n™ ~F C St THE MEDICAL AND SURGICAL COMPANION. FOR THE USE OF FAMILIES, SEAMEN, TRAVELLERS, MINERS, &o. A BRIEF DESCRIPTION, IN PLAIN LANGUAGE, OF THE DISEASES OF MEN, WOMEN, AND CHILDREN. THE MOST APPROVED METHODS OF TREATING THEM. A. I. FENN, M.D., FELLOW OP THE MASSACHUSETTS MEDICAL SOCIETY. *S BOSTON: DPUBIUSIIICD BY THE AUTHOR. 1870. NOTICE This book can be obtained of the author and agents only. It is not for sale in the bookstores. Price, neatly bound in line Leather (Library Style), $2.50. It will be forwarded by mail, postpaid, to any part of the country, on receipt of price. Entered, according to Act of Congress, in the year 1870, by ARTEMAS I. FEXN, M. D., In the Clerk's Office of the District Court for the District of Massachusetts. Stereotyped at the Boston Stereotype Foundry, No. 19 Spring Lane. PREFACE, It will be well to remark, in presenting this book to the public, that it is not designed to super- sede the attendance of a physician, in cases of disease, accident, &c, but as a work which can be used as a guide, when persons are in any way «o situated that they cannot readily obtain the services of a medical man. Families, seamen, travellers, miners, and others, who are often unable, for days, and in some cases even weeks, to obtain the aid of a physician, need some book to which they can refer for advice and guidance, in cases of sudden illness or accident. All persons should possess a knowledge of what is most proper to be done in cases of accident, drowning, hanging, poisoning, bleeding, &c; for a person's life, in such instances, often depends upon what is done on the instant, and before a phy- sician can possibly be called. In preparing this volume I have consulted many works of author- ity, appropriating whatever seemed to me of value ; and have endeavored, within as small a compass as convenient, and in as plain a manner as possible, to lay down such rules, and give such directions, as will enable every one who reads them, to adapt to his (or his friend's) case, the plan of treatment most proper for it. Used for the purpose for which it is designed, I trust this book will do no harm, but much good, and that it will become a welcome Medical and Surgical Companion to many. A. I. FENN. No. 90 Avon Steeet, Boston, April, 1870. CONTENTS. PART I. PEACTICE OF MEDICINE. CHAPTER I. ON THE PRESERVATION OF HEALTH. PAGE Cleanliness and Clothing. — Pure Air. — Food, Drink, Diges- tion, &c. — Labor. — Rest. — Recreation and Amusements. — Hints to Travellers in Health. — Flannel. — Beds. — Water. — Cold. — Hints to Invalids Travelling. — Apotheca- ries' Weights and Measures. — Blood Vessels. — The Pulse. — General Rules to be observed in the Treatment of Dis- eases. — The Sick Room. — The Nurse 1-15 CHAPTER II. FEVERS. Of Fever in General. — Simple Inflammatory Fever. — In- termittent, or Fever and Ague. — Remittent Fever. — Bilious Fever. — Yellow Fever. — Typhoid Fever. — Typhus Fever. — Hectic Fever. — The Eruptive Fevers. — Small Pox. — Varioloid. — Kine, or Cow Pox. — Chicken Pox. — Measles. — Scarlet Fever 16-38 (v) CONTENTS. CHAPTER III. Acute Rheumatism. — Chronic Rheumatism. — Sciatica. — Gout. — Scrofula. — Anaemia. — Chlorosis 39-48 CHAPTER IV. DISEASES OF THE NERVOUS SYSTEM. Inflammation of the Brain. —Water in the Head. —Apoplexy. — Sun Stroke. — Delirium Tremens. — Insanity. — Head- ache. — Paralysis.— Palsy. — Hemiplegia. — Paraplegia. — Mercurial Palsy. — Lead Palsy. — Shaking Palsy. — Epi- lepsy. — Hysteria. — Fainting. — Catalepsy. — St. Vitus' Dance. — Locked-Jaw. — Hydrophobia. — Neuralgia. . 49-70 CHAPTER V. DISEASES OF THE AIR PASSAGES AND LUNGS. Acute Catarrh. — A Cold. — Chronic Catarrh. — Clergyman's Sore Throat. — Acute Inflammation of the Larynx. — Mem- branous Croup. — Spasmodic Croup. — Diphtheria. — Influ- enza. — Whooping Cough. — Bronchitis. — Asthma. — Hay Asthma. — Pleurisy. — Lung Fever Consumption. — Spitting of Blood 71-105 CHAPTER VI. DISEASES OF THE HEART, &c. Palpitation. — Angina Pectoris. — Pericarditis. — Endocardi- tis. — Blue Disease. — Diseases of the Blood. — Scurvy. — Purpura 106-112 CHAPTER VII. DISEASES OF THE ORGANS OF DIGESTION. Inflammation of the Tongue. — Aphthse. — Canker. — Thrush. — Mumps. — Inflammatory Sore Throat. — Dyspepsia. — Pain in the Stomach. — Water Brash. — Vomiting of Blood. — Inflammation of the Stomach. — Ulcer of the Stomach. — Cancer of the Stomach. — Inflammation of the Intestines or Bowels. — Colic. — Diarrhoea. — Dysentery. — Cholera Mor- bus. — Malignant or Asiatic Cholera. — Obstruction of the Bowels. — Worms 113-138 CHAPTER VIII. DISEASES OF THE LIVER AND SPLEEN. Inflammation of the Liver. — Cancer of the Liver. — Jaun- dice. — Enlargement of the Spleen. . 139-145 CHAPTER IX. DISEASES OF THE PERITONEUM, OVARIAN DROPSY, &c. Acute Peritonitis. — Chronic Peritonitis. — Abdominal Dropsy. — Ovarian Tumors. — Abdominal Consumption. . . 146-150 CHAPTER X. DISEASES OF THE KIDNEYS AND BLADDER. Inflammation of the Kidneys. — Bright's Disease. — Bloody Urine. — Diabetes. — Irritability of the Bladder. — Inflam- mation of the Bladder. — Paralysis of the Bladder. . 151-159 VU1 CONTEXTS. CHAPTER XI. ON SOME DISEASES OF THE SKIN AND HAIR. Erysipelas. — Rose Rash. — Nettle Rash. — Tetter. — Shin- gles. — Eczema. — Pemphigus. — Rupia. —Ecthyma. — Im- petigo. — Scald Head. — Itch. — Lichen. — Itching. — Scaly Leprosy. — Salt Rheum. — Dandruff. — Acne. — Lupus. — Barber's Itch. — Sycosis. — Elephant Leg. — Barbadoes Leg. — Diseases of the Hair. — Blanching of the Hair. — Bald- ness. — Gray Hair 1G0-177 CHAPTER XII. DISEASES OF WOMEN, &c. Itching of the Vulva. — Leucorrhrra. — Whites. — Inflamma- tion of the Uterus. — Tumors. — Polypus. — Cancer. — Dis placements of the Uterus. — Falling of the Uterus. -Ante- version of the Uterus. — Retroversion of the Uterus. — Men- struation. — Menstrual Diseases. — Pregnancy. — Miscar- riage. — Abortion. — Milk Leg 178-198 CHAPTER XIII. MANAGEMENT AND DISEASES OF INFANCY AND CHILDHOOD. Food of Infants. — Weaning. — Cleanliness and Clothing. — Exercise and Sleep. — Teething. — Eruption of Permanment Teeth. — Disorders of the First Dentition. — Disorders of the Second Dentition. — Convulsions. — Cholera Infantum. — Infantile Fever. — Incontinence of Urine. . . . 199-221 CONTENTS. IX CHAPTER XIV. ON SUSPENDED ANIMATION, POISONING, &c. Suspended Animation from Drowning, Hanging, Impure Air, and Cold. — Boat Accidents. — Clothes catching Fire. — Sea Sickness. Poisoning — from Opium, Laudanum, Morphine, Arsenic, Alcoholic Liquors, Alkalies, Mineral Acids, Oxalic Acid, Prussic Acid, Strychnia, Corrosive Sublimate, and Lead. Trichina Spiralis. — Diseased and Decaying Food.— Caution to Persons overtaken by a Thunder Storm 222-232 PART II. PRACTICE OF SURGERY. CHAPTER I. ACCIDENTS, WOUNDS, SURGICAL INJURIES, &c. Prostration. — Collapse. — Shock. — Methods of arresting Hemorrhage, or Bleeding. — Inflammation. — Mortification. — Gangrene. — Wounds. — Wounds of Particular Parts. — Poisoned Wounds. — Stings of Bees, &c. — Bites of Mos- quitos. — Fractures. — Dislocations. — Sprains. — Bruises. — Burns and Scalds. — Concussion of the Brain. — Com- pression of the Brain. — Bleeding from the Nose. — Com- pound Accidents. — Amputation. — Ruptures. . . . 233-260 CONTENTS. CHAPTER II. ' REMOVAL OFJ FOREIGN BODIES, BLOOD-LETTING,' &c. Removal of Foreign Bodies from the Throat, Nose, Ears, and Eyes. — Blood-letting. — Leeching. — Cupping. — Direc- tions for Passing Catheters, Bougies, and Sounds. . . 261-269 CHAPTER III. ON SOME DISEASES OF THE EYE AND EAR. Near Sight. — Long Sight. — Weakness of Vision. — Inflam- mation of the Eye. — Stye. — Dimness of Sight. — Cataract. — Squinting. — Earache. — Inflammation of the Ear. — Discharge from the Ear 270-276 CHAPTER IV. THE VENEREAL DISEASES, &c. Gonorrhoea. — Balanitis. — Gonorrhoeal Inflammation of the Eyes. — Gonorrhoeal Rheumatism. — Gleet. — Gonorrhoea in the Female. — Syphilis. — Primary Syphilis. — Affec- tions that may be Mistaken for Syphilis. — Treatment of Primary Syphilis. — Bubo. — Venereal Warts. — Secondary Syphilis. — Syphilitic Sore Throat. — Tertiary Syphilis. — Syphilitic Disease of Bone. — Treatment of Secondary and Tertiary Syphilis. — Syphilitic Disease in Children. — Other Diseases of the Urino-Genital Organs. — Stricture of the Urethra. — Swelled or Inflamed Testicle. — Dropsy of the Scrotum. — Varicocele. — Spermatorrhoea. — Impotency. — CONTENTS. * XI Diseases of the Prostate Gland. — Prostatorrhoea. — Inflam- mation of the Prostate Gland. — Enlargement of the Pros- tate. — Gravel and Stone. — Phymosis and Paraphimo- sis 277-307 CHAPTER V. ON ABSCESS AND ULCERS. Abscess. — Ulcers. — Healthy Ulcer. — Inflamed Ulcer. — Fungous Ulcer. — Sloughing Ulcer. Indolent Ulcer. Varicose Ulcer. — Carious Ulcer. 308-312 CHAPTER VI. DISEASES OF THE BONES. Caries. — Necrosis. — Brittleness of Bones. — Softening of Bones. — Rickets. — Disease of the Hip Joint. . . . 313-315 CHAPTER VII. MISCELLANEOUS SURGICAL DISEASES. Tumors. — Aneurism. — Polypus. — Cancer. — Piles. — Fis- sure of the Anus. — Fistula in Ano. — Boils. — Carbuncle. — Chilblains. — Frost Bite. — Felon. — Whitlow. — "Wen. — Warts. — Corns. — Bunion. — In-growing Toe Nail. — Care of the Feet. — Rules for the Preservation of the Teeth 316-328 PART III. CHAPTER I. Recipes. — Prescriptions. — Medicines. — Preparations for the Hair. — Colognes. — Tooth Powders. — Medicine Chest. 329-3G2 CHAPTER II. Dietetic Preparations and Beverages for the Sick. . . 363-374 PART I. PRACTICE OE MEDICINE. CHAPTER I. ON THE PRESERVATION OF HEALTH. Cleanliness and Clothing, In order to keep the body in a state of health, frequent bathing is requisite. In winter, once or twice a week will be sufficient ; but in summer, when the body perspires much, it should be clone • oftener. A bowl of cool water, a little soap, a sponge, and coarse towel, are all the essentials for keeping the body in a cleanly condition, if they are properly used. Under Garments should be changed at least once or twice a week in winter, and oftener in summer. All our clothing should be adapted to the climate, season of the year, and state of the weather. JPure Air. Pure air is essential to health, and all should see that the apartments in which they do business during the day, and in which they sleep, are well ventilated. Food, Drink, Digestion, &c. If you would keep your body in good condition, be tem- (i) 2 MEDICAL AND SURGICAL COMPANION. perate both in eating and drinking. Only three meals a day should be taken, and the last at least three hours before retiring. The diet should consist of a proper admixture of animal and vegetable food, and its thorough mastication is essential. Tea and Coffee may be taken in moderate quantities, if they do not disagree with you. Alcoholic Liquors, taken daily, in health, are injurious to the system, and the less used the better. The same may be said of tobacco. Opium should never be used, except when prescribed by a physician. Time required for Digestion. The time required for digesting food, and for emptying the stomach of its contents, differs in different persons and circumstances. One kind of food is more easily dissolved than another ; and some persons can digest any definite kind of food more readily than others ; some are even oppressed by that which another digests with ease and comfort. There is also a difference in regard to the digestive power in the same person in different states of health. Dr. Beaumont's Observations. A young soldier, Alexis St. Martin, had a hole through his side and into his stomach, in consequence of a gun-shot wound. Through this aperture the whole process and prog- ress of digestion could be observed. Dr. Beaumont availed himself of this opportunity to learn the time required to digest various kinds of food, and to empty the stomach of its contents. The following table, which is taken from a larger table in Dr. Beaumont's work, shows the time required by St. Mar- tin for the digestion of the most common articles of diet. As the digestive power differs in different persons, this table must be received only as an approximation of the HINTS ON THE PRESERVATION OP HEALTH. average periods required for the digestion of these ar- ticles. Apples, sour, hard, . Apples, sweet, do. . . Beans, pod, Beef, fresh, lean, rare, Beefsteak, Beef, salted,old, hard, Beets, ... • . . . . Bread, wheat, fresh, . Bread, corn, Cabbage, with vine- gar, Cabbage, Cake, sponge, .... Cheese, old, strong, . Chicken, full grown, . Codfish, cured, dry, . Corn,green,and beans, Custard, Dumpling, apple, . . Eggs, fresh, Time. Preparation. m a = ~. Raw, ?, 50 Raw, 1 ■>,() Boiled, 9, :-!<> Roasted, a Broiled, 3 Boiled, 4 IS Boiled, 3 45 Baked, 3 30 Baked, 3 15 Raw, 9 Boiled, 4 30 Baked, 30 Raw, 3 :-;u Fricass'd, " 45 Boiled, ?! Boiled, 3 45 Baked, « 45 Boiled, 3 |Boiled, 3 Eggs, fresh, Fowl, domestic, . . Lamb, fresh, Liver, beers, fresh, . Meat, hashed with ve- getables, Milk, Mutton, fresh, . . . . Pork, fat and lean, . . Pork Steak, Potatoes, Irish, . . . Potatoes, Irish, . . . Rice, Sausage, fresh, . . . Soup, beef, vegeta- bles and bread, . . Tripe, soused, . . . . Turkey, domestic, . . Turnips, flat, . . . . Veal, fresh, Fried, Boiled, Broiled, Broiled, Warmed, Raw, Roasted, Roasted, Broiled, Broiled, Roasted, Boiled, Broiled, Boiled, Boiled, Roasted, Boiled, Fried, All persons should observe carefully the effects of various articles of food, as well as physic, upon their bodies, and choose those which experience proves to agree best with them. It is a vulgar, but sometimes true saying, that " what is one man's meat is another's poison." Severe exertion of body or mind, immediately after a full meal, should be avoided. No man should put himself to the severe exertion of mowing grass, pitching hay, planing boards, or severe exercise of the muscular system of any kind, for about an hour after eating ; and especially after dinner, Avhich is* generally the largest meal. Labor. A proper amount of labor, both physical and mental, is necessary to keep body and mind in a state of health ; but excessive labor must be avoided. No one should exceed ten hours a day. Rest. A sufficient amount of rest or sleep is required, every twenty-four hours, to restore or refresh the nervous system. 4 MEDICAL AND SURGICAL COMPANION. The amount required varies, in different individuals, from seven to nine hours. It is well to have some regular time for retiring and rising. Children and youth who are grow- ing, require, as a general rule, more sleep than adults. Recreation and Amusements. All persons require periods of relaxation and rest from the toils and cares of business, whatever it may be ; and at such times, hunting and fishing excursions, picnics, sleigh rides, and plays and games which have no evil tendency, may be made profitable to health. These occasional amusements are recommended, not for the mere pleasure they are adapted to give, but also for the purpose of recreating and preserving a healthy and vigorous state of the body and mind, which cannot always be done without these aids. Those persons especially who are devoted to constant mental labor, must have resort to some kind of mental relaxation, or their constitutions will suffer loss : the mind cannot bear to be kept constantly on the stretch of exertion ; it will soon lose its elasticity and power, and the body give way. HINTS TO TRAVELLERS IN HEALTH. Flannel. The sudden changes of the weather, which so particularly characterize the climate of the United States, render a supply of flannel, to be worn next the skin, a matter of much consequence to the health and comfort of the traveller, who is more exposed than others to the morning and evening damps, as well as the meridian heat. As a general preservative of health, there is no habit more valuable than this. The garments for summer wear may be lighter than those for winter, but travellers should never leave off flannel entirely during any season of the year. HINTS TO TRAVELLERS IK HEALTH. O Beds. Travellers should examine closely the beds in which they are to sleep, and should be satisfied that they are clean ; for by sleeping in dirty ones, many troublesome and disgusting diseases of the skin may be contracted. It is better to sleep on the floor, with only your overcoat around you, than to sleep in a filthy bed. Water. Change of water is" apt to produce some little disturbance of the bowels ; and when this is the case, a little spirit, or essence of peppermint mixed with it, may prove beneficial. Cold. To prevent as much as possible any danger from frost, while travelling in excessively cold weather, having well cased your whole body (and feet in particular) in warm clothing, avoid approaching the fire, and the use of spirits or hot drinks of every description. When you stop on the road, instead of seating yourself by the fire and calling for liquor, walk about in the open air as rapidly as possible ; and if you are thirsty, take a glass of cold water or milk, and partake of as much substantial food as the system requires, three times a day. Three men once set out from Boston for Canada East, during the middle of a very severe winter, each one in his own sleigh. Two of them were in the habit of stopping at every hotel they came to, and drinking freely of liquor ; the other never entered a house, except for his meals or to sleep. While his horse rested he stretched his limbs, and when he was thirsty he partook of the same element with his beast. The consequence of this was, that out of the three, he was the only one who arrived at his journey's end uninjured. One of his companions had his feet so badly frozen, that he lost them both, and the other was taken out 6 MEDICAL AND SURGICAL COMPANION. of his sleigh at the door of a hotel, where his horse nat- urally stopped, frozen to death. If, notwithstanding all your care, you become much affected with the cold, beivare of going to sleep. No matter how strong the inclination may be, resist it for your life ; it is the sleep of death I ICp 3 Never let false delicacy, or any other cause, prevent you from emptying the bladder as often as you feel the in- clination ; a painful and lingering, sometimes an incurable disease arises from neglecting this call of nature. The bowels should move at least once in twenty-four hours ; and the habit of attending to this demand of nature at some particular time in the day, as after breakfast or supper, will do much towards keeping them in good con- dition. HINTS TO INVALIDS TRAVELLING. Although the preceding advice or directions apply to all travellers, sick or well, they should be more particularly studied and observed by invalids, who, while travelling by laud, either for the restoration of their health, or from necessity, will find it well to observe the following rules : — Rule 1. Never commence your journey in the morning until you have breakfasted and emptied the bowels, or endeavored to do so. To obtain the wished-for result, make it a regular practice to solicit the evacuation directly after your meal. Rule 2. During the summer never pursue your journey, if you can avoid it, in the heat of the day. It is better to borrow an hour or two from the morning, and one from the evening, than to risk the excitement liable to be produced by a broil- ing sun. HINTS TO INVALIDS TRAVELLING. V Eule 3. Make short stages, always remembering that exercise should never be pushed to fatigue ; the latter is as injurious as the former is beneficial. Rule 4. Always carry a piece of good rhubarb in your pocket, and, if costive, chew a portion of it during the day, and swallow the saliva. Laudanum and essence of peppermint it is always well to have at command. Eule 5. Be careful to have no ligatures about your body. Cravat and " elastics " should be loosely fastened, and let all your clothing be easy. The flannel shirt is indispensable. Eule 6. Always carry with you an ample overcoat or cloak ; early in the morning and in the evening, even of summer days, you may find occasion to use it with pleasure and profit. Always have a complete suit of winter clothing in your trunks, although you be travelling in the month of July. If the weather becomes cool, on with your woollens, stock- ings included. Inattention to the simple rule of adapting the clothing to the temperature of the air in its extreme changes kills thousands yearly. Eule 7. Never hesitate a moment to comply with the calls of Nature : much mischief is occasioned by deferring these evacuations. It is better to be accused of a want of deli- cacy than to have a suppression of urine, or a fever and headache. Eule 8. This is a " golden rule," and is of high authority : — Keep your body open, your feet dry and warm, and your head cool. MEDICAL AND SURGICAL COMPANION. MEDICINES. Persons travelling by land or sea, and whether sick or well, should have a few medicines with them to use in cases of sudden attacks of illness. A few well-selected and well-understood medicines will be far better than a large number, the uses of which are not well understood by those having them. I will mention only a few which will be found most useful. Laudanum. (Tincture of Opium.) This may be used to relieve pain and promote sleep. The ordinary dose for an adult is twenty-five drops. It should not, as a general rule, be repeated oftener than once in three to six hours, and not then unless really required. In cases where there is severe pain, thirty to forty drops may be re- quired to give relief. A youth of fourteen years will require about half as much as an adult ; a child of four years, three to five or six drops. Paregoric. (Camphorated Tincture of Opium.) This preparation is used for the same purposes as Lauda- num, but is better adapted to young children. A child three to six months may take . 3 to 5 drops. " from six months to one year, . 5 to 10 drops. " from one to two years, . . 10 to 15 drops. " from two to four years, . . 15 to 30 drops. These preparations should only be used when absolutely required to relieve pain or promote sleep. MEDICINES. y Essence of Peppermint. Useful in cases of wind in the bowels (flatulency), and as a stimulant in cases of faintness. Dose for an adult, one teaspoonful ; children in proportion to age. A little laudanum or paregoric may sometimes be added to advantage. It may be given in a little warm water, sweetened or not, according to preference. It may be repeated as occasion requires. Powdered Ipecac. This is an emetic, and may be used to throw off indigesti- ble food, and may sometimes be of advantage in the early stage of fever. Dose for an adult, .... 20 grains. " for a youth of fourteen years, . 15 grains. " for a child of three to six years, . 3 to 8 grains. It may be mixed with molasses, or sugar and water. After waiting a few minutes, drink freely of warm water, or some warm bitter herb tea, until free vomiting takes place. Wine of Ipecac. This may be used for the same purpose as the above, also in teaspoonful doses as an expectorant in bronchitis. Dose for an adult, as aD emetic, one ounce. For children, one to two teaspoonfuls may be given, and repeated every ten or fifteen minutes, until vomiting takes place. Warm water may be freely taken until it operates. Compound Cathartic Pills. An excellent purgative. Dose for an adult, two to three.. Castor Oil. Dose for an adult, as a purgative, one ounce. For chil- dren, one teaspoonful to a tablespoonful. This is a mild 10 MEDICAL AND SURGICAL COMPANION. and excellent purgative, and may be used in cases where more powerful cathartics would be objectionable. Tincture of Mliubarb. An excellent and common purgative. Dose, from an ounce to an ounce and a half. Adhesive Plaster. This is often of use, and no family or traveller should be without a good supply for dressiug cuts, wounds, &c. Simple Ointment. Useful in dressing burns, scalds, sores, and wounds. Glycerine. Excellent for chapped hands, excoriations, &c. Anodyne Liniment. Take of Laudanum, .....£ ounce. Tincture of arnica, .... 1^- ounce. Mix, and mark Liniment. An excellent preparation for sprains, bruises, &c. Brandy. A little brandy is never out of place in a traveller's trunk, providing he will only use it when necessary as a medicine to relieve sudden faintness or great prostration from accident or sickness. The amount taken at a time should not, as a general rule, exceed one to two tablespoonfuls. MEASURES. Apothecary's Weights and Measures. The weights accompanying apothecary's scales are thus marked : — WEIGHTS AND MEASURES. 11 . equal to 8 drachms a 4 a a 120 grains. cc 60 " a 30 a c; 20 a u 10 a §j for one ounce, § ss " half an ounce, . 3ij " two drachms, . 3j " one drachm, . 3 68 " half a drachm, 9j " one scruple, 9ss " half a scruple, The thin grain weights are marked, exclusive of the stamp, with a peculiar round mark or dot for each grain. Fluid or Wine Measure. The graduated glass measures used by apothecaries in measuring fluids are marked with the § (ounce) and 3 (drachm) signs. The pint or pound contains 16 ounces. The ounce " 8 drachms. The drachms " 60 to 120 drops Domestic Measure. A small teacup is considered equal to A wineglass, A tablespoon, A teaspoon, 4 fluid ounces, or 1 gill. 2 1 fluid drachm. The Doses of Medicine adapted to Different Ages. For an adult, suppose the dose to be one, or 1 drm., equal to 60 grs. Patients of 1 year will require only ^ or 5 grains. " 2 years " " " i,or7i « " 3 " " " 1 , or 10 » " 4 " " «« i , or 15 « . " 7 " " " \ , or 20 " " 14 " " " \ ' or \ drachm « 20 " " " " |, or 2 scruples 21 " « " one, or 1 dr., the Above Persons above sixty-five years require the dose to be diminished as they grow older. 12 MEDICAL AND SURGICAL COMPANION. Women, as a general rule, require only about three fourths as much as men. In the same manner for fluids, divide the quantity suited for an adult by the above fractional parts. Opiates affect children more powerfully than adults, and must be used with caution. Habit has an important influence on the operation of med- icines. In general, habit diminishes the effect resulting from the action of external powers on the system ; hence med- icines lose power by being continued. This is particularly the case with stimulants and narcotics, and the doses of them, therefore, require to be increased when their use is protracted. When doses have been mentioned in this work, they have been for adults, unless otherwise stated. BLOOD-VESSELS. There are two kinds of blood-vessels in the body — arte- ries and veins. The arteries carry the blood from the heart to the extremities of the body, where they are connected with the veins, which bring it back again. The Pulse. The pulse is the beating of an artery, which is a vessel conveying blood from the heart. Every time the heart con- tracts, a portion of blood is forced into the arteries, which dilate or swell to let it pass, and then immediately regain their former size, until, by another beat of the heart, a fresh column of blood is pushed through them, when a similar action is repeated. This swelling and contracting of the arteries, then, constitute the pulse, and consequently it may be found in every part of the body where those vessels run near enough to the surface to be felt ; but, from motives of convenience, physicians usually look for it at the wrist. THE PULSE. 13 The strength and velocity of the pulse vary much in dif- ferent persons, even in a state of perfect health. It is much quicker in children than in adults, and in old persons it grows more slow and feeble, owing to the decreased energy of the heart. In children under four years of age it generally exceeds one hundred beats per minute. In the adult male it may be stated at about seventy, and in the adult female at about eighty. The pulse is increased both in strength and velocity by running, walking, jumping, and riding ; also by eating, drinking, singing, speaking, and by joy, anger, &c. It is diminished in like manner by rest, fear, melancholy, want of nourishment, excessive evacuations, or whatever tends to debilitate the system. The temporary excitement often caused by the approach of the physician to the bedside causes increased rapidity of the pulse, for which due allow- ance should be made, or, what is better, we should wait a few minutes, until the excitement has ceased. A full, tense, and strong pulse is when the artery swells boldly under the finger, and resists its pressure more or less ; if, in addition to this, the pulsation be very rapid, it is called quick, full, and strong ; if slow, the contrary. A hard, corded pulse is that in which the artery feels like the string of a violin, or a tightened cord, giving consider- able resistance to the pressure of the finger. The soft and intermitting pulses are readily recognized by their names. In cases of extreme debility, on the approach of death, and in some particular diseases, the artery vi- brates under the finger, like a thread. In feeling the pulse, two or three fingers should be laid on at once. As already mentioned, the most convenient spot to do this is at the wrist; but it can be done readily on the temple — just be- fore and close to the ear, in the bend of the arm, and on the top of the foot. 14 MEDICAL AND SURGICAL COMPANION. GENERAL RULES TO BE OBSERVED IN THE TREAT- MENT OF DISEASES. Rule 1. In every complaint, whatever it may be called, if you find the pulse quick, hard, full, and strong, tongue foul, skin hot, pain in head, the proper course is to keep the patieut quiet, and on a low diet, with cold water or lemonade for drink. A smart purgative may also be administered. Rule 2. If, on the contrary, the pulse be small, soft, feeble, and intermitting, the tongue dark, and great debility or weak- ness is evident, reverse the whole plan ; the diet must con- sist of milk, strong beef-tea, or essence of beef, the bowels opened with gentle laxatives, — such as a small dose of cas- tor oil, or a Rochelle powder, — and the strength supported by wine, brandy, quinine, &c. Rule 3. Incessant and earnest entreaties, on the part of the sick, for any particular article of diet or drink, if steadily perse- vered in, may be indulged to a proper extent, whether the use of it agrees or not with our preconceived ideas on the subject. Rule 4. In all fevers, where the pulse is quick, full, and strong, the skin hot and dry, sponging the whole body of the patient, once or twice a day, with warm water, will prove beneficial. The patient should always be wiped dry. The addition of a tittle bicarbonate of soda to the water, every second day, is Advisable. A tablespoonful to a pint will be sufficient. GENERAL RULES. 15 Eule 5. The SicJc Hoom. The sick room should be of good size, away from noise, and from the odors of the kitchen. It should be kept clean, of proper temperature, and well ventilated. A plenty of fresh air is an important remedial agent in all diseases. The excretions of the patient should be removed as soon as passed, and his clothing and the bedding require frequent changing. Eule 6. The Nurse. If a nurse is employed, be sure that she is a woman of good sense, good disposition, temperate, kind, attentive to her duties to the patient, and one who will carry out the in- structions of your physician. A nurse who is continually neglecting the physician's orders, or questioning his judgment in regard to the man- agement of the case, and perhaps trying to get the patient placed under the care of another physician, for whom she has a predilection, is unworthy of confidence or trust, and the sooner discharged the better for all concerned. 16 MEDICAL AND SURGICAL COMPANION. CHAPTER II. FEVERS. OF FEVER IN GENERAL. In a work of this kind, I believe it is a matter of little consequence with what particular complaint we begin, since each one is to be described ; therefore I will commence with fever, which arises from the contamination of the blood by some morbific agent, and is by far the most common disease to which the human body is subject. It is indicated by a hot, dry skin, rapid pulse, thirst, loss of appetite, weak- ness, and inability to sleep. It makes its appearance in two ways, — either suddenly and violently, or gradually and gently. When it comes on in the first manner, it is attend- ed with chills, or a cold shaking, nausea or vomiting, pain in the head, &c. When its attack is gradual, a feeling of soreness over the whole body — such as is experienced after a hard day's work, by one not accustomed to it — indicates its approach. Nausea, pains in the head, and more or less heat and thirst, soon follow. As those symptoms vary infi- nitely in their degrees and violence, the vigor of treatment to be pursued must differ accordingly. Fever produces a general disturbance, visible throughout the whole system. I will now proceed to consider the different varieties of fever, and will take them up in the following order : — 1. Simple Inflammatory Fever. 