated blood, it is sometimes permissible to make an incision for the purpose of effecting a discharge of blood. In more severe cases of contusion, where subsequently suppuration and mortification might set in, the treatment laid down under " Abscess " and " Gan- grene " must be adopted. As a supplement to the above prescribed treatment, compare the articles on " Bleeding" and "Bruises." FRACTURED BONES. The fracture of a bone is a separation of the connection of a bone, caused by external force, or by a violent contraction of the muscles. The fracture' of a bone is known : i. By the changed form and direction of the limb, the ends of the bone deviating from each other more or less. 2. By the impeded motion of the limb. 3. By the crepitation when the broken ends of the bone rub against each other. 4. By the violent, pricking pain, and the large swelling setting in after a short time. In most cases a broken bone is readily recognized ; yet difficulties may present themselves, if the bone is surrounded by a considerable quantity of soft parts, or if swelling has already set in, or the broken ends have not separated far from each other, and, finally, if of two bones of a limb the thinner one only is broken. Although all bones in the human body are liable to fracture under certain circumstances, yet some of them are more liable to it than others. Thus, for in- stance, bones lying near the surface are more liable to fracture than those which lie deeper. The same holds good of bones with which nature has enclosed a cavity, as, for instance, the clavicle or ribs ; but most liable to fracture are the hollow bones of the arms and legs, which, from their function, are exposed to external violence. Old and debilitated persons are more subjected to the breaking of bones FRACTURED BONES. 20 T from external force than young and vigorous people. The bones of persons who have suffered from certain diseases, such as gout, venereal diseases, scrofula, rickets, scurvy, &c, are more liable to fracture than those of other people. Fractures of bones are generally the result of external causes, such as a fall, push, pressure, &c, or they may be produced by strong con- traction of muscles, in cramps, for instance. The prognosis is favor- able, if the individual is healthy, young and vigorous, if the soft parts have not been injured at the same time, and if the fracture is not in the neighborhood of joints ; but unfavorable, if the individual is weak, unsound in health, or old, or whether the fracture is compli- cated, whether the soft parts are destroyed, and whether it is a com_ minuted fracture. Under equal conditions, fractures of bones lying nearer to the surface, and not covered by a great deal of flesh, are more readily healed than under contrary circumstances. Fresh fractures heal much easier than old ones. Treatment in every case of fractured bone must be submitted to a surgeon. Treatme?it of broken limbs, arms, legs, &c: After the physician has reduced the fracture, he dips his hand in cold water and passes it several times over the fractured place. He then lifts the limb a little and applies the proper bandages. The bandage consists of about eight or ten layers of cloth, similar to the Scultet bandage. Each piece of cloth must be of the same width, from five to six inches, and of sufficient lenght, to lap over the fractured place from one to two inches. Folds must be avoided, and the bandage must lay on tight all around. After the bandages have been thus carefully applied to the broken limb, and all folds avoided, wooden splints, one inch wide and eighteen inches long, are placed around the broken limb, leaving, according to necessity, about half an inch space between each splint. These splints may be prepared from shingles or other thin boards ; according to the size of the limb, from eight to twelve splints will be required. These splints are tied down with strings, the limb placed in the most convenient and comfortable position possible, and covered with dry flannel. If the moist cloths should become hot and dry, cold water should be squeezed from a sponge between the splints in sufficient quantities to reduce the heat of the injured limb and create a comfortable feeling. As the heat disappears from the limb, the cold 208 DISEASES OF THE JOINT. applications need not be made as often, and the bandages will retain their moisture, in some cases, from five to six hours. Every three or four days the bandages are removed and replaced by fresh ones. The whole limb, arm or leg, is kept in its proper position by having splints attached to it, to its full length, besides the short splints before described. The constant application of cold water to the bandages has the particular advantage of reducing the inflamma- tion rapidly, and also in quieting the pain. The moist heat has also the effect of aiding in the formation of osseus substance ; it progresses so rapidly that the broken limb is usually restored in half the time it could be accomplished by any other treatment. In my practice I have preferred this mode of treatment, and always with the most splendid effect. GENERAL DISEASES. SWOLLEN VEINS-STRUMA VENOSUS-VARIX— PHLEBECTASIA. By this disease is understood a more or less large expansion of veins, particularly at the valves, filled with dark or black blood, which generally congeals. The vein becomes nodose, and the overlying skin has a more or less dark appearance. At first the knob is elastic and yields to pressure, but returns again as soon as that is removed. Large swollen veins of old standing are pretty hard, and scarcely yield to pressure at all. Sometimes inflammation and suppuration sets in, in the places where the knobs are situated ; ulcers form, which are generally very obstinate. In such cases a troublesome pressure, connected with itching and tension, generally sets in, to which is finally added a pulling, tearing pain. The swelling occurs principally in the surface blood veins of the lower limbs, particularly in the neighborhood of the foot, whence it extends not infrequently up to the thighs. The veins increase very slowly, although in some instances they become very large. Upon the whole, men are less troubled with them than women, who particu- larly suffer from this malady in time of pregnancy. They result from various causes, particularly from continued pressure, contusion, too close a fit of garments, garters for instance, too frequent warm foot- baths, too constant standing up, the turning into cartilage of the valves in the veins, also from suppressed hemorrhoids and menstrua- tion. -In the two last mentioned cases, there frequently occurs a bleeding in the suffering part, if the knots in the blood veins have already changed to an ulcer. In regard to the removal of this diseased condition, great caution is necessary, inasmuch as the varix is not rarely a relatively, salutary evil for the body, which curative nature employs, to save some nobler organs from serious overflow of blood. If the lower limbs are 14 (209) 210 GENERAL DISEASES. attacked by it. rest and horizontal position of the same is necessary. The diseased limb should be wrapped up, or it should be laced up in a stocking made of leather or some other solid material. If the malady has not already progressed too far, it is sometimes removed by pursuing this course. Cold water poultices are applied, also a solution of alum or lead water, or a decoction of oak, willow and elmwood bark. In some cases stimulating embrocations and washes are beneficial. Of late electricity has been recommended as an in- fallible remedy. The patient is seated on an insulated chair, and sparks are drawn from the diseased limb along the swollen vein. Ob- servations are said to have been made, that the application of elec- tricity will immediately cover the ulcers in the neighborhood of the varix with a fine skin. PLEBOTOMY. Plebotomy is the opening of a vein lying near the surface of the body, for the purpose of drawing off a larger or smaller quantity of blood. Blood is a fluid which constantly supplies the body with the necessary power of development. It is, therefore, evident that a de- pletion of blood deprives the organism not only of the most important means of vivifaction, but it also causes an extraordinary change in the course of the blood. The motive power of the whole machinery of the body seems to be subjected thereby to a change. A depletion of this life-giving fluid as a remedy, is of the greatest importance and efficiency. Where bleeding is necessary, no other remedy can be substituted for it. But where it is resorted to unnecessarily, it may be attended with the most disastrous results. If this would always be duly considered, blood-letting would not be improperly resorted to. In former times much more frequent recourse was had to it, and it is to be regretted that even now it is not of rarer occurrence. In regard to the spot whence the blood is to be drawn, any sufficiently large vein lying near the surface may be selected ; the arms, hands and feet are, however, preferable for that purpose. The operation is performed either with a lancet or a spring lancet. The first method is preferable in so far as the instrument is entirely under the control of the operator ; the incision with a lancet is somewhat more painful, and it needs a more practised hand than is required for the use of the LEECHES. 211 spring lancet. The conditions under which bleeding would become necessary, are various and cannot all be enumerated here. Under the following circumstances, however, a layman in medicine might also be permitted to order bleeding : In cases of high internal inflamma- tions, particularly of the chest and brains ; in cases of apoplexy, severe external injuries where no blood is lost and congestion is apparent, as for instance in heavy concussions, contusions, shocks, dislocations, fractures of bones, strangulated hernia, also in hemor- rhages, to prevent their recurrence, which is often the case, particu- larly, however, if the symptoms indicate a return of them. These symptoms are uneasiness, dizziness, faintness, blackness before the eyes, buzzing in the ears, nausea, &c. If the patient, however, has become very weak by the preceding hemorrhage, bleeding must not be resorted to, as in that case it might prove fatal. LEECHES. In the treatment of some diseases the leech is of the very highest importance. Attempts have been made to substitute an artificial con- trivance in its place ; which, however, has not proved successful up to this time. It must, therefore, be of general interest to learn some- thing more about it ; because there are other species of leeches, the common or horse-leech for instance, with which it may be confounded. The leech used for curative purposes is distinguished from the horse- leech not only by its size, but also by six orange-colored stripes, run- ning on its back and sides from the head to the tail. The color on its belly is steel-brown, but frequently intermixed with so many yellow spots, that yellow would almost appear to be its color. The leech, particularly when first taken from the water, is exceedingly slippery, in consequence of the secretion of a slimy substance from its body. The head part runs into a point, and is provided with small teeth, placed in a triangular position ; the tail end or foot is more obtuse, and ends in a suction disk, standing off from its body. Its body con- sists of rings, which increase in size with its growth, and sometimes also in numbers. By the expansion and contraction of these rings, it is enabled to move, alternately taking suction with the mouth and its tail suction disk. 212 GENERAL DISEASES. Although the leech may attach itself to any part of the body, yet it is more advisable to avoid all larger vascular and nerve trunks ; without this precaution some dangerous accident might occur. The place to which they are to be applied must be washed off clean and be freed from all scents. If the place is covered with hair, it must be carefully shaved off. It is sometimes very difficult to make the leech bite. In such a case, moisten the place with a little sweetened water, milk or cream. If not successful with that, the skin of the patient may be very lightly pricked with a lancet or sharp penknife, so as to draw a little blood, when it will take hold immediately. To make the leech take suction on any part of the body, it is put in a wine glass which is inverted over that spot. If it is required that the leech should be applied in a cavity, the mouth for instance, a rolled-up card, or a glass or metal cylinder, may be used for that purpose ; a single leech is shoved into it, and the cylinder with the imprisoned leech held to the spot. To avoid its being swallowed, a thread may be drawn through the leech's tail, and left dangling out of the patient's mouth. If, in spite of all these precautions, in applying the leech in the cavity of the mouth, it should slip into the stomach, administer a good deal of salt water, and immediately afterward an emetic. After the leech has sucked itself full of blood, it drops off. The bleeding, however, continues, and should be kept up for a longer or shorter period, according to the circumstances. With children the bleeding is permitted to continue usually for half an hour or an hour, but with adults for several hours. Bleeding is promoted by repeatedly washing off the blood with a sponge dipped in warm water, or by the application of a hot meal poultice. To stop the bleeding, it is, as a rule, only necessary to apply to the spot of the leech bite a sufficiently large piece of good sticking plaster. Sometimes, however, the bleed- ing continues for so long a time, particularly in children, as to endan- ger their lives ; every effort must then be made to stop the bleeding. In such cases it would be best to apply to the spot a pitch plaster, or a solution of glue, spread upon a piece of soft leather. Less desir- able is it to sprinkle on the bleeding spots a glutinous, astringent powder, consisting of gum arabic, rosin and alum, and over it place adhesive plaster, or cover it with lint steeped in a concentrated solution of alum or sulphate of iron. Much too troublesome, and CUPPING HEMORRHAGES. 213 after all not always satisfactory, is the stuffing up of the wound with lint. Very effective, but too painful for children, is the application of a red-hot pin to the bleeding place, or the pressing in deeply into the wound a pointed piece of lunar caustic for a few seconds. It is also very effective to place a four- fold piece of cloth on the wound, and press on it with the surface of a heated spoon or other piece of metal ; the spoon must not be heated to the extent of causiug combustion. It is necessary to watch children at night who had leeches applied to them, as cases of bleeding to death have occurred. For the purpose of freeing the leech from the blood which he has sucked, and to preserve it for future use, it is customary to sprinkle it with salt, snuff, and other pungent material, or the blood is squeezed out of its body with the fingers. The process, however, injures the leech more or less. It is, therefore, better to drop some wine vinegar on its head, or to put it in charcoal, when it will also disgorge the blood. It is well to leave one-third of the blood in him for food. The quantity of blood sucked by a leech, including the after-bleeding, averages from five to six drachms. The size of the leech should be taken into consideration, however. CUPPING. Cupping is called the application of cups, made of glass or tin. It is made use of either for the purpose of drawing the blood to a greater degree to the surface, without removing it thence (dry cup- ping), or to draw the blood by means of the scarificator from the cut. HEMORRHAGES. A hemorrhage is the extravasation of blood in large or small quantities from blood vessels. The extravasated blood may empty into an inner cavity, for instance, the chest or cranial cavity, &c, or effuse outwardly, in which case, however, it may not always become visible on the outer surface. It remains sometimes under the skin or in the cellular tissue, whence it may be drawn by an incision. We will discuss the treatment of different hemorrhages under their proper heading, but will remark that a moderate, voluntary bleeding, often has a salutary effect, and for that reason should be treated with 214 GENERAL DISEASES. caution. If the hemorrhage is excessive and exhausting to the patient, stiptic remedies should be resorted to (see the article). BLOOD VESICLES. Blood vesicles frequently appear on the feet from long walks, if a constant pressure exists from the fold of a stocking, or from some other mechanical source. They are also sometimes caused in some other parts by a push or contusion. The blood vesicles may be opened by pricking the skin at a short distance from the affected part, gently squeezing out the blood, and leaving the cure to nature. INFLAMMATION OF BLOOD VESSELS. Inflammation of a blood vessel results sometimes from blood-letting, particularly if the instrument used was rusty. The place of incision, as well as the larger part of the limb through which the vessel extends, becomes painful. The vessel feels like a strand, oedema sets in, and sometimes also erysipelatous inflammation. If the patient does not at the same time suffer from some general disease, the treatment should be antiphlogistic. Apply leeches to the affected limb, not too near, however, to the wound, also poultices of cold water, ice or lead water, and keep the limb very quiet. If a hardening of the cellular tissue, or erysipelatous inflammation of the surrounding part, has already set in, warm fomentations (de- coction of different herbs, such as camomile, elder, lemon balm, &c), and the application of little cushions filled with herbs, are beneficial. CONGESTION. Congestion is a local plethora of blood in one or several organs of the human body. In some cases it is the result of overheating, colds, mental exertion, excitement of the mind, and the use of spirituous liquors, particularly with persons who are strongly inclined to con- gestion. The parts to which the congestion is directed may vary, according to the irritation of the particular spot, or the inciting causes, and which usually influence the feelings caused by the congestion. They usually consist of a throbbing of arteries, fulness, redness, heat and pressure. If the congestion increases, it mav easilv INFLAMMATIONS. 215 result in inflammation or hemorrhage ; the last must not be stopped, unless the body is greatly weakened thereby. Congestion of the head and chest are always important. In the first, it manifests itself by buzzing in the ears, throbbing, pressure, blackness before the eyes, and in the latter by difficulty in breathing, a feeling of fear, and throbbing of the heart. In cases of that kind, all heating food and beverages, particularly the use of coffee, must be strictly avoided, and cooling substances sub- stituted. The parts effected must be kept cool and frequently bathed with cold water. As revulsives may be used warm hand or foot-baths, and if necessary, leeches and blood-letting may be resorted to. In congestions to the upper part of the body, the feet should be pro- tected against col4. ■ INFLAMMATIONS. Inflammation is a condition of increased vital activity in a part of the body, contrary to rule. It manifests itself by increased redness and swelling, a higher temperature of the body, and pains, which interrupts the function of the attacked part, and causes fever. It develops particularly strong in severer inflammations, particularly of the inner organs, the blood assuming a peculiar condition. The blood drawn from the body by bleeding forms on the surface a firm, more or less thick, leather-like, yellowish-white skin, which is called buffy coat or crusta inflammatoria. Inflammation is terminated by dispersion, exudation, suppuration, hardening and mortification. Inflammation is divided in various ways, but this is not the place to enter upon it extensively. The principal divisions only shall be mentioned here : they are the acute and chronic. In acute inflammations the symptoms above enumerated are very violent, and the course is exceedingly rapid, while in chronic inflammation the symptoms are less prominent, of longer duration ; they sometimes disappear and reappear again. Aside of these, there are certain specific inflammations, which originate from causes lying dormant in the body, but are called out by external influences. To these belong chiefly : 1. Catarrhal Inflammation. — It has its seat in the mucous membrane, is marked by severe swelling and bloating of the parts 216 GENERAL DISEASES. affected, and ends with secretion, watery and acrid at first, but finally thick, mild and slimy. This inflammation is accompanied by incidents peculiar to catarrhal fever (catarrh). 2. Rheumatic Inflammation. — This inflammation has its seat in the muscles and their membranaceous linings. The pain is not limited to the affected part alone ; this kind of inflammation is greatly inclined to move from one place to another. The swelling takes place after the inflammation proper has passed off, and usually ends with exudation, but sometimes with suppuration. The fever accom- panying it increases at night, and terminates with perspiration ; the urine shows a heavy sediment. 3. Gouty Inflammation is similar to the one last above described ; it is caused by various disorders of digestion,* and attacks the joints. It terminates with the exudation of calcareous substances, and readily spreads to vital organs. 4. Scrofulous Inflammation principally attacks the lymphatic glands, eyelids and joints; appears in children and youthful people of scrofulous constitution, and passe s off slowly without extraordinary redness or pain. The swelling continues for a long time," and fre- quently passes slowly into suppuration. 5. Syphilitic Inflammation is the result of contagion, is strictly confined to one place, the circumference of which is of a coppery red. Pain and heat are generally inconsiderable. In the treatinent of inflammation, the following has to be kept in view : The cause must be removed, and the inflammation reduced to the point, which will lead to the most favorable result ; the diseased state accompanying the inflammation must be taken into consideration, and the recovery must be conducted according to the different issues. The principal treatment, which is directed against inflammation, is called antiphlogistic, and consists in blood-letting by venesection, leeches, cupping, and by the application of cold water, ice and snow^ Solutions of sulphate of tin or sugar of lead may be applied, and where great weakness of the vessels is present, poultices of spirits of camphor or whisky may be added ; the poultices must be frequently renewed. Heat also is antiphlogistic, and may be applied moist or dry. The moist warm poultices which are applied in cases of very CATARRHAL INFLAMMATION OF THE EYES. 21 T violent, painful inflammation, accompanied by dry swelling, are pre- pared of mucilaginous, farinaceous substances, such as mallow, linseed meal, wheaten bran, oatmeal, bread crumbs, boiled into a mash with water or .milk, and applied warm to the inflamed part. If the poultice is to be at the same time pain-allaying, add from one-fourth to one- third henbane to it. Where moist heat does not agree, for instance in cases of erysipelatous and rheumatic inflammation, apply warm, small cushions of bean-meal, bran, &c. The rubbing in of grey mercurial ointment after bleeding has proved to be very efficacious ; it effects a dispersion at the same time. In many cases revulsives have had a good effect, such as hand and foot-baths, the application of epispatics, mustard, stimulating salves, tartar emetic ointment, &c. In cases of internal, and in support of external inflammation, anti- phlogistics are prescribed, such as bitartrate of potassa, cream ol tartar, epsom salt, saltpetre, &c. I will here also describe the inflammation of the eye. What has been said of inflammation generally, is equally applicable to inflam- mation of the eye. CATARRHAL INFLAMMATION OF THE EYES. The catarrhal inflammation of the eyes begins with or without any indication of a violent catarrh, with an irregular, pale and somewhat yellowi3h redness of the conjunctiva, which, however, never extends to the cornea. The secretion is lessened at first, but subsequently increases, when the eyelids agglutinate at night by the thickening of the mucus of the glands. The inflammation usually passes off in from seven to fourteen days, but may extend to a longer period. This generally light inflammation, which is not at all dangerous, is treated according to its character (see " Catarrh "). Externally it requires the application of a mustard plaster on the neck, and in more severe cases, some leeches. After the inflammation has subsided, the following eye-water may be used, should it be required : sulphate of zink two grains, rose water four ounces, subacetate of lead thirty grains, gum arabic solution two drachms ; if the eyes should itch very much, one drachm of opium water may be added to it. The eye cannot always bear moisture, and in such cases it would be well to hang (but not tie) a small cushion filled with herbs before it ; or an ointment 218 GENERAL DISEASES. prepared from one part of powdered opium, mixed with three parts of the yolk of an egg, may be used. For old catarrhal inflammations of the eye, use an ointment pre- pared from red oxide of mercury two grains, and lard two drachms ; anoint the eyelids with it mornings and evenings, using a piece of the size of a pea. RHEUMATIC INFLAMMATION OF THE EYES. In rheumatic inflammation of the eyes, the lids are not swollen, nor do they agglutinate ; the conjunctiva and corium appear a uniform dark red, which is represented on the corneal margin as a fine red corona vascularis. The pain is stinging and tearing, photophobia very great, with an inclination to inflammation and the formation of abscesses on the skin. Its course is at times rapid, and at other times slow. People having an irritable skin are usually troubled with this inflammation, if exposed to a frequent change of temperature. It should be treated in the same way as rheumatism. If the inflam- mation is still on the increase, apply a blister, mustard plaster, or leeches to the neck or behind the ears; three leeches are sufficient. Hand and foot-baths are also veiy good. SCROFULOUS INFLAMMATION OF THE EYES. Scrofulous inflammation of the eyes, like the catarrhal, attacks the mucous membrane and mucous glands of the eyes, and also the exter- nal skin. The eyelids, particularly the upper one, are thick and swollen ; acrid, burning tears, and a mucus of the same kind, are secreted, which agglutinate the eyelashes at their roots. The con- junctiva of the eyeball is redened by the blood vessels running to the cornea, the patient feels a burning pain in the eye, and is greatly troubled by photophobia. The inflammation is generally worse in the morning, while in those previously treated of it is usually worse in the evening. The course of scrofulous inflammation of the eyes is more of a chronic character, slow and long continued ; there is an inclination for the formation of pustules and penetrating ulcers on the cornea. Scrofulous children are particularly inclined to this kind of inflammation of the eyes, if attacked by sickness produced by cold, poor food, dampness, moist air, &c. OPHTHALMIA. 219 In treating this disease, the general health (see "Scrofula") and the inflammation should be taken into consideration. Begin with a strong laxative, place a tartar emetic plaster on the neck, and rub mercurial ointment around the outside of the eye. Leeches are very rarely required. Apply warm poultices or fomentations of hemlock leaves, or poppy heads mixed with a little henbane. After the inflam- mation has continued for some time, it is followed by mucous secre- tion, when the following eye-water may be applied : calomel one grain, rose water six-ounces, Sydenham's laudanum half a drachm. GOUTY INFLAMMATION OF THE EYES. Gouty inflammation of the eyes is the result of gout. It is charac- terized by a tearing pain in the forehead, a dark redness formed by tuft-shaped vessels of the external skin of the eye, which, however, leaves an unobstructed ring around the cornea. The eyeball subse- quently appears uneven and rough, produced by the extended vessels of the choroid. A foamy secretion, not viscous, however, collects in the corners of the eyes. Both eyes are usually attacked, but at differ- ent times and in different degrees. The treatment prescribed under " Gout " is applicable for this dis- ease, aside of which diverting remedies should be applied by means of Spanish fly, tartar emetic ointment, &c, and the pain quieted by meal poultices, to which henbane has been added. Grey mercurial ointment is to be rubbed in around the outside of the eye. OPHTHALMIA, OR BLENORRHCEAL OPHTHALMIA. Watering of the eyes usually attacks children during the first week, but rarely after that. Its seat is particularly in the conjunctiva of the eyelids, and may result in blenorrhceal ophthalmia. This disease of the eye begins with photophobia, epiphora, and increased secretion of mucus of one eye ; at the expiration of twenty-four hours, the other eye is also attacked. The mucous glands of the eyelids appear more fully developed, and the conjunctiva a little red. If the disease in- creases, the eyelids swell, the eyes remain closed, and a large quantity of white, thin, acrid mucus is discharged, agglutinating the eyelids, ihe inflammation and swelling of the conjunctiva is greater, but the 220 GENERAL DISEASES. cornea remains clear. Occasionally a bleeding of the eye occurs, which, however, is without danger. If the malady increases, the cornea is obscured; and the eye is generally lost. Inflammation of the eyes usually results from uncleanliness, cold or contagion. If the malady is still in its first stage, a restoration to a normal condition may be effected by attention to cleanliness, the prevention of irritation from light, baths, and in keeping warm. The eyes must be often bathed or washed clean with lukewarm milk (preferably with the mother's milk). If the disease has passed into the second stage, apply lukewarm poultices to the eyes ; in case of urgent necessity, place a leech behind each ear and rub in mercurial marshmallow ointment on the forehead or temples. INFLAMMATION OF THE BRAIN. Indications of inflammation of the brain are constant deliriousness, or total insensibility, or both combined with fever and signs of con- gestion to the head. A red, bloated face, redness of the eyes, hot forehead and skull, throbbing of the jugular veins, and frequent reach- ing of the patient with his hands toward the head, are also indications of inflammation. The disease may appear independently of all others, or in connection with others, such as fevers, inflammations, eruptions of the skin, as for instance, scarlet fever and small-pox. It should be noticed, however, that only uninterrupted deliriousness or continued insensibility are sure indications of inflammation of the brain. If these symptoms are transient, however, then they are only the result of an irritation of the brain, as. for instance, in malignant fevers, where the inflammable condition of the intestinal coat reacts as an irritation of the brain. Headache is not always present ; but where it is the case, it is very violent, and frequently extends over the whole head, or it sometimes affects particular parts only, such as the forehead, the top or the back of the head; Where it does occur, it forms one of the main features of the disease, and almost sets the patient crazy. He complains likewise of buzzing and ringing in the ears, or his hearing has become very acute ; he is also troubled with photophobia and dizziness, sees different colors before his eyes, is very fearful and anxious, and suffers from spasms of the eyelids. This condition may last for several days with the same intensity, and with INFLAMMATION OF THE BRAIN. 221 sleeplessness, and usually without a trace of deliriousness. Finally longing sets in, the sense of sight and hearing decreases, speaking becomes difficult, cold, clammy sweats break out, the sense of feeling is wanting, and paralysis ensues. Inflammation of the brain, of which deliriousness is the principal feature, begins in the same way as that before mentioned. Soon the ideas of the patient follow each other in rapid succession. At first he follows subjects with which his mind was occupied immediately pre- vious to his sickness, but soon an entire change comes over him. The patient whose temper has been gentle, becomes violent and irritable, and shows indifference to matters which were previously of the greatest interest to him. His face becomes bloated, his eyes protrude, glisten, and have a wild look. A short sleep is followed by the gnashing of of his teeth, carphologia, spasmodic twitches, throwing about, until finally total insonrnolence causes raving. The raving is uninterrupted, the patient becomes violent, and can scarcely be restrained. He fre- quently injures himself and those surrounding him, whom he now rarely recognizes. Thus he continues until death ends his sufferings, or a change occurs, when, after a continued deep sleep, full conscious- ness returns and the patient recovers. Inflammation of the brain, accompainied by a comatose sleep, very frequently occurs in old people after a concussion of the brain, being produced by a pressure on the brain. The disease begins with deep breathing, a deep, rough voice, and headache. These symptoms con- tinue with a violent fever, until after a day or two the patient finally falls into deep insensibility and somnolency, during which he murmurs to himself and seems to be constantly chewing something. Frequently he snores, grasps at something with his hands, rolls up his bed clothes, and constantly reaches with his hand upward to his head. His eyes are red and his teeth covered with a black phlegm. Inflammation of the brain results from deep, straining thoughts, violent emotions of the mind, particularly anger, disappointed hopes, fright, jealousy, domestic grief, constant study, and immoderate drinking. It is also produced by suppressed menstruation, by lochia arrested too soon, or the sudden checking of diarrhoea with opiates, by concussion of the brain and injury to the head, by colds, sunstroke, particularly when sleeping in the sun with uncovered head during the hot seastm, by 222 GENERAL DISEASES. various diseases, by typhoid and rheumatic fevers, erysipelas, scarlet fever, measles, small-pox, gout, eye and ear inflammations. Children are particularly inclined to inflammation of the brain. Treatment of the patient during inflammation of the brain : First of all, the patient must be kept very quiet. Talking in the sick room must be strictly prohibited. Everything exciting to the mind must be removed ; a light room is objectionable, it must be kept moderately dark, but not too much so, because that frequently leaves the patient in a gloomy condition. The presence of a friend who is well liked by the patient may be permitted, because it frequently has a pacifying effect on him. The patient must be treated with the greatest forbear- ance. Contradiction excites his mind and aggravates the disease. His wishes must never be absolutely refused ; he should be pacified by promises. It is frequently much better for the patient if his demands, to which he obstinately adheres, are even partly complied with, although they may not be exactly suitable for his condition, than to excite his anger by a refusal. Every effort should be made to keep his mind quiet ; he should have no cause for excitement. Nothing will afford the patient greater relief than sleep, which is sometimes successfully induced by a uniform, low, long continued sound, for instance, the uniform ticking of a clock, or the dropping of water into a basin, &c. The patient, and particularly his head, should be kept cool. If the attack is in any way severe, the hair must be cut off at once ; the heud should never be covered in inflammation of the brain. An upright position is the most favorable; care must be taken for the security of his person. The patient must take no food except a few cupsful of cooled oatmeal or barley water, seasoned with a little lemon or current juice ; he must be as strictly kept as in a case of inflammatory fever. Treatment of inflammation of the brain : Every effort should be made to divert the blood from the head to other parts of the body. Twice a day the feet should be put in a warm alkaline bath, prepared with either saleratus, carbonate of potash, or lie. If the disease is fully developed, free bleeding, which should never be deferred long, is beneficial. This course should always be proceeded with in adults from the beginning. In severe pains in the head, the drawing of INFLAMMATION OF THE BRAIN. 223 blood from the foot is very quieting, otherwise the arm should always be selected. After bleeding by venesection apply to the temple, be- hind the ears and on the neck of an adult from twelve to fourteen leeches. It is very beneficial if a few are applied in the nose. Where leeches cannot be had, cupping glasses applied on both sides of the spine are very effective. People suffering from hemorrhoids, or women in childbed, should have the leeches applied to the anus. If a volun- tary bleeding at the nose, or any other hemorrhage, should set in, it must on no account be checked, but must be promoted hy the appli- cation of warm water poultices. After bleeding has stopped, cold applications on the head are of the highest importance, and frequently it is the only means of saving the life of the patient. For that pur- pose ice-bladders are employed. A bullock's bladder is oiled on its inside, and filled half full of pounded ice. This is placed on the head of the patient, and renewed as often as required by the violence of the attack, and as long as the patient will permit it. The feeling produced by the application of the ice is generally very grateful to the patient, and even while delirious, it has occurred that they have pressed the bladder with both hands to their head. If the ice becomes annoying to them, it should be removed. If ice cannot be procured, the following poultices should be applied : water two quarts, vinegar one quart, saltpetre fifty grammes, sal-ammoniac twenty grammes. The poultice must be frequently renewed, and constantly continued. A cold water poultice is beneficial only if removed at once when it becomes in the least degree warm. A fresh, cold one should be im- mediately substituted. Revulsives are of great importance, but more particularly cooling injections. Take a decoction of oatmeal or wheat-bran two cupsful, oxymel two tablespoonsful, and use it in a lukewarm condition for an injection. Lukewarm foot and hand baths, and with men, cold poul- tice applications to the genitals, frequently stop the most violent raving. At night, administer a strongly operating laxative : Take powdered jalap twenty grains, calomel twenty-five centigrammes, sugar six grains, mix, divide into four powders, and administer every evening one or two powders. A mustard plaster should be applied at night to the thighs and calves of the legs ; it moderates the fever, lessens the 224 GENERAL DISEASES. rush of blood to the head, and for that reason is indispensably neces- sary. Internally administer, saltpetre six decigrammes, calomel six centi- grammes, sugar two grammes, mix, divide into three powders ; dose, one powder every two hours. If the powders should produce a metallic taste in the mouth, put them in the drink, so that from four to six grammes will be consumed during twenty-four hours. This is the course to be pursued when the disease first makes its appearance ; during its progress, however, the treatment becomes too difficult, and the danger too great, and it cannot therefore be given here. The assistance of a physician becomes indispensable. It may be remarked, however, that frequently good, judicious nursing will effect more than all medicines. INFLAMMATION OF THE EAR, AND EARACHE. Inflammation of the ear, which is usually the cause of earache, has its seat particularly in the nerves and membranes of the ear. It is the result of colds, moist air, suppressed perspirations, and lying down on damp ground. The pain at first is dull and piercing, and some- times it stops altogether. Finally it becomes violent and continues without intermission, is increased by the motion of the jaw, and extends more and more, and the hearing becomes dull. The inflammation is accompanied by catarrhal fever, usually connected with a violent catarrh, insomnolence, and violent headaches, and some- times also with erysipelas in the face and swelling of the glands of the ear. On the third or fourth day the disease decreases with a discharge of matter from the auditory canal. If the fever is violent, recourse is had to venesection; if mild, leeches are placed around the whole ear at different times, or cupping glasses on the neck. For internal use prescribe cooling purgatives : Take pulp of tam- arinds and manna, twenty grains of each, epsom salt fourteen grains, boil in two pounds of water until reduced to one and a half pounds, strain, and add one and a half ounces of raspberry juice ; dose, a tablespoonful every two hours, until it operates. Warm foot-baths are beneficial ; a few drops of the following mixture may be dropped in the ear : Take equal parts of laudanum, olive oil, honey and com" EAR DISEASES. 225 pound tincture of myrrh ; mix, and drop a few drops in the ear, and stuff cotton in it ; repeat this every two or three hours. If the pain is very severe, hold the ear over steam of bitter herbs, or apply warm hop poultices. If the disease increases, and an abscess is formed, which is recognized by the fact that, with accompanying chills, the preceding stinging pains are changed into a dull, throbbing pain, and by the appearance of a red swelling in one spot of the auditory canal, emolient poultices and fomentations should be applied. This may be accomplished by placing a sponge, dipped in a decoction of mallow flowers or in warm milk, on the ear. In the ear itself drop lukewarm milk or oil, and apply a soothing, softening poultice behind the ear. If the abscess opens, it will heal of its own accord. Inflammation of the ear arises from an irritation of the oral cavity, for instance, from cutting double teeth, from a decayed tooth, and other diseases of the mouth. EAR DISEASES, Of a large number of diseases to which the ear is subject, I will mention the most important only. Otorrhea (running of the ear) is called any flow of long duration from the auditory canal, caused by an abscess formed in the ear itself, or by one, as previously mentioned, finding an outlet in the auditory canal. Running of the ear is either the close of an inflammation, or it occurs without any perceptible cause. The discharge consists either of mucus or matter. Otirrhcea catarrhalis (flow of mucus from the ear) has its seat in the external auditory canal, or by the piercing of the membrane of the tympanum in the cavity of the tympanum. The flow of matter from the ear is, however, always caused by caries of the bony parts of the auditory canal. Otirrhcea catarrhalis occurs frequently in scrofu- lous children ; often, however, it is of a rheumatic, gouty or syphilitic nature, and generally caused by the transfer of another blenorrhcea. It originates undei the same conditions as other old catarrhs, and generally cannot be suppressed without danger. In children the malady usually subsides of its own accord, if general medical treatment has been correctly conducted. Externally cleanse the ears with milk or soap and water ; remedies of a metallic nature 226 GENERAL DISEASES. should be abstained from at first, at least ; tartar emetic ointment may be rubbed in behind the ears. Hearing is usually not at all or very little impeded by otirrhoea catarrhalis. Obstruction of the External Auditory Canal may be caused by an undue accumulation of ear-wax, which gradually hardens, stops up the auditory canal, and in that manner even produces deafness. It may also be caused by swelling, excrescences, exuded lymph, which has become hardened and formed into crusts, or by filaments and adhesions of the membrane lining of the canal. Hardened ear-wax is first softened by oil of almonds, soap-water or milk, and after that it is removed by an ear-spoon. Insects which may have crept into the ear, if still alive, must be suffocated by dropping oil, warm water, or other more effective fluids into the ear, after which it may be drawn out by pincers. Other foreign bodies, such as gravel, cherry pits, peas, &c, are frequently best removed by injections of water, which runs behind the object and forces it out. EARACHE. Earache, if purely nervous and therefore not produced by inflam- mation or organic diseases, is frequently the result of face or tooth- ache. It begins at once with great severity, frequently affects the whole head, and is not limited as to time. In treating this malady, care should be taken not to introduce ano- dynes, such as tincture of opium , poultices, prepared with the addi- tion of opium, are preferable, they should be applied to the temple or behind the ear. TINNITUS AURIUM-RINGING IN THE EAR. Ringing in the ears consists in the perception of sounds which occur in the interior of the ear or in its proximity ; they may perhaps exist in imagination only. The sounds introduced into the ear from the outside may be false, they may not be perceived with both ears at the same time, or be otherwise changed. The malady usually results from a congestion to the head, or from a contraction of the walls of the auditory canals. It also manifests itself in persons of nervous debility, after a considerable loss of blood and humors. DEAFNESS. 22T In the first mentioned cases, local or general bleeding and revul- sives are required, and in the cases last mentioned, internal treatment only ; a little cotton impregnated with oil cajeput may be introduced in the ear. DEAFNESS. Deafness is either innate or acquired. The first is called deaf- muteism The acquired deafness may have its seat in various parts of the auditory canal, as for instance, in the external auditory canal, in the cavity of the tympanum, in the interior part of the ear, and in the nerves of the sense of hearing. Injuries, mostly catarrhal-rheumatic, congestions, abdominal diseases, nervous debility, or irritation and organic defects, are the inducing causes. In treating deafness, a close examination should be made whether an obstruction does not exist in the interior part or auditory canal. Sometimes the sole cause of deafness of long duration is the accum- ulation and solidifying of ear-wax. Mucous plugs, polypus, and other formations, even foreign bodies, introduced from the outside, if greatly obstructing the auditory canal, must weaken hearing considerably. These obstructions should therefore be removed in a proper manner. But, if a similar mechanical obstruction is found in the cavity of the tympanum, or in the Eustachian tube, which generally con- sists in an excessive accumulation of mucus, obstructing the open- ings, revulsives should be applied to the skin and intestinal canal. Rub in Spanish fly or tartar emetic ointment behind the ears, or in the mammilary process region, administer every morning and evening fourteen grains guiac wood, with one grain of calomel and one grain of sulphur, and incite the mucous membrane of the nose to greater activity by a suitable sneezing powder. Where inflammation need not be feared, introduce externally ethereal oils, mixed with fatty oils or a little ox gall dropped on cot- ton. If these remedies afford no relief, the physician should make injections into the cavity of the tympanum through the Eustachian tube, after having probed whether that passage is open. In most cases the causes of deafness can only be surmised ; they cannot be ascertained with certainty. The course pursued can therefore be exper- imental only, and must be shaped according to general rules. 228 GENERAL DISEASES. Electricity is applied with advantage in many cases of deafness depending on paralysis. Bleeding, laxatives, setons, douche baths, stimulating fumigations, ethereal or sulphuric vapors, conducted into the cavity of the ear, have sometimes afforded temporary relief. The last experiment is the ear trumpet. PNEUMONIA. Pneumonia is a disease of the lungs, occurring particularly during raw east and north winds. It manifests itself by pain in the chest, dyspnoea, stinging in the chest, and inflammatory fever. In most cases inflammation of the pleura is connected with it, which is indicated by severe stitches in the side. This disease usually begins with chills and a deep-seated, increasing pain in the chest, with troubled, short, uneasy breath, because the patient is not able to draw a long breath, as the upper pectoral muscles or the abdominal muscles only are in motion. A short, dry and very painful cough sets in, which some- times is accompanied by the expectoration of bloody mucus. An effort in speaking, a motion or a long breath, causes the patient to cough. The fever is highly inflammatory, and usually connected with a hard, full pulse ; sometimes, however, the pulse is small and soft, particularly if the inflammation of the lung is deep and severe, so that the large vessels in its proximity are restrained thereby. The disease itself is usually of short duration, and frequently terminates within two weeks, and often in a much shorter time. As soon as the patient passes into a state of convalescence, he breaks out into a heavy perspir- ation, accompanied by a great voidance of urine, and often also by hemorrhages from the nose, lungs, anus, &c. In very favorable cases the patient feels particulary relieved by the expectoration of a mild mucus, which at first is streaked with blood ; after that he is soon restored to health. The disease, however, frequently becomes fatal from the violence of the inflammation or by a change to some other disease. Such changes are suppuration of Jhe lungs running into pul- monary consumption, dropsy in the chest, and the rarer cases of induration of the pulmonary tissue, or intergrowth of the lung mem- brane with the pleura, or, what is still rarer, mortification of the lungs. One of the causes of inflammation of the lungs is taking cold in the chest, particularly during the inclement seasons of the year, with con- tinuous east and north winds. PNEUMONIA. 229 There is a predisposition to this disease in young, rapidly growing, in plethoric people, suffering from congestions, also in those whose build inclines them to consumption, as is mentioned under the heading " Consumption." No less predisposing for that disease is the inhalation of irritating substances, such as dust, sand, acids, and many others of the same nature, also an exertion and irritation of the lungs in dancing, running, riding, playing of wind instruments, &c. The disease must at all times be considered dangerous, even if it appears in its lightest form, as it may unexpectedly become exceed- ingly dangerous by sudden changes. It is therefore of the greatest importance to call in a physician with the least possible delay, for neglect and injudicious treatment cannot subsequently be made good again. Treatment : The patient must avoid most strictly all causes for an attack, every exertion and irritation of the lungs. He should rest in a somewhat darkened, moderately cool, but not cold, and still less in a hot room. All speaking, and, if possible, coughing must be avoided. He must not eat meat, or soups prepared from meat, nor food hard of digestion, neither drink sharp, heating or stimulating beverages. Everything which he consumes must be mucilaginous and cooling, but not cold. His food should consist of decoctions of oatmeal, rice, groats, sago, &c, all sweetened with sugar, and he may drink lemon- ade, almond milk, &c. One of the most important remedies, to be ordered immediately by the physician, is copious bleeding, according to circumstances, on each arm, and this may be repeated. The appli- cation of leeches to the painful places of the breast, cupping glasses on the neck and breast, are sometimes required. The patient may drink, without restriction, of decoctions of linseed, poppy and almonds, or decoctions of mucilaginous substances, such as salep, marshmallow, to which saltpetre has been added, one or two drachms to six or eight ounces of the fluid ; it may be sweetened with sugar, syrup or honey. If saltpetre incites cough, it must be mixed with a few grains of henbane, or add to half the quantity of the mixture halt cherry-bay water. Externally apply emollient meal poultices on the chest ; inhalation of soothing vapors is sometimes very beneficial. After the inflammation has been broken up, the salt- 230 GENERAL DISEASES. petre ordered for internal use is changed to sal-ammoniac (one or two drachms to six or eight ounces) ; tartar emetic is administered in small doses (from ten to twenty grains) in a mucilaginous decoction ; also emetic wine and sulphur. Subsequently apply Spanish fly plaster on chest, arms and other parts, and administer internally sudorific remedies, elder blossom tea, with the addition of Minderer's spirit, or succinate of ammonia from ten to thirty drops. Calomel is also ot service in some cases. If recovery sets in, it should not only be aided in every way, but relapses must be guarded against. The lungs should be strengthened, which is done by gradually accustoming the patient to fresh air, avoid- ing, however, all drafts and colds. Rub the chest with flannel, wash it at first with spirituous fluids, afterwards with cool water, increasing it to cold by degrees. As a drink, give tea of fennel, anis and star anisseed, also Selters water. INFLAMMATION OF THE CHEST. Inflammation of the chest usually results from a stagnation of blood in the lungs ; this stagnation is the effect of cold, severe fever, or the inhalation of acid vapors. If irritation is produced in the upper part of the trachea and its ramnifications by a living or an inanimate body, it results in catarrh or in asthma. If the external surface of that part of the lobes of the lungs, which is in contact with the pleura, becomes attached to it, an accumulation of serum takes place in the thoracic cavity. Rarely, however, a case of inflammation of the chest is met with, where the pleura alone or the lungs alone are inflamed. As a rule, both are affected at the same time, so that true inflammation ot the lungs is also connected with pain. The following are the symp- toms of inflammation of the chest : i. Stinging or pain in one part of the chest, which is increased by inhalation. The patient, therefore, does not breathe fully ; the pulse is hard and full. Stitches in the side commence in that way. 2. Pressure and oppression of the chest, quick breathing, anxiety, with small, intermittent pulse. Inflammation of the chest and lungs are accompanied by much or little pain. One of the principal symptoms, inseparable from every INFLAMMATION OF THE CHEST. 231 inflammation of the chest, is that the absence of cough is a sure indi- cation of inflammation, provided pain and the other indications exist. A transient stitch in the side may result from flatulency, but this is not accompanied by either fever, cough, or acceleration of breath. The cough is either dry or moist, with expectoration, as is stated in ''Inflammation of the Lungs". If the indications of a salutary expectoration have fully appeared, the patient will soon pass into a state of recovery. If, however, it passes into suppuration, the follow- ing symptoms will be noticed : the pain decreases, but a constant pressure on the chest remains, which is particularly felt in drawing a deep breath, or by lying on one side. Drawing a deep breath, speak- ing and walking, result in coughing, the pulse is quick and feverish. With otherwise apparent good health, appetite returns, but in from three to four weeks a hectic fever sets in at night, the hands burn, after meals the cheeks become red and hot, the expectoration of pus increases, or with a closed pyocistis the cough and other thoracic complaints increase. If the inflammation changes into induration of the lungs, or into tubercles, it is indicated by the following symptoms: abatement of fever, but breathing not entirely free ; short, dry cough, particularly if a deep breath is drawn ; occasional transient stitches in the chest, otherwise health seemingly restored. If the disease threatens to turn into catarrhal phthisis, which is not unusual in aged people, the fever abates, but a constant, very considerable mucous expectoration con- tinues, with visible emaciation and increasing debility of the body (see ''Catarrhal Phthisis)." Sometimes dropsy in the chest sets in during this disease. The treatment of inflammation of the chest is the same as that of inflammation of the lungs : bleeding or leeches. With children, leeches are preferable ; cooling, derivative medicines are the principal remedies in this inflammation. First of all, bleeding of the arm of the affected side as soon as possible ; the bleeding should be copious, and be permitted to flow until the stitches or pressure in the chest abate or have entirely ceased. The patient should be bled in a lying- down position, and the bleeding should not be stopped until the stitches or pressure have entirely ceased, unless the physician finds that the pulse is unequal and intermittent. As often as pain and 232 GENERAL DISEASES. oppression of the chest return, bleeding again becomes necessary. This inflammation requires and can bear the most abundant bleeding, but it should not be continued to the fainting point. The sooner bleeding is resorted to, the larger the opening of the vein, the more copious the flow of the blood at the first bleeding, the more decided will be the effect on the inflammation. Repeated bleeding, and con- sequently a great loss of blood, will be avoided in pursuing this course. In patients with diseased lungs, suffering from tubercles, and a dis- position to consumption, bleeding is still more a necessity. It is to be particularly understood, however, that not all inflammations can be treated in that manner ; there are some where bleeding is not only not beneficial, but absolutely injurious. The following will require different treatment : gastric and particularly biliary inflammation of the lungs ; they generally appear at a time when bilious diseases pre- vail, therefore late in the summer or during the fall. The outbreak ' is always, and for some time, preceded by indications pointing to a morbid secretion of bile (see "Bilious Fever"). The fever increases in these cases at various times, not always in the evening, as in pure cases of inflammation of the chest. Perspiration and expectoration set in at the beginning of the disease, which in the other case does not occur; in this case the urine is muddy and resembling whey, while in the other case it is red and has a flaming appearance. If in this case bleeding is resorted to, it affords temporary relief, but the heat soon increases, and the fever becomes serious. Under these cir- cumstances two courses are open ; nature herself seems to point out how she desires to be assisted ; the impurities of the abdomen are pressing upward. With the most violent stitches in the side, with the most severe oppressions of the chest, the tongue feels thick, and is covered with a bitter, bilious mucus ; the taste is very bitter and some- what putrid, and accompanied by nausea, inclination to vomit, or vomiting itself, headache, and a greenish-yellow color in the face, and particularly around the mouth. Under these circumstances an emetic should be administered at once : take tartar emetic two decigrammes, distilled water one hundred grammes ; dose, a tablespoonful every quarter of an hour, until the desired result is produced. In most instances this remedy operates favorably, for frequently the violent stitches disappear after the vomiting. INFLAMMATION OF THE CHEST. 233 After vomiting has ceased, let the patient drink freely of barley- water, which maybe prepared in the following manner : take a hand- ful of barley, boil in three pints of water until the husk bursts ; the clear, decanted fluid is mixed with a few spoonsful of oxymel. Or administer a laxative, consisting of pulp of tamarinds and manna, six- teen grains of each, Glauber's salt fourteen grains, boil in fifteen ounces of water until reduced to ten ounces, strain, and add one and a half ounces of raspberry juice ; dose, a tablespoonful every two hours, until the proper result has been attained. RHEUMATIC INFLAMMATION OF THE CHEST. This disease has its seat in the. external parts of the chest, and very rarely affects the pleura, and then only to a very limited extent. It is rheumatism of '.he pectoral muscles, resulting generally from a cold, draft, &c. It is of the highest importance to distinguish this disease from inflammation of the chest, which is not easily done in all cases. If inflammation of the chest is mistaken for rheumatic inflammation of the chest, the vigorous treatment required in an attack of the former disease would not take place, and the patient would thus be exposed to the greatest danger. On the other hand again, the patient would unnecessarily lose a great deal of blood. The following is the difference in the two diseases : Rheumatic inflammation of the chest begins with violent pains in the joints or limbs, and rheumatic pains precede and accompany it. TRUE INFLAMMATION OF THE CHEST. This disease is not accompanied by rheumatic pains. It begins with a heavy chill, but frequently only with a very light one. The pain appears with the chill and extends over the whole chest, the epi- gastric region, or towards the back. The pain usually moves from one plage to another,and is increased by outward pressure, and the motion of the arm and chest. The patient cannot lie on the affected side, constric- tion and pressure of the breast do not exist at all, or are very light. The cough is moist from the start, and frequently is not present at all. True inflammation of the chest is treated like rheumatic inflamma- tion. 234 GENERAL DISEASES. SPURIOUS INFLAMMATION OF THE CHEST. This disease is a catarrhal-feverish condition of the extreme ramifi- cations of the bronchi in the lungs, with a general debilitated con- dition of the body, or an engorgement and surcharge of the lungs in weak people, or it is caused by a bilious black condition of the humors. The first of these spurious inflammations of the chest are more of a catarrhal nature, and attack old people, children and women when taking a cold in damp, wet and moderately cold weather. It begins with asthmatic breathing, pressure on the chest, but with very little coughing, and very rarely with pain. The fever and heat are very moderate, the pulse moderately quick, but very small. A tough, trans- parent mucus is expectorated at once, or an inclination to do so mani- fests itself by a rattling in the chest. The attacks of this disease are not as sudden as those of true inflammation of the lungs ; they are usually preceded by catarrhal inclinations, and also by asthmatic difficulties, neither is the course of the malady as rapid. Finally the disease changes into inflammation of the lungs, with haemoptysis, violent mucous cough, perhaps stitches in the side, great heat and very hot breath. The limbs of the patient become cold, his face is red and bloated, he is no longer able to expectorate, and dies of suffoca- tive catarrh or apoplexy. The danger is nearly as great, if not as pressing, as in true inflammation of the lungs, and it leaves the patient in a condition very susceptible of other diseases. The greatest cau- tion should be observed in subjecting the patient to bleeding, and in most cases even leeches would be hurtful. The best remedy is a strong emetic. Take tartar emetic two deci- grammes, distilled water one hundred grains. Dose, one tablespoonful every quarter of an hour until it operates properly. If the main trouble has been removed thereby, administer a loosening emulsion consisting of the following: Seneca root four grains, to a decoction- of two hundred grammes of water, four grammes sal ammoniac, tartar emetic six centigrammes, licorice juice eight grammes ; dose, tw o tablespoonsful every two hours If expectoration stops again, administer the following emetic : ipecac cne grain, tartar emetic five centigrammes, syrup of squill root and raspberries fifteen grains of each, well water thirty grammes; dose, one INFLAMMATION OF THE LUNGS. 235 tablespoonful every quarter of an hour until vomiting sets in ; dose for a child, a teaspoonful ; a plaster of Spanish fly should also be applied. If the patient becomes very weak, administer the following : prepare a decoction of four grammes seneca root, with one hundred and eighty grammes of water, and scald with it arnica flowers four grammes, spirits of sal-ammoniac containing anis three grammes, syrup of squill root thirty grammes ; dose, one tablespoonful every hour. ATRABILIOUS INFLAMMATION OF THE LUNGS. Atrabilious inflammation of the lungs is preceded by indigestion and general indisposition, accompanied by violent headache. The symptoms of this disease, excepting the abdominal disease accompany- ing it, are precisely the same as those in catarrhal spurious inflamma- tion of the lungs, with the only difference that it is connected with a blackish, sooty secretion or evacuation. The tongue has usually a black coating, and the teeth a black covering, or the evacuations, expectorations, and even the urine, have a blackish coloring. The disease is always very tedious, and even if the inflammatory symptoms of the chest have subsided, other affections of the chest and digestive organs remain. The mind becomes greatly depressed, and usually swellings of the glands appear in different parts of the body. The disease is very rare, a cure difficult, and therefore it will not be discussed here any further. My intention is to show the difference in the symptoms of these species of spurious inflammation of the lungs, so as to prevent an application of wrong remedies. SLOW INFLAMMATION OF THE LUNGS. The symptoms indicating slow inflammation of the lungs, are con- tinuous pains in the chest, or pains returning from time to time ; these pains are usually accompanied by cough and breathing difficulties. Slow inflammation of the lungs, according to the cause that induced it, is of more or less importance. In people who have a sensitive skin, and who frequently expose themselves to sudden changes of heat or cold, or to drafts and other colds, who are inclined to rheumatic dif- 236 GENERAL DISEASES. Acuities, but who are not given to spit blood, and have a well built chest, in such people these pains are generally of a rheumatic character, and with proper care, of no great importance. A blister, maintaining suppuration, placed on the painful spot of the chest, flannel worn nearest to the skin, and the use of colchicum wine, dose, from twelve to twenty drops, will be sufficient to remove the disease. If there are indications of hemorrhoids, or if the patient has heridit- ary germs of that disease in him, or if the regular bleeding has not taken place, if the indications of slow lung inflammation should man- ifest themselves even in connection with bloody expectoration, it may be assumed that the pectoral difficulties are caused by hemorrhoids. These attacks are treated like the irregular hemorrhoids ; they are never connected with any great danger. Suppressed menstrua- tion may also induce slow inflammation of the lungs; if the former is restored, the latter soon disappears. But if the cause for this malady is in the lungs, then great danger is connected with it ; a change to phthisis may then be anticipated. One of two conditions are then to be assumed. The first is, that a close ulcer has formed in consequence of a regular inflammation of the lungs, which, becoming inflamed from time to time, causes the pain. The fate of the patient then depends solely how nature will finally accomplish the opening of the ulcer. The second condition is, that there exists a tendency to phthisis or that tubercles have formed already. This is the point to which I desire to draw the attention of my readers particularly, because it frequently remains unrecognized, and the time for possible assistance is lost. The following are the symptoms of the diseased condition : the patient usually feels a deeply seated secret pain in 'the chest, manifesting itself on certain provocations, such as moving quickly, or exerting his lungs when it is felt like a constriction, breathing becomes more difficult when resting on the side, coughing, pressure and stitches are provoked by a change of position. A deep inflation of the lungs excites stitches and a burning and contracting sensation; the cough is short, but not constant, and mostly dry ; expectoration restricted or slimy and fre- quently bloody. This bloody expectoration continues for several days, disappears and returns quickly, but at uncertain periods of time. At the time when the expectoration of the blood occurs distinct and Lasting attacks of fever manifest themselves during the evening, the INFLAMMATION OF THE LUNGS. 237 stitches increase, cheeks are burning and red, and the head is hot and aches. Some parts are burning hot, while others continue cold ; the patient feels dull and feeble, his limbs are heavy ; he has lost his appetite, the tongue has a white coating, bowels are alternately loose or constipated, night-sweats set in, although they are not permanent. With the cessation of the bloody cough, these feverish manifestations dissappear, but the former uncomfortable feelings in the chest remain the same. The patient has a slight cough, feels oppressed, and btitches pass through his chest. Although the fever has left him, his pulse remains excited, and the cheek of the side where he experiences pain, is red. A very little excitement from the use of spirituous beverages, or running, dancing, &c, invariably causes attacks. At first these disappear readily, but return on the same spot on the least provocation. After a while they last longer and become more obsti- nate ; the patient begins to expectorate blood and matter, and phthisis pulmonalis has full sway. It is, therefore, necessary to remove, as quickly as possible, these feverish attacks and recurring small in- flammations, as well as the exciting cause, the existing tubercles. Patients in that condition do not feel, nor do they think that they are sufficiently sick to submit to medical treatment, yet they require it most urgently. As soon as an exciting, feverish con- dition sets in, every exciting cause must be at once removed ; move- ments of every kind must be entirely discontinued. No other food must be taken except water-gruel and vegetables. Administer fresh pressed lemon juice sixteen grammes, saturated with carbonate of potassa, linden-blossom water four ounces, bitter almond water four grammes, sugar ten grammes; dose, every hoar one tablespoonful. Should the fever be very violent, leeches are very beneficial ; also administer the following medicine : red fox-glove leaves six deci- grammes, boil gently for one-quarter of an hour in six ounces of water, strain and add polychrest {sal poly chrestus) ten grammes, sugar eight grammes ; dose, a tablespoonful every hour. When the attack has passed off, the patient should take very great care of himself, and avoid every occasion which might cause a renewal of the same. With every new attack the danger is increasing. What course to pursue to dissolve the indurations, is discussed under "Phthisis." 238 GENERAL DISEASES. GASTRITIS. INFLAMMATION OF THE STOMACH. There are two kinds of gastritis, a clearly defined and a hidden one. We will now discuss the first. It is best recognized by the con- tinued, violent, burning sensation and pain in the pit of the stomach (cardiac region), which is increased by drawing a breath, from external pressure, or from anything that is taken into the stomach. The cardiac region becomes expanded, bloated, sensitive and hot ; fre- quently a palpitating, throbbing feeling is experienced there. Everything taken into the stomach, even pure water, is rejected. Constant nausea and vomiting is experienced, and a great desire for cold water or any cold beverage is felt. The pain is inten- sified by pressure on the gastric region, and by deep inspira- tions ; the patient cannot take warm drinks, because they are imme- diately thrown off again ; even cold water, if taken in too large quantities, soon causes pain, because it expands the stomach. The tongue is either red at the point, and has a white coating on the edges and in the middle, or it is red altogether. The intestinal canal is always constipated, except when it also suffers from inflammation. The pulse is quick, small and hard ; breathing short and accelerated ; the skin hot and dry, and the urine deep red. The patient prefers to lie on his back with his legs drawn up ; he is very restless, feels very weak, and has an anxious look ; his face is deathly pale, and most of the time covered with cold perspiration; his limbs are cold, while internally he experiences a burning heat. The sufferer is troubled with dryness of the mouth, and thirst, which he dare not gratify, be- cause it increases the pain in his stomach ; frequently cramps, fainting fits, derangement of mind, great faintness and trembling of the limbs, set in. The course of the disease is very rapid, and always very dan- gerous. The disease itself is usually caused by the swallowing of sharp, corrosive, burning and injurious materials, such as poisons, needles, glass, nails, copper, &c. Sometimes it is caused by taking cold drinks or swallowing a piece of ice when greatly heated, or by checking a bilious diarrhoea with heating remedies, or by suppressed menstruation or hemorrhoids. If medical assistance cannot be immediately procured, the patient should be bled to a moderate extent as soon as possible. After that GASTRITIS. 239 has been done, from fourteen to eighteen leeches should be applied repeatedly ; they are indispensable and very effective. The idea must not be entertained, however, that when the pain has stopped, the inflammation has ceased ; nothing is more erroneous than that. The first leeches applied frequently remove the pain and sensitiveness of the gastric region, yet the quick, small pulse reveals the high fever and the burning thirst, the continuation of the inflammation, both of which require the renewed application of leeches. The bites of the leeches should not be covered with warm poultices to promote bleed- ing; the warmth and weight of them would be objectionable to the patient ; he objects to heat, and throws off the bed-covers in order to have the cool air pass over the gastric region. Instead of maintaining the secondary hemorrhage with warm poul- tices, the application of fresh leeches is preferable. If the bleeding by venesection and leeches have not produced a favorable change, if weakness is increasing very much, and nervous attacks are added to it, then a continued application of ice-filled bladders may produce a change for the better. In cases where injurious substances (needles, glass, copper, &c.) have been introduced in the stomach, ice should be applied from the first. To keep the bowels open, for attacks of that kind are always connected with costiveness, laxative medicines must under no circumstances be administered, for all internal medicines operate in such cases like poison ; the stomach cannot stand it, and will reject them ; therefore injections alone are applicable. Take forty grammes electuary of senna, and fifteen grains of sulphate of potassa, dissolve in three cups of water, and use as an injection. If the patient can retain cold water on his stomach, it may be given to him ; but nothing is so grateful to him as small pieces of ice, which he may keep in his mouth, and swallow the water as it melts. Nothing need be feared from the use of ice in case of inflammation of the stomach, it can do good only. All other remedies are not at all applicable ; they increase the vomiting and consequently the inflam- mation. Even soda powders, which are frequently administered with the intention of stopping the vomiting, are injurious in these cases, and rather increase it. To guard against a relapse, it is very good, if the patient, after recovering from the attack, will wear a seton on the foot. During convalescence, strict care must be observed in diet. 240 GENERAL DISEASES. Nothing solid must be eaten at first ; milk and water, but particularly whey and buttermilk, are the most appropriate food and drink. It is only by degrees that a change can be made to farinaceous substances. The convalescing patient must not leave the bed for a long time ; sitting up, or occupying an upright position of any kind, or physical exertion, may be followed by the most melancholy results. A slow, inflammatory condition of this part is more frequent than the inflam- mation described ; it frequently results in years of suffering, and finally changes sometimes into consumption, induration, or ulcerous condition. SLOW GASTRITIS. It is frequently the case that this disease is caused by injudicious treatment of the preceding inflammation, or by a relapse through im- prudence, or too stimulating nourishment, excitement of the mind, &c. The manner in which this malady manifests itself, differs greatly. Frequently the patient is without any appetite, and eats nothing for several days ; then again his appetite returns and keeps up for some time ; again the malady sets in anew, and once more he is compelled to fast. Thus the patient keeps alive until his true condition is ascertained and a cure effected, or until it changes into induration of the stomach and consumption. Apparently tonics have a good effect ; the malady is not removed, however, but the unfortunate end only hastened thereby. This condition is very easily mistaken for indigestion, or for spasm of the stomach, and the patient does not think of the danger which is threatening him from slow gastritis. And this is particularly the case with those suffering from hemorrhoids, with whom the period- ical congestion of the abdomen also renews the trouble with the stomach. Usually it is supposed to be gasteras-thenia (weakness of the stomach). Slow gastritis only occupies a small place of the stomach, and the symptoms manifesting themselves differ very much. If the orifice of the stomach is spasmodically affected, it seems to the patient, when he takes food, as if it passed through a painful ring ; it is accompanied by eructation, spasmodic contraction of the stomach, and a feeling of burning. In lighter cases, these difficulties are incon- siderable and transient. After a few hours the patient feels some pain behind the left edge of the breastbone, which, like rheumatism, GASTRODYNIA. 241 extends toward the back to the left shoulder-blade. Usually palpita- tion of the heart, contraction and burning in the throat, accompanies it, and in the morning a disagreeably tasting, sharp and sour fluid collects in the mouth of the patient. The back part of the throat is dry, or filled with a thick tough mucus. Subsequently, however, vomit- ing is added to this. If the stomach is the suffering part,, then the food itself will create a disagreeable feeling in it ; if it is of an irritat- ing quality, it frequently creates a feeling in the patient as if the lower part of his chest was surrounded by a tight belt, and a painful belching and hiccoughing is the result. A few hours after eating, the pain increases here also. Occasionally vomiting of blood occurs, which may create the belief that it is ulceration of the stomach. Patients afflicted in that way are given up by their physicians, on account of an incorrect diagnosis. Most generally the seat of the disease is at the outlet of the stomach. In that case the appetite is good, and satisfying it affords the usual grati- fication. In a few hours, however, the suffering begins ; pains, like the pricking of needles, are felt on the right side extending up to the tonsils. The food, although not entirely vomited up, rises up from the stomach. At first only a tough, rancid, ill-tasting mucus is thrown off, but as the malady increases, the patient throws off all nourish- ment. To my regret, I have frequently experienced in my practice that many patients discharge their medical attendant, and use all sorts of quack medicines. I do not write this for the purpose of inducing the patient to treat himself in serious cases, but oniy for the purpose of enabling him to judge whether the physician in whom he confides has a correct knowledge of the disease. As before said, in most cases a wrong course is pursued with this disease, and a malady which might be cured becomes incurable ; examine also what we say of spasms of the stomach (" Gastrodynia "). GASTRODYNIA. SPASMS OF THE STOMACH. Gastrodynia is a painful, tearing, pinching feeling in the stomach region, recurring at stated periods, and connected with nausea, chok- ing, and the vomiting up of a small quantity of clear fluid, accom- 16 242 GENEEAL DISEASES. panied at the same time by cold feet and hands, and occasionally by fainting. There are in reality two principal forms of gastrodynia 3 which frequently fuse into each other. In the first form it appears in consequence of a state of weakness of the stomach caused by indigestible food containing no nourish- ment and being ill-conditioned, or by the use of too large quantities of relaxing beverages. Taking cold in the stomach, sitting constantly in a bent position, constant emotions of the mind, care, grief, unin- terrupted mental labor, or long-continued use of medicines affecting the digestive organs, tend to the same result. In this form the powers of digestion are much impaired, which may be known by the fact that the malady is hardly noticed with an empty stomach, but that it manifests itself at once after eating, frequently accompanied with nausea, choking, belching and vomiting. The other form manifests itself by a directly opposite condition to the before-mentioned, and appears generally in irritable, nervous, hysterical persons, or in those weakened by long after-pains, fasting, or disorders of the mind. The pain shows itself principally when the stomach is empty with great violence, but usually ceases after a bountiful meal. The longer gastrodynia has lasted, the more obstinate it becomes, and it may finally change into an organic disease of the stomach, terminating with death. In treating this disease, particular attention should be paid to diet and the general mode of life. The kind of food and of beverages used must be easy of digestion and nourishing ; simple food, but not salted, smoked or highly-seasoned meats, and the use of well-fermented, light beer or good wine, are best adapted for that purpose. Food causing flatulency, or of an indigestible character, and also relaxing beverages, particularly tea and coffee, must be strictly avoided. In regard to the remedies to be used, they should always conform to the form assumed by the disease. If it is the result of weakness, the stomach, intestinal canal and digestive organs generally should be invigorated. Ox-gall (see " Gall "), in connection with other bitter remedies, such as inspissated gall, extract of dandelion, two drachms of each, are made into a mass with a sufficient quantity of powdered rhubarb, divided into two grain pills and covered with cinnamon powder ; furthermore, other bitter remedies such as buckbean, century GASTRODYNIA. 243 minor, gentian, orange peel, &c, may be used as tea. Later the lighter preparations of iron (see the article), particularly the dissolv- ing iron waters, also aromatic and stimulating substances, such as cascarilla bark, ginger, sweet flag, may be used as infusions or in the form of powders. For gastrodynia, caused by an excited nervous condition, these remedies are not adapted. In such cases antispasmodic remedies should be administered, particularly valerian root, peppermint drops, fennel or caraway, bismuth, tartar emetic (from one-half to one grain). Nitrate of bismuth from two to three grains, calcined magnesia twenty grains, sugar of milk one drachm, mixed, divide into ten pow- ders ; dose, one powder every four hours. Bathing of the gastric region with cold salt and water, is very ben- eficial. The application of stomach plasters (to be found in the apothecary shops), and of diverting strong foot-baths, are also very useful. If the stomach is soured, carbonate of magnesia, carbonate of potassa or soda, oyster shells with orange peel or cascarilla bark, or rhubarb, are beneficial. External embrocations of the gastric region (see " Ether") with oil of camomile, peppermint, balmmint, spirits of soap, nerve ointment, mace ointment, tincture of opium, &c. , are soothing ; also bathing the affected part with spirits of camphor, spirits of aromatic herbs, particulary wild thyme, and antispasmodic injections, are excellent. Generally infusions of peppermint, valerian and camomile will be of good service. Where gastric acid predominates, the remedies pre- scribed for heartburn are applicable. Gastrodynia from taking Cold.— This occurs usually from being dressed too light, from damp dwellings, and from being engaged in the washing business, therefore not an unusual disease with washer- women. In cases of that kind, the whole body should be brought to a warm state, but more particularly the feet and gastric region ; this may be effected by rubbing with hot flannel and the application of hot iron covers, or bricks, and the rubbing in of caustic spirits of sal-ammoniac thirty grains, camphor two grains, olive oil eighty grains, tincture of opium one and one-half grains ; rub in well and cover with hot flannel. 244 GENERAL DISEASES. Poultices are also of great service : take four ounces of powdered linseed, hemlock leaves forty grains, henbane twenty grains, boil with water to a very stiff mass, and add oil of henbane thirty grains, and apply in a lukewarm condition. Give a warm foot-bath, prepared with one ounce of cooking salt and one tablespoonful of mustard, place the feet up to the knees in the water for twenty minutes. The following preparations for external use also afford relief: tinc- ture of cantharides eight grains, caustic spirit of sal-ammoniac twenty- four grains, spirits of wild thyme thirty-four grains, well rubbed in ; of good effect is spirits of camphor, angelica spirits, of each fifteen grains; or spirits of formate, spirits of camphor and of hartshorn, ot each twelve grains. To be rubbed in. Internally, use liquid acetate of ammonina one ounce, water of camomile flowers four ounces, syrup of camomile flowers one ounce ; dose, one tablespoonful every hour until relieved from pain. Spasms of the Stomach from Worms are indicated by the usual symptoms when worms are present. First of all the worms must be expelled (see " Helminthiasis "). Spasms of the Stomach from Flatulency. — This is very com- mon, and consits of a painful feeling of expansion and fulness of the stomach, connected with a continual belching of wind. Administer the following mixture : assafcetida four grains, syrup of peppermint thirty grains, peppermint water three and one-half ounces ; dose, a tablespoonful every hour, until relieved. The following can be highly recommended : ethereal tincture of castor in camomile tea, dose, from thirty to forty drops every hour ; also oil of peppermint from one to three drops on sugar. If the patient is costive, administer an injection of powdered assafoetida (three to four grains), stir together well with the yolk of an egg, and mix with one pint of camomile tea ; after the decoction, strain thoroughly before using it as an injection. In Cases of Biliary Spasm of the Stomach, which frequently shows itself in the beginning of autumn, and usually attacks people after violent fits of anger, the following preparation will generally afford quick relief : as much potassa as will lie on the point of a knife, with a little water, and immediately afterwards a tablespoonful of lemon juice ; or the following powder may be adminstered : tartrate of HEART-BURN AND ACIDITY OF THE STOMACH. 245 soda eight grains, bicarbonate of soda three grains ; this powder is put in a white paper; tartaric acid three grains, put in a blue paper. The powder in the white paper is dissolved in a tumbler of sweetened water, and that in the blue paper added to it, the mixture must be drank during effervescence. The following antispasmodic ointment has proved efficient : cam- phorated ointment forty grains, oil cajeput, balmmint oil, six deci- grammes of each, tincture of opium four grains ; to be rubbed in on the gastric region. HEART-BURN AND ACIDITY OF THE STOMACH. Acidity of the stomach manifests itself by the elimination of an acid vapor or fluid, which dulls the teeth, by a white-coated tongue, loss of appetite, and burning in the throat and stomach. It is caused by easily fermenting food, or by a defect in the gastric juices. The alkaline remedies, partly given under "Spasms of the Stomach," are particularly applicable. Heart-burn creates the peculiar feeling of a hot vapor arising from the stomach and throat into the mouth. A painful, tearing feeling is caused in the stomach, and also a burning in the throat ; generally an acid or fatty, clear fluid is vomited up. This condition is usually a sign of a weak stomach and poor digestion. It mostly follows the consumption of indigestible, easily fermenting, somewhat sour food and drinks, particularly of fat meat, milk and vegetables. Sometimes it shows itself after a violation of dietetic rules ; it may also become chronic. The treatment consists in the administration of alkaline remedies, and in the strengthening of the digestive organs. Among the former are carbonate of magnesia, a teaspoonful in water ; powdered oyster shells (from the apothecary shops), as much as will lie on the point of a knife, three times a day. Another remedy : Take carbonate of potassa, and carbonate ot soda, two drachms of each; dose, from four to six drops in water twice a day. Another approved remedy : Take medical soap and bullock's gall, one drachm of each, mix, and make into pills of two grains each ; sprinkle with licorice root powder. 246 GENERAL DISEASES. Another remedy : Medicinal soap and carbonate of potassa, two drachms of each, sufficient buckbean extract to form into a mass, divide into pills of two grains each, and sprinkle with licorice powder ; dose, from three to four pills three times a day. Another remedy : Fennel water three ounces, liquid carbonate of potassa half an ounce ; dose, a tablespoonful mornings and evenings. Another remedy : Extract of gentian root and blessed thistle, two drachms of each, fluid potassa one drachm, camomile and balmmint, three ounces of each, watery tincture of rhubarb half an ounce, tinc- ture of cinnamon two drachms, cherry laurel leaves one drachm, mix ; dose, a tablespoonful three times a day. It is necessary, however, that the patient should live regularly and avoid all food that does not agree with him. COLIC. Colic is a severe, griping, pulling, tearing and cutting pain in the bowels, particularly in the navel region, which comes and disappears. It results from various causes, for instance, from eating indigestible or flatulent food, such as legumes, cucumbers, &c, from swallowing sharp or pointed objects, from strangulated hernia when the patient is very constipated. Every, even moderately violent and obstinate colic, is serious, and may become dangerous under circumstances. It is therefore advisable to call in a physician as soon as possible under such circum- stances. Usually every attack of colic is at first supposed to be suppressed flatulence, and bitter stomachics, bitter and spiced whisky, &c, are be- lieved to be infallible remedies. But this is a very dangerous error, and may lead to very sad results. It is sometimes the case that, if not inflam- mation of the bowels, at least congestion, stagnation, or a super- abundance of blood in the abdomen, is the cause of the pains. The use of heating substances would do more harm than good. It might even lead to a dangerous inflammation of the bowels, which a mild treat- ment would have prevented. In this case, and in all other cases of disease, as previously and repeatedly remarked, the cause of the dis- ease must be removed. The milder and less irritating attacks of colic are treated in the first instance, the greater will be the advantage ; it can never result in any disadvantage. Mucilaginous and oily remedies to soothe the spasms, which always exist in these cases, and the colic. 247 removal by gentle remedies of existing impurities, always alleviates the pain, and often effects a cure. Oatmeal gruel and linseed tea have the quickest effect in reducing pain. Put forty grains of linseed in three pints of hot water, boil gently, strain, and drink at pleasure. Thirty grains of manna, with sixty grains almond oil, taken in a cupful of oatmeal gruel, are of excellent service. Sudorific remedies, producing activity of the skin, are very desirable in these attacks; to produce this effect, drink tea made of comomile, elder blossom, peppermint, sweet flag, cascarille, fennel or ' anisseed. All these ingredients are pain-allaying and sudorific ; the one or the other may be used. To prepare the tea, take one and one-half ounces of the ingredient selected for a decoction with one quart of water, to which a little of Hofmann's anodyne may be added, and drink warm at pleasure. Apply warm woolen cloths ; of greater effect are poultices prepared from roasted or baked flour, to which ground cloves or any other spice has been added, boil in water, add finally a glass of wine, and apply a fresh poultice every two hours until the pain has subsided ; or the abdomen may be rubbed with ethereal ointment (nervine oint- ment), or with cologne water or opodeldoc. Administer internally, oil of peppermint ; dose, half a grain twice a day. Injections prepared from baldrian, camomile or elder, to which linseed oil has been added, are of great benefit. But where the pain continues without any intermission, or even increases, where it remains in the same spot, and violent fever, anguish of mind, profuse perspirations, obstinate constipation, are added to it, where the ab- domen is very tender to the touch, a physician should be called in at once, for all these are symptoms of a dangerous disease, as has been before stated. Invagination of the intestines, or strangulated hernia, or inflammation of the bowels, are all connected with the greatest danger. Frequently impurities in the stomach and intestinal canal are the cause of colic pains ; biliary pain of the bowels is particularly violent. All above enumerated symptoms of bilious impurities in the stomach and intestinal canal precede bilious colic ; it can be distinguished from all other kinds of colic ; the most violent pains are usually felt in the navel region. Constipation is frequently so obstinate in that 248 GENERAL DISEASES. case, and choking and vomiting so violent, that the disease quickly changes into inflammation of the bowels. PAINTER'S COLIC-LEAD COLIC. Painter's colic is a disease which attacks people who handle a great deal of lead or lead-containing substances ; people working in the lead mines, in white-lead factories, in color manufactories, also painters, &c, are liable to these attacks. The first symptoms of the disease are costiveness, cardialgia, a sweetish taste in the mouth, pain and constric- tion in the abdomen ; movements of the bowels are slow, difficult, lumpy and hard ; the appetite is disturbed, and sometimes biliary vomit- ing sets in ; breathing becomes difficult, with a pulling, tearing pain in the limbs, sometimes even extending to paralysis of the same, particu- larly of the arms. If no effort is made to relieve the patient, it finally changes to consumption. In treating the patient, he must be made to keep away from the employment that caused the disease. Where lead-poisoning has already occurred, an effort must be made of extracting the lead from the body, or at least of neutralizing it, and thus removing the disease. For that purpose sulphur and soap baths should be employed ; the abdomen should be rubbed with softening ointments or oils, and soft- ening and anodyne poultices should be applied to it. For internal use, prescribe oils (almond and olive oil) and oil emulsions, with extract of henbane or laudanum; also soap, sulphuret of potassium, milk of sulphur, golden sulphuret, alum, sulphate of zinc, and calo- mel. One of the best remedies, however, is powdered opium ; dose, from one-quarter to half a grain every four hours. The following prescription containing opium is an excellent remedy : pure opium one and one-half grains, triturated camphor two grains, refined sulphur and crushed sugar, half a drachm of each, powder the whole and divide into six parts ; dose, one powder every four hours. We give here only the general treatment ; the physician who will be called in, and must necessarily be consulted in so serious a case of disease, will prescribe further. HICCOUGH — APHTHAE. 249 HICCOUGH. Hiccough is a short, spasmodic inhalation of air, caused by an un- usual irritation of the orifice of the stomach and diaphragm. Usually the attack passes off of its own accord, and it is of no particular importance ; only in cases of nervous and putrid fevers, and in very debilitating diseases, is it a serious symptom. It is caused by taking cold suddenly, cold air, drinking cold beverages, acidity of the stomach, &c. Ordinary attacks will yield generally by breathing slowly, holding a key between the teeth, or sneezing, drinking cold water slowly and in small portions, washing the hands with cold water, rubbing hard the gastric region, rubbing gently with a magnet from the larynx to the pit of the stomach, or to a few drops of Hof- mann's anodyne. Nursing children are relieved by taking any warm drink, such as fennel tea, warm milk, nursing from the breast, &c. APHTHAE. The little, pearl colored pustules, which appear on the mucous membrane of the mouth and throat, are aphthae. They do not only make their appearance during very early childhood, when they are usually evidence of a disturbance in the digestive organs, but they also appear in consequence of various diseases, in every stage of life ; in that case, however, they are always indications of a dangerous malady. I will here give a description of the postules as they appear in children. In children they break out sometimes without being caused by sickness; frequently, however, they are accompanied by derangements of the stomach and the intestinal canal, by restlessness and attacks of fever. Apparently the child feels pain while taking the breast, and its mouth is so hot that the mother feels it while she nurses it. Where only a few of these pustules appear, and if no derangement of health is perceivable, the malady is not dangerous. But if there is a large number of them, and the tongue is of a deep red color, and at the same time diarrhoea, fever and insomnolence set in, or if the pustules are the result of debility and emaciation, they are always an indication of considerable danger. Treatment : If the malady is of a light type, mild remedies only are needed for its removal. Acidity of the stomach, if any exists, 250 GENERAL DISEASES. is removed with carbonate of magnesia, which may be combined with a little rhubarb, provided there is no irritation of the intestinal canal. Aside of this, the stomach and intestinal canal should be generally cleansed by mild laxatives. As local applications, astringent remedies are very useful ; among these borax may be counted ; it is prepared for that purpose by mixing one part of it with eight parts of water, gum water, syrup or rose honey ; the pustules are painted with this solu- tion ; or the mouth may be sprinkled twice or three times a day with finely powdered sugar, and if this does not remove the malady, then the sore places are painted three times a day with the juice of twenty grains of quince mucilage, ten grains rose honey and one grain borax. A mixture of ninety grains fresh expressed juice of yellow carrots and forty grains of lime water, well mixed, and applied with a little paint brush, are of excellent service. If the child has not a proper movement of the bowels, and if it has no fever, the - following mixture may be administered : fennel water thirty grains, watery tincture of rhubarb, manna juice, eight grains of each, carbonate of magnesia one and one-half grains, shake well ; dose, one teaspoonful every three hours. But if the pustules should become malignant, if their blue-black color arouses a fear of mortification, a physician must be consulted, which should be done at any rate as soon as these pustules appear in large numbers, and the child suffers at the same time from hoarseness and diarrhoea. CANCRUM ORIS. Cancrum oris, or canker, as it is usually called, is an indication of a number of forms of diseases which generally attack infants. They all have it in common, however, that they originate in the mouth in con- sequence of an inflammation, which changes to swelling, pustules, ulcers, and even to gangrene of the parts lining the oral cavity and the neighboring parts. These pustules (see the article entitled ''Aphthse" of this work) may, under the mentioned circumstances, or in a prevailing epidemic, or foul atmosphere, assume a malignant charac- ter. The pustules become confluent and discolored in the mouth, and change into ulcers which attack the lips, gums, cheeks, tongue, and palate, and after some time may partly or wholly destroy these. The child will finally die of general emaciation. INFLAMMATION OF THE SPINAL CORD, ETC. 251 This disease, which frequently becomes serious, must be treated with emetics, laxatives and acids. For external use there is recommended gargling and painting, with a small pencil brush, with a solution of chloride of lime, or sulphate of zinc in water. If the debility is great, strengthening aromatic remedies should be administered. Cancrum oris, be it of scorbutic or gastric origin, passes into gangrene under these unfavorable circum- stances. Not only do the gums separate from the teeth, which drop out one by one, but ill-colored spots form, which are destroyed by gangrene. The latter extends more and more, even to the maxillary bones. This usually fatal malady requires treatment principally with acids, particularly pyroligneous acid, muriatic acid, creosote, and a solution of sulphate of zinc or copper, or of chloride of lime. For internal use, powdered charcoal and strengthening and volatile stimu- lating remedies are recommended. In case of loosened, miscolored, readily bleeding gums, relief can be given only after the calculus dentalis, which adheres to the collum de?itis, has been removed, when a cold and astringent mouth-wash of alum, sage, or decoction of loxa bark may be used ; it can be used three or four times a day as a mouth-wash and for gargling. INFLAMMATION OF THE SPINAL CORD AND THE VERTEBRA. Inflammation of the spinal cord manifests itself by a constant severe pain in any part of the back, accompanied by violent fever. It may change to paralysis of the limbs. These are the indications of an inflammation of the spinal cord. This disease is very rare, and is gen- erally the result of external injuries ; it is usually treated by bleeding, leeches, and particularly by constant ice poultices, the usual cooling remedies, and exceedingly stiict water diet and rest. The abdominal position must be kept. The disease is extremely dangerous, but we cannot discuss it here any further. Of greater importance is a knowledge of the secret vertebral in- flammation or irritation. If it is considered that the nerves alone diffuse vital strength over the whole body, and that on them not only' depends sensation and motion, but also nutrition, sanguification and 252 GENERAL DISEASES. preparation of the humors, and if it is considered that the spinal cord is the root of nervous distributions, it will become clear at once how very serious and how various the derangements of health may be that can result from a diseased condition of the spinal cord. Every im- portant part of our body has its peculiar nerves, upon which depends its function, as well as its power of perception; they originate in different localities of the spinal cord. If, then, the root from whence they branch becomes diseased, then the whole nerve falls into the same state, that is in the part for which it was originally intended. This disease is perceived because sensation or motion, or the particular function of this part, appears disturbed. It results, therefore, in violent pain, convulsive motions and spasms, or other disturbances in the vitality of the limb, because the power sustaining its vitality is changed or suppressed. And for that reason the throat, heart, lungs, stomach, liver, urinary bladder, uterus, limbs, &c, may become diseased if the part of the spinal cord, where the nerves belonging to the particular part originate, has become diseased. A disturbance of that kind is easily and frequently created, however, by an inflammatory irritation of the same, and it has the peculiarity that the pain in the back is usually insignificant, or cannot be felt at all, and that it cannot be perceived in any other way than by moderately pressing with the thumb every single vertebra of the whole spine, from the neck downward. Then the patient frequently perceives in one of the vertebrae, or in several of them, distant from each other, an increased sensitiveness, but fre- quently also a very severe pain, which is transmitted with great rapidity to the suffering part lying at a distance from it. It may even happen that the patient is suffering most excruciating pain, and yet it may not be even surmised that the origin of it is in the spinal column. This is the main reason why the malady remains so frequently un- noticed, and why the condition of the spinal column is disregarded. Investigation would soon reveal the cause of the disease, and the painful spot discovered by pressure as indicated. In diseases of the head, such as dizziness, buzzing in the ears, &c, a close investigation should not be neglected. In an examination, the head should be bent forward ; in that position even the most inexperienced will be able to find and press the vertebrae. The surest and clearest indication of a slow inflammation of the spinal cord always is the sensitive spot INFLAMMATION OF THE SPINAL CORD, ETC. 253 in the vertebral column, yet the dizziness, connected with obstinate constipation, and a feeling of fatigue in the knee-joints, may be deemed symptoms usually accompanying this disease. This malady, excepting neither age nor physical condition, is usually of a rheumatic nature. It is, therefore, noticed in persons who have suffered from wandering pains, and at times also where other rheumatic maladies usually prevail. If this is the case, and the condition is properly recognized, the trouble may be soon removed, but it returns from time to time. But be the origin of it what it may, the means to remove the malady, and the various and serious diseases resulting therefrom, will be the appli- cation of leeches or cupping-cups, Spanish fly plasters, blister-drawing ointments, together with proper diet and alvine evacuations. Accord- ing to age and physical condition, from four to twelve leeches should be applied on each side of the spinal column, where the tender spot has been discovered. If there are several of these sensitive vertebras, a similar number of leeches must be applied on each side of them ; the leech-bites must be kept bleeding for two hours. With men, and robust and very fleshy persons generally, leeches do not cause sufficient depletion ; for such, a like number oi cupping-cups must be used. In ordinary cases, and after the incisions made by the leeches have healed up, a Spanish fly plaster is applied, and the suppuration result- ing from it kept up, until a pressure on the vertebrae leaves no pain behind internally, and until the disease has disappeared. If the pain is violent under pressure, or if the patient is very irritable and nervous, a pustule-creating ointment is preferable to the application of Spanish fly, because the latter may cause an increase of pain by too great an irritation, and would under these circumstances do more harm than good. After that, use tartar emetic ointment ; rub in on the painful spot twice or three times a day a quantity of the size of a small filbert, until pustules are formed ; these increase to the size oi cow-pox, but soon dry off; but as soon as the vertebrae become painful again, the ointment must be renewed. Superior, and frequently pre- ferable to the tartar emetic ointment, is the croton oil, provided the skin is not too irritable. To produce a strong, diverting irritation of the skin, use the croton oil, of which rub in, in any selected spot, from three to four drops, at intervals of twelve or twenty-four hours. 254 GENERAL DISEASES. Frequently, even after the first application, the skin will appear rose- colored and inflamed ; the spot will be covered with a large number of small pustules, causing considerable and even painful itching. These little pustules will remain for a few days only, when they dry off, without leaving ulcers. If the skin is very irritable, add equal parts of almond or olive oil to the croton oil. TABES DORSALIS. CONSUMPTION OF THE SPINAL CORD. Tabes dorsalis is a slowly increasing, wasting or softening of the lower part of the spinal cord, which is connected with a gradually in- creasing, and finally total paralysis of the emaciated legs, genitals, urinary bladder, and rectum. Men are more frequently attacked by this disease than women. The first symptoms of tabes dorsalis mani- fest themselves by an unusual inclination to fatigue, particularly in the legs and back ; the feeling in these parts then becomes defective. Standing or walking, and even in lying down, the feet feel numb; the patient in standing has the feeling as if always standing on some soft material, it makes his walk insecure, and he likes to put his feet to the ground with some energy. By degrees he loses the ability of using the muscles without the assistance of his eyes. The patient, on shutting his eyes, or in the dark, loses the feeling of equilibrium, he becomes dizzy, reels, staggers, and tumbles over. All voluntary move- ments become insecure, because the elasticity depending on the spinal cord is wanting ; his walk becomes hasty, shaky, and stumbling. The patient is unable to stop or turn around suddenly ; he is prevented from doing so by comparatively small obstacles. Finally he is only enabled to walk with assistance. Accompanying symptoms are un- usual sensations, such as constriction, itching, burning and cold, tear- ing and piercing pains in the legs and back, around the abdomen and chest, in the rectum and urinary bladder, also' paralysis of the muscles of the bladder and rectum, of the abdominal walls and genitals. At first the desire for urinating is more frequent, and can not be satisfied quickly enough ; it increases to such an extent that drops will invol- untarily escape. An involuntary flow of urine will occur during sleep ; the urine is no longer discharged in a curve, but flows down CONSUMPTION TRACH1TIS PHTHISIS. 255 more perpendicularly, and the bladder cannot be entirely emptied. Spontaneous discharge of urine alternates with ischuria ; the patient is almost constantly costive, and the pressure of the abdominal muscles during evacuation becomes weaker. Frequently a feeling of constriction manifests itself, proceeding from the dorsal and lumbar vertebrae, tightening the abdomen as if with a strap, and creating a difficulty in breathing. Very often these difficulties are superadded by. weakness of sight, and subsequently by deafness, loss of memory, melancholia, and idiocy. In the further course of the disease, the flesh becomes flabby and emaciated, particularly on the buttocks, legs and back. The ability of voluntary motion remains, although it is very feeble. Treatment requires that every debilitating action which has caused the disease should be avoided ; for that reason there should be neither loss of spermatorrhoea, nor physical excitement. The diet should consist of nutricious and easily digested food, with very moderate exercise in fresh, pure air (country air) ; baths should be taken first quite warm, then lukewarm, and decreasing in temperature until quite cold. All medicines that may be applied internally or externally will do more harm than good. CONSUMPTION-TRACHITIS-PHTHISIS. Phthisis and trachitis occur more frequently than any other kind of consumption. I propose to treat of them here more particularly. The characteristics of phthisis are cough, shortness of breath, slow fever, and emaciation. The cough may be connected with expector- ation, which may be of a mucous or purulent character, or it may occur without any expectoration ; it frequently also appears accom- panied by pain in the chest, although not essential. The disease generally passes through three periods. i. The beginning of phthisis is characterized by weakness of the lungs, frequent catarrhs, by the inflammatory condition or increased irritability of the lungs, with a short cough, frequently with blood expectorations, stitches in the chest and oppressed breathing. During this state, however, fever does not manifest itself. Besides a particular heriditary or acquired predisposition for the malady, it may also be 256 GENERAL DISEASES. called out by chronic diseases of the abdomen, mucous obstruction of the bowels, suppressed customary hemorrhages, or skin diseases. 2. Developed Phthisis is distinguished from the former by the appearance of slow fever, which increases in the evening, and sub- sequently at noon also, but passes off toward morning with exudation. The expectoration is of a purulent character, when most of the tuber- cles generally present in the lungs in this disease have passed into sup- puration, and are thrown Off with coughing. The patient becomes emaciated, but keeps a good appetite, and does not think his condi- tion to be serious. 3. In fully developed Phthisis excessive and exhausting sweats occur in the morning, accompanied by diarrhoea. There aie daily two attacks of fever, the emaciation becomes more serious, the expec- toration heavier, breathing shorter, until finally with an increase of all the symptoms described, death occurs from inability to draw breath or from suffocation. The immediate cause for phthisis is that the lungs are unable to perform their functions, being prevented by cer- tain morbid substances. A predisposition for phthisis, which may be inherited, may be recognized by a flat chest, bent sideways or back- ward, a long throat, wing-like shoulder blades, and a peculiar irrita- bility of the vascular system and the lungs. The disease is most readily developed during youth and early manhood. In some cases it is instigated by rapid growth, dry air, particularly in mountainous regions, frequent over-exertion of the lungs, often occurring catarrhs, scrofulous disposition, deformed chest, and when haemoptysis or inflammation of the lungs or other morbid matter exercise their influ- ence on the lungs. Treat?nent. — When the first symptoms of phthisis appear, every- thing must be carefully avoided which has a tendency to cause con- gestion of the lungs, and everything should be done to strengthen them properly. Any existing inflammatory irritation should be removed by moderate depletions, cooling diet, saltpetre, cream of tartar, cherry laurel water, foxglove, milk, and the juice of herbs. In a case of predisposition for consumption, use Iceland moss, and strengthen the lungs by exercise and washing with cold water. In fully developed phthisis an effort should be made to improve and heal the local affection of the lungs, the fever must be brought under CONSUMPTION TRACHITIS PHTHISIS. 257 control, and the loss of strength replenished by proper nourishment and strengthening remedies. For that purpose either palliative and quieting or stimulating remedies should be used. Among the former are water fennel, foxglove, cherry laurel water, in a decoction of marshmallow, cucumber juice, lime water and sugar of lead. To the stimulating remedies belong myrrh, balsam of copaiba creosote and iron. All these remedies must be carefully administered, so as not to cause oppression of the chest, or an increase of the fever. Aside of that, inhalation of aromatic or oxigenated vapors, staying in cow stables, sea air, &c, can be highly recommended. The expec- toration of mucus is facilitated by syrup of squill, sulphuret of antimony, sal-ammoniac and tartar emetic, in small doses. Setons, if applied, are of much benefit, provided the patient is not already too weak. To reduce the fever, prescribe cooling, but not weakening mineral salts, or reduced mineral acids ; even very moderate deple- tions may operate very beneficially. To replenish the wasted energies, order nourishing, strengthening food, such as milk, barley-gruel, Ice- land moss, a decoction of salep, or marshmallow root, &c. The troublesome cough may be relieved with henbane or cherry laurel water, and the night sweats with sage tea, alum, white agaric and acids ; the diarrhoea with armia root, simaruba or rhatany bark. Opium is almost the only remedy which affords relief to the patient in the third stage. Trachitis begins with hoarseness and cough, which at first is only irritating and dry, but subsequently is connected with purulent expec- toration ; there is also a feeling of rawness or burning in the trachea. Speaking and swallowing becomes difficult, but respiration remains unrestricted. Slow fever sets in subsequently. The course of the disease is slow. The causes of the disease are neglected catarrh, excessive exertion of the trachea, &c. The treatment is generally the same as for phthisis. The most effectual remedies, besides those given for phthisis, are a long-con- tinued seton at the throat or a fontanelle on the upper arm, an anti- phlogistic diet, sulphate of lime, and Plummer's powder, with fox- glove or bittersweet ; applying and keeping a plaster of hemlock or henbane around the throat has an excellent effect. 17 258 GENERAL DISEASES. NERVOUS PHTHISIS. Nervous phthisis generally results in consequence of a natural physi- cal disposition for the disease, or from accidental pernicious influences. To these belong emaciation, the result of severe, acute or tedious dis- eases, or exhausting methods of treatment, for instance, long fasting, also continuous over-exertion of the mind, particularly if connected with night-watching, constant sorrow and grief, long-continued melancholia, particularly, however, a constant waste of vitality, pro- tracted hemorrhages, blennorrhea, spermathorrhcea, and excessive copulation, masturbation in both sexes, excessive use of spirituous beverages, opium, purgatives, &c. Although with a predisposition for any of the different forms of consumption, a desire for sexual intercourse becomes strong at the time of puberty, yet the danger of self-pollution is in none so great or so early developed as in those with an inclination for nervous phthisis. It does not need here a frightful example and seduction, but the own instinct furnishes the means for an unnatural and health-destroying gratification. Education alone can protect these unfortunate individuals from this vice. It can be done by an early hardening, which will lessen the sensual irritability of the body, and subsequently, and at the time of the awakening oi the instinct, a nobler and higher direction may be imparted to the mind, to enable it of grasping the idea of a better world, and of the better life to come. The existence of nervous phthisis is indicated by no other symptom than extreme emaciation. The patient does not at first complain of trouble in the chest ; he has neither cough nor dyspnoea, and only in very rare cases is nervous phthisis accom- panied by slow fever. The patient seems literally to wither, as if struck by a blight; he complains of acidity of the stomach, and disordered movements of the bowels. Usually there is no appetite at all, or it alternates with voraciousness, which, however, is soon satis- fied. Defective digestion produces poor juices in the body, and these obstruct the glands and intestines. Frequently, therefore, a visible swelling of the liver, spleen and mesentery is discovered, which is often met with in phthisis in children. Another symptom of nervous phthisis is an insatiable thirst. Water bloats when the disease has reached a high stage ; wine, which is always injurious in cases of acidity of the stomach, increases it, and has a heating effect ; and PURULENT CONSUMPTION. 259 beer, besides increasing the acidity, also creates a dryness, so that at the close of his days, the patient is hardly able to find an appropriate beverage. A good remedy is the exclusive use of milk or whey, and as a medi- cine, administer the following preparation : muriate of ammonia, muriate of quinine, powdered rhubarb, extract of gentian root, two grains of each, make into eighty pills, roll them in powdered cinna- mon ; dose, two pills every three hours. Calisaya bark also is ot good service : take calisaya bark forty grains, and three pints of water, infuse for twelve or fourteen hours, shake frequently, strain, and drink a cupfull three times a day. PURULENT CONSUMPTION. Purulent consumption manifests itself in a similar way as does nervous phthisis, by hsemaporia, emaciation, connected with flac- cidity, debility, and a continuous state of inflammation, forming pur- ulent matter, and destroying life. This form of consumption is the result of either accidental causes, or, what is much more usual, and there- fore of greater importance, it develops itself from a deeply seated germ. To describe clearly this predisposition, and picture it in its true colors, is one of the objects of this work ; it differs only in a few symptoms from nervous phthisis. Here also we discover the germ for purulent consumption already in small children, particularly in those who are given to bleeding of the nose, and who in their youth suffer from haemoptysis. Their cheeks are red, chests contracted and weak, and the slightest motion puts them out of breath, and causes a short, dry cough ; their activity is great, but they soon tire, because they do not possess the power of endurance. With girls, menstruation does not set in at all, or, if nature has removed the obstacles, it occurs most imperfectly. Menstruations are extremely irregular, and frequently, having hardly set in, cease again for a long time, or forever; at other times the menstruation is excessive, and exhausts the girl. If, subsequently, phthisis makes its appearance, it is erroneously sup- posed that it has resulted from irregularity of menstruation. Both spring from the same source ; the irregularity of menstruation is simply the precursor of consumption. It is therefore very wrong and 260 GENERAL DISEASES. injudicious if, under such circumstances, every effort is made to force this hemorrhage, and if stupidity is successful in producing that for which nature has not furnished material, then full developed phthisis is sure to follow with greater speed. The symptoms here are the same : recurring catarrhs and inflam- matory chest difficulties, which are the more sure to follow, if nose- bleeding is stopped with astringent remedies. Bleeding of the nose in these cases should be mitigated by rest and cooling, antiphlogistic means ; it must not be suddenly suppressed unless there is great neces- sity for it, otherwise the danger of phthisis is largely increased. The predisposition for this species of consumption, where it has taken root, is continually growing from childhood to the age of youth. From that time up to the age of manhood the danger culminates, but grad- ually diminishes, so that the beginning of old age brings perfect security against it, if not then produced by external causes. The nearer such a person approaches the middle age of life, the easier will a slight cause produce phthisis. For that reason the utmost care should be exercised at that time. PHTHISIS TUBERCULOSA. Phthisis tuberculosa is the most usual and also the most fatal form of phthisis. In purulent phthisis, as we have seen, there exists too great mobility and heat in the blood ; in that form of phthisis the seat of the disease is in the glands, which have a morbid tendency ; this has been observed at the dissecting table. In phthisis there is secreted from the blood into the pulmonary tissue a coagulating, greyish and yellowish mass. This mass, which almost always settles at first in the apex of the lungs, assumes in most cases the form of tubercles, and for that reason it is called tuberculous mass. These tubercles are not rarely found stuffed into the pulmonary tissue, thus crowding out all air. The deposit of this mass always occurs with the increased afflux of blood to the affected part of the lungs, and for that reason small vessels, surcharged with blood, burst, which causes spitting of blood (hsemoptisis). After this tuberculous mass has existed for some time, it is subjected to a change in one of two directions : it either dries up entirely and becomes hard, or it softens and liquifies gradually to PHTHISIS TUBERCULOSA. 261 a thick, cream-like fluid, which putrifies by coming in contact with air, and may thereby become very caustic. In the case first mentioned, the dried, hard tubercles, which are discovered in the apex of the lungs of apparently healthy persons, remain there during life without causing any trouble. In the second case, the liquified mass corrodes and destroys the surrounding lung tissues forever. A number of tubercles are formed, the contents of which (liquified tubercle mass and destroyed lung tissue) is either expectorated by coughing, or it gradually dries up into a chalky mass. This destructive process, which is called phthisis tuberculosa, or tuberculosis pulmonalis, spreads irresistibly, gradually attacks the whole lungs, and invariably results in death. Nature, but never a physician, raises an unsurmountable barrier, separating the deceased part from the healthy part of the lung. In this condition, and with the remaining part of the lungs, be the same larger or smaller, a person may live well and for some time, if prudent in his ways, even if for some time after he expec- torates by coughing destroyed lung tissue and liquified tubercle mass. No anxiety need be entertained, therefore, on account of the obstinate cough, expectoration, or temporary blood-spitting. The condition of consumptive lungs already existing, need not be feared, but that which may subsequently be added to it, that is, a new deposit of tuberculous mass. It must be healed, because it endangers life. This disease does not show the rapidity and mobility attending pur- ulent consumption. The redness of the cheeks is not so clearly defined; the color of the face is mostly greyish, pale, frequently blackish-yellow; the skin rough, dry, and parchment-like to the touch, and even the white of the eye has a pearl-colored hue. The eye, which in purulent consumption reflects by its lustre the inward fire, is here dim and heavy. This disposition is usually found in per- sons with black hair and eyes, while in the case previously mentioned, persons with blue eyes and flaxen hair are met with ; the blood also is remarable for its unusually dark color. Although scrofula, if not cured, may subsequently be the cause of tubercular phthisis, yet there is nothing in common between the two diseases, except their seat. Where in scrofulous diseases everthing is bloated and watery, every- thing is here juiceless, withered and dried, and hence frequently the highest degree of emaciation exists. Much later than in purulent 262 GENERAL DISEASES. consumption does the predisposition for phthisis tuberculosa pass into the fully developed disease, and a person may reach the age of forty before it reaches the last stage. The course of the disease is entirely different and much slower than that previously discussed, and skill is often enabled to prolong life for some time, although the disease has run its course. Phthisis tuberculosa is usually connected with a melan- cholic or phlegmatic- melancholic temperament. The patient therefore shows great dejection and utters complaints ; his condition fills him with much anxiety, although he errs and places the disease in the abdominal part of the body, paying less attention to the pectoral part ; he is always cross and angry, and frequently wishes himself dead. All " evacuations are lessened by the dryness of the body, and his bowels are generally costive, and the alvine evacuations hard. The sluggish circulation of the blood causes stagnation and pressure in the chest, pain in the back, a constant inclination to cough, and frequent attacks of palpitation of the heart. With the short cough there is but little expectoration, consisting of a small quantity of tough, frothy saliva and fetid, cheesy matter, which in this form of phthisis appears sometimes from the beginning. An inclination for chalky deposits does not occur in the lungs alone, but arises also in other organs, and particularly in those of the abdomen. The patient therefore frequently complains of a feeling of spasmodic constriction, as if the abdomen was pressed with a belt. These deposits irritate the lungs, which induces inflammation and suppuration, and finally hectic fever, the course of which, however, is in this case much less rapid than in purulent consumption. In cases where the lungs have already become affected by tubercular formations, the patient is at once attacked with cough, particularly when leaning with his back against some hard substance, and nothing will appease it until he sits up free. The cough, which almost resembles a dry spasmodic cough, is much more easily excited than any other cough ; it even follows ordinary conversation. Hoarseness also is much greater than usual. Aside of these attacks, the cough is inconsiderable and dry at the beginning of the disease; it disappears allogether for a time but returns soon. If the disease has extended further, changes in cough- ing are noticed. With some patients the cough remains dry to the time of death, or a small quantity of mucus is expectorated only. PHTHISIS TUBERCULOSA. 263 With others the cough is very violent ; the attacks are frequent and very trying, disturbing the patient particularly at night and in the morn- ing. In others again it is somewhat spasmodic and resembles whoop- ing cough. During the progress of the disease, the cough in some cases becomes less violent and less frequent, and in very rare instances tubercles form and increase without any cough. Expectoration very rarely occurs in the beginning of phthisis tuberculosa ; it makes its appearance usually when the disease has progressed some weeks or even months. At first the expectoration is usually transparent and foamy, and scarcely differs from saliva. By degrees, small, turbid, greenish-yellow or ash-colored little lumps appear, which partly sink and partly swim in water ; they have small fine threads between them, and are sometimes streaked with blood. As the disease progresses, the ash-colored little lumps become constantly more numerous. They are not present, however, in every instance ; on the contrary, the expectorated mass consists sometimes of dirty, whitish, slimy, purulent matter, which partly swims and partly sinks in water. This continues until a few days before death, when a dark, rusty-colored, fetid expectoration appears, which signifies the early dissolution of the patient. In a few cases, small, chalky lumps are coughed up. Much labor has been bestowed to discover whether the expectora- tion contains matter. This labor is quite superfluous, because true phthisis pulmonalis may exist, and the patient die, and yet genuine matter may not have been noticed in the expectoration. As long as such patients remain quiet and do not speak, their breath- ing remains free ; but if they speak rapidly and loud, they soon lose their breath; with some, strange to say, breathing remains undis- turbed even whilst walking or talking. But if tubercles have been already formed, the breath usually becomes more or less difficult, and with the increase of number and size, the breathing difficulties also increase ; they grow with every little excitement of the mind, and after meals are particularly trying to the patient. The spitting of blood is so usual that it may be assumed that of five who suffer from it, there is but one who has not tubercles, and that of six who have died of phthisis tuberculosa, there was but one who had not expec- torated blood. 264 GENERAL DISEASES. QUICK CONSUMPTION. This disease begins with an ordinary catarrh, and usually progresses irresistibly. The patient grows constantly paler, and becomes more emaciated with coughing, expectorating, spitting of blood, and fever, the latter sometimes resembling the ague. This form of phthisis advances rapidly, and in a few months from the time the first decided symptoms have appeared, the largest part of the diseased lungs is destroyed, when death sets in. It is self-evident that I can give here only a short sketch of the malady and its treatment, as in this dangerous disease no one will fail to consult a physician from the beginning. It must be remarked, however, as has been previously stated, that there are a great variety of forms of phthisis ; in most cases it assumes a more favorable shape, and if the patient will be prudent in his mode of living, he will greatly prolong his life. It is frequently the case that with catarrhal phthisis the person attacked seems apparently quite well, or is but slightly troubled ; the attacks of dispnoea, cough and expectoration appear periodically. I cannot omit to give here a few tried prescrip- tions, which have proved beneficial in all forms of consumption. CURE OF PHTHISIS. Remedy for night-sweats : Take two nutmegs, one ounce of alum, and two small teaspoonsful of cloves, pulverize the whole, and put it in one pint of brandy; if brandy cannot be had, use whisky; dose, a tablespoonful three times a day. The bottle must be well shaken before the medicine is taken. Another remedy ; Take sixteen drops of aromatic sulphuric acid in two tablespoonsful of water, mix with sage tea and drink frequently ; or take one quart of brandy and two ounces of common salt, put in a bottle, and place it in the sun from three to four hours until the salt has settled and the brandy has become clear again ; pour off the brandy, and wash the abdomen or the whole body with it mornings and evenings. Pour fresh brandy on the sediment remaining in the bottle, and keep for use.. CURE OF PHTHISIS. 265 A very valuable remedy for the cure of consumption, phthisis pulmo- nalis, phthisis tuberculosa, and lung diseases gene/ ally. I have used it in my practice with great success : Herba Marrubii agrestis (Stachys germanica), Speedwell, ... Elecampane root, - Black snake root, - Mugwort, - Wall wort, - Hyssop, - Sage, .... Wild cherry bark, Sweet flag, ... Wood Betony, - Lungmoss, - - St. John's wort, Blue violets, Polypody root, - - Licorice root, - Violet root, - Anisseed, - Licorice juice, - Chicory root, ... Rhubarb, - Manna, Wild thyme seed, Cumin seed, Mullein flowers, These dried herbs and roots must all be cut up fine and pulverized, pour on them two gallons of well-water, and let it stand from twenty- four to thirty hours, place it on the fire in a well-covered vessel, and let it boil until reduced to one-half, then strain through a cloth. After the fluid has been entirely separated, place it in a well-covered kettle, add two pounds of rock candy, and boil it down to one-half again ; take it off the fire, let it cool, and add one pint of spirits of wine and ten drops of spirits of hartshorn. Dose, one tablespoonful every two or three hours. If this medicine is to be administered to children, or ounce. ounces. y 2 ounce. 266 GENERAL DISEASES. to people suffering from heart disease, the spirit of hartshorn must be omitted. I have prescribed this medicine in cases which seemed incurable, with excellent success, and it has proved beneficial in the most obstinate cases. Another remedy : The following also is an excellent remedy in lung diseases : Syrup of marshmallow root, - -2 ounces. Syrup of squill root, 1 ounce. Oil of sweet almonds, - - 2 ounces. Licorice extract, - - - 2 " Syrup of poppy heads, - - 1 ounce. Tincture of myrrh, - - - y 2 " Mix the whole in a bottle and keep in a dry place. Dose, a tea- spoonful every two hours. If the patient has a vigorous constitution, a tablespoonful may be administered every four hours. Another remedy, which has acquired a very good reputation in lung diseases : Skirret, leaves and flowers, - 2 ounces. St. John's bread, - - - 2 " Marshmallow root, - - 2 " Licorice root, - - - - 2 " Linseed, - - - - 1 ounce. Centaury minor - - 2 ounces. Anisseed, - - - - 1 ounce. • Coltsfoot, - - - - 1^3 ounces. The dry herbs and roots are cut up fine and mixed ; then add one gallon of well-water, let stand twenty-four hours, put on the fire, cover up well, and let it boil down to one-half; the fluid is then decanted, put on the fire again, and one pound of sugar added to it, and boiled down again to one-half; take it from the fire, let it stand until cold, and add three ounces of spirit of wine. Dose, a tablespoonful every two hours. This medicine may be prepared in another way : take all the dry herbs and roots, cut them up small, put them in a stone jug, pour on them two quarts of the best whisky, and let it stand forty days in the sun or some other warm place. Shake it up well every day, and at CURE OF PHTHISIS. 267 the expiration of the forty days it is ready for use. Dose, for weak persons, one tablespoonful three times a day ; stronger persons may take a tablespoonful every three hours. The mode of preparing it by boiling, given above, is better for women, young people or children. Another valuable remedy is the lung syrup ; it is prepared as follows : Arrow root, Sarsaparilla, Wild cherry bark, Manna, Flax seed, Elm bark, Quince seed, Licorice juice, Star anisseed, Fennel seed, 2 ounces. 2 2 " i ounce. i i 2 ounces. 2 " 2 " i ounce. Boil the whole in two gallons of soft water until reduced to one gal- lon, strain through a cloth ; place it on the fire again, and let it boil down to two quarts, add three pints of molasses, and boil down to a thick syrup. After the syrup has boiled sufficiently, add three ounces of burdock root juice. Dose, one tablespoonful three or four times a day. Another remedy : Cod liver oil is also a very good remedy. Take two ounces of cod liver oil, two ounces molasses, and one ounce of olive oil, boil slowly for six minutes, take it from the fire and stir until cold. Dose, one tablespoonful three times a day. Another remedy against phthisis : Dandelion root, Larch-tree bark, - Rhatany root, 2 Marygold root, - - - 4 " Saltpetre, - - 1 ounce. Elecampene root, - - - 2 ounces. Licorice root, - - - 2 " Boil in one and one-half gallons of water until reduced to one half, strain through a cloth, add three pints of molasses, and boil down to a syrup. Dose, one tablespoonful three or four times a day. 4 ounces 6 " it 268 GENERAL DISEASES. Another remedy : Common houseleek syrup, - 2 ounces. Syrup of squill, 1 ounce. Balsam of lobelia, - - - y 2 " Marshmallow syrup, . - - . 2 ounces. Tormentil root syrup, - - 1 ounce. Tincture of myrrh, - - . - y " Balsam of tolu, - - ° y " Mix the whole of this together; dose, one teaspoonful three or four times a day. More or less may be taken of this, according to the condition of the stomach. Another remedy : Rub the body twice a day with camphor oint- ment, opodeldoc, or pine oil. ATROPHY. Atrophy attacks preferably children and young people, from the first to the fourteenth year. The cause of it is scrofula, and its seat chiefly the mesenteric glands, which swell and become obstructed, subjecting the whole to suffering. The longer the malady lasts, the more degen- erated become the mesenteric glands } they fill up with a lardaceous, cheesy substance, and also become suppurated. The little patients gradually become more and more emaciated, the pale skin becomes withered and flabby, the face looks peevish, the whole body, with the exception of the abdomen, shrinks, which becomes unproportionately large, and in which the mesenteric glands, swollen to the size of pigeons' or hens' eggs, may be felt. The object of the treatment is the removal of the causes, which, aside of hereditary predisposition, are unsuitable food, overfeeding, impure air, uncleanliness, &c. If no effort is made to effect a change in that respect, no favorable result can be expected from treat- ment. Easily digested food, pure, dry air, frequent change of linen, lukewarm baths twice or three times a week, are essentially necessary for a recovery. Acorn coffee for larger children, and a mixture of milk and not too fat broth for smaller children, is often more useful than all medicines. The best adapted among the latter are the diluent, laxative and strengthening, such as rhubarb, antimony, &c. Dose, for children under three years of age, from one to three grains, HEPATITIS INFLAMMATION. 269 children over three years of age, from three to six grains. The treat- ment does not materially differ from that laid down for scrofula (see "Scrofula"). HEPATITIS. The liver is a very highly important organ of the body. It prepares the bile, the proper condition of which is indispensably necessary for the digestion of food; aside of that it purines the blood. It is there- fore easily explained why diseases of this organ deserve so much attention. As for instance, in inflammation of the chest the disease assumes a different form, according to whether the membrane cover- ing the lungs, or the pulmonary tissue itself, is in a state of inflamma- tion, so does inflammation of the liver, be it acute or slow, appear in two different forms. INFLAMMATION OF THE PERITONEAL COATING OF THE LIVER. The following are the symptoms of this disease : a sudden attack of violent pain on the right side below the short ribs, which is increased if pressure is applied to the painful spot ; considerable fever and bilious vomiting, the patient cannot lie on the left, which is the healthy side. The last is frequently the only symptom by which the disease can be distinguished from pleurisy, because in that disease the patient cannot lie on the affected side. Sometimes, however, pneu- monia and hepatitis occur at the same time, inflammation of the lungs being very readily transmitted to the liver. The causes of this disease are not well understood ; among them, however, are the fol- lowing : contusion from external violence, a fall, &c, intense sum- mer heat, violent physical exertion, colds, sleeping in damp clothes, &c. Persons predisposed to rheumatism, are readily attacked by it. Treatment: Bleeding, the application of leeches, particularly at the rectum, or cupping, Spanish fly plaster, and the following mix- ture : freshly expressed lemon-juice twenty grains, carbonate of potassa sufficient to saturate the acid of the lemon-juice, linden-flower water one hundred and twenty-five grains, almond water five grains, sugar fifteen grains ; dose, a tablespoonful every two hours. If the inflammation does not soon disappear, make embrocations of blue ointment, until the breath becomes offensive, and in obstinate cases until salivated. 2T0 GENERAL DISEASES. INFLAMMATION OF THE HEPATIC SUBSTANCE. This is a very deceptive disease, and often not understood; it changes most unexpectedly to suppuration. If it appears in a very covert way, the patient is taken with a chill, which changes to heat with a heavy, clammy exudation. Without any indications of liver disease, these fever attacks return irregularly. The patient, although feeling very sick, has no idea of the great danger which is threatening him. As the disease progresses, heavy chills and night-sweats occa- sionally manifest themselves, the pulse becomes quicker, the tongue is coated, and the patient runs down. For the first time symptoms of a serious abdominal difficulty appear ; digestion is greatly affected, spasmodic pains, with tenesmus, are added, and the patient dies with the symptoms of nervous fever, as a consequence of suppuration of the liver. Most cases are accompanied by the following symptoms : a feeling of heaviness and pain in the right side and shoulder, or between the shoulder-blades ; yellow or pale complexion ; great dejection ; lack of appetite, inactive stool ; the urine is very dark, and deposits a red sediment and thread-like mucous masses. The disease is usually more or less accompanied by fever and dry heat, to which is added a dull pain in the right side, resembling that in pleurisy. In lying down, an uncomfortable feeling is noticed, and breathing is oppressed ; a dry cough sets in, and sometimes nausea and vomiting. If, after some time, the malady becomes chronic, the following symptoms are usually added to those above mentioned : flatulence, gastrodynia, bad breath, a very heavily coaled tongue, indigestion, yellowish complexion, and yellow color of the white of the eye, clay- colored alvine evacuations, and gradually increasing emaciation. These symptoms make their appearance so gradually and in so mild a form, that they are scarcely perceived, until finally large abscesses, or internal accumulations of matter are formed, followed by hectic fever, under which the patient sinks, the abscess not opening at all. In case of a strong constitution, and if the strength is not exhausted, it often happens that between the part where the abscess has formed, and an adjoining part, an adhesion is established, or that they grow together, while the matter finds an outlet through the various pas- sages with which this organ is connected ; it is discharged by vomit- ing, coughing, and evacuation of the bowels. Not rarely the abscess SLOW INFLAMMATION. 271 opens internally. The patient then usually recovers, except his con- stitution was already too greatly weakened, which the sanative powers of nature, even if supported by medicines, can overcome. Inflam- mation of the liver is much more frequent in warm than in cold countries, and there is always a disposition for the formation of abscesses. Persons going to a hot climate, who are predisposed for that disease, should be exceedingly cautious in their diet, because people who live sumptuously are more readily attacked than those who live moderately. The treatfnent of this disease rarely requires bleeding, but always an application of leeches to the anus, and cupping. The most im- portant remedy is mercury, which cannot be applied too soon, and must be carried to salivation. This should be done under the direc- tion of a physician, and also the succeeding use of the Karlsbad. In juxtaposition with these two forms of acute inflammation of the liver are two others with less rapid termination. In regard to treatment there is no difference, but there is as to symptoms and termination. SLOW INFLAMMATION OF THE PERITONEAL COATING OF THE LIVER. Acute inflammation of the liver may terminate without an imme- diate recovery of health. Repeated attacks of this disease leave the external membrane of the liver in a slow state of inflammation, or at least inclines it to change into it. But there are cases when, without a previous acute inflammation, the coating of the liver is attacked by a slow secret inflammation. Its symptoms are heaviness, with a feeling of fullness under the short ribs of the right side ; chilliness, with occasional irregular attacks of fever, burning skin, thirst, a brown or white coated tongue, a hard but not frequent pulse, -alternately very dark or very slightly colored alvine evacuations, nausea, disturbed digestion, not infrequently dysenteric symptoms, jaundiced skin, muddy and highly colored urine, pain below the right clavicle, in- ability of lying comfortably on the left side, and disturbed sleep. Treatment : Apply leeches in the hepatic region and the anus, and administer the following laxative,: tamarind pulp three ounces, 272 GENERAL DISEASES tartrate of potassa eight grains, water one quart ; dose, half a cupful every two hours. SLOW INFLAMMATION IN THE LIVER. Symptoms : A heavy feeling of fullness in the right side ; the liver feels as if enlarged ; the patient is disinclined to be examined ; tight clothes are uncomfortable to him ; pains on the shoulder or over the right shoulder blade, sometimes down the right side of the back, with occasional dyspncea. Although the patient assures that he can rest on either side, yet he prefers to lie on the right side, and sleeps lying on the back ; viscous tongue, with a brown coating, and dry in the morning ; the pulse is but little changed ; the skin hot and dry, or cool and viscous ; chills, flatulency and disturbed digestion, evacua- tions greatly varying, being black or green and foamy ; hemorrhoids ; urine muddy, with brick-like sediment ; sleep very restless and not refreshing; state of mind, gloomy; complexion, yellowish and sickly. Cause of the disease, immoderate eating and drinking. I think I have described the disease with sufficient clearness to enable my readers to seek timely advice. For, if the disease is permitted to progress without check, the whole liver becomes diseased, tubercles and ulcers form, and the patient dies of dropsy or emaciation ; or the liver changes to an organically degenerated mass, which causes death by ceasing its function and suppuration. Treatment : If the patient is costive, an injection is given, con- sisting of one pint of water and one tablespoonful of linseed oil, or a decoction of camomile, of honey and lard each a tablespoonful. In cases of costiveness, calomel is recommended ; drink half an ounce boiled in water three times a day. Dandelion is a favorite remedy in liver diseases ; dose, eight grains made into tea, and drink once a day. The following liver pills are recommended : tormentil root one ounce, dandelion extract one and one-half ounces, may-apple root one ounce ; make into pills of one grain, sprinkle them with rhubarb powder, and take two pills twice a day. This is an excellent remedy, and relieves pain at once. (For further instruction, see prescriptions for liver disease). LIVER SPOTS — ENTERITIS. 273 LIVER SPOTS. Liver spots are called smaller or larger yellowish-brown spots, little or not at all raised above the surface of the skin ; they appear in dif- ferent parts of the body. Their origin is not always known, but they are frequently the result of a derangement in the secretion of bile, menstruation, liver complaint, hemorrhoids, &c. In cases of that kind, the primary cause must be taken into consideration. The removal of liver spots is best effected by diluted acid : take a tablespoonful of water, and drop into it from six to eight drops of sulphuric or muriatic acid ; apply this fluid with a pencil brush to the spots; it wrinkles them up, and they peel off; this must be often repeated. In place of acid, caustic spirits of sal-ammoniac may be used (one scruple of spirits of sal-ammoniac to one ounce of water). Vinegar mixed with the juice of horseradish may also be used ; scrape the horseradish, or rub it on a grater, and add half the quantity of wine vinegar to it. The following is recommended as being one of the most effectual remedies : white hellebor (cut up small and dried) half an ounce, on which pour half a gallon of whisky, cork up tight, and expose it for eight days to the heat of the sun, or of a stove, shake it up well occa- sionally. With this tincture touch the liver spots and rub with the bare hand, or with a piece of flannel, until entirely dry ; it must be frequently repeated. In cutting up the hellebor, care should be taken not to inhale any of the dust. To remove liver spots quickly, touch them frequently with a quill and fuming muriatic acid; rough spots are formed in these places, which after some time dry up, drop off and leave a white skin. ENTERITIS. Inflammation of the bowels is a seated, burning or tearing pain, usually in the navel region, but sometimes lower down. External pressure and motion or concussion of the abdomen increases the pain. At first the pain is limited to a small spot ; it soon becomes more violent, however, extends gradually, and sometimes spreads over the whole abdomen. The abdomen becomes sensitive to such an extent as to make even the contact with the bed covers unbearable. In some 214 GENERAL DISEASES. cases the abdomen becomes bloated and expanded, and in other cases it remains as usual, or rather drawn in. If the inflammation is in the neighborhood of the stomach, the patient becomes very much depressed, and vomiting sets in ; but if its seat is lower down toward the rectum, it is accompanied by tenesmus, a discharge of mucus through the anus, dysenteric symptoms, expanded hemorrhoidal vein, and retention of urine. The pulse is always very small and hard, limbs cold, and internal heat great, features distorted and eyes sunk ; the patient is very weak, in some cases the constipation is obstinate, and in very severe cases, stercoraceous vomiting sets in, and loss of speech, fainting fits and spasms indicate the approaching end. The course of this disease, if only confined to inflammation of the bowels, is usually short. It generally sets in with a chill, at once accompanied by pain, followed by heat and severe fever, the limbs always remain- ing cold. In from three to four days, but at latest in seven days, the disease terminates either favorably or otherwise. But inflammation of the bowels, which appears in connection with other diseases, or which is added to colic, strangulated hernia, hemorrhoids, bilious impurities, worms, &c, begins and ends slower, and therefore is more difficult to diagnosticate, and may deceive even the most experienced physician. Causes of the disease : It may result from obstinate and long-con- tinued costiveness, from wounds and other injuries of the intestines, from violent colic, the use of unripe fruit, cold in the abdomen, and cold feet, drinking ice-cold water, when heated, severe purgatives, swallowing strong poisons, or pointed, hard bodies, such as needles, nails, fishbones, bones, &c, wounds or other injuries, for instance from confinement, or other surgical operations, &c. The treatment is the same as in gastritis. If the attack is severe, use ice bladders. Internally administer the following : oil of almonds six grains, gum arabic sufficient to make an emulsion with the oil, water, syrup of almonds, of each thirty grains, extract of henbane twenty-six grains ; dose, a teaspoonful four times a day. Linseed oil, which can be highly recommended, may also be administered ; dose, a teaspoonful every three hours. Buttermilk may also be administered with advantage. Externally use grey ointment, spreading it thickly upon a cloth, place it on the abdomen, where it may be kept from eight to twelve hours. If the pain has not entirely disappeared, or, INFLAMMATION OF THE KIDNEYS. 2*75 as is very often the case, it returns, the treatment given under the head of "Gastritis," must be proceeded with, which is, repeated bleeding and repeated applications of leeches, and quieting meal poultices, prepared as follows : linseed four ounces, hemlock leaves two ounces, henbane one and one-half ounces, boil in water to a moderately stiff mass, then add oil of henbane one and one-half ounces, and apply in a lukewarm condition. For internal use, take watery extract of opium four grains, sugar two grains, make into six powders; dose, one powder every three hours. When the disease abates, let the patient drink oily or mucilaginous beverages, particularly, however, the following : ground hemp seed, ground poppy heads, half an ounce of each, boil for half an hour in one and one-half pounds of water, strain, add syrup of poppy seed one ounce, and drink half a teacupful at a time. Milk of almonds, whey or buttermilk, are very conducive. If the constipation of the bowels is obstinate, injections of cold water, two every hour, should be administered ; cold sitz-baths have sometimes a very favorable effect in dangerous cases, and may subdue the inflammation without the use of any other remedy. If cold in- jections cannot be administered because the patient is unable to endure them, administer injections prepared from oatmeal gruel, to which from one to two tablespoonsful of linseed oil has been added. The injections are repeated every two hours until the bowels move. On recovery the patient must be very careful, keep his abdomen warm by covering it with flannel underclothing, and avoid all food tending to create, flatulence, and that which is hard to digest; he should also abstain from the use of heating food and beverages. INFLAMMATION OF THE KIDNEYS. Inflammation of the kidneys manifests itself by violent pain in the kidney region, extending below the last rib and bladder, or the lower part of the abdomen, and sometimes also by vomiting. The pain is increased by outward pressure, concussion of the body, such as sneez- ing, laughing, coughing and pressure in urinating and alvine evacua- tions. A feeling of expansion extends to the pubic region and even 216 GENERAL DISEASES. to the urethra. In men the testicles are drawn up spasmodically, the flesh of the seat and thighs becomes numb. The pain in the thighs frequently prevents the walking or standing of the patient ; it is in- creased by the heat of the bed. This critical disease is not easily dis- persed, and generally ends in ulceration or hardening ; it results in a kind of colic pain, called renal colic. It manifests itself by a con- siderable bloating of the abdomen, the passing off of a great deal of wind, choking, vomiting, tenesmus, costiveness, &c. According to the inflammation of the right or left kidney, the pain is increased by lying on one or the other side ; neither does lying on the back bring relief. Inflammation of the kidneys causes a pressure for urinating, but the urine is voided in small quantities and drops only. During the disease the urine becomes very red, dark, bloody, and subsequently purulent. The course of the disease is rapid, and is usually accom- panied by fever. Inflammation of tne kidneys is caused by concussions, frequently by riding in vehicles or on horseback, dancing, nephroliths, by the abuse of sharp, diuretic remedies, falling, heavy lifting, by the driving in of cutaneous eruptions, rheumatism, suppressed hemor- rhoids, &c. All this may produce inflammation of the kidneys. The treatment is the same as in the case of enteritis ; depletion, cooling and softening remedies afford the best relief, particularly leeches, which in this case are also to be placed at the anus. If the malady is the result of suppressed hemorrhoids, emollient poultices of linseed meal are to be repeatedly applied to the perinseum ; it affords relief, and so do warm sitz-baths in a decoction of emollient, muci- laginous ingredients, such as linseed, bran, marshmallow or mullein leaves ; all these ingredients may also be used for poultices. Internally administer sweetened nitric acid two ounces, oil of sweet almonds two ounces, linseed oil one and one-half ounces, mix ; dose, half a teaspoonful in a cup of warm linseed tea every four hours. If the pain is very severe, use the following for embrocation : juniper oil one ounce, oil of turpentine one ounce, ladies mint oil one ounce, laudanum one ounce, and one pint of whisky, mix, and rub in three times a day, in the back and the kidney region. CYSTITIS — SPASM OF THE BLADDER. 277 CYSTITIS. Inflammation of the bladder manifests itself by a burning pain in the bladder region, with external swelling, tension, heat and pain, hot urine of a red color, strangury, retention of urine, constipation, frequent and painful constriction for urinating, hard pulse, and fever symptoms. Occasionally the voidance of urine becomes very difficult, or almost impossible ; frequently tenesmus, nausea and vomiting are connected with it ; the voided urine is mixed with mucus and blood. It is caused by taking cold, stone in the bladder, diuretic remedies, external injuries, particularly in congestion of the hemorrhoidal veins, or rheumatic, gouty or syphilitic acridity, pregnancy, confinement, childbed, suppression of menstruation, paralysis and wounding. It is treated in the same way as inflammation of the kidneys. The patient must be kept quiet and warm ; he must avoid all spirituous beverages, coffee, spices and heavy food. A mustard plaster should be applied to the lower part of the abdomen, to be followed by warm poultices, or the patient may take warm sitz-baths. Movement of the bowels is effected by injections, which are prepared from a decoction of linseed, with the addition of a tablespoonful of linseed oil. An injection is given every hour until followed by stool. If the swelling prevents the voidance of urine altogether, it must be drawn off with the catheter. SPASM OF THE BLADDER. Spasm of the bladder manifests itself by violent pain in the lower part of the abdomen and the urethra, pressure to urinate, without power of accomplishing it ; frequently it is also accompanied by tenes- mus. Inflammation of the bladder differs from spasm by the con- tinuous, pricking, pulsating pain, with fever, which accompanies inflammation. Spasm of the bladder is induced by stone, and malig- nant swellings in the bladder, diseases of the rectum and the uterus, irritating urine and worms. For the purpose of relieving the patient from the attack quickly, he should take a hot sitz-bath, or hot poultices should be applied to the suffering part ; internally administer from one-half to one grain of opium, with sugar, until relieved. If the urine is acrid, take three times a day eight grains of bi-carbonate of potassa, with six drops of 278 GENERAL DISEASES. tincture of opium in half an ounce of camphor-water ; stone in the bladder (see article " Stone in the Bladder ") must be removed. If the spasm is the result of disease of other organs, take twenty drops of tincture of iron in water three times a day. The patient must not use spirituous beverages and spices ; the use of tobacco and excessive exertions must be avoided ; light nourishing food and mucilaginous drinks, such as flax seed tea, barley-water, gum arabic water, are con- ducive ; flannel underclothing should be worn. The feet should be kept warm, and sitting down on cold seats avoided. HEMATURIA. Hematuria consists in a discharge of blood with the urine ; it may be recognized not only by its color, which is blood-red, but also by its muddy appearance, forming blood-coagulum, with a blackish-red sediment of little lumps and flakes. Occasionally the urine has a bright red color, particularly in cases of fever, and it may also be caused by the consumption of certain coloring substances ; in the latter case, however, the urine is generally clear and transparent. Causes of hsematuria are inflammation of the kidneys, urinary passages and the bladder, stone or gravel in the bladder, bleeding hemorrhoids, finding an outlet through the kidneys, external injuries, such as a push 01 blow on the kidneys or bladder region, and the irritation of these organs by various medicinal remedies or applications, such as Spanish fly, &c. A danger of bleeding to death in this manner does not really exist, and it is therefore unnecessary to apply astringent remedies. The best treatment for cases of that kind are rest to the patient, lying in a horizontal position, and using mucilaginous drinks, particularly decoctions of linseed, oatmeal, poppy heads, solution of gum arabic, together with milk, emulsions, &c. All irritating food and beverages must be strictly avoided, and in case of costiveness emollient injec- tions should be given. If the discharge of blood with the urine is connected with irritation and pain, order warm baths, emollient, quieting poultices (see the article) to the painful part, and apply leeches or cupping-cups. In severer cases of inflammation, or discharges of blood, bleeding, cold poultices on the abdomen, thigh or perinaeum, are beneficial. ISCHURIA. 279 Under such circumstances, however, it would be better to consult a physician. ISCHURIA (RETENTION OF URINE). Ischuria is called the diseased condition, when the urine is retained in the parts designed for its secretion, by some obstruction. There are three forms of this disease : the first is bradysuria, when the flow of the urine is checked and painful ; the second is strangury, when it passes off drop by drop, and the third ischuria or retention of the urine, which denotes the condition where the voiding of the urine is entirely suppressed, and the painful pressure connected with swelling of the bladder. The general symptoms of this disease are continual, and mostly a painful pressure to urinate, when only a few drops, or nothing at all passes off; tension, pain, and bloating in the bladder region, which may be felt externally and through the rectum ; cos- tiveness; violent, rapidly increasing anxiety and restlessness; spas- modic, nervous and feverish fits ; swooning, nausea, vomiting, cold sweats, and finally death in consequence of the violent inflammation of the bladder, mortification, or the bursting of the bladder. If retention of the urine is slowly formed, inflammation of the bladder sets in gradually, which changes to a thickening of the walls of the bladder, and other variations, consuming the strength of the patient with a slow fever. According to the causes, producing a retention of the urine in the bladder, the disease is designated as being either in an inflammatory, spasmodic, paralytic or obstructed condition. The Inflammatory Retention of the Urine is characterized by its rapid course, heavy pressure, deep-seated pain in the bladder region, fever, &c. The inflammation readily extends to the bowels. It is seated either in the bladder itself, or in the neck of the bladder, or in the urethra. It is the result of injuries to these parts, in fistulae of the anus, gonorrhea, stone in the bladder, the use of tincture of can- tharides or large bladder plasters, and from other causes. In Spasmodic Retention of the Urine, the neck of the bladder or the urethra is narrowed by an increased contraction of the muscles. It frequently attacks nervous people, or those suffering from hemor- 280 GENERAL DISEASES. rhoids, or it is the result of a cold, the use of unfermented beverages, worms, &c. (as has been stated under the head of " Inflammation of the Bladder "). Another symptom by which it is known, is thai it seemingly creates a feeling of cold in the bladder. It comes and passes off quickly, without any inflammatory indications, which mani- fest themselves only in case the malady continues for some time. The Paralytic Retention of the Urine is of slow growth ; the urine is not ejected with sufficient force ; the necessity for it returns at short intervals, but is always unaccompanied by proper success and with great exertion. The bladder forms a large swelling, mostly with- out pain, from which a portion of urine may be sometimes emptied by pressure. Frequently, however, inflammation, pain, fever, vomit- ing, &c, are added to it, the bladder becomes gangrenous, or bursts. This malady attacks old people, or voluptuaries and old drinkers, where the spinal marrow is already in an incipient state of paralysis, and also in consequence of a frequent and prolonged retention of the urine. The Retention of Urine from Mechanical Causes is the result of an organic malformation of the bladder, or the urethra; for instance, a thickening of the membrane, enlargement of the bladder, swellings of various kinds on the bladder, the prostrate glands and surrounding parts, a growing together and contraction of the urethra. It also manifests itself if foreign substances enter the bladder, such as stones, coagulated blood, matter, and accumulations of mucus, the expansion of the rectum or uterus, or if the latter are crowded from their position. The symptoms occurring under these circumstances, have been stated already in general terms. In treating retention of urine, which naturally should be done only by a physician, the causes and the diseased condition upon which they are based, should be taken into consideration. It is either anti- phlogistic, antispasmodic or irritating* In cases of inflammatory urine retention, mucilaginous drinks, and calomel and opium should be administered. Mix twelve grains of calomel with one grain of opium, divide into four parts ; dose, one part twice a day. The application of lead plasters should be avoided. The introduction of a catheter should only take place after the men- tioned remedies have been applied for a time. CATHETER. 281 Spasmodic urine retention is treated with the application of warm poultices of camomile, henbane and linseed meal on the lower part of the abdomen and the bladder region, and by embrocations with volatile ointment, opium, oil of henbane, and antispasmodic injections. Internally administer Dover's powder, six grains twice a day • or the following may be taken : lycopodium forty grains, mixed with six ounces of thin syrup ; dose, a teaspoonful four times a day. In cases of hemorrhoids, administer sulphur with prepared cream of tartar, as follows : prepared cream of tartar twelve drachms, sulphur ten drachms, mix thoroughly, divide into six parts ; dose, one part three times a day. In case of worms, take worm remedies. Treatment of paralytic urine retention consists in drawing the urine from the bladder with the catheter, and in a restoration of the power of contraction. The catheter is repeatedly applied until the urine flows through it in a full, uninterrupted stream. The power of con- traction of the proper muscles is strengthened by cold washing, poul- tices and elixirs, embrocation of volatile and irritating ointments in the region of the bladder, and internally by arnica, Spanish fly (in substance with camphor or in tincture with almond milk). Cold baths, vesicatories applied to the small of the back, and electricity, are bene- ficial. In cases of retention of the urine, resulting from mechanical causes, the inflammatory irritation must be removed by antiphlogistic reme- dies; the catheter must be frequently used, which alone often removes the obstruction ; the causes must be removed by appropriate remedies. CATHETER. This instrument is a tube which is inserted through the urinary passage into the bladder, in order to open free exit to the urine. There are two kinds of catheters, flexible and inflexible. The first named is preferable. It consists of a cylinder of silk tissue, lined inside and outside with rubber. Others are made of metal, usually of silver. Catheters are made for males and females, differing in form. As cases may arise where patients are obliged to apply the catheter themselves, I will here explain the mode of introduction. Take the penis with the thumb and index finger under the glans penis, extend it somewhat upward and forward, and at the same time open 282 GENERAL DISEASES. by gentle pressure the meatus urinarius. Then take the catheter pre- viously selected and which must be warmed and greased with olive oil, at the lower end, and insert the upper end in the meatus urinarius, so that, if it is a metal catheter, the hollow side is turned toward the abdomen, and shove the instrument in further by gently turning it, at the same time pulling the urethra upward. The introduction of the catheter in a woman is much easier effected, and with very slight instruction, women will generally be able to apply it themselves. NEPHROLITHS— STONE IN THE BLADDER. GALL-STONES. Stone-like concretions are formed in various organs of the body, particularly in those which contain or secrete a fluid, for instance, in the salivary glands, gall-bladder, urinary bladder, &c. They are formed from substances contained in those fluids which gradually hard- en, and are apt to give considerable trouble. Among these hardenings we will consider here only the stone in the bladder, which consists of different kinds of earth and salt. The so-called gravel in the bladder. is composed of the same ingredients. These concretions appear more generally in the bladder, frequently, however, also in the kidneys, the urethers, the urethra, under the fore-skin, &c. The formation of the stones in the bladder is firm in some instances, and in others soft, sandy and brittle ; the surface is smooth, knotty, or rather mulberry- like. In the interior they are firm, uniform, and frequently composed of different stratifications, often showing a variety of hues. The cen- tre of the stone is formed either of a foreign body, or of one of the ingredients mentioned. The size differs according to locality where found and the material of which it is composed. The nephroliths are formed in the renal calix and the pelvis of the kidneys, and are gen- erally found in one of the kidneys in larger numbers, assuming dif- ferent shapes corresponding to the shape of the place where located. They generally cause a dull, pressing, straining pain in the kidney region, and also nausea, vomiting, haematuria, inflammation of the kidneys, &c. The treatment of this malady, which is frequently tedious, and sometimes fatal, can only consist in the application of alleviating STONE IN THE BLADDER. 283 remedies. Stones in the ureters descend from the kidneys. They move down gradually under violent pain, the accumulated urine greatly expanding the ureter above ; in favorable cases they finally slip into the bladder, when the pain diminishes, and they change into stone of the bladder. Stones in the bladder are generally already formed in the kidneys. They descend through the ureters and increase in size in the bladder, some foreign or morbid solid body, such as a little lump of coagulated blood or viscous mucus of the bladder, sediment of the urine, &c, forming the nucleus. This is gradually covered with substances existing in the urine, or produced by a morbid condition. The stone varies in size from an almond to a hen's egg, or even larger. In most cases the stone lies free at the bottom of the bladder, but sometimes it is retained in certain places. The following symptoms point to the presence of one or more stones : the patient has an annoying feeling of warmth or tickling at the mouth of the urethra, which becomes easily inflamed. This feeling changes to pain by degrees, which manifests itself particularly in urinating, for which the pressure is always great. The stream of urine is frequently inter- rupted thereby ; this strangury produces the most excruciating pain, and the patient only finds relief by lying on the back, or by drawing up his legs and pressing the perinaeum upward. The severest pains occur previous to, or after the passage of the last drops. With this occur erections of the penis, pollutions, prolapsus vaginae, and prolapsus recti, and involuntary discharges from the bowels ; the two last particularly in children. All these symptoms are increased by physical exercise, emotions of mind, or the use of heating food or drink. The urine voided is usually pale and clear, but frequently also muddy ; it has a slimy sediment, and an offensive smell. The irritation of the walls of the bladder produces a gradual, slow inflam- mation, and the urine becomes muddy and slimy. The bladder thickens up, contracts around the stone, and finally passes into a state of suppuration, and becomes perforated, when the patient succumbs, generally with the symptoms of a slow fever. As causes for this disease are given, living in swampy places, a cer- tain hereditary disposition, the consumption of a great deal of cheese, particularly old cheese, hard drinking water, too much acid wine, a a predisposition for hemorhoids, gout, a flow of vesical mucus, &c. 284 GENERAL DISEASES. The treatments either surgical, or by the administration of medi- cines. In the latter instance, lime-water, magnesia, carbonated alkalies, particularly mineral waters containing those alkalies and acids, are administered, or similar solutions are injected into the bladder for the purpose of dissolving the stone directly ; among these are atten- uated caustic lye, and attenuated acids. The cases of success by these means are very rare, however, and for a complete removal of the stone, nothing remains but surgical treatment, that is by lithotomy. BUBO. Bubo is a swelling or inflammation of the inguinal gland, which, according to circumstances, results in dispersion, or suppuration, but rarely in a hardening. The locality in which the malady appears, may sometimes lead to a confounding with hernia, therefore we will here remark that hernia frequently makes its appearance suddenly; its form, size and appearance usually remain the same ; it only increases in size by drawing a long breath and coughing, but immediately assumes its former shape again. It is a rounded-off swelling, and has no connection with any other external diseases manifesting themselves at the same time. The bubo, however, clearly shows a development ; it increases gradually, and color, hardness and form change ; it rarely makes its appearance disconnected from other diseases which manifest themselves at that time. The bubo orignates from various causes. First, there are rheumatic and catarrhal bubos, which are caused by colds, and require the same treatment as given for axillary abscess under similar circumstances (see the article). Bubos sometimes originate in youth while growing, but they disappear again of their own accord, by keeping quiet. Sometimes they appear in consequence of some other disease, particularly after attacks of fever. In such cases bubos keep abreast of the irritation, by which they are caused, and consequently the treatment ought to be directed against the cause. Dispersion of the bubo, to which treatment should be directed, may be effected by lukewarm poultices, prepared from dispersing herbs, or linseed with lead-water, or by the application of leeches near the place where the inflammation is greatest. If the inflammation is very irritable, add to the poultices henbane or hemlock leaves, or use the RUPTURES OF THE ABDOMINAL CAVITY. 285 oil of henbane as an embrocation. To make these remedies more effectual, use grey mercurial ointment, and extract of henbane, equal parts, with which rub the parts surrounding the bubo. If, after removal of the inflammation, a hardness should remain, use volatile liniment, with or without camphor, mercurial plaster, and also iodide of potassa. Bubo, resulting from syphilitic disease, will be treated under the head of " Venereal Diseases." RUPTURES OF THE ABDOMINAL CAVITY. Rupture is the partial or total extravasation of a part of the intes- tines from its cavity into the integument. The extravasated part of the intestine is usually enveloped in a sack, consisting of cellular tissues, and a part of the integument lining the cavity from which it was extravasated, and which is called hernial sack. As to size, rup- tures differ very much. They are frequently so small as to be scarcely discernible, and often so large as to embrace two-thirds of the whole intestines. Ruptures are divided according to the locality where they have their seat, and from which they derive their name ; thus we have encephalolcele, pneumocele, bubonocele, omphalocele, oscheocele, &c. I will discuss here only the ruptures of the abdominal cavity. Ruptures are distinguished by the following characteristics : a swelling arises, either gradually or suddenly, which is either soft or stretched, but color and painless, elastic, and formed according to the opening from which it was extravasated in that part of the body, corresponding to the projecting intestines. It is con- nected with various derangements. The swelling may be easily pressed back in some cases ; when the patient coughs, a concussion will be felt in the finger held on the spot. TJte treatment is either mitigating, by pressing back the extravasated parts, and the application of a proper truss, or by an operation. Bubonocele projects through the enlarged inguinal ring on one of the sides ; it is called oscheocele if it is let down into the scrotum, and hernia labialis if let down into the labia cunni. The danger and prospect of recovery or amelioration of the disease depends on par- ticular circumstances. If the person is young, and the rupture of recent date, it may be easily reduced and kept in its proper place by 286 GENERAL DISEASES. properly placed trusses, so that the opening through which the hernia passes, heals up. The patient may subsequently lay aside the truss. Older persons, if not wishing to submit to an operation, must wear a comfortable, well fitting truss. The most common causes for rupture are violent exertions, lifting of heavy weights, jumping, external hurts, such as a push or blow on the abdomen, violent coughing, vomiting, or screaming, the playing of wind instruments, &c. Per- sons following the latter occupation are usually somewhat inclined to hernia. Strangulated Hernia is extremely dangerous, and consists of a strangulation of the prolapsed intestine through the opening, some- times causing inflammation, pain, and spasmodic constriction. The hernia itself may have distended to such an extent, by means of the material collected therein, as to make a reduction impossible. A reduction of hernia of its own accord is of very rare occurrence ; science must come to its assistance in most cases. If the condition is inflamed and spasmodic, it should be removed by the application of leeches and warm poultices, and the hernia reduced subsequently ; or the surgical operation of widening the opening, by which the hernia is strangulated, must be performed. If one or the other is not done soon, the strangulated part of the intestine passes into a state of in- flammation, becomes gangrenous, which is indicated by the blackish color of the pustules appearing on the skin over the place of the hernia, and the patient soon dies. The strangulation manifests itself by the following indications : obstinate constipation, which cannot be removed ; pain and tension on the spot, increased by coughing or pressure ; impossibility to reduce the hernia by proper means, subsequently a feeling of alarm, restlessness, nausea, pain, and inflation of the abdomen, fever, stercoraceous vomiting and hiccough- ing. Sometimes death occurs within twenty-four hours, and at other times only after several days. General treatment : Reduction of hernia. This is best done in the morning, before the patient has taken his breakfast ; let him void the urine, and administer a softening injection, and let him take a position on his back, so as to cause the abdominal muscles to relax. Grasp the hernia according to its size with either one or both hands, TRUSSES. 287 and gently press it from every side inwardly and upwards. If not successful in this, make the attempt to reduce first the part of the intestine lying nearest to the opening, and to gradually shove in the rest. Care must be taken, however, that the part of the intestine already reduced, does not slip out again. The patient must remain in an extremely impassive state ; he must breathe gently, must not cry out, and must avoid coughing or laughing. In small children, hernia will heal of its own accord, if they remain on their backs for some time. The place may be bathed with great benefit, several times a day, with red wine, rum, and with decoctions of laxa bark, oak, willow and elm bark. In cases of hsematomphalocele in small children, the hernia may be first reduced, and one-half of a nutmeg wrapped in cloth so placed on it that the round half lies downward. Fasten this down with pieces of strong adhesive plaster, upon which place a compress, and fasten the whole of it down with a long bandage passing around the body, which, however, must not be wound too tight. With every kind of hernia, the advice of a good physician should be obtained. I would here remark that people who live in the country, where a physician cannot always be obtained, should observe great caution in the reduction of hernia. In cases of external bubonocele, the pres- sure must be made upward and outwardly, that is toward the upper point of the hip-bone, of the same side ; in cases of hip hernia, downward and backward, and in cases of omphalocele, in a straight line backward. Every kind of violence must be avoided, and the greatest caution and care must be exercised in touching the parts, in order to avoid pain and injury. If the reduction has been successful, it is of importance to keep the parts in position. This is best done by trusses, and by keeping quiet. TRUSSES. A truss is a bandage constructed according to certain rules, for the purpose of keeping abdominal hernia in its place, and if possible to thoroughly heal it. The latter is done by keeping the inner abdomi- nal walls in a favorable position to effect a healing. Trusses are either elastic or inelastic. The latter consist of variously shaped cushions, 288 GENERAL DISEASES. constructed of wood, leather, and even sheet-iron, fastened to the affected place by means of a belt and hip straps, with hooks, buckles and buttons. Cushions of that kind are easily moved out of place, and the intestine prolapses again. The pressure resulting from these trusses may also cause severe illness. Better adapted for the purpose are the elastic trusses, consisting besides of a shield or head, of an elastic steel spring, and a supporting strap. The cushion is padded with flannel, wool or horse hair, the spring and strap are covered with linen or cotton flannel, and the whole covered with soft leather. A truss of that kind must fit closely and accurately ; the spring must possess the proper resisting power, and must be provided at each end with two or three holes, for the purpose of fastening the shield and strap ; the cushion must entirely close the opening of the hernia, and firmly and unchangeably remain in its position, so that no part may slip from under it. SUSPENSORY BANDAGE. The suspensory bandage is a flat sack, provided with a belt, which serves as a support for the male genitals, particularly of the scrotum. A suspensory bandage is not only of importance in certain diseases of the genitals, but it is also very beneficial to people in good health, who have to lift or carry a good deal, or who jump, or ride on horse- back ; by its use they are protected from many injuries to the testicles and the scrotum. To make a suspensory bandage, take, according to size of the scrotum, two square pieces of linen, cotton flannel, or vel- vet, double them and round off two corners so as to form a half circle ; of the two opposite sides one is cut out in a convex, and the other in a half-moon form. Both pieces are sewn together with the rounded-off edges, while the other edges remain open, thus forming a flat sack. Ribbons are sewn on both sides, by means of which the suspensory sack is attached to a belt, made of cotton flannel, which is fastened around the waist above the hips. On the back part of the sack two thigh ribbons may be attached and buckled to the belt. The best material for a suspensory bandage is heavy silk, or it may be knit of heavy cotton. GANGRENE AND MORTIFICATION. 289 GANGRENE AND MORTIFICATION. By mortification is understood a complete suspension of vitality in any part of the body, while life continues in the rest of the body. There is usually a distinction made between gangrene and mortifica- tion. In gangrene, vitality is not entirely extinguished, circulation of the blood continues in the larger vessels, and a recovery may be possi- ble. In mortification, vitality is entirely destroyed ; the circulation of the blood is entirely suspended, the flesh is dead, and its preservation has become an impossibility. Gangrene manifests itself by a diminu- tion of the preceding pains, heat decreases, the color which was formerly red, turns dark, bluish, and the swelling appears doughy. If energetic remedies are not at once applied, gangrene changes to mor- tification, pain ceases, and either changes to an itching, or all feeling disappears. The part becomes cold, ash-colored and black; the swelling becomes softer and finally pulpy ; the epidermis is raised into blisters, containing a dirty-colored, fetid ichor. For the treatment of mortification, where life is always in danger, a physician should be consulted as soon as possible. Only if one can- not be obtained, proceed in the following manner : If inflammation has reached a point so as to threaten gangrene, apply a number of leeches and ice cold poultices to the spot, which may be continued even after gangrene has set in. If, however, vitality of the part is lowered, apply warm, aromatic poultices of an infusion of camomile or spearmint, to which, according to circumstances, may be added more stimulating ingredients, such as spirit of camphor, oil of tur- pentine, &c. The internal condition of the patient must be at once considered, as in most cases he is exhausted and debilitated. Admin- ister strengthening and invigorating remedies, particularly wine, an infusion of valerian, camphor, and cold water, with a sufficient quantity of sulphuric acid, to give it an acid taste. The gangrenous ulcer should be cleaned, and infusions of sage, mint, rosemary, sweet flag root, camomile flowers, &c, be applied in connection with spirituous remedies, for instance, red wine, alchohol, wine vinegar, and mineral acids, such as pyroligneous acid, creosote, fermenting pulpy poultices, and particularly carrot pulp. 290 GENERAL DISEASES. USTION. Ustion is an inflammation of a peculiar character, produced by a body, the temperature of which is higher than any part of the living organism. To this belongs the effect of caustic substances, particu- larly concentrated mineral acids, which correspond with burns result- ing from fire, hot fluid, or solid bodies. This differs according to the nature of the body producing the burn, the degree of heat, and according to the duration of the effect and susceptibility of the burned part. In this respect four different degrees of burning are usually distinguished. The first degree is indicated by a slight inflammation of the skin, a vivid redness, and little pain, but without any swelling, fever, or destruction of the parts. In the second degree, the red color and swelling is greater, pain violent, with fever ; blisters are raised, which fill with a clear, yellow fluid. In the third degree, these symptoms are more intense, the cuticle separates, and gradually or at once forms blisters, which are generally pretty large, and most usually suppuration sets in. Inflammation spreads very much, and the burn may even become gangrenous. Cicatrization progresses slowly and imperfectly, leaving the place im- perfectly healed or grown over, whereby the affected part may be interrupted in, or totally prevented from, doing its functions. The fever is violent, and frequently even the mucous membrane of the intestinal canal shares in the suffering, and the consequences are spasms, vomiting, and other fits of illness. In the fourth degree, the affected part is really destroyed or burnt, that is to say, crusted over ; it looks black, and is gradually cast off by suppuration. If the injured part is not very large, the case is not much more serious than in the third degree. Prognostication in burns is not altogether guided by its extent and the organic condition of the injured part, 'if, for instance, the whole body has been scalded (perhaps by hot water), the case is much more serious than if a small portion of a principal part has been destroyed by a red hot iron. Burns on very active parts of the body usually leave scars and dis- figurations. UST10N. 291 The treatment of burns changes with the degree, extent, and the constitution of the patient in general, and the injured part in partic- ular. The lighter kinds of burns of the first and second degrees require only poultices of cold water, ice, grated potatoes, or a cold- producing solution of salts (saltpetre and sal-ammoniac), with which wine vinegar, a solution of subacetate of lead, &c, may be combined. The application of raw cotton is also recommended. If the patient is feverish, the necessary antiphlogistic remedies are employed, and a proper diet observed. If there are only a few blisters raised, prick them with a fine instrument, squeeze out the fluid, and as long as the flesh is not bared of the skin, cold applications are continued ; the blisters will contract and dry up. But if (in the third degree) a large place is deprived of the cuticle, cold applications can not be endured; the wound must be dressed with mild, oily, fatty, cooling, and drying remedies. Almond, olive, and linseed oil, made into a liniment with lime water, or subacetate of lead, may be used for that purpose. It may be prepared as follows : olive oil, or fresh pressed linseed oil, one ounce, the white of an egg, subacetate of lead ten grains, mix ; satu- rate pieces of cloth with this preparation, and apply to the injured place ; renew often. A good effect is also obtained by the use of lead ointment. But if the burnt part is very large, lead remedies should be avoided, because in that case colic or other spasmodic attacks may result from them. Stahl's ointment for burns may be used. It is composed of equal parts of yellow wax, and fresh, unsalted butter, rubbed up with distilled water. Decoctions of linseed, or other nar- cotic remedies, applied cold, are very good. If considerable pullula- tion should arise, it must be suppressed by a weak solution of lunar caustic (one grain to one ounce of distilled water). Cold applications should be continued to the parts surrounding the denuded spot. In the fourth degree of ustion, the secretion and loosening of the burnt part must be effected by softening and palliative poultices, lin- seed meal, with henbane or hemlock leaves; these should be con- tinued until the crust is detached. The wound is treated with drying' or other proper remedies. If it should change into a pullulating ulcer, touch it with lunar caustic. If, in burning, foreign bodies, such as gunpowder, shot, &c, have passed into the wound, they must be removed at once. 292 GENEEAL DISEASES. For the severe pain with which burns are often attended, and if accompanied by nervous attacks, the internal and external use of opium is required; gastric and other disturbances must be treated with the proper remedies. The diarrhoea which usually sets in during cicatrization (the latter should be properly promoted by mechanical means), must not be quickly checked by opiates or similar remedies. OINTMENT FOR BURNS. The following salves for burns may be prepared at home, if neces- sary : equal parts of lime-water and olive oil, shake up until a salve is formed ; apply with a pencil-brush every two hours to the burn, until well healed. Another : One-quarter of an ounce yellow wax, and two ounces of fresh linseed oil, melt together and stir until cold. When cold, the yolk of an egg is rubbed up with it. Spread on a fine cloth, and make fresh applications every two or three hours. Another : Take the white of two fresh eggs, and three ounces of olive oil, stir together, and apply the mixture to the burn with a pencil-brush every hour or two. Another: Take equal parts of fresh olive oil, white of egg and cream, mix up well, spread it thickly upon a cloth, and renew the application often. It is an excellent remedy in fresh burns. Another : Take fresh, washed and unsalted butter or olive oil one ounce, melt with half an ounce of yellow wax, and half an ounce of mutton tallow, spread on a piece of cloth, and apply fresh every two hours. Another : Take tincture of myrrh one ounce, yeast one ounce, and charcoal powder one ounce, olive oil one ounce. This is an excellent application, and has proved beneficial in all cases of burns. The poultice should be frequently renewed, and the parts when being dressed, should also be washed with the fluid. A decoction of wild indigo is also very useful as a wash. As soon as gangrenous flesh be- comes loose, it must be removed, and fresh poultices must be applied. Another : Take common houseleek and squill root equal parts, boil in water, and apply as poultice to the burn. It is very cooling, soothes pain, and heals quickly. VENEREAL DISEASES. SYPHILIS. Under the name of venereal disease, many phenomena of diseases are embraced, which, although greatly varying in form, are neverthe- less related to each other. They are all the final result of contagious matter, locally absorbed by the skin, whence the venereal disease spreads by degrees to other parts, and finally may even be transferred to the bones. Passing through a syphilitic disease, does not diminish the susceptibility for taking it again; even a new contagion may occur, while the patient is still suffering from it. The matter eman- ating from a diseased person may cause the disease to break out in a healthy spot in the same patient, that is to say he may infect himself. Venereal disease is usually divided into primary, or that which occurs directly from contagion, and secondary, or that which subse- quently results from it, when the primary has permeated the juices generally. The following are the primary : i. The syphilitic blenorrhea — clap. 2. The syphilitic ulcer — chancre. 3. Phimosis. 4. Paraphymosis. To the secondary belong : 1. Syphilitic ulcers. 2. Protuberances. 3. Eruptions. GONORRHOEA-SYPHILITIC BLENNORRHEA. Gonorrhoea appears as urethral inflammation, erroneously called spermatorrhea; vaginal gonorrhoea, also vaginitis, which is errone- ously called blennorrhcea. (293) 294 VENEREAL DISEASES. Urethral Gonorrhoea. — The seat of this disease is the urethra. A few days after an unclean copulation, usually between the third and ninth day, an itching is felt in the urethra, which is not disagree- able, but rather inciting to renewed copulation. In a short time this changes to a burning pain, with pulling toward the testicles, spermatic cords and unguinal region; a watery mucus passes off; the glans penis swells, turns red, becomes extremely sensitive, painful, and the discharge assumes a purulent consistency of greenish-yellow color. The burning pain is particularly painful and troublesome at the time of urinating. The flow of the urine is restricted, and at first frequently issues in a divided stream; pain and tension increase. Painful erections, particularly at night, with spermatorroea, tenesmus, rest- lessness at night, with a light fever in the evening, complete the picture of the disease. By degrees these symptoms become amelior- ated; the discharge becomes tougher, somewhat thick, white, glassy, draws into threads between the fingers, and about three weeks from the time of the breaking out, a hardened drop of mucus can only be seen in the morning at the meatus urinarius for several days. Sometimes the whole disease assumes a more violent form. The cause of this may lie in the malignant character of the contagious matter, in faulty or neglected treatment, in error of diet, or in other unfavor- able circumstances. The disease comes sooner to an outbreak, the inflammation is more violent and extensive. With an exceedingly troublesome tension in the groins, the glands in that region swell and become inflamed, interfering with walking. Erections occur day and night, so that spermatorrhoea takes place even during the day, and there are cases where they do not cease at all. The penis rarely curves upward, but mostly has a painful curve downward. If some small vessels burst with this, the patient sometimes loses several ounces of blood, which usually produces a remarkable relief. Partly on account of increased inflammation, and partly because the dis- charge is more acrid, the foreskin also becomes inflamed, and phimosis sets in. The discharge becomes thinner, white-colored, smells dis- agreeable, flows sparingly, increases the inflammation, and finally ceases altogether (dry gonorrhoea). This is the highest degree of the disease. Urine is voided with the greatest difficulty, or is retained altogether, and prostate glands and testicles become inflamed. In this state a GONORRHOEA SYPHILITIC BLENNORRHEA. 295 change is made to the eyes. If finally all these symptoms cease, dis- charge and pain of the urethra continue, at least while urinating, and there remains the so-called gleet. If the course was a mild one, all symptoms usually disappear in from three to four weeks, and generally no evil consequences need be feared. If the case was very severe, in- duration and swelling of the prostrate glands and testicles remain ; but more usually gonorrhoea is followed by a contraction and thickening of the urethra. hi the treatment of gonorrhcea, which should be left to a physician, if possible, the following two points must be observed : i. The inflammation that has set in must be removed. If the state of inflammation requires bleeding, leeches should be preferred to venesection, because the inflammation always attacks the skin rather than the inner organs, and it therefore has more of a superficial than a deep tendency. Mucilaginous, diluent drinks should be frequently taken during the state of inflammation, but no longer. For that pur- pose may be taken daily from ten to twelve cups of a decoction of marshmallow, to which may be added (daily) one drachm of saltpetre, barley water, thin milk of almonds, sweetened water ; besides light laxatives, such as tamarinds, manna, &c. If sensitiveness is very great, for instance, if after depletion the erections are very painful, admin- ister half a grain of opium. If the symptoms are very violent, and if several parts are effected, calomel, being an antiphlogistic remedy, is very valuable. Strict diet must be observed, avoiding all spiced meats, and spirituous liquors. A suspensory bandage should be used, and the utmost cleanliness must be observed by frequently washing with lukewarm, mucilaginous fluids, such as milk, and mullein, and malva decoctions, &c. During the state of inflammation, immission should be only rarely used. 2. All bad results from gonorrhoea should be prevented and re- moved. First among these is gleet. This term is applied to a contin- ued flow of mucus, after the primary inflammation has been completely removed, which would be in from three to four weeks after the break- ing out of gonorrhoea. In order to counteract this condition, all relaxing, thinning beverages should be stopped immediately after in- flammation has ceased, and to meet the case, scrofulous, weak persons may at that time take Selter's water and milk with benefit. If the 296 VENEREAL DISEASES. flow continues, nevertheless, it results from three different causes. It results from general, and therefore local, weakness. The emission in that case is as clear as the white of an egg, glutinous and inodorous. It is strongest in the morning and evening, and is accompanied by slight itching only. Balsamic, strengthening remedies are required under these circum- stances, among which copaiba balsam is pre-eminent. The best mode of taking it is pure ; dose, from fifteen to twenty drops on sugar three times a day. If, in that shape, it should disagree with the patient, make it into pills as follows : copaiba balsam half an ounce, extract of bittersweet stems two drachms, powdered rhubarb one drachm, powdered gum arabic a sufficient quantity to enable the formation of pills of one grain ; powder the pills with ground cinnamon ; dose, two pills four times a day. The following remedies may also be ad- ministered : turpentine by itself or in connection with myrrh, or myrrh and sulphate of iron, or extract of catechu, or loxa bark in a decoction, or as an extract, particularly in general debility. Finally cubebs, either as a powder, of which take a teaspoon ml three times a day, or in the shape of an oily-resinous extract, as for instance, ethereal extract of cubebs one drachm, powdered gum arabic half a drachm, distilled water one drachm, white magnesia one and one- half drachms, mix, and make into one hundred pills ; dose, five pills every three hours. Easily digested, nourishing food should be used in connection with it. These remedies should never be administered at the beginning of the disease, or during inflammation. If the malady should still resist the use of these internal remedies, washing and bathing of the genitals with spirituous infusions of aromatic herbs may be applied to this form of gleet. But if all these remedies remain without any effect, apply a Spanish fly plaster to the perinseum. Electricity has also been recommended. General and Particularly Local Increased Irritability of the Mucous Membrane of the Genitals. — This condition hardly ever entirely changes. It discontinues, however, up to a slight trace, and increases again on the slightest provocation, such as a change in the weather, error in diet, &c. The discharge, therefore, differs very materially in its consistency and color ; strangury hardly ever disap- pears altogether, but varies greatly in degrees at different times. It is GONORRHOEA — SYPHILITIC BLENNORRHEA 297 self-evident that immissions or wrong treatment during the inflam- matory period easily produce this form of gleet. Immission must, therefore, be entirely omitted, as even the mechanical irritation is detrimental. The internal use of mineral acids, for instance acidu- lated tincture of spices, is recommended ; dose, from twenty to thirty drops three or four times a day, or Haller's acid in a decoction of salep root. Organic Interruptions, Particularly a Contraction or Ulcer in the Urethra, or Swelling and Induration of the Prostrate Gland. — The discharge is a thin ichor, and if ulcers exist, is mixed with streaks of blood. Pain does not altogether disappear, but is limited to the diseased place, which is readily recognized as being stationary in urinating, in making an examination, and touching it on the outside. The contraction of the urethra consists either of a local restiform thickening of the urethra, or of a warty excrescence, or it may also be spasmodic. The latter does properly not come under this head ; its peculiar characteristic is that in the investigation it is not always found in the same place, as in the other two cases. The spasmodically contracted urethra is also always very sensitive, and the bladder is not always emptied at once ; frequently a retention of urine occurs here also. The patient usually waits until then before he calls for advice. This must be removed first, because it is generally an indication of inflammation, created by degrees through local irrita- tion. Leeches should therefore be applied to the perinaeum first of all, to be succeeded by warm poultices. This is frequently beneficial in cases of spasmodic contraction, because they are sometimes con- nected with hemorrhoidal difficulties. In such a case it is judicious to add henbane to the poultice. Internally administer an oily emul- sion, to which, if the case is of a spasmodic nature, opium may be added. In all cases required, give an injection. After this treatment, the urine will usually flow of itself, or a flexible catheter or bougie may be introduced by a skilled hand. Ulcers in the urethra may also maintain gleet ; but if they are not accompanied by any secretion of the other mucous membrane, it is indicated by a very trifling secretion, and the disease cannot be called gleet. If the ulcers have reference to a general syphilitic malady, then anti-syphilitic treatment is required. 298 VENEREAL DISEASES. Vaginal Gonorrhoea. — The same may be said of this form of the disease, that has been said of urethral gonorrhoea. The difference in the organic construction of the diseased parts, however, requires cer- tain variations. The disease takes in the lips of the pudenda, and the whole inner vagina, particularly, however, the upper and posterior surface of the same. The secretion, if it takes place, covers the whole surface, the lips of the pudenda swell, and it is usually accompanied by rawness, and sometimes by ulcers. As a rule, the urethra remains unaffected, yet during the height of the inflammation, the burning after urinating is never wanting. If the inflammation has become very violent, a particularly sharp and copious secretion effuses up to the anus, and there causes pain and tenesmus, or the so-called gonor- rhoea of the rectum, or it effuses over the inner surface of the thighs, causing inflammation and rawness, and making walking and sitting exceedingly difficult. With this degree of inflammation, pain and tension in the inguinal region, bladder, and the perinaeum sets in. These manifestations of evident inflammation, connected with the blooming appearance of the patient, and the regular recurrence of menstruation, increasing the inflamed condition, and more particularly the origin of the disease, readily distinguish it from the opposite con- dition, the non-syphilitic whites (leucorrhoea). The disease progresses usually milder than the urethral gonorrhoea ; but it changes more easily and oftener into vaginal gleet and secondary syphilis, to which the ulceration contributes. The treatment is the same as in urethral gonorrhoea. Softening and ameliorating vapors are much more easily applied, and immissions, which should be altogether avoided in urethral gonorrhoea during in- flammation, are permissible here during the different stages. During inflammation, immissions of lukewarm milk alone, or mixed with lime water, or, if ulcers exist, immissions of a lunar caustic solution, from two to five grains to one ounce of water, twice or three times, are beneficial. An ointment, prepared from one ounce of mutton tallow and two ounces of almond oil, is excellent to prevent the inner surface of the thighs from becoming raw; it is still better to have this salve rubbed in several times a day as a preventative. If suppu- ration has occurred, the ulcers must always be covered with a com- press, upon which simple mercurial ointment has been spread, so as to CHANCRE — SYPHILITIC ULCER. prevent the infection of the opposite wall of the vagina. If gleet threatens, strengthening and astringent immissions may be applied without danger, because a contraction of the vagina is rare, and occurs only to a moderate extent. It cannot interfere in a future confinement. CHANCRE-SYPHILITIC ULCER. Any part of the membrane may be the seat of chancre. It is found most usually, however, on the genitals; in men, principally on the foreskin, more rarely on the glans penis, and still more rarely at the mouth of the urethra, or inside of the same. In women it is found on the large and small lips of the pudenda, more rarely at the entrance of the vagina, and very rarely within the same. On the spot where the venereal matter has been deposited, arises, between the third and ninth day after the contagion, a small blister, filled with a clear fluid. It arises above the surface of the skin, bursts open and forms an ulcer of roundish shape, with sharp edges and a lardaceous foundation. If no notice is taken of the chancre, it grows to a cer- tain size, remains stationary, lose; its syphilitic characteristics, cicatrizes in from four to six weeks, and after that is usually developed into secondary gonorrhoea. If properly treated at first, a cure is effected in from two to three weeks, and secondary gonorrhoea need not be feared. In regard to the treatment :: the chancre, local applications alone cannot be relied upon. It requires general anti-syphilitic treatment. The following principles should be kept in view, in regard to local treatment : If the ulcer is inflamed too much, painful, dry, hard around the edge, the so-called specific remedies will not be absorbed by the swelled vessels, and caustic remedies are too irritating. Cases of that kind should be treated with emollient poultices, to which hen- bane is added. If a liberal suppuration has been effected by these means, or if it was present in the first instance, and if the ulcer has improved in appearance, it is manifest that a healing activity is present. In such cases nature should not be disturbed bv local remedies, but the ulcer should be kept very clean by a drv and often repeated lint-dressing. In both ca=es. from five to eighty grains of 300 VENEREAL DISEASES. grey mercurial ointment may be rubbed in around the ulcer, if its locality will admit of it. But if the appearance of the ulcer, with defective, violent inflammation, does not seem to improve, then remedies should be applied to destroy the venereal matter, and aid nature in her efforts. For that purpose use lime water, chlor water, or a solution of caustic alkali. Lime water has acquired a high repu- tation, and ought to be applied everywhere until cicatrization, when there exists no particular reason to change it for any other remedy. Caustic remedies applied at first are well adapted to kill the malady ; the best adapted for that purpose is caustic alkali. But external treat- ment alone must not be depended upon. The removal of the hard edges of the developed ulcer by caustic remedies is entirely improper. Most likely by this operation the wall is destroyed, which nature has erected to prevent a rapid absorption of the noxious matter. Every chancre that may come in contact with a healthy part, must always be covered. Internally neutral salts, or the light preparations of mercury, such as calomel, should be used. PHIMOSIS. CONTRACTION OF THE FORESKIN BEFORE THE GLANS PENIS. Some people are born with this defect. As a disease, it is the in- flammation of the foreskin with a constriction before the glans penis, and is called complete phimosis, if it cannot be moved back at all over the glans penis, and incomplete, if it can be moved back only with great difficulty. Any irritation can produce this disease, but par- ticularly easy is it effected by venereal matter. For that reason phi- mosis is met with most frequently as a companion of urethral gonor- rhea or balanitis, and of chancre on the foreskin or glans penis of persons with too long a foreskin. The latter begins to itch and swell, and, according to the degree of inflammation, appears deep red, with little, but tense and shining, swelling, and is very painful; with less and superficial inflammation, pain and redness are less, but the swelling greater, semi-transparent, and sometimes covered with little blisters, or finally, after removal of the inflamed condition, there sometimes remains a thickening, in the form of a cartilagi- nous- ring But prognostication may sometimes be falsified by the GONORRHOEA WITH URETHRAL HEMORRHAGE. 301 thickening just mentioned, or a possible intergrowth of the foreskin with the glans penis, or a destruction of the foreskin ; inasmuch as a chancre on the inner surface, with existing phimosis, may eat through the foreskin, or perhaps destroy it by gangrene. As a rule, however, timely and proper treatment results in the desired-for dispersion. To remove the inflammation, if it is anywise considerable, apply leeches to the perinaeum, to be followed by lukewarm poultices pre- pared from bread crumbs with Goulard's water, or of poultices made of dispersing herbs with henbane and milk. If the inflammation is inconsiderable, clear and rose-colored, and oedema considerable, dry herbs, such as camomile flowers, lavender, rosemary, &c, are to be preferred as poultices. The bowels must be kept regular. GONORRHOEA WITH URETHRAL HEMORRHAGE. CONTRACTION OF THE FORESKIN BEHIND THE GLANS PENIS PARAPHIMOSIS. This disease is in its nature and character the same as the phimosis, differing only in the particular that the place constricted by the foreskin lies behind the glans penis. This, therefore, increases the danger of gangrene, because the mechanically interrupted circulation in the penis is much greater than in phimosis, from which, however, paraphimosis readily results, if in the former the foreskin has been drawn back by force. In paraphimosis the problem is to remove the constriction by bringing the' foreskin over the glans penis. For this purpose, clasp with the left hand the penis behind the glans penis, shove the whole skin forward, and at the same time move with the fingers of the right hand the glans penis towards the left hand, hold- ing the skin of the penis. If several of these attempts have remained without result, apply several leeches in the neighborhood of the in- flammation; apply cold water, or, if the patient has not gonorrhoea, let him sit down in a basin of cold water. This contracts the penis, and the drawing of the foreskin over the glans penis may generally be effected. 302 VENEREAL DISEASES. BUBO. Bubo is a swelling or inflammation of the inguinal glands, which, according to circumstances, changes to dispersion and suppuration, but rarely to induration, and under very unfavorable conditions only to gangrene. We have already spoken of the non-syphilitic bubo (see the article). Syphilitic bubo is usually the result of a former or still existing chancre. It has its seat in one of the upper inguinal glands, which swells, becomes more painful, and in a short time reaches the size of a pigeon's egg. • The swelling is limited, copper- colored, painful and hard, and interferes with the walking of the patient. Under symptoms of fever, the painful, pulsating swelling passes into suppuration, which finally breaks, when the malady soon shows the evidences of a syphilitic ulcer. In treating a syphilitic bubo, general internal treatment is abso- lutely necessary ; suppuration must be favored at the same time. To promote the latter, softening, warm poultices of bread and milk, emollient herbs, linseed meal, &c, should be applied, and in cases of great irritability, henbane, hemlock leaves, opium, &c, should be used. If the bubo is in a weak, inactive condition, irritating remedies are required, such as a plaster of Spanish fly alone, or in combination with two parts of protoxide of lead ; or poultices of burnt onions, black soap, &c, or a poultice consisting of three parts of leaven, two parts of mustard, and one part of black soap, boiled in whisky and water. These remedies are repeatedly applied during the day, but at night the place is covered with a plaster, until all hardness has disap- peared. SECONDARY SYPHILIS. This disease manifests itself with attacks of light fever, and at un- certain times, usually, however, within six weeks after contagion. It shows itself in various forms, of which I will only mention ulcers and excrescences. The ulcers usually originate in the form of little blisters in the oral cavity, on the hard and soft palate, on the tonsils, in the mouth and nasal cavity. The little blisters soon break and form ulcers, which spread in every direction ; they have a lardaceous foundation, scalloped edges, and a defined, deep red circumference. If they corrode the SYPHILITIC CARICOUS TUMOR. 303 soft palate or the uvula, speech becomes greatly impeded. The ulcers on the hard palate secrete quantities of a thick, greenish matter. Not rarely it also results in deafness, if the ulcers attack the Eustachian tube. From the tonsils they spread not quite so rapidly ; but if they reach the periosteum, they are apt to cause caries. To this danger the spongy bones of the nose are particularly exposed, giving the latter a compressed shape. The presence of the ulcers manifest themselves, even if seated very low down in the throat, where they cannot be seen, by a redness ascending to the palatine arch. They also show themselves in other parts of the body ; particularly over bones, where they are usually painless and apt to spread' out. In regard to the external treatment of these secondary ulcers, the same rules apply that have been recommended for primary ulcers : In cases of greatly inflamed ulcers in the throat, gargles or fomentations of a decoction of marshmallow and malva flowers, and in cases of great irritation, with hemlock and henbane, &c. All ulcers, how- ever, which admit of a bandage, must be properly dressed ; if the irritation is not too great, a salve prepared from the yolk of an egg and turpentine may be used- SYHHILITIC CARICOUS TUMOR (CONDYLOMA). Syphilitic caricous tumor is a soft flesh-like growth, corrugated on the surface, which usually appears in larger numbers on the genitals and their surroundings, and also on the anus. From its surface oozes frequently a sharp contagious ichor ; sometimes it bleeds and breaks open, when a secondary syphilitic ulcer is formed. Sometimes, how- ever, an outgrowth, resembling a cock's comb, appears on the genitals, which is not at all of a syphilitic nature, but the result of pressure or contusion. The relation which these growths bear to each other, must explain their nature. In treating this malady locally, the principal must not be lost sight of, not to proceed to its extirpation, until fully developed. This is known from the fact that the warts do not enlarge any longer, and assume on their points a white or greyish-white coloration, as if they had been touched by lunar caustic ; this is a sign that they are wither- ing. They are touched with a solution of subacetate of lead, or, what is preferable, cauterized with lunar caustic, then wrapped in a 304 VENEREAL DISEASES. cloth saturated with a solution of subacetate of lead. This treat- ment is continued until the excrescences are entirely exterminated. If a large number of these excrescences exist, the whole of them are not to be treated at the same time, but gradually. If they have stems, the physician should cut them off with a pair of scissors as low down as possible, or he may ligate them. GENERAL TREATMENT. Preservative remedies should either prevent the absorption of venereal matter, or if that has already occurred, should destroy it. To the first belong the condons, or the embrocation of the male genital with oil, grease, &c. To the second, ablutions and immis sions of water, soap water, greatly attenuated solutions of chloride of lime, or muriate of soda, lime water, alkalies, diluted muriatic and nitric acid, &c. Excepting the condon, none of these remedies afford sure protection. To men, the precautionary measure particularly recommends itself of urinating immediately after impure copu- lation, and to slightly press the foreskin together, in order to restrain the flow of the urine for a short time, and then eject it suddenly with pressure. But if the disease has broken out, the problem presents itself of destroying the effect of the venereal matter, and of removing it from the organism. To attain this object, not only a variety of remedies are required, but it also depends upon the mode of living of the patient, in order to realize the full benefit of those remedies. The conditions are a strict diet, warmth and cleanliness. By strict diet, nourishment is withheld from the venereal germ ; it may be said that it is dying off; morbid excrescences wither, and as this diet increases the absorption in the whole body, the existing foreign material is con- veyed to the three principal secretionary organs, the skin (by exuda- tion), the kidneys (voiding of urine), and the intestinal canal (faeces), and thus it is removed from the body. There are instances where hunger alone, without the assistance of any other remedies, has cured venereal diseases. A little white bread, water soup, and very little light vegeta- bles, afford the most wholesome diet. Whenever the ulcers lose their peculiar syphilitic appearance, food may be increased, and finally it may be changed to light meats, pro- vided the improvement progresses favorably. A warm atmospheric PRESERVATIVE REMEDIES. 305 temperature is indispensable for a cure, because the skin secretes con- siderable morbfd matter, as well as the mercury occasionally used in the treatment. It may be asserted beyond contradiction, that when- ever the disease affects internal parts, for instance the bones, eyes, &c. , that the activity of the skin was insufficient to secrete the venereal matter, together with the mercury. For this reason the patient should avoid a change of temperature. The best plan is to live uninter- ruptedly in a temperature from eighteen to twenty degrees, and, if possible, to keep the bed. Extreme cleanliness must be connected with this. Under such conditions only is it possible to thoroughly extirpate the malady with the help of the necessary remedies. Among these remedies may be named, mercury, sarsaparilla, acids, basic and acid salts, and finally iodines. The preparation of these remedies is too complicated, certain precautions indispensable, and an enumera- tion of all the proportions too circumstantial, as to be given here, and as there is no disease requiring the aid of a physician more than this, the management must be left to him. PRESERVATIVE REMEDIES. If it is feared that the contagion has been communicated, the first thing to be done is to wash down thoroughly, preferably with tar water (see "Tar Water"), after that with sulphate of zinc dissolved in water. Immediately after that, wrap the parts in powdered cam- phor, either externally or internally, according to the gender of the person ; the trifling burning sensation produced thereby, passes off in a few minutes. Drink a glass of sweetened water, to which one grain of camphor and two or three drops of ether has been added. By persevering in this treatment, it is almost certain that the contagion will not take, or will not extend further. But if the malady has made its appearance, then the remedies should be applied as heretofore advised, FEVERS. Fever is generally called the condition of a sick person, whether suffering from a local or general malady, whose pulse is more frequent and quicker, and temperature of body higher than in a healthy state, superadded by a peculiar feeling of sickness. If the fever represents a certain form of disease, it is denoted by an interruption of the usual feeling, increased warmth, usually preceded by chills, by quick pulse, interruption of secretions and excretions, by a certain succession of attacks of disease, and by an inclination to a decision by remarkable phenomena, mostly in the secretory and excretory organs, or by a crisis. But hardly ever are all these symptoms combined in one case of fever ; the majority of them must therefore decide. The progress of the fever can be noted by certain periods of time or stages. Thus there are the period of premonition, of its appearance, height, crisis, decrease and recovery. Premonition consists in a depression of spirits, disaffection, increased irritability, feeling of heaviness, lassitude, interrupted sleep, and in bad digestion. The beginning of the fever is generally indicated by chills, which may be connected with frequent pulse, difficulty in breathing, &c. During the increase of the fever the chill changes to heat, which is connected with quick pulse and breath, thirst, headache and other symptoms, which gradually grow with a periodical increase or decrease. If these symptoms have reached their height, they remain stationary for a time, until the morbid matter which has caused the fever is pre- pared for secretion, and which is ejected after passing a preceding critical point on the seventh, ninth, eleventh, fourteenth, seventeenth and twenty-first day. This is usually performed by exudation, by a peculiar deposit in the urine, which previously was usually of a red color, or by vomiting, diarrhoea, hemorrhages, and other discharges. The fever decreases, the different organs gradually resume their legiti- (306) INFLAMMATORY FEVER. 30*7 mate functions, appetite returns, with recovery all spasmodic attacks disappear, and only great irritability and weakness remain for some time. The causes for the disease must be looked for partly in a de- fective mixture, or in disturbed mutual relations of external influences of the atmosphere, food, and drink, &c, necessary for the preserva- tion of life, or in disturbed relations of the inner functi'ons of the body, particularly of the secretions, and the circulation of the blood, or in forces having a direct detrimental effect on life. In the treatment of fevers, the following points have to be consid- ered : first of all, remove the cause of the fever, if it still exists and continues nourishing it If this is impossible, the treatment is limited to a removal of the disease itself. Fevers are divided into continual, remitting, and intermittent. The continual fevers extend with the same violence and without any intermission during their whole pro- gress. In remitting fevers, the symptoms change at certain hours of the day, being usually more favorable in the morning, and less favorable in the evening. Intermittent fevers appear only periodically, and cease entirely after each attack. We will now consider somewhat closer the forms of fevers most im- portant to our purpose. i. Continual or Remitting Fever. INFLAMMATORY FEVER. Inflammatory fever is frequently the companion of a local disease, such as cutaneous eruption, rheumatism, bodily injuries, &c. Every other fever may also assume an inflammatory character, particularly if the weather is favorable for it, and other inflammatory irritations are added to it. Inflammatory fever begins with a heavy chill, which soon passes off, and is immediately succeeded by a uniform, general heat. The pulse is moderately accelerated, full and hard ; the blood is in the same condition as described under the head of "Inflammation ;" breath is oppressed, the face is red, mouth and tongue dry, thirst great, appe. tite none, bowels constipated, urine limited and red, and sleep dis- turbed. The fever usually lasts from one to three days, rarely longer, and ends generally with nose bleeding, exudation and red urine. 308 FEVERS. The treatment of this fever, which is usually free from danger, is anti- phlogistic, of which we have already spoken in the article " Inflam- mation. " The selection of remedies to be applied depends on the state of the fever. In light cases, a proper . observation of diet is frequently sufficient. Severer cases, however, require assistance with saltpetre and other salts, leeches or bleeding, but always with particu- lar consideration of existing local complaints. When the crisis has arrived, act upon exudation and secretion of urine by sal-ammoniac, acetate of ammonia, cream tartar, &c. Convalescence rarely requires medical assistance. WOUND FEVER. Wound fever sets in after any considerable injury; it accompanies the inflammation with which it usually begins in from twenty-four to forty- eight hours after injury, with shivering, and progresses in the same manner as other inflammatory fevers. If the nervous system has re- ceived a severe shock, convulsions, tetanus, and delirium may set in, which is particularly the case in injuries to the nerves, sinews and joints. The duration of wound fever is generally three days, and in severe cases longer. The treatment must be directed so keep the fever down and pre- vent its increase ; this is done partly by surgical aid, and partly by antiphlogistic and palliative remedies. CATARRHAL FEVER. Catarrhal fever is inflammatory in its character, with local irritation of the mucous membrane, particularly the respiratory organs, which at first secrete a thin, sharp, and subsequently thick, mucous fluid. The catarrhal fever begins with the local irritation, or sets in subse- quently. The symptoms are milder than with inflammatory fever, chills alternate with heat, the pulse is moderately rapid, but weak, the head, particularly in the frontal region, and also the chest, feel oppressed, sleep restless, digestion disturbed, and secretions lessened during the first part of the disease. The local disorder appears as an inflammatory irritation of the mucous membrane lining of the nasal cavity, throat, larynx, and trachea ; the eyes, and also the tympanum, RHEUMATIC FEVER. 309 are sometimes affected. Catarrhal fever generally lasts from five to seven days, rarely longer. It passes off by the expectoration of mucus, exudation and urinating. Sometimes it may change to other diseases, into inflammatory and nervous fever, or to ague ; if the catarrh continues for some time, it may become chronic. Catarrhal fever is caused by a peculiar, changeable condition and temperature of the atmosphere, and taking cold, which easily affects an excited body by violent exer- tion of the respiratory organs. The disease frequently combines with gastric, but more rarely with nervous conditions, and is a precursor or companion of various acute cutaneous diseases. The treatment of this disease, which in itself is not at all dangerous, consists in diverting the causes, influencing or supporting the fever by keeping warm, ameliorating the irritable condition of the respiratory organs, and by supporting nature at the critical moment. In case of considerable inflammatory irritation, the application of leeches, and even bleeding, may become necessary. Sudorific and diuretic remedies should be administered for the restoration of the suppressed secretions, and expectoration by small doses of tartar emetic, sulphur, and syrup of squill root. Care should be taken not to mistake catarrhal fever for the begin- ning of measles, whooping cough, or perhaps croup. RHEUMATIC FEVER. Rheumatic fever is a mild inflammatory fever, with local irritation, which usually manifests itself by pains moving from one place to another. It usually begins with local pain, to which fever is added after a few days. It is characterized by a moderate chill and heat, headache, disturbed appetite, stool and sleep, increased thirst, viscous exudation, the urine being at first restricted, but subsequently more abundant, with a deposit resembling brick dust. The pulse is fre- quently tense and hard. The local pain is tearing, piercing, and sometimes connected with a pale red swelling. The pain is increased by pressure or motion, moves from one place to another, and keeps abreast of the fever. The duration of the fever is from seven to twenty- one days, and winds up with exudation, urine of the above mentioned condition, and sometimes also with a miliary eruption of 310 FEVERS. the skin. The chief cause of rheumatic fever is interruption of the functions of the skin, to which persons with an irritable tender skin are particularly inclined. In treating this disease, the cause, if it still exists, has to be removed, the fever must be treated according to its character, and the local inflammation removed. The former is accomplished by keeping in an even warm temperature, and observing a proper diet. The fever is best treated with a solution of saltpetre, sal-ammoniac, and oxymel, for instance, saltpetre one drachm, sal-ammoniac two scruples, oxymel six. drachms, elder blossom water six ounces, mix well • dose, a tablespoonful every two hours. The local pain requires leeches or cupping-cups, and with very stout, plethoric persons, bleeding, and for its dispersion, dry, warm poultices of emollient and dispersing herbs, would be very beneficial. After removal of the inflammation, blistering plasters are very service- able to remove any remaining pain and swelling. In rheumatic fever, the patient must bear his pain with fortitude ; remedies do not avail much, and in most cases they are even hurtful. In most instances I have found bleeding very beneficial ; it produced an immediate amelioration of pain. Castor oil has also proved very excellent in rheumatic fever. Take a tablespoonful of castor oil in a cupful of barley gruel ; for weaker persons, half a tablespoonful. In rare cases, a repetition of this dose would be required on the following day. A decoction of marshmal- low root, or even plain water, would be sufficient for a full restoration. No particular benefit will be derived from the various sudorifics, be- cause the patient perspires without them. GASTRIC FEVER. Gastric fever is caused by undigested or undigestible food, or by an accumulation of gall or mucus in the intestinal canal. From the various causes which have produced the disease, it is distinguished as the simple gastric fever, bilious fever, and pituitary fever. Gastric fever results from too large a consumption of food and drink, or from other influences weakening to digestion. The symp- toms of gastric disease are lack of appetite, nausea, inclination to BILIOUS FEVER. 311 vomiting, or vomiting itself, rising of the stomach, pressure in the gastric region, coated tongue, increased thirst, a somewhat bloated abdomen, sometimes stomachache, costiveness or diarrhoea. The pulse is rapid, full, and soft, the skin warm, and head dizzy. The fever is frequently inconsiderable, begins with a chill, decreases toward morning, and lasts from seven to fourteen days. Its critical point is vomiting, diarrhoea, exudation, and urine. TTie treatme?it is principally directed to the removal of impurities, by emetics and laxatives. Emetics are necessary if the patient suffers from nausea, or the tongue is heavily coated, and if he is inclined to vomit. But, if the abdomen is bloated, with rolling in the bowels, flatulence, costiveness, &c, administer dissolving extracts (gentian, buckbean, rue, &c); diet must be strict and assist the remedies. Convalescence requires bitter aromatic remedies. If a mild diarrhoea remains, watery tincture of rhubarb, one teaspoonful twice or three times a day, should be given. The use of acidulated drinks, particu- larly lemonade, during the progress of the disease, is very beneficial. If, during recovery, the appetite does not return, give wormwood wine, or Hoffmann's stomach elixir; dose, from forty to sixty drops, twice or three times a day \ or give quassia, prepared as follows : boil one drachm of it in four teacupsful of water for one-quarter of an hour ; dose, a cupful three times a day. BILIOUS FEVER. Bilious fever is connected with an increased secretion of a morbidly changed condition of the gall. It results from causes operating in an irritating, detrimental way on the liver, in persons of a choleric, mel- ancholic temperament, during the hot season, if cold is taken, or from a violation of dietetic laws, violent passion, injuries to the brain, &c Symptoms of bilious fever are yellowish color of the eyes and edges of the lips, and of the whites of the eyes, yellow-coated tongue, bitter taste, bitter eructations, loss of appetite, bilious vomiting, inflation of the gastric and hepatic region, increased thirst, colic, and bilious diarrhoea. The fever begins with a chill, succeeded by heat. Occa- sionally headache, dizziness, cramps, pulling and piercing pains in the side, are connected with it. The patient is wakeful at night ; chills 312 FEVERS. alternating with heat, which frequently increases to a burning heat, combine with it ; the pulse is rapid, and sometimes hard and full. Other patients frequently suffer from intermittent dull pains in the head ; the eyes glisten and are suffused with tears ; the cheeks have a dark-red demarcation ; the skin of the angles of the mouth and of the alee nasi are yellow ; sometimes the patient is attacked by frequent bleeding of the nose ; the lower lip trembles ; breath becomes offen- sive ; the tongue has a white coating, is dry or moist, at least on its edges ; frequent spitting, an unquenchable thirst, and a desire for acid drinks, manifest themselves ; a tension of the gastric region, and of the two sides, particularly of the right, of the upper abdominal region, is perceivable, and is very sensitive to pressure ; the patient is troubled by tension, flatulence, and moving pains in the abdomen \ stool is either inactive, or a bilious, pulpy, very offensively smelling diarrhoea appears ; the urine is thick, wheyey and yellow colored ; the patient sometimes complains of pains in the limbs; the skin is gen- erally rough, dry, and yellow, and sometimes considerable exudation takes place. The fever, with all of its accompanying symptoms, dimin- ishes considerably toward morning, but reappears with renewed yiolence in the evening. During the night the patient is very restless ; if he falls asleep, he frequently wakes up with a start, and is usually delirious. The disease lasts from seven to fourteen days, and if it terminates favorably, it ends with diarrhoea, exudation or eruption of the skin and urinary deposits. If this is not the case, the disease changes to nervous fever or hepatitis. This disease is caused by living in a marshy country, great heat, excitement of the mind, and particularly anger, grief, and trouble. The disease itself is not contagious, but it may become so, and change into putrid fever. Certain kinds of bilious fevers may be removed by movement of the bowels and vomit- ing, but there are cases where, besides the evacuation of the gall, other conditions must be taken in consideration if the patient is to be cured, and these conditions are either inflammatory, rheumatic, or nervous. In treating this disease, the irritated condition of the liver is chiefly to be considered. In mild cases this is effected by mild, loosening salts and extracts, particularly tartaric acid, and in severe cases by BILIOUS FEVER. 313 the embrocations of grey mercurial ointment. The morbid accumu- lations are evacuated as in cases of gastric fever ; but if the intestines have become greatly irritated, mucilaginous remedies should be applied previous to taking the prescribed medicines. Recovery will follow, if diet is observed, and strengthening remedies applied. INFLAMMATORY BILIOUS FEVER. Inflammatory bilious fever attacks particularly young and plethoric people, if they are given to drink, or after the suppression of customary hemorrhages, and especially in the summer. In such cases, the gen- eral symptoms of bilious fever are combined with those of inflam- matory fever. Aside of those, the following symptoms will be noticed : very severe headaches (as stated under " Bilious Fever "), yellow color of the white of the eye, frequent bleeding of the nose, reddish-yellow urine, burning sensation in the stomach, pain in the pit of the stomach and the epigastric region, extending to the right side, where a touch will cause pain, and increase that which already exists. The voluntary evacuations do not afford any relief, and the cessation of fever is less perceptible. A violent inflammatory bilious fever resem- bles yellow fever in many respects. RHEUMATIC BILIOUS FEVER. Rheumatic bilious fever commences with a rapid change of the weather, particularly if the days are very hot, and the nights cool. The fever begins like the rheumatic fever, but the symptoms of bilious fever are preceded by inflammation of the eyes, or pain in the throat, cough, and cold in the head. During the progress of the disease, rheumatic pain in the limbs, pain in the abdomen, and dysenteric symptoms, manifest themselves ; the liver (the right side below the last ribs) is not always free from pain. NERVOUS BILIOUS FEVER. Nervous bilious fever begins like simple bilious fever, more fre- quently, however, like inflammatory bilious fever. Gradually the features of a malignant fever manifest themselve, such as great failing 314 FEVERS. of strength. This kind of bilious fever is sometimes the result of faulty treatment, or of the body being weakened and enervated pre- vious to the attack, or of violent emotion of the mind. Frequently the symptoms of an inflammatory bilious fever are added to this, which makes treatment exceedingly difficult. Treat?7ient or cure of bilious fever is always difficult, as no positive rules can be laid down for it. It is an error to suppose that the clean- ing out of the gall is all that is required ; the character of the disease must be taken in consideration, and it must be decided whether it is of an inflammatory, rheumatic, or nervous nature. First, administer the following potion : cream of tartar twenty grains, boil with three pints of water until the powder is dissolved ; when cooled off, add a sliced lemon, sweeten with sugar and use as a drink. Another cooling drink : Take one quart of well water, and rasp- berry, currant, or mulberry syrup, or lemon juice, two tablespoonsful, and drink at pleasure. Treatment of inflami?iatory bilious fever : If the patient is still young and vigorous, the pain, tension, and burning sensation in the stomach will be all the more severe ; under such circumstances, bleed- ing may be resorted to with safety. If the patient is weak and irri- table, from ten to fourteen leeches may be applied; obese people require the application of ten or twelve cupping-cups to the abdomen. The gastric region should be covered with bran poultices. Internally administer marshmallow tea, or almond milk, with gum arabic (one tablespoonful to be dissolved in almond milk) ; dose, two tablespoons- ful every two hours. If the stomach is not too weak, give the follow- ing mixture : milk of almonds two pounds, refined saltpetre ten grains, barley sugar eighteen grains ; dose, every three hours a tablespoonful. Treatment of bilious fever should be confided to an intelligent physician, because the smallest mistake may produce a disastrous result. PITUITARY FEVER. Pituitary fever results from an accumulation of mucus in the in- testinal canal, produced by a laxness of the solid parts and a defective mixture of the blood. Under such circumstances, helminths are PITUITARY FEVER. 315 developed in the intestinal canal, which by their irritation produce worm fever. Pituitary fever makes its appearance with debility, lack of appetite, alternate chills and heat, sometimes with dry skin, at others, with a sour smelling exudation in particular parts of the body ; the pulse is quick, and the fever increases during the evening. The patient complains of heaviness in the head, ringing in the ears, and appears stupified ; he is troubled with a constant spitting of a tough phlegm, and has a nauseous taste in his mouth ; the throat is red, and frequently filled up with a great deal of phlegm, threatening suffoca- tion, and causing cough and vomiting. The patient complains of heart-burn ; a feeling of fear, griping in the stomach, flatulence, and hiccough. The stomach is expanded and cannot bear pressure ; acute pains in the bowels and diarrhoea with bile-like stools occur, in other cases the patient is costive ; the urine is thick and wheyey ; hemor- rhoids appear sometimes, or the patient passes worms. In the course of the disease, aphthae, miliaria, and all symptoms of malignant in- flammatory nervous fever appear, when it is likely to pass into a slow nervous fever. Persons with scrofula are particularly inclined to this fever, and females are more liable to its attacks. Youths and old peo- ple are more subject to it, while middle-aged people are almost exempt from it. Pituitary fever is caused by a peculiar state of the atmosphere, by cold, damp weather, marshy, unclean localities, famine, raw, watery, flatulent or spoiled food, and depressing feelings of mind, such as anxiety, fear, care, grief, &c. Sometimes mucous obstruction precedes the fever, frequently, however, it appears in the course of the fever, and always points to a highly irritated and even inflamed con- dition of the mucous membrane of the digestive organs. With the first there is rarely any. danger, unless the disease is neglected, when it may result in consumption. If the fever has moderated and the trouble in the gastric region has ceased, but if loose discharges of mucus accompany the stool, a de- coction of columbo root should be administered, which is to be pre- pared as follows : columbo root twenty grains, from which make a decoction of ten ounces ; dose, two tablespoonsful every two hours. During convalescence, give at first mild, bitter remedies with rhu- barb : take dandelion and buck-bean extract from eight to ten grains of each, vinous tincture of rhubarb, Hoffman's stomach elixir, six 316 FEVERS. grains of each, peppermint water five ounces ; dose, a tablespoonful three times a day. After the patient has somewhat recuperated, administer the following preparation : take scraped quassia wood twenty grains, boil it for ten minutes in one quart of water, strain, and add to the strained liquid ten grains of vinous tincture of .rhubarb, Hoffmann's drops three grains, orange peel syrup forty grains ; dose, a tablespoonful three times a day. If the patient becomes very debilitated by a continued discharge of mucus, give Iceland moss. During the fever, simple mucilaginous remedies are administered, subsequently broths, with rice or oatmeal, and finally wine or strong beer. Care should be taken not to give the patient too much of any of the above mentioned articles. SLOW NERVOUS FEVER. Nervous fever results from any other fever, or unites with some other local complaint. If a fever changes into nervous fever, the pulse sinks, becomes soft, more frequent and irregular, the skin be- comes dry and burning hot, the features sink, face becomes pale, or of a circumscribed red, the eyes dull, dim, and are riveted mostly to one spot. The patient complains of headache, dizziness, insomno- lence, or vivid dreams. All voluntary physical and mental acts pro- ceed slower, and are more difficult to perform ; pains in the loins appear ; at first, the patient generally complains more of cold than of heat; frequently the feet burn, while the hands remain cold ; some- sometimes all the limbs are cold, and the head is burning hot. Great irritability of the mind is noticed, and the face becomes suddenly flushed on the least provocation. But just as quick does the patient become pale and frightened at every trifle ; the voice is very weak and trembling, the patient cries a great deal, is very peevish, changed and discouraged. This condition sometimes continues for weeks without the patient being confined to his bed. Finally debility grows rapidly, the patient is hardly able to move, and even speaking is a trouble to him. Diarrhoea, leucorrhcea, hemorrhoids, viscous exudations, &c, set in, frequently to such an extent that death soon follows, if not stopped by skillful treatment. SLOW NERVOUS FEVER. 317 This disease is caused by everything that has a direct debilitating effect upon the nerves, and by everything that limits the nourishment of the body in its interior. Among these causes are depressing pas- sions, continual great sorrow and distress, shame, anger, longing, great exertion of the mind, particularly with a sedentary mode of life, and watching at night. Small children also are frequently taken with a slow fever, caused by an insufficient quantity of milk in the breast of the nurse, who does not receive proper food. If, from the symp" toms heretofore given, it becomes evident that a nervous fever is threatening to develop itself, everything should be done to prevent its breaking out. This is done, above all things, by careful abstinence from all the different influences, which might lead to a full develop- ment of the malady. The patient should be cheered up, and must be provided with as much diversion as possible ; good, substantial, easily digested food should be selected for him, but, nevertheless, great care should be taken in the observation of proper diet, as a dis- turbance of digestion is easily brought about, which is connected with the most dangerous consequences. Taking cold should be carefully avoided, as the patient is very susceptible of it with a change of the weather. To prevent the break- ing out of the fever, give the following cold infusion : calisaya bark forty grains, water one quart, let it stand fourteen hours, shake fre- quently, and strain ; dose, a cupful twice a day. In most cases it will suppress the fever at once. The proper use of cold baths is of great advantage ; they are taken in the following manner : The patient is wrapped up in wet sheets, and remains in that condition until perspi- ration breaks out ; his whole body must then be quickly sponged off with cold water. If the patient has sufficient strength to leave the bed without an effort, he may remain out of it for some time, or, if possible, he may take a little exercise out of doors, but must on no condition fatigue himself. These wet wrappers should be used twice a day. If fever is considerably decreased, and strength increased, by this treatment, the patient is permitted to remain in a state of perspi- ration for half an hour in the wrapper, and is then placed in a cold bath, of from twelve to fourteen degrees, for one or two minutes. This is continued until the patient is entirely restored, which will occur sooner than by any other mode of treatment. 318 FEVERS. If digestion is defective, the patient should content himself with a thin broth, from which all fat must be removed, but it may be thickened with rice, oatmeal, &c. The broth may also be thickened with the yolk of an egg ; thin calves-foot jelly, or fresh oysters, may also be given. If the appetite of the patient remains good, he may eat easily digested meats. With an increase of appetite, and the in- vigoration of the digestive organs, richer food may be given to the patient. Poultry is best to begin with, subsequently veal may be tried, and finally beef. Roasted meats are preferable to boiled, but browned butter must not be used with them. Spices, and all food heavy of digestion, as well as warm, heating drinks, must positively be avoided. At first, and until the fever disappears, soup, as well as meat, must be eaten cold. During the whole treatment, cold milk with light bread should form the patient's breakfast and supper, and cold water his ordinary drink. If the patient's stomach feels very empty between meals, the yolk of an egg f with sugar, may be given in cold water. In connection with this diet, other proper rules should be observed. It is well for the patient to rest and sleep several times a day, after meals, which greatly aids digestion. To very weak persons, a long sleep is never beneficial ; they awaken from it in an exhausted condi- tion, and much weaker than when they went to sleep. It is therefore better never to let sick people sleep very long ; short and frequent naps are much better for them. The patient must be kept very clean ; the air which he inhales should be pure and dry, and he must be kept in a pleasant frame of mind. ACUTE NERVOUS FEVER. Everything that paralyzes the nervous force, and weakens the blood, causes acute nervous fever. It is brought about by grief, fright, fear, great anxiety, lack of sleep, and severe exertions of the mind ; by poor food, eating of unripe fruit or cucumbers, damp and unwholsome dwellings, severe labor, continuous humidity of the air, west wind, and excessive loss of juices. The following are the symptoms of the disease, which frequently pre- cede the attack for weeks. The head feels heavy and painful, the patient complains of dizziness, insomnolence, or vivid dreams, trembling of ACUTE NERVOUS FEVER. 319 the limbs, and headache ; the tongue is very dry, stool thin, and the urine red and clear. As the disease proceeds, indications of delirious- ness, inflation and tension of the abdomen, manifest themselves ; the coating of the tongue assumes a browner hue, the lips become dry and brown ; diarrhoea, convulsive motions and spasmodic fits occur, which gradually change into paralysis. The treatment of this dangerous disease must be directed to the removal of the causes. Aside of that, the fever should be treated according to its nervous character. It requires soothing remedies, or where a certain degree of dullness prevails, more inciting, even irritat- ing medicines. Of importance are external remedies inciting to the skin. Diet must be more nourishing than in other fevers, but not heating. The duration of the fever is usually from twenty-one to twenty- eight days, sometimes even longer. Convalesence is very slow and tedious, and subject to relapses. From an attack of severe ner- vous fever, the patient does not regain his strength for two or three months. This fever has the peculiarity, that a well-founded judgment can not be given of its termination. With the most favorable symp- toms, the disease sometimes takes a most unfavorable turn, and in other instances again, the patients recover with all the symptoms pointing to an early dissolution. The principal rule is, never to give up all hope. In regard to particular internal remedies to be administered to the patient, they cannot be discussed here. There are too many different points involved to lay down a rule equally applicable to all cases, and even with a particular explanation of all that is to be observed, it would, after all, be impossible for people to ehoose the proper remedy ; it is even difficult for the most skillful physician to make the proper selection. An error in that respect is invariably connected with a disastrous result. Even the general rules laid down above for diet in attacks of fever, which in all external relations should be also here observed very strictly, must frequently be materially changed to suit the condition of the patient ; but on account of the great danger, it must always be entirely under the direction of the physician. One point, however, is fully settled, a person attacked with this disease must not be permitted to fast too long. The patient may be sup- plied with cold water at all times, but care must be taken that he does 320 FEVERS. not overload his stomach with it. Cold baths are strictly prohibited, because they may produce paralysis. On the other hand, however, the following treatment is free from all danger, and attended with success : The patient is entirely undressed, and during the fever is placed on a large woolen blanket, and wrapped up in a bedsheet, which has been dipped in cold water and then well wrung out. The blanket is then closely put around him, and aside of that, he is covered up with a bed- quilt, which is also placed closely around him, so that no air can strike the body, with exception of the head, which must be entirely free. While the patient is in that situation, the room must be well aired. It is well to keep a window open at all times of the year, and to sprinkle spirit of camphor frequently around the room, as it purifies the air. It is also beneficial to sprinkle the sick-bed with it. Pure air cannot injure the patient ; he cannot take cold from it. The pure, fresh air which he inhales, can do him good only. The patient is kept in this condition as long as the dry fever heat lasts ; he is wrapped up in a fresh wet sheet every two hours. If .the heat has abated, or if a warm perspi- ration breaks out in the face of the sick person, he is taken out of the sheet and bed, and his whole body washed with cold water ; he is then dried off thoroughly, clean linen put on him, and placed in a well-warmed bed. The ablution with cold water is continued until the patient has passed the crisis, and he has broken out in a healthy, warm (not cold) perspiration. This usually occurs while the patient is wrapped in the wet sheets. If this perspiration breaks out, it is kept up for one hour, when the patient is washed with cold water, and put to bed, when a profuse perspiration sets in again. This last per- spiration is permitted to continue for any length of time ; the patient may be permitted to drink cold water, and, if he calls for it, he may also be supplied with easily digested food, even thin broth. But if the perspiration begins to abate, the ablution with cold water is renewed every morning. It is a silly prejudice to suppose that by this course the life of the patient is endangered. Experience has taught that the envelopment of the patient in sheets, from which the cold water has been wrung out, is the surest remedy, and is always attended with the best success. ACUTE NERVOUS FEVER. 321 But for people who fear the application of water, the following is an excellent remedy, which may be applied with success in every case of malignant fever : take chlorine water twenty grains, distilled wa- ter eight ounces, sugar ten grains, wrap the bottle in dark paper, and cork well. Dose, every two hours one tablespoonful. But if at the beginning of the fever, nausea or vomiting manifest themselves, and if the tongue of the patient has a yellowish or brown coating, and if he has a bad taste, the following emetic is administered : ipecac one grain, syrup of squill fourteen grains, tartar emetic two grains, raspberry syrup fourteen grains, well-water forty grains ; dose, every quarter of an hour a tablespoonful, until vomiting sets in ; dose, for children, a teaspoonful. This must be administered to the sick person at once, even if he is to be treated with cold water. If this is omitted, bad consequences may result therefrom. The emetic here prescribed often breaks up the incipient disease, and a failure to ad- minister it may result in a tedious disease difficult to cure, and some- times it may become altogether incurable. Costiveness must not be permitted during the fever, yet laxatives may easily become debilitating, and therefore very injurious. Injec- tions therefore become indispensable, but they must not be adminis- tered either too cold or too warm, nor while the patient is in a state of perspiration. The best injections are camomile tea, to which a tablespoonful of linseed oil has been added, or two cups of sweet milk and one tablespoonful of honey. Warm baths are also frequently of much benefit, and often prefer- able to all internal remedies. They have a very quieting effect on the patient, and are very suitable in cases of deliriousness, headaches, in- somnnolence, pains and spasms of every kind, and with a dry, hot, rough skin. If the patient is inclined to perspiration, they should not be given. The degree of heat at which these baths should be taken, must agree with the feelings of the patient, and cannot be given according to degrees indicated by the thermometer. The patient must feel com- fortable in the bath, and as long as that feeling continues, he may be left in it. Caution in going into and coming out of the bath is greatly to be recommended. In case of deliriousness and headache, the application of a Spanish fly plaster on the neck, and mustard plaster on the calves of the legs 322 FEVERS. and soles of the feet, are of excellent service. The Spanish fly plaster must never remain until it draws a blister, but must be removed when the skin becomes red, which is generally done in from three to four hours. This, however, differs very much with different people. The raising of a blister after the plaster has been removed is best prevented if a piece of cloth, dipped in strong vinegar, is applied to the place. But should the blister nevertheless appear, it must be cut open as soon as possible, and the wound healed by the application of lead water. Mustard plasters operate quicker and just as powerfully, and have the advantage of not drawing blisters so readily; they, therefore, ought to be preferred as a rule in nervous fever. The mustard plaster is prepared by mixing ground black mustard with warm but not boiling water, and a little good vinegar to a thick mass, which is spread upon cloth. Mustard plasters, should remain until the patient begins to complain of their causing a burning sensation, which usually happens in from ten to fifteen minutes ; with patients who are unconscious, they should remain until the skin has become red. They should never remain too long, because they cause violent and painful inflammation of the skin, and also draw blisters. If, however, severe pain should result, it is best allayed by the fol- lowing ointment : rose salve forty grains, solution of subacetate of lead fourteen drops, spread upon a cloth and apply to the place. In cases of great debility and constant inclination to fainting, sponging with warm wine or aromatic vinegar and spirits of camphor is very good. In an extreme degree of this condition of weakness, when the patient was already insensible and motionless, the abdomen bloated, and even involuntary discharges of stool and urine had taken place, the following remedies have afforded relief : very old Rhine wine, administer a tablespoonful at a time, five Spanish flies applied at the same time, one to the pit of the stomach and the others to the arms and feet, a very warm bath (from twenty-six to twenty-eight degrees) to which wine or whisky had been added ; ice cold poultices applied to the abdomen and head, injections prepared from one cupful of wine and six to eight drops of Hoffman's anodyne ; the injection must be warm, wine alone may be used for that purpose, and the anodyne may be omitted. ACUTE NERVOUS FEVER. 323 Internally administer the following drops : tincture of ambergis with musk, two grains, oil of cinnamon ten drops, Hoffman's balsam of life four grains, sulphuric ether five grains ; dose, every one, two or three hours twenty to twenty-six drops in a little water. The convalescence after nervous fever requires particular considera- tion. If the fever was the result of weakening causes, and if it was of long duration, the convalescence will extend over a long period of time; it may be prolonged for months, and may be interrupted by relapses. The question involved here is how to restore firmness and strength to the body. The so-called calisaya bark and steel wines are excellent for that purpose. Take powdered calisaya bark two ounces, orange peel twenty-five grains, iron twenty-five grains, both in powder, good Rhine wine one bottle ; place the bottle well corked in a warm place for a few days, shake up frequently, and strain ; dose, two tablespoonsful three or four times a day. It is frequently the case that, on account of an accumulation of impurities in the intestinal canal, the calisaya bark does not agree with the convalescent person. This manifests itself by a coated tongue, rolling in the bowels, the frequent passage of very offensively smelling winds and stools, colic pains, and an inclination alternately to diarrhoea and costiveness. Under such circumstances, administer a watery tincture of rhubarb: dose, a tablespoonful everv two hours until a few evacuations have taken place, when the obnoxious substances will have been removed from the intestinal canal ; the cal- isaya bark may then be taken without any further trouble. If the convalescent person suffers from diarrhoea, or if the inclination for it is great, columbo root is the best remedy for it. Take columbo root twenty grains, make a decoction of five ounces from it, to which add aromatic tincture ten grains ; dose, two tablespoonfuls every two hours. If, after recovery, frequent expectoration continues, or, if by continued mucous evacuation (caused by weakness of the chest), emaciation, or painful short cough, burning in the palms of the hands, and a general dry heat during the evening manifests itself, administer the following excellent remedy : Iceland moss, i ounce. Speedwell, - - - i " Mugwort, - - - - i " 324 FEVERS. Chicory root, Violet root, Star anisseed, Licorice juice, Licorice root, Mullein flowers, Mullein leaves Polypody, Wild thyme, Rhubarb, 2 ounces. 3 " i ounce. 2 ounces. 2 " 2 " i ounce. i " i " The dried herbs, and also the roots, must be cut up fine and pow- dered, two gallons of well-water are poured over them, and left over night ; it is then placed on the fire in a covered pot, and boiled down to one-half; the decoction is then taken from the fire and well strained; the strained liquid is again boiled down to one-half (two quarts), and one pound of rock candy added to it ; it is then taken from the fire, cooled off, one pint of spirits of wine added to it, filled in bottles, and well corked ; dose, one tablespoonful every hour. If the patient becomes stronger and more invigorated, the dose may be increased to two tablespoonsful an hour. The patient should also be kept in a cheerful state of mind ; he should take exercise corresponding to his strength, and, if the weather permits, in the open air. He should never be permitted, however, to fatigue himself. Excessive exertions, both of mind and body, must be carefully avoided. Lukewarm baths, from twenty-six to twenty- eight degrees, can be recommended. PUTRID OR SPOTTED FEVER. This disease is connected with weakness, flaccidity of the solid parts, and an inclination for a solution of the juices. The cause lies in an already existing defective mixture of the juices of the patient, induced by humid, hot, impure air, poor food, vitiated blood, the absorption of sharp, corrupt fluids, &c. It frequently occurs as an epidemic in crowded hospitals, vessels and prisons, in fortresses in- vested by an enemy, in populous cities, where diseases are much more frequent than in the country, and particularly in narrow streets, with filthy habitations, and in the neighborhood of battlefields, where a PUTRID OR SPOTTED FEVER. 325 large number of people were buried. No less inciting of the disease are heavy floods, the accumulation of large quantities of putrid vege- table material, the storing of cast-off, soiled clothing, from which a much more dangerous poison exhales than from man himself; further- more from the consumption of spoiled, putrid food, tainted meat and fish, poor, spoiled flour or water, &c. Putrid fever, therefore, is the most faithful companion of scarcity and famine; for that reason it attacks mostly poor people, and therefore has also been called starvation typhus. The symptoms accompanying an attack of this fever are debility, despondency, chills, headache, and disagreeable, pricking heat. The pulse which at first is full, becomes small, irregular and quick ; the face turns pale, the eyes become dull, the tongue and lips have a brown coating ; taste and breath are fetid, the skin is covered with suggillations and purples, and also with small spots resembling flea- bites, which, however are not raised above the surface of the skin ; gangrenous sores appear at the end of the spine, and on the shoulder- blades. The urine is dark, stools fetid, and sometimes bloody, fre- quently also watery. Frequently the patient, without his knowledge, evacuates a blackish matter, smelling like carion ; bleeding of the nose also occurs occasionally. The duration of this fever is from seven to twenty-eight days. Mild cases generally terminate by exuda- tion, urine, eruptions, &c. Severe cases terminate in death, or the disease changes to another, not less dangerous, however. Treatment : No general established rules can be furnished for treat- ment of this disease. All epidemics have their own peculiar character ; what in one may be the only saving remedy, kills in another. There prevailed epidemics at times, when the only remedy for saving the life of the patient consisted in taking the blood from him by the quart, and again others when even the slightest bleeding proved disastrous. In other cases again, emetics are required for the preservation of the patient's life, and in others again, purgatives are indispensably neces- sary to save him from the grave, while the same remedies at other times will deprive the patient of all the strength he may have left. There are remedies, however, which generally have proved beneficial. First of all, the patient should be taken out of the pestilential air which surrounds him, and be transferred to some more wholesome 326 FEVERS. locality ; he should have a plentiful supply of fresh air and cold water. The rules for his diet are the same as those laid down in nervous fever. Patients who take no medicine, but are transferred to a wholesome place, have a better chance for recovery than those who are frequently supplied with the best of medicines, and have the best of care. An excellent remedy is the application of cold water, which should be poured on the patient. This is best done by placing the sick person in an empty tub, and pour cold water on his head as long as he may feel comfortable. The person performing the operation may place himself on a chair or a table for that purpose. This is repeated until it ceases to have a beneficial effect, but again resorted to when the serious symptoms of fever, particularly violent raving, stupefaction, or a total exhaustion of vitality again appear with renewed vigor. During the long cold baths, which are very disagreeable to every sick person, every effort should be made to keep the patient in the bath until he is chilled. As the condition of the patient becomes worse, which is frequently the case, and delirium sets in again, cold water must again be poured on his head, as before stated; but if an improve- ment occurs, the operation may cease. All food taken by the patient must be cold. Close observation in hospitals has elicited the fact that the delirium will cease as soon as the patient has drank a cold liquid. To prevent contagion as far as possible, constant renewal of the atmosphere in the sick-room is required. The most scrupulous cleanliness must be observed in everything ;, the linen of the patient must be changed as of- ten as possible, and stool and urine carefully removed at once. To dis- infect the room, sprinkle cold vinegar on the floor, and not on hot stones; it is still better to use spirits of camphor for that purpose ; a blazing flame, on which juniper berries are thrown, carried through the room, are also recommended. Fumigations are also very excellent for that purpose. Pour drop by drop six grains of sulphuric acid on twenty grains of saltpetre, when white fumes will be developed. Great care should be taken, however, to remove all . good clothes, furniture, looking-glasses, but particularly polished metal from the room, as the fumes will injure them ; they also excite coughing and asthma, and therefore do not agree with patients suffering from thoracic complaints. It is, therefore, preferable to develop these furnes oftener, but in smaller volume. HECTIC FEVER. 327 The following rules should be observed by persons visiting the sick room : Do not enter the room with an empty stomach, and do not swallow your saliva while there, nor unnecessarily touch or handle the patient. Be careful not to inhale the effluvia arising from the sick- bed, when the patient lifts his covers, and draw your breath through a cloth moistened with strong vinegar; rinse your mouth frequently with vinegar and water, or with camphor and water, and wash your hands in a solution of carbolic acid every time you touch the patient. If the first symptoms of contagion are noticed, the progress may be sometimes arrested, by sponging the whole body with spirits of cam- phor ; wrap up the body, and expose yourself in that condition to fresh air. If a free perspiration sets in, the disease is smothered, and the attack averted. HECTIC FEVER. Hectic fever is a slowly progressing disease, and is induced by de- fective nutrition, which gradually destroys organism. This is caused by a weakening of the nervous system, gradual loss of juices, or by a deterioration of the digestive power, defective sanguification, and is the result of dejection of mind, excessive mental exertion, violent pain, exhausting suppuration, suppressed cutaneous eruptions, rapidly healed ulceus, and of many other causes. The commencement of hectic fever is scarcely perceptible, resem- bling at first a light inlermittent fever, which manifests itself in the evening. A burning sensation of the cheeks, palms of the hands, and soles of the feet, small, hard, and quick pulse, weakening morning sweats, and muddy urine will be noticed ; the patient becomes very irritable and sensitive. Although in most cases the appetite is not lost, yet the patient becomes gradually more and more emaciated. After a time the fever increases, a second attack usually setting in after dinner, and finally there is no intermission in the fever. Lastly, diarrhoea deprives the patient of his whole strength, aphthae appear in the mouth, the feet swell, and entire exhaustion is followed by death. Hectic fevers have the peculiarity of progressing very slowly ; they may continue for months and even years. They usually commence so 328 FEVERS. gradually, that at first they may be easily overlooked. Their progress, and the symptoms accompanying them, are not according to any settled rule ; at times an improvement takes place, and again a relapse occurs. These changes depend mostly on the weather, and the mode of life of the patient. In dry, warm weather the patient improves, but grows worse again when the air is damp, wet and cold. Deple- tion of juices, severe physical labor, depressing emotions of the mind, overloading of the stomach, &c, aggravate the disease, but it also occurs sometimes without any perceivable cause. The usual general symptoms of fever, such as heat, headache, &c, appear only in a very mild form, so that the patient is even able to attend to his business at first. Great debility soon follows, however, to which a remarkable emaciation is added. The patient is no longer entirely free of fever, and although the particular symptoms of the fever disappear at certain hours of the day, yet the pulse remains constantly excited and quick. However various the causes may be from which a slow fever can result, they after all are always divided into two general grand classes, upon which is based a double, greatly differing, and even opposite character of the same. In their external symptoms they differ but little, and for that reason a knowledge of the causes is indispensable for a proper treatment of the disease. The fundamental condition of these slow fevers consists in a very great nervous and general debility, or in a slow inflammation of the inner membrane of the stomach and the small intestines, and in an inflammable, irritated condition of the blood and the nerves. In the treat?nent of this fever, which in its severer forms is always fatal, the removal of the cause must be kept in view ; thus, a limb, for instance, which endangers life by an incurable suppuration, must be amputated. If the cause cannot be removed, the chief aim must be to revive as much as possible the failing strength, by invigorating and nutricious remedies ; the particular character of the fever, how- ever, must not be lost sight of. The chief remedies are calisaya bark and Iceland moss. Take three and one-half ounces of Iceland moss, and soak over night with four grains of potash, dissolved in hot water, which removes its bitter taste ; drain off the water in which it was soaked, and boil in three quarts of well water until reduced to one-half, strain, and squeeze out INTERMITTENT FEVER AGUE. 329 the residue ; add to the decoction six grains of salep powder, pre- viously made into a pulp by being rubbed up with a little cold water, and boil down again, with constant stirring, to one-half (about one quart), and while still hot, add one and one-half ounces of rock candy. Dose, from one to two teaspoonsful three or four times a day. Also administer calisaya and steel wine : take powdered calisaya fifty grains, powdered iron twenty grains, put in a bottle of good Rhine wine, cork up well, and let it stand for a few days in a warm place, shake it up frequently, and finally strain. Dose, two tablespoonsful three times a day. To check exhausting diarrhoea, administer tincture of opium, from five to twenty drops, once or twice a day. In case of night-sweats, give a tea prepared from sage and diluted sulphuric acid three or four drops, to which raspberry syrup has been added. Strict diet must be observed, however. INTERMITTENT FEVER-AGUE. This disease occurs at stated periods ; chills, heat, and exudation following each other. With the usual symptoms attending fever attacks, chills appear, which, beginning in the back, extend over the whole body, It is accompanied by shaking of the limbs and the lower jaw (chattering of teeth), small, spasmodic, quick and uneven pulse, troubled breathing, and the secretion of a clear, pale urine. When this chill, which, according to circumstances, may be more or less severe, has continued for one or two hours, it gradually changes to heat ; the skin of the body becomes warm, assumes a redish tint, thirst increases, breathing and pulse become freer and fuller; the urine is colored again, with which considerable vascular excitement and severe headache is connected. In from two to four hours heat is succeeded by exudation, which is usually of yellowish color, viscous, and of an acid smell, or accompanied by a miliary eruption ; the urine becoming muddy at the same time. Finally, and until the next attack, all fever symptoms disappear, and only the gastric state, and a feeling of lassitude remain during the time the patient is free of fever. This usually occurs on the following, or on the second or 330 . FEVERS. or third day, according to which order intermittent fevers are classi- fied. Sometimes a mild attack of the fever occurs on the first day, which is succeeded by a stronger one on the next, and again by a milder one on the third day, or the fever only returns every third day, in which case there are two attacks in one day. There is also another kind of fever which lasts for two days, followed by one day of intermission, and again by two days of fever. The four-day fever makes two attacks on every fourth day. The mildest form of inter- mittent fever is that which appears every third day; it generally ends with five or nine attacks. The fever is generally connected with dis- arrangements of the digestive organs, and frequently occurs in the spring or autumn, particularly if the patient lives in damp places, or does not follow dietetic rules. The one-day intermittent fever easily becomes irregular, and, like the four-day fever, more obstinate It usually appears during damp and cold autumns, and attacks persons who are inclined to abdominal diseases. It is difficult to eradicate on account of the many relapses to which the patient is subject, and not rarely leaves liver, spleen, and other abdominal diseases, behind. Intermittent fevers are rarely unmixed or independent of other dis- eases, but, as before remarked, they are mostly connected with de- rangements of the digestive organs. Ordinary intermittent fevers, however, usually terminate favorably and regularly. In cases of the one and four-day intermittent fever, it is a sign of approaching recovery, if the three-day fever is passed over. It is, however, un- favorable if a three-day fever changes to a four-day, or a one-day fever into a continuous fever. Treatment : Strict diet must be observed. The patient may drink warm camomile or elder blossom tea, while the chills are upon him, and cooling acid drinks, such as lemonade, diluted raspberry vinegar, &c, during the heat. Everything tending to interrupt or suppress perspiration should be avoided. During the time when the patient is free from fever, it should be the aim. in the first instance, to remove the causes of the fever as much as possible, and then reduce the fever itself. In many instances an emetic administered at first has a very good effect; laxatives and resolving remedies are also necessary. If all other causes have been thus removed, and if the patient, aside of the fever, is in general good health, medicines should be given to INTERMITTENT FEVER AGUE. 331 break up the fever. One of the best remedies for that purpose is calisaya bark, which in most cases has the desired effect. For reasons stated under the head of "Calisaya Bark/' it is preferred not to administer the bark itself, but the quinine (see the article) contained therein, which is given in the form of sulphate of quinine. An adult suffering from the intermittent or from the three-day fever, may take two grains twice or three times a day ; this must be taken on the day when he is free from fever ; in case of four-day fever, he must take the same quantity four or five times a day. It is prepared as follows : sulphate of quinine twenty-four grains, the same quantity of sugar, powdered and mixed, and divided into fourteen powders. Dose for children, a part or one-half of the quantity, according to age. Of a large number of domestic remedies for intermittent fever, which frequently have proved useful, I will give here the following: i. A cup of very strong coffee (without milk, and three-quarters of an ounce of coffee to the cup), with the juice of a lemon, taken every morning, or one hour before the fever sets in, which will induce a heavy perspiration 2. Black pepper-corn (from ten to sixteen), taken daily mornings and evenings. 3. Powdered black pepper (a small teaspoonful) or powdered nut- meg in rum, taken a short time before the fever begins. Great caution is necessary in the administration of these sharp remedies, as they readily increase the heat. 4. One drachm of powdered camomile flowers three times a day, taken during the time when the patient is free from fever. 5. Powdered charcoal one drachm every two hours. During the state of convalescence, the patient has to abstain from the use of unripe fruit, fish, heavy legumes, hard eggs, &c , and must be very careful not to take cold. It should be particularly noted that the intermittent fever is often inclined to inflammation, if it comes in contact with blood which is in an inflammatory condition. This combination occurs much more frequently than is usually supposed. There are circumstances under which it may be assumed w r ith cer- tainty that the blood is in an inflammatory condition. Thus, if the intermittent fever, which commenced in the spring, does not yield to treatment with quinine, or if it was suffered to run its course by 332 FEVERS. neglect ; if, under these circumstances, oppression of the chest, spasms in the same organ, or palpitation of the heart, should set in, particularly in young women, whose menstruation has stopped, the correctness Of the assumption would amount to a certainty. If, under these considerations, fear should prevent venesection, it would with certainty open the road to phthisis pulmonalis. The inflam- matory state is much more easily recognized if the patients are young and plethoric, if the fever appears in the winter or in the beginning of spring, and if at the outset violent headache and deliriousness, or inflammatory thoracic complaints manifest themselves. Pregnant women frequently miscarry, and the fever cannot always be broken up previous to confinement. Favorable weather expedites recovery. Treatment of intermittent fever during an attack of the fever : First of all, care should be taken that the patient is not surprised by the fever with a very full stomach. If the time of the attack is known, the patient should not eat a heavy meal just previous to it, even if urged to it by an unusual appetite. He should most carefully avoid very fat, heavy, indigestible food, and shortly before the attack he should abstain from drinking too much. When the chill occurs, but little remains to be done ; the patient, however, should not await the attack out of bed, but lie down immediately, and cover himself up moder- ately warm. Artificial means to warm the patient, such as warming pans, rubbing with heated cloths, heavy feather-beds, greatly heated rooms, &c, must not be resorted to, however much he may desire it. The application of these means is connected with considerable dan- ger, particularly if the patient is already advanced in life ; for there is always a dangerous determination of blood from the outer parts toward the head and breast, which would be still more increased by these methods of creating heat. For the same reason should all tight clothing be removed from the patient during the chill. The great thirst which is always present, must not be unconditionally gratified because it unnecessarily overloads the stomach. Small quantities of lukewarm black tea or coffeee without milk, or an infusion of orange leaves or flowers, or elder-blossom tea with a little lemon juice, may be given. The vomiting which sometimes occurs during the chill, is greatly facilitated by these drinks. If the chill is connected with a great deal of cramp, Selters water, or half a drachm of carbonate of ABDOMINAL TYPHUS. 333 lime, dissolved in half a cupful of water, may be given, and immedi- ately after it a tablespoon ful of lemon juice or vinegar. When the chill changes to heat, the patient may be kept a little cooler, but only moderately so, in order not to retard exudation. In that stage of the fever, weak lemonade, or the following preparation, may be given as a drink : diluted sulphuric acid three grains, raspberry syrup four ounces ; one tablespoonful of it to be put in a tumbler of water. If the headache is very severe during the heat, apply a poultice made of bread, powdered juniper berries, and vinegar, to the fore- head. Nothing, however, decreases the heat and headache more than a cooling injection, which is prepared as follows : take a decoction of oatmeal or bran two cupsful, oxymel two tablespoonsful ; the injec- tion to be given lukewarm. If the patient calls for food, give him a little broth or oatmeal gruel. It is well to change linen and bedding after the exudation, and the patient may also change rooms. The greatest cleanliness is desirable. ABDOMINAL TYPHUS. Typhus is a most dangerous fever; in the beginning of the present century it was almost unknown. Since then it has more or less crowded out all other nervous fevers, and now, if nervous fever is spoken of, it may be assumed with certainty that abdominal typhus is meant by it. But true nervous fever and abdominal typhus, although very similar, are nevertheless two very different things, and mistaking the one for the other is of great import. The disease must be counted among the acute eruptive diseases, with this difference, how- ever, that while in small-pox, measles, scarlet fever, &c, the eruption appears on the surface of the skin, it attacks in typhus the inner mem- brane of the small intestines. It is true that this eruption is accom- panied by all the symptoms of true nervous fever, but whatever may be administered in nervous fever through the intestinal canal, the con- dition of which during that disease differs but little from its normal state, must under no circumstances be administered in a case of abdominal typhus, where the inner membrane is covered with pustules and ulcers, threatening corrosion and cribating of the intestines. This, however, is not infrequently the case, and although the disease itself is connected with great danger, yet injudicious treatment will 334 - FEVERS. cause an unfavorable result oftener than the nature of the disease warrants. All exciting remedies administered internally in nervous fevers only tend to destroy life more surely if administered in cases of abdominal typhus. I will therefore endeavor to describe the dis- ease in a manner so as to be understood by a lay-man, and to explain the principal symptoms. It will become clear to him then why a judicious physician administers but little medicine. It will tend to preserve the confidence of the patient in his medical attendant. But it will also serve as a warning against those prescription writers, who think it necessary to write two or three new prescriptions for the poor patient at every visit, even should they call two or three times a day. This writing prescriptions in quantities is always proof of the uncertainty and lack of judiciousness in a physician, and this insane industry is sure to carry the patient to his grave. The difference between the disease in question and nervous fever, and which, with a little attention, must even strike the lay-man, is the following : Abdominal typhus may originate, from contagion, and therefore also become contagious. It attacks both healthy people and invalids. It can never be traced to a certain cause, and its origin is just as much unknown as are the causes producing scarlet fever, small- pox, &c. The fever usually attacks people suddenly and unexpectedly, while apparently in excellent health, and without any note of warning. Of two hundred people attacked by typhus, one hundred were attacked suddenly, and fifty only with premonitory symptoms. If premonitory symptoms precede the attack, which is rarely the case, they resemble in many respects those of nervous fever ; yet the peculiar expression in the face, diarrhoea, pain in the right side of the abdomen, and its expansion, are never absent as indications of disease of the intestines. The attention must be particularly directed to the following indica- tions, which never fail from the beginning to the end of the disease : The change of features is most remarkable, and manifests itself at the beginning of the disease. They are distinguished for their peculiar elongation and distortion, giving the face a gloomy expression, indi- cating a deep-seated disorder. Diarrhoea is another important symp- tom. It is never wanting, and usually sets in on the first or second day of the attack ; it rarely appears later than that. Pain in the abdomen, however, indicates the full meaning of this symptom. This ABDOMINAL TYPHUS. 335 pain is usually not of much importance to the feelings of the patient, because he rarely complains of it. But if the abdomen below the navel and toward the right side is pressed down hard, the patient ex- periences considerable pain, which, if in an unconscious condition, he manifests by a distortion of features, and it may even recall him to consciousness for a short time. With the appearance of the abdomi- nal typhus, the patient complains of violent headache, particularly in the morning when he gets up; the features change rapidly, and stupor is frequently noticed ; he feels extremely weak and debilitated, and even then diarrhoea and pain in the abdomen preclude all doubt of the nature of the disease. In the severer stages of the disease, the symptoms are of a pecu- liarly changeable character. Violent subsultus tendinum, screaming, constant efforts to leave the bed, unconsciousness, and insensibility, deliriousness, and finally deep somnolence, make their appearance. Between the seventh and ninth day not infrequently small rose-colored spots appear on the abdomen, and sometimes also on the chest and thigh, which, however, spread only rarely. They are more distinct and clear in white than in dark-skinned people, and are difficult to distinguish in the latter. The duration of this eruption is not always alike. Frequently it lasts only two or three days, while in other cases it continues for twelve or fifteen days. The skin is dry, and its tem- perature greatly increased. The tongue is entirely dry, fissured, and adheres to the palate. The teeth are covered with a brown offensively- smelling matter ; speech is unintelligible ; diarrhoea continues, although not quite so severely as during the first stage ; the bowels are unconsciously discharged, and are mixed with blood ; the blood which is here frequently discharged in considerable quantities, consists of a thickish substance ; the distention of the abdomen increases fre- quently to the tightness of a drum, and the patient easily gets sore from lying in bed. During this stage the disease frequently ends in death, often on the eighth day, usually, however, between the six- teenth and forty-fifth day. If the disease is to terminate favorably, the severe symptoms gradually decrease. If the patient replies to the questions addressed to him, he does it with greater precision, and he turns his eyes on the person who converses with him. This first look and expression of face are indications that the patient is casting off 336 FEVERS. the stupor in which he has been lying, and it may be considered a favorable symptom. In other cases the patient passes from the stupor in which he has been lying into a quiet slumber, from which he awakens much improved. This favorable change may occur between the eighth and forty-fifth day. Sometimes, however, and against all expectation, the most serious symptoms manifest themselves again. Violent pains in the abdomen, fainting fits, nausea and vomiting, in- dicate that the intestines are cribrated, and that an effusion of faeces into the cavity of the abdomen is taking place. Under these circum- stances death cannot be averted. Recovery : If the disease takes a favorable turn, the patient does not pass at once from danger to a complete recovery. The improve- ment frequently is extremely slow, and there are patients who remain in a painful condition from one to two months after the disappearance of the violent symptoms. Sometimes the patient becomes ravenously hungry after recovery ; if he should satisfy it, the worst consequences might result therefrom. If nothing unfavorable occurs, the patient gradually recovers his consciousness, his strength is increasing day by day, and he improves, if he does not lose sight of the necessity of observing strict diet, takes cold, or commits some other error. Non- observance of these rules frequently results in bad consequences, or even in death. In regard to treatment, it must not be forgotten that this typhus should no more be disturbed in its course than other acute eruptions, and for that reason any particular medical interference should be avoided. The general rules of medical science should be directed to the position and nursing of the patient, and the prevention of external injurious influences. The course of the disease should be carefully observed, and suitable remedies administered at proper times, or for the purpose of averting threatening danger. This disease, more than any other, requires the greatest care in the admission of fresh, whole- some air. As but little can be done during the course of the disease, the greatest care should be taken to prevent the malady. This is done particularly by living moderately, by tranquility of mind, great clean- liness, by diligently airing the rooms and bedding, and finally, if gastric difficulties occur, by the administration of an emetic. Nothing is required for the cure of this disease than a comfortable, clean bed, ABDOMINAL FEVER. 337 which should be rather cool than warm, the greatest cleanliness in everything by which the patient is surrounded, and no other food than thin mucilaginous drinks, mixed with some acid vegetable juice. A drink prepared from red bilberries has proved to be very excellent, and can therefore be recommended above all others. The patient may use il at pleasure. In case of headache, bathe the head with cold water and vinegar, apply mustard plaster to the calves of the legs, and cold poultices to the head. In case of violent diarrhoea, administer strengthening injections. During convalescence the best remedies are cleanliness, fresh air, and absolute quietness. In case of severe pain in the abdomen, but more particularly in wind dropsy, ice-bladders should be applied to the abdomen. If after this treatment the symptoms have improved, proceed as in nervous fever. Wrap the patient in wet sheets, then wash him off with cold water, &c. SEXUAL DISEASES OF WOMEN Menstruation is the natural discharge of a fluid, resembling blood, from the genitals of woman, which usually commences about the time of maturity, between the fourteenth and sixteenth year. Nature, however, pursues her own course, and it sometimes begins prior or subsequent to the time mentioned. It usually returns every four weeks, under the same conditions, and continues for a longer or shorter period of time, varying from two to seven days. RULES FOR THE MENSTRUATION PERIOD. The woman should avoid every physical exertion, also the use of all exciting food and drinks. To the latter class belong wine, chocolate, coffee, &c. She should forbear sexual intercourse, and, if she uses medicines, discontinue them during menstruation ; baths or foot-baths must not be taken, nor must she be bled during that time. She should carefully guard against taking cold, and avoid all emotions of mind, particularly anger, fright, &c. If, by some accident, menstruation has been suddenly suppressed, warm foot-baths may be resorted to ; tea prepared from lemon balm, peppermint, camomile, valerian root, fennel, anis, &c, may be drank. If menstruation does not reappear, or perhaps another disease be the result, a judicious physician should be consulted, as sometimes very critical derangements result from these interruptions. PREMATURE APPEARANCE OF MENSTRUATION. These occur usually under certain climatic conditions. Cases are reported where girls from five to nine years old were taken with regu- lar monthly courses. Cases of that kind are very rare, however ; they are usually caused by an hereditary peculiarity of the body, and, for that reason, are rarely adapted for medical treatment. Frequently, (33*) PREMATURE APPEARANCE OF MENSTRUATION. 339 however, this irregular condition is the result of a faulty mode of life, or of other diseases existing at the same time. Among the injurious influences, the following may be enumerated : poor nourishment and neglect in very early childhood, poverty, poor food, dwelling in damp, cold habitations, too early, hard and debili- tating labor, sedentary mode of life, lack of exercise, particularly in the fresh air, too liberal use of heat, and highly spiced food and drink, sleeping in beds too warm, and also frequent touching and irri- tation of the genitals, particularly self-pollution, early novel reading, and visits to the theatre. Among the diseases resulting from a too early sexual development in girls are scrofula, rickets, emaciation, worms, intermittent lever, and dropsy. Worms may produce a dis- charge of blood from the female sexual organs, because the itching and scratching may cause excoriation of the parts. The scratching may cause bleeding, which has often been mistaken for an early ap- pearance of the menses. But the constant irritation produced by the presence of worms in the rectum may really have caused the menses too soon. This premature appearance of the menses readily leads to emaciation and consumption, and particularly if the girl is very young, and if, with a weak, excitable constitution, the sexual instinct has been violently called out. To remove this morbid condition, the above enumerated injurious influences are to be avoided. Their place should be taken by a better physical education, healthier, dry habita- tion, exercise in the open air, appropriate occupation, and pleasant diversion of mind. A change of climate, and living in the country, are excellent remedies, and frequently sufficient to cure the disease entirely. If no other diseases, such as scrofula, worms, &c, exist, if the condition is not produced by premature sexual irritation, if no painful feelings are excited in an examination of the spine, if no impurities exist in the entrances, then only the general debility of the body has to be overcome. The following tea should therefore be taken at first : orange peel and sweet flag four ounces of each, buckbean nine ounces ; forty grains of these herbs to be scalded with three cupsful of boiling water, and left to draw for one-quarter of an hour ; after being cooled down, sweeten with sugar ; dose, half a teacupful four times a day. Subse- quently use Iceland moss. 340 SEXUAL DISEASES OF WOMEN. Externally, spiced embrocations should be applied to the abdomen, pubic and sacral region, prepared from compound mastic, or angelica spirits, with the oily-balsamic mixture, or with the following: com- pound mastic spirits fifty grains, oily-balsamic mixture forty grains, caustic spirits of sal-ammoniac fifteen grains, balsam of nutmeg six grains, Peruvian balsam four grains. The food should be light and not at all, or very moderately, spiced ; strong broths, sago and rice soup, veal, mutton, and tender, poultry eggs, easily digested root vegetables, &c, can be recommended. Wine is too heating ; a good beer, not too strong, is preferable, par- ticularly porter, which may be administered in the morning as a strengthening medicine, a tablespoonful at a time. During the time of the menses, everything must be avoided that may increase the flow in any way, or that may entirely or suddenly check it ; for instance, laxatives, baths, embrocations, &c. On the other hand, care should be taken to have it continue as moderately as possible. It is therefore necessary that the patient should absolutely rest during that time, observe strict diet, and use cooling drinks. In very rare cases does the effusion of blood become so violent as to threaten danger. Should such a case occur, however, foment the abdomen with a cold effusion of wild thyme, wormwood, and lemon balm, mixed with wine ; drop ether on the abdomen, and administer internally from six to eight drops of phosphoric acid in mucilaginous drinks. If the case should be more serious, medical advice should be obtained. If the prema- ture puberty of the girl is a consequence of violent excitement of sexual instinct, strict supervision should be kept over her, unsuitable books and bad company prohibited, self-pollution prevented, and the use of all heating drinks, such as wine, chocolate, coffee, and green tea, as well as highly spiced food, carefully avoided. If, as is usually the case, the spinal cord also suffers, apply from two to four leeches to the sensitive part of the vertebral column, and use embrocations of equal parts of croton and sweet almond oil. But where only weak- ness prevails, lukewarm baths of camomile or valerian, and particu- larly cold ablutions and cold sitz-baths, are very beneficial ; cooling, soothing remedies are also excellent, for which purpose use the follow- ing : take fresh-pressed lemon juice fourteen grains, saturate with carbonate of potash, linden flower tea four ounces, bitter almond NON-APPEARANCE OF MENSTRUATION. 341 water four grains, sugar twelve grains ; dose, a tablespoonful every hour or two. NON-APPEARANCE OF MENSTRUATION AT THE TIME OF PUBERTY. A girl cannot arrive at the years of puberty, without the appearance of menstruation. Although this always deserves our whole attention, yet the non-appearance should not at once be looked upon as a disease, and the attempt made to produce menstruation by medicines. There are some- times women found with whom menstruation occurs very late, and there are even some who never have any menstrual period at all, and yet remain perfectly healthy. If, however, symptoms manifest them- selves, indicating an effort on the part of nature, to bring about the menstrual period, and if it is not followed by menstruation, but on the contrary if in its place the health of the girl is affected thereby, then a morbid delay of menstruation may be supposed to exist. The symptoms which may be considered as an effort by nature to produce menstruation are anxiety, dizziness, headache, general debility, and heaviness of the limbs, painful swelling and tension of the breasts, pain in the back ; besides these, the abdomen is somewhat bloated and harder than usual, a burning sensation is also felt in the vagina, and not rarely a mucous effusion occurs. Wherever these symptoms do not present themselves, nothing at all should be done, but the result patiently awaited. But if the symptoms are present, and the health not otherwise disturbed, it is sufficient at the time when they manifest themselves, to take at night a foot-bath up to the knees, to rub repeatedly the chine-bone and the inner sides of the thighs with dry, warm flannel, or still better with the warm hand, to let the girl work industriously, keep her in good spirits, and permit her to exercise freely in the open air. But if in spite of these premonitory symptoms menstruation does not follow, and if various morbid disorders manifest themselves, it would not be advisable to apply forcing remedies at once, but it would be well to investigate and endeavor to discover the cause of the delay, and to remove the same. It is altogether wrong to imagine that every difficulty is caused by this delay of menstruation, and that remedial 342 SEXUAL DISEASES OF WOMEN. treatment should be limited to produce the monthly courses. If the body is weakened and exhausted by a preceding or still existing dis- ease, or if the girl suffers from a disease retarding the development of her body, the non-appearance of menstruation should be looked upon as beneficial, rather than as the cause of the disease. Under such circumstances, this flow of blood, as well as any other loss of blood, would only increase physical debility, and only tend to aggravate the condition. It will therefore be readily perceived what injury may result from the application of remedies to produce the monthly courses, if they do not appear at the regular time. In every case of delay, accompanied by morbid symptoms, and in every case of de- rangement of the monthly courses, attention should be directed to the inducing causes only, and the aim should be to combat and remove them. The menstruation may be prevented by a deformity of the vagina, or of the mouth of the womb, permitting a secretion of the blood in the womb, but not the outflow of it. In such cases, and with all signs of puberty, the above described premonitory symptoms of menstruation appear regularly, such as bloating of the abdomen, irregular digestion, pain in the back, &c, symptoms which may fre- quently create a suspicion of pregnancy. Under such circumstances an examination will give the necessary information, and if a deformity is discovered, it is usually removed without great difficulty, by a sur- gical operation. The time for the monthly courses is often retarded by an abundance of blood, full of vital strength in a robust body, as is often to be found in strong, vigorous country people, and also in well-fed city people. This is particularly the case, if to these condi- tions are added diet, severe labor, and violent emotions of mind. If, under these circumstances, menstruation does not soon occur with such persons, the abdomen becomes turgid and painful, headaches, ringing in the ears, heat in the head, particularly by bending the body forward, anxiety, oppression, palpitation of the heart, and active con- gestions result ; an inclination to fever and inflammation, and even apoplectic fits manifest themselves, or it results in severe hemorrhages from the nose or lungs, or even in insanity. The chief remedy in such cases is vigorous bleeding at the foot, which often removes the difficulty at once. If, however, lumbago, pain in the sacral region and bowels, tension and turgidity of the abdomen remain, leeches must be NON-APPEARANCE OF MENSTRUATION. 