2. Intermittent, or Fever and Ague. 3. Remittent Fever. 4. Yellow Fever. 5. Typhoid Fever. 6. Typhus Fever. SIMPLE INFLAMMATORY FEVER. 17 7. Hectic Fever. 8. Eruptive Fevers, — Small Pox, Chicken Pox, Measles, and Scarlet Fever. Continued fever is so termed from the fact that it pursues its course without any well-marked remissions. Simple inflammatory fever, typhoid fever, and typhus fever, are called continued fevers. SIMPLE INFLAMMATORY FEVER (Febricula). Simple Inflammatory Fever usually makes its invasion abruptly, and the patient will generally have some irregular chilly sensations, a rapid pulse, hot skin, thirst, loss of appe- tite, headache, constipation, scanty and high-colored urine, &c. The febrile career usually ends suddenly, after one, two, or three days, the limit of the duration being ten days. Causes. Among the causes may be mentioned expo- sure to cold, violent exercise, exposure to the sun's rays, intemperance, the indulgence of unruly passions, &c. Distinguish it from typhoid fever by the strength and hardness of the pulse, white tongue, and high-colored urine. Treatment. Rest in bed, open the bowels with a dose of Epsom salts, and if the skin be very hot, and there is much thirst, give a teaspoonful of R. 21 in a wine- glass of water every fourth hour. Half a teaspoonful of sweet spirit of nitre will answer very well, if you do not have this mixture at hand. In some cases, where the fever runs very high, the dose may be repeated every second or third hour. Soaking the feet in hot water, and applying cloths wet with cold water, or spirit and water, to the head, will prove beneficial in all cases, especially if there is much headache. For nourishment, the patient may take oatmeal or Indian meal gruel, and milk. For drink he may take cold water or lemonade. 2 18 MEDICAL AND SURGICAL COMPANION. The apartments in which fever patients are sick should be kept quiet, clean, well ventilated, and a little darkened ; and every source of excitement should be avoided. INTERMITTENT, OR FEVER AND AGUE. There are several varieties of this fever, differing from each other only in the length of time that elapses between their attacks. When a paroxysm occurs every twenty-four hours, it is called quotidian ; when every forty-eight hours, it is designated tertian ; aud when the interval lasts seventy- two hours, it is termed quartan. Symptoms. The disease commences with yawning, stretching, and uneasiness, succeeded by slight chills or shiverings, which end in a violent convulsive shaking of the whole body. This is called the cold fit or stage, aud is im- mediately followed by the fever, or hot stage. The pulse then rises, the skin becomes hot, there is paiu in the head, a white tougue, and all the marks of fever, terminating in a profuse sweat, which gradually subsides, leaving the patient in his natural state, though somewhat weakened. Causes. Marsh miasmata, or the effluvia from vegeta- ble matter, in a state of decomposition ; also, the effluvia arising from certain soils impregnated with moisture, but apparently free from vegetable decomposition. Treatment. If the bowels are constipated, give two or three compound cathartic pills, and then commence giving R. 14G, in teaspoonful doses, every hour, the first dose to be given six hours before the expected paroxysm, or chill. When the medicine begins to cause ringing in the ears, it may be omitted for a time. If another paroxysm occurs it may be resumed. The medicine is not to be given during the paroxysms, but between them. After the paroxysms have been interrupted, the remedy should be taken, three or four times a day, for a considerable period. REMITTENT FEVER. 19 During the cold stage of this fever warm drinks may be administered, and warm bricks or bottles of hot water placed to the feet and sides. During the hot stage, relief may be procured by sponging the body with cold or tepid water, and partaking of cooling drinks, lemonade, &c. During the sweating stage, comfort is promoted by wiping the body with warm flannel, and changing the linen and bed-clothes, taking due care to aroid exposure to cold. REMITTENT FEVER. This disease is known under different names, as Gastric Fever, Bilious Fever, and Bilious Remittent Fever. It is accompanied by distinct exacerbations of variable duration and severity, but without any complete intermission, such as we have in intermittent fever. Symptoms. There is tenderness of the epigastrium, or pit of the stomach, and some irritation of that organ ; and yellowness of the skin, and bilious vomiting, are generally present in a greater or less degree. Diarrhcea is sometimes present, while in other cases the bowels are obstinately constipated. The tongue is either remarkably clear, or covered with a thin fur, or redder than natural at the tip and edges. The pulse ranges from ninety to one hundred and twenty. Head symptoms are not very common, but when they do occur, the patient is not often delirious, but melancholy. In the Remittent Fever of hot climates, the symptoms of gastric irritation and bilious disorder are more strongly marked, and violent delirium, with intense thirst and great heat of skiu, often shows itself at an early period. The duration of this fever is from one to four or five weeks. It may be distinguished from the intermittent, or fever and ague, by the incomplete intermission ; from contin- 20 MEDICAL AND SURGICAL COMPANION. ued fever, by the occurrence of intervals of comparative freedom from fever. Treatment. If the bowels are constipated, give a ca- thartic composed of eight grains of calomel and twelve of jalap. If there is great heat of skin, the surface of the body may be bathed once or twice a day with cool or mod- erately warm water, into which may be put a little bicarbo- nate of soda. Cold water, toast water, barley water, or lemonade, may be drank to allay thirst. Should there be much tender- ness at the pit of the stomach, with some vomiting, a mus- tard poultice placed over that region will generally prove beneficial. It should be kept on as long as it can be con- veniently borne, and when removed, hot fomentations may be substituted. When the headache is severe, cold water may be freely applied to it, aud warmth to the feet. When the fever ruus high, a teaspoonful of R. 21 may be taken in water three or four times a day. If this mixture is not at hand, half a teaspoonful of sweet spirit of nitre three or four times a day may be substituted. If the patient does not rest well, ten grains of Dover's powder may be given at night to promote sleep. Duriug the remissions, or when the patient is comparative- ly free from fever, give a teaspoonful of R. 146, every hour, as in fever and ague, until slight ringing in the ears is expe- rienced, when it may be omitted. If another paroxysm occurs, it may be resumed. After the paroxysms have been interrupted, the remedy may be taken three times a day for a week or two. It should never be given during a parox- ysm of fever. For diet ; gruel, milk, &c. YELLOW FEVER. Yellow fever is a disease of warm climates, and depends upon a special cause. It occurs mostly during the summer months, and ceases on the appearance of frost. It occurs YELLOW FEVER. 21 chiefly in towns along the seaboard, or upon streams which empty into the ocean. Symptoms, &c. The striking features of this fatal disease, in addition to the general fever, are the yelloAvness of the skin ; severe headache, referred to the forehead and bottom of the orbit ; mental and bodily prostration, and great irri- tability of the stomach, — the matter vomited being at first slimy and tasteless, but gradually assuming the appearance of coffee-grounds, when it is called the black vomit. The dejections generally have a tarry appearance. There is often suppression of urine. The usual duration of the disease is from three to seven days. When the sixth day elapses without the appearance of Hack vomit, or suppression of urine, there is great hope of recovery. Death, when the disease proves fatal, usually occurs from exhaustion. The special poison of yellow fever appears particularly to affect the liver. Treatment. The indications for treatment are not very prominent, but urgent symptoms should be treated as they present themselves. If the bowels are constipated, give five grains of calomel with fifteen of jalap, to move them. If the fever runs high, give half a teaspoonful of sweet spirit of nitre, in a little water, every third or fourth hour. If there is much headache, apply cold water to the head and warmth to the feet. If the stomach is very irritable, apply a mustard poultice, followed by hot fomentations, over that organ, and let the patient swallow, occasionally, small pieces of ice. If there is much prostration, half a teaspoonful of the tincture of the chloride of iron, in a wineglass of water, every second or third hour, will generally prove beneficial. In some cases of great prostration, stimulants do good. The apartment should be kept well ventilated, and all excrementitious matters promptly removed. MEDICAL AND SURGICAL COMPANION. TYPHOID FEVER. This is a slightly infectious and contagious fever, and, be- ing most prevalent in autumn, is known in some parts of this country as the autumnal or fall fever. Persons between the ages of twelve and thirty years are most subject to it. It attacks all classes, rich and poor alike. Cause. This is not definitely known ; but it is most prevalent where we find pools of stagnant water, bad drain- age, foul air, &c. Symptoms. This disease is generally very insidious in its approach. There is a sense of weariness, languor, and general uneasiness, slight headache on rising in the morning, dulness of intellect, irregular flashes of heat or chilliness, slight acceleration of the pulse, furred tongue, and a dis- position to diarrhoea. These symptoms may last from sev- eral days to a week or more, after which the disease is established by the occurrence of a chill, followed by the ordinary phenomena of fever. After the disease has be- come settled, the pulse rauges from ninety to one hundred and twenty, being generally higher in females than in males. As a general rule, the pulse is under one hundred per min- ute. There is pain in the limbs, back, and head, with a dull, heavy expression of the countenance, restlessness, bleeding from the nose, and yellow, watery diarrhoea. As the disease advances, these symptoms become aggra- vated, the pulse increases in frequency, the skin becomes hot and dry, the tongue is parched, and becomes red at the tip and edges. There is pain in the right iliac region, ■with a gurgling sound upon pressure ; tympanitis is also present, and there also frequently appear, about this time, symptoms of either bronchitis or lung fever (pneumonia). About the seventh or ninth day, if the surface of the ab- domen be carefully examined, there will be discovered upon it a number of small, round, red spots, called " rose-spots," TYPHOID FEVER. 23 which disappear temporarily upon pressure, and constitute a characteristic eruption. They are about one line in diam- eter, and are slightly elevated above the surface of the body. At the same time, or sometimes not until a week later, a crop of vesicles, called sudamince, may also be detected upon the neck and chest. The rose-colored spots are not met with in all cases. In severe cases, about the middle of the second week, all the symptoms become aggravated, delirium supervenes, with ringing or buzzing sounds in the ears, followed by dul- ness of hearing, or deafness ; the eyes are injected, the tongue becomes incrusted with a black coating, which often cracks and peels off, leaving the raw surface exposed, and the teeth are covered with sordes ; the pulse becomes more frequent and feeble, and there is a low, muttering delirium, and sometimes twitching or spasm of the muscles. As the patient becomes more feeble, he slips down to the foot of the bed : there are involuntaiy evacuations, with hemorrhage from the bowels or other mucous surfaces. If the disease is to terminate favorably, the symptoms abate, the countenance brightens, the tongue clears, the pulse lessens in frequency, and the evacuations become more healthy. If the tongue ceases to clear, and if it again be- comes dry, it indicates an increase of intestinal disease. There is scarcely an organ in the body which may not be, in this disease, the seat of some anatomical lesion ; those which are most characteristic, however, are found in the intestines, and consist in the thickening, softeniDg, and ulcer- ation of the glands of Peyer. Sometimes, in the course of the second or at the beginning of the third week, the patient is seized with intense pain in the abdomen, vomiting of green, bilious matters, a small, fluttering pulse, fainting, and coldness of the extremities. The cause of these symptoms is perforation of the intestine, and escape of its contents into the cavity of the abdomen, causing inflammation. It occurs most frequently in the mild forms of the disease, and is almost uniformly fatal. 24 MEDICAL AND SURGICAL COMPANION. This disease may be distinguished from others by the slowness and insidiousness of the attack, by the diarrhoea, the dusky hue of the countenance, the bleeding from the nose, the rose-colored eruption, the gurgling in the right iliac fossa, the tympanitis, the stupor and delirium, the ap- pearance of the tongue, and, lastly, by the duration of the disease, and the peculiar musty smell when the skin is dry, and acid smell when it is moist. Not even the mildest cases of this disease can be looked upon as free from danger ; and, on the other hand, there is no condition so low, no symptom so fatal, that death should be considered inevitable. Among the most unfavorable symptoms are constant delirium, a belief on the part of the patient that nothing ails him, a sudden shifting of posi- tion on the elbows, deep coma, twitching and rigidity of the limbs, profuse diarrhoea, or bleeding from the bowels, &c. Treatment. Most physicians of the present day regard this as a self-limited disease, and do not believe it can be shortened by treatment. It usually runs its course in about three weeks, when convalescence begins. It is only slightly contagious, and some physicians do not believe it is at all so. It is not often that those who take care of "typhoid fever patients contract the disease, when they take proper care of themselves, are not too much deprived of rest, and keep the sick room well ventilated, and see that the patient's excreta are promptly removed. A little chloride of lime or chloride of soda, set in vessels about the room, is useful as a disiufectant. The sick room should be of good size, Avell ventilated, and away from noise. No more persons should be allowed in the room than are necessary to take care of the pa- tient. For nourishment, good milk may be freely drank. A cupful, or more, repeated every two hours, is better than a large quantity takeu at longer intervals. As drink to allay thirst, cold water, weak lemonade, or barley water, may be taken. TYPHOID FEVER. 25 At the commencement of the disease, an emetic of ipecac may sometimes prove beneficial ; but cathartics are seldom advisable, as there is usually a tendency to diarrhoea, which needs to be repressed rather than encouraged. if the skin is hot and dry, half a teaspoonful of sweet spirit of nitre, or a teaspoonful of R. 21 may be given in a little water, two or three times a day, and the whole surface of the body may be sponged over once a day with R. 134, warm, after which it should be wiped dry. If severe pain in the head and delirium are present, cold water, iced water, or cold spirit and water, freely applied, will be very beneficial. If the patient is restless, and not inclined to sleep during the night, eight or ten grains of Dover's powder may be given. If you have diarrhoea, either with or without hemorrhage from the bowels, give a powder of R. 72 twice or three times a day, to keep it in check. Should the patient at any time become very much pros- trated, a little wine, or brandy and water, may be given three or four times a day, and beef tea, or essence of beef, wine whey, or milk punch, given as occasion requires. The quinine mixture, R. 146, may also be given in teaspoonful doses, three or four times a day. It may be given in water, or added to the spirit. During convalescence, greater care will be required than after other forms of fever ; since any irritation applied to the cicatrizing or healing ulcers in the intestine will possi- bly affect them unfavorably, and re-excite that morbid action which may end in perforation of the bowels, and, conse- quently, death. The return to the usual diet must be very gradual, no solid food being allowed until the tongue has become clean and moist, the pulse soft, and till all feverish excitement has vanished ; until which time, also, the patient should neither be allowed to leave his bed, nor even to sit up much in it. Zt> MEDICAL AND SURGICAL COMPANION. I have dwelt at some length in treating of this fever, be- cause it is a very common and serious disease. Always place the patient under the care of a regular physician, if one is to be obtained. TYPHUS FEVER. Under this head are usually classed camp, jail, and ship fever. It is eminently contagious and infectious ; it often prevails epidemically, attacking individuals of all ages ; and it is the accompaniment of destitution, being generated in over-crowded and ill-ventilated dwellings, ships, &c. Its duration is from fourteen to twenty-one days. Of the nature of the disease little is known. The prob- ability is, that a poison is absorbed, which at once depresses the powers of the nervous system, and vitiates the blood. Symptoms. Before the attack commences, the patient is often low-spirited and languid, loses his appetite, and he feels ill without knowing why. At the same time there may be sharp pains in the head, back, loins, aud lower extrem- ities. A chill or violent shivering is often the immediate precursor of the disease ; sometimes, however, the cold stage is so slight as scarcely to be noticed. When the fever is fairly established, it is generally well marked. The skin is hot and dry, and the heat is of a pungent, biting character. The pulse is full, frequent, and possessed of some degree of strength, but is easily compressed. The tongue is moist, and covered with a yellowish-white fur. Sometimes there is nausea and vomiting. The bowels are costive, and no stools are procured without medicine. The aspect of the patient is peculiar ; the countenance is of a dusky hue, with injection of the eyes ; the features are fixed and inexpres- sive, or expressive only of apathy and indifference. In severe cases, as the disease advances, the symptoms augment in violence, the heat of the skin increases, the TYPHUS FEVER. 27 pulse rises in frequency and diminishes in force, ranging generally from one hundred and twenty to one hundred and fifty, or one hundred and sixty. The respiration is frequent, and sometimes imperfect at the back and lower part of the chest. At a period ranging from the fourth to the eighth day, a peculiar eruption appears upon the surface, not con- fined, however, to any particular locality. It varies in color from a dusky reddish-brown to purple or black. It is not elevated above the surface, neither does it disappear upon pressure. The tongue becomes dry, brown, and cracked, and, along with the gums, is covered with sordes ; the urine scanty and highly colored ; the discharges from the bowels, when procured, black and offensive ; a peculiar am- moniacal odor is exhaled from the body ; the nervous system becomes more prominent ; there is dizziness, confused vis- ion, ringing in the ears, and sometimes deep stupor, which becomes characteristically more profound as the disease advances. Sometimes violent delirium takes the place of stupor ; the patient is sleepless or restless, with the sensa- tion of utter prostration and helplessness. Should no im- provement take place, the disease passes on to the last stage — that of prostration. The patient lies insensible, or in a muttering delirium, with twitching of the tendons, hic- cough, involuntary evacuations, and extreme insensibility of the surface, till at length death approaches silently and without violence. Sometimes a critical discharge takes place from some organ, and the patient begins to improve ; generally, how- ever, by slow degrees, and under the influence of supporting treatment. The duration of the disease varies ; sometimes, in mild cases, terminating on the seventh day ; sometimes running out to six weeks, or more. When fatal, death rarely occurs before the second week. Treatment. A large, well-ventilated room, frequent changes of linen, daily bathing of the patient's body, re- 28 WEDICAL AND SURGICAL COMPANION. moval of all unnecessary carpets and curtains, and the im- mediate removal of all evacuations, are measures essential, both to mitigate the patient's disease, and to prevent it from infecting his attendants. Chloride of lime, or liquid chloride of soda, may be sprinkled about the room every day or two. When this disease makes its appearance on shipboard, or in jail, or camp, free and thorough ventilation and cleansing should immediately be resorted to, and chloride of lime be sprinkled about in abundance. No violent efforts should be made to cut this disease short, but the symptoms should be watched, and relieved as they arise. In the early stages, and in the whole course of mild cases, it is particularly necessary to beware of doing too much — of interfering too actively with Nature. We are able to treat, but cannot cure, these maladies, any more than we can cure small pox or measles ; and therefore our aim must be to keep the patient alive until the fever poison has expended itself. When the patient is seen early, an emetic may prove advantageous, and one ounce of wine of ipecac, with plenty of warm water, may be given for that purpose. Imme- diately after the operation of the emetic, a purgative, to thoroughly clear the intestines, will generally be useful. The following drink generally proves serviceable in this disease : — Take of Diluted Hydrochloric Acid, 3 drachms. White Sugar, ... 1 ounce. Water, or Barley Water . 1 quart. i Mix. Use as a daily drink. As a change, plain water, barley water, lemonade, or toast water may be allowed. The diet should be restricted to milk, farinaceous food, and thin broth, well salted. Tea and coffee, when they do not disagree, are considered useful by some. TYPHUS FEVER. 29 As soon as the powers of life begin to fail, and there is a signal loss of strength, a dark-brown tongue, and a rapid, feeble pulse, a stimulating plan of treatment should be com- menced. This consists in giving strong beef or chicken tea, with brandy and water. The brandy should be given in such quantities as the extent of prostration may demand. Two teaspoonfuls, or one tablespoonful, or two tablespoon- fuls may be administered in water or beef tea, every two hours, or every hour, the effect produced being closely watched, and its repetition guided by such effect, remember- ing that severe febrile symptoms do not contra-indicate it. Most care is needed in the use of spirit when the urine is scanty, or when there is violent delirium, with throbbing pains in the head. A few doses, however, will show whether the delirium is increased or diminished by its use. When its frequent administration is called for, care must be taken not to allow the patient to sleep too long without it. One is naturally unwilling to rouse a patient who may have pre- viously been without sleep for days, to give him his spirit and nourishment ; but unless we do so at each appointed hour, he may awake, and pass into a state of fatal pros- tration. When there are much general irritability and sleeplessness, in cases where there is no lung trouble, half a grain of ex- tract of opium may be given every three hours until the patient is calmed. If there is much headache, cold water, or iced water, may be freely applied to the head. After the first three or four days, the patient should not be allowed to use the night stool, or to get out of bed, but should be pi-ovided with a bed-pan, containing a little chlo- ride of lime. The bladder ought to receive daily attention, lest there be retention of urine. Under this management the patient may often remain in a very precarious state for some days ; but at last he will begin very gradually to recover, sleeping much as he improves. A teaspoonful of the quinine mixture R. 146, taken three times a day, with 30 MEDICAL AND SURGICAL COMPANION. a gradual return to solid food, will ultimately complete the cure. During the whole course of the disease, no person should be allowed about the patient, except his attendants. HECTIC FEVER. This is a remittent fever, and generally depends upon some local source of irritation, especially if attended with an ex- haustiDg discharge, perhaps arising from the absorption of diseased secretions. It is in the advanced stages of con- sumption that hectic fever is developed in its most character- istic form. When abscesses are forming in the liver, hip- joint, &c, it usually occurs. Symptoms. Chills, succeeded by flushes, terminating in a hot skin and frequeut pulse, and these, by perspiration, con- stitute the paroxysm of hectic fever. There are usually two such paroxysms in the twenty-four hours. During the paroxysms the pulse is quick and frequent, ranging from ninety-six to one hundred and thirty, or even more ; the urine is high-colored, and deposits a pink sediment ; the cheeks have a florid, circumscribed redness ; there is burn- ing heat in the palms of the hands and soles of the feet. During the remission, the pulse is reduced in frequency, but seldom falls so low as in health. The appetite is not much impaired, and the tongue is clean, moist, and red. The patient rapidly loses flesh. Treatment. This must depend on the disease of which the hectic fever is a symptom. If there is no apparent dis- ease to produce the hectic symptoms, the treatment must be that of debility, and the quinine mixture (R. 146) will be an appropriate remedy. The general health should be im- proved in every way possible. r? Q o SMALL POX. 31 THE ERUPTIVE FEVERS. These are diseases attacking a person, for the most part, only once, beginning with fever, and followed, after a short and nearly definite interval, by eruptions upon the skin. They are, — Small Pox, ..... Variola. Chicken Pox, .... Varicella. Measles, ..... Rubeola. Scarlet Fever, .... Scarlatina. SMALL POX. This disease may be defined as a fever, commencing with lassitude, pain in the head and back, with more or less vomiting. On the third day from the commencement of the attack, an eruption of small, hard pimples begins to appear — first on the face, then on the neck and wrists, then on the body, and, lastly, on the lower extremities. In some instances it is accompanied by a similar affection of the mucous membrane of the nose and mouth. The pimples gradually ripen into pustules, the suppuration being complete by the ninth day, at which time the pustules break, and crusts or scabs form. In four or five days more these scabs begin to fall off. Now, the severity of the disease always bears a direct re- lation to the quantity of the eruption. When the pustules are distinct, and not very numerous, the disease is milder than in the confluent form, in which they are very numerous, especially on the face, where they run together, so as to form almost a complete scab. The pustules attain their full size about the eighth day, when they have a round, whitish look, reminding one of a quantity of peas half embedded in the skiu. About this time dark spots may be seen on 32 MEDICAL AND SURGICAL COMPANION. the pustules, aud they soon break and discharge their con- tents ; and these, drying on the surface, form crusts, which in a short time fall off, and leave the skin beneath of a dark-brown color, which gradually fades out. During the course of this disease, the face, hands, and limbs often swell considerably. The patient is convalescent about the seven- teenth day. In the more severe cases, permanent white scars are left upon the skin of the face, aud other exposed parts of the body. The period occupied by the change from pimple to pustule is called the period of maturation. At different stages of this process, according to the amount of eruption, but gen- erally as early as the eighth day, secondary fever sets in, characterized by extreme restlessness, sleepless nights, a frequent and quick pulse, scanty and high-colored urine, and frequently by delirium, especially at night. Cause. A specific contagion, emanating from persons laboring under the disease, or from clothes, or other articles, worn or used by them. The disease manifests itself in about twelve days from the time of exposure. Treatment. The less drugs are used in the manage- ment of small pox the bettter, since they will neither shorten the disease nor exert any favorable influence upon it. In the early stages the patient should be kept quiet in bed, in a well-ventilated room; his diet should consist of milk, arrowroot, gruel, or weak beef tea ; he should be allowed plenty of lemonade, or barley water, or plain water ; and when the skin is very hot, sponging the surface of the body with warm water will prove very refreshing. If the bowels are confined, a Rochelle powder, or a little castor oil, may be occasionally given ; or if there be great irritability and nervousness, ten grains of Dover's powder at bed-time will do good ; or if the maturation or filling out of the pustules goes on slowly, good broths, or beef tea, and small quan- tities of brandy, are indicated. In treating the secondary fever, which, as before stated, KINE OR COW POX. 33 sets in about the eighth day, keep the bowels gently open by mild laxatives ; administer five to ten grains of Dover's powder, if needful, once or twice a day, and support the system by a nourishing but digestible diet, such as strong beef tea, milk, the yolk of one or two eggs daily, &c. When there is great prostration, liberal and frequent doses of whiskey or brandy are demanded. To relieve the intol- erable itching, sponge carefully with R. 134, warm. To prevent pitting, glycerine, sweet oil, or cold cream may be used. When the pustules have burst, some dry powder, as the oxide of zinc, or powdered starch, should be freely applied to absorb the matter. VARIOLOID. This is small pox, modified by previous vaccination, the vaccine disease affording complete protection to only about one half of those subjected to it. Varioloid is capable of producing genuine small pox in the unprotected. In some cases the fever alone exists ; in others only an eruption going on to the fourth or fifth day, and then drying up. Its progress is always shorter, by several days, than small pox, and it is destitute of the characteristic odor of that disease. The treatment is the same as for mild cases of small pox. KINE OR COW POX. (Vaccinia.) The fatality of small pox has been very much diminished since the discovery of vaccination, by Dr. Jenner, towards the close of the eighteenth century. The disease was first noticed in the cow (whence its name), in which animal it appears in the form of small vesicles upon the teats. The matter taken from such vesicles, when introduced under the skin, sets up in the human system a very mild disease, 3 34 MEDICAL AND SURGICAL COMPANION. which is fully protective against small pox in one half the cases, and greatly modifies it in the other half. It is not now necessary to take this matter directly from the cow, but from some person who has the vaccine disease. The matter should be taken about the eighth day. MODE OF PERFORMING THE OPERATION OF VACCINATION. Two or three punctures should be made near each other, on the outside of one arm, about six or eight inches below the shoulder. The skin being made tense, a sharp lancet should be inserted obliquely downwards under the skin, so as to draw a single drop of blood. If the matter is taken di- rectly from the arm of another child, the lancet should be dipped in the lymph of the vesicle, and then inserted in the punctures. If the matter is on quill points, it should be first moistened by the breath. If portions of crust or scab are used, they must be carefully crowded into the punc- tures. On the second or third day small red spots appear, which gradually increase until they attain their full size, about the eighth day, from which time they gradually dry away, the crusts falling off about the fifteenth or twentieth day, leaving deep marks or indentations on the skin, of a cir- cular form, with as mauy pits as there were cells in each vesicle. Infants may be vaccinated at any time after the sixth week. Some have recommended the repetition of vacci- nation at intervals of a few years ; and I regard this as a wise precaution. No treatment is required. CHICKEN POX. This is a trifling complaint, almost peculiar to infants and young children. It runs its course in about a week. The disease consists of an eruption of transparent vesicles sur- CHICKEN POX. MEASLES. 