343 applied to the genitals, or cupping-cups to the inner side of the the thighs. This should be repeated as often as required by circum- stances. The following remedies may be administered : soluble cream of tartar fourteen grains, a decoction of eight ounces of cucumbers, sugar at pleasure ; dose, two tablespoonsful every three hours. In case of constipation, give bitter water in a little milk, and in costive- ness, use tamarinds : take pulp of tamarinds four ounces, bitartrate of potassa ten grains, water one quart ; dose, half a teacupful every two hours ; or give castor oil, from one to two tablespoonsful in a cup of oatmeal gruel. The patient must freely use watery, thinning, acid- ulated drinks, a moderate quantity of young vegetables and fruit, and must avoid too much sitting, and also emotions of the mind. Every- thing causing heavy exudations, and increased secretions of urine, is injurious, because these discharges of liquid aid in thickening the blood. I cannot enter here upon a fuller discussion of the diseases which may result from the non-appearance or the derangement of the monthly courses, as space forbids to enter into minutiae; I must limit myself, therefore, to the principal points which have been already stated. I will only add the following short hints : A condition of the body, resembling more that of a man than a woman, is also fre- quently a cause for the delay of menstruation. These male-women are distinguished by their larger size, length and breath of the chest, small development of breasts, manly features, a greater abundance of hair on the upper lip, flat abdomen, and smaller hips, and not rarely there also exists a defective development of the genitals. In such women the monthly courses begin later than in others, and in some cases the sexual development is so much retarded that nature en- deavors in vain to effect the purification, from which, as before stated, may result the morbid conditions referred to, mental and nervous derangement. Treatment must conform to the physical con- dition of the patient. The different variations should receive the consideration of a professional gentleman. 344 SEXUAL DISEASES OF WOMEN. SUPPRESSION OF MENSES. The suppression of this hemorrhage occurs in a twofold way : the menstruation is either suddenly suppressed during its flow, or it does not occur at its usual time, after having regularly appeared for a shorter or longer period. The diseases resulting from a sudden sup- pression of the menstruation are much more violent and dangerous than from a simple non-appearance of the same. These diseases - are either of an inflammatory or spasmodic character, or are even of a paralytic nature. The inflammatory diseases arise in young, robust, plethoric women, more rarely in mothers, if the menstruation is sup- pressed by taking cold, particularly by cold feet, or through the sexual organs ; for instance, by sitting on cold stone benches, by be- ing thinly clad, by overheating, the abuse of heating remedies, the use of spirituous liquors, irritating food, violent passions and emotions, such as fright, vexation, anger rage, or even by too much joy. It is usually immediately followed by severe pain in the bowels, connected with heaviness in the loins, which is greatly increased by be- ing touched. To this is added a more or less violent inflammatory fever, particularly, however, congestion or inflammation of other vital parts, for instance, the brain, lungs, heart, and abdomen, or haemop- tysis, vomiting of blood, and even apoplexy in consequence of an internal bleeding of the brain. Antiphlogistic treatment is indispens- able under these circumstances. Bleeding at the foot, or, in less robust persons, the application of leeches on the genitals, must be im- mediately resorted to, and the attack must be generally treated like an inflammatory fever. The patient should also take warm foot-baths, and sit over the fumes of a hot infusion of emollient herbs. Poul- tices made of mallow flowers, linseed, or bran, should be applied to the abdomen and genitals, and an emollient infusion, prepared as follows, should be repeatedly given: take fourteen grains of lin- seed, boil in one pint of water, strain well, add two table- spoonsful of sweet butter, or two tablespoonsful of linseed oil, or one tablespoonful of honey, and use it in a lukewarm state for an injection. If fever and inflammation are not too severe, administer from five to six grains of borax, mixed with an equal quantity of sugar, three or four times a day. The following powder may also be given : tartrate of soda six grains, bi-carbonate of soda SUPPRESSION OF MENSES. 345 three grains, put this powder in a white paper ; cream of tartar three grains, put in blue paper. The powder in the white paper is dissolved in a glass of sweetened water, the powder in the blue paper is then added to it ; it must be drank during effervescence. The diseased condition originates with very sensitive women of nervous debility, and irritable constitution, who are inclined to faint- ing fits and nervous pains, or who are convalescent from severe sick- ness, or who have repeatedly miscarried, or live an unhappy matri- monial life, or who have suffered for some time from spasmodic dif- ficulties during menstruation, or from violent spasmodic labor pains. With such women it needs but very little to cause a suppression of the menses. Among the most common causes are very insignificant emotions of mind, vexation, anger, colds, and particularly drafts striking the genitals ; cold immissions, perhaps made with the inten- tion of lessening excessive menstruation, or copulation during the menses. The diseases resulting from suppressed menses are partly local and partly general. The menses are either suppressed at once, or redish water continues to escape, drop by drop, with pains resem- bling labor pains. The abdomen, and particularly the region of the womb, expand, and become very sensitive, and occasionally are spas- modically drawn inwardly. The most violent pains pervade the abdomen, which occur at intervals, and therefore resemble labor pains. They are not at all, or very slightly, increased by external pres- sure, and in that respect differ from the pains accompanying an inflam- matory condition. Frequently the patient experiences a violent pres- sure on the bladder and the rectum, without being able to discharge either urine or fasces. The general disorders are very manifold, and differ with the nature of influencing causes. If caused by violent passions, it is usually succeeded by trembling, pallor, chillness of the limbs, hysterical crying or laughing, fainting, severe nervous attacks, spasms with rigidity, convulsions, &c. If caused by cold, the spas- modic attacks are accompanied by congestion of other parts, and therefore inflammatory attacks of the brain, lungs, abdomen, or hem- orrhages in other parts. In treatment, the causes should be taken into consideration ; if suppression of the menses is caused by wrath or anger, an emetic should be administered. If it has resulted from taking cold, the 846 SEXUAL DISEASES OF WOMEN. patient should be kept warm, drink abundantly of warm drinks, such :s camomile tea, and take of Dovers powder from three to four decigrammes, sugar two grains, to which four centigrammes camphor are to be added. Bad results will be prevented thereby, and present morbid symptoms removed. In attacks of violent spasms and faint- ing fits, give the following antispasmodic drops : oily spirits of harts- horn and etherial tincture of valerian, six grains of each, tincture of opium with saffron two grains ; dose, from ten to twenty drops with sugar every half hour. Also apply embrocations of the following antispasmodic ointment : opium two grains, marshmallow ointment forty grains ; if the pain is severe, rub in a quantity of the size of a hazel nut ; a poultice prepared from the following herbs may also be applied : linseed four ounces, hemlock leaves two ounces, henbane one and one-half ounces ; boil with water to a mass of medium consis- tency, add forty-five grains of oil of henbane, and apply lukewarm to the abdomen. In severe attacks of pain in the abdomen, apply mus- tard plaster, which keep on the place from ten to fifteen minutes, until the skin becomes red. The spinal column must also be ex- amined, and if tender parts are found, the treatment heretofore pre- scribed should be followed. EXCESSIVE MENSES AND FLOODING. It is difficult to determine whether the flow of the menses is too great, because some constitutions require larger discharges for their health than others. The effect on the body must therefore be the guide of the sufficiency of the flow of blood. In cases where the result is a weak, or intermittent pulse, general debility, cold limbs, faint breathing, palpitation of the heart when moving about, lack of appetite, and dejection, or if perhaps the feet swell in the evening, it is evident that the flow is too great. The same is the case if the menses continue too long, from six to eight and more days, or if they return too often. Menstruation amounts to flooding, if, with comparatively rapid dis- charges, weakness increases to fainting. This condition, however, may occur at other times than at the time of menstruation. A con- stant flow of blood from the womb also occurs sometimes without regard to time. The results of this flow of blood are general de- EXCESSIVE MENSES AND FLOODING. 347 bility, particularly of the nerves and their function, hysterics, spasms of every kind, emaciation and an inclination to dropsy. Causes are, a flaccid condition of the body, sedentary mode of life, particularly with luxurious living, or the use of strong beer, great sen- sitiveness especially of the womb, morbidly excited sexual instinct, by frequent intercourse with men, novel reading, &c, too frequent copu lation, onanism, frequent childbed, weakness of the main parts, scorbu- tic condition of the blood, impurity of the gall, &c. ; also indurations and excrescences {polypi') in the womb. The treatment is two-fold : it is either to cure the disease by the removal of the cause, or to avert the threatening danger * caused by the severe loss of blood. Frequently a proper mode of living, par- ticularly by avoiding everything that may be injurious, is sufficient to diminish or prevent altogether excessive menstruation. The patient should abstain from eating irritating, heating, and too warm food, or using beverages of the same character, avoid excessive and heating exercise, and wear no garments pressing the body. She should also avoid all emotions of the mind. If she is married, she should be moderate in the enjoyment of copulation, particularly a short time previous to, or soon after, menstruation ; standing or sitting too much should be avoided ; a reclining position both day and night is prefer- able. Should, however, all this be insufficient, medicines are to be used. The most frequent cause is weakness and relaxation of the womb. The debilitated exterior of the patient preceding frequent confinements and sedentary mode of life, point to that condition. Strengthening remedies only are of service under these circum- stances, and particularly tincture of Peruvian bark, prepared as fol- lows : Haller's acid six grains, compound tincture of quinine thirty- five grains, tincture of orange peel six grains ; dose, fifty drops, three times a day in a cup of water. Particularly efficacious is alum whey, which is prepared in the fol- lowing manner : take two and one-half pounds of milk and six grains of alum, this turn into whey, sugar eighteen grains (or in case of bleeding of the womb, from twenty to thirty grains cinnamon syrup); dose, half a cupful every one, two or three hours. Cinnamon tea is also excellent, four grains of cinnamon, scalded with two cups of boiling water, to be used during the day. 348 SEXUAL DISEASES OF WOMEN. In case of great debility and long duration of the disease, and if the blood does not pass off in lumps, iron is beneficial : take car- bonate of iron fourteen grains, gum arabic and sugar, ten grains of each, make into one hundred pills ; dose, at first one pill a day, and increase in divided doses to ten and twelve pills daily. This remedy should be continued for some time. If, however, the malady obstinately continues, give the iron in combination with other strength- ening remedies: quinine, rhatany bark, extract of sage and catechu, ten grains each, sulphate of iron four grains, make into two hundred and sixty pills ; dose, from six to eight pills three times a day. Avoid everything of a weakening character, abstain from all warm drinks, and use everything as cold as possible. To avoid a relapse, it is neces- sary, particularly if the pills are used, to continue them from two to three months after the malady has disappeared, provided the stomach can bear them. If great irritability of the nerves exists, ipecac in small doses oper- ates very beneficially : take ipecac root, from two to three centi- grammes, with one grain of sugar ; dose, every three hours a piece. Phosphoric acid, in doses from eight to twenty drops in a cup of raspberry water, every three or four hours, has proved very efficient. Plethora and inflammatory excitement have rarely been the cause of this morbid condition, yet there are cases when the flow of blood during menstruation became very violent in persons of plethoric habits and full of health, by the use of heating food and drink, wine and coffee, and by excessive dancing, too much exercise, particularly in hot weather, or during severe colds in the winter, &c, and which could only be stopped by bleeding at the arm. Under such circum- stances, cooling laxatives may be administered with advantage. Administer the following : pulp of tamarinds and manna, of each fifteen grains, epsom salt twelve grains, boil in fourteen ounces of water until reduced to ten, strain, and add two and one-half ounces of raspberry syrup ; dose, every two hours one tablespoon ful, until it has produced a proper effect. Besides bleeding, the following is a good remedy : red foxglove eight decigrammes, hot water five ounces, acetate of potassa sixteen grains, sugar ten grains \ dose, two or three tablespoonsful every day. The following is a sedative: saltpetre six grains, tartrate of potassa EXCESSIVE MENSES AND FLOODING. 349 sixteen grains, divide into twelve powders ; dose, two to four powders a day, according to circumstances. If, on acount of great weakness, &c, it is necessary to stop the flow of blood as soon as possible, proceed in the following manner: Place the patient in bed in a horizontal position, interdict every motion of the body, or disturbance of the mind. The temperature of the room should be moderate, and the covering light. All noise, too glaring light, and all strong scents, must be prevented. The bed should not be placed in a position to throw the light in the face of the patient ; the windows should be darkened as much as possible. This is all the more necessary if the patient is very weak, because a glaring light will instantly produce nausea and vomiting, which would increase the flow of blood. Strangers should never be admitted to the room. The most trifling emotion of the mind, or fright, should be prevented ; the excited mind and the anxiety of the patient should be calmed as much as possible ; sleep should not be prevented, but rather induced ; the patient, however, should not be neglected during that time ; she should be carefully examined whether bleeding has set in again, or has greatly increased. The patient must keep the bed, which must not be either too soft nor too warm ; feather beds must never be used as a covering. It is much better if the patient does not lie with her chemise under her ; it should be turned up, and an oil cloth, with several thicknesses of cloth, placed under her. It is better adapted for the preservation of cleanliness, as well as for the comfort of the patient, as a change does not involve any great motion on her part, and the bed can be kept in a better condition and more comfortable. Leaving the bed too soon, or even the carrying from one bed to another, may be very detrimental, and renew the bleed- ing. The patient must lay on her back, and with her head low down, and, if possible, with her legs crossed. It would be serviceable, if during the night the thighs would be loosely tied together above the knees with a cloth. For alvine evacuations, a bed-pan should be used. Constipation must be avoided, and injections should be given with very great care ; the patient should move as little as possible. If great weakness does not prohibit it, a laxative remedy may be admin- istered, for which purpose castor oil, or the Vienna potion, may be administered. The air of the sick-room, the bed, food, and drinks 350 SEXUAL DISEASES OF WOMEN. must be kept cool. In winter, the room should be kept moderately warm. If the patient is plethoric, if the flow of blood is accompanied by the symptoms of an inflammatory fever and burning pains, if the before mentioned exciting and heating causes have preceded it, then bleeding from the arm must be resorted to as soon as possible. Internally administer the following remedy : almond milk sixteen ounces, refined saltpetre from six to eight grains, barley sugar twelve grains ; dose, a tablespoon ful every two or three hours. Preparation of a cooling drink : One quart of well-water, two tablespoonsful of raspberry, currant, cherry water, barberry beer, or mulberry juice, and lemon juice, to be drank at pleasure. If a flow of blood, accompanied by inflammatory symptoms, should occur in a person of more tender and excitable constitution, the following medi- cine may be administered : phosphoric acid four grains, distilled water four and one-half ounces, raspberry syrup forty grains ; dose, a tablespoonful every two hours. Venesection must on no account be resorted to if the patient's features are pale and sunken, her pulse small and weak, and if flood- ing continues uninterruptedly, and with little or no local sensation. In such a case, administer four decigrammes powdered alum, mixed with a like quantity of sugar : every two hours a piece, or every two hours half a cupful of alum whey (see "Alum Whey") ; tincture of cin- namon may also be administered, in doses of from twenty to forty drops every hour, or oftener. If spasmodic symptoms, irritation, and syncope manifest themselves at the same time, give the following medicine : acetic ether six grains, tincture of cinnamon forty grains ; dose, from fourteen to twenty drops every half hour. If flooding continues, and if it has existed for some time, morbid changes in the tissues of that part exist, such as slow inflammation, rawness, ulceration, sponginess, polypi, swellings, and indurations, or the womb has assumed an irreg- ular position. In all these cases judicious and close investigation of the condition are necessary previous to the application of the proper remedy. The use of astringent immissions, according to your own opinion, are for that reason never advisable. SPASMS AND PAINFUL MONTHLY COURSES. 351 SPASMS AND PAINFUL MONTHLY COURSES. Of all derangements of menstruation, none are so painful, and so detrimental to general health, and threatening to life, than spasms. Usually only the beginning of the monthly courses is accompanied by spasmodic attacks, but there are a number of women who are troubled with hysterospasmus during the whole period of menstrua- tion. In mild cases the spasm is only local and periodical. In more dangerous cases even the muscles of the heart and thorax are affected, froth appears on the lips, and the patient often remains unconscious for hours at a time. If my limited space would permit, I could pro- duce any amount of evidence tending to show that these apparent dead women were only saved by a thorough examination of a physi- cian from being buried alive. Several cases have occurred in my practice, where the breathing was so faint as to be scarcely perceptible on a looking-glass held before the mouth of the patient, and the beat- ing of the heart so weak as to be almost inaudible to the listening ^ar. These spasms, however, are not always so dangerous. Either the first appearance of the monthly course is painful, or the monthly reappear- ance of the menstruation is accompanied by violent colic, partic- ularly over the pubic region, pains resembling labor pains, headache, pain in the back, vomiting, toothache, cholera morbus, fainting fits, cramps, epilepsy, catalepsy, delirium, melancholy, insanity, loss of eye-sight, &c, as has been before stated. These symptoms occur either during menstruation, or for several days previous or afterwards. The flow of blood itself at the time is either regular, too weak, too strong, or of a bad color. Sterility, and a sad, partly painful exis- tence, and not very rarely degeneration of the womb, are the calami- tous consequences of this condition. The malady may have been inherited, in which case other local diseases of the womb may be expected. Two essentially differing conditions mast be particularly distinguished from each other. Either the pains, spasms, and other morbid symptoms, rest upon a diseased, increased irritability and sen- sitiveness of the sexual organs, and of the body generally, or upon a slow inflammation of the womb, and a congestion of blood towards that part. But there are also cases found where sensitiveness of some of the vertebrae manifests itself when pressure is applied, and where 352 SEXUAL DISEASES OF WOMEN. the two conditions are combined ; or, where the cause of the disease is to be looked for in a degeneration of the structure, or in a diseased change of the position of the womb. Painful menstruation, caused by nervous debility and excitability, may attack women of any age ; but those over thirty-six years are more liable to it than those under that age, and also such who have remained unmarried, or, if married, have had no children. It usually attacks women of irritable temperament, and of delicate frame of body. About one day previous to menstruation, a feeling of general discomfort and chilliness is felt, and, as is sometimes expressed by the patient, it effects even the bones. Headache precedes or follows the menstruation/ The pains accompanying menstruation be- gin in the lower lumbar region of the back, and extend around the lower part of the abdomen, and the thighs. In some instances they seem to come in regular paroxysms, with intervals of rest, and in others they remain uniform. The violence of the pain also differs very much. It is sometimes so severe as to make the patient twist and squirm, causing her to faint. Sometimes it is of short duration only, and is limited to a few hours previous to, or following, the beginning of menstruation. During the attack there is neither excitement in the blood, nor fever perceptible. The skin is cool, pulse weak, and the color of the face pale. Subsequently, however, the patient appears less weakened than might be expected from the violence of the pain. As a rule, the flow of blood is moderate, very frequently of bad color, and mixed with small lumps of blood. In other respects no particular derangement is perceptible in the health of the patient. Evacuation .of the bowels is regular, and with some the appetite is hardly disturbed. This diseased condition is the result of an effeminate education from early childhood, frequent colds, from living in damp habitations, and being too scantily dressed, frequent excitement of sexual im- pulses, onanism, too early and too frequent copulation, depression of mind, trouble and affliction, blasted and unrequited love, preced- ing menstruations, and frequent miscarriages, tight lacing of the abdomen, sedentary mode of life, and venereal diseases. Other dis- eases of the abdomen, and particularly of the womb, may also cause this difficulty, such as constipation, swelling, induration, &c. The SPASMS AND PAINFUL MONTHLY COURSES. • 353 expulsion of worms have also caused the disappearance of sufferings of that description. The inflamed condition with painful menstruation is distinctly marked from that above described, in regard to persons as well as the disorders accompanying it. It appears in women of solid build, violent temper, and generally at an earlier time of life. It is also fre- quently observed in widows. Unmarried women are particularly sub- ject to this disease ; but also married women, even if they have born children, are not exempt from it. An examination during the inter- mediate time affords the best information, when the womb will be found partly or wholly in a swelled state of inflammation. The attack is preceded by but few indications. A certain unrest and feverish condition, accompanied by chills, followed by heat, and flushed face, and frequently also headaches, precede the menstruation several hours. A few hours after its commencement, the disease is very violent. The patient complains of pain in the back and limbs, fatigue, headache, sensitiveness to light and noise ; the face is red, skin hot, pulse strong and quick, and frequently a swelling of the abdomen above the pubic region may be felt. All these symptoms are miti- gated, when the menses are under a full flow. The time when this occurs varies very much. If the fever increases, delirium sometimes sets in. Not rarely a discharge of mucus will be observed between the periods, which in the disease previously described is only rarely the case, or, if at all, it is never very considerable. The attack may return with every menstruation, but it does not continue as regularly as in the one previously described, and if not extensive, is no bar to conception. Frequent causes of this disorder are excitement of sexual instinct, taking cold by being too thinly clad, particularly on a cool evening, after a hot summer day, too rich food, and heating drinks. On the approach of the first period, girls frequently suffer from various dis- orders ; if these do not exceed a certain boundary, they cannot be deemed a diseased condition. They do not always end with the first menstruation, but return a few times regularly every four weeks ; at first a redish blood-water, and finally clear blood, is discharged ; with every succeeding menstruation the disorder becomes less severe. 23 354 SEXUAL DISEASES OF WOMEN. No attempt should be made to lessen this disorder by medical treat- ment, or to expedite menstruation. Painful menstruation, caused by- nervous sensitiveness, proves frequently exceedingly obstinate in spite of all applied remedies. In attacks of severe pain, administer Dovers powder every hour or two, prepared in the following manner : Dovers powder from three to four grains, sugar two grains, camphor two grains, divide in two parts; dose, one powder every two hours. If it should affect the head too much, henbane should be preferred : take henbane four grains, sugar eight grains, to be divided and taken as above directed, for Dovers powders. The following spasmodic drops might also be administered : oily spirits of hartshorn, ethereal tincture of valerian, six grains of each, tincture of opium with saffron two grains ; dose, from eight to twenty drops every quarter or half an hour, to be dropped on sugar. Camomile and valerian tea afford great relief. Most serviceable, however, are usually camomile injec- tions, to which from six to eight drops of tincture of opium has been added. These injections should be commenced a few days previous to the appearance of the menstruation, if painful attacks are to be prevented. If spasmodic attacks manifest themselves, administer thirty or forty drops of assa foetida water in camomile tea every hour or two ; a liberal use of that tea is very beneficial in cases of this kind. Tea prepared from equal parts of valerian and licorice root, lemon balm, balmmint and camomile flowers, has been successfully used. In many cases, and particularly where a cool, dry skin exists, and a continuous cold is supposed to be the cause of the disorder, acetate of ammonia, from three to forty drops in sweetened water every three hours, is an excellent remedy. It may always be taken without any danger. Particularly to be recommended are the following soothing poultices : Take linseed four ounces, hemlock leaves two ounces, henbane three grains, boil in water to a moderately thick mass, then add forty grains of oilof henbane, and apply lukewarm. To cure this disorder thoroughly, administer the following pills in the meantime : Assa foetida, gum galbanum, watery extract of myrrh, ten grains of each, sulphate of iron four grains, add sufficient essence of bitter orange to make two hundred pills ; dose, from six to eight pills two or three times a day. If the patient has become very much GALACTIRRHCEA. 355 reduced, give quassia. Take rasped quassia wood forty grains, let it boil up a few times with a sufficient quantity of water, then let it draw for a quarter of an hour, strain, and to each nine ounces of the strained fluid, add vinous tincture of rhubarb fourteen grains, Hoffman's ano- dyne two grains, syrup of bitter orange peel forty grains; dose, a tablespoonful three times a day, which will be sufficient to remove the malady. Between the times, the patient should confine herself more to vegetable food, diet strictly, drink a good deal of cold water, lead an active, industrious life, and avoid everything that may heat and excite the blood, but particularly the sexual organs. GALACTIRRHCEA. The lacteal secretion is here either too great and debilitating, or it does not cease after weaning the child. In both cases the body does not receive full nourishment, and it results in dizziness., ringing in the ears, headache, disturbed digestion, general emaciation, and hectic fever. In the first case> weaning must proceed very gradually ; it must not be done too suddenly, else it will result in swelling, inflam- mation, and galacto metastasis. The child must therefore be weaned gradually; the breast must be rubbed with camphorated oil, tied up- wardly, and covered with camphorated soap plaster. Perspiration must be induced by drinking linden or elder blossom tea, and the movements of the bowels must be kept regular. As a strengthening remedy give wine, particularly Peruvian bark wine, prepared in the following manner : take finely powdered calisaya bark forty grains, Rhine wine one quart, let it stand for fourteen hours, shake frequently and for a long time ; dose, three tablespoonsful during the morning hours. But if the patient is suffering from hectic fever, tue strength- ening remedy must not be administered until the fever has been re- moved by the use of milk and Selters water. As soon as lacteal secretion decreases, more nourishing and easily digested food may be permitted. Galactirrhcea, if continuing after weaning, should be treated in the same manner ; it occurs usually in consequence of long nursing or of absence of menstruation. The restoration of the latter, as above indicated, is certainly the principal point. Externally, apply little sacks filled with herbs or camphor to the breasts, and the latter also under the arm pits. Internally, administer the following pills : 356 SEXUAL DISEASES OF WOMEN. iodide of iron and powdered iron, two grains of each, make into twenty pills with purified honey, cover with sugar ; dose, one pill morning and evening. LEUCORRHCEA. The whites, which is not a rare disease, is easily distinguished. Its chief feature consists in the discharge of a mucous fluid from the vagina, which is rarely so imperceptible and small in quantity, but it may be perceived in the urine as flocculi. This malady, so trouble- some to the female sex, is rarely dangerous, but in many respects injurious to general health. On account of infecundity, or at least of great inclination to miscarriages, which results therefrom, it is of im- portance to the human race. The whites alone, which in the years of beginning puberty sometimes precede menstruation in otherwise healthy girls, or which appear during the latter part of pregnancy,, need no further consideration, because this discharge must be con- sidered natural, and not a disease, if it does not transgress its boun- daries. As easily as the malady may be recognized generally, just as difficult is it to explain its character, because the latter is not always the same. It is to be regretted that even physicians do not always weigh this difference with the same care, which is absolutely required if the remedies are not to be administered at hap-hazard, but with a greater probability of success than heretofore. This may also furnish the reason why this malady is deemed to be of so obstinate a character. A very essential difference in the whites rests on the seat of the dis- ease, which is to be looked for either in the vagina or in the womb. According to the seat, the flow itself differs in character, which is also the case with its progress, being either acute or chronic. Of what- ever nature the secretion of the fluid may be, it is t caused either by an irritated, inflammable condition, or by a relaxation of the secretion of the tissues. The differences here mentioned must be taken ^'con- sideration, if the disease is to be successfully treated. These differ- ences are sometimes difficult to discover, and frequently only after a very close examination with the hysteroscope, particularly as far as the seat of the malady is concerned. Many other organic diseases of the female sexual organs, such as cancer, ulcers, polypi, and venereal ACUTE BLENNORRHEA OR WHITES. 357 infection, are accompanied by a species of whites. But as this is not an independent disease, it cannot be further discussed here. ACUTE BLENNORRHEA OR WHITES. All cavities of the human body, having outlets connecting them with external air, are lined with a velvety skin, the so-called mucous membrane, which, by the constant secretion of a mucous covering, maintains the necessary lubrication of the parts, protects the sensitive parts lying under it from the effects of rough materials, and prevents an intergrowth of the walls. If the activity of this mucous mem- brane is morbidly increased by any irritation, if the whole of the mucous membrane system, or the mucous membrane of any part of the structure, has become more irritable and sensitive generally than should naturally be the case, or if their excre- tory ducts are relaxing, then the secretion of mucus increases, and changes to a morbid condition, and results in mucous obstruc- tion or blennorrhcea. These mucous membranes are intimately connected with the external skin, of which they are only a continua- tion. Everything, therefore, tending to derange perspiration of the external skin, creates an inflammatory state of some mucous mem- brane. Thus, if the mucous membrane of the nose is affected, it is called catarrh % if the mucous membrane of the air passages, catarrh of the larynx or lungs, and if the female sexual organs are concerned, it is called the whites. This kind of whites may therefore properly be called catarrh of the female sexual organs. In fact it is nothing else, and is the result of a suppressed activity of the skin, and requires the same treatment. Its principal seat is in the vagina, but it extends occasionally to the cavity of the womb. It is caused by a constant cold, damp, foggy, windy, changeable climate, damp and cold weather, damp habitations, by being too lightly dressed, sitting down on cold stones or damp ground in a heated state of the body ; in shorty everything that may suddenly or permanently suppress perspiration. Blennorrhcea may also result fi o n inflammatory irritation of the mucous membrane of the genitals, by suddenly suppressing a catarrh, or sweaty feet, or the suppression of cutaneous eruptions. Local irritations affecting the vagina may also result in the same malady, for instance, mascaris, pessaries, fungi, &c. 358 SEXUAL DISEASES OF WOMEN. In this case, a feeling of increased warmth in the diseased parts is always present, sometimes increasing to a disagreeable burning sensa- tion, and which may even extend to the rectum and the bladder, so as to create difficulties in evacuation, and in making water. Relief from these difficulties is first experienced with the beginning of the flow, which is slimy, sometimes thick, whitish, yellowish, purulent, mostly greenish, medley-colored, and ichorous ; it usually also has an offensive smell, and is acrid, making the genitals and inner sides of the thighs sore. Care should be taken that the flow continues unin- terruptedly, and that it does not appear only previous or subsequent to the monthly period, or that at that time at least it increases consider- ably, and then again diminishes, as is always the case under other cir- cumstances. The monthly period has no effect whatever on this catarrh of the genitals, for as long as the inner or outer morbid irrita- tion continues, just as long also continues the flow uninterruptedly. This flow, however, is closely connected with the morbid condition of other membranes, so that if blennorrhea occurs in other parts, that in the vagina decreases, and vice versa. It is- thus frequently noticed that blennnorrhcea of the genitals appears and disappears, as catarrh, slimy diarrhoea, &c, is either checked or restored. The general health of the patient is not at all, or very little, disturbed by it. It is only when the mucous membrane degenerates or suppurates by the long continuation of the inflammatory catarrhal irritation, or when the flow assumes a violence exhausting the strength of the patient, that danger is threatening ; that condition then requires medical treatment. Otherwise it does not interfere with either the capability of conception, nor the regular course of pregnancy, or menstruation in non pregnancy. If the case is not of too long duration, and if there are no other disarrangements connected with it, keeping warm, wearing of drawers, and an appropriate hardening of the body, are usually sufficient to remove the malady. If the patient experiences heat, and a burning sensation in the pubic region, and if an irritated condition of the suffering parts exists, leeches should be applied to the sexual organs, groins, or the rectum. In that case it will be neces- sary to keep warm and quiet, live on vegetables only, and avoid all heating drinks. If the disease originated from a cold, mild sudorifics should be taken. In the early stages of the disease, liquid acetate of BLENNORRHEA. 359 ammonia is of excellent service. Take liquid acetate of ammonia forty grains, emetic wine five grains, elder blossom water and distilled water four ounces of each, sugar fourteen grains ; dose, a tablespoonful every two hours. Or take the following twice a day : Dovers powder two grains, sugar two grains, to be administered with elder blossom tea. For some time thereafter take sal-ammoniac, prepared as follows : Seneca root three grains for a decoction of eight ounces, sal ammoniac four grains, licorice juice eight grains ; dose, two tablespoonsful every two hours. To allay local irritation, lukewarm emolient immissions, prepared from marshmallow root, mallow flowers, or linseed tea, may be used. When the immission is made, the pelvis should be in a somewhat elevated position, so that the liquid may not flow out at once, but he retained for about ten minutes, forming a local bath. Great cleanliness should be observed, the parts should be frequently bathed by washing, and covered with soft cloths to prevent taking cold. BLENNORRHEA. This disease manifests itself by an excessive, abnormal secretion of mucus from the mucous membranes, and their glands, greatly varying in regard to quantity and condition. At times the secretion is very limited, and again it appears on so extensive a scale as to exercise no inconsiderable effect on the strength of the patient. Its consistency, color, and other peculiarities, also vary to a considerable extent. Thus it appears as a thin or thick fluid, viscous, whitish, yellowish, greenish, &c, sometimes acrid and burning, and sometimes again very mild. The immediate cause of this abnormal condition is a weakness of the mucous membrane, produced by various irritations, by substances operating mechanically, or by a particular predisposition in the man- ner, as in scrofulous, rheumatic, or goutish persons. It also results from chlorosis, catarrh, the abuse of warm baths, laxatives, hemor- rhages, frequent confinements or miscarriages, grief, care, sorrow, from innate poverty of the blood ; thus the least irritation befalling the genitals results in unusual and violent blennorrhea, even during pregnancy. This kind of blennorrhcea or whites never causes excres- cences, indurations, or other local diseases of the female genitals; but if it is not properly treated, a general loss of strength, emacia- 860 SEXUAL DISEASES OF WOMEN. tion, hectic fever, and finally catarrhal phthisis is the inevitable result. In treating this malady, first of all the cause should be removed, to be followed by proper local remedies, to effect the morbid mucous membrane of the particular organism, and where the diseased condi- tion is of a general nature, remedies should be applied, strengthening the whole system. If, for instance, scrofula, gout, syphilis, &c, have induced the disease, the treatment should be directed against either of those diseases. The internal use of myrrh, gum benzoin, ammonia, gum galbanum, copaiba balsam, Peru balsam, &c, are very effective against excessive blennorrhoea. The use of mercury is also very useful. Local applications of astringent, stimulating and strengthen- ing remedies are very effective ; but in their application the physician should always keep in view the particular condition of the patient, and the state of the disease. Among these remedies may be enumer- ated camomile flowers, sage, willow, elm, oak, and loxa bark, and also alum. BLENNORRHEA OF THE GENITALS. Non -syphilitic blennorrhoea of the urethra, or non-malignant gon- orrhoea in males or females, is most usually the result of a preceding inflammation, or other irritation of the urethra, conditioned by both internal as well as external influences. Internal causes of blennor- rhoea may result from certain diseased conditions, such as gout, rheu- matism, scrofulous and other maladies, stone in the bladder, the use of strong beverages and medicines (Spanish fly, for instance), a general cold, &c. Among the external causes may be enumerated mechanical irritations, such as strong immissions, &c. The appear- ance of blennorrhoea is preceded by more or less violent burning and piercing pains, particularly while urinating ; the urethra appears red and inflamed, and sometimes the penis swells. The patient feels a constant pressure for urinating, and yet only a few drops pass away with violent pain and a burning sensation. In the same way as in gonorrhoea (see "Venereal Diseases"), finally a discharge of greenish, blackish, or bloody mucus occurs, with painful erections of the penis and seminal emissions at night. Swelling of the testicles and inguinal glands may also appear. In women, the naturally increased BLENNORRRHCEA OF THE GENITALS. 361 flow of mucus (which sometimes takes place previous to or after men- struation or sometime previous to confinement), should not be mis- taken for the morbidly increased blennorrhsea from the vagina, which sometimes originates from mechanical irritation, or other internal causes, and which is known by the name of " Whites "; the latter is either of late origin or of very old date. In the first case, all symp- toms of inflammation, such as heat, burning sensation, tension of sexual organs, &c, are present. The flow of mucus following is at first thin, watery, of a greenish color, and exceedingly acrid, so that the genitals and sometimes even the anus become sore and corroded, whereby the malady becomes more extended. The named symptoms finally disappear ; the mucus increases in quantity and consistency ; has a purulent appearance ; is much milder, and changes into the other kind of whites. If the malady has not become malignant from other causes, the mucus usually appears mild, without smell and of a whitish color, which, however, occasionally turns greenish or yellow- ish. The longer this condition continues without any attempt being made to remove the causes, and unless the greatest cleanliness is most scrupulously observed, the more sharp and corroding becomes the mucus : the genitals relax and swell, and the menstruation becomes limited, irregular, or ceases altogether. At the same time, other morbid disorders appear, such as nausea, vomiting, palpitation of the heart, dyspnoea, spasmodic symptoms, &c. Treatment of non-syphilitic gonorrhoea does not in general differ much from syphilitic gonorrhaea in men. During the state of inflam- mation, an antiphlogistic diet should be observed. The patient should abstain from eating meat, or fat, and sour food, or use spirituous and sharp beverages, such as wine, whisky and beer. He should keep quiet and be careful not to take cold ; foment the penis in warm milk and water, and in case of strong erections, or strangury, rub in around the penis, ointments prepared from opium, with the addition of henbane or hemlock. Internally, mucilaginous and emollient remedies, particularly milk of almonds, to which saltpetre may be added, if inflam- mation still continues, are very beneficial ; also emulsions of hemp, or poppy seed, with gum arabic, or extract of henbane with lauda- num. The bowels should be kept regular, and in other respects ob- 362 SEXUAL DISEASES OF WOMEN. serve the same treatment laid down for syphilitic gonorrhoea (see " Venereal Diseases "). In regard to treatment of whites in women, it does not vary in general essentially from that laid down above, only that vapors and immissions are much more easily and advantageously applied than in men. In inflammatory cases, the immissions must be prepared from mild and emollient ingredients, such as decoctions of poppy seed, mallow, henbane, &c. In old cases, where a relaxed and soft condi- tion of the sexual organs exists, stimulating and other astringent im- missions should be administered. They may be prepared from decoctions of oak, willow, and chesnut bark, extract of sage and myrrh, also lime water, solutions of alum and sulphate of iron. These preparations may also be applied for local baths. It should be re- membered, however, that these remedies are only intended to assist the medicines given internally, which always are the chief reliance. Among the principal remedies for internal use are gum resins and balsam, rhatany, tormentil root, Senegal gum, calisaya, &c. If, however, catarrhal phthisis should have developed itself, treat- ment, mode of living, and preventatives, are no other than those for true catarrhal phthisis (see "Catarrhal Phthisis)". CHLOROSIS. Chlorosis is a disease affecting the female sex only. It usually man- ifests itself at the age of puberty, by an extremely pale, sometimes greenish-yellow color, frequently with pale lips and bluish rings around the eyes. The skin is relaxed and bloated, the body languid and weary, and the mind depressed. The malady is always connected with derangements of menstruation, and in the worst cases changes to dropsy and slow fever. In treating this disease, particular attention should be paid to a regular but nourishing diet. All flatulent food and beverages should be avoided. The patient must abstain from the use of coffee and tea, live on light meats and vegetables only, and take frequent exercise in the fresh air, but must not tire herself: her mind should be kept in a cheerful state, but every excitement of sexual instinct should be most strictly avoided. CHLOROSIS. 363 Chlorosis does not always depend on the same morbid condition of the body, which may vary greatly. For that reason there is no remedy adapted for all circumstances ; what may be beneficial in one case, may be very detrimental in another. Two kinds of chlorosis may therefore be distinguished : i. Chlorosis, caused by a general reduced nourishment of the body ; and 2, that caused by too great irrita- bility. Chlorosis caused by a general reduced nourishment of the body. To this class belongs the frequently occurring chlorosis, which results from a nourishment of the body entirely disproportionate to its too rapid development. A life without care, good food and proper exercise soon bring about menstruation, and with its appearance the. malady disappears, leaving no trace behind. The disease is not so readily conquered, however, if the nourishing power itself has been consider- ably lowered by constant unfavorable influences. Among the usually existing, pernicious influences may be counted : poor food, relaxing beverages (particularly an excess of tea and coffee), damp, dark hab- itations, indolence, or exhausting exertions, preceding diseases detri- mental to the strengthening of the body, such as diarrhcea,blennorrhcea, too violent menstruations, intermittent fever, nervous fever, ulcera- tions, &c. Patients who are badly nourished have a bloated appear- ance, their flesh is flabby and withered, every motion exhausts them, and they lose their breath, appetite is lacking, and their stool is inert ; in short, the body has the appearance of debility and lassitude. No trace of fever or congestion exists; menstruation does not exist at all, and even the symptoms indicating a completed period, which might make its appearance, are entirely absent. On the other hand, an un- interrupted flow 01 ■ mucus from the genitals is hardly ever absent. If the disease is not removed, it changes to dropsy. The most important point in treating this disease, is to discover the causes that induce it, and to remove them. An injudicious mode of living is a very frequent cause of this disease ; a proper change is therefore the most important step for its cure, which is frequently effected without the aid of medicines, provided there are no other dis- eases to be combatted, such as scrofula, worms, blennorrhcea, hemor- rhages, intermittent fever, &c. It is often the case that these have really interfered with the nourishment of the body, from which 364 SEXUAL DISEASES OF WOMEN. chlorosis has finally resulted. The mode of living having been changed, it is then necessary to proceed to the removal of the dis- ease. Some seem to think that the best remedy against this disease is marriage. In that they are greatly mistaken. Where vital force is lacking to make a woman of the girl, matrimony, which nature calls for only when the woman is in a state of puberty, and without which copulation can only be detrimental, must end in an exhaustion of vitality already too low. The patient should therefore be provided with a healthy, dry, well-lighted habitation, a sojourn in fresh, pure air, if possible in a mountainous region, comfortable, warm clothing, and moderate exercise of body, cleanliness, careful nursing, and proper activity of the skin by diligent use of lukewarm, aromatic baths, and nerve-invigorating herb baths. For an herb bath, take camomile, lavender, rosemary leaves, wild thyme, and sweet marjoram, two ounces of each; boil for a bath. The patient should live upon nourishing, easily digested food, and particularly more on meats than vegetables. If the patient is troubled with a weak digestion, it may be removed by the use of centaury minor, prepared by scalding forty grains of the herb with three cupsful of boiling water ; dose, half a cupful twice or three times a day. Gentian root is also very good for that purpose : take gentian root fifteen grains, orange peel six grains, infuse in fourteen ounces of boiling water for one hour ; dose, half a teacupful three or four times a day. If the stomach is filled with phlegm, buckbean tea is highly recommended (sixteen grains to one quart of boiling water). In a case of general mucous obstruction, and an engorgement in the abdo- men, the fresh juice of dandelion in the spring of the year is an excellent remedy. If digestion is not too much disturbed, but physical debility very great, nothing will surpass the effect of ferruginous mineral springs. If the disease becomes obstinate, stronger remedies must be applied. Take carbonate of iron sixteen grains, gum arabic and sugar ten grains each, make into one hundred pills, of which take at first one a day, and increase in divided doses to eight a day, which should be continued for a time. Care should be taken, however, not to crowd the patient with this medicine, as otherwise the tone of the digestive organs might be still more lowered by irritation. CHLOROSIS. 365 Chlorosis, caused by irritability of the nerves : The predominant character of this kind of chlorosis is also weakness, but it is founded in this case originally in the nervous system, particularly in an innate, excessive irritability of the same, while in the kind discussed above it is the result of insufficient nourishment, particularly in persons who are inclined to mucous obstruction, and whose digestive organs are weak. Here everything is variable and irritable, while in the other case dullness and debility prevail. Girls, and young women of frail frame, extreme irritability and sensitiveness, suffer particularly from this kind of chlorosis. They bear more or less clearly the imprint of the germ of nervous phthisis. They are pale, emaciated, only slightly bloated, suffer from spasms and nervous attacks of all kinds, are sickly generally, and their mind is just as irritable as their body; they are equally excitable by joy or grief. More inclined to melan- choly and dejection of mind, they seek solitude. Their eyes are watery, and they suffer from headache, spasms of the stomach, short- ness of breath, and frequently from terrible palpitation of the heart. Their skin is alternately cool or hot, and appetite rather degenerated than bad, frequently showing a desire for the most heterogeneous in- digestible food. They also suffer from heartburn, and not rarely from dysturia, but almost always from pain in the back and loins, and from pressure and heaviness in the pubic region, all of which are increased by walking. A flow of mucus does not occur, but great sexual excitability is observable. If the malady is permitted to take its own course, if the causes are not removed when it is possible to do so, if strengthening remedies are administered at improper times, the patient sinks into emaciation and nervous phthisis. The treatment is exceedingly difficult, and there are even many physicians who are not equal to it. For that reason it cannot be dis- cussed here any further. Even the arrangement of diet calls for much consideration in order to meet the requirements for each partic- ular case. One other point we will bring to the attention of the reader, which is that there may also occur an irritation of the spinal cord, frequently overlooked by the physician to the detriment of the patient, and which must be removed in the well known manner, ere a cure can be hoped for. 3t>6 SEXUAL DISEASES OF WOMEN. PROLAPSE. Prolapse is called the protrusion, to a greater or lesser extent, of a soft organ from its natural position, so that it comes in immediate contact with external air. Prolapse results from a rending or relaxa- tion, and immoderate expansion of the natural attachments of an organ, and also from an irregularity of adjoining formations, which crowd the parts forward by a disarrangement of the connection, or by pressure, &c. Several organs of the body, if no longer restrained in proper manner, may surfer a prolapse. I will name here only prolapsus vagince, prolapsus uteri, and prolapsus recti. PROLAPSUS VAGIN/E. Prolapsus vaginse consists in an entire or partial prolapse of the canal forming the vagina. It usually extends to all of its membranes, and is always connected with a falling of the womb. In case of an entire prolapse, the vagina falls to its whole extent ; in a partial pro- lapse, only one part or fold of it, mostly on the anterior wall. In the first case, the lower or middle part of the vagina appears in the form of a fold of the skin, forming at first a soft, bluish-red, nearly smooth, ring, projecting between the lips of the pudenda, and gradually pro- longing to a cylinder, at the lower end of which the mouth of the womb may be felt. The inner wall of the vagina forms in that case, by inversion, the external covering of the prolapsed part. By stand- ing or walking, this condition is favored ; in assuming a horizontal position, however, the part usually easily returns. In time the pro- lapsed membrane of the vagina becomes dry and hard, inflames readily, and also suppurates, when drawing, bearing-down pains in the abdomen, difficulties in urinating and evacuation occur. A partial prolapse of the vagina forms only a blind sack, mostly springing from the anterior vagina, causing otherwise no important derangements ; sometimes, however, it causes anteversion of the womb. The causes of the prolapse of the vagina are frequent childbed, protracted whites, too frequent copulation, severe exertion in lifting heavy weights, violent vomiting, coughing, and bearing down in labor pain or evac- uations. Mechanical pressure of stone in the bladder, or in ascites, enlargement of the ovaries, &c. , may produce this disease. PROLAPSE OF THE WOMB. 367 The treatment is purely surgical, aided by external medicinal remedies. Old cases are difficult to cure; frequently it is only possi- ble to alleviate the sufferings. In less severe cases of recent date, cause the patient to lie down in a horizontal position, and draw up her thighs to the abdomen ; introduce the oiled index or middle finger into the vagina, and with it shove the prolapsed part upward ; during this process the patient must hold her breath. Where inflammation and swelling prevent the restoration, cold or mollifying, gently astringent poultices should be applied ; the patient should remain on her back for some time. After the restoration of the prolapsed part to its proper place, the patient must kaep the bed for some time, avoid every motion, and abstain from the use of flatulent food, &c. Aside of that, a sponge filled with a coarse, astringent powder of loxa, oak, or elm bark, mixed with wormwood, and then dipped in red wine, or a solution of alum, must be introduced into the vagina; it must be renewed from time to time, and kept there for several weeks. Strengthening sitz-baths, consisting of a decoction of astrin- gent herbs, will greatly aid in curing the prolapse, and prevent its recurrence. In obstinate cases, the use of pessaries must be resorted to. PROLAPSE OF THE WOMB. Prolapse of the womb differs from prolapse of the vagina, in so far that in the former the womb falls down first, drawing the vagina with it from the upper part, where in the other case, the lower or middle part of the vagina falls down first, drawing the other part with it. According to the extent of the prolapse of the womb, it is divided into complete and incomplete prolapses. The prolapse is complete if the womb, together with the vagina, protrude between the lips of the pudenda. In the incomplete prolapse, the examining finger feels the ce?-vix uteri deeper down than in the natural state ; the space between the mouth of the womb and the upper part of the vagina is extended. With this usually appears a dull, continuous pain in the back, and in the loins, a down -bearing pressure, and an increased desire for urinating. These symptoms increase when the patient stands up or walks, but on assuming a horizontal position, they are scarcely felt. They are much 368 SEXUAL DISEASES OF WOMAN. more severe in a case of complete prolapse of the womb. The intes- tines of the abdomen are lowered into the sack formed by the inver- sion of the vagina, and the bladder and rectum are considerably compressed thereby. Aside of direct difficulties produced, vomiting, spasms in the abdomen, fainting, and fevers, &c, also appear occa- sionally. Prolapse of the womb appears almost only in the non-pregnant condition of the patient, and it sometimes happens that an. existing prolapse is removed during pregnancy by the ascension of the uterus, which occurs at that time. The causes of these prolapses are generally the same which induce prolapses of the vagina, if they have effected only the upper part of the vagina, and the broad ligaments. All diseased changes of the womb, increasing its weight, such as polypi, swellings, &c, may also cause prolapses. The freatment of prolapse of the womb consists in reducing to their normal condition the parts which have moved from their posi- tion, and in the prevention of its return. In case of an incomplete prolapse, the womb either returns to its normal position of its own accord, if the patient lies on her back, or it is shoved back with two fingers toward the axis of the pelvis, after an evacuation of the rectum or bladder, the patient lying in a horizontal position. In case of a complete prolapse, and if inflammation or swelling of the parts are connected with it, bleeding, leeches, warm baths, mollifying, soothing poultices, and cooling remedies should first be resorted to, and then the attempts to restore the parts can be made, the patient assuming a horizontal position, with raised posteriors. In many cases, however, in order to prevent a recurrence of the prolapse, it becomes neces- sary to resort to pessaries, the form and application of which are to be designated by the physician. If an old prolapse can not be reduced, the womb must be supported by a bandage and protected against all external irritation. Care should be taken for the proper evacuation of the bladder and rectum. PESSARIES — INFLAMMATION OF THE WOMB. 369 PESSARIES. Pessaries are called ring-shaped instruments, which are introduced into the vagina for the purpose of supporting the prolapsed womb, or to keep back the prolapsed vagina. Pessaries are made of gold, sil- ver, ivory, various kinds of wood, horn, cork, whal bone, elastic rosins, &c. INFLAMMATION OF THE WOMB. Inflammation of the womb manifests itself by a constant, burning pain in the region of that organ, and a feeling of pressure and weight. Frequently a piercing, burning pain extends on both sides of the abdomen, and sometimes the whole of it is very painful and sensitive, and appears hot and tensive. With it the patient is costive, and the urine limited, or suppressed, the tongue is dry and furrowed, and the pulse accelerated and excited. Inflammation of the womb may be caused by severe and long continued labor-pain during a hard de- livery, by retention of the monthly courses and after-birth, by internal or external injuries, taking cold, the use of instruments and the pro- lapse of the womb. Treatment : One of the first things to be done is, to cause an evac- uation of the bowels, if the patient is costive, which is best done by an injection. For that purpose take camomile tea, or a decoction of linseed, strain well, and of this take for an injection two teacupsful, to which two tablespoonsful of linseed oil are added. After that, ad- minister a tablespoonful of castor oil. Warm poultices of bitter herbs should be applied to the abdomen, in the region of the womb. At that time use the following immission, which must be placed in the vagina by means of a uterine syringe : take a heaped teaspoonful of chloride of lime, and dissolve it in one pint of cold water ; this solu- tion use twice or three times a day, making several immissions at one time. Gradually the quantity of chloride of lime may be doubled for the same quantity of water. The chloride of lime may be obtained in any apothecary's shop. An excellent way, when there exists more or less inflammation in a prolapse of the womb, is, to immit for a few days, the solution of the chloride of lime alone, until the inflammation is reduced ; after that, immissions may be made of a decoction of oak bark- 24 370 SEXUAL DISEASES OF WOMEN. PROLAPSE OF THE RECTUM. Prolapse of the rectum may appear under three different forms: The rectum may prolapse with all its membranes, or its inner membrane only, or an inserted part of an upper intestine may protrude. Pro- lapse of the rectum, to an unimportant extent, causes no great trouble of itself, but it may become inflamed and strangulated in time, when the effects of strangulated hernia will be produced. Prolapse of the rectum occurs mostly in children in consequence of a diarrhoea, too frequent injections, suppositories, too heavy bearing-down pressure, worms, stone in the bladder, severe cough, screaming, &c, and some- times in old, weakly people. In children the trouble usually discon- tinues of its own accord, but returns on renewed provocation. A good remedy is equal parts of gum arabic and rosin, which should be sprinked on the prolapsed intestine three or four times a day. Aside of that, the malady from which the prolapse has resulted, should be removed by the necessary remedies. If, however, these means are insufficient to remove the trouble, and if the prolapse of the intestine has continued for some time, then it is necessary to shove back with oiled fingers the portions lying nearest to the anus, and continue until the whole prolapse has been reduced. During the operation the patient should lie on his stomach with outstretched thighs. Finally put it in its proper place, with a finger introduced in the rectum, A decoction of camomile, to which a little oil of camomile has been added, may be used with great advantage. In obstinate, spasmodic cases, or in inflammatory strangulations, soften- ing, antispasmodic, or antiphlogistic remedies, must first be employed externally, before a reduction becomes possible. If danger is threat- ened from delay, call in at once a skillful physician, who will order the required remedies. MISCELLANEOUS DISEASES. DROPSY. Dropsy manifests itself by a morbid accumulation of an aqueous fluid, which, according to the part of the body affected, is more or less connected with other disorders. Among the principal kinds of dropsy are the following : ASCITES— ABDOMINAL DROPSY. The signs of abdominal dropsy are bloating and tension of the abdomen, which changes with the position of the patient, and succus- sion. If the palm of one hand is placed on one side of the abdomen, and the back of that hand is struck by the other, a movement of the water and its reflux are felt. At first the water is best felt in the lower part of the abdomen, the patient occupying a standing position. The patient complains of a troublesome fulness in the gastric region, and also of various disorders of digestion. The stool is infrequent and dry; the urine limited, and of dark -brown, beer color. To this are added watery swellings of the genitals and feet ; breathing is oppressed ; skin, tongue and mouth are dry, and the patient is tor- mented by thirst and insomnolence. The more the abdomen swells, the more do the limbs become emaciated, or anasarca and dropsy in the chest- are added to it. Finally, a slow, emaciating or malignant, inflammable fever appears. If the fluid is enclosed in several cavities, the swelling shows itself uneven from the beginning ; the urine is lighter colored. By degrees the scrotum swells, and, as previously mentioned, in the woman the lips of the pudenda ; a dry cough, or inflammation of the abdomen, are added to it. The duration of the disease is frequently very long. The causes of the disease are constipation, and other diseases of the abdominal organs, particularly of the liver, neglected intermittent (37i) 372 MISCELLANEOUS DISEASES. fever, gout, old colds, excessive use of spirituous beverages, lingering acute fevers, particularly scarlet fever, mechanical injuries, and lacera- tions in the abdomen. The treatment, which is not always successful where considerable indurations and other organic diseases exist, with a weak constitution of the body, should be guided by the causes and character of the dis- ease. Dropsy, which follows soon after inflammation of the abdomen, or a suppressed hemorrhage, must be treated by antiphlogistic remedies, such as leeches, saltpetre, and calomel, while, on the other hand, dropsy resulting from the loss of a large quantity of blood, or other weakening causes, must be treated with strengthening remedies, such as quinine, quassia, and tincture of iron. If the dropsy sets in after suppressed diseases, sulphur and mercury are to be used ; if in consequence of an obstructed liver, dandelion and diurectic remedies must be administered. The water must also be discharged. This is done by exciting the lymphatic system with emetics, foxglove, and gum guiac ; by exciting the nerves with squill root, foxglove, cream of tartar, juniper, and other diuretic remedies (see " Diuretic Remedies "), or by exciting the rectum by gamboge, colocynths, elaterium (one sixth of a grain), jalap, and aloes. Besides these remedies, the patient should drink a tea made of lovage, rest harrow, and juniper berries. If these remedies produce no result, then admin- ister for a time solvent remedies, and then return to diuretics. Gently strengthening and stimulating medicines (quassia wine) aid in the cure. The final remedy is the tapping of the abdomen. Aside of the removal of the fluid, it has the further advantage of enabling the absorbing organs to exercise their functions better, and in that manner to aid restoration. It will be for the physician to decide, who conducts the operation as here indicated. The inclination for a relapse is always very great in this disease ; a patient whose skin remains dry, hard and parchment-like, must never be considered as having entirely recovered from dropsy. Abdominal dropsy is very frequently of an inflammable nature, in which it quickly results with feverish symptoms, a full pulse, indications of an abdomi- nal inflammation after suppressed hemorrhages, and in consequence of other inflammable diseases. For such a state, the remedies given ASCITES — ABDOMINAL DROPS¥. 373 for inflammable anasarca are well adapted. Very effective, and justly highly reccommended, is tartar emetic : take tartar emetic one grain, parsley water six ounces ; use as a drink. If the disease is not of an inflammable nature, the following compound is very effectual : elder berries, water cress, conserve, two ounces of each, jalap and sulphate of potassa, sixteen grains of each, syrup of squill sufficient to make a soft mass ; dose, one teaspoonful every three hours. Th£ following remedies are also of excellent service : gum gamboge four grains, carbonate of potassa (liquid) sixteen grains ; dose, from two to thirty drops four times a day in water. Another remedy ; Dried squill root, scammony, resin jalap, two grains of each, compound extract of rhubarb four grains, spirits o wine sufficient to make fifty pills ; dose, one pill every four hours. Another remedy : Rest harrow root, horsetail, maiden-pink leaves, two ounces of each, juniper berries, lovage root, one ounce of each, divide into ten parts ; to be used as a tea in the evening. This tea may be recommended in all cases of dropsy. Another remedy : Prepare an ointment composed of two parts marshmallow salve, and one part of turpentine, or copaiba balsam, apply externally by rubbing in, partly on the abdomen, and partly in the kidney region. Another : Take calisaya bark half an ounce, boil it for half an hour to make eight ounces of liquid, press through a cloth, and add refined argol and sugar, of each half an ounce, shake well ; dose, one tablespoonful every two hours. Another remedy : Wormwood leaves, buckbean, sweet flag, of each half an ounce, licorice root half an ounce, Rhine wine one quart, macerate for twenty-four hours, strain, and add carbonate of potassa four grains, sugar of anis oil fifteen grains ; dose, three tablespoonstul four times a day. As a strengthening remedy, give the patient Selters water ; a glass of wine, particularly champagne, is frequently very beneficial. The treat7nent here prescribed will, however, never entirely dis- pense with judicious medical treatment. 374 MISCELLANEOUS DISEASES. DROPSY OF THE HEART AND CHEST. Indications of dropsy on the chest are great oppression of breath, particularly when lying on the back, anxiety, short, frequently spas- modic cough, drawing pain between the shoulders, swelling of hands, expansion of the space between the ribs, particularly sudden waking up at night, with a feeling of the greatest anguish, and an irresistible effort to get fresh air, frequent sighing, a feeling of pressure, drawing and tension in the chest, a short, dry cough, subsequently accom- panied by frothy, blood-streaked expectoration, palpitation of the heart, asthma, dryness of the throat, rough, weak voice, restless sleep, or entire absence of the same, relief in breathing while sitting upright or standing, increase of the trouble in lying down flat, or by exercis- ing. Much surer indications of the disease are, if to the above mentioned symptoms are added frequent rush of blood to the head, redness of tne cheeks, sometimes bordering on a bluish shade, dis- tended veins of the head and throat, projecting throat, protruding eyes, and a pale, sallow face, watery swelling of the eyelids, hands and feet, and sometimes also of the male genitals, timid demeanor, and trembling. It must not be supposed, however, that the symptoms above given are necessarily all present in dropsy of the chest. Frequently several of them do not appear at all, and yet the patient suffers from the dis- ease. The first described symptoms, which manifest themselves at the beginning of the malady, are hardly ever absent. Neither do they always appear with the same violence. The variations depend partly on the diet observed by the patient, and partly on the change of the weather and season. It requires the closest medical examination to decide definitely that the patient is suffering from dropsy ot the chest, and the particular kind of that disease. A flaccid, flabby, inactive condition of the body in advanced life, total want of exercise, living in a bad, foul atmosphere, and weak- ness of the chest, are always conducive to the production of dropsy in the chest. One of the most important causes for this disease must be considered the intergrowth of the pleura. This may possibly remain without any injurious influence on the general health during a long life, but in the end it frequently causes tedious pulmonary diseases, and particularly dropsy in the chest. These intergrowths originate from DROPSY OF THE HEART AND CHEST. 375 severe catarrhs, and similar inflammatory disorders of the chest, if the application of strong antiphlogistic remedies, and particularly the required bleeding, have been neglected. Every severe inflammation of the lungs may of itself result in dropsy of the chest, or it may be caused by faulty treatment. Scarlet fever, measles, erysipelas that has struck in, suppressed itch, tetter, hemorrhoids, but particularly gout, are frequently the cause of this disease ; it also accompanies feverish disorders, if the body has been already previously weakened, and digestion disturbed. It is for that reason that drunkards are frequently attacked by dropsy of the chest. If the patient suffering from this disease does not receive the most judicious and careful medical treatment, he can never recover, nor can his sufferings be ameliorated ; for that reason a physician should be called in as soon as possible, and the sooner that is done, the better for the patient. In case of necessity, administer the following powders : red fox- glove leaves four grains, flowers of zink by sublimation, and extract of henbane, three grains of each, sugar of milk eight grains, divide into twelve equal parts ; dose, one powder three times a day. An in- fusion of Seneca root is of good service. Prepare it in the following manner : Seneca root six grains, leaves of red fox-glove one grain, let it infuse in hot water for half an hour, add to four and one-half ounces of the tea after cooling. German lactucarium one and one- half grains, sugar ten grains ; dose, a tablespoonful every two hours. The suffocating fits, with which the patient is attacked from time to time, and particularly during the night, require instant relief on account of their danger to life. In such cases, administer sixteen drops of amber-containing spirits of hartshorn in a little water, or one or two drops of sulphuric ether in a spoonful of distilled water ; this will revive the patient, who was apparently already in a dying condition, and relieve him from the danger of suffocation. In moments of danger from such an attack, the patient may also be per- mitted to inhale a mixture consisting of two parts sulphuric ether, and one part of tincture of opium. For this purpose pour a teaspoonful of the above mixture in a cup, and permit the patient to inhale with open mouth the fumes which will develop from it ; a sitting position, with the upper part of the body raised as much as possible, is best 3T6 MISCELLANEOUS DISEASES. adapted for the patient. The application of mustard foot-baths is also very good. In extreme cases, where undulation is perceivable between the ribs, paracentisis affords the best relief; this operation, however, must be performed by a physician. The following is also an excellent remedy for the cure of dropsy : juniper berries, mustard seed, and ginger root, two ounces each (crushed or ground), horseradish and parsley root, two ounces of each, old cider one pint ; dose, half a cupful three times a day ; the quantity may be daily increased. The following is a well recommended remedy for dropsy of the chest : Juniper berries, i ounce. Mustard, ----- Wolfs milk root, - Horseradish, - Black elder bark, • - Mandrake root, - Dwarf elder bark and root, Bittersweet bark and root, Crush, and pour one gallon of old cider on it, let it macerate for two weeks ; dose, half a cupful three times a day, one hour before meals. Another approved remedy , Wolf's milk, - Juniper berries, Linseed, Horseradish, Mugwort, Red foxglove, Squill root, Horsetail, Manna, Licorice root, i ounce. 2 ounces. 2 i ounce. 2 ounces. 2 " i ounce. 2 ounces. 2 2 a Each of these herbs is crushed or bruised by itself; pour on one gallon of good cider, let it stand fourteen days ; dose, half a cupful four times a day. If it disagrees with the digestive organs of the patient, let him take it two or three times a day. It will impart •ANASARCA. 377 activity to the kidneys, cause a free discharge of urine, and cause the removal of the water accumulation. ANASARCA. Anasarca is called the accumulation of water in the cellular tissues, usually underneath the skin ; the disease is either general, or attacks particular parts, (swollen feet, for instance). In a milder form, it is called bloatedness. In anasarca, the swelling is soft and doughy ; it yields under the pressure of the finger, and leaves an indentation. The skin itself is pale, dry and tensive ; a swelling of that kind feels either cool or hot, frequently burning hot. The patient has lost his appetite, and feels' debilitated and sleepy. The watery swelling usually shows itself at the ankle, and ascends from that point ; traces of bloatedness may be noticed in the face, and the eyelids appear with a watery swelling. As a rule, the swelling of the feet is greatest, but diminishes if the patient is stretched out in bed. In the course of the disease, painful, burning ulcers frequently break out on the thighs, which easily become gangrenous. Tight clothing, or garters, &c. , soon cause a watery swelling even in healthy persons, who uninter- ruptedly travel both day and night ; watching nights, and otner ex- cessive unusual exertions, will sometimes cause a swelling of the feet ; with pregnant women and old men it is quite a common occurrence. Sudden suppression of perspiration, a single drenching of the clothes, readily produces anasarca. It also appears after scarlet fever, and other diseases, and is frequently the accompanying symptom of dropsy of inner organs, such as abdominal dropsy and degeneration of the kidneys, in which case it can only be treated in connection with the disease by which it is caused. If anasarca is not the symptom of an inner, deeper seated malady of an organ, it readily yields to treat- ment. Frequently the water is discharged of its own accord, by the opening of places through which it runs off. The course to be pursued in the treatment depends principally upon the question whether the disease is acute and connected with fever, or lingering and feverless. In anasarca which is the result of scarlet fever, and other inflammations, or of a violent cold, where fever is not absent, bleeding frequently has a marvelous effect, if the pulse is 378 MISCELLANEOUS DISEASES. strong and full, with a congestion to the head and chest, and the patient is still young and vigorous. In case of violent fever, admin- ister internally saltpetre : take refined saltpetre six grains, Glauber's salt fourteen grains, tartar emetic three grains, well-water eight ounces, raspberry juice forty grains ; dose, a tablespoonful every four hours. Another remedy : Cream of tartar fourteen grains, tartar emetic four grains, divide into twelve powders ; dose, one powder every three hours ; it may also be taken in a cup of sweetened water. Another remedy, particularly adapted for children, is the pulp of tamarinds : take pulp of tamarinds one ounce, small raisins two ounces, and six figs ; boil in two quarts of water until reduced to one quart, and when cool, administer to the patient at pleasure, half a cupful at a time. Another remedy : Pulp of tamarinds four ounces, bitartrate of potassa eight grains, water one pint ; dose, half a cupful every two hours. Another remedy : Soluble cream of tartar has acquired a particular reputation in all the various kinds of acute dropsy. Use daily from fifteen to thirty grains, dissolved in a suitable drink (barley water, oatmeal gruel, sugar water, &c). Another remedy : In tedious and feverless cases of anasarca, the following pills have acquired a great reputation : gum gamboge, squill root, golden sulphuret, extract of pimpinell, two grains of each, make into sixty pills ; dose, one pill four times a day, increase the* dose slowly. Another re?nedy : Watery extract of aloes five grains, gum gamboge dissolved in Malaga, antimonial gum, sulphate of potassa, three grains of each ; make into two hundred pills ; dose, two pills twice a day. Dose to be slowly increased. Another remedy : In case of cold, watery swelling of the feet, apply the following embrocation : spirit of juniper berries five ounces, squill root vinegar four ounces ; rub in morning and evening. PREVENTION OF RELAPSE IN DROPSY FLATULENCE. 379 PREVENTION OF A RELAPSE IN DROPSY. Frequently after recovery from dropsy, a peculiar infirmity remains, without an indication of any particular disease. Urinating, evacua- tions, perspiration, appetite, taste, sleep, breathing, and pulse, are all regular, and yet the convalescent does not recover. He looks sick and withered, and feels discouraged. Patience is all that is required ; his recovery is slow, but certain. His habitation should not be damp, and, if possible, have an elevated location, removed from swamps and standing water, all heavy food, and tepid, watery bever- ages, should be avoided. He must not expose himself to damp, cold weather, or be troubled with care. An adherence to these rules will all the more surely restore him to health. If the attack of dropsy was not of an acute nature, but connected with exhaustion, then convalescence requires more consideration ; the relaxation remaining must be relieved. If the patient has suffered from swelled feet, it will be necessary for him to wear bandages, or laced stockings, use spiced embrocations (juniper spirits, &c), and take as much exercise as his strength will permit ; keeping as much as possible in the open air, living in the country, or making short jour- neys, are of very great benefit. After an attack of dropsy, the result of debility, woolen clothing must never be changed again for others. If an inactiye stool remains, the following pills will have a very bene- ficial effect : extract of aloes, improved by sulphuric acid, four grains, marshmallow root five grains, make into forty pills ; dose, one or two pills at noon. FLATULENCE. Flatulence is a frequent, troublesome malady, causing frequently the greatest torture and anguish to persons attacked by it, but particularly to hypochondriacal and hysterical people. Very often it is considered the cause of many troubles, in which, however, it has no part. It can not be denied that it ex: ends its influence to a great part of the body, and it [may canse not only abdominal, but also («hest and head dis- orders. This mistaking of flatulence as causes for diseases is not always as inconsequential as might . be supposed. If particularly the inflammatory pains in the abdomen are deemed a result of flatulence, 380 MISCELLANEOUS DISEASES as is frequently the case, and as we have often had an opportunity of observing in attacks of colic, then heating remedies and carminatives are resorted to, which, without fail, will change the slightest disorder into a very serious case. Most people are led into this mistake, be- cause with inflammatory pains, the exit of flatulency above and below gives seeming relieve for a short. Only if these troubles, which greatly resemble abdominal and pulmonary diseases, disappear, Or are lessened for a few moments, or a longer period of time, it may be assumed that they are caused by flatulence. Flatulence causes a number of complaints by extension and tension of the gastric region, and of the whole abdomen. To these belong asthma, great anguish and raving (nightmare), depression of mind, pains under the ribs, particularly on the left side, stitches in the side, palpitation of the heart, spasms, buzzing in the ears, double vision, and hemiopia. The truest picture of all these symptoms is furnished by the so-called wind-colic, which is also called cramp-colic, because there are always cramps connected with it. The abdomen is always a good deal expanded with it and tensive, although not even, as knots may be plainly felt. The pain is very violent, moving from one part to another, and is connected with considerable rolling in the bowels. The disorder also effects the cavity of the chest, causes pain and stitches, which, like those in the bowels, go from one place to another, and are connected with anguish and palpitation of the heart. The abdomen sometimes expands to such an extent, that the navel pro- trudes, enlarged to the size of a fist, and has a vesicular appearance. Spasms are usually connected with the attack ; light contractions in the face, hiccoughs, spasmodic drawing up of the testicles, and invol- untary spermatorrhoea, are noticeable. In spite of incessant efforts by the patient, he is unable to expel the air, but as soon as he accom- plishes it, it affords great relief. If flatulence increases to a great extent, it results in two troublesome disorders, namely : eructation, when the patient is tormented with winds incessantly forced out with a loud and frequently squeaking sound, and a rolling sound in the abdomen, where the wind is forced about in the bowels, frequently with the strangest of sounds; sometimes the air is rolled around like a ball. The true cause of flatulence is weakness and great irri- tability of the stomach and the intestines. It is therefore mostly FLATULENCE. 381 found in hysterical and hypochondric persons, and also in those who have weakened their abdomen by the frequent use of laxatives, sexual excesses, a sedentary life, &c. Where this weakness prevails, the use of flatulent food is not always required to produce flatulency ; it may be produced by emotions of the mind and nerve irritations ; taking cold may also bring it on. Most usually, however, food caus- ing flatulence is the cause ; to this class belong particularly cabbage, turnips and fermenting drinks. If the malady has reached an ad- vanced stage, the smallest quantity of vegetable food will cause vio- lent flatulency, and if the digestive organs of the patient are very weak, the most innocent food will produce the same effect. The treatment of this malady must have a twofold aim : first, an effort must be made to relieve the attack ; and secondly, to cure the morbid condition. In the first case, fennel, anis, or peppermint should be used as a tea, but more particularly the following ingre- dients : star anisseed, coriander, fourteen grains of each, lemon balm leaves three ounces ; dose, a small tablespoonful for one cup of tea. Also essential oils, such as oil of anis, peppermint, &c; dose, from- four to six drops on sugar, every half hour or hourly. Another remedy ; Oil of peppermint twelve drops, Hoffman's ano- dyne five grains, spirits of hartshorn containing anis, valerian tincture, eight grains of each ; dose, from fifteen to thirty drops, to be taken in caraway seed tea. Another remedy : In very severe cases of attack take the follow- ing : essence of peppermint, essence of Canadian castor, Hoffmann's anodyne, four grains of each, laudanum two grains; dose, from twenty to thirty drops on sugar twice a day. Another remedy : The embrocation of the following ointment is of excellent effect : volatile camphorated ointment forty grains, oil of cajeput, oil of balmmint, six grains of each, tincture of opium four grains ; mix well, and apply twice a day. Administer an injection of the following ingredients : pulverized assa fcetida three grains, incorporate thoroughly with the yolk of an egg, and mix with oatmeal gruel, or a decoction of camomile. The patient will derive much benefit by taking every morning before breakfast a cup of caraway tea (from three to four grains boiled in one cup of water), and in addition thereto, take every fore- 382 MISCELLANEOUS DISEASES. noon and afternoon forty drops of compound essence of bitter orange. These preparations are much better than the use of caraway cordial, as the latter may get people in the habit of drinking spirituous liquors. The use of every kind of vegetables must be discontinued, and also warm drinks and hot soups. Cold water may be drank dur- ing meals, but no beer, although this is against the usual advice. If but little water is drank, it induces the fermentation of the food con- sumed, and therefore flatulence. But if at least from three to four glasses are drank, the coldness of the water prevents the fermentation to which every weak stomach is inclined, facilitates digesion, and therefore is the best protector against flatulence. To effect an entire cure, the stomach and intestines require strengthening. A cold, dry diet is best adapted for that purpose, drinking of cold water, ice pills, washing of the gastric region and abdomen with cold water, &c. Another remedy : The following drops can also be highly recom- mended : tincture of wormwood, compound tincture of orange peel, sixteen grains of each, essence of peppermint ten grains ; dose, from fifteen to thirty drops on sugar twice a day. Another remedy : Assa fcetida, condensed ox gall, extract of worm- wood, quassia extract, orange peel extract, four grains of each, make into one hundred and sixty pills ; dose, from three to four pills, morn- ings and evenings. In cases of eructation, which is so very troublesome, the same rem- edies are applied as in spasms of the stomach. The following powders are very efficacious : subnitrate of oxide of bismuth two decigrammes, opium two centigrammes, sugar one grain \ dose, one powder twice a day. HEMORRHOIDS, PILES. Hemorrhoids is a disease which, when fully developed, man- ifests itself periodically by a discharge of blood during an evacu- ation of the bowels, and if not fully developed and regular, by a swelling of the veins at the mouth of the rectum. The first are called bleeding, and the latter blind piles. If the disease is not fully developed, it manifests itself with disturbance of digestion only by internal pains, stitches, and cutting pain in the abdomen. If, instead of blood, mucus only passes with the stool, they are called haemor- rhoids mucusce. The disease may remain in its first stage without any HEMORRHOIDS PILES. 383 further developement, or the morbid matter, instead of being dis- charged through the rectum, is transferred to other organs, for instance the stomach, spleen, kidneys, bladder, womb, lungs, &c, where it either causes hemorrhages, or exercises some other disturbing influence in the functions of these organs. Causes of the disease are extravagant consumption of wine, strong beer, whisky, coffee, highly spiced food; also a sedentary mode of life, interruptions of activity of the skin, excessive sexual intercourse, and finally an hereditary disposition may also favor a development of the disease. The treatment is intended to remove principally the causes of the malady, which are stagnation of blood in the abdomen. For that purpose the following rules should be observed : take diligent exercise in the open air, avoid too long and continuous sitting, particularly on upholstered chairs, abstain from the use of coffee, strong beer, and wine, and drink fresh water and acidulated beverages. Costiveness should be removed, which may be accomplished by light laxatives. Hemorrhoids are preceded by a certain excitement in the circula- tion of the blood, palpitation of the heart, orgasm, pain in the back and loins, the latter to such an extent as to prevent the patient from changing his position or bending down, a feeling as if cold water was being poured down his back, colic pains, costiveness, and tenes- mus. To this is frequently added morbid condition of the genitals, strong inclination for copulation, incitement at night, and spermator- rhoea ; urinating is frequently connected with difficulties, the urine depositing a red, sandy sediment, or the secretion is altogether sup- pressed for the time being. Although hemorrhoidal difficulties may be induced by everything tending to weaken the nerves of the abdo- men, therefore also by bad digestion, a sluggish circulation of the blood, and therefore by an accumulation of the blood in the same part of the body, yet there exists also a hereditary disposition for it. which, if not counteracted by a system of hardening in youth, and by a well regulated mode of living when advanced in life, will in all cases result in hemorrhoids. If this predisposition is ignored, they appear unusually early, degenerate easily, and, if the least obstructed in their regular course, cause violent disorders, frequently dangerous to life. But even if the premonitory symptoms of hemorrhoids 384 MISCELLANEOUS DISEASES. appear, they are not always followed by bleeding, or a real discharge of blood through the rectum ; the local disorders at the mouth of the rectum disappear entirely, while others of a more serious nature mani- fest themselves in consequence of the morbid matter being retained. To these belong particularly hypochondria, spasms, fainting fits, diz- ziness, lameness, apoplexy, diseases of the heart, asthma, phthisis pul- monalis, particularly tuberculosis, hemorrhages of all kinds, tetters, and ulcers on the feet. Patients can therefore be cured only if these disorders are treated in the same manner as the hemorrhoids are treated. Due considera- tion should be given, however, to the spinal marrow, because that may become irritated by the acridity of the hemorrhoids, so that a larger number of the before mentioned disorders may result from it. From this it will be seen of what importance a predisposition to this disease, as well as the hemorrhoids themselves, is ; it is one of the most frequent, and also misunderstood, first causes of many serious diseases. BLEEDING HEMORRHOIDS. When the general hemorrhoidal difficulty is about to change to the bleeding condition, tenesmus, tension, and pain in the back, itching at the rectum, and burning in urinating, and also costiveness and con- stipation, keep increasing. Frequently spasms appear to such an extent as to prevent the application of injections, and the faeces can- not find an outlet. Finally, with a continued pressing and squeezing, blood makes its appearance ; often, however, the hemorrhage happens without any pain, and even unnoticed. Sometimes the blood is dis- charged previous to the faeces, or the bleeding spot is found to be on the external part of the rectum. After the blood has passed, the patient usually feels relieved, all preceding difficulties disappearing. If this is not the case, the cause is usually a too small discharge of blood ; sometimes, however, the latter is too violent, or continues for too long a time, for in very old cases it sometimes hardly ever stops altogether. The discharge of blood usually continues for several days, and returns sooner or later, either regularly or in larger quanti- ties. In some cases so-called hemorrhoidal colic accompanies the bleeding, which will be mentioned hereafter. Simple bleeding hem- orrhoids is not a dangerous disease, but is nevertheless exceedingly BLEEDING HEMORRHOIDS. 385 troublesome, which may easily degenerate, and even become dan- gerous to life, if the greatest care is not observed in the mode of living. Therefore it cannot be considered as performing the same service for the male sex, which menstruation does for the female sex. If bleeding hemorrhoids prevent congestions to other vital parts, and if by it pernicious hemorrhoidal acridity is removed from the body, then it may be right to say, as did our ancestors, that bleeding hem- orrhoids are more precious than gold. Yet it is better, if successful, not to cure one disease by another (for instance, dizziness by hemor- rhoids), but cure both at the same time. To women, who still have their monthly period, bleeding hemorrhoids are usually very detri- mental, and must be combatted with full energy. Only in cases of pregnancy, and with those phthisically inclined, an exception should sometimes be made. The earlier bleeding hemorrhoids occur in young people, or perhaps in children, the worse it is ; with old age the disease disappears of itself. If bad consequences are to be prevented, the disease must receive very careful medical treatment. If the hemorrhoids are not inherited, and not of too long standing, they may be thoroughly cured by a well regulated mode of life, without the aid of any medicine, and nothing else is needed but to avoid everything carefully what has been before stated as the cause of the disease, and to live in such a manner as not to grow old before one's time. There are many cases where constant traveling for six months, or an active country life, with proper diet, has affected a cure. Frequently it is necessary, how- ever, to remove the obstructions in the abdomen for the free circula- tion of the blood, by mild laxative remedies. If obstructions and inflations of the abdominal intestines are perceptible, and, as is usually the case, of the liver in particular, and if the patient is clearly of a melancholic-choleric temperament, as above described, or if he suffers from a feverish state of the blood and orgasm, and if the general morbid condition is serious, but the local symptoms of the rectum and genitals not fully developed, the following remedy will be of ex- cellent service, if continued for a few weeks : extract of dandelion, extract of couch grass, tartrate of potassa, cherry laurel water, six- teen grains of each, water six ounces ; dose, a tablespoonful three times a day. 25 386 . ' MISCELLANEOUS DISEASES. Another remedy : During spring the freshly expressed juices of herbs may be used with excellent success in place of herb extracts : take buckbean, water cress, dandelion root and leaves, equal parts of each, press eight ounces of juice, to be mixed early in the morning with broth, and taken in three doses, at intervals of half an hour. Another remedy : The patient may chew the stems of the dande- lion flower, immediately after picking it, suck the milky juice, and spit out the fibrous part; the stems must not be withered, nor the flowers entirely done flowering. The patient must then wait for half an hour, before he takes his breakfast. Begin with from six to twelve stems, and go up as high as twenty or thirty. This must be continued for three or four weeks. Not only the cheapness of the cure, but also the proper exercise in the air, and the juice of this wholesome plant, which is thus obtained unchanged, and in all its freshness, gives it preference over all other herb cures. In all other cases, where a morbid state of the body exists, pointing to hemorrhoids, but never in cases of bleeding piles, sulphur is a tried remedy. This remedy not only cures all decided hemorrhoidal affec- tions, but also removes and prevents, best of all, those diseases, which so often appear in consequence of diverted hemorrhoids, as hypo- chondria, spasms, fainting fits, dizziness, paralysis, heart diseases, asthma, haemoptisis, consumptive symptoms, particularly of the larynx, dropsy, hemorrhages, and blennorrhea of all kinds, &c. The best mode of taking sulphur is the following : cream of tartar one ounce, flowers of sulphur half an ounce ; dose, one teaspoonful once or twice a day, so as to produce one or two soft stools ; to be used for a few days. Another remedy : Flower of sulphur, magnesia, cream of tartar, oil of lemon sugar, half a grain of each ; this powder to be taken in the evening, in a cup of water. This powder is particularly adapted for people of nervous weakness, and generally in cases where digestion is disturbed. But with the addition of rhubarb powder, it is particularly beneficial where the functions of the liver are irregular, and the stool checked. The addition of rhubarb invigorates the intestines, and causes them to contract energetically, and thus discharge the accumu- lations of weeks and months, and with it removes at the same time a BLEEDING HEMORRHOIDS. 387 chief cause of the obstructions in the blood vessels and rectum. Sul- phur usually removes the constipation, but it must not be used where the blood is in a feverish or heated state. One or two tablespoon sful of castor oil in a cupful of oatmeal gruel, removes the morbidly ex- cited condition and constipation at the same time. In long-continued cases of hemorrhoids, the continual use of yarrow leaves, used cold as a tea mornings and evenings, cannot be sufficiently recommended. We must also remark, that a remedy for the hemorrhoids must not be taken in case of fever or biliousness, and during menstruation. Treatment of bleeding piles : Regular bleeding piles, which do not bleed too strong, and are not connected with particular difficulties, need no medicine ; it is even possible that the latter may do more harm than good. Everything that may increase or stop the bleeding must be avoided. The patient must therefore carefully avoid every violent motion, too great warmth or cold, particularly a sudden change of both, remain if possible in an outstretched position, particularly keep his feet and abdomen warm, for that reason avoid cold water- closets, where a draft of air strikes the seat, which may very easily stop the bleeding. The diet must be light, and not flatulent ; nothing very hot must be eaten. Tea, coffee, wine, whisky, strong beer, &c, are injurious, but cold water, freely drank, very beneficial. Tranquility of mind must be maintained as much as possible. Violent passions, particularly anger and fright, may become very dangerous, and very easily result in spasms and inflammation of the abdomen. Costive- ness or constipation must be relieved, for it may result in bad con- sequences, and in the most fearful pain. It is not a matter of indif- ference, however, in what manner this is effected, the mildest remedies are always the best, for instance, the juice of stewed prunes, with Thomas sugar, taken a cupful at a time, also tamarind whey ; the latter is prepared in the following manner : take one pint of hot milk, pulp of tamarinds one and one-half ounces ; let it boil until the cheese has separated, and after it has cooled off, strain, and take half a cupful twice a day. A mixture of equal parts of oil of almond and marshmallow juice, of which take from one or two tablespoonsful a day. A decoction of linseed and water is highly recommended ; dose, a cupful twice a day. Where these remedies do not produce the desired effect, administer tartrate of potassa, one to two tea- 388 MISCELLANEOUS DISEASES. spoonsful in a cup of water, morning and evening ; it has an excel- lent effect. All these remedies, however, are surpassed by cold in- jections, which, in this case, are just as beneficial as warm ones are detrimental. In case of severe bleeding of hemorrhoids, great cau- tion is always necessary before an attempt is made to check it ; for it is always difficult to determine whether there is really too much blood discharged. There is no reason to consider the flow of blood too ex- cessive, as long as the patient is not greatly weakened and rather feels relieved thereby. In very many cases the flow of blood is critical in regard to obstructions in the abdomen, or in place of bleeding of other vital organs, for instance, the lungs. Only if the flow of blood continues for a long time, and more or less symptoms of a severe loss of blood appear, such as paleness of the face, particularly around the mouth and lips, glistening before the eyes, buzzing before the ears, or if the bleeding decreases and frequently returns, and if lack of appe- tite, emaciation, difficulties of digestion, slow fever, &c, are added to it, the bleeding should be stopped. Usually it is sufficient to cause the patient to lie quietly on his back, drink alum whey, and inject it repeatedly cold into the rectum. Alum whey is prepared in the following manner : take two and one-half pints of milk, alum eight grains, from which whey is prepared, add sixteen grains of sugar ; dose, half a teacupful every hour or two. Various domestic remedies, which are applied with very good success, have been recom- mended for the cure of hemorrhoids. To that class belong a beverage prepared from huckelberries, a tea made of red rose leaves ; but yar- row flowers enjoy the best reputation here also. The patient must in this case also always pay proper attention that his stools are of soft con- sistency. The best laxative for that purpose is tamarind whey, which has justly acquired a high reputation. If the remedies here enumer- ated do not result beneficially, medical assistance becomes necessary. BLIND HEMORRHOIDS. As long as hemorrhoidal tumors do not discharge any blood, they are called blind hemorrhoids. The size varies from a pea to a walnut, or even to that of an apple (hemorrhoidal sacks). Their seat is either on the mucus membrane of the rectum (when they are called internal BLIND HEMORRHOIDS. 389 hemorrhoids), or outside of it, surrounding the anus in the form of a ring (external hemorrhoids). The internal tumors, if increased in size, are readily forced out under pressure of an evacuation, but usually return of their own accord when the pressure ceases. Some- times, however, they are wedged in by the contracting sphincters of the anus, and become gangrenous. They also may by their weight draw downward the mucous membrane of the rectum, and cause a prolapse of the rectum, which at first may be readily reduced, but which finally remains permanent. It is self-evident that unless the pressure is removed from the wedged in tumors, that inflammation will set in, and that an extension of the inflammation and suppuration in the rectum, will cause fistula. The treatment is, upon the whole, the same as that given in the preceding article, as both kinds differ only by the presence or absence of bleeding ; in other respects they are essentially the same. If the tumors are very painful and inflamed, castor oil, and in case of neces- sity, mild opening injections (if the tube of the syringe can be in- serted) are very beneficial. The injection is prepared from linseed oil, barley water, milk and honey, or cold water may be used for that purpose. For a cure of blind hemorrhoids, if they are the result of a general disorder and not of local causes, (for instance, pregnancy, abuse of injections, &c.,) there is no better remedy than tartrate of potassa. Administer, as previously stated, mornings and evenings one or two teaspoonsful of it in a cup of water. If it should result in diarrhoea, reduce the dose to one-half. If the malady is not already too deeply rooted, it will gradually disappear. This remedy should be continued for some time (from six to eight weeks), but in case of weak- ness of the stomach, it should be combined with some aromatic sub- stance. Prepare it as follows : tartrate of potassa one ounce, extract of dandelion half an ounce, fennel water ten ounces; dose, a tablespoonful three or four times a day. To soothe the pain usually caused by swollen hemorrhoids, fresh unsalted butter may be used, also marshmallow oint- ment, but more particularly common toadflax salve. Still more effective is a salve prepared from four grains of borax and one ounce of rose po- made ; apply fresh two or three times a day. In extreme cases of very severe pain, the following remedy is excellent : take common toadflax salve, and oil of henbane, half an ounce of each, sugar of lead two 390 MISCELLANEOUS DISEASES. grains ; anoint the hemorrhoidal tumors repeatedly with this prepar- ation, but this remedy must not be continued for too long a time. In cases of very violent inflammation, bleeding, leeches (but under no condition should they be applied to the tumors themselves), and internally saltpetre and meagre diet, are required. Sitz-baths, taken by the hour, have a splendid effect. Old, degenerated and indurated tumors, which constantly become irritated by evacuations, and inflame and suppurate, should be made as callous as possible. This is best done by the application of a cloth dipped in a solution of alum (four grains of alum to two cups of water or camomile tea), by ointments prepared from fresh unsalted butter (two parts), and powdered nutgall (one part), fomentations of whisky or wine, but more particularly by anointing with the following salve : take lead ointment half an ounce, alum eight grains, thebaic extract two grains. WHITE OR MUCOUS HEMORRHOIDS. Hemorrhoidal tumors frequently have the same effect in the rectum that foreign bodies would have, by placing the mucous membrane in a catarrhal condition, and creating an increased secretion of mucus (mucous hemorrhoids), which sometimes appears thin and watery, and at other times viscous, like the white of an egg. The disease is therefore identical with the other, and no change in general treatment should be made ; only local difficulties should be taken into consideration. If the patient feels weak, administer yar- row leaves, buckbean tea, and finally Iceland moss. If the rectum has prolapsed, or if hemorrhoidal tumors are visible, wash the anus with cold alum whey. If blennorrhea is excessive, and continues for some time, so as to create the danger of general debility, admin- ister cubebs four to six grains a day, divided into four powders; it is a very effective remedy against this complaint. In obstinate cases, the following pills are very valuable : gum kino, alum, cubebs, and muriate of ammonia, eight grains of each, gum arabic sufficient to make, with the addition <5f a few drops of water, pills of two grains each ; dose, mornings and evenings from four to five pills. The same remedies may also be applied with success in catarrh of the bladder. HEMORRHOIDS OF THE GENITALS, ETC. 391 HEMORRHOIDS OF THE GENITALS AND URINARY ORGANS. Just as hemorrhoids frequently represent the bleeding which other- wise would have attacked other organs, so on the other hand, the secretion of the obstructions and engorgements of the blood circula- tion accumulated in the intestines of the abdomen, occur in other organs than the rectum ; this process we frequently find in progress in the mucous membrane of the genitals and the urinary organs. It may be readily perceived that these disorders are of a hemorrhoidal nature, if it is noticed that they, like the hemorrhoids in the rectum, appear at stated times, and at the same time with local disorders, or at least alternate with them. Sometimes the patient has no longer any local sensation in the rectum, when its hemorrhoidal nature may be assumed, if they follow hemorrhoids formerly existing in the rec- tum, or if they are hereditary with the patient. Sometimes the dis- order is exceedingly violent, and consists in severe pains in the kid- neys and bladder, in a spasmodic and very painful drawing up of the testicles, involuntary discharge or retention of the urine, fierce burning while being discharged, troublesome itching, to which are usually added violent fever, tenesmus, and very severe pains of colic There are also produced, particularly in women, erysipelatous inflam- mation of the genitals, and swellings greatly resembling abscesses, which sometimes change to suppuration ; it is also frequently accom- panied by the so-called pushing down of the womb. This is a spasm of the uterine ligaments, and creates the feeling as if something was being violently pressed out through the womb. These hemorrhoidal difficulties of the genitals and urinal organs may also change into the bleeding hemorrhoids of these parts. The flow is usually very dif- ficult, and is accompanied by excruciating pain, spasms of the blad- der, and other nervous disorders, as well as by strangury, and even by a total suppression of the urine. Bleeding hemorrhoids of the womb, &c, also occur sometimes in young girls, being a premature menstruation, but more frequently in women, after the monthly period has ceased. Blind hemorrhoids of the female genitals frequently prevent copulation, make it very painful, cause miscarriages or great trouble during pregnancy. Mucous hem- 392 MISCELLANEOUS DISEASES. orrhoids of the named parts are not at all rare, but more frequent are the mucous hemorrhoids of the bladder. The discharge of this mucus, which may vary in density, color, and smell, occurs most usually with spasms of the bladder, and a burning sensation extending to the urethra. There is also a flow of mucus from the urethra, which very closely resembles that which results from unclean copulation. The so-called whites in women are not rarely based on hemorrhoids. These discharges, as well as the mentioned disorders of the genitals and urinary organs generally, are always exceedingly difficult to treat, which, if neglected or mistaken, may result in the most serious con- sequences. Upon the whole, the treatment does not differ from that of the ordinary hemorrhoids. The attacks are ameliorated by cold sitz- baths, the application of from twelve to fifteen leeches on the rectum, and by drinking milk. Administer every hour from six to eight drops of bitter almond water, and apply hourly soothing poultices to the abdomen. The poultice is prepared from the following ingredients : linseed four ounces, hemlock leaves one and one-half ounces, henbane one ounce, boil to a moderate consistency, and then add one and one-half ounces of oil of henbane ; the poultice to be applied in a lukewarm condition. The costiveness is removed with castor oil. Retention of urine requires immediate medical and surgical assist- ance. To cure hemorrhoidal difficulties : To remove constipation of the bowels, the following is an excellent remedy : tartrate of potassa half an ounce, dandelion extract three drachms, lemon balm water eight ounces, mix ; dose, one tablespoonful every two hours. Another remedy : A good ointment for hemorrhoidal tumors is the following : take a cupful of lard, melt in a pan, and add four ounces of venison tallow to it, then add two tablespoonsful of olive oil, and one ounce of extract of henbane ; spread on a cloth, and apply until the pain ceases ; cloths dipped in lead water may also be applied with good results. Of very good effect is a decoction of mullein leaves in milk ; saturate cloths with the decoction, and apply to the hemor- rhoidal tumors. RHEUMATISM. 393 RHEUMATISM-ARTHRITIC PAINS. This disease is produced by a cold of the external skin. It mani- fests itself by pains, changing from one place to another, and is increased by the warmth of the bed. Rheumatism shows itself at one time by the painful swelling of a single part, at another time it is more violent, and of an inflammable nature, and connected with an inflam- matory fever, then again it runs into a moderate irritative fever, and thus forms the rheumatic fever (see " Rheumatic Fever "), when the local pains are, so to say, blended with the general pain. Persons with a tender skin, sensitive to changes of temperature, are usually predisposed to rheumatic disorders. The next cause is suppressed or impaired perspiration, induced by taking cold, or by a sudden change of temperature, by living on a wet soil, in a damp house, &c. The treatment of this disease, not dangerous in itself, but which by frequent returns becomes very obstinate, requires, aside of a mode of living restoring the functions of the skin, a restoration of the sup- pressed perspiration, and its proper regulation. I will here mention several kinds of rheumatism : ACUTE RHEUMATISM. Rheumatic inflammation is a disease, the progress of which is deter- mined by the local disorder. The joints of the limbs, and sometimes also the muscles of the throat and back, are often attacked by the same disorder. Externally an elastic, redish swelling, painful and hot to the touch, often occurs, making motion of the attacked parts impossible, or very painful. In regard to the inflammation of interior parts, we will only observe that it manifests itself more by pulling, tearing, wandering pains, without being accompanied by fever to any great extent, and without passing into suppuration. Treatment of rheumatic inflammation should be moderate and cautious, antiphlogistic, and sudorific (see "Rheumatic Fever"); after removal of inflammation, the swelling and pain, which may still remain, should be removed by blisters. 394 MISCELLANEOUS DISEASES. RHEUMATISM OF OLD STANDING. This disorder is the result of former attacks of rheumatism not fully removed, particularly if the patient exposes himself to new causes of attack, by impairing the action of the skin. It consists in more or less violent pains, increasing with changes of the weather. These pulling or tearing pains are unaccompanied by fever, move from one place to another, and manifest themselves in the muscles, joints, and in the fibrous parts of the body generally. It differs from gout, which it otherwise greatly resembles, and in combination of which it generally appears, by the absence of periodical attacks, and by the deposit of earthy matter in the joints. In the treatment a restoration of free perspiration should be adhered to, and more incisive remedies resorted to, such as sulphur, antimony, and gum guiac. Take, for instance, gum guiac three drachms, milk of sulphur, and medicinal soap, one drachm of each, extract of bittersweet sufficient to form pills of two grains each ; dose, mornings and evenings, five pills ; also leopardsbane, cod liver oil, and wolfsbane, which should be supported by the use of general and local baths (of sea salt, alkaline salts, liver of sulphur), steam baths, blisters, embrocations of stimulating ointments, or essential oils. Inflammatory or plethoric conditions require bleeding, saltpetre, and strong purgatives, while a weak state calls for quassia and cold baths. If the pain is very severe, apply henbane plaster and opium, or tobacco fomentations. APYRETIC RHEUMATISM OF RECENT DATE. This rheumatism is either the result of acute rheumatism, or it manifests itself without any fever whatever. The symptoms of the attack are as follows : the patient has more or less violent and extend- ing pains in various parts of the fleshy portion of the body, and sometimes in the skin only. It mostly attacks the limbs, neck, shoulder-blade, chest, and sometimes also the face. Sometimes the pain commences in the abdomen, and descends into one of the testicles, which swells, and is exceptionably painful. At times the attacked parts are red, swollen, and hot, and again they are frequently unnaturally cold to the touch, and exceedingly sensitive. Frequently RHEUMATISM. 395 the attack is caused by local colds, draughts of air, which have struck the part while in a state of perspiration. During cold and moist weather many people are frequently attacked by this disease. Some- times, however, it is not caused by external influences, but by a very sensitive and irritable condition of the skin. If the rheumatic affection is free from fever, and the painful part neither red nor inflamed, Russian baths are of great benefit. They frequently prevent the full development of the attack, if taken at the time of the first appearance of the pain and difficulty of motion. If these baths are not accessible, the full development of the attacks may be prevented either by the application of bags filled with powdered camphor and camomile or elder blossoms, or by embrocations. For the latter purpose, take caustic spirit of sal-ammoniac, spirits of cam- phor and angelica, eighteen grains of each. In ordinary cases the following has a good effect : opium two centigrammes, camphor and ipecac one decigramme of each, sugar one gramme ; the whole to be taken in one dose. It is better if the patient will take it in the even- ing, in one or two cups of elder blossom tea, just previous to going to bed, and cover himself up moderately warm. A light perspiration is the result, and the attack frequently disappears in one night. In lean people with rigid fibres, its operation is more certain if the patient will take a warm bath two hours before retiring for the night. During the day administer colchicum wine, dose from ten to thirty drops, should the case not 'yield to the treatment first prescribed. If this remedy is to prove effectual, it must produce several soft discharges from the bowels ; for that purpose the dose should be increased gra- dually until the desired result is accomplished. If the patient is of a nervous, irritable constitution, administer every three hours from twenty to thirty drops of equal parts of succinated spirits of harts- horn and Hoffmann's anodyne. If the patient is of a phlegmatic con- stitution, administer extract of wolfsbane, prepared in the following manner : take extract of aconite from two to three decigrammes, col- chicum wine from fourteen to twenty drops ; dose, from ten to twenty drops every two or three hours. In very many cases the juice of the artichoke has proved to be an excellent, useful, simple, and inexpen- sive domestic remedy. It is prepared as follows : take fourteen grains of the juice of the leaves and stems of the artichoke (freshly ex- 396 MISCELLANEOUS DISEASES. pressed), syrup eight grains, water ten ounces; dose, the fourth part of the mixture every eight hours. A tincture prepared from this juice has also been given with good success : Take freshly pressed juice of artichokes eight ounces, spirits of wine eighteen ounces, let it stand in a warm place for two weeks, strain, and administer twice a day from four to eight grains in half a cup of water. In very obstinate cases, external must be combined with internal remedies. Embrocations of croton oil are of excellent service in that case. For the purpose of producing a strong diverting counter irrita- tion of the skin, have from three to four drops of croton oil, well rubbed in, in any chosen part of the skin, at intervals of from twelve to twenty-four hours. Frequently after the first application already an erysipelatous inflammation of the skin appears, covered with a large number of small blisters, which causes a painful itching. These little blisters only remain for a few days (three or four), and dry off with- out leaving any ulcers behind. If the skin is exceptionally irritable, the croton oil is mixed with a like quantity of almond or sweet oil, and applied in the same manner. If the part is cold and almost in- sensible to the touch, a Spanish fly blister has a splendid effect. It must remain, however, until a blister is drawn, and should be applied to the morbid part, or as near as possible to it. If one plaster is not sufficient to relieve the patient from pain, another is applied near it on the day following. The part should be kept as warm as possible, and should be wrapped in flannel, and still better in oiled silk. Un- der cover of the latter a strong perspiration breaks out, which is very beneficial. The oiled silk should lie closely to the skin, as it will in- duce perspiration sooner. But as it is usually exceedingly sticky and tough, the oiled silk must be removed every twelve hours for the pur- pose of cleaning the skin. If the pain still continues, have a plaster prepared of equal parts of camphor and henbane, spread on leather, and cover the morbid part with it. As these remedies cannot be very well applied to all parts of the body, for instance to the face, bags filled with aromatic herbs, particularly camomile flowers, with two grains of camphor, may be applied as warm as possible. Very effect- ive in severe pains has proved a poultice made of a strong decoction of Virginia tobacco leaves. One and one-quarter ounces of tobacco leaves are boiled in a quart of water, until the liquid is reduced to RHEUMATISM. 397 one-half. Sometimes the hot application of any substance to the painful parts does good service. Crusts of fresh, hot bread, applied as hot as the patient can bear it, have frequently brought instantaneous relief. Hot leaven, hot sand in bags, hot bran, &c, are also bene- ficial. A domestic remedy of unusual efficacy is the application of fresh carded wool ; it has frequently removed light cases of rheuma- tism in one night. Fumigations with amber can be highly recommended for phleg- matic persons, provided no inflammation exists. The following embrocations are very useful in cases of heat, redness, and swelling : take spirits of caustic sal-ammoniac one and one-half ounces, sweet oil three ounces, camphor two grains, tincture of opium one and one- half grains; to be rubbed in, and also covered with warm flannel, saturated with the compound. In the absence of redness, swelling and inflammation, the following may be used as an embrocation : tincture of Spanish fly six grains, spirits of caustic sal-ammoniac twenty grains, spirits of wild thyme one ounce ; to be rubbed in twice or three times a day. There is no better remedy for relapses, for persons inclined to rheumatism, than the application of cold water previously mentioned. If, however, the patient is too delicate to bear it, great precaution against taking cold, and cold feet, and avoiding exposure to a damp, wet and cold atmosphere, is a protection ; the frequent hard rubbing of the affected parts is also very beneficial. Frequently the wearing of flannel next to the skin may prevent an attack of the disease. The patient must not, however, become too effeminate, but must follow the instructions given above. Warm sulphur baths are usually ordered a great deal too much, and without any discrimina- tion ; they are only beneficial to persons of a cold, phlegmatic con- stitution, who suffer from a superabundance of stagnating humors. Much better is usually bathing in the river, or sea-baths, or lukewarm baths with sea salt, two ounces to a bath. If the patient does not suffer from weakness of the skin alone, but also from a genereal debility, the internal as well as the external use of ferrigenous water is particularly useful. Of very good service is also the long continued and often repeated use of quinine in powder ; dose, as much as will lie on the point of a knife, two or three times a day ; also the use of ferrigenous wine, and calisaya and ferrigenous 398 MISCELLANEOUS DISEASES. wine, prepared as follows : take powdered calisaya three ounces, orange peel and powdered iron, one ounce of each, good wine one quart. Let it stand in a well-corked bottle, in a warm place, for a few days, shake frequently, and strain ; dose, a tablespoonful three or four times a day. RHEUMATIC HEADACHE— NEURALGIA FACIALIS. This is a violent, rheumatic-nervous pain in the face. The malady appears mostly in the middle period of life, and ceases at uncertain times, just as it sometimes suddenly begins, frequently without any- real cause, after a mechanical irritation, such as sneezing, coughing, chewing, &c. The pain extends from one of the ears toward the face, particularly the lower part of the eye, and the cheeks. The pain is tearing, piercing, perforating, and sometimes resembling electric shocks. The disease is less dangerous than tedious, torment- ing, and in the highest degree depressing to the mind of the patient. The necessary energetic treatment of this malady must be left to a physician. In general it does not very materially differ from that of rheumatism and gout. Sometimes hollow teeth are the cause of the attack, which must be removed. Blisters and mustard plasters applied behind the ears, frequently relieve the pain ; croton oil rubbed in be- hind the ears has the same effect. Magnetism, galvanism, and elec- tricity sometimes prove to be excellent remedies ; at other times leeches or cupping-cups applied to the suffering part, are of great benefit, and so is the application of mercurial ointment with opium or hemlock, and also the nerve ointment. RHEUMATIC HEADACHE. This disease frequently attacks persons who otherwise never suffer from headache ; it usually follows rheumatic affections of the eyes, teeth, gums, neck, limbs, &c. Frequently the pain is very severe, and torments the patient day and night. It usually begins with a stiffness and pulling pain in the neck, and extends over the whole head to the forehead, so that even touching the hair of that part of the head is very painful ; it is connected with a feeling as if the hair itself was aching ; a decided palpitation is perceptible. Sometimes the pain RHEUMATISM. 399 ceases for a while, but soon sets in again with redoubled violence. The appetite is not impaired, and in this respect it differs from the headache resulting from a foul stomach, or from a gouty attack. It is not of long duration, but returns frequently. If the patient perceives the approach of the headache, he may avoid it by working himself into a general perspiration, which is best done by severe exercise in the open air. But if the attack has developed itself, leeches must not be applied, but mustard foot-baths, and warm covering to the head ; the patient should remain quietly in bed. Internally take colchicum wine, or succinated sal-ammoniac, as previously indicated; the patient should also take plenty of warm drinks, such as linden and elder blossom tea, &c. By the use of steam baths, taken when free from the attack, and the observation of the dietetic rules above laid down, the malady may be forever removed. RHEUMATISM OF THROAT AND NECK. The application of a Spanish fly plaster, and keeping warm, usually removes rheumatic stiffness from these parts. But if the throat is not subsequently guarded against cold, the malady soon returns. RHEUMATISM OF THE BACK. Rheumatism of the back is frequently mistaken for hemorrhoidal pain, and vice versa', it is self-evident that under such circumstances the wrong remedies are applied. With hemorrhoidal pains, costive- ness and great heat prevail, which is not the case with rheumatism. By quietly keeping the bed, the latter ceases altogether, while the former continues ; with rheumatic pain the patient cannot stand upright, except with a great deal of trouble, but is obliged to keep a stooping position, which is not the case with hemorrhoids. If this pain continues for a long time, and is neglected, it results not infre- quently in an incurable bending of the body, which can never assume an upright position again. When first attacked, embrocations are beneficial. Prepare an ointment of tincture of Spanish fly six grains, caustic sal-ammoniac twenty grains, spirits of wild thyme one ounce. Subsequently, and if an improvement does not occur soon, warm baths, but particularly steam baths, are the chief remedy. 400 MISCELLANEOUS DISEASES. RHEUMATISM IN THE BRACHIAL AND SHOULDER JOINT. Relief is certain in these cases, if spirits of camphor, or the follow- ing liniment is applied : spirits of caustic sal-ammoniac, spirits of camphor, and angelica spirits, half an ounce of each ; rub in twice a day. Fennel should be worn next to the skin, exercise as much as possible, and take a warm bath from time to time. SCIATICA AND LUMBAGO. This is a violent, mostly rheumatic pain, resulting from a slow in- flammation of the sheath of the muscle and nerve sheath in the hip- joint and lumbar vertebra region, which sometimes extends along the sciatic or crural nerves to the hollow of the knee ; it appears periodi- cally, and frequently changes its seat. Sometimes the disease changes to lameness of the thighs. In treating the disease, local and external remedies must be chiefly relied upon. Aside of local bleeding (by cupping), much benefit will be derived from rubbing with woolen cloths, embrocations with grey mercurial ointment, tartar emetic ointment, and also from vesicatories, which, in case of sciatica, are wound around like a ribbon from the head of the fibula upward and downward on the outer side of the thigh and leg. Rheumatic drops : Take compound tincture of myrrh and valerian, three ounces of each ; dose, half a teaspoonful in warm linseed tea, three times a day. Another remedy : Powdered gum guiac and Jamaica pepper, four ounces of each, powdered blood root two ounces, pearl-ash one ounce, strong whisky one quart; macerate for one week, shake the mixture three or four times a day ; dose, a teaspoonful three times a day in water. This is almost an infallible remedy against rheu- matism. Rheumatic drops : Formic spirits two ounces, spirits of nitre and juniper oil, one ounce of each, mix well ; dose, sixteen drops in water morning and evening. HEADACHE. 401 Another remedy : Brandy, juniper berries, rhatany root, tulip tree bark, six ounces of each, cut up or ground fine, place in a one-gallon jug, and fill up with two quarts of brandy ; let it stand nine days ; dose, a tablespoonful three times a day, to be taken twenty minutes before meals. Another remedy : Formic spirits one ounce, spirits of hartshorn two grains, Hoffmann's anodyne four grains, mix well; dose, from fifteen to thirty drops every four hours. Another remedy : Tincture of myrrh, ilgen oil, earthworm oil, fifteen grains of each, mix well ; dose, fifteen drops three times a day. Liniment : Spirits of turpentine, spirits of sal-ammoniac, spirits of camphor, raw linseed oil, two ounces of each, add one ounce of laud- anum, mix well ; to be rubbed in before a hot stove. Liniment : One quart of wine vinegar, salt, saltpetre and juniper berries, one ounce of each, mix well ; to be rubbed in two or three times a day. Liniment : Spirits of camphor, and spirits of nitre, two ounces of each, polecat oil four ounces, spirits of turpentine six ounces, put the whole in a bottle, and shake it up well before using it ; rub in three times a day. HEADACHE. Headache is the result of so many causes that it is difficult to make a proper summary. Sometimes the cause is entirely hidden from view, the brain being the attacked part. The suppression of any usual or natural effusion, such as bleeding hemorrhoids, menstruation, perspiration, &c., is not rarely the cause. Frequently headache is the result of a neglected catarrh, of rheumatism, or of a morbid irrita. tion of the stomach. Stagnation of the blood, or congestion towards the head is also a cause of it. These different kinds of headache are, therefore, only indications of some other disorder, which disappear with the cause. There is, however, a kind of headache, the result of nervous debility. The malady manifests itself here in the form of a dull, heavy feeling in the head, and yet the latter does not ache very 26 402 MISCELLANEOUS DISEASES. severely ; the sufferer is unfit for any intellectual work, his eye-sight is dim, hearing dull, and memory more or less impaired. This kind of headache results from continuous mental work, particularly if extended into the night, or in consequence of a severe shock, grief, anxiety, fright, &c, or from excessive evacuations, severe diarrhoea, too liberal bleeding, and sudden fainting fits. Another kind is the chronic headache. The pain is severe with a feeling of pressure in the forehead ; it sometimes ceases for a while, but soon returns again. The cause of this kind of headache lies fre- quently in the brain itself, when it cannot be reached by medicines ; frequently, however, it results from rheumatism, particularly in con- sequence of cold feet. Another kind is the semi-lateral headache, or migraine ; in that case the pain is seated in the forehead, or on one of the sides of the head. The disorder attacks most usually persons in poor health, of weak constitution, or irritable temperament, particularly if they suffer from indigestion or hypochondria ; under these conditions the malady is induced by very unimportant causes. Frequently the disorder as- sumes a periodical character, when the pain becomes seated in a cer- tain part of the head, generally more on its surface ; at times, how- ever, it seems to penetrate deep into the inner parts, when the eye is unable to bear the least ray of light. The violence of the attack fre- quently ceases at a regular time, but returns at a certain hour. This kind of headache is at times connected with throbbing or beating, which is caused by the extraordinary strong pulsation of an artery. All these different kinds of headaches are sometimes connected with nausea, choking, or even with vomiting, caused by the morbid condition of the organs, which prepare the food for the proper nour- ishment of the body. Treatment : If there is no congestion of blood to the head, an emetic has proved of good service in the beginning, and in case of costiveness, aloes and rhubarb may be given as laxatives, particularly if the patient does not suffer from hemorrhoids, in which case extract of rhubarb is preferable. If the m alady is of a rheumatic character, then sudorific remedies, particularly Dover's powders, should be ad- ministered, besides the emetics. Sometimes bleeding may prove very efficacious in such cases. LUMBAGO. 403 In attacks of serai-lateral headache, composing and antispasmodic remedies are applicable, particularly valerian, camphor, musk, hen- bane, hemlock, &c. At the same time poultices of salt water, or a solution of acetate of ammonia, should be applied. In case of heavy congestion of blood to the head, which may be recognized by heat and redness in the face, throbbing pain, burning of the eyes, particu- larly in young, vigorous persons, antispastic remedies are necessary, particularly foot-baths, also washing the head and temples with cold water. Internally, give cooling beverages, cold water, sugar water, lemonade, or water acidulated with cream of tartar. In cases of violent headache, with severe congestion of blood to the head, vene- section and more energetic antispastic remedies are successfully ap- plied, such as mustard plaster on the calves of the legs, a bladder with snow, or pounded ice on the head. Persons liable to this disease should avoid all heating beverages, spiced food, &c. , and confine themselves more to vegetables. In chronic or old cases of headache, local bleeding by means of leeches or cupping has proved very serviceable, and even where an organic defect of the head exists, bleeding has sometimes afforded relief. Where the headache is more of a nervous nature, every ex- citement and exertion of the mind has to be carefully avoided, regu- lar and frequent exercise in the open air should be taken, the neck should be bathed in cold water every morning, and strict diet ob- served. Sometimes a cup of black coffee, or washing the temple with fragrant spirits, the inhalation of certain stimulating ingredients, such as spirits of sal-ammoniac, salts, &c, are beneficial; tincture of va- lerian from ten to twenty drops on sugar, or valerian tea, have been given with excellent success. LUMBAGO. Lumbago results mostly from rheumatic and gouty disorders, in women also, in consequence of irregularity of the sexual organs, par- ticularly suppressed menstruation, whites, &c. With the removal of the cause of the disease itself, such as rheumatism, gout, whites, &c, the result disappears also. 404 MISCELLANEOUS DISEASES. GOUT, PODAGRA, ARTHRITIS. Gout is a disease to which adults are subject. It manifests itself by a peculiar inflammation of the joints, particularly of the feet and hands, and is connected with a deposit of earthy and uric salts ; in most cases it returns regularly and periodically. A severe pain springs up in or around the joint of the large toe ; this part becomes inflamed and swells, which is usually accompanied by feverish attacks. In persons leading an irregular life, who are exposed to frequent colds, and whose vigor has generally decreased, irregular gouty attacks, moving pains, deposits of large quantities of earthy masses around the joints, stiffness, and remarkable disfiguration of the same, occur. Rheumatism differs from gout, particularly by the former appearing in people of every age ; it attacks more the muscles and sinews, is not accompanied by earthy deposits, and terminates differently. Both diseases may combine, however; rheumatism may also change to gout in time. Gout most usually results from a luxurious mode of living, particu- larly from the use of a good deal of wine, and excesses in sexual impulses. It sometimes also results from opposite conditions in people who are exposed to frequent colds, live in damp habitations, and are oppressed by care. If nature cannot furnish a regular outlet to gout, or if the disorder is interfered with in its course, it readily attacks some of the inner organs, particularly the stomach, lungs and brain, frequently with fatal results. Treatment : The patient should lead a moderate and well regulated life ; he must avoid all heating and spirituous beverages, stimulating, indigestible, salted, smoked, or heavily spiced food ; he must keep his bowels regular, which he may effect, if free from an attack, by diligently drinking very fresh well-water. In regular attacks of gout, accompanied by fever, he should wrap up the affected part in warmed woolen wrappers, or in cotton, carded wool, oakum, oiled silk, or in a rabbit or cat's skin, or surround it with a warmed bag of meal. All moist poultices are strictly prohibited, as being injurious to the patient. The same is the case with all irritating, spirituous or cam- phor-containing remedies, as disturbing the regular course of the malady, and throwing it on other organs. The limb should be kept GOUT, PODAGRA, ARTHRITIS. 405 quiet, and in a horizontal position. Cooling and solvent remedies, such as sal-ammoniac, saltpetre, small doses of tartar emetic, &c, are best adapted for internal use ; strong laxatives must never be used. If, from unsuitable treatment, or for other causes, the gout has changed its location to a more vital organ, an effort should be made to recall it to its former place by the application of a mustard plaster, vesica- tory, or embrocation of irritating remedies, for instance, tincture of cantharides. In old cases of gout, administer sudorifics, such as Minderer's spirits (liquid acetate of ammonia) in camomile or elder blossom tea, twenty to thirty drops to the cup, tartar emetic in small doses, and golden sulphuret : take golden sulphuret two grains, sugar of milk one drachm, mix to a powder, which is to be divided into six parts; dose, one powder three times a day. The patient must observe a very strict diet, as has been above indicated, and continue it even after the attack of gout has passed off; he must avoid emotions of the mind, and if his means will permit, visit minernal springs. Ulcers resulting from gout must be treated with the utmost care, as they are frequently outlets for the disease. In rare cases only should an attempt be made to heal them, and not then until a seton has been applied. If the gout is accompanied by inflammatory fever, if the patient is very plethoric, and the attacked part very red and hot, nitre should first be administered. It is prepared in the following manner : refined saltpetre six grains, Glauber salt half an ounce, tartar emetic three grains, well-water eight ounces, raspberry juice one and one-half ounces ; dose, a tablespoonful every three hours. In a few days after that, administer sal-ammoniac : take sal-ammoniac and licorice, four grains of each, dissolve in four ounces of linden flower water, emetic wine three grains ; dose, every three hours one tablespoonful. If the inflammation causes much pain, a few cupping-cups may be applied near the painful part, which will afford relief. Whether under these circumstances the patient should be bled, must be determined by a phy- sician. It is but rarely necessary, and very dangerous, as it may result in dropsy. If there is unquestioned evidence of the presence of gastric impuri- ties, connected with unequivocal efforts by nature to throw it off, either above or below, administer either an emetic, or a purgative, 406 MISCELLANEOUS DISEASES. according to circumstances ; the patient will feel greatly relieved thereby. But where no decided symptoms of the kind prevail, these evacuations should not be attempted, as it may result in very serious consequences, and may even cause a dangerous relapse. In cases of violent pain, without any signs of serious inflammation, and where a rather nervous and spasmodic state exists, prepare a thin ointment from extract of henbane and water, which apply in a lukewarm state. In the evening, administer the following powder : extract of henbane four grains, sugar three grains ; also, two or three grains of Dovers powder, with an equal quantity of sugar, should be taken. If the fever ceases, and the local difficulties, particularly the pain, remain unchanged, then nature has not sufficient strength to excrete entirely the morbid matter. In such a case, give guiac : take guiac and gum arabic, six grains of each, distilled water six ounces, salt- petre three grains, emetic wine three grains, almond syrup one ounce ; dose, one tablespoon ful every three hours, which will effect two soft evacuations daily. In old cases of gout, give from twenty to forty drops of succinate of hartshorn in a cupful of linden blossom tea. If these remedies have no effect, a physician should be consulted. In case the gout has been driven in suddenly, very dangerous internal inflamma- tions, with violent fever, may result from it. Under such circum- stances, the chief object should be to draw the gout to the surface again. In case of violent fever and inflammation, the patient should be bled at once, and antiphlogistic remedies administered. To the place from which the gout disappeared, a mustard plaster should be applied, and to the place attacked, a Spanish fly plaster ; when the violence of the fever has subsided, administer internally camphor, prepared in the following manner : camphor four grains, saltpetre four grains, sugar six grains, divide into six powders ; dose, one pow- der every three hours. RICKETS. This malady usually manifests itself when scrofula attacks the bones. The first symptom of it appears in children, when backward in learning to stand and walk, in distension of the bones at the joints, particularly at the wrist; in the progress of the disease, follows curvature of the bones, particularly of the shin-bone, breast- PARALYSIS. 407 bone, ribs (hence asthma), of the spine, distension and deformity of the bones, frequently of the whole body, particularly of the pelvis, and for that reason a lame, waddling gait; children thus afflicted are usually precocious, and possess mental ability. The disease dis- appears frequently with the development and growth of the body. In the advanced stages, curvature of the spine, feet, breast-bone, and ribs, and sometimes general deformity remains through life. The cure of rickets is the same as that of scrofula, particularly as far as diet is concerned. Aside of that, malt and salt baths, to which sweet flag has bren added, and washing of the back and limbs with whisky, and also with formic spirits, is beneficial. Internally admin- ister iron, prepared as follows : powdered iron four grains, cassia four grains, prepared oyster shells four grains, sugar one grain ; dose, morning and evening one-half of the powder. Tincture of malate of iron may be administered ; dose, from ten to twenty drops twice a day. If the child is costive, add one decigramme of rhubarb to the powder. Cod liver oil is a.so very beneficial; dose, a teaspoonful morning and evening. PARALYSIS. Paralysis is a considerable impairment or total cessation of motion, and also sometimes of sensation. The paralysis is either general, when it affects every part of the body, or partial, when it affects only single limbs or organs. If motion only is interfered with, it is called an incomplete paralysis, but if at the same time sensation also has ceased, it is called complete. Paralysis sometimes occurs suddenly, for instance in cases of apoplexy, and again it comes gradually when the attack is preceded by weakness, a feeling of chilliness and crawl- ing over the limbs (as if ants were running over the skin), convul- sions, cramps, &c. The paralyzed parts feel unbent, languid, and cold, and become emaciated ; or a watery swelling, and even gan- grene appears, the pulse is small, soft, feeble, and intermittent. The predisposition must partly be looked for in the condition of the nervous system of the person ; but, aside of the causes hereafter to be adduced, it may be caused by polychsemia, omission of customary venesection, suppression of regular hemorrhages, cuttings, and exsec- 408 MISCELLANEOUS DISEASES. tions, amputation of the larger limbs, advanced age, and gradually growing pseudoplasms in the brain. The paralysis is readily recog- nized if it has its seat in external parts, but more difficult if it has attacked inner organs, where its existence can be inferred only by the inability of these organs to perform their functions properly, such for instance as involuntary discharge of the bowels and urine, which would indicate a paralysis of the rectum and the bladder. The duration of paralysis differs very materially, it belongs to the class of wearisome diseases. A complete paralysis is rarely curable. Causes inducing paralysis are injuries to the brain and spinal cord, external injuries, and internal diseases, emotions, severe fright, anger, serious attacks of spasms-, immoderate eating and drinking, the use of poisonous substances, inhalation of pernicious gas, great heat or cold, sun-stroke, concussion of, and extravasation of, blood into the brain, &c. The treatment, which should always be attended to by a physician, requires internal and external remedies. To the former class belong strongly stimulating and neurotic remedies, such as Hoffmann's liquor, tincture of valerian, camphor, musk. The external remedies should be applied directly to the suffering organ ; among them are aromatic and spirituous embrocations, such as alcohol, naphtha, spirits of camphor, Hoffmann's balsam of life, spirit of caustic sal-ammo- niac, and tincture of cantharides ; also rubbing and brushing of the attacked parts, dry cupping, and the application of Spanish flies and mustard plasters to the lamed part. If the paralysis is the result of plethora, or of suppression of accustomed depletion, then venesec- tion or leeches are indispensable. In case of paralysis of the eyelids, apply embrocations of volatile remedies to the eyebrows, and Spanish flies ; if the facial muscles are attacked, in which case half the face and the mouth are distorted, the application of a mustard plaster on the cheek of the lamed part is very good. In case of deafness caused by paralysis of the auditory nerves, place a few grains of ambergis in each ear. The introduction into the ear, morning and evening, of a few drops of the following compound may have a beneficial result ; camphor liniment and distilled water, two drachms of each, spirit of ammonia ten drops. APOPLEXY — SEROUS APOPLEXY. 409 In case of paralysis of the bladder, either the neck or the body of the same is the affected part. If the former, the urine passes off continuously and involuntarily in drops, if the latter, it is retained ; both cause much trouble. If the neck of the bladder is affected, em- brocations of strong ointments are to be applied, for which purpose mix together nervine ointment one ounce, tincture of cantharides two scruples, camphor one scruple ; one and one-half teaspoonsful of this mixture to be rubbed in every three or four hours. Another : Balsam of life and spirits of camphor one ounce of each, spirits of caustic sal-ammoniac three drachms, Venetian soap one drachm ; rub in twice a day. In case of retention of the urine in the bladder, the catheter must be inserted as often as it has accumulated, which is usually very easily performed, and which the patient himself may very soon learn how to do Local baths may result beneficially ; for instance, mustard or horseradish baths, formate baths, and douche baths. APOPLEXY. Apoplexy is the condition when consciousness suddenly disappears, and voluntary motion and feeling ceases, while the beating of the heart, pulse, and animal heat continue, breathing is increased, and becomes snoring and rattling. This condition may appear to an intense or lower degree, according as the activity of the brain and nerves may be more or less suppressed, for this suppression is the cause of apoplexy. It is usually assumed that three different kinds of apo- plexy exist, conditioned by the cause that has induced the attack. They are called: r, Serous apoplexy; 2, Ictus sanguinis (apoplexy), and 3, nervous apoplexia. SEROUS APOPLEXY. Serous apoplexy is the exudation of a watery liquid in the brain, creating a pressure which incapacitates it from performing its func- tions. This kind of apoplexy properly belongs to hydrocephalus (^see " Hydrocephalus "). 410 MISCELLANEOUS DISEASES. ICTUS SANGUINIS. Ictus sanguinis consists in a surcharge of the brain with blood, which disturbs its efficiency and functions. The attack is usually pre- ceded by congestion of blood to the head (see the article), heaviness in the head, pressure on the cervical vessels by the ossification of some of the blood vessels, which manifests itself in old age if neckties have been worn too tight, dizziness, buzzing in the ears, blackness before the eyes, dull headache, costiveness, restless sleep, obtuseness of intel- lectual powers, red, bloated face, &c. It begins with extreme dizzi- ness, darkness before the eyes, oppression of the chest, heaviness of the tongue, indistinctness of speech, the patient loses his senses, he falls down, the tace is of a bluish-red hue and bloated, the eyes are fixed, the arteries pulsate strongly, sometimes the lips are covered with foam and the pulse is full and strong. An attack of this kind may result fatally in a few minutes, or after some time, or it may be repeated several times and disappear again ; it may result in a paraly- sis of certain parts, or the patient may entirely recover. The treatment of apoplexy must be confided to a skilful physician ; the following general rules should be observed, however: All tight- fitting garments, such as necktie, collar, garters, pantaloons, &c, should be loosened at once ; the body should be raised to a sitting rather than a lying down position, and the patient should be bled on the side not paralyzed, cupping-cups should be applied to the back of the head, and leeches on each side of the face and the throat. Stim- ulating injections, consisting of soap, cooking salt, Glauber salt, ep- som salt and vinegar, should be administered. Give warm foot and hand baths, rub the feet with warm flannel, apply mustard plasters to the thighs, and cold water poultices to the head. Internally, adminis- ter cool accidulated drinks. The physician will prescribe further. NERVOUS APOPLEXIA. Nervous apoplexia occurs in much rarer instances than ictus san- guinis. It is the result of entirely different causes. The action of the nerves becomes suddenly paralyzed, and manifests itself usually in connection with disease of the nerves, particularly in weak, excitable persons. SOFTENING OF THE BRAIN. 