35 rounded by a slight redness, commencing on the shoulders and breast, affecting the scalp, but often sparing the face. These vesicles form small scabs, which rapidly dry up ; there is no constitutional disturbance of any importance, and the accompanying fever is slight. When the eruption is abundant, the body presents the appearance of having been exposed to a momentary shower of boiling water, each drop of which has caused a small blister. No treatment is neces- sary. MEASLES. The distinguishing characters of this disease are a con- tinued contagious fever, accompanied by an eruption, and frequently attended with inflammation of the mucous mem- brane of the respiratory organs. The eruption usually ap- pears about the fourth day. The period of incubation, or, in other words, the time which elapses between the period of infection and the appearance of the eruption, is from ten to fifteen days. Symptoms. Very much, at first, like those of a common " cold," or catarrh. These are lassitude, shivering, fever ; with affection of the mucous membrane of the throat, nose, windpipe, aud bronchial tubes. There is also swelling of the eyelids, eyes suffused and watery, and intolerant of light; sneezing; dry cough, with hoarseness, and at times diffculty of breathing ; drowsiness ; great heat of skin ; fre- quent and hard pulse. When the eruption first appears, it consists of small circu- lar dots, like flea-bites, which gradually coalesce into small blotches of a raspberry color ; they present, often, a horse- shoe shape, and are slightly raised above the skin. The rash appears first on the forehead and face, and gradually extends downwards ; it begins to fade on the seventh day, in the same order, and is succeeded by slight scaling of the cuticle, and great itching. 36 MEDICAL AND SURGICAL COMPANION. It is worthy of notice that the fever does not abate on the appearance of the eruption, as in small pox ; nor does the severity of the attack at all depend upon the quantity of the rash. The contagion of measles is strong, but less power- ful than that of small pox. It is mostly seen in children ; but adults may have it, if they escaped in childhood. The usual duration of the disease is from nine to twelve days. The complications most to be feared in this disease are croup, bronchitis, and lung fever. The diarrhoea, which often sets in as the rash declines, is for the most part bene- ficial. Treatment. Exposure to cold to be carefully avoided. The patient should be confined to bed in an apartment mod- erately warm. Low diet, mucilaginous drinks, laxatives, and mild diaphoretics, may be had recourse to. The follow- ing mixture may be given with advantage : — Spirit of Mindererus, . . .1 ounce. Sweet Spirit of Nitre, . . .2 drachms. Paregoric, . . . . .2 drachms. Syrup of Gum Arabic, . . . jounce. Mix. A teaspoonful may be given to a child six years old, every four or six hours. For others, let the dose be in proportion to age. - If croup, severe bronchitis, or lung fever arise, treat ac- cording to the rules laid down for treating those diseases. SCARLET FEVER. This is a contagious and infectious fever, accompanied by a scarlet eruption, or rash, upon the skin, which usually makes its appearance on the second day, and terminates in scaling of the cuticle. More or less soreness and swelling of the throat are also present in the larger proportion of fV3 SCARLET FEVER. 37 cases. The disease makes its appearance in four to six days from the time of exposure. Symptoms. Chills, followed by a hot skin, rapid pulse, thirst, headache, nausea, and sometimes vomiting, restless- ness, and sleeplessness. On the second day, in the greater number of cases, a bright scarlet rash is perceptible on the face, neck, and arms, whence it extends over the trunk and limbs. It generally begins to decline on the fifth day, and wholly disappears by the eighth day. Entire duration of the disease from eight to thirty days, or more. Treatment. In simple scarlet fever, which is unac- companied by throat trouble, very little treatment is re- quired. The patient may be kept in doors for a few days, and allowed plenty of milk, arrowroot, &c. If very thirsty, a little plain water or lemonade may be given as often as occasion requires. Never allow the throat and mouth to become parched for want of water. Towards the decline of the disease, the bowels may be moved by some mild pui-gative, as castor oil or magnesia. In a more severe form of the disease, accompanied with some soreness and swelling of the throat, great heat of skin, &c, the patient demands a little more attention ; but in no case can we shorten the disease by treatment ; we can, however, relieve urgent symptoms as they arise. When the heat of skin is great, sponging the surface of the body once or twice a day with warm water will prove bene- ficial, and the following mixture will tend to lessen the fever : — Take of Spirit of Mindererus, . . 1 ounce. Sweet Spirit of Nitre, . . 2 drachms. Syrup of Gum Arabic, . . 6 drachms. Mix. Give half a teaspoonful to a teaspoonful, three or four times a day, to a child four to six years old. For the throat trouble, one drachm of powdered chlorate of potassa may be dissolved in a pint of water, and a few 38 MEDICAL AND SURGICAL COMPANION. swallows taken every two or three hours. A flannel cloth passed several times around the throat may bo of some advantage, and I believe a hot flaxseed poultice to the throat will, in some cases, prove serviceable. If there is much debility, a little wine or brandy may be given three or four times a day. The tincture of chloride of iron may be given after the fever has declined. For a child three or four years old, four drops may be given, in a little water,- four times a day. In malignant scarlet fever, all the symptoms are aggra- vated, and the throat trouble is very severe. The vital pow- ers are so prostrated by the deadly force of the poison, that unless we support them by the free administration of brandy or wine, they will fail altogether. If we do the best we can, the larger number of cases may prove fatal. In these cases, swabbing out the throat once or twice a day, for several days, with a solution of the crystals of nitrate of silver, will generally prove useful. The solution should be quite strong — forty to sixty grains to an ounce of water. A hot flaxseed poultice may be applied to the throat. Sometimes I have painted the throat outside with tincture of iodine, once or twice a day, for several days, with apparent benefit. For diet, good beef tea and milk may be freely given. Beware of giving cathartics too early in this disease, for it is one in which the powei-3 of life must be supported, instead of lowered. If the bowels are constipated at the commencement, a gentle laxative only should be given. Mothers should be very careful of their children for three or four weeks after they have had scarlet fever, lest they take cold, which is liable to cause kidney and dropsical trouble of a serious nature. ACUTE RHEUMATISM. 39 CHAPTER III. ACUTE RHEUMATISM. This disease consists of an inflammation of the larger joints, accompanied by well-marked fever symptoms ; the. inflammation often shifting from joint to joint, and in many cases attacking the fibrous textures of the heart. Symptoms. The disease generally sets in soon after ex- posure to cold and wet, with all the symptoms of a " cold ; " the pain in the back and limbs being unusually severe, and accompanied by a sensation of coldness and stiffness. In the course of two or three days, inflammation shows itself in one or more of the larger joints of the body, characterized by redness and heat of surface, acute pain, extreme tender- ness, swelling, and tension. There is great constitutional disturbance, with extreme restlessness, intense thirst, and loss of appetite. The pulse ranges from ninety to one hun- dred and twenty, and is full, hard, and jerking. The skin is often bathed in a profuse acid sweat, which, however, affords no relief. There is constipation in most cases, and the urine is high-colored and scanty. This disease is rarely confined to the joints first attacked ; but after some hours or days, it attacks other joints, sometimes continuing in those first affected, at others leaving them quite free from pain and swelling. In rarer instances, it returns to the joints first affected, and ultimately extends to all the larger joints of the body. Some amendment usually takes place at the end of two or three weeks ; the pain lessens ; there is less fever and less perspiration; the urine is more abundant; 40 MEDICAL AND SURGICAL COMPANION. the appetite returns ; the thirst diminishes ; the pulse falls ; and the patient's movements become more free. In many cases the disease extends to the fibrous tissues of the heart. The symptoms which denote this formidable complication are difficulty of breathing, palpitation, pain in the region of the heart, &c. Cause. The disease is supposed to depend upon an excess of lactic acid in the blood. The exciting cause is exposure to wet and cold. Treatment. At the commencement it is advisable to give a thorough purgative, which may consist of eight grains of calomel and fifteen of jalap. During the whole course of the disease the bowels should be kept rather loose, by giving every day or two, either a Rochelle powder or a small quan- tity of Epsom salts. Opiates in full doses are generally neces- sary to relieve the pain and general irritability. A pill, com- posed of two grains of opium, may be given every night ; ami unless the patient perspires freely, one of the following pow- ders may be given once in four or six hours during the day. Take of Powdered Opium, . . .6 grains. Powdered Ipecac, . . .6 grains. Powdered Nitrate of Potassa, . 48 grains. Mix thoroughly and divide into twelve powders. In addition to the foregoing, the following mixture will prove very beneficial in most cases : — Take of Bicarbonate of Potassa, . . 1 ounce. Peppermint water, . . . C ounces. Syrup of Orange Peel, . . 2 ounces. Mix. A tablespoonful may be taken every third hour, for two or three days, after which one half the quantity may be given, until the pain and fever are very much lessened. If the disease remains stationary in one or two joints, a couple of grains of iodide of potassium may be advantageously ad- ministered with each dose. During convalescence, II. G2 or R. 63 may be taken with benefit. The diet must at CHRONIC RHEUMATISM. 41 first be low, consisting of gruel, arrowroot, &c. Whenever signs of depression are observed, good beef tea and milk may be administered, with, if necessary, brandy and water. Light puddings, potatoes, and fish should be allowed as soon as the appetite returns, and the stomach appears capable of digesting them. As soon as convalescence is thoroughly established, mutton, beef, and poultry may be given. In the early stages, when there is much thirst, a plenty of lem- onade may be allowed. Local Remedies. When the wrists and ankles are chiefly affected, much benefit will arise, from frequently soaking them in a warm alkaline bath ; or from fomenting them with warm water, to which a little bicarbonate of soda and lauda- num have been added. Rubbing the parts two or three times a day with opium liniment often proves serviceable. Wrapping the affected joints in cotton wool and oiled silk frequently gives relief. When the acute symptoms have partially subsided, the swollen joints may be painted with tincture of iodine. CHRONIC RHEUMATISM. This is sometimes the sequel of rheumatic fever, but fre- quently a separate constitutional affection, coming on quite independently of any previous acute attack. It is quite common in people past the meridiau of life, few old persons being entirely ignorant of its symptoms. In chronic rheumatism the fibrous textures around the joints, or the fibrous envelopes of the nerves, or the aponeu- rotic sheaths of the muscles, the fasciae, or the periosteum, are the parts that suffer. Whichever tissue may be affected, there is, at first, only slight constitutional disturbance ; but the sufferer is constantly annoyed, and his existence at length made miserable, with chronic pains, causing him to be rest- less at night, and destroying all comfort during the day. 42 MEDICAL AND SURGICAL COMPANION. There are two or three different forms of chronic rheuma- tism. Thus rheumatic inflammation of the lumbar fascia is termed lumbago, the pain being referred to the fleshy mass of muscles on one or both sides of the loins, and being increased by every movement of the back. Stiff or wry neck is another variety, generally due to sitting in a draught. In sciatica the suffering is due to disease affecting the sheath of the sci- atic nerve. "When the muscles between the ribs, or tlie fibrous fascia? lining the chest, are affected, the di- frequently called Neurodynia. The " stitch " which follows a deep inspiration must not be mistaken for the lancinating pain of pleurisy. Treatment. In the treatment of chronic rheumatism 'it is always necessary to attend to the geueral health, as by so doing the disease will generally be materially mitigated. Care must be taken that the function of digestion is per- formed naturally; while sleep must be afforded by opiates, if necessary. There are several remedies that have proved beneficial in this disease, but I cannot in this work mention them all. The iodide of potassium, and the cimicifuga ra- cemosa or black snalceroot, will be found very efficacious in the majority of cases. Take of Iodide of Potassium, . . 8 scruples. Fluid Extract of Cimicifuga, . 2 ounces. Syrup of Gum Arabic, . . 2 ounces. Mix. A teaspoonful may be taken in a wineglass of water three times a day, after meals. Local applications, such as blisters (R. 80), iodine paint (R. 8G), and chloroform and opium liniment (R. Ill), often give temporary relief. In lumbago, a large belladonna plaster, applied over the whole loins, will often be productive of great comfort. Ironing the part, a piece of paper or cloth being placed between the hot iron and skin, deserves mention. All sufferers from chronic rheumatism should wear flannel, and beware of exposure to wet and cold. 43 SCIATICA. This disease is a form of neuralgic rheumatism, and con- sists of acute pain following the course of the great sciatic nerve, extending from the hip down the back of the thigh to the knee, and frequently along the nerves of the leg to the foot. Causes. Rheumatism ; pressure upon some part of the nerve, such as may arise from intestinal accumulations, or from simple or malignant tumors of the womb ; and occa- sionally from inflammation. Usually one limb only is affected. The muscles feel stiff, and as if their action were impeded, so that the patient limps along with the aid of a stick. The duration of sciat- ica varies from a few weeks to several months or years. The middle period of life, from forty to sixty, is most ob- noxious to it ; and occasionally attacks of it alternate with other rheumatic or neuralgic affections. Treatment. Remove the causes, if they can be ascer- tained. If it has a rheumatic origin, the treatment recom- mended for chronic rheumatism will prove beneficial. GOUT. {Podagra.) Gout may be defined as a specific inflammation, having a constitutional origin, and being much favored by an heredi- tary taint. Symptoms. The acute attack may be preceded by pre- monitory symptoms, or it may come on suddenly. In the former case, the patient complains, for two or three days prior to the seizure, of heartburn and flatulence, and of dull pains in the left side of the chest, with inability to lie com- fortably on that side. Very often, however, there is no warning. The victim 44 MEDICAL AND SURGICAL COMPANION. goes to bed apparently well, but towards morning awakes with a severe burning and throbbing pain in the ball of the great toe, or in the heel, or the fascia? covering the instep of the foot, or the thumb. There is often a slight chill, suc- ceeded by heat. The pain is most excruciating; but it abates near the dawn, and the patient falls asleep. On again awaking, the affected part is found red, swollen, aud exquisitely tender to the slightest touch. The sufferer is feverish, restless, very irritable, aud much depressed ; his bowels are constipated, and his urine scanty and high- colored. The bladder is often irritable, so that it has to be emptied frequently, while the urine in its passage gives rise to a sense of heat in the urethra. In a few days, sometimes almost in a few hours, the at- tack passes off, and the patient is well; often better, indeed, than he has been for a long time previously. But the dis- ease will return. At first two or three years may elapse ; with each paroxysm, however, the interval will shorten, until at length, perhaps, the patient is hardly ever i're? from an attack, except it may be for a few weeks in summer. At first, also, it confines itself to a single joint ; by degrees several joints in both feet or in the hands suffer. Deposits are formed around aud outside the joints of a material re- sembling moist chalk, and consisting of lilhate of soda. Gout sometimes leaves a joint, and goes to some internal organ, more especially to the stomach. It is then called retrocedent gout. This disease may be distinguished from rheumatism by the seat of the disease being the smaller joints, especially the great toe ; by the more intense color of the inflamed part ; by its more sudden attacks. Causes. It is often hereditary, but more frequently ac- quired by a luxurious mode of living, sedentary habits, and over-mental toil and anxiety, especially when stimulants are resorted to for the purpose of making this toil more support- able. It generally begins between thirty and forty years GOUT. 45 of age. Women are much less liable to this disease than men. Treatment. The treatment of gout naturally divides itself into that proper during an attack, and that to be adopted in the interval. At the commencement of the at- tack, the bowels may be moved by a Rochelle powder, or dose of Epsom salts. This may be repeated every second day, if necessary. The preparations of colchicum prove very beneficial in this disease, and may be given in combination with some alkali and laudanum. The following is a good prepara- tion : — Take of Bicarbonate of potassa, . 6 drachms. Tincture of opium, . 4 " Wine of colchicum seed, . 12 " Liquid acetate of ammonia, 10 ounces. Mix. An adult may take a tablespoonful in a little water, three times a day. The dose may be diminished as the inflammation abates, and it may be given in small doses, of from one to two tea- spoonfuls, for a week or two after the disappearance of the malady. The local treatment may be the same as recommended for rheumatism. This disease may be prevented by regular living, avoiding the exciting causes of the disease, by ab- stinence from liquors, and the moderate use of animal food, and by a milk and vegetable diet, friction with the flesh- brush, regular exercise, bathing, the regular use of mild laxatives, and when dyspeptic symptoms are present, the treatment applicable to that disease. Treatment of Ketkocedent Gout. If the stomach is attacked, apply a mustard poultice over that region, and soak the i'cet in hot mustard water. Warm brandy and water may be taken rather liberally. 46 MEDICAL AND SURGICAL COMPANION. SCROFULA. By the term scrofula is understood a peculiar state of constitution, characterized by want of power and tone ; the deposit of a substance called tubercle in several organs of the body, and a tendeucy to indolent inflammatory swellings and chronic ulcers. The most common forms of scrofulous disease, are chronic inflammation and suppuration of the glands of the neck, enlarged tonsils, " white swelling," and pulmonary con- sumption. The form of scrofula to be described in this place is that which attacks the absorbent glands of the neck. Other scrofulous affections will be treated of elsewhere in these pages. Symptoms. This disease most commonly affects children of a las habit of body, with a smooth, soft skin, delicate, rosy complexion, fair and fine "hair, large blue eyes, and full upper lip. A less common combination is the dark hair and olive complexion. The subjects of this disease often display great acuteuess and aptitude, with lively imaginations and ardent affections, and not unfrequently a great precocity of intellect. The scrofulous affection of the glands of the neck first appears as a slight swelling of one or more of the glands of one or both sides of the neck, especially of those situated beneath the lower jaw. The tumor is even to the touch, not tender, nor marked by any inflammation of the skin. Sometimes the swollen gland, or glands, will remain in this state without perceptible change for weeks, months, or even years. Sometimes, under proper treatment, they gradually disappear. In the large majority of cases they proceed to suppuration, when pus and a curdy or cheesy matter is dis- charged. The abscess thus formed heals slowly, has an unhealthy appearance, a dull red color, with hard, swollen, SCBOFULA. 47 irregular edges, and an uneven base, clogged with curdy- matter. The constitutional disturbance which accompanies these local changes is often slight. The patient frequently has every appearance of good health. In some cases there is general debility, emaciation, and loss of appetite. In advanced stages of the disease, especially in young adults, pulmonary consumption may supervene, and the two dis- eases run together until they destroy the patient. Causes. Hereditary taint, syphilis, or gout, or a shat- tered constitution in one or both parents, disparity of age, scanty and unwholesome food, and impure air. Treatment. In treating this disease we must endeavor to improve the general health, promote the absorption or dispersion of local tumors, and the healing of ulcers. A nutritious diet, adapted to the age of the patient, with a due allowance of animal food, will be required. During the formation of matter, wine and malt liquors, in mod- erate quantity, may be given with advantage. Daily exercise, short of fatigue, is beneficial. The cloth- ing should be warm, and flannel should be worn next the skin. Change of air, especially from a low, damp situation to a high and dry one, is advisable. Sea air and sea bathing in the summer and autumn months may prove advantageous. Daily ablution of the skin with cold or tepid water, fol- lowed by friction with a coarse towel, will do good. The bowels may be regulated by laxatives, if necessary. The preparations of iron (R. 59, 60, 63) and iodine (R. 67, 68) may be given with advantage in all cases. Cod-liver oil is a valuable remedy in this disease. Simple enlarge- ment of the glands of the neck may be treated by giving R. 67, and frequently applying to the tumor the iodine paint. Open scrofulous ulcers may require to be touched with lunar caustic, and afterwards a poultice or resin ointment may be applied. 48 MEDICAL AND SURGICAL COMPANION. ANEMIA, CHLOROSIS. This is a disease dependent on a decrease of the red par- ticles and solid constituents of the blood. It usually comes on gradually. Symptoms. Universal paleness of the skin, tongue, gums, and lining membrane of the mouth ; cold extremities, debil- ity, fainting fits, palpitation, and difficulty of breathing on the slightest exertion, headache, pain under the left breast, or a sense of fulness in the chest, pulse frequent, small, and quick, increased by exertion and motion. The patient is easily agitated by slight noises and unexpected events, and suffers from depression of spirits, and in some cases from hysteric fits. The bowels are generally torpid. This dis- ease occurs oftener in females than males, and is generally in some way connected with the function of menstruation. In males it may be occasioned by overwork, as in bakers, and other men following exhausting occupations, without sufficient time for rest and refreshment. Treatment. Remove as far as possible the causes of the disease, and administer the preparations of iron (R. 59, 61 or 63) for a considerable time. The diet should be substantial ; good beef, mutton, and poultry are excellent. Out-door exercise short of fatigue, the respiration of pure air, and cool bathing, particularly in sea water, will prove serviceable. If the bowels are constipated, they may be kept regular by taking, every second or third night, two or three of the pills of aloes and myrrh. INFLAMMATION OF THE BRAIN. 49 CHAPTER IV. DISEASES OF THE NERVOUS SYSTEM. INFLAMMATION OF THE BRAIN. Symptoms. Intense pain in the head ; the eyes incapable of bearing the light ; delirium ; face flushed ; oppression of the breast ; the pulse hard and very rapid ; tongue at first fiery red, then yellow, brown, or black. Causes. Excessive heats, or great vicissitudes of temper- ature ; exposing the head uncovered to the sun {coup de soleil), violent exercise, excited passions of the mind, ex- ternal violence, the abuse of spiritous liquors, metastasis of gout, rheumatism, erysipelas, small pox, measles, scar- let fever ; whooping-cough, teething, &c. Treatment. To an adult give a purgative, composed of five grains of calomel and fifteen of jalap. In three or four hours after this is taken, give a tablespoonful of Epsom salts, dissolved in a tumbler of water. Repeat the purge every day or every second day, according to the urgency of the case. The application of cold to the head, after it has been shaved, is a remedy of great importance. Pounded ice in a bladder, or the constant application of cold water, or iced water, will often be followed by the most happy results. Rice water, barley water, lemonade, or cold water, should be the only diet, until the symptoms begin to abate. The patient's room should be well ventilated, but darkened, and should be kept quiet, as very slight noises will disturb him. 50 MEDICAL AND SURGICAL COMPANION. When, from exhaustion of the nervous force, an extreme degree of prostration occurs, brandy or R. 43 should be given, as occasion requires, and strong beef tea and milk may be freely taken. WATER IN THE HEAD. (Acute Hydrocephalus.) This is a common disease of children under five years old. It generally occurs in feeble, scrofulous children, but may occur in others. Symptoms. The symptoms are somewhat various and uncertain. There is fever, appetite variable, the tongue furred, the breath offensive ; there is often nausea and vomiting, and the bowels are disordered — generally consti- pated. The child is drowsy, yet restless ; it sleeps badly, moans, grinds its teeth, screams, and awakes suddenly in alarm, without any apparent cause. la four or five days, if the disease is unchecked, its nature becomes apparent, and its cure almost hopeless. The child at this stage wishes to remaiu quiet in bed ; its countenance is expressive of anxi- ety and suffering ; its eyes are closed, and eyebrows knit ; and it is annoyed by light and noise. If old enough to reply to questions, it complains of headache, weariness, and sleep- iness ; crying out frequently, " O, my head ! " As the dis- ease advances, the pulse falls rapidly, sometimes from one hundred and twenty to eighty in a few hours ; the slightest exertion however accelerates it. Stupor and heaviness soon come on ; there is often squinting ; convulsions frequently occur, and sometimes paralysis. At the end of a week or two the child may pass into a profound sleep, or stupor, from which it is impossible to rouse him. Sometimes convulsions put an end to the painful scene. Treatment. This disease is one of the most serious to which children are liable, and when it is suspected, send for a physician at once, if one is to be obtained. APOPLEXY. 51 Keeping the bowels open, and the constant application of cold water to the head, are approved measures of treatment ; but the disease generally terminates fatally. APOPLEXY. By"apoplexy, is understood sudden insensibility — the loss of sensation, thought, and power of voluntary motion ; to- gether with more or less severe disturbance of the functions of respiration and circulation. Symptoms. Falling without sense or motion ; profound sleep ; face livid or flushed ; eyes wide open, or half closed, and immovable ; stertorous breathing, &c. Causes. The excessive use of intoxicating drinks, tobac- co, opium ; a rush of blood to the head, from any cause ; violent exercise ; sudden excitement ; intense heat ; anger, &c. An attack of apoplexy may gradually pass off, leaving the patient well, or it may terminate in incomplete recovery, the mind being impaired, and some parts of the. body para- lyzed ; or it may end in death. Persons whose ancestors have suffered from the disease, and fleshy individuals, with short, thick necks, are most sub- ject to this disease. Persons beyond fifty years of age are most liable to it. This dreadful disease is seldom experienced without some previous threatenings ; which, properly interpreted, should put the patient on his guard. Among the warnings are headache and giddiness, experienced particularly on stoop- ing ; a feeling of weight and fulness in the head, with noises in the ears and temporary deafness, transient blind- ness, or sometimes double vision ; repeated bleeding from the nose ; fits of nausea, and a sense of numbness in the limbs ; loss of memory ; partial paralysis, sometimes affect- ing a limb, sometimes the muscles of the face, sometimes the tongue or eyelids. 52 MEDICAL AND SURGICAL COMPANION. Persons who have these warnings must carefully guard against everything liable to bring on an attack. They should live sparely, and avoid the use of spirits, tobacco, and opium ; tight neckcloths, straining at stools, long-continued stooping, excitement, &c. In most cases of death from apo- plexy there is an effusion of blood (from the rupture of some small artery), upon or between the membranes of the brain. Treatment. When a person falls in an apoplectic fit, if the vessels of the neck are congested, and if the face be flushed and turgid, bleeding may be resorted to. But if the patient is feeble, and has an almost imperceptible pulse, and a cold, clammy skin, bleeding will only insure a speedy fatal termination. In either case the patient ought be re- moved into a cool, well-ventilated room ; his head should be well raised ; all the tight parts of his dress must be loosened, especially his cravat and shirt collar ; and cold water, or pounded ice in a bladder, applied to his head. His feet may be put into a vessel of very warm mustard-water at the same time. If it be a case requiring bleeding, it should be done at once, by opening a vein at the bend of the arm or in the foot, and half a pint to a pint of blood be allowed to flow. Active purgatives are very serviceable. Three or four drops of Croton oil, made into a pill with a crumb of bread, should be given at once. An injection, R. 12, should also be given immediately. These cases admit of no delay. Supposing a patient to recover from the fit, great care will afterwards be required to prevent a second attack. SUN STROKE. (Coup de Sohil.) This disease is allied to apoplexy. It proceeds from exposure to the sun's rays. Symptoms. These are, generally, faintness, thirst, great DELIRIUM TREMENS. 53 heat, and dryness of skin, with prostration. Sometimes the patient is suddenly prostrated as in apoplexy, and dies at once ; at other times the disease comes on very insidiously. A man will be seen to be listless and stupid, but he makes no complaint beyond saying that his head feels a little queer. Yet in twelve hours he may be dead. Treatment. Apply cold to the head perseveringly, and warmth to the extremities, as in apoplexy. If prostration becomes very great, spirits may be given, and the applica- tion of cold to the head discontinued. In such cases send for a physician as soon as possible. DELIRIUM TREMENS. This is quite a common disease, and generally arises from the excessive use of ardent spirits, wine, or beer. The habitual use of opium, and excessive mental excitement, may cause it. Men are very much more subject to it than women. Symptoms. This disease is characterized by sleepless- ness ; a busy but not violent delirium ; constant talking or muttering ; a trembling of the hands ; and general excited and eager manner. If questioned about his disease, he will answer readily and to the point ; describe, in an agitated manner, his feelings, put out his tongue, and do whatever you ask him. But soon afterwards his mind wanders from the scene around him to some other that exists only in his imagination. His thoughts generally appear to be dis- tressful and anxious ; perhaps he gives orders that relate to his business, to persons who are absent ; or he is devising plans to escape from some imaginary enemy ; at times he fancies that " little devils," rats, mice, reptiles, &c, are run- ning over his bed, or that strangers are in his room. He looks suspiciously behind the curtain, or under his pillow, and he is perpetually wautiug to get out of bed, but is gener- 54 MEDICAL AND SURGICAL COMPANION. ally readily induced to lie down again. It is not often that he meditates harm, either to himself or to others ; there is, rather, a mixture of cowardice and dread with the delirium. Sometimes, however, he will be obstinate, and inclined to get out of the house, even if he has to jump from a window. In such cases the watchful care of attendants is required. Treatment. The great object is to induce sleep ; and for that purpose give a morphine pill, R. 45, every hour, until three have been given, unless the patient falls asleep before the third hour has expired. At the same time stimu- lants are necessary, and, as a rule, that stimulant will be most beneficial to which the patient has been accustomed. Thus, if whiskey is his favorite liquor, give him that ; but if most accustomed to brandy, administer it now. When there is great prostration, good beef tea and milk should be freely given. Occasionally it is necessary to restrain the patient's move- ments by strapping him to his bed, or by putting on a strait waistcoat. This should never be done, however, if it can possibly be avoided, as it always increases the excitement and prevents sleep. It will be much better to have one or two attendants at the bedside to quietly control him. The apartment occupied by the patient should be kept quiet, a little darkened, and well ventilated. INSANITY. Insanity is a general term used to express the mental con- dition opposed to sanity, — sanity being that state of mind which enables a man to discharge his duties to his God, his neighbor, and himself. This definition is open to many objections, and every definition will be so. For as nothing can be more slightly defined than the line of demarcation between sanity and insanity, so, if we make the definition INSANITY. 55 too narrow it becomes meaningless ; and if too wide, the whole human race may be involved in it. Varieties of Insanity. The following classification is, perhaps, as simple and intelligible as any : Mania, Monoma- nia, Dementia, and Idiocy. It must be remembered, howev- er, that the differences between these varieties are almost always indistinctly marked, and that the various forms fre- quently run into each other. Mania. Mania, or raving madness, is characterized by general delirium. The reasoning faculty, if not lost, is dis- turbed and confused ; the ideas are abundant, erroneous, absurd, wandering, — not under control. The manners are violent, excited, mischievous. Although mania does not always make its incursions sud- denly, it is that form of insanity which most frequently does so. From its commencement the delirium is general, and the fury often extreme. Then it is that maniacs frequently destroy themselves ; either from not knowing what they do, or from despair, being conscious of their condition, or from accidentally injuring themselves. In general, maniacs soon become weak and emaciated. The mere physical exertion which they go through, some- times shouting, howling, laughing, reciting, &c, for hours together, often restless, constantly and rapidly moving about, would quickly exhaust a strong man. Combined with this fatigue is a want of refreshing sleep, and not unfrequently an aversion to all food. When recovery takes place it is preceded by sleep, a desire for food, and a gradual cessation of the agitation and delirium. Puerperal Mania is a peculiar affection, sometimes oc- curring to women about the fourth or fifth day after delivery. In most cases there is considerable debility. The delirium is often violent, and there is great general irritability. Treatment. These cases of puerperal mania require peculiar care. The indications are to rouse and support 56 MEDICAL AND SURGICAL COMPANION. the powers of the patient, and to allay the irritability of the brain and nervous system. Good milk and beef tea, and wine or brandy, may gener- ally be used to advantage. To allay irritability and promote sleep, a morphine pill, R. 45, may be given, and repeated in four to six hours, if necessary. Lupulin, in drachm doses, often proves useful when given two or three times a day. The patient must be controlled effectually, but mildly, by a good nurse, accustomed to the management of these cases ; and when the disease threatens to be of considerable dura- tion, she should be separated from her family and friends. Monomania. Monomania, or partial insanity, is that form in which the understanding is partially deranged, or is under the influence of some particular delusion. The mind is vig- orous, the ideas are few, erroneous, fixed, not under control. The manners are in accordance with the predominant idea or train of ideas. At one time the intellectual disorder is confined to a single object, or a limited number of objects. The patients seize upon a false principle, which they pursue logically, and from which they deduce legitimate consequen- ces, which modify their acts and affections. Thus, a mono- maniac will insist that his body is made of glass, and being thoroughly impressed with this idea, will reason correctly that slight causes will injure it ; he constantly walks with care, and avoids any rough handling. Aside from this partial delirium, he often thinks, reasons, and acts like other men. Another monomaniac will fancy himself possessed of a demon, or evil spirit, or will believe himself to be a god, imagining that he is in communication with heaven. That form of monomania which is characterized by fear, moroseness, and prolonged sadness, has been separately described by some as melancholia. Such cases are pain- ful to have charge of, the despondency is often so great. Such persons are occasionally bent on committing suicide, and will often resort to modes of destructiou such as baffle all ordinary precautions. INSANITY. 57 Kleptomania is another form of monomania, in which the individual seems to have an irresistible desire to steal. Py- romania is another form, in which the person has a propen- sity to set houses on fire. The two latter forms are some- times treated of under the head of moral insanity. Perhaps in some of these cases the term depravity would be more appropriate than that of insanity. Dementia. Dementia, or incoherence, is that condition in which weakness of the intellect, induced by age or accident, is the prominent feature. The mind is altogether weak ; the ideas are confused, vague, obscure, incoherent, unfixed, and the memory is impaired. The patients are ignorant of time, place, quantity, &c. They forget in a moment what they have just seen or heard. Their manners are undecided, childish, and silly. They see their best friends and rela- tions without pleasure, and they leave them without regret. The ultimate tendency of mania and monomania is to pass into dementia, which is rarely cured. Idiocy. This condition is characterized by partial or complete absence of the intellect, either from date of birth, or occurring in early life. The mind is not developed ; there are no ideas, -or they are few. The manners are child- ish, with occasional gusts of passion. The countenance is vacant, and void of aught approaching to intelligence. Causes of Insanity. The causes of insanity are often difficult to detect. ' It is no doubt frequently hereditary ; or it may be traced to marriages among near relatives ; or it may, perhaps, be due to syphilis in the system of the parents, or to drunkenness on their part. The more immediate causes may be injuries of the head, abuse of alcohol or nar- cotics, as tobacco and opium, sexual excesses, and particu- larly masturbation ; defective nutrition, long protracted watcbings and loss of rest, fevers, the retrocession of eiysip- elas or gout in persons predisposed to insanity. Then there are certain moral causes, as blighted ambition, disappoint- ment in love, perverted religion, immoderate grief, long- 58 MEDICAL AND SURGICAL COMPANION. continued anxiety and distress, prolonged intellectual exer- tion, and pecuniary reverses. The age at which insanity appears to be most common, is between twenty and forty ; in women, perhaps, between twenty and thirty, in men between thirty and forty. General Treatment of Insanity. When a person is thought to be insane, the case should be submitted to some reliable physician for examination ; and if he confirms the suspicion, abide by his judgment in regard to the manage- ment of the patient. As regards the medical treatment, it must of course de- pend upon the state of the patient ; but it may be positively asserted that under no circumstances should a lowering or reducing system be pursued. Our object clearly must be to restore and maintain the general health. In an ordinary case of insanity, I should especially take care that the patient had a nutritious diet, warm clothing, exercise in the open air, healthy and regular evacuations from the bowels, and sound sleep at night. At the same time no mechanical restraint is to be resorted to ; and such cheerful occupation and mental amusement should be afforded as the patient could beneficially enjoy. Where patients obstinately refuse their food, strong beef tea mixed with wine, and gruel or milk, must be introduced into the stomach, by means of, the stomach pump. As re- gards the moral treatment, no rules can be of universal application. I will only say, therefore, that it should be regulated by the " law of love ; " and that no harshness, or means which induce fear, should be tolerated. The patient should be controlled, when possible, by firmness and kind- ness, rather than by coercion. In order to render restraint necessary, a lunatic should be in such a state as to be dan- gerous to himself or to others. It is undoubtedly true that many asylums contain harmless lunatics, who would be much happier, and in no degree injured, by a residence elsewhere, but who, unfortunately, have relations and friends who will not be troubled with them. HEADACHE. 59 HEADACHE. (Cephalalgia.) Headache is of common occurrence, as a prominent symp- tom in the progress of most acute, and of many chronic diseases. Occasionally, however, it predominates so much over the other phenomena, that instead of being a symptom, it really becomes a disease. Three varieties of headache may be noticed. First, the Plethoric Headache, which is connected with fulness of blood ; the vessels of the head become congested ; there is a sense of pulsation in the ears, and giddiness on stooping. Persons who live too high, who rise late in the morning, &c, are liable to it. Plethoric young women, with irregu- larity of the menstrual function, are also subject to it. The Second, or Bilious Headache, may be temporary or constant. When temporary, it generally arises from some error of diet, some excess either in food or wine, and passes away when the cause ceases. The constant bilious head- ache occurs in persons of weak stomach, who are almost always suffering from dyspepsia or indigestion. The Third, or Nervous Headache, is generally due to de- bility and exhaustion. Sometimes it assumes an intermittent form, and is then characterized by its tendency to recur every day, or every second day, with the same degree of regularity as an ague fit. It is often due to constitutional debility. It is sometimes caused in women by over-nursing. Treatment. In treating Plethoric Headache, administer a thorough purgative, put the patient's feet in hot water, and apply cold water to the head. It is also well to observe a low diet for a day or two. The Bilious Headache will disappear when the digestive organs are put in good condition. If the patient is dyspep- tic, treat him for that disease. The Nervous Headache will disappear when the general DU MEDICAL AND SURGICAL COMPANION. health and strength have been improved. A nourishing diet, and tonics R. 63, R. 146, will prove beneficial. PARALYSIS. PALSY. By paralysis, or palsy, is understood a total or partial loss of sensibility or motion, or of both, in one or more parts of the body. All paralytic affections may be divided into two classes ; the first, including those in which both the power of motion and the sense of feeling are affected ; the second, those in which the one or the other only is lost or dimin- ished. The former is called perfect, the latter imperfect paralysis. Imperfect paralysis is divided into paralysis of motion, and paralysis of sensibility. Again, the paralysis may be general or partial, as it affects the whole body or only a portion of it. Partial paralysis is divided into hemi- plegia, when it is limited to one side of the body, and -para- plegia, when it is confined to the lower half of the body. The term local paralysis is used when only a small portion of the body is afflicted, as the face, a limb, a foot, &c. There are certain forms of paralysis which arise from the use of metallic poisons, as mercurial palsy and lead palsy. There is also a peculiar affection known as paralysis agitans, or shaking palsy. GENERAL PARALYSIS. General paralysis — or complete loss of sensation and mo- tion of the whole system — cannot take place without death immediately resulting ; but this term is usually applied to palsy affecting both hands and feet, whether any other parts of the body are implicated or not. HEMIPLEGIA. By the term hemiplegia is understood paralysis of one side, extending generally to both the upper and lower extremities. PARALYSIS. 61 It is the most common form of palsy ; the left suffers more than the right side. When only one extremity suffers it is generally the arm. The paralysis usually extends to the side of the face, the angle of the mouth being drawn slightly upwards and to the sound side. The tongue, also, is often affected ; when protruded, its point is turned towards the palsied side. The paralysis is always limited to one half of the body, the median line being the boundary. In most cases the sense of feeling as well as motion is lost. The mental faculties are sometimes uninjured, but more frequent- ly are irreparably damaged. The memory especially becomes affected ; at the same time there is a peculiar tendency to shed tears, and to be much affected by slight causes. If recovery takes place, the symptoms of amendment are first noticed in the leg. In hopeless cases the limbs waste ; and they are colder, and unable to resist the influence of cold or heat equally with the sound parts. Hemiplegia is generally the result of organic injuries of the brain. It is often a sequel of apoplexy, and in such cases the effused blood is found on the side of the brain opposite to the affect- ed half of the body. PARAPLEGIA. By the term paraplegia is meant paralysis of the lower half of the body. It generally comes on slowly and insidi- ously, with weakness and numbness of the feet and legs, or with tingling of these parts, unattended by pain. By de- grees the weakness increases until there is complete loss of sensibility and motion in the lower extremities, with paraly- sis of the bladder and rectum. Although voluntary motion is completely abolished in the lower limbs, involuntary move- ments and spasms of the muscles are not uncommon. Para- plegia may arise from injury of the spinal cord or its mem- branes ; from inflammation or other diseases of these parts ; from tumors pressing upon the cord ; as well as from affec- tions of the bones and cartilages of the spinal column. 62 MEDICAL AND SURGICAL COMPANION. LOCAL PARALYSIS. Of the different varieties of local palsy, I will oiily men- tion paralysis of the face. As only one half of the face is affected, the appearance is very striking, the features on the paralyzed side being blank, unmeaning, and void of all ex- pression. It is generally free from danger, being but rarely connected with disease of the brain. Exposure to cold is said to be a frequent cause of it. MERCURIAL PALSY. Mercurial palsy, or mercurial tremor, as it is sometimes termed, consists of a kind of convulsive agitation of the voluntary muscles, which is increased when volition is brought to bear upon them. In advanced stage of the dis- ease, articulation, mastication, aud locomotion are per- formed with difficulty, while the use of the hands is almost entirely lost. The skin acquires a brown hue, aud the teeth turn black. Workmen exposed to the fumes of mercury., such as gilders of buttons, glass-platers, barometer-makers, &c, are very liable to it. LEAD PALSY. This affection usually follows or accompanies lead colic, though it may exist independently. The poison of lead appears to exert some peculiar noxious influence over the nerves of the forearm and hand ; in consequence of which the extensor muscles of the hands and fingers become para- lyzed, so that when the arms are stretched out the hands hang down by their own weight, or, as the patients say, the wrists drop. The lower extremities are very rarely affected. The sufferers frequently experience attacks of lead colic. A characteristic symptom of lead in the system is the existence of a blue or purplish line — the sulphuret of lead — round the edges of the gums, just where they join the teeth. numbers, painters, color-grinders, type-founders, &c, are the usual sufferers from this affection. PARALYSIS. 63 PARALYSIS AGITANS. Paralysis agitans, or shaking palsy, is characterized by a tremulous agitation, — a continued shaking, — usually com- mencing in the hands and arms, or in the head, and gradu- ally extending over the whole body. The disease progresses slowly, but when far advanced the agitation is often so vio- lent as to prevent sleep ; the patient cannot carry food to his mouth ; swallowing and mastication are performed with difficulty ; the body is bent forward, and the chin bent on the breastbone ; the urine and feces pass involuntarily, and coma, with slight delirium, closes the scene. TREATMENT OF PARALYSIS. . As paralyisis is only the effect of some morbid disease or injury in the brain or spinal cord, our treatment must be directed to the diseased condition on which it depends. In hemiplegia, when seen early, benefit may be derived from active cathartics, such as two or three drops of Croton oil, made into a pill with a crumb of bread, or ten grains of calomel and fifteen of jalap. The Croton oil is to be pre- ferred, as it operates in much less time than calomel and jalap. Stimulating and purgative injections often prove beneficial. But in cases of hemiplegia and paraplegia, pa- tients should be placed under the care of a regular physician as soon as possible. In mercurial palsy the patient must be removed from the injurious atmosphere. Warm baths, good food, sea air, and iodide of potassium in five to ten grain doses in a gill of water, three times a day, will generally effect a cure. Lead Palsy. In the treatment of lead palsy, the follow- ing mixture will be found beueficial. Take of Iodide of Potassium, . . 8 scruples. Peppermint Water . . .4 ounces. Mix. One to two teaspoonfuls may be taken in a gill of 64 MEDICAL AND SURGICAL COMPANION. water, three times a day. The iodide of potassium acts as a curative agent in lead poisoning, by converting the lead into a form (the iodide of lead) which can again be readily taken up by the blood, and evacuated by the natural outlets. In paralysis agitans, or shaking palsy, I know of no meas- ures likely to do much good. But the effects of pure air, nourishing diet, baths, preparations of iron, and occasional opiates, may be tried. EPILEPSY. Symptoms. A fit, in which the patient usually utters a loud shriek or scream, and immediately falls to the ground in a convulsion ; the eyes are distorted and turned up ; hands clinched ; limbs convulsed, foaming at the mouth, the whole ending in a deep sleep. Causes. The tendency to epilepsy is often hereditary. Sudden fright, anger, injuries to the nerves, &c, may pro- duce it. Treatment. During the fit, the patient should be laid in an easy position, his neckcloth, together with any tight parts of his dress, loosened. A piece of cork or soft wood should, if possible, be introduced between his teeth, to pre- vent injury to his tongue. The application of cold water to the head will sometimes be useful, especially if the counte- nance is turgid and congested. In the interval, give tonics, and endeavor to improve the patient's general health. Persons subject to frequent attacks, may find the following mixture beneficial. Take of Bromide of Potassium, . . £ ounce. Spearmint Water, . . .3 ounces. Mix. From half a teaspoonful to two teaspoonf'uls, in a wineglassful of water, may be taken three or four times a day. 65 HYSTERIA. This is a nervous disorder, often assuming the most varied forms, but commonly presenting a paroxysmal character. It chiefly affects females between the ages of fourteen and forty- five, and principally those possessing great susceptibility of the nervous system and of mental emotion. Symptoms. Convulsive movements of the trunk and limbs, violent beating of the breasts with the hands clinched, or tearing of the hair or of the garments, shrieks and screams, violent agitation, and the sensation of a ball rising upwards to the throat, frequently attended by a feeling of suffocation, the attack ending with tears, convulsive fits of crying or laughter, and sometimes with violent hiccup. Oc- casionally the patient sinks to the ground insensible and exhausted, remains so for a short time, and then recovers, tired and crying, The fit is often followed by the expulsion of a quantity of limpid urine ; occasionally it is passed invol- untarily during the paroxysm. In most cases the patient is aware of what is passing around her. Treatment. During the fit, the patient's dress should be loosened ; she should be prevented from injuring her- self; should be surrounded by cool air; and the following mixture given in teaspoonful doses : — Take of Fluid Extract of Valerian, . . 4 drachms. Tincture of Assafcetida, . . 4 drachms. Mix. Give a teaspoonful, and repeat in twenty minutes. Bathe the head with cold water. If the patient is not relieved within one hour, give thirty drops of laudanum, which will almost invariably end the fit in less than an hour. Hysterical women are generally troubled with some irregularity of I he menstrual function, and require some treatment to improve the general health. 5 MEDICAL AND SURGICAL COMPANION. FAINTING. Causes. Sudden and violent emotions of the mind, inju- ries, bleeding, debility, the warm foul air of crowded rooms, disease of the heart, &c. Treatment. Lay the person on his back, take off his cravat, open the doors and windows, or carry the patient into the open air, and sprinkle cold water in his face. Smelling salts may be held to the nose, and as soon as he revives so as to be able to swallow, give some spirit, as brandy or whiskey. CATALEPSY. This is a rare disease. Nervous hysterical women are most likely to suffer from it. By a fit of catalepsy is implied a sudden loss of consciousness and volition — the patient remaining, during the attack, in the same position in which she happens to be at the commencement, or in which she may he placed during its continuance. The attack may last only a few minutes, or several hours, or even one or two days. On recovery, which is generally instantaneous, there is no recollection of what has occurred. The treatment should be similar to that for hysteria. Avoid all lowering remedies. ST. VITUS' DANCE. {Chorea.) This disease is characterized by incomplete subserviency of the muscles of voluntary motion to the will, giving rise to irregular, tremulous, and often ludicrous actions. It occurs most frequently in young girls between the age of six and sixteen. CHRONIC RHEUMATISM. 67 Symptoms. It generally begins with twitchings of the muscles of the face. By degrees all, or almost all the voluu tary muscles become affected ; the child finds it impossible to keep quiet ; there is a constant movement of the hands and arms, and even of the legs ; one side of the body is generally more affected than the other ; the features are curiously twisted and contorted, the speech is affected, and these movements are always most severe when the child is watched. During sleep these irregular actions usually cease. The disease is scarcely ever fatal, or even danger- ous, unless it merges into organic disease of the nervous centres, or into epilepsy. Although most common in girls, yet boys not unfrequently suffer from it. Causes, &c. This disease may last from one week to several months ; the average duration, in uncomplicated cases, under the use of tonics and good food, being about four weeks. It is often complicated with hysteria, and the general health is usually below the normal standard. Fright seems to be a frequent cause ; blows or falls seem some- times to have induced it ; and the occurrence of the disease from irregular teething, or from the irritation of intestinal worms, has long been noticed. Deranged uterine function is occasionally the apparent cause. Treatment. The bowels should be well regulated by giving appropriate cathartics. If worms are suspected, give the remedies recommended for them, for a reasonable time. A plenty of good food and fresh air are essential. Three to five drops of the tincture of chloride of iron, in half a wine- glassful of water, three times a day, will probably prove beneficial, if continued for some time. Recipe No. 57 generally proves beneficial. 68 MEDICAL AND SURGICAL COMPANION. LOCKED JAW. {Tetanus.) This is a disease characterized by long-continued, painful contraction or spasm of a certain number of the voluntary muscles. Symptoms. The muscles of the jaws and throat are usu- ally first affected. When the disease proceeds, the muscles of the trunk and extremities become implicated. The mus- cles of the back are sometimes so much affected that they bend the body into the shape of an arch, so that the patient rests upon his head and heels. The abdominal muscles, when much affected, may bend the body so that the head will nearly touch the feet. The muscles of the side may also be similarly affected. The suffering caused by the tetanic spasms is absolutely frightful to contemplate. Causes. Exposure to damp aud cold, bodily injuries or wounds, local irritation of a nerve, &c. Treatment. If it arise from a wound, or injuries done to nerves or tendinous parts, apply laudanum very freely to the wound, after which cover it with a warm poultice. Opening or enlarging the wound may do good in some cases, but laudanum freely applied to the seat of injury, aud also given internally, in large doses of from thirty to sixty drops, every three to six hours, according to the urgency of the symptoms, will probably do about as much good as any course of treatment. Etherizing the patient, and keeping him under the influence of that drug for many hours, is sometimes beneficial. At the commencement of this trouble the bowels should be moved by some cathartic, unless they are at the time quite free. If any nourishment is given, let it be milk or beef tea. This is a very serious and often fatal disease, and it will be well to call a physician as soon as possible. If one is not to be obtained, follow the above directions, and hope for a favorable result. HYDROPHOBIA. 69 HYDROPHOBIA. This is a most fearful, painful, and fatal malady, arising from the bite of a rabid animal. It manifests itself after an uncertain interval, varying from one month to eighteen. The majority of cases present symptoms within thirty or forty days from the inoculation of the poison. Symptoms. A sense of chilliness, languor, and lassitude ; there is restlessness also, and some headache. Sometimes there is a sensation of numbness or soreness in the bitten part. In two or three days the confirmed stage of the disease commences with talkativeness, peculiar sighings, and a horror of liquids ; then succeeds a frequent sense of suffocation, an excessive secretion of saliva, and violent spasmodic convulsions of the whole body, occasioned espe- cially by the sight of liquids, or the sound of running water, or any attempt at drinking. The general duration of this disease is from two to three or four days. As the fatal issue approaches, the sense of suffocation becomes more urgent, the convulsions more violent, the saliva more diffi- cult to expel, though the attempts at spitting are incessant, and the terror greater, until at length wild delirium suc- ceeds, followed by exhaustion and death. There seems reason to believe that only a part of those bitten by rabid animals suffer from hydrophobia. Treatment. This must be preventive, for the cure of the disease seems, in the present state of medical knowledge, almost hopeless. For directions for treating bites of rabid animals, &c, see the article on " Poisoned Wounds," in the Surgical part of this work. In treating the disease" itself, I should resort to the inhala- lation of ether, or to large doses of laudanum or opium, to relieve the patient, but with little or no hope of curing the disease. 70 MEDICAL AND SURGICAL COMPANION. NEURALGIA. Neuralgia consists of violent pain in the trunk or branch of a nerve, occurring in paroxysms, at regular or irregular intervals. It may attack the nerves of the head, face, trunk, or extremities ; the subcutaneous nerves of these parts suffer the most frequently. Causes. Predisposing. — The nervous temperament. Low state of the system. Delicate health. Exciting. — Irritation of the root of the nerve within the cranium. Re- mote organic disease, especially disease of the kidney. Irri- tation of decayed teeth, &c. Treatment. This must vary with the cause. If there is any source of local irritation, as a decayed tooth, it should be removed. If the general health is poor, improve it in every way possible : — by relaxation from business for a time, in cases where application has been too close ; by giv- ing some preparation of iron (R. 59), or epiinine (R. G3), in cases where there is much debility. During a paroxysm, to relieve the pain, apply liniment No. Ill, and take a dose of laudanum, or morphine if necessary. Persons subject to neuralgic attacks must endeavor to ascei'tain the cause or causes, and remove them ; otherwise pcrmaueut relief can hardly be expected. The digestive organs often need attention, and in women, the uterine func- tions should not be neglected. 71 CHAPTER Y. DISEASES OF THE AIR PASSAGES AND LUNGS. ACUTE CATARRH. A COLD. Acute Catarrh consists of inflammation of the mucous membrane of some part of the air passages. It is com- monly known as " a cold." If confined to the eyes and nos- trils, it is termed a cold in the head ; if it extends to the bronchial tubes, it is called bronchitis. It is the common- est of all diseases, and arises not from mere cold, but from too sudden a change of temperature, or from exposure to wet, &c. Symptoms. The symptoms chiefly consist of lassitude, pains in the limbs, aching of the back, a sense of tightness across the forehead, excessive discharge from the nostrils, profuse lachrymation, hoarseness, sore throat, furred tongue, more or less feverishness, thirst, loss of appetite, and a quick pulse. At the end of two or three days these symptoms be- gin to subside, or the disease passes into some more sevei-e affection, as acute bronchitis, lung fever, &c. Treatment. No one applies to a doctor to cure a cold. Every man acts as his own physician, and judiciously amuses himself with slops or herb teas, putting his feet in hot water, &c, while the disease runs its course, and in three or four days exhausts itself. Doubtless the cure may sometimes be hastened by a good purgative, followed by ten grains of Dover's powder ;it bedtime, or the use of R. 21 or R. 22. In some persons, an opiate at bedtime (ten to fifteen grains of Dover's powder) will cut short a catarrh or " cold." 72 MEDICAL AND SURGICAL COMPANION. CHRONIC CATARRH, &c. Attacks of acute catarrh are apt to recur, ou slight causes, in many susceptible subjects, and occasionally it becomes chronic in persons whose systems are not strong ; and when it has become so, it is increased by the supervention of a fresh attack of the acute form of the disease ; and if these recurrences are frequent, serious impediments will be offered to a termination of tbe affection. Symptoms. Persons who apply for the purpose of being treated for what they term catarrh, complain of more or less discharge from the nostrils, also of a " dropping down " of matter from the posterior nasal passages into the throat ; and there is in many cases an unnatural and more or less pro- fuse secretion from the mucous membrane of the throat, which obliges the patient to hawk and spit frequently. The tonsils are often in an unhealthy and sometimes enlarged condition, and the uvula is frequently elongated to such an extent that its point lays upon the back part of the tongue, causing a tickling seusation to be experienced there, often accompanied by a desire to swallow. In some cases the patient is troubled with slight cough, and the disease is threatening to extend downwards into the larynx, trachea, bronchial tubes, &c, which it may do, sooner or later, if allowed to go on unchecked. This disease is very common in our climate, and probably ever will be, and it is a source of great annoyance and dis- comfort to those who are afflicted with it. Treatment. Chronic catarrh, affecting the mucous mem- brane of the nasal passages and throat, is often a very ob- stinate disease to treat ; but many cases can be cured, and all greatly relieved or checked by appropriate general and local medication. Persons afflicted with this trouble are continually trying " catarrh snuffs," and other quack preparations, one after CHRONIC CATARRH. 