411 The attack very frequently occurs without any premonitions ; the patient becomes unconscious at once, and falls down ; all voluntary motions cease, and in their place appear convulsive motions of the face, distortions, cramps, trembling, immobility of the eyes, general pallor, and coldness of the skin; the pulse is small and contracted. An attack of this kind is usually immediately fatal ; sometimes, how- ever, it changes into wearisome convulsive diseases and paralysis. The causes of nervous apoplexia are usually a feeble, irritable consti- tution, weakly built body, past, or still existing, nervous diseases, violent emotions, severe hemorrhages, and exhaustion of every kind. Medical treatment of this disease differs from that of ictus sanguinis. Bleeding is not at all applicable ; the patient must be treated with stimulating remedies. Emetics, if they can be taken, prove some- times useful. Strong revulsives should be applied to the head, neck, and spine, for which purpose use horseradish or mustard plaster; the cardiac region and temples of the patient should be bathed with volatile, stimulating substances, for instance, vinegar, naphtha; or Hoffmann's liquor should be introduced in his mouth; hold to his nostrils volatile salts, ammonia, vinegar, &c; rub the body with flannel, and also brush it. Internally- administer nervines, such as castor, ammonia, musk, &c, which the physician, who is called in, will prescribe, according to circumstances. SOFTENING OF THE BRAIN. This disease usually attacks people of advanced age. It manifests itself by a peculiar feeling, as if ants were creeping in the limbs, in- security of motions, but more particularly by a steady decrease of mental vigor, and loss of memory. The latter applies at first to single points, for instance, names and places, subsequently by an in- creasing change in the mode of expression, so that unknowingly, and unintentionally, thoughts are expressed by different words than cus- tomary. Suddenly the patient breaks down, as if in a fit of apoplexy. If death does not occur, paralysis of single organs, senses, or the mind, remains. Although this condition is mitigated in course of time, yet it never disappears again. Under renewed attacks of apoplectic fits, which may occur, however, at intervals of months, 412 MISCELLANEOUS DISEASES. intellectual and physical decay progresses, and finally the scene is closed with complete imbecility of mind. The disease, as before stated, is more a weakness of old age. It is best prevented by nourishing food and abstinence from heavy wines and spirituous drinks, by living in a wholesome, fresh atmosphere, and avoiding excessive mental efforts and excitements. The attack itself should receive immediate medical attention. VERTIGO. By vertigo is understood a feeling of apparent motion of one's own body and external objects. The following are the various kinds of vertigo : Vertigo from Congestion of Blood. — Its causes are suppressed menstruation, hemorrhoids, and other hemorrhages, too long sleep, heating beverages, such as wine, coffee, strong beer, coal gas, cal- careous evaporations, overpowering scents, and poisons, violent sneezing, and pregnancy. If the inflammatory vertigo is transient, it needs nothing but an antiphlogistic diet, as before mentioned ; should it continue, however, antiphlogistic treatment must "be combined with it, which consists in bathing the head with cold water, mustard foot-baths, and bleeding. It is preferable to draw the blood from the arm, and not from the foot, and repeated bleeding is better than drawing a large quantity at one time. Sometimes the patient does not seem at all plethoric, as is frequently the case with delicately built pregnant women ; strengthen- ing remedies are injurious to them, but bleeding soon restores them. Leeches should be applied to the head, but in case of hemorrhoids, to the anus, and with suppressed menstruation, to the ankles ; luke- warm foot-baths should be taken. Internally take refined saltpetre eight grains, barley sugar sixteen grains, milk of almonds one pint ; dose, a tablespoonful every three hours ; mild laxatives should also be administered, particularly bitter water ; or take pulp of tamarinds and manna, one-half ounce of each, Glauber salts ten grains, boil in fourteen ounces of water until evaporated to ten ounces, strain, and add one ounce of raspberry juice ; dose, every two hours two table- spoonsful, until it has sufficiently operated. Or take cream of tartar one ounce, boil in one quart of water until the powder is dissolved ; when VERTIGO. 413 cool, add one sliced lemon, sweeten with a sufficient quantity of sugar, and use at pleasure. With old, plethoric people, inclined to gout, nothing works so well as does the following powder : gum guiac three decigrammes, cream of tartar and sugar, two grains of each ; dose, one powder on going to bed, which is to be continued for some days. Rheumatic Vertigo occurs in sudden changes of weather ; it is preceded by pains in the limbs, catarrhal difficulties, catarrh, &c. In this case also treat with antiphlogistic remedies, as above, but apply a Spanish fly plaster to the neck, and administer the following sudorific : nitre six grains, liquid acetate of sal-ammoniac one ounce, elder blossom water and distilled water, four ounces of each, sugar one ounce ; dose, two tablespoonsful every three hours. If the vertigo continues, give the remedy previously described : gum guiac two grains, cream of tartar and sugar, two grains of each ; dose, one powder at night when going to bed, which is to be continued for a few days. The same powder is also administered to plethoric, gouty people, who are troubled with vertigo. But if they are not of a vigorous constitution, administer the following artificial milk : gum guiac three grains, the yolk of an egg, water two ounces, syrup half an ounce ; dose, one tablespoonful three or four times a day. Woolen socks and oil-cloth socks are indispensable ; frequently setons on the neck and issues on the arm are quite necessary. Bald-headed people must wear a wig. Vertigo, the Result of Impurities, or Diseases of the Abdo- men, and particularly of the Liver. — Rarely or never is an emetic to be given in an attack. Administer vinegar injections, prepared in the following manner : take two cupsful of a decoction of oatmeal or bran, oxymel two tablespoonsful ; acidulated drinks, warm poultices on the abdomen, and rest, are the best means for the removal of the attack. If flatulence is present, give to a robust individual the follow- ing powder : carbonate of magnesia, sulphate of potassa, rhubarb, valerian root, fennel seed, eight grains of each, reduce to powder ; dose, a teaspoonful every three hours. To irritable persons of nervous debility, give the following pills : extract of aloes, improved with sulphuric acid, four grains, marshmallow root six grains, make into fifty pills; dose, one or two pills at noon. 414 MISCELLANEOUS DISEASES. Vertigo from a Weak Stomach is removed by white pepper- corns (eight or ten to a dose) ; it should be taken before breakfast. To produce a proper result, eat your regular meals morning and noon, but only very moderately in the evening. With old people, who are not plethoric, chocolate, wine-soup, flavored with mace, cloves, or saffron, agrees very well, also preserved nuts, nutmegs, or ginger. Frequently vertigo is produced by accumulations in the abdomen, which must be removed by clysters for the bowels : take dandelion root, soapwort, mullein flowers, and camomile flowers, equal parts of each ; for every injection take half an ounce, and boil with a handful of wheat -bran. . Nervous or Hysterical, and Hypochondriacal Vertigo. — The looks of the patient are frequently fearful ; it is the result of exhaus- tion and emotions of the mind. Vertigo in this case follows even a moderate movement of the bowels, which is usually beneficial in such cases. The urine is watery, and the attack is accompanied by tasteless eructations. Derangement of menstruation is not rare in these cases. The treatment recommended in nervous headaches is here also applicable. For a wash, take compound lavender water, and bathe the head with it three times a day ; or take equal parts of camphor and spirits of hartshorn, and rub the head with it twice a day. Apply to the temple a mixture of two parts of gum galbanum plaster, and one part of Spanish fly, spread on leather. Internally administer valerian tea with Hoffmann's anodyne, or oil of cajeput, three or four drops on sugar. The mustard cure, which is recommended in such cases — three to four grains of mustard seed swallowed several times a day, — has had a bad effect on digestion. The following drops are recommended : tincture of Canadian castor, spirits of hartshorn, four grains of each, sulphuric ether two grains ; dose, fifteen drops on sugar, once or twice a day. SYNCOPE-FAINTING FITS. Syncope resembles apoplexy ; the patient loses consciousness, sensa- tion, and power of motion; it differs from apoplexy only in so far that breathing and pulsation are nearly or entirely suspended. This SYNCOPE FAINTING FITS. 415 condition is usually only transitory, but there are cases where it has continued for several hours, and even days. In weak-nerved, hysteri- cal women, who are inclined to syncope above all others, this condi- tion is not very serious, even if it lasts for a long time, and does change into asphyxia. In plethoric persons it is of greater signifi- cance, because the syncope may end in apoplexy. It is most dan- gerous in the beginning, or during the progress of fever ; it is always a bad symptom under such circumstances. In lighter attacks of syncope, the patient only becomes dizzy and semi-unconscious ; all objects seem to him to be covered with black crape ; he does not clearly hear what is said ; consciousness is only clouded, but not en- tirely obliterated. In more severe cases the patient turns pale, the nose is pointed, a general coldness spreads over the body, usually accompanied by a cold sweat ; the senses, together with consciousness, are in a state of suspense, and the patient falls down ; the pulse is trembling, and scarcely perceptible ; breathing is almost entirely sup- pressed, and scarcely perceptible ; in an extreme state of syncope, the patient resembles a corpse. Syncope results from three different causes. It proceeds from the nervous system through violent emotions, fright, joy, nervous fevers, but more particularly through hysterics ; also from vitiated air, over- powering scents, in hysterical persons, from the sweet scent of flowers, stupefying poisons, and worms, or by a rush of blood to the heart; therefore, through plethora in youth, by violent movements in consequence of suppressed or approaching hemorrhages, from tight lacing, and in consequence of heart disease, and finally from weak- ness, fasting, severe physical exertions, loss of blood, exhausting evacu- ations, for instance, violent diarrhoea, and in parancentisis of water in dropsy, if done without intermission. The remedies to recall a person from a fainting fit, differ with the causes that have produced it. The only general and harmless remedy is sprinkling with cold water. Every tight-fitting garment must be loosened, and cool, fresh air should be admitted ; in hysterical syn- cope, burnt feathers, sliced onions, and strong vinegar, should be held under the nose ; the cardiac region, face, and temples, should be bathed with vinegar, or with wine, cologne water, or lavender, and injections of valerian, or of milk, water, and soap, should be adminis- 416 MISCELLANEOUS DISEASES. tered. Under all circumstances, noisy proceedings should be pre- vented. This kind of syncope is sometimes considered soothing to the excited nervous system. If not interrupted, the patient usually awakens more vigorous, in better spirits, and stronger. If interrupted too soon, the result is usually entirely different ; heaviness, debility, and depression remain just the same as if suddenly awakened from sleep ; but this also has its limits. In cases of syncope from weakness and exhaustion, the patient should be placed on a level. A small bottle of spirits of sal-ammo- niac should be held under the nose of the patient, and in other respects he is treated as in hysterical syncope. As soon as he is able- to swallow, a little wine should be administered. In syncope caused by congestion, the feet of the patient should be permitted to hang down, but the head and chest should be raised ; cold air, sprinkling with cold water (but under no circumstances smelling salts, and bathing with scented spirits, &c), lukewarm foot and arm-baths, cold injections of vinegar and water, and if the faint- ing fit still continues, bleeding must be resorted to. When recalled to consciousness, cooling drinks may be administered. REMEDIES. Remedies are the means and preparations applied in recalling per- sons from syncope or asphyxia, or other conditions whereby life is en- dangered. They may be divided into external and internal remedies, of which the former deserve here our particular attention. I will, in the first place, enumerate some of these remedies in general, and then give the various occasions on which they may find application. Rubbing — Brushing. — The object of this operation is to promote the circulation of the blood in the body. For this purpose, woolen or warmed cloths, or where these can not be had, flax, oakum, hay, straw, old garments, or even the naked hands, may be used. To pro- duce a stronger effect, particularly in parts which are covered with a hard skin, for instance the soles of the feet, it is done by means of brushes. To increase the effect of the rubbing, the material em- ployed for that purpose may be sprinkled with vivifying remedies, for REMEDIES. 417 instance, spirits of camphor, camphorated vinegar, cologne water, wine, &c. The whole body is subjected to this friction, or it is limited to single parts, such as the chest, cardiac region, soles of the feet, &c. ; begin the rubbing gently, and increase by degrees. Warmth. — The restoration of warmth to the body, which seems to have entirely disappeared in some cases, is of importance. Its appli- cation must never be made in a very high degree at once, but only gradually. The most convenient way of effecting it is by baths, among which may be enumerated earth, sand, and ash baths, the tem- perature of which must vary according to circumstances. Aside of that, warming pans, warm stones, bricks, and cloths, are used. Rubefacient Remedies. — They are intended to create activity of the skin and excite circulation of the blood, particularly of the super- ficial parts. Among these may be enumerated Spanish flies, mustard, horseradish, onions, and brushing. Bleeding. — Bleeding belongs to the most important remedies, par- ticularly in a case of surcharge of the blood vessels, in apoplexy, for instance. The venesection is usually performed on the arm. Insufflation of Air through the Mouth or Nose. — The first is done by causing a healthy person to blow air into the mouth, at the same time pressing together the nostrils of the inanimate person. This can be done from mouth to mouth, or by means of the tube of a pair of bellows, which is surrounded with moist cloth or bladder ; in the latter case, the lips must be closely pressed to the tube. Should the mouth be tightly closed, an attempt must be made to blow air through a tube into one of the nostrils, while the other nostril is kept tightly closed by an assistant. If the chest or abdomen begins to raise, discontinue the insufflation, and rub the breast gently from the short ribs upward. Particularly effective are injections of tobacco and vinegar. For the former, an infusion, or the steam of tobacco, is used, for which purpose particular contrivances have been con- structed; if necessary, information can be obtained on the subject (see "Syringes"). Remedies causing Vomiting. — To administer emetics to an appar- ently dead body, would not only be difficult, but also frequently con- 27 * 418 MISCELLANEOUS DISEASES. nected with danger. An attempt should be made to cause vomiting by tickling the gullet with a feather, or a fine hair-pencil, or try to infuse lukewarm water, a little soap water, milk, beer, with oil or butter, &c, and cause vomiting in that way. Sternutatories. — They are applied for the purpose of reanimation, and also particularly to excite the olfactory nerves, which are closely connected with the brain. For this purpose, spirits of hartshorn and spirits of camphor are used, or onions, grated horseradish, fresh ground black mustard, wine vinegar, are held to the nostrils, or white hellebor, powdered sweet marjoram, small houseleek. &c, are blown through a quill into the nose, or the nostrils may be tickled with a feather or fine hair-pencil. Among the remedies must also be enumerated, the sprinkling of cold water or vinegar into the face and the cardiac region. To revive the senses, drop ether, Hoffmann's anodyne, or warm vinegar, on the tongue. Galvanism and Electricity should also be mentioned among the remedies, which, under circumstances may serve excellently well, but an expert is required to apply them. In the application of remedies, it is particularly important to remove as quickly as possible the pernicious influences that may still continue. Assistance should be given as quickly as possible, but calmly, and with presence of mind. A certain order should be observed in the application of the necessary remedies, particularly in regard to stimulating remedies ; begin with the weak remedies, and gradually pass to the stronger. We will now proceed to the consideration of accidents. DROWNING. Even if a drowned person has all the appearance of being dead, yet attempts should be made for his restoration. The body should be taken from the water as quickly and carefully as possible, and divested of his clothing. His face, mouth, nose, and throat should be cleaned of slime, dirt, &c, and he should be stretched out upon a suitable couch. The custom, still prevailing in some places, to stand the body on its head, should be abolished ; in many cases where there was still a spark of life remaining, death was the result of the performance. DEATH BY FREEZING. 419 The upper part of the body should be somewhat raised, the head turned a little on one side, so that the water, which may stiil remain in the mouth or throat, may run out. The room to which the body is removed, must be free and airy, but no draught must be permitted. The body should then be wrapped in blankets, and rubbed and brushed, particularly the chest, arms, legs, and especially the soles of the feet. Or, if circumstances permit, the body may be placed in a lukewarm bath, where the operations for its reanimation may be con- tinued. Subsequently it must be most carefully dried and warmed in the manner already indicated. If, from existing indications, it may become apparent that apoplexy has occurred, bleeding, stimulating foot-baths and injections should be applied. Insufflation of air must not be omitted, neither must embrocations with spirits, smelling of spirits of sal-ammoniac, tickling of the gullet to produce vomiting, be neglected. If during these attempts a quivering motion in the face or limbs is noticed, or a trembling of the lips, a heaving of, or sound in, the chest, rolling in the bowels, or if the eyes should open, they must be considered very favorable symptoms. Efforts at revivification must not cease, however, until life is fully restored, breathing has set in regularly, the pulse is distinctly felt, and natural warmth and motion are perceptible. After the application of some remedies, the reani- mated patient usually falls into a quiet slumber, with gentle perspira- tion, which is the surest sign of an early restoration. In winter, when persons break through the ice, and are seemingly drownded, they should be treated as if they had been frozen. DEATH BY FREEZING. If in the frozen person the cold has reached a certain degree, the necessary vital heat is thereby withdrawn from the body to total exhaustion, the head is dizzy, the senses dull, circulation of the blood is checked, and finally ceases altogether, the person sinks into a deep sleep, syncope, and if not soon aroused from this condition, death occurs from apoplexy. In reviving frozen persons, care should always be taken not to bring them immediatedly into a warm room. This would result in death without fail, when otherwise they might be recalled to life with a moderate effort. 420 MISCELLANEOUS DISEASES. The following is the treatment to be applied : The stiff body is taken into a cold room, undressed, and covered with snow, which must be lightly pressed to the body. In case the snow melts, it should be renewed ; the mouth and nostrils only should be kept free from snow. The body remains under this snow cover until symptoms of returning animation manifest themselves. If there is no snow at hand, dip large bed covers, &c, in ice-cold water, and wrap the body in them, and if these also cannot be had, place the body carefully in a trough of ice-cold water. If the frozen body thaws out in this, an ice-crust must form around him, and if that melts again, the body must be taken out, and rubbed for some time with snow or ice-cold water. This should be done with the utmost caution, as smaller parts, such as fingers, the tip of the nose, &c. , may be easily broken off; subse- quently add a little whisky or wine to the water. If warmth and limberness of the limbs are noticed, the patient is dried off with warmed cloths, and placed in a moderately warm bed, but under no circumstances in a heated room. The necessary restorative remedies must also be applied in this case. If the patient is able to swallow, administer a few cupsful of tea, made of lemon balm or peppermint, with orange peel, but never wine or whisky at first. In case some parts of the body should still remain frozen, an effort must be made to restore them entirely by rubbing them with snow, or by dipping them in ice-cold water. DEATH BY STRANGULATION, SUFFOCATION, AND CHOKING. There are people, who in a fit of desperation or insanity, commit suicide by hanging, or the act may have been committed by the hands of some wicked men. If a body is found in that condition, it should be cut down at once. In doing so, however, the greatest caution should be observed, so that the unhappy individual may not get injured. The noose should then be removed from the neck at once. The body is taken to a cool place, best out of doors, and placed in a half-reclining position. All tight-fitting garments must be loosened, and blood drawn from the arm, foot, or jugular vein, and cupping-cups applied to the neck ; cold water is sprinkled in the NOXIOUS VAPORS, ETC. 421 face and to restor breath, throat and breast are rubbed, and air in. sufflated. If the object is not attained by these means, stronger stim ulating remedies tsum be applied. Place the body in a warm bath, and at the same time apply cold poultices to the head, brush hands and feet, and apply stimulating injections. If the unfortunate indi- vidual begins to swallow again, give him warm camomile or lemon balm tea, with a little wine or vinegar, and in case of continuous congestion of blood to the head, apply cold water and vinegar to it. The place around the neck filled with blood under the skin, should be fomented with a decoction of camomile flowers in vinegar, and the addition of a little sal-ammoniac. NOXIOUS VAPORS, FOUL AIR AND DELETERIOUS GASES. There are various vapors and gases, which cause stupor in a person who is exposed to them for any length of time, and either produce asphyxia or death. These noxious vapors and foul air partly lack the oxygen necessary for respiration, and partly possess poisonous qualities affecting the lungs directly, causing suffocation or an accumu- lation of blood in the lungs, and therefore apoplexy of the lungs. The usual symptoms accompanying it are a feeling of constriction around the chest, tension in the head, dull pain in the forehead, a feeling of fear, uneasiness, cough, inclination to vomiting, drowsiness, dizzi- ness, trembling, syncope, frequently involuntary evacuations in the position where the unfortunate individual was exposed to the effect, small, intermittent pulse, &c. Face and lips are brown and blue, the veins in them swollen, eyes protruding, the abdomen bloated, and unconsciousness, insensibility, deliriousness, convulsions, &c, mani- fest themselves. The gases which may not be inhaled are : i. Coal Vapor. — It arises from the glimmering embers of wood, turf, or hard coal, particularly in closed rooms ; for that reason the great drawback in fire pans and the imprudent and hasty closing of dampers in stoves. 422 MISCELLANEOUS DISEASES. 2. Fire Damp. — It develops itself particularly in places where atmospheric air cannot penetrate, and for that reason in caverns, mines, holes, cellars, where beer and other liquids are fermenting. 3. Sulphuretted Hydrogen. — It develops in canals and in deep, miry ditches. It is found in very small quantities in sulphur springs, where it operates beneficially in pulmonary diseases ; if inhaled, it is fatal. 4. Nitrogen Gas forms particularly where many people or animals occupy a small room, also by exhalations in sick rooms, in tombs, by smoky candles, strongly scented flowers, &c. The first and most important thing to be done is to remove as quickly as possi- ble a person confined in this noxious atmosphere, into the open air, which, together with sprinkling of cold water or vinegar, or the inhal- ation of spirits of sal-ammoniac, and loosening the tight parts of the clothing, is usually sufficient to recall him to consciousness, if he has fainted only. Where the party is affected to a more serious degree by noxious vapors, he must be carried into an airy room, denuded of his clothing, and laid down on the floor with the head elevated. If symp- toms of apoplexy manifest themselves, general and local bleeding is ne- cessary, and frequently to a large extent. Cold poultices should be ap- plied to the head, and stimulating injections, brushing of the soles of the feet, mustard plasters and Spanish flies to the gastric region, &c. The face should be constantly sprinkled with cold water, or it should per- haps be poured over the whole body ; place spirits of sal-ammoniac in the nostrils, and blow strong snuff or sternutatories into them. Emet- ics and injections of tobacco would be in their place here. To restore respiration, insufflation must be resorted to, for which purpose other gases, particularly oxygen, may be administered, in order to counteract chemically the noxious effects of the previously inhaled air. To persons under the effects of fire damp, sal-ammoniac is applied, which is poured on pieces of cloth and placed on the mouth, or spirits of sal-ammoniac is poured into hot water, and the vapor permitted to descend the throat of the affected party. To counteract the effects of mineral and metallic poisons, to an attack of which miners are frequently exposed, tepid, moist inhala- tions should be applied, and if able to swallow, oily liquids should be STRUCK BY LIGHTNING — STARVATION. 423 administered. If these remedies have remained without success, the previously mentioned stronger restoratives should be resorted to. STRUCK BY LIGHTNING. Lightning does not always kill, but frequently only injures to a greater or less degree, and sometimes only produces a stupe- fying effect. The person struck by lightning must be quickly removed from the place filled with sulphurous vapors, into a pure atmosphere, undressed, and cold water poured on him. Sprinkle vinegar in the face, apply cold poultices to the head, and drop stimu- lating remedies on the cardiac region, hold a bottle of spirits of sal- ammoniac under the nose, and endeavor to restore respiration by the means heretofore pointed out. If the face is bloated, dark-red, or brown, or if symptoms of apoplexy are noticed, bleeding must be resorted to. Injections of cold water or vinegar are also applicable. Electricity and the earth-bath are highly recommended. In the application of the latter, the naked body is placed with the head elevated, in a ditch about two feet deep, and covered with earth to the depth of four or five inches ; of course, the face must remain un- covered. To avoid the danger of being struck by lightning, shun places where many people or animals are congregated, draughts of air, the proximity of windows and chimneys, high towers and build- ings, trees, the neighborhood of water, &c, and keep the middle of large rooms, if possible ; if outside of buildings, avoid booming heated by running, the protection of high superstructures or walls ; do not lie down in gullies, or stand under trees ; the neighborhood of hay-stalks and granaries is also dangerous. Horsemen, overtaken by a thunderstorm, should dismount and keep away from the horse. People restored to life from a stroke of lightning, will suffer from nervous affections, which must be treated according to science. STARVATION. Cases of starvation resulting from certain diseases, such as con- traction or coalescence of the oesophagus, &c, cannot be considered here. We can only speak here of cases where people, either volun- 424 MISCELLANEOUS DISEASES. tarily or involuntarily, have been deprived of all nourishment, either fluid or solid. How long a man may go without food, cannot be stated with certainty. In rare cases only, however, can the time exceed six or nine days, although very much depends on the age, constitution and disposition of the individual. The consequences of starvation are prostration and emaciation, solution of the humors, fetid breath, violent pain in the stomach and abdomen, nausea, vomiting, excite- ment of the nervous system, cramps, convulsions, insanity, loss of mind, and finally death. If any hope remains to save the person, the first point to be attended to is to preserve his remaining vital power, and with the observation of the greatest caution to strengthen the body by first administering easily digested, but nourishing food. For that purpose commence with small quantities of liquid food, such as milk, a de- coction of salep, &c; administer a little cassia water, aromatic tea, and gradually progress to more solid and stronger food. POISONING. Poisons are called substances which, administered to the human body, even in very small quantities, operate destructively. I will here only speak of the antidotes necessary to remove the effect of the poison. The remedies to counteract poisons that have been taken, are called counter-poisons. The poisons to be considered here, are found in the vegetable, mineral, or animal kingdom. Vegetable poison! have a stupefying, and mineral poisons a corrosive, effect on the body, while animal poisons become effective only when introduced into the circulation of the blood by a wound in the body. The symptoms produced, when poisons are introduced into the human system, reveal their character. It is therefore of the highest im- portance that the party aiding to save the poisoned individual, should closely observe these symptoms, in order to apply the proper anti- dotes. We will first speak of vegetable, then of mineral, and finally of animal poisons. VEGETABLE POISONS. 425 VEGETABLE POISONS. OPIUM. Opium, taken in small quantities, causes excitement, a kind of in- toxication ; it accelerates the circulation ot the blood, causes perspi- ration, with an itching of the skin, &c. Taken in large doses, it produces a deep sleep, usually, however, only after three-quarters of an hour, or an hour, lethargy, and an accumulation of blood in the brain to such an extent as to produce apoplexy. Antidotes : After emptying the stomach by the aid of emetics, water, with vegetable acids, should be given as a drink, also strong black coffee, with vinegar or lemon juice, vinegar injections, and strong foot-baths ; spirit of sal-ammoniac should be held under the nostrils. HEML OCK LEA VES. The application of this poison causes dizziness, dryness of the throat, and thirst, heaviness and stiffness of the tongue, a feeling of constriction in the throat, weakness and heaviness of the limbs, slow pulse, bluish color of the skin, periodical blindness, deliriousness, fear, spasms of the stomach, and vomiting. Vegetable acids should be administered, as in poisoning with opium. HENBANE. Henbane produces nearly the same effect, with this difference, how- ever, that the spasms increase to tetanus ; sometimes it is accompanied by madness and frenzy. Antidotes : Emetics and purgatives, vinegar, oil, and the remedies previously mentioned. DEADL Y NIGHTSHADE— BELLADONNA, Creates violent thirst, scratching and constriction in the throat, burning in the stomach, spasms of the stomach, nausea, and vomiting, irregu- lar eyesight, sparks and glittering before the eyes, dilatation of the pupils, and even total blindness, buzzing in the ears, heaviness of the head, staggering, dimness, loss of consciousness, deliriousness, and even frenzy. 426 MISCELLANEOUS DISEASES. Antidotes: Emetics, copious drinking of milk, subsequently vin egar, vinegar injections, purgatives, cold water, black coffee, &c. STRAMONIUM LEA VES AND SEED. The effect of stramonium resembles that of belladonna, and requires the same antidotes. PRUSSIC ACID-HYDROCYANIC ACID. Prussic acid is one of the strongest vegetable poisons, and kills in- stantaneously, if taken in a larger dose. In small doses it causes rapid relaxation and weakness of the joints, particularly of the thighs, frequent yawning, shuddering, with membrane spasms, insuperable sleepiness, or general restlessness, violent excitement, dizziness, oppression in the head, contortion of the eyes, pain in the stomach, heat and burning in the stomach, fear and oppression, convulsive motions, general paleness, bordering on the blue, decrease of vital heat, pliancy and flexibility of the limbs, &c. Ammonia is the safest and almost only antidote. Administer spirits of caustic sal-ammoniac, properly diluted, up to twenty drops ; strong coffee, camphor, and the free use of cold water, are also recom- mended. ERGOT. Ergot (a morbid excrescence in grain) becomes sometimes mixed up with flour, and is baked into bread. It produces a peculiar kind of poisoning, known as convulsio cerealis. In larger doses it creates formication, a troublesome feeling in the feet, as if ants were run- ning over the flesh. This is followed by spasm of the stomach, the fingers are contracted to such an extent as to be scarcely able to straighten them out again, even with the greatest force, and the joints have the appearance as if sprained. The patients cry out aloud, have violent burning in hands and feet, and the whole body is in a profuse perspiration. This is followed by dizziness, hallucina- tion, convulsive motions, and the patient dies in epileptic fits. The treatment against these attacks consists in the administration of power- ful emetics and purgatives, calomel, with rhubarb and jalap, a strong infusion of senna, with rhubarb and Glauber salt. For the nervous MINERAL POISONS. 427 attacks, administer valerian, camphor, leopardsbane, assafcetida, essence of castor, bistort root, &c. The effect of these remedies is aided by the embrocation and bathing of the spinal column with stimulating substances, such as tincture of Spanish fly, and the appli- cation of Spanish fly and mustard plasters. FUNGI. The symptoms of poisoning by fungi are vomiting, bloating of the abdomen, and rolling in the bowels, syncope, painful evacuations of the bowels, convulsions, madness, with fatal termination. The toad- stool is one of the most poisonous of the fungi. Treatment : Apply leeches to the gastric region, and to arrest vomiting, administer internally opium, carbonate of potassa, saturated with lemon juice ; subsequently give black coffee, and mucilaginous, oily drinks. Some recommend the free drinking of cold water as be- ing the best remedy. We limit ourselves here to the enumeration of the principal vegetable poisons, as the effect of all of them is about the same on the human frame, and therefore require about the same treatment. MINERAL POISONS. ARSENIC. Arsenic is one of the strongest corrosive poisons. It causes violent, burning pains in the stomach, throat, and abdomen, strong, constant choking and vomiting, cramps, insatiable thirst, with a dry, fibrous tongue, and increased secretion of saliva, hoarse voice, violent diarrhoea, with bloody, putrid stools, drawing in of the abdomen, terrible feeling of fear, oppression of the chest, irregular pulse, trembling of limbs, and general convulsions. Subsequently the limbs suffering from convulsions become paralyzed, the beat of the heart and pulse become weaker, the senses become dull, the hair drops out, and the epidermis peels off. Antidotes : Strong solutions of soap, one pound of soap to four pounds of water ; dose, a teacupful every three or four minutes, administered lukewarm ; tersulphuret of potassa, sulphate of iron dis- 428 MISCELLANEOUS DISEASES. solved in hot water, the sediment of the water used to cool iron in blacksmith shops (hydrated oxide of iron), drinking a great deal of warm water, oil, &c. For poisoning by vapors of arseniuretted hydrogen or arsenic dust, the inhalation of tersulphuret of potassa is recommended. LEAD AND ITS COMPOUNDS. Litharge, red oxide of lead, sugar of lead, solution of subacetate of lead, and Goulard's extract, produce the following symptoms: sweetish taste, dryness of the mouth and throat, a feeling of weight in the stomach, lack of appetite, loss of strength, paleness and emaci- ation, oppression in the cardiac region, dizziness, deafness, cough, hiccough, choking, nausea, vomiting, a hard pulse, strung like the string on an instrument, palpitation of the heart, excruciating pain in the limbs, violent colic pains, constriction of the abdomen, as if a rope was pulled around it, knotty evacuations resembling sheep's dung, cramps, paralysis of the limbs, and cold sweats. These com plaints are known under the name of lead colic. Antidotes : If the poison has been taken only recently, administer ipecac as an emetic, and subsequently castor oil, alum with opium, liver of sulphur, which is particularly efficacious in this malady. COPPER. To this class belong particularly verdigris. Besides the general symptoms heretofore adduced, a coppery taste manifests itself, spasms of the pharynx, irritating pain in the stomach, anguish, &c. The cases of poisoning by verdigris in families usually occur in conse- quence of acid or acidulated food kept for some time in a copper vessel. Antidotes : Administer ipecac as an emetic, sugar water, the white of eggs, oil with gum arabic and water, sulphur, sulphate of lime dissolved in warm milk, or a decoction of nut galls. POISONS OF THE ANIMAL KINGDOM. 429 MERCURY. Mercury may be swallowed without injury, because it passes un- changed through the intestinal canal. Its compounds, however, par- ticularly corrosive sublimate and red precipitate, cause destructive results to the organs, such as violent inflammation of the throat, stomach and the intestinal canal, which quickly pass into a gangren- ous state, violent fever and convulsions, dysentric diarrhoea, faint- ing fits, dizziness, delirium, &c. .The best effect is produced by mucilaginous, enveloping remedies, more particularly the white of eggs (six eggs to one pound of water), taken in large quantities ; also mucilaginous drinks, milk, lukewarm water, oil, &c. ANTIMONY. Antimony and its compounds produce, aside of violent vomiting and diarrhoea, the usual symptoms heretofore given. The violent vomiting must be checked as quickly as possible by administering sugar water, or Niver's mixture. Administer also a decoction of nut galls, calisaya, oak or willow bark, green tea. The other symptoms are treated with opium, leeches, bleeding and poultices. POISONS OF THE ANIMAL KINGDOM. SPANISH FLIES. The powder or tincture of Spanish flies produces the following symptoms : nauseating, fetid breath, burning taste, heat in the mouth, throat and stomach, nausea, choking, vomiting, frequent and some- times bloody stools, urinary affections, bloody urinations, troublesome stiffness of the penis with immoderate and insatiable desire for copu- lation, violent pains in the stomach, colic, rapid breathing, burning thirst with inability of swallowing, dread of water, convulsive mo- tions, catalepsy and madness. The antidotes to be applied are : oily and mucilaginous remedies, decoctions of salep, malva, marshmallow, milk, water, camphor, either in milk or in an emulsion, mucilaginous injections, oily, mu- cilaginous immissions in the bladder, &c. 430 MISCELLANEOUS DISEASES. TOADS. The urine and the milk-like substance squirted from the warts cov- ering the surface of the body, is deemed poisonous, although this is denied by some naturalists. Usually the complaint is only of a local character, and consists of inflammation and swelling of the infected part. But there are nevertheless instances where the poison was com- municated to the whole body, causing vomiting, difficulty in breath- ing, jaundice, loss of speech, dizziness, and syncope. Treatment : Wash the inflamed parts carefully with salt water, place the limb in the ground, and apply fresh leaves of rue. Inter- nally administer salt water, or valerian in wine. Some recommend the sweating cure. SNAKES. All poisonous snakes belong to the species of rattlesnakes or vipers, among which is distinguished the viper found in Europe (^Coluber Beruz). Immediately after the bite, a stinging, throb- bing pain sets in, in the scarcely visible wound, accompanied by a red swelling. On the burning surface small blisters are formed. After a longer or shorter period of time, frequently immediately after the bite of the rattlesnake, a weakness sets in, accompanied by a feeling of anxiety, vomiting, great thirst, swelling of the face, tongue, and often of the whole body. The pulse is small, rapid, and irregular, breathing heavy, followed by convulsive motions and death. THE EUROPEAN VIPER. The bite of this viper is followed by a rapid swelling of the part ; great depression, anxiety, cramps in the stomach, and inclination to vomit, manifest themselves, and the whole body swells. Treatment : After the bite of a poisonous snake, tie, as quickly as possible, a cloth, ribbon, or strap, &c, around the limb, to check the reflux of the blood to the heart. The wound should be washed with salt or soap water, apply dry cupping- cups, caustic remedies, or a cautery iron, to it, and keep up suppuration on the bitten part for a long time. Around the wound apply oil, fat, or soap, and renew it as often as it dries in, wiping off carefully all that flows out of it. POISONS OF THE ANIMAL KINGDOM. 431 This treatment is continued as long as the symptoms last. Inter- nally proper remedies should be administered. INSECT STINGS. All insect stings, which become troublesome by itching and burn- ing, and perhaps also swell up, as those of the bee and hornet, are of a poisonous nature. They are quickly cured if spirits of sal-ammoniac is poured on the sting, and the bathing with it continued. A sure protection against the sting of insects is the washing with oil. This may be done when a person has to sleep in a place full of fleas, bed bugs, musquitoes, &c. In sensitive persons, Spanish flies externally applied as a blister, may produce urinary disorders, act diuretically, and cause a burning sensation in urinating. If, by accident, or in- tentionally, they are applied to the epidermis in larger quantities, or introduced into the stomach, they produce an immediate inflammation of the kidneys, which prevents the secretion of urine, and yet creates a most violent pressure for it ; it usually results in hgematuria. If applied in larger quantities, or for a longer period of time, inflammation of the stomach and throat sets in, causing bloody vomiting, bloody evacua- tions from the bowels, terrible pains, convulsions, and the patient dies a terrible death. In case of poisoning with Spanish flies by internal use, administer at once an emetic (ipecac two grains, in one dose), and give large quantities of mucilaginous drinks, also injections of the same character, but under no condition should the latter contain oil, as this dissolves the blistering qualities of the Spanish fly still more. As an antidote, camphor must be administered, prepared as follows : take milk of almonds seven ounces, camphor, ground with gum arabic, thirty grains, sugar ten grains ; dose, one tablespoonful every hour. The inflammation of the digestive and urinary organs must be treated by bleeding and leeches, under the advice of a physician. In case of poisoning by the external application of Spanish flies, the same treatment is applied, excepting the emetic. 432 MISCELLANEOUS DISEASES. MAD POISON. * The most dangerous and terrible of all animal poisons in our cli- mate is the poison of the mad dog, which originates generally only in the canine race, but perhaps also in cats. It also develops in other animals through a paroxysm. In the dog it shows itself at first as an inflammation of the throat, which makes swallowing difficult for him, without interfering at all with his food or drink. The dog is friendly, and plays, but is not as lively as usual. His hoarse bark changes im- mediately into a howl ; the dog holding up his head while doing so. His bark is peculiarly hoarse ; he refuses to have his throat touched, and snaps at every body who tries to do so, even at his master. He dies frequently already while in that condition ; it is usually called quiet madness. In most cases, however, the fever increases, and he becomes quite rabid ; in this paroxysm he runs away, and bites every- thing that comes m his road. It is commonly supposed that aversion to water is a sure symptom of this disease, and for that reason it is called hydrophobia. This, however, is altogether wrong, because the same symptom is met with in various other nervous affections ; it is also frequently absent with men and animals in fully developed hydro- phobia. Although in most cases aversion to water must be considered as one of the characteristic symptoms of the disease, it must not be argued from its absence that the animal could not have been mad, because decidedly mad dogs and wolves are known to have drank a good deal, to have swam rivers, and to have left their direct road for the purpose of "attacking men who were working in the water. HYDROPHOBIA. I now propose to describe hydrophobia more particularly. Hydro- phobia is called a usually fatal disease, consisting of an inflammation of the organs of deglutition, connected with aversion to water, and spasms, commonly the result of the bite of a rabid animal, more particularly of the dog. Hydrophobia voluntarily develops itself in dogs in consequence of great heat or cold, but more particulaily in consequence of a lack of water. If a dog becomes sullen, lazy, snap- pish, if he does not want to eat or drink, or if he eats unusual things ; if, instead of barking, he utters a dull, half howling, grunting sound, holding his head at the same time in an upward direction, it is ex- HYDROPHOBIA. 433 tremely likely that he is rabid. He then usually begins to snap and bite at everything, even at his own master, tumbles madly about, breaks down frequently, and finally dies in convulsions. A distinc- tion is made between raging and quiet madness. If dogs are taken with raging madness, their irritability is increased from the start ; they like to lick cold objects, become restless, run away from their masters, and snap and bite at everything. Subse- quently they appear surly and cross, their eyes are somewhat red, and run, and the upper eye region is wrinkled. The mouth of a truly mad dog is dry, his tail becomes slack, and drops ; he runs aimlessly in various directions, and only towards the close of the attack he runs more straight. Dogs attacked with quiet madness are unusually dull and dejected, drop the lower jaw as if paralyzed, can not swallow, saliva flows from their mouth, they show no particular desire to bite, the tongue pro- trudes slightly between the teeth, and they make very little noise. A mad dog never shows aversion to water, or to shining, glittering objects. If a dog, suspected to be mad, has run away, or if he has died, and if certainty is desired as to his true condition, spread a little of his saliva or blood upon a piece of bread, or rub it on the gums of the dead animal, and offer it to another dog. If the latter anxiously refuses to eat, or even to touch it, the suspected dog is, or was, most likely mad. Mad dogs develop a contagion of a fixed nature, which is conveyed by the saliva, the slime dropping from the throat, or the blood. It can only reproduce the same disease, if it is directly transferred to the fluids of another individual. It need not be in- fused in an open wound, or by a bite, to demonstrate its action, but may be absorbed by a place having a very thin epidermis, or by a spot which has been imperceptibly abrased. However, as above remarked, not every bite of a mad dog results in hydrophobia, but a peculiar susceptibility is necessary for it. The bite of a dog that is not mad, or of any other enraged animal, may cause an attack of hydrophobia. The time for the breaking out of the disease after the bite, or after the instilling of the poison, by anything which is imbued with it, varies very much. Frequently seven or fourteen days elapse, and sometimes several months, or even years. 28 434 MISCELLANEOUS DISEASES. The next proofs of the contagion are said to be the so-called lysses, which sooner or later appear on the side of the frenulum ; they are round or oblong, brownish, generally transparent, and of the size of a lentil. They quickly disappear again, frequently already after thirty hours, when the other symptoms of the disease make their appearance. The bitten part, which heretofore did not show any particular change, becomes sensitive and red, the edges of the wound turn over, become inflamed, and a thin ichor flows from it. If the wound is already closed, an itching, painful sensation is felt in the neighborhood of the scar, which spreads thence in all directions, particularly to the neck and throat. The scar becomes inflamed, swells, breaks open, and discharges an offensively smelling ichor ; the lymphatics and glands surrounding them swell somewhat ; sometimes, however, the cicatrized place does not change at all. Aside of that, a peculiar lassitude and heaviness of the limbs, dizziness, shuddering, sadness, sensitiveness, take . possession of the patient ; his sleep becomes restless, and is interrupted by depressing dreams, the face seems distorted, becomes pale, the eyes are dull and tearful, a fever with burning heat manifests itself, particularly in the gastric region, the pulse is small, hard, and irregular, breathing oppressed, sighing, sobbing, speech hollow and trembling, saliva collects in the mouth, nausea sets in, vomiting of green gall, the stool is costive, urine pale and voided, with a burning sensation. All these symptoms increase periodically \ light becomes unbearable to the patient, the pupil enlarges, the difficulty of swallowing in- creases, and the thirst is terrible. The sight of a bright, glistening fluid, or even of a looking-glass, or the slightest draught, causes con- vulsions in the patient, which are connected with a painful constric- tion of the throat and cervical muscles, to which is added a barking, cough-like cry. These attacks are repeated periodically, and without any provocation, and when under the effect, the patient assumes a sitting position, and draws up his thighs ; he has spermatorrhoea, and voids urine involuntarily, and is so little conscious of surroundings, that he attempts to bite and slabber objects or persons near him. Be- tween times, he is quiet, and fully conscious of his condition. Finally convulsions return more frequently, hallucination increases, the voice grows hoarse, until vital strength becomes exhausted, when the attacks HYDROPHOBIA. 435 become weaker, and the patient often quiets down ; frequently, how- ever, the patient succumbs under a new and more violent attack, which usually occurs on the second or third day from the beginning of the attack. The malady may be sometimes mistaken for tetanus. For the treatment of this disease, a skillful physician should be called in as speedily as possible, but any one may make some preparations to counteract the effect of the poison in the wound. Tie at once a strip of cloth firmly above the wound, particularly if the bite is on the arms, hands, feet or legs, which will prevent the reflux of the blood with the infused poison to the heart; wash the wound industriously with warm water or urine, and apply a cupping glass to it. If such is not at hand, submerge a corked empty bottle in some hot water, and keep it there until well heated, take it out of the water, open it so that the hot air may escape, and place the mouth of the bottle over the wound ; a second bottle, prepared in the same manner, is kept in readiness, and immediately applied to the wound as soon as the first is taken away, and the blood washed off. The physician, who has been called in the meantime, will, as the safest remedy, either cut out the wound or cauterize it with a cautery iron, or with butter of antimony, sulphuric acid, caustic potassa, &c. The scab which has formed is removed, and suppuration maintained for months by sprinkling pow- dered Spanish fly in the wound, or by stimulating ointments applied to it. On the outside of the wound, grey mercurial ointment is rubbed in until salivation results ; the quantity of the ointment to be applied is from half a drachm to a drachm a day. Internally, ad- minister to the patient powdered belladonna root : dose, from one to four grains ; or calomel, until salivation is effected, or Spanish flies or May worms. It is self-evident that the physician should be the party prescribing the use of the above internal remedies. The treatment, particularly the cauterizing part, is necessary, even if the wound has closed, but begins to pain and swell. If hydro- phobia has already manifested itself, repeated bleeding, cold plunge baths, musk, opium, &c, must be administered in addition to the remedies already prescribed. It should be remembered that everything infected by the saliva of a mad dog, or by a man who has died of hydrophobia, and also the clothing worn by the latter, must be burnt or buried; if there are 436 MISCELLANEOUS DISEASES. metal tools which cannot be melted readily, they should be heated to red heat. Touching such objects with the naked hand must be avoided. GANGRENE OF THE SPLEEN. Poisoning by gangrene of the spleen is a terrible disease. It may be easily transferred to the human body by touching animals infected with that disease, or to persons who come in closer contact with the offal of these animals, such as herdsmen, butchers, flayers, furriers, tanners, veterinary surgeons, soap makers, &c. The skin, blood, fat, wool, &c, are the carriers of this contagious matter, which it is almost impossible to destroy. The law strictly prescribing the total destruc- tion of all animals attacked with that disease, and even their litter and manure, is frequently evaded from greediness. Some time after contagion, a red spot may be noticed, usually on the uncovered parts of the body, the hands, arms, head, and face, itching as if from the bite of some insect ; underneath the skin may be felt a lentil-shaped, hard, movable little knot, which increases rapidly, and above it is raised a little pustule filled with ichor. It increases in hardness, becomes immovable, the pustule breaks, the ichor issuing therefrom causes new blisters, typhoid fever sets in, and it usually terminates in death. As a protection to persons who have any business with cattle in- fected with the disease, the utmost cleanliness is to be recommended, also the greasing of the hands with fat or oil, washing with diluted chlorine water or a solution of carbolic acid of about two or three per cent, strength. If infection has occurred, procure a physician as quickly as possible, and, until his arrival, cauterize the infected place with caustic potassa, or a red hot cauterizing iron, and then apply without intermission poultices of solution of chlorine, or of carbolic acid, as above directed. SAUSAGE POISON. We will add a few words in regard to this poison. In badly-smoked meat, in black pudding, and liver pudding, which have not been prop- erly smoked, or the smoking of which has been too long delayed, a RECALL OF APPARENTLY DEAD PERSONS. 43? poison, called fat-poison, is easily engendered. The same poison is formed in hams which have been treated with wood vinegar, in place of being, smoked. The symptoms of poisoning by sausage poison do not manifest themselves at once, but only after twenty or twenty-four hours. They are debility, pain in the bowels, heartburn, nausea, choking, vomiting, diarrhoea, and subsequently dryness in the mouth, double vision, inability to swallow, with great hunger and thirst, en- larged pupils, drooping of the upper eyelids, tensive and costive abdomen, mortification of the finger ends, hoarseness of voice, and finally paralysis, which ends with death. Treatment : If vomiting does not set in of its own accord, it must be produced by administering ipecac. Antidotes deserving mention, are vinegar, lemon juice, sulphuric acid, diluted with water, vinegar ablutions, vinegar or soap injections, with internal treatment, appro- priate to circumstances. GENERAL REMARKS ON THE RECALL OF APPAR- ENTLY DEAD PERSONS. There is nothing more important in practice, nothing that affords greater gratification, if successful, than the saving of apparently dead people ; but there is also nothing calling for greater presence of mind and endurance. Daily experience teaches that a failure of the attempts to recall the apparent dead, and save poisoned persons, must be attributed to the inconsiderate and unsystematic application of the required remedies ; it is also a fact, however, that relief must almost be instantaneous to be effectual. In every case of unexpected death, it is advisable to make attempts at resuscitation. As long as in sudden deaths, infallible symptoms do not indicate certain death, the possi- bility of its being a case of asphyxia must be assumed, and every- thing should be done to revive the almost extinguished vital spark. It is inexcusable and unconscionable to bury such a body. Aside of putrefaction, there is no symptom indicating that life is really ex- tinguished. Absence of the beating of the heart and pulsation at the wrist, and suspension of breath, which is usually ascertained by placing a vessel filled with water on the cardiac region, and holding 438 MISCELLANEOUS DISEASES. a looking-glass before the mouth, are just as little sure indications of death, as are total insensibility of the surface, the stiffening of the limbs, and the dropping of the lower jaw. The body should not be considered really dead, and no attempt to bury it should be made, as long as the eyes retain their fullness and the lustre which they had in life. Putrefaction, as before said, is the only peculiar and character- istic indication of death. If bluish-green spots make their appear- ance on the body of the corpse, when the body emits the peculiar, not to be mistaken, smell of putrefaction, it must be considered dead, and must be removed from among the living. As essential as the in- dications of real death are, just as pleasurable are the first symptoms of returning life. After having continued the attempts at resuscita- tion for a long time, when success is hardly to be hoped for any longer, if all who have been active in the application of the remedies, begin to tire and despair of success, if then a slight symptom of life manifests itself, how exciting to the friends surrounding the body. A slight, hardly perceptible trembling of the under lip, a slight trembl- ing of the eyelids, a convulsive movement of the eyelashes, or of a finger, a scarcely perceptible heaving of the chest, are usually the first symptoms of the scarcely hoped for return of life. If these first traces are not counteracted by too violent treatment, or by an untimely certainty of success, and a cessation of further efforts at resuscitation, if by the continuation of further active measures, the vital spark is gradually fanned, then more decided symptoms of return- ing life will manifest themselves. A faint beating of the heart, a gentle drawing of breath, a scarcely audible sigh, strong movements in the abdomen, a decided warmth in the cardiac region, a voluntary appearance of foam, and finally a returning flush in the face, are notice- able. But a short time elapses ; natural warmth, free breathing, a distinct, regular beating of the pulse manifest themselves, and all functions of life gradually develop. Scarcely has the patient returned to life, when he is wrapt in gentle slumber, which completes the resuscitation, and restores to regular action the inter- rupted functions of life, and he is saved from the terrible state of asphyxia. The general rules which should be observed by every layman, in case of accidents, and consequently in every attempt to preserve life, DELIRIUM TREMENS. 439 are, to call in a physician as quickly as possible, and, as before said, to proceed in the effort at resuscitation. DELIRIUM TREMENS. This disease is the result of a too liberal use of strong spirituous liquors. It manifests itself particularly by a derangement of intel- lectual powers and trembling of the limbs. The malady is preceded by indigestion, weakness, trembling of hands, pains in the stomach, restlessness, anxiety, disturbance of sleep, &c. This horrible disease attacks the drunkard generally after a night's debauch. It is usually warded off as long as he is able to obtain his usual night's rest undis- turbed. It also breaks out with the habitual drunkard, if he is sud- denly deprived of his usual strong potations. The following are the symptoms manifesting themselves : With an irresistible desire for spirituous drinks, these people possess a peculiar, bloated appearance; they become dull, depressed, tremble, particu- larly in the morning, and are unable to perform any work until they have drunk their accustomed quantity ; their breath becomes offensive, and they are tormented by choking and vomiting; sleeplessness sets in, with violent motions, and frequent jumping out of bed. Gradually the attack increases in violence, the patient imagines that he sees spiders, mice, crabs, bugs, and other small animals creeping around him. His hands and feet tremble violently, and from this fact the dis- ease derives its name. In cases of that kind, medical aid alone can save the seriously threatened life of the person. If this cannot be quickly obtained, apply ice poultices, and administer a solution of tartar emetic, in the proportion of twenty-five centigrammes to four ounces of distilled water ; dose, a tablespoonful every two hours. The tartar emetic is increased daily by one decigramme, and when the patient arrives at the point of complaining of nausea, and begins to vomit, sleepless- ness and delirium decrease, and he is cured until the irresistible de- sire for strong drink causes a fresh attack. To induce the decisive sleep, administer one centigramme of acetate of morphine every two or three hours, or chloral hydrate, administered of late with excellent success. The prescription for the latter is : three grains of chloral 44:0 MISCELLANEOUS DISEASES. hydrate, dissolved in four ounces of distilled water, orange peel syrup and gum arabic half an ounce of each ; dose, one tablespoonful every hour, until the patient falls asleep. The disease sometimes passes off with a heavy perspiration, and the urine ; at other times, inflammation of the brain, apoplexy, &c, set in, which is quickly fatal. One of the best remedies is opium, in doses of one-half to one grain every two or three hours. It should not be given in every case, however, and should be ordered by a physician only, and then per- haps after the patient has been bled, and the stomach or intestines cleansed by emetics or purgatives, for which purpose calomel and jalap are preferable. Ipecac root, in doses of one-quarter to half a grain, is frequently an excellent remedy. The use of alcoholic drinks must not be dis- continued suddenly, but only gradually. The method of treatment is very simple. Take extract of gentian root, with a little sweet flag powder, of which make pills weighing each two decigrammes ; of these let the patient take three or four, four times a day ; besides that he must drink each day five grains stirred in water. This treatment generally suffices to produce, in most cases, a very salutary and remarkable change in the constitution of the inebriate individual, and creates in him an aversion to whisky. In rare cases, where the pernicious results of drunkenness were dis- tinctly marked, and a general state of dropsy began to develop itself, from one to three centigrammes of sulphate of iron should be added to each pill. The method of curing the disease by producing nausea, has also been successfully applied in some cases. It consists in giving to the patient, who is kept under strict surveillance, all his food and drinks mixed with, or cooked in, whisky. To support this treatment, administer every two hours a tablespoonful of a solution of tartar emetic, pre- pared as follows : tartar emetic two grains, distilled water three ounces ; dose, a tablespoonful every quarter of an hour until the desired result is produced. If the patient does not possess self-determination to be cured of drunkenness, not only other attacks of delirium tremens may be expected, but also other diseases, which usually result in death. An attack of apoplexy is not at all unusual, and is fatal in most instances. But if in some instances, the life of patients is SOMNAMBULISM— SEA-SICKNESS. 441 preserved, still they will remain paralyzed and idiotic. Epilepsy, dropsy of the chest and abdomen, are also the frequent results of inebriety and delirium tremens. SOMNAMBULISM. To prevent somnambulists from leaving their bed at night and walk- ing into dangerous places, where, frightened by some accident, they might receive injury, wet sheets should be spread before the bed, or a large wash or bath tub placed before the bed. When the somnambu- list leaves his bed, and touches the cold water with his bare feet, it awakens him at once, and he returns to bed. SEA-SICKNESS. Sea-sickness is a malady which usually attacks persons who go to sea for the first time. There are some persons so susceptible, how- ever, that they are attacked every time they go to sea, and frequently remain sick during a large part of the voyage, while others are never troubled with it. The malady manifests itself by great uneasiness, nausea, and vomiting. Gouty, rheumatic, and hypochondric persons are generally great sufferers from this malady ; those who suffer from asthma are said to be benefitted by a sea voyage. The following may be recommended as a preventative : the person who is about to embark on a sea voyage, should go on board in a pleasant frame of mind, and with the firm determination not to be- come sea-sick. This will not always avail, but, nevertheless, a firm determination has sometimes overcome similar situations. Remain as much as possible on the deck of the vessel, and take as much exercise as possible. Many persons, however, are unable to comply with this advice, and find relief in lying down. Be moderate in eating and drinking, and avoid all food which may create nausea, particularly fat meat. The food should be highly seasoned ; drink lemonade, and use sliced lemons, sprinkled with sugar. Beverages containing a great deal of carbonic acid, such as champagne, Selters water, with wine, &c, can be highly recommended. Where there is an inclination to nausea, a few drops of Hoffmann's anodyne, or naphtha on sugar, 442 MISCELLANEOUS DISEASES. may be beneficial. The gastric region may be bathed with rum or other spirituous liquids. It is also recommended to keep a little bag of saffron applied to the chest. It is also well to wear a belt around the abdomen, which should be drawn pretty tight, so as to compress the stomach. Between the times of vomiting, acid beverages, such as lemonade, may be drank. SPLENALGIA, Or stitches in the side, after severe exercise, is a painful feeling on the left side under the short ribs, which is of no particular signifi- cance, and usually disappears by keeping quiet for a time. HYPOCHONDRIASIS-SPLEEN. Hypochondriasis is a disease which particulary attacks men of great irritability and depressed spirits. It manifests itself at first in a peevish and ready irritability of mind, love of solitude, relaxation, dislike for work, derangement of the digestive organs, pressure and tension in the abdomen, swelling of the liver and spleen, inert stool, &c. Subsequently the patient withdraws from all his former connect- ions, shuns society, and occupies himself almost solely with his own bodily condition, ponders over it, looks gloomily to the future, imagines that he is troubled with a disease of one kind or another, and brooks no contradiction even from his own physician. He partic- ularly complains of pains moving from place to place, chills and heat, buzzing in the ears, headache, &c. The disease sometimes improves with the bleeding of hemorrhoids, bilious fever, or the ague ; some- times, however, it changes into melancholy, dropsy, or jaundice. The malady generally attacks middle-aged men, and particularly those of a melancholy or choleric temperament. Sometimes the disease is inherited, and in that case is usually connected with hemorrhoids. Frequently it is the result of constantly sitting in rooms having a musty atmosphere, or of the consumption of indigestible food and spirituous beverages, by wearing and constant efforts of the mind, depression of mind, misfortunes, excesses in sexual intercourse, &c. In treating this disease, it is necessary that the mode of life of the patient should be entirely changed. An effort should be made in a HYPOCHONDRIASIS SPLEEN. 443 friendly and kind manner to detract his attention from himself ; this should be done without contradicting him. He should be induced to take proper exercise ; if possible, persuade him to undertake a jour- ney, endeavor to limit the labor which ties him to his desk, or to change it for a more active occupation. He should be particularly careful in his diet, eat nothing that is indigestible or flatulent, and abstain from heating beverages, although a good, light wine will not be injurious to him. In respect to medicinal remedies, administer particularly that which will strengthen the digestive organs, and over- come flatulency, colic pains, heart burn, &c, which may appear ; the movement of his bowels should be kept very regular. To attain this end, rhubarb should be administered in the following form : take of the yellow part of orange peel two drachms, rhubarb root and bitar- trate of potassa, three drachms each, mix ; dose, as much as will lie on the point of a knife, three or four times a day ; peppermint or camomile tea may be given at the same time. To strengthen the di- gestive organs, use bitter remedies and essences, particularly sweet flag, dandelion, celandine leaves, doggrass, which may be taken with mineral water; also the following digestive powder: carbonate of magnesia, sulphate of potassa, rhubarb, valerian root, fennel seed, eight grains of each ; dose, a teaspoonful every four hours; also the following tea : star anisseed and coriander, fifteen grains of each, lemon balm four ounces, one tablespoonful of tea to two cups of water ; this tea will relieve cramp in the abdomen, flatulence, acidity, and costiveness. It is sometimes the case, however, that the cause of the extraordi- nary sensitiveness of the abdomen, which does not only cause these cramps, but also produces in the patient the erroneous conceptions of his physical condition, together with his delusions in regard to his feelings and sensations, are based on a congestion or inflamed irrita- tion of the stomach, and the upper part of the intestines. It will therefore be readily perceived that everything tending to irritate these parts, and for that reason nearly every kind of medicine, must increase the illness. The poor patient will soon notice this, yet his desire to increase his doses of medicine will not be lessened thereby. If the saliva of the patient is found to be sour, if he complains of pains in the stomach, burning sensation in the abdomen, below the 444 MISCELLANEOUS DISEASES. short ribs, violent throbbing in the abdomen, if he has a flushed face, and is troubled with frequent bleeding of the nose ; if these difficul- ties increase after drinking even the smallest quantity of wine, or after eating, it may be justly assumed that the prognosis is correct. Under these circumstances, nearly the same treatment should be followed which is prescribed for inflammatory slow nervous fever. If under these circumstances purgatives should not be constantly admin- istered, yet constipation should also be prevented. In this case senna coffee is of excellent service : take six grains of senna leaves (without stems), pour a good-sized cupful of cold water over them, let it stand over night in a covered vessel, then strain. With the water thus ob- tained, prepare a cup of ordinary coffee, and drink with milk and sugar. This remedy neither causes colic, nor does it purge ; but if such should be the case, take a less quantity of senna leaves. It is particularly well adapted for hydochondriacs or woman, even while the latter is nursing her child. Another remedy for that purpose is a de- coction of buckthorn bark, one-half or one tablespoonful with two cups of water, boiled down to one-half, with a little yarrow leaves. But if the patient is also suffering from piles at the time, take sulphur as follows : flowers of sulphur six grains, anis or fennel seed three grains, sugar half an ounce ; dose, a small teaspoonful morning and evening. Superior to all purgatives are cold injections ; besides causing a movement of the bowels, they are strengthening to the abdomen. If required, they may be administered with advantage two or three times a day. The internal as well as external application of cold spring water is very excellent, and can never be sufficiently recom- mended. Many a man who has hopelessly dragged out a miserable existence for years, has been restored to health by its use. This, however, is rarely the case if the patient remains at home, and in accustomed surroundings ; but it frequently occurs, if he resides for months in a strange place, healthy atmosphere, and pleasant society, and continues the application with steady perserverance, and full of confidence. HYSTERICS. 445 HYSTERICS. Hysterics is a disease to which women only are subject. It appears in diversified forms, and it is impossible to give an accurate descrip- tion of it. It is rare to find two persons suffering from this disease who will complain of the same symptoms. Yet the general character of the disease is so peculiar that if one has observed a person once with hysterics, it will be readily recognized in others. To furnish a general idea of this multiform disease, it should be stated that it has its origin in a failure to attain the object in the life of a female, which is propagation, and resulting in depression of spirits, irritability and sensitiveness of mind, which has also gained an morbidly in- creased influence and power over the body, so that the symptoms manifesting themselves must be considered the reflex of a morbidly irritated mind. The result of this is that hysterics must be considered more a morbid condition of the mind than purely a disease of the body, and in this also is to be found great similarity between it and hypochondria, and which has induced even some great physicians to declare that there is no difference between these two diseases. In the hypochondriac, with the high value which he places upon his own importance, the discontent with himself and the rest of the world, results from a wrongful conception of the objects of his own intellectual life; this creates delusive symptoms of diseases, which finally undermine his health. In the woman a similar condition (hysterics) results from a deprivation of sexual life, which, in regard to her physical condition, appears much more distinctly on account of her greater nervous irritability. But just as well as a real morbid condition of the body can induce a hypochondrical state of the mind, just as well may a real morbid condition of the finer female sexual organs create a hysterical irritation of the mind. The malady, however, usually proceedes from the sexual system, and is related to spasmodic diseases. The state of mind is, however, extremely change- able, sometimes the patient is in turn lively, even to hilarity, or de- pressed and sad, disconsolate, and in despair ; she alternately laughs and cries, and these conditions change rapidly and unexpectedly. She suffers from illusions of mind, and there is no disease of which she does not imagine she is suffering in turn. Smell and taste, accord- 446 MISCELLANEOUS DISEASES. ing to the usual acceptance of the term, are perverted ; a fetid smell is perfume to her, and what is bad tasting, or has no taste at all, she finds delicious. The patient is talkative, particularly with reference to her malady, and paints it in the most glaring colors. Her true condition, however, does not always remain unchanged ; she has hysterical attacks, which closely approach spasmodic attacks. These attacks begin with stretching and yawning, pains in the occiput, cramps in the stomach, oppression, anxiety ; the patient loses con- sciousness and speech, and the condition sometimes changes to real spasms, with crying or laughing. Sometimes a sensation is felt as if a ball was rolling upward from the abdomen to the throat, contracting and constricting it, or as if a nail had been driven into the head, caus- ing great pain. Digestion is generally interfered with, stool inactive, menstruation frequently deranged, sometimes too profuse, and again too scanty ; frequently the whites show themselves. The malady is sometimes inherited, and at other times acquired by sexual impulses, limited exercise, idleness, or the reading of exciting books, exhaust- ing hemorrhages, difficult delivery, too long nursing of the child, de- rangements of menstruation, spasmodic condition, St. Vitus' dance, epilepsy, &c. The treatment of this disease must be the same as in hypochondria, in regard to a change of mode of life, diet, exercise, &c. taking in consideration the sex of the patients, however. As palliatives for syncope and spasm, should any occur, stimulating remedies should be applied, such as Hoffmann's anodyne, acetic ether, spirits of harts- horn, etherial tincture of castor, from ten to thirty drops three or four times a day ; etherial tincture of valerian (three or four drops on sugar), assafcetida, infusions of lemon balm, peppermint, valerian tea, bathing of the temples with vinegar, cologne water, smelling salts, dry rubbing of the limbs (concerning which see the article in this work), &c. In attacks of vomiting, give effervescing powders. Attacks of colic, constipation, diarrhoea, &c, should be treated as laid down in this work, under the respective headings. The following prescriptions have been attended with excellent success : castor tincture two and one-half drachms, spirits of harts- horn three drachms, Hoffmann's anodyne one drachm, mix; dose, thirty to forty drops in camomile tea. EMOTIONS— TREMBLING. 447 Another remedy : Castor fifteen grains, myrrh, gum galbanum, half a drachm of each, assafcetida one drachm, tincture of valerian suf- ficient to make into two-grain pills ; dose, four pills twice a day. EMOTIONS. Every healthy individual is subject to emotions ; he is susceptible of joy, cheerfulness, pleasure, hope, grief, anxiety, fright, anger, wrath, &c. If emotions of that kind occur suddenly and unexpect- edly, they may result in serious diseases, and may even cause death. They are all the more dangerous, the more excitable the affected party may be, and the more the individual may be already weakened by other maladies. It is impossible to enter here more particularly into a discussion of emotions, and I must therefore limit myself to treat concisely of the course to be pursued in those cases of emotion which occur more fre- quently, and are more detrimental in their result, such as anger, wrath, and fright. An effort should be made to divert the mind from the subject which has created the emotion, and direct it in into other channels. Steps should be taken to quiet the excited nervous system, and to cause a free circulation of the blood. For that purpose every article of tight clothing, neckties, corsets, &c, should be removed ; fresh air should be admitted to the patient, or if he is seriously affected, he should be placed in a bath, or at least take a foot-bath. Sugar water or lemon balm tea should be administered, or a few drops of acetic ether in water, or Hoffmann's anodyne on sugar.. In case of necessity, the whole body may be rubbed with the hand, or warm flannel. In case of great anger, an emetic becomes sometimes necessary. TREMBLING. Trembling indicates weakness, congestion, or nervous irritation. In the beginning of a fever it is one of the chief indications of a nervous state ; the trembling of the limbs of a drunkard, especially during the morning hours, is particularly characteristic. 448 MISCELLANEOUS DISEASES. SPASMS. Spasms indicate irritation of the nerves, caused, for instance, by worms, or a surcharge of the vessels, congestion to the head and spinal chord, or an exhaustion of strength, and for that reason it is one of the worst signs in hemorrhages and loss of juices. It should not be overlooked, however, that they may result in small children, or nervous women, from small causes, and that in such cases they are not of great importance. With these they usually result from a derangement of the intestinal canal. CRYING AND LAUGHING. Crying in diseases points to spasms and nervousness ; it is fre- quently noticed in hysterical women. An excess of tears in the eyes in fevers points to a congestion to the head. Laughing in fevers is the precursor of delirium, or spasm. THE BLOOD. The blood collected from venesection, as well as that from hemor- rhages, may serve as an indicator of diseases, or of a predisposition to it. Coagulated Blood. — If the blood coagulates rapidly into a firm blood cake, and if but little watery fluid separates from it, it points in healthy persons to a strong constitution, and to an inclination for inflammation ; if the person is already sick, it indicates an inflam- matory condition, or an inflammation already existing. Thin, Watery Blood shows an inclination to dropsy, chlorosis, and scurvy. Color of the Blood. — Dark-red and firmly coagulated blood indicates a strong constitution ; if too dark, scorbutic or atrabilious diseases; if too light-colored and pale, it indicates weakness; if of too light a red, it points to gouty and rheumatic acridity, &c. The color of the separated, watery fluid also deserves notice. If it is clear, it is an admirable sign of regular sanguification and health ; if HUNGER WANT OF APPETITE, ETC. 449 muddy or milky, it indicates weakness ; if very yellow, gall in the blood ; if gory, it shows a putrid condition. HUNGER-WANT OF APPETITE, Show in the first instance, and most generally, the existence of dele- terious, indigestible matter in the stomach, aside of the feverish con- dition; because all fevers take away the appetite, except rheumatic and hectic fevers, or nervous depression (in hysterics and melancholy) gasterasthenia, or a morbid change in the interal formation of the coats of the stomach. IMMODERATE APPETITE AND VORACIOUSNESS, Demonstrate a lack of nutricious matter in the body ; hence, after a long siege of vomiting, diarrhoea, in hectic diseases, and internal sup- purations; or they result from irritation of the abdomen, for instance, worms, acrid matter in the stomach, or of a morbidly increased irri- tability of the stomach, in nervous diseases, hysterics, aberration of mind, and longings of pregnant women. AN UNUSUAL STRONG APPETITE FOR CERTAIN THINGS, Points to a depression or increased irritability of the digestive nerves, but it is also a sign of a wholesome instinct of nature. Thus an appetite for lime and earth indicates acidity of the stomach ; an ap- petite for salty things, proves the presence of phlegm, and a desire for acids demonstates a heated condition of the blood, or a putrid state of the juices, and a longing for wine shows weakness and a neces- sity for strengthening remedies. THIRST. Thirst demonstrates internal heat, and is therefore an indication of fever and inflammation, or of cramp or acridity in the stomach and blood. 29 450 MISCELLANEOUS DISEASES. NAUSEA AND VOMITING. Vomiting indicates a presence of obnoxious, irritating matter in the stomach, which is demonstrated by the vomiting itself, or the coating of the tongue. It may also proceed from a morbidly increased irritability or inflammation of the stomach, if the patient immediately throws off again everything that he has eaten. It may also be induced by inflammation of the liver, bowels, an accumulation of faeces in the intestines, by stones in the gall or kidneys, by concussion of the brain and accumulation of water in the head, or by deterioration of the stomach, or an intestine connected with it, or finally by strangulation of abdominal hernia, or other obstruction of the intestinal canal (in- vagination of the intestine). Nausea, or vomiting, in the morning without any indications of a foul stomach, is frequently a sign of hidden stones in the kidneys, and in women, the beginning of preg- nancy. FLATULENCE-AIR-EXPANDED ABDOMEN. Frequent flatulency above and below indicates an accumula- tion of noxious, air-generating matter in the stomach and intestinal canal. A constant inclination toward it demonstrates weakness and feebleness of the digestive organs. Great expansion by air during fevers is always an unfavorable sign. It either indicates a large accu- mulation of vitiated, foul matter in the abdomen, connected with great weakness, or, if the abdomen is very painful and tensive, it is a sign of inflammation. The expansion of the stomach in children is an indication of worms. ALVINE EVACUATION. Increased alvine evacuation either demonstrates the presence of noxious, unusually irritating matter in the intestinal canal, among which worms should be counted, or a strange irritation in the bowels, such as ulcers, transposed morbid matter, or increased irritability of the same, which again may be caused by an inflammatory, nervous, or spasmodic condition. It also indicates anguish or surpressed per- CHOLERA CHOLERA MORBUS — CHOLERA NOSTRAS. 451 spiration (colds), or finally the highest state of weakness, a liquefac- tion of the body. Dark -brown stools indicate a surplus of gall; uncolored, a lack of gall ; green evacuations in nursing children indi- cate accidity. Diminished evacuations and constipation show either a lack, or a defective condition, of the gall, or lack of irritability, or weakness and debility, or a spasmodic state of the intestines. It also indicates a dryness of the juices from neglect of drinking, or from too great perspiration. From the form of the evacuations, it may also be seen whether there exists an internal swelling, or a contraction of the in- testinal canal generally, or an excessive expansion, particularly of the rectum. In the latter case, lumps of the size of a fist are frequently discharged. In the first case, the faeces frequently assume a flat, band- shaped form, or pass off in an incomparably thin, tubular form. Painful evacuations point to irritating, acrid matter in the bowels, or to inflammation or cramp. Frequent inclination for evacuation, without any material result, indicates an inflammation of the rectum » dysentery, or hemorrhoids. Involuntary and unconscious discharges are of no import, if they have happened while dreaming, during delirium, or in case of diar- rhoea ; if paralytic symptoms are connected with it, then serious dan- ger threatens. CHOLERA-CHOLERA MORBUS— CHOLERA NOSTRAS. Cholera is called the terrible disease with which we have become acquainted during late years. It manifests itself by a violent vomiting and purging of a whey-like or rice-water-resembling fluid, connected with inexpressible anguish, hoarse voice, unquenchable thirst, bluish color of skin, icy coldness, and cramps in the calves of the legs. Urinary secretion and perspiration are entirely suppressed ; the face assumes a very peculiar appearance ; the eyes are sunken and sur- rounded by bluish or blackish rings ; the skin of the fingers is relaxed to such an extent as to lay over in folds. The mind remains un- clouded, in some cases even to the last moment. If the disease takes a favorable turn, vomiting and purging gradually cease; urinary 452 MISCELLANEOUS DISEASES. secretion and perspiration occur again, and the pulse, which was scarcely perceptible, becomes stronger again. Often, however, the cholera changes to nervous fever, which is just as certain of carrying off the patient as the original disease itself. The duration of the malady differs very much ; sometimes its course is rapid, while in other instances it drags along for a longer period of time. Symptoms preceding the attack are : weariness, loss of appetite, a dull feeling in the head, rolling in the bowels, pain in the abdomen, dizziness, diarrhoea, which is soon followed by vomiting. The cholera is either sporadic, that is, attacking single individuals, or epidemic, that is, carrying off many people in the same neighborhood at the same time ; in the latter case it appears in a more violent form. It appears at times in some form in every climate, particularly in warmer regions; it raged during 1830-32 with perfect fury in some parts of the world. Whether the cholera is contagious or not, is still an open question ; both sides are able to prove their side of the question by adducing facts. It seems certain, however, that it originates partly by a coincidence of causes unknown to the world, and partly by transmis- sion and spreading, and, therefore, by contagion. Both of these modes seem to operate together during the prevalence of great epidemics. Causes of cholera are usually an overloading of the stomach, the use of raw, easily fermented food, particularly cucum- bers, melons, and other similar fruit, cold drinks, taken while the body is in a heated state, and colds of every kind. An attack of the disease is favored by poor sustenance, inebriety, uncleanliness, depres- sion of mind ; fear, sadness, &c. Treatment : In light attacks, nothing is to be done but to excite perspiration by keeping warm and drinking elder blossom, camomile, or peppermint tea. Apply hot cloths or other hot materials to the gastric region, rub the abdomen with the hand or flannel, and when appetite returns, use mucilaginous drinks, such as oatmeal gruel, lin- seed meal, salep, &c. If this treatment does not afford relief, if pain in the bowels and diarrhoea become more violent, give emulsions, pre- pared from oil and gum arabic, and, if no inflammation exists, add a little of Sydenham's preparation of laudanum. If the attack becomes more violent, and cramps more severe, administer the following ASIATIC CHOLERA. 453 powder : ipecacuanha half a grain, opium from one-quarter to one- half a grain three times a day. ASIATIC CHOLERA. This kind of cholera is terrible in its spread, and from the numberless victims it carries off everywhere. In its rapid course, and with the violence of symptoms accompanying it, to combat which medical science remains almost powerless in spite of all investigations and efforts, it has traveled around the earth since the second decennial of the present century, destroying thousands upon thousands of lives Its home is in the East Indies, particularly in the part lying at the mouth of the river Ganges, where it probably originates in consequence of the vapors arising from swamps and the overflows of the aforesaid river, and whence it spreads. I find it almost impossible to explain the nature and causes of the disease, the remedies which have been applied for its cure, and their judiciousness or injudiciousness. Although the treatment of this disease is connected with so much difficulty, and should therefore be confided to a judicious physician only, yet very much may be done to check the disease in the begin- ning. It is therefore of the utmost importance to recognize the dis- ease in its incipient stages, because that time is the most favorable to turn aside the great threatening danger ; no other disease avenges neglect so quickly, nor is it as irremediable in any other disease as in cholera; diet, therefore, deserves particular attention in time when the epidemic is prevailing. During the time of cholera epidemic, a great inclination to diarrhoea and disorders of digestion prevails, even in people of good health This is partly attributed to the generally prevailing atmospheric con- ditions, and partly to fear of the disease, but which should be care- fully noticed, because from that state itself the disease is easily de- veloped. The disease is generally preceded by symptoms, which consist in the increased disposition generally prevailing ; that is in severer diarrhoea, when yellowish colored, offensively smelling evacua- tions occur under a feeling of growing weakness, bloating of the ab- domen, light colic pains, uneasiness and pressure in the cardiac region, and dizziness. Frequently, however, cholera suddenly attacks 454 MISCELLANEOUS DISEASES. people in perfect health, and without any premonitory symptoms whatever. A careful watching during the period of premonitions, where such manifest themselves, affords the best opportunity to check a further development during the incipiency of the disease. The change to the true, fully developed disease occurs mostly by rapidly increasing diarrhoea, the discharged matter growing lighter in color, and more fluid, and of a less catarrhal nature, vomiting and cramps are added, and perfect exhaustion of strength sets in very rapidly. The evacuations above and below, following each other in more rapid succession, consist of a greyish- white whey, the skin becomes ice cold, its folds, when raised, remain standing for some time, its color, and that of the nails, are of a dirty bluish hue, the face depicts the utmost weakness of the patient, and his great anguish of mind, the eyes are sunken, and have the glassy stare of a corpse, the nose becomes elongated and pointed, the tongue is cold, and coated white, the voice hoarse, dull, and almost without sound. The arms, fingers, thighs, and calves of the leg, are attacked with, and contracted by, painful cramps, the pulse is scarcely or not at all perceptible ; the exhaled breath is cool, although the patient complains of internal, burning heat ; he eagerly calls for cold drinks, which are immediately thrown off again ; the urinary secretions are entirely suppressed. The mind of the patient is clear, and he is fully aware of his terrible con- dition. Thus the cholera, when at its height, presents the picture of a general cramp, the spark of life is almost extinguished, and to the intestinal canal alone seems to be transferred the entire activity to remove the whole fluid of the body. The quantity of the discharged fluid is really astonishingly large. This is the usual course of cholera, yet there occur a variety of symptoms ; the principal one is that there are some cases, although rare, when vomiting and diarrhoea are en- tirely absent ; in such cases, however, all other symptoms appear with increased violence ; this is the so-called dry cholera. If the disease does not kill when at its height, then a more or less rapid recovery may be anticipated. The cramps decrease gradually, the patient breathes freer, his pulse is stronger, the color of the skin grows more natural, warmth returns by degrees, a warm perspiration breaks out over the whole body, the patient usually falls into a quiet sleep, ASIATIC CHOLERA. 455 from which he awakens refreshed, discharges urine abundantly, and from that time his recovery progresses pretty rapidly. Frequently, however, the reaction does not take place so quietly. Life returns fiercely to the almost stiffened body; the abdomen becomes painful, although vomiting and diarrhoea cease, but an obstinate hic- cough appears, the tongue turns red and dry, teeth and lips are covered with a sooty covering, the face becomes red, the heat of the skin increases, but is still cool compared with the fever which sets in. The patient complains of headache from the beginning, but lies in a comatose condition, or is delirious. In short, the whole condition has a great resemblance to typhoid fever ; for that reason it has been called cholera typhoid. In this manner many are carried off who have escaped the true cholera. Recovery is very slow, and usually connected with considerable derangement of disgention, or inclina- tion to cramps. In other cases of cholera, the passing of the crisis is indicated by cutaneous eruptions, sometimes resembling the measles, and at other times nettle-rash ; arms and hands are usually attacked by it, whence it spreads over throat, breast and the lower extremeties, leaving the usual traces. Cholera is usually quickly fatal, sometimes in three, six, or twenty- four hours ; the attack itself rarely lasts over two days without a de- cisive result. It has been already mentioned that many die during the following stages of the cholera typhoid, mostly up to the ninth, tenth, and twelfth day. Relapses are by no means rare, and an attack does not protect against a second attack. In some sections of the country there appear sometimes in the fall, after a hot, dry sum- mer, isolated cases of cholera morbus, the so-called domestic cholera, which in its principal features strongly resembles the Asiatic cholera, but must not be mistaken for the latter. These cases differ particularly from the Asiatic cholera, inasmuch as they are merely sporadic in their character, the evacuations being mostly of a bilious nature, and the attacks themselves are not as severe, nor have they the significance of the former. The recovery is usually very rapid. If the symptoms of cholera manifest themselves more clearly, if vomiting and diarrhoea increase, and if the evacuations show the characteristic rice-water evacuations, no time should be lost in calling 456 MISCELLANEOUS DISEASES. in medical assistance. In the meantime, and until the arrival of the physician, which, particularly in the country, may be delayed for some time, the vomiting diarrhoea and sensation of coldness should be checked as much as possible by administering to the patient warm peppermint tea, even if it should be thrown up again every time, or by administering the so-called Lobcavitz camphor drops, consisting of a mixture of dissolved camphor and tincture of burnt rye ; dose, every quarter of an hour one or two drops, and if the symptoms appear very alarming, four or five drops in water, or on sugar. Where these do not have any effect, administer the Russian drops : ethereal tincture of valerian twenty grains, ipecac five grains, saffran opium tincture three grains, oil of peppermint two grains ; dose, from twenty to thirty drops every hour. It is there- fore advisable to keep these remedies in the house, in case of emergency. As a drink, administer to the cholera patient little lumps of ice, which are more apt to remain on the rebellious stomach. To quiet the cramps as much as possible, and to excite the activity of the skin, and also to assuage fear, place strong mustard plasters on the cardiac and gastric region; brush the calves of the legs and thighs incessantly with coarse flannel, which may be moistened either with spirits of sal-ammoniac alone, or with a mixture of one ounce of spirit of sal-ammoniac and six and one-half ounces of angelica spirits. The repeated bathing of the whole body with cold water, and envel- oping it in flannel, has frequently proved beneficial. The following remedy has been prescribed with great success : Cassia, powdered ^ ounce. Cloves, " - y& " Nutmeg, " - - - y 2 " Guiac, " - - - J4 " Spirits of wine, - i pint. Mix ; dose, one teaspoonful every half hour until relieved. Another: Good old red wine, - - i pint. Ginger, 2 ounces. Cassia, - - - - 1 ounce. Mix the whole of it together, boil for four minutes, and administer every half hour four tablespoonsful, hot. The patient is placed in a ASIATIC CHOLERA. 457 good warm bed, and hot applications are made to the abdomen, until he breaks out in a heavy perspiration. Another , ounce. Orange peel, - Nutmeg, - Cloves, - Peruvian bark, - Gentian root, - Castoreum, - Guiac, - Acorn juice, - The whole of these ingredients are placed in a bottle or stone jug, and one quart of spirits of wine poured on them, and kept at moder- ate temperature for a few weeks. It is then filtered through filtering paper into another bottle, and kept for use. When first attacked with cholera, twenty-five to thirty drops are to be taken ; if the dis- ease has already developed itself, administer a teaspoonful every half hour until relieved. It need hardly be feared that anyone, be it a nursing baby, child, or adult, will die of summer complaint, dysen- tery, diarrhoea, or cholera, if the remedy is administered according to the above prescription. I have used it in my practice with good effect, and it has acquired a great reputation in all cases of cholera. To children from three months to two years old, administer from five to ten drops every hour; to older children, from fifteen to thirty drops every hour according to age. Another ; Spirits of camphor, - - - 4 grains. Laudanum, .... 3 drachms. Oil of peppermint, - - 40 drops. Oil of anis, - - - - 50 " Oil of cinnamon, - - 40 " Mix well and shake before using it ; dose, half a teaspoonful every half hour. In case the attack should increase in severity, administer every half hour a teaspoonful, until relieved. Place hot bricks to the soles of the feet, and other heated materials to the thighs and abdo- men. 458 MISCELLANEOUS DISEASES. Another : Tincture of an is, - - - 2 grains. " " Spanish pepper, - 2 " " " opium, 1 grain. " " cinnamon, - - 2 grains. Spirits of camphor, - - - 3 " Mix thoroughly, and shake well before taking it ; dose, from four to forty drops, according to the age and condition of the patient. In- stead of water, give to the patient a small piece of ice. Where ice cannot be had, give acorn coffee. Another : Spirits of sal-ammoniac, Spirits of camphor, Hoffmann's anodyne, - Tincture of ginger, " " Spanish pepper, - " " opium, Mix well ; dose for an adult, a teaspoonful every half hour until relieved ; dose for children, from three to twenty drops every half hour. 3 grains. 3 " 2 " 1 ounce. 2 grains. 2 " Another : Cinnamon water, Tincture of opium, Spiced formate spirit, - Spirits of camphor, Mix well ; dose, from a teaspoonful to a hour. To be well shaken before taking, sweetened with sugar. Another: Castor, - Gentian, - Valerian, ... Sulphur, - - Blackberry leaves, Camphor, - Spirits of wine, 3 ounces, 2 grains. 3 ounces. 2 " tablespoonful every half If preferred, it may be 2 ounces. 2 3 " 1 ounce. 2 ounces. 1 ounce. 3 pints. ASIATIC CHOLERA. 459 Let the whole macerate for two weeks ; dose, a teaspoonful every half hour. In case of great necessity, a teaspoonful may be given every fifteen minutes. Dose for children, from five to thirty drops every half hour. This medicine should be in every house, or in every family, so that it may be immediately applied in case of a cholera attack. Another : Brandy, 3 pints. Cinnamon, - - - 3 ounces. Cloves, - - - - 3 " Ginger, - - - - 2 " Myrrh, - - - - 1 ounce. Gum guiac, - - - 1 " Powder these ingredients coarsely, let the mixture macerate in a bot- tle or jug with the brandy for fourteen days, shaking it up well twice or three times a day, in order to prevent its caking firmly at the bottom, then filter through filtering paper, and press out the residue ; to this liquid add oil of peppermint and anisseed, two grains of each, and five ounces of spirits of wine ; mix the oils thoroughly with the spirits of wine in a bottle, and then add it to the liquid first obtained. Dose, one or two teaspoonsful every half hour, according to the urgency of the case. Another ; Spirits of camphor, 1 ounce. Tincture of opium, - - 2 grains. " " rhubarb, - - - 2 " " " myrrh, - - 2 " Dose for children from one to five years, from three to ten drops • for adults, from twenty to sixty drops every hour. In case of dysen- tery, administer an injection of warm port wine. Another : As a drink, give decoctions of oatmeal gruel, linseed meal, salep, &c, make embrocations of warm spirits of camphor, or spirits of hartshorn, formate spirits, or apply a good stomach plaster (see " Stomach Plaster "). 460 MISCELLANEOUS DISEASES. DYSENTERY. Dysentery appears mostly as an epidemic, passing through whole sections of country. It is a catarrhal, rheumatic difficulty of the lower part of the intestinal canal, with a severe bearing-down pres- sure for evacuations, severe pain in the bowels, and a discharge of slimy, bilious, and frequently bloody fluid. Sometimes, however, it is unattended by any evacuation, when the faeces remain in the upper part of the intestinal canal, the anus at the same time being strongly pressed outward ; it is connected with urinary difficulties and fever, increasing towards evening. The skin is hot and dry, connected with great thirst. The pressure for evacuation is infrequent at first, but in- creases subsequently to such an extent that the patient scarcely leaves the close-stool. The substance of the evacuations grows constantly thinner, frequently watery, purulent, bloody, or somewhat putrid. By degrees all these symptoms decrease again, the evacuations become more regular, and a critical perspiration and urine set in. During con- valescence the patient is inclined to relapses, and not rarely suffers from diarrhoea and constipation. The result, however, is not always favorable. Frequently inflammation and mortification of the bowels set in, as a consequence of the retention of the faeces in the intestinal canal. At other times the evacuations become terribly exhausting, and carry off the patient. Again the malady changes to liver com- plaint, jaundice, and dropsy, and in other instances the fever is so malignant as to produce a fatal result. When at its height, dysentery becomes infectuous, particularly if accompanied by nervous and putrid fevers. Frequently epidemic influences are the causes of this disease, par- ticularly during the hot season ; also colds, eating food and using bev- erages, which either sour or ferment on the stomach, particularly unripe fruit, melons, drinking bad beer, &c. From what has been said above, it will be readily perceived that dysentery may assume different phases, and it must therefore be treated accordingly. Under such circum- stances it is advisable to call in a physician without delay. In general, the treatment should be as follows : The room occu- pied by the patient should be of equable temperature, and he should be carefully protected against taking cold ; he should keep the bed, DYSENTERY. 461 and use a bed-pan or close-stool pan, which may be placed under him in bed ; the utmost cleanliness should be observed, and if anything should have happened requiring it, his personal as well as the bed linen should be changed after having been carefully aired and thoroughly warmed. The evacuations and soiled linen should be at once removed from the bed chamber, and the room fumigated with vinegar. The food for the patient should be of a mucilaginous character, such as soups made of rice, sago, barley, decoctions of marshmallow, salep, oatmeal, almond milk, &c. ; the drinks administered to him should be of a similar nature. To remove the violent bearing-down pressure attending the attempts at evacuation, apply to the anus a sponge dipped in warm milk, or in warm oil, or a cloth dipped in warm mucilaginous decoctions, or apply the following embroca- tions in the same place: marshmallow ointment half an ounce, fluid laudanum half a drachm, mix, and rub in four or five times a day, until relief is obtained ; or the hot vapors of camomile, valerian, or elder blossom tea may be applied to the anus, by pouring these fluids boil- ing hot into a chamber and causing the patient to sit down on it. Oily, mucilaginous, and quieting injections should also be adminis- tered ; apply warm poultices (see " Poultices ") to the abdomen, and rub in softening, anodyne ointments, such as opodeldoc, nervous ointment, mace ointment, &c. An effort should be made to induce perspiration through elder, camomile and peppermint tea, Dover's powders (see "Dovers Powder"), liquid sal-ammoniac, &c. Another : Take of pulp of tamarinds and manna half an ounce of each, boil in eight ounces of water until reduced to seven and one - half ounces, strain, and add half an ounce of raspberry juice ; dose, a tablespoonful every two hours. This remedy may be taken for twenty-four hours, when it is discontinued, and the following substi- tuted : Gum arabic mucilage, - - i ounce. Water, .... 6 ounces. Fluid laudanum, - - - - 16 drops. Marshmallow juice, i ounce. Dose, one tablespoonful every two hours ; in urgent cases administer a tablespoonful every hour. In cases inclined to be inflammatory, administer the following remedy : 462 MISCELLANEOUS DISEASES. Nitrate of potassa, 3 grains. Milk of almonds, - - - 6 ounces. Gum arabic mucilage, 1 ounce. Bitter almond water, - - 8 grains. Sugar, - - . - ^ ounce. Dose, a tablespoonful every hour. If the disease increases, a physi- cian should be called in. To remove severe pain in the bowels, warm poultices should be applied (see " Poultices)". The attempt to cure dysentery with wine, whisky, or other checking remedies, is the height of folly ; it will only result in the most serious consequences. Another remedy : Take dry opium, gum kino, manna, cloves and cinnamon, half an ounce of each, triturate to a coarse powder, pour over it one pint of brandy, let it macerate several weeks, shaking it up daily, strain and press ; dose for an adult, from twenty to fifty drops every four hours, according to the patient's condition; dose for children, from three to ten drops, according to age ; to be repeated until the condition of the patient improves. DIARRHCEA. Diarrhoea is a rapidly repeated evacuation of a soft or fluid consist- ency from the bowels. We will pass by the cases when the diarrhoea is critical, or when it appears in consequence of a prece ding disease, and consider it only as an independent disease. As such it manifests itself as a catarrhal difficulty of the intestinal canal, or after taking cold, particularly in the bowels, or in consequence of cold feet, or it is the result of dietetic digression, particularly of eating unripe fruit, indigestible and easily formenting fruit and drinks. It also results from relaxation and mucous obstruction of the intestinal canal, par- ticularly in hemorrhoids ; interrupted cutaneous eruptions and blen- norhoea. In cases of diarrhoea, which must never be suddenly checked, mu- cilaginous drinks, such as oatmeal gruel, barley water, decoctions of linseed, salep, sago, marshmallow root, emulsions of gum arabic, &c, are of much benefit. The abdomen and feet should be kept warm DIARRHCEA. 463 with flannel coverings. If the stomach is very painful, apply warm poultices, and otherwise pursue the same treatment as in cases of colic. In a case of diarrhoea resulting from cold, sudorific remedies are required. They are the same as those enumerated in the article treat- ing of " Colic." Dovers powder is particularly applicable under the circumstances. Diarrhoea, caused by indigestible food, usually disappears after the use of the mentioned mucilaginous remedies. In cases of acidity of the stomach, which manifests itself by sour belching, carbonate of magnesia may be administered, ateaspoonful at a time, stirred in water. If the evacuations are excessive, and followed by weakness and debility, injections of starch should be made, adding, if necessary, from fifteen to twenty drops of Sydenham's laudanum ; the use of mucilaginous remedies and aromatic, warm poultices on the abdomen being continued. Internally administer opium, from one-third to one-half of a grain, with ten grains of fennel sugar, made into powder, three or four times a day. Besides that give bitter and aromatic drinks of flag root, quassia, gentian, also hot wine, Whytt's elixir or Hoffmann's stomach elixir, to be taken several times a day, in doses from twenty to thirty drops. In cases of long stand- ing, a physician should be consulted. The diarrhoea attacking children during dentition, should under no circumstances be suddenly checked. If, however, there is reason to believe that the child is losing strength too fast, rhubarb should be constantly administered, preferably the vinous tincture, in doses from six to ten drops, in connection with gum arabic and black cherry water, in the following proportions : Vinous tincture of rhubarb, 2 scruples. Gum arabic mucilage, - - "3 drachms. Black cherry water, - - - 5 " Mix ; dose, a teaspoonful every three hours. Besides that, apply embrocations to the abdomen of oil of mace, or nervous ointment, two or three times a day. 464 MISCELLANEOUS DISEASES. OBSTRUCTION OF STOOL-CONSTIPATION. We do not speak here of the constipation which not rarely accom- panies other diseases, for instance colic, but of habitual costiveness, and stools at great intervals. The following may be enumerated among the causes for this trouble : It results from a bad habit of carelessness, and a certain amount of indolence in this respect, from dry, heavy, insipid food (legumes), heavy food prepared from flour, chestnuts, nuts, almonds, insufficient use of liquids — therefore more frequent in women than in men — or from the daily use of spirituous drinks, such as wine, whisky; sedentary habits, but also constant driving and riding on horseback, lacing of the abdomen, inactive secretion of gall, in which case the faeces have only a light yellow color, bordering more on white, sluggishness, cramp or paralytic weakness of the intestines, and particularly an ex- cessive expansion of the rectum; in the latter case the faeces are frequently forced out in hard lumps as large as a fist. Constant costiveness causes headache, inclination to vomiting, colic, and other abdominal complaints. Costiveness produces a particularly bad effect on hypochondriacs and nervous women. There are per- sons, however, who may not, for some time, feel immediate bad results from continued costiveness; but eventually, perhaps after some years, this pernicious habit will be the cause of many difficulties, because the faeces harden, and frequently accumulate in the intestines in incredible quantities. This is particularly the case with women, .but also frequently with men. These accumulations cause pain, sensi- tiveness, hardness, and enlargement in the right epigastric region; the patient has a bilious appearance, and frequently complains of pain in the right shoulder. At times he is subject to violent colic pains, particularly if flatulence is present, or after a cold. These symptoms may readily lead to mistakes, as they greatly resemble those of inflam- mation of the liver; it is only if the constipation is taken in con- sideration, to which the patient has been subject perhaps years previously, and from which he may not even suffer at that time, that the true cause of his disease is discovered. In other cases, the patient does not constantly suffer from local difficulties in the abdomen, but he is frequently attacked by vomiting and pain in the bowels, particu- OBSTRUCTION OF STOOL — CONSTIPATION. 465 larly if flatulency is present, or after colds. The circumstance that the attack was ostensibly the result of a known cause, for instance, of a violation of the laws of diet, or of cold, may easily deceive, and the accumulation of the fseces, the true cause of it, be overlooked ; unless these are removed, the attacks will recur again. The cure of these difficulties must, under such circumstances, pro- gress without any other aid, as they are frequently overlooked by physicians. It is therefore necessary that the attention of the reader should be directed to the fact, so that he may, at least, have an idea of it, and inform his physician of the circumstance, although the constipation may have ceased years ago, and he be no longer subject to it. In order to prevent this troublesome malady, constipation, it is desirable to acquire the habit of going regularly every morning, at a certain time, to the water closet. Even should the attempt at evacuation be unsuccessful for several days, yet the body becomes habituated to the fulfillment of this function, just as much as it does to the reception of food at certain hours of the day, and for which it regularly craves. Persons inclined to costiveness must endeavor to relieve themselves of it by diet, otherwise they will in time suffer from it more severely ; it will eventually lead to a disarrangement of the digestive organs. Above all, they should drink a great deal, particu- larly light beer or water ; the latter should not be hard, however. The food should be rich in juice, and operate gently on the bowels ; for that purpose juicy vegetables, fruits, particularly apples, prunes, grapes, &c. , are conducive. All dry, heavy food must be avoided ; bread made of pure rye, or from a mixture of rye and wheat flour, is preferable to wheat bread. It is also injurious to keep the body too warm, and to perspire too much. For that reason costiveness is noticed as a result of Russian steam baths, and for the same reason patients suffering from costiveness should not lie in bed too late in the morning. Nothing promotes evacuations of the bowels more than a moderate walk out of doors ; if prevented to take the accustomed exercise, rub the whole body, but more particularly the abdomen, with flannel, and wash it morning and evening with cold water. If all this does not produce the desired effect, apply two or three injec- tions of cold water each day. They are never injurious, and cure constipation thoroughly by strengthening the intestinal canal. 30 466 MISCELLANEOUS DISEASES. For feeble children, who, in consequence of weakness of the bowels, suffer from constipation and expansion of the rectum, besides injec- tions of cold water, the use of acorn coffee is very beneficial. If forced to apply internal remedies, the following can be recommended: refined cream of tartar one and one-half ounces, small raisins one and one-half ounces ; pour on this one quart of hot water, let it boil up gently a few times, and then strain. Dose for nursing children, two tablespoonsful a day, and for adults, from three to four table- spoonsful. Another : Senna leaves, stripped from the stems, four grains, pour on them a large cupful of cold water, let it stand over night in a covered vessel, and then strain. With the water thus obtained, pre- pare a cup of ordinary coffee, and drink with sugar and milk. This remedy does not cause any pain in the bowels, and does not purge. However, should such be the case, a smaller quantity of senna leaves should be taken. It is particularly adapted for hypochondriacs and woman, even if at the time she should be nursing a child. The taste of this senna coffee is not disagreeable, and induces a movement of the bowels, without the pain usually caused by senna ; its use may be continued, if the irritability of the intestinal canal is not too great. Where the inclination to costiveness is persistent, St. Germain tea, for older persons, has justly acquired a great reputation (see " St. Germain Tea"). Another : Take aloes and sulphate of iron, three grains of each, make into forty-five pills \ dose, one pill every evening. Another : Pulp of tamarind one ounce, small raisins two ounces, six figs, boil in two quarts of water until reduced to one quart, let it get cold, and administer to the patient a cupful at a time, as fre- quently as he wants to take it. JAUNDICE. This disease manifests itself first by the white of the eye turning yellow, which is followed by the face, and by degrees by the rest of the body. In more rare cases, everything looks yellow to the patient ; the other fluids of the body, such as saliva and urine, also have a JAUNDICE. 467 yellow color. Derangement of the digestive organs is usually con- nected with it, because the secreted gall is prevented from entering the intestinal canal, and therefore is carried by the blood to the sur- face of the body; hence the yellow color. The evacuations are clayey, whitish, or grey ; the patient has no appetite, and a bitter taste in his mouth ; he is also troubled with cardialgia and oppression of the chest. Diseases of the^ liver, or of the biliary ducts, are the causes of this malady, as, for instance, inflammation, swelling, indu- ration of the liver, contraction of the biliary ducts, stones in the same, &c. In such cases, the cure of jaundice depends on the cure of the disease inducing it. The lighter cases are usually induced by impurities in the stomach and intestinal canal, excitement of the mind, such as anger, wrath, and colds. The treatnient should be directed to the removal of the noxiou s substances from the body, and to the restoration of the digestive organs to a healthy condition. The patient should observe the strictest diet, abstain from the use of all stimulating and heating drinks and food, such as coffee, tea, wine, whisky, and meats. He should use cooling, acidulated drinks, light soups, decoctions of fruits, with cream of tartar, and take mild laxatives (see " Laxa- tives"). If the jaundice is the result of a cold, sudorific remedies should be administered. The following are generally known as popu- lar remedies against jaundice : the juice of carrots, cucumbers, com- mon houseleek, celandine leaves, the daily use of the yolks of several eggs ; also a decoction of small raisins and linseed, the use of fruits, particularly of strawberries ; looking into a barrel of tar is claimed to be a remedial agent in attacks of jaundice. In case of serious attacks of the liver and biliary ducts, the advice of a physician should be procured. Jaundice in newly born children disappears of its own accord. If jaundice is the result of gall-stones, sudden violent pains, yellow color of the skin, and deficiency of gall in evacuations are the result, without being preceded by any other general derangements of health ; the pain in the hepatic region is much more violent than in inflam- mation of the liver. Between these attacks of violent pain, the patient has intervals of complete rest. At other times, a gnawing feeling is constantly felt in the place where the pain has been. Some- 468 MISCELLANEOUS DISEASES. times this condition continues for a very long time, and yet the patient recovers. If a fever sets in at the same time, the case becomes much more aggravated, because it indicates inflammation, which, in these cases, is always very dangerous. The following is the treatment for this kind of jaundice : In order to prevent inflammation, and in order to relax the spasmodic tension which retains the stone in the excretory ducts of the gall-bladder, one of the veins should be opened, if the strength of the patient will admit of it, or at least fifteen or twenty leeches must be applied to the painful spot of the abdomen. Aside of that, lukewarm half-baths of milk, soap and bran are desirable. Another : Take six quarts of bran, place it in a small bag and boil in from eight to twelve quarts of milk, then pour the decoction as well as the bag in the bath. Three ounces of soap may be dissolved in the milk according to circumstances. Antispasmodic and Pain-soothing Poultices. — Linseed four ounces, hemlock leaves one and one-half ounces, henbane one ounce, boil it with water to a middling solid mass, then add one ounce of oil of henbane ; apply it lukewarm. Embrocation for the same purpose. — Olive oil six ounces, spirit of sal-ammoniac one ounce, tincture of opium six grains, camphor four grains ; rub in with the hand, or saturate a piece of flannel and apply it to the place. Another : Opium two grains, marshmallow ointment one ounce ; rub in a piece of the size of a hazel nut, if pain is severe. Another : Emollient injections : one half ounce of herbs, water one pint, boil until reduced to one-half, strain, and use it for an in- jection. After that, use a strong purgative acting on the intestinal canal. Take powdered jalap six decigrammes, calomel twenty-five to thirty centigrammes, sugar four grains ; prepare three powders like these. If the first does not operate within three or four hours, ad- minister the second. When the second has done operating, it is best to quiet the pain in the bowels which follows, by using camomile tea, or oatmeal gruel. After that administer the following powder : watery extract of opium three centigrammes, sugar one grain, prepare three powders of that kind \ dose, one powder every three hours. JAUNDICE. 469 This treatment must be continued until the pain has ceased, and the evacuations have assumed a yellowish and therefore bilious color- ing. When that occurs, the stone has passed off, and the malady is removed for the time being. Usually there are several stones of that kind in the gall-bladder, which cause a repetition of the same condi- tion. In order to prevent this, treatment for the gall-stone must be pro- ceeded with (see "Gall-stone"). The best remedy to prevent another formation of gall-stone is the use of the Karlsbad waters for several weeks, and the observation of a diet for weeks, strictly exclud- ing all acid and fat food, and therefore also butter. Degeneracy of the substance of the liver, its excessive enlargement, fatty degenera- tion or cancer of the same, usually bring obstinate jaundice with them in their train, which, however, remains incurable, because the cause itself cannot be removed. Intermittent fever is also frequently fol- lowed by jaundice, of which we have already treated (see " Intermit- tent Fever"). In cases of spasmodic jaundice, the symptoms of an inflammatory condition, above mentioned, are wanting. In some respects it resem- bles the above described species of that disease, but nevertheless differs from them in two ways. First, pressure diminishes pain in this case, whilst in the other it is considerably increased ; secondly, the attack appears more suddenly and unexpectedly than in the former. In jaundice, resulting from gall-stone, the patient constantly feels a certain amount of pain and uneasiness, previous to the break- ing out of the attack, while in spasmodic jaundice the symptoms appear at once and unexpectedly. The disease is also counected with other hysterical symptoms and cramps, and for that reason the urine voided is clear. It attacks particularly hysterical women and hy- pochondriacal, nervous persons, and orignates particularly in conse- quence of sudden and violent emotions, or from the use of heavy indigestible food. Frequently it ceases with the exit of flatulence above and below. In the first instance, administer from ten to fifteen drops of tinc- ture of colocynths (given in oatmeal gruel or marshmallow tea), which will operate on the intestinal canal. Then give an injection of assa- fcetida powder from two to four grains, well incorporated in the yolk of 470 MISCELLANEOUS DISEASES. an egg, and mixed with an oatmeal or camomile decoction. Then let the patient take the following drops : empyrematic spirits of hartshorn, ethereal tincture of valerian, four grains of each, tincture of saff- ron and opium two grains; dose, from fifteen to thirty drops on sugar every quarter or half hour. If, from inactive stool, obstructions occur in the abdomen, which cause the jaundice, the following medicine is to be administered : extract of dandelion, extract of celandine leaves, twelve grains of each, tartrate of potassa half an ounce, watery tincture of rhubarb one ounce, peppermint water two ounces, distilled water four ounces, syrup of peppermint one ounce ; dose, a tablespoonful every two hours. Another: Rhubarb powder, extract of dandelion and celandine leaves, medicated soap, ammoniac, four grains of each, aloe one grain, make into one hundred and fifty pills ; dose, eight pills three times a day. Another : Extract of aloes, improved by sulphuric acid, four grains, marshmallow root six decigrammes, make into thirty pills; dose, one or two every noon. If the disease is very obstinate, a physician should be called in. OBESITY. Obesity is the inclination of the body to an excessive formation of fat ; it may lead to difficulties, attack of diseases, and even death. The morbid condition, in consequence of a too rapid formation of fat, manifests itself by lassitude after even the slightest exertion, or even after walking. The patient also suffers from difficulty of breath- ing, palpitation of the heart, oppression of the chest, and profuse perspiration. For that reason he loves rest, which is most pleasant to him, but which at the same time helps to increase the malady. The appetite of the patient is usually good, and, occasionally, borders even on voracity ; the stool is inactive, and all food is converted, so to say, into fat. These difficulties increase all the more, the more the fine organisms, such as the heart, lungs, &c, are surrounded and troubled by fat. If the treatment of this condition is to be successful, the patient must abandon his lazy mode of life ; he must at first take very moderate exercise, adapted to his bodily condition, but must subse- PALPITATION OF THE HEART. 471 quently constantly increase it. He must avoid all dishes of which flour is the principal part, and also strong meats and drinks, particu- larly strong beer and wine ; he must not sleep too much, and rest on a hair mattrass instead of a feather bed. The best occupation for him is one requiring physical exertion, such as gardening, turning, sawing wood, or similar work, which may be changed according to the condition and sex of the patient. If it otherwise agrees with him, cold water baths may be taken ; but, aside of that, the use of bitter-water, and also the water of the Karlsbad springs, are useful. Occasionally light laxatives, particularly calomel, manna, aloes, or rhubarb, may be taken. In high repute is white soap, dissolved in water, beginning with a drachm, and subsequently increased to half an ounce ; this should be taken every evening, and continued for a long time. For an ordinary drink, obese patients may use lemonade and vinegar, diluted with water ; the latter should be used only in limited quantities, as the effect may sometimes be fatal. Where suffo- cation is threatened, free bleeding is sometimes required. PALPITATION OF THE HEART. By the continuous influx and efflux of the blood, the heart is kept in incessant motion. This motion is frequently increased by physical exertion in running, dancing, &c, and also by emotions of the mind, such as Tright, anguish, &c, when the beating of the heart may be distinctly heard. If a person is in good health, this condi- tion soon passes by without leaving any bad effects. It is entirely different, however, if the beating of the heart is increased by a mor- bid state. It either continues in this excited condition without inter- ruption, or it sets in with the least exertion, for instance in ascending stairs, or mountains, or even by assuming a sitting position after lying down. This kind of palpitation of the heart may be caused by a disease of that organ itself, or it may be the result of many other diseases, a description of which, however, cannot be entered into here. I will, therefore, give some general rules only, which should be strictly observed by people suffering from palpitation of the heart. The patient must abstain from every excessive exertion, such as run- ning, dancing, &c, he should take moderate exercise, with proper 472 MISCELLANEOUS DISEASES. intervals of rest, and strictly avoid all spirituous beverages, strong beer, and particularly coffee. He should take cooling drinks, such as sugar-water, lemonade, water in which cream of tartar is dissolved, or containing a little wine vinegar. He should moderately eat of easily digestible food, but never immediately before going to bed ; his stools should be daily and regular, and, if necessary, with the aid of mild laxatives. In cases of palpitation of the heart of long dura- tion, a physician should be consulted. HOARSENESS. Hoarseness is always an indication that the trachea or larynx are affected in some way ; it is always accompanied by catarrh. Remedies applied for the removal of the latter, will also remove the former. Keep the throat warm, and wear flannel or a woolen necktie around it. If the hoarseness is very severe, apply a mustard plaster over the larynx, and do not remove it until it has drawn a red spot. A Spanish fly plaster may be applied to the side of the throat, or croton oil may be rubbed in. Internally administer mucilaginous, sweet remedies, such as barley sugar, raw eggs, with sugar, &c. When the inflammation of the throat has been reduced somewhat, apply gargles, as directed under the head of " Catarrh." Radish juice, mixed with sugar, administered a teaspoonful at a time, will afford relief. Par- ticular care should be taken of children, if they are hoarse, as it may easily change into croup. A well endorsed remedy againt hoarseness : Three ounces squill root, three ounces freshly grated horseradish, pour over it one quart of good wine vinegar, let it stand over night, then add half a pint of honey, bring it to a boil, strain through a cloth, and press it ; dose, one or two teaspoonsful several times a day. This is an excellent remedy against hoarseness, difficulty in speaking, and ordinary cough. ASTHMA. Asthma, sometimes also called spasm in the chest, manifests itself by difficult, labored breathing, anguish and oppression, and creates a feeling as if the chest was being tightly contracted, threatening im- ASTHMA. 473 mediate suffocation, which, in factj does sometimes occur in extreme cases. The malady originates usually at night, sometimes while the patient is very soundly asleep. He suddenly raises himself up in bed, gasps for breath, perhaps jumps out of bed, tears open a window to find relief by inhaling fresh air. The breathing of the patient is accompanied by a rattling or whistling in the throat. The attack may last one or more hours, when the bad symptoms pass off, and the usual condition of health returns, leaving no other traces behind, ex- cept lassitude. Upon the whole, the malady seems to consist of a spasmodic condition, the nature of which is not exactly known. The disease is caused by the inhalation of noxious vapors, suppression or' cutaneous eruptions, and foot sweating, bleeding hemorrhoids, and rapid healing of ulcers. Sometimes the malady is inherited, and is called out by the smallest provocation. Treatment : In case of an attack, place the patient in an upright position, if he has not already assumed it of his own accord ; loosen all tight garments which he may wear, rub his arms, legs, and breast hard with flannel cloths, and, what affords still greater relief, let him take foot or arm baths ; let him drink camomile or elder blossom tea. The following are excellent house remedies : In a case of moist asthma, or where the spasm in the chest is connected with a strong secretion of mucus, the daily use of speedwell tea is beneficial, also the expressed juice of radishes, several tablespoonsful taken every morning, or grated horseradish, mixed with honey, a tablespoon ful before going to bed. But where there is no expectoration, an in- fusion of anis tea is very effectual. Mustard is also a highly recom- mended remedy : take morning and evening a teaspoonful of bruised yellow mustard, in broth or tea, and also smoke from a clay pipe the leaves, stems and root of the thorn-apple, gathered in the month of October. Where danger of suffocation is very great, the application of a pitch or mustard plaster on the chest frequently affords quick relief. Nervous asthma is relieved by the application of dry cupping- cups on the chest ; valerian tea should be administered at the same time. Frequently, in case of congestion of the chest, bleeding affords instantaneous relief. Animal magnetism is also one of the principal remedies in spasm in the chest. These remedies are not always sufficient, however, to remove the malady entirely, and for that 474 MISCELLANEOUS DISEASES. reason the cause of the disease itself should be removed. Suppressed sweating of feet, hemorrhages, ulcers, cutaneous diseases, should be restored, or a seton should be applied ai a revulsive, which of course must be done with the advice of a physician. Asthma resulting from nervous affections, requires antispasmodic and nervine remedies. To stout persons, where the asthma is connected with mucous ex- pectorations and rattling in the chest, the following remedies are administered with beneficial results : half a drachm of golden sul- phuret, half an ounce gum ammoniac, half an ounce licorice, made into two-grain pills ; dose, five to eight pills three times a day. Or, one drachm extract of myrrh, two drachms extract of marrubium, two drachms gum ammoniac, one drachm golden sulphuret, three drachms refined licorice, made into two-grain pills ; dose, from four to six pills a day. The diet should be very regular ; abstain from all heating drinks and food, and avoid emotions of every kind, anger, wrath, fright, &c. The following kinds of asthma remain to be noticed : ASTHMA OF HYPOCHONDRIACS AND HYSTERICAL PERSONS. The attack may rise to such a height as to make the patient appear as if in a stupor or asphyxia. The attack usually ends with a violent shock through the whole body, and general convulsive motions, and a rolling sensation in the abdomen. Notwithstanding the extraor- dinary violence of these attacks, there is never any danger connected with them ; they disappear as suddenly as they come. To remove the attack as quickly as possible, administer the follow- ing remedy : anti-hysterical water thirty grains, orange blossom water two ounces ; dose, take a tablespoon ful repeatedly. Sometimes the patient has eaten some flatulent food, when the following should be administered : tincture of castor, and Hoffmann's anodyne, equal parts of each; dose, from twenty to thirty drops. An antispasmodic injection should be administered, for which purpose take powdered assafcetida three grains, stir well with the yolk of an egg, and mix with oatmeal gruel and a decoction of camomile. If the attack is caused by anger, effervescing powders are of good service : take tar- SPASMODIC SHORTNESS OF BREATH. 475 trate of soda two grains, put in white paper ; take two grains of tartaric acid and put in blue paper ; the powder in the white paper is dissolved in a glass of sugar-water, with which the powder in the blue paper is mixed ; the mixture is drank while in a state of effervescence ; or the following soothing powder may be administered : take saltpetre four grains, tartrate of potassa half an ounce, divide into ten powders ; dose, three powders a day. If the attack is the result of eating sour things, administer the following pills : medical soap and assafcetida, four grains of each, pulverized orange peel six deci- grammes, make into forty-five pills ; dose, four pills twice a day. In taking cold, and particularly from cold feet, use warm foot-baths, pre- ferably ash- baths. These, and warm clothing, will greatly relieve the patient, and aid in his rapid recovery from every kind of asthma, if the attack is not the result of a congestion of blood to the lungs. SPASMODIC SHORTNESS OF BREATH. The attacks of this malady come frequently very sudden, without any cause, and without previous symptoms. Frequently, however, they are preceded by headaches, pains in the neck, watery urine, restless sleep, peevishness, and a peculiar dullness of the mind. The first attack usually occurs at night. In awakening suddenly, considerable oppression of the chest is experienced, a feeling like constriction. The patient wheezes, gasps for air, expresses great anxiety, cannot remain lying in a horizontal position, and is very anxious for cool air. The attack continues some minutes, but sometimes from half an hour to an hour ; the highest degree of this kind of asthma is the so-called suffocative catarrh. The attack begins with a feeling of exceedingly great fear, and the patient lies almost in a swoon, is covered by a cold sweat, his limbs are cold, and he becomes unconscious. His face is either pale, and the whole body in a kind of paralytic condition, or it is red, with a terrible pressure to the head, dizziness, insensibility, and drowsiness, which finally passes into somnolence. The danger of suffocation or apoplexy is very great under these circumstances. Asthma of a milder degree generally passes subsequently into moist asthma. The reasons for it have been given above. Bleeding is, be- yond all question, one of the most effectual remedies, particularly 4T6 MISCELLANEOUS DISEASES. where there is great congestion of blood to the breast and head. Bleed- ing would, however, be out of place where the patient has a pale face, is very weak, and has nervous fainting fits, nor must it be repeated too often, else it leads inevitably to dropsy on the chest. In this case em- brocations with spirits of sal-ammoniac are of great benefit. Previous, and after the application of the sal-ammoniac, hot cloths are placed on the chest ; these remedies and warm baths soon overcome the asthma, particularly in children; bleeding would kill them. But where bleeding is found necessary, give to adults the following spas- modic drops : empyrematic spirits of hartshorn, and ethereal tincture of valerian, four grains of each, tincture of saffron and opium two grains ; dose, from fifteen to thirty drops every hour, to be taken on sugar. Give foot-baths, prepared with mustard and ashes, cover hands and feet with flannel, which has been steeped in hot camomile tea, and adminis- ter injections, prepared as follows : powdered assafcetida from two to four grains, rub it up well with the yolk of an egg, and mix it with suf- ficient oatmeal gruel, or a decoction of camomile tea, and ten drops of tincture of opium (the opium must be omitted in an injection for children) ; rub the thighs, chest, and soles of the feet. Bandaging tightly the arms above the elbows, and the feet above the knees, affords great relief during the attack. The smoking of the leaves and stems of the thorn-apple, either alone or mixed with a little tobacco, has proved to be very efficient in quickly checking the attack. Some care should be taken in the smoking, as it produces stupefaction ; it should be done at intervals, at first only from ten to fourteen draughts at a time, which may be gradually increased. With the overcoming of the attack, the disease is by no means removed ; a renewal of it may always be expected ; careful diet, and avoiding the cause of the attack, are essentially necessary. The patient must avoid all weaken- ing influences, particularly copulation ; his diet may consist of nourishing, but not of stimulating food ; he should be very moderate in the use of spirituous drinks, avoid exercise and physical exertion, but particularly taking cold, wear woolen underclothing next to the skin, and avoid dry and sharp air. The entire cure of the disease is exceedingly difficult, and most cases should be treated by a physi- cian. ASTHMA CAUSED BY CONGESTION FETID BREATH. 477 ASTHMA CAUSED BY CONGESTION. The patient, with a well-fed and thick-set body, always has an un- usually red, bloated face; the veins of the throat are largely swollen; he frequently suffers from violent palpitation of the heart, dizziness, buzzing in the ears, and also from nose-bleeding. The attacks are most violent, if the malady results from suddenly suppressed hemor- rhages, suppressed lochia, menstruation, and hemorrhoids. Hemor- rhoidal asthma is always accompanied by profuse secretion of mucous from the lungs. The attack is not quite so violent with old people, who have been subject to bleeding by artificial or natural means, and which have been discontinued, nor with individuals who have lost a foot or an arm, and also in well-nourished women, whose menses have ceased at the regular time, but too suddenly. Bleeding is quite necessary, even during the attack. After cessa- tion of the asthmatic attack, a repetition should be prevented by slen- der fare and abstinence from heating drinks ; a liberal use of water for drinking, short sleep, a good deal, but not too violent and heat- ing, exercise, and cold sitz-baths are beneficial. FETID BREATH. m This malady is less annoying to the party who is troubled with it, than to those with whom he comes in contact. This odor is either produced in the mouth itself, by neglecting the proper cleansing of the teeth, particularly when decayed, or when the gums are in a mor- bid condition, or when the saliva is in a bad state. It may also result from the stomach, if its functions are deranged, and digestion has become defective by reason of it ; it may also come from the lungs when in a morbid state. The offensive smell may either be of short duration or permanent ; the first, after eating strongly smelling food, such as onions, horseradish, mustard, cheese, &c. We propose to treat here of the permanent fetid smell only, as the transient smell usually disappears in the course of twenty-four hours, after the removal of the cause by the digestive process. The permanent fetid smell must be either removed, or at least concealed. If the fetid smell results from uncleanliness, the mouth must be frequently rinsed, 4*78 MISCELLANEOUS DISEASES. and moi'2 particularly after every meal ; the teeth should be brushed with powdered charcoal, or if they are hollow, they must either be filled, or stuffed with the material advised to be used under the head- ing " Odontalgic Remedies," so that no food may lodge in them. There are two principal remedies, which either absorb or entirely de- stroy the smell : they are charcoal powder and chlorine, in the shape of chloride of lime. Fresh-powdered charcoal destroys the smell origi nating in the mouth. For that purpose well burnt and powdered charcoal, prepared from linden wood, is generally taken. It is either used by itself or in connection with other substances (see " Tooth Powder "), or lozenges may be prepared from charcoal, gum mucilage and sugar, which may be kept in the mouth. The following com- pound can be recommended : powdered chocolate one and one-half ounces, finely powdered charcoal half an ounce, vanilla half a drachm, solution of tragacanth sufficient to make into small pastilles, weigh- ing one scruple each ; dose, from four to six a day ; put them in the mouth, and let them melt. Preparation of the chlorine : Take half an ounce of chloride of lime, which may be had at an apothecary's shop, rub it gradually together with four ounces of water, filter the solution from the sedi- ment, add to it two ounces of good spirits of wine, and to this mix- ture add a few drops of essential oil of lemon, cloves, or orange. .Pour one teaspoonful of it in a wine glass filled with water, and rinse your mouth with it. Or take one ounce of sugar and twenty grains of gum tragacanth, and make into a paste, with a sufficient quantity of a solution of chloride of lime, by triturating in a porcelain or glass mortar (a metallic mortar must not be used), add ethereal oil suf- ficient to give it a pleasant flavor, and form into small lozenges. Take one of these in your mouth, let it melt, and spit out the liquid. If the offensive breath is caused by spongy gums, or vitiated saliva, the following remedy may be used for rinsing the mouth ; a decoc- tion of loxa, oak, or willow bark, diluted watery tincture of myrrh ; or boil in wine : rosemary flowers and leaves, with a little cassia, myrrh, and benzoin, until reduced to one-half ; or pour vinegar on rosemary, sage, and oak or willow bark, let it stand, and pour it on the decayed teeth (see " Odontalgic Remedies "). INJURIES TO THE EYE. 479 INJURIES TO THE EYE. Any small substance, such as dust, sand, &c, which may fly into the eye, is usually washed out by the lachrimal fluid, which is excited in the eye by the irritation of this foreign substance. If necessary, it can be washed out with cold water. Larger bodies are removed from the eye by causing the eyelid to be lifted, and the foreign sub- stance brushed away with a very fine hair-pencil, or with the twisted end of a linen handkerchief. If cautic substances, such as tobacco, snuff, &c, have lodged in the eye, the hair-pencil or twisted end of the handkerchief should be moistened with a little mild oil. If in a blacksmith shop a red-hot scale of iron should have got into the eye, where it usually imbeds itself, it must be carefully removed with a blunt needle, or a fine pair of forceps ; cold poultices should then be applied to the eye. If spasmodic closing of the eyelids should result from it, the patient must be placed in a darkened room, and warm poultices, which should never become cold, must be applied to the eye. To the poultices a small quantity of Sydenham's laudanum or henbane may be added. If spots remain on the cornea, they are usually removed by the following remedy ; previous to its application, however, all inflammation of the eye must be removed. The remedy consists of eye-stone (white copperas) one grain, rosewater one and one-half ounces, Sydenham's laudanum and solution of gum arabic, half a drachm of each ; it is applied to the spot with a fine hair- pencil. If the spots are large, the following ointment should be used : red precipitate of mercury half a grain, Sydenham's laudanum one scruple, lard two drachms, well mixed ; a piece of the size of a pin head should be put in the eye. In case of a burning of the eyes, poultices of grated potatoes are applied to the closed eyes ; they must be frequently changed. In case of wounding the eye, cold water poultices should be applied, and a skillful occulist consulted (see "Inflammation of the Eye "). 480 MISCELLANEOUS DISEASES. PTERYGIUM. Pterygium is a thickening, to a greater or lesser extent, of the external films of the eye, which are permeated by many inflated vessels, showing, according to the condition of the malady, a yellowish color, inclined to red, or a greyish, purplish color. The power of vision is more or less disturbed by it ; the patient usually sees objects as if through a fog. The disease is caused by external irritation in the first instance, and is sometimes induced by diseased eyelashes and eyelids. Usually, however, a deeper general disease is the inducing cause, such as gout, scrofula, rheumatism, &c. In treating this disease, the existing diseased eyelashes should be removed, and the general condition of the patient considered. Gout, scrofula, and rheumatism, must be treated with proper internal remedies. Particularly applicable are general and local revulsives, such as setons, the embrocation of small-pox ointment in the neck, and Spanish flies ; the suppuration must be kept up for a long time. If the disease is of a serious character, it is advisable to call in a skillful occulist as quickly as possible. MACULA CORNER. In light cases of this disease, a trembling or winking of the eyelids only is observable ; if the malady increases, the eyelids close spas- modically, when considerable pressure in the eye occurs. This malady results generally from a cold in the head, or from catarrhal or rheumatic troubles ; it may also occur in scrofulous inflammation of the eyes, in severe congestions of blood to the head, or in nervous- ness. To effect a cure, the cause inducing the disease should be removed. If it is the result of a catarrhal affection, cutaneous irritation in the neck, and behind the ears, should be applied ; blisters and small-pox ointment are particularly adapted for that purpose. The application of suitable internal remedies must not be neglected. In cases of nervousness, use fomentations and # poultices of infusions of henbane, hemlock, and belladonna, or, where the remedies in a fluid form do not agree with the patient, an extract of the same, in connection with BLEPHAROPLEGIA HORDEOLUM STYE. 48 1 opium, should be applied to the eyelids by means of a hair-pencil. Electricity has also often proved useful. BLEPHAROPLEGIA. Frequently a laming, particularly of the upper eyelid, occurs after a violent cold. After the abatement of the latter, rub the lamed part with strong aromatic stimulants, such as life-balsam, oil cajeput, ethereal camphor ointment, spirits of camphor, cologne water, &c; or, in severer cases, apply Spanish flies or tartar emetic plaster in the neighborhood of the affected part, and after blisters and pustules have appeared, keep up the suppuration for some time, by covering the place with Spanish fly salve. HORDEOLUM-STYE. Stye is called a small abscess, appearing usually on the outer edge of the upper eyelid, under the eyelashes. It is of a round or barley- shaped, sharp, defined form, painless at its appearance, and assuming, frequently only after several days, the dark redness of an abscess. After a preceding itching and tension, the sensitiveness is often in- creased by considerable pricking, the swelling enlarges, runs to a point, and passes into suppuration between the fourth and seventh day. The malady originates from scrofula, and is caused by bad digestion, gastric impurities, and bilious acridity, which easily accounts for its repeated appei.raace. In treating the malady, remove in the first instance the immediate cause, which is done by pulling out the eyelashes. If, by the applica- tion of the ointment given below, the swelling is not dispersed, apply, what is still better, softening poultices, prepared from milk and wheat bread, or linseed meal, wheat bread and honey, roasted apples, mixed with double the quantity of saffron, unsalted butter, with the white of egg, and oil of lily, made into an ointment, &c, which will soften the swelling, and cause its suppuration. At night, cover the eye with a light herb bag. When fully ripe, the stye may be opened. If it should threaten to become hard, or if that has already occurred, use the following ointment : iodide of potassium one grain, grey mer- 482 MISCELLANEOUS DISEASES. curial ointment half a drachm, mix well ; use for rubbing in, twice a day, a quantity equal to the size of a lentil. STRABISMUS-SQUINTING. If squinting has not become habitual, it points either to a malady of the brain, for instance at the commencement of inflammatory dropsy on the brain in children, or to impurity in the abdomen, par- ticularly worms. A staring, fixed look of the eye, directed to a cer- tain point, indicates insanity ; a languid look, which occurs suddenly, either indicates a loss of strength, or nausea and vomiting. Enlarge- ment of the pupil shows either pressure on the brain (in cases of inflammation or dropsy of the brain), irritation, particularly that caused by worms, obstruction in the abdomen or amaurosis. Con- tracted pupils, and great sensitiveness against light, shows increased irritability ; a desire for light indicates great weakness, and is an un- favorable symptom in cases of fever. Black spots before the eyes, or dimness of sight, indicate either a congestion of blood to the head, or an upward pressure of the impurities of the stomach, or a loss of strength, and an approaching fainting fit. Diplopia, or hemiopia, point to spasms, and usually indicates irritation of the abdomen. Sometimes it is only an hysterical or hypochondriacal trouble ; pro- jecting, red, glistening eyes indicate a severe congestion of blood to the head ; sunken eyes point to weakness. HELMINTHIASIS. Helminthiasis is the morbid condition, where worms are generated and continue to live in the human body. Worms in the human body do not only appear in the intestinal canal, but also beneath the skin, in the liver, kidneys, &c; particularly is this the case in hot climates. We will consider here only the first species, or those which are usually found in the intestinal canal. Of these there are generally four species. i. The tricocephalus dispar or filiaria. This worm is from one to two inches in length, and rarely recognized in the living body, but is frequently found in dissections, after death, in large quantities in the HELMINTHIASIS. 