73 another, obtaining but little if any relief, until at length, after the disease has been upon them for a long time, and has become almost intolerable, they are led to apply to a physician for treatment. Various are the means and measures used in the treatment of catarrh of the throat and nasal passages. Astringent gargles, inhalations of medicated vapors, and atomized li- quids, &c, are found to be useful in nearly all cases. The nasal douche, by which a stream of medicated water passed into one nostril escapes from the other, is also very ben- eficial, when properly managed. If, when applied to for treatment in these cases, the uvula is very much elongated, I remove a portion of it ; and if the tonsils are so much enlarged as to impede respiration, their removal is also recommended. Then I proceed to make such applications to the throat and nasal passages as experience has taught me are most beneficial and effective in restoring the mucous membrane to a healthy. condition. Solutions of the crystals of nitrate of silver, varying in strength from twenty to eighty grains to an ounce of water, when applied to the parts by means of a " shower syringe" which I have made for this purpose, will, I believe, do more good, in the majority of cases, than any other course of treatment. The strength of the solution should vary according to the condi- tion of the parts. It is not often necessary to use one stronger than forty grains to the ounce. The application should be made, in some cases, every day, for a week or more ; then every second, third, or fourth day, until the mu- cous membrane begins to have a natural or healthy look. While making these applications, the general health of the patient requires attention. If he is scrofulous, or has any poison lurking in his system, tonics and alteratives will be required. Treatment should be persevered in for several months if necessary. 74 MEDICAL AND SURGICAL COMPANION. CLERGYMAN'S SORE THROAT. This disease, in its early stages, consists of irritation of the investing membrane of the fauces. Subsequently a series of morbid changes takes place, such as congestion, inflammation, or relaxation of the mucous membrane, en- largement of the tonsils, elongation of the uvula, and irrita- tion, inflammation, morbid deposit, and ulceration of the mucous follicles. This sore throat either exists alone, or it may accompany or follow laryngitis, bronchitis, or consump- tion. Clergymen, lawyers, public speakers, actors, singers, &c, are most liable to it. Symptoms. These consist of an uneasy sensation in the upper part of the throat, with continued inclination to swal- low. The patient also makes frequent attempts to clear the throat by coughing, hawking, and spitting ; he will point to the larynx, too, as being the seat of pain. At the same time the voice undergoes an alteration ; there is loss of power and hoarseness ; sometimes complete loss of voice, especially towards the evening. On examining the throat and fauces, we shall find these parts presenting an unhealthy, slightly raw or granular appearance ; the mucous follicles will be visible, sometimes filled with a yellowish substance, and a viscid muco-puruleut secretion will be seen adhering to the palate. Treatment. In the early stages, the treatment must con- sist in the use of tonics, especially iron and quinine, the cold bath, or sea-bathing, and temporary change of scene and occupation. "When the disease is further advanced, a combination of internal with local remedies will be necessary. Iodide of potassium (R. 67) or iodide of iron (R. 68) may prove beneficial. The local treatment consists in the application of a solution of nitrate of silver (one to four scruples to the ounce of distilled water) to the diseased parts, even to the ACUTE INFLAMMATION OF THE LARYNX. 75 interior of the larynx if possible, by means of the shower syringe, or probang. The operation requires dexterity, and can only be properly done by a physician. The application will require to be made about every second day for two or three weeks. When the tonsils are much enlarged, they will need attention ; and if the uvula is considerably elon- gated, it may require excision. ACUTE INFLAMMATION OF THE LARYNX. {Laryngitis.} This is not a very common disease, but in the greater proportion of cases in which it has occurred in a very severe form, it has proved fatal. Cold and wet are com- monly the exciting causes of it, and, generally speaking, it is peculiar to adults. "Washington is supposed to have died of it. Symptoms. The symptoms of acute inflammation of the larynx are often at first obscure, as the disease may make its approach in a very insidious manner. Generally, how- ever, they are these : Fever, harsh cough, pain referred to the Pomum Adami, difficulty of breathing and of swallow- ing, excessive anxiety, hoarseness, or even complete loss of voice, and frequent spasmodic exacerbation of these symp- toms, causing the most distressing paroxysms of threatened suffocation. The inspirations are long, and attended with a peculiar wheezing sound, as if the air were drawn through a narrow reed. The face is flushed, the eyes protruded, the lips swollen, and the pulse hard. Unless relief be afforded, the distress gets greater and greater, the larynx and trachea move with great rapidity upwards and downwards, the chest heaves violently, the patient tries to get to the open window to obtain more air ; he soon becomes drowsy and delirious, and then speedily dies, suffocated. The inflammation is often of very limited extent : the danger is owing entirely to its situation. 76 MEDICAL AND SURGICAL COMPANION. Treatment. In some mild cases, seen early, an emetic, composed of the following articles, will prove benefic.al : - Take of Wine of Ipecac, . • • U ounces ' Tincture of Lobelia, • \ ounce * Mix. Give a tablespoonful in half a cupful of warm water every fifteen minutes, until free vomiting takes place. Keeping the patient slightly nauseated for several hours by giving, every hour or two, from half a teaspoonful to a tea- spoonful of the mixture, will generally prove beneficial. The bowels should be moved by a good dose of Epsom salts as early after the operation of the emetic as convenient; but the nausea must first be allowed to subside. In some cases, especially where the bowels are somewhat constipated, it may be advisable to give the purgative first. A hot flaxseed poultice may be placed upon the throat, and during the whole treatment the patient should avoid using his voice altogether, or speak only in a whisper, and should suppress the cough as much as possible. Rest and low diet are also requisite. Iu severe cases the above measures will prove of little avail. Something more prompt and decisive must be done at once, or the patient may be dead in a few hours. With a probang, sponge the epiglottis, larynx, and cavity of the larynx, with a solution of the crystals of nitrate of silver, sixty to eighty grains to the ounce of water. It will gen- erally give marked relief within twenty minutes. Repeat. the operation in two or three hours if necessary. Let the patient hold small pieces of ice in the back part of Ins throat continually, and very hot fomentations should be applied to the throat externally for a considerable length of tune. After the urgent symptoms have subsided, the treatment applicable to milder cases will complete the cure. But if this treatment fails to give relief, a surgeon should be called at once, who will proceed to open the windpipe, which may save the patient. MEMBRANOUS CROUP. 77 Chronic Laryngitis, &c. The larynx may also suffer from chronic disease. Thus chronic inflammation and ul- ceration is not uncommon in cases of pulmonary consump- tion, and the lining membrane of the laryngeal cartilages often becomes thickened and ulcerated in secondary syphilis. "Warty growths may also arise from different parts of this tube, and cause great impediment to the entrance and exit of air. These cases always require the attention of a physician. MEMBRANOUS CROUP. (Tracheitis.) This disease consists of inflammation of the trachea (windpipe), often of the trachea and larynx, ending, in the majority of cases, in the exudation of false membranes upon the affected surface. It is a disease of early life, most cases occurring between the second and fourth year of child- hood. It is sometimes complicated with pneumonia (lung fever) or bronchitis. Symptoms. In the commencement they are those of a cold ; slight fever, cough, hoarseness, drowsiness, suffusion of the eyes, and running at the nose. In a day or two there is an alteration in the character of the cough, which be- comes attended with a peculiar ringing sound, rendering it " brassy," this cough being followed in a few .hours by a remarkable change in the respiration. The act of inspira- tion becomes prolonged, and attended with a characteristic crowing or piping noise, readily recognized when once it has been heard. If now the throat be examined, the tonsils will be found enlarged and of a red color ; the uvula also is sometimes slightly swollen. As the disease advances the fever increases, the breathing becomes more hurried and impeded, the cough more frequent, the pulse becomes weak and irregular ; there is great thirst, and the child is very irritable and restless, and, with features expressive of alarm and distress, he grasps at his neck, or thrusts his lingers 78 MEDICAL AND SURGICAL COMPANION. into his mouth, as if to remove the cause of his suffering. The child appears brighter in the morning than at night. Should there now be a tendency towards restoration to health, the cough will lose its peculiar clang, aud become moist, whilst the crowing inspirations will almost cease. On the other hand, when the disease is about to cud fatally, the drowsiness soon becomes extreme, though the sleep is un- easy ; the child starts and wakes in terror, the skin gets cold aud covered with clammy sweats, and the child often dies directly after an inspiration, or coma aud convulsions close the scene. Sometimes the disease runs a very rapid course, the child dying in less than twenty-four hours, though its usual dura- tion ranges from four to ten days. Fully one half of those attacked die. Treatment. In no disease, perhaps, is it more necessary to be prompt and cautious. In all cases the patient must be confined to bed, aud should be clothed in flannel. The air of the room should be kept warm and moist. When the disease is seen early, the continuous application of very hot fomentations to the throat will do great good. But if much benefit be not quickly apparent, an emetic should be given, and the following will, perhaps, be as good as any : — Take of.Wmc of Ipecac, . . l£ ounces. Tincture of Lobelia, . . £ ounce. Mix. For a child from one to three years old, give from half a teaspoonful to a teaspoonful, every ten minutes, until free vomiting takes place. Also give a warm bath. Sup- posing that the disease advances, notwithstanding these meas- ures, send for a physician, if one is to be obtained ; for opening the windpipe (tracheotomy) may possibly save the child. Some physicians recommend sponging the larynx with a strong solution of nitrate of silver, as directed in acute laryngitis in adults, and I believe it should be tried DIPHTHERIA. 79 when other measures fail to give relief; but as the false membrane often extends down the windpipe, and even into the bronchial tubes, it is not probable that in such cases much benefit would be derived from it. SPASMODIC CROUP. {Laryngismus Stridulus.) This affection occurs in children. A child is suddenly attacked during the night, having, perhaps, gone to bed ap- parently in perfect health. The breathing is labored and sonorous, the cough presents, in a marked degree, the shrill, ringing, crouped character. This causes great alarm, and the physician is sent for in urgent haste. This is a purely spasmodic affection, and, as a general rule, unattended with danger. Treatment. Give an emetic of ipecac at once, and, after its operation, the bowels should be moved by some mild cathartic. A hot foot bath, and warm fomentations to the throat, may prove beneficial. DIPHTHERIA. Diphtheria may be defined as an epidemic sore throat, due to poisoning of the blood. It is attended with much pros- tration, and is characterized by the exudation of false mem- branes on the tonsils and adjacent parts. It runs a rapid course. When it does not end fatally, it is often followed by an alteration in the voice, partial paralysis of the muscles of deglutition, weakness of the upper extremities, and im- paired vision. It is regarded as a contagious disease. It attacks both sexes, at all ages, though children seem to be especially obnoxious to it. It is most fatal to such as reside in damp situations and in badly-drained houses. Spring and autumn appear to be the seasous when its ravages are greatest. 80 MEDICAL AND SURGICAL COMPANION. Symptoms. This disease comes on very gradually, with feelings of depression and muscular debility, headache, nausea, slight diarrhoea, chilliness, and drowsiness. Before the throat is actually sore, a sense of stiffness in the neck is complained of. Soon the tonsils become inflamed and swol- len, and the glands about the angles of the lower jaw get tender. As the disease progresses, the whole throat becomes more or less involved, and there are some pain and difficulty in swallowing in most cases. It is probable that in some mild cases the inflammation begins to subside at this stage, and the patient is soon re- stored to health. But more commonly the characteristic fea- ture of the disease now becomes manifested, and a plastic fibrinous material is effused. This exudation commences on the soft palate, or on one tonsil, or on the back of the throat, in the form of small ash-colored specks ; these spots enlarge and run together, forming patches of considerable size; As the disease spreads, the false membrane increases iu thickness and in extent ; it usually becomes firmly at- tached to the mucous tissue beneath, and if it be forcibly removed, a new patch will be found at the end of a few hours. But if the exudation be cast off naturally, then either no new false membrane is formed, or only one which is much more filmy than the first. The membrane has been compared to wet parchment, or to damp, dirty wash-leather. It may spread forwards to the cheeks and gums, upwards into the nasal passages, downwards into the windpipe and oesophagus. When the membrane begins to separate and decompose, the patient's breath is rendered most offensive. As the lymphy deposit is cast off, we may have ulceration, sloughing, or gangrene of the mucous coat, or this tissue may gradually assume a healthy appearance. In all cases, this is a very grave disease. Death may occur, even within thirty-six hours, from the intensity of the general disorder, or at a later period from the severity of its local effects, or from the occurrence of some complication. DIPHTHERIA. 81 The duration of the disease may be stated as commonly from three to twelve days. Treatment. This disease is not controllable by any known specific remedy. The great object of treatment is to support the system, endeavoring to keep the patient alive until the disease has run its course. The complaint being one characterized by great prostration, the diet should con- sist of milk, beef tea, or essence of beef. Stimulants are also called for, and an adult may take, in severe cases, an ounce or two of brandy or whiskey every hour or two. For youth and children, the dose should be in proportion to age. The tincture of the chloride of iron, either with or without quinine, should also be given. The following is an excellent preparation : — Take of Sulphate of Quinine, . .16 grains. Tincture of Chloride of Iron, £ ounce. Water, 7£ ounces. Mix. An adult may take a tablespoonful in a wineglass- ful of water, four times a day. A youth of fourteen years, one half tablespoonful ; a child two to six years of age, from one half teaspoonful to a teaspoonfnl. Two drachms of chlorate of potassa may be dissolved in a pint of water, and used freely as a gargle. Small pieces of ice or snow may be continually held in the mouth, if the effect be agreeable. The tincture of chloride of iron, applied to the throat by means of a camel's-hair brush, several times in the twenty- four hours, generally proves beneficial in checking the exu- dation of false membrane. This being a very serious disease, a physician, if one is to be obtained, should be early called to take charge of the case. 6 82 MEDICAL AND SURGICAL COMPANION. INFLUENZA. Influenza, or epidemic catarrhal fever, is a disorder attend- ed with great depression, chilliness, running from the eyes and nose, frontal headache, cough, restlessness, and fever. It arises at various periods from some peculiar condition or contamination of the atmosphere. The poisonous influ- ence, whatever its nature may be, wings its way with greater celerity than the speed of human intercourse, while its prog- ress seems uninfluenced by the season of the year. It is said to travel from east to west, and it seldom remains in one district more than six or eight weeks. Some visitations are more severe than others. It differs from a common cold in its greater severity, and especially in the amount of prostration to which it gives rise. Between the reception of the poison and the commencement of the symptoms, there is a period of incubation ; but as to the duration of this we know nothing, since, in some well-observed ci has appeared to be only ten or twelve hours, while in other instances it has been as many days. Young people seldom die of this disease ; but amongst the aged the mortality lias sometimes been large. Symptoms. The chief symptoms of this mysterious affec- tion are heat and dryness of skin, urgent frontal headache, soreness or tenderness of throat, hoarseness, harassing cough, shortness of breath, and disorders of the stomach, together with all the signs of nervous and muscular prostration, such as an uncommon degree of languor, debility, and low- ness of spirits. In favorable cases, this disease runs its course in about a week, leaving the patient very much debilitated. Treatment. The patient should be kept in bed, and bar- ley water and nourishing broths administered. The following mixture may be given with benefit : — WHOOPING COUGH. 83 Take of Syrup of Squills, ... 1 ouuce. Syrup of Gum Arabic, . . 1 ounce. Sweet Spirits of Nitre, . . 1 ounce. Paregoric, .... 1 ounce. Mix. One to two teaspoonfuls may be given three or four times in twenty-four hours. If the bowels are constipated, a mild cathartic may be given. A mustard poultice to the chest, and the inhalation of the steam of hot water, may prove beneficial in severe cases. When prostration is the predominant symptom, stimulants, such as wine or brandy, may be freely resorted to. The subsequent debility will be the quickest removed by tonics, especially by quinine and iron. WHOOPING COUGH. (Pertussis.) Wl looping cough is a contagious and infectious malady, characterized by a peculiar cough, occurring in paroxysms, terminated by vomiting. The disease makes its appearance in about a week after exposure. It occurs mostly in chil- dren, although adults are not wholly exempt from it. It rarely attacks the same person twice. SYMPTOMS. The disease generally sets in with the symp- toms of a common cold, and it is not till the second or third week after the attack, and when the fever symptoms have somewhat abated, that it assumes its peculiar and character- istic paroxysmal form and whoop. The cough now comes on in distinct fits, each fit consisting in a series of violent and convulsive expirations, with congestion of the face, and threatening of instant suffocation, followed by a sudden and lull inspiration, accompanied by a peculiar whoop, from which the disease has obtained its name. The convulsive coughing is renewed, and continues in the same manner as 84 MEDICAL AND SURGICAL COMPANION. before, till a quantity of mucus is thrown up from the lungs, or the contents of the stomach are evacuated by vomiting, or the fluid issues from the mouth and nostrils, mixed with blood, which usually terminates the fit. The patient then generally has an interval of perfect freedom from cough, and often expresses a desire for food ; but when the fit has been very severe, it is followed by general languor and debility, hurried breathing, &c. The disease is usually most severe ahout the latter part of the fourth, or during the fifth week, after which the paroxysms become less severe. The frequency with which the paroxysms of cough recur, varies : there may be only two or three in a day, or as many in an hour. The duration of the disease varies, in different cases, from two or three weeks to three or four months. It frequently proves fatal when occurring iu quite young children. Treatment. In mild cases very little management is required ; the patient should be warmly clothed, kept in doors, and fed with light nourishing food. In the more se- vere form of the disease, an emetic may prove beneficial, and the wine of ipecac will be as good as any ; it may be given in teaspoonful doses, every ten minutes, until vomiting takes place. Mixture No. 28, given in one to two teaspoon- ful doses, three to five times a day, will be found beneficial in most cases. The following mixture may be tried in cases which prove obstinate : — Take of Sulphate of Zinc, . . .32 grains. Extract of Belladonna, . . 8 grains. Water, ..... 4 ounces. Mix. A child three years old may take a teaspoonful, in a little water, four times a day. Every second day, the dose may be slightly increased, so that at the end of two weeks, two or three teaspoonfuls may be given at a time. The child's bowels should not be allowed to become constipated, BRONCHITIS. 85 and care must be taken to prevent it from taking cold, lest bronchitis or luna; fever set in. BRONCHITIS. By bronchitis, is meant an inflammation of the bronchial tubes. It may be either acute or chronic. ACUTE BRONCHITIS. This is a common disease, and occasionally proves serious in consequence of the inflammatory action spreading to the vesicular texture of the lungs. Syjiiptoms. Fever, a sense of tightness or constriction about the chest, hurried breathing, with wheezing, severe cough and expectoration, at first of a viscid, glaring mucus, which subsequently becomes purulent. The pulse is fre- quent, and often weak, the tongue foul, and there is head- ache, lassitude, sickness, and great anxiety. By placing the ear to the chest, we may now hear dry, wheezing or whistling sounds, and after a time the sounds change in character in conseqnence of the inflamed mucous membrane pouring out a viscid, transparent, tenacious mu- cus. As the air passes through this mucus, we hear a moist, crepitating sound. In favorable cases, this aflection begins to decline between the fourth and eight day, and shortly either entirely subsides, or passes into the chronic form. In severe or unfavorable cases, the disease may assume a more dangerous character ; the strength becomes much re- duced, signs of congestion of the lungs ensue, which may soon end in death. Treatment. Give a thorough purgative, after which the following mixture may be taken with benefit : — 86 MEDICAL AND SURGICAL COMPANION. Take of Spirit of Miudererus, . . -J ounce. Sweet Spirit of Nitre, . . £ ounce. Syrup of Squills, . . . £ ounce. S) r rup of Ipecac, . . .2 drachms. Paregoric, . . . 2 drachms. Mix. One to two teaspoonfuls may he given to an adult, three or four times a day. If there be much debility, mixture No. 2-4 may be given instead of the above. • A mustard poultice applied to the chest occasionally, and kept on each time as long as it can be conveniently borne, will prove beneficial. It may be followed by hot fomenta- tions. Light food should be given if the fever runs high, but when there is depression, good beef tea may be freely taken. The inhalation of the steam of hot water often prm viceable. CHRONIC BEOHCHITIS. This disease is generally the sequel of the acute form, and is very common in middle and advanced life. Symptoms. The slighter forms are indicated only by habitual cough, some shortness of breath, and copious ex- pectoration. During the summer little trouble is expe- rienced from it, but it returns with cold weather, and lasts through the winter. After a time, when the patient's gen- eral health has become very much reduced, the cough con- tinues even through the summer, aud unless some effectual treatment is resorted to, the patient finally wears out, or dies of bronchial consumption. Severe examples of chronic bronchitis, with abundant ex- pectoration, are often taken by quad: consumption curers, for cases of pulmonary consumption, and they then vaunt their very ordinary cures as extraordinary. ASTHMA. 87 Treatment. This is a disease in which the inhalations of medicated vapors and atomized liquids prove very bene- ficial ; but the limits of this work will not allow me to speak of all the preparations which may be used to advantage in this disease. R. 29 will prove excellent in many cases. The vapor of tar often proves serviceable. Stimulating expectorants are also useful ; and R. 24 may be taken with benefit in most cases. If the patient is debilitated, iron, quinine, and cod-liver, oil may be used to advantage. The patient should dress warmly, and wear flannel next the skin, both winter and summer. ASTHMA. Asthma may be defined as great difficulty of breathing, accompanied with a wheezing sound of respiration, occurring in paroxysms, and ceasing at the end of a few hours, with mucus expectoration, more or less abundant. Symptoms. A fit of the asthma often occurs suddenly, without any warning ; but in some cases it is preceded by headache and sleepiness, or by various digestive or other disturbances. The patient awakes towards morniug with a sensation of suffocation or constriction about the chest, the difliculty of breathing gradually increasing until a fearful and most painful struggle for breath sets in. Various pos- tures are assumed to facilitate the attempt at filling the luDgs, and the patient often rushes to the open window, at which he will remain a long time, gasping for air. If the ear is now placed to the chest, we hear loud wheezing or shrill whistlings. The pulse is small and feeble, the eyes Btaring, and the countenance anxious. After a certain lapse of time, a remission comes. Cough ensues, with expectora- tion of little pellets of mucus, and soon the paroxysm ceases, to allow the sufferer to full asleep. 88 MEDICAL AND SURGICAL COMPANION. During the interval which elapses between one asthmatic paroxysm and the next, the patient often enjoys fair health, and has his breathing quiet and free. This disease is more common in men than in women. It is often hereditary, and it sets in at any time of life, though most frequently about the middle period. It may be uncomplicated ; that is to say, the patient is healthy in all other respects, there being no lesion of the brain, lungs, heart, or other organs. This form is known as spasmodic asthma. In other cases it is complicated with, or indeed symptomatic of, some disorder, such as chronic bronchitis, heart disease, &c. When thus complicated or symptomatic, it is known as symptomatic, or organic asthma. Spasmodic asthma very seldom, if ever, directly destroys life. Many of its subjects live to a good old age, perhaps for the reason that they are obliged to take good care of themselves. Treatment. Under this head must be considered the measures necessary to relieve the paroxysm, and those which may be employed in the hope of preventing or delaying its recurrence. The following emetic, given at the commence- ment of the attack, will be beneficial : — Take of Wine of Ipecac, ... 1 ounce. Tincture of Lobelia, . . £ ounce. Mix. Two teaspoonfuls may be given in a little warm water, every fifteen minutes, until vomiting takes place. After the operation of the emetic, if the bowels are consti- pated, a purgative may be administered. The inhalation of mixture No. 30 will generally prove very beneficial. Mustard poultices, applied to the back and front of the chest, seem occasionally to give relief. The inhalation of sulphuric ether will sometimes put an end to the paroxysm very speedily. Smoking stramonium leaves often does good. A warm climate is generally very beneficial to sufferers from this affection. HAY ASTHMA 89 After the paroxysm has ceased, the general health of the patient should receive attention, with a view to prevent a recurrence of the trouble. It is always advisable, in these cases, to consult some good physician. HAY ASTHMA. This is a peculiar disease, which resembles a severe cold, to which asthmatic symptoms are frequently superadded. Symptoms. There is headache, suffusion of the eyes, sneezing, irritation of the nose and throat, with a dry, ha- rassing cough. Then at intervals there may be paroxysmal attacks of asthma, the difficulty of breathing being some- times so urgent that the patient has the most distressing sensations of impending suffocation. This is not a common disorder. Causes. It is supposed to arise from the inhalation of the aroma of spring grass or hay, or from the perfume of the Nardus Striata when in flower, — a grass which is abundant in many grazing fields, for cattle will not eat it. Exposure to the emanations of 'powdered ipecac will pro- duce it in impressible individuals. Treatment. The disease will probably have a duration of three or four weeks, if allowed to run its course without medical treatment, It may, however, usually be cut short by removal from the cause, sometimes residence at the sea- side being effectual. In some cases the susceptibility to the disease has been destroyed by the use of certain drugs — iron, quinine, arsenic, and nux vomica. During the paroxysm, inhaling R. 30 will generally give relief. Smoking tobacco is said to prove very beneficial for moderating the attack. Stramonium leaves may answer as well. 90 MEDICAL AND SURGICAL COMPANION. PLEURISY. (Pleuritis.) By the term pleurisy, is meant inflammation of the pleura, which is the serous membrane investing the lungs, and lining the cavity of the chest. Symptoms. Chills, followed by fever, and an acute lanci- nating pain in the side, called a " stitch." The pain is in- creased by the expansion of the lung in breathing, by coughing, by lying on the affected side, and by pressure. There is also a short, harsh cough, the skin is hot and dry, the cheeks flushed, the pulse hard and quick, and the urine is scanty and high-colored. If the ear be placed to the pain- ful part of the chest, at this stage of the disease, we may hear the dry, inflamed membranes rubbing against each other, and producing a friction sound ; if the hand be placed on the corresponding part of the chest this rubbing may also be felt. But this sound does not long continue ; either the inflammation subsidesj and the two surfaces of the pleura regain their natural moisture and smoothness, or the rough- ened and inflamed surfaces become adherent ; or they be- come separated by the effusion of a serous or watery fluid, and a kind of dropsy results, known as hydrothorax, or water in the chest. If the pleurisy has been severe, the effu- sion becomes excessive, and the fluid accumulating in the sac of the pleura, compresses the yielding lung, suspends its functions, displaces the heart, and somewhat distends the sides of the chest. From one ounce to several pints of fluid may be effused. "When the amount is great, there is much difficulty of breathing ; and on gently tapping the diseased side with the ends of the fingers, we get a dull sound, very unlike that obtained from the well side, by the same process. At the same time, also, the sufferer is unable any longer to lay on the sound side, clearly because the movements of the healthy lung would be impeded by the superincumbent weight of the dropsical pleura. If the two sides of the chest PLEURISY. 91 are measured, the side containing the effusion will be found the larger. Causes. The most common cause of pleurisy is exposure to cold and wet. Mechanical injuries will also excite in- flammation of the pleura. Thus the jagged ends of a frac- tured rib often give rise to it. Treatment. We must first subdue the inflammation ; and, secondly, promote the removal of its products. If the patient is very robust and plethoric, the fever high and pain severe, bleeding will give relief quicker than any other meas- ure which can be employed. From half a pint to a pint of blood may be taken from a vein at the bend of the elbow ; or six to twelve leeches may be applied about the seat of pain. In most cases I should use the leeches, and encourage bleeding from the bites for some time, by warm fomenta- tions. When the pain is not very severe, instead of bleed- ing, a mustard poultice may be applied to the diseased side, and allowed to remain on as long as the patient can conveni- ently bear it, after which hot fomentations should be con- tinually applied until relief is obtained. The bowels must be moved by a smart purgative, which may be repeated, if necessary, every second or third day ; the diet should consist of gruel, arrowroot, and broths ; and cooling drinks are to be allowed. To relieve severe pain, give Dover's powder, in ten to fifteen grain doses, two or three times a day, if necessary. If the fever is high, and the pulse quick and hard, the fol- lowing mixture may prove beneficial : — Take of Tincture of American Hellebore, 1£ drachms. Sweet Spirit of Nitre, . . 6£ drachms. Syrup of Gum Arabic, . . 1 ounce. Mix. Shake before using. A teaspoonful may be given, in a little water, every third hour, to reduce the frequency of the pulse. Its effect must be closely watched, and if it causes vomiting, or much prostration, it should be discontiu- 92 MEDICAL AND SURGICAL COMPANION. ued, and half a teaspoonful of sweet spirit of nitre, three or four times a day, substituted for it. If these measures prove insufficient, and effusion takes place, we then endeavor to promote absorption. The patient must be kept on a moderate diet, free from stimulants, and purgatives and diuretics administered. A succession of blisters to the side may do good. The following mixture will often prove serviceable : — Take of Iodide of Potassium, . . 4 scruples. Tincture of Digitalis, . 1£ drachms. Tincture of Squills, . . 3£ drachms. Simple Syrup, . . .11 drachms. Mix. Give a teaspoonful, in water, three times a day. Tonics, such as iron, quiuine, &c, may also"be required. When these means fail, tapping the chest, so as to let the fluid out, has been resorted to, on many occasions, with suc- cess. A good physician should always be consulted in these LUNG FEVER. (Pneumonia.) Lung fever, or pneumonia, is an acute inflammation of the substance of the lungs, and consists of three stages ; viz., first, that of congestion, or engorgement ; secondly, that of red hepatization ; and, thirdly, that of gray hepatization, or purulent infiltration. In the first stage, the substance of the lung becomes loaded with blood ; and if we listen to the chest, when the lung is in this condition, we shall hear a fine, crepitating sound, re- sembling that produced by rubbing a lock of one's own hair between the finger and thumb, close to the ear. If the inflammation proceeds, it passes into the second stage, in which the spongy character of the lung is lost, and it becomes hard and solid, resembling the cut surface of the liver, whence it is said to be hepatized. If we now gently LUNG FEVER. 93 tap the chest with the ends of the fingers, there is dulness over the whole of the affected part. And if we listen to the chest, no crepitating will be heard. We now come to the third stage, which consists of a diffused formation of matter in the pulmonary tissue. If .the inflammation subsides before the stage of purulent infiltration, as it usually does, then the liver-like condition of the lung may remain permanent, or may gradually cease. In the latter case we shall find the air slowly re-entering the lung, as will be indicated by a return of the crepitating sound. In each stage there is fever, more or less pain in some part of the chest, most severe at the commencement ; accel- erated and oppressed breathing ; occasionally delirium ; cough, and expectoration of a viscid, rust-colored sputa, which unite into a mass so tenacious that even inversion of the vessel containing them will not detach them. Pneumonia may affect one or both lungs ; or, technically speaking, may be double or single. The right lung suffers twice as often as the left ; about once in eight cases both are affected. The lower lobes are more obnoxious to inflammation than the upper. The aver- age duration of the disease, when uncomplicated, is about two weeks ; when complicated, about three. More or less bronchitis almost always accompanies pneu- monia. It may occur with or without pleurisy. Treatment. "When first taken, attention must be paid to the bowels,, and a dose of castor oil may be given if neces- sary. The patient should go to bed and remain quiet, the air of the sick room being kept moist by the evaporation of boiling water. The temperature of the room should not be allowed to fall below 65° Fahrenheit. From half a tea- spoonful to a teaspoonful of R. 21 may be given every two, three, or four hours, to promote the action of the skin. It should be well diluted with water. Hot fomentations may be applied to the affected side of the chest, and when both 94 MEDICAL AND SURGICAL COMPANION. lungs are affected, apply to both sides. The patient's diet should be light, as gruel, milk, &c, and he may have for drink cold water or lemonade. As soon as there are auy indications of greater weakness than the patient can support, give freely of strong beef tea, or essence of beef, and wine or brandy at regular intervals. When the crisis occurs, by sweating or by diarrhoea, care must be taken not to check it unnecessarily. During conva- lescence, milk, raw eggs, and animal food may be allowed. During this disease, whenever there is much restli ten to twenty-five drops of laudanum, once or twice a day, or oftener, will prove very beneficial. "When the patient does not seem to regain his strength readily, iron and quinine may be given. CONSUMPTION. (Phthisis.) Pulmonary consumption, the commonest and most fata malady to which the human race is subject, is a constitution- al disease, which [days its most conspicuous pari in the lungs. A morbid product, called tubercle, or tuberculous matter, is found deposited in the areolar tissue, betweeu the air cells, iu the air cells themselves, and in the smaller bronchial tubes communicating with them. Wherever a particle of this matter is deposited from the blood, it continues to in* crease by constant addition. In its hard state it is called crude tubercle. After a time inflammation arises in the pulmonary substance surrounding the deposit, suppuration occurs, the tubercular matter softens and breaks down, and at length is gradually expelled or raised by coughing, leav- ing cavities or ulcers behind, of various sizes. Sometimes these cavities close and heal, and the patient recovers ; more frequently tubercular matter continues to be deposited on their sides, and in other parts of the lungs, until these organs become diseased to an extent incompatible with the continu- ance of life. CONSUMPTION. 95 Symptoms. The disease usually begins with a short, dry- cough, occurring, most frequently, on first rising in the morning, and so slight as to become habitual before it excites the attention of the patient. It is sometimes accompanied by slight difficulty of breathing, increased on exertion, and the patient generally loses flesh, is soon fatigued, and easily thrown into a perspiration ; or he complains of unusual coldness of the body and extremities. Slight dyspeptic symptoms, diarrhosa, frontal headache, and a small, fre- quent, quick pulse, are also among the early symptoms ; and, on inquiry, the patient will often recollect that at some previous period he raised a little blood. After these symptoms have continued for a variable peri- od of several weeks, months, or even years, in consequence of a cold, or some trivial exciting cause, the cough becomes more constant and troublesome, and is attended by expecto- ration, at first of a frothy mucus, afterwards of a more vis- cid and opaque substance, ofteu mixed with small, round particles of tubercular matter, with pus, or with streaks of blood ; or bleeding from the lungs occurs in a more marked form, and to a greater extent. As the disease advances the cough and difficulty in breath- ing become more urgent, the expectoration more abundant, the emaciation and weakness greater, the pulse more fre- quent ; there are chills at noon or in the afternoon ; the face flushes towards evening, the palms of the hands and soles of the feet are affected with burning heat ; in a word, hectic fever sets in, followed, towards morning, by profuse perspi- ration. The patient now rapidly loses flesh ; diarrhoea, either due to disordered secretions or to ulcerations of the mucous membrane of the intestines, often sets in and ifl- - the debility ; the lower extremities frequently be- come painful and swollen, and death soon ends the scene, — tin: mental faculties remaining clear until the last few hours. This disease is by some divided into three stages. Dur- 96 MEDICAL AND SURGICAL COMPANION. ing the first, that in which tubercles become developed in the lungs, neither the local nor the general symptoms warrant us in announcing the presence of any other affection than a severe catarrh. In the second stage, the tubercles increase both in number and size, so as to compress and obstruct the substance of the lung, and occasion difficulty of breathing. In the third, or last stage, jhe tubercles become softened ; they make an opening for themselves through some of the surrounding or involved bronchial tubes, and being thus evacuated, they give rise to the formation of cavities. By auscultation, or listening to the sounds made by the air in passing through the various structures of the lungs in the process of breathing, physicians can learn much in regard to the condition of those organs. By percussing, or gently tapping the chest, they also learn something in regard to any internal changes which may have taken place. But auscul- tation and percussion can only be practised to advantage by physicians whose ears have become accustomed to the sounds given forth from the chest, both in health and disease, and who have also learned what those sounds indi- cate. Causes, &c. Consumption may be inherited or it may be acquired. It is not contagious. The left lung suffers more frequently than the right. The upper and back parts of the upper lobes of the lungs are ordinarily the situations in which the tubercular deposit first takes place. No period of life is exempt from this disease, and it may affect the foetus in utero ; but it is most liable to be developed between the ages of twenty and thirty. Iu this country, at least one death in every eight is caused by consumption. 'Among the predisposing causes, may be mentioned the scrofulous diathesis ; sedentary life ; residence in a low, damp, and marshy district ; a close and confined atmosphere ; insufficient and unwholesome food ; depressing passions of the mind ; dissipation and intemperance ; profuse evacua- tions ; immoderate indulgence of the sensual passions ; and all causes of debility. CONSUMPTION. 97 As exciting causes, pneumonia (lung fever), catarrh, asth- ma, syphilis, small pox, scarlet fever, and measles may be mentioned. The dust to which certain artificers are ex- posed, — as needle-pointers, stone-cutters, pearl button- makers, millers, &c, — often excites disease in the throat, bronchial tubes, and lungs. Duration. The average is about two years. In acute cases fi'om one month to one year. In chronic cases, death often takes place after the lapse of years, and after repeated attacks. Treatment. As this is a constitutional disease, the great object of treatment is the removal of this constitutional morbid condition. The chief end to be kept in view is the prevention of further tubercular deposit ; or, in other words, an arrest of the disease. It is extremely desirable for the arrest to take place as quickly as possible, in order that the amount of deposit may be limited, and the amount of dam- age to the lungs proportionably small. And with a view to a speedy arrest, the importance of early detecting the dis- ease can hardly be overrated. This disease is not removable by any known special reme- dy or remedies. This, however, is by no means saying that there arc not remedies useful in cases of pulmonary con- sumption. Important indications are to be fulfilled by remedies, but it should be clearly understood that far more reliance is to be placed on hygienic, than on medicinal meas- ures of treatment. Speaking in general terms, everything is to be avoided which tends to impair the appetite, disorder digestion, and lower the vital powers. The measures indicated arc those which tend to strengthen and invigorate. These relate to diet, exercise in the open air, clothing, mental encouragement, and change of climate. The diet of consumptive patients should be generous as Wgards quantity, quality, and variety. The articles should be highly nutritious, and adapted to the digestive powers. All the varieties of wholesome food which the patient is 7 98 MEDICAL AND SURGICAL COMPANION. able to take with relish should be allowed, and the appetite should be encouraged as much as possible. Meats, milk, farinaceous articles, and the different vegetables, are to be combined in relative proportions, according to the choice, habits, and experience in individual cases. It is desirable that cream, butter, and other fatty articles, should enter into the diet as largely as possible, without inducing disgust and disorder of digestion. The same remark applies to sugar. Exercise in the open air, or out-door life, is, of all meas- ures, the most important. The physical exercise should be accompanied by either mental recreation or occupations which iuterest the mind. It should, as far as possible, be incidental to pursuits which engage the attention. Adapted simply as a hygienic measure, it will rarely be persisted in. It is often essential, therefore, for patients to make a radical change in business, or, if they are able to devote their time to the restoration of health, hunting, fishing, sporting, trav- elling, etc., are to be resorted to as a means of securing the union of out-door life with an agreeable exercise of the mental faculties. The body sbould be protected against atmospherical changes by warm clothing ; but a superfluity of clothing is to be avoided. The object is to provide ade- quate protection, without an undue accumulation of heat and perspiration. In a cold or temperate latitude, during the winter season, a waistcoat of buckskin or chamois leather, worn during the daytime, over a light woollen or silk shirt, is to be recommended to patients of either sex, as securing the proper protection, without the inconvenience of being burdened with an overplus of garments. The feet should be well protected against cold and wet. Properly clothed, the patient, if he has strength enough to go out of doors, should rarely be kept within by the state of the weather, but should resolutely keep up habits of out- door life, despite the ordinary changes of temperature and winds, remaining in the house only on inclement days. The cool or cold sponge bath, taken daily, appears to CONSUMPTION. 99 benefit some consumptive patients. It may be safely tried and continued, provided it be followed by an agreeable glow. The proportion of cases in which an arrest of the disease is effected, is sufficient to encourage patients strongly to employ the hygienic measures which have been briefly considered. The influence of the disease on the mind is to induce either an expectation of recovery without effort, or resigna- tion to death. It is important for patients to understand that very much depends on their own exertions. One of the great difficulties in the way of successful management, is a passive, patient, tranquil frame of mind, which cannot be roused to any vigorous efforts. Persons endowed with reso- lution, energy, and perseverance, other things being equal, are more likely to struggle successfully with the disease than those who are deficient in these mental qualities. Change of climate in this disease is frequently beneficial, but it may be taken for granted that there is no specific in- fluence in any climate. Observation shows that different climates are suited to different cases. As a rule, the quali- ties which render a climate favorable are uniformity and dryness. As regards the latter, the rule is, perhaps, not without exceptions : some patients appear to do best in situ- ations in which the atmosphere is warm and moist. With respect to temperature, a uniform cold climate is best for some cases, and a uniform warm climate for other cases. It has become quite customaiy of late years to send patients to a cold latitude, and in many instances the climate of Min- nesota has proved highly serviceable. In other instances a change to a warm climate has appeared to accomplish all that could be desired. In deciding whether a cold or warm climate will be likely to prove most advantageous, the feel- ings and choice of the patient are to have considerable weight. If, when in health, more vigor and enjoyment are habitually experienced in summer than in winter, a warm climate will probably be best, and if the reverse be true, a cold climate is to be preferred. The condition as regards 100 MEDICAL AND SURGICAL COMPANION. feebleness is an essential point. If the patient be so feeble as not to be able to live out of doors in cold weather, or if the reaction from the impression of cold be slow and imper- fect, a warm climate is more suitable. It is rarely proper to send patients to a cold climate, if the disease be consider- ably advanced ; and, as a rule, a cold climate is better suited to male than female patients. With reference to the partic- ular situation to be selected, it should contain resources for occupation and mental interest. There must be induce- ments for out-door life. It is frequently better to move about from one place to another than to remain stationary : as soon as a place becomes tiresome*, it is best to leave it. Travelling in foreign countries, without any special regard to climate is often the best plan, the advantage consisting in the interest and inducements to exercise derived from a succession of new scenes. A sea voyage is generally useful, and if patients are fond of the sea, a long voyage, if practicable, may be advisable. Places which are especially the resort of patients, are to be avoided. The moral effect of seeing daily exam- ples of the different stages of the disease is unfavorable. A change is often useful when there is no superiority on the score of climate, because it is in this way only, in certain cases, that relief from the cares and anxieties of business, can be secured. The habits and tastes of the patient are to be considered. Persons who are dependent on the associa- tions and comforts of home and friends for their happiness, will not be likely to be benefited by being sent away, espe- cially if alone and among strangers. The stage of the disease and the rapidity of its progress are points of great importance. It is truly a cruel act to send to a distance patients who are in a condition admitting of but little prospect of improvement, and who will prob- ably not live to return. Although change of climate is often an important element in the treatment of this disease, it must be borne in mind that this change is to be resorted to only in the early stages and in. chronic cases. When sof- CONSUMPTION. 101 tening of the tubercles, or the third stage has begun, it will generally be too late to expect much benefit. Passing now to consider the remedies which enter into the management of this disease, I will speak first of cod- liver oil, which may be regarded partly as an article of food, and partly as a medicinal agent. To whichever of its con- stituents its efficacy may be due, there cannot be a doubt that it is, beyond all others, the remedy on which most reli- ance can be placed. Of course its virtues are most strik- ingly displayed in the earlier stages of the disorder, and in cases where there is not a strong inherited predisposition to tubercular disease ; but speaking generally, it may be stated that the oil proves serviceable at all ages, and in all stages of the disorder. The symptoms and physical signs often ameliorate under its administration with a rapidity which is sometimes quite surprising ; and in favorable cases the weight of the body increases, the cough and expectoration decrease, the appetite improves, and the night sweats, and other unfavorable symptoms, gradually disappear. The improvement which results from cod-liver oil is not found to follow the administration of neat's-foot and other oils, which equally supply an oily matter ; and as in admin- istering cod-liver oil we are conveying into the system iodine, bromine, phosphorus, and other matters which are known to exercise a powerful influence on the animal economy, it is probable that the peculiar efficacy of cod-liver oil depends partly on the supply of oil which it affords, but partly also on its containing elements which are wanting in most cases of consumption, and which in such cases it satisfactorily sup- plies. But without regard to how or why it proves ben- eficial, its extraordinary virtues cannot be doubted, and it ought to be administered in all cases of consumption in which it does not derange the stomach. Not only does it produce increase of weight, but the patients, whilst taking it, gain strength and color. Sometimes the oil thoroughly disagrees with the stomach, 102 MEDICAL AND SURGICAL COMPANION. giving rise to nausea, acid eructations, and even vomiting, together with feverish derangement of the system. In these instances it must either be omitted altogether, or adminis- tered in small doses, and, at all events, it must be discon- tinued until the stomach is brought into better order, and has the power to digest and assimilate it. But when the oil is tolerated, and under ordinary circum- stances, a tablespoonful may be given two, three, or even four times a day, and the dose may be cautiously increased to three or four tablespooufuls. It should be taken about an hour after meals, and may be given floating on a glass of wine, whiskey, ale, porter, or milk, whichever proves most beneficial and agreeable to the patient. It is nut sufficient to persevere in the administration of the oil until some sen- sible improvement has taken place ; the very fact of im- provement should rather be regarded as a stimulus to further perseverance. The deposit of tubercle is so clearly con- nected with constitutional derangement, and any material alteration in the constitution is notoriously effected so very slowly, requiring not weeks or months, but rather years for its completion, that if the patient's safety be consulted, we must urge him to take the oil for many months after he con- siders his health reestablished. If be refuses to do so, the probability will be that the improvement will be only tem- porary, and, after a short interval of comparative tranquil- lity, the system will again get out of order, mischief will recommence in an active form, aud our power may not avail to arrest it ; whereas if the patient can be persuaded to con- tinue taking the oil for a year or two, omitting it only three or four times in the twelvemouth, for three weeks or a month at a time, while he is enjoying change of air, and is otherwise under peculiarly favorable hygienic conditions, it is probable that in a considerable proportion of cases the tendency to the disease will not only be arrested, but the improvement which has occurred will be maintained, even after the oil has been discontinued. CONSUMPTION. 103 Alcoholic stimulants seem, in a certain proportion of cases, to exert a curative influence, and may be taken in connection with the cod-liver oil, or without it, when that article cannot be tolerated. Whiskey, wine, brandy, porter, or ale, whichever seems to agree best with the patient, may be takeu, in proper quantity, three or four times a day. If whiskey or brandy is used, the dose may be from two to four tablespooufuls ; if wine suits best, from three to six tablespoonfuls. When porter or ale agree best, a small tumblerful will be a proper dose. The fusil oil has been thought by some to affect favorably the pulmonary symptoms, but I do not believe it amounts to much as a curative agent. When used, three to five drops may be taken in a little sweetened water, three times a day. Touics, as the preparations of iron, Peruvian bark, or quinine, often prove serviceable in this disease. Medicines to allay superfluous cough — that is, cough not required for expectoration — are useful; but expectorant remedies, as a rule, are not called for. If they diminish appetite, occasion nausea, or disturb digestion, they do more harm than good. Soothing inhalations (R. 30, R. 31) are sometimes useful in allaying tin: irritation which excites cough. The following mixture may often prove serviceable in allaying a harsh cough : — Take of Sulphate of Morphia, . . .1 grain. Syrup of Wild Cherry, . . 1 ounce. Syrup of Balsam of Toln, . . J- ounce. Mucilage of Gum Arabic, . £ ounce. Mix. A teaspoouful may be taken three or four times a day. When night sweats occur, R. 146 may prove beneficial. Gallic acid, in five grain doses, three times a day, often pro\ es serviceable. For diarrhoea, R. 71, 72, or 74, will prove useful. 104 MEDICAL AND SURGICAL COMPANION. Pain in the chest should be met by counter-irritation, with R. 81 or 85. Fistula in ano is another symptom, occurring frequently, which must not be lightly dealt with. As long as the dis- charge is insignificant in amount, and the patient's mind is not seriously disturbed by its continuance, so long is it ad- visable to confine our efforts to the treatment of the consti- tutional malady, and not to disturb the fistula. Any attempt at curing it by operation under these circumstances would probably be followed by an immediate increase of the cough and other pectoral symptoms, and therefore would be high- ly injudicious. In some instances the discharge is profuse, and constitutes an important source of waste, and the pa- tient is so distressed and alarmed at its continuance, that DO treatment can be of any avail until his nervous apprehen- sions are overcome. He can neither eat nor sleep for think- ing of it, and his whole system is depressed in consequence. In such cases, the greatest benefit may result from an op- eration, combined with the formation of an issue in the arm, the use of a proper diet, and the administration of cod-liver oil, quinine, iron, and other appropriate remedies. SPITTING OF BLOOD. (Haemoptysis.) Spitting of blood is one of the most alarming incidents to which we are liable. It very often occurs without any warning. A slight tickling in the throat, a little cough, probably produced by the blood let loose in the air-cells of the lungs, and a slightly saltish taste in the mouth, are all the inconveniences commonly felt in spitting blood. Some- times the blood will be spit up in small quantities, and at other times in large mouthfuls. The blood which comes from the lungs is always of a light-red color, and comes up by coughing. Blood which comes from the stomach is al- ways of a dark color, often mixed with particles of food, SPITTING OF BLOOD. 105 and comes up by vomiting. Blood is sometimes discharged from the mouth, back part of the nasal passages, and the throat, and is liable to be confounded with raising it from the lungs. TVhen it comes from the mouth merely, there is no coughing or vomiting, and when it comes from the upper part of the throat, and the posterior nares, it is brought out by mere hawking, and if the throat is examined, blood may be seen issuing from the capillary vessels. Treatment. The patient should be placed in an easy chair, or on a bed, with the head and shoulders raised, as the blood cannot so easily issue from the vessels of the lungs in that position as when he lies down. He should be directed not to talk, or to use exertion of any kind. He should be allowed free air, and only a light covering. ' A teaspoonful or two of common fine salt, taken into the mouth and swallowed, sometimes seems to be efficacious in arresting hemorrhage from the lungs, and may be given at once. Small pieces of ice held in the mouth may do some good. Powders of Gallic acid and opium (R. 72) often prove very beneficial. The following mixture of turpentine frequently proves serviceable : — Take of Sulphate of Morphia, . . .1 grain. Oil of Turpentine, ... 3 drachms. Mucilage of Gum Arabic, . . 1 ounce. Syrup of Balsam of Tolu, . 5 drachms. Mix. Shake before using, and take a teaspoonful every hour or two. The bowels should generally be moved, and a Rochelle powder, or dose of Epsom salts, may be given for that purpose. ( Sold water or lemonade may be drank to allay thirst. A fight diet should be strictly adhered to until all appearauccs of bleeding have ceased. 106 MEDICAL AND SURGICAL COMPANION. CHAPTER VI. DISEASES OF THE HEART, &c. PALPITATION. The term palpitation is given to frequent, strong, and tu- multuous movements of the heart, -without appreciable or- ganic lesion. When existing in an extreme degree, the beats of the heart are both heard and felt by the patient, and seen by the by- stander. The palpitation is attended by a painful sensation of sinking, referred to the region of the heart, or pit of the stomach, and spoken of as a "sinking at the heart." In some cases there is a tendency to fainting. It generally oc- curs in persons of a nervous temperament. Causes. The exciting causes are strong mental emotions, — joy, grief, auger, sadness, fear, anxiety, violent exercise, excessive use of tobacco, tea, or coffee ; debility caused by chronic diseases, or occurring during convalescence from fevers, or other acute diseases ; excessive loss of blood, want of nourishment, intemperance, want of sleep, continued anxiety arid distress, dissipation and debauchery ; excessive sexual intercourse ; onanism. In females, " change of life" Treatment. Remove the causes of the trouble, if possi- ble, and improve the general health. The following mixture will be found useful in controlling the action of the heart : — ANGINA PECTORIS. 107 Take of Tincture of Digitalis, . . £ ounce. Fluid Extract of Cimicifuga, . £ ounce. Compound Tincture of Lavender, i ounce. Simple Syrup, . . . . 