483 lower part of the intestinal canal ; particularly is this the case in mucous diseases. 2. The oxyuris vermicularis is a small, whitish worm, of several lines in length, which is to be found in large numbers in the lower part of the intestinal canal, where it causes a good deal of itching. 3. The ascaris lumbricoides resembles the earth-worm very much, and is from two to fifteen inches long, and of a straw or redish color. It lives in the upper part of the intestinal canal, frequently creeps into the stomach, and is sometimes thrown off by vomiting. 4. The tape-worm ; of this there are two kinds. The short- jointed, broad tape-worm, lives in the middle part of the intes- tinal canal ; its joints are rather long than broad ; it causes much trouble, and occurs frequently. The tenia solum, or long- jointed, small tape-worm, causes much more trouble than the first, consists of long, small joints, and is provided with a double hook at the head ; he also is to be found in the middle portion of the intestinal canal, and measures from thirty to fifty, and even one hun- dred feet in length, and sometimes even exceeds that. I have here only enumerated the worms which are found in the in- testinal canal, and deem it proper to give a description of each. We find worms in all intestines of the body, in the liver, lungs, kidneys, womb, urinary bladder, and even in the brain, eyes, &c. In the blood, hair, and teeth, worms are also found. There is a great variety of worms. During the first years of childhood, all diseases to which the child is subjected, are usually charged to dentition. When the period of dentition has passed, worms are deemed to be the cause of most of the diseases, which is not as much the case as is usually imagined ; for there are frequently worms in the intestinal canal which do not cause the slightest trouble. It is only when another disease is added to it, that they leave the place in which they have been located, and are expelled. The erroneous conclusion is then arrived at, that they are the cause of the disease, because they come to light at that time. But even if worms do not make their appearance, they are fre- quently suspected of being the cause of indisposition in children, and 484 MISCELLANEOUS DISEASES. yet they are not even in the remotest way connected with it, and per- haps have no existence in reality. This error, however, is of no small importance, because the chief attention is directed to the expul- sion of the worms, and the true cause of the disease is overlooked. Improper remedies are administered in consequence, and a good deal of injury done by it. Great caution should be observed in adminis- tering worm-remedies to women and girls, in diseases the symptoms of which resemble those indicating the presence of worms, for similar symptoms may be produced by pregnancy. Worms, as long as they remain in a quiet state, and are not present in too great numbers, do not always cause disarrangement of health, and even where they pass away, in cases of attacks of disease, they must not always be con- sidered the cause thereof. Yet, their presence always indicates a morbid condition of the digestive organs ; some danger therefore exists that very serious diseases may result from the irritation which they are producing, or that the danger from other diseases which may arise may be largely increased thereby. The presence of worms in the in- testinal canal is not easily recognized, particularly if some of them, or pieces, have not already passed away. If, however, several of the hereafter mentioned symptoms are met with at one and the same time, it may be assumed that in all probability worms are present in the intestinal canal. These symptoms are : a pale face, blue rings underneath the eyes, enlargement of the pupils, frequent change of color in the face, offensive breath, increased secretion of saliva, par. ticularly in the morning before breakfast, nausea, irregular appetite, voraciousness, thirst, frequent itching of the nose, and on the ridge of it, sneezing, bloated, hard abdomen, pain in the bowels, in the navel region, nose-bleeding, restless sleep, connected with grating of the teeth, and sometimes with sudden starts, lying on the stomach, vivid dreams, which sometimes continue to the wakeful state, unusual emaciation, and an inclination to the greatest variety of spasmodic attacks. As has been already stated, three kinds of worms are mostly found in the human body : i, the oxyuris vermicularis ; 2, the ascaris lum- bricoides ; 3, the tape- worm. TAPE-WORM, ETC. 485 OXYURIS VERMICULARIS. They are to be found in children as well as in adults. They are named thus from their movements after they have been expelled. They are usually located in the rectum. The presence of these worms may be assumed, if, in addition to the before mentioned symptoms, a troublesome itching occurs, particularly in the evening, and a mucous discharge from the rectum takes place. With girls, similar symptoms manifest themselves in their genitals, which, from the tickling created, are attended with bad results. They also frequently cause urinary difficulties, costiveness, apparent hemorrhoidal difficulties, and periodi- cal depression of mind, and sadness. ASCARIS LUMBRICOIDES. The presence of these worms may be assumed, if the patient, with many other indications of worms, complains of pain around the navel, of disagreeable movements, and a feeling of slight jerking in the same region. They are usually found in the small intestines j sometimes, however, one of these worms creeps into the stomach, and is then thrown out through the mouth. Usually, however, and for a long time previous to its being thrown off, nausea and inclina- tion to vomiting prevails. TAPE WORM. This worm is jointed ; its head is knobby, with a pointed proboscis for sucking purposes ; the throat is small, almost thread-like, and gradually passes into more distinct, broader joints, which form the rest of the body. Its length is considerable. The tape- worm lives in the small intestine of the human body. In some people it creates no trouble at all, in others it is but trifling, and in others again it is very severe at times, but never dangerous. The tape-worm consists of a number of single, separate joints, and as every one of these joints is a complete worm in itself, the tape-worm must be designated as a worm chain or colony. This .colony starts from the head, because that is the mother ; it increases in length by the additional growth of joints from above. The joints of the lower end of the worm chain 486 MISCELLANEOUS DISEASES. pass off alive from time to time with the stool, as soon as they are ripe. The mother animal, or head, develops from a tape-worm egg of one joint, not, however, immediately as a tape-worm, neither is it located in the intestinal canal in the first instance. It originates as cysrti- cercus (larva) of a neuter gender. Three different kinds of tape-worm have been thus far found in the human body : the tcznia so/um, the bothriocephalus latus y or small tape-worm. THE BOTHRIOCEPHALUS LATUS. This species causes less trouble. It differs from the other kind by its full joints being more of a square shape ; the largest diameter of the joints is from side to side (the width) ; its head, being without any armament, is provided with two holes only, and its genitals are not on the edge, but in the centre of each joint. THE CANAL-WORM. This is the most troublesome and obstinate of the species of tape- worms. It is broader and fatter than the others, and is distinguished by a canal running lengthwise through the joints. Its large head has four black sucking cups, but no hooks. Whether an individual is troubled with tape-worm, can only be ascertained with certainty if parts of the worm are passing away, be- cause all worm diseases cause derangements of digestion and nutri- tion. A suspicion of the existence of a tape-worm may be realized, if, by fasting, or after the use of food which is disliked by the worm, such as onions, garlic, horseradish, mustard, carrots, sourcrout, fruit, asparagus, radish, sour cucumbers, anchovies, and herring, a sensation of creeping, twisting, heaving, or sucking is felt in the abdomen ; while, on the other hand, by the use of milk, bread and butter, &c, and nourishing food generally, the irritated worm is pacified with remarkable rapidity. Whether this parasite has passed off entirely, can only be ascer- tained with certainty if the head of the tape-worm is discovered. The best means for the discovery of a tape-worm in the bowels is koosso, a very old popular African remedy, which is pretty certain to THE CANAL-WORM. 487 expel, without creating any difficulty, single joints or whole lengths, but very rarely the head. The tape-worm develops itself first as a tape-worm larva in the flesh of some animal, particularly in the hog. This cysticercus passes into the intestinal canal, and there, after throwing off the vescicle and segmentation of the throat, it is changed to a tape-worm, the head of which is that of the larva. It is then developed into a mother-worm. The tape-worm is transferred from an animal to the human body, and usually develops itself in man be- tween the tenth and fortieth year. It is generally generated in people who eat a great deal of raw meat or pork. This assertion may be positively made, because from very close observation it has been ascer- tained that the larva of the hog is developed into a tape- worm in the human body, as previously stated. The worm disease is not dangerous in itself, but in children it inter- feres with their development and vigorous growth. Aside of that, worms are not rarely the cause of very severe spasmodic diseases, such as epilepsy, St. Vitus' dance, catalepsy, tetanus, even paralysis, vocal paralysis, disturbance of sight, and apoplexy. All these diseases are more easily cured than if they resulted from some other cause, as soon as their proper origin is recognized. The effects of an irritation from worms do not always manifest themselves. People may have worms, and remain otherwise in a healthy condition for a long time, until violent attacks set in at once. This may happen either from a large increase in the number of worms, by rousing them with means which they greatly dislike, also by hunger, an accumulation, and adhering by suction to a particularly tender spot of the intestinal canal, and finally by an increased irritability and sensitiveness of the intestinal canal, which is particularly the case in every attack of fever. The younger the child, the more troublesome are the worms, and the more readily spasms and other symptoms of worm disease result therefrom. If children grow up with worms, they frequently get rid of them in a a riper age, particularly if the mentioned causes are removed. If this is not the case, however, scrofula, rickets, and various cutaneous dis- eases are added to it. Treatment of worm diseases is always tedious, and requires patience and perseverance. It is not very difficult to expel the worms, but it is difficult to bring the digestive power to a condition to prevent the 488 MISCELLANEOUS DISEASES. reproduction of the worm. The longer and greater the severity of the malady, the more difficult becomes its cure; the disease may, under such circumstances, continue through life. Oxyuris vermicularis are more easily expelled, but are just as easily reproduced ; ascaris lumbricoides are more difficult to move. In the treatment of worm diseases, it is intended either simply to overcome the attack for the time being, or to expel the worms, and prevent their reproduction. It may be presumed that the above mentioned attacks are caused by worms, if some of the latter have already been expelled, and if similar conditions have been previously noted from time to time. A further evidence of worms is, if during these violent attacks the abdomen of the child is strongly drawn in, and if at the same time it complains of severe pain in the bowels; or, if without any perceivable cause, and without any indication of other existing diseases, in either children or adults, sudden fits occur, endangering life. The presence of worms is still further indicated, if, for instance, the patient falls down, as if struck by apoplexy, if his limbs become cold, the pulse small, and hiccoughing sets in, or if he suddenly loses his speech, or becomes unconscious, if he rolls his eyes in a fearful way, or if he suddenly grows crazy, or is attacked by violent spasms, or is seized with violent colic, retention of urine, &c. These violent fits usually occur in the evening, with women at the approach of menstruation, or during a fever, or whilst the patient is under treatment for worms, when the latter have been too much irritated by it. Under such circumstances, the treatment must be confined to a palliation of the attack. An expul- sion of the worms at that time would then take too much time, partly on account of the continued irritation, and partly because the fits might be still more increased thereby. The chief remedy under these circumstances is the administering of milk as a drink, as an injection, and as a poultice on the abdomen. Oily remedies, such as sweet oil of almonds, olive, and castor oil, administered internally, and as in jections, can be highly recommended. Also the following : freshly expressed oil of sweet almonds one ounce, powdered gum arabic half an ounce; triturate with six tablespoonsful of almond milk, and administer a tablespoonful every hour ; the mixture should be well EXPULSION OF WORMS. 489 shaken before taken. In case of violent colic, give the following preparation : oil of almonds four grains, gum arabic sufficient to tri- turate the oil, water and syrup of almonds, one ounce of each, extract of henbane twenty-five centigrammes; dose, two teaspoonsful at short intervals. If spasms are connected with the worm fits, administer the follow- ing powder : oxide of zinc from five to eight centigrammes, and wormseed powder five decigrammes ; dose, one powder every four hours. If the irritation of the worms should induce fever, administer the following mixture : fresh lemon juice half an ounce, carbonate of potassa sufficient to saturate the acid of the lemon, linden flower water four ounces, bitter almond water four ounces, sugar ten grains ; dose, a tablespoonful every hour. Emollient poultices should also be ap- plied ; take linseed four ounces, boil in water to a moderate consis- tency, then add thirty grains oil of henbane, and apply in a lukewarm state. Administer also emollient injections, prepared as follows : take half an ounce of herbs for each injection, boil in one pint of water until reduced to one-half, strain, and use for an injection. As soon as it becomes evident that worms are present, by some of them passing away, their removal must be seriously considered. This must not be forced, however, at the wrong time. It is best to choose the time when the moon is on the decrease, as worms are then easier expelled. Each species of worm has its peculiar and particular worm remedy. EXPULSION OF WORMS. To expel the oxyuris vermicularis, various purgatives are used. The following powder is for adults : powdered jalap six decigrammes, calomel thirty centigrammes, sugar six grammes ; prepare four of these powders. The second is administered in from three to four hours, if the first did not have a proper effect. One powder is to be taken three mornings in succession. The griping in the bowels which follows the administering of these powders, is best quieted with oatmeal gruel. To vigorous children, the following powder may be administered : santoninum one decigramme, calomel four centigrammes, sugar of milk four decigrammes ; prepare six of these powders, and give one powder 490 MISCELLANEOUS DISEASES. three times a day. To less vigorous children, administer the follow- ing : rhubarb four grains, sulphate of magnesia six grains, divide into twelve parts; dose, one powder morning and evening. To small children, give the following : Levantic wormseed six grains, senna leaves three grains, pour hot water over it, strain, so that it will amount to four ounces, manna one ounce ; dose, one teaspoonful every hour. Frequently the swallowing of whole lemon seed has a good effect ; or boil from twelve to fourteen lemon seeds in half a pint of milk, and a little sugar, press out the residue, and let the child drink the liquid before breakfast. This is repeated every morning for eight or fourteen days. To adults, administer the following pills : extract of walnut leaves six grains, oil of tansy three grains, marshmallow sufficient to make sixty pills, which cover with powdered cinnamon ; dose, three pills every two hours. The principal seat of the oxyuris ver?nicularis be- ing the rectum, injections are frequently more effectual than internal remedies; the two should always be combined. The introduction of mercurial ointment in the rectum frequently operates very successfully in expelling the worms. Among the usual domestic remedies, are injections of oil, mixed with a little sugar or honey, a decoction of garlic, which is very effectual, causing a terrible smell, however ; salt water, very diluted vinegar, warm, strongly salted milk, suppositories dipped in oil, a suppository made of bacon, to which the worms attach themselves, if left in the rectum for a while, and with which they may then be drawn out. The oxyuris vermicularis does not in this respect differ from other worms ; sometimes it will give way to one remedy, and at other times to another. If they should be found in the vagina of a girl, the men- tioned remedies may also be injected there; in doing so, however, great caution should be exercised. It is very advisable to continue the application of these remedies for some time. Even if the worms seem to have entirely disappeared, there frequently remains their ofif- spr ing, which is so small as to be scarcely perceptible ; they grow quickly, however, and soon begin to torment the patient anew. Treatment of the ascaris lumbricoides : With this species of worms also, different remedies must be tried, ere they can be successfully ex- pelled. The most effectual remedy is wormseed, and the Levantic EXPULSION OF WORMS. 491 wormseed, prepared as follows : take Levantic wormseed one grain, jalap root five decigrammes, calomel one decigramme; dose, every morning and evening half a powder ; for a child of six years of age, it should be continued for three days. To children who do not like to take medicine, give a teaspoonful of sugared wormseed every morning for fourteen days ; they will take it willingly, and finally administer a purgative, consisting of santoninum one decigramme, calomel five centigrammes, sugar of milk four decigrammes ; prepare six of these powders, and take one powder three times a day ; or a small cupful of grated carrots and honey may be given them in the morning before breakfast. Extract of walnut shells is frequently very effectual for adults, as well as for children. It is prepared as follows : extract of walnut shells six grains, simple cinnamon water half an ounce ; dose, from thirty to fifty drops twice a day. In cases of spasm, administer the following remedy: valerian one ounce, worm- seed half an ounce, scald it with sufficient hot water, so that, after straining, six ounces liquid remain, to which add extract of walnut shells eight grains, ethereal tincture of valerian six grains, honey one ounce ; dose, a tablespoon ful every three or four hours. External remedies also promote the expulsion of worms ; for in- stance, embrocations of oil of bergamot or tansy applied to the abdo- men, poultices of tansy leaves and wormwood. If these remedies are to have a proper effect, or if the reproduction of worms is to be pre. vented, the treatment must be supported by a proper diet and mode of living of the patient. For that reason all indigestible food, such as pastry, puddings, legumes, potatoes, a great deal of bread, and also cheese, fat milk, warm drinks, and similar things, productive of profuse secretion of phlegm, must be discarded. On the other hand, the use of animal food, in connection with young vegetables and roots, containing a good deal of saccharine matter, also carrots and sourcrout, can be recommended ; a little cooking salt, taken with a swallow of wine, is very serviceable. A few other approved remedies for the expulsion of worms : For children up to the age of ten, the following is an excellent remedy : To one tablespoonful of good wine vinegar, add as much pure chalk as will lie on the point of a knife, and administer while it is efferves- cing, in the morning before breakfast. Continue it for several days. 492 MISCELLANEOUS DISEASES. Another: Take two drachms of wormseed oil, tansy and oil of turpentine, one drachm of each, olive and castor oil, two ounces of each, mix and shake well before using it ; dose, one teaspoonful twice a day according to age; to vigorous persons give two teaspoonsful morning and evening. Another : Make a strong decoction of two parts of sage, three parts of valerian root, and two parts of Levantic wormseed, strain, and add sufficient sugar to make it into candy, boil down until it begins to candy, and then roll it into sticks, and permit the children to eat it ; it is a very good, infallible remedy. Another: Take flowers of tansy and Levantic wormseed, four grains of each, sulphate of iron three grains, ethereal oil of valerian ten drops, divide into twelve powders; dose, one powder morning and evening, to be taken in orange flowers. Another : Manna one ounce, myrrh one ounce, tansy leaves one ounce, Levantic wormseed one ounce, pour over it one pint of brandy, let it stand fourteen days; of this administer to children once a week, or once a month, as circumstances may require, from one-half to a teaspoonful. To small children it is given in quantities from five to thirty drops once a month. As long as they continue to take it, they will not be troubled by worms. Another : Take iron filings from six to eight centigrammes, cinna- mon three decigrammes, sugar one grain ; dose, every morning before breakfast one or two of these powders ; a little good white wine should be taken after it. Another : Worm electuary : take Levantic wormseed half an ounce, valerian root six grains, jalap root four grains, tartrate of potassa eight grains, squill root honey twelve grains, raspberry juice sufficient to form an electuary ; dose, one teaspoonful two or three times a day. Another : Embrocate the navel region with fresh ox-gall, garlic juice, or oil of turpentine, morning and evening for one week. Another: Administer an injection prepared from wormwood, valerian, tansy, and orange peel, two ounces of each, to one quart of water, let it boil for ten minutes, strain, and then add to it two cups- ful of molasses, let it boil for ten minutes longer, take it off the fire, EXPULSION OF WORMS 493 let it cool down and preserve it for use. For an injection, which should be administered twice a day, take one tablespoonful of the above to one cup of water. The expulsion of the tape-worm is best undertaken at the time when some of the joints pass away. Success is not assured until the head is found among the pieces that have passed off. A tried remedy is the bark of the pomegranate root, if applied according to prescription : take bark of pomegranate root forty-five grains, boil in a quart of well-water until reduced to one pint, strain, and take every half hour two tablespoonsful. Of late years, koosso, which grows in Abyssinia, has acquired con- siderable prominence as a sure remedy for tape-worm. It is used in the following manner: pour hot water on eighleen grains of koosso, and drink it, without straining, in the morning before breakfast ; it should be shaken up before it is drank. For patients who are unable to take this preparation without nausea and vomiting, it may be prepared in the shape of an electuary. For that purpose take eighteen grains of koosso, and three ounces skimmed honey, and mix well ; divide into two parts, which must be taken within a quarter of an hour. Still better adapted for that purpose are lozenges of com- pressed koosso, of which each contains from one-half to one grain ; the quantity taken must contain from eighteen to twenty grains in all, and are to be swallowed within half an hour ; they may be washed down with peppermint tea. In order to insure the success of this remedy, the following rules must be strictly followed. The day pre- vious to the taking of koosso, the patient must eat nothing but herring salad, containing an abundance of chopped onions; on the morning of the day when the medicine is taken, he may be supplied with a cup of black coffee, sweetened with syrup. The offensive taste of the remedy may be improved by a little lemon juice, rum, or red wine. After the medicine has been taken, the patient must remain strictly at rest. If after three hours no evacuation follows, admin- ister castor oil, a tablespoonful at a time, or St. Germain tea, until it operates. The root of the male fern is equally effectual as a remedy. Administer of it, either before breakfast, or after taking a cup of sweetened, black coffee, three doses from three to four grains each, which must be taken within a quarter of an hour. One hour after 494 MISCELLANEOUS DISEASES. the last dose has been taken, give two tablespoon sful of castor oil, which must be repeated every half hour until it operates. It is necessary that the chamber which is used should be filled half full of water, having the temperature of blood, so that the worm may not draw back when he comes in contact with a temperature which is either above or below the temperature of human blood. TRICHINAE. It was reserved to the present time to discover this disease, to ob- serve the terrible consequences to the life and health of the human race, and bring to light the cause and its importance to national economy. The trichinae have been known ever since the year 1832, and had been observed occasionally in man, without presuming any connection between them and any disease. The trichina, as it ap- pears in the flesh, is a round worm, perceptible rather by its trans- parency than from its size (in length it measures from one-third to one-half of a line). Between the muscle bundles, which place it reaches by emigration from the intestine, the animal is usually en- closed in a lemon-shaped capsule, formed by calcareous deposits, and in connection with it appears as a whitish point only. The trichina is found in all muscles, excepting the flesh of the heart, but more par- ticularly at the ends, in the neighborhood of the apophysis of the sinews and bones ; aside of that, it is most numerous in the small muscles of the throat, in the intercostal muscles, particularly at their ends, the eye muscles, and the diaphragm. Their number varies greatly ; but to obtain an approximate idea of their enormous quantity, we state that Professor Dr. Lenckart has calculated that in a dissection, a piece of flesh from a human body, weighing one and one-half ounces, contained over three hundred thousand. Now, if it is considered that the muscular tissue is dispossessed and sequestered by this enormous number, it furnishes an explanation for the weak- ness and depression manifesting itself in this disease. The trichina, enclosed in the capsule, is, so to say, in its infancy. If they are taken into the stomach and intestines of the human body, or of cer- tain other warm-blooded animals, with the meat in which they are contained, they are transformed from muscle trichinae into intestinal TRICHINAE. 496 trichinae, which, liberated from the capsule, develop themselves rapidly into male and female, and already on the sixth day after their immi- gration produce living offspring. These begin their emigration im- mediately, pierce the walls of the intestinal canal, settle down between the muscular fibres, where they enclose themselves into capsules again as muscle trichina within a few weeks. The real danger lies in the production of a young brood through the intestinal trichinae. A full grown female trichina is said to contain within her body about one hundred living young, and behind these young, new eggs are con- stantly produced. I am not informed as to the exact duration of their life, and their procreativeness, but I know positively that they remain at least from three to four weeks in the intestinal canal, and during that time con- stantly produce new broods. If we calculate only two hundred young to^each female trichinae, then five thousand of them are sufficient to produce one million of young for immigration, and that number of females may be contained in a few mouthsful of meat, even if there does not exist a full degree of replenishment. It is evident that this enormous piercing of the intestinal walls and muscles may produce the most manifold symptoms, incessant nervous irritations, and, in consequence of both, even death. The viability of trichinae is very great ; neither putrefaction of the meat itself, nor cold, pickling, and smoking, can entirely kill them ; only a high and constant degree of boiling heat is capable of killing them. For that reason is it of so great importance, if one desires to be protected against danger, to carefully cook pork, in which experience teaches us they are mostly contained. By cooking we do not mean that the pork should be simply subjected to boiling heat, but that the meat itself should be divided into small pieces, and boiled, so that the in- side may also be thoroughly cooked. The symptoms of the disease itself are governed by the quantity of the muscle trichinae taken into the stomach, and the number of intes- tinal trichinae which may develop therefrom. The symptoms have usually some resemblance to a rheumatic fever, assuming a typhoid character. The patients complain of great debility, lack of appetite, constant restlessness and sleeplessness, generally also of costiveness, but rarely of diarrhoea ; the latter would be favorable in so far as 496 MISCELLANEOUS DISEASES. many mother trichinae and the young brood would be ejected thereby. Fever and nervous symptoms are added to it, and the face swells, with a dropsical appearance. On about the seventh or eighth day after eating the trichinae-containing meat, an extraordinary pain fulness of all muscles sets in, which cannot bear the slightest pressure. As a con- sequence of this attack on the intercostal muscles and the diaphragm, considerable breathing difficulties manifest themselves, the movable- ness of the limbs is seemingly suspended by the lassitude of the mus- cles. The piercing of the muscles of the larynx by trichinae causes hoarseness; the patient presents a picture of perfect helplessness. Feet and legs swell as in dropsy, and with the excessive exudations, to which the patient is subjected, the last remnant of strength disap- pears ; consciousness, however, remains unclouded. If under these severe symptoms death does not occur, then a prospect for restoration remains after weeks of sickness. The immigrated trichinae encase themselves, the irritating symptoms disappear gradually, and the use of the limbs returns. Prevention of infection by this disease is the most important part, inasmuch as there are but few remedies known which will with certainty kill the trichinae in the human body. The use of raw pork, to which some people, such as butchers and cooks, are accustomed in some countries, must be absolutely avoided. To be entirely sure that the trinchinae have been all killed, the meat should be sliced fine, and exposed to a boiling temperature for several hours, because in thick pieces some of the inner parts of the meat may not have been reached by the heat. Simply salting and smoking, particularly after the new, artificial, rapid curing process, does not offer any security. The only safety lies in a microscopic examination of the pork previous to its use. No particularly expensive instru- ment, or peculiar knowledge, is required for that purpose; a micro- scope of thirty or forty magnifying power is sufficient. It is by far the safest way to discover the trichinae, the cause of the disease. But as a general inspection of meat has not been introduced as yet, nor could it possibly be carried out, if introduced, and as the examination of sausages, which are usually composed of various kinds of meat, can never be entirely satisfactory, it seems that the only safe remedy lies in a thorough boiling of the meat in small pieces. This should never be lost sight of, for all the remedies offered to the public as a EPILEPSY FALLING SICKNESS. 497 protection, such as liquors, wines, tinctures, &c, by whatever name they may go, are nothing but delusions. In case of an attack, a rapid removal of trichinae in as large quan- tities as possible, should be effected by laxatives, and for that purpose the following medicine may be administered : powdered jalap root six decigrammes, calomel twenty-five centigrammes, sugar four grains ; pr pare two of these powders. The second is given if the first has not properly operated within three hours. The further treatment must be left to a physician. EPILEPSY-FALLING SICKNESS. Epilepsy is a spasmodic movement of the body during entire uncon- sciousness. The attack begins sometimes with certain premonitory symptoms. The patient, for instance, has a feeling as if a hot or cold draught of air was passing from hands or feet to the brain ; at that time consciousness leaves him, and he breaks down with a scream. At times the patient has twitching of the face, he yawns, his limbs tremble, and he must involuntarily stretch himself; saliva gathers in his mouth, &c. During the attack itself, his eyes are fixed, features distorted, and jaws spasmodically closed, his lips are covered with foam, breathing is difficult with rattling in his throat, and his thumbs are firmly drawn in the inside of his tightly closed hands. After the patient has laid quietly in that condition, or after having tossed about, the spasmodic condition gradually decreases ; he has a good deal of rolling in his bowels, with passing flatulence, nausea and vomiting; he then usually falls into a deep sleep. When the patient awakens, he looks somewhat troubled, and has no recollection of the attack; he is depressed and dejected, and suffers from severe headache. These attacks are renewed at shorter or longer intervals, and originate of their own accord, or are induced by various causes. The malady is either inherited, or innate ; frequently it results from strong emotions, such as fright, fear, terror, and other affections of the mind. It may also be caused by inebriety, injuries to the head, worms in the intes- tinal canal, &c. This disease is always very serious, and can be but rarely cured, except if the malady occurs in early life, as the result of worms. 498 MISCELLANEOUS DISEASES. In regard to the treatment of the disease, two conditions must be taken into consideration : i, the attack itself; and 2, the general state of the disease. In regard to the first, it should not be inter- fered with, because all interruption may become very highly injurious ; all that should be done is to be careful that the patient does not receive injury on falling, and that every part of his tight clothing should be loosened. The popular, pernicious custom of opening the patient's thumbs must not be permitted under any circumstances. It is best to let him lay quiet without administering any medicine. But if something must be given to the patient, administer a few table- spoonsful of camomile or peppermint tea, or a few drops of Hoff- man's anodyne, ether, or succinate of sal-ammoniac. It is self evident that the treatment of epilepsy must necessarily be guided by the dif- ferent causes. Frequently, however, nothing remains but the appli- cation of such remedies as experience has taught to be generally applicable in this disease. Among the best approved are the following : oxide of zinc two grains, licorice juice sufficient to form sixty pills; dose, two pills morning and evening, and every other day one pill in addition there- to. If, however, they should produce nausea, the dose must not be increased, but rather decreased at once. If nausea does not manifest itself, the dose may be increased by degrees to twenty pills. In severe cases of the disease, the medicine must be continued for half a year, and even for years ; in lighter cases it should be taken for two weeks in every month. On account of the exceedingly mild char- acter of the remedy, it is well adapted for young people and the female sex. Another remedy for epilepsy : Oxide of zinc and extract of henbane, six decigrammes of each, ethereal valerian oil one drop, powdered valerian root one grain ; dose, one powder mornings and evenings. The use of this remedy must be continued for some time, in order to produce an effect. Even after the attacks have ceased, still the use of the powder should be continued ; it mny be taken at greater intervals, however, so that finally one powder may be admin- istered every six or eight days. If the attacks return, the quantity of zinc should be gradually increased to one and a half or two grains for each powder, and the extract of henbane to two decigrammes. ST. VITUS' DANCE. 499 Another remedy : Take mugwort root and orange leaves, also the root of mugwort or violet root ; all of these roots may be used as tea in eases of epilepsy. Another : Take tincture of stramonium and tincture of henbane, one ounce of each, mix ; administer from eight to thirty drops twice a day. Begin with eight drops, and increase by one drop for each dose, until thirty drops are reached, or until it makes the patient slightly dizzy ; in that case, change the dose to fifteen or twenty drops three times a day. Another: Take finely powdered indigo fifteen grains, aromatic powder from two to four grains, syrup two ounces; divide the above into three parts, and administer to adults one part on each day for three days; for children, divide into six parts, and administer the same in six days. By degrees the dose is increased. It is a well-tried remedy. Another remedy : Take black bistort root, henbane, ladies' slipper root, mugwort, orange leaves, two ounces of each, put the whole of it in a jug, and pour upon it two. quarts of spirits of wine, le t it stand fourteen days; dose, two tablespoonsful every two hours. The dose is gradually increased. Two warm sitz-baths a week should be taken. ST. VITUS' DANCE. St. Vitus' dance is a peculiar nervous disease, accompanied by con- vulsive motions, distortions, and other strange, clumsy, and involun- tary spasmodic motions ; although consciousness is frequently clouded it does not entirely cease. In more serious cases of this malady, con- vulsions and somnambulism frequently occur. This condition usually develops itself gradually ; the patient feels in the first instance nausea, spasm of the stomach, palpitation of the heart, shortness of breath? twitching of the limbs, and more particularly most mischievous im- pulses of the mind, which subsequently induce him to laugh, scream, climb, jump, hide, &c. The patient is constantly in motion, he can neither walk quietly, nor stand still, and sometimes is not even able to eat or drink without assistance. The malady begins usually during childhood and youth, and continues mostly until the patient reaches 500 MISCELLANEOUS DISEASES. the age of manhood. In some cases paralysis of particular parts remains, or the malady changes to hysterics or epilepsy (see that article). The disease must be treated on the same principle as epilepsy, but the method of treatment must be conducted by a physician, accord" ing to circumstances. The patient should observe strict diet, and live on digestible, wholesome food ; take frequent exercise in the open air, which may even be connected with physical exertion. He should abstain from using heating drinks, wine, coffee, strong beer, and whisky ; all emotions, fright, fear, grief, &c. , and also headwork, must be prevented ; he should not be held tight, or be otherwise under restriction, with the intention of preventing the mentioned movements. Bathing with cold water, rubbing with flannel, or the naked hand, are beneficial. Constipation of the bowels is removed by light laxatives, particularly rhubarb. NIGHTMARE. This malady, which occurs particularly in younger, and also gen- erally in irritable and nervous, and frequently also in stout persons, is properly a spasmodic condition, connected with flatulence, mani- festing itself by a distressing feeling during sleep, and threatening suffocation. In old times it was supposed that the afflicted party was plagued by the devil, but our enlightened century has disposed of that monstrous idea. Nightmare, however, is no indifferent malady, and if afflicted with it to a higher degree, other and more serious morbid conditions result from it, among which may be enumerated epilepsy, St. Vitus' dance, congestion, apoplexy, &c; and if this un- welcome guest is not met by energetic remedies, it may also show itself in the daytime. This condition usually manifests itself afte the patient has fallen sound asleep, and is disturbed by dreams. He suddenly feels a heavy load pressing on his chest, which threatens to suffocate him ; in vain does he attempt to relieve himself from it. Imagination practices its deceptions, and the patient feels a dog, bear, cat, monster, murderer, &c, lying across his chest, which he en- deavors to shake off in vain. He breathes with great difficulty, finally groans, large drops of perspiration stand on his forehead, and NIGHTMARE. 501 the danger of suffocation increases. Frequently the patient is aware that he is dreaming, and endeavors to shake off the incubus, or to escape it, but is incapable of making any motion whatever, or utter- ing a sound. Finally he succeeds in uttering a cry of distress, with which he usually awakens, and the painful condition ceases. The attack usually occurs during the first hours of sleep, and rarely only during the morning hours ; lying on the back aids in its production, particularly if the head occupies a position hanging backward ; some- times, however, it also occurs when lying on the side, and more par- ticularly on the left side \ it may also occur while taking a nap in the afternoon. As a rule, the nightmare occurs but once during the night, but in old cases it makes its appearance oftener. Frequently the patient is but rarely attacked, perhaps once a year, a month, or a week, but sometimes it occurs every night. It occurs more frequently during the years of youth and manhood, in those whose breathing organs are not entirely unaffected. Overloading the stomach, and therefore too bountiful suppers of heavy food, accumulation of flatu- lency, or plethora, either of a general or local character, of the abdo- men, or lying on the back, are the usual causes of nightmare. hi treating this malady , the patient must abstain from eating heavy, indigestible and flatulent food, particularly in the evening; he must live on plain, light food, and avoid all compounded dishes. He should take sufficient, but not exhausting exercise, avoid all mental excitement during the night, not lie on his back, but on his side, with his head slightly elevated. It is also beneficial to rub the chest and abdomen well with whisky, cause a regular movement of the bowels, which may be induced by light laxatives ; salts must not be employed for that purpose, however. If the attacks recur frequently, it would be well for some one to watch with the patient, and immediately arouse him from his sleep when the attack occurs, which may be readily seen by his anxious features, groaning, &c. The patient should then drink one or two cups of weak but very warm camomile tea, which he may take also before going to bed. It is also asserted that little children, who suddenly wake from their sleep with a scream, and who can scarcely be pacified, and will not even take the breast, are troubled with the nightmare. Acidity of the stomach .may also cause the awakening from sleep with a start. 502 MISCELLANEOUS DISEASES. SLEEP. Nature has ordained sleep as a state of rest for the physical and spiritual forces, as a compensating means for the various active efforts of the human organism, and for the recuperation of the loss of power employed in the exercise of the various functions. It may vary from the normal state, and we will consider here a few of these variations : SLEEPLESSNESS. We speak here only of the insomnolence which makes it imposible to procure sleep, although there exists no disease, or other external or internal cause disturbing the peace of mind or body. It may result in a painful malady, the duration of which may extend over a period of months, and even years, and finally be productive of weak- ness, emaciation, and intellectual and physical derangements, and often be the cause of many brain and nervous diseases. The danger threatening children in such cases is inflammation or dropsy of the brain, and convulsions ; in middle-aged persons it is productive of dizziness, melancholy, hypochondria, consumption, and in aged people, particularly if insomnolence occurs suddenly, it may result in derangement of the mind. In children, insomnolence is frequently caused by the retention of meconium, dentition, the use of sweets, too much or too poor milk, too much and too thick pap, by unclean- liness, heat or coldness of the room, and by too tight swathing. In women this trouble sometimes occurs in consequence of the retention of menstruation, and pregnancy ; in old people, who suffer from it, it may be caused by foggy, windy, wet and cold weather, heavy food, flatulence, ruptures, hemorrhoids, and derangements in the secretion of urine. There are various kinds of sleeplessness : Sleeplessness caused by Plethora and Congestion. — It is the result of suppressed hemorrhoids, abstinence from copulation, sun- stroke, drinking, deep cogitations, &c; somnolency under such cir- cumstances is connected with a feeling of general heat, itching of the skin, bright urine, and an unusual palpitation of the heart and arteries. , SLEEPLESSNESS. 503 With a vigorous constitution, youthful age, and clearly pronounced plethora. — in connection with which it should be stated that lean persons are usually more plethoric than those who are fat,— bleeding at the foot is of good service in this kind of insomnolency. In less vigorous people, and more particularly if one of the vertebrae is found to be painful, place cupping-cups on the back, or leeches on the head, and if hemorrhoids are present, at the anus. Milk of almonds, to the preparation of which a few bitter almonds may be mixed with the others, agrees very well with delicate persons and children, provided the latter are not too young ; for men, whose digestion is not de- ranged, one or two glasses of water, prepared as follows, are well adapted : cream of tartar one-half ounce, boil in one quart of water until the powder is dissolved, and cool ; add to it a sliced lemon, and the necessary quantity of sugar. This may be drank at any time, but preferably in the evening. Sitz-baths are very excellent in this case, and almost always successful. The sleepless party takes the bath from one-half to one hour previous to going to bed. The cold water in the tub must not exceed four or five inches in depth ; breast and head must be previously washed in cold water. During the night, wetting the head with cold water, without drying it, promotes sleep very much. If congestion and irritability of the body, and not plethora, are the cause of insomnolence, take one or two of the following powders during the evening and before going to bed : saltpetre four grains, bitartrate of potassa half an ounce, divide into ten powders ; dose, according to circumstances, from two to four powders a day ; or drink one or two glasses of sugar water, to which from ten to fifteen drops of Haller's acid are added. Nervous Insomnolence is caused by bad habits, excessive exertion of the mind, use of narcotic remedies, too frequent copulation, and emotions. There are usually hypochondric and other nervous symp- toms connected with it, particularly frequent pressure for urinating, fear, anxiety, heat, and orgasm. In such cases lukewarm hand and foot-baths, ablutions, and warm baths, tickling, or rather gentle rubbing of the soles of the feet, emollient injections, arc beneficial; for nervous women, injections of camomile infusions are very excellent. Tartar emetic in small doses 504 * MISCELLANEOUS DISEASES. is of excellent service : take tartar emetic three centigrammes, dis- tilled water six ounces ; dose, one tablespoonful every three hours. Under these conditions, milk of poppy seed is very beneficial : take peeled sweet almonds one ounce, white poppy seed one-half ounce, and prepare like almond milk (see " Almond Milk"). In cases of nervous insomnolence, opium may be used with advan- tage. Take watery extract of opium three or four centigrammes, crabstone powder and sugar, five decigrammes of each ; take one powder before going to bed. More successful will be the administer-' ing of henbane, or acetate of morphine in its place : take acetate of morphine four centigrammes, sugar four grains, mix to a powder, and divide into eight parts. Before going to bed, take one powder. For weak people generally, tincture of ambergis with musk, twenty or thirty drops, is very good. In less irritable persons, where nervous insomnolence is connected with spasms of the stomach and abdomen, together with flatulence and mucous obstruction, this malady is best overcome by pills with ox-gall : take assafcetida and condensed ox- gall, extract of wormwood, extract of quassia, extract of orange peel, four grains of each, make into one hundred and sixty pills, and take one or two in the evening. NERVOUS DISEASE. All disarrangements in the functions of the nerves are called nervous diseases, and manifest themselves either by an interruption of the power of motion, spasm, or laming of perception and function of the senses, pain, insensibility, too sharp, too weak, or defectively working senses, or of the power of thinking, excitement of the mind, debility, derangement of intellect, or idiocy. The disposition for nervous diseases is either inherited or it is based on a weak constitu- tion. Infancy, female sex, an effeminate education, dentition, and development of speech, commencement of puberty, moist climate, living in the city, or in a room, and frequently peculiar conditions of the weather (low barometer, west wind), generally invite an attack of this disease. A frequent cause of it is debilitation, in consequence of a lack of food, or its inferior condition, vitiated air, dampness and cold, or loss of blood, too frequent menstruation (frequently a con- NERVOUS DISEASES. 505 cealed cause), too great a loss of semen by copulation and self- pollution, involuntary seminal emissions, too frequent confinements in childbed, too long nursing, diarrhoea, whites, blennorrhcea, saliva- tion, excessive perspiration, or too great irritation and exhaustion of strength, too great physical and mental exertions, acute diseases of long duration, excessive heat, excessive use of spirituous liquors, cof- fee and tea, want of occupation, therefore idleness, one of the most fruitful sources of nervous diseases, or through weakening influences •affecting the nerves directly, such as distress, sorrow, melancholy, longing, envy, listlessness, inactivity of the mind, giving way to feel- ings, abuse of narcotics, such as opium, prussic acid, &c. Nervous diseases are also produced by a discontinuance of the equilibrum of the iunctions of the body, too great and vigorous sanguification, sup- pression of the power of motion, of perspiration, of the functions of the abdomen, of sexual activity, of menstruation, hemorrhoids, or by local and peculiar irritation. To the latter belong : i. Irritations in the abdomen, from worms, gastric materials, sit- ting too much, and constipation of the bowels. 2. Congestion, particularly to the brain and abdomen; hemorr- hoidal diseases being one of the most frequent causes of numerous nervous diseases. 3. A change in the seat of morbid matter, gouty, rheumatic, scro- fulous, venereal, scabious morbid acridity, mechanical irritation, sub- stances introduced from the outside, such as splinters, as well as those originated in the body itself, swellings, indurations, stones, &c ; finally morbid excitement of the mind, fixed ideas, and over-excited imagination. Upon the causes here adduced is founded the important and nat- ural division of nervous diseases, which should be particularly con- sidered in the treatment. They are therefore divided : 1. In nervous diseases, being based upon a morbid condition of the nerves themselves. 2. Those which result from weakness. 3. Those depending upon the blood ; or, 4. From transposition of morbid matter ; or, 5. From gastric matter ; and finally, 6. From mechanical causes. 506 MISCELLANEOUS DISEASES. This also demonstrates the difficulty presenting itself in a proper treatment of a nervous disease ; because it is no easy matter always properly to discern the inducing causes, and to select the appropriate remedies. There is but one method which can be successfully ap- plied, whether the nervous disease manifests itself in the form of pains, spasms, paralysis, morbidness of mind, &c, and that method is the scientific application of cold spring water. It must not be im- agined that all patients can be treated alike, without any distinction, in order to attain a like favorable result by this mode of treatment. On the contrary, the constitution of the patient, and the cause of the disease, create a material difference in the application of this splendid remedial agent, which, however, operates in various ways. If there exists a purely nervous weakness or a general debility of the body, wrapping in wet sheets, cold ablutions, shower baths, finally river, wave, and sea baths, and more or less strong douches, affusions, and plunge baths, only are desirable. In cases of plethora, congestion and engorgements, antispastic head, arm, sitz or foot- baths should be applied ; an accumulation of gastric impurities should be treated with cold injections, and if morbid matter is present, by a vigorous sweating cure. SELF-POLLUTION. Self-pollution (masturbation) is called the involuntary effusion, usually during the night, of seminal fluid. During the years of man- hood, these seminal effusions occur in otherwise vigorous people, who iead a chaste life, without its being necessarily a morbid condition; it deserves that name only when the emissions occur very frequently, and perceptibly weaken the body. In such cases they are generally connected with voluptuous dreams in those who suffer from them, or if in a higher degree, they even occur during the day time, while being awake. Under such circumstances the malady requires the utmost care, because other sericus and incurable diseases may result therefrom, such as hectic fever, tabes dorsalis, &c. Inciting causes for this malady are a strong incitement of the imagination by voluptuous pictures, excesses in sexual impulses, the pernicious malady of onanism, certain exciting food and drinks, and also some exciting medicines. ONANISM MASTURBATION. 507 Treatment : The more serious cases require the advice of a skillful physician. In general, the following rules should be observed : never eat shortly before going to bed, and least of all, anything that is in- citing and exciting ; do not sleep on too warm bedding, or under too warm bed covers; do not lie on the back, but on the side; occupy your mind with serious objects, mentally as well as physically ; avoid all pictures and literature inciting to imagination ; use cold baths, and, if those cannot be had, cold, local ablutions, eat wholesome and easily digested food, get into the habit of standing up if you have a great deal of writing to do, or, at least, do not use upholstered, but cane seat chairs. If the body has already become much weakened, strengthening remedies ought to be used, which, however, should be ordered by a physician. t ON AN ISM-MASTURBATION. If we were to furnish in this place a full explanation of this malady, it would be a mistaking of the object of this work, because even a good intention might lead to abuses, which could not be corrected without damage. We can not at all approve, however, that the con- sequences of this vice should be painted in such terrible colors, as has been done by some writers, because that sometimes is productive of a twofold evil ; on the one side it deprives the unfortunate victims of this secret sin, to some extent, of the hope to retreat from the path leading to their ruin, and their situation becomes wretched and des- perate, and on the other hand, it would lead others to think if they did not at once perceive the evil consequences on themselves, that those pictures were painted in too glaring colors, and continue in their fatal course. I beg, however, not to be misunderstood. I do not mean to say that those descriptions contain untruths, and are set up as a scare-crow. Those writers did paint from nature, but they described cases of rare occurrence, and we may find consolation in the fact that, however deep one may have sunken in vice, he may still return and regain his lost mental and physical strength, if not in their full vigor, at least in part ; all he has to do is to desist with determi- nation from the course he has heretofore pursued. So much for those who are capable of thinking for themselves. But this vice is usually 508 MISCELLANEOUS DISEASES. practiced during early youth, and here it is the sacred and bounden duty of parents and educators to keep a strong supervision over them. No one should imagine that his children or pupils are too well edu- cated, and too moral, to be addicted to this vice, because it is not always founded in immorality, as it may be originally induced by certain morbid conditions. Some children, even nursing children, feel a certain irritation in the sexual organs, produced by worms and other morbid matter ; they keep rubbing, pulling, and scratching around them, in order to obtain relief, and woe unto the child with whom it has become habitual. In little innocent children, who know not what they are doing, this cannot remain concealed for any length of time ; proper remedies may be applied to prevent this in larger children, who, although not acquainted with the bad results of their pernicious habits, practice them secretly from a certain sense of shame. In these cases it must be left to parents or educators, whether they can best accomplish their object by kind admonition and an explanation of the consequences, or by severe measures. The following brief hints may guide them to a knowledge of the evil. Look to the associates of these children, and see whether they love solitude, and why they seek it ; keep a careful watch over all their doings, particularly when least expected by them ; watch whether they remain in the water-closet for any length of time, and what they are doing there ; investigate whether they remain lying in bed awake, whether they keep their hands under the covers, and lift the latter sometimes unexpectedly. The following are further symptoms : The child has a dreamy look, is inattentive, shudders, and is frequently startled when suddenly spoken to ; his eyes look heavy, and lose their lustre ; he frequently crosses his legs, keeps his hands under his gar- ments ; yet these symptoms do not always indicate the practice of that vice. In regard to avoiding this malady, the rules must vary according to circumstances, but for want of space they cannot be given here; yet I cannot avoid in charging some of the public schools, however many advantages they may possess in other respects, as being nurseries for this vice. From reports in the school journals we gather that in some schools, particularly in the country, a general epidemic seems to pre- vail in this respect. DRUNKENESS. 509 We will add the following general rules : Keep your children from coming in contact with those who use indecent language ; prevent their seeing immoral pictures or books, or using stimulating drinks, or too nourishing, spiced food. Above all, a restoration of lost strength is required. For that purpose, besides a total cessation of the prac- tices which must lead to destruction, a light nourishing diet, frequent baths, early rising, frequent exercise in the air, physical occupation, and an inclination to a pleasant frame of mind, should be induced. Deeply rooted maladies imperatively require the attendance of a physician. DRUNKENESS. For want of space, I cannot here enter into a long treatise on in- toxication, a habit alike destructive to body and mind, and the dis- eases resulting therefrom. I will therefore limit myself to give some well endorsed remedies adapted for the removal of this miserable vice. Where still an earnest, determined will prevails, everyone will be able to suppress a habit which lowers one in the estimation of others, as well as in his own, aside of the many misfortunes which this vice threatens to bring in its train. It is to be regretted, however, that this required self-command cannot always be found ; usually the un- fortunate victim is the slave of this tyrannical passion. In such cases the following remedies may prove useful : One of the best remedies for creating an aversion to whisky is to mix diluted sulphuric acid with it. To each glass holding one ounce of whisky, add from eight to ten drops diluted sulphuric acid, obtainable in the apothecary shop. In order that the teeth may not be attacked by the acid, take a little oil or butter in the mouth, immediately before drinking, and in order that the stomach may not be affected, use a little magnesia or bitter stomach elixir. Tartar emetic mixed with every glass of whisky, a quarter of a grain to each glass, causes a feel- ing of aversion against the whisky, by the nausea which it creates. (See " Delirium Tremens' ). 510 MISCELLANEOUS DISEASES. WOUNDS. By a wound is meant a forcible separation of parts of the body by external mechanical means, connected with more or less bleeding. Among all wounds, those of the skin and muscles are more readily and easily healed, particularly if made with clean, sharp instruments. Wounds of tendons and sinewy parts are sometimes attended by bad results ; they do not heal very readily, particularly if the tendon has been entirely separated. Wounds of bones heal kindly in some cases, but the process is a very slow one, and when healed, leaves very great sensitiveness in the bone. In the wounding of blood vessels, particu- larly the larger ones, sometimes severe bleeding occurs, which may result in exhaustion, syncope, and even death. The healing of the muscles and skin may be effected in two ways : either the edges of the wound are brought together in close contact, when they grow together by inflammation and exudation of lymph, which process is called the healing by direct union ; or the first inten- tion, or suppuration, and the formation of granulations sets in, which fills the wound, and finally cicatrizes it ; this is called the healing by means of suppuration and cicatrization, or by second intention. Wounds of blood vessels might, under circumstances, also be healed by direct union, were it not that it is difficult to keep the edges of the wound in constant contact with each other, which is prevented by the peculiar inclination on the part of blood vessels to contract, and the constant pressure of the flow of blood. The healing of such wounds is mostly accomplished by the coagulation of the blood in and around the injury, which forms a thro?nbus, and which closes the blood vessel altogether. Suppuration sets in, and in consequence thereof, exudation of lymph, which combines with the thrombus, and causes an intergrowth with the parietal layers of the blood vessels. Nerves may heal by direct union, if the separated ends can be kept in contact. Previous to an attempt being made to heal a wound, exact informa- tion of its condition should be obtained by an examination with the finger or probe. The examination with the finger is preferable, if the wound is sufficiently large for its admission, because the feeling with the finger is much finer than that with the probe. The attempt should be made to obtain a clear idea of the direction of the wound, of the WOUNDS. 511 presence or absence of foreign bodies, and also of the parts that have been injured, and take proper steps in accordance with the informa- tion obtained. The next step is to stop the bleeding. The best remedy for that purpose, particularly in small wounds, is the application of poultices of ice cold water, or the cold produced by artificial means, such as a combination of salt and sal-ammoniac, solutions of astrin- gent and spirituous remedies, for instance, solutions of alum, whisky, Theden's arquebusade (see " Hemmorhage"), adhesive or astringent powder, like gum arabic, dragon's blood, and various other gums and earths such as gum kino, catecheu, &c, rye flour, bean meal, &c; useful and sometimes indispensable is the application of pres- sure either with a finger or by a compress. It sometimes becomes even necessary to apply caustic remedies, the application of which forms a scab on the surface of the wound which prevents further bleeding. After the bleeding has been stopped by one of these remedies, an attempt is made to extract from the wound, with proper instruments, the foreign substances remaining in it. But in case the substance forced into the wound is not accessible, or if the wound is not sufficiently large to permit of its ready extraction, the surgeon must enlarge the wound in order to accomplish his purpose. Finally the wound is cleaned either directly or through suppuration. The first is preferable in fresh incisive or sword wounds, the second in wounds in which the foreign substance still remains, in severely contused, crushed and torn wounds; also in cases where violent inflammation may be expected, or in deep wounds where, aside of the muscles, other tissues, such as sinews, bones, &c, are injured; finally also in poisoned wounds, where by long continued suppuration the poison is entirely removed from the system. The position of the patient, or of the part injured, must be governed by the form and condition of the wound ; thus longitudinal wounds require an outstretched position, transverse wounds a rather bent, relaxed position of the limb or of the part. If, after a bandage has been applied to the wound, severe pain or inflammation sets in, it may be loosened and antiphlogistic and anodyne remedies applied, such as poultices of lead water, decoctions of malva flowers, henbane, poppy heads, &c. If no changes occur, and if the healing process progresses regularly, the bandage may be renewed, according to cir- 512 MJSCELLANEOUS DISEASES. cumstances, every two or three days, or at shorter or longer intervals. The pieces of the bandage adhering to the wound must always be softened with warm water and a sponge, and then gently removed with a pincette. If, on account of the torn, contused, or other un- favorable condition of the wound, a direct healing dare or cannot be accomplished, it must be attempted in an indirect way, that is, by suppuration. After the wound has been most carefully cleaned, it is covered with soft lint, on which is spread a mild ointment ; it is then tied with a compress and bandage. After a few days the bandages are removed, to be exchanged for fresh ones. After that the wound is covered with dry lint, and the bandages are renewed daily, or every other day, according to the state of suppuration. If, by limited suppuration, the lint adheres to the wound, so that its removal will cause pain to the patient, the wound may be first covered with a fine cloth, and the lint placed over that. An effort is then made to bring the edges of the wound as close together as possible, which is effected, particularly in larger wounds, by stroking it with the hand from the opposite sides toward the centre of the wound, in which position it is maintained by roller bandages ; this favors the healing of the wound, and also reduces the size of the scar. The circumference of the wound, which is not rarely soiled by the application of the ad- hesive plasters, and also by the discharged matter, is best cleaned through fomentation with warm spirits. For the purpose of ex- pediting cicatrization, the edges of the wound may be gently touched with a mild caustic, for instance sulphuret of copper, lunar caustic, &c.j the latter is also used if proud flesh begins to grow more rapidly than is desirable. Where the wound does not show proper activity, and the matter assumes a bad ichorous appearance, which frequently does not result from the condition of the wound itself, but from the internal condition of the patient, the course- should be pursued to in- vigorate and support the strength of the patient generally, when the wound will soon assume a better appearance of itself. Externally, spirituous, stimulating sponging off may be resorted to, or the lint applied to the wound may be steeped in a stimulating fluid. STYPTIC REMEDIES — INFLAMMATION OF THE THROAT. 513 STYPTIC REMEDIES. One of the most important remedies to stop bleeding are applica- tions of cold water, snow, or ice, to the bleeding place. This remedy can be recommended all the more, because it also vigorously checks the inflammation which usually sets in. The following remedies are also desirable as applications for external bleeding : Theden's arquebu- sade, spirits of wine, solutions of alum, sulphate of zinc, iron, and copper, decoctions of Peruvian, oak, elm, willow and chestnut bark, &c; absorbing applications, such as German tinder, spider webs, and the glutinous powders, such as starch, gum arabic, rosin, and caustic remedies, such as lunar caustic, and the cautery iron, also belong to this class of remedies. If, at the same time, a proper pressure can be brought to bear by compresses and bandages, the named remedies will prove all the more effectual. A decoction of raw tobacco leaves is also an excellent remedy. In severe bleeding of arteries, which manifests itself by a fountain-like flow of light red blood, a hard sub- stance wrapped in linen, placed on the bleeding artery, and com- pressed by a bandage or cloth, so as to keep the bleeding vessel in a state of compression, becomes necessary. A skillful surgeon should be called in at once. INFLAMMATION OF THE THROAT. The symptoms of that disease are various, according to the parts of the throat affected ; whether the inflammation affects the particular part used in swallowing or breathing, a strict boundary line be- tween the two cannot be drawn. Inflammation of the Parts used in Swallowing. — In this case breathing is not obstructed, but pain is felt in swallowing. The patient is better able, and with less pain, to swallow a large morsel than a small one, or even fluids. The more the upper parts are in- flamed, the more visible becomes the redness and the inflammation. The tonsils are frequently swelled to such an extent as to touch each other, they then completely close the throat ; or the uvula hangs down on the tongue, which makes swallowing particularly painful. The attacked parts, from which pain frequently extends to the ears, 33 514 MISCELLANEOUS DISEASES. are in the first instance dry, hot and slightly red. These symptoms increase to the third, fifth, but rarely to the seventh day, when, after a more or less violent perspiration, the fever, if there was any, disap- pears, the swelling and inflammation gradually ceases, and the nor- mal condition is restored. The application of a towel steeped in water and wrung out, and the administering of elder blossom tea with lemon juice, for the pur- pose of creating perspiration, will in most cases be sufficient to effect a cure. Frequently, however, this inflammation of the uvula passes into suppuration. This may be assumed to be the case, if after three or four days, with a constant fever, the violence of the symptoms, particularly that of swallowing, does not only not disappear, but rather increases. In this case, inhale through the mouth the vapors of elder blossom tea, milk, and honey, and apply all around the throat poultices, prepared of mollifying herbs, or of linseed meal. If suffo- cation is threatened, administer an emetic, or, as the patient may not be able to swallow it, the abscess should be opened as quickly as pos- sible by a physician. The abscess usually opens of its own accord within twenty-four hours, which frees the patient at once from all pain. He should nevertheless continue for some time the inhalation of warm vapors, gargle frequently with a decoction of malva and marshmallow flowers, and he must eat or drink nothing that is either irritating or sharp. There are individuals with whom inflammation of the throat has, so to say, become habitual, and they are attacked by it whenever they take even the slightest cold. Such people will do well to harden themselves by cold ablutions and cold baths, particularly sea baths. They should also for some time continue the use of the following gargling water, morning and evening : take alum five grains, honey one ounce, water six ounces. Sometimes a returning, slow inflammation of the throat continues for months. In such cases, tie up the throat, particularly at night, with a thick flannel, which may be saturated with a volatile ointment. The strong local perspiration which ensues cures the disease. If gout, scrofula, or hemorrhoids are the cause of the disease, it must be treated accordingly. If, after the inflammation of the throat has passed off, a swelling of the tonsils remains, the following gargl- ANGINA DIPHTHERIA. 515 ing water will be serviceable : distilled water six ounces, honey one ounce, carbonate of ammonia four grains. Another kind of throat inflammation is ANGINA-DIPHTHERIA. This disease must be discussed here, because a mistake in that case would be followed by the greatest danger. The characteristic symp- toms of the disease are an accumulation of partly white, cheesy, and partly yellowish, medley-colored masses on the tonsils, uvula, and the palate, which, breaking up, leave ulcers in these parts ; descending to the larynx and trachea, they also destroy these, which results in death. The patient complains of difficulties in swallowing, the food is forced out again through the nose, the submaxillary glands swell and are hard to the touch, fever sets in, accompanied by loss of strength, hoarseness, and expectoration of bloody, stringy matter. The dis- ease usually attacks poorly-fed persons, or those who occupy un- healthy habitations ; it is also a companion of scarlet fever and ab- dominal typhus, and is very contagious. It is usually fatal to children. It is self-evident that this is not the place to speak more particularly of the treatment which is divided into a local, by cauterizing with lunar caustic, and into a general. We can only draw attention to the great danger and the urgent necessity of calling in medical assis- tance. Of remedies for internal use, the following should be preferably administered : four grains of chloride of potassa, dissolved in five ounces of distilled water ; dose for adults, a tablespoon ful every hour ; for children, a teaspoonful every hour, and to very small children, half a teaspoonful. There should be a constant supply of fresh air and nourishing food (broth, milk). Care should be taken to remove the lumps forming in the throat with a proper instrument. It is ad- visable, however, to call in a physician as soon as possible. 516 MISCELLANEOUS DISEASES. INFLAMMATION OF THE LARYNX, AND BRONCHITIS. If the parts necessary in swallowing are not affected, neither red- ness nor swelling will be perceptible, while, on the other hand, the breath is wheezing, whistling, and connected with a more or less painful, spasmodic, and very tormenting cough ; the expectoration, of a glassy appearance at first, changes subsequently to a thick, purulent mucus. The voice is changed, whistling, thin, hoarse and insonorous. The patient has severe, piercing pains in the larynx, and on pressing the tongue down, a redness and swelling of the epiglottis will be noticed, and an increase of pain felt from external pressure. Drink- ing and swallowing excite attacks of coughing, and even symptoms of suffocation. The fluid attempted to be swallowed, frequently passes out through the nostrils. If the inflammation is seated deeper down in the trachea, the swallowing of food does not always increase the permanent piercing pain. Breathing then becomes still more difficult and whizzing, and a great deal of speaking causes attacks of spas- modic coughing. This kind of inflammation of the throat is always more serious than the first ; the danger increases with the violence of the fever, and even death may result from suffocation or apoplexy. Causes : Among the causes may be mentioned : the state of the weather favoring catarrhal attacks, the poison engendered by measles and scarlet fever, taking cold in the throat from external or internal means, by drinking cold water whilst being heated, loud screaming, singing, speaking, blowing of wind instruments, &c. Inflammation of the throat, the result of venereal diseases, does not belong to this class of diseases. Treatment : Fever ought to be particularly considered here. In catarrhal inflammation of the throat it is either not pressent, or is ex- tremely weak. By total absence of fever, rest, mild drinks, low diet, and wrapping up the throat in flannel, is all that is necessary, for this external irritation relieves the inner parts, if the inflammation is not too severe. The patient must not take any cold drinks ; everything should be lukewarm. Simply malva flower or elder blossom tea, with a little milk, or lukewarm sugar-water, are all that is required for a gargle; the patient must be confined to the room, however; in the INFLAMMATION OF THE LARYNX. 51 7 evening before going to bed he must take a sour foot bath : to the proper quantity of water take two and one-half quarts of common vinegar and two handsful of salt ; in some cases two ounces of mus- tard are added to it. The foot-bath must be taken lukewarm, for eight or ten minutes, and the patient must thereupon immediately retire to bed, and drink a few cups of warm, boiled lemonade. Meat, spiced food, or heavy meals and heating drinks must be avoided. If the inflammation of the throat is connected with a catarrhal fever, an emetic should be administered : give ipecac one grain, tartar emetic four Centigrammes, syrup of squills and raspberry syrup, one ounce of each, well-water one ounce ; dose, a tablespoonful every quarter of an hour until vomiting results ; dose for children, a tea- spoonful. After that, administer light laxatives : take compound infusion of senna and barley gruel, fifteen grains of each, Glauber's salt two ounces j dose, every two hours two tablespoonsful (to children a teaspoonful is administered at a time), until it operates properly. Sal-ammoniac affords the best and speediest relief. It is prepared for that purpose as follows : sal-ammoniac and juice of licorice root, four grains of each, dissolve in four ounces of linden blossom water, emetic wine three grains ; dose, a tablespoonful every two hours ; dose for children, a teaspoonful every two hours. Externally rub the throat with volatile liniment, tie a silk or cotton cloth around it ; flannel is too heating in this case ; or leaven or a mustard plaster may be put around it. As a gargle, use elderblossom tea, with a little vinegar and honey. In cases of violent throat inflammation, gargling is of slight account ; it is even more injurious than beneficial, on account of the strain to which the affected part is subjected thereby ; for that reason lukewarm immissions are much preferable. For that purpose, use at first the following immission : take saltpetre four grains, bar- ley water nine ounces, mulberry juice one ounce ; to be immitted in a lukewarm condition. If the malady continues for a longer time, take elder blossom tea ten ounces, sal-ammoniac five grains, oxymel two ounces ; to be used as a gargle and immission. In immissions, which must be effected very gently, the syringe is introduced in the angle of the mouth ; children must have their head bent forward. If the mucous secretion is very severe in the throat and mouth, 518 MISCELLANEOUS DISEASES. which is usually the case towards the close of the inflammation, the following remedy is preferable as a gargle, or for immission : take of sage and elder blossom tea, together one-quarter of a pint, pimpernel essence one ounce, and alum eight grains. At the same time the following remedy may be used with great advantage : take essence of pimpernel eight grains, marshmallow juice three ounces; dose, one tablespoonful every half hour. The frequent swallowing of a tea- spoonful of mulberry juice has an excellent effect in every case of throat inflammation ; also the following preparation : syrup of squill root two ounces, marshmallow juice three ounces ; dose for children, half a teaspoonful every hour, and for adults a tablespoonful every half hour. If the inflammation increases very much, and if the fever reaches an inflammatory state, bleeding becomes necessary, leeches must be applied, and the following powder administered : saltpetre five decigrammes, calomel five centigrammes, sugar two grains ; dose, one of these powders every two hours. If a metallic taste results in the mouth from these powders, they must be discontinued. The leeches must not be applied to the throat itself, because in the neigh- borhood of the inflamed spot they cause, by the irritation which they produce, an additional flow of blood. At some little distance from the spot they act as a revulsive. Besides that, the throat is a very dan- gerous place to which leeches may be applied, particularly in children, as ignorance or carelessness may easily cause death by bleeding. For that reason the breastbone should be selected, but in girls and delicate women, in order to obviate visible scars, the part of the neck im- mediately at the edge of the hair should be chosen. In those places apply, according to age and constitution, state of inflammation and fever, from six, eight, ten, fifteen to twenty leeches ; the after-bleed ing should be kept up for two hours. After the bleeding has discon- tinued, cover, after some time has elapsed, the entire front part of the throat with a piece of linen, on which grey ointment has been thickly spread ; let it remain undisturbed from ten to twelve hours. As an immission for such cases, apply saltpetre four grains, barley water five grains, mulberry juice one ounce, to be administered in a luke- warm state. If the air passages are inflamed, the case is serious ; the application of leeches then becomes absolutely necessary, and frequently bleed- SWEATY FEET. 519 ing cannot be avoided ; the use of the grey ointment and the powders are then also always required ; take saltpetre five decigrammes, calo- mel five centigrammes, sugar one grain ; dose, one powder every two hours, and, if a metallic taste should occur in the mouth, they must be discontinued, as before stated. In place of immissions, warm vapors may be substituted with advantage ; care should be taken, however, not to scorch the throat, which may be readily done, if ap- plied too hot. Proceed in the following manner : pour hot elder blossom tea and milk in a small pot, and cover with a funnel, take the end of the funnel in the mouth, and in this manner lead the vapors by inhalation to the diseased parts. The inhalation of warm vapors from common salt is also beneficial, for which purpose take one teaspoonful of salt to three and a half ounces of water. Sour foot-baths, to which mustard has been added, must not be omitted. If the hoarseness is considerable, a Spanish fly plaster should be applied to the throat after bleeding, and suppuration must be kept up for some time. If fever is present, proceed as in catarrhal fever (see " Catar- rhal Fever "), or if very violent, treat as in inflammatory fever (see " Inflammatory Fever"). But, if after a proper application of antiphlogistic remedies, the malady still continues, and danger is threatening, administer an emetic : give ipecac root one grain, tartar emetic four centigrammes, syrup of squill root and raspberry syrup, one ounce of each, well- water one ounce ; dose, one tablespoonful every quarter of an hour, until vomiting sets in ; dose for children, a teaspoonful. SWEATY FEET. Strong, offensively smelling, sweaty feet are mostly caused by a sickly mixture of humors, and, however desirable a riddance of this troublesome evil may be, great caution should be observed not to suppress sweaty feet, of whatsoever nature they may be, quickly and suddenly, as the most dangerous diseases, and even death, may result therefrom. In most cases they are a drain for other diseases, as fre- quently gouty, herpetic, gastric, pectoral, and other diseases, have been known to disappear soon after sweaty feet manifested them- selves. 520 MISCELLANEOUS DISEASES. All that can be done is to keep the feet clean, frequently wash them with lukewarm water, and not wear too warm foot-covering ; the stockings should be frequently changed, and the feet should never get cold in the wet stockings, as the cold taken thereby would result in a suppression of the sweaty feet. If the sweat increases to such an extent as to soak through stockings and boots, the patient may occa- sionally sprinkle wheat -bran or lycopodeum in the stockings or over the feet. Caution should be observed, however, also in this. Cold baths or drying remedies, such as white lead, should be particularly avoided. It is only if the malady, which finds vent through this channel, has been removed, of which, however, a physician only can judge, that remedies may be applied to cure sweaty feet. At first the feet should be washed with spirituous, aromatic fluids, such as brandy, Cologne water, &c, and keep hardening them by degrees by wearing very light foot-covering. If the sweat has been suppressed, an attempt should be made to restore it as quickly as possible ; for that purpose apply warm stimu- lating foot-baths, particularly of sand and ashes, wear woolen stock- ings, which cover with oil cloth or hog's bladder, to prevent air from striking the feet, and also to further perspiration ; place your feet in fresh, dry elder or birch leaves ; use camphorated embrocations and mustard, lay pitch or assafcetida plaster around the feet, and apply dry poultices of arnica flowers. The chief malady must, however, also be treated with proper remedies. HEARTBURN. In some sections of the country nurses still continue to rub down children for the purpose of removing the so-called heartburn. Aromatic oils are used for that purpose, such as orange, lemon, cara- way, anis, fennel, peppermint, camomile oil, &c, these are made into soap, with fat, and warmed ; this soap is usually rubbed from the pit of the stomach towards the left side, and from the shoulders along the back. Although this rubbing down may be useful in some cases, care should be taken not to apply much force, which might easily cause some injury. This malady in children is usually the result of acidity of the stomach, flatulency, and the cramps resulting therefrom, which FALLING OF THE UVULA MEDULLARY SARCOMA. 521 could be overcome much more readily by injections and antispasmodic remedies. FALLING OF THE UVULA. This is a morbid condition, where, in consequence of catarrhal attacks, or a previous inflammation, the uvula is elongated and en- larged, offering an obstruction to, and causing pain in, speaking and breathing, but more particularly in swallowing. As long as an in- flammation of the parts prevails, this malady must be considered as belonging to the quinsy class, and requires treatment suitable for that disease ; but if it is a case of long standing, if the uvula is very much relaxed and elongated, so that the symptoms above spoken of are much more severe, stimulating and astringent remedies should be applied, such as gargles, prepared from Peruvian bark, oak or elm bark, in form of a decoction, also a solution of alum or diluted sul- phuric acid, or a powder composed of equal parts of alum, camphor, and soda, or of alum and sugar, which ingredients should be applied to the uvula with a proper instrument. Strongly diluted muriatic acid, also tincture of protochloride of iron, or tincture of acetate of iron, with naphtha, and applied with a hair pencil, is highly recom- mended. If the relaxation of the uvula is the result of a catarrhal condition, it is recommended to apply to it equal parts of salt and powdered pepper, with the handle of a spoon, or other appropriate instrument, or to use a solution of starch as a gargle. i MEDULLARY SARCOMA. Fungus vasculosus is a morbid production, originating as a small, limited, moderately firm, smooth and even swelling, which increases rapidly, remains elastic, and finally breaks open, when a bloody ichor issues. Through the opening thus formed in the skin springs up a redish, white, medulla-like, spongy, proliferating growth, rooted at the bottom, which bleeds at the slightest touch, and secretes a fetid, greenish ichor. The medulla sarcoma always points to a general dis- order, based upon a morbid change of the humors, holding out but little prospect for improvement, quickly destroying the strength of 522 MISCELLANEOUS DISEASES. the patient, and terminating much more rapidly than cancer. It is treated like cancer, although rarely with any benefit. BREAST DISEASES OF WOMEN. Frequently indurations and nodes appear on the breasts of women soon after confinement ; they are usually produced by stagnation of the milk. They should be dispersed as quickly as possible, because they easily break open, when they change into very painful ulcers. If the child will not take the breast, it is best to draw the milk with a breast-glass, or have it sucked off by the mouth of another person. For various reasons this cannot always be done. Under such circum- stances an attempt should be made to disperse the nodes. For this purpose the breast may be steamed several times a day with strong elder blossom tea, which is best done by pouring the tea in a bowl, holding the breast over it, and covering it with a woolen cloth, so that the painful spot only is touched by the steam. The breasts may be stroked downward toward the nipple, in order to promote the out- ward flow of the milk. Place warm parsley, dried on a coal shovel held over the fire, on the breast ; keep the breast covered with a soft lamb, rabbit, or hare skin, or with wadding. The woman should live on low diet. If the breast becomes inflamed, leeches must be applied ; sometimes bleeding is required. If the dispersion does not succeed, suppuration sets in, which usually manifests itself by throbbing pain ; it is treated as directed under "Abscess." Swellings appearing during the time of nursing are usually less obstinate than those which occur immediately after confinement. They are dispersed as above in- dicated, but may be treated with the following domestic remedy : Prepare a poultice from white soap, and put it on the breast. This is an excellent remedy. Warm almond or olive oil, or ordinary melted butter, may be rubbed in ; warmed wadding, sprinkled with camphor, or even ordinary blue sugar-paper, may be put on it. Prepare the following ointments, which spread on linen, and apply to the breast every other day : white wax, venison tallow, sperm, almond oil, one ounce of each, camphor two scruples, melt on a tin plate ; or, fresh unsalted and unwashed butter, yellow wax, white brandy, and rose water, mixed together. THE NIPPLES. 523 THE NIPPLES. Drawing out the nipples is a very troublesome thing, and extremely painful, particularly if the child is nursing ; it frequently happens with the first child. Pregnant women do well, therefore, to try and pre- vent this trouble sometime previous to confinement by a process of hardening the nipples. All tight clothing pressing on the breasts should be removed, and the latter frequently bathed with cold water. Care should be taken, however, not to take cold in them. The breasts may also be fomented with spirituous liquids, such as rum, brandy, &c. To bring the nipples out, wet them with a little saliva, applied with your index finger ; or wear hollowed-out nutmegs, or the shells of a walnut, as capsules over the nipples. The following is recommended as an excellent remedy for chapped nipples : Turkish nutgalls six drachms, over which pour six ounces of white wine; macerate for twenty-four hours; apply to the nipples three or four thicknesses of linen steeped in this liquid. Care should be taken not to let the liquid reach any part of the underwear, as it will make spots difficult to eradicate. These remedies may also be applied after confinement ; the breasts should be carefully cleaned, however, previous to nursing the child. If the nipple is very sore and painful, or if it has suppurated, apply repeatedly during the day mollifying and pain-allaying remedies, such as cream, unsalted fresh butter, an ointment prepared from equal parts of oil of almonds, and the yolk of an egg, apple salve, venison tallow, or the petals of the white lily, softened by being steeped in olive oil. The following ointments would be more beneficial, how- ever : gum arabic solution and the yolk of an egg, half an ounce of each, Peruvian balsam ten drops,* well mixed, embrocate the nipples repeatedly with it ; gum arabic two drachms, Peruvian balsam one drachm, oil of almonds half a drachm, rose water one ounce, make into a liniment, and embrocate the nipple with it six times a day. SALT-RHEUM. Salt-rheum resembles tetter very much, and is a very troublesome and tedious cutaneous disease, showing itself in the form of eruptions 524 MISCELLANEOUS DISEASES. in various parts of the body, most frequently, however, on the back of the hands, in the face, and the sexual organs. Usually very small pustules appear, which, breaking open, discharge a thin, caustic and irritating fluid, causing violent itching. The treatment required is the same as in tetter (which see) ; I will not omit, however, to give a few prescriptions for salt-rheum, which have acquired a high reputa- tion. For embrocation : Take camphor, olive oil, white lead, and lith- arge of silver, one ounce of each, good wine vinegar half an ounce, mix the whole to an ointment ; stir well for one hour, then spread on a piece of linen, and apply fresh two or three times a day. Another : Saltpetre one ounce, ox-gall soap one and a half ounces, white chalk one ounce, mixed with half a pound of unwashed butter ; the chalk and one tablespoon ful of turpentine are added last, and thoroughly mixed ; the affected part is rubbed with it three times a day. Each time before using the ointment, the affected part is to be washed with olive oil soap, almond or sulphur soap. The water in which you wash should have a little borax in it, which must be thoroughly wiped dry before using the embrocation. Another ; Take yellow mercurial ointment and red precipitate, half an ounce of each, sugar of lead half an ounce, white vitriol one gramme, heat half a pound of venison fat, add the above articles to it, and stir until cold ; rub the affected part with it three times a day. Another : Lard half a pound, turpentine two ounces, yellow wax one ounce, honey two ounces, ox-gall one ounce, white vitriol two grains, aquafortis one ounce ; melt the lard, wax and honey together in an earthen pan, and after it has boiled slowly, take it from the fire, add the other ingredients, and stir until it has become cold. Another : Take oil of sweet almonds and spermaceti, two ounces of each, saffron one ounce, mutton tallow a quarter of a pound, honey one ounce, sweet butter a quarter of a pound ; rub in three times a day. Another : Oil of amber and rosin, one ounce of each, red precipi- tate one ounce, flowers of sulphur three drachms, lard half a pound, mix thoroughly, and rub in daily. Before using the above oint- CATARACT. 525 ment, wash the affected part well with alkaline or bran water, and wipe thoroughly dry. Another : Dry and pulverized tobacco leaves one ounce, beef mar- row half a pound, white sulphur one ounce, white vitriol one drachm, raw linseed oil two ounces. The powdered tobacco and beef marrow are slowly boiled together, take it from the fire, and stir until it has become lukewarm, then add the linseed oil, stir for half an hour longer, add the other ingredients, and stir for another hour. Rub in two or three times a day. Another : Lard half a pound, black soap one ounce, sugar of anis oil one ounce, sulphate of zink half an ounce, flowers of .sulphur one ounce, mix well, and rub the affected part three times a day with it. Internally administer a good blood-purifying remedy : Take burdock root and gum guiac, two parts of each, sassafras and licorice root, one part of each, cut the whole of it fine, mix, and boil (not infuse) it for a tea. This beverage must be used for a long time ; it is particularly well adapted for cutaneous eruptions ; drink a cupful warm twice a day. Another : Take myrrh two ounces, burdock root two ounces, yel- low sorrel one ounce, poppy seed two ounces, sassafras bark one ounce, cut fine, and put in a jug or bottle, pour on it one quart of spirits of wine, let it macerate fourteen days, shaking it up daily; dose, a tablespoonful a day (see "Blood-Purifying"). CATARACT. Certain morbid conditions of the eye, from which partial or total blindness result, are called cataracts. The three kinds most known to people are (grey) cataract, (green) glaucoma cataract, and (black cataract) amaurosis. The grey cataract is caused by a dimness of the lens, or the capsule of the lens ; green cataract is falsely called the dim- ness of the vitreous body of the eye, and amaurosis (black cataract) is caused by a paralysis of the retina of the eye, or of the optic nerve. Grey cataract alone may receive surgical treatment. This is not the place to enter into a particular description of these morbid con- ditions. The treatment should be undertaken by a physician only. 526 MISCELLANEOUS DISEASES. WANT OF APPETITE Is usually the result of a lack of exercise and proper activity, of sedentary habits, disorders of the mind, also of excess, of too frequent use of strong spirituous beverages, and continuous brain work. En- deavor to remove the cause, and appetite will return. Much, however, can be effected by medicines, as well as by a well-regulated diet, particu- larly as loss of appetite is mostly caused by a relaxed activity of the digestive organs. Salty and spiced food, such as onions, mustard, herring, anchovies, caviar, &c, excite the appetite to a certain extent, but they may also be the cause of eating more than is good. Spirituous preparations from bitter substances are most suitable for that condition, such as wormwood, orange peel, gentian, sweet flag, &c, taken as a cordial or stomachical elixir. A very good remedy for that purpose are Hoffmann's cordial drops, from twenty to forty drops in a glass of wine. Salt and sea baths are also very excellent for that purpose. FRECKLES. Small, yellowish or brownish spots are called freckles, which usually make their appearance during the summer in persons with a tender, white skin and light hair ; they bleach towards winter. It is said they are caused by the rays of the sun falling on the drops of perspiration (when the body is heated), thus operating like a burning ense on the skin, and burning it. But they also appear on parts of the body which are usually covered with clothing. The following is [an excellent wash for their removal : Venetian borax one drachm, and rose water two ounces. Touching the freckles with oil of myrrh is also highly recommended. In this case all remedies recommended for liver spots are also applicable. LOSS OF HAIR. This morbid condition of the hair results frequently from cutaneous eruptions of the head, but also from severe general affections, such as nervous fever, childbirth, &c. It usually appears in old age, but also manifests itself frequently in youth or manhood ; in the latter cases it deserves our particular attention. If the hair comes out after a LOSS OF HAIR. £2T general sickness, it grows in again in most cases, and frequently much heavier than it ever was. In cases where old people lose their hair, very little can be done, because it usually results from a dimin- ished flow of humors, which the human body lacks in old age. In early life, however, this malady is based on inactivity or relaxation of the scalp, and in rarer cases only can it be attributed to a diminished flow of humors to the head, which causes the hair to become brittle, and break off short at the roots. A consideration of this circumstance is of the highest importance in the cure of this malady. Where a relaxation of the scalp occurs, stimulating and irritating remedies should be applied, but where a certain dry and juiceless state prevails, softening preparations are in their place. The following prescriptions deserve particular consideration : freshly expressed lemon juice and tincture of cantharides, one drachm of each, extract of quinine, prepared in the cold way, two drachms, beef marrow two ounces, oil of cedrat one scruple, oil of bergamot half a scruple, mix carefully. The following is a pomade for the promotion of the growth of the hair after severe diseases : mace, cloves, and fresh laurel leaves, one scruple of each, cardamon two scruples, all of which to be triturated, add one ounce of beef marrow, digest in a closed glass vessel in a hot place for six hours, and press through linen. If inactivity and relaxation of the scalp are the cause of the loss of hair, particularly in early manhood, during which it frequently happens, then every remedy in the shape of salve is more injurious than beneficial, because the fat, which forms the largest part of the pomade, relaxes the scalp still more. In these cases it is beneficial to wash the head with warm water and soap several times a week, and to use spirituous, sharp, aromatic and invigorating remedies for embro- cation. Among the latter may be enumerated diluted spirits of wine, onion juice in connection with whisky, a decoction of mustard, wal- nut leaves, and centaury minor, and also tincture of quinine. It is also particularly recommended to rub on to the hairless spot of the scalp, several times a day, a solution of tartar emetic, about four or five grains to one ounce of distilled water. 528 MISCELLANEOUS DISEASES. LICE. Man is usually infected with three kinds of lice : the head-louse {pediculus capitis), the clothes-louse {pediculus vestimenti), and the body-louse (pediculus pubis). The body-louse appears on the haired part of the genitals, the anus, arm pits, eyebrows, and in the face. It bores its head into the skin and produces a tubercular eruption ; in color it is pale, dirty yellow, ^in the middle a redish-brown ; it is short and broad, and almost square in shape. The two fore-feet are the guiding and the four hind feet the climbing feet ; the broad breast is not distinctly separated from the hind quarter. The body-louse increases very rapidly, and if remedies for its extermination are not applied as quickly as possible, it spreads rapidly over all parts of the body covered with hair, except the hair part of the head. Frequently the eyebrows and eyelashes are fringed with them, when they appear like small scales. Many different kind of remedies have been applied for the extermi- nation of these disgusting insects. Thus black soap, a decoction of tobacco or tobacco ashes, or expressed juice of garlic, have been rubbed in ; these substances were permitted to remain on the affected parts, and subsequently cleaned with soap and water. None of these remedies are as sure as mercurial preparations ; of these the grey mercurial ointment is the most reliable. A single ap- plication to the infected part generally suffices to anihilate the insects. It is unnecessary to combine this ointment with ethereal oils, unless desired for the purpose of obtaining a pleasant scent. Oil of berga- mot or anis are usually employed for that purpose. The application of a solution of sublimate also destroys these insects. The head-louse is sometimes the cause of scald head. It is of a whitish color, the breast part of an oblong square, the hind quarter longer than the fore part, terminating in a notched oval. Its sides are saw-edged, bordered black, and it is provided with climbing feet. To exterminate this troublesome and disgusting insect, which is mostly found in children and uncleanly persons, cleanliness is the most simple and best remedy ; frequent combing of the hair and wash- ing of the head with soap and water are very useful for that purpose. If the malady has become rooted, embrocation of the head with spike CONTAGIOUS MATTER. 529 oil, alone or in combination with oil of almonds, may be of service ; also oil of anis may be used for the same purpose, when the head must be immediately sprinkled with parsley seed, and tied up in a cloth. It is also proposed to mix the fresh juice of garlic with un_ salted butter, to be rubbed on the scalp ; this ointment should be left in the hair for some time, and then combed out with a fine tooth comb. For the extermination of the clothes-louse, the greatest cleanliness is also required ; the severe bite of this insect produces an itch-like eruption. This insect is somewhat paler, more slender, with a sharply defined neck, and a shorter and smaller forepart than the head-louse. The hind quarter has a rounded, not notched, body, and its edges are not quite so deeply fringed with saw teeth. The greatest cleanliness is required for its extermination ; the clothes and bedding should be well boiled when being washed. Grey mercurial ointment may be rubbed in the seams and other places of the clothes where these lice prefer to nest. The louse of the sick is of a pale yellow color, somewhat rounded head, and a larger and broader upper part of the body than the other lice. The hind quarter, from the width of the breast, is shorter, be- ing somewhat smaller behind, and has no tooth-shaped edge, but is of a wave-like form. These lice can be exterminated by constant clean- liness, washing, bathing, combing, cutting off the hair close, and the rubbing in of grey mercurial ointment. The linen, bedding and clothes must be freed from the vermin by hot air, or by strong lye. CONTAGIOUS MATTER Is called the virus, whether visible or invisible, which always causes in animal bodies the same malady or one very closely related to it. Con- tagious matter may be transferred directly or indirectly from one in- dividual to another, or it may be contained in the atmosphere, and affect those who are susceptible for it. Contagion differs from miasma in so far that in the latter a decomposition of animal or vegetable sub- stances occurs, infecting the air, which in its turn affects animal or- ganization • it does not, however, result in the same malady in every instance. Miasma and contagion may, however, easily change from one tothe other. 34 530 • MISCELLANEOUS DISEASES. HARDENING. I will speak here of the hardening of the human body, in so far as it is strengthened thereby to resist external influences more readily, being enabled to bear heat, cold, fatigue, and toil, without detriment to itself. The best time to begin this process of hardening is in child- hood, when the organic structure is, so to say, as pliable as wax, assuming any form into which it is moulded. It is therefore at this time of life when the mistake is more readily made, and the founda- tion is laid for that effeminacy which is so frequently met with in old age. Yet, even adults may harden themselves physically, and over- come the effeminacy for which the foundation has been laid in child- hood, if possessing the requisite courage and endurance. It should not be forgotten, however, that all extremes are injurious, and if too much is demanded from the body, it can only be hurtful. Hardening of any kind mnst be proceeded with only very gradually and cau- tiously. The best hardening remedies are exercise in the open air, activity, and more particularly ablutions with cold water, which is a protection against the effects of a change of temperature. In this also the progress should be very gradual, as the effect of a sudden, in- creased degree of cold, to which the body is unused, may become very injurious. In eating and drinking, be always moderate. Too much sleep should not be indulged in, but the body ought to have sufficient rest. As a rule, six hours of sleep is sufficient for an adult, but children need more. In regard to dress, the greatest caution should be exercised, particularly with children. It is fallacy to think that they can be hardened by wearing light clothes in every kind of weather. The clothing should be in accordance with the weather. To become hardened against hunger and thirst by practicing them would be silly, as that would be done at the expense of the body. The practice of a certain regularity in both would be desirable, how- ever. INSTRUCTIONS FOR THE RECOGNITION OF ALL DISEASES TO WHICH THE HUMAN BODY IS SUBJECT, BY TIKE TTZE^IHSTIE. The faculty of being able to recognize all diseases of the human body by the urine, is truly a discovery. First of all, we remark that urine is a fluid secreted by the kidneys for the purpose of excretion from the body. Urine contains a large quantity of different salts, which have been most carefully examined by the most celebrated phy- sicians. The most prominent of these salts are uric acid, phosphates of soda and ammonia, muriate of soda and of ammonia, and lactic acid. The object of the secretion and excretion of the urine is to separate certain ingredients from the blood, which, if remaining in the body, would become detrimental to the former, and also to seg- regate certain parts of the food which does not assimilate with the blood. Chemists recognize certain ingredients in the urine, which are also found in the blood, to wit : water, lactic acid, and the animal matter accompanying it, fixed alcalies, and lime. They also discover in the urine certain matter formed by the acidulating influence of the kidneys on certain parts of the blood, such as sulphuric and phos- phoric acids, urea, and uric acid. During a certain diseased state of the kidneys, they form too much acid, such as nitric acid, or their acidulating power is destroyed when they segregate albuminous sub- stances, blood, sugar, or ammonia, unchanged. If acids are segre- gated in excess, it usually results in a disease of an inflammable nature ; the segregation of the urine is limited and highly colored. In diseases of debility and irritation, or hysterics, the urine is pale (5.H) 532 DISEASES BY THE URINE. and abundant. The state of the digestive organs has a remarkable influence on the condition of the urine. Much information may therefore be obtained in cases of indigestion of the seat of the disease and also of the effect of remedies, by a careful examination of the urine. Even very moderate changes in diet will have a correspond- ing effect on the urine in morbid conditions. If the urine deposits uric acid in crystals, it is usually disconnected with anything else ; but if the form is irregular, they frequently contain ammonia. All urine contains uric acid, which remains in solution at all tem- peratures, if voided by a healthy person ; if contained in excess, it is deposited as soon as the urine gets cold. This deposit points to a derangement of the digestive functions ; in persons with weak con- stitutions, it may be produced by the slightest error in diet. Some- times the urine contains sufficient albumen to cause its coagulation on the application of heat. This is the case in certain kinds of dropsy, and with these exists a certain inclination to inflammation in some parts of the system. In order to prevent these, bleeding becomes necessary. Sometimes the urine exists in immense quantities, has a sweet taste, and on evaporation contains a large quantity of sugar. This condition is called diabetes. THE URINE. There is no doubt that in former times the examination of the urine has led to many abuses and a good deal of superstition. Many pretented to be able to recognize from it not only diseases, but everything else. It need hardly be stated that such is an impossibil- ity. This brought the uroscopists in discredit and contempt. But it is nevertheless true that the urine is still a deep study, and it is also true that there are but few uroscopists who have made it a proper study. There are still a few honest physicians who examine the urine only for the purpose of recognizing the disease, and these men deserve thanks for having preserved the faith of the people in it. I propose to adhere to my experience, and I am convinced that those who have become acquainted with me in my practice will fully agree with me. THE URINE. 533 Urine is nothing but a secretion of fluids, not adapted to mix with the blood and other moist matters of the body. Four points must be taken in consideration in connection with it: i. The color. 2. The substance. 3. The composition of the substance. 4. In how many parts the urine may be divided. Urine has two chief colors, to wit : white and dark, which indi- cate its condition. Between these two colors there are more than twenty different shades, of which each has a peculiar significance. The substance indicates the degree of the prevailing moisture, be- cause the urine may be moist or dry ; that is to say, thin or thick. It may also contain many foreign substances, such as sand, little scales, pus and blood. The causes of this I will explain more fully hereafter. Aside of that, the urine is divided into three parts, as follows: first, the lower part, above which is the middle part, and over that stands the upper part ; the lower part indicates the condi- tion of the body below the ribs ; the middle part, the middle part of the body to the throat, and the upper part, the head. Before enter- ing upon the discussion of this subject more fully, six rules should be understood, which uroscopists should carefully observe, otherwise mistakes may readily occur, because urine is a sure indicator only with the closest attention and knowledge. THE FOLLOWING SIX RULES HAVE TO BE CARE- FULLY OBSERVED. Rule i. In order to examine the urine, it must be put in a fine white glass, the inside bottom of which should be finally rounded off, and it must have no streaks. Rule 2. If the urine is contained in a vessel, as above described, it must not be examined and tried where the rays or radiance of the sun strike it, nor where it is too dark, because the sun shining into the urine dazzles and prevents a proper observation of its condition, so that the sediment of the urine at the bottom of the glass, which is of weighty importance, cannot be recognized and distinguished. In a somewhat dark place, on the other hand, neither the color can be distinguished nor the fine particles be seen. The physician may also 534 DISEASES BY THE URINE. be easily deceived if he holds the urine too near to or too far from his eyes, because the nearer it is brought to the eye, the lighter does it appear, and vice versa. It should therefore always be held at a cer- tain distance, to which the eye becomes accustomed, and by which it is no longer easily deceived. An observation by candle light deceives even practiced uroscopists ; it should therefore not be attempted. A light room, from which the rays of the sun are excluded, should be selected for that purpose. Rule 3. An old, celebrated uroscopist said : " The urine must always be examined in the same place;" a uroscopist should always bear that in mind. The urine to be examined must be that freshly voided in the morning after a completed digestion ; at other times its color would be changed by the food consumed, which would lead to mis- takes. The urine voided in the morning should be kept standing for six hours (this is only mentioned to guide beginners and students) ; for, an experienced uroscopist may examine the urine already after one hour. It is then tested ; if it stands longer, color and ingredients are subjected to a change, and it would therefore interfere with an accurate judgment. From this it will be seen that carrying the urine for any distance (a short distance excepted), would be objectionable, and frequently would do more harm than good. For that reason it should not be examined at all, for it would require a skillful and experienced uroscopist to arrive at a correct conclusion. Rule 4. When the urine is brought in for examination, proper notice should be taken whether it is clear and clean, or whether it is muddy. Cover it up well, and put it aside for some time; then ex- amine it again, and notice whether any change has taken place. It is sometimes the case that urine immediately after being voided is entirely clear, but subsequently becomes muddy ; while on the other hand again, it is muddy when voided, and becomes subsequently clear. In other cases again, it remains in its original condition. Some muddy urine clears itself when held in warm water. No proper opinion can be formed in that case, because heat causes a change in color as well as substance. Rule 5. Previous to the examination of the urine, the age of the person should be accurately ascertained, because the urine changes THE URINE, 535 with the age of the individual. The cause of this lies in a greater or lesser activity of the respective organs, the difference of the body, and in the entire different mode of life. The urine of a very small child usually has a milky color ; that of older children is muddy and not entirely white ; that of boys or girls to the age of puberty, yel- lowish and thin. In old people the urine is white and thin, which is founded upon the fact that the body does no longer possess its former natural heat, by reason of which it remains white. Aside of that, the excretory ducts are obstructed by lessened activity, which completely filters it before it is voided. The reasons why all this should be strictly observed are given here- with. If a white, muddy urine is voided by a youth of eighteen, it may be mistaken for that of a child in full health. If, on the other hand, the age is known, the urine being of the before mentioned con- dition, indicates that it did not come from a healthy youth, but that it is caused by a disease resulting from a cold. Aside of that, it is well to be acquainted with the temperament of the individual. This, however, is frequently a difficult problem, because passions and licentiousness of every kind impart a quality to the urine, misleading the judgment of the most skillful. Uroscopists are frequently deceived, because the urine of animals is often submitted to their examination, in place of that of indi- viduals. It is also often the case that the uroscopist is imposed upon by being told that the urine submitted is that of a child, when it is that of a man ; or that it is the urine of a woman, when it is that of a man. Nothing good can result from this. The uroscopist may be deceived by all this, if he is not well conversant with uroscopy, and this brings discredit upon all of them. It is therefore better for any- one, if he has not made uroscopy a study, not to attempt it. Rule 6. This also is based upon frank and candid information. It consists in obtaining proper information of the mode of life of the individual in general, of what he eats and drinks, ere an opinion is given on the urine. The condition of the urine is essentially affected by diet. If, for instance, saffron has been used with the food, the urine will be yellow colored ; if salad has been eaten, the urine will have a greenish tint the following morning ; if a large quantity of 536 DISEASES BY THE URINE. food is consumed, it will have no color ; long fasting will color it ; if wine has been drank, it will be light colored, and if beer, dark brown. Violent anger, severe labor, bathing, and other affections in psyco- logical and physical life, produce a change in the urine, which should not be overlooked. These six rules of uroscopy must be strictly observed, if a correct opinion is to be given. SIGNIFICANCE OF COLOR IN URINE. The principal colors of the urine are white, black, or dark, and are subdivided into the following twenty colors : FROM BLACK TO GREY. If the urine has a black, ink-like color, or if it approaches a lead color, it indicates a burnt humidity, which will result in acute dis- eases. WHITE TO PALE. If the urine is as white as water, or of the color of a whitish transparent horn, or whitish fat milk, or if pale like the color of a camel, it indicates an excessive activity of the digestive organs, which in time becomes very pernicious, because it has a weakening effect. PALE. If the urine has a pale color, similar to the color of water in which meat has been soaked, or if it is pale like broth, in which meat has been half boiled, it indicates moderate digestion. QUINCE AND APPLE-YELLOW. If the urine is as yellow as a quince, or yellow of the color of a pale apple, it indicates a complete good digestion. PALE AND REDISH-GOLD-YELLOW. If the urine is red, like pale gold, or red, like beautiful, red gold, it points to a commencement of digestion. BLACK COLOR OF URINE. 537 SAFFRON AND FIRY-RED. If the urine has the color of light or fat saffron, or if it is as red as a flame of fire, it signifies poor digestion, which ought to be attended to without loss of time. LEATHER-COLORED, MUDDY RED AND GREEN. If the urine has the color of leather, of muddy-red wine, or of green herb juice, it indicates a lack of proper digestive power. If the twenty different colors of urine have been distinguished according to the five distinctions of digestion, according to which its origin, beginning, transition, and end, is denoted, the decision is made in accordance therewith, and according to the condition of the individual, which last should never be lost sight of in uroscopy. BLACK COLOR OF URINE. The black color of the urine is produced by three different causes, and results from too violent sexual impulses, connected with a loss of vigor, mixed with some black matter. For the purpose of distinguishing its significance, the following eight rules should be borne in mind : i. If the urine is very abundant, showing a black sediment, it indicates, in violent fevers, very violent headache, and noticeable delirium. 2. If the black-colored urine has a strong smell, it indicates great heat in the lungs and chest, out of which a fatal disease may rapidly develop itself. 3. Urine at first green, changing to black, indicates an excessive cold of the internal organs, extinguishing the heat, and usually de- veloping in a fatal disease. 4. A very black urine, discharged by drops, is evidence of an in- ternal malady, which will prove fatal quickly. 5. If the urine of a female is black below and clear and clean above, it indicates that she will have a natural flow in her sickness. 538 DISEASES BY THE URINE. 6. If the urine is black at the beginning of a fever,, and if it retains that color to the seventh day, it is proof that the patient will recover by proper treatment. 7. If in a four-day fever the urine is black, it indicates the recovery of the patient. 8. If a fever patient perspires on the head, neck, or back, and if, in connection therewith, the urine is black, it indicates that death is not far off. LEAD-COLORED URINE. The following rules are taken from the oldest masters in uroscopy. I cannot, however, give the whole of their instructions, as that would lead too far. I will therefore only mention those only which I have tried myself, to wit : 1. Every "highly lead-colored urine indicates a fatal malady. 2. A lead-colored urine, bordering on black, but which has been green at first, indicates that death is near at hand. 3. If the upper part of the urine is lead-colored, it is an indication of epilepsy, and of other maladies having their seat in the nervous system and the head. 4. If the urine, after having stood for a time, assumes a lead color, it indicates a dangerous case of dropsy. 5. If many bubbles appear in lead-colored urine, it indicates pectoral ulcers, and phthisis pulmonalis. 6. If the urine is light lead-colored and fat, like oil, it indicates a dissolution of the natural humidity of the human body. 7. If by frequent urinating only a small quantity is discharged, that being lead-colored, it proves that the bladder is obstructed. 8. If a great deal of impurity of a flocculent nature is seen in lead- colored urine, it is proof of a disease of the joints. GREEN URINE — WHITE URINE. 539 9. If the urine assumes a lead color in diseases of the head, and more particularly in inflammation of the brain and disorders of the mind, it may be set down as death's messenger. GREEN URINE. In regard to observations of the green urine, the following four rules should be borne in mind : 1. If, in a severe attack of fever, the urine turns green, it will end fatally. 2. If the urine of a child is of green color, it indicates cramps, and excessive, cold humidity in the nerves. 3. If the urine is green in gastric maladies, and at the same time not flocculent at the bottom, it indicates that poison has been admin- istered. 4. If, in insanity and other maladies of the mind, a green circle shows itself, it may be considered death's messenger beyond all doubt. WHITE URINE. Having mastered the preceding rules on urine, the attention should be directed to white urine, and to the many causes producing it. It results from internal organic diseases, natural heat, dispersion of humidity, decrease of vigor, obstructions, and many other similar causes, the enumeration of which would lead too far. The following six rules must, therefore, suffice : 1. If the urine is of a nice white color, it indicates obstruction of the spleen, which is likewise connected with a pale color of the face, and great inactivity of the inner organs. 2. If white urine has a lead-colored circle, it indicates obstruction of the brain and epileptic attacks. 3. White urine, possessing a slimy character, indicates a large quantity of coarse, undigested matter in the body. 540 DISEASES BY THE URINE. 4. If white urine is half lead-colored and purulent, it is a sure in- dication of ulcers in the kidneys and liver, through which urine finds its outlet. The causes of these ulcers are various. 5. If a white, fine, clear urine is inclined to lead color, it indi- cates stones in the kidneys and bladder. If it is desired to know whether the stones are in the kidneys or in the bladder, examine the urine closely, when a very fine sand will be discovered at the bottom. If it is of red color, the stone is in the kidneys; if white, in the bladder. 6. Thick, white, fat urine is a sure indication of existing con- sumption. RED URINE. As a rule, red urine is a symptom of great internal heat. There are, however, exceptions to this rule, which are not at all rare. It even appears sometimes in maladies in which cold predominates. In such a case too copious a discharge of urine is the cause. It has fre- quently occurred that uroscopists, when seeing red urine, decided that internal heat was present, whereupon they advised the use of cold food and remedies, which proved very injurious to the patient. The same is the case with other attendants of patients, when discovering that the latter are thirsty, dry in the mouth, and discharge red urine. They cannot, under these circumstances, imagine that cold predomi- nates, and charge the person making such an assertion with stupidity. I have seen a good deal of abuse dealt out on this point. Red urine results from many causes; it becomes red in cold dis- eases, particularly from obstructions of the membrane between the gall and intestines, from phlegmatic, cold humidity, which prevents the passage of the red cholera into the intestines, instead of which it is forced to the kidneys, in consequence of which the urine must be- come redened. The following eight rules on red urine deserve to be generally noted : 1. If the urine remains red, it is an indication of diseases in the loins, and particularly of inflamed ulcers in those parts. SUBSTANCES CONTAINED IN THE URINE. 541 2. Red urine, retaining that color, and where the red color is not deposited, indicates acute fever, which usually results fatally. 3. Red, muddy, urine points to an ulcer in the liver. 4. If the urine has the color of red oil-paint, and is voided only sparsely, and if it has an offensive odor, it is a sure indication of a fatal result. 5. If the urine is red at the time of urinating, but subsequently changes to lead color, it points to abscesses and phthisis. 6. If the red urine is mixed with black, it is an indication of great heat of the liver. 7. If the urine is rose-colored, ephemera is present. 8. If the urine is red and thick, showing a yellow color on the edge of the glass, when stirred in it, it points to jaundice ; the nearer this yellow approaches the color of saffron, the more progress has the disease made. I have now given the most important points on the color of the urine. It may, however, show other shades of coloring ; the signifi- cance may be ascertained, if proper interest is taken in the matter, and proper attention paid to it. Always take the palest and darkest color, and in that way a correct decision will be easily arrived at. SUBSTANCES CONTAINED IN URINE. As has already been mentioned, three different points should be noticed in the urine : first the color, and then the substances con- tained therein. I have already fully discussed the coloring from which may be concluded that in this a part of the substance is in- cluded. The latter does, however, exist independently in the urine, and for that reason it requires more particular consideration. In order to be better understood in this matter, we will, first of all, enumerate these substances generally, and then proceed to the con- sideration of each substance. 542 DISEASES BY THE URINE. The following sixteen substances are principally contained in the urine : The circle. The foam. The blood. The sand. The natural semen. Pearl bubbles. Granules. Cloudiness. 9. Flocculent matter. 10. Scales. 11. Branny substances. 12. Dust. 13. Wheaten substances. 14. Pus. 15. Sediment. 16. Water. (1). THE CIRCLE IN THE URINE. By circle is understood the uppermost part of the urine. It de- notes a bright and clear mind. Remember the following seven rules on this point ; 1. If the urine has a thick, coarse circle, it indicates injury to the back part of the head, 2. If the circle is violet-colored, and of a coarse substance, it indicates a disease in the inner part of the head. 3. A circle of pale color and fine substance indicates that the left side of the head contains too much melancholic humidity, and that the suffering results from it. 4. A colored circle of fine substance indicates that the head is suffering from choleric humidity. 5. If the circle has a thick substance, and is lead-colored, it is evidence of epileptic attacks, and more or less obstruction in the brain. THE FOAM IN URINE. 543 6. A green circle with a fine substance indicates in high fever that a dangerous inflammation of the brain is developing itself, which usually results in death. ' 7. A vibrating circle indicates an apoplectic fit, or severe catarrh in the head. (2). THE FOAM IN URINE. The foam which sometimes appears in the urine is nothing but a tough humidity, the result of great internal heat. The foam of the urine may be compared to the tough, foamy humidity forming on the shores of hot countries. When the sun shines vertically on the waters, they are moved hither and thither by the heat, the result of which is the formation of foam. Urine being carried from one place to another, also foams readily, and for that reason must be permitted to remain undisturbed previous to examination. Foam caused in that way soon disappears, when a correct opinion may be arrived at. The following four rules ought to be particularly observed in regard to foamy urine : 1. If the urine is covered with foam, which .does not disappear and is moderately coarse, it signifies a lack of digestion, and obstruc- tion of the loins, particularly if, in addition thereto, the urine is thick. 2. If the foam of the urine is soft and lead-colored, it indicates heat in the lungs, heart, chest and liver. 3. If occasionally black foam shows itself, it points to lepra nigricans ; black streaks and spots show themselves on the joints, which is connected with trembling and convulsion of the joints. It originates in consequence of melancholic humidity, which accumulates if an obstruction occurs between liver and spleen, preventing its en- trance into the spleen, and its direct passage through the kidneys into the urine. 4. A foam, the green of which is dispersed, or which is of a saffron color, indicates great heat in the liver, or jaundice, and is proof of pain under the ribs and in the right side. 544 DISEASES BY THE URINE. (3). BLOOD IN URINE. The appearance of blood in urine, having passed off through the urinary organs, is not very rare. Sometimes it is clean, at other times mixed. The following five rules apply in that case : 1. If the blood in the urine is thick and cloggy, of a strong smell, and causing pain in its passage, it may be assumed with some certainty that it comes from the bladder. 2. The blood passing from women during menstruation, is cloggy, and sinks to the bottom in urine. 3. If the blood in the urine is not cloggy, and lays as a black substance at the bottom, it may be assumed that it comes from the kidneys. 4. If the blood appears entirely pure in the urine, just as it would flow from a fresh wound, and if pain in the back is connected there- with, it flows from a vein. 5. If the blood is pure in the urine, and if no pain in the back is connected with it, but stitches on the right side, it is the result of a hemorrhage of the liver. (4). SAND IN THE URINE. The following four rules apply to sand in the urine : 1. If red, hard sand is found in the urine, and if pain in the back is connected with it, it indicates stone in the kidneys. 2. If the passage of hard, red sand produces relief of pain in the loins, it demonstrates that the stone in the kidneys has become severed. 3. If a white, hard sand appears in the urine, settling at the bot- tom, and if connected with pain in the genitals, it is a sure symptom of stone in the bladder. NATURAL SEMEN AND PEARL BUBBLES IN URINE. 545 4. If, during fever, red or white sand is found in the urine, and if pain in the loins is connected with it, then both liver and kidneys are in a heated condition. (5). NATURAL SEMEN IN URINE. It sometimes occurs that natural semen is found in the urine of the male as well as female sex. The following three rules are applicable to it : 1. If the semen in the urine is divided into many parts, it indi- cates either that libidinous thoughts have been indulged in, or that two persons of the opposite sex have playfully approached each other. 2. If the semen appears ctoarse and cloggy in the urine, it demon states that the individual has led a pure and chaste life, and has not responded to the demands of nature ; not infrequently many diseases result therefrom. 3. If seminal matter passes off continually and for some time with the urine, and if it is connected with a burning sensation in the urethra, it is an indication of gonorrhoea, which, if not checked in time, consumes the natural humidity, and becomes very pernicious to health. (6). PEARL BUBBLES IN URINE. Now and then pearl bubbles are found in the urine, which are not foam. Three rules are applicable to this condition : 1. If one or more large bubbles are noticed on the urine, some time after being left in an undisturbed condition, a tedious sickness is in store for the individual. 2. If a large bubble is observed on the urine, which invariably passes to the same side when the glass containing it is inclined, it in- dicates flatulence, which causes severe pain. 3. A large, but not a particularly distinguishable bubble on the the urine indicates gastropathy, and also pain in the small intestines, resulting from coarse humidity or winds. 546 DISEASES BY THE URINE. (7). GRANULES IN URINE. The following two rules apply to granules or small bubbles appear- ing in urine : i. If granules appear in the upper part of the urine, it indicates a catarrhal affection in the head. 2. If the granules appear in the middle, it indicates that the catarrhal affection has descended to the chest and joints. (8). CLOUDINESS OF THE URINE. The following two rules should be observed in regard to this con- dition of the urine. i. If lead-colored cloudiness appears in the lower part of the urine, the existence of consumption is thereby revealed. 2. If urine is foamy besides being cloudy, and of a yellowish or greenish color, it indicates great heat in the liver, resulting from superfluous humidity. (9). FLOCCULENT MATTER IN URINE. Occasionally flocculi are found in urine, which are sometimes coarse, and at other times tender, large, and small. The following four rules apply in this case : i. Red or yellow-colored flocculi in the urine are evidence of ex- cessive heat in the kidneys. 2. If flocculi are found in urine that is fat, it indicates a liquefac- tion of the kidneys. 3. If the coarse flocculi in the urine disappear when the glass is shaken, it indicates an obstruction of the kidneys by a thick, tough humidity. 4. If flocculi appear in an oil-colored urine, it indicates a de- crease of all physical vigor, and the existence of consumption. SCALES IN URINE, ETC. 547 (10). SCALES IN URINE. In regard to the appearance of scales in urine, the following two rules should be observed : i. If scales are found in urine, and no fever present, it indicates an impurity of the skin. t 2. If the urine contains scales, being connected with pain in the genitals, it indicates an eruption on the bladder. (n). BRANNY SUBSTANCES IN URINE. Sometimes it occurs that a branny substance shows itself as sedi- ment in urine, which indicates maladies not easily removed. The following three rules should be observed : i. If a branny substance shows itself in the urine of a female, it is a sure indication that she is suffering from a disease of the womb, the result of salt-rheum or herpetic eruption, or that she has the whites. 2. If the urine contains branny substances, and at the same time emits an offensive smell, it is safe to say that, besides stones, there are ulcers in the bladder. 3. If the urine is branny in fever, consumption will be rapidly developed. (12). DUSTY SUBSTANCE IN URINE. It is no rare occurrence to find in the urine a fine substance, which can be best compared with dust in the sun. On this point notice the following three rules : 1. If fine dust is found as a sediment in the urine, it indicates pain in the limbs or joints (gout). 2. If this fine dust is found in the middle of the urine, it points to difficulty in breathing, and lung maladies connected therewith. 548 DISEASES BY THE URINE. 3. If the urine is generally clean, and a cloud appears in it, caused by this fine dust which rises and falls like dust in the sun, it may be assumed that the woman is pregnant. It must not always be assumed, however, that the woman is not pregnant if this cloud of dust is not present ; because many women are pregnant, and yet it is not manifested by either this nor any other symptom, which must be assigned to a bad constitution or to a poor way of living. Exper- ience demonstrates that the pregnancy of women has been recognized through these indications, and yet many a uroscopist has been very much deceived by it. These indicating symptoms must be carefully attended, as there is much that cannot be communicated in this place. (13). THE COARSE SUBSTANCE IN URINE. It is not a rarity to find a coarser substance in urine than bran ; the following three rules should therefore be observed : 1. If the substance found in the urine is as coarse as spelt or wheat kernels, adhering to each other, and if it has settled to the bottom, it maybe assumed with certainty that in women menstruation is obstructed. 2. If a black substance of that kind is deposited in the bottom of the glass, it indicates too great a flow in the female sex. 3. If at the bottom of the urine a cohering substance of grey color is found, the existence of a disease of the spleen may be assumed with safety. (14). PUS IN URINE. Frequently common pus is voided with the urine. When that is the case, the following three rules must be noted : 1 . If but little pus appears with the urine, it reveals an ulcer in the kidneys. FOG AND WATER IN URINE. 549 2. If much pus is found in the urine, and if it emits a taste or smell, it indicates an ulcer on the bladder ; but if the urine is that of a woman, it reveals an ulcer of the womb. 3. If pain under the ribs, particularly on the right side, is con- nected with urinating, it indicates ulcers on the liver. (15). THE SUBSTANCE PRESENTING AN APPEARANCE OF FOG AT THE BOTTOM. In regard to this manifestation, the following three rules should be noted : 1. If a grey, uneven cloud becomes visible at the bottom, it in- dicates an obstinate disease of whatever nature, difficult of being cured. 2. If the fog at the bottom is lead-colored, it indicates the cessa- tion of the natural heat, which has death in its train. 3. If on the lower part of the glass a black fog is visible, it indi- cates iliac passion. (16). WATER IN URINE. In many diseases it happens that a part of the water consumed by the individual, passes off in its original state or condition. It appears in the urine in the middle, at the bottom, or top. On this point phy- sicians, unless very careful, may be deceived by mistaking it for fog. The following three rules should therefore be particularly noted : 1. If the urine contains a raw, therefore not diluted, humidity, it signifies, if on top, a disease of the chest and difficulty of breathing. 2. If the raw, undigested humidity — the natural water — is found in the centre of the urine, it indicates pain in the stomach and in- testines, resulting from colds or winds. 3. If the raw, undigested fluid is found in the lower part of the urine, it indicates ulcers on the kidneys or loins. 550 DISEASES BY THE URINE. The foregoing contains the best, most reliable, and fully tried in- structions on urine. We might with it close this section, were we not of the opinion that it would afford satisfaction and bring convic- tion to our readers, if we reproduce here more fully the views of a few old masters. THE PROPER COLLECTION OF THE URINE, AND SUITABLE VESSELS FOR THAT PURPOSE. If a safe conclusion is to be arrived at from an examination of the urine, it should, first of all, be collected at the proper time, which is after the first and second digestion have been fully accomplished, and therefore after a night's sleep, about five or six o'clock in the morn- ing. As soon as an inclination for urinating manifests itself, it should not be restrained, because it lessens the certainty of the indications, which it contains. On the other hand, the person should not be urged, if the necessity for it does not exist, as that would be acting contrary to the demands of nature. The urine voided in a regular way should be collected in a sufficiently large glass, for if every part voided at the time is not collected, no reliable observations can be made. If the pressure for urinating should occur previous to the time mentioned, say between the hours of two and four o'clock in the morning, it should be satisfied at once. If the necessity for urinating occurs again between the hours of six and eight o'clock, it should be collected in a separate glass. Both should be examined, in- asmuch as the urine collected in the bladder during the night, contains much surer indications than that voided during the day. The glass in which the urine is collected should be as thin as possible, of proper capacity, and as clear as crystal ; it must be free from every coloring, and have neither a green, yellow, red, blue, or any other tint. If it has any kind of a tint, or if the glass is too thick, a reliable examination becomes an impossibility. The collected urine should be kept in a moderately warm place, such as in bed, or in a room, but should not be placed near the fire. One hour after it has been voided, it may be taken to the physician for examination, and his decision obtained. THE PULSE The pulse is caused by the alternate contraction and expansion of the heart and the arteries. This contraction, aided by the vigor of the heart, forces the blood through every part of the body. As the pul- sations of the arteries correspond with the movements of the heart, the condition of the circulation is determined according to the pulsa- tions of the arteries, and from this many important indications of diseases are derived. The beating of the pulse, in a state of health, is about seventy-two pulsations, or it varies between sixty and eighty. It is somewhat less in some individuals, without being detrimental to health. The pulse is always . a little quicker in the female than in the male sex, in san- guine than in melancholic temperaments, in youth than in age. The pulsation in a newly-born child runs to about one hundred and thirty to one hundred and forty during the first days of its life, sometimes more, sometimes less ; the exact numbers cannot be ascertained. During the first year it runs from one hundred and ten to one hun- dred and twenty. From the state of the pulse, together with other symptoms, the existence of inflammatory diseases is ascertained, and in accordance with it the existence of debility and the effect of certain remedies are determined. In attacks of fever the pulse increases to from one hundred to one hundred and eighty pulsations ; sometimes it is impossible to count them. In certain maladies, such as dropsy in the chest, it changes and becomes irregular ; the same effect is produced by the use of fox-glove. In some persons an intermittent pulse is the normal state, in others it changes in consequence of gastric and intestinal derangements, and also in affections of the mind. The artery selected for the examination of the pulse is the radial artery above the wrist, where it passes immediately underneath the skin. But where this cannot be conveniently done, the temporal or (55i) 552 THE PULSE. facial artery, where it passes over the edge of the inferior maxilla, is selected. The examination of the pulse requires some attention, as it is, in some persons, accelerated by temporary excitement of the mind, such, for instance, as the entrance of the physician, or by his ques- tions and remarks on the condition of the patient. The physician should therefore examine the pulse both at the time of his entrance and departure. If it has been attempted to ascertain the nature of the disease from the urine, particular care should be taken to examine the pulse also, because from these the most accurate conclusions of existing maladies may be arrived at. We have seen already that the pulse is nothing but a motion of the heart and arteries, as it moves up and down, and aside of the distribu- tion of the blood to all parts of the body, it also effects a cooling down of the natural heat. The cause of this vigorous motion is the secret power of life, which it would be impossible to ascertain, as all opinions heretofore expressed are not founded on a solid basis. BEATING OF THE PULSE. Nine different and distinct pulsations may be discovered in the beating of the pulse, which I will here enumerate : i. The pulse is large and full, if the pulsation is long, broad and deep. 2. With the distinct opening and closing of the arteries, the pulse may be quick, medium, or slow. 3. According to the strength or weakness of the power, the pulse also is strong, medium, or weak. 4. According to the condition of the arteries, the pulse is hard, medium, or soft. 5. If the pulse beats strongly, it is large ; if it beats weakly, and is infrequent, it is weak. 6. To this belong the regular and irregular beating of the pulse, that is to say, a pulse which beats a few times rapidly in succession, ON FEELING THE PULSE. 553 which is followed by a pause, and again succeeded by a few slow pul- sations, and again by rapid pulsation, &c," 7. The intermittent pulse, varying in the number of its pulsa- tions. 8. The entirely regular pulse. 9. The pulse heating the artery. ON FEELING THE PULSE. When the physician visits a patient, he should not feel his pulse at once, but sit down for a short time and converse with the patient, because the mind of the latter having become excited by the arrival of the physician, and his expressions, produces a change of the pulse for a short time. The hands of the physician should not be too cold nor too warm, for the external influence of the cold moderates the pulse, while it becomes excited by heat. When the hand has assumed the natural tempera- ture, the physician should take with the lower joints of the fingers of his right hand, the left of the patient. The tips of the four fingers are applied, in order to ascertain whether the artery is long or short, while he takes the fingers of the patient with his left hand, slightly pressing them. During this examination he should remain quiet long enough to count at least fifteen pulsations ; frequently, however, the physician will find it necessary to count up to one hundred. After being fully satisfied with the examination of the pulse of the left hand, the right hand should also be examined, as the pulse of that hand is usually stronger. This would be the safest mode to pro- ceed. It will now become evident, that feeling the pulse is of much greater importance than is usually imagined. A physician can only arrive at a safe conclusion by it through long practice, and if he is well acquainted with the person he is examining. Thus a man of sanguine temper may feel very well with an accelerated pulse, while one of phlegmatic temper, if his pulse is slightly more accelerated than that of the former, is really dangerously ill. It will hardly be 554 THE PULSE. necessary to say that in this there is a gradual progression according to temperament and mode of living, and that individuality must be closely examined and tried. INFLUENCES EFFECTING A CHANGE IN THE PULSE. The pulse is greatly changed by external surroundings, in regard to which the following four rules should be remembered : i. With a heated atmosphere, the pulse is quick and full. 2. Under the influence of cold, the pulse is weak and slow. 3. Under the influence of moisture, the pulse is deep and broad, and frequently beats unequal, and also soft. 4. In a dry atmosphere the pulse is tight and hard. The pulse is also greatly changed by the constitution, and very much depends whether a person is lean or fat, plethoric, or dry. Lean people have a much larger and stronger pulse than those who are fat. The reason of this is, because with the former the arteries are not so deeply imbedded as they are with the latter, where they lie deeply in the flesh. On the other hand, in fleshy people the pulse is quite quick, large and soft. With the increase of years the pulse also changes very much. The pulse in children is quick, on account of the heat that is in them, and thick because they are weak. The pulse of boys and girls is large,*and entirely different from that of children, whilst in old people it is small, slow and thin, which results from the decrease of internal natural heat. In regard to the pulse of men and women, a great difference pre- vails. In men it is much stronger than in women, as their nature is much stronger ; that of women is much quicker and fuller. The pulse is also effected by the seasons. In spring, for instance, it is small and strong ; in summer, small, quick, and thick; in autumn it is strong, soft, and slow ; in winter, small, thin, and weak. RESPIRATION. 555 The changes in the weather exercise a very great influence on the pulse ; it is effected by it in precisely the same manner as by the seasons. Food and drink also produce a marked effect on the pulse. SIGNIFICANCE OF CERTAIN SYMPTOMS IN RESPIRATION. i. Frequent Respiration, if repeated oftener than usual in healthy persons within a given time, indicates as follows : first, a more rapid circulation of the blood (therefore, in fevers ; for the more rapid the respiration, the more violent the fever ; frequent, deep respiration is a symptom of the highest grade of inflammatory fever) ; second, weak lungs, when persons lose their breath after very slight exertion ; lastly, an impediment to the expansion of the lungs, for instance, in inflammation of the lungs or the liver, dropsy of the chest, and flatulence. 2. Respiration at Long Intervals is the opposite of the pre- ceding, and indicates a quiet motion of the blood, free entrance of air, and circulation of blood through the lungs. Deep respiration at long intervals, and with a good deal of exertion of the pectoral muscles, indicates a great lack of vigor ; if accompanied by sighs, it points to approaching fainting fits or convulsions ; short, cool respi- ration at long intervals is an indication of approaching death. 3. Rapid Respiration, that is, if exhalation follows inhalation rapidly, indicates pain in the chest and abdomen, which is increased with the expansion of the chest ; rapid exhalation intends to lessen the expansion ; the same is the case in inflammation of the bowels and lungs ; or it is caused by an increased irritability of the lungs, which is usually connected with cough, as in catarrh ; or it indicates an ob- struction to the expansion of the lungs, for instance, tubercles in the lungs, in case of an inclosed ulcer in the lungs. 4. Slow Respiration indicates the opposite, free expansion of the lungs, free circulation of the blood through them, and absence of 556 THE PULSE. irritation and spasms. The ability to draw a long breath, and hold it for some time, is, therefore, the best indication of a sound chest. 5. Deep Respiration. — If this can be done without difficulty, it is a sign of sound lungs. It is different, however, if it requires a great effort of the chest, and has to be forced, or if it is done in fear and becomes audible. Under such conditions it is a symptom of a surcharge of blood, of spasms, and of an insensible, delirious con- dition, particularly if it occurs at long intervals. 6. Short Respiration results from an obstructed expansion, spasms, and weakness of the lungs. 7. Difficulty of Respiration is divided into several degrees : asthma, oppression of the chest, wheezing or sighing breath, and the highest grade, suffocating breath. With these afflictions the patient can only breathe in a sitting or standing position, with outstretched throat, and with great exertion. With all difficulties in respiration the blood accumulates in the brain, and may produce insensibility ; at the same time the regular distribution of the blood in the rest of the body is prevented, the pulse becomes small and intermittent, and the limbs cold. Difficulty in respiration points to an obstruction in and outside of the air passages (in entirely healthy people it is frequently only an indication of plethora), or it is a morbid condition of the lungs. Suffocating respiration indicates an insurmountable obstruction, the highest degree of inflammation of the lungs, an effusion of water and matter into the chest, &c. 8. Rattling Respiration indicates accumulation of phlegm, pus or blood in the bronchi, or a palsied condition of the lungs; it occurs in the dying. 9. Whistling Respiration indicates a contraction in the trachea, which is induced either by spasms (spasmodic asthma), or by the exu- dation of coagulating mucus (croup). 10. Hot Breath indicates an accelerated circulation of the blood. Very hot breath indicates either a general inclination to in- RESPIRATION. 557 flammatory diseases, or inflammation of the lungs, or other abdominal intestines lying near the chest. This is of particular importance in little children, for it is frequently the only symptom by which this kind of inflammation may be discovered in them. The worst symp- tom in inflammation is a hot breath with cold limbs. ii. Cool Breath indicates a sluggish circulation of the blood, watery blood, obstructions in the lungs, and entirely cold breath in- dicates a dying state, and internal mortification. HOUSE DISPENSARY. The following remedies are almost indispensable for a proper house dispensary, particularly in the country, where a physician cannot always be found, or an apothecary shop is accessible: SIMPLE REMEDIES. Almonds. Almonds, bran of. Alum. Anisseed. Assafcetida. Bitter salt. Bran of almonds. Butter (unsalted). Cajeput oil. Camomile. Camphor. Caraway seed. Cinnamon. Creosote. Elder flowers. Elder juice. Epsom salt. Fennel seed. Flannel. Glauber salts. Gum. Honey. Leeches. Lemons. Marshmallow leaves. " root. Marjorum, sweet. Mezereon bark. Mustard. Myrrh. Nutmegs. Oak bark. Oatmeal. Olive oil. Pepper. Peppermint. Poppy heads. Rum. Saffron. Sage. Salep root. Sea salt. Senna leaves. Spirits of wine. Spunk. Sulphuric acid. Sweet flag. Syrup. (558) HOUSE DISPENSARY. 559 Licorice. Linseed. Linseed oil. Lint. Lycopedium. Magnesia. Mallow flowers. Mallow leaves. Thyme, wild. Valerian root. Venison tallow. Wax. Willow bark. Wine. Wine vinegar. COMPOUND REMEDIES. Sugar. Ether. Tincture of arnica. Arquebusade. Salve for burnt limbs. Effervescing powder. Diachylac plaster (simple and compound). Court plaster. Goulard's extract. Hoffmann's life elixir. " anodyne liquor. Spirits of camphor. Quieting powder for children. Laudanum (Sydenham's). Lip-salve. Stomach elixir. Opodeldoc. Powder (sedative). Spirits of sal-ammoniac. Soap plaster. Species (herbs). Pectoral tea. Grape salve. Wax. Oil-cloth. Tooth tincture. Herbs for poultices. Blood-purifying herbs. Besides the above, a larger number of simple or compound remedies, such as are hereafter mentioned, may be kept ready for use. All remedies should be kept in a cool place, and in good order; those spoiled should be replaced by fresh. AACHEN'S (AIX LA CHAPELLE) SPRINGS. They are partly cold chalybeate, and partly warm sulphur springs, varying in temperature from thirty-seven to forty-seven degrees Reaumur. These celebrated sulphur springs are particularly beneficial in old cases of venereal diseases, metal poisoning, such as lead, cop- 560 HOUSE DISPENSARY. per, arsenic, quicksilver, and also in old cases of gouty foot-ulcers and paralysis. The city of Aachen has pleasant surroundings, and a fine fresh air, presenting to patients who come from abroad, a healthy and pleasant abode. ACETATE OF AMMONIA Is used in the liquid form, or as "spirit of Minderus." Internally administered, it acts as a sudorific ; it is an excellent remedy for that purpose ; one or two drachms of the liquid may be added to two or three cups of elder blossom tea. Externally it operates as a discutient, particularly in swellings and indurations of the glands, milk-knots, and very old swellings of the testicles. It is one of the best remedies for freckles, for which purpose it is at first diluted with equal parts of water, and afterwards used pure. ACONITE. This poisonous plant grows wild on the Alps of Switzerland; with us it is raised in the garden. It furnishes an important remedy for gout and rheumatism of long standing, diseases of the lungs, blennor- rhcea of the same organ, whooping cough, &c. Prepare from it a powder (dose, five to fifteen grains twice or three times a day), or take it in the form of an extract (dose, one to four grains twice a day), and as a tincture (dose, from eight to twenty drops twice a day). ACORN COFFEE. Acorns used for that purpose must be fully ripe, and after the outer hard shell has been taken off. They are roasted and ground like the coffee bean. Acorn coffee is principally used for scrofulous children with bloated abdomen. It is strengthening to the bowels, and a remedy in liver and heart diseases. ACRID LETTUCE Grows wild in the southern part of Germany ; with us the plant is sometimes raised in gardens. All of its parts have a disagreeable, stupefying smell, and a tough, sharp, bitter, burning, milky juice, which is obtained by slight incisions of the plant ; the juice dried in HOUSE DISPENSARY. 561 the air, yields a mass resembling opium. From the fresh leaves the extract is prepared in the apothecary shops. Both preparations have a considerable quieting, soporific, antispasmodic, anodyne, and also a diuretic and diluent effect. Acrid lettuce is an excellent anodyne in spasms of the respiratory organs, in asthma of old people, in whooping cough ; in the latter, however, only after cessation of the inflammatory state ; also in swellings of the glands, and particularly of the liver. It is therefore an excellent remedy for jaundice. The extract is usually used for adults, in doses of ten grains twice a day. To children under seven years, from two to three grains are adminis- tered for whooping cough. ALMONDS. The almond tree is indigenous to the northern part of Africa, but it is now raised in all mild climates. The fruit which it bears, is covered with a juiceless, leathery, perforated shell, the kernel of which is the well-known almond. There are two kinds, the bitter and the sweet almond. Both of them are made use of in medicine for emulsions (see the article), and an oil is expressed from both. The oil of the bitter almonds contains also prussic acid in no incon- siderable quantity, and for that reason bitter almonds would have a poisonous effect if eaten to excess. Some animals, parrots for in- stance, may die after eating a single bitter almond. The residue, after the oil has been pressed out of the almond, furnishes almond- bran, which still retains sufficient oil to be used as a wash for soothing and beautifying the skin. The milk of almonds, or emulsion of sweet almonds (one ounce of almonds yields on an average eight ounces of emulsion), is a soothing and lightly nourishing, thirst-quenching remedy; in inflammatory diseases it is used for the purpose of enveloping other sharp remedies (for instance saltpetre). Oil of sweet almonds allays irritation, and is soothing, and for that reason it may be used in irritated conditions of the respiratory organs. An excellent combination for any cough is the following : oil of sweet almonds two ounces, violet syrup one ounce, rock candy one and one-half drachms. The oil is also useful in attacks of colic, particularly in lead-colic, in inflammation of the urinary organs, and spasmodic costiveness; for stomachache in 36 562 HOUSE DISPENSARY. small children, administer a teaspoonful at a time (see "Almond Milk"). ALOES Is the juice of several aloe plants hardened in the air, of which there are three different kinds : the liver aloes, horse aloes, and soccotrine or shining aloes ; the last is the best of the three. Aloes, adminis- tered in small doses, from one-half to one grain, increases the activity of the digestive organs ; for that reason it is used in many stomachic elixirs. In larger doses it causes severe purging; its use requires great caution, and it is very irritating and heating. It should not be taken in cases of inflammation of the bowels, in hemorrhages, or during the time of menstruation. The preparation, which may be taken with less risk, is the watery extract of aloes, as it produces the least inflammation, and is less irritating. It is usually combined with a powder, for instance licorice powder in equal parts, made into pills of two grains each. Persons of advanced years, troubled with con- gestion, and if suffering from costiveness, may take one or two pills before going to bed. Externally, tincture of aloes is applied with a small hair-pencil to old, flaccid ulcers with great advantage. ALLSPICE, PIMENTO, Is the fruit of an evergreen tree indigenous to the West Indies. Pimento is a very good remedy in weakness of the stomach and the intestinal canal, with an inclination to mucous formations. It may be taken every four hours in the form of a powder, from three to eight grains as a dose, or as an infusion. from one to two drachms to six ounces of boiling water ; dose, a tablespoonful several times a day. ALUM. Alum is a salt, consisting of a combination of sulphuric acid, potassa, alumina, and water, which forms the so-called crude alum. Burnt alum is obtainable by heating, which expels a portion of the water. The former is an astringent, and the latter a slightly caustic remedy. AMBERGIS Is a fatty, finely scented substance, which is found swimming on the ocean near the Sunda Isles, in pieces of from twenty to one hundred HOUSE DISPENSARY. 563 pounds. It is probably a morbid production of the spermaceti whale. It is used as one of the ingredients in fumigations, finely scented tinctures, dentrifices, &c. It furnishes a vivifying, nervine remedy in medical prescriptions. It is triturated up to twenty grains with sugar, and taken in coffee or chocolate, or spirituous tincture of ambergis is taken, from ten to fifteen drops. To some persons the scent is offen- sive, causing nausea and headache. In such cases the smelling of burnt hair, feathers and assafcetida, is the best remedy. AMMONIA, CAUSTIC, LIQUID. Externally applied, it has an irritating effect. The fumes are very beneficial for weakness of the eyes. It is mostly used, however, in the form of concentrated caustic, volatine spirits of sal-ammoniac, for the bites of poisonous snakes, adders, and mad dogs ; it is also very good for stings of bees, wasps, and hornets. By touching in the latter cases the spot with spirits of sal-ammoniac, the pain is im- mediately lessened, or entirely removed. Diluted, it is used as a dis- cutient of swellings, milk-knots, indurations, &c. It is particularly used for making liniments, with camphor and soap, for embrocations in rheumatic and arthritic pains. AMMONIA. Carbonate of ammonia operates like caustic ammonia. AMMONIA, CARBONATE OF AMMONIA, SALT OF HARTSHORN, Is used frequently for external applications, in liniments and oint- ments, as a discutient remedy in lameness and lax skin (without an inflammatory condition). Combined with ox-gall, it is used for spots on the cornea, when it is applied with a hair-pencil. For the same malady it is used in combination with other substances, as follows : salt of hartshorn five grains, ox-gall half a drachm, extract of hem- lock half a drachm, water one ounce, mixed ; a small quantity is dropped into the eye several times a day. This remedy has acquired an extensive reputation. 564 HOUSE DISPENSARY. AMULET, Derived from the Arabic word " Hamalet," meaning appendix. Although superstitious people may have been imposed upon in regard to amulets, it cannot be denied that the wearing of certain amulets 'has produced beneficial effects, be this the result of the peculiar me- dicinal virtues of the material, or of the faith of the wearers, or from excited imagination. To the first, particularly, belongs rhe wearing of opium in a little bag around the throat, for earache, toothache, and faceache ; also the wearing of ambergis, assafcetida, valerian root, henbane, &c, for inflammation of the throat ; of camphor and juniper berries as protection against infectuous diseases, such as scarlet fever, measles, small-pox, &c; sulphur, powdered and carried in a little bag on the back part of the head, for nervous headache ; a silk ribbon and amber beads for inflammation of the throat ; a magnet for rheumatic and gouty affections, &c. From the class based on imagination, we select the following few from a large number : antispasmodic rings, made from the nails of dug-up coffins; an eel's skin worn as a garter or armlet against cramps ; chicory root, having an uneven number of knots, dug up during the wane of the moon, and worn around the neck by a thread for goitre ; a garden spider put in a nut shell, and worn by the patient around his neck for chills and fever. Never hav- ing tried it, I cannot say whether it is a specific. ANGELICA ROOT. Angelica root is generally known as possessing medicinal qualities ; it has a very biting, bitter, taste, and a very agreeable flavor. It is very warming, and for that reason is very effectual in all spasmodic pains, flatulence and winds of the stomach. It is also very good in cases of nervous headaches ; for weak digestion it can be highly recom- mended. Angelica root may be administered as a tea, or in a decoc- tion. A potion may be prepared from it by pouring six ounces of boiling water on half an ounce of the cut-up root, and permit it to draw for a time ; in that shape it is administered a tablespoonful at a time. Of the tincture, take from twenty to fifty drops; it is pre- pared by infusing a part of the root with four parts of rectified spirits, HOUSE DISPENSARY. 565 for three days. It is then filtered. It is also made into a cordial and prepared as a preserve. ANISSEED— STAR ANISSEED. It is an excellent carmination and expectorative ; for children it is an antispasmodic, the last on account of the ethereal oil it contains. Anis is a popular remedy in catarrh, colic, diarrhoea, pectoral affec- tions, and profuse mucus secretion. Anis is best used as a tea, which may also be given to children with beneficial results. It is usually prepared in the following manner : anis rolls, half a pound of fine flour, half a pound of powdered sugar, one ounce green anis, the yolk of one and the white of two eggs, a thimbleful of powdered cream of tartar, well mixed, knead and formed into small loaves ; dry in a warm place for twenty-four hours, and then bake in an oven. Anis cordial is good for flatulence. Anis oil from four to six drops on sugar, administered for coughs, flatulence, and catarrhal difficulties (loosening phlegm and promoting its expectoration) ; combined with fat, it is rubbed on the head for insects. Sugared anisseed may be obtained at the confectioners. Star anisseed operates like the common anis. ANTIMONY Is a brittle, lamellar metal, and when pure, of a white metallic lustre. It rarely occurs in a pure state, but most frequently in connec- tion with sulphur (sulphuret of antimony). Antimony may be com- bined with various ingredients, most of which find application in medicine. First, with oxygen in various proportions, then with sul- phur as sulphuret of antimony, or crude antimony, precipitated sul- phuret of antimony or Kerme's mineral, golden sulphuret, with chlorine (the so-called butter of antimony), with tartar (see "Tartar Emetic"), with lime (see "Liver of Sulphur"), &c. All antimonial preparations have a particular effect on the secretory organs, and for that reason they are approved sudorifics and diuretics. Their effect also extends in a high degree to the activity of the skin, and therefore they are also excellent remedies in many cutaneous diseases. They also cause vomiting, and are among the most approved solvent iemedies. 566 HOUSE DISPENSARY. ARNICA. An important remedial agent, particularly used as an infusion and tincture. The powder of the flowers and root is added to sternuta- tories. Internally, as well as externally, an infusion and tincture is principally used. Externally it is used in injuries where the flesh has not been wounded, such as by pressure, blows, contusions, &c; it soon removes extravasations. These preparations are used internally and externally in lameness, gout, nervous affections, great debility, fits of long standing, epilepsy, St. Vitus' dance, &c. The infusion is prepared by pouring six ounces of boiling water on one or two drachms of dried flowers, let it stand in a covered vessel until cold, and strain. Adults take half of this potion in hot elder blossom tea in the even- ing, and the other half the next morning. This is done three days in succession, when several days are permitted to elapse, without taking the remedy, then proceed in the same manner until the malady is removed. The same infusion may be used externally as a poultice. It is better, however, to make embrocations with the tincture, which may also be taken internally, in doses from thirty to forty drops several times a day. The extract or ethereal oil of arnica is not commonly used. ARSENIC. The use of arsenic as a remedial agent we pass by altogether, as the use of this poison in the hands of a layman is always connected with danger. We will consider it here only in so far as to speak of it in connection with poisoning, when immediate assistance is required. The taking of arsenic produces violent, burning pains in the stomach, spreading upward to the throat, and downward to the abdomen, severe and continuous choking and vomiting, connected with spasms, unquenchable thirst, with dry, hard tongue, hoarse voice, violent diarrhoea, with bloody stools, drawing in of the abdomen, terrible anguish, oppression of the chest, irregular pulse, trembling of the limbs, and general cramps. Subsequently the convulsed limbs be- come paralyzed, the heart and pulse beat slower, the patient becomes unconscious, the hair falls out, the cuticle peels off, and death follows. HOUSE DISPENSARY. 567 Remedies : Endeavor to produce vomiting as quickly as possible, by administering quantities of lukewarm water with olive oil or but- ter. Give also a great deal of mucilaginous drinks, such as warm fat milk, decoctions of oatmeal, linseed, and marshmallow root ; particu- larly serviceable is a solution of scraped white soap in hot water (one pound of soap to four pounds of water), of which administer a tea- cupful lukewarm every three or four minutes ; drinking the water used for some time by blacksmiths for cooling their red hot iron (protoxide of iron). ARTICHOKE Is a kitchen plant of which there are different species, possessing medicinal qualities. The leaves adhering to the stalk, and also the root, have diuretic qualities. They were formerly frequently used in dropsy. The extract, in doses of three grains several times a day, or the tinture, from one to two drachms, are good remedies for long continued rheumatism. The tincture is obtained by digesting for several days one pound of crushed leaves in one quart of spirits of wine, and then filter. The extract is obtained by evaporating the juice of the leaves and stalks. ASSAFCETIDA. This is the dried, milk-like juice of the root of a plant, five or six feet high, growing in Persia. Assafoetida is one of the best remedies in physic, particularly in nervous diseases, hypochondria, hysterics, diseases of the abdomen and uterus, obstructions of the liver, spleen, &c.; jaundice, dropsy, helminthiasis, difficulties in the urinary and genital organs, respiratory organs, in blennorrhea, &c. Externally it is used for injections, in asphyxy, nervous apoplexy, and for dis- solvent plasters In the apothecary shops various preparations can be found, such as simple and compound assafoetida water and tincture. On account of its bad smell, it is usually administered in the form of pills. AVENS ROOT Is the root of a tree indigenous to Europe, of balsamic flavor, faintly resembling that of cloves, and of a similar, but more astringent, bitter taste. Avens root is one of the best substitutes for calisaya bark, and 568 HOUSE DISPENSARY. is administered in connection with it. It is particularly useful in cases of dysentery, diarrhoea, muscular debility, scrofula, and rickets. It is most effectual in the shape of powder, in doses from one-half to one drachm, taken several times a day ; it may also be taken with beneficial results in the form of an infusion or decoction (from one- half to four ounces in boiling water). BADGER'S GREASE Is used in certain salves for external use, and has a soothing effect in pectoral maladies, if taken internally, and for that reason it is very useful in cases of consumption. BALMMINT Is a well known, hardy plant, growing wild in many parts of Europe, and is frequently raised with us in gardens. The leaves are used in medicine, and possess an aromatic, bitter, burning taste, and strong, pleasant aroma. They are used for infusions, poultices, baths, herb cushions, and tea. The truly effective portion of the plant is its ethereal oil, which is used internally and also externally for embro- cations. In the apothecary shop may be found balmmint water, and also balmmint syrup. Its efficiency and application does not differ very much from peppermint (which see). BALSAM. In former times every strongly scented, natural, combustible, vege- table resin of the consistency of a syrup, was called balsam. At the present time balsams are also called several compositions containing ethereal oils, resins, and similar ingredients of the same consistency. Natural balsams are, for instance, balsam of tolu, copaiba, Peru. &c. The number of artificial balsams is uncertain, as they may be manu- factuerd at pleasure. They are used mostly externally, and a few only internally. Of the artificially prepared balsams we will name here a few only. Elemi Balsam. — Elemi, Venetian turpentine, mutton tallow, and lard, equal parts, melt over a gentle fire, and strain through oakum. The ointment is of a pale yellow color, and smells of elemi. HOUSE DISPENSARY. 569 Lifebalsam — White Spanish soap and oil of turpentine, half a pound of each, carbonate of potash one ounce, mix thoroughly. For external use. Hoffmann's Lifebalsam. — Oil of lavender, cloves, cinnamon, lemon, nutmeg, marjoram, rue, and orange, twenty grains of each, black balsam of Peru one drachm, spirits of wine ten ounces, mix, and shake up occasionally, while the mixture is kept in a cool place for several days. The fluid part is then poured off, the balance filtered and corked up air-tight in a bottle, and put aside. For in- ternal use. BARLEY WATER. Boil a part of washed barley with about twelve or sixteen parts of water, until the husks crack off, strain, and add a little lemon or rasp- berry juice, with sugar to taste. This enveloping, thirst-quenching beverage is well adapted for inflammatory and feverish diseases, in hoarseness and rawness of the throat, &c. BEARBERRY Grows wild in the forests and mountainous regions of Germany. The leaves, gathered in summer, are preferably and almost exclusively used for diseases of the urinary passages, particularly in mucous ob- structions, and weakness of the same. It is administered in a decoc- tion (one ounce with twelve ounces of water, boiled down to six ounces, every two hours half a teacupful), or as a powder, in doses from eight to twenty grains. BEAR'S GREASE Is rarely obtained genuine from the apothecary shop, lard being usually substituted in its place. It is rubbed in, in painful places, for earache, gout, swellings, and similar maladies. BELLADONNA. This poisonous plant grows in America, as well as in Germany, and as a poisoning may occur, particularly with children, we will examine it here more fully. The stalk grows to the height of from 570 HOUSE DISPENSARY. two to five feet, stands upright, is of a redish brown color, and some- what striped ; the leaves are pretty large, dark green on the inside, and pale green on the outside, and fine-haired, egg-shaped and pointed at both ends. The blossoms are dark red, and have stems ; the calix is monopetalus, five-clefted ; the crown of the flower nearly one inch in length, bell-shaped, and with five divisions ; the cherry- shaped berries are green at first, and turn black afterward ; they have a disgusting sweetish taste, and are divided in the inside into two compartments full of seeds. The root is long, turnip-shaped, and one or two inches in thickness. Symptoms of poisoning : Small doses cause dryness in the mouth and throat, harsh taste, diminution of saliva, dryness of the eyes and nose, decrease in stool and urine evacuations, and sometimes redness of the skin of the face and breast. Larger doses cause heaviness, pressure in the head, dizziness, stupefaction, weakness of sight, dark- ening of vision, spasmodic contraction of the throat and gullet, cramps, finally deliriousness, insanity, extravasation in the face, con- siderable enlargement of the pupils, protrusion of the eyes, difficulty in breathing, and death. Remedies for poisoning : In the first place, administer a strong emetic (three grains tartar emetic, and twenty grains ipecac, or sul- phate of zinc, or blue vitriol from four to eight grains, dissolved in one ounce of water, of which administer one teaspoonful every ten minutes until it operates), drink strong coffee after it, administer diluted vinegar in large quantities, and also vinegar injections. As a medicine, the powdered leaves are principally used, of which powder give to small children one-sixth to one-quarter of a grain (prescribe, for instance, two grains powdered belladonna leaves with eight grains of sugar, from which prepare eight or twelve powders); to adults, administer from one-half to one grain several times a day. A dose of tincture of belladonna for adults is from ten to twenty drops ; less adapted is the extract. Belladonna is an excellent remedy for whooping cough, scarlet fever, hydrophobia, and also for paralysis, St. Vitus' dance, and epilepsy. Externally applied, it operates as a discutient and pain-allayer in swellings and glandular indurations, particularly as a plaster. The internal use requires HOUSE DISPENSARY. 571 great caution ; a beginning must be made with very small doses. It is best to use it under the direction of a physician. BENZOIN. Benzoin is a fine-scented gum; it is chiefly used for fumigations and cosmetic purposes. One part of gum benzoin dissolved in six parts of rectified spirits, to which rose water is added, yields the so- called virgin's milk, a toilet article for beautifying the skin. Com- pound tincture of benzoin is used as arquebusade for injuries of ten- dinous parts ; it is composed of the following ingredients : gum benzoin four and one-half ounces, aloes half an ounce, balsam of Peru one ounce, rectified spirits of wine three pounds; it is digested in a closed vessel at a gentle heat. BESTUSCHEF'S NERVINE TINCTURE, Ferruginious, sulphuric ether, the preparation of which, having been formerly kept a secret, was sold at a high price ; it can now be had in every apothecary shop. It is prepared in the following manner : one part of solution of protochloride of iron, two parts of sulphuric ether, shake for one-quarter of an hour. The ether swimming on the surface is poured off, a part of which is mixed with two parts of rec- tified spirits of wine, put in well-stoppered bottles, and placed in the sunlight until it has become quite clear. It is invigorating and nerve- stimulating in nervous affections of women, chlorosis, and spasms ; dose, from ten to thirty drops twice a day. BIBERNEL, Or common pimpinella, a plant growing in Germany in dry places ; the root of it is principally used for medicinal purposes. The pow- dered root is given in doses of from ten to twenty grains three or four time a day, or an infusion (half an ounce of the root with four to six ounces of boiling water), or the tincture, from fifteen to thirty drops three times a day. It is administered for weak digestion, mucous ob- struction of the stomach, old cases of croup, with a sponginess of the tonsils, and as a gargle in old cases of lung catarrh and mucous asthma. 572 HOUSE DISPENSARY. BIRCH BARK. The external white skin of birch bark is an excellent remedy for the restoration of suppressed sweating of the feet. For that purpose cut out soles from the bark, and place them in the shoes or boots, with the inner surface facing the sole of the foot. The leaves of the tree may also be used for that purpose ; fill little bags with them, in which place your feet. Young birch leaves and the buds, distilled, yield a fine ethereal oil. An extract prepared with spirits of wine or whisky, furnishes an excellent domestic remedy in colds, weakness of the stomach, scurvy (take half of a cordial glass several times during the day) ; externally it is used for cuts. Tea prepared from the leaves and used internally, has a similar effect. One part of fresh leaves and two parts of grease yield a salve for tetter and other cutaneous diseases. Birch-juice is a pleasant drink, and very beneficial to people who suffer from rheu- matism and gout. Birch tar or oil is obtained by the dry distillation of birch bark, which is. applied internally and externally for gout and rheumatism ; a good antiarthrictic paper or taffeta may also be pre- pared from it. BISMUTH. This metal is white and brittle, has a crystalline, laminated texture, and has been known for a long time. With nitric acid, the subnitrate of oxide of bismuth is formed, which was formerly called the magistery of bismuth. The latter is an excellent remedy for diseases of the nerves, particularly spasms of the stomach, for which it has acquired a high reputation. Dose, from one-half to one grain. It should be prescribed only by a physician. BITTER ORANGES. This is the fruit of a tree indigenous to China, but now cultivated in all parts of southern Europe. The leaves, blossoms and peelings of the fruit are used in the house as well as for medicinal purposes. Apothecaries prepare from it oil of orange flowers, orange flower water, syrup, tincture, and extract. All of these preparations have a very good effect in gasterasthenia, colic, flatulence, acidity of the HOUSE DISPENSARY. 5 to stomach, irregularity of stool, &c. The leaves are best administered as an infusion (from one-half to one ounce, to from four to eight ounces of boiling water) to be used daily ; orange flower water is administered, a tablespoonful every two or three hours, and of the syrup from half an ounce to one ounce is added to other mixtures ; the yellow part of the orange peel is given as a powder, from six to twelve grains several times a day, or as an infusion, from two to four drachms, to four and six ounces of boiling water. The extract is taken in doses from ten to fifteen grains several times a day ; the tincture is used in connection with other stomachics from one-half to one drachm. BITTERSWEET Is a good remedy in long continuing lung catarrhs and lung blen- norrhea, whooping cough, cutaneous diseases, rheumatism, gout, scrofula, blennorrhea of the genitals, &c. A decoction is used for poultices and as a wash in herpetic maladies and ulcers. Internally, the remedy is rarely applied alone. The stalk is usually used, from which the decoction or extract is prepared. A dose is half an ounce in six ounces of water, to be taken within twenty-four hours. BITTER SALT, EPSOM SALT. Epsom salt, sulphate of magnesia, is a cooling and laxative drink (see " Purgatives"), of which one ounce, dissolved in water, may be taken at once. BITTTER WATER Contains a solution of the bitter salt before mentioned, in larger or smaller quantities. The bitter water of Saidschuetz is stronger than that of Seidlitz. Of the former, take from four to six ounces before breakfast ; it may be taken with milk. BLESSED THISTLE Is a plant growing wild in Southern Europe, it is sometimes met in our gardens. It is used in medicine for its bitter extractive matter 6T4 HOUSE DISPENSARY. with great advantage in mucous obstruction of the lungs and catarrhal cough. The extract may be found in the apothecary shop, and may be taken several times a day, in doses from ten to twenty grains, dis- solved in aromatic water. BLOOD-PURIFYING HERBS Consist of soapwort, burdock root, gum guaiac, two parts of each, sassafras and licorice root, one part of each, cut up small, and mixed and boiled (not infused) as tea. It must be used for some time, and is particularly useful in cutaneous diseases, gout and rheumatism. BORAX Is a white, crystallized salt, which is an important external remedy. In aphthae in children, borax is principally used in connection with rose honey; it is also used in external ulcers, particularly in the mouth. Also in cases of drawn-up nipples, for which purpose it is made into a salve with the yolk of egg f Peruvian balsam, and oil of almonds. It is also used in the following diseases : in spots on the cornea as powder, salve, or in solution ; for liver spots and heat blis- ters, dissolved in rose (water half a drachm of borax in one ounce of rose water), as a wash. Dissolved in water, it may be used as a wash in old cases of whites. BREAD WATER. Boil some stale, grated wheat bread with six to eight parts of water in a covered pot for about one hour, strain, and add again boiling water to it. This water may be mixed with other substances ; it makes a healthy drink. Toasted bread may be used for the same purpose. BUCKBEAN. Buckbean is a tonic and febrifuge, of bitter taste ; the dried leaves and the extract may be obtained in the apothecary shop. The leaves are used as an infusion, powder, or electuary, and the freshly expressed juice in the spring. Buckbean, however, is almost always admixed with other remedies. HOUSE DISPENSARY. 515 BURDOCK ROOT Is the root of a plant growing wild on uncultivated lands. Its opera- tion is mild, sudorific and diuretic, without causing any gastric difficul- ties. It is therefore administered in cases where a slight, continual per- spiration is required, such as rheumatism, gout, chronic cutaneous dis- eases, &c. A decoction is used for a drink ; one to one and one- half ounces to one and one-half pounds of water, boiled down to one-half, and mixed with licorice root or licorice. The decoction may also be employed externally as a poultice for scald head, and gangrenous and herpetic ulcers. It is a popular belief that if used as a wash for the head, it promotes the growth of hair. CALISAYA BARK, Peruvian bark, is the bark of the chinchona tree, indigenous to the West Indies. There are several kinds of this bark, of which the cali- saya is the best. Its taste is acrid, bitter, spicy, and astringent. Calisaya bark is one of the best remedies for intermittent fever, and frequently effects a cure without the use of any other remedy; at the same time it is invigorating and antiseptic, and is therefore useful in all cases of debility, and in nervous and putrid fevers. On account of the mentioned qualities, it is also useful as an external remedy in relaxed and putrid ulcers, spongy, scorbutic gums, &c. Taken inter- nally, it is difficult to digest ; it also causes constipation, and is irri- tating to blood vessels. It cannot be used therefore where the diges- tive organs are weakened, and obstinate constipation prevails. The bark is given in the form of a powder, in doses from one-half to one drachm every three hours, and for the purpose of inciting the diges- tive organs to activity, there is added to every ounce of the calisaya bark either one drachm of orange peel, or half a drachm of cinna- mon. The following decoction is also used : one ounce of calisaya bark with eight ounces of water, reduced to six ounces by boiling ; also the watery extract from ten to eighty grains, and the spirituous extract from five to fifteen grains for a dose. CALOMEL Is a mild preparation of mercury, which is a chief remedy in many diseases, and is particularly used for the purpose of causing secretion 5T6 HOUSE DISPENSARY. in the liver and the mucous membrane of the intestines, also to de- crease the activity of the vascular system, and as an antispastic to the intestinal canal. In ^most cases it may also be used as a purgative, for which purpose it may be administered to adults in doses from two to four grains, and to children in doses from one-quarter of a grain to two grains. If evacuation is not effected, it must be administered in much smaller quantities. While taking it, abstain from using salt, and more particularly acid food and drinks. Its use should not be continued too long, as it easily results in salivation. CAMPHOR. The camphor in common use is obtained by sublimation of the twigs and leaves of the camphor tree, growing in the East Indies and Japan. It is an excellent stimulating remedy, which is frequently used internally and externally in medicine. For external use, the camphor is usually dissolved in spirits or vinegar, and applied by em- brocation for lameness, contusion, dislocations, in gouty and rheu- matic difficulties, watery swellings, chilblains, &c. Rheumatic tooth- ache is allayed by a little camphor, wrapped in cotton, and introduced in the ear, or by placing camphor on a hot plate, cause the vapor to permeate some sheep's wool, which apply to the aching part. Inter- nally it is used in many diseases, the particulars of which will be given in the different cases. It is also sometimes used against vermin. CARAWAY SEED. A well known, spicy seed growing in meadows, furnishing an ex- cellent carminative and stomachic. Caraway seed is generally used for a tea, for which purpose several drachms of caraway are crushed and infused with boiling water. Triturated caraway two parts, gin- ger one part, salt one part, is an excellent powder for the stomach ; it must not be taken, however, during a state of inflammation. For cramps, flatulence, and a weak state of the stomach, hypochondria and hysterics, caraway may also prove beneficial. Oil of caraway is used for flatulence, a few drops at a time on sugar. It is also exter- nally applied for similar difficulties, by rubbing it in on the abdomen. HOUSE DISPENSARY. 577 CARDAMON Is the capsule of an East India plant, containing seeds having a strong, pleasant, and somewhat camphor-like flavor, and a spicy, strong taste. This spice is particularly useful in non-inflammatory weakness of the stomach and the intestinal canal, with great incli- nation to the formation of mucus. Cardamon may be administered in the shape of a powder, in doses of from three to eight grains every four hours, and as an infusion of from one to four drachms to six ounces of boiling water. It is administered a tablespoonful at a time. CARMELITE WATER Is prepared in the following manner : fresh lemon balm leaves one and one-half pounds, the outer yellow rind of lemons four ounces, nutmeg and coriander seed, two ounces of each, cascarill bark, cin- namon and cloves, one ounce of each, rectified spirit of wine five pounds, lemon balm water three pounds. This remedy, which is ad- ministered internally, in doses from one to three drachms, is heating, and a nerve stimulant, and is useful in spasmodic colic and flatulence. CARROTS. This well-known vegetable furnishes nourishing and wholesome food, which may be eaten also by convalescent persons. Greater medicinal virtue has been ascribed to it than it really possesses. As a popular remedy, they are used (perhaps with some advantage) for intestinal worms, when eaten raw, or the expressed juice is drank. For hoarseness and inclination to cough, carrot juice is a pleasant palliative. In the apothecary shops the inspissated juice is kept as carrot syrup. More extensive and important use is made of the car- rot as a pulp, for internal use, particularly for burns (applied grated and raw). The manner of application will be found under " Carrot Pulp." CASSIA BARK. This is the inner bark of the twigs of the casia laurel tree, and is indigenous to Malabar and China. The flavor and taste is the same as that of cinnamon. Both cinnamon and cassia are stimulants, pro- moting digestion, and are particularly useful in weakness of the 37 578 HOUSE DISPENSARY. stomach and intestinal canal. From it are prepared tincture of cassia, syrup of cassia, and cinnamon water. The first is given in doses of from fifteen to thirty drops ; the other two are added to other remedies. CASTOR. Of the various kinds, the Siberian and Muscovian is the best. It is an antispasmodic remedy and has proved beneficial in hypochondria, hysterics and epilepsy. It is administered solid or as a powder, in doses from one to eight grains twice or three times a day; of tincture from ten to forty drops three times a day; the ethereal preparation from ten to twenty drops. Externally as injections. Combined with opium, it modifies the narcotic effects of the latter. CASTOR OIL. This is a fat, mild, whitish-yellow oil, which is obtained from the seed of a tree growing in the East and West Indies. In this country it grows to the height of five or ten feet, while in the East and West Indies, and in some parts of Africa, it reaches from twenty to fifty feet. Castor oil is an article too well known to require further descrip- tion. The oil is a simple, mild, but certain purgative, and may be administered to persons of every age and condition. It is a very valuable purgative, and being very mild in its operation, it is adapted for children and delicate women, particularly in pregnancy, and in certain diseases when exhausting or strong remedies would be dan- gerous, for instance in inflammation of the bowels, hemorrhoids, ruptures, &c. A dose for adults is from one to two tablespoonsful twice a day, and for children, one or two teaspoonsful once a day. CATECHU, JAPAN EARTH, Is an extract obtained by decoction in water of the inner wood of several species of acacia. It is used in medicines particularly for its astringent qualities. CAUSTIC. By caustic is meant a sharp substance, which is destructive to any substance with which it is brought in contact. It not only produces HOUSE DISPENSARY. 519 local inflammation, suppuration and gangrene, but it also effects the organism generally, because it excites vitality, and operates antispas- tically on the spot destroyed. Caustics therefore occupy an import mt place among remedies. Among these are certain earths, such as unslacked quick lime and burnt alum ; alkalies, such as caustic am- monia, caustic potash, and caustic soda ; of acids, particularly sulphuric, muriatic and nitric acid ; of metals, mercurial prepara- tions, such as sublimates and precipitates, sulphuret of copper, arsenic, antimony, from which pustule or tartar emetic salve is pre- pared. CAUSTIC POTASH Is potash free of carbonic acid, which is melted, and, after being cast in proper forms, is permitted to solidify again. It must be carefully kept in well-stoppered bottles, because it deliquesces when exposed to air. It operates rapidly and vigorously on the organism, and for that reason the greatest caution should be observed in its application. Neither should it be applied to parts of the body that are exposed to view, if the same object can be attained by other caustic remedies, as it leaves a very disfiguring scar. CELANDINE LEAVES. This plant grows wild all over Europe. The root and leaves yield a yellow juice, of a sharp, bitter, burning taste, and pleasant aroma. Celandine extract is principally prepared from the leaves, and is used in abdominal diseases, obstructions of the liver, the portal system, dropsy, obstructions of the functions of the female sexual organs, hemorrhoids, indurations of the liver, spleen and mesenteric glands, &c. Externally the fresh juice is used for spots on the cornea, for the corrosion of warts and old inflammation of the eyelids. The ex- tract is given in doses of from five to twenty grains. The freshly expressed juice is used as a spring medicine (one-half to one drachm). CENTAURY MINOR. This plant grows wild in Germany, and also in this country. The same may be said of this plant that has been said of hedge hyssop (which see). 680 HOUSE DISPENSARY. CEVADILLA SEED. This is the seed of a plant growing in America. It is an excellent remedy for insects (lice) ; its application requires great caution, how- ever. It is used internally as well as externally, but must be ordered by a physician only. CHALK, WHITE, Is sometimes used for effervescing powders. For that purpose half a drachm of powdered chalk is mixed with a tablespoonful of water ; a little wine vinegar is added to it, and the fluid swallowed while in a state of effervescence. CHARCOAL. This vegetable coal, particularly that prepared from the lighter woods, is one of the best antiseptic remedies for the removal of bad odors (see " Fetid Breath "), but it is also used for other purposes, both internally and externally. It is particularly useful in cases of putrid fever, heart-burn, rising of the stomach, phthisis pulmonalis, intermittent fever, flooding resulting from debility, and in cases of metal poisoning. Externally, charcoal is applied to gangrenous, putrid, fetid, cancerous and scorbutic ulcers. It is used in the form of an ointment in cases of scald head and tetter. It is also used as a tooth powder (see the article). Internally, charcoal is administered either as a powder, or in the shape of an electuary (which is the best form), in doses of from ten to thirty grains several times a day. For external use, no particular measure or weight is required,. but for a salve it is customary to take equal parts of fat and charcoal. We will remark that freshly burnt and powdered charcoal, placed in flat vessels, purifies the air very quickly; sprinkled in the chamber-pot and privy, it removes the offensive smell. The powder for external use is frequently mixed with camphor, myrrh, or opium. CHERRY LAUREL LEAVES. This is an evergreen shrub indigenous to Syria ; the leaves of which, when ground or crushed, emit the flavor of bitter almonds, being caused by the prussic acid contained therein. From it cherry laurel HOUSE DISPENSARY. 581 water is prepared, which cannot be distinguished from bitter almond water ; one may replace the other. It is administered in doses, from five to twenty drops and upwards, in cases in which diluted prussic acid would be administered. CHLORINE Is a yellowish-green gas compressed to a fluid. The inhalation of the gas is very injurious, but as it is one of the best disinfectants, readily destroying all contagious matter and offensive effluvia, it has been frequently used with" much benefit in contagious diseases. For that purpose chloride of lime is best adapted ; it may be bought in the apothecary shops. Chlorine is externally applied on putrid and foul ulcers. CINNAMON. Cinnamon is the bark of various trees growing in Ceylon and the Antilles ; it has an agreeable, aromatic, sharp and sweet taste. In medicine it is used in the same way as cassia. CLOVES Are the buds of a beautiful tree, indigenous to the Molucca Islands, but now raised in any part of the East Indies. Upon the whole, they are more hurtful than useful as a spice, and as a medicine, at most applicable only for great inactivity of the intestinal canal. The oil of cloves, which is refreshing and acts as a stimulant, is used for toothache, by impregnating a wad of cotton with it and putting it in the hollow tooth ; for diarrhoea of long standing, and weakness of the intestinal canal, after dysentery, it is rubbed in on the abdomen. CLUB MOSS" Is beneficial in retention of urine, weakness of the bladder, and the resulting inability of urinating, and also generally as a diuretic rem- edy. Two heaped tablespoonsful are boiled in one pint of water until reduced to half a pint, of which a cupful is drank every ten minutes, or it may be used as a tea. 582 HOUSE DISPENSARY. CLYSTER Is an injection into the rectum. It is prepared from various medica- ments, which come in contact with a large part of the intestinal canal, and are partly absorbed and transferred into the general juices ; the largest part, however, passes off again through the rectum. Clys- ters are administered if a local effect is to be produced on the rectum, the lower intestinal canal, the bladder, &c, or if medi- cines and food cannot be administered by the mouth. Evac- uating clysters consist of twelve ounces of camomile infusion, with one or two tablespoonsful of English or table salt, a few tablespoonsful of linseed oil, and also a little white soap, sugar or honey. For children, the quantity of the fluid, as well as the in- gredients to be added, must be greatly reduced, and must be adapted to the age of the child. Cooling clysters, consisting of two parts of water and one part of vinegar, to which bitter or Glauber salts has been added, are applicable in inflamatory diseases, acute fevers, bilious fever, &c; astringent clysters, consisting of linseed, isinglass, and more particularly of starch decoctions for diarhcea, dysentery, and cholera ; diluent clysters, prepared from a decoction of dande- lion, doggrass, soapwort, fumitory, centaury minor, and yarrow leaves, are excellent for abdominal complaints. Antispasmodic clys- ters', consisting of infusions of camomile or valerian, with assafoetida dissolved in the yolk of an egg, or mixed with small doses of poppy seed juice, are very soothing in all spasmodic maladies of adults, as well as children. The clyster must not be administered too hot ; the tube of the syringe must not be inserted too deep, and the patient should not strain during the injection. COD LIVER OIL. This is an oily substance obtained by exposing the liver of the cod- fish to the sun, when it drips out. It has a yellowish or brown appearance, and is of a disagreeable train-oily taste. Of late it has been a favorite remedy for scrofulous diseases, rickets, cutaneous dis- eases of the head, chronic cutaneous diseases of the skin, rheumatism, and gout ; in these cases it is prescribed for internal use, and also ex- ternally for embrocations, or to be applied with saturated lint. To HOUSE DISPENSARY. 583 get rid of the bad taste in the mouth, a little peppermint water is drank after it, or the mouth is rinsed out with it, or peppermint lozenges may be kept on the tongue until melted. The remedy must be continued for weeks or even months ; it is administered a table- spoonful at a time, three or four times a day. But as its continued use easily affects the digestive organs, it may be administered with the same effect in the form of injections ; three or four tablespoonsful are sufficient for one injection. COFFEE BEAN Is the seed of a cherry-like fruit of a tree from fifteen to twenty feet high, indigenous to Ethiopia, but now growing in the East and West Indies. Its preparation as a beverage is well known everywhere. Coffee is refreshing and stimulating in its action, and has a very strong effect on the nervous and blood system. It would undoubtedly be in- valuable as a medicine, if its wholesome effect were not lost to us by the daily use we make of it. With the qualities we have just named, it is impossible that it should agree with every constitution, or in every state of health. Neither does it produce all those bad effects with which its use is charged, particularly as our organical structure has become somewhat blunted to its medicinal action by daily use. It shows itself particularly beneficial during convalescence after severe and debilitating nervous diseases ; in intermittent fevers, in connection with lemon juice (three quarters of an ounce of coffee, with three ounces of water, boiled down to one-half, to which three drachms of lemon juice is added), in nervous headaches, and gastro- dynia ; also as an antidote for intoxication, in poisoning with opium, and in asthmatic difficulties. The use of coffee is, however, clearly injurious in all conditions showing an excited state of the blood, in plethora, palpitation of the heart, congestion to the head and chest, in hemorrhoidal difficulties, derangement of menstruation, hysterics, hypochondria, chlorosis, whites, weakness of the genitals, spermator- rhoea, &c. For medicinal purposes the coffee should be stronger than for ordinary use. In the latter case, on an average three cups of water are allowed to half an ounce of coffee, but in the former, one ounce of water is taken for one cup of coffee. 584 HOUSE DISPENSARY. COFFEE TINCTURE. This tincture is prepared by digesting from two to two and one-half ounces of roasted and ground coffee, with one and one-half pounds of hot whisky. It is recommended as a good remedy for intermittent fever. It is administered when the patient is free from fever, in doses of from one to two tablespoonsful every two or three hours. COLCHICUM. This bulb root grows all over Europe; it flourishes best in wet meadows, but is also cultivated in gardens. The root, seed and flowers of this plant are utilized, particularly for gout and rheuma- tism, and also for dropsy. It is one of the most powerful remedies. Oxymel, wine, and tincture, are prepared from colchicum. At the present time, the tincture and wine find preference. Of the former, from one to three drachms, and of the latter, from three to six drachms, are given in twenty-four hours." It should be taken, however, only by direction of a physician. COLOCYNTHS Is the peeled, dried fruit of an East India plant. The pith of it is prescribed as a powerful remedy to effect strong, watery evacuations of the bowels, and urinary secretions in dropsy, jaundice, obstructions of the liver, mucous obstructions, laming of the feet, and also diseases of the mind. In the apothecary shops the tincture and extract may be obtained. Of the former, administer from eight to fifteen drops, of the latter, from two to four grains. A watery infusion is also pre- scribed (fifteen to twenty grains to five ounces of water), dose, one tablespoonful three or four times a day. COLOPHONY Is the resin obtained in the distillation of turpentine. Powdered and sprinkled on oakum, and moistened with spirits of wine, it is used for the dispersion of cold swellings, particularly of white swellings of the knee-joint ; it is also haemostatic. It is also used as an addition to stimulating and dispersing plasters. HOUSE DISPENSARY. 585 COLTSFOOT. This plant is found all over Europe, as well as America. It is useful in pulmonary diseases, and in maladies of the respiratory organs; it is one of the herbs composing pectoral tea; promoting the expectora- tion of mucus ; it is also beneficial in lung catarrh. The infusion pre- pared from the plant is taken warm, a cupful at a time, and in quan- tities to suit the patient. The decoction is used for fomentations, and the fresh leaves are applied to wounds and ulcers. COMMON SCURVY Is a plant growing on the shores of the sea of Northern Europe ; with us it is raised in the garden, which, when in bloom, is gathered entire, or its root-leaves only are collected. The plant has a pecular cress- like, bitter-salty .taste, and a sharp smell. The plant is one of the best remedies for scurvy. The fresh leaves are used as salad, or they are eaten on bread and butter, or* one or two ounces of the freshly expressed juice is taken in whey, tea, wine, or broth. The crushed leaves may also be applied externally to scorbutic ulcers. In the apothecary shops the common scurvy spirit may be obtained, which is taken internally in quantities of thirty to sixty drops for scorbutic gums, flaccidity of the mucous membrane of the throat, tonsils, &c. It is also used as a component part of several mouth-washes and gar- gles. A conserve, and also a water, are prepared from the plant, neither of which is, however, of great efficiency. COPAIBA BALSAM Is a thickish, aromatic, acrid, bitter-tasting juice, exuding from in- cisions in the trunks of various trees in Brazil ; its consistency is somewhat heavier than fat oil. Copaiba balsam is principally pre- scribed in blennorrhcea, particularly of the urethra, after the first in- flammatory state has passed. Dose, twenty to forty drops twice or three times a day. COPPER. Copper in its various forms is one of the most important, and, at times, one of the most beneficial remedies. Of the preparations, we mention the following : 586 HOUSE DISPENSARY. i. Sulphate of Copper, blue vitriol, is prepared by pouring diluted sulphuric acid on copper filings, evaporating the solution, tri- turating the residue, dissolving it in pure water, filtering and re-crystallizing it. Of late the sulphate of copper has been used in- ternally for membranous croup (which see); dose administered to children from one to seven years, from one-eighth to one- quarter of a grain every half hour ; mixed with sugar of milk to form six-grain powders, it is administered until vomiting sets in ; it is also given in phthisis, blennorrhea of the lungs, severe diarrhcea, and scorbutic hemorrhages. Externally it is used for malignant ulcers, cankered mouth, blennorrhea of the genitals, hemorrhages, inflammation of the eyes of long standing, &c. A dose for internal use is from one- eighth to one-half of one grain twice or three times a day. As an emetic, from four to six grains are dissolved in water, which is ad- ministered, a teaspoonful at a time, until vomiting sets in. For diseases of the eye, from one to three grains are dissolved in one-half to one ounce of distilled water, which is dropped in the eye. A water for dressing wounds is prepared by dissolving from ten to forty grains in from two to four ounces of water. 2. Ammonio-sulphate of Copper. — It is prepared by dissolving triturated sulphate of copper in water of ammonia ; pour over it pure spirits of wine, and, after having remained undisturbed for several days, pour off the fluid, and carefully preserve the remaining crystals. Ammonio-sulphate of copper is an excellent remedy for epilepsy and St. Vitus' dance (which see). Dose, internally administered, from one-eighth to one-half a grain, twice or three times a day. 3. Acetate of Copper, Verdigris. — Verdigris (which see) is rarely used internally ; externally it is used as a powder for sprinkl- ing on flaccid, inactive ulcers ; sometimes also in blennorrhceal oph- thalmia, to be used with a pencil-brush, and as a gargle for an ulcerated throat, the result of venereal disease. 4. White Copperas, Eye-stone. — White copperas is mildly astringent and drying, and is used exclusively for diseases of the eye, particularly where the parts are flaccid and inactive. From one to HOUSE DISPENSARY. 58 1 five grains are used for one-half to one ounce of distilled or rose water, to be dropped into the eye. CORROSIVE SUBLIMATE Is formed by a sublimation from a mixture of sulphate of the pro- toxide of mercury and common salt. It is very poisonous, even in small doses. It should only be administered by order of a physician. Antidotes are given under that head. COTTON Is an excellent discutient and pain-allaying remedy, by covering or wrapping up the suffering part and the surroundings with carded cot- ton. It has proved particularly beneficial in gouty and rheumatic attacks, stiffness in the joints, swelling of the glands, indurations and knots in the female breasts, whitlow, and burns. CRABSTONES Are stone-like formations, which occur in the month of August, on the side of the stomach of crabs, at the time when they shed their old shell and get a new one in its place. Crabstones are ground into a fine powder, which, like magnesia, is used particularly in cases of acidity of the stomach. CREAM OF TARTAR. This is gradually deposited in the form of a hard crust on the sides of vessels in which acid wine is kept ; the color responds to the color of the wine ; red from red wine, and yellowish from white wine. This product is called the crude tartar, from which, by various con- trivances, purified or crystallized tartar is obtained. Cream of tartar enters into combination with various other ingredients, from which it obtains its name, for instance, with ammoniac it becomes tartrate of ammonia, with soda it becomes tartrate of soda or Rochelle salt. All these salts are cooling, antiphlogistic, increasing secretion and ex- cretion, and laxative. Purified bi-tartrate of potassa is used more fre- quently than any of the others in diet and medicine, particularly as an admixture to drinks. On an average, several drachms may be taken during twenty-four hours. 588 HOUSE DISPENSARY. CREOSOTE In its pure state is a translucent, colorless, light-refracting fluid, con- stituting the antiseptic and meat-preserving element of wood vinegar and wood tar. Although creosote has not proved as beneficial as has been claimed by many people of late, yet it still remains an excellent remedy ; externally, for putrid ulcers ; in toothache, the consequence of hollow teeth, applied as a salve combined with fat ; for scrofulous induration of the glands, mixed with water (creosote water), four to eight drops of creosote, dissolved in a little spirits of wine, and dilu- ted with one ounce of water ; for poultices for obdurate oedema in the feet, gangrene, cancerous ulcers, decubitus, chilblains ; as a gargle, for putrid croup and cankered mouth. The following pills may be put in hollow teeth : creosote half a scruple, marshmallow powder sufficient to make into one-grain pills. The following preparations are well adapted for toothache : i. Creosote eight drops, spirits of wine one drachm, mix. 2. Creosote six drops, sweet oil of almonds one drachm, mix. CROTON OIL Is pressed from purging seeds of a tree growing in India. It is a very irritating, sharp purgative ; one drop of which will cause several severe evacuations in an adult. Mixed with olive oil (one drop to a drachm), it yields a milder laxative, resembling castor oil in its operation; it operates on children, rubbed in on the abdomen. The use of it should be prescribed by a physician only. Externally applied, it causes pustules and blisters, and is an excellent remedy in gouty and rheumatic difficulties, toothache, hoarseness, &c, where it is rubbed in several times in the proximity of the aching part. CUBEBS Are the dried berries of a shrub growing on the Sunda Isles; they resemble pepper, with the addition of a stem. They are powdered, and administered in doses of one drachm three times a day in blennor- hcea of the urethra and vagina. Candied, they are taken in the morning, ten or twelve at a time, for dizziness resulting from disor- ders of the stomach. HOUSE DISPENSARY. 589 CUCUMBER JUICE. The expressed juice of cucumbers is drank with beneficial results for irritation of the respiratory organs, and an inclination to pulmo- nary consumption. CUCUMBER POMADE. Grate white cucumbers, and mix the grating with an equal part of fine olive oil in a porcelain vessel. Place the vessel in a pot of water, and put it on the fire until it nearly comes to a boil. Take the porce- lain vessel out of the pot, strain the fluid, add again grated cucum- bers, place it again in the hot water, and repeat the same process four or five times. This pomade has to be carefully kept from the air. It is used as a beautifier of the skin, and particularly for heat-pimples. CUMMIN SEED Is indigenous to Egypt and Ethiopia, but the plant is also cultivated in Southern Europe, and in this country. The fruit has a strong, dis- agreeable, aromatic flavor, and a peculiar, bitter taste. As a remedy, it does not stand second to the ordinary caraway, and its oil is an ex- cellent remedy for hysterical difficulties, from one to three drops on sugar or in water, taken several times a day. Taken as a tea, cum- min seed has frequently a beneficial effect in colic. CAT THYME Is a plant indigenous to the Orient, but it is now also cultivated in other countries ; it grows to the height of four feet, and has a strong aromatic and pleasant odor. The remedy was formerly used for asthma and dyspnoea in old people. It stimulates the activity of the brain and nerves, and was formerly, and is now, used as a component part of sternutatories. It is generally used as an infusion, one- quarter to one-half of one ounce to from three to six ounces of fluid, to be taken during twenty-four hours. DANDELION Is a well-known plant, growing wild all over Germany, in meadows and fields. Its flower is yellow, seed round, and its tubular stalk con- 590 HOUSE DISPENSARY. tains a milky juice. The root and leaves are used for medicinal pur- poses. Dandelion is a diluent, blood -purifying and laxative remedy, and is therefore adapted for stagnation in the abdomen, glandular swellings, and liver diseases. The freshly expressed juice is either used alone or in connection with yarrow flowers, from one to two ounces a day, in the so-called spring medicine. In the apothecary shops a fluid and an inspissated extract of dandelion may be obtained, which can be taken by itself, in broth or in aromatic water ; dose, a teaspoonful at a time. The expressed juice, or the crushed leaves, may be applied externally to impure and putrid ulcers and wounds. Of the dried root, an infusion is prepared from four ounces of the root to one pound of water, boiled down to one-half, to which half an ounce Glauber salt is added ; dose, a tablespoonful at a time. DECOCTION. A decoction is only made of such medicinal plants and other sub- stances, which either possess no volatile parts, or the retention of which is not desired, as, for instance, of oak bark. Substances of a volatile nature must not be boiled, but only infused (drawn), for in- stance, peppermint tea, valerian, &c. DERIVATIVES. All substances used as medicines to draw a malady from vital parts of the body by an irritation, are called derivatives. There are ex- ternal and internal derivatives. To the class of external derivatives belong those which redden the skin, or cause a sore by drawing a blister, such as a mustard or Spanish-fly plaster, horseradish, &c. In- jections, setons, issues, and hot foot-baths, are also classed among the derivatives for congestion to the head. Purgatives belong to the in- ternal derivatives. DEXTRINE Is the nourishing portion of starch, be the latter prepared from grain or potatoes. Dextrine may be used for bread and other preparations in sickness, when it is intended to keep up the strength of the patient. HOUSE DISPENSARY. 591 DIGESTION Is called the process when a fluid is poured over Fonne substance, par- ticularly if of a medicinal nature, and exposed for some time to a gentle warmth, and permitted to extract. DILL, A plant which is quite common with us. Besides its use as a spice, it possesses considerable medicinal virtues. It is a good remedy for flatulence, and may also be used in catarrhal difficulties of the lungs and intestinal canal. An infusion as a tea (one drachm to one pound of water) promotes the secretion of milk. Oil of dill is administered for similar purposes, two or three drops on sugar, six times a day. A still greater effect is produced by dill-fennel (see "Fennel"). DOGGRASS. This weed is found in Europe, as well as in this country. It has a long, cylindrical, knotty root, possessing a good deal of mucilaginous and saccharine matter, which furnishes a very good remedy for irrita- tion and inflammation, particularly of the mucous membrane ; it is beneficial in cases of cough and catarrh. The remedy is at the same time very nourishing, and for that reason is of considerable benefit in cases of abdominal diseases, great debility, ulceration and suppuration of some of the organs, and old blennorrhcea of various kinds. The freshly expressed juice is preferable ; dose, from three-quarters of an ounce to one ounce a day ; the fluid extract or doggrass syrup (from the apothecary shops), or the simple extract, may be administered half an ounce a day. The expressed juice may also be given in wine or broth. DOVERS POWDER Consists of equal parts of opium and ipecac, and about ten times the quantity of sulphate of potassa. It principally promotes perspiration, and is a useful remedy in rheumatism, spasmodic coughs, and colds generally. It is found in the apothecary shops ; dose for adults, from five to ten grains, to be taken before going to bed ; dose for children, from one to two grains. 592 HOUSE DISPENSARY. DRAGON'S BLOOD Is the inspissated juice of several kinds of trees indigenous to the East Indies, which was formerly used as a styptic, and to check diar- rhoea. EEL POUT Is a fish living in sweet water. The oil obtained from its liver is a remedy for spots on the cornea of the eye. It is obtained by cutting the liver in several places, laying it on little sticks over a tumbler, and exposing it to the rays of the sun, when the oil drips into the tumbler. EFFERVESCING POWDER. It is usually prepared in the following manner : carbonate of mag- nesia and powdered tartaric acid, one drachm of each, to be taken, a tablespoonful at a time, in water during effervescence. ELDER TREE. This shrub or tree is found all over Germany as well as America. All parts of it can be used, but particularly the blossoms and berries, which furnish one of our best family remedies. The blossoms are particularly used for tea as a sudorific, and for flatulence ; they are also used as an antispasmodic remedy, for which purpose one quarter or one-half of an ounce of the blossoms are infused (not boiled) with several cups of boiling water, the whole of which are taken at once. Its operation is mild, and for that reason it may be used without any hesitation in all cases where it is desired to produce moderate perspi- ration. When a stronger perspiration is desired to be produced, a little of spirit of Minderus (see the article) is added. The fresh blossoms, used as tea, are a laxative ; boiled together with whey, they yield a diuretic for children, and are useful in cases of dropsy, after they have passed through scarlet fever. Externally they are used dried, or in connection with camomile, peppermint, marjoram, &c, for herb-cushions, or poultices for rheumatic pains, slight inflamma- tions, toothache or earache. They are also used for wet poultices, and with the addition of a little vinegar, as an infusion for fomentations or gargles in cases of inflammation of the throat. Even the steam resulting from it, inhaled through mouth and nose, is very beneficial HOUSE DISPENSARY. 593 for that purpose ; it soothes the cough, and induces the expectoration of mucus. In the apothecary shops, elder blossom water is kept, which is used for the solution of other sudorifics. From the elder berries a preparation is made, of which half or one ounce, stirred in water, furnishes a good remedy to promote perspi- ration, stool, and micturition. From the seeds of the berries an oil is obtained, which, taken internally, or even rubbed externally on the abdomen, is a strong purgative. A healthy, strong adult may take from twenty to forty drops in broth. A wad of cotton impregnated with it and placed in a hollow tooth, soothes the pain ; it is also useful for chilblains and glandular swellings. The young sprouts, making their appearance with the opening of spring, yield a purgative and blood-purifying remedy ; they may be used in a moderate quantity as a salad, with vinegar and oil. A very useful, blood-purifying wine is prepared from them in the following manner : one ounce elder sprouts, infused in one gallon of good, old wine, placed in a warm place for four days, then decanted ; half a wine glass or a wineglassful may be taken every morning. The fresh, crushed leaves are used as an application for light burns, pain and inflammation from t nettles, stings from mosquitoes, bees and wasps ; boiled in milk and placed on the piles, soothes the pain. The root of the elder is diuretic, and for that reason it is used in cases of dropsy. If too much of it is taken, it causes vomiting and purging. ELECAMPANE ROOT. This plant is generally known, and is planted in many of our gar- dens for medicinal purposes. Elecampane root is diuretic, induces expectoration in pectoral diseases, is very strengthening, and acts considerably on the womb. It is generally used in chronic diseases of the lungs, and in phthisis. A dose of the powdered root is from fifteen grains to one drachm, or a teaspoonful of the infusion, or a cupful of the decoction. It may be drank at pleasure. ELECAMPANE WINE. Boil eight gallons of sweet must for one hour, then add two ounces peeled and dried elecampane root, two ounces licorice root, cut up, 3% 594 HOUSE DISPENSARY. two ounces lemon peel, and reduce by boiling to one-half. It should be constantly stirred while boiling. A small tablespoonful of this produces a quantity of elecampane wine, which is beneficial in pectoral maladies by promoting expectoration. The pectoral malady must, however, not be of an inflammable character. ELECTUARY Is a mass of the consistency of jelly, prepared from saccharine juice, syrup, honey, fruit juice, conserve, or pulp, in connection with various medicines, such as salts, resins, powder, extracts, &c. EMETIC WINE, ANTIMONIAL WINE, Is a solution of tartar emetic in Malaga wine, which is administered to children and weak persons as an emetic, a teaspoonful at a time. From two to twenty drops of the wine in elder tea is used as a sudorific. EMULSION Is an opaque, milk-like fluid, resulting from a combination of oil or rosin, or from an oily substance with water, by means of mucilage, gum, or the yolk of an egg. By triturating oil, containing fruits or seeds with water, a similar emulsion is obtained, inasmuch as these substances. contain at the same time the required mucilage. Emul- sions are frequently employed where other remedies, purely adminis- tered, would cause too great irritation, and they are therefore envel- oped in emulsions. Emulsions must be freshly prepared, as they easily spoil, particularly if kept in a warm place ; they should be placed in cold water. For an almond emulsion, take one part almonds to twelve parts of water, to which, as an improvement of the taste, half an ounce of sugar or three-quarters of an ounce of white syrup may be added. Previous to the addition of the saccha- rine matter, the liquid should be strained through a fine cloth in order to remove the more solid parts. ERGOT OF RYE Is the changed seed-corn of various grains, particularly of rye and barley. This changed seed-corn, projecting in the ear of grain, has externally a bluish-black appearance, being white internally, and pos- HOUSE DISPENSARY. 595 sesses a somewhat disagreeable, sharp taste, is hard and brittle, from one-half to one inch in length, and about one-quarter of an inch in diameter. It is used as a remedy, particularly to promote the pains in dystocia. It is a very powerful, pain-promoting, and forcing remedy, and should be administered with extreme caution. It serves to support the womb during the ejection of the child. If the labor has already commenced, and if no serious local obstruction exists for delivery, if there is no malformation of the pelvis of the mother, no irregular position of the child, and if the only cause of the slow pro- gress of the labor proceeds from inactivity of the womb, and its in- sufficient contraction, the ergot of rye may be administered with per- fect safety. It must be administered with the greatest caution, and the physician, or midwife must be quite sure that no local obstruction exists, before proceeding to its use, as it usually operates quickly and energetically. If perfectly sure that no local obstruction exists, it is administered in the following manner : one or two teaspoonsful of the powdered ergot of rye is put in a cupful of boiling water, well stirred up, and after having drawn from ten to fifteen minutes, one table- spoonful of the infusion is administered every ten minutes, until labor-pains set in, and the required effect has been produced. The oil of ergot, obtained from the ergot, is now generally in use, and may be administered on such occasions. A dose is from fifteen to twenty-five drops, administered in warm tea in the same manner as the infusion of the ergot, and repeated until the desired result is pro- duced. Yet it must be administered only by a physician, or a well- skilled midwife, as it may result in poisoning (see ' 'Antidotes"). ESSENCE Is a spirituous solution of aromatic, spicy, bitter or other medicinal ingredients, which were formerly called tinctures and elixirs, accord- ing to their lighter or more concentrated condition ; these terms are now nearly synonymous. I will here give the composition of some bitter essences : i. Single : One-quarter of an ounce of flag root, one-quarter of an ounce of centaury minor, three-eights of an ounce of dry orange peel, triturated with one quart of spirits. 596 HOUSE DISPENSARY. 2. Double : Two and one-half ounces of buckbean, one and one- quarter of an ounce of water germander, one and one-quarter of an ounce of orange peel, one and one-quarter of an ounce of wormwood, half an ounce of cinnamon, half an ounce of gentian, five quarts of spirits. Both essences are tonics. ETHER Is a fluid obtained by the distillation of spirits of wine with an acid. Ether is extremely volatile, refreshing, and stimulating, and for that reason is a strong stimulant in some morbid conditions of nerve and brain action, such as syncope, asphyxia, &c. The ether derives its name from the acid with which the spirit of wine unites. Thus we have sulphuric ether, nitric ether, muriatic ether, and acetic ether. EUPHORBIUM. The euphorbium for medicinal use was originally brought from the tropical parts of Africa, from Egypt, Arabia, &c. Several species of it are also found in Germany, possessing a milky juice, which is ex- ceedingly sharp, and if taken internally, operates like poison. Ex- ternally, euphorbium is applied to the extermination of warts and similar formations, and also for stimulating flaccid and inactive ulcers, and for caries. The extract found in the apothecary shops is best adapted for that purpose. EXTRACT. In medicine the extraction of soluble parts from medicinal sub stances, mostly plants, by water, spirits, vinegar, or other fluids, is called an extract. Most of the extracts are evaporated in the. apothecary shops to near or entire dryness. EYE-STONE, White copperas, is a mass consisting of alum, saltpetre, and verdigris, in equal parts, and one-sixteenth part of camphor, which, dissolved in water, has proved to be a good remedy in many diseases of the eye. HOUSE DISPENSARY. 59? FENNEL SEED Is the seed of a plant frequently cultivated with us. All that has been said of anis (see "Anis"), applies also to fennel. For children, fennel water is a favorite remedy. Fennel tea is a popular remedy to promote the flow of the mother's milk. Fennel oil, taken in doses from six to twelve drops on sugar, is an excellent remedy for mucous obstruction of the intestinal canal. The seed, baked into small loaves, cut open hot, hollowed out, and held to the ear, is claimed to be a remedy for deafness. FIGS. The fig is a fruit of a tree indigenous to Asia and to Southern Europe, which, on account of the large quantity of sugar and muci- lage it contains, furnishes a very useful medicinal remedy. A decoc- tion of figs is used as a gargle in inflammation and ulceration of the throat. Boiled in milk, they furnish an excellent maturation remedy for abscesses of the gums ; taken internally in a decoction, they are also useful in old maladies of the air passages, the intestinal canal and urethra. FORMIC OIL Is obtained by the distillation of ants (particularly of the red ant) and their larvae. It is found in the apothecary shops. To obtain an oil which will have a similar effect, olive oil may be poured over crushed ants, and exposed for six weeks to the heat of the sun. This oil is an excellent remedy for rheumatism and gout, if rubbed on the affected part. Rubbed into the region of the genitals, it strengthens them, and excites a desire for sexual intercourse. FORMIC SPIRITS Is obtained by digesting for several days, in a closed vessel, about one pound of fresh ants in two pounds of rectified spirits of wine, and then distilling the fluid in an apparatus adapted for that purpose. The fluid passing over is formic spirits, and is used in the same way as formic oil. 598 HOUSE DISPENSARY. FUMITORY, COMMON, Is a plant very frequently met with ; it has a bitter, somewhat acrid taste. The medicinal application of it promotes secretion and excre- tion in the human body, invigorates the digestive organs, is particu- larly beneficial in costiveness, in old cases of blennorrhea and catarrh. The preparation of it is the freshly expressed juice, administered either by itself, or in combination with other herb juices, in daily doses of from two to four drachms. The extract bought in the apothecary shops may be used for the same purpose, in daily doses of from one to two drachms. GALL, OX-GALL, Is the well-known yellowish-green, slimy animal fluid contained in a particular bladder, of nauseous smell and bitter taste. On account of its peculiar properties, it furnishes in pharmacy a not unimportant remedy, and is used principally as a stimulant, and to invigorate the stomach and intestinal canal, and as a mild promoter of excretion and secretion. For that reason it is useful in weakness of the stomach, and of the digestive organs generally, in flatulence, bloating of the intestines, jaundice, hypochondria, melancholy, old hemor- rhoidal disease, and habitual costiveness. The fresh ox-gall is best taken in a light, sweet wine, or with aromatic water (cinnamon, fen- nel, or peppermint water) ; dose, from one to three teaspoonsful daily, in half a wineglassful of the mentioned liquid. For that pur- pose an ox-gall may be procured from the slaughter-house, tied up, and hung in a glass of water, which will keep it fresh for several days. When required for use, it is lifted out of the water, and the required quantity taken from it. Of inspissated gall (from the apothecary shops), from one to two drachms are administered in twenty-four hours. It is best given as a pill, in connection with bitter extracts of gentian, buckbean, dandelion, &c, and an aromatic powder, such as sweet flag. Externally, ox-gall is used for spots on the cornea. GARGLE Is called the fluid remedy which the patient takes in his mouth for the purpose of removing a disease of the mouth or throat, by moving HOUSE DISPENSARY. 599 it about at the opening of the throat by the contraction of the soft palate, and the forcible expulsion of air. Almost any remedy, exer- cising an external, but not too severe, influence on the mucous mem- brane, may be used as a gargle in the shape of a decoction, infusion, or solution. Care must be had with children, however, not to use any remedies which, if any of it should be accidently swallowed, might be injurious. Gargles may be divided into emollient, astringent, antiseptic, purifying, &c. An emollient gargle is used in cases of inflammation and ulceration of the tonsils. Take, for instance, figs and marshmallow root, one ounce of each, boil in two pounds of milk until reduced to one-half, strain, and use for a quarter of an hour. Another favorite gargle consists of marshmallow root, licorice root, figs, and pearl barley, one ounce of each, gum arabic half an ounce ; boil in three pounds of water until reduced to one-half, and add three ounces of syrup. Astringent gargles are chiefly used in flaccidity, and also in hemor- rhages ; for instance, oak bark one ounce, well water two pounds, reduced by boiling to one pound, to which add one drachm of alum and one ounce of rose honey. Or the following : sage one ounce, boiled in one pound of water until reduced to one-half, rhatany extract half a drachm, tincture of bibernel half an ounce, mulberry syrup two ounces, mixed. Antiseptic gargles are used in gangrenous ulcers, malignant croup, and cancerous mouth ; take calisaya powder two ounces, boil in two pounds of spring water, strain, and add camphor one drachm, tri- turated with one ounce of gum arabic. Purifying gargles are particularly used in ulcerations, such as can- cerous mouth, resulting from mercurial remedies. They generally consist of vegetable and mineral acids, for instance, pyroligneous acid half an ounce, cinnamon water four ounces, mulberry syrup two ounces, mix. The bottle containing the gargle should be wrapped up in a black paper, so that the mixture may not be affected by the light. 600 HOUSE DISPENSARY. GARLIC. This bulb being used for culinary purposes, also yields very efficient medicinal remedies, particularly for oxynris vermicular is, internally, and for injections in lung catarrh, mucous asthma, dropsy (distilled with vinegar), weakness of digestion, scurvy, stone, intermittent fever (the juice mixed with brandy is a popular remedy). Cotton impreg- nated with garlic juice, and placed in the ear, is a remedy for rheu- matic deafness ; triturated with chalk and tin filings, spread upon cloth and placed behind the ear, it is a good remedy for toothache ; garlic used with food excites the appetite, and promotes digestion. Used to excess, it becomes very irritating, and may cause inflamma- tion of the stomach and intestinal canal. For internal use, garlic is administered raw, in doses from one to two drachms, or the juice is pressed out, and one ounce of it mixed with one pound of milk, which is administered a cupful at a time (particularly for worms) ; for an injection, three-quarters of an ounce of juice is taken to half a pound of milk. A salve prepared from garlic juice and olive oil, rubbed in the abdomen, is used for worms, and the dispersion of cold swellings. GENTIAN ROOT. Of this plant, which grows on the Alps, the root is used as an ex- ceedingly effective remedy for weakness of the stomach and the in- testinal canal, also for scrofula in adults, but under no circumstances in children. It is administered as an infusion or weak decoction of the root from two to four drachms to seven ounces of water, to be taken in twenty-four hours. Still better is extract of gentian, from one-half to one scruple three or four times a day. Gentian is one of the ingredients of most stomach elixirs. GINGER Is a root of a plant growing in the East Indies. It is not only used as a spice, but it also possesses not inconsiderable medicinal virtues. Ginger is used to invigorate the digestive organs, and operates bene- ficially on weakened glandulous formations, and mucous membranes. The best form in which it can be used, is the preserved ginger. HOUSE DISPENSARY. 601 GLAUBER SALTS, SULPHATE OF SODA, Is found in nature in mineral and salt springs ; it is also chemically manufactured. As well known, it is an excellent purgative, which must not be continued too long, however, as it weakens the intestinal canal. In inflammatory conditions, particularly of the brain, it is one of the best antispastics ; it is a purgative, and is given to adults m doses from one-half to one ounce dissolved in water. GLOWWORM Is the well known little beetle with red wing cases, which are usually marked with seven spots. It has a somewhat penetrating smell, and is used crushed while alive, and applied to hollow teeth or the gums, for rheumatic toothache. A tincture for toothache is also prepared by crushing from sixty to eighty fresh beetles, infusing them in recti- fied spirits of wine, and exposing them for eight days in a stoppered bottle to the sunlight, and finally strained. GLUE. Ordinary glue, applied warm with a brush on chilblains, and left there for some time, and again renewed, is an excellent remedy for that malady. GOULARD'S EXTRACT Is prepared from half a part of subacetate of lead, two parts of recti- fied spirits, and twenty-four parts of well-water. It is used externally for poultices in attacks of inflammation ; it operates as an anodyne and exsiccant. GOUT PAPER, ANTARTHRITIC PAPER, Is a paper covered with a thin layer of a resinous mass, preferably tar, which is applied with benefit to the part affected by rheumatism and gout. GRAPHITE, PLUMBAGO, BLACK LEAD. Ttie chief component part of this mineral is carbon, which, used internally and externally, is one of the best remedies for tetters. 602 HOUSE DISPENSARY. Internally, administer half a drachm twice a day, as an electuary or in pills ; externally, apply it as a salve mixed with grease or saliva. GREENOUGH'S TINCTURE. This tincture for toothache is prepared in the following manner : take two ounces of fluid laudanum, one drachm camphor, one drachm saffron, one-quarter of an ounce of cinnamon, the same quantity each of nutmeg and coriander, infuse in two pounds of spirits of wine, let it stand for four weeks, shake frequently, and finally strain. GROUND IVY. This plant is common with us ; in former times the leaves were used either for a tea, or the juice was expressed and administered in intermittent fever, diseases of the abdomen, chest, and urinary organs. GUM AMMONIAC Is sometimes made into a mass for plasters, by boiling it with squill root juice ; it is then spread upon leather and used as an excellent discutient remedy. GUM ARABIC Is the condensed and dried juice which exudes spontaneously from several species of acacia in Africa. One part of the gum dissolved in four parts of water, furnishes a mucilage very commonly used in medicinal preparations. With this gum, emulsions are prepared from different oils and water. Of itself it serves as an enveloping remedy in colic, dysentery, diarrhoea, inflammatory state of the lungs, &c. Powdered gum arabic, sprinkled on oakum and mixed with spirits of wine, is one of the best styptic remedies. GUM GALBAMM Is the juice of an Oriental plant dried in the air ; it is used both in- ternally and externally. Internally in cases of abdominal maladies, melancholy, hysterics, spasms, weakness of mucous membrane, &c. A tincture and ethereal oil is prepared from it ; of the former, one or HOUSE DISPENSARY. 603 two drachms, and of the latter, from five to fifteen drops may be used in twenty-four hours. Of the gum, from one to two drachms may be used during the same time. GUM GAMBOGE Is the dried resin of a tree growing in the East Indies. It causes violent purging, and if given incautiously, may produce death. GUM GUAIAC. The guaiac tree is indigenous to the West India islands. It sup- plies guaiac, guaiac chips, and the guaiac resin, all of which have been in use for a long time for medicinal purposes. The chips act as a sudorific, and are added to wood-drinks. Both the wood and gum are adapted for gout, venereal diseases, scrofula in adults, and dis- eases of the mucous membrane. The gum is administered in the shape of powder, pills, or emulsions, in doses from six to ten grains three times a day. Guaiac soap is administered to adults. Of guaiac tincture, from twenty to forty drops are taken three or five times daily. HANDS (CRACKED). Cracked hands should be anointed with an emollient cerate (see the article), or with venison tallow. HARTSHORN. From the antlers of the stag, which contain principally carbonate and phosphate of lime, and jelly, some important medicinal prepara- tions are obtained. The bones and horns of other animals, having the same component parts, may be used for the same purpose. From it are prepared spirits of hartshorn, oil of hartshorn, salts of harts- horn. See further particulars of these preparations under "Am- monia." HARTSHORN- OIL, ETHEREAL, Is a great stimulant, and is applied in nervous diseases of every kind, but particularly in those of the abdomen, also for hysterics, hypo- chondria, and worms. Internally, administer from five to thirty 604 HOUSE DISPENSARY. drops, either alone or in connection with sulphuric ether, three or four times a day. Externally it is used for cramps as an embrocation, in connection with fatty oils, salves, or plasters. HELLEBOR, WHITE AND BLACK. Black hellebor possesses the same medicinal virtues which the wh : te does, only in a much smaller degree ; I will therefore speak only of the latter. It is a plant growing in Switzerland and the southern part of Germany. The root has no flavor, but a sharp, burning, bitter taste, and when powdered and drawn up in the nostrils, causes violent sneezing. It was in former times much oftener used in medicine than at present, although sometimes it is administered even now. It should be prescribed by a physician only. HEMLOCK. This is the name of a family of poisonous plants ; their resemblance to parsley or parsnips has been the cause of frequent poisoning. There are usually three kinds of the plant found : i. Spotted hemlock grows in waste grounds. The root resembles parsley and parsnips, and when ripe, has a milk-white juice, the taste of which is sweetish at first, but turning sharp subsequently. The Stem grows to a height of from four to six feet, and over ; it is spotted brown or red, hollow on the inside, and wrinkled on the outside ; the leaves resemble those of celery or parsley, and if bruised or crushed between the fingers, emit a very disagreeable odor. 2. Small hemlock leaves {cethusa cynapium) grows wild all over Germany, and is spreading rapidly; the stem is straight, smooth, branching, moderately thick and striped. The leaves are flat, glossy on the under side, greenish-black ; the root is spindle-shaped ; the stems of the leaves spring from striped sheaths ; the odor is incon- siderable. 3. Water hemlock grows in wet meadows. Its leaves are large, smooth, and dark green ; stem very thick, striped with white and red lines, hollow and knotted ; stem and root contain a milky juice, and the latter resembles parsley and celery roots. The odor is stupefying, HOUSE DISPENSARY. 605 resembling that of dill; taste, at first like parsley, and subsequently sharp. For signs of poisoning and antidotes see "Antidotes". HEMLOCK, SPOTTED HEMLOCK AS A MEDICINE. It is particularly applicable in swelling and induration of the glands, scrofula, inflammation of the trachea of long standing, tuber- culosis pulmonalis, cancer of the breast and womb, bloating and in- duration of the abdominal organs, cutaneous diseases, semi-lateral paralysis, and whooping-cough. The powdered leaves are adminis- tered in doses of two to five grains several times a day ; the extract is given from one to three grains twice in twenty-four hours. No one but a physician should prescribe hemlock. Hemlock plaster is an excellent discutient remedy, particularly in scrofulous swellings, milk-knots, and other indurations. The leaves are used for baths, and as an addition to poultices. HEDGE HYSSOP. A plant growing in many parts of Europe. The leaves and roots are used for medicinal purposes ; they have a bitter taste, and must be considered as a diluent sharp remedy. They are particularly useful in diseases of long standing of the abdomen, the mucous membrane, particularly of the respiratory organs, in cases of blennorrhcea, asthma, cutaneous diseases, worms, dropsy, &c. The remedy is administered in the form of a powder, twice or three times a day ; dose from two to six grains ; or it is given as a decoction (one drachm to two ounces of fluid), two tablespoonsful three times a day ; or the extract in pills, or with bitter almond water, from one to four grains. HENBANE. This poisonous plant grows in Europe, in waste places and on mounds of refuse. It has an upright stalk, from one and a half to two feet in height ; its leaves are egg-shaped, sticky, rough, and dark green, the flowers stand single, are of a dirty yellow, with blackish veins ; the seed is small, roundish, kidney-shaped, ash-grey, and has a narcotic smell, and bitter taste ; the root is turnip-like, and of the 606 HOUSE DISPENSARY. thickness of a finger. It has been mistaken for parsnips, with poison- ous results. Symptoms of poisoning : At first it produces a certain hilarity, deliriousness, dryness, and heat in the mouth, thirst, nausea, pressure in the head, ringing in the ears, stupor, enlargement of the pupils, double vision, tearing and pulling pain in the limbs, numbness, diffi- culty in breathing, finally mania, cramps, paralysis, and death. The treatment is the same as in poisoning with belladonna (which see). Henbane is one of the best and indispensable medicinal remedies, and is used both internally and externally. It is of excellent service for the dispersion of indurated glands, milk-knots, and swell- ings, and is applied for that purpose as a plaster or a poultice ; the leaves are used for that purpose. It is also used in spasmodic diseases, whooping-cough, spasms in the chest, hydrophobia, inflammation of the lungs, haemoptysis, &c. From the apothecary shops may be ob- tained henbane plaster, the ointment and extract, also oil of henbane, and the tincture. Internally the powder of the dried leaves is admin- istered in doses from one to three grains, the extract in doses from one-quarter to one and one-half grains, triturated with milk sugar, twice or three times a day. The oil is used externally for embroca- tions. Henbane should be used only by direction of a physician. HERB CUSHIONS Are small bags made of a soft cloth, and stuffed with aromatic herbs (usually in a powdered state), such as camomile, elder, wild thyme, balmmint, peppermint, lavender, &c. They are quieting and dis- cutient, and are usually applied in glandular swelling, rheumatic pains, particularly of the teeth or face. If the cushion is to be pain- allaying at the same time, the herbs should have an admixture of henbane (see ' 'Henbane"). HERRING'S MILT Is used for trachitis, but whether with beneficial result, cannot be readily ascertained. Roasted with butter, and pressed through linen, it yields a good salve for chilblains. HOUSE DISPENSARY. • 607 HUKCLEBERRIES, BILBERRIES. These well-known berries contain a great deal of tannin, and for that reason are used as a popular family remedy to check diarrhoea, and also in scorbutic diseases, with great benefit. The leaves, as well as the stems, possess an astringent quality, and for that reason are boiled with them. HOFFMANN'S ANODYNE LIQUOR Is a combination of one part of sulphuric ether, and three parts of rectified spirit of wine ; it has an ethereal flavor and taste. This liquor is taken in doses from five to twenty drops, on sugar, or it is combined with other medicinal substances. It is stimulating, and a powerful nervine for nausea, vomiting, syncope, cramps, headache, toothache, &c. It should be kept in well-stoppered bottles, as it is very volatile. HONEY. Honey is a mucilaginous substance, containing a large quantity of saccharine matter, which is very beneficial in cases of irritation of the mucous membrane, particularly of the respiratory organs ; it also pro- motes the secretion and excretion of the same. The following remedy, it is said, has been found beneficial in con- sumption : eight tablespoonsful of fresh, unsalted butter, made from goat's milk, melted, to which is added and stirred in four table- spoonsful of good honey, let it become cool, and then keep stirring it for one hour ; dose, a tablespoonful morning and evening. The honey, however, will be injurious in all cases where there is a tendency to acidity, which is usually the case in children. Externally, raw honey is used as a poultice for fresh wounds and insect stings, or it is spread on the injured part. It is also added to gargles for inflamma- tion of the throat, and also for injections ; worked up with rye flour, it aids very materially in maturing abscesses. Skimmed, and mixed with borax, it is used in painting aphthae, or other inflammations and ulcerations of the oral cavity. HOPS. This plant grows in Germany, as well as in America, and not in- frequently finds useful application for medicinal purposes. It possesses 608 HOUSE DISPENSARY. warming, stimulating, and strengthening qualities, and for that reason is adapted for weakness of the digestive organs. It is also a useful remedy for gout, particularly if it is the result of a weakened con- dition (in poor people), and also for dropsy. It is generally preferred to administer the infusion, for which purpose, for an adult, half an ounce of hops is used for four ounces of fluid ; the strength is gradu- ally increased threefold. Not so desirable is the powder, in doses from ten to thirty drops several times a day. The tincture, as well as the extract, are also used. Hops are externally applied for contusions? cold swellings, oedema, colic, gastrodynia, glandular swelling, hydro- cele in children, &c. They are used in those cases as poultices, either boiled, or dry and warmed. It is said that in cases of insomnolence, hop-pillows will induce sleep. HOREHOUND, WHITE. Horehound is a very common and well-known plant. The follow- ing are its medicinal qualities : White horehound is very strengthen- ing ; it induces expectoration, and operates diuretically. In colds, it is usually administered as a syrup ; it is also used for coughs, lung affections, and in difficulties of respiration ; and is also very effectual as a tea, or in a warm infusion. It is also a very good remedy for females in all cases, particularly for spasms, and for suppressed or painful menstruation. It may be taken at pleasure as a tea or syrup. HORSE-CHESTNUT BARK. It is used for a decoction, and applied as an astringent remedy in certain weakened condition of single organs; it is also used to prepare gargling water. HORSERADISH Is a plant growing both in Europe and America, the root being used for culinary purposes ; it also possesses medicinal qualities, which seem to proceed from the sharp, ethereal oil contained in the root in its fresh condition. Horseradish, internally administered, is a great stimulant for the digestive organs, and also has a great effect on the mucous membrane and blood. For that reason it is an excellent HOUSE DISPENSARY. 609 remedy for scurvy, mucous obstruction of the stomach and intestines, the stone and other difficulties of the urinary organs, dropsy, old catarrhs, gout, &c. The fresh-grated horseradish or the expressed juice only are used ; dose, from one to three drachms with sugar once or twice a day. Externally applied, it reddens the skin and draws blisters, and in this respect surpasses both Spanish flies and mus- tard. In toothache, a little grated horseradish is applied to the artery of the arm on the side where the aching tooth is ; it is to be kept there until it has drawn a red spot ; frequently the toothache disap- pears at once. Grated or cut fine, and infused with wine vinegar, horseradish is a good remedy for freckles ; the freckles are touched with the fluid before going to bed. HOUSELEEK, COMMON Is a juicy, evergreen plant, of sharp, biting taste, growing on old thatched roofs and ruins. In former times it was used particularly for blennorhcea of long standing, constipation, dropsy, gravel, &c, and of late, also for epilepsy with good results. Externally, the freshly expressad juice, or the crushed leaves are applied with par- ticular benefit to scrobutic, scabious and cancerous ulcers. Inter- nally, it is given in doses from six to ten grains. Boiled with twelve parts of beer, the remedy has sometimes proved beneficial in dropsy. ICELAND MOSS. This plant grows in the northern part of Europe, and also in Ger- many and some other countries ; it is usally found in pine forests. This plant being rich in mucilaginous and bitter substances, furnishes one of the best remedies in all cases where the patient has become debilitated, which is the case in weakness and inactivity of the diges- tive organs, and also generally in all cases of weakness, caused by a bad mixture of the juices. It is also beneficial in all diseases of the mucous membrane, and particularly in bronchial affections, in old lung catarrh, in tuberculosis pulmonalis and catarrhal phthisis. The moss is used in decoctions of one-half to one ounce, with from ten to eighteen ounces of water boiled down to six or twelve ounces ; sub- 39 610 HOUSE DIPENSARY. subsequently it may be boiled down still more and used as a jelly. To remove to some extent the bitter part of the moss, it may be in- fused with hot water for a time, and the water, which contains the largest part of the bitter part, is poured off; the moss is then pre- pared in the usual way with sugar or licorice wood. A nicely tasting moss jelly is prepared in the following way : two ounces of moss are boiled with one and one-half pounds of water until reduced to one-half, two ounces of sugar and half a drachm of starch flour are then dissolved in it, a little lemon peel, twelve bitter and thirty sweet pounded almonds added to it, and the whole of it strained and set to cool ; dose, a tablespoonful every three hours. INFUSION. An infusion is prepared by pouring boiling water over medici- nal substances, such as herbs, roots, leaves, &c, let them get cool, and, if necessary, filter through linen, flannel or paper. Infusions are made of substances having aromatic or volatile properties which would be lost by boiling. IODINE. This substance was discovered in 1811. It was first observed in kelp, or the ashes of sea weed ; it furnishes a very important remedy in medicine for head and other gland diseases, when it is adminstered both internally and externally. The greatest caution should be ob- served in its use, and it should never be administered except by the advice of a physician. Internally, tincture of iodine is administered in doses from five to eight drops in aromatic water ; the dose may be gradually slightly increased. Externally, iodine ointment is used, consisting from six to ten grains of iodide of potassium, to one drachm of lard ; a piece of the size of a filbert is rubbed in several times a day. IPECAC. This root, imported from Brazil, is an effectual remedy. It causes nausea, vomiting, dizziness, &c. Administered in small doses, it is binding, and for that reason it is ordered in dysentery and diarrhoea. HOUSE DISPENSARY. 611 In doses of from two to six grains for children, and from ten to twenty grains for adults, it causes vomiting. It is especially used for that purpose. IRON PREPARATIONS Form in medicine a number of very strong and excellent remedies, which seem to produce a stimulating and invigorating effect, particu- larly on the blood and muscles. They should not be administered, however, in cases of plethora, congestion, or where there is an incli- nation to constipation. They are particularly beneficial in chlorosis, seated mucous obstructions of the lungs, in muscular debility, relaxations of the vascular coating, &c. The following are the prin- cipal preparations of iron : iron filings, finely powdered, are usually administered in the shape of pills, from two to four grains three times a day; carbonate of sesquioxide of iron is easily digested, and is given in doses of ten to twenty grains ; malate of iron is of very easy digestion, and is administered in doses from six to eight grains several times a day. Green vitriol, or sulphate of protoxide of iron, is the most powerful of all salts of iron, and particularly very astrin- gent ; it should be administered in very small doses (one or two grains), as it easily causes difficulties of digestion. Sulphate is given internally for tape-worm, in old cases of whites, and other cases of blennorrhea. Dissolved in water (from one to two grains in one ounce of water), and externally applied, it is an excellent styptic remedy, and is also used for immissions, baths, &c. The muriate of sesquioxide of iron operates similar to sulphate of iron, but not quite so strongly. There are other preparations which we have mentioned in describing the diseases for which they are applied. Klapprot's tincture of iron should also be mentioned here ; it is administered three times a day, in doses from eight to fifteen drops for cramps, chlorosis, and blen- norrhea. It is particularly useful to women who are inclined to miscarry. It is administered in the following manner : Klapprot's tincture of iron one drachm, spirits of cinnamon six ounces, mix; dose, one tablespoonful to be taken at night. 612 HOUSE DISPENSARY. JALAP Is a willow plant, growing wild in the warmer parts of America, par- ticularly in Mexico, the root of which is used as an energetic purga- tive (which see), and not resulting in costiveness. As a stimulant for the intestinal canal, from three to five grains are given ; to children, from one to three grains. As a purgative for adults, administer from fourteen to twenty grains; to children, from six to twelve grains, with sugar. JUNIPER. This is partly shrub, and partly tree, found all over Europe, but is particularly cultivated in gardens. It is likewise found in some parts of this country. The wood, as well as the berries, but more particu- larly the latter, are used for medicinal purposes, and furnish excellent remedies for weakness of the stomach and the intestinal canal, flatu- lence, obstructions of the abdomen, liver, spleen, mesenteric glands, in light attacks of abdominal dropsy, and the skin, retention of urine, blennorrhea, lithiasis, gouty and rheumatic maladies, and old cuta- neous diseases. In the apothecary shops are kept spirit of juniper, oil of juniper, and inspissated juniper juice. Of the berries, a decoc- tion in wine or water is prepared (half to one ounce in twenty ounces of fluid, reduced by boiling to ten ounces) ; dose, a teaspoonful. The oil is given on sugar, from two to six drops. The spirit of juniper is administered in doses from twenty to sixty grains, and the juice, from one to two drachms. Externally, the juniper berries are used for fumigations, by directing the smoke to the suffering part, or woolen cloths are permeated by the smoke, and the suffering parts rubbed with them. This is particularly applicable in dropsical swellings of the joints, and in rheumatic and gouty pains. KINO Is the inspissated juice of several plants imported from India ; it is used for hemorrhages and blennorrhcea, although it is not absolutely necessary. Is is administered as a powder, and in pills, in from ten to twenty grains, and the tincture in doses of one drachm. Exter- nally, the powder and tincture are used to stimulate flaccid ulcers. HOUSE DISPENSARY. 613 LAUREL Is a tree indigenous to Asia Minor, northern Africa, and Greece ; it now also grows in Spain, Italy, and the south of France ; its leaves are used for medicinal purposes, and its fruit (laurel berries), and the ethereal and fat oil expressed from them, are also used for medicinal purposes. The berries are stimulating, and are used for weakness of the stomach, sluggish movement of the blood in the abdomen, and particularly for blood obstructions in the uterus. The laurel oil is used for embrocation as a nerve-stimulant, and as an addition to car- minative injections. For light laming, the following salve may be used for embrocation : laurel oil and lard, half an ounce of each, powdered sulphate of copper one-quarter of an ounce, mix for a salve. LAVENDER. This fragrant plant is indigenous to the south ot France and Switzerland, and is frequently raised in our gardens. The cylinder- shaped, blue flowers, which have a pleasant, spicy flavor and taste, are used. They possess a good deal of ethereal oil, which is obtained by distillation, as the well-known oil of lavender. Besides that, there is also prepared from them the plain and compound lavender spirit. The flowers and leaves form usually a part of the filling for perfume bags ; they are also used for poultices, and as additions to herb baths. The oil of lavender is used for embrocation in cramps, lameness, and cold swelling. LEAD OINTMENT Consists of acetate of lead, wax, and lard, and is an excellent remedy for inflammations, slight burns, &c. LEAD VINEGAR Is a preparation obtainable in the apothecary shops, and consists of a solution of subacetate of lead, which, mixed with a sufficient quantity of water, is frequently applied as a wash or poultice to superficial inflammations, the result of external influences. 614 HOUSE DISPENSARY. LEAD WATER May be prepared in the following manner : one drachm of sugar of lead, dissolved in eight ounces of clear water ; it is used like lead vinegar. LEMON BALM Is a plant growing wild in southern Germany; in this country it is raised in ditches. The leaves and flowers have a strong, balsamic aroma, and a similar bitter taste. It has a similar effect to camomile, but it is not near so strong, and for that reason can be dispensed with. It is also a cultivated here in gardens, but is indigenous to Southern Europe. It has an agreeable, lemon-like aroma, and a balsamic, some- what sharp taste. In the apothecary shops, lemon balm water is prepared from it, by distilling twenty pounds of water over two pounds of lemon balm leaves. It is used only for the purpose of improving the taste of medicines. A strong infusion of the leaves used as tea has a sudorific and nervine effect ; it is antispasmodic and cooling, and may be given to fever patients as a cooling tea, of which they may drink at pleasure. The tea is also useful for painful menstruations. LEMON JUICE Is one of the best remedies for scurvy, and also for some putrid and nervous fevers. The juice of half a lemon, squeezed into a cup of very strong coffee, is a tried remedy for intermittent fever. For light fevers, connected with nausea, one or two cupsful of green tea, in connection with lemon juice, is an excellent family remedy. LEMON PEEL Promotes digestion. A piece of the fresh, yellow rind, entirely cleaned from the inner white peel, put on one or both temples, where it readily adheres, affords relief in various kinds of headaches. Keep it on the temples until it has drawn a red spot. LENTILS. A decoction is used with advantage, for the purpose of smoothing and bleaching pock-marks. HOUSE DISPENSARY. 615 LEVANTIC WORMSEED. This is the seed of several shrub like East India plants, the particulars of which are not fully known ; it has a peculiar nauseous flavor, and a somewhat sharp, bitter, resinous taste. The seed is one of the best remedies for maw-worms. It is made into an electuary with honey, syrup, or carrot juice, and is administered a teaspoonful at a time, or the electuary may be spread on bread or biscuits ; it may also be taken in fresh milk, or in syrup, or it may also be baked in small loaves, or in so-called worm-cakes. Between the doses, a light laxa- tive is administered. LIEBER'S HERBS, BLANKEIM TEA. Eifeler tea consists of the dried plant of the hemp nettle, from which, after being cut up fine, an infusion is prepared. This tea is a good remedy for pectoral difficulties, and is also a popular remedy for consumption. LICORICE ROOT. This is the root of two species of plants, the prickly and smooth licorice root plant ; the first grows principally in southern Russia, and the latter chiefly in the southwest part of Europe. From the licorice root licorice is made by cutting up the root small, boiling it for a time, squeezing it out, and finally evaporating the fluid. The licorice, and also the powdered root, is used as a palliative for children in catarrhal difficulties, and also as an addition to other medicinal remedies, to improve their taste. LIME. Quick lime is a component part of several remedies, formerly in use, and particularly of rusma (see the article). A caustic paste is prepared from equal parts of unslacked lime and black soap, which is used for the extirpation of warts, corns, and moles ; it is applied with a small stick of wood. The lime water kept in the apothecary shops is used in connection with other medicinal substances for the preparation of various remedies. 616 HOUSE DISPENSARY. LINIMENT Is a remedy for external use, and is of a consistency between oil and salve. LINSEED. Linseed is of an egg-shaped form, containing an abundance of mucilaginous matter and furnishing the well-known linseed oil. The infusion and decoction of linseed is used for irritation and inflamma- tion of the mucous membrane of the oral cavity, the respiratory organs, the intestinal canal and the urinary organs ; hence, in catarrh, croup, dysentery, diseases of the urinary passages and spasms of the intestinal canal. Poultices prepared from linseed meal and oil are very useful for external application, and also as a decoction for in- jections. For an infusion, take from half an ounce to one ounce of the crushed seed to one pound of boiling water, and drink as tea, to which may be added as a flavor some licorice root or fennel seed. Linseed oil mixed with an equal quantity of lime water, makes a good ointment for burns. LIVER OF SULPHUR Is obtained by heating sulphur and carbonate of potassa in a covered vessel. Liver of sulphur is not very often used internally. It is, how- ever, used externally for bathing (one drachm of the liver of sulphur to four ounces of water), for baths (from half an ounce to two ounces for a bath) and for ointments. LOVAGE. This plant, indigenous to Southern Germany, is often raised here in fields and in the garden. The root, which is thick, spindle- shaped and pulpous, has a spicy aroma, and is used for medicinal pur- poses. A decoction of it is used, prepared from six drachms boiled with from four to six ounces of water, strained, to be used during twenty-four hours. The extract (from one to two drachms) is admin- istered for weakness of the digestive organs and glands, and more particulary for dropsy. HOUSE DISPENSARY. 617 LUNAR CAUSTIC Is molten nitrate of silver, cast into forms, and furnishes one of the best and most useful remedies. Dissolved in water, it is used for var- ious external injuries as a stimulating remedy, where the solid lunar caustic would not be applicable. It is taken internally in small doses for epilepsy ; the skin, however, will assume an olive color in conse- quence of it, and the remedy should be prescribed by a physician only. LYCOPODIUM Is a well known, popular remedy for chafing in children. It is also used as an addition to mild ointments, and internally for strangury in children, when it is administered in a thin syrup, from ten to thirty grains, morning and evenings. MAGNESIA. Of this there are the pure or calcined magnesia and carbonate of magnesia, being used particularly for accidity of the stomach and heartburn. It may be taken stirred in water, or mixed with .fennel, cinnamon, flag root, orange peel, &c. Magnesia, in combination with rhubarb, is used in the form of powder for children, particularly for cramps, administered several times a day. The following are excellent prescriptions : i. Calcined magnesia, rhubarb powder, and sugar of cassia oil, half a drachm of each, powdered and divided into two parts. One powder every half hour in water (for accidity of the stomach). 2. Ipecac root two grains, oil of cedar six drops, carbonate of magnesia one drachm, sugar seven grains, powdered ; dose, a tea- spoonful at a time. MALLOW FLOWERS. There are two species of mallow flowers ; both are used, and both possess a great deal of mucilaginous matter, and for that reason they are used for medicinal purposes. Internally, the tea prepared from it is given for irritation of the mucous membrane of the air passages ; externally, the decoction is used for injections. 618 HOUSE DISPENSARY. MALT BATH. It is prepared by boiling four or six pounds of malt for a long time, which is added to a warm bath. It is beneficial in debility, particularly for children. MALT POTION. This is prepared by infusing from a half to one pound of ground barley malt ; let it stand for several hours. It must not be boiled. The potion has a pleasant, sweetish taste, which may be improved by the addition of a little white wine and sugar. It is easily digested. It is used with benefit as a blood-purifying, antiscorbutic, mildly laxa- tive remedy, and is also beneficial in cutaneous eruptions and ulcers of various kinds. The quantity above given must be drank daily, as it does not keep over twenty-four hours without turning sour, and for that reason must be prepared fresh every day. * MANNA. The manna used for medicinal purposes is the hardened exuding juice of a tree growing in the south of Europe, and known as the manna ash. It furnishes a mildly laxative remedy, and is, therefore, well adapted for children. It is not well, however, to administer it in cases where children suffer from acidity of the stomach ; under such circumstances it is advisable to combine it with rhubarb ; the manna and syrup of rhubarb are given in equal parts, a teaspoonful at a time, until it operates. To adults, give as a laxative at least from two to three ounces, dissolved in hot water, a tablespoonful at a time. In inflammation of the intestinal canal, the manna is used to envelop other irritating medicines. Manna syrup is also used as an addition to other medicinal remedies, besides the above mentioned. MARJORAM, SWEET, Is a plant indigenous to Southern Europe and the Orient ; it is cultivated here in gardens ; the blossoms and leaves of the plant are gathered, which have a strong, agreeable, aromatic scent. The prin- cipal component part is the ethereal oil. Leaves and blossoms are HOUSE DISPENSARY. 619 used as tea for flatulence and abdominal spasms, for which purpose the oil also is rubbed in on the abdomen. MARJORAM, WILD, Is used as an addition to herbs for herb bags. The ethereal oil of this plant and also that of Cretian marjoram is used for toothache. It is applied by placing a wad of cotton, saturated with the oil, in the hollow tooth. MARSH TEA Is a small shrub, from two to four feet in height, growing wild in Germany, and other parts of Northern Europe. The fresh leaves, which resemble rosemary very much, have a strong, nauseating, over- powering odor, and a bitter, astringent taste. The leaves are used for an infusion, from two to three drachms in twenty-four hours ; it is an excellent house remedy for cutaneous eruptions of long stand- ing. Formerly the leaves were also used for dysentery, diarrhoea, croup, rheumatism, &c. They are also an approved remedy for ver- min, particularly bed bugs, if placed fresh in bed. MARSHMALLOW PASTE. There are two colors of this preparation, brown and white. The first is prepared from an infusion of licorice root, gum arabic, and sugar; the latter from the mucilaginous marshmallow root, gum arabic, the white of egg, beaten up to a foam, with orange water and sugar. Marshmallow paste is a pleasant, quieting remedy for colds and inclination to cough. MARSHMALLOW ROOT. This root, containing a large quantity of mucilaginous matter, furnishes one of the most excellent, mollifying and soothing remedies, and is administered internally in cases of irritation of the respiratory organs (cough) and intestinal canal ; in the latter case as an injection. It is prepared by boiling about half an ounce of peeled, coarsely cut- up marshmallow root in sufficient water to leave about six ounces after being strained. To this add, by constant stirring, sugar or syrup, and use it by the cupful or teaspoonful. 620 HOUSE DISPENSARY. MARSHMALLOW SYRUP, MARSHMALLOW JUICE, Is a sedative for coughs in small children ; the juice is administered in doses of a teaspoonful at a time. It may be bought in apothecary shops, but can easily be prepared in the following manner : pour two and one-half pounds of boiling water on two ounces of peeled marsh- mallow roots, let it cool, strain, dissolve in it three pounds of crushed sugar, and add the white of two fresh eggs, beaten to a froth, boil it again, skim, and strain. In summer, place the marshmallow syrup in a cool place, or in' cold water, as it sours readily. MARYGOLD FLOWERS Are found in Southern Europe ; they were formerly used much more frequently than now. On account of the beautiful, yellow flowers they bear, they are planted in our gardens. The fresh leaves, and also the flowers, are sometimes used for the purpose of softening corns, the hard, horn-like swelling of the feet, and to remove warts. The following preparation is recommended as one of the best styptic remedies : Collect the fresh yellow flowers, and place them, without pressing, in a long medicine bottle, holding from four to ten ounces, cork up the bottle, tie it to a string, and hang it in a place where the sun strikes it, and leave it there until freezing weather begins. A fluid collects at the bottom of the glass, which is poured off from time to time; finally press out the leaves. The fluid thus obtained must be preserved in a well-corked bottle. It is applied to bleeding wounds, with small pieces of cloth saturated with it ; or a bottle is filled with the fresh leaves of the marygold flowers (not the leaves of the stem), and diluted spirit of wine poured over it. The spirit of wine is diluted with one-third of water. Let the whole remain quiet for three weeks. It is used for contusions, also for flesh wounds, by straining the fluid, saturating a piece of cloth with it, and applying it to the injury. It is also applied to old ulcers. MASTERWORT. This plant grows on the mountains of Southern Europe, but is now also domesticated in all other parts. The root is used -for medicinal purposes. It is somewhat bitter, very spicy, ethereal, and particularly HOUSE DISPENSARY. 621 effective in weakness of the mucous membrane, therefore for blen- norrhea of the air passages, the stomach, intestines, and also in pituitary fever, weakness of the muscles, and nervous indigestion ; it must not be administered, however, in inflammatory and gastric con- ditions. It is best applied as a saturated infusion (half an ounce with four ounces of boiling water). MASTIC Is the inspissated, resinous juice of a tree growing from ten to twelve feet in height, and indigenous to Greece. In the apothecary shops a compound spirit of mastic is prepared from it, which is used exter- nally for embrocations in cold swellings, rheumatism, and gout. For similar purposes, the resin can be used for fumigations; it is thrown on the fire, the smoke is permitted to pass into the flannel, which is then applied to the suffering part. Equal parts of mastic and sandarac, dissolved in spirits of wine, with which a wad of cotton is saturated, and placed in a hollow tooth, is a good remedy for rheu- matic toothache. MAY WORM Is a blue-black bug, with soft, short wing shells, thick, one and one- half inches in length, of nauseating smell (resembling that of the Spanish fly), which seems to be produced by a yellowish, thick, sharp matter, exuding from the leg joints. The bug was formerly adminis- tered for dropsy, impotence in man, and as a secret remedy by the name of " Prussian Electuary." It has also been frequently used for the bite of mad dogs, and has acquired a great reputation. To pre- pare them, take twenty-four May worms, preserved in honey, with the honey adhering to them, cut them up, and crush them, and mix them with two drachms finely rasped and sifted ebony wood, one drachm of pulverized Virginia snake root, twenty grains of finely ground mountain ash sponge, and one drachm of finely filed lead; all of which is made into an electuary with two ounces of large valerian, of which give from twenty to sixty grains, according to the age of the person. For twenty-four hours after taking the medicine, the patient must not eat anything, and for twelve hours he must not drink; after that he may quench his thirst with elder tea, await the 622 HOUSE DISPENSARY. subsequent perspiration in bed, and at the expiration of twenty-four hours he must change his linen and bed. He remains quiet, and avoids all heating food and drink ; the wound is washed with salt water or wine vinegar, and dressed with basil herb salve, or fresh salted butter, and kept open for some time. To preserve the May worms, after carefully collecting them, proceed in the following man- ner : take hold of the May worm with a pair of wooden tongs particu- larly adapted for that purpose, cut off the head with a pair of scissors, and drop the body quickly in honey. MEADOW ANEMONE. Of this the water, distilled from the fresh leaves, in quantities of two to four drachms, or the extract prepared from freshly expressed juice, is used. Begin with one grain, and increase the dose gradually, particularly for pain in the face, rheumatism, gout, and lameness. MERCURY Is a heavy metal, of silver-white color, and is fluid at ordinary tem- perature. There are two oxides of mercury, a greyish-black suboxide, and a red oxide. Besides that, it enters into many other combina- tions, of which we will mention a few only : i. With chlorine in small quantities as calomel (which see), and in larger quantities as sublimate (which see). 2. With sulphur as cinnabar. 3. With nitric acid, antimony, and many others. Mercury in its combinations furnishes one of the most important remedies in medicines. In its pure state it possesses no particular curative powers, yet it is sometimes administered with good effect in obstinate constipation, where it seems to operate mechanically by gravity. A decoction of water over liquid mercury is a household remedy for worms. For this purpose, boil with constant stirring two ounces of mercury in two gallons of water, pour off the water care- fully, and use it as a drink. The water may remain on the mercury for twenty-four hours ; it is then poured off. In a state of combina- tion, it is used, according to the substance with which it is combined, in many cases internally and externally. Its specific effect in venereal diseases is generally known, yet great caution should be observed in HOUSE DISPENSARY. 623 its use, particularly if the sublimate or percipitate is used, which may- act as poison even in small doses. A very useful and easily made preparation is the grey mercurial ointment, consisting of a mechanical mixture of liquid mercury and fat. The mildest and most useful pre- paration is the sweetened mercury of which I have already spoken under " Calomel " (which see). MEZEREON BARK. This the bark of a shrub growing all over Europe ; it is thin, very tough, and externally covered with a greyish skin. It contains a sharp, biting substance, which, if applied to the skin, draws a red and subsequently pale spot, and, if permitted to remain for any time, it will even form ulcers. Mezereon bark is administered internally, particularly for venereal diseases, and old cases of gout and rheuma- tism. It should be prescribed, however, by a physician only. Ex- ternally, the fresh bark is applied. But where that cannot be ob- tained, bark which has been softened by being soaked in water for several hours, may be applied. The spot upon which the old bark is to be fastened, should be previously rubbed with vinegar until it is reddened ; the piece is to be one inch in length and half an inch in width, and kept on the spot by being fastened, for a longer or shorter time, according to the effect which is intended to be pro- duced. The bark is also added as a powder to salves, and a decoc- tion of it is used for poultices. MILFOIL, LEAVES AND FLOWERS. This a plant growing wild all over Europe, the flowers of which have a weak, spicy, and balsamic scent, and an aromatic, bitter taste. Milfoil (leaves and flowers) is an old, favorite, popular remedy for many maladies ; it is a useful and much valued plant in America and other countries, a place which it deserves, and ought to retain. It is particularly applicable for maladies of the stomach and the intestinal canal, diarrhoea, wind colic, hemorrhoids, and spasms. As a house remedy, it is generaly used in the form of a tea (half an ounce to six ounces of water, to be taken during twenty-four hours), or the freshly expressed juice may be taken, perhaps in doses of one ounce several times a day. In the apothecary shops an extract is prepared, of 624 HOUSE DISPENSARY. which from one to two drachms are mixed with other remedies. Mil- foil greatly resembles hedge hyssop (which see), and may be used in the same manner. MILK CURE. By milk cure is understood the long and continued use of milk, either of the ass, goat, or cow ; for which purpose it is best to go to the country. The best time is during the last quarter of the month of May, and the beginning of June, when milk has the most aroma. Regular exercise should be taken at the same time, and easily digested food used. It is best to drink it warm, just as it comes from the animal. MONKS RHUBARB Is the root of a plant growing on the Alps, which has great resem- blance to the genuine rhubarb, but its operations are much weaker. It is now used but little. MOON SEED, COLOMBO, Is a plant growing on the east coast of Africa, the root of which is used for medicinal purposes. It has a very aromatic, bitter, muci- laginous taste, and is used particularly in weakness and irritation of the stomach and the intestinal canal, disarrangement of digestion, defective secretion of mucus, accidity of the stomach, and also in diarrhoea of long standing. It is best to use a saturated infusion (one ounce of the root with eight ounces of boiling water) ; it should be used during thirty-six hours. In the apothecary shops may be found an extract of Colombo, of which take from five to ten grains twice or three times a day. MUGWORT. Of this plant the root alone is now used, which is made into powder when fresh ; it is one of the best remedies for epilepsy. The patient takes this powder in warm, weak beer, goes to bed and keeps drinking warm, weak beer; a strong perspiration which sets in and sometimes has an offensive smell, is a very favorable symptom. For irritable adults, thirty grains (half a drachm) would be a dose ; for less irritable persons, thirty-five to fifty grains. If a strong perspiration does not set in soon, the patient should take an- HOUSE DISPENSARY. 625 other dose at the expiration of twenty-four hours ; the second dose should be increased from five to ten grains. The powder is Lest taken a little before the time when the attack usually sets in. It is particularly useful for little boys, and also for girls from twelve to fifteen years of age. MULBERRIES Are the fruit of a tree indigenous to Persia, but now also growing in the south of Europe. Mulberries are sometimes used in apothecary shops for the preparation of a syrup, which, however, is not prefer- able to other syrup. MULLEIN LEAVES. Of this plant, which grows all over Germany, the flower is princi- pally used, less frequently the leaves. The former are used as a mu- cilaginous and enveloping remedy, particularly as a tea in catarrhs, or catarrhal fevers, cough, hoarseness, and irritation of the respira- tory organs generally ; also in diarrhoea and dysentery. The leaves boiled in milk and used as a warm poultice, is an excellent remedy for painful hemorrhoidal tumors. By extracting, at a very moderate heat, two parts of the flowers in three parts of olive oil, a pain- allaying and emollient oil is obtained. MURIATIC ACID Is usually obtained from common salt and sulphuric acid. It is used in nervous fevers, typhoid fevers, putrid fevers, intermittent fevers, cutaneous eruptions, scrofula, scurvy, and diseases of the urinary organs ; externally, for gangrenous, putrid ulcers, tetters of old stand- ing, and scald head. It is administered internally from five to ten drops diluted with water, in a mucilaginous fluid sweetened with syrup. MUSK Is a substance of most powerful odor, contained in a sac or bag near the genitals of the male of the musk deer, and is used for medicinal purposes. There are many varieties, adulterations and imitations of it. For medicinal purposes, Oriental musk, mostly brought from China, is best adapted. Musk is one of the best remedies we have, and 40 626 HOUSE DISPENSARY. no other medicine can be substituted for it. Its chief quality con- sists in being an effective nervine, invigorator and antispasmodic. It is particularly used for nervous fever, inflammatio n of the brain and the spinal marrow, gangrena senilis, and spasmodic diseases. It is best administered in the form of a powder ; dose for children, from one- quarter to half a grain, larger children, from one to two grains every half hour, and for adults a proportionately larger dose. MUSTARD SEED, BLACK. This is an annual plant, cultivated through the whole of Europe, and also in America ; it bears pods, which contain blackish seed. Mustard is a very good, stimulating tonic, inducing digestion, and is a particularly good remedy for mucous obstruction of the stomach. It is also useful in dropsy, asthma, mucous asthma, whooping cough, putrid fevers and scurvy. Externally, it is applied as an antispastic in cases of blennorrhea of the lungs, paralysis of the tongue, throat, and intestines, catarrhal and rheumatic inflammations, typhoid and nervous fevers, eruptive diseases, suppression of gout and rheumatism, and in many other maladies. It is administered internally, powdered or in the corn, from one-half to one drachm (as an infusion, of seven ounces fluid, to one-quarter to one-half ounce), three or four times a day, a tablespoonful for a dose ; this decoction is also used for a mouth-wash and for gargling. Mustard plaster is prepared from black mustard two parts, rye flour or rye bread one part, mixed with warm water ; it is one of the best antispastics. It may be made still stronger by adding pepper, horseradish, &c. On children the mus- tard plaster remains from eight to ten minutes, and on adults for a quarter of an hour. For a stimulating foot-bath take a handful of mustard seed, pour boiling water over it, and then mix with the bath. A decoction is also used for chilblains. MYRRH Is the resinous juice exuding from the bark of a tree growing in Arabia, and inspissated in the air, consisting chiefly of ethereal oil and balsam fir, which gives it its medicinal efficacy. Myrrh is prin- cipally used for sluggish movement of the blood in the abdomen, obstructions, glandular swellings, diseases of the mucous membranes, HOUSE DISPENSARY. 627 particularly of the lungs, chlorosis, scrofula, scurvy, &c; when ad- ministered, the patient should be free from all excitement, and inter- nally it should be used with the greatest caution. Externally, myrrh is applied to putrid, scrofulous and. scorbutic ulcers. Internally, it may be administered in the shape of a powder or pills, three, five, eight and ten grains several times a day, or in an alcoholic extract, which is prepared by pulverizing from two to four ounces of myrrh, and extracting it with one quart of spirits of wine. Dose, one to two teaspoonsful morning and evening. For external use, it is made into a salve, or the tincture may be used, or the powder sprinkled on. NITRIC ACID Does not occur pure in nature, but is prepared from nitre by means of sulphuric acid. It is used in liver and biliary diseases, for instance, in inflammation, swelling and induration of the liver, jaundice, dis- eases of the urinary organs, skin and abdominal dropsy, syphilitic ulcers in the mouth and throat, cutaneous eruptions, and heart-burn ;, externally, for chilblains. Internally, it is given in doses of from five to ten drops (with a little alcohol and tincture of opium) in mucilaginous drinks. NUTMEG Is the nut of a pear-shaped fruit of a tree cultivated on the Molucca Islands, and in other hot countries ; it grows to the height of from twenty to thirty feet, and is called the nutmeg tree. The outside or shell of the nut is covered with mace. The nutmeg, usually used as a spice, possesses also medicinal properties ; mace has the same effect, and both are useful in weakness of the stomach and intestinal canal, derangement of digestion, colic, dysentery, diarrhoea, worms, &c. A dose for adults is from three to eight grains of the powder, and for children from one to two grains, usually in connection with some other remedy. Balsam of nutmeg is the hot pressed oil of the nutmeg, which is used as an embrocation for pain in the intestines, and cramps, particularly for children. The tincture is given intern illy, in doses from fifteen to thirty drops. The ethereal oil of nutmeg is used for the same purposes as the balsam. 628 HOUSE DISPENSARY. NUX VOMICA. This is the fruit of a low, thick tree, growing at Malabar and Ceylon. The seed is yellowish-white, or ashy-grey, of a circular shape, from eight to ten lines in diameter, with navel-shaped eleva- tion, and is covered with fine hair. Administered even in small doses, it produces violent results and for that reason must be adminis- tered with great caution. The remedy has frequently proved beneficial in paralysis, convulsions, dysentery, and diarrhoea. The really effective part is the alkaloid obtained from it, which is called strychnine. Remedies of that kind should not be used, except pre- scribed by a physician. In cases of poisoning by strychnine, opium, administered in a fluid form, and in not very small doses, is the surest antidote. OAK BARK Possesses strongly astringent powers, and is used as a decoction (half an ounce, boiled down with half a pound of water) for poul- tices, flatulence, gargling, immissions, &c, in cases where an in- vigorating and astringent effect is to be produced. OIL OF AMBER Is used externally for embrocations in lameness, and is internally ad- ministered in doses from five to fifteen grains in spasmodic attacks. OIL OF BERGAMOT. It is a fragrant oil, principally used to mix with pomades and other cosmetics. OIL OF CAJEPUT Is an ethereal, aromatic, and fine scented oil, which is obtained from the leaves and twigs of a tree growing in the East Indies. Internally, it is but little used as a medicine, but externally it is used as a stimulat- ing nervine, particularly in nervous toothache, when a wad of cotton saturated with the oil is introduced in the hollow tooth. It is also used in cases of gout and rheumatism, earache, deafness, &c. HOUSE DISPENSARY. 629 OIL OF GARDEN-SPIDER. This oil is obtained by placing a number of garden or cross-spiders in olive oil, which is to be kept for two weeks or more in a moderately warm place. The oil is then poured off. It is used for spots on the cornea of the eye. OIL OF LEMON Is an ethereal oil of a fine, aromatic flavor, obtained from the lemon peel. A few drops on sugar are good for flatulence ; it is also used for pomades, &c. OIL OF WHITE LILY Is prepared by macerating lily blossoms in oil ; it is used for light burns. OLIVE OIL Is a soothing, enveloping remedy. It is applicable in inflammatory and irritated conditions, particularly of the mucous membrane of the intestinal canal and the urinary organs, and also as an enveloping remedy, where strong, caustic, or poisonous substances have been in- troduced in the stomach and intestinal canal. Externally it is applied as a soothing remedy in irritated conditions of the membrane, either by itself or in combination with other substances as a salve. OILED SILK, OIL-CLOTH, Is prepared from silk or other cloth, and is used in rheumatism and gout for bandaging the painful parts, inasmuch as it promotes per- spiration, and keeps off moisture and fluids. It is also beneficial to use it for suppressed foot sweating, by wearing inside soles of this material under the stocking. OPIUM Is obtained by light incisions made in poppy-heads. The exuding milk-like fluid assumes, when drying, a brownish color of strong taste, and narcotizing odor. Opium is one of the most important medicinal remedies, both for internal and external use. Being poisonous if administered in large doses, it may be abused, and there- 630 HOUSE DISPENSARY. fore should only be prescribed by a physician. It is tranquilizing, slightly exciting, pain-allaying, antispasmodic and sudorific, which may develop into plethora, congestion, costiveness, inflammation, fever, &c, if not administered in proper quantities. In cases of poisoning with opium, an emetic should be administered, to be followed by drinking wine vinegar or coffee. Various preparations of opium are kept in the apothecary shops ; the powder (from one-eighth to one-third of a grain), in combination with ipecac, constituting Dovers powder (which see) ; the watery extract (from one-quarter to one grain) ; plain tincture (from two to ten drops) ; compound tinc- ture, or Sydenham's laudanum (dose as before, from two to ten drops). ORRIS ROOT, FLORENTINE. This is the root of the irk fiorentina, indigenous to Southern Europe, and also cultivated in our gardens. It has the agreeable violet flavor, and is mostly used as a dentrifice, and for perfumery. Sometimes it is also put around the neck of teething children, to let them bite on it (an old popular custom). OYSTER SHELLS. They consist of a small part of animal jelly and carbonate and phosphate of lime. They are boiled in water, brushed clean, dried, and pulverized extremely fine, then elutriated and used as prepared oyster shells in cases of acidity of the stomach, and heart-burn ; dose for childien, from five to ten grains, and for adults from ten to twenty grains three times a day. PANSY. The leaves and flowers of this plant are used for a tea, prepared by infusing with boiling water (usually two drachms for four or five ounces of water). It has proved beneficial as a blood purifier in several diseases, particularly in milk-scall, cutaneous eruptions, gout, and rheumatism, scrofulous diseases, glandular indurations, &c. The same quantity of the leaves maybe boiled in milk, and combined with a little fennel or anis. In cases where children do not like to take the tea, the powder of the plant may be sprinkled on bread and but- HOUSE DISPENSARY. 631 ter. After the remedy has been used for some time, the smell of the voided urine resembles that of a cat, which is to be considered a favorable symptom (see " Milk scab"). PARSLEY Is a well-known vegetable ; it came originally from Sicily and Greece, but is now raised everywhere. A distilled parsley water is kept in the apothecary shops, possessing diuretic virtues, and is used in dropsy for the purpose of compounding other medicinal remedies. The root has a similar effect. The leaves dried on a hot pan, are applied to the breasts for the dispersion of the milk, when children are being weaned. The juice of the leaves is recommended for the sting of a wasp. PECTORAL TEA. The herbs used for that purpose are obtained ready prepared in the apothecary shops. The tea is composed of marshmallow root eight ounces, licorice root three ounces, orris root one ounce, coltsfoot four ounces, mullein leaves, red poppy flowers, star anisseed, one ounce, of each, all cut up, and mixed. Another : Marshmallow root, skirret, coltsfoot flowers and leaves, mullein flowers, St. John's bread, four ounces of each. Cut up fine, and mix well. Of the mixture boil two ounces in one quart of water for half an hour, add one ounce of licorice, let it draw for a while, strain, and use the same during the day, a cupful at a time. Another: Licorice root, marshmallow root, mullein flowers and leaves, star anisseed, fennel seed, violet flowers and leaves, one ounce of each. Take of this one ounce and boil in one quart of water for half an hour, strain, and use during the day, a cupful at a time. PELLITORY ROOT. The fresh root applied to the skin causes inflammation and blisters, and for that reason it can be employed as a stimulant and derivative. Formerly it was a favorite remedy for lameness, rheumatism, gargling in malignant croup, and as a mouth-wash in scorbutic affections. It is particularly applicable in rheumatic toothache, when a piece of the 632 HOUSE DISPENSARY. root itself is placed in the hollow tooth, or a warm effusion (two drachms of the root with four ounces of boiling water) is held in the mouth, or a small wad of cotton, saturated with the tincture of the root, is placed in the hollow tooth. In cases of paralysis of the tongue, the root may be chewed. PEONY FLOWERS. This well-known plant is indigenous to Europe, and is here raised in gardens for the red flowers it bears. It grows to the height of three or four feet. An oil is prepared by taking four ounces of the flowers and eight ounces of sweet oil ; the two ingredients are put together in a glass bottle, and exposed for four weeks to the heat of the sun ; the liquid is then poured off and used. It is a good remedy for sore eyes, gout, rheumatism (rubbed in), and also for tetter and salt rheum. The root has a disagreeable odor, and a bitter-sweet taste as long as it is fresh ; it is an excellent nervine and antispas- modic remedy. The root of the peony is mostly used for an infusion, taking one ounce of coarsely powdered or crushed root to one pint of boiling water ; dose, half a cupful twice a day. In former times it was freely used for cramps, epilepsy, and St. Vitus' dance. PEPPER, BLACK: AND WHITE. Pepper, a berry-like fruit of the size of a pea, is the product of a shrub in the East Indies. It is picked before it is ripe, and subse- quently turns black, and becomes corrugated (black pepper). The fully ripe berries, being of a reddish-brown color, are softened in water; freed from their shell, they appear white (white pepper). Pep- per is one of the best remedies for the ague (see "Ague"); besides that, it is also beneficial when rich and indigestible food is eaten, in flatulence, sluggish evacuations of the bowels, and gasterasthenia. It must not be administered, however, in super irritation of the stomach, tendency to diarrhoea, dizziness, &c, without the sanction of a phy- sician. For internal use, whole pepper is adapted, in doses from five to fifteen pepper corns, once or twice a day. Powdered pepper is sometimes added to mustard for the purpose of making it stronger. HOUSE DISPENSARY. 633 PEPPERMINT Is a strongly aromatic plant, raised in our gardens. It has a pene- trating odor and taste, and is particularly rich in ethereal oil. As an infusion (two to three drachms for four to six ounces water), pepper- mint is one of the most excellent house remedies for colic pain, flatu- lence, weakness of the abdominal organs, the stomach, and intestinal canal, cramps, cholera, &c. The apothecary shops keep peppermint water, and oil of peppermint; the first is used to envelop other medicines, and of the latter, one or two drops are given on sugar for the above mentioned complaints. For flatulence, peppermint lozenges are excellent ; they are prepared in the following manner : finely crushed white sugar is made into a mass with water, a little pepper- mint oil is added, well stirred and heated until it becomes a fluid, and dropped on iron plates. PERUVIAN BALSAM. There are two Kinds of this balsam, one is black, and is obtained by burning a tree growing in South America, and the other is white, the source of which is not fully known. Internally, it is frequently used with advantage in blennorrhcea of the lungs, womb, and genitals generally, in spasms of the kidneys, catarrhal phthisis, and tetanus. Externally, it is applied to stimulate flaccid ulcers, in lameness, in protracted local rheumatic sufferings, and in injuries of sinewy parts. It is administered internally in doses from fifteen to thirty drops on sugar, or in an emulsion, or in the shape of pills. For external use, it should be warmed, as it then operates more effectually. PHOSPHORUS Was formerly obtained from urine, but is now chemically prepared from bones. It is an extremely inflammable substance, which also finds application in medicine. We will pass it by here, as the ad- ministering of it may operate most injuriously, even if given in small doses. PITCH, Like colophony and hemlock gum (from the latter the yellow pitch is prepared), is used externally for discutient plasters. 634 HOUSE DISPENSARY* PLUMMER'S POWDER Is a preparation of equal parts of golden sulphuret and calomel, sometimes in connection with guaiac. It is applied for various dis- eases, particularly in scrofula, rheumatism, tetter, &c, but particu- larly in salt rheum. POLYPODY. Of this plant, which grows wild nearly all over Europe, the root is used. It has a nauseating-sweetish, somewhat acrid and bitter taste, and is used as an infusion. If used when fresh, it acts as a purgative ; in catarrhal maladies, it has a somewhat similar effect as licorice root. POTASH Is that part of the ashes of wood and plants soluble in water. The most simple way of preparing it is to pour water over the ashes, and let it stand for some time, stirring it from time to time. The fluid is then drawn off and evaporated ; the residue is the raw potash. It is used for stimulating foot-baths (which see). For medicinal purposes, the potassa is prepared from it (see the article). POTASSA Belongs to the class of alkalies, designating a number of substances composed of metalloids and oxygen ; they have a sharp, caustic, alkaline taste, and urine-like odor. In combination with fat or oil- soaps, and acids, they form neutral salts ; restore reddened vege- table colors, but impart a different tint if applied to the original color. The alkalies are divided into different classes, for instance, the pure or caustic, carbonate or mild, volatile and fixed ; the former volatilize in the air, the latter by strong heat. Potassa is designated according to its combination, and is used for various purposes in medicine. i. Acetate of potassa promotes nearly all secretions and excretions, and is particularly useful in hypochondria, melancholy, jaundice, dropsy, hemorrhoids, difficulties of menstruation, &c. It is best ad- ministered as a solution, one ounce in twenty-four hours ; to children, administer from one-fourth to one-half of that quantity. HOUSE DISPENSARY. 635 2. Bicarbonate of potassa is a very mild preparation, inciting the digestive organs, promoting gentle evacuations, and neutralizing acids, particularly vegetable acids, for instance, with lemon juice it is used for effervescing powders (which see). It is a Iministered internally in doses from ten to twenty grains several times a day. 3. Carbonate of potassa is somewhat more caustic than the pre- ceding preparation. It is used for £c:idity, heartburn, gout, scro- fula with swelling of the mesenteric glands, scald-head, rickets, lithi- asis, dropsy, blennorrhea of the lungs and genital organs, tetanus, and poisoning with mineral acids. Externally, carbonate of potassa is used for baths. It is administered internally in doses of from three to ten grains several times a day. 4. Caustic potassa. This preparation is very corroding. It is used internally in very small doses for various diseases ; it should be given, however, with great caution. It is mostly used externally for cauterizing purposes. 5. Tartrate of potassa is a combination of cream of tartar and potassa. It is an excellent remedy for hemorrhoids, and also for feverish conditions with disarrangement of the digestive organs. Dose for adults, from two to six drachms every twenty-four hours. PRUSSIC ACID. In its pure state, prussic acid is almost the most deadly of all poi- sons. Some animals, for instance, young dogs, cats, &c, die instantly if a few drops are placed on their tongues. Men, however, can stand more, and gradually can get used to quantities, which would kill them instantly if taken in the first instance. Symptoms of poisoning. If prussic acid does not kill instantly, the poisoned party is attacked with headache, bitter taste in the mouth and nausea; convulsions, tetanus, and paralysis . set in, fol- lowed by death. The corpse emits the remarkable scent of bitter almonds. Antidotes. Inhaling the vapors of chlorine, or of fluid caustic ammonia ; a sponge inpregnated with chlorine water, or diluted aqua 636 HOUSE DISPENSARY. ammonia, is held before the mouth of the person having taken the poison; of the latter, a few drops may be administered internally. Emetics are only applicable immediately after the poison has been taken. I will pass by the medicinal application of prussic acid, as the laymen cannot understand it, and on account of its great danger it is better to warn the reader against it. PYROLIGNEOUS ACID Is obtained by the dry distillation of wood, and is one of the most vigorous medicinal remedies. Internally, it is administered particu- larly for putrid, typhous diseases ; very great caution should be exer- cised in administering it. Externally, it is applied to gangrenous, putrid, cancerous and herpetic ulcers, by placing saturated lint on the sore. QUASSIA Is a tree growing in Surinam, flowering almost the whole year ; it attains the height of twelve to fourteen feet, throws out many branches, and furnishes one of the most bitter and excellent remedies. From the rasped chips various remedies are prepared, all of which act as a tonic, but do not always agree ; to the latter belongs the powder, for instance. The best preparation is a watery or vinous extract, which may be taken in doses of from five to ten grains twice a day, and the infusion of one or two drachms in five ounces of boiling water, to be taken during twenty-four hours. QUINCE. Is the fruit of a shrub-like tree, indigenous to the Island of Crete, but now also growing in Germany, and also in this country. The fruit contains a seed rich in mucilaginous substance, and for that reason is used for medicinal purposes. The seed must be macerated with cold water only for the purpose of extracting the mucilaginous sub- stance, as it is chiefly used for eye water ; they contain prussic acid, and if prepared by decoction, the poison would pass over with it. QUININE Sulphate of quinine is the efficient substance of the calisaya bark, and is used wherever the administering of the bark is considered HOUSE DISPENSARY. 637 necessary. Aside of that, it has the advantage of not weakening the digestive organs, and fjr that reason it can be given in cases where the bark could not be administered for the reason above given. The sulphate of quinine is prescribed in doses of one or two grains, com- bined with sugar or sugar of milk, to be taken every two or three hours. RASPBERRIES. From this universally known and refreshing fruit, raspberry syrup, raspberry vinegar, and raspberry water, are prepared, which are added to many medicines to improve their taste. Raspberry vinegar is par- ticularly used in inflammatory and feverish diseases, in nervous and putrid fevers, and also in diseases of the liver. Much benefit is de- rived from its use in those diseases. RED POPPY FLOWERS. This known plant, growing wild in grain fields, has red flowers, and is used in medicines for pectoral diseases. It is used as an in- fusion for irritated conditions, particularly of the air passages, and has a quieting effect. In the apothecary shops, syrup of red poppy flowers may be found. REST HARROW ROOT (ONONIS SPINOSA). A plant growing wild, the root of which is mildly diuretic, and beneficial for irritation of the mucous membrane. It is taken either as a powder in doses of one-half to one drachm, or as a decoction of one ounce in twenty-four hours. RHATANY ROOT. This shrub, attaining a height of from two to three feet, is found in South America, as well as in this country. Its roots are cylinder- shaped, branchy, and of the thickness of a quill, having an astrin- gent, somewhat bitter taste. Rhatany is an excellent remedy for old hemorrhages of the womb ; it is a powerful astringent, and moderately strengthening remedy. It is administered as an infusion or tincture, from one to two drachms in twenty-four hours, and the extract in doses from ten to fifteen grains, three or four times a day. 638 HOUSE DISPENSARY. The decoction is also u^ed for bleeding gums, chronic diarrhoea, and too severe menstruation. RHODODENDRON (YELLOW-FLOWERED). This is a small shrub, indigenous to Siberia, Tauria, Kamtchatka, &c; its leaves are used * for medicinal purposes. It is a very good remedy for gout and rheumatism, particularly for chronic rheumatism, and lameness resulting' from it ; also for the swelling of the joints, with gouty pains in the limbs. The powdered leaves are given in doses of ten grains several times a day, with a gradual increase. An infusion is also prepared from it, RHUBARB. Rhubarb is the root of several plants. The best comes to us by way of Russia, in lengths of from three to four inches, and several inches in thickness ; its shape is cylindrical, but also flat. Stripped of the rind, its outside color is yellow, being covered with yellow powder ; the inner part is rose-colored, marbled with white. The inner part is easily crumbled; its taste is disagreeably bitter, some- what sharp and astringent; the flavor peculiarly nauseous. Rhubarb is one of the most important medicinal remedies ; it is beneficial in derangements of digestion, accidity of the stomach, flatulence, ob- struction of the blood in the abdomen, jaundice, diarrhoea, dysentery, blennorrhoea, scrofula, emaciation, and rickets of children ; admin- istered in larger doses, it acts as an excellent purgative, which may be given in cases of weakness, where other laxatives could not be used. Various preparations of the rhubarb are found in the apothe- cary shops. The powder is given in doses of from two to eight grains three times a day; of the watery extract, from five to twenty grains, and as a purgative, from one to two drachms; compound extract (used only rarely, and with great caution), the watery and vinous tincture, from one to three drachms, and as a purgative, from one to two drachms; an infusion is also prepared from it, which is very effi- caceous. ROCK OIL, PETROLEUM, Is a fluid bitumen found in various parts of the world, but always in the neighborhood of coal fields, running from the seams of rocks ; HOUSE DISPENSARY. t)39 sometimes it is also found swimming on the water. The finest and most purified rock oil is called mountain naphtha. Rock oil, mixed with mucilaginous decoctions, is administered internally (from tv/enty to fifty drops), particularly for tape-worm, old cases of rheumatism and gout, dropsy, and weakness of the bladder (from five to twenty drops). Externally, it is applied as a stimulant, nervine, discutient* of obstructions, and also for chilblains, gouty and rheumatic lameness, tophus, and stiffness of joints. ROSE-HONEY. Pour eight parts of boiling water over one part of rose leaves, let them stand over night, press them out, mix the strained fluid with one part of skimmed honey, and evaporate with moderate heat to the consistency of syrup. Rose-honey may be obtained in the apothecary shops. It is used in connectiou with borax (which see) for aphthae in the mouth, also for gum-boils and ulcerated throat, or dissolved in water as a gargle. ROSEMARY LEAVES. This is a shrub-like plant, growing wild in Southern Europe ; it is cultivated here in gardens and in greenhouses. It is an evergreen, and its leaves are used for poultices and little herb-sacks, to disperse non-inflammatory swellings. The oil is used for the same purpose, and also for lameness, weakness, the result of sprains, &c. In similar cases, the compound rosemary, or nervous salve, and also spirits of rosemary, is used. RUE Is a shrub growing in Southern Europe, Northern Africa, and in other parts of the world. It is now raised in our gardens. The leaves have a strong, disagreeable flavor, and a bitter, spicy taste. Rue is an invigorator of the digestive organs, and a nerve-stimulating, an- thelmintic remedy ; the leaves are made use of. Dose, from eight to fifteen grains of the powder; of the oil, from two to five drops, and of the decoction, from one-half to one ounce. The leaves are also used for herb poultices, or the steam generated in boiling permitted to strike the eye as an invigorator of that organ. 640 HOUSE DISPENSARY. SAFFRON, GENUINE. This is a bulb growing in the Orient, and also in the south of Europe ; the eye of the seed is used for culinary and medicinal purposes. The flower and other parts of the plant are thrown away. Saffron is given in the form of a powder (two to ten grains twice a day), or as a tincture, from twenty to thirty grains ; it may also be given in the form of an infusion. Syrup of saffron may also be prepared ; it is used as an addition for plasters. It is also useful in certain kinds of nervous fevers, spasmodic difficulties of the stomach and intestinal canal, spasmodic cough, spasmodic colic, jaundice, dropsy, hypo- chondria, hysterics, obstructions of menstruation, and spasmodic attacks of the womb. Externally applied, it is pain-allaying, emol- lient, and suppurative. It can be found in all apothecary shops. SAFFRON, GARDEN. This well-known plant is raised in gardens in this country, partly for ornament and partly on account of its medicinal qualities. The flowers of this kind of saffron, which alone possess medicinal properties, are beautiful, of deep yellow or orange color, sudorific, and promot- ing menstruation ; they are mostly administered to women and children, in the form of tea, or as an infusion to produce activity of the skin, and in small-pox, measles, and diseases of that class, to cause an eruption. It may be administered at pleasure, a teacupful at a time. SAGE. This little shrub grows wild in Southern Europe, but is cultivated in gardens in this country ; it is of strong, spicy flavor, and a sharp, bitter, and somewhat astringent taste. An infusion of sage (from half an ounce to one ounce for six to eight ounces of boiling water, during twenty-four hours ; for children one-half of that quantity) is a very good remedy for debilitating sweats, if the latter are the result of weakness only, for blennorrhcea of the respiratory and urinary organs. It is also well adapted for moutL- washes and gargles in scor- butic conditions of the gums (see "Gargles"), for croup, &c. HOUSE DISPENSARY. 641 SAGO. Sago is prepared from the pith of various species of the palm tree. It contains a great deal of mucilage, and for that reason affords proper nourishment in many diseases. SAL-AMMONIAC, OR CHLORIDE OF AMMONIUM. Externally it is employed as a discutient, dissolved in water as poul- tices for chilblains, injuries of the head, contusions, swellings, exuda- tions, varicose knots, milk-knots, swelling of glands, and malignant ulcers. Combined with vinegar, for scrotocele in little boys. As a powder, combined with quinine and aromatic substances, it is used for the cleaning of teeth, and as a tonic for the gums. Internally, it operates as a solvent, aiding in expectoration and digestion, one to two drachms to from four to six ounces of fluid. SALEP. There are two species of this plant growing in all parts of Ger- many, but they are also very frequently found in Turkey. The root of this plant is used ; it has a bulb-like appearance, and is mostly im- ported from the Orient. It contains extraordinary quantities of starch, and for that reason is used powdered as a decoction for irritations of the stomach and intestinal canal, diarrhoea, dysentery, emaciation in adults and children. Some spice may be added to the salep, and it may be added to broths, for its nourishing qualities. SALINE SPRINGS Owe their properties to saline compounds, such as sulphates and car- bonates of lime, magnesia, and soda, and the chloride of calcium, magnesium, and sodium. The waters are used for baths, either cold or warm, particularly in scrofulous diseases, old cutaneous diseases, gout, rheumatism, nervous debility, and debility of various kinds generally. SALT, COMMON. This well-known and indispensable article stimulates the appetite, and promotes digestion. As a medicinal remedy, it is administered 41 642 HOUSE DIPENSARY. for haemoptysis and spitting of blood, a teaspoonful several times a day. Also for blennorrhoea, obstruction of the lungs and liver, dis- eases of the glands, cahexia scrofulosa, cold swellings, and white swelling in the knee-joints. Administered in larger doses, it operates as a purgative and anthelmintic ; it also causes vomiting. It is used for foot-baths (usually a handful) and for injections (one or two table- spoonsful). SALTPETRE, NITRE, NITRATE OF POTASSA. This salt is composed of potassa and nitric acid, which is frequently found in nature, or it is artificially prepared. Saltpetre is one of the strongest antiphlogistic remedies ; it is refrigerant and sedative, allays congestions, thins the blood, and acts as a diuretic, and in larger doses as a purgative. It is very weakening to the digestive organs, however, if its use is continued for any length of time. Carefully administered, it is one of the best remedies for inflammation (but not for inflammation of the stomach, intestinal canal, and the urinary passages), for hemorrhages, and dropsy. Externally it is used on account of its refrigerant qualities, for poultices in cases of inflamma- tion of internal or external parts, for instance, in Schmucker's poul- tices (which see) for strangulated hernia, for gangrenous or putrid ulcers, &c. It is administered internally in doses of from five to ten grains three times a day in mucilaginous decoctions. SARSAPARILLA Is a willow-like, thorny plant growing in South America, of which the root is used for medicinal purposes. It acts as a sudorific and diuretic, and is a well-known remedy in venereal diseases, in old cases of rheumatism and gout, and diseases of the skin. It is usually given as a decoction, for which purpose about two ounces are boiled with four pounds of water, until reduced to two pounds; it is used a tea- cupful at a time. SASSAFRAS Is a tree-like shrub indigenous to America, the root of which is used in medicine; it has a peculiar, spicy, fennel-resembling flavor and taste, which is caused by the ethereal oil it contains. It is princi HOUSE DISPENSARY. (J43 pally used as an addition to blood-purifying potions, and in that case it is used in the form of an infusion. SCAMMONY. Is a willow-like plant growing in many parts of the Orient ; it has a spindle-shaped, fleshy root, filled with a milky juice, which hardens on being exposed to the air. Scammony yields a strong purgative which is now but little used. SCARLET PIMPERNELL Is a small plant with red blossoms, which was formerly used for nerv- ous diseases, dropsy, jaundice, insanity, and more particularly for hydrophobia ; it was also externally applied for cancerous and mal- ignant ulcers. For hydrophobia it is sometimes still administered in the following manner : The person bitten by the rabid animal, takes for the first three days, morning and evening, fifteen to twenty grains of the powdered leaves; for the three following days nothing is taken. After the expiration of that time the same quantity is taken in an infusion, for which purpose two drachms of the leaves are used for one quart of water. Nothing more is taken, but at the same time the wound is kept open, or an attempt is made to destroy it, by syringing it with urine, drying it with blotting paper and dripping into it the burning sulphur of a lighted bundle of sulphur matches. SEDATIVE POWDER Is used for the purpose of allaying the excited blood after violent emotions, anger, fright, &c. The following prescriptions may be used for that purpose : i. Sulphate of potassa and saltpetre, one drachm of each, mixed; dose, a quantity sufficient to cover the point of a knife, to be taken in water. 2. Half a drachm of refined saltpetre, one and one-half drachms of refined cream of tartar, three drachms of sugar, powdered and mixed. 3. Refined cream of tartar, white magnesia, loaf sugar, one drachm of each, powdered and mixed ; dose, of either of the pow- ders (2 and 3) a teaspoonful in water. 644 HOUSE DISPENSARY. SENNA LEAVES Are the leaves of two species of shrubs, growing in Nubia and Egypt ; they are used as purgatives. They form the chief ingredient of the Vienna laxative potion, the preparation of which has been given under the head of "Purgatives." SENECA ROOT. This plant is indigenous to America, the root of which is used as a medicinal remedy. It has a disagreeable flavor ; its taste is sweetish-* sour at first, which subsequently becomes sharp and harsh, and con- tinues for a long time. It is useful in obstinate blennorrhea of the lungs, chronic catarrh, whooping cough in old people, inflammation of the lungs, catarrhal croup, dropsy, &c. The natives use it inter- nally and externally for the bite of poisonous snakes ; externally it is used for mouth washes and gargles. It is administered in the form of a powder, from ten to twenty grains, as a decoction two to four drachms for seven ounces of fluid. In the apothecary shops a syrup and extract may be found. SIMARUBA BARK. This plant grows in America. The rind of the root is generally used, particularly for dysentery, for which it has acquired a good reputation ; it has also proved beneficial in diarrhoea, blennorrhoea, and hemorrhage, caused by weakness. It is usually given as a decoc- tion, half an ounce for four to five ounces of fluid ', it is also admin- istered as an electuary. SOAPWORT. This plant is growing wild in Germany. It is used in medicine as a diluent in diseases of the abdomen, obstructions in the liver, portal system, jaundice, dropsy, fever, dry cough, and adhering mucus in the respiratory organs. The extract is administered in doses of from ten to fiften grains up to two drachms, or a decoction is given a cup- ful at a time (one ounce to one pound of water). HOUSE DISPENSARY. 645 SODA Is one of the alkalies, and what has been said of the others, is like- wise applicable to this; it has nearly the same properties as the potassa (which see). It is composed, like that, of a metal, in connec- tion with oxygen. In its pure, caustic state it is but little used, much more frequently, however, in other combinations, of which a few are here given. i. Sulphate of soda, a combination of soda with sulphuric acid ; it constitutes the so-called Glauber salt (which see). 2. Acetate of soda, a combination of soda and acetic acid, which has the same properties as the acetate of potash (which see). 3. Muriate of soda, a combination of soda and muriatic acid, which is common salt (which see). There are some other combinations, such as carbonic acid, which have nearly the same properties as those given under "Potassa" (which see). SPANISH FLY Is really a bug, to be found particularly in warm countries, but it is also found in Germany. From it is prepared Spanish fly plaster and Spanish fly tincture. The first has been mentioned in the article "Vesicants," the second is rarely and very cautiously used inter- nally ; it is, however, used externally to produce an irritation. SPEEDWELL,, SCARLET PIMPERNELL, COMMON GOLDEN ROD. This plant is frequently met with ; the leaves have an acrid, astrin- gent, somewhat bitter taste. As a popular remedy, it is used as a tea in mucous obstruction of the chest, and at the commencement of pulmonary consumption. Externally, the remedy was formerly used for wounds, ulcers, and swellings, for which purpose it was crushed and applied. SPERMACETI. This is a fatty, animal substance, contained in the cavity of the head of the sperm-whale. Spermaceti is used in surgery for oint- ments and cerates. 64:6 HOUSE DISPENSARY. SPIDER. Some of the spider species, particularly the cross-spider, are used for the so-called spider oil, which is a good remedy for spots on the cornea. The cross-spiders are collected in a vial, sweet oil poi red over them and digested for fourteen days, when the oil is poured off. SPIDER WEB Is sometimes advantageously used as an antefebrile for intermittent fever. Spider webs, particularly of the cross-spider, are collected, beaten clean, and eaten on bread and butter. SPRUCE GUM Is the resin exuding from the spruce tree ; it is used, spread upon leather, as a discutient for scrofulous glands and obstinate swellings, and also forms a part of many discutient plasters. SPRUCE SPROUTS Are used in their young and fresh state, in connection with guaiac wood, sassafras wood, and juniper berries, for a tincture, which is a remedy for rheumatic and gouty maladies, and also for scurvy. In North America a wine-like beverage is prepared from them, which is very refreshing and blood-purifying. SPUNK. In surgery it is used for small wounds, to stop the bleeding from the application of leeches, &c. For that purpose it must be free from addition, such as saltpetre, and it is best to procure it in the apothe- cary shops. SQUILL ROOT Is a house plant raised on the coast of the Mediterranean Sea, on the shores of Sicily and France ; the bulb attains the size from a fist to that of a child's head. Squill root is an excellent remedy for mucous obstruction, from weakness, for scrofula, and worms. It is also ad- ministered as a diuretic and an emetic ; it was formerly also often ad- ministered for dropsy, but is not applicable to every case. In the HOUSE DISPENSARY. 647 apothecary shops various preparations are made of it ; among which vinegar of squills, and honey of squills, can be highly recommended. Of the former, from twenty to sixty drops are administered to adults, and of the latter, one ounce and upward during twenty-four hours ; dose for children, proportionately less ; to the latter, syrup of squills is administered, a teaspoonful at a time, as an emetic. ST. IGNATEA BEAN Is the seed of a cucumber-like fruit of a tree growing on the Phillip- pine Islands. The remedy seems to be very effectual, but the present experience for its application is too limited. ST. JOHN'S WORT. This plant, which blooms about St. John's day, had formerly a great reputation as affording protection from witchcraft. It is still occasionally used as a vulnerary, and for hemorrhages. STRAMONIUM (THORN APPLE). This poisonous plant is indigenous to the East Indies, but grows now also in Germany and America. Its stem is from two to four feet high ; leaves large, egg-shaped, smooth, upper side dark green, and lower side more pale ; flowers, solitary, funnel-shaped, with a long tube, and a plaited, five-toothed border ; color, white or violet. The fruit is as large as a walnut, egg-shaped, covered with spines, divided in four parts, containing a large quantity of egg-shaped, somewhat corrugated seed. Stramonium is a useful remedy for chronic rheu- matism, certain spasmodic diseases, asthma, epilepsy, hemicrania, hysterics, and hydrophobia. It is administered as an infusion, ex- tract, or tincture ; these preparations should be ordered by a physi- cian only. As antidotes in cases of poisoning, the same remedies are to be ad- ministered which are given for poisoning with belladonna (which see). SUGAR. Sugar of itself is not a medicinal remedy, but only nourishing, very good, and readily digested for every age, if given in proper 648 HOUSE DISPENSARY. quantities, and taking in consideration other conditions. In combi- nation with other remedies, and in a diluted state, it certainly pos- sesses medicinal virtues, and in that way allays irritation, and is refreshing and quieting, promotes secretion and excretion, blunts gall irritation, and acts as a mild palliative for the mucous membranes, and more particularly of those of the respiratory organs. Externally applied as a powder, it is a gentle caustic for spots on the cornea, and also proves useful and relieves chronic nasal catarrh, when drawn up in the nostrils. SUGAR OF MILK Is a sacharine preparation from milk, which is sometimes used in con- nection with other medicines. SUGAR OF OIL Is the name of sugar, in combination with any of the ethereal oils, which can be found prepared in the apothecary shops. From the various oils with which it is combined, it receives its name. Thus we have sugar of fennel, anisseed, caraway, and cinnamon. Sugar of lemon oil is prepared by rubbing white loaf sugar against fresh lemon peel. SULPHUR. Sulphur is used in many combinations; for medicinal purposes, refined sulphur, flowers of sulphur, or milk of sulphur, are generally used. Sulphur is one of the best and most useful remedies in many diseases. It is particularly valuable for old pectoral diseases, such as chronic cough, hoarseness, mucous asthma, congestion of the lungs, chronic cutaneous eruptions, particularly for itch, whooping-cough, phthisis, blennorrhcea of the lungs, hemorrhoids, diseases of female sexual organs, gout, and rheumatism, scrofula, dropsy, &c. Sulphur is administered internally, in doses of from three to ten grains, for loosening mucous, and promoting activity of the skin ; to cause a mild evacuation, it is given in doses of from ten to thirty grains. Milk of sulphur is administered in smaller quantities. Sulphur is also applied externally, particularly as a salve. HOUSE DISPENSARY. 649 SULPHURIC ACID, OIL OF VITRIOL, Is rarely produced pure by nature ; it is obtained by various chemical processes. As a medicinal remedy, it is used in a very diluted state for various purposes ; it is particularly beneficial in nervous and putrid fevers, scurvy, eruptive fevers, bilious fevers, diseases of the blood system, and various diseases of the nerves ; externally, it is applied as a caustic, and for gargles. Internally, Haller's acid is frequently used, consist- ing of three parts of rectified spirits of wine and one part of sulphuric acid. Sulphuric acid is also used in other combinations. SWEET FLAG Is the root of a plant growing in marshes; it furnishes a strengthen- ing remedy for the stomach and nerves. It is generally used as an infusion (not decoction) as tea, for which purpose half an ounce, with about six to eighteen ounces of water, is used ; it is administered every hour, a tablespoon ful or cupful at a time. In the apothecary shops a simple or compound tincture of sweet flag may be obtained, both of which are used as a stimulant for the stomach or nerves ; dose, from thirty to fifty drops. Oil of sweet flag is very beneficial in attacks of wind colic. Externally, sweet flag is used for baths. In fuse four ounces of it with with forty-eight ounces of boiling water, which is added to the bath. Candied sweet flag, which may be used for the purpose of promoting digestion, can be obtained in confec- tionaries. Sweet flag whisky may be used for the same purpose. TAMARIND PULP. This is the pulp of the fruit of a tree growing in the East Indies, Arabia and Egypt. The tree is beautiful, and reaches the height of thirty or forty feet. Tamarind pulp is a cooling, mildly laxative remedy, and for that reason is beneficial in many diseases. Adults may use from one to one and a half ounces during twenty-four hours, and children from one-third to one-half of that quantity. TANSY Is a plant growing wild all over Europe, furnishing one of the best worm remedies. An infusion is prepared from the blossoms and 650 HOUSE DISPENSARY. leaves (six drachms with four ounces of fluid); dose, a tablespoon fnl every two hours, given in hot milk or boiling water.. From the seed a powder is prepared, of which from fifteen to thirty grains is a dose for adults; for children of seven years and upwards, one half, and for younger children, one-fourth of that quantity. An extract is pre- pared from it in the apothecary shops, which may be administered in doses from six to ten grains several times a day ; of the oil distilled from it, two drops are given for one dose. The oil is used externally for embrocations in abdominal dropsy, old rheumatism, worm dis- eases, &c. TAR. Tar is obtained by the dry distillation of various kinds of pine wood ; it is a dark, thickly flowing substance, from which pitch (which see) is obtained. Tar is a useful remedy for certain diseases of the skin, scald head, tetters, salt rheum, &c, administered inter- nally in the form of pills, and externally as an ointment. Tar water is also used for the same purpose ; it is also used for gout and rheu- matism. Tar fumigations (tar warmed over a spirit lamp, and the fumes inhaled) are very beneficial for some kinds of consumption, particularly of the larynx and trachea. TARTRATE OF POTASSA, ROCHELLE SALTS, Is a combination of carbonate of potassa and tartaric acid, and is used as a purgative, particularly in swellings and obstructions of the abdomen. THYME. This spicy plant, which is quite common, may be used in slight disorders of the stomach and intestinal canal. Externally, it is used for herb bags, baths, and poultices. TIN FILINGS Was formerly frequently used for worms ; it was made into a powder or electuary, with several other remedies. • TINCTURE Is called an alcoholic extract made from a medicinal or other sub- stance. HOUSE DISPENSARY. 651 TOBACCO. This poisonous plant is an annual, and indigenous to South America ; it is now also cultivated here, as well as in Europe. The herbacious leaves, separated from each other, spring from the root, and attain the height of two or four feet. Tobacco furnishes a very active, medicinal remedy, and is particularly beneficial for abdominal dropsy, spasmodic difficulty in discharging the urine, whooping- cough, spasmodic asthma, tetanus, spasmodic abdominal difficulties, cramp colic, strangulated hernia, asphyxia ; externally for old cuta- neous eruptions, and adenoid tumors. It is given as a powder, in- fusion, and decoction ; its use, however, requires the greatest caution, and it should be prescribed by a physician only. Tobacco smoke dislodges insects from house plants. TORMENTIL ROOT. This plant grows in Europe and also in this country ; the root oi which is sometimes used for medicinal purposes. It is best adapted as a decoction for poultices ; containing a good deal of tannin it acts as an astringent, and can therefore be used like oak bark (which see). TRAGACANTH, GUM OF, This is the hardened, mucilaginous juice of a shrub-like plant, growing in Asia Minor. Gum tragacanth is much more mucilaginous than gum arabic. The latter is nevertheless much better adapted for medicinal purposes. TURPENTINE. This is a resinous, balsamic liquid, flowing from the bark and wood of several species of the pine. There are different qualities of tur- pentine. By distilling turpentine with water, the oil of turpentine is obtained, which is colorless, as clear as water, and very limpid ; it has a sharp flavor and taste. Turpentine is a very vigorous remedy, and may be used for many diseases, particularly for dropsy, lameness, liver complaints, blennorrhcea of the urinary and genital organs, hemorrhoids, obstruction in the abdomen, nervous diseases, epilepsy, worm diseases, and particularly for tapeworm. Externally it is applied for putrid, cancerous and gangrenous ulcers, gangrene, gouty lame- 652 HOUSE DISPENSARY. ness, chilblains, toothache, and as a styptic for local hemorrhages. Dose, from five to twenty grains in twenty-four hours, administered in mucilaginous preparations. Its internal use requires much caution, and it should be prescribed by a physician only. VALERIAN ROOT. Valerian root grows in several parts of Germany ; but as its gather- ing, preservation and preparation previous to being used for medicinal purposes requires much care, it is best bought in the apothecary shops. It is a gently stimulating, vivifying, antispasmodic, and also an anthelmintic remedy. It is also adapted for severe nervous excitement, fear, anxiety, and general excitement of the mind, particularly in cases of melancholy, hysterics, and hypo chondria ; also in cases of spasm occurring in the female sex, in con- sequence of interrupted menstruation ; also for spasms in small children during dentition, and for headache and pains in the bowels ; finally, it is one of the best vermifuges. It is best administered in the form of tea, or as an infusion, in proportion of one part of the root to twelve parts of water, in doses of a tablespoonful or half a cupful at a time ; also in the shape of a powder, in doses from ten to thirty grains ; the simple tincture of valerian, obtainable at the apothecary's (an extract of the root in rectified spirits of wine), from twenty to forty drops on sugar several times a day ; ethereal tincture of valerian, in doses from fifteen to thirty drops. For worms, administer to children from eight to ten grains of the pow der, with an equal quantity of sugar, three or four times a day. VENISON TALLOW Is used as an emollient for chapped hands, hemorrhoidal tumors, and for sore feet from walking. As a remedy for the latter, cloths spread with venison tallow are wrapped around them, or the stockings are well impregnated with it. VERDIGRIS. This is a salt composed of oxide of copper and acetic acid, which, taken internally in larger doses, operates as a poison (see " Anti- dotes' ). HOUSE DISPENSARY. 653 VESICANTS Are substances, the external application of which cause the outer cuticle to be raised in a blister filled with a watery fluid. To this class belong horseradish, mustard, mezereon bark, and many other remedies. The Spanish fly plaster is, however, preferred to all these ; this is spread on leather or linen, and is left on the place at least twelve hours, during which time it usually has had its effect. If it is intended to produce a transient irritation and revulsion, as in fever diseases, the formed blister is opened by puncture in the lower part, so that the fluid may run out without hindrance. The place is then dressed with simple ointment. But if the revulsion is to be continued for some time (as is required for the cure of rooted maladies), the blister is cut around at the base with a pair of scissors, and the wound is then dressed with an irritating ointment, to cause suppuration, which is to last for some time. For this purpose, Spanish fly plaster is usually employed. But as its continued use may produce urinary affections, savin ointment ought to be preferred. The same object is attained by it without causing the same trouble. If the Spanish fly plaster is to be applied to* places overgrown with hair, they should first be shaved off, so that the plaster may have a better effect ; the place may be rubbed either with a piece of flannel, or washed with vinegar, previous to the application of the plaster. Transitory blis- tering plasters are called those remaining on one place only for a short time, and which are transferred to another place before they have had their full effect. VINEGAR, WINE VINEGAR. Vinegar is one of the most useful and indispensable articles for the house; it is volatile, stimulating, refreshing, sudorific, and diuretic, and for that reason it is used with great advantage in inflammatory and putrid diseases, such as nervous, putrid, gastric, or bilious fevers, &c; it is also used in cases of delirium, mania, hypochondria, and melancholia. For a long time it has been, and is now, considered a preventive of contagion of all kinds ; one of the most excellent an- tidotes in cases of poisoning by opium, henbane, or hemlock, and a reviving remedy in fainting fits, asphyxia, &c; it is an internal and 654 HOUSE DISPENSARY. external remedy after fatigues and exertions. It is also applied in contusions and general injuries of the surface, as a poultice to stop bleeding, and for gargles and injections. It is excellent for fumigat- ing purposes, improving vitiated air. Sometimes wine vinegar is combined with medicinal ingredients, by triturating the latter with it for a number of days, or the vinegar is poured on hot, and permitted to draw for one hour ; it is then decanted and strained. Pest or four-thieves vinegar, a remedy against pest contagion, is prepared in the following manner : take wormwood, sage, balm- mint, rosemary, rue, one and one-half ounces of each, lavender flowers two ounces, sweet flag, garlic, cinnamon, cloves, nutmeg, one- quarter of an ounce of each, all of them in a comminuted condition, triturate in the sun, with three and one-half quarts of good wine vinegar or distilled vinegar, in a glass bottle, tied up with a wet bladder, for eight days or longer, decant, press out the residue, and strain. VIOLETS. The root of this lovely, universally known little flower causes vomit- ing and purging ; from a quarter to one-half a drachm of it causes re- peated vomiting and purging ; it also acts as a diuretic. It is adminis- tered for lung diseases, coughs, consumption, &c, and also in diseases of the kidneys and urinary organs, where mucilaginous, diuretic remedies are required. An infusion of the beautiful blue or dark violet flowers and leaves is very beneficial in venereal diseases ; the tea may be used at pleasure, a cupful at a time. VIOLET SYRUP Is of no other use in medicine than for the purpose of coloring the remedies. VIRGIN'S MILK Is a wash for the softening of the skin, prepared from storax and benzoin, five parts of each, cinnamon one part, flag root and rose- mary, two parts of each, digested for four weeks in twenty-five parts of whisky, which, at the expiration of that time, is poured off. It is used by pouring a few drops in the water used for washing, which acquires a milky appearance from it. HOUSE DISPENSARY. 655 VIRGINIA SNAKE ROOT Is a plant indigenous to America (Virginia), having a short rugged root stalk, from which depend many long, thin, interlaced roots; it has a penetrating, spicy odor, resembling valerian root, and a sharp, bitter taste. It is an exciting, volatile, and heating remedy, princi- pally used and beneficial in nervous diseases. The powder is admin- istered in doses of from ten to twenty grains, or as an infusion (from one quarter to half an ounce for four ounces of fluid), one table- spoonful every two hours. WALNUTS. This is the fruit of a tree indigenous to Persia; it is now cultivated in Germany, America, and in other countries. The young walnuts, in their green state, are used for the preparation of walnut extract. They are crushed in a mortar for that purpose, the juice squeezed out, strained and evaporated. In the apothecary shops may also be found walnut oil and dried walnut shells. This remedy is used for mucous obstruction of the intestines, worms, scrofulous diseases in connection with the glandular system. Walnut shells, like loxa, oak and willow bark (which see), are applied externally, as poultices or fomentations, on account of their acrid, astringent qualities, for flaccid, putrid, scrofulous, salt rheum, and herpetic ulcers. Inter- nally, a decoction is usually administered, from one-half to one ounce for eight ounces of fluid, reduced by boiling to five or six ounces; dose, a tablespoonful every two hours (particularly for worms) ; the extract is given in doses of from ten to thirty grains. Two drachms of the extract, dissolved in half an ounce of cinnamon water, may be administered to children from two to three years, beginning with twenty to thirty drops twice a day, subsequently three times a day, and also with a gradual increase of the dose. WARMBRUNNEN (WARM SPRINGS). This is a small place, enchantingly situated in a valley, at the foot of the Riesengebirge, and famous for its warm springs. The waters are beneficial for obstinate cutaneous diseases, gout, and rheumatism, obstructions in the abdomen, hemorrhoids, &c. 656 HOUSE DISPENSARY. WATER FENNEL. This plant is found in Germany in standing waters ; the seed of which alone is used as one of the best remedies in diseases of the respiratory organs, particularly in old cases of mucous catarrh and consumption. The seed is administered as a powder, in pills, or as an electuary, from ten to twenty grains and upwards several times a day, an infusion from one-half to one ounce for six ounces of fluid ; dose, a tablespoonful. WATER GERMANDER. This plant grows wild in Germany in wet meadows, ditches and swamps. It has a garlic-like flavor, and a bitter, acrid and spicy taste. In former times it was frequently used, particularly for malig- nant ulcers, putrid fevers, nervous fevers, and the pest; also for mucous obstruction of the stomach, worms, rheumatism, and gout. In modern times the remedy has been applied with advantage for catarrhs of long standing, accompanied by mucous obstruction of the intestinal canal. The infusion is used as a tea, which may also be used externally for fomentations of gangrenous ulcers, and for gargles in scurvy and putrid croup. The crushed, fresh leaves, mixed with salt and vinegar, are applied with beneficial results for putrid ulcers ; the same can be said of the powdered leaves for sprinkling on the ulcers. A simple and compound tincture can be found in the apothe- cary shops, which is administered in doses from thirty to sixty drops. WAX, GREEN, Consists of twelve parts of yellow wax, six parts of Burgundy resin, four parts of turpentine, and one part of verdigris. It is one of the best corn plasters. Another consists principally of verdigris, and is used as a corn- plaster. See the article " Verdigris." WAX, WHITE, Is used in surgery for the preparation of some salves and plasters. HOUSE DISPENSARY. 657 WHEY Is called milk from which the cheesy part has been separated, but which still contains its other component parts. From the substance that has caused the curdling of the milk, the whey is named ; thus there is alum whey, lemon whey, vinegar whey, mustard whey, cream of tartar whey, &c. Fresh milk is used for the preparation of the whey, from which, first of all, the cream has been skimmed ; it is then brought to a boil, and permitted to curdle ; it is then strained. Whey furnishes a cooling, diluent, thinning and laxative remedy, which is used as a beverage in various diseases. WHITE AGARIC Grows on the oak trees, which is prepared and powdered in the apothecary shops. Formerly it was used as a strong purgative, which has been properly abandoned. This fungus, however, has a good effect in the suppression of emaciating sweats in tedious diseases. For that purpose two grains of the powder are administered in a table- spoonful of water several evenings in succession. WHITE BRYORY ROOT. There are two kinds of this plant in Germany; they grow around fences and in the woods. They are distinguished by the color of their berries, the one bearing white and the other red berries. The root is very large and carrot-shaped. It has a milky juice, of acrid, bitter taste, having a disagreeable flavor. Taken internally, it causes violent purging and vomiting, with severe pains in the bowels; its use, therefore, requires great caution. Externally applied, in its fresh state, it causes redness, and also inflammation, and may be used in place of a mustard plaster. It was formerly particularly administered for dropsy and gout, often with great benefit. For watery swelling of the feet, crushed slices of the root are applied, when a large quantity of water is asually discharged. It was also applied in cases of semi-lateral headaches with benefit. The dried root is given several times a day, in doses of one grain, triturated with sugar. 42 658 HOUSE DISPENSARY. WILD CUCUMBER. A plant with a branchy stem ; it is also cultivated in our gardens, and bears a juicy pumpkin-like fruit, which, when ripe, drops from the flower stalk, and ejects juice as well as seed. Claterium is prepared from it, which in former times had a high repute for dropsy, and which is now but very rarely used as a violent purgative. WILD THYME Is an aromatic plant, the leaves of which are used as a stimulating, discutient remedy in swellings, lameness, and stiffness ; they are used as infusions, herb powders, baths, &c. Spirit of wild thyme is used for washes in inactive, cold ulcers, old local rheumatic pains, lame . ness, &c. WHITE-LEAD OINTMENT Consists of wax, white lead, and lard ; it can be found in the apothe- cary shops, and is applied in cases of slight inflammation and in- juries to the epidermis. WHITE-LEAD PLASTER Consists of litharge, white lead, and olive oil ; it can be obtained in the apothecary shops, and is used for light dressing. WILD PATIENCE ROOT. This plant grows in all parts of Europe, and was formerly used for cutaneous diseases, particularly for tetter, itch, &c. A decoction (f the root is principally used (one part for from twelve to twenty-four parts of water) as a wash and potion. WILLOW BARK. This is the bark of the well-known willow tree, which grows here in many places. Possessing astringent and invigorating qualities, it was formerly frequently used for intermittent fever. It is also bene- ficial for hemorrhages, in consequence of weakness of the womb, for blennorrhcea, particularly of the urinary and genital organs, diarrhoea of long standing, scrofula, and scurvy. Externally applied, it is a very good remedy for putrid, scorbutic, cancerous ulcers (used for bandaging, and as a poultice), and as a decoction for gargles, and HOUSE DISPENSARY. 659 for the fomentation of gangrenous croup ; also for baths in general weakness of the muscles. An extract may be found in the apothe- cary shops. The bark is usually administered internally in the shape of a decoction, from half an ounce to one ounce for one pound of water ; dose, a tablespoonful every hour ; the extract is usually given in the form of pills, from ten to thirty grains as a dose. WOOD LOUSE. This well-known insect was formerly frequently used in medicine as a diuretic and mucus solvent in dropsy, obstructions in the abdomen, jaundice, &c. A powder, electuary with honey, and tincture were prepared from it ; but now other effectual remedies are preferred to this disgusting remedy. WORM-MOSS. This is a mixture of a variety of small herbs., which grow on the rocks of the Mediterrenean sea. It was formerly used in Corsica as a popular remedy for maw- worms, but is now also used with great benefit in other countries for the same purpose Dose for children under seven years, from ten to thirty grains and upward , for adults, double the quantity ; it is usually administered in the form of a pow- der, and also as an electuary. An infusion and decoction may also be prepared from it. WORMWOOD. This plant is indigenous to the south of Europe, but is now raised everywhere in this country ; it has a very strong, spicy flavor, and a very bitter taste. Wormwood is used for iight intermittent fevers, weakness of the digestive organs, scrofula, rickets, chlorosis, scurvy, &c. Externally, it is used for herb cushions, as a diluent in watery swellings, and cold abscesses, and also as an injection for worms. The leaves are used for an infusion, half an ounce for six ounces of water or wine, or if the bitter part only is to be used, as a decoction. In the apothecary shops the extract may be obtained (dose, from ten to thirty grains), also the tincture (dose, from fifteen to thirty drops; and ethereal oil, which is usually taken a few drops on sugar. 660 HOUSE DISPENSARY. ZEDOARY. This plant is indigenous to the East Indies. The root, which has a strong, spicy, camphor-like odor, and an acrid, bitter taste, was formerly particularly administered for worms, weakness of the stomach, and malignant nervous fever. It is now used only as an ad- dition to some other remedies. ZINC. This remedy is not found entirely pure in its natural state, but combined with other substances. Several preparations of it are used for medicinal purposes : i. Oxide of zinc, flowers of zinc. — This preparation is principally used for diseases of children, and also for epilepsy, the result of worm diseases. It is also administered to adults for St. Vitus' dance, whooping-cough, and spasmodic cough. For external use, flowers of zinc is made mto a salve with fat, and applied to badly suppurating, gouty, and other ulcers. It is administered internally, in doses of from one-half to three grains. 2. White vitriol, or sulphate of oxide of zinc, is used particularly in nervous diseases, morbid excretions, hemorrhages, and blennor. rhcea, and also as a quickly operating emetic. Externally, the remedy is used for injections for chronic blennorrhcea, hemorrhages, the result of relaxation, and for several diseases of the eyes. Its pre- scription should be made by a physician. DIRECTIONS FOR THE COLLECTION, DRYING AND PREPARATION OF ZMLZEZDIOIlSr^JL, HERBS. FLOWERS. Flowers must be collected in fine, dry weather, and when fully ripe. They are to be spread out in thin layers, in a dry shady place ; dried and preserved in dark, well-made bags or vessels. SEED. Seed, after being fully ripe, must be dried in the shade, and be pre- served in a dry place. MEDICINAL PLANTS. Medicinal plants should be collected while in bloom, and carefully dried in the shade. They should not become too ripe, and ought to be collected any time before frost sets in. BARK. Bark is best stripped when the sap begins to ascend in the trees or shrubs ; it is then more easily peeled off. After separating from it the outer rough rind, the bark is cut in thin strips, and dried in a dry, airy and shady place. When fully dried, it should be preserved in a dry and appropriate place for use. ROOTS. Roots of annual plants must be collected in the fall, after the leaves of the plant have died ; the roots of biennials are collected in the spring before the sap ascends into the plant ; they should be (661) 662 HOUSE DISPENSARY. cleaned of all dirt ; if the roots are thick, they should be cut into smaller pieces, and dried and preserved as directed for bark. apple-pulp' poultices. The application of rotton apples to chilblains has often proved beneficial. In the same way, a pulp made of stewed apples and mixed with red wine, applied to hemorrhoidal tumors, has also proved beneficial. An application of the pulp of sour apples for the ameli- oration of pain in boils, is in high repute. CATAPLASM (POULTICE), Is the form of external medicinal remedies, having the consistency of pap or pulp, which may be accomplished by boiling the same, or otherwise. Most of them are applied as warm as possible, and taken off as soon as they begin to cool down, when they are replaced by others for the purpose of continuing the intended moist heat. As a foundation for these poultices are usually selected mucilaginous and faranacious substances, such as linseed, oatmeal, beanmeal, bran, bread crumbs, marshmallow root, malva flowers, &c, which are made into a pap with water, milk, wine, vinegar, or other fluids, and mixed with other necessary substances. If volatile substances are to be added to poultices, it should be done after the boiling of the pap. According to the substances from which the poultices are to be prepared and the effect aimed at, they are divided into emollient, for which purpose the above mentioned ingredients may be used (the herbs for an emollient poultice may be obtained in the apothecary shops); into stimulating, when stimulating substances, such as roasted onions, leaven, mustard, turpentine, &c, are added; in discutient, for which proper herbs may be obtained in the apothecary shops ; in- to antispasmodic and anodyne, when henbane or saffron may be added ; in antiseptic, by boiling oatmeal or bread crumbs, &c, with quinine, for eight ounces of the poultice one ounce quinine, to which one drachm of camphor is added, or yeast or grated carrot is used for that purpose. HOUSE DISPENSARY. 663 GRATED CARROT POULTICES. This poultice is prepared of grated carrots or yellow turnips ; press out the juice, and heat the pulp in a pan, stirring it to a pappy con- sistency. As a poultice, it is one of the most important remedies for scorbutic, putrid, cancerous, and other malignant ulcers. It is ap- plied warm, and is not removed for twelve hours, during which time it usually passes into fermentation, causing an abundant development of carbonic acid gas, which probably contains the curative power. The most violent pains are usually allayed by the application of this pulp, and the ulcers have an improved appearance. A SOOTHING POULTICE. Take rye flower six parts, elder blossoms four parts, henbane two parts. Boil in milk to a pap, and apply it to the aching part. It is very soothing as a poultice for children attacked by colic, and also for adults. HOP POULTICES. Boil a handful of hops for ten minutes in a pint of water, in a covered vessel, and press out the juice ; place this fluid again by the fire, thicken with rye flour, add two tablespoonsful of lard, and use for poulticing. BREAD POULTICES. Take crumbs of stale bread, pour boiling water over them, boil and stir until soft ; take from the fire, and add a little lard or olive oil to make it smooth. POTATO POULTICES. Take half a pound of unpeeled potatoes, boil them soft, and pour off the water, put this fluid on the fire again, and thicken with corn- meal ; add six tablespoonsful of cornmeal, and three tablespoonsful of rye flour, by dropping it gradually through your fingers into the fluid, which keep constantly stirred ; add two tablespoonsful of fat, and use for poulticing. SOOTHING POULTICE. Take linseed five ounces, hemlock leaves one and one-half ounces, henbane one ounce, boil in water to a pap of moderate density, add one o unce of oil of hemlock ; apply in a lukewarm state. 664 HOUSE DISPENSARY. YEAST AND LEAVEN POULTICES. Take one and one-half pounds of wheat flour, one pint of yeast or leaven, which is still better, add a sufficient quantity of vinegar, place on a moderate fire, and when it begins to boil, take it from the fire, and apply warm. MUSTARD POULTICE. Take three ounces of linseed meal, three ounces of pulverized mus- tard, two ounces of wheat flour, make into a thick mass, and to pre- vent its sticking, add a little lard. MALT POULTICES. Mix sufficient ground malt with boiling beer, to make a pap, which spread thickly on cloth, and pour over it a tablespoonful of good yeast. This poultice, which should be changed several times during twenty-four hours, is beneficial for scorbutic and putrid ulcers, which are much improved thereby, changing the discharging pus for the better. APPLE SALVE. Mutton tallow and yellow wax, equal parts of each, mixed with apple juice, and made into salve, is particularly used for chapped lips and milk-knots. ELECAMPANE SALVE. This salve is prepared by boiling until soft in half a pound of water, three ounces of peeled and cut -up elecampane root ; press through a hair sieve, and then mix the pulp with two ounces of lard, by con- tinually stirring it, until it assumes the condition of a salve. This salve is used as an innoxious remedy for the itch; it is very good for children. Rub the affected parts with it morning and evening, and after a few hours wash it off with soap and water. GUM AMMONIAC Is sometimes mixed with the juice of squill root, to a mass of suffi- cient consistency to be used for a plaster ; it is spread upon leather, and used as an excellent discutient remedy. HOUSE DISPENSARY. 665 LEAD SALVE. This salve consists of lead vinegar, wax, and lard, and is an excel- lent remedy for inflammation, light burns, &c. WHITE-LEAD PLASTER. This plaster consists of litharge, white lead, and olive oil ; it may be found in the apothecary shops, and is used for light dressing. WHITE-LEAD SALVE. This salve consists of yellow wax, white lead, and lard, may be found in the apothecary shops, and is applicable in light inflamma- tions and injuries of the epidermis. OINTMEMTS FOR BURNS. The following salves may be prepared at once by anyone, if neces- sary : Take equal parts of lime water and olive oil, shake until it sets in- to a salve, touch the burnt part with it, or spread on cloth, and apply at pleasure. Another : Take yellow wax one-quarter of an ounce, fresh linseed oil two ounces, melt them together, and stir until cold ; after it has become cold, stir in the yolk of an egg, and apply as above. Another : Take the white of two fresh eggs, whip them up with three ounces of olive oil, and spread it with a hair pencil on the burnt place. Another : Take Hufeland's ointment for burns, equal parts of fresh olive oil, the white of egg and cream, mix, spread thick on cloth, and renew frequently ; it is an excellent remedy for fresh burns. Another : Take fresh, washed, and unsalted butter, or olive oil, melt with an equal quantity of wax, stir until cold, then add half a drachm of powdered saffron; spread on a cloth, and apply it. 666 HOUSE DISPENSARY. Another : Take raw, grated potatoes, mix with linseed oil, and ap- ply to the burned part ; it should be frequently renewed. It is very cooling, and heals the wound rapidly. Another ; Take mutton tallow two ounces, linseed oil three ounces, rye flour a tablespoon ful, melt the mutton tallow and linseed oil to- gether, stir thoroughly until cold, then add the flour, spread on cloth, and apply it ; it must be renewed often. Another : Take one ounce prepared pulverized chalk, lard three ounces, mix well, and apply to the burn. This salve is an excellent remedy. TARTAR EMETIC PLASTER Consists of hemlock, spruce gum, and tartar emetic. It is applied in similar cases as the following remedy. TARTAR EMETIC SALVE, Authenriet's salve. This is prepared from two parts of finely pow- dered tartar, and three parts of lard. A quantity of the size of a hazel nut is rubbed in twice or three times a day, which will produce pustules, resembling small-pox, and for that reason the salve is also called small-pox salve. This salve is applied when a revulsion from a more vital part is desired. COLOPHONY. Powdered colophony is sprinkled on oakum, and moistened with spirits of camphor or spirits of wine. It is used for the dispersion of cold swellings, particularly of white swelling of the knee and lipoma ; it is a styptic, and is also used as an addition to stimulating and dis- cutient plasters. DIACHYLAC PLASTER. Of this plaster two kinds are prepared, the simple and double. The first is prepared by boiling litharge with oil ; it is particularly used as an adhesive plaster ; the latter contains several kinds of gums and turpentine. It is an efficient remedy to advance the ripening of abscesses, adenoit tumors, &c. HOUSE DISPENSARY. 667 DIGESTIVE SALVE. This salve consists mostly of turpentine, honey, and several resins. It is chiefly used for the purpose of generating matter in wounds and ulcers. COURT PLASTER. This plaster is prepared by stretching black or flesh-colored taffeta in a frame, covering one side of it twice or three times with a decoc- tion of isinglass, and the other side with tincture of benzoin, laid on with a brush. For one ounce of shred isinglass, sufficient water is usually taken to produce, after decoction and straining, about six ounces of fluid in all. Every application must be perfectly dried in a warm place, previous to the following application. It is not advis- able to mix tincture of benzoin or other stimulating substances, such as storax or balsam of Peru, with the isinglass, for the purpose of spreading it on one side of the taffeta, because it makes the plaster too stimulating. The plaster is used for the purpose of healing small cut wounds, and as an adhesive, for which purpose it is moistened on the glossy side with saliva, ROSIN. This rosin exudes from pine trees ; spread upon leather, it is used as a discutient for scrofulous glands and obstinate swellings ; it is also used as one of the ingredients of most other discutient plas- ters. GUM GALBANUM PLASTER. This plaster is prepared from equal parts of gum galbanum, litharge of silver, and plaster of sweet clover (inelilotus officinalis) ; frequently saffron is added to it. The plaster is stimulating, diluent, and mat- ter-generating. ANTARTHRITIC PAPER. This is a paper thinly covered with a resinous mass, containing principally pitch, which may be applied with benefit to parts attacked by gout and rheumatism. t)t>8 HOUSE DISPENSARY. CORN PLASTER. This plaster consists of twelve parts yellow wax, six parts burgundy pitch, four parts turpentine, and one part of verdigris. It is one of the best corn plasters. SULPHUR OINTMENT. Simple sulphur ointment consists of one part of sulphur and two parts lard. The compound ointment contains one part sulphur, one part powdered white vitriol, and four parts lard. Both of these ointments, but more particularly the latter, are used for itch. ANODYNE SALVE. After an application of mustard plaster, use the following : rose salve thirty grains, lead vinegar fifteen drops, spread upon a cloth, and apply. MARSHMALLOW SALVE. Take grey salve and marshmallow salve, six grains of each, spread on cloth. This salve is very good for chilblains and old sores, also for salt rheum and tetters. OPIATE SALVE. Take opium two grains, marshmallow salve thirty grains ; in case of severe pain, rub in a piece of the size of a hazel nut. ANODYNE PLASTER. Take henbane plaster one ounce, opium two grains, spread on leather, and apply it to the painful spot. A GOOD ANODYNE SALVE. Take balsam of nutmeg and rose balsam, fifteen grains of each, balsam-oily mixture four grains, simple tincture of opium one and one-half grains ; rub the painful spot with it twice a day. ANTISPASMODIC SALVE. Take ethereal camphorated salve one ounce, oil of cajeput and oil of balmmint, six decigrammes of each, tincture of opium four grains • rub in twice a day. HOUSE DISPENSARY. 669 ANODYNE PLASTER. Opium three grains, camphor eight grains, Burgundy pitch and compound lead plaster, equal parts of each, spread this mass on leather and apply to the painful place. SALVE FOR LAMENESS. Take human fat and crude petroleum, two ounces of each, and two ounces of camphor salve, mix well ; rub the lamed limb with it three times a day. SPLINTER SALVE. Molten pitch and white onion, one ounce of each, cut up or crush the onion, mix thoroughly, make into a plaster and apply it to the place where the splinter is. It removes the splinter quickly without any pain. SALVE FOR BURNS. Take four tablespoonsful of white flour, and boil it with water to a thick mass, take it from the fire, mix two ounces linseed oil and two ounces unsalted butter with it, spread on cloth and apply to the burn. A PLASTER FOR MALIGNANT ULCERS. Take two tablespoonsful of wheaten flour, the yolk and white of one egg, and one tablespoon ful of fat ; mix and stir for one hour, spread on cloth and apply ; it heals very quickly. SALVE FOR TETTERS AND SALT RHEUM. Take five ounces fresh, unsalted butter, one and one-half ounces red precipitate, one ounce oil of turpentine, and two ounces of cam- phor salve, mix well ; rub in once a day, and take internally a good purifying remedy. DISCUTIENT SALVE. Take bittersweet bark, linseed and mullein leaves, cut up fine, two ounces of each. Pour over it one quart brandy and let it infuse from four to six days ; add half a pound of lard and let it boil gently for one hour, strain and press, put it on the fire again and add one ounce of yellow wax and one ounce of mutton tallow and let it boil 670 HOUSE DISPENSARY. for six minutes more; take it from the fire, and stir until cold, and use as a plaster. This is a very good discutient for swellings and ulcers. A GOOD SALVE FOR SCALD-HEAD. Take one ounce of charcoal, one ounce of sulphur, half an ounce of white vitriol, and four ounces of unsalted butter, mix well. Be- fore using it, the hair must be cut short ; wash the head well with Venetian soap and warm water, and rub with the salve once a day. The head must be washed, as directed, previous to every application. CANCER SALVE. Take linseed three ounces, vervain, wood sorrel, and marygold flowers, two ounces of each ; boil with two quarts of water until reduced to one-half of the fluid, strain, and press well, put it again over the fire, add three ounces of venison tallow, and four ounces of lard, let it boil until the mass becomes suitable to spread upon cloth, take it from the fire, and stir until cold. Spread upon lint or linen, and apply three times a day to the cancerous place. Another: Take linseed meal two ounces, powdered myrrh one ounce, common white lily root three ounces, figs four ounces, black bean meal four ounces, boil with water ; then add six ounces lard, and let it boil a short time longer. Take it from the fire, and use it for a poultice. This poultice has acquired a high reputation for cancerous ulcers. Another : Take linseed two ounces, wormwood leaves two ounces, lettuce leaves four ounces, and carrots four ounces, boil with two quarts of water until reduced to one quart, strain, and press, so that one quart fluid remains. Place it on the fire again, and add half a pound of boiled, unsalted butter to it, let it boil fifteen minutes longer, and use for a poultice. It is good both for cancerous ulcers, and also for wounds. ANOTHER FOR CANCEROUS TUMORS, AND OTHER VIRULENT PUSTULES. Take crude wax four ounces, crude pitch one ounce, linseed oil three ounces, and half a pound of lard ; melt all of it together, take HOUSE DISPENSARY* 671 it from the fire, and stir until cold, spread thin on cloth, and apply twice or three times a day to the sore place. If the cancer has began to suppurate, or has become a wound, this remedy is no longer of any use ; those previously given are under such circumstances pre- ferable. A REMEDY FOR WARTS. The wart is treated with a compound of one part pulverized Spanish fly, and six parts nitric acid ; a small, pointed piece of wood is dipped in the preparation, and the wart touched with it. Another : Take finely powdered cayenne pepper and blood root, one ounce of each, salmiac one ounce, wax and mutton tallow, two ounces of each, mix thoroughly, and apply a plaster of it to the wart until it becomes dry and drops off. A fresh plaster may be ap- plied every day. Another : Take a piece of chalk and rub the warts with thoroughly for a week, every evening before going to bed. Those which have been rubbed with chalk, will disappear in a short time. A PLASTER FOR WHITLOW ON THE FINGER. As .soon as you perceive pain on the finger, apply a plaster of Spanish fly, of the size of one cent, to the spot, and let it remain there from five to six hours. At the expiration of that time the ulcer will be visible closely under the blister ; it may be lifted out by means of a needle or lancet. A GOOD SALVE FOR CARIES AND OTHER SORES. Wax one ounce, venison tallow three-quarters of an ounce, white rosin one ounce, white lead one-quarter of an ounce, washed litharge one and one-half ounces, olive oil four ounces, and half an ounce of saffron, powdered. The wax, resin and oil are boiled together several minutes, then the balance is added to it, and stirred until cold ; pre- serve for use ; apply a fresh plaster three times a day. The wound must be washed out with warm wine before the salve is applied. 672 HOUSE DISPENSARY. SALVE FOR A SWELLING. Take oil of turpentine and camphor salve, one ounce of each, oil of anis half an ounce, mix well ; rub the swelling with it three times a day. It disperses the swelling quickly. SALVE FOR SWELLING. Take oil of turpentine and camphor salve, one ounce of each, oil of anis half an ounce, mix well ; embrocate the swelling with it twice or three times a day. It disperses the swelling quickly. SALVE FOR AN ULCER, WHICH DOES NOT WANT TO BREAK. Take honey and saffron, one ounce of each, rye flour two ounces, and the yolk of one egg. Mix thoroughly, and apply as a salve to the ulcer. It is a very good plaster. Another: Take honey, white onions, and white bread, one ounce of each, boil the whole of it in milk, and apply. Another : Take soap, honey, and lard, two ounces of each, mix well, and apply as a plaster. Another : Take linseed meal, black bean meal, one ounce of each, one white onion, ground mustard half an ounce, boil the whole in water, and apply. A GOOD PLASTER FOR AN OPEN WOUND. Take wax and resin, one ounce of each, unsalted butter two ounces, linseed oil and mutton tallow, one ounce of each, put in a pot and let it boil, add three tablespoonsful of red wine, and keep it on the fire ten minutes longer, remove it from the fire, and stir until cold ; spread upon linen, and place on the open wound ; renew the applica- tion three times a day. A GOOD SALVE FOR CHAPPED HANDS. Take rue and carrots, two ounces of each, olive oil two ounces, mutton tallow two ounces, wax one ounce ; boil together for a salve, and rub the hands with it. HOUSE DISPENSARY. 673 A GOOD SALVE FOR GOUT, RHEUMATISM, AND OTHER PAINS. Take masterwort, common houseleek and centaury minor, two ounces of each, wormwood and henbane, one ounce of each ; boil the whole of it in wine, strain, press, and place again on the fire, and evaporate until reduced to one quart of fluid ; then add beef marrow and bear's fat, three ounces of each, let it boil a little longer, remove it from the fire, and rub in three times a day. AN APPROVED REMEDY FOR THE CURE OF CANCER AND WHITLOW. Take sassafras and marygold flowers, two ounces of each, boil in one quart of beer (cover the pot well, so that the vapor does not escape) ; take four tablespoonsful three times a day. Wash the wound well with the same tea, sprinkle powdered bone-ashes on the wound ; renew this three times a day. * Before sprinkling the powder, the wound must be well washed. A GOOD REMEDY FOR LYMPHATIC HUMOR (SYNOVIA). Take leaven one quarter of a pound, powdered laurel leaves two ounces, wormwood leaves two ounces, boil in one quart of good wine vinegar until it becomes a thick mass, spread on a cloth, apply it to the place, and renew the application every three hours. REMEDY FOR PROUD FLESH. Take white wax one and one-half ounces, resin and olive oil, two ounces of each, lard three ounces, melt together, take it from the fire, add half an ounce copperas, spread on cloth, and apply to the affected part ; it will eat away the proud flesh. REMEDY FOR THORACIC TUMOR, HEART TUMOR, AND ABDOMINAL SWELLING. Take hemp seed, celandine leaves, mullein leaves, burdock root, and marshmallow root, four ounces of each, boil in three quarts of beer until reduced to one quart, take it off the fire, strain, stir in four 43 614 HOUSE DISPENSARY. tablespoonsful of rye flour, and two tablespoonsful of fat, let it boil for one minute more, spread it hot on a cloth, and apply warm. TO DRIVE AWAY AN EXCRESCENCE. Take marshmallow salve one and a half ounces, zillo one and a half ounces, oil of white lily one and a half ounces, lard one and a half ounces, juniper berries and pine oil, one ounce of each, crude pitch one ounce, melt it together, and stir until it is turned into a salve. spread on a cloth, and apply to the excrescence. STOMACH PLASTER. Take molten wax and resin, one ounce of each, ground cloves and nutmeg, half an ounce of each, turpentine and wormwood oil, half an ounce of each, let it boil for ten minutes, stir it up well, let it get cold, spread on cloth, and place it on the stomach. It is a very good stomach plaster. GOOD BLACK PLASTER. Take olive oil half a pound, litharge of silver a quarter of a pound, good rose vinegar a quarter of a pound, put the whole of it in an iron pan, place it on the fire, let it boil, stirring constantly, until it has turned black, empty it into cold well water, and leave it there until cold ; then take it out, put it on a stone, give it any form you please, or press it in a form, when it is ready for use. It has to be spread on cloth, and applied twice a day. This is a very good plaster, and is used for many injuries. A SUPERIOR CORN PLASTER. Take one ounce of gum ammoniac, yellow wax one ounce, dissolve them together, add three grains of verdigris, and one grain lemon juice, and mix well, spread on cloth, and place it on the corns. FOR CHAPPED LIPS AND HANDS. Take equal parts of almond oil, white wax, and spermaceti, melt together, pour in forms, and anoint the chapped lips and hands with it frequently. HOUSE DISPENSARY. 675 Another : Preparation of red lip salve : take oil of almonds one and one-half ounces, white wax one ounce, spermaceti one drachm, melt together in a pan, add to the molten mass a piece of alkanet root, for the purpose of coloring it, strain, add oil of lemon and ber- gamot, twelve drops of each, and pour the mass in paper capsules. Rub the lips and hands with it twice a day. GRAPE POMADE FOR CHAPPED LIPS AND HANDS. Take grape juice and rose water one ounce of each, fresh unsalted butter one ounce, yellow wax 'one-quarter of an ounce ; melt the whole of it together. It operates very mildly and cooling, and is also very good for small burns. SALVE FOR HEMORRHOIDS. Take lard four ounces, opium two grains, plaster of henbane one ounce, mix together thoroughly, spread on leather, and apply. NERVINE SALVE. Bear's fat, 2 ounces. Polecat fat, - - - 2 " Venison fat, 1 ounce. Laurel oil, - - - - }4 " Camphor salve, 2 ounces. Juniper oil, - - - - 1 ounce. Melt the whole of it together, and after it is cold, mix half an ounce tincture of myrrh with it, stir well until cold ; rub the wasting limb with it twice a day. FOR A SORE BREAST. Extract of juniper, - Distilled glori, White wax, Mutton tallow, Lard, Precipitate, Honey, 2 ounces. 2 " 3 " 2 Vz ounce. 676 HOUSE DISPENSARY. Melt the whole of these ingredients into a salve, stir until cold, spread on cloth, and apply once a day to the breast. A GOOD VESICATORY. Turpentine, - - - - i^ ounces. Yellow wax, - - - 3 " Linseed oil, - - - - 3 " Fig tree resin, - - - i*^ " Spanish fly powder, - - - 2 " " Melt these ingredients together, keep stirring the mass during the time it is melting, spread on fine leather, and apply as a vesicatory. A PLASTER FOR A SORE BREAST. Resin, 1 ounce. White wax, - - - 1 " Linseed oil, 2 ounces. Syrup of squills, - - - 2 " Oil of wormwood, 1 ounce. Unsalted butter, - - - 4 ounces. Saffron, ----■}£ ounce. Venison tallow, - - - 2 ounces. The whole of these ingredients are put in a pot, and boiled for one- quarter of an hour, taken from the fire, stirred until cold, and used as a plaster. A GOOD BLACK SALVE. Oil of turpentine, 1 ounce. Honey, Saltpetre, - - Copperas, ------- Gunpowder, - Soot, ----- Red wine, - - - - 2 ounces. Beef suet, - - - 3 " Lard, - - - -' - 8 " Put the whole of these ingredients in a pot over a moderate fire, boil slowly, to prevent its boiling over, and keep stirring it well. HOUSE DISPENSARY. 677 After having boiled for a quarter of an hour, remove it from the fire, stir until cold, spread upon cloth, and apply three times a day to the injured place. This salve is very good and healing for every kind of sore. SALVE FOR OPEN SORES. Lard, - 2 ounces. The white and yolk of an egg, White sugar, 1 ounce. Nettle juice, - - • 1 " Oil of anis, 1 drachm. Common houseleek juice, - - 1 ounce. Mutton tallow, - 2 ounces. The mutton tallow, lard and sugar, are put on the fire, together and boiled for a short time; taken from the fire, the other ingredients are added before the mixture has become entirely cold (the egg and other material must be well mixed together, before adding it to the lard, tallow and sugar). It is then spread upon cloth and applied to the sore four or five times a day. It is good for all open sores, and heals very rapidly. ANOTHER GOOD VULNERARY SALVE. Wine vinegar, 2 quarts. Honey, - - - - -" 1 pint. Common houseleek leaves, 3 ounces. Powdered myrrh, - - - }4 ounce. Dragon's blood, - - - % " Oil of turpentine, - - y 2 " Mutton tallow, - - - 1 " Dog's fat, - - - 4 ounces. Put the whole of it in a pot, boil, stirring constantly until it has become a thick mass, let it cool, spread on linen, and apply twice or three times a day. 678 HOUSE DISPENSARY. Another: Bear's fat, 2 ounces. Petroleum, - - - - 1 ounce. Beef marrow, 3 ounces. Linseed oil, - - - T / 2 ounce. Olive oil, - - - - 1 " Venison tallow, - - - 2 ounces. Burnt bone, powdered, - - 1^ ounces. Powdered white chalk, - - 1^ " The whole is put on the fire for melting, and then stirred until cold. It is a good salve for wounds, new or old sores, caries and wounds of that kind ; it is spread on cloth and applied. A GOOD SALVE FOR WASTING LIMBS. Oil of turpentine, - \y 2 ounces. Pine oil, white, _ 2 a Oil of white lilies, . i# 11 Oil of wormwood, . 2 (< Oil of anis, - % a Dog's fat, - 3 a Man's fat, - 2 11 Camphor salve, - 2 ti These ingredients are mixed together, stirred for one hour and rubbed warm on the wasting limb three times a day. Another : Whisky, - 2 ounces. Venison marrow, - 2 ' Fox tallow, . 2 ' Juniper oil, - *X • Earthworm oil, - 2 ' Laurel oil, - & ' Formic oil, - 1 ' Mix and stir thoroughly for half an hour, and rub in y T arm twice a day. HOUSE DISPENSARY. 679 GOOD GREEN SALVE. Unsalted butter, - - - 2 ounces. Pal moil, - - - - 1 ounce. Lard, ----- 3 ounces. Rose honey, - - - 1 ounce. Verdigris, - - - - X A " Mutton tallow, - - - -2 ounces. White wax, - - - • 2 " The wax and mutton tallow are put together on the fire and melted, taken off, and when cooled down somewhat, the other ingredients are mixed up with it, well stirred, and used as a salve. GOOD VULNERARY SALVE. Yellow wax, 1 ounce. Resin of firs, - - - 1 " Mutton tallow, - - - 1 " Oil of turpentine, - - - 1% ounces. Beef's marrow, 1 ounce. Olive oil, - - - - 1 " Red bole, - - - - 1 " Powdered crab's eyes, - - J4 " These ingredients, except the turpentine, are put together in a pot, and melted over a fire ; the pot is then taken from the fire, and the turpentine added ; the mass is then stirred until cold, spread upon cloth, and used as a plaster. A GOOD HERB SALVE. Centaury minor, 1 ounce. Figwort leaves and flowers, - - 2 ounces. Marygold flowers and leaves, - - 2 " Catnip leaves, - - - 1 ounce. Stramonium leaves, 2 ounces. Put the whole of it in a vessel, pour over it two quarts of wine, let it infuse four days, then place it on the fire, and let it boil down to one-half; take it from the fire, strain, and press, so as to leave one quart fluid ; place the fluid again on the fire, and add four ounces of 680 HOUSE DISPENSARY. yellow wax, two ounces of resin of fir, and four ounces of lard ; let it boil until it has the consistency of an ointment, when it is taken from the fire, and used as a salve. It is used for all kinds of sores. GOOD EYE SALVE. Take red precipitate of mercury twenty centigrammes, fresh un- salted butter one ounce, vinegar of lead and saffron-opium tincture, four decigrammes of each, embrocate the eye with a piece of the size of a lentil, morning and evening. OPODELDOC. This liniment is prepared from camphor, soap, spirits of wine, and various ethereal oils ; the composition of it is somewhat complicated, and it is best to buy it in the apothecary shops. It is used for embro- cation in cases of rheumatism, gout, lameness, contusion, cold swell- ings, chilblains, &c. NERVINE LINIMENT. Take three ounces of olive oil, one ounce of hartshorn, oil of wormwood one ounce, tincture of cayenne pepper and pine oil, one ounce of each, cod liver oil four ounces ; mix well, and fill in bottles. It is a good nervine remedy, and is very useful for violent pain, rheu- matism, headache, cramps, lameness, gout, toothache, and all sorts of toothache ; to be rubbed in three times a day. Another: Take oil of lavender one ounce, oil of mace one ounce, oil of henbane one ounce; olive oil two ounces, spirit of sal-am- moniac one ounce, laudanum half an ounce. This is one of the best nervine remedies, and, as stated above, is beneficial in violent pain, lameness, gout, rheumatism, cramps, headache, catarrh, &c. To be rubbed in twice a day. A GOOD LINIMENT FOR SEVERE PAINS OF ANY KIND Take spirits of camphor one ounce, spirits of sal-ammoniac one ounce, spirits of hartshorn one ounce, laudanum one ounce, cod liver oil four ounces, mix well. This is a good liniment for severe pain of any kind ; rub in twice or three times before a warm stove. HOUSE DISPENSARY. 681 INDIAN LINIMENT. Tincture of iodine three drachms, spirits of sal-ammoniac three ounces, oil of turpentine one ounce, spirits of camphor three ounces, olive oil three ounces, formic oil and earthworm oil, two ounces of each, laudanum half an ounce ; mix, and preserve in well-corked bottles. It is beneficial for severe pain, sprains, and swellings, rheu- matism, cramps, gout, &c. DISCUTIENT LINIMENT. Take oil of turpentine one ounce, hartshorn oil one ounce, tincture of myrrh half an ounce, olive oil two ounces, oil of lavender one ounce, mix ; rub in twice or three times a day. It disperses hard swellings, intumescences, and gatherings. It is also good for pain in the hips, back, and loins, &c. It is particularly recommended for swelling of the knee, cold and hot swellings, sore throat, and in- flamed breasts. LINIMENT FOR DISEASES OF THE JOINT. Take spirits of camphor half an ounce, linseed, amber oil, half an ounce of each, oil of wormwood, oil of anis, half an ounce of each, oil of earthworm one ounce, laudanum half an ounce, olive oil two ounces, mix or shake up well, and rub in well twice a day. It is one of the best liniments for diseases of the joints. EMBROCATIONS FOR RHEUMATISM. Take tincture of Spanish fly one ounce, caustic spirits of sal-am- moniac one-half ounce, spirits of wild thyme half an ounce, olive oil two ounces ; mix, and rub in once or twice a day. Another liniment : Take spirits of camphor, angelica spirits, caustic spirits of sal-ammaniac, formic spirits and brandy, one ounce of each, mix and shake up well ; to be rubbed in twice a day. It is a very good liniment for severe pains. Another : Take turpentine and oil of camphor, one ounce of each, oil of rosemary half an ounce, tincture of Spanish fly one ounce, olive oil two ounces, mix, and rub it in well. It is a good liniment for gout, rheumatism, St. Vitus' dance, &c. 6H2 HOUSE DISPENSARY. Another : Take spirits of camphor one ounce, spirits of hartshorn one ounce, spirits of sal-ammoniac, formic spirits, one ounce of each, mix well, and rub in twice a day. It is a very good liniment, allays pain, and disperses the swelling in the feet and arms; it is equally good for stiffness in the joints. DIURETIC LINIMENT. Take brandy two ounces, oil of white lily one ounce, oil of juniper two ounces, oil of spearmint one ounce, mix well, and rub back and abdomen twice a day. LINIMENT FOR SPASM OF THE STOMACH. Take formic spirit two ounces, oil of camomile one ounce, worm- wood oil one ounce, put in a bottle, and use for embrocation. LINIMENT FOR RHEUMATISM. Take juniper spirits one ounce, opodeldoc, and oil of lavender, one ounce of each, mix well, and rub the painful place with it twice a day. It cures rheumatism, toothache, stitches in the side, &c. Another : Take spirits of sal-ammoniac half an ounce, Hoffmann's anodyne and oil of sassafras, half an ounce of each, sweet oil of almonds and earthworm oil, one ounce of each, tincture of Spanish pepper half an ounce, mix together, shake up well, and rub the pain- ful places with it. LINIMENT FOR LAMENESS. Take formic spirits, spirits of rosemary, Hoffmann's balsam of life, and spirits of sal-ammoniac, two ounces of each, rub the lame limbs twice a day with it. FOR CUTANEOUS ERUPTIONS OF EVERY KIND. Take four drachms of ipecac wine, flowers of sulphur two ounces, tincture of cardamon one ounce ; dose, a teaspoonful in a glass of water three times a day. HOUSE DISPENSARY. 683 A GOOD SALVE FOR CONTUSIONS. Take powdered crude alum half an ounce, white of egg half an ounce, olive oil one ounce, stir for one hour until it assumes the consistency of a salve, spread on linen, and tie up the injured parts with it. It should be renewed as it becomes dry, and the contusion will soon be cured. A GOOD SALVE FOR SALT RHEUM. Take litharge one ounce, olive oil three ounces, yellow wax one and a half ounces, Armenian bole one ounce, melt the wax in the olive oil, then add, before it cools off entirely, the other ingredients, and keep stirring for half an hour ; anoint the affected parts with it. FOR CORNS. Take soap one ounce, oak leaves one ounce, nut-blossoms one ounce, garlic one ounce, and one lemon, boil the whole in a pint of water, until reduced to half a pint, take it from the fire, pour off the liquid, press, so that the expressed fluid measures half a pint. Put it again on the fire, add to it linseed oil and wax, one ounce of each, and boil until it becomes a thick mass, when it is removed from the fire, and stirred until cold ; apply a plaster to the corn morning and evening ; the plaster should cover the whole toe. Between the sixth and ninth day the corn may be extracted with the root without the least pain ; it is not likely that another corn will appear again in the same place. FOR ITCH, SALT RHEUM, AND TETTER. Take flowers of sulphur and lard, two ounces of each, pulverized white hellebore and salt of tartar, two drachms of each, lemon oil twenty drops, mix well, and embrocate the affected part twice a day. Another : Take refined sulphur four drachms, lard two ounces, sul- phuric acid two ounces, mix, and embrocate twice a day. POMADE FOR SORE NIPPLES. Take unsalted and unwashed sweet butter one ounce, yellow wax half an ounce, venison tallow, white brandy, half an ounce of each, 684 HOUSE DISPENSARY. rosewater one ounce, inspissate by boiling, and keep stirring ; then take it from the fire, stir until cold, anoint the nipples, or spread on linen, and lay it over the nipples. It is a good, innocent remedy for children, if they suck off any of it. Another : Have the following mixture prepared in the apothecary shop : Peruvian balsam and gum arabic, one ounce of each, rose- water two ounces. This makes a good salve, and heals splendidly, particularly if the nipple has become sore from the sucking of the child. It does not affect the child if in nursing it gets some of the mixture in the mouth. PAIN-KILLING PLASTER. Take one pound of olive oil, boil hard in an earthen pot, until it assumes a brownish color, and smokes considerable. When cooled down somewhat, add, stirring constantly, half a pound of the best pulverized red oxide of lead, and let it boil until it assumes a brown or blackish color ; it is then taken from the fire, and after a quarter of an hour, and without placing it on the fire again, powdered amber and powdered myrrh, one-half ounce of each, is added ; it is then well stirred, and the plaster put in wooden or tin boxes. It is a good healing plaster for old suppurating wounds, fistulae, chilblains," cancer, whitlow, &c. GOOD ANODYNE SALVE. Take the white of two eggs, put in a large bottle, shake for half an hour, then add to it oil of wormwood, laudanum, and alcohol, one ounce of each, and linseed oil one and a half ounces, shake for half an hour longer, and preserve for use. FOR BURNS OR SCALDS. Take oil of peppermint, and spread it on the injured spot with the feathery end of a quill ; it relieves the pain quickly, and the wound soon heals, leaving no scar. This oil, which is very inexpensive, should always be kept on hand. Until the oil is applied, the burnt part of the limb may be kept under water to lessen the pain. It is still better to mix the oil of peppermint with glycerine ; the mixture is applied in the same way. HOUSE DISPENSARY. 685 FOR BURNS. Touch the wound with bi-carbonate of soda. Another: Syrup of squill, or freshly expressed juice of squill, ap- plied to the burn, allays the pain, and heals quickly. Soap and a little salt, or lime water, or freshly grated carrots, or raw scraped otatoes, applied to the burn, are very cooling.' BED SORES. Precaution : a cleanly, smooth, elastic bed, frequent change of position, frequent washing of the parts of the body exposed to pres- sure with water, vinegar and water, brandy, lead water, and spirits of camphor. If inflammation shows itself in a place, it must be washed with lead water, creosote water, pyrolygneous acid, or place under it cotton, or an oiled, partly inflated bladder, or an air-cushion. Ul- cerated places are painted with collodion, and covered with a white lead plaster, or they are bandaged with dry salves. LOCKJAW. The wound should be smoked with burning wool, or with a burn- ing woolen rag. Smoking it for twenty minutes will relieve the worst wounds from pain ; repeated smoking will also cause the inflammation to disappear. ARM-BATH. An arm-bath is one of the best antispastics for toothache, spasms in the chest, croup, inflammation of the throat, &c. Hot water is used for that purpose; various ingredients, such as are used for foot- baths, may be added to the bath, which should be as hot as it can be borne. The arms are inserted in it. ASH-BATH. This bath is prepared from unexhausted, sifted, warm wood ashes ; it is used dry, and in a warm state, for the purpose of reviving suffo- cated, drowned, frozen, and other apparently dead persons. A sheet is covered to the depth of several inches with ashes, the body is placed upon it, and covered, with the exception of the face, with 686 HOUSE DISPENSARY. warm ashes to the depth of several inches. If required, the body is left in this ash-bath for several hours. ALEXIS BATH. These springs are situated in a romantic part of the lower Harz mountains, in the valley of the Selke, Anhalt-Bernburg. The bath is particularly beneficial for diseases resulting from weakness and flac- cidity of the muscles and nervous system, hemorrhages, old diseases or dissipation. It is therefore particularly useful for sexual impotence in man, blennorrhea, female sterility, inclination to miscarriages, &c. ANT-BATH. This is a very effective remedy for weakness, lameness, rheumatic and gouty difficulties. There are two kinds of this bath, the dry and the wet. The wet bath consists in crushing a quantity of ants and their eggs, pouring boiling water on them, and using it for a bath ; or in crushing the ants with or without their eggs, putting the mass in a bag, pouring boiling water on it, squeezing the bag well and using the fluidfor a bath. For a general bath, from three to four gallons of ants are used, and for a local bath from one to two gallons. The dry bath is used in various ways : i. A piece of linen or a whole shirt, after being saturated with oil of anis, is buried in an ant hill ; it is then worn next to the skin. This is an excellent remedy for suppressed gout. 2. Cut out an ant hill and cover the affected part with the earth ; or the affected limb may be placed in the ant hill. The first favor- able symptoms are itching and reddening of the skin, and subsequently its scaling. BATHS. Baths are divided into whole baths, partial baths, half, or general baths, according to the circumstance, whether only a part or the whole body is subjected to the bath. They are distinguished accord- ing to the substance used, as earth-baths, sand-baths, herb-baths, air- baths, mineral baths, ash-baths, &c, and according to temperature in cold, lukewarm, and hot. Tney are further divided in' dry and wet baths, in medicinal baths, and such as are taken for pleasure, or HOUSE DISPENSARY. 68 1 where no certain medicinal object is in view. I will only speak here of the latter, as to the former they are discussed under the different heads. To the baths in question belong the cold, lukewarm, and warm baths. The cold bath has its effect first on the epidermis, whence it spreads quickly. The vessels of the epidermis contract spasmodically, and the blood and juices flow into the interior. As soon as this effect passes off, a reaction takes place in a healthy per- son ; the vessels of the epidermis again expand, and the bulk of the juices return to it. On this is principally based the effects of a cold bath. But where the organism does not posses sufficient vigor to pro- duce this healthy reaction, the cold bath can only be injurious. It is only injurious to persons who suffer from congestion of the head or chest ; lukewarm and warm baths are much better adapted for them. These aid particularly the insufficient activity of the skin, and cause a uniform activity of the nerves and vessels. For that reason they are to be used where a deficiency of the named functions prevails. Warm baths are particularly beneficial to little children, nervous women inclined to spasms, and to people who have suffered for a long time from rheumatism and gout, and also in protracted cutaneous diseases. Certain rules must be observed for taking cold as well as warm baths : do not remain too long in the water, and leave it as soon as a certain discomfort is experienced. Never take a bath immediatly after a meal, but either previous to it or at least several hours after it. If a co'd bath is taken, one in the open air is preferable, either during the morning or in the afternoon, in order to avoid the noon heat which has an in- jurious effect. Never enter the bath unless you are well rested and cooled off. First wash your head, chest and arms, and then dive, not excepting the head, for the purpose of producing a uniform tempera- ture over the whole body. While in the water, move about or swim rapidly, and leave it, as before stated, as soon as you feel a certain discomfort. BATHS FOR BEAUTIFYING THE SKIN. i. Take three ounces of Cologne water, two ounces of orange blossom water, eight ounces of rose water, half an ounce of tincture of benzoin and three quarters of an ounce of Hoffman's life balsam, 688 HOUSE DISPENSARY. mix, add one ounce of finely triturated Spanish soap, two ounces of white spiced almond bran, half an ounce of carbonate of potash ; place the whole of it' in a warm water-bath. 2. Take three ounces of Cologne water, three-quarters of an ounce of tincture of benzoin, three-eighths of an ounce of Hoffmann's balsam of life, two ounces white, spiced almond bran, one ounce pul- verized Spanish soap, previously dissolved in six ounces of rose water. 3. Take two ounces spiced spirits of soap, half an ounce of Hoff- mann's balsam of life, and twenty drops of ethereal oil of sweet flag. Strengthening aro?natic bath : To six ounces of distilled water add two ounces Cologne water, two ounces of spiced almond bran, and one quarter of an ounce of ethereal oil of sweet flag. Bath for improving the skin : Six ounces of powdered white bole, one-quarter of an ounce of caustic potassa, half a drachm of oil of lavender. All these ingredients are placed together in a water-bath. WATERING PLACES. The springs of Baden-Baden : The water is used for drinking, as well as for bathing purposes, particularly for gout, lameness, cuta : neous diseases, obstructions of the abdomen, hemorrhoids, irregularity of menstruations, &c. The country surrounding the place is very beautiful. In Austria, several miles from Vienna. The springs possess about the same qualities as those of Aachen (which see). They are bene- ficial in cases of metal poisoning, lameness, gout, protracted rheu- matism, derangements of the female sexual functions, ulcers, cuta- neous diseases, &c. SPONGES. The sponge is the habitation of various animal-plants, and contains several very effective substances used for medicinal purposes, such as iodine, sulphur, phosphate, and carbonate of lime, &c. Besides its well-known quality for bathing purposes, it is used in surgery as press- sponge saturated with molten wax, and pounded out, or tightly wound HOUSE DISPENSARY. 689 with a cord, and dried in that state. The cord is then taken off and used in medicine (burnt and pulverized) as one of the most effectual remedies for goitre. When used, the greatest caution should be ob- served, because it readily affects the stomach and digestive powers. Aside of that, if incautiously applied, it has an injurious effect on the breast of the women and testicles of men. Burnt sponge may be obtained in the apothecary shops, or it may be prepared in the follow- ing manner : the sponge, not having undergone as yet the process of purification, is torn in small pieces, the dust beaten out, then roasted in a coffee roaster until it assumes a blackish-brown color, pulverized, and carefully preserved in a well-stoppered bottle. From ten to twenty grains of this are administered daily, in the shape of powder, in connection with anis and sugar ; or one ounce of the roasted sponge is boiled in one pound of water, infused for twelve hours, filtered, and one ounce of cinnamon or peppermint water added to it; dose, a tablespoonful every three hours. BERINGER SPRINGS. This watering place is pleasantly situated in the neighborhood of Quedlinburg, and is particularly beneficial in stagnation of the abdomen, cutaneous diseases, and blennorrhea. . STEAM-BATHS. They consist in a direct influence of steam evolved from water, or various medicinal substances on the whole surface of the body, arranged in [rooms for that purpose, or in bathing closets, &c, or directed to particular parts of the body by a peculiar apparatus. The ordinary steam bath is particularly administered in cases where the activity of the membrane needs thorough stimulation, and where a local deposit of morbid matter on the surface of the body and the limbs is to be dispersed, and particularly in protracted rheumatism and gout, and also in obstinate cutaneous affections, and herpetic diseases. An inclination to congestions, and the presence of feverish conditions, are a bar to steam-baths. A simple steam or sweat-bath may be prepared at home, by pour- ing some spirits of wine in a small bowl, igniting it, and placing it 44 690 HOUSE DISPENSARY. under a cane-seat chair. The person sits down undressed on the chair, throws large woolen blankets around himself, and outside of the chair, and awaits the breaking out of the perspiration. To prevent being burnt by the chair, which will become heated, a cushion should be placed on the chair. After the perspiration has broken out freely, retire to a warmed bed, and if nescessary, drink some elder blossom tea. DOUCHE-BATH. This consists in the application of a more or less heavy stream of water, directed with some force to any diseased part of the body. The required stream of water is brought down from a considerable height by a pipe, or a peculiarly constructed hand-engine is used for that purpose. The stream must be brought down gradually, and not by squirts. This vigorous remedy is particularly used for protracted and obstinate nervous diseases of every kind, lameness, spasms, epilepsy, St. Vitus' dance, lingering and rooted rheumatism, and gout. For the last mentioned diseases, it is best to use warm water. FOOT-BATHS. By a warm foot-bath the blood is collected in the feet, the vital strength of the skin is increased, and its sensibility excited. Medical science makes use of this for the purpose of drawing the flow of the juices from attacked or surcharged organs, particularly from head and chest (in cases of headache, toothache, earache, pain in the chest, &c); the feet must be carefully dried, which should be done by somebody - else, as from bending over a part of the good effect is lost, and retire to bed. The effect of the foot-bath may be increased by adding a few handsful of salt, or a handful of ground mustard, or a few pounds of wood-ashes. KARLSBAD. This place, situated in a romantic part of Bohemia, near the Saxon frontier, is famous for its hot springs. The water is laxative and diluent, particularly for glandular formations. It is therefore bene- ficial in chronic obstructions of the intestinal canal, protracted vom- iting, acidity of the stomach, heartburn, jaundice, diseases of the liver and spleen, scrofula, gout, and diseases of the urinary organs, HOUSE DISPENSARY. 691 particularly the stone ; further, in cutaneous diseases, diseases of the female sexual organs, hysterics and melancholy, and nervous diseases generally. KISSINGER This watering place is situated about five or six miles from Wiirtz- burg (Bavaria) ; it is famous for its springs. The water is used in cases of relaxation of the abdomen, flatulence, hemorrhoids, derange- ment of menstruation, the whites, and other cases of blennorrhcea, gout, dysuria, cutaneous diseases, swelling of the glands, &c. HERB-BATHS. They are prepared from the infusion and decoction of various . aromatic or astringent substances : peppermint, balmmint, lemon balm, marjoram, thyme, lavender, camomile, elder, wormwood, fen- nel, wild thyme, sweet flag root, willow, oak, elm, chestnut, and loxa bark. Usually from one-half to two pounds of the mentioned vegetable substances are taken for a bath, to which is added, according to circumstances, wine, whisky, spirits of wine, spirits of camphor, &c. From the aromatic substances an infusion is prepared, and from the astringent substances a decoction, which are added to the bath. MALT-BATH. It is prepared by boiling for some time from four to six pounds of malt, which is added to the bath. It is used for weakness, particularly in children. MARIENBAD. This pleasant watering place is in Bavaria, in the neighborhood of Karlsbad and Eger ; its springs contain various minerals. Particularly famous is the Kreuzbrunnen (similar fo the Karlsbad water), which is drank ; the Marienbrunnen, which is used for bathing only ; the Fer- dinandsbrunnen, the waters of which are taken internally only; the Carolinen or Neubrunnen ; the Amboliusbrunnen or Aeolbrunnen. The various springs are used for the greatest variety of diseases, and are therefore used by patients in the most varied way. 692 HOUSE DISPENSARY. SCHLANGENBAD. This watering place is situated in a lonely valley of the duchy of Nassau. Its springs are hot, and principally used and very beneficial for convulsive diseases, hysterics, hypochondria, rheumatism, and gout, obstructions of menstruation, &c. SITZ-BATH. This is an arrangement which permits the bathing of the genitals, the anus, and the surrounding parts. A bath of this kind, prepared from varied substances, is beneficial in various maladies of the named parts. PLUNGE-BATH Is" called the bath when water is poured over the head and body of the patient, from a greater or lesser elevation, according to the effect to be produced. The plunge-bath is a very vigorous remedy in various diseases, particularly in inflammation of the brain, insanity, and diseases of the mind generally. ANIMAL-BATH. This is called the introduction of diseased parts of the body into the bodies of freshly-killed animals, or into the still warm entrails. These baths are excellent remedies for stiffness, gouty and rheumatic lameness, and other contractions. WIESBADEN. This watering place is located in the neighborhood of Mayence, and is the capital of the duchy of Nassau. It has become famous for its mineral springs, its splendid accommodations, and the fine country around it. The warm springs are excellent for obstinate gout, lame- ness, scrofulous swellings, chronic cutaneous diseases, and ulcers, mucous obstructions of the intestinal canal, obstructions of the abdo- men, hemorrhoids, &c. PURGATIVES, LAXATIVES. Purgatives act by inciting the stomach and intestinal canal to greater activity, and causing the excretory vessels of the intestinal canal to HOUSE DISPENSARY. 693 effuse a larger quantity of fluid, whereby the contents of the alimen- tary canal are attenuated. It must not be supposed, however, that these juices are bad, nor must laxatives be taken without necessity. Laxatives are generally used for costiveness, after overloading the stomach, for headaches, when caused by costiveness, after having swallowed injurious substances, which can no longer be voided by taking emetics, for children when suffering from worms and scabs, and also for teething. Purgatives should not be taken for pain in the stomach or bowels, or by weak and debilitated persons, during great heat, for digestive derangements, and particularly not by pregnant women. Purgatives must not be administered for too long a time. The following rules should be observed in taking purgatives : after taking a purgative, drink warm, attenuating, mucilaginous potions, such as oatmeal and barley gruel, a decoction of prunes, thin decoc- tions of rice, or very thin, sweetened coffee ; all these will aid in the operation of the medicine. A laxative should never be taken imme- diately after a meal ; 'after its operation has ceased, little and only light food should be taken at first, as both the stomach and intestinal canal are in a weakened condition. Senna leaves : Take from one-half to one ounce of senna leaves, pour half a pint of boiling water over them, cover them up, and let them infuse at least for half an hour, strain the fluid through a cloth. Senna leaves must not be boiled, because the resinous parts contained in the leaves would pass over into the potion and cause severe stomachache. To this infusion from half an ounce to one ounce of epsom salt and one ounce of ordinary syrup may be added. For children, one ounce of manna may be dissolved in the strained senna infusion, in place of the epsom salt and syrup. Of this preparation, an adult may take a teaspoon ful every hour, and children a teaspoon- ful, until it takes proper effect. Another: Epsom or Glauber salt is dissolved, in proportion of about one ounce to four glasses of warm water ; of this take half a cupful every hour, until it produces the desired result. Two ounces of epsom salt may be dissolved in a bottle of water, of which half a tumblerful is taken in the morning before breakfast ; it greatly pro- motes the stool. The use of salts must not be continued too long, 694 HOUSE DISPENSARY. as it results in flatulence and in the weakening of the intestinal canal. A very mildly operating, and at the same time not disagreeable tasting laxative, consists of six grains of calomel and one scruple of loaf sugar, made into a powder and divided into three parts. One of these powders is taken at night before going to bed, the second the next morning, and if in one or two hours after taking the second powder no movement occurs, take one-half of the third powder, and subsequently the rest. Half of the above prescribed quantity is sufficient for children from six to twelve years of age. Weak coffee may be drank after it, but everything of an acid nature must be avoided. Another : For children, take watery tincture of rhubarb, or syrup of rhubarb. The so-called Vienna potion may be found ready pre- pared in the apothecary shops. All these remedies are given every hour one teaspoonful. Another: Senna leaves from one-half to one drachm \ pour over them a teacupful of a hot decoction of dried prunes, put it in a warm place for half an hour, strain, and take the whole of it in one dose. LAXATIVE COFFEE. Take senna leaves from one-half to two drachms, pour a sufficient quantity of cold water over them in the evening, and let them infuse all night, strain on the following morning, and prepare your coffee with the strained liquid. We may here also mention jalap, castor and croton oil (which see). Another : Take compound tincture of aloes two grains, extract of wild cucumber one grain, extract of jalap fifteen grains, mix, and take as a purgative from one-half to two teaspoonsful a day. Another: Herbs for St. Germain tea. Take senna leaves (without stems) four ounces, macerate in strong alcohol for twenty-four hours and then dry them, but not in a warm place ; add elder blossoms two ounces, fennel and anis, two ounces of each, cream of tartar twenty- five grains, mix thoroughly. Two ounces of this tea are infused in five cups of boiling water and kept in a warm place, without letting them come to a boil ; the supernatent liquid is then poured off clear ; HOUSE DISPENSARY. 695 if the stomach is weak, drink half a cupful of it with the addition of a small quantity of Malaga wine. This tea may always be successfully used without any injury whatever. GOLDEN BLOOD -PURIFIER. Chicory root, i ounce. Wormwood, - Century minor, - Sassafras, - - - - - Rhubarb, - Manna, - Fennel, - Anis, - - - - y 2 Lemon peel, - Elecampane root, - - - - Juniper berries, - Sloe blossoms, .... Sage, ----- Sarsaparilla root and bark, - 1}^ ounces. Dandelion, i cunce. Myrrh, Castor - - - - - Licorice root, - Jalap, ----- Colomel, - - - - - Common scurvy, - Lobelia leaves, - The dried herbs must all be cut up small or triturated ; the whole of them are then put in a strong jug, and two quarts of the best whisky added to them ; let it infuse in a warm place for three weeks (shaking it up well every day); at the expiration of the three weeks, strain through a cloth and fill in bottles for use. Dose, from a teaspoonful to three tablespoonsful a day. This medicine is the best blood purifier ; it is beneficial for irregular digestion, loss of appetite and all disorders of the stomach and keeps the bowels regular. It is good for head- 696 HOUSE DISPENSARY. ache of every kind, humors, rheumatism, consumption, lung and heart diseases, liver and kidney diseases, hysterics, salt rheum, tetter, can- cer, toothache, colds and catarrhal cough, hemorrhoids, &c. ounce. A. VERY GOOD BLOOD PURIFYING SYRUP Licorice, .- - - Senna leaves, -.._-•_ Manna, - Fennel seed, Star anisseed, - Club moss, - Valerian root, - Bibernell root, -.•--- Rhubarb, - Cut the roots in small pieces, boil the whole of it in one gallon of water until reduced to one quart of fluid ; strain, and press, put it again on the fire, and add two pounds of sugar to the quart of fluid, let it boil for a short time longer, take it from the fire, let it cool, and fill in bottles. This syrup is a good purifying remedy, particu- larly for children and pregnant women ; it is an easy laxative. Dose for children, from one-half to three teaspoonsful ; for adults, from one to three tablespoonsful. It is beneficial for fevers con- nected with inflammation, for blennorrhea, &c. BLOOD-PURIFYING SYRUP. Bittersweet, i ounce. Burdock root, - - • - Gum guaiac, Licorice, -'---- Aloes, powdered, - Sassafras, -..'.- Cut the whole of it up small, mix, and boil in one gallon of water until reduced to one quart of fluid, press, and strain carefully ; place the fluid again on the fire, add one and a half pounds of sugar, let it boil until the sugar is dissolved, take it from the fire, let it cool off, HOUSE DISPENSARY. ()9T fill in bottles, and preserve for use. It is a good blood-purifying syrup, and is particularly beneficial for cutaneous diseases, gout, and rheumatism, scrofula, lung catarrh, &c. Dose for children, from half to three teaspoonsful, and for adults, from one to three table- spoonsful. Another : Marshmallow root, 3 ounces. Manna, - - - - 1 ounce. Myrrh, - - - European turnip (arum maculatum), Rhubarb, - Elecampane root, ... Licorice, - Lemon peel, Anisseed, - Caraway, ----- Fennel seed, - All the roots are cut up fine, mixed, and placed in a pot, to which one and one-half gallons of water are added, and infused for twenty- four hours, then put on the fire, and boiled down to one-half, taken from the fire, pressed, and strained, and again placed on the fire until reduced to one- half ; one pint of honey and half a pound of sugar are added, and boiled down to the consistency of syrup, taken from the fire, cooled, and filled in bottles for use. Dose for children, from one -half to three teaspoonsful ; for adults, from one to three table- spoonsful. This blood-purifier is particularly beneficial in diseases of the respiratory organs, chronic mucus catarrh, consumption, vertebral diseases, hip diseases, liver diseases, and inflammation of the kidneys and bladder. It is taken for all abdominal and cutaneous diseases, cough, lung diseases, &c. Another : Angelica root, Valerian root, Wild caraway, Tamarinds, Juniper berries, 2 ounces. 2 1 ounce. 1 1 " 69S HOUSE DISPENSARY. Hops, - - - - y 2 ounce. Jalap powder, - - - i " Manna, - - - - - i " Mullein flowers and leaves, - - 2 ounces. Cut up fine, place in a pot, pour one gallon of water over it, put on the fiie, and boil until the liquid is reduced to three pints, take it from the fire, press, and strain. The fluid thus obtained is again put on the fire, and two pounds of white sugar and one ounce of marsh- mallow juice is added to it; let it boil for fifteen minutes, and then bottle it. Dose for children, from one-half to three teaspoonful, and for adults, from one to four tablespoonsful. This blood-purifier is good for all diseases of the chest, lung diseases, liver and heart dis- eases, throat diseases, cough, &c. BLOOD-PURIFYING TEA. Soapwort, burdock root, and gum guaiac, equal parts of each, sassa- fras and licorice, one part, cut fine, mix, and boil for a tea (not in- fused). This potion must be continued for some time; it is very beneficial, particularly for cutaneous eruptions, gout, and rheuma tism. Another: Polypody root, bibernell root, rest harrow root, bear's wort, fox grape root, sassafras bark, walnuts, and manna, three ounces of each, anisseed one ounce, common agrimony two ounces, mother- wort and licorice root, two ounces of each, put the whole in a vessel, infuse with three quarts of water over night, then place on the stove, but not in a place where it will boil, let it remain there for six hours, add one pint of spirits of wine and one pound of white sugar, let it remain four hours longer on the stove (but not boil), strain, and take three tablespoonsful four times a day. EMETICS. In the use of emetics great care should be observed, for where they are not useful, they are invariably detrimental. They may be- come necessary when pernicious substances are to be removed from the stomach ; but in such cases they must be applied within four or eight hours after the substance has been taken in the stomach ; they HOUSE DISPENSARY. 699 are also used in case of overloading the stomach with too much or indigestible food, which the stomach cannot master. This condition is usually indicated by a yellow-coated tongue, a bitter taste, nausea, and even voluntary vomiting. Emetics are beneficial in various other diseased conditions, such as croup, and in certain cutaneous dis- eases. Emetics must not be administered during pregnancy, in ruptures, plethora, inclination for congestions to chest or head, spasms of the stomach, &c. It is best to take emetics before breakfast ; only in cases where vomiting is exhausting to the person, a little thin, but not fat, soup may be eaten. An emetic adapted for most cases con- sists of four grains tartar emetic, dissolved in two ounces of distilled water ; to an adult one-half of this solution is administered, and if it remains without effect at the expiration of half an hour, a tablespoon- ful in addition thereto may be given every half hour. Children from six to twelve years take the above solution, a tablespoonful at a time, until it operates. Another : Ipecac ten grains, tartar emetic two grains, white sugar one scruple ; adults must take the whole dose in water at once. For children under three years of age, these emetics are not well adapted ; syrup of squills, a teacupful at a time, is more suitable for them. The administering of the following preparation is, however, frequently very judicious : ipecac eighteen grains, syrup of elecampane two ounces, well shaken up ; dose, a teaspoonful at a time until it operates. In cases of poisoning (which see), when immediate vomiting becomes a necessity, the following is administered : sulphate of copper from eight to ten grains, or sulphate of zinc, in doses from three to eight grains and upward, dissolved in water, of which a teaspoonful is taken every five minutes. • If some substance has lodged in the throat, which is to be removed by an emetic, give an injection, consisting of one pound of water, in which one scruple of tartar emetic is dissolved ; or three grains of tartar emetic, dissolved in one ounce of distilled water, may be in- jected in a blood vessel ; this operation, however, can only be per- formed by a physician. After vomiting, abstain from eating for some time, and then only light food should be taken. Mechai ical irritation of the gullet (for 700 HOUSE DISPENSARY. instance tickling with the feathered part of a quill, the insertion of a finger or of a tallow candle in the throat), will also produce vomit- ing. EMETIC WINE, WINE OF ANTIMONY. This is a solution of tartar emetic in Malaga wine, which is admin istered as an emetic to children and debilitated people, a teaspoonful at a time ; as a sudorific, it is administered in elder blossom tea, in doses of from two to twenty drops. IPECAC ROOT. This root, imported from Brazil, furnishes an efficient medicinal remedy. It creates nausea, vomiting, dizziness, &c, is constipating, if administered in small doses, and for that reason it is prescribed for dysentery and diarrhoea ; administered in doses of from two to six grains to children, and from ten to twenty grains to adults, it causes vomiting; it is* particularly applied for that purpose. REMEDY FOR A WEAK STOMACH. Take one ounce of cut-up gentian root, one ounce of orange peel, and half an ounce of white pepper ; infuse in one quart of wine for one week, filter, and take from one to two teaspoonsful every day. AN EXCELLENT STOMACHIC. Take bayberry bark and cayenne pepper, half an ounce of each, cloves half an ounce, castor two ounces, cinnamon one ounce, calisaya bark two ounces, nutmeg one ounce, gentian root one ounce, orange peel one ounce ; the whole to be cut up fine, put in a bottle, and in- fused in one quart of wine, and kept in a moderately warm place for four weeks ; shake up thoroughly every day, and filter through filter- ing paper, and bottle for use. Dose for children, from three to ten drops, and for adults from twenty to sixty drops. It is a good remedy for cholera, summer complaint in children, dysentery {dysenteric/, rubra and dysenteria alba), &c. HOUSE DISPENSARY. 101 SUMMER COMPLAINT IN CHILDREN. Take valerian tincture fifteen grains, saffron containing opium three grains, oil of peppermint two grains ; dose for children, from five to ten drops every hour. To adults, administer in severe cases of diarrhoea fram twenty to thirty drops. It is advisable to keep remedies of that kind always in the house, so as to be accessible in case of necessity; if connected with severe pains in the bowels, poultices should be applied. Take linseed meal and rye meal, two ounces of each, boil in sweet milk, then add one ounce of wormwood oil, and apply the poultice warm. REMEDY FOR WEAK STOMACH. Take green oranges and calisaya bark, three ounces of each, worm- wood half an ounce, hip-fruit two ounces, cut up small, put in a bot- tle, and add one quart of strong, good whisky ; let it infuse two or three weeks, strain, and bottle ; dose, a tablespoonful twice or three times a day. It is a very good tonic for a weak stomach. SPASM OF THE STOMACH. Take powdered calisaya bark one ounce, cascaril one ounce, pow- dered valerian one ounce, caraway one ounce ; put the whole of it in a bottle, and add one quart of brandy ; let it infuse in the sun, or near a stove for four weeks, pour off, strain, and bottle for use. It is administered as required, when the stomach is attacked by spasms. Dose, from a teaspoonful to a tablespoonful. Another: Take valerian root, peppermint and camomile flowers, two ounces of each. Cut up fine, mix, and boil for tea. When attacked by spasm, drink from half a cup to a cupful, warm. REMEDY FOR CANKERED MOUTH. Cankered sore mouth, from neglect of the gums, or from some other cause, is treated by taking spirits of common scurvy one part, common scurvy water two parts, mix well, and rinse the mouth with it; chew sweet flag root afterward. ?02 HOUSE DISPENSARY. For Children : Juice of common houseleek one ounce, rose honey, one ounce, mix well, cleanse and wash the mouth with it until healed. Another : Take well-burnt charcoal (if possible, the coal should be prepared from maple wood), powder the charcoal and rub the teeth with it frequently. Another : Take violet root, sweet flag root and low mallow leaves, boil in wine, strain, and rinse the mouth with it three or four times a day. Washing the mouth with borax is also beneficial. Wrap a small piece of linen around the index finger, dip it in powdered borax, and rub the cankered parts of the mouth with it thoroughly three or four times a day. Another: Take strawberry water, lemon water, and rib -grass water ; the mouth is thoroughly cleaned with these waters ; then mix well one ounce charcoal with one ounce rose of honey, anoint the gums and mouth with it. This has to be done three times a day, until the cure is complete. GARGLE FOR CANKERED MOUTH. Take sage, juniper berries, and common scurvy, one ounce of each, cut fine and put it in a pot, add two quarts of water, boil until re- duced to one-half, take it from the ^fire, strain, and gargle with it three or four times a day. Another : Take blackberry root, veivain, common houseleek, and meadow sage, two ounces of each ; cut up fine, put in a pot and boil with two quarts of water until reduced to one quart, take it from the fire, strain, and gargle with it three or four times a day. TO REMOVE APHTHA IN SMALL CHILDREN. Take rose honey, one and a half ounces, powdered borax a quarter of an ounce, dissolve in the rose honey, and apply to the mouth with a hair pencil five or six times a day. It is also very good to apply it to the nipples of the mother's breasts. If the aphthae should extend far down the throat, administer to the child several times a day as much of carbonate of magnesia as will lie on the point of a knife ; it would be beneficial to mix the carbonate of magnesia with a tea- spoonful of marshmallow or noble yarrow tea. HOUSE DISPENSARY. 703 A GOOD TOOTH-POWDER. Take precipitated chalk one ounce, powdered sweet flag root a quarter of an ounce, powdered orris root one drachm ; mix thoroughly, and use for a tooth-powder. A GOOD REMEDY FOR SNAKE-BITE. Take spirits of hartshorn half an ounce, lemon juice and anis oil, one ounce of each, pour it on the wound. CANCER REMEDY. Dissolve half an ounce carbolic acid in a quart of water. It takes off the putrid smell, and cures external cancer. If the inner parts are not affected, saturate lint or a piece of linen in the dissolved car- bolic acid, and apply it to the cancer. The solution may be made stronger or weaker. The application is frequently renewed. REMEDY FOR OBSTINATE COUGHS AND COLDS. Take syrup of hops and syrup of malt, one ounce of each, tincture of myrrh one ounce, licorice two ounces, radish juice half an ounce, boil the whole of these ingredients together for ten minutes, take from the fire, and bottle ; dose, a tablespoonful every two hours ; dose for children, a teaspoonful every two hours. Another : Take syrup one ounce, castor oil two teaspoonsful, and spirits of camphor, mix, and administer a tablespoonful every two hours ; dose for children, a teaspoonful every three hours. Another : Take hyssop leaves one ounce, figs two ounces, sage one ounce, licorice root two ounces, boil the whole in one quart of water for a quarter of an hour, take it from the fire, and sweeten with honey. Dose, every two hours a tablespoonful; dose for children, a teaspoonful every three hours. It is an excellent remedy for a cough, catarrh, and sore throat. Another : Take marshmallow root and speedwell, two ounces of each, Iceland moss three ounces, cut-up licorice root and star anis- seed, half an ounce of each, boil in three pints of water until reduced 704 HOUSE DISPENSARY. to one-half, and dissolve it in two ounces of brown rock candy. Dose, half a cupful three times a day; dose for children, a table- spoonful every three hours. Another : Take marshmallow root, speedwell, and coltsfoot, two ounces of each, licorice root two ounces, elder blossoms half an ounce ; of this take a tablespoonful (cut fine) to one pint of water, and drink that quantity every day ; to children, administer it a table- spoonful at a time. REMEDY FOR CATARRHAL COUGH. Take speedwell two ounces, ground ivy leaves two ounces, water fennel two ounces, mullein flowers two ounces. Take a heaped table- spoonful for three cups of water ; , dose, half a teacupful of tea three times a day. It may be sweetened with licorice or rock candy. To children, administer from four to five tablespoonsful a day. Another: Take onions two ounces, licorice three ounces, two lemons, marshmallow root three ounces, brown rock candy four ounces, honey four ounces ; boil the onions, licorice, lemons, and marshmallow in three pints of water, until reduced to one quart, take it from the fire, decant, add the candy and the honey, and let it boil for ten minutes longer, let it cool off, and bottle for use. Dose for adults, two tablespoonsful three times a day, and for children, from a teaspoonful to three tablespoonsful a day. FOR A DRY COUGH. Take lemon juice one ounce, powdered gum arabic half an ounce, dissolve in the lemon juice, paragoric two drachms, cod liver oil one ounce, boil the whole of it together, take it from the fire, add two ounces of rock candy, let it cool, put in a glass, and preserve for use. Dose, from three to four teaspoonsful a day. COUGH SYRUR Take marshmallow root, speedwell, elecampane root, ginseng root, and marygold leaves, three ounces each, cut up fine, put in a suitable vessel, infuse in two quarts of whisky for two weeks, then add one HOUSE DISPENSARY. 705 gallon of water, and let it evaporate slowly over a fire for fourteen hours, until reduced to two quarts (but not boil) ; press well, strain through a cloth, add one and a half pints of purified honey, three ounces of essence of an is, and four ounces tincture of myrrh, mix well, and preserve for use. Dose, a tablespoonful three or four times a day. It is one of the best syrups for coughs, thoracic complaints, phthisis, croupy cough, and all other kinds of coughs. COUGH TINCTURE. Take tincture of juniper berries, tincture of marygold root, syrup of tolu balsam, tincture of rhubarb, two ounces of each, licorice root extract four ounces ; mix. Dose, a teaspoonful three or four times a day. It is one of the best cough tinctures, and may also be adminis- tered to children. Dose for children under one year, from five to ten drops twice or three times a day ; for larger children, from twenty to fifty drops four times a day. COUGH SYRUP. Squill root vinegar and rose vinegar, half a pint of each, honey one pint, tincture of blood root two ounces, tincture of lobelia one ounce, mix well, heat it lightly, take it from the fire, cool, and bottle for use. Dose, from one to two teaspoonsful as often as required. It is a good cough syrup, particularly in lung catarrhs, and similar pectoral affections. REMEDY FOR HOARSENESS. European turnip and horseradish, six ounces of each, sage and horehound, three ounces of each, cut fine or chopped, cover with one quart of raspberry vinegar, infuse for twenty-four hours, and add one pint of honey, let it boil for fifteen minutes, take it from the fire, press, and strain, and bottle when cold. Dose, from one to three teaspoonsful a day. This is a very good remedy for hoarseness, difficulty in speaking, and for ordinary coughs. REMEDY FOR CONSUMPTION. Speedwell and horehound, powdered, three ounces of each, lobelia herb two ounces, marshmallow root and milfoil leaves, six ounces of each, marygold leaves one ounce, star anisseed two ounces, licorice 45 706 HOUSE DJSPENSARY. root six ounces, caraway one ounce, cut up or pulverize, put in a proper vessel, infuse for ten or fourteen days in one quart of strong spirits of wine, strain, press, filter, and add one pint of honey, bottle for use. Dose, from one to three teaspoonsful a day. This is one of the best remedies for consumption, pulmonary diseases, coughs, &c. A POWDER FOR ASTHMA. Powdered rhubarb half an ounce, powdered crab's eyes one ounce, sulphur one and a half ounces, cream of tartar one ounce, anis seed and powdered fennel seed half an ounce, well mixed. Dose, from a half to one teaspoonful in a tablespoonful of honey or syrup before going to bed, and, if necessary, the same dose may be taken in the morning. It is an excellent powder for asthma. COUGH REMEDY. Speedwell, coltsfoot and flaxseed, two ounces of each, cut up fine, boil as a tea, taking three cups of water for one tablespoonful of the ingredients, boil down to two cupsful ; sweeten with honey and take one cupful warm, morning and evening. To small children it is administered a tablespoonful at a time. FEVER REMEDY. Columbo root, rhubarb and peppermint, one ounce each, put in one pint of water, add one pint of whisky, and infuse for three or four weeks, pour off and bottle. Dose in case of fever, two table- spoonsful four or five times a day. PILLS FOR THE AGUE. Take powdered rhubarb and quinine, one ounce of each, cayenne pepper half an ounce, gum arabic three grains, gentian two grains- mix, and make into thirty pills. Dose, one pill every hour or two. PILLS FOR FEVER HEAT AND CHILLS. Take aloes two ounces, gum gamboge one ounce, quinine half an ounce, squill root one-quarter of an ounce, opium half an ounce, water maudlin sufficient to make into a mass for pills; make into HOUSE DISPENSARY. 707 thirty pills, and administer one every hour during the time of the fever. Another: Take tartaric acid one ounce, saltpetre half an ounce, powdered rhubarb two ounces, powdered myrrh half an ounce, gen- tian sufficient to work into a mass for pills ; make into pills of one grain each ; dose, one pill every hour. GOOD DILUENT PILLS. Take powdered rhubarb, medicinal soap, gum ammoniac, ten grains of each, make into pills of one decigramme each, and take from three to four a day. They are very good diluent and laxative pills, and very good for the liver and gall, &c. REMEDY FOR WARTS. Take a small piece of sal-ammoniac, wet it, and rub the wart with it two or three times a day for two or three weeks ; the warts disap- pear without any pain, and leave no mark. TREATMENT OF SPLINTERS IN THE FLESH. If a splinter has entered the skin, causing pain and swelling, it must be dug out at once with a needle or other pointed instrument. If the swelling is too great, so that this cannot be done, poultices must be applied at once, consisting of wheaten bread, linseed meal, and milk. The swelling will soon go down, so that the splinter may be removed, when the wound will quickly heal. When pieces of glass have been forced into the flesh, the same course is to be pur- sued. INGROWN NAILS. The nails should always be cut straight with the toes ; the edges should project beyond the flesh, ingrown nails will thereby be pre- vented, and a painful operation avoided. On the fingers the nails are trimmed off round, but on the toe this is very injurious, because the pressure of the shoe forces the nail to grow into the flesh. 108 HOUSE DISPENSARY. REMEDY FOR TOOTHACHE. Infuse two ounces of finely powdered Spanish camomile roots with sixteen ounces of spirits of lavender, and half a drachm of sal-am- moniac, keep it in a warm place for one week, filter, and use it on cotton, placed into, or applied to, the painful tooth. REMEDY FOR SOUR ERUCTATIONS During digestion : fluid caustic ammonia, from six to eight drops, balmmint water half an ounce, distilled water five ounces ; to be taken in one or two doses. REMEDY FOR DIPHTHERIA. Take white sugar three ounces, pulverized alum one ounce, mix well, and administer according to the danger threatening the patient, a teaspoonful at intervals of from fifteen minutes to one hour. Alum is said to possess the quality of removing rapidly from the throat of the patient the false membrane which has formed, and thus curing the disease. Another : Take a teaspoonful of sulphur, put in a glass of water, stir well with your finger in place of a spoon, while the sulphur is be- ing mixed with the water. When the sulphur is well mixed, use it for a gargle, and the patient is out of danger in from ten to fifteen minutes. The sulphur kills every kind of fungus ; it is well if the patient is able to swallow the gargle instead of spitting it out, as it will do no injury. In extraordinary cases, when the inflammation has progressed so far as to prevent the patient from gargling, the sul phur may be blown into the throat by means of a quill, and as soon as the inflamed membrane has contracted, the patient may use the gargle. If the patient cannot gargle, take a live coal, sprinkle a little sulphur on it, and let him inhale the vapor. It is one of the best remedies for diphtheria, and has been attended with wonderful results in most cases, even when the patient was on the point of choking. Wherever I have applied these remedies, the patients were all saved. HOUSE DISPENSARY. 709 REMEDY FOR SCALD HEAD. Take carbonate of ammonia one ounce, spirit of rosemary four ounces, and one pint of elder flower water ; mix thoroughly, and wash the head with it twice a day. LIVER PILLS. Take extract of aloes and jalap resin, two grains of each, gum gamboge two grains, make into a mass with extract of May apple, and form one hundred pills of it ; dose, from two to three puis. As a laxative, from four to five pills must be taken. INDIAN BLOOD-PURIFYING PILLS. Take medicinal soap ten grains, powdered rhubarb fourteen grains, watery extract of aloes six grains, extract of anis six grains, make with dandelion into one-decigramme pills. If necessary, from two to four pills a day may be taken. PILLS FOR DYSENTERY. Take rhubarb twenty grains, powdered opium ten grains, anis ex- tract ten grains, leptandra twenty grains, form into forty pills with gum arabic ; dose, one pill twice or three times a day. REMEDY FOR PALPITATION OF THE HEART, AND CORDIAL. Take chicory root half a pound, blackberries half a pound, nut- meg, cassia, and cloves, one ounce of each, polypody a quarter of a pound, put in a suitable vessel, add two quarts of water, and infuse for two days, place on the fire, and boil down to one quart, remove from the fire, press, and strain through a cloth, add one pound of white sugar, let it boil for a short time longer, cool, add one pint of good brandy to it, and bottle. Dose, from four to five tablespoonsful a day, according to strength and age ; to children, give from one-half to four teaspoonsful daily. This medicine is a good remedy for nervous persons j it strengthens the nerves, heart and lungs, and is beneficial for protracted diarrhoea 710 HOUSE DISPENSARY. or dysentery, summer complaints, and all kinds of abdominal dis- eases. It has proved a most useful remedy. FOR SPASMS IN THE CHEST, AND ASTHMA. Take golden sulphuret two drachms, May apple root two grains, licorice one ounce, gum ammoniac one ounce, mix into a pill mass, and make into pills of one drachm each ; dose, from two to four pills a day. Another: Take wine vinegar one pint, juniper berries half an ounce, white onions two ounces, the whole to be pounded fine, placed in a suitable vessel, put on the fire, and boiled in the wine vinegar for ten minutes ; let the steam be inhaled, strain one-half of it through a cloth; dose, one teaspoonful every hour. FOR RICKETS. Take spirits of wine six ounces, olive oil six ounces, mullein flowers two ounces, earthworms one pound, put the whole of it in a bottle, and expose it to the heat of the sun, or to a warm stove, let it infuse for fourteen days, strain, and bottle for use. Rub the limbs of the child with it morning and evening. FOR SPASM OF THE STOMACH. Take oil of caraway half an ounce, arrack half an ounce, or cherry spirits half an ounce, mix, and take from ten to twenty drops during the spasm. REMEDY FOR BAD BREATH. Take chloride of lime two drachms, dissolve in six ounces of water, clear, strain and dissolve in one ounce of water, strain and mix with one ounce of rose honey; gargle and wash the mouth with it twice or three times a day. It is a very good gargle for bad breath from the throat and mouth. CURE FOR THE AGUE OR INTERMITTENT FEVER. Take calisaya bark one ounce, laurel leaves one ounce, pulverize ; dose, a small tablespoonful in a glass of water. The powder has a HOUSE DISPENSARY. Til very high reputation, and it is claimed that it cures the most obstinate cases of intermittent fever. A GOOD SYRUP FOR INTERMITTENT FEVER. Take hops half an ounce, calisaya bark one ounce, laural leaves one ounce, juniper berries half an ounce, elder blossoms and linden blossoms two ounces of each ; this is put together in a suitable vessel and boiled with two quarts of water ; let it boil until reduced to one quart, take from the fire, strain carefully through a cloth, add two pounds of white sugar, one drachm of camphor and half a pint of spirits of wine, let it boil for a short time longer, take it from the fire, bottle, and preserve for use. Dose, three tablespoonsful a day. This syrup is one of the best remedies for every kind of intermittent fever, and also for yellow fever. FOR INFLAMMATION OF THE EAR. Take linseed one ounce, juniper berries one ounce, elder blossoms and carrots, all crushed fine, boil in water and apply. It relieves the severest pain in a short time. Another : Take elder blossoms, mullein flowers, and Roman cam- omile flowers, boil either in water or vinegar, let the steam enter the ear by means of a funnel; small bags filled with camomile, elder blossoms and linden blossoms, may also be applied. REMEDY FOR LUMBAGO. Take mullein flowers and celery root, four ounces of each, boil for twenty minutes in two pints of port wine, remove from the fire, strain, and press ; dose, a tablespoonful three times a day. FOR RHEUM OR RHEUMATISM IN THE ARM OR FOOT. Take cherry bark, juniper wood, oak bark, thistle and celery roots, equal parts of each, boil in water and let the steam strike the arm or foot or any other part that may be affected ; repeat often, it is a tried remedy. 712 HOUSE DISPENSARY. FOR SWELLING OF ARMS OR LEGS. Take hartshorn, camphor, and spirits of sal-ammoniac, two ounces of each ; the swollen limbs are rubbed with it twice a day. FOR INFLAMMATION OF THE EYES. Take rose water one ounce, powdered alum one grain, the white of one egg, put the whole of it in a bottle, shake up well, take a small piece of linen and poultice the eyes with the mixture ; or take one drachm of alum, boil in a cup of milk, and use it as a poultice for the eyes. Another: Take figs one ounce, alum a quarter of an ounce, boil in two cups of milk until reduced to one cup, and poultice the eyes with it. Another : Take common houseleek half an ounce, boil for five minutes in a cup of milk, and apply as a poultice to the eyes. Another : Take the inside part of carrots and the inside part of raw potatoes equal parts, and crush into a smooth mass, place between two layers of linen, and apply to the inflamed eye ; let it remain tei minutes, and repeat until the inflammation is removed. EXCELLENT EYE-WATER. Take sugar of lead one ounce, rose water five ounces, and two drachms of brandy, mix ; moisten the edges of the eyelids with it twice or three times a day. STRENGTHENING EYE-WATER. Take eyebright leaves one ounce, anisseed, fennel and rosemary leaves, one drachm of each, cut up fine, put in a bottle, pour on it rain water and brandy, half a pint of each, expose it to the sun for three weeks, press out well, strain through a cloth, bottle, and add one ounce of oil of white lily ; wash the eyelids with it twice a day. Another : Take oil of white lily, formic oil, and earthworm oil, one ounce of each. This oil is used for all diseases of the eye ; it is applied twice or three times a day, with the feather end of a quill. HOUSE DISPENSARY. 713 FOR INFLAMMATION OF THE EYES. Take rose water three ounces, finely powdered alum two drachms, the white of two eggs, well beaten, put in a bottle, and shake for half an hour longer, and anoint the eyelids with it twice a day. It strengthens and preserves the eyes. Another : Take brandy one ounce, rain-water two ounces, mix well, and bathe the eyelids with it two or three times a day. COMPOUND TINCTURE OF BENZOIN. Take benzoin four and a half ounces, aloes half an ounce, balsam of Peru one ounce, rectified spirits of wine, put in a well closed ves- sel, and distil at a moderate heat. This is a very good water for wounds, and for injuries of tendinous parts. A GOOD HAIR LINIMENT. Take spirits of sal-ammoniac one ounce, spirits of wine half a pint, milk of sulphur, sugar of lead, and borax, one and a half ounces of each, tincture of myrrh half an ounce, common salt one ounce, tinc- ture of cloves half an ounce, essence of bergamot one and a half ounces, let it infuse for two days, and use. This valuable liniment does not only impart a beautiful gloss to the hair, but it also causes the hair to grow on bald heads ; it also restores the original color to grey hair. How to apply it: If the hair is thin, or the head has become bald, apply it twice a day, until it is used up. If the hair should begin to grow previous to that time, then rub it in the roots of the hair with a hair brush, a piece of cloth, or the hand. If the hair is grey, an application once a day is sufficient. There is nothing injurious in the mixture, and it may be applied without danger. It strengthens the scalp, cerebral nerves, and eyes, and promotes the growth of the hair. TO PROMOTE THE GROWTH OF THE HAIR, AND TO PREVENT ITS COMING OUT. Take beef marrow and the fat of ox-feet, a quarter of a pound of each, lard two ounces, oil of bergamot and rose oil, one drachm of 714 HOUSE DISPENSARY. each ; melt the beef marrow, the fat of the ox- feet and lard together, add, constantly stirring, a little wine, take it from the fire, and stir until cold, add thebergamot and rose oil, stir for half an hour longer, and use. It is a very good pomade for the hair ; it strengthens the hair roots, prevents its falling out, and promotes the growth of the hair. In case there are bald places on the head, they should be rubbed particularly twice a day. GOOD HAIR LINIMENT. Take rose water one ounce, expressed lemon juice half an ounce, vinegar of Spanish fly and Cologne water, one ounce of each ; mix well, and use for a hair liniment ; rub it in the roots twice a day, until a change for the better is evident. This remedy is highly recommended for bald heads, or where the hair is dropping out. Another : Take spirits of wine half a pint, castor oil half an ounce, ammonia, tincture of cantharides, a quarter of an ounce of each, mix, and shake up well ; use twice a day, and shake up well each time. Another ; Take carbonate of ammonia one ounce, rub it down with a pint of olive oil, and two ounces of oil of burdock ; use once or twice a day until the hair ceases dropping out, or until it has grown of a sufficient length. Another : Take mace one ounce, sage two ounces, laurel leaves one ounce, bruise fine, and put in a bottle, add one quart of brandy, one ounce of Cologne water, and half an ounce of common salt ; expose it to the heat of the sun, or put in a warm place for two weeks, strain carefully, and use it by washing the head with it once a day. This is the best liniment when the hair is turning grey. It prevents the hair from turning grey at once, imparts a darker color to it, prevents the scalp and the root of the hair from becoming dry, and promotes the growth of the hair. If the hair is to be still darker, add to the above mixture, when preparing it, one ounce of leaves of the nut tree, and half a pint of rain-water. HOUSE DISPENSARY. 715 A GOOD REMEDY FOR THE HAIR. Take burdock root one and a half ounces, castor oil eight ounces, oil of bergamot half an ounce, tincture of myrrh one ounce, oil of hartshorn half an ounce, oil of lavender half an < unce, put all of it in a bottle, shake well, and use as a hair oil. This is an excellent remedy ; it beautifies and softens the hair, promotes its growth, and prevents its dropping out and turning grey. A GOOD HAIR POMADE. Take three ox- feet, cut them into three or four small parts, split them open, and boil for six hours in a clean pot. When the broth has become cold, skim off the fat swimming on top, stir it with half a pint of good wine, then add, stirring all the time, an equal quantiy of each of mutton tallow and lard, place again on the hot stove, let it melt (but not boil), take it off the stove again, stir for an hour and a half, and when somewhat cooled off, add two ounces of oil of ber- gamot and one drachm of rose oil, put in a suitable vessel, and use. Another : Take freshly expressed lemon juice and tincture of can- tharides, one drachm of each, extract of quinine two drachms, beef marrow two ounces, oil of cedrat and bergamot, one scruple of each, and stir thoroughly. This a very good pomade for the hair, to pro- mote its growth after severe sickness. Another : Take beef marrow and lard, a quarter of a pound of each, melt together, strain, and add to the lukewarm mass three drachms extract of quinine (dissolved in one and a half ounces of orange blossom water), almond oil and oil of bergamot, one ounce of each, mix, and stir for one hour. REMEDY FOR CLEANING THE HAIR. Take spirits of sal-ammoniac four ounces, salt of tartar a quarter of an ounce, spirits of wine half an ounce, rain-water three pints, oil of bergamot half an ounce, mix thoroughly, and wash the head with it. This cleanses the hair and strengthens the scalp and the roots of the hair. 116 HOUSE DISPENSARY. GOOD COLOGNE WATER. Take oil of bergamot one ounce, oil of orange blossoms one drachm, oil of jassemin a quarter of an ounce, oil of lavender one drachm, oil of cinnamon five drops, tincture of benzoin one and a half ounces, tincture of musk a quarter of an ounce, pure spirits of wine two quarts, rosewater one pint, mix well, let it rest for a few days, shaking it from time to time, after which it may be used. It is somewhat expensive, but very good. CHEAP COLOGNE WATER. Take oil of lemon and oil of rosemary, half an ounce of each, oil of bergamot and lavender, one drachm of each, oil of cinnamon eight drops, oil of cloves and rose oil, fifteen drops of each, spirits of wine two quarts, mix well, and shake from time to time for one week, after which it may be used. GOOD HAIR OIL. Take castor oil four pints and a quarter, alcohol one pint, oil of citronel half an ounce, oil of lavender a quarter of an ounce, mix, and shake well before using it. It is one of the best hair oils now in use. POMADE FOR THE HAIR. Take white wax two ounces, let it melt slowly by the fire, add two ounces each of lard and fresh olive oil, take from the fire, and stir until cold, then add oil of bergamot and Cologne water, one ounce of each, stir for one hour more, put in a suitable vessel for use. Another : One ounce of finely powdered red cinchona is rubbed up with a small quantity of oil of almonds, and then sufficient is added to make two drachms ; it is then gradually mixed with six drachms of putified ox marrow, and perfumed with a little oil of ber- gamot. This pomade is very good ; it invigorates the scalp, and pro- motes the growth of the hair. FOR LIVER-SPOTS. Take camphor and Venetian borax, half an ounce of each, almond- bran one ounce, tincture of lemon, rose water, white lily water, and HOUSE DISPENSARY. 717 Solomon's seal water, half an ounce of each, put the whole of it in a bottle, expose to the rays of the sun, and apply it frequently to the spots. FOR FRECKLES. Take powdered crab's eyes three ounces, rye not quite ripe (it must be taken when the grain is still in a milky state), rose water and spirits of wine, four ounces of each, water two ounces, put the whole of these ingredients in a bottle, expose it to the rays of the sun for three or four weeks, strain through a cloth, press out, bottle it, and wash the face with it twice a day. The crab's eyes or crab stones may be used alone, for which purpose take one ounce of finely pul- verized crab's eyes, rub the freckles with it, and wash off with milk. It is a very good liniment for freckles, makes the face smooth and white, and gives the skin a beautiful white appearance. FOR LIVER-SPOTS AND MOLES. Take Turkish beans four ounces, triturate them, put in a bottle, pour one pint of wine over them, cork well, and put it for one week in a warm place, then wash once or twice a day with it, or wash the spots only with a sponge. > FOR PIMPLES AND ULCERS IN THE FACE. Tie up four ounces of saltpetre in a small piece of cloth, dip in rain-water, and touch the face with it. At the same time use a good blood-purifying remedy (see "Blood Purifier). EXCELLENT WASH FOR BEAUTIFYING THE COM- PLEXION OF THE FACE. Take four ounces of barley corn, pound in a mortar, and almond bran two ounces, put together in a bottle, add goat's milk and spirits of wine, half a pint of each, shake up well, place in the sun or in hot sand, where it is to be left for two weeks, then strain, and add rose water one ounce, and tincture of lemon one ounce, shake well before using it. This is one of the best washes for beautifying the 118 HOUSE DISPENSARY. skin. It is an innocent remedy, removes wrinkles from the face, and imparts to it a fresh, healthy appearance. Another: Take tincture of benzoin one ounce, rose water and milk of almonds, two ounces of each, borax half an ounce. This is a very good, favorite wash. It prevents too great a rush of blood to the face, whitens a face which is too red, smoothes the skin, and removes all eruptions from the face. Another : Take almond bran two ounces, tincture of benzoin half an ounce, rose water two ounces, borax one drachm, rain-water four ounces, and spirits of wine one ounce, mix well, and put in a bottle ; wash the face with it every morning before going out. These remedies are extensively used for the toilet. Where soaps operate too severely and irritating, these remedies are frequently very useful. Another : Dissolve two ounces of gum benzoin in one pint of recti- fied spirits of wine, and mix with it three ounces of rain water. It makes an excellent wash, and beautifies the skin. Another: Take almond bran one ounce, rose water and orange blossom water, eight ounces of each, .tincture of benzoin and borax, four grains of each. If the skin is very irritable, omit the borax. This wash is used at night before going to bed. FOR FRECKLES, LIVER-SPOTS, AND BEAUTIFYING OF THE SKIN. To prevent freckles, and to remove them, avoid the rays of the sun, perspiring in the open air, and washing immediately before going out. Use the following water : take almond bran one ounce, orange flower water three ounces, tincture of sage two ounces, rose water three ounces, tincture of benzoin two ounces, mix well, and use. FOR FRECKLES AND LIVER-SPOTS. Take rose water eight ounces, milk of sulphur and acetate of am- monia, two ounces of each, mix; wash the freckles with it at night before going to bed, or twice a day. HOUSE DISPENSARY. 119 Another : Take ox gall and solution of carbonate of potassa, one ounce of each, mix well. With this mixture rub the spots at night before going to bed, and wash off the following morning with soap and water. Another ; Take oil of almonds three ounces, lemon juice and for- mic oil, two ounces of each, ground mustard one drachm, mix well, and wash the spots with it twice a day ; or take juice of horseradish, mixed with buttermilk, and wash the face with it twice or three times a day. Another : Take sage three ounces, parsley water or parsley root, put the two in a vessel, add one pint of brandy, put in a warm place for a week, strain through a cloth, put in a bottle, add rose water and milk of almonds, three ounces of each, mix well, and use it ; wash the face with it twice a day. REMEDIES FOR FRECKLES. Take green currants three ounces, put in a vessel, add rain-water and spirits of wine, one pint of each, also one pound of finely crushed cucumbers, keep in a warm place for one week (it must not come to the boiling point, however), pour off, strain, and press out well, put in a bottle, add one ounce of galatian water, and three ounces of rose water. Wash the face with it twice a day. Another : Take spirits of camphor, juice of cresses, juice of horse- radish, and rose vinegar, two ounces of each, mix, wash the face or spots with it twice a day. Do not expose yourself to the air im- mediately after washing. Another : Take rose water three ounces, cucumber juice and liver of sulphur, one ounce of each, tincture of benzoin two ounces, almond bran four ounces, mix together, and wash the spots with it twice a day. PAINT. Be particular in avoiding the poisonous substances of paint ; the continued use of it only increases the evil. Cosmetics of that kind 720 HOUSE DISPENSARY. should not be thoughtlessly used ; do not paint extravagently, and be particularly careful not to use injurious and poisonous paints. INNOXIOUS PAINT. Toilet powder : Take rice starch flour six ounces, powdered orris root one ounce, perfume with half an ounce of oil of lemon, oil of berganot and cloves, half an ounce of each. This is a very good white paint. Red paint : Take spirit of sal-ammoniac half an ounce, carmine a quarter of an ounce, pour the spirit of sal-ammoniac on the best quality of carmine, and shake well several times a day. On the fourth day, add one pint of rose water and one p.nt of good rose spirits, shake it well, let it stand well corked from eight to ten days, decant the clear red rose paint, fill in small bottles, and use. Another : Take six ounces of the finest, pure starch flour, triturate it with half an ounce of the best quality of carmine, scent the mix- ture with oil of sandal wood and oil of roses, one ounce of each, mix well and use. BEAUTIFYING WATER. Take powdered orris root two ounces, orange blossom water and bitter almond water, two ounces of each, rose water six ounces, gum benzoin one ounce, put all together, mix well and bottle for use. It is a very good water for the face, and makes the skin appear clean and white ; to be applied for liver spots and moles. Another : Take storax and benzoin, five parts of each, cinnamon one part, sweet flag root and rosemary, two parts of each, infuse with twenty-five parts of whisky for four weeks, and then decant. It is used by pouring a few drops of it in the water used for washing ; it makes the skin tender and soft, and dispels all impurities of the face, strengthens the eyes, and is very good for headache and faceache. SOAP Is a combination of vegetable and animal oil or fat, with vegetable and mineral alkalies. Medicinal soaps for internal use consist of one part of freshly prepared caustic soda and two parts of olive oil ; these substances are mixed together, triturated and poured into forms. It HOUSE DISPENSARY. 721 is chieflly used as a good diluent remedy for abdominal obstructions, swellings, stagnations, indurations of the liver, spleen, mesenteric glands, jaundice and dropsy (usually in connection with bitter extracts, such as gentian, buckbean, centaury minor, &c), for gout and stone; as an antidote for poisoning, particularly by strong acids ; it is an excel- lent remedy for obesity. It is administered internally in doses of from five to twenty grains several times a day, usually in the form of pills. Externally, common soap is used for bathing purposes (from three to six ounces of soap for a bath) ; for injections, salves and plasters. Spirits of soap consists of one part of soap, one part of rose water and three parts of spirits of wine. It is particularly useful in contu- sions, dislocations, sprainings, hemorrhages, &c. (but only after the state of inflammation has been removed by cold poultices, leeches, &c.) Soap plaster is prepared from lead plaster three parts, yellow wax half a part, Spanish soap one-fourth part, and a little camphor; it is an emollient and diluent remedy, 46 MEDICINAL PRESCRIPTIONS. REGULAR DIVISION AND DOSES FOR ADULTS, AND ALSO FOR CHILDREN. I will assume that the dose for an adult is sixty grains, or one drachm, the sub-division would be as follows : For a child under one year, 5 grains, years, 8 •' " two " " three " four " " seven " " thirteen person " twenty For a person over twenty-one years of age, the full dose of sixty grains ; for a person of seventy-five years of age, the reverse order would again take place ; the dose would have to be diminished again by five grains. Women generally require a smaller dose than men, on account of their different formation of body and strength. 10 15 20 3° 40 DOSES OF MEDICINE. The following are the general rules for prescriptions : if a dose for a person of middle age is sixty grains, a dose for a person from four- teen to twenty-one years is forty grains ; for a child of four years, fif- teen grains ; for a child of three years, ten grains ; for a child of two years, eight grains ; for a child of one year, five grains, or one- twelfth part of the dose for a person of middle age. DOSES FOR CHILDREN. It is generally assumed that where a dose for an adult is a tea spoonful of any kind of medicine, that the dose for a child of seven years is half a teaspoonful, and one-fourth of a teaspoonful for a child (722) MEDICINAL PRESCRIPTIONS. 723 from three to five years, one-eighth of a teaspoonful to a child from one to three years, and one-sixteenth to a child under one year. THE ABOVE RULES Hold good for all kinds of medicine, with the exception of some cases, of which we give a few herewith : Calomel is administered to adults as a purgative, in doses of ten grains; it must not be given to children at all. Laudanum for an adult, from 15 to 30 drops. " " a child " 1 " 3 " For castor oil a different rule is observed. The usual dose for an adult is one ounce, or two tablespoonsful ; for a child of two years, one tablespoonful ; for a child under one year, a quarter of an ounce, or from one to two teaspoonsful. Medicines should always be weighed or measured, but must never be administered or taken by guess. It is very advisable that every family should possess a marked glass measure for fluids, indicating drops, drachms and ounces ; they may be bought in any apothecary shop. Medicinal weights should also be provided for weighing pow- ders. They are not expensive, and very useful, particularly in the country, where prepared medicines cannot be had. APOTHECARIES' WEIGHTS AND MEASURES. 1 pound - 16 ounces - 480 grammes, - 480,00 8 " - - 240 tt - - 240,00 1 ounce, - 30 tt - 30,00 % " - - 15 (I - - i5>°° 1 drachm (60 grains) 3^ ii - 3»75 30 grains, - ItV(T5 it - - 1,875 20 " - *% It - 1,25 16^ " - I a - 1,00 10 " - T 6 A 0r ft grammes, 0,600 5 " • - - ,% " \ 3 o f( - 0,300 1 " - ih grammes, 0,06 tV " - Tinny tt .- - 0,006 T&5 - TS^H? tt - 0,0006 724 MEDICINAL PRESCRIPTIONS. The above list is an accurate calculation ; in prescriptions, how- ever, it is rounded off, in order to avoid unnecessary fractions. A prescription therefore does not call for 3,75 (3^) grammes for 1 drachm, but simply for 4,00 (4 grammes) ; for one-half drachm, not 1,875, b ut 2 >°° ( 2 grammes). The division of grammes is in tenths, hundredths, and thousands, which are called decigramme, centi- gramme, milligramme. For instance, six decigrammes — 0,06, are ten grains; six centigrammes, the tenth part — 0,06 — is only one grain ; the tenth part of this is six milligrammes — 0,006. MEASURE FOR FLUIDS. One cupful is deemed equal to 4 ounces — 120 grammes. One tablespoon ful ' One teaspoonful One pint One wineglassful }£ ounce — • 16 1 drachm — 4 6 ounces. or 300 drops. " 60 " APPENDIX. Well cooked and proper food being an important factor for the preservation of health, and it being of vital importance that the greatest care should be bestowed upon the preparation of the food and beverages for the sick, I consider it appropriate to attach an appendix to this book, giving proper directions for the preparation of food and beverages adapted both for sick and well people. BEVERAGES. i. THE VARIOUS KINDS OF COFFEE. Washing, Roasting and Grinding of Coffee, and a few Surrogates. Mocha coffee is the finest, best tasting and most expensive, but on ac- count of its strength not the healthiest. Next in rank is the yellow, and still better the brown, Java coffee ; of course, it must be the genuine, natural, and not the colored Java. Equal to it is Minado coffee. Porto Rico is a strong and pleasant coffee ; if roasted a little too much, it has an acrid taste. San Domingo has less strength, and is frequently impure, but it is mild and wholesome. Brazil coffee is very disagreeable on account of its peculiar offensive flavor, and it is incomprehensible how it finds purchasers. The tase of the coffee depends as much on the way it is roasted as on its quality. Too much roasting imparts an acrid taste to it. If not roasted sufficiently, it imparts to it a very disagreeable, somewhat accidulated taste. (725) 723 APPENDIX. Some of the larger merchants have the coffee picked over, yet it would be well to examine whether it contains any black, spoiled beans, which are the cause of its poor taste. Some insist that washing coffee makes it much stronger. This seems to be an idea only, but there is no question that the coffee ac- quires a finer and more pleasant taste thereby. In washing it, cold and not hot water should be used ; rub the coffee rapidly between the hands, throw it on a strainer, pour water over it, dry in a coarse clean cloth by rubbing it thoroughly, and spread it out to dry in the sun or in a warm place. It may be roasted immediately after that. The washing also has the advantage of cleaning the coffee of dye. Coffee is best roasted in drums which can be turned, as in these the roasting is best done by a moderate and at the same time lively fire ; the drum should be kept in constant motion, because it roasts the coffee gradually, and imparts to it a uniform color. The so-called sweating of the coffee must be prevented : it is caused by the oily parts coming to the surface. As soon as the coffee has a fine medium brown color, and if the beans can be easily broken in two, it is suffi- ciently roasted. By paying proper attention and by practice, the drum may be taken from the fire previous to the coffee being done ; in that case, the drum should be shaken until the coffee has ceased to be hot. In this manner it will receive the proper degree of roasting, and at the same time retain greater strength. Those who are not practised in roasting coffee, should place a flat vessel at hand, in which the coffee may be thrown at once and stirred, as it is well known that at a certain point coffee will turn very readily. Coffee should be kept in a tin canister or in a wide mouthed bottle, which should be kept carefully closed. A mill should be used that grinds fine; finely ground coffee strengthens the beverage consider- ably; it also clears much more rapidly. A coffee mill which grinds coarsely, can be sharpened by any blacksmith. 2. COFFEE AS A BEVERAGE. To prepare strong coffee, half an ounce should be allowed for each person ; for a large number of persons more or less is used. The coffee pot, containing boiling water, should be placed on a hot stove, APPENDIX. 72? so as to heat it thoroughly before the coffee is introduced into it. Coffee should be fresh ground and not kept exposed to the air. Then add to it at once hard boiling water, take a few cups of the coffee out of the pot again and pour it back, place it on the hot stove again for a few minutes, or until bubbles begin to rise to the surface. When the coffee has settled and has cleared itself, it may be poured at pleasure into another hot coffee pot. Hard water makes a better tasting coffee than soft water. Good milk should be provided : poor milk spoils good coffee. If an exceedingly good cup of coffee is desired, raw cream should be used. If, however, this cannot be had, and fat, boiled milk is objectionable, because some people find fault with the skin, the fol- lowing course may be pursued : place fresh milk on a quick fire and keep stirring it constantly until it boils, take the pot from the fire, beat up the yolk of a very fresh egg with a few drops of cold water, add gradually of the boiling milk, and keep stirring for a little while longer, to prevent the formation of skin. It imparts a pleasant taste to the coffee. Remark. I consider it rather a disadvantage to put the coffee on the stove with a small quantity of water, however frequently that course may be pursued. The addition of chicory or any other surro- gate, which is used for black coffee, depends on the taste of the in- dividual. It certainly does not improve the coffee, and is done for economical purposes. 3. TEA. In former years black tea was used only as an admixture to green tea, but now black tea is used almost altogether, as it is less exciting to the nerves than green tea. Pecco is the best quality of black tea; the more white points the leaves have, the better is the quality of the tea. The Pecco tea brought over land is preferable to that imported by vessel, as the sea air affects the peculiar flavor of the tea; it possesses an extremely fine and pleasant aroma, but is also much more expensive. Souchong tea is much cheaper than ordinary Pecco, and a good quality of it can be recommended. Congo tea is less esteemtd, but there are some qualities of it which are not bad. 728 APPENDIX. To make good tea, take, if possible, a teapot with a round bottom and without feet, so that it may be placed on a hot stove. The tea- pot must be rinsed out with boiling water and placed on a hot stove with boiling water. After it has become thoroughly hot, pour out the water ; allow two large teaspoonsful of tea for each person (for a large number of persons proportionately less tea may be used), be- cause tea that is too strong is not so good; put a small quantity of boiling water to the tea and let it draw, then fill up the pot with boiling water, put it in a hot place on the stove, and stir with a teaspoon. Green tea is prepared by pouring a cupful of boiling water over it, and immediately emptying the water again; it is then moistened with boiling water and after it has drawn, the necessary quantity of boiling water is added ; green tea must never boil. In serving tea, not more than two or at most three cups should be poured out, when the same quantity of boiling water should be added to it again. A little fresh tea should be added from time to time. In this manner the tea lasts longer, a less quantity is used and it remains good. Soft water is better than hard, and cream or milk which is not boiled, preferable to that which is boiled. Remark. Tea prepared for the sick, as soon as properly prepared, should be poured off the leaves ; it is said that in this shape it is less injurious to the sick, even in light fevers. 4. MILK-CHOCOLATE. On account of the quality and taste of the chocolate, no definite proportions can be given. However, it is usually calculated that three ounces of good sweet chocolate should be taken for one and a quarter quarts, or half an ounce for a cup and a half, ten grains for one cup ; some allowance is made for evaporation in boiling. Of bitter chocolate a smaller quantity is taken. Put the chocolate on the fire with sufficient water, so as to barely cover it ; after it has become entirely soft, stir it into a uniform mass, and add fresh milk, which may be diluted with one-third of water ; this imparts a pleasant taste to the beverage, and is also much more easily digested than if APPENDIX. 729 prepared with milk only. Then add the necessary quantity of sugar, and let it boil with constant stirring for about ten minute?. 5. CHOCOLATE WITH WATER. Place two ounces of chocolate with two cups of water on the fire • as soon as it begins to boil, pour off the water into a pitcher, and work the chocolate into a smooth mass. Then pour the water in the pitcher back on the chocolate, and sweeten with the necessary quantity of sugar. After the chocolate has boiled once more, it is kept bubbling in the pot until it has considerable foam on the surface, when it is put on the table. 6. REFORMED TEA. Tie two pinches of tea and a small piece of cassia in a piece of fine flannel, and let it boil up once in a quart of milk ; then sweeten with sugar, with which the outside of a lemon has been rubbed off. Then beat the yolks of four eggs into the tea, and let it boil up once more, while constantly stirring ; it is then caused to bubble in a pot, when it is ready for the table. WARM AND COLD BEVERAGES. For Sick and Well Persons. 7. ORANGE PUNCH. Peel lightly the outside yellow skin of two oranges, so that not the least part of the white adheres to it ; put it in a closely covered porce- lain bowl and stand it aside. One and a quarter gallons of rum are brought to a boil with one and a half pounds of sugar, skim clean, pour about one pint of this on the yellow orange peel in the bowl, and cover up close again. Add the juice of six oranges and four lemons, and another quart of rum or a quart of arrack, and a cupful of scalded tea water. The whole of this, with the infused yellow orange peel, is placed on a coal fire and stirred until hot, strained through a clean cloth, poured into a punch bowl, and served. 8. ORANGE PUNCH OF ANOTHER KIND. Peel a fine orange lightly, and put the peelings in a closely covered bowl, boil half a pound of sugar with one pint of water, pour one-half ^30 APPENDIX. of it on the orange peel, and cover closely. The juice of the orange, and also that of two lemons, and one bottle of white wine, is added to the rest of the sugar, to which is added the scalded orange peel and three-quarters of a pint of arrack. Stir this while on the fire with a silver spoon, strain through a hair sieve into the bowl, and serve the punch. 9. BURGUNDY PUNCH. Take the outside yellow peelings of two oranges, put in a bowl with one pint of boiling pure sugar, and put it aside. Then clear one and a half pounds of sugar with a quart and a half of water, place a wet napkin over a stew pan, and strain the above, together with the juice of six oranges and the scalded orange peel, into it. Add to the strained part two bottles of Burgundy wine and a half bottle of arrack, heat the punch, pour it into the punch bowl, and it is ready for use. 10. ENGLISH PUNCH. Boil two pounds of sugar with two quarts of water and the finely peeled yellow skin of two lemons and two oranges, to which is added one bottle of Rhinewine, one bottle of rum, and one bottle of Burgundy. Add to it the juice of two lemons and four oranges, cover well and place it in a warm place on the side of the stove or hearth, and let it infuse for an hour; the punch is then strained into a bowl, and is ready for use. 11. SLEMP, A GOOD WINTER BEVERAGE. Put a quarter of a cup of drawn green tea, a tablespoonful of bar- ley, a pinch of saffron, six cloves, a little mace and cassia with boil- ing water into a teapot ; the spout of the teapot should be stopped up with paper. Let it draw for one hour. Boil three-quarters of a quart of fresh milk, into which strain the tea through a sieve, beat up the yolk of four eggs, which add by stirring, and serve in teacups. 12. IMPERIAL PUNCH. Take a pineapple, cut up in fine slices, one bottle of champagne, one bottle of Rhinewine, not quite a whole bottle of arrack, half a jug of Selters water, one and one-eight quarts of boiling water, one APPENDIX. 731 and a quarter pounds of sugar, rub off one lemon, and, according to taste, the fine peeling of a small green orange, four oranges, the juice of four fresh lemons, three grains of fine cinnamon, and a piece of vanilla, of the length of half a finger. Infuse thoroughly in boiling water the cinnamon and vanilla, strain the solid substance out of the liquid, pour the liquid into the bowl, add the sugar, lemon juice, and the oranges, divided into eights, and the pineapple. When cooled off, the Rhinewine, champagne, arrack and Selters water are added. 13. STRAWBERRY PUNCH. Take one bottle of good rum, and two pounds of strawberries, mash the berries with a spoon in a china bowl, put the mass in a well- covered stone or glass jar, pour the rum on it, and let it infuse for two or three days. During that time keep stirring it repeatedly. Pour off the fluid, and filter into another vessel through a hair sieve , the remaining strawberry mash is also put on the sieve by degrees; and is strained through the sieve by rubbing. Pour the remaining mash into a stretched clean cloth, and squeeze out the fluid which may still be contained therein. Bottle this so-called strawberry rum thus obtained, cork well, and seal the bottles, lay them on their side, and keep for use. This strawberry rum will keep for a year. For a punch, take to one bottle of the strawberry rum the juice of two good lemons (keeping out the seeds), and sweeten to taste, about two pounds of sugar and four bottles of water. The sugar is put in a bowl, the lemon juice squeezed on to it, then the rum is added, and finally boiling water. The punch thus prepared is covered up in the bowl, and kept until cold ; that which has been prepared in the morning tastes much better in the evening, as if drank hot and im- mediately after being made. This punch may also be filled in bottles, and kept for several days ; the bottles should be laid down, however. It sometimes improves even in taste when kept. By keeping this strawberry rum for a. length of time, it turns partly into a jelly in the bottle, which can be then emptied only by shaking ; it immediately dissolves when mixed with water. The strawberry mass remaining from • the preparation of strawberry rum may be made into a good punch, by pouring on it boiling water, stirring, and letting it stand 732 APPENDIX. for several hours; the liquid is then drawn off, and the necessary quantity of sugar and lemon juice added to it. 14. HOLLAND PUNCH. One part strained lemon juice, two parts powdered sugar, four parts of fine arrack, measured by a glass measure. This is covered up in a small vessel, placed on the fire, and dissolved, and eight parts of water added to it. 15. WINE PUNCH. Six bottles of Rhinewine, and from one-half to three-quarters of a bottle of arrack (or better, genuine old Jamica rum), are heated to the boiling point with four ounces of sugar for each bottle, and put on the table in a bowl. 16. HUNTERS PUNCH. For two bottles of Moselle wine, take half a bottle of arrack punch syrup and a little sugar, heat it to the boiling point, but do not let it boil j the surface will be covered with a fine white foam. 17. ANOTHER WINE PUNCH. Three bottles of Rhinewine are heated to the boiling point, a bottle of strong tea is added to it, prepared from half an ounce of tea, the yellow rind of a lemon is rubbed off with one and a half pounds of sugar, which, with the juice of the lemon, is added to the punch. After this mixture has been put in the bowl, add from one-quarter to half a quart of arrack, according to the strength desired. 18. FRENCH PUNCH. Take one bottle good tea, four bottles of fine French red wine, one bottle of port wine, one bottle cognac, half a bottle of Madeira, and the yellow rind of two lemons, rubbed down with one pound of sugar. 19. CHAMPAGNE PUNCH. Boil one and a half pounds of sugar with one quart of water, add the juice of five or six lemons, one pint of arrack, and one bottle of APPENDIX 733 champagne; heat the punch, strain into a bowl, and serve im- mediately. 20. EGG PUNCH. One and a half bottles of French wine, one pint of boiling water, four and a half ounces of sugar, with which the yellow skin of a fresh lemon has been rubbed off, the juice of two lemons, a little tea, nutmeg, and a few cloves, and eight fresh eggs. Infuse the spices in boiling water, and afterwards press, add the rest, and beat up the whole with an egg-beater over a quick fire, until a thick foam arises, but it must not boil. When the pan is taken from the fire, the beat- ing must be continued for a short time longer, and during that time arrack may be added to it, according to taste. 21. MULLED WINE. One pound of sugar, eight cloves, the fine peelings of an orange and lemon, and a small piece of cinnamon, are well boiled in a pint of water, to which two bottles of Burgundy wine are added. After the whole of it has been thoroughly heated, the mulled wine is poured through a fine sieve, and immediately served. 22. MULLED WINE, WITH VANILLA. One vanilla bean is split in two, put on the fire with a quart of water and two pounds of sugar, and well boiled ; to this is added four bottles of red wine, and the juice of two oranges. When the whole of it has again reached the boiling point, the mulled wine is strained through a cloth into the punch bowl, well covered up, and kept in a warm place until used. 23. HOT EGG-WINE. Take a fresh egg and two ounces of sugar for each half pint of white wine. It is then put on a quick fire, and beaten with an egg beater until it reaches the boiling point. It must not be permitted to boil, as that would coagulate the eggs. 134 APPENDIX. 24. COLD EGG-WINE (A REFRESHING BEVERAGE). Take for half a pint of either red or white wine, two very fresh eggs, stir them up with powdered sugar and nutmeg, and gradually add the wine to it. 25. AN EXCELLENT PUNCH EXTRACT. Take one and a half pounds of fine sugar, the juice of four fresh, juicy lemons, and a bottle of fine arrack. Boil the sugar until clear with one and a half cups of water, add the lemon juice, and after having cooled off, add the arrack. When used, pour upon one part of this extract two parts of boiling water. 26. FINE BISHOP. Add to one bottle of red wine the very thin peelings of a small green orange, three ounces of sugar, and a little cinnamon, put it on the fire, let it come to a boil, and it is ready for use. 27. BISHOP AFTER THE RUSSIAN STYLE. Take the fine peelings of four bitter oranges, put in a tureen with three bottles of Muscat Lunel (sweet French muscatel wine), cover up close, let it infuse for one hour ; then strain the bishop, bottle, place it on the ice, and serve cold. 28. WINE FOAM. Three eggs, and the yolks of three more eggs, one pint of white wine, a small piece. of cinnamon, and the thin peelings of one lemon, are beaten over the fire, until the whole of it begins to rise, and is transformed into a thick foam ; it is immediately served in glasses. 29. RICE PUNCH. To one part of punch extract, one part of rice water is added. 30. GROG. One part of fine rum, mixed with two parts of water, and sweetened with the necessary quantity of sugar. APPENDIX. 735 31. WARM LEMONADE. Into a quart of sweetened boiling water, squeeze the juice of three or four lemons, squeeze through a cloth, and serve the lemonade at once. 32. WHISKY. Four pints of boiling water are added to half an ounce of tea. After the tea has properly drawn, add the juice of six lemons, and strain through a tea strainer over one and a half pounds of crushed sugar. It is then mixed with a gallon of good red wine, brought to a boil, and served in glasses. 33. SPICED WINE. Six ounces of cinnamon and twelve white pepper-corns are crushed in a mortar, and put in a porcelain pot with one quart of white wine, six ounces of sugar, the thin peelings of one lemon, and as much amber as will lie on the point of a knife ; it is then well covered, and left to infuse from six to eight hours. It is then carefully strained, and put on the table. 34. POLISH TEA. Two quarts of white beer, a piece of cinnamon, the thin peelings of one lemon, and half a pound of white sugar, are well boiled, then add one pint of Rhinewine, the yolks of six eggs, half a glass of maresquino, and the juice of a lemon, and heat on a coal fire until it begins to foam, and serve in cups. 35. ROYAL PUNCH. Put one and a half pounds of sugar in a bowl, pour one quart of weak tea over it, and when the sugar has dissolved, add the juice of three lemons and three oranges, and one pint each of champagne, Bordeaux, Johannisberg, arrack, maresquino, and pineapple juice. After thoroughly mixing it, the punch is bottled, and placed on ice until used. 36. CARDINAL. To one pound of sugar add two bottles of good Rhinewine, the finely peeled skin of two and the juice of five oranges, and one bot- 736 ' APPENDIX. tie of champagne ; place on ice. A short time previous to using it, the cardinal is strained through a cloth. 37. CARDINAL WITH PINEAPPLE. To the cardinal, prepared according to the above prescription, add half a pint of pineapple jelly, which imparts to this beverage a very fine and superior flavor. 38. BARLEY WATER FOR THE SICK. One ounce of barley is washed in several warm waters, and then boiled in one gallon of water until the barley cracks open ; the juice is strained through a clean cloth, and sweetened with the necessary quantity of sugar ; boil two ounces of washed raisins, which is added to the other liquid ; it is administered in cups in a lukewarm state. 39. RICE-WATER FOR THE SICK. Three ounces of rice are washed in several waters ; the rice is then put on the fire, with three pints of water and a small piece of cinna- mon, and boiled for half an hour ; the liquid is then strained, sweet- ened to taste, and the beverage used in a lukewarm condition. 40. TOAST-WATER FOR THE SICK. Toast a few slices of bread, put in a porcelain bowl> pour lukewarm water over them, and add sugar to taste. 41. CHERRY, RASPBERRY, AND CURRANT WATER. To one part of either of the above fruit syrups, add two parts of fresh water, and it is ready for the use of the sick. 44. LEMON WATER (LEMONADE) FOR THE SICK. One-quarter of a pound of crushed sugar is dissolved in two pints of fresh well-water; the juice of four lemons is then added to it, and well mixed ; it is then strained through a hair sieve, when it is ready for use. A small quantity of light white wine may be added to it. » APPENDIX. 737 45. ORANGE WATER FOR THE SICK. To the water, as above prepared, the juice of three oranges is added, when it is treated in the same manner as the lemon water. 46. ALMOND ESSENCE FOR THE SICK. Peel half a pound of almonds, wash in several waters, and gradu- ally triturate with one and a half pints of water, as fine as possible ; press through a cloth. In the meantime, clear one and a quarter pounds of sugar, boil quickly, add the almond milk to it, and boil the whole of it. After having ceased to foam, it is taken from the fire, cooled, bottled, well corked, and kept in a cool place. 47. ALMOND MILK. One part of almond essence, as above prepared, is mixed with three parts of well-water, when it is ready for use. 48. RASPBERRY VINEGAR. Put three quarts of raspberries in a dish, and pour one gallon of wine vinegar over them. It is well covered, and left in that state for several days ; it is then well pressed, and to each two quarts of the juice one pound of sugar is added. Put it on the fire, let it boil, skim until clear, set it to cool, and bottle. If this vinegar is diluted with water, it furnishes a well-tasting, cooling, and healthy beverage. 49. ICE WATER. Fill a bottle with pure well-water, cork it, and place it on the ice, when it begins to freeze, it is ready for use. 50. APPLE- WATER FOR THE SICK. Wash twelve choice apples, quarter them without peeling, but take out the core. They are then boiled in three or four pints of water for a quarter of an hour ; the water is then strained through a hair- sieve, and sweetened to taste. Whoever likes it, may boil some cin- namon and lemon peel with them. 47 738 APPENDIX. 51. WARM BEER. To one quart of beer add, over the fire, three ounces of sugar, a small piece of cinnamon and a little lemon peel. When the beer has boiled up once, it is beaten up with the yolks of six eggs and put in a jug. 52. NEGUS. Put two quarts of red wine with a quarter of an ounce of cloves, a sixteenth of an ounce of nutmeg and half a pound of sugar over the fire, cover up closely and let it get hot ; as soon as it boils, it is poured through a hair sieve into a tureen, covered, and sent to the table. 53. CURRANT WINE. Strip ripe currants from their stems, crush them, and press out the juice. To one pint of currants take one quart of water, fill in a wide- mouthed bottle, and add a quarter of a pound of sugar. The bottles must be shaken for the first two days, then stand them up in a cool place. The bottles must be filled up to the brim, so that when fer- mentation takes place, the foam and impurities may be thrown off. The open bottles, covered with paper only, are left standing in that condition until the juice has become quite clear, which will take place in from six to eight weeks. The impurities which have risen to the top are carefully removed with a silver strainer and the clear wine bottled, corked and placed in the cellar. The longer it is kept, the better it becomes. 54. NECTAR Take the thin peeling of four oranges, place in a bowl, pour over them a glass of white wine, cover up well, and let it infuse for half a day, so that the wine may become thoroughly impregnated with the aroma of the orange peeling. Empty into a punch-bowl two bottles of Bordeaux wine, two bottles of champagne, and two bottles fine white wine, pour the extract obtained from the four oranges through a hair sieve, and mix it well with the wine in the punch bowl by stirring it thoroughly with a ladle, when it is ready for use. APPENDIX. ^39 55. MAY-BOWL WITH WOODROOF. Take a quantity of woodroof and place it in a bowl, add three bottles of red and three bottles of white wine, and two and a half pounds of sugar, cover it well, and let it infuse for five or six hours ; strain through a hair sieve, and it is ready for use. If liked, sliced oranges may be added. 56. MAY-BOWL OF A DIFFERENT COMPOSITION. Take one gallon of good old white wine, one pound of sugar, one drachm fine cinnamon and the thin peelings of half a lemon. Add to this five leaves of lemon balm, two and a half ounces of leaves of peppermint, one ounce of pimpinell and one ounce of garden gera- niun, all of these with their flowers; also, milfoil leaves and terragon, one ounce of each, meadow sweet leaves and balm of Gilead, a quarter of an ounce of each, half an ounce of basil herb, two black currants, two stalks of southernwood, worm- wood and thyme, one quarter of an ounce of each, balm mint, and lungmoss with its flowers, three-quarters of an ounce of each. The leaves and flowers are washed and wiped dry, put in a porcelain bowl with the wine and spice, tightly covered and set aside in a cool place, where it is left for six or eight hours, being stirred up frequently. It is served with the leaves. 57. LEMONADE FOR THE SICK (WITH FEVER). Add to one and a half quarts of boiling water the juice (not the peeling) of one good lemon, removing all seed. This is bottled and given to the patient sweetened with sugar. 58. ALMOND MILK FOR THE SICK. Four ounces of peeled, washed and crushed sweet almonds are mixed with from three-quarters to one and one-eighth quarts of cold water, pressed through a very clean cloth which has been kept soaking in hot water (because almond milk is easily tainted by any foreign flavor), and sweetened with sugar. Almond milk may be kept, except dur- ing a hot summer, in a bottle, put in cold water and in a cool place for two days. From four to six bitter almonds may be added to the sweet almonds. T40 APPENDIX. 59. WHEY FOR PULMONARY DISEASES. A piece of dry rennet, which may be obtained from the butcher, is soaked in cold water for twelve hours. Boil one and one-eighth quarts of milk, stir the piece of rennet and the water in which it has soaked, into the milk which is kept boiling slowly, and keep it boiling on a slow fire until the separation occurs, which will take place in about a quarter of an hour. The cheesy mass must not become hard. Pour the whole of it in a very clean scalded linen bag, and strain. In the absence of rennet, a tablespoon ful of thick sour milk answers the same purpose. This beverage is taken according to the prescription of a physician. 60. AN EXCELLENT BEVERAGE IN CASES OF DIAR- RHOEA AND SPASMODIC DIFFICULTIES. Take four ounces of the best quality of rice, scald, put in an earthenware pot with three-quarters of a quart boiling water, and half an ounce of cinnamon, boil down to one and one-eighth liter, and pour through a sieve without stirring. Sugar may be added or not ; it is drank during the day. This is continued until recovery. 61. ICELAND MOSS (FOR PECTORAL DISEASES). Boil one ounce of scalded Iceland moss in one and one-eighth quarts of water for three hours, until reduced to three cups. Press and sweeten with sugar ; it may be drank in the morning with fresh milk. It can be boiled the day previous and warmed up the next morning. 62. VIOLET VINEGAR, A composing draught for the sick, particularly for those suffering from nervous diseases and headache. From two to three handsful of blue, aromatic violets without the stems are put in a bottle, filled with vinegar, corked and infused for some time in the sun or in a warm place; filter the vinegar through filtering paper, and preserve the liquid in a well-corked bottle for use. A teaspoonful is added to a small glass of water, and sweetened with sugar. This vinegar may also be used for seasoning sauces and ragouts. APPENDIX. 741 CORDIALS. Remarks. Cordials are filtered through filtering paper, or a flannel cloth, placed in a funnel, bottled, and kept in the cellar. For the preparation of cordials, cherry spirits or brandy may be used ; the strength of the cordials may be reduced by the addition of water. 6 3 . CURACAO. Three quarts of brandy or cherry spirits are poured over the peel- ings of six oranges and one and a half lemons ; add a quarter of an ounce of fine cinnamon, as much saffron as will lie on the point of a knife, and a quarter of an ounce of coriander, and infuse in a large alembic for four or six weeks in a warm place, and then filter through filtering paper. Put it in a brass pan, with two and a half pounds of crushed sugar and three quarts of water, and let it simmer until the sugar is dissolved. When cooled, the curacao is bottled, well corked and kept in the cellar. 64. CREAM CORDIAL. To one quart of cherry, brandy or whisky, take one pound of crushed rock candy, half an ounce of cloves and two ounces of fresh cut-up bitter orange peel ; infuse for one day, filter, add three cups of sweet cream, and let it infuse for eight days longer ; filter again and bottle. 65. VANILLA CORDIAL. One gallon of whisky, and two and a half beans of vanilla are put in an alembic and infused for fourteen days. At the expiration of that time, boil two pounds of sugar with a gallon of water, add the whisky, let it simmer for a moment over live coal, and filter. This cordial may be colored red by adding a little cochineal. 66. ANIS CORDIAL. Infuse one ounce of anis, or anis flowers, in two quarts of whisky for eight days, boil down one and a quarter pounds of sugar with two and a half quarts of water, and proceed as with " Vanilla Cordial." 742 APPENDIX. 67. LEMON OR ORANGE CORDIAL. Infuse the peelings of four lemons in two quarts whisky ; after ten days, boil one and a quarter pounds of sugar with two quarts of water into a syrup, and proceed as in " Vanilla Cordial." In like manner orange cordial is prepared, substituting four oranges for the four lemons. 69. QUINCE CORDIAL. Peel and grate the quinces and put them in the cellar over night. Press out the juice. To one and a half gallons of quince juice take two quarts cherry spirits, three-quarters of a pound of sugar, one ounce cinnamon, half an ounce cloves and two ounces bruised bitter almonds. All of this is placed in an alembic, which is closed up, and set aside for fourteen days, shaking it up daily ; it is then filtered. 70. NUT CORDIAL. Take two quarts of whisky and one pound of green nuts. The nuts are cut in small pieces and put in a large bottle. The whisky is then poured over them, and the bottle placed in the sun and permit- ted to infuse for fourteen days. The liquid is then strained through a funnel, and again bottled ; then add for every two quarts of whisky, half an ounce of cinnamon, a quarter of an ounce of cloves, both crushed coarsely, and again infuse for fourteen days ; then take for each two quarts, three-quarters of a pound of sugar, and boil in one quart of water to a syrup, add the strained nut cordial, and let the whole boil together once more. The cordial is then filtered and bottled. 71. CORDIAL OF BLACK CURRANTS. To one quart cherry spirits add one pint of crushed black cur- rants, to which is added half a pound of bruised rock candy. It is put in the sun to infuse for six or eight weeks. The cordial is then filtered. Whoever is fond of the taste, may add a little cinnamon and a few cloves to the liquor during the infusion. APPENDIX. 743 72. CORDIAL FOR THE STOMACH. One ounce of bitter orange peel, three-quarters of an ounce of star anis, a quarter of an ounce of common anis, two ounces of green root, quarter of an ounce of refined tartar, and a quarter of an ounce of centaury minor, are infused in the sun for three weeks in an alembic ; the essence is then filtered, diluted with a little water, and sweetened with two pounds of sugar. 73. CINNAMON TINCTURE. Three quarts of spirits of wine, three ounces of Ceylon cinnamon, and two ounces of cassia, are infused for fourteen days, the tincture filtered through filtering paper, and preserved in corked bottles. 74. STOMACH BITTER. A quarter of an ounce each of wormwood, centaury minor, alicant leaves, and orris root, an eighth of an ounce of angelica root, a quarter of an ounce of blessed thistle, an eighth of an ounce of cin- namon, bitter orange peel half a pound, nutmeg an eighth of an ounce, are put in two quarts of spirits, and infused in the sun for four- teen days, filtered through blotting paper, and preserved in well-corked Dottles. 75. PEPPERMINT CORDIAL. Put a large handful of peppermint leaves and two quarts of whisky 111 an alembic, and let it infuse in the sun for three or four weeks ; the whisky is then poured off, half a pound of sugar is boiled with half a pint of water, and when cold, it is mixed with the whisky, bottled, and put away. 76. CARAWAY CORDIAL. Thirty drops of oil of caraway, two drops of oil of fennel, and one drop of oil of cinnamon, are dissolved in one ounce of spirits, then mixed with four bottles of good whisky, and one and a half pounds of boiled sugar. The cordial is then bottled, and preserved. 77. HIP CORDIAL When preserving hip, all trimming, as well as shells and stones, may be put in a bottle (without any great regard as to proportions), *744 APPENDIX. and filled up with whisky. After infusing for some time, and filter- ing, add four ounces of sugar to one and one-eighth quarts of the filtrate. PRESERVED FRUiT. Remarks. The success in preserving fruits depends on the beauty and quality of the fruit, as well as on the manner in which it is treated in the process. It is particularly necessary to become acquainted with the time of the ripening of the fruit, and when it is in a proper condition for preserving. All unripe, hard fruit should be blanched and softened to facilitate its impregnation with sugar ; this is particu- larly the case with the larger kinds of fruit. The blanching is done in the following manner \ the unripe fruit to be blanched, is pierced several times with a needle, and placed in a kettle (which must not be tinned) with cold water on the fire. After it has become very hot, put a cover over it, and take it off the fire. After a few moments, place the kettle on the fire again, and take it off again as soon as it begins to boil ; proceed in that manner until the fruit has become soft. If the fruit is of a large size, each piece should be taken out of the kettle, and examined to see whether it has become soft. If that is the case, the fruit is thrown in cold water, in which it remains until cooled off, when it is drained of the water on a sieve. One pound of fruit requires one pound of sugar. The latter is boiled until it begins to become lightly stringy, when it is poured over the fruit. On the day following, the sugar is poured off again, and boiled until it appears more stringy, when the fruit is permitted once more to boil up again in it. The syrup is well skimmed, the fruit taken out of it, the sugar boiled again until it becomes stringy, and the pro- cess of preserving finished on the third day. Particulars will bfe found in the various recipes given. It is well if the fruit is placed warm in the jars, because it keeps better. Care should be taken that all pre- serves are kept in a dry, cool place. 78. PRESERVED RASPBERRIES. One pound of fresh raspberries are carefully picked and freed from the small leaves. Boil one pound of white sugar with one glass of fresh water to the proper consistency, add the raspberries to the sugar, APPENDIX. 745 skim carefully, and let them boil up a few times. Take the rasp- berries out of the pot with a brass skimmer, boil the syrup down again until it has become stringy, and pour the fruit in a stone ware or porcelain bowl, cover carefully with a clean cloth, and keep them in a cool place until the following morning, when the whole of it is poured through a sieve in a sufficiently large vessel to receive the sieve, and the juice drained off; the latter is put on the fire once more, and boiled until the syrup begins to be stringy again. Add the raspberries, and let them boil up once more ; take them out of the pot, and boil the juice for the third time, and put the raspberries into it again. While in a h kewam condition, fill them in the jars in which they are to be kept, cover them with a piece of paper dipped in cherry spirit, and tie up tight with ox-bladder. The jars should be kept in a cool place. 79. PRESERVED STRAWBERRIES. This fruit should be carefully gathered, and is preserved in the same manner as raspberries. 80. PRESERVED CURRANTS. After being stripped from the stems, they are preserved like rasp- berries. 81. PRESERVED CHERRIES. For one pound of black cherries, take one pound of skimmed and cleared sugar. The cherries are freed from their stems, and the pits taken out with a small pointed stick ; they are then boiled for six or eight minutes in the sugar, taken out of the juice, and placed in a clean dish. The sugar is then boiled down to the second degree, and poured over the cherries, covered with a clean cloth, and put in a cool place. On the following day the cherries and syrup are poured out on a sieve, and after the syrup has drained off entirely, it is put on the fire, and after having boiled for a few minutes, the cherries are added to it. After having boiled up a few times, and being skimmed, they are taken out, put back in the dish, and left standing over night. On the third day, after the syrup has been drained from the cherries, it is put on the fire again, and boiled, the cherries put back into the 746 APPENDIX. syrup again, and boiled up once more. Let them cool off somewhat, fill in glass jars, cover with a paper saturated with cherry spirit, tied up closely, and keep in a cool place. 82. CANDIED CURRANTS. For this purpose select the finest and largest currants. Put them in a dish, pour the sugar, boiled into syrup, over them, swing them backward and forward with it, and then roll the currants in finely powdered sugar, so that they are fully covered with it ; they are then placed on a sieve to dry slowly. They are used for desert. 83. RED AND WHITE CURRANTS. Strip the finest and largest currants of their stems ; take one pound of sugar for each pound of berries, boil the sugar into a syrup, throw the berries into it, and let them boil up slowly several times over a very moderate fire. Put them in small glass jars, cover them with round paper covers, saturated with cherry spirits, and carefully tie up the jars after they have become cold. 84. PRESERVED RIPE PEACHES. Press the stones out of the ripe peaches with a small stick, place them in a dish, pour over them for each pound of peaches one pound cleared, warm sugar, cover with a paper, and let them stand over night. Strain off the sugar on the following day, and boil into a syrup, put the peaches again in the syrup, let them boil up slowly, and skim clean, when they are again placed in a dish until the following day. This is repeated two or three times, until the fruit contains no longer any ferment. The last time the peaches are boiled up once in the syrup, placed on the sieve to strain, and the balance of the syrup is boiled down until it appears stringy. Place the peaches in regular layers in the glass jars, pour the warm syrup over them, lay a piece of circular paper, steeped in cherry spirit, on top, and tie up with a soaked hog's bladder. After the latter has become dry, tie another paper over it. 85. PLUMS AND PRUNES. Take ripe plums, cut off half of the stems, pierce the fru : t with a needle in several places, throw them in cold water, and then in boil- APPENDIX. 747 ing water. As soon as they appear on the surface of the water, lift them with a skimmer, and put them back in cold water. For each pound of the fruit, take one pound of sugar ; the sugar is purified, the plums placed in a sieve and drained of the water, put in the syrup and boiled up once ; they are then covered with a clean cloth, and put in a cool place over night. On the following day the syrup is poured off and boiled ; the plums are again thrown into it, let them boil up once, and again put them aside over night. They are treated in the same way on the third day, the syrup is boiled down a little closer ; on the fourth day it is boiled until it beads heavily, and the fruit is added to it once more. After boiling up once, the plums are taken out, let the syrup come to a boil, skimming it off clean, and finish as prescribed for peaches. Prunes are prepared in the same way. 86. PRESERVED QUINCES. Take fine apple-quinces, cut them into four or six slices, cut out the core, boil the quinces in water until soft, and put them on a cloth to drain off the water. For each pound of quinces take one pound of sugar, melt, and when cold, put it with the quinces in a dish, and let it stand over night. On the following day pour off the liquid, and boil until it becomes stringy, then let it cool. It is again poured over the quinces, and thus continue five days in succession ; on the last two days, the syrup is poured hot over the quinces. The syrup must be boiled down thicker on each day, and for the seventh it must boil until large bubbles appear. Filling in jars and tieing up is the same as directed for other fruit. 87. PRESERVED HIP. Take choice hips, cut off the top, remove the kernels, and all hairy parts from them, and lay the fruit in a clean dish. For each pound of the fruit, take one pound of sugar, boil it into a syrup, and after cooling it moderately, pour it over the hip, cover with a cloth, and let it stand over night. On the following day pour off the syrup, boil it again, skim, and pour it again over the hips, and let them stand again over night ; on the third day the sugar is 748 APPENDIX. boiled until it is lightly stringy, the hips are then added to it, the syrup is now boiled until it is very stringy, and then poured over them. After cooling, they are put in glass jars, and finished as directed for raspberries. 88. PRESERVED PEARS. The required quantity of pears are peeled, and the stems cut off one-half; they are then pierced, blanched soft in water, and cooled in cold water, put on the sieve to drain, and then placed in a dish. Pour on it as many pounds of purified sugar as there are pounds of fruit, cover with paper, and let it stand over night. On the follow- ing day pour off the sugar, boil it down somewhat, constantly skim- ming it, add the pears, and let them boil up once, skim, put them in a dish, and cover them up. They are thus treated on the third and fourth day, with a further addition of syrup on each day. On the fifth day put the pears on a sieve, and let them drain clean, boil the syrup down, add the pears, and let them boil up once. When cooled off, fill in glass jars, and tie up closely. 89. GREEN GOOSEBERRIES. They are picked in the beginning or middle of June, the stems and tops cut off, and the seed taken out with a pointed wire. The kind of gooseberries must be taken only which remain green even after they are-ripe, because all trouble to preserve their green color would be in vain, if berries are taken which turn red or yellow when they ripen. Put a stew-pan (not tinned) on a coal fire, fill it half full of water, and throw into it a small piece of alum. When the water boils, put in the gooseberries, and leave them in the water until they turn white and rise in the water. The water must not boil, because they easily boil to pieces. If the berries are easily blanched, pour off the water, and throw them into cold water, in which they remain for a few hours ; put them on a sieve to drain, and again pour cold water over them. After being drained, they are placed in a dish, and a very thin clarified syrup poured over them ; they are well covered up, weighted down so that they cannot rise, and placed in a cold place for twenty-four hours. On the second day the syrup is poured off, well boiled, and skimmed, some fresh syrup added to it, which is APPENDIX. 749 poured warm over the berries ; this is continued for two days ; on the fourth day the gooseberries must boil up ten or twelve times, and put back into the dish. The boiling restores the green color to them. They are put aside for one day longer, filled in glass jars, tied up close, and put away for use. 90. STRAWBERRY MARMALADE. Press the strawberries through a hair sieve ; for each pound of the pulp take one pound of sugar, if the marmalade is to keep, boil down well, stirring constantly, skim off clean, and fill when cold in glass jars ; cover with paper saturated with cherry spirits, tie up close, and put aside for use. 91. Cl>RRANT JELLY. Take picked, ripe currants, crush, pour a little water over them, let them boil up once, place them on a sieve, and let the juice drip off clean. This juice is filtered once more ; take for each pound of juice twelve ounces of sugar, let it boil, constantly skimming, until it drops from the skimmer in small flakes, or until a bubble adheres to the skimmer. If the jelly has reached that state, it is immediately filled into warmed glasses, and put into a cold place ; paper steeped in arrack is put on top of the jelly, and it is then tied up. 92. ANOTHER KIND OF CURRANT JELLY. Pick fully ripe currants, press out the juice, and put in a dish. For each pound of juice allow one pound of crushed sugar, stir for three hours, fill in glasses, and tie them up as directed above. 93. RASPBERRY JELLY. Equal weights of raspberries and white currants are put on the fire until they become warm, the juice is then pressed out, and the jelly treated as above directed. 94. CHERRY JELLY. Take equal weights of currants and black cherries, and proceed as bove directed. 750 APPENDIX. 95. QUINCE JELLY. When quinces are boiled for marmalade, the juice is poured oil and filtered like that of apples. For one pound of juice half a pound of sugar is clarified and quickly boiled, the juice added to it, and the jelly treated as previously directed. 96. APPLE JELLY. For this purpose pick ripe apples from the trees, because the juice is clearer and whiter than that of apples which have been kept for some time. The apples are cut into four slices, put in a kettle with the peelings, and covered with water to the depth of two fingers. The apples are then boiled until soft, the jelly filtered through flannel, and treated as directed for currant jelly. 97. STRAWBERRY JELLY. Take three pounds of garden strawberries and three pounds of white currants, press thoroughly, filter, and treat the juice as directed for jellies from other fruits. ) 98. CURRANT JUICE. To one pound of filtered currant juice add twelve ounces of sugar, fill a bottle with it, and shake until the sugar is dissolved, cork well, seal, and put aside for use. 99. RASPBERRY JUICE. The expressed juice of good ripe raspberries is filtered; boil twelve ounces of sugar quickly for each pint of juice, pour the juice into it, and let it boil with it for five minutes, and skim very clean. When cold, bottle, cork well, and seal with wax. 100. CHERRY JUICE. Free the cherries from their stems, crush them together with the stones, cover them up, and let them stand over night, after which they are well pressed. For each pint of juice take three quarters of a pound of sugar. The sugar is quickly boiled, the juice again APPENDIX. 751 strained through a sieve, boiled with the sugar for two minutes, and skimmed clean. When cold, it is filled in bottles and corked. 101. MULBERRY JUICE. The mulberries are crushed immediately when they are picked from the trees, the juice pressed out, and after being slightly warmed, poured through a filtering bag. One pint of the juice is boiled with halt a pound of sugar until it becomes very stringy and is well skimmed. After it has become cold, it is bottled as directed for the bottling of other juices. 102. VIOLET SYRUP. One of the first flowers of spring is the violet. The leaves are picked off in such a manner that nothing green becomes mixed up with them; they are put in a tin congealing box and boiling water poured over them, covered up close, and left over night. On the following morning press the juice through a cloth. For each pint of juice take half a pound of sugar and boil for a quarter of an hour in a new earthen pot ; add to it the juice of one lemon, skim clean, and finish as directed above. BROTHS. Broths are used for soups, sauces, vegetables and meats. With proper attention, a good broth may be prepared from a small quantity of meat. 103. A NOURISHING SOUP. Take from two to three pounds of meat and the same quantity 01 bones, put in two gallons of water, place them on the fire, and bring to a boil ; the scum rising to the surface must be promptly taken off. If it boils too hard, it should be removed to the side of the stove, so that it may boil slowly, as that is the only way in which a clear broth may be obtained. After the broth has been skimmed, a sufficient quantity of salt is added ; care should be taken, however, not to put in too much ; roots should be added to give a strong taste to the broth, for which purpose may be used, celery roots, carrots, onions, 7 02 APPENDIX. stems of leeks, parsley and savoy. The roots used are tied together with a string and boiled in the broth for three hours; the soup meat is then placed on the table. It is better, if the soup kettle remains covered during the slow boiling ; a condenser can be highly recom- mended. It is not intended to convey the idea that the quantity of meat used should be that above given ; it may be increased or de- creased, according to the quantity of soup required. 104. BROWN SOUP. Good soup fat or butter is put in a stew-pan or earthen pan, the bottom of which is lined with onions and slices of carrots. From three to four pounds of beef (shank part) and the same quantity of bone or trimmings of poultry, is added to it, and the whole placed on a hot fire. Turn over frequently until it assumes a brownish-black color ; the fat is then poured off clean, from two to two and a half gallons of water, or still better, cold broth, is added ; when it comes to a boil, skim clean. Boil with it a little salt and a head of savoy for three hours ; strain the whole through a hair sieve, and put it away for use. The broth may be served in cups or turned into soup. 105. TO CLEAR BROTH. One pound of chopped or cut-up beef is beaten up with the white of six eggs, and stirred in a stew-pan ; then add about three gallons of the broth, to be clarified, place the whole on a slow fire or on coal, and let it come to a boil, after which the broth is strained, and put on the table. 106. LENTEN SOUP. Take half a pound of butter and put in a pot with a handful ol carrots, two large white turnips, three large onions, some celery roots, one head of savoy, and a handful of chervil. When properly stewed down, add one quart of dried peas, soaked over night, pour over it from six to ten quarts of water, and boil for two hours, adding a little salt, nutmeg, and a few pepper corns ; the soup is then pressed through a clean napkin. APPENDIX. 753 107. LENTEN SOUP OF FISH. Six pounds of carp, pike, or tench are scaled and washed, and of the above lenten soup poured over it, slowly boiled for two hours, and poured through a fine sieve or strainer. 108. CHICKEN BROTH. Three or four old hens are picked clean, singed, drawn, washed clean, and put on the fire with three pounds of calves' tails and two and a half gallons of water. As soon as it begins to boil, it must be well skimmed and the fat taken off. Then add salt, celery roots, onions, carrots, leek warts, and sliced savory; keep boiling slowly for four hours, and strain through a cloth. 109. GAME BROTH. Patridges, larks, field-fares, pheasants, and also hares, are all treated in the same way, if to be used for broth. After being picked, skinned, drawn and washed clean, they are cut up in small pieces; put a piece of good butter in a stew-pan and lay the cut-up meat on top of it, put it on the fire, and fry until it assumes a fine light yellow color. Then pour over it from a gallon to a gallon and a half of strong beef broth, add laurel leaves, a little celery root, leeks, parsley root, a few pepper- corns, one onion, and a little salt. The broth is then boiled for three hours, and finished like chicken broth. no. SOLID BROTH. Five pounds of tail pieces and the same weight of veal bones, four old hens, and three scalded calve's feet, and three gallons of water, are put in a kettle over the fire and brought to a boil. It is well skimmed and boiled, without the addition of either salt or spices, from five to six hours, strained through a cloth, and put aside in a cool place over night. On the following day skim off the fat, and put the remainder in a stew-pan, let it boil, constantly skimming it, until it becomes substantial, when it is poured into a proper vessel and left to congeal. It is then taken out, exposed to the air for the purpose of being dried, and put aside for use. For one cup of broth take a 48 T54 APPENDIX. piece of the size of a walnut, pour upon it a cup of boiling water, while constantly stirring, and season with salt and nutmeg. SOUPS. Remarks. The strongest broth is in reality a soup, because every- one likes a strong soup, as an introduction to the rest of the meal. It is remarked, and not without reason, that a poor soup spoils all the following dishes. Particular care should be taken not to season any soup with a great deal of nutmeg or cives; it has spoiled the appetite of many a guest. Every good cook should be very careful not to add the least particle of anything which would not be approved of by the most fastidious taste. Whoever takes pleasure in cooking, will never be satisfied with the knowledge she possesses of cooking, but will endeavor to improve upon it constantly. in. WATER SOUP WITH MELTED BUTTER. Cut rye bread in thin slices, dry in an oven, scald with boiling water, and cover it up ; or it may be permitted to boil up once, when it is properly seasoned with salt ; butter is then melted, and sliced onions browned in it, until they assume a yellow color, and intro- duced in the soup. 112. BOILED WATER SOUP. Wheaten bread is cut up, cold water poured over it and boiled with a little piece of butter, properly seasoned with salt, stirred until smooth, and served. If preferred, the yolks of a few eggs may be beaten up with a little sour cream and added. 113. STRAINED BREAD SOUP. Wheaten bread (for persons in good health, rve bread may be taken) is cut into slices, boiled soft in strong broth, strained or pressed through a hair sieve, and thinned with the necessary quantity of broth. It is a very light and pleasant soup for sick people. APPENDIX. 755 114. BURNT SOUP. Brown four large tablespoon sful of flour in a quarter of a pound of butter, until it assumes a yellowish brown color, when a gallon of water is added to it by constant stirring. Then add a little salt, let the soup boil well, add bread cut in little squares, and it is ready for the table. This soup is also very good if eggs are stirred into it. 115. SOUR CREAM SOUP. Toast or bake in the oven slices of rolls ; for six slices use a quart of boiling water with the necessary quantity of salt ; mix with it two tablespoonsful of sour cream, and the soup is ready for the table. The soup may be boiled up once, before the cream is added, or it may be covered up well after boiling water is poured on the toast. 116. PANADA. Cut up from six to eight rolls, or some wheaten bread, add cold water and a good sized lump of butter, and put it on the fire ; after having well boiled, it is forced through a strainer or hair-sieve, and again put on the fire ; stir in the yolks of six eggs, with half a pint of sweet cream and a little nutmeg. The soup is added to the eggs, and immediately sent to the table without letting it come to a boil again. 117. PANADA WITH WINE. Stale biscuit is boiled well with wine, sugar, cinnamon, and lemon peel, pressed through a hair sieve, beaten up with the yolks of eggs and fresh cream, and sent to the table. 118. SOUP WITH POACHED EGGS. One quart of water, half a pint of vinegar (for sick persons take wine or water in place of vinegar), and a little salt, are put on the fire, and when boiling hard, from twelve to sixteen eggs are broken into it, which, however, should be done with great care. Let them boil for two minutes, remove them with a skimmer, and place them in a soup-tureen. Toasted slices of milk-rolls are added, one gallon of brown, strong broth poured over it, and the soup placed on the table. 756 APPENDIX. 119. EGG CHEESE SOUP. Beat up with a spoon or egg-beater, in a dish, eight eggs, and the yolks of eight eggs, add a little salt, nutmeg, half a pint of broth, and half a pint of sweet cream. Put the mass in a tin pan, greased with butter, place it up to its middle in hot water, and let it boil until it has become firm. Pieces are dug out of it with a teaspoon, put in the broth, and placed on the table. 120. SOUP OF RAW POTATOES. Peel and slice ten or twelve large, raw, mealy potatoes, add some sliced carrots and celery root, boil with the broth until it rises above the vegetables, and until all of it is boiled soft, pass through a hair sieve ; brown a few tablespoonsful of flour in a little butter, until it is of bright, light yellow color, boil this up once with the strained potatoes, and add some small square pieces of bread, fried in butter, sweet cream, and eggs. 121. SOUP OF BOILED, COLD POTATOES. Peel and grate the potatoes, smother in butter, finely cut-up pars- ley and onions, add the potatoes and a little flour, and finish the soup in the same way as directed above for raw potatoes. 122. MILCH-BREAD SOUP. Grate fine four or six milk rolls, beat it up with eight eggs, and mix well ; let it stand for a quarter of an hour, pour a few ladlesful of broth over it, work until perfectly smooth, and add one gallon of strong broth. Before sending it to the table, which may be done at once, add a little brown broth to it. 123. MILK SOUP. Put the necessary quantity of soup on the fire, and bring it to a boil, pour it over finely 'cut-up rolls or slices of bread, cover it up, let it stand for five minutes, and it is ready for the table. APPENDIX. 757 124. WHITE WINE SOUP. Brown two large tablespoonsful of flour in two ounces of butter, add one and a half pints of white wine and half a pint of water, sweeten with sugar, add a small piece of cinnamon, and boil, with constant stirring, until smooth. Cut some milk bread in the shape of dice, and roast them yellow in the stove, in butter, or without it ; stir the white of two eggs with a little lemon juice, and pour the soup over the roasted bread with the yolk of the eggs, and it is ready for the table. 125. RED WINE SOUP. This soup is prepared precisely in the same way as that of white wine, with this difference only, that the red wine takes the place of the white, and that the yolk of the eggs may be dispensed with. 126. BEER SOUP. A quarter of a pound of butter is placed on the fire, three large tablespoonsful of flour are browned in it to a very light color, add one gallon of white beer, and bring it to a boil. Add a small piece of cinnamon, lemon peel, and sufficient sugar to sweeten, the yolks of six or eight eggs are mixed with a little sweet cream, and the soup poured over it. Some toasted bread may be added. 127. LEMON SOUP. A grated loaf of milk-bread, or as much flour as is required to make one, is roasted completely dry in a little butter ; peel two or three lemons, cut into small round slices, extract the seed, and place in a dish, cover thickly with sugar, and add also the roasted bread ; heat two pints of wine, the same quantity of water, and a suffl cient quantity of sugar, and pour over the round lemon slices ; cover the soup, and let it stand for ten minutes, and place on the table with sugar. 128. MEAL GROATS SOUP, WITH BROWNED BROTH. About three-eights of a pound of meal-groats are stirred into one gallon of browned broth ; the stirring is continued until it has well 758 APPENDIX. boiled up, as it otherwise may be lumpy. The soup may be ready for the table in ten minutes. 129. WHITE MEAL-GROATS SOUP. This soup is prepared in the same way as that above, with this dif- ference, however, that in place of the browned, white broth is used ; before putting it on the table, beat it up with an egg and sweet cream. 130. BROWNED MEAL GROATS SOUP. Brown one pound of meal-groats in half a pound of butter to a chestnut color, pour on it one gallon strong broth, and stir constantly until it comes to a boil ; the soup is ready or the table in a quarter of an hour. Should it be too thick, it may be thinned with a little brown broth. 131. RICE SOUP, WITH EGGS AND CREAM. Wash clean a quarter of a pound of rice, and put on the fire with cold water ; when it is on the point of boiling, stir it, pour off the water clean, put fresh cold water on it again, and let it boil up ; then pour it in a strainer, cool it in cold water, let it strain, put it in a pot with a gallon of strong broth, and place it on the fire, where it boils for half an hour, until the rice is entirely soft. The yolk of eggs and sour cream are stirred into the soup, when it is ready for the table. Nutmeg and cives are very good in this soup. 132. BROWN RICE SOUP. The rice for this soup should be treated in the same way as that above, but instead of adding eggs and cream, it is served with brown broth. 133. RICE WATER. The rice is treated in the same way as above directed for rice soups. For half a pound of rice, take an eighth of a pound of but- ter, add two quarts of broth, boil until soft, and work through a hair sieve : then add two and a half quarts more of broth, let it boil up, stir in an egg, and put it on the table. APPENDIX. 759 134. BARLEY WATER. The barley is boiled up with a spoonful of water and a small piece of butter, to which is added strong broth ; after an hour and a half, a few large spoonsful of flour are mixed with a little sweet milk, poured into the soup, and boiled with a slice of celery and a little nutmeg for three-quarters of an hour ; before it is put on the table, the soup, is worked through a hair sieve. 135. BARLEY WATER IN ANOTHER WAY. The barley is browned for a few minutes, with a quarter of a pound of butter and three or four large spoonsful of flour ; strong broth is then added to it, and slowly boiled for two or three hours, with occa- sional stirring. The soup is finished as directed for the one above. 136. BROWN SAGO SOUP. Two or three quarts of brown broth are brought to a full boil ; half a pound of sago, which has been previously washed in several waters, is then run into it, boiled for half an hour, and the soup is ready. 137. WHITE SAGO SOUP. The same quantity of white broth, as directed above for brown sago soup, is placed on the fire ; when boiling, half a pound of sago is put into it ; after having boiled for an hour, the yolk of three eggs is beaten up with sweet cream, and the sago soup poured on it. 138. EGG SOUP. Four large tablespoonsful of flour are browned to a very light color with a quarter of a pound of butter ; eight eggs are beaten up with a little cold water, and half a gallon of strong broth poured upon the browned flour, boiled, stirring constantly, when it is ready for the table. 139. BRETZEL SOUP. Soak the bretzel in water until soft, squeeze out the water, boil with strong broth, press through a hair sieve, stir in an egg with sour cream, and it is ready for the table. During lent the same soup may *760 APPENDIX. be prepared with water in place of broth ; poached eggs may be added to it, which makes it a palatable soup. 140. VERMICELLI SOUP. Make a solid dough with four eggs, work it up well, and roll it out to the thickness of a card-board. After drying for a short time, fold it, cut into very fine vermicelli, and let them boil for five minutes in two gallons of brown or white broth. 141. GRATED SOUP THICKENING. Make a firm dough with six eggs ; after being well worked, grate on a grater, and spread them on a board to dry ; they are then stirred in boiling broth, and are ready for the table. If too thick, add brown or white broth. 142. BROWNED GRATED SOUP THICKENING. The thickening prepared as above described is placed in a tin pan greased with butter, on top of it also put a few slices of butter ; put in the oven, brown to a chestnut color, frequently turning it over, and finally stir into the soup and let it boil up several times. The thick- ening may also be browned in any other pot. 143. CHOPPED SOUP THICKENING. Make a middling light dough with four eggs, put it on a vermicelli or chopping board, and chop with a chopping knife. If the dough should be too moist, use a little flour with it while chopping ; the dough must remain yellow, however, and not turn too white. 144. FANCY THICKENING. Dough, prepared according to the above direction, is rolled out thin, cut into oblong squares, boiled in strong broth, and it is ready "for the table. APPENDIX. 761 f 145. BAKED FANCY THICKENING. The dough, prepared according to the above direction, is cut a little larger and baked in hot suet, laid upon blotting paper or bread until the fat has drained out of it ; it is then placed in a soup tureen, boiling broth poured over it, covered up for five minutes, when it is ready for the table. 146. WAFER SOUP. Take any suitable quantity of flour, make into a light dough with milk, add salt, stir in some eggs, and pour in sufficient milk to make it into a thin dough ; heat suet in a pan, and pour it into a dish ; stick half an onion on a fork and dip into the fat, or use a sward, and grease the pan for each wafer, bake both sides a nice yellow (the wafers must be as thin as thin card -board), lay them on a board, and cut into strips of the width of a finger, or in squares. It must not be overlooked that these wafers should be baked very thin. When they are all baked and cut up, strong boiling broth is poured over them, or they are brought to a boil in the soup. 147. COTTON SOUP. Stir half a pound of butter until light, beat ten eggs into it, add ten tablespoonsful of flour and a small cupful of cream, stir up thor- oughly and season with a little salt and nutmeg ; drip this dough into a gallon of strong broth. After the soup has boiled up once, it can be sent to the table. 148. ITALIAN VERMICELLI-PASTE SOUP. Boil one and a half gallons of strong white broth with half a pound of Italian vermicelli-paste until it is very soft ; before pouring it in the soup tureen, add one quart of brown broth. 149 MACCARONI SOUP. Half a pound of genuine maccaroni are broken up into pieces of the same length, boiled in salt water until soft, put into a sieve, and cold water thrown over them ; they are then boiled up once with 762 APPENDIX. one gallon of stiong brown broth, and sent to the table with Parmesan cheese. 150. DROP SOUP. Six large tablespoonsful of flour are worked with water until smooth, to which nine eggs are gradually added, and a suf- ficient quantity of water and salt, until the dough drops from the spoon in nice, smooth drops ; drop it in from two to three gal- lons of broth, and the soup will be ready for the table in five minutes. 151. SPRING OR ^OOT SOUP. Take equal parts of split peas, carrots, carviol beans, celery root, leeks, rape-cole, savoy, &c; each of them is cut or broken in small pieces and all boiled together in salt water, and strong broth poured over it. Add toasted bread or meat dumplings, and stir in some eggs or brown broth. 152. ANOTHER KIND OF ROOT SOUP. Cut fine the different roots and stew with fine slices of onions and a piece of butter until soft, pour over it, as may be desired, either white or brown broth, let it boil, and send to the table with dif- ferent kinds of dumplings. Toasted wheaten or rye bread may be boiled with the roots. 153. STRAINED ROOT SOUP. The above mentioned vegetables and roots are properly cleaned and washed, cut in large slices, stewed until soft with a piece of fresh butter and some raw ham, and forced through a hair sieve ; the re- quired quantity of broth is then added and poured over toasted slices of rolls, or some finely cut up carrots, or some brown broth, may be added, or an egg may be stirred into it. 154. WHITE ONION SOUP. Peel six or eight onions, slice into thin slices, stew them with a piece of butter until soft, brown with two large tablespoonsful of flour APPENDIX. 763 to a light yellow, boil with a gallon of broth, press through a hair sieve, stir in the yolk of two eggs with a little cream, and serve over sliced rolls. 155. CHERVIL SOUP. The chervil is picked with its stems, cut up fine with parsley and a piece of onion, well stewed with a piece of butter, to which is added one gallon of broth with three or four large tablespoonsful of flour ; it is then boiled for half an hour, the yolks of eggs and sour cream stirred in, and poured over toasted sliced rolls. 156. SORREL SOUP. This soup is prepared in the same way as the one in the preceding number ; sorrel taking the place of chervil. 157. GREEN PEA SOUP WITH RICE. Shell about two quarts of peas, wash clean and put them on the stove with strong broth, slices of celery, leeks, parsley, a few slices of onions and a quarter of a pound of butter, and boil until soft. As soon as the peas are sufficiently soft, the whole of it is forced through a hair sieve or a strainer, thinned with more broth, boiled up a few times more, poured over soft boiled rice, and put on the table. 158. YELLOW PEA SOUP. Take one quart of yellow peas, wash and soak them in soft water over night, put on the fire with cold water, and boil until sufficiently soft to be forced through a sieve ; brown four large tablespoonsful of flour in a quarter of a pound of butter to a light yellow color, add the strained peas and the necessary quantity of broth, and pour over toasted sliced rolls, cut in little squares. 159. GREEN KERNEL SOUP. The kernels are either ground or crushed, put on the fire and slowly boiled for two hours with strong, white broth and slices of wheaten bread ; whilst boiling, it should be stirred and filled up from time to 764 APPENDIX. time. It is then forced through a hair sieve, the yolks of a few eggs beaten with a tablespoonful of cream, and added to it. 1 60. STRAINED LENTIL SOUP. This soup is prepared in the same way as pea soup ; when prepared for the table, slices of smoked, fried sausage are thrown in. 161. ASPARAGUS SOUP. Green asparagus is cut into pieces of the same length, boiled in salt water until soft, put in a strainer, and cold water thrown over it. After being well strained, fill with as much brown broth as is required, let it boil for a few minutes more, and send to the table with toasted bread or any kind of dumplings. 162. BROWN VEAL SOUP.' About two pounds of veal, cut in slices, is put on the fire, and stewed for one hour with a quarter of a pound of butter, some onion, celery, and carrots, then boiled up with one gallon of strong broth, to which is added from four to six milk-rolls, cut in slices. If all is well cooked, the whole of it is forced through a hair sieve, and thinned with brown broth. Let the soup boil up a few times more, add pike sausages or poultry dumplings with nicely toasted rolls, cut into pieces one inch long, and it is ready for the table. 163. WHITE VEAL SOUP. This soup is prepared like the one described above, with this dif- ference, however, that in place of brown, strong, white soup is taken ; the yolks of eggs and sweet cream are added to the soup before send- ing it to the table. 164. HARE SOUP. Roast a fine, large hare. In the meantime brown three or four large tablespoonsful of flour, and stir it with the sauce in which the hare was roasted, and one gallon of strong, brown broth. When the hare has become cold, the buttock piece is cut from the bones, cut into pieces of one inch in length, and set aside. The skeleton and legs of. APPENDIX. 7 1>0 the hare are ground to a jelly, put in the broth, and boiled for two hours. The soup is then forced through a fine hair sieve, put on the fire for a few minutes more, and before putting it in the soup tureen, there may be added to it, according to taste, Madeira wine, and fillets of hare, or small dumplings, prepared from game. The soup is then ready for the table. 165. SOUP PREPARED FROM PATRIDGES OR FIELD-FARES. These two soups are prepared in the same way as hare soup. In place of a hare, roast three patridges or eight field-fares. The meat part of the breast is cut off, cut into fillets, and put into the soup when it is ready. The bones of the game are always pounded in a mortar, and treated in the same way as directed for hare soup. 166. LARK AND SNIPE SOUP. The gizzard of these birds must be drawn, because it is very bit- ter ; the balance of the inside is not drawn, but roasted in the birds. In place of one hare, take twenty-four larks, or from three to four snipes, and prepare the soup in the same way as hare soup. 167. PHEASANT SOUP. This soup is treated in a similar way as directed for the preceding game soups, with this difference, that the meat of the breast is separated previous to roasting. A cup of broth and two ounces of butter are brought to a boiling heal, and a sufficient quantity of flour stirred into it to make a stiff dough (scalded dough) ; this is ground up in the mortar with the meat of the breast, the yolks of four eggs, and a little salt, and forced through a hair sieve. This is made into dumplings, boiled in salt water, and added to the soup. 168. CRAB SOUP. For twelve persons, boil thirty soup-crabs in salt water for about ten minutes, until they have a fine red color, break off the tails, and strip them of the shell, open the body, and take out that which is not 766 APPENDIX. clean. Then pound the body and the shells of the tails very fine, with a quarter of a pound of butter, add another piece of butter, some celery, leek-wort, a slice of onion, and a little parsley, put in a stew pan, and brown for ten minutes. Then sprinkle with a large tablespoonful of flour, and fill up with strong broth. After boiling for a quarter of an hour, the red layer of fat, which is called crab- butter, is skimmed off and put aside until the soup is ready to be served ; the latter is then boiled for three-quarters of an hour longer, poured through a hair sieve or cloth ; make any kind of dumplings, mix them with the yolks of a few eggs and sour cream, add the crab- butter and tails to the soup in the tureen, and it is ready for the table. In place of dumplings, soft-boiled rice may be added to the soup. 169. CALF'S HEAD SOUR Scald a calf's head, clean, wash, and soak in water, so as to make the skin white, put on the fire in cold water, boil for half an hour, take it out of the pot, and put it in cold water, cut it up in nicely shaped fillets, and boil in strong broth until done. Put a quarter ol a pound of butter in a sauce-pan, add as much flour as the butter will take up, brown it in the butter, stir in sufficient brown, strong broth, and a pint of red wine, to make the sauce of proper consistency, but it should not . be too thick. The soup must boil from one to two hours, and the fat taken off promptly ; it is then poured through a hair sieve, and added to the cut-up calf's head, with small forced dumplings, the hard boiled yolks of a few eggs, a little cayenne pep- per, and half a pint of Madeira. It is then ready for the table. 170. LIVER SOUP. Take a calf's liver, scrape it very fine into a mass, place in a dish, stir in three or four tablespoonsful of fine flour and ten eggs, and throw it in boiling broth with a spoon. The liver is apt to become hard, if not put on the table at once. iyi. SOUP a la REINE. For forty persons take three hens ; after being properly cleaned, the meat is cut off the breast, and the rest of the bones are cut up small ; APPENDIX. 767 three-quarters of a pound of butter is put in a stew-pan, six large table- spoonsful of flour browned yellow in it, mixed with strong broth, and boiled with the cut up chicken bones for two hours. The soup is then forced through a fine hair sieve, the yolk of eggs and Madeira wine stirred in, poured over the little balls prepared from the breast of the chickens, and sent to the table. 172. FISH OR LENT SOUP. The fish must be scaled clean, washed and skinned. They are then cut up nicely, dipped in flour and eggs, and baked in hot suet until of a nice yellow color ; after the fat has dripped off, they are put in a soup tureen, and put aside for use. Put in a stew-pan a piece o,f butter, add nice roots, such as carrots, celery tops, onions, some savoy, turnips, leeks, and parsley root. All this is stewed together slowly, then boiled with the bones and heads of the fish, some pep- per corns, five or six large, sliced potatoes, and one and a half gal- lons of water and salt, strained through a fine sieve, and added to the fish. 173. OYSTER SOUP. Open forty or fifty oysters, save the water contained in the shells, brown in butter a few tablespoonsful of flour, add one gallon of strong broth, a pint of good white wine, the juice of one lemon, and the strained water saved from the oysters, let it boil well j then stir in the soup the yolk of four eggs, add the oysters, and they are ready for the table. 174. OYSTER SOUP WITH MILK. Take twelve oysters, half a pint of water, and half a pint of milk, half an ounce of butter, and a quarter of a pound of crackers, either whole or crushed. Bring the water and oysters to a boil, add half a pint of boiling milk, then the other ingredients, with a little salt or pepper ; do not let it boil longer than from four to six minutes ; it is then ready for the table. 175. BRAIN SOUP. Two calf s heads are put in lukewarm water, and skinned. After they have been well watered, and the water drained, they are chopped 168 APPENDIX. up fine with onions and parsley, browned in a pound of butter, four large tablespoonsful of flour added, and quenched with as much strong broth as may be required, the yolk of an egg stirred in, and served over toasted bread. 176. SWEET BREAD SOUP. Two sweet breads are put on the fire with cold water, because it draws the blood better than if put on with warm water ; after having boiled soft, they are cut up in nice dice-shaped pieces ; brown finely chopped parsley and onions in butter, add four large tablespoonsful of flour and the sweet bread, and otherwise proceed with them as with brain soup. This soup may be served with toast, or with any kind of dumplings. 177. HASH SOUP. Cold meat, chopped fine, stewed in butter with onions, parsley, and a few large tablespoonsful of flour, and the soup prepared as directed for brain soup. 178. SOUP FOR SMALL CHILDREN. The fourth part of a roll is soaked in water, squeezed through a cloth, and put on coal, after that again stirred with a little water, and finally a little milk and a piece of crushed sugar is added and boiled . 179. ANOTHER. Add to a quarter of a pint of boiling milk, a teaspoonful of arrow root, which has been stirred with cold milk ; the arrow root is added, while the boiling milk is being constantly stirred. Sugar is added according to taste. 180. PEARL BARLEY SOUP FOR THE SICK. Fine pearl barley is boiled with a little boiling water, and a small piece of fresh butter, and the repeated addition of boiling water until soft ; the soup is then seasoned with salt, finely chopped parsley or nutmeg ; in case of weakness of the stomach, the latter is pre- ferable. APPENDIX. 769 181. OATMEAL SOUP FOR THE SICK. Wash good, fresh oatmeal, by stirring it in cold water and drain- ing it. Let it boil with two slices of lemon (from which the peel and seeds have been removed) for one hour in boiling water, and stir through a hair sieve. If the latter cannot be had, let it run through a larger sieve without stirring, and add sugar and very little salt, or give powdered sugar separate with it, because sick people use more or less of it. The lemon must not be added if the patient has pain in in the bowels. 182. ANOTHER KIND OF OATMEAL SOUP. Boil for one hour washed oatmeal in water, with a little salt, and two tablespoonsful of fresh, finely crushed almonds, stir through a hair sieve, and serve with rusk and sugar. 183. RUSK SOUP FOR THE SICK. Finely crushed rusk is boiled with water and one or two slices of lemon, until it does not settle any more ; sugar and a little salt is added, and, with the permission of the physician, the yolk of an egg may be stirred in. 184. BREAD SOUP FOR THE SICK. Half a loaf of wheaten bread is boiled to solution in water, stirred through a hair sieve, boiled with currants, a little salt, sugar, and slices of lemon, until the former have become soft, and, in case it is not interdicted by the physician, the yolk of an egg, with a little wine, may be stirred in. 185. A GOOD SOUP IN CASES OF DYSENTERY AND DIARRHOEA. Half a cupful of pearl barley, which must boil white, is put on the fire in an earthen pot, with a piece of butter of the size of a white bean, a piece of fine white cinnamon, and half a quart of boiling water, and boiled until quite soft ; during the boiling, a little water is added from time to time : the soup is then poured through a sieve, 49 1 710 APPENDIX. boiled up with sugar, and very little salt, and the yolk of a very fresh egg stirred in. The soup must be neither too thin, nor too pappy. Re?nark. The patient may use rice water as a beverage. The mode of preparing it can be found under the head of "Beverages." FRUIT SOUPS. 1 86. LEMON SOUP, ALSO FOR THE SICK. Boil wheaten bread in water quite soft, stir through a sieve and bring it to a boil again, add the juice and the yellow skin of a lemon, which has been rubbed off with a little lump sugar, a small quantity of salt, sugar according to taste, and stir in the yolk of an egg. Remark. The lemon skin and yolk of an egg must be omitted, in case the patient is suffering from fever. 187. STRAWBERRY SOUR Boil finely crushed rusk with water, add wine, sugar and cinna- mon, and if the soup is not sufficiently agglutinated, add a little water mixed with starch or potato flour ; it is then taken from the fire, and a proportionate number of saucersful of very ripe straw- berries stirred in, which must be covered with sugar an hour pre- viously. The soup can be served with slices of rusk or biscuits. Remark. If garden strawberries are used for this soup, a part of them may be boiled with the rusk, and stirred through the sieve ; field berries have sometimes a bitter taste when boiled. 188. SOUP OF FRESH SOUR CHERRIES. Take sour cherries, extract the stones from some of them, and pound in a mortar. Boil the cherries with rusk and a little lemon peel, or two or three cloves, and the necessary quantity of water, until the cherry meat is boiled to pieces ; stir the soup through a sieve, bring it to a boil again, and finish it by adding some red wine (which must not boil through), sugar, a little salt, and cinnamon. Sweet cake may be floated on the soup, or it may be served with rusk. APPENDIX. 771 189. DRIED CHERRY SOUP. The cherries are well washed, put on the fire with oatmeal and some lemon peel. One-third of the quantity of cherries is crushed in a mortar previous to putting them on the fire. In all other respects the cherries are treated in the same way as fresh cherries. 190. APPLE SOUP. This soup is well adapted for patients suffering from fever. Sour apples are boiled soft in water with biscuit or wheaten bread and lemon peel, forced through a sieve, boiled with sugar, salt and wine, and beaten with the yolk of an egg and cinnamon. 191. THE SAME. A soupplateful of sour apples, cut up small, is boiled with a cupful of scalded rice until quite pulpy, forced through a sieve, boiled with sugar, cinnamon, lemon peel arid a little salt, and stirred with the yolk of an egg. 192. THE SAME WITH CURRANTS. Boil some wheaten bread with the apples, force through a sieve, add rye bread fried in butter, currants, a few cloves, and salt, let it. boil a little, and stir in the soup some cinnamom and a tablespoonful of thick cream. 193. THE SAME WITH ANIS. Boil ordinary sour apples until pulpy, and force through a sieve ; stir some flour in milk, add anisseed, the prepared apple pulp, a little sugar, cinnamon and salt, stir over a hot fire until it boils. 194. SOUP OF FRESH PRUNES. Cut out the stones, boil the prunes with water and wheaten bread, until soft, stir through a sieve, boil with some sugar and cinnamon, add wheaten bread fried in butter. 772 APPENDIX. 195 THE SAME WITH MILK. {A very nice Soup for Supper.*) Take a soupplateful of ripe prunes, clean them properly, stir two heaped tablespoonsful of flour in water until smooth, add to it one and a half quarts of milk and a little salt, put it on the fire with the prunes, and let the soup boil for a time, but frequently stirring it, so that the flour may be done ; the prunes may burst open, but must not boil to pieces. If the prunes are ripe, no addition of sugar is needed. The soup is eaten when half cold. 196. PRUNELLO SOUP. {Also for the Sick.) Boil oatmeal thin, and force through a hair sieve, add a quantity of prunellos cut in slices, sliced lemon, sugar, cinnamon and salt. As soon as the prunellos have boiled soft, add a couple of glasses of wine to the soup and stir in one or two yolks of eggs. If wine and eggs are prohibited to the patient, they must be left out. 197. SOUP OF DRIED PRUNES. {Also for the Sick.) The prunes are well washed, rubbed between the hands, boiled until soft with water, lemon peel and some wheaten bread, forced through a sieve, add sugar, cinnamon, and,Jat pleasure, also a glass of wine stirred in, and poured over toast. For sick people, wine, wheaten bread and toasted wheaten bread are omitted. 198. OATMEAL AND DRIED PRUNES. {Also for the Sick.) After having boiled the prunes to a pulp, and the water on the oat- meal changed several times, put each by itself on the fire, boil the meal with a little water until very smooth, pour through a sieve, add the prunes with the water in which they have boiled, a few pieces of cin- namon and two slices of lemon from which the seed has been re- moved, boil until the prunes are quite soft, and season with sugar and salt The soup will then be of a good consistency, but not too thick. APPENDIX. 773 Allow for each person about two ounces of oatmeal, and two ounces or twenty dried prunes. 199. THE SAME WITH RAISINS AND CURRANTS. The oatmeal is boiled and strained as above directed ; for each person allow from one-half to one ounce of picked and washed raisins or currants, add a small piece of cinnamon, a little salt and a slice of lemon, let the raisins boil until very soft, and stir the yolk of an egg and some sugar into the soup ; white wine may be added to the soup according to taste, or a few sour apples may be boiled with the oatmeal and stirred through a sieve. 200. HIP SOUP, ALSO FOR THE SICK. The hips are boiled in water with some rusk or wheaten bread until soft, stirred through a sieve, brought again to a boil, sugar, cinna- mon, and a little wine added, provided the use of the lattei is per- mitted to the patient. 201. THE SAME, DIFFERENTLY PREPARED. A few handsful of hips, one handful of raisins and a cupful of oatmeal are boiled soft, stirred through a strainer, again brought to a boil, some wine, sugar, cinnamon and the yolk of an egg stirred in and rusk added to it. DUMPLINGS. General Remarks in regard to Dumplings. Of the dough prepared for dumplings, one dumpling should be boiled in either salt water or broth for a trial. If the dough is too soft, flour should be added, and, if too hard, an egg. Every house- wife knows that dumplings are best when sent to the table imme- diately after being boiled, as they become heavy by standing for a longer time. It frequently occurs that either baked or boiled dum- plings are put in the soup ; in that case, one-half of the dumplings are boiled and the other half baked in suet until they are of a fine yellow color. Larger dumplings are mostly used for ragouts, but for 174 APPENDIX. plainly kept tables, they are put on the table with salad. Onions, parsley and cives may be omitted, if these vegetables are objection- able. Dumplings remaining over may be fried. 202. BACON DUMPLINGS. The crust of fine rolls is cut off, cut in thin slices and scalded with a pint of boiling milk ; parsley and onions are cut up fine, a quarter of a pound of bacon and the same quantity of smoked ham cut into dice shape, and browned with a piece of butter, and added to the former with half a pound of fine flour, eight to ten eggs, nutmeg and salt. Large dumplings are formed from this, boiled in salt water, and fried with butter and toast. 203. MARROW DUMPLINGS. A quarter pound of rendered ox marrow is stirred smooth with three eggs and the yolks of two eggs, add two soaked, and expressed rolls from which the crust has been cut off, also a little flour ; from this round dumplings are made, put in the broth and slowly boiled. 204. SOUP BISCUIT. Stir half a pound of butter till white, add eleven tablespoonsful of flour, eleven eggs and a little salt. Grease oblong tin-forms with butter, fill with the mass prepared as above, and bake in a moderately hot oven; they may then be cut in any desired shape and used. 205. SOUP BISCUITS OF ANOTHER KIND. The same quantity of butter as above directed, but in place of eleven, sixteen tablespoonsful of flour are used ; a piece of yeast of the size of a walnut is stirred in a cupful of milk, added to the mass, and baked in the same manner as prescribed for the biscuit in the last number. 206. POTATO DUMPLINGS. A quarter of a pound of butter is stirred until light, from six to eight large mealy potatoes, which must be cold, are grated, four APPENDIX. < iD eggs and the yolks of four eggs are added to it, also a French roll bi owned yellow in butter and cut in little squares, salt, nutmeg and a small quantity of parsley. From this either oblong or round dumplings are formed, as may be preferred, thrown into boiling salt water, and served with toasted bread. Should the dumplings remain too soft, a little flour may be added. 207. POTATO DUMPLINGS, DIFFERENTLY PREPARED. Six large mealy potatoes are grated when cold ; four rolls are cut into small squares, half of them browned in butter, until they have a yellow color, the other half is moistened with a little milk. Onions, bacon and parsley are cut up fine, and stewed in butter; all of it is then put in a dish, about half a pound of flour and nine eggs added, and treated as above. 208. DUMPLINGS OF ROLLS. Six rolls are put in soak, stewed with a piece of butter, and a little finely cut-up onions and parsley ; salt and nutmeg are added, and five or six eggs are stirred in. The dumplings are then cut out with a tablespoon, and boiled in salt water. Dumplings left over may be fried. 209. DUMPLINGS OF ROLLS, STEWED. Four rolls are soaked in water, and squeezed out. Parsley and onions, cut up fine, are stewed with a piece of butter, the rolls put in and fried, placed in a dish, and put aside to get cold ; four or six eggs, with salt and nutmeg, are stirred in, and the dumplings put in boiling broth, and covered up. 210. ROLL DUMPLINGS, BAKED. These dumplings are treated as above described, baked in hot suet until of a fine light brown color, and laid on bread or blotting paper to drain. 211. PLUCKED ROLL DUMPLINGS. Half a pound of butter is stirred until light. The sott part is plucked out of eight or ten rolls, and stirred into butter, with ten or ?76 APPENDIX. twelve eggs. Nutmeg and salt are then added, and the whole of it put in boiling broth. If the dough should prove too soft, a little bread, grated fine, is stirred in, in addition. 212. SCALDED DUMPLINGS. One pint of milk is brought to a boil in a pan, a quarter of a pound of butter added, and fine flour stirred in, until the dough loosens from the pan. When the dough has cooled off, from eight to ten eggs are added, and the dumplings put in boiling broth. 213. SCALDED DUMPLINGS, THIRD KIND. Prepare a scalded dough from one pint of water, a quarter of a pound of butter, and one pound of flour, add salt, and stir eggs to it, until of a proper consistency ; the dumplings are then put in boil- ing broth or water. 214. DUMPLINGS OF GRATED BREAD. Half a pound of butter is stirred until light, then stir in twelve eggs, and with each egg a small spoonful of finely grated bread, also salt and nutmeg ; form dumplings from the mass, and put in boiling- broth. 215. GRATED BREAD DUMPLINGS, BAKED. These dumplings are prepared like those above, baked in hot suet, and placed on slices of bread or blotting paper to dry. 216. GROAT DUMPLINGS Put two ounces of fresh butter in a pint of milk ; when it boils, stir into it a quarter of a pound of groat-meal ; the mass must then be stirred until it peels from the pan. When somewhat cooled down, eight eggs are beaten into it, together with a little salt, stir well, cut out small dumplings with a teaspoon, and drop them in boiling broth. 217. BAKED GROAT DUMPLINGS. These dumplings are prepared in the same manner as the above, baked in hot suet, and laid on slices of bread or blotting paper to drain. APPENDIX. 777 2 1 8. MEAT DUMPLINGS. Chop fine one pound of pork and one pound of veal ; then take fine cut onions, parsley, and a quarter of a pound of raw or smoked bacon, cut up in small quares, and stew it with the chopped onions, parsley, and four rolls, soaked in water, in a quarter of a pound of butter. Put the stew in a dish, add the chopped meat, half a pound of flour, and five or six eggs, salt, and nutmeg ; work them up to- gether, and form large, round or oblong dumplings. 219. LIVER DUMPLINGS. A calf's liver is chopped or cut up fine, two handsful of spinage are picked over, and washed clean, together with a little parsley, cut up fine, together with an onion, and stewed with some bacon, cut up in little squares. Four or six rolls are soaked in water, squeezed out, and put in a dish, together with the above ; one pound of flour, nut- meg, salt, and four or six eggs, are mixed with it. Dumplings are then made of it, put in salt water, boiled, and served with buttered toast. 220. LIVER DUMPLINGS OF ANOTHER KIND. These dumplings are prepared in the same manner as those above, with this difference, however, that the rolls are not soaked in water, but sliced fine, and moistened with a little lukewarm milk ; a little cold meat, cut up fine, may be added to it. VEGETABLES. Remarks. The first vegetables which spring brings us are hops, followed by asparagus, carrots, peas, beans, rape-cole, &c. All these vegetables require great promptness, particularly as all of them form a favorite dish on the dinner table of German families. Green vegetables, after being prepared with the greatest care, must be boiled in a great deal of water, which has been previously boiled and salted. After having been boiled, they are placed in a suitable vessel, which is filled with cold water, for the purpose of drawing out the green raw taste The vegetable must look better on the dish than what it 778 APPENDIX. did when picked. An industrious cook will never avoid the trouble of preparing in the most careful manner, according to rule, even the most simple vegetable, for which she will, no doubt, always receive much praise. 221. HOPS. After the hops have been broken off, they are washed and boiled soft in boiling water, which is done very quickly. They are then thrown in a strainer, and a few pints of cold water poured over them ; a rich butter sauce is then prepared, which, when boiled, is drawn with the yolks of a few eggs, and a little lemon juice. The hops are then boiled up in it once, and sent to the table with half soft, so- called five minute eggs. 222. ASPARAGUS. The lower part of asparagus, where it has been cut off, is scraped or peeled. It is then tied in bundles, and boiled in salt water, but not too soft, so that the heads may not break off. In the meantime, prepare a sauce from a quarter of a pound of butter and three large tablespoonsful of flour ; to quench, take one-half broth, and the other half asparagus water; after being well boiled, it is stirred with the yolks of four eggs, and the juice of one lemon. The aspar- agus is placed on a cloth to drain, laid properly upon a dish, and the sauce served separately. 223. CARROTS. The green heads and fine roots of this vegetable are trimmed off; they are then boiled in salt water until they can be peeled like almonds ; after being peeled, they are washed in cold water, placed on a strainer to drip off dry ; then put in a stew-pan a piece of butter, a tablespoonful of sugar, parsley, and onions, cut up fine, and stew the carrots in it until soft, sprinkle a little flour over them, and after having cooked for ten minutes more, they are ready for the table. 224. CARROTS AND GREEN PEAS. Shell some green peas, pick them, and wash them, throw them in cold water, and boil until soft ; put a pot on the fire, containing a APPENDIX. 779 piece of butter, a tablespoonful of sugar, some parsley and onions cut up fine ; the peas are then placed in the middle of the carrots, which are prepared in precisely the same manner as directed in the preceding number, dished, and sent to the table. 225. CRUMBLED PEAS. Shell some green peas, and pick them, boil them in salt water until soft ; care should be taken to preserve their fine green color. They are then thrown on a sieve, and flooded with cold water. In the meantime, stew for two minutes in a stew-pan a large tablespoonful of flour, with a piece of butter, and some parsley and onions, cut up fine, quenched with the necessary quantity of broth, and spiced with nutmeg ; the peas are then thrown in, and boiled up a few times. Tney are sent to the table with fricandean. 226. DRIED PEAS. The peas, after having been picked, are soaked in soft, cold water over night, washed on the following morning, and put on the fire in cold water. When nearly boiled soft, they are seasoned with the necessary quantity of salt, and with as much ground pepper as will lie on the point of a knife. Two ounces of butter and the same quantity of pork are put on the fire, and three large tablespoonsful of flour, with one tablespoonful of onions, cut up fine, are browned to a light yellow color. The peas are are then pressed through a hair sieve, boiled up with the browned flour and onions, and sent to the table, with fresh liver pudding. 227. STRING BEANS. After being stripped of the stringy part, the beans are cut up lengthwise in very fine slices, washed clean, placed in boiling salt water, and boiled until soft. They are then put on a sieve or strainer, and cold water thrown over them. In the meantime, a yellowish brown sauce is prepared from a piece of butter, or good suet, and two large tablespoonsful of flour, to which is added parsley, onions, summer savory, and a little garlic, all of v.hich is cut up fine, to which is added the necessary quantity of broth, the beans put m, 780 APPENDIX. and the whole spiced with nutmeg. Let it boil up a few times, and send to the table with grilled breast of mutton. 228. WHITE BEANS. After being picked, soak them in cold water over night, wash them in the same water on the following morning, and put them on the fire with cold water. When about half done, add the necessary quantity of salt, and boil them until soft. Two ounces of butter and the same quantity of lard are heated in a pan, three large tablespoonsful of flour and one tablespoonful of fine cut onions are browned in it until of a light yellow color, quenched with the necessary quantity of broth and half a pint of vinegar, and poured over the beans. Add as much white pepper as will cover the point of a knife, and let them boil for a quarter of an hour more. They are then ready for the table. 229. GREEN RAPE-COLE. The leaf part of this vegetable is stripped off and washed, boiled in salt water until soft, and put in cold water. The rape- cole is peeled, and also boiled in cold water. The green part is pressed in a cloth, and finely cut up, and the rape-cole cut in thin slices ; a butter sauce is prepared, and spiced with nutmeg ; to one-half of this sauce the sliced rape-cole is added, and to the other half the chopped greens. After each for itself has been well boiled, the rape-cole is first placed on the dish, and the greens put in the centre. 230. CURLED SAVOY. Caterpillars and snails like to live in the heads of the cabbage species ; it is therefore particularly necessary that they should be most carefully cleaned. The heads of the curled savoy are cut asunder, carefully picked over, and the coarsest ribs removed from them ; they are then washed through several waters, boiled soft in boiling salt water and a small quantity of fat, thrown into cold water again, firmly squeezed out, and cut up fine. An onion, cut up fine, is stewed in a stew-pan with a quarter of a pound of butter, until very soft, and eight large tablespoonsful of flour and the savoy added ; the APPENDIX. 781 whole is then well stewed, broth being added as required, and seasoned with nutmeg and salt. After the vegetable has boiled slowly for half an hour, it is ready for the table. 231. STEWED CURLED SAVOY. The cabbage is cut into four parts, boiled in salt water until half done, placed on a sieve, and drenched in cold water. Place a piece of sweet butter in a stew-pan, add the cut-up cabbage, pour a soup- ladelful of broth over it, cover up close, and stew until done. It is served with the juicy gravy of the meat, and a shoulder of mutton. 232. WHITE CABBAGE. The white cabbage is stripped of its outside leaves, the head cut into seveial strips, washed clean, and boiled soft in salt water. It is then placed on a sieve, cold water thrown over it, squeezed closely, and cut fine ; the cabbage is then boiled in a rich butter sauce, and put on the table with fresh sausages. Whoever fancies the taste, may add some caraway ; it gives it a rich flavor. 233. STEWED WHITE CABBAGE, The cabbage is cleaned and washed, cut in strips, and boiled in salt water until half done ; the cabbage is then put in a stew-pan with a quarter of a pound of buUer, a little salt, and a soupladleful of broth, and stewed until done ; it is then placed on a dish, and sent to the table with butter sauce or roast meat gravy. 234. BAVARIAN CABBAGE. The cabbage is cleaned and, bored out, cut as fine as possible on a cabbage cutter, and sightly salted. Put in a stew-pan four ounces ot butter, and the same weight of lard, add two tablespoonsful of sugar and onions, the latter cut lengthwise in very fine slices, and browned until of a fine chestnut color the cabbage is then added to it, a glass of good vinegar and a glass of wine thrown in, and stewed, with fre- quent stirring, until done. Sprinkle two large tablespoonsful of flour over it, add two tablespoonsful of sugar coloring, let it boil ten min- utes longer, and serve with fillets of pork. 782 APPENDIX. 235. SPINACH. Spinach is cut off at the stem, carefully picked and washed clean ; it is then boiled in salt water, well soaked in cold water, pressed out and chopped fine. An onion cut up fine with a quarter of a pound of butter is stewed in a stew-pan, three large tablespoonsful of flour and the spinach are then added and stewed for five minutes ; strong broth and the juice of roast meat are poured over it and boiled, seasoned with salt and nutmeg, put in a dish, and dressed with baked eggs. It is then ready for the table. 236. SPINACH PREPARED IN ANOTHER STYLE. The spinach, after having been cut up fine, is worked into a fine mass in a mortar ; a rich butter sauce is then prepared, properly seasoned with salt and nutmeg, and well boiled; the spinach is then stirred into it. After having boiled up once, it is kept warm in boil- ing water, until placed on the table. 237. CAULIFLOWER WITH BUTTER SAUCE. The beautiful flowers should remain whole, if possible ; all blossoms should be cleaned from the seams and the hard covering of the stems pulled off. The cauliflower is then boiled soft in salt water and a piece of butter, and then taken out of the water ; after being somewhat drained, it is sent to the table with a butter sauce prepared with the yolk of an egg and lemon juice, and mixed, with a small quantity of the cauliflower water. 238. TURNIPS. The turnips are peeled, cut in slices, formed into oblong strips, and boiled in salt water until soft. Brown in a stew-pan a quarter of a pound of butter, three large tablespoonsful of flour with a table- spoonful of fine cut onions, until it has the color of a chestnut, then throw over it good broth and the juicy gravy of roast meat; let the turnips boil up in it, and they are ready for the table , a roasted breast of mutton may be served with it. APPENDIX. 783 239. BLACK ROOTS. The roots are washed, and after the skin has been scraped from them, they are rinsed in cold water. Two large tablespoonsful of flour are stirred with half a gallon of water until smooth, one pint of vinegar is then poured in, and each single root, as soon as scraped and rinsed, is cut into pieces of the thickness of a finger and put in the prepared water, so that it may not turn red until the whole of them are cleaned. The roots are then taken out of the broth, boiled soft in salt water with a piece of butter, and served with a butter sauce. 240. ROSE COLE. This is broken from the stems and, if possible, cleaned up alike, boiled in salt water, thrown on a sieve and rinsed with cold water. Prepare a butter sauce from a quarter of a pound of butter, one onion cut fine and two large tablespoonsful of flour ; quench with one quart of broth, seasoned with salt and nutmeg. When well boiled, the cole is thrown in, boiled up once with the juicy gravy of the meat, and it is ready for the table. 241. RED OR BLUE CABBAGE. It is cleaned and cut up fine like the Bavarian cabbage, and at once sprinkled with a little vinegar, which causes its color to remain a fine red. It is then treated like the Bavarian cabbage. 242. SOURCROUT AND SMOKED PORK. The sourcrout is put on the fire in cold water, and a piece of goose fat or bacon added to it ; a piece of smoked pork is boiled in it, and when done, it is taken out. A piece of pork fat is heated and a sliced onion browned on it until of light yellow color; x few table- spoonsful of flour are then added to it and boiled up a few times. This is then stirred in the sourcrout, boiled for a quarter of an hour, and sent to the table with the smoked meat. 784: APPENDIX. 243. LENTILS. The lentils are carefully picked, soaked over night in soft water, washed out of that water in the morning, and put on the fire with cold water. When done, two ounces of lard and the same weight of butter are put in a pan, and three large tablespoonsful of flour and an onion cut up fine are browned to the color of a chestnut, and quenched with half a pint of vinegar and broth, and also a little meat juice. ■ The lentils are thrown on a sieve to drain, put in the sauce, seasoned with salt and white pepper, boiled up a few times, and served with lightly smoked sausages. 244. POTATO CHIPS. The potatoes are washed clean, peeled, cut into nice chips and thrown in a dish of water. Parsley and onions, cut up fine, are stewed in a stew-pan with a quarter of a pound of potatoes, stirred a few times with two tablespoonsful of flour, and quenched with broth. The potato chips are washed in a sieve and boiled in the sauce until they are done, seasoned with the necessary quantity of salt and nutmeg, and served. 245. FRIED POTATOES. The potatoes after being boiled, are cut in slices, fried nicely in but- ter, and salted ; fine cut onions may be fried with the potatoes, if liked. 246. BAKED POTATOES. The potatoes are peeled, sliced, or otherwise cut up, baked in hot lard to a nice yellow color, and put on blotting paper to drain ; they are then sprinkled with salt and white pepper, and sent to the table hot. SIDE DISHES FOR VEGETABLES. Remarks. Side dishes cannot always be selected to suit individual tastes, as they must be adapted to the vegetables. For herbaceous vegetables, fat kinds of meat may be selected ; for legumes, moslty smoked meats, sausage or tongue ; salted pastry dishes are usually accompanied by fricasseed meats. It is not always the case, however, that vegetables are served with small meats as side dishes, they are oc- casionally accompanied by roasts. APPENDIX. 785 247. VEAL CUTLETS. Of the ribs the ridge is cut away, each rib is separated, the lower half of the rib stripped of meat and the skin separated ; the meat is then boiled and nicely shaped ; the ribs are then well salted, dipped in eggs and dried, finely powdered in wheaten bread or in finely grated crumbs of bread, turned over and fried in melted suet, which must be very hot, until they are of a fine yellow color. 248. LARDED SWEET BREAD. The sweet bread is put on the fire with cold water. When the water becomes heated, it is poured off ; this is repeated several times until the sweet bread becomes entirely white, when the water may be permitted to boil up several times ; they are then put in cold water, trimmed clean, larded, and prepared in the same way as larded cut- lets. 249. GRILLED SWEET BREAD. After the sweet bread has been boiled as directed, they are cut in slices, dipped in egg and grated bread, and baked of a fine yellow color. 250. BAKED CALF'S HARSLET. The harslet is rubbed hard with a handful of salt, in order to sepa- rate the slime ; it is then washed through several waters, and boiled in salt water until soft ; it is then taken out of the water and placed on a board to drain, and baked in swimming-hot suet. 251. BAKED BRAINS. The brains are stripped of the pellicle and soaked in lukewarm water, boiled for half an hour in broth, and laid on a sieve to dry, dipped in egg and rolls or grated bread, and baked in suet until of a yellow color. 252. BAKED CALF'S HEAD. After soaking the calf's head thoroughly, it is boiled with carrots in salt water, boned, cut in nice pieces, dipped in eggs and grated bread, and baked in hot suet. The head may be left entire ; the treat ment remains the same as when cut up. 50 786 APPENDIX. 253. BAKED CALF'S FEET. They are boned and boiled soft like the head, taken from the water and placed on a board, cut crosswise in any sized pieces, dipped in scalded dough, and baked yellow in swimming suet. 254. GRILLED BREAST OF MUTTON. A breast of mutton is boiled in salt water with a few bulbs of gar- lic, cut into oblong squares, dipped in eggs and grated bread, and baked in hot suet. 255. CALF'S TONGUE. After the tongue has been boiled and skinned, it is cut crosswise in slices of the thickness of a finger, which are covered with herbs in the same manner as cutlets ; they are then wrapped in double white paper of the size of a hand, which has been dipped in olive oil, and broiled on the gridiron on both sides, until of a yellow color. 256. BAKED FROG LEGS. Wash and dry them in a cloth, interlace them, salt, dip and bake in hot suet. 257. BAKED FROG LEGS, DIFFERENTLY PREPARED. Prepare the frog legs and salt them, dip in egg and grated rolls, and bake in suet. 258. BAKED PIGEONS. Pick, singe, and draw the pigeons, wash them clean, cut up to suit, boil up once in broth, dry them well, dip in egg and grated rolls, and bake in suet. 259. BAKED CALF'S LIVER. Skin the liver, wash clean, dry and cut in slices of the thickness of a finger, dip in grated bread, and bake quickly in hot suet ; it is then salted, and that it may remain tender and not become hard, it must be put on the table with the juice of roast meat. APPENDIX. 787 260. STEWED CALF'S LIVER. Cut in slices, as for baked calf's liver, put in a pan a quarter of a pound of butter, dip the liver in flour and in the butter on both sides, and fry. The butter is then poured off, a soupladleful of juice of roast meat poured over the liver, and stewed for five minutes. It is then put on a dish, and the roast meat juice in which it has been stewed, poured over it. 261. STEWED CALF'S LIVER, AFTER ANOTHER FORM. After the skin has been carefully removed from the liver, it is larded with bacon, of the thickness of a finger, and stewed with butter, onions, carrots, lemons, one laurel leaf, a few cloves, and some pepper-corn. A sauce is prepared with a little flour, which has been brought to a boil with a glass of wine. It is then ready for the table. 262. MUTTON CHOPS. The ridge of the rib part is cut off, as for veal cutlets, and the ribs nicely cut apart ; the meat is stripped from the lower part of the ribs, pounded, and shaped. Salt and white pepper is then sprinkled on them, and broiled in hot butter, quenched with roast meat juice, and stewed close, so that the chops may have a nice appearance. They are then nicely ornamented, some lemon juice dripped on them, and some roast meat juice poured over them. 263. GRILLED MUTTON CHOPS. After being properly prepared, they are dipped like the veal cutlets in eggs and grated bread, turned over, and fried in buter. 264. BROILED MUTTON CHOPS. After having been prepared as above directed, they are dipped in olive oil, and broiled on the gridiron, lemon juice squeezed on them, and sent to the table with roast mutton juice. ?88 APPENDIX. t 265. STEWED GOOSE LIVER. For this purpose a fi eshy, not too fat, goose liver must be taken, and cut in suitable slices, fried in butter, and sent to the table with lemon juice. 266. GRILLED PIGS FEET AND EARS. Pigs feet, after being boiled soft, are boned, dipped in melted but ter, and crumbs made from rolls, and quickly fried in hot lard. Pigs ears are treated in the same way, but must be pressed by being weighted down for some time between two little boards after being boiled, ere they are dipped in eggs and roll crumbs, and baked. 267. GRILLED PORK CHOPS. The chops, after being pounded and salted, are dipped in beaten eggs and roll crumbs, as directed for veal cutlets, and baked in hot suet. 268. BROILED PORK CHOPS. They are cut and trimmed like mutton chops or veal cutlets, pounded and salted, and nicely shaped, dipped in olive oil, and broiled on a gridiron over coal. 269. SNOW PANCAKES. For one pancake, two large tablespoonsful of flour are stirred into a quarter of a pint of milk, worked until smooth, and salt added to it ) the yolks of two or three eggs are then added, the white of one egg beaten to a froth, and lightly mixed up with it. Melt fresh beef suet in a pan, put the pancakes in it with a spoon, and bake them swimming in it. 270. ORDINARY PANCAKES. The same quantities of the ingredients above mentioned are taken, with the difference that the whole of the eggs are used, in place of beating the white of one egg to a froth. 271. BAKED SLICES OF BREAD. Cut up a loaf of milk-bread lengthwise, dip in milk, and lay the slices in a flat pan alongside of each other ; two eggs are stirred with APPENDIX. 789 a little salt, the slices of milk bread dipped into it, and baked in hot suet until of a yellow color. 272. THE SAME PREPARED DIFFERENTLY. Cut ordinary rolls and moderately thick slices, and dip in milk. Mix a moderately light pancake batter, dip the sliced rolls into it, and bake in hot suet until of a fine yellow color. 273. BAKED EGGS OR OX EYES. Melt butter in a pan, break eggs into it, according to requirement, one egg alongside of the other ; care should be taken that the yolks do not break up. After remaining in the pan for two minutes, they are put in a dish, and a little salt, pepper and cives sprinkled on the yolks of the eggs. 274 HAM AND EGGS. Put a small piece of butter in a pan, add the slices of ham, and break over them a sufficient number of eggs to cover the whole of the ham. When the white of the egg has become solid, the ham is ready for the table. 275. BAKED FISH. Scale and take out the inside of the fish, wash them clean, salt them thoroughly, and envelop them in flour; dip them in eggs, sprinkle them well with roll crumbs or finely grated bread, and bake them in hot suet until crisp and of yellowish-brown color. Bake quickly green parsley in the suet, so as to retain its green color, and place it on the fish with slices of lemon. BEEF. BOILED AND ROASTED BEEF. Remarks. The hind quarter of beef furnishes the best pieces for the table. The breast part is used for boiling, and also for corning and smoking. The loin part is the finest ; the ribs are used for roast beef, the latter being also used for other purposes. The loin part is used for a roast, and also for steaks and stewed meat. The chuck rib 790 APPENDIX. is very profitable for ordinary table use ; it does not furnish a clear broth, however. The shank makes the best broth, and is usually used for that purpose. Be particular in using meat only that has been kept for forty-eight hours; newly-killed meat is never good. All meat put on the fire should be pounded. If boiled meat is to be savory, juicy, rich, and nutritious, it must be put on the fire with boiling, and not with cold, water ; meat prepared in this way, does not furnish as strong a broth, because the juice is retained in the meat. 276. RUMP PIECE, BOILED. Take four pounds of the rump, pound it, and place on the fire with two gallons of water. As soon as it begins to boil, it must be care- fully skimmed. The necessary quantity of salt, a bunch of celery, leeks, parsley root, and a carrot, are tied up together, and put in the broth with an onion ; the boiling is then slowly continued for three hours, and the result will be a strong broth. The meat must remain in the broth until sent to the table. 277. RUMP PIECE, STEWED. Pound a rump piece thoroughly, rub in salt, and put it on the fire with two ladlesful of cold broth or water, six cloves, six pepper-corns, one laurel leaf, two onions, and one carrot, and stew slowly for four hours. As soon as it is' done, it must be placed on a dish or carving board, in order to pour off the fat ; a large tablespoonful of flour is sprinkled in the gravy, a glass of wine and a little broth are added, and boiled up with the gravy, then strained through a hair sieve, and the meat put back in it. 278. ENGLISH ROAST. A flank piece is boned, well pounded, salted, sprinkled with cayenne pepper, rolled up, and tied evenly with pack-thread. Two onions, one carrot, two slices of celery, six cloves, eight pepper-corns, one laurel leaf, and two slices of lemon, are put in a stew-pan, the tied roast put in, and a quarter of a pound of butter, with a ladleful of broth, added. In case broth is not at hand, the same quantity of water may take its place. As soon as the roast is done, and has a APPENDIX. 791 fine yellow color, the fat is poured off, and sent to the table with the gravy which it has made. The roast may be garnished with cold, scraped horseradish, and sent to the table with potato dumplings. 279. ENGLISH ROAST OF ANOTHER KIND. Six or eight pounds of flank are tied with pack-thread, and shewed in a stew-pan with onions, carrots, a quarter of a pound of butter, and a quart of broth. When the gravy is browned to a nice yellow color, the fat must be poured off, the meat is garnished with vege- tables, and sent to the table with the gravy which it made. 280. ROAST BEEF. Cut thin slices from the ribs, and let it brown with a piece of but- ter and cut-up onions. When nicely browned on both sides, add the juice of roasted veal and lemon juice ; the roast is then sent to the table with round or sliced fried potatoes. 281. LARDED BEEF Take a piece of the round, and trim nicely. Procure good, smoked bacon, cut up into nice thin slices, and cut the slices in nar- row strips, lard the beef in straight rows, and place it in a pan with onions, carrots, one laurel leaf, four cloves, eight pepper-corns, four slices of lemon, and a quarter of a pound of butter. During the time the meat is roasting, it is constantly basted with its own gravy; a glass of wine and a large tablespoonful of flour is added to the gravy, and the meat sent to the table with maccaroni. 282. LARDED BEEF DIFFERENTLY PREPARED. The meat is prepared and roasted as directed in the preceding num- ber, with this difference only, that sour cream is added to the gravy. When the gravy has boiled hard, it is passed through a hair sieve, and kept hot until required for use. It is sent to the table with mac- caroni. 283. BEEFSTEAK. Cut from the round, crosswise, a slice of meat of the thickness of two fingers, pound it until expanded to the thickness of one finger, 792 APPENDIX. salt, and shape it. One ounce of butter is melted in a flat pan, the salted meat put into it, slowly roasted, and turned over. When browned on both sides, beef juice is poured over it, and it is ready for the table. 284. BEEFSTEAK, ENGLISH FASHION. The steak is prepared in the same manner as above, but it must be broiled over a quick fire, and must be somewhat rare in the centre ; it is sent to the table with lemon juice, a little juice of the meat, and small potatoes. 285. GRILLED BRISKET. Boil until done a nice piece of brisket, then rub it with pepper and salt, cover with egg, and sprinkle with flour, bake in hot suet until brown, or broil on the gridiron until brown, and send to the table with gravy and potatoes. 286. BEEF TONGUE WITH CAPER SAUCE. Brown gravies left over are best adapted for that purpose, when boiled with onions chopped fine, and browned in butter and a little good vinegar. It is then passed through a sieve, the tongue put into it, and before it is ready to be put on the table, one ounce of capers are added to the gravy. 287. ROASTED BEEF TONGUE. After the tongue is well boiled, skin it, cut in slices of the thick- ness of a finger, sprinkle with salt and pepper, dip in egg and grated bread, and bake in hot suet. Before putting on a dish, squeeze lemon juice over it. 288. PICKLED AND SMOKED BEEF TONGUE. A beef tongue is rubbed hard with one ounce of saltpetre and half a pound of salt, put in a stone jar, covered up with a cover, which must be weighted down, where it must remain for fourteen days, but it should be turned over frequently. After it is taken out of the jar, it is smoked, or it is boiled, when taken out of the pickle. APPENDIX 793 The tongue should always be skinned while hot; when cold, it is hard to remove. 289. BAKED BEEF. Remnants of beef are cut up in nice pieces and rubbed with fine salt and pepper. Stir until smooth a large tablespoonful of flour in a little milk, add two eggs, a little salt and onions cut up fine ; dip the cut-up meat in this and bake in hot suet. 290. ROASTED BEEF. The beef prepared as above directed is dipped in eggs and flour and roasted in butter. The same kind of meat may be stewed in butter with onions cut up fine. 291. BEEF'S BRAIN. Place the beef's brain in warm water, skin, wash, and boil for half an hour in vinegar mixed with the same quantity of water, to which are added onions, carrots, four cloves, six pepper-corns, two slices of lemon and one laurel leaf; it is sent to the table with a mustard sauce. 292. BAKED BEEF'S BRAIN. A beef's brain, prepared as above directed, is dipped in eggs and flour and baked in hot suet until it is of a fine yellow color. 293. BEEF'S PALATE WITH ANCHOVY SAUCE. Clean a beef's palate, cut off all the black parts, and boil until soft in salt water. Parts of it are cut out at pleasure and boiled with anchovy sauce for a quarter of an hour more, seasoned with a little cayenne pepper, and sent to the table. 294. TRIPE. Tripe is very carefully cleaned, thoroughly soaked in water, and boiled until soft, cut up in strips or little squares, browned with onions and butter, and eaten with potatoes or a sour sauce. 794 APPENDIX. SAUCES AND BUTTER. The preparation of sauces is of great importance in cooking, and ought to be carefully and promptly attended to. After having been prepared for use, keeping them warm is of much consequence ; par- ticularly is this the case with egg-sauces, which are very apt to coagu- late. It is best to put the sauce in a moderately deep stew-pan, which is placed in a somewhat deep frying pan ; the latter being filled half full of water, is placed in a warm place on the stove, where it remains until required for use. Before sending them to the table, they must be thoroughly stirred up. Stock Sauces. 295. BROWN SAUCE. Put half a pound of butter in a stew-pan, and when somewhat melted, add eight large tablespoonsful of flour, which is then browned to a chestnut color. This is then quenched with sufficient cold broth and brown broth until the sauce has become fluid ; it is stirred on the fire until it boils, set back, and permitted to boil slowly for two hours. The fat is then taken off, the sauce strained through a hair sieve, and stirred until cold. The sauce must be smooth, and neither too thick nor too thin. This sauce can be used as a foundation for all kinds of brown sauces ; it is seasoned and spiced when prepared for use. During the winter, this stock sauce may be kept for a long time, and the oftener it is boiled up, the finer it becomes. 296. WHITE SAUCE. The same quantity of butter and flour is taken for this sauce as is prescribed for the preceding brown sauce, but it must be but very slightly browned, so that the sauce may remain white. This sauce is quenched with entirely clear broth ; it is also boiled for two hours, and finished in precisely the same manner as the brown sauce. It is used as a foundation for all white sauces. Sauces for Beef. These sauces are given not only with ordinary beef, but also as sauce for ragouts. To all these sauces the following spices are APPENDIX. 795 added : four cloves, six pepper-corns, one laurel leaf, and two thin slices of lemon. 297. YELLOW MUSTARD SAUCE. Slice an onion, and stew in a quarter of a pound of butter until of a light yellow color, brown in it three large tablespoonsful of flour for two minutes, quench with broth and a little vinegar, add two spoonsful of mustard and spice, and let it boil up ; press all of it through a hair sieve, and stir in the yolks of two eggs and the juice of half a lemon. 298. BROWN MUSTARD SAUCE. Take strong brown sauce, add two tablespoonsful of mustard and a little red wine and spice, and boil it up. 299. WHITE ONION SAUCE. Put two ounces of butter on the fire, slice a large white onion, and stew in the butter until soft, add two large tablespoonsful of flour, quench the whole with one pint of broth and four tablespoonsful of vinegar, and let it boil up with spice. 300. BROWN ONION SAUCE. Brown one onion, cut in thin slices, with a quarter of a pound of butter and four large tablespoonsful of flour, until of fine chestnut color, quench with vinegar and broth, and let it boil up with spice. 301. HORSERADISH WITH BROTH. Two sticks of horseradish are peeled and grated, stewed in a quarter of a pound of butter, with three large tablespoonsful of flour, quenched with clear broth, salt and mace are added, and then boiled up. 302. HORSERADISH WITH MILK. It is treated like horseradish with broth, in the preceding number, with the exception that in place of all broth, one half of sweet cream and a little sutrar are taken. 796 APPENDIX. 303. HORSERADISH WITH ALMONDS. After the horseradish has been boiled with cream and sugar, finely pounded almonds are added in quantities to suit, which are kept boil- ing with it for a quarter of an hour. 304. TOMATO SAUCE. Place six or eight tomatoes in rich butter sauce, let them boil thoroughly, press them through a hair sieve, and add a sufficient quantity of lemon juice. 305. MIXED SAUCES. A little parsley, a few eshalots, vinegar pickles, mushrooms, and capers, are chopped up fine together, steamed with two ounces of butter, brown sauce poured over them, boiled up once, and put in a warm place until used. 306. PARSLEY SAUCE. Finely chopped parsley and onions are stewed in a quarter of a pound of butter; after five minutes, four large tablespoonsful of flour are added and stewed, frequently stirring with the parsley and onions, and the whole quenched with four tablespoonsful of vinegar and one pint of broth. One laurel leaf, one slice of lemon, three cloves, and a few white pepper-corns are then boiled up with it, and the sauce kept warm until used. 307. BUTTER SAUCE FOR CAULIFLOWER. Prepare a rich butter sauce from a quarter of a pound of butter and four tablespoonsful of flour. The flour should be stewed in the butter only for a moment, and should be at once quenched with one quart of strong broth, and boiled up together with a soupladleful of the water in which the cauliflower is being boiled ; the necessary salt and nutmeg is then added. The yolks of four eggs are beaten with lemon juice, and stirred into the boiled sauce, run through a hair sieve, and kept warm until required for use. APPENDIX. 797 308. BUTTER SAUCE FOR ASPARAGUS. This sauce is prepared in precisely the same way as the above for cauliflower, with this difference, however, that asparagus water is used in place of cauliflower water. 309. HORSERADISH. One stick of horseradish is peeled, grated, and stirred with white crushed sugar and vinegar. 310. HORSERADISH WITH ORANGES. Grate the horseradish, and sweeten with sugar, add the juice of an orange, and the outer skin of the orange, rubbed off with sugar, also a little vinegar, and stir thoroughly. RAGOUTS AND ROASTS. VEAL. Remarks. Veal is a meat indispensably necessary for the table ; it helps to fill many a gap on a bill of fare, by the variety of ways in which it may be prepared. There is scarcely any part of the calf which an inventive and skillful cook cannot transform into a delicious dish, by the extensive art of cooking. It must be regretted, how- ever, that this useful animal is exposed to many tortures, deteriorat- ing to the quality of the meat. Neither is time granted for the meat to get its proper flavor and strength, as the calf is frequently slaughtered when one or two weeks old, while in reality the meat acquires strength, #nd becomes of good quality in from six weeks to three months. 311. CALF'S HEAD WITH MADEIRA SAUCE. A fine calf's head is cut off a hand's width behind the ears, scalded, boned, and soaked in water ; it must be entirely white when it reaches the kitchen. It is best prepared by the butcher. It is placed on the fire with cold water. After having boiled up once, it is placed in cold water, and cut into oblong squares of suitable size. It is again placed on the fire with three quarts of strong broth, one pint of white 798 APPENDIX. wine, half a pint of vinegar, one laurel leaf, two large slices of lemon, six cloves, eight white pepper-corns, two slices of onion, and one carrot, and boiled until done. In the meantime, from sixteen to eighteen eshalots are chopped fine, stewed with a piece of butter, and boiled up with a little Burgundy wine ; at the expiration of a quarter of an hour, two soupladlesful of brown sauce are added, with half a pint of strong meat gravy, and it is then permitted to boil for half an hour. It is then poured through a hair sieve, and eight mush- rooms, and the same number of truffles, cut up fine, and stewed until done in butter with lemon juice, and sufficient cayenne pepper to cover the point of a knife is added ; the sauce is kept boiling gently until wanted for the table. Small dumplings are then prepared from chicken or veal, and boiled in salt water, poured through a hair sieve, and added to the sauce. The pieces of calf's head are then placed on a cloth, put upon the dish, and dressed ; it looks very pretty if the ear is nicely scalloped, and placed in the middle. The prepared sauce with its contents is poured over it. The edge of the dish is ornamented with bread, cut in triangular pieces, and baked in hot suet until of a light brown color, and garnished on the inside with hard-boiled eggs. 312. CALF'S HEAD WITH HORSERADISH. The calf's head is cleaned, as directed in the preceding number, washed, and boiled, cut up in suitable pieces, placed on the dish, sloping from the centre to the rim of the dish ; some strong veal- gravy is poured over it, and sent to the table with grated horseradish, prepared with vinegar and sugar. 313. BAKED CALF'S EARS. Calf's ears, after having been properly cleaned, are boiled like a calf's head, placed on a table to drain, covered with flour, dipped in eggs and roll crumbs, and baked in hot suet until they are of a fine brownish-yellow color. 314. CALF'S BRAIN WITH SAUCE. For one dish, six whole calf's brains are required ; the pellicle is taken off in warm water, then placed in cold water until the blood is entirely soaked out. They are then put in a stew-pan with two quarts cf APPENDIX. 799 water, one pint of vinegar, two cloves, one laurel leaf, six pepper- corns, two small slices of lemon, carrots, and slices of onion, with the necessary quantity of salt, and boiled for a quarter of an hour, laid en a sieve to drain, and sent to the table with Holland sauce. The dish is ornamented with baked triangular pieces of bread. 315. CALF'S BRAIN WITH ANCHOVY SAUCE. The brains are prepared and dished, as in the preceding number, anchovy sauce poured over them, and sent to the table, garnished with baked triangular pieces of bread. 316. GRILLED CALF'S LIVER. The liver is skinned, watered, and cut in slices, dipped in flour, baked quickly in hot suet, salted, and sent to the table with roast meat gravy. 317. CALF'S LIVER WITH CREAM SAUCE. Larded calf's liver, prepared as above directed, is fried in butter, and cream sauce poured over it ; it is left in a warm place for five minutes, and then sent to the table. 318. SOUR KIDNEYS. Brown to a chestnut color four large tablespoonsful of flour in a quarter of a pound of butter; add to this finely cut-up onions and thinly sliced kidneys, and let it stew five minutes more ; pour on it one pint of broth, a little vinegar, and roast meat gravy ; boil the kidneys in this for a quarter of an hour, after having added sufficient cayenne pepper to cover the point of a knife, and the required season- ing of salt, and send to the table. 319. STEWED KIDNEYS. Wash the kidneys, and trim off the fat, cut them in slices, stew in butter and onions, cut up fine for half an hour, and put them on a sieve. Boil them up for two minutes in a strong brown sauce, season them with salt and cayenne pepper, and they are ready for the table. 320. STUFFED CALF'S HEART. Take as many hearts as required, trim off the tube, and wash the hearts clean, stew a few soaked rolls, from which the water has been ex- 800 APPENDIX. pressed, in a piece of butter, with onions, and parsley chopped fine, add salt, pepper, and two eggs, and fill into the opening of the cut- off tube. Stand up the hearts on a slice of bacon in a frying-pan, and be careful to guard against the dropping out of the stuffing ; add butter, onions, eorrots, a small slice of lemon, two cloves, four pep- per-corns, and one laurel leaf, and stew for three-quarters of an hour ; then take them out, add two large tablespoonsful of flour, a quarter of a pint of sour cream, and a little wine, to the gravy, boil it up, and strain through a hair sieve. The hearts and the gravy are sent to the table as hot as possible. 321. ROASTED CALF'S HEART. Put choice fat or butter in an earthen pan ; wash and dry the hearts, and cut them in two, lay them in a pan, and roast them to a nice yellow color on both sides. They are then taken out; to the iat in the pan, add from four to six large tablespoonsful of flour, brown it with onions, cut up fine, quench with broth and a little vinegar, then boil up at once with two cloves, one laurel leaf, four pepper- corns and two slices of lemon, and strain through a hair sieve ; boil the hearts in it until done, and they are ready for the table. 322. CALF'S FEET WITH MALAGA SAUCE. The calf's feet are scalded, cleaned, boned, and boiled like a calf's head. They are then taken out, cut in pieces of any desired size, boiled up once more in a good Malaga sauce, and sent to the table. 323. CALF'S FEET WITH PIQUANT SAUCE. Stew close in a quarter of a pound of butter, onions cut up fine, parsley and capers, with a little wine vinegar ; mix well two soup- ladlesful of brown sauce, with one tablespoonful of mustard, and boil up, place in it the calf's feet, cut up in pieces, and put in a warm place until wanted for the table. 324. LARDED CALF'S BREAST. Bone a choice calf's breast, and lard it between the gristle, wash, and put on the fire with cold water ; boil for a quarter of an hour ; APPENDIX. 801 place it in cold water, take it out, and dry and lard on the upper side with slender strips of bacon. Put in a stew-pan a quarter of a pound of butter, sliced onions and carrots, three cloves, one laurel leaf, six pepper-corns, and two slices of lemon ; the larded breast, with a sufficient quantity of salt, is stewed in this for a full hour, when the juices will have stewed into it, giving the meat a glazed ap- pearance; it is then taken out. Sprinkle a little flour in the sauce, add half a glass of wine to it, with a pint of gravy of roasted meat or broth, and let it boil up. The fat is then removed, the sauce strained through a hair sieve, and placed on the table hot with the breast. 325. STUFFED CALF'S BREAST. The breast is boned, a crosswise incision is made between the skin and the meat, and worked with the hand until the opening assumes the shape of a sack. Cut up two and a half rolls in the shape of dice, and moisten with a little milk • onions cut fine, and parsley and a little bacon cut in small square pieces, are stewed in a little butter, and lightly mixed with eight eggs and the cut-up rolls, the whole mass stuffed in the opening of the breast, and sewed up with a thread. Onions and sliced carrots are put in a pan, the breast is properly seasoned with salt, and laid on top of it, cut up a quarter of a pound of butter, and lay it on top, add a little fat of broth, and roast in a hot oven for an hour and a half, or two hours ; baste frequently with the fat in the pan. The breast is then taken out, the thread removed, and the meat placed on a suitable dish, and sent to the table with its own gravy, from which the fat has been removed. 326. STUFFED CALF'S BREAST, DIFFERENTLY PREPARED. The breast is prepared for stuffing, the crust is removed from four rolls, soaked in water, and pressed out, a quarter of a pound of but- ter is stirred up light, the rolls, nutmeg and salt are added, and thoroughly stirred with the yolks of six eggs ; the white of six eggs are beaten to a stiff froth, lightly mixed with the mass, and the breast stuffed with it, sewed up, and roasted in the same manner as the one in the preceding number. 5i 802 APPENDIX. 327. STEWED VEAL, Four or five pounds of breast or ribs of veal are nicely cut up and put on the fire with cold water; when the water begins to get hot, pour it off, and put cold water to it again. Boil in the second water with the necessary quantity of salt until the meat is half done, and put it again in cold water, so that the meat may become very white. Put a quarter of a pound of butter in a stew-pan, stew four large table- spoonsful of flour in it so that it will remain white, and add three or four pints of clear strong broth. The meat is placed on a sieve, and when properly drained, it is boiled in the sauce, to which the necessary quantity of salt and nutmeg has been added, for three-quarters of an hour, or until done, with an onion, in which four cloves have been stuck, a little lemon peel, the juice of half a lemon, and one laurel leaf. It is then put on a dish, the sauce poured over it, and sent to the table.. 328. ROAST LEG OF VEAL. A nice white leg of veal is properly pounded, the hip bone trimmed out, and the knucklebone cut off, salted, and roasted with half a pound of butter, onions and sliced carrots for two hours ; it must be frequently basted with its own gravy. 329. ROAST LEG OF MUTTON. The hip bone is trimmed out of a leg of mutton and the knuckle bone cut off. The meat is rubbed with salt and white pepper, put in a proper vessel, and roasted three or four hours with onions, car- rots, two small pieces of garlic and some water. It is sent to the table with its own gravy, after the fat has been taken off. 330. LEG OF MUTTON WITH TURNIPS. Prepare and salt the leg of mutton as directed in the preceding number, and send it to the table garnished with turnips. 331. ROAST HARE. The hare is skinned, opened, and washed clean, the legs, breast and head cut of, the pellicle stripped off, and larded with narrow strips of APPENDIX. 803 bacon ; it is then put in a suitable pan and roasted with sliced onions and carrots, the spices heretofore mentioned, four ounces of butter and the necessary salt ; during the time it is roasting, it is frequently basted with the gravy it is making. The hare is then placed on a dish, put in a warm place, and garnished on top with slices of lemon and parsley. Boil in the gravy a tablespoonful of flour with sour cream and a glass of red wine, press the sauce through a hair sieve, and serve it as hot as possible with the hare. POULTRY. 332. ROASTED PARTRIDGE. The young partridges are picked, singed, cleaned and drawn, the inside rubbed with a cloth, salted and dressed. They are wrapped up in vine leaves, tied up in slices of bacon, and roasted with spice and butter for three-quarters of an hour. They are then prepared, placed on an oval dish, the head, which has not been pickled, is sur- rounded with fringed paper stuck on to the neck and the .breast, covered with small lemon slices, and sent to the table with the gravy which has been made in roasting. 333. ROAST TURKEY. A fine young turkey is killed, picked, and hung up in the air for a few days in a cool place ; it is then singed, drawn, the inside rubbed with a cloth, salted, and dressed \ it is then tied up in buttered paper and sliced bacon, placed in a suitable pan, and roasted for two or two and a half hours in half a pound of butter, sliced onions and carrots ; during the roasting it is frequently basted. The pack-thread, with which it is tied up, is then taken off, the turkey put on a dish, and sent to the table with the gravy made under it in roasting. 334. STUFFED TURKEY. After the turkey has been properly dressed, it is salted ; one pound of roast meat, the liver of the turkey, onions, parsley, and a few an- chovies, are chopped fine and closely stewed in a quarter of a pound 804 APPENDIX. of butter and two ounces of scraped bacon. Two loaves of milk bread are then cut in little squares, an ounce of capers, salt and four eggs are stirred in with it ; the crop of the turkey is stuffed with it, well sewed up, and the turkey properly shaped ; it is then roasted for two hours with half a pound of butter. The fat is removed from the gravy and the latter strained, the turkey placed on the dish, garnished with cress, and sent with the gravy hot to the table. 335. ROAST CHICKEN. Kill three or four young chickens, dip them in boiling water, and take them out again quickly, pound them slightly, so that they become thoroughly wet ; they are then picked, singed, drawn immediately, and the breastbone broken out, which is easily done if attempted while still warm ; they are then salted and dressed ; the cleaned gizzard and liver is put inside of the chicken with a piece of butter ; they are then roasted as directed, prepared for the table, placed on a dish, the gravy poured over them, and served at once with a head of lettuce and soft-boiled eggs. 336. ROAST PIGEONS. ' For this purpose young, fat pigeons are selected ; they are best when green peas are in season. Take the pigeon in your left hand, cut or tear off the head quickly ; the skin of the neck should not be in- jured, however ; the head is exsected, the neck cut out of the skin, the insides drawn, the same as in chickens ; they are then washed out, salted, dressed and roasted in the same way as chickens. 337. ROAST PIGEONS, STUFFED. The pigeons are prepared as above described, the breast is stripped of the skin, but in such a way as not to tear the flesh, and leave the skin whole. For three pigeons take two ounces of butter and stir light, remove the crust from three rolls, soak the soft part in water, squeeze it out, and stir it in the butter with salt, nutmegs, cives cut fine, and three eggs, and stuff the pigeons by means of a sausage funnel, through the skin of the neck, and sew them up ; a teaspoon may be used for the same purpose. They are stewed in white broth and baked with butter. APPENDIX. 805 33 8. ROAST DUCKS. Ducks, like other poultry, should be killed a few days previous to using them. They are picked, singed, cleaned, drawn, washed out and dressed. They are then stewed with salt, onions, slices of carrots, and good fat of roast meat, put on an oblong dish, and sent to the table with a good herring salad. 339. ROAST YOUNG GOOSE. The first young geese *are mostly brought to market picked ; they are then drawn, singed, washed and well salted ; place a small bunch of savory inside, dress it and roast with butter, onions and carrots. Great caution must be observed in roasting, as the meat of all young poultry is easily roasted too soft. 340. STUFFED YOUNG GOOSE. After being prepared as directed in the preceding number, the young goose is stuffed with potato stuffing ; the liver is separated from the gall, the stomach cleaned, and the soft fleshy part of the latter cut up fine with the liver, onions and parsley. A small quan- tity of ham, bacon, and four boiled potatoes are cut in dice shape, stewed with the above for five minutes in three ounces of butter, and seasoned with salt and nutmeg ; two eggs are then stirred in with the stuffing, with which the goose is filled, and roasted until of a fine yellow color. Very young geese must always be roasted in butter, if they are to be good ; older and fatter geese may be put to roast with water. 341. STUFFED GOOSE WITH APPLES AND RAISINS. Pick the goose, clean, prepare it nicely, and salt ; peel and core from twelve to fifteen fine apples, and stew for a few moments with a piece of butter and sugar. Half a pound of small and large raisins are washed clean, boiled up once in sugar and water, thrown on a hair sieve to drain; add them to the apples, stuff the goose with it, and sew it up ; after being dressed, it is roasted as directed in the pre- ceding number. 806 APPENDIX. 342. BAKED GOOSE LIVER. A fine, firm liver is cut in slices of the thickness of a finger, and quickly fried in butter until yellow on both sides. It is sent to the table with a little gravy and lemon juice. If preferred, the slices of liver may be dipped in flour and fried with cut-up onions. SALADS. Remarks. For salads, vegetable plants in their raw state, or boiled, and some kinds of meat, are taken ; they are prepared with salt, pepper, vinegar and oil, and are eaten cold. They are sent to the table in dishes prepared in a simple way. 343. LETTUCE. The lettuce must be nicely picked over, and washed clean ; it is then well drained in a salad sieve, placed in a dish, vinegar, oil and salt added, and thoroughly mixed. It is then garnished with hard boiled eggs, sprinkled with cives, and sent to the table. 344. WATER- CRESS SALAD. The cress is carefully picked over, washed clean, and when the water is well drained off, it is dressed with vinegar, oil and pepper. 345. GARDEN-CRESS SALAD. It is picked over and washed, and prepared like the water cress. 346. SUCCORY SALAD. The succory is cut fine, washed, placed in a sieve to drain, and dressed with oil, vinegar, fine onions, salt and pepper. 347. RED BEETS FOR SALAD. They are washed clean, boiled until soft, and peeled while still warm, cut in slices, and mixed with coriander, salt, pepper-corn and horseradish cut up in small squares, good vinegar poured over them, and set aside in stone jars for use. APPENDIX. 807 348 RADISH SALAD. Wash some fine radishes, cut them up in very thin slices, add salt, and let them stand for some time ; they are then pressed, dressed with vinegar and oil, and sprinkled with pepper. 349. BEAN SALAD. Cut off some green, tender beans, free them from the fibres, and cut in two lengthwise, boil them in salt water, cool with cold water, and lay in a hair sieve to drain. They are then dressed with fine oil, vinegar, a little pepper and salt, and, if to taste, onions cut up fine may be added. They are put in a salad bowl, the outside of which is garnished with cauliflower. 350. POTATO SALAD. To prepare this salad, mealy potatoes should not be selected ; boil the potatoes with salt until soft, peel at once and cut in thin slices. For a plateful of sliced potatoes, take eight tablespoonsful of vinegar, a little salt and pepper, and mix with a little broth ; then add eight tablespoonsful of oil, and mix the salad again with it. Some onions cut up fine may be added, if preferred. 351. WARM POTATO SALAD. The potatoes, after being boiled, are peeled while hot, and sliced ; heat goose grease or lard, and add vinegar as required. When it ha come to a boil, add some fine cut onions, salt and pepper, and pour it over the potatoes ; the whole is then mixed and sent to the table at once. Instead of lard, bacon may be used. 352. HEAD OF LETTUCE. The external green leaves are stripped off, the yellow leaves are cut in pieces from the ribs, and the cores cut in two or four parts, according to their size. The lettuce is then washed clean and put on a lettuce strainer to drain ; if it is to be done quickly, it may be put in a napkin and rinsed, which will remove all water from the lettuce. It is then dressed with salt, vinegar and oil, and nicely arranged in 808 APPENDIX. a salad bowl, the cores laid on the top, and the salad garnished with so-called seven-minute eggs. 353. CELERY SALAD. Eight or ten heads of celery are cleaned and washed, boiled soft in salt water, cooled off, peeled, cut in thin slices, and dressed with vinegar, oil, salt and pepper. If liked, potatoes may be mixed with it. E 906 mam 1 mm ■