2£ ounces. Mix. A teaspoonful may be taken three times a day for a week, when it should be omitted for a time, and resumed if necessary. ANGINA PECTORIS. Angina pectoris is a paroxysmal disease, which has been termed a disorder of the breast. Symptoms. Those who are afflicted with this disease are seized whilst they are walking, and more particularly when they walk soon after eating, with a painful and most disa- greeable sensation in the breast, which seems as if it would take their life away if it were to increase or to continue. The moment they stand still, all this uneasiness vanishes. In all other respects the patients are, at the beginning of this disorder, perfectly well, and in particular have no hurried breathing, from which.it is totally different. The duration of the seizure rarely exceeds a few minutes, though it may last for half an hour, or an hour, or even longer. The attacks occur at uncertain intervals of weeks or months ; in confirmed cases the periods of recurrence ap- proximate more and more with each successive paroxysm. The seizure may come on at any time, not only when the patient is walking, but even when in bed. The pain is most severe, and is attended with a feeling as if life were about to cease : in some cases the paroxysm has at once destroyed life. No favorable prediction can be made in regard to this dis- ease ; for if death does not occur in the first or second seiz- ure, it generally does so in some subsequent attack. The occurs most frequently in advanced life, and is much 108 MEDICAL AND SURGICAL COMPANION. more common in men than in women. In some few in- stances it has seemed to have some connection with gout. Treatment. During a paroxysm administer stimulants, as whiskey, or brandy, and of anti-spasmodics, such as ether, opium, &c. A belladonna plaster, worn constantly over the region of the heart, may do good. The return of the seizure is to be guarded against by improving the general health, by great attention to diet, and by the avoidance of stimulants, excessive exercise, and all mental excitement. PERICARDITIS. Pericarditis, or inflammation of the external covering of the heart, is a grave disease. Causes. It often arises from acute rheumatism, from the contaminated state of the blood produced by disease of the kidneys, from damp and cold, and from mechanical injuries, Symptoms. High fever ; pain referred to the region of the heart, often darting through to the left shoulder blade, upwards to the collar bone and shoulder, and down the arm : violent palpitation, the motions of the heart being tu- multuous, and perceptible at a distance from the patient ; irregularity of the pulse, hurried breathing, incapacity of lying on the left side, strong pulsation of the arteries of the neck, anxiety of the countenance, and frequently noises in the ears, giddiness, and bleeding from the nose. Treatment. If the disease is not checked quickly, fluid becomes effused into the pericardium, or heart-case, and when such is the result, a large blister may be placed over the part. At the commencement of the disease, give a thorough pur- gative, as an ounce of Epsom salts, or one composed of five grains of calomel and fifteen of jalap. If the inflammation be of a rheumatic character, the treatment laid down for DISEASES OF THE HEART. 109 acute rheumatism will be proper. Opium in some form may- be given to allay pain. At first the patient's diet should be light, consisting of gruel, arrowroot, and mutton broth. As soon as the strength begins to fail, however, the diet must be more strengthening, and milk, strong beef tea, and wine freely allowed. ENDOCARDITIS. Endocarditis is an inflammation of the membrane which lines the interior of the heart and its valves. Severe or- ganic disease arises from it. Symptoms. A sense of oppression and uneasiness about the region of the heart, fever, small, feeble, and intermit- tent pulse, great anxiety, cold sweats, oppressive difficulty in breathing, fainting, &c. When the inflammation is only of limited extent, or when it assumes a chronic form, the symptoms are much milder and more obscure. Treatment. The same as recommended for pericarditis. BLUE DISEASE. {Cyanosis.) This disease is characterized by a blue or purplish discol- oration of the skin. It generally arises from some mal- formation of the heart, permitting direct communication between the right and left cavities. Treatment. This must be simply palliative, the organic cause being irremediable. OTHER DISEASES OF THE HEART. In addition to the diseases already mentioned, there are others of an organic or structural character, as enlargement (hypertrophy) and diminution (atrophy) of the heart ; also 110 MEDICAL AND SURGICAL COMPANION. valvular disease, fatty degeneration, dilatation, &c. ; but as these diseases can only be detected and properly managed by a physician, it will be useless for me to treat of them in this work. Persons afflicted with organic disease of the heart have more or less trouble at all times ; but in cases where the disease is purely functional, there will be times when no trouble whatever is experienced. All who are afflicted with disease of the heart should live temperately and regularly, and avoid excitement. DISEASES OF THE BLOOD. SCURVY. (Scorbutus.) This disease consists in a peculiar depraved state of the blood, the nature of which is not clearly understood. Symptoms. This disease commences with a feeling of languor, or general debility, and mental despondency ; a sense of fatigue is experienced on the slightest exertion ; the face is either pale or sallow, and presents an appearance of puffiness; the gums are swollen, soft, and of a purplish color, and bleed easily ; the breath becomes offensive, and small purple spots appear over the body. These spots, which are sometimes very numerous, are generally small and circular, resembling flea-bites ; but often, especially when the disease is a little advanced, we meet with other spots as large as the palm of the hand, sometimes much larger, in which the skin is of a variegated violet and green tint, and which resemble in every respect the marks produced by a severe bruise. In advanced stages of the disease, the complexion has a more dingy, and somewhat brownish hue ; the gums are SCURVY. Ill more swelled and more livid, forming in some cases a black, spongy mass, which completely covers the teeth ; the teeth themselves become loose, and frequently drop out, and the debility is such, that the slightest exertion, even the erect posture, causes breathlessness and palpitation, and not un- frequently an alarming faintness. Bleeding frequently oc- curs from mucous surfaces, and the feet become swollen. The tongue and appetite often continue unaffected. When death takes places, it is produced either by the debility or hemorrhage, the intellect remaining sound to the last. Causes. The chief cause is the deprivation of proper vegetable food. Other causes may contribute, such as long- continued exposure, fatigue, the depressing passions, &c. The exclusion of fresh vegetable food will not produce it, provided fresh animal food can be procured. It occurs most frequently on board of ships on long voyages, and occasion- ally, also, on land, under similar circumstances. Treatment. This is very simple ; all that is requisite is to remove the cause by giving plenty of fresh vegetable food and acids, especially lemon juice or citric acid. Cab- bages and potatoes are also excellent anti-scorbutics ; but oranges, lemons, or fruits of that class, if they can be pro- cured, should be preferred. The salutary effect of them is extraordinary, and such as would scarcely be imagined by persons who have not witnessed it. If the state of the gums be such as to prevent the patient from masticating, he should be kept for a few days on milk diet or on soups, in addition to the fruits ; but as soon as possible, fresh animal food and vegetables should be given. If a patient be very feeble, wine, ale, or porter may be taken. 112 MEDICAL AND SURGICAL COMPANION. PURPURA. This disease is characterized by the appearance of livid or purplish spots, generally commencing on the extremities. Two varieties are described — simple purpura, and -purpura hemorrhagica, although it is probable they do not essentially differ ; in the latter we may have hemorrhage from the bow- els, lungs, nose, gums, &c. In some cases there are constitutional symptoms, as in scurry, especially neuralgic pains in the back. It appears often in successive crops, the spots being usually small, but at times becoming very large by increase of the effusion. Occasionally it is periodical. It is not elevated, nor is it ac- companied by any sensatious. It is simply an effusion of the coloring matter of the blood. Causes. Not well understood. It occurs in depraved constitutions, as a general rule, though this is not always the case ; it is more common in the young and in the very old. It most resembles scurvy in its general character, though it differs from it in not being prevented nor cured by fresh vegetable food. In purpura, the gums, although pur- plish, do not soften, nor swell, nor ulcerate, as in scurvy. Treatment. The chief indication is to correct the low state of the blood by fresh air, good food, and tonics, as the preparations of iron, quinine, &c. A milk diet is often very beneficial. Astringents and opium are sometimes required to check hemorrhage, and in such cases the following powders will prove serviceable. Take of Gallic Acid, .... 2 drachms. Powdered Opium, . . 8 grains. Mix, and divide into twelve powders. One may be taken in syrup, three or four times a day. Perfect rest is essen- tial in severe cases. APHTHA, THRUSH, CANKER. 113 CHAPTER VII. DISEASES OF THE ORGANS OF DIGES- TION. INFLAMMATION OF THE TONGUE. (Glossitis.) Symptoms. Pain, heat, and swelling ; the tongue of a deeper red color than usual, and occasionally the swelling proceeds to such an extent that the cavity of the mouth is not large enough to contain the organ, and it projects beyond the teeth. This condition, which often occui'S very rapidly, sometimes in a few hours, is attended with urgent increased frequency of breathing, and requires prompt attention. Treatment. Active purgatives should be administered by means of injections, and the vapor of hot water may be perseveringly inhaled. Six or eight leeches applied around the edge of the lower jaw will generally prove very bene- ficial. In severe cases, send for a physician without delay. APHTHA. THRUSH. CANKER. Symptoms. Small, round, white specks, or patches, scat- tered over the tongue and lining membrane of the mouth. They form a special disease in infancy. In adult age they are apt to appear in the course of other diseases. In some forms of this disease, microscopical parasitic plants are said to be developed in large quantity, and are, in fact, the eaUBe of the disease. 8 114 MEDICAL AND SURGICAL COMPANION. Treatment. The treatment of this disease consists in the use of alteratives (R. 67, 68) and tonics (R. 59, 60), and the application to the aphthous parts of the following preparation : — Take of Powdered Borax, . .1 drachm. Clarified Honey, . . .1 ounce. Mix. Apply to the canker spots, two or three times a day, using a camel's-hair brush. The following mixture is said to be very efficacious in cases attended with the formation of parasitic plants : — Take of Sulphite of Soda, ... .1 drachm. Rose Water, .... 1 ounce. Mix. Apply to the aphthous spots, with a camel's-hair brush, two or three times a day. MUMPS. (Parotitis.) This is a specific contagious inflammatory affection of the salivary glands, and of the parotid gland especially. Symptoms. Slight fever, with swelling and soreness be- neath and in front of one or both ears, the swelling often extending along the neck to the chin, and involving the sub- maxillary glands. The disease reaches its height in four or five days, and then declines. Treatment. Give a gentle laxative, as a Rochelle pow- der, or small dose of castor oil. If there is much fever, R. 21 may be given, and hot fomentations made to the swollen parts. INFLAMMATORY SORE THROAT. (Tonsillitis.) Inflammatory sore throat, sometimes termed quinsy, man- ifests itself by smart fever, redness and swelling of the DYSPEPSIA. 115 fauces and tonsils, and difficulty of swallowing, together with, in severe cases, pain shooting from the throat to the ear, along the course of the Eustachian tube. Under ordinary circumstances the inflammation runs a certain course, and terminates by resolution in a few days, merely leaving the tonsils enlarged ; when violent and prolonged, however, it frequently leads to abscess in one or both tonsils. Chills often announce the formation of matter, and the pain is very severe until the abscess bursts, or is opened artificially. Causes. The principal exciting cause of quinsy is cold. The liability to it is increased by repetitions of the attacks. Treatment. A dose or two of some cooling purgative, as Epsom salts, and hot fomentations, or flaxseed meal poul- tices to the throat, will prove serviceable. Inhaling the steam of hot water often gives great relief. In severe cases the outside of the throat may be painted once or twice a day, for two or three days, with the tincture of iodine. DYSPEPSIA. This is one of the most common diseases which physi- cians have to treat. Anything which interferes with the healthy action of the stomach will give rise to it. Symptoms. The symptoms vary, but the most constant are loss of appetite, flatulence, heartburn, a sense of fulness and oppression after eating, or a feeling of languor and de- pression, relieved by taking food. These symptoms, vari- ously combined, and generally accompanied by some disor- der in the functions of the bowels, in the form of constipa- tion, diarrhoea, or the two alternately, and with more or less derangement in the functions of the liver, constitute the most common form of dyspepsia. In addition to the above, we may have cold extremities, headache, dizziness, a foul tongue, singing in the ears, pyrosis, &c. Causes. Debility, want of exercise, food difficult of 116 MEDICAL AND SURGICAL COMPANION. digestion, overloading the stomach with food, liquids in ex- cess, especially hot tea and coffee ; too short or too long intervals between meals ; the abuse of spiritous liquors, opium, and tobacco ; the frequent use of drastic purgatives ; exercise immediately after taking food ; disease of the liver, &c. Dyspepsia is a frequent precursor of pulmonary con- sumption. Treatment. In treating dyspepsia, we must first en- deavor to correct any bad habits into which the patient may have fallen, and to regulate the diet. Then we must at- tempt to restore tone to the stomach, and at the same time palliate urgent symptoms as they arise. The most impor- tant step to be taken in the cure of dyspepsia is to point out to the patient the necessity of changing such habits and pursuits as may have tended to give rise to the disease, and continue to aggravate it. Unless the causes of the disease! are sought out and removed, no permanent benefit need be expected from treatment. Digestion is always very much improved by those means which invigorate the system generally, as by rest and retir- ing early, relaxation from severe studies, or from the ha- rassing cares and anxieties of business, change of air, sea bathing, cold or tepid sponging, horse exercise, the disuse of tobacco and of alcoholic stimulants, where these have been too freely indulged in, &c. The regulation of the diet is of the greatest importance. In severe cases, it may be well to give the stomach a com- plete rest for a day or two, while we sustain the patient by giving an injection of a gill or more of good beef tea every third hour. Then, for a time, merely the plainest food should be allowed, and only small quantities taken at a meal. Milk, to every pint of which may be added a gill of lime-water, gruel, soup, and arrowroot, will all be use- ful. When these articles can be taken without causing any pain or uneasiness, the diet should be increased, and fish, poultry, and mutton may be taken. Stale or unfermented PAIN IN THE STOMACH. 117 bread may be eaten ; but vegetables, pastry, cheese, beer, and spirits should be forbidden. If any stimulant be need- ed, a little sherry wine, or weak brandy and water, will prove the least injurious, and in some instances will be even beneficial. With regard to medicines, several are useful. Pepsin (R. 64), the digestive principle of the gastric juice, is very valuable when there is an imperfect performance of the functions of the stomach, and especially when this is indi- cated by disturbance following the use of animal food. The tonics (R. 65 and R. 66) often prove serviceable. In some instances R. 62 and R. 63 do mnch good. If there is great sourness of stomach, alkalies (R. 76, R. 77) are indicated. If there is yellowness of the skin, or conjunctiva, or the evacuations are clay-colored, or there is hemorrhage from the stomach or bowels, the nitro-muri- atic acid (R. 148) will generally prove beneficial. In cases where a laxative is required, the compound rhubarb pills (R. 149) may be used. After the patient's health is re- stored, great care must be taken to prevent a relapse of the disease. PAIN IN THE STOMACH. (Gastralyia.) Symptoms. Acute pain in the region of the stomach, occurring at a variable interval of from half an hour to three hours after a meal, generally relieved by pressure and by food. It is associated with other symptoms of dyspep- sia, and is often terminated by pyrosis or water-brash. Causes. Those of dyspepsia ; strong and sudden mental emotions ; the abuse of tea, coffee, and warm liquids. Treatment. Remove the causes of the trouble, and give one of the following powders, two or three times a day : — Take of Sub-nitrate of Bismuth, . . 2 drachms. Divide into twelve powders. They may be taken in syrup or molasses. 118 MEDICAL AND SURGICAL COMPANION. WATER-BRASH. (Pyrosis.) Symptoms. In the morning or forenoon, when the stom- ach is empty, or some hours after a meal, and after suffering from pain in the stomach, vomiting of a thin, watery fluid, in considerable quantity, sometimes of a sour taste, but often quite insipid. The free discharge of the fluid generally gives relief to the pain, aud puts an end to the attack. Causes. The common causes of dyspepsia. TREATMENT. That of gastralgia, or pain in the stomach. If the liquor vomited be highly acid, R. 76 or R. 77 will prove beneficial. VOMITING OF BLOOD. (Hasmatemesis.) Symptoms. Vomiting of dark-colored grumous blood, in greater or less quantity, often mixed with food, and preceded by a sense of weight and dull pain in the region of the stomach. Causes. Predisposing. — The female sex, intemperance, peculiarity of constitution. Exciting. — Suppression of ha- bitual evacuations, especially of the menstrual discharge (vicarious hrematemesis), tumors, compressing the liver or spleen, external violence, &c. Distinguish this affection from spitting of blood (haemop- tysis) from the lungs, by the blood being vomited ; by be- ing mixed with food, and not with sputa, and by being of a dark color instead of a bright red. Vomiting of blood seldom proves fatal, except when oc- curring in persons of hemorrhagic diathesis, who are liable to bleed profusely, and even unto death, from slight causes, as the extraction of a tooth, biting the tongue, &c. Treatment. The treatment must consist in abstinence from food ; perfect rest, in the horizontal posture ; cold wa- INFLAMMATION OF THE STOMACH. 119 ter and small pieces of ice may be swallowed, and pounded ice may be applied to the pit of the stomach in urgent cases. The following powders often prove serviceable : — Take of Tannic Acid, .... 1 drachm. Powdered Opium, . ... 12 grains. Mix, and divide into twelve powders. One may be taken in a little syrup every third, fourth, fifth, or sixth hour, ac- cording to the urgency of the case. The oil of turpentine often proves highly beneficial, and may be given in the following forni : — Take of Oil of Turpentine, . . . £ ounce. Mucilage of Gum Arabic, . . 2 ounces. Syrup of Balsam of Tolu, . . £ ounce. Mix. Give a teaspoonful, in a little cold water, every hour or two. When the hemorrhage has ceased, endeavor to prevent its recurrence by removing causes, and a strict attention to the digestion and general health. In all cases of vomiting of blood, a physician should be called as soon as possible. INFLAMMATION OF THE STOMACH. (Gastritis.) Inflammation of the mucous membrane of the stomach may be acute or chronic. Causes. Very cold water, rapidly swallowed, while the body is heated ; irritating and corrosive substances ; fatiguing exercise ; over-distention ; improper food ; metastasis of gout or rheumatism, &c. Symptoms. Vomiting, and a burning, lancinating pain in the stomach. There is a desire for cool drinks, and an aversion 'to warm, which aggravate the complaint. The pulse is small, tense, and quick ; the pain is constant, ex- cept for a moment after taking a cold drink ; the pa- 120 MEDICAL AND SURGICAL COMPANION. tient generally lies on his back, and moves as little as possible. Treatment. The first and most important object in the treatment is, to secure for the inflamed organ as much rest as possible. With reference to this object, the less of anything introduced into the organ the better. To allay in- tense thirst, small pieces of ice may be swallowed, or iced water, taken often, in very small quantity at a time. It is desirable to administer opiates in order to quiet the stomach, and render the system more tolerant of the disease. The following powders, placed dry upon the tongue, may be tried : — Take of Sulphate of Morphia, . . .1 grain. White Sugar, . . . .12 grains. Mix thoroughly, and divide into six powders. One may be taken every two, three, or four hours, or as occasion re- quires. If vomiting be provoked by this mode of admin- istration, half a teaspoonful of laudanum, in a wineglass of starch- water, may be injected into the bowels, and repeated every three to six hours, if necessary. A mustard poultice, followed by hot fomentations, or a blister, four inches square, may be placed over the pit of the stomach. If the bowels are constipated, relieve them by a soap-suds injection. Ca- thartics are not admissible. The importunities of the pa- tient for an emetic are to be resisted. It would do harm rather than good. Stimulants and solid nourishment will not be borne. For a day or two, or until the urgent symptoms have subsided, the patient may be sustained by injecting into the bowels a gill of strong beef tea, or essence of beef, three or four times in the twenty-four hours. If the patient be very much prostrated, an ounce or two of wine may be added to each injection. When the improvement iu the symptoms render it prob- able that food will be retained, milk, with the addition of a tablespoonful or two of lime-water to every gill, will be ULCER OF THE STOMACH. 121 likely, at first, to be best borne. It should be given in small quantities at short intervals. Other forms of food may be gradually added. Chronic Inflammation of the Stomach is much more common than the preceding, and fortunately much milder. Causes. Excess in eating and drinking ; unwholesome food ; an occasional increase of dyspepsia, &c. Symptoms. Pain in the region of the stomach, increased by pressure ; and immediately on taking food, with constant nausea or sickness, the stomach rejecting food as soon as it is swallowed, or after a short interval. The tongue is some- times red at the tip and edges, and furred in the centre ; at others morbidly red over the entire surface, but in many cases perfectly clean. The bowels are generally costive. Treatment. In the more severe cases, half a dozen or more leeches may be applied over the region of the stom- ach, and followed by a blister, mustard poultice, or fomen- tations. In less severe cases, the leeches will not be re- quired. The diet should consist of gruel, arrowroot, or sago, made with water or milk, to the entire exclusion of solid food, till the sickness and tenderness on pressure dis- appear, when the patient may be allowed gradually to re- sume his usual diet. The bowels may be kept open by Rochelle powders or castor oil. ULCER OF THE STOMACH. This is an interesting disease, variously spoken of by authors as the simple, chronic, or perforating ulcer of the stomach. The ulcer is more frequent in the female than the male, in the proportion of nearly two to one. It is specially a disease of middle and advancing life, and is more frequent in the poor than in the rich. The ulcer varies in. size in 122 MEDICAL AND SURGICAL COMPANION. different cases, being sometimes so small as to be discerned with difficulty, and sometimes of the size of a half dollar, or dollar, or even considerably larger. If small in size, it has generally a round or oval form, and presents an appear- ance, in some cases, as if a portion of the tissues had been punched out. About half the instances of this disease un- dergo what is probably a spontaneous cure ; in exceptional cases, the ulcer has been fatal in ten days, generally by perforation, sometimes by exhaustion, caused or hastened by vomiting, and very rarely by hemorrhage. When perforation of the stomach takes place, its contents are generally poured into the abdomiuial cavity, and give rise to fatal inflammation. Symptoms. The most constant symptom is pain in the back and pit of the stomach, and when in the latter region, it is frequently described as dull and sickening, and it is increased by food. There is occasionally eructation of a sour fluid, and at times nausea and vomiting. The patient generally loses flesh, but otherwise the constitutional symp- toms are usually slight. After the disease has continued a longer or shorter time, perforation may occur ; or, failing this, there may be a severe attack of hemorrhage, indicated by vomiting of blood. But iu favorable cases, the ulcer gradually heals, the pains diminish, and the patient com- pletely recovers. Treatment. In the treatment of this disease, we must endeavor to support the system, and facilitate the healing of the ulcer. "When the pain is very severe, a mustard poultice may be applied over the stomach, and followed by hot fomentations. In obstinate vomiting, or in hemorrhage, the application of ice is more advisable. Small pieces of the same may be occasionally swallowed. Laudanum or morphine may often be administered with very great ad- vantage. The patient's diet in this disease should consist of those nutritious articles of food which will be best retained by the CANCER OF THE STOMACH. 123 stomach, and give rise to the least inconvenience. Milk and fai-inaceous substances will be best borne. Condiments, al- coholic stimulants, solid and indigestible food of any de- scription, should enter as little as possible, or not at all, into the diet. The quantity of food taken at a time must be small, and the intervals regulated according to circum- stances. Milk and other liquids should be taken cold. . Lime-water added to milk renders it less likely to occasion disturbance. Quietude of the body is to be enjoined, more especially during the process of digestion. Cathartics are injurious in this disease, and constipation, if it exist, is to be relieved by injections. When an improvement in the symptoms renders it prob- able that the ulcer is healing, great care in diet is im- portant to prevent a relapse. CANCER OF THE STOMACH. Symptoms. In the early stage of the disease the symp- toms are very obscure. They are either those of dyspepsia or chronic gastritis. But after a longer or shorter interval, during which the patient loses flesh, and obtains little or no relief from his dyspeptic symptoms, a circumscribed tumor may be discovered in the region of the stomach. At this stage of the disease the symptoms are generally of a more marked character. The pain is described as burning, gnawing, or cutting ; and there are acid or bitter eructa- tions, with nausea and frequent vomiting of food, of mucus, of blood, or of a dark grumous matter ; constipation ; great emaciation, and a sallow countenance. Causes. Predisposing. — The cancerous diathesis. JEx- viting. — Long-continued dyspepsia. All causes of inflam- mation or congestion of the stomach. Depressing passions. Treatment. This can only be palliative ; for the dis- ease mukes continual progress, exhausts the powers of 124 MEDICAL AND SURGICAL COMPANION. life, and, in the majority of cases, causes death within one year. Laudanum or morphine, administered either by the mouth or bowels, will be necessary ; it should be given in free and repeated doses to subdue the pain. "When the vomiting is very severe, nourishment, in the form of beef tea, must be given by means of injections ; where it can be borne, how- ever, a milk diet will be beneficial. INFLAMMATION OF THE INTESTINES. {Enteritis.) Inflammation of the intestines, or bowels, varies much in severity, being sometimes so slight as hardly to attract at- tention, but often so severe as to threaten, or even rapidly destroy life. Symptoms. Chills, hot skin, thirst, hard and rapid pulse. There is acute pain in the abdomen, increased by pressure over the inflamed part, and gradually, in severe cases, ex- tending to the whole abdomen, accompanied by swelling and tension. The patient lies on his back, with the knees drawn up, and can scarcely suffer the pressure of the bed-clothes. In colic, it must be remembered, pressure upon the abdo- men gives relief instead of pain. There is obstinate cos- tiveness ; also nausea and frequent vomiting, the matters thrown off being generally bilious, aud in some instances highly offensive. The urine is high-colored, and there is great prostration of strength. In fatal cases, the swelling and pain increase ; the extremities grow cold ; the skin is bedewed with a soft sweat ; and death takes place from exhaustion, preceded by a cessation of pain. This disease sometimes occurs in young children from six to eight months old. The child is hot and restless in the early stages, and suffers from thirst ; the tongue is dry, or covered with a brownish crust ; there is frequent screaming ; dis- INFLAMMATION OF THE INTESTINES. 125 turbed sleep ; vomiting ; pain in the bowels, increased on pressure, and in some cases diarrhoea, the feces being often discharged with considerable force. Thus far the disease does not diiFer much from a sharp attack of diarrhoea. Se- vere constitutional symptoms, however, soon set in, such as high fever, thirst, vomiting, dryness of the tongue, &c, fol- lowed by a rapid and unexpected exhaustion, or sometimes by a morbid disposition to sleep, with a peculiar pale, waxen appearance of the body. These symptoms may come on before the disease has lasted any considerable time, and whilst it can scarcely be distinguished from the ordinary bowel complaints of children. It should be remarked that an erythematous redness is generally observed around the anus. Treatment. Twenty-five or thirty drops of laudanum, or a morphine pill (E. 45), may be given to an adult once in two, three, or four hours, according to the urgency of the symp- toms. Hot fomentations perseveringly applied to the abdo- men will give great relief. All purgatives are to be rigidly avoided, but the bowels may be relieved by injections of warm water thrown up in large quantity, gradually and slowly. The diet should be very simple, and ought to con- sist chiefly of gruel, milk, or beef tea. Cold water may be freely allowed. When there is a disposition to prostration, stimulants, as wine, brandy, or whiskey, may be resorted to. After the inflammation has ceased, mild laxatives, as castor oil. or Rochelle powders, may be required. In chil- dren, the same kind of treatment must be pursued, though the preparations of opium, — laudanum, morphine, &c, — must be given to them with caution. The warm bath, and hot fomentations, or linseed-meal poultices to the abdomen, will give great relief. If the child is at the breast, no other food should be allowed ; otherwise, the diet must be very mild, consisting chiefly of milk with a little broth. 126 MEDICAL AND SURGICAL COMPANION. COLIC. Symptoms. Pain in the bowels, especially about the umbilicus, occurring in paroxysms, and relieved by pressure. It is accompanied by constipation, and often by vomiting. There is no fever, no quickness of pulse, and no depressing anxiety, as in inflammation of the intestines. Causes. Acrid or indigestible food ; redundance of acrid bile ; collections of hardened feces ; wind ; certain metallic poisons, as lead ; worms, &c. Treatment. We must first endeavor to relieve the pain, and get the bowels to act. If the trouble is caused by wiud, give twenty-five drops of laudanum, aud a teaspoonful of es- sence of peppermint, in a little warm water, at once. After the patieut becomes easy, give an ounce or two of castor-oil, or a good dose of Epsom salts, to clear the bowels. In cases arising from indigestible food, or a redundance of acrid bile, — which will be indicated by the patient's vomiting a yel- lowish, bitter fluid, — first give half a teaspoonful of bicar- bonate of soda in a gill of cool water, and immediately afterwards a purgative, consisting of three compound cathar- tic pills, or five grains of calomel aud fifteen of jalap. If the pain is very severe, or the inclination to vomit such that nothing can be retained on the stomach, one or two opium (R. 44) or morphine (R. 45) pills may be given to produce relief, before giving the cathartic. The application of a mustard poultice and hot fomentations to the bowels must not be neglected. The cathartic may be aided by a liberal warm water or soap-suds injection. This is often termed Bilious Colic. In Lead Colic, or Colica Pictoxum, so called from its former frequency among the Pictones, or inhabitants of Pictou, there are superadded to the former symptoms a twisting pain around the uavel, with retraction of the abdom- inal integuments towards the spine, and pain in the back. In nearly all cases of lead colic a blue line may be observed around the edges of the jrums. colic. 127 Cause. This disease is caused by the introduction of lead into the system in sufficient quantity to give rise to its morbid effects. It may be introduced through the lungs, stomach, the mucous membrane in other parts, and the skin. Certain occupations involve the inhalation of lead. Persons employed in the manufacture of lead paints are most ex- posed, and of those who suffer from lead poisoning, the largest proportion are of this occupation. Next to this class, painters are most exposed. More or less exposure, by inhalation, belongs to a great number of occupations, such as paper-staining, grinding of colors, glazing cards, man- ufacturing earthen pottery, plumbing, shot-making, &c. Lead poisoning has repeatedly occurred from sleeping in newly-painted rooms. Lead may be introduced through the stomach in various articles of food and drink. Spurious wine and cider are sometimes adulterated with lead to give them sweetness. Iu the treatment of severe cases of lead colic, laudanum or morphine must be given to relieve pain, and active cathartics to open the bowels. A mustard poultice, followed by hot fomentations to the abdomen, should not be neglected. As a cathartic, five grains of calomel and fifteen of jalap may be given ; or, if preferred, an ounce of Epsom salts dissolved in half a pint of water. An hour or two after the cathartic lias been administered, an injection of warm water or soap-suds may be given. The bowels must be thoroughly acted upon or purged. After the urgent symp- toms have subsided, the following medicine may be taken for a considerable time to remove the lead from the sys- tem : — Take of Iodide of Potassium, . . 8 scruples. Water, . . • . .3 ounces. Syrup of Orange Peel, . . 1 ounce. Mix. One teaspoonful maybe taken iu a wineglass of water after each regular meal. 128 MEDICAL AND SURGICAL COMPANION. DIARRHCEA. Symptoms. In addition to the looseness of the bowels, or purging, there is generally some degree of nausea, a furred tongue, foulness of breath, flatulence, griping pains, acrid eructations, constant desire to evacuate the howels ; more- over, the stools are unhealthy. Causes. The use of improper food or decaying fruit, great mental emotion, exposure to cold or too great heat. From the latter cause, relaxation of the bowels is common during the summer months. Treatment. This will, of course, depend upon the cause. When the purging arises from the presence of some offend- ing matter in the intestinal canal, the expulsion of such matter must be aided by giving a dose of tincture of rhu- barb, castor-oil, or Epsom salts, combining ten to twenty- five drops of laudauum with the dose, if there be much paiu. If no such cause exist, give a powder composed of three grains of calomel and one of opium, and three hours after- wards a dose of castor-oil. The patient should keep quiet, and lay down when convenient. Gum arahic water, cool water, and liquid nourishment only should be allowed dur- ing, and for a few days after the attack. If the diarrhoea does not cease soon after the operation of the cathartic, opium and astringents (R. 71 or 74) may be given. DYSENTERY. This disease consists chiefly in inflammation and ulcera- tion of the large intestine, or colon and rectum. Symptoms. At the commencement there is uneasiness, and pain in the abdomen, of a griping character, with a fre- quent inclination to go to stool, which is followed by relief. As the disease becomes developed, the desire to go to stool DYSENTERY. 129 is more frequent, and the ease which succeeds more tran- sient; the evacuations are thin, mucous, and bloody, and frequently mixed with small, hard, separate lumps of feces. The scanty evacuations soon produce distress rather than relief; the patient is constantly tormented with a desire to go to stool, and griping ; the stools become fetid, dark-col- ored, and mixed with shreds of lymph, and the bladder sympathizes with the bowels, causing frequent desire to uri- nate. In all cases there is more or less fever and constitu- tional disturbance ; the tongue is furred ; pulse quick and small; skin harsh, hot, and dry; thirst urgent; no appe- tite ; hurried breathing, and great prostration. This is a serious and often fatal disease. Causes. Cold and wet, contagion, malaria, polluted wa- ter, bad food, drastic purgatives, &c. Treatment. In commencing the treatment of this dis- ease, it is proper to well clear out the bowels, and for this purpose a large dose of castor-oil may be given, and with it twenty-five or thirty drops of laudanum, to relieve pain. Instead of the oil, I sometimes give the following mix- ture : — Take of Epsom Salts, Laudanum, Peppermint Water, Pure Water, 1 ounce. £ drachm. 3 ounces. 3 ounces. Mix. A tablespoonful may be given to an adult, in a little water, every half hour, until free watery discharges from the bowels take place. This seems in most cases to give the patient great relief. After the bowels have been well cleared out, half a teaspoonful of laudanum, mixed with two or three tablespoonfuls of thin warm starch-water, may be injected into the bowels, and this injection may be repeated <5nce in three to six hours, or often enough to pre- vent the patient suffering from pain. Warm fomentations and hot poultices to the abdomen always give relief. If 130 MEDICAL AND SURGICAL COMPANION. a syringe is not at hand with which to administer the lau- danum and starch injection, an opium (R. 44) or morphine (R. 45) pill, or twenty-five drops of laudanum, may be taken every three to six hours as a substitute. After two or three days, if the disease continue, the purga- tive may be repeated, if not contra-indicated by the feebleness of the patient ; and afterwards the use of opium resumed. Attention must invariably be paid to the diet ; emollient drink, — gum-water or barley-water, — milk, arrowroot, and essence of beef only being allowed during, as well as for a few days after the attack. In severe cases the patient should be confined to the bed, not even being allowed to rise to use the vessel, as the more quiet the bowels are kept the better. When there is con- siderable hemorrhage from the bowels, astringents (R. 71 or 74) may be used. When there is much prostration, a little brandy and water may be given every two or three hours. Dysentery being a grave disease, requiring careful management, a physician, when obtainable, should always be> called to take chanre of the case. CHOLERA MORBUS By cholera morbus, is meant that peculiar affection of the alimentary canal, characterized by vomiting and purging, and attended frequently with more or less cramps or spasms of the abdominal muscles, and also of the extremities, and, in severe cases, with considerable prostration. Symptoms. The disease commences with a feeling of op- pression in the stomach and bowels, with perhaps chilliness, and a feeling of great distention, with violent pain in the abdomen. Soon there is nausea and griping pains, with obstinate vomiting, and copious liquid discharges from the bowels. The pulse becomes weak and frequent, the skin cool and moist, the strength is prostrated, and, along with MALIGNANT OB ASIATIC CHOLERA. 131 more or less severe cramps in the bowels and extremities, there is sometimes wandering of the mind, or slight de- lirium. If the discharges and cramps continue, they may lead on to a fatal termination. Causes. Excessive heat, or sudden transitions from heat to cold ; food of difficult digestion ; unripe or decaying fruit, or an excessive quantity of ripe fruit ; putrid meat ; decayed vegetables, &c. This disease occurs during the summer months. Treatment. The patient should be confined to bed, in a cool, airy room. A teaspoonful of bicarbonate of soda or saleratus may be added to a tumblerful of cool water, which may be drank at once. Then give an opium (R. 44) or morphine (R. 45) pill, or thirty drops of laudanum, and repeat it in half or three fourths of an hour, unless the pain, vomiting, and purging cease. If the opiate first given is vomited immediately, or within fifteen minutes, give the second dose at once. Our aim should be to give sufficient to relieve the urgent symptoms within an hour or two ; alter which the dose may be repeated every two, three, or four hours, or as occasion requrres, lengthening the intervals between the doses as the patient improves. Mustard poul- tices to the abdomen and extremities prove serviceable. "When the cramps in the extremities are severe, rubbing the limhs briskly will ease the patient. When there is great prostration, brandy and water may be taken, as occasion requires. The diet should at first be light, as gruel and milk ; and when the disease has subsided, the usual diet must be gradually resumed. MALIGNANT OR ASIATIC CHOLERA. This is probably the most fatal disease known in the an- nals of medicine. We are wholly ignorant of its origin. 132 MEDICAL AND SURGICAL COMPANION. All that our experience has taught us is this : that the dis- ease attacks the poor in a much larger proportion than the rich ; and that as we remove destitution, filth, foul air, and the causes of disease generally, so we destroy the agencies through which this formidable malady operates. Symptoms. The disease does not always begin in the same way. In a few cases it makes its attack suddenly ; the patient vomits once or twice, or passes one or two loose motions; complains of giddiness, blindness, or deafness; falls down, and expires in a few minutes. Such cases are rarely seen out of India. In the majority of cases, the fol- lowing is the order of the symptoms : After a preliminary attack of diarrhoea, of greater or less severity, and contin- uing for some hours or days, the patient is seized Avith symptoms of collapse or prostration, accompanied, in most cases, by vomiting. The acts of vomiting and purging are generally unattended by pain or tenderness in the abdo- men ; and the matters rejected from the stomach and bowels are free from bile, have a faint fishy odor, or are altogether inodorous, and resemble yeast ; or they consist of a thin, colorless serum, or they bear a close resemblance to rice- water, and are familiarly known as " rice-water discharges." Sometimes they have a pink color, or the deeper hue of port Aviuc. Severe and painful cramps commence in the fingers and toes, and rapidly extend to the calves of the legs, to the thighs, and muscles of the abdomen; the eyes are sunken, and surrounded by a dark circle ; the features con- tracted and sharpened ; the expression of countenance indif- ferent and apathetic ; the face, extremities, and sometimes the whole surface of the body assumes a leaden, bluish, or purple hue ; the limbs are shrunken and contracted ; the nails blue ; the hands clammy and sodden ; the surface covered with a profuse cold sweat ; the pulse thready or impercepti- ble at the wrist, arm, axilla, temple, or neck ; and if a vein or artery is opened, the blood trickles away, thick and dark. In spite of the extreme coldness of the surface, the patient MALIGNANT OR ASIATIC CHOLERA. lS3 complains of heat, throws off the bedclothes, and suffers from great restlessness and incessant jactitation ; complains of a burning heat in the region of the stomach, and is tormented with thirst ; the respirations are below the number in health, the inspiration difficult, and the expiration short and con- vulsive ; the voice is plaintive, the patient speaking in a hoarse, sepulchral whisper ; the breath feels cold as it issues from the mouth ; the tongue is white, or of a leaden color, cold and flabby. The secretion of urine is entirely sup- pressed, or a small quantity of limpid urine is passed, and there is an earthy or cadaverous odor exhaled from the body. In this state of collapse the disease often proves fatal, the patient dying without a struggle, and retaining his faculties to the last. In other cases the patient gradually rallies, the pulse rises, the blueness of the surface disap- pears, the body resumes its warmth, the cramps and vomit- ing cease, and a rapid and complete recovery takes place. Duration. In fatal cases, from a few minutes to twenty- four hours, or more. More than half the fatal cases die within the first twenty-four hours. The average duration is about two days. Causes. Predisjjosing. — Debility ; impaired health ; in- temperance ; impure air ; impure water ; low and damp situations ; the summer and autumn seasons. Exciting. — A peculiar poison diffused through the atmosphere. There is also reason to believe that the disease spreads by conta- gion, though the contagion is not so intense as to cause anxiety among the attendants on the sick ; and by means of water polluted by cholera evacuations. Treatment. The preliminary diarrhoea requires the treatment of common diarrhoea. In the ordinary run of cases, R. 71 or R. 74 will prove serviceable, the diet being restricted to gruel or arrowroot, made with milk. In more severe cases, an opium (R. 44) or morphine (R. 45) pill may Ijc taken every one, two, or three hours, according to the severity of the case, until five or six have been taken, 134 MEDICAL AND SURGICAL COMPANION. unless relief be sooner obtained. In epidemics of Asiatic cholera, patients suffering from diarrhoea should be prompt- ly treated and carefully watched. Perfect quietude is im- portant, and the patient should not be permitted to get up to go to stool, but should be provided with a bed-pan, and he should be urged to resist, as much as possible, the desire to evacuate the bowels. He should be restricted to a small quantity of water, or brandy and water, given at short in- tervals, or to small pieces of ice. When the disease is arrested by these means before pro- ceeding to the stage of collapse, the recovery is usually speedy. Regulated diet, rest, with perhaps a tonic (R. 146), suffice for the cure. The bowels should be allowed to remain constipated for several days, and then, if move- ments do not spontaneously occur, simple warm water in- jections will probably be sufficient ; if not, a little rhubarb or castor -oil may be given. In some cases, owing to persistent vomiting and frequent purging, remedies are not retained sufficiently long to exert their effects, and then this course of treatment may fail ; and it is not available when, from any cause, the stage of collapse or prostration occurs so quickly that there is not time enough to obtain remedial effects. These difficulties are equally in the way of success from any remedies. In a large proportion of cases, after collapse has taken place, little can be done with much hope of success. Even if the vomiting and purging cease, recovery may not follow. The blood may have been damaged irremediably. Recov- ery, however, takes place in a certain proportion of cases, and under a great variety of treatment. It may take place when no treatment is pursued. The object of treatment iu this stage, aside from the arrest of vomiting and purging, is to excite and aid the efforts of nature in restoring the circulation, together with the functions dependent thereon. The measures to be employed for this object are external heat r stimulating applications to the surface, brandy or OBSTRUCTION OF THE BOWELS. 135 whiskey, and nourishment. The application of heat may be made by means of warm blankets, or bottles of hot water placed about the body. A large mustard poultice may be applied over the abdomen, and smaller ones to the extremi- ties. Brandy or whiskey and water should be given as freely as the stomach will bear, always recollecting the risk and the evils of inducing vomiting. It will be most apt to be retained if given in small quantities at a time, and often repeated. If vomiting be provoked by either drinks, rem- edies, or food, more or less injury is done. Stimulants, such as capsicum, ginger, &c, are appropriate, if they are grateful to the stomach, and retained. Concentrated nour- ishment — essence of beef, chicken broth, and milk — may be given in small quantities at a time, if retained by the stomach. It is doubtless desirable to introduce liquid into the system as far as possible. The only objection to the free drinking of water is the risk of provoking vomiting. Small lumps of ice should be freely allowed. If the patient emerge from the collapsed state, support the system by the moderate use of brandy or whiskey, and by nourishment. The patient will require close attention for some days, and any unfavorable symptoms which may arise must receive prompt attention. OBSTRUCTION OF THE BOWELS. This much to be dreaded disorder may arise from several conditions, the most common of which is, perhaps, strangu- lated hernia. It may also be caused by the reception of a portion of intestine into another portion (intussusception) ; by the twisting of a portion of intestine around another portion of intestine, &c. Symptoms. The chief symptoms are constant vomiting, which is at first simple, consisting of the contents of the stomach and mucus, but which in a few hours or days 136 MEDICAL AND SURGICAL COMPANION. becomes fecal ; pain varying in degree, often very severe ; great mental depression, and constipation. In almost all instances the prostration sets in early. The lower the ob- struction is situated the less urgent will be the vomiting. Treatment. In the management of obstinate constipa- tion, we at first resort to the use of purgatives and injections. An ounce or two of castor-oil, into which should be put thirty to forty drops of laudauum, may be taken at once ; and soon after a quart or two of warm soap-suds may be injected into the bowels. If we are convinced, however, that there is some mechanical obstruction, another plan must be pursued ; for under such circumstances, purgatives will generally do harm rather than good. Laudanum may be given in doses of thirty to forty drops, and the dose re- peated in an hour or two, if necessary to relieve pain or arrest vomiting. Hot fomentations may be applied to the abdomen. At the same time large quantities of soap-suds — one or two quarts — may be thrown into the bowels with a proper syringe. The patient must be advised to abstain as much as possible from food and liquids, being assured that the more he takes the more his sufferings will be in- creased. If the first injection does not give relief, another may be given in an hour or two. Physicians sometimes in- ject air into the intestines in these cases with good effect. When these means fail, the obstruction may sometimes be overcome by a surgical operation. WORMS. Several kinds of worms are found inhabiting the intes- tinal canal — the long thread- worm, large round-worm, small thread-worm, tape-worm, &c. The large round-worm is found in the small intestines, especially of ill-fed children. It somewhat resembles in size the common earth-worm, varies in length from six to WORMS. 137 nine inches, and is of a light yellow or cream color. Al- though the habitat of this worm is the small intestines, yet it may pass into the stomach, or downwards into the large intestine, and consequently be vomited in the one case, or passed with the stools in the other. Sometimes these worms are very numerous. An instance is recorded in which a girl voided upwards of two hundred in one week. The symptoms which this worm gives rise to are thirst, disturbed sleep, with grinding of the teeth, pallid countenance, fetid breath, swelled abdomen, emaciated extremities, depraved appetite, slimy stools, itching of the nose and anus, and frequent desire to go to stool. The small thread-worm, or " pin-worm," is found in the rectum or lower bowel, and is the smallest of the intestinal worms, averaging only about a quarter of an inch in length. It gives rise to intolerable itching and irritation about the anus, desire to go to stool, depraved appetite, picking of the nose, fetid breath, and disturbed sleep. The common tape-worm exists in the small intestines, and varies in length from five to ten or more feet, and in breadth from one line, at its narrowest part, to four or five at its central or broadest part. The head of this parasite is small aud flattened, having in its centre a projecting papilla, armed with a double circle of hooks, around which are four suckers or mouths, by which nourishment is im- bibed. The symptoms of its presence are not very striking, its existence being generally unsuspected until single joints arc passed in the stools ; in many cases, however, there is a continual craving for food, debility, pain in the stomach, emaciation, and itching about the nose and anus. The most conclusive sign of intestinal worms, of whatever kind, is the passage of some of them, or joints of them, in the feces ; aud iudeed without this the other symptoms are of but little value. Treatment. For the common round-worm, give R. 34 or 11. .'I"). For tape-worm, R. 36. For the small thread-worm 138 MEDICAL AND SURGICAL COMPANION. or " pin- worm," iojections of salt-water (R. 37), or a solu- tion of aloes (R. 38), generally prove effectual. After worms have been removed, some tonic (R. 63 or R. 146) may prove beneficial in preventing their re-appear- ance. Patients should also be directed to take plenty of salt with their food, and to have the latter well cooked. INFLAMMATION OF THE LIVER. 139 CHAPTER VIII. DISEASES OF THE UVER AND SPLEEN. INFLAMMATION OF THE LIVER. Inflammation of the liver may be acute or chronic ; both forms are rare in this climate, but common in tropical countries. Causes. All the common causes of inflammation ; bil- iary concretions ; the violent operation of emetics ; external injury; intense heat ; hot climates ; intemperance, &c. Symptoms. The symptoms of acute inflammation of the liver are, high fever, hot skin, thirst, and scanty urine, the fever sometimes assuming a typhoid character ; pain, more or less severe, in the region of the liver, increased on pres- sure, deep inspiration, or cough ; inability to lie on the Jeft side ; a yellow tinge of the eye, and often complete jaundice ; hurried breathing ; sympathetic cough, and vom- iting, and hiccup. In affections of the liver, the right col- lar-bone and shoulder become the seats of gnawing and aching sympathetic pains. Terminations. The most favorable termination of acute inflammation of the liver is resolution. When this happens, the paiu and fever gradually abate, and the patient is soon well. The inflammation may, however, go on to diffused Suppuration, or to the formation of circumscribed abscesses, or even to gangrene. Abscesses of the liver sometimes attain a great size, and in extreme cases may contain several pints of pus or 140 MEDICAL AND SURGICAL COMPANION. matter. They may burst internally, and give rise to fatal inflammation. Most frequently, however, when the matter gets near the surface of the gland, adhesive inflammation is set up in the structures immediately above it, and lymph is poured out, which glues the organ to adjacent parts — to the abdominal parietes, the diaphragm, stomach, or some part of the intestines ; the pus is then discharged ex- ternally, or into the lung, or pleura, or stomach, &c. Treatment. If the bowels are constipated, give a dose of Epsom salts to move them. Mustard poultices, followed by hot fomentations over the region of the liver, prove ben- eficial. If the pain is very severe, six to twelve leeches, applied over the seat of pain, may prove serviceable. Lau- danum, or some preparation of opium, is indicated to re- lieve pain. Dover's powder, in ten or twelve grain doses, will prove as beneficial as any form. The diet should consist of gruel, milk, and light broths. In all cases active treatment is not advisable ; but it is especially so when we infer that the formation of matter or suppuration has taken place . Nourishing food, as milk, beef tea, or essence of beef, will then be required. Tonics, such as quinine (R. 146), or quinine and iron (R. 63), or the nitro-muriatic acid (R. 148), will also be necessary. The bowels may be reg- ulated by Rochelle powders, or the compouud rhubarb pills (R. 149). "Warm water injections occasionally prove ser- viceable. When an abscess has formed, and we are sure that its surface is adherent to the abdominal wall, we may — after making an exploratory puncture with a grooved needle — open it with a lancet, or may puncture it with a trocar ; but great judgment and caution must be exercised. None but a surgeon should attempt to open it. Chronic inflammation of the liver may be the se- quel of acute, or it may arise from diseases of the liver, such as cancer, tubercles, &c. Causes. Intemperance, and the repeated use of alcoholic CANCER OF THE LIVER. 141 liquors, are frequent causes of this disease ; this is more especially the case iu hot climates. Symptoms. Fulness and weight in the region of the liver ; shooting pains felt at times in the same region ; un- easiness or pain on pressure ; discomfort from lying on the left side ; perhaps some degree of jaundice ; and sometimes a certain amount of fever, combining itself with more or fewer of these symptoms. Treatment. A three-grain blue pill may be given on retiring, two or three times a week, for two or three weeks ; and on the following morning a Rochelle powder, or a small dose of Epsom salts, may be taken. The iodine paint (R. 86) may be applied over the region of the liver, once a day, for a week or two, with benefit. After these measures have been used for two or three weeks, they may be omitted, and the following mixture taken for a time : — Take of Diluted Nitro-muriatic Acid, . £ ounce. Pure Water, . . . .1 ounce. Fluid Extract of Dandelion, . 1£ ounces. Simple Syrup, . . .1 ounce. Mix. Shake before using. An adult may take a tea- spoonful in a wineglass of water three times a day, before meals. Persons troubled with any disease of the liver should con- sult some regular and reliable physician, as soon as con- venient. CANCER OF THE LIVER. Nearly every variety of cancer has been met with in the liver ; encephaloid, or soft cancer, is more common than the scifrhus, or hard kind. SYMPTOMS. When a liver contains numerous masses of cancer, it is generally much enlarged. These masses do 142 MEDICAL AND SURGICAL COMPANION. not give rise to inflammation of the substance of the liver ; but when superficial, they often cause some inflammation of the adhesive kind, so that after death the tumors are found adherent to the diaphragm or to the abdominal walls. The remaining symptoms are very obscure ; constant diffused pain and tenderness, with disorder of the digestive organs, being generally the most prominent. Treatment. Our remedies can do little more than pal- liate urgent symptoms. Relief to the pain must be given by opium in some form, while the digestive organs should be strengthened by tonics, and by a light nourishing diet. JAUNDICE. {Icterus.) This is rather a sign of some affection of the liver than a separate disease. Causes. It may be produced in two ways: 1st. By some impediment to the flow of bile into the intestine, and the consequent absorption of the retained bile ; and, 2d. By defective secretion on the part of the liver, so that the principles of the bile are not separated from the blood. The most common impediment to the flow of bile into the intes- tine is the impaction of a gallstone in the duct which conveys it. Gallstones consist of inspissated bile. Large numbers are sometimes found in the gall bladder. Sedentary occupa- tions and free living tend to their formation. When the obstructing stone has passed into the intestine, it is voided with the feces, and the cause of the jaundice being re- moved, the skin gradually assumes its natural color. The other causes of jaundice from obstructed gall ducts are, can- cer of the liver or pancreas, closure of the ducts from ad- hesive inflammation of the liver ; by mental shocks, or grief, or dissipation ; by certain poisons in the blood, and by certain disorders of the stomach. Stmptoms. The skin and white portion of the eyes are OTHER ORGANIC DISEASES OF THE LIVER. 143 of a yellow color ; the urine has the tint of saffron ; and the feces are whitish, or of a light clay appearance. If the disease continue long, there may be stupor, delirium, and other indications of cerebral derangement ; the patient also becomes weak and thin from mal-nutrition ; and frequently there appears to be a tendency to hemorrhage, as bleeding from the nose, gums, &c. When there is obstruction from a gallstone, the most acute suffering is induced ; the pains beiug paroxysmal, and often attended with vomiting and hiccup. Should the concretion not pass through the duct, fatal exhaustion may set in. Treatment. The selection of remedies must, of course, be guided by the cause. When the jaundice is due to some obstruction, hot poultices, or mustard poultices, warm baths, a purgative of Epsom salts, and low diet will be called for ; while, during the passage of a gallstone, full doses of laudanum — thirty-five to fifty drops — will be necessary, either alone or combined with draughts of hot water, to every gill of which a teaspoonful of bicarbonate of soda or saleratus may be added. On the other hand, the disease being due to suppressed secretion, we may cautiously make use of the treatment recommended for chronic inflammation of the liver. The patient should observe a light but nour- ishing diet, take frequent baths, and avoid over-work and excessive exercise. OTHER ORGANIC DISEASES OF THE LIVER. The liver is subject to several organic diseases besides those already described — to enlargement, diminution of size, hardening, softening ; to fatty degeneration, cirrhosis, tubercular deposit, and to all forms of malignant degen- eration. Fatty degeneration op the liver is of very common occurrence in pulmonary consumption, and is commonly 144 MEDICAL AND SURGICAL COMPANION. met with in conjunction with fatty degeneration of the kid- ney and other internal organs, in drunkards. It is gener- ally, but not always, accompanied by a great increase in size, and when once developed, does not admit of cure. Cirrhosis, or hob-nail liver, sometimes called gin or whis- key liver, is not a very uncommon disease ; and in the vast majority of cases is supposed to be due to spirit-drinking. It is usually marked by the peculiar granular state of the sur- face, the diminished bulk of the organ, and the co-existence of abdominal dropsy. Malignant degenerations are very apt to occur in the liver. They assume the several forms of hard and soft caucer, &c, and, like malignant degenerations of other im- portant viscera, are necessarily fatal. They generally oc- casion a great increase in the size of the organ, and are accompanied by obstinate jaundice, and in many cases chronic dropsy. The treatment of all these organic diseases of the liver is palliative, and varies with the symptoms and the existing state of the system. DISEASES OF THE SPLEEN. The spleen, which is situated in the left side, at the end of the stomach, may be the seat of inflammation, acute or chronic, as well as of simple enlargement, the result of con- gestion. But as the symptoms of inflammation of the spleen are admitted to be very obscure, it will suffice to treat the diseases of this organ under the single head of ENLARGEMENT OF THE SPLEEN. Causes. Previous attacks of intermittent or fever and ague ; morbid degeneration, especially the deposit of tuber- cles ; morbid softening, Injection of Salt Water. Take of Common Fine Salt, 1 ounce. Warm Water, 1 quart. Mix. One half or even the whole may be injected into the bowel of an adult, and retained fifteen minutes, if possible. It should be repeated once or twice a day, for a week or two. When used for children, let the quantity be in proportion to age. If the general health is below the proper standard, it should be improved by tonics, and other appropriate measures. No. 38. Injection of Aloes. Take of Powdered Aloes, \ ounce. Water, 1 quart. Mix. Use in the same way as the preceding. 10. STIMULANTS. No. 39. Stimulants Are medicines which increase and sustain the action of the heart. They are often useful in diseases characterized by great prostration, RECIPES. PRESCRIPTIONS. MEDICINES. 339 and in convalescence from fevers, &c. Brandy, whiskey, wine, &c, are stimulants, and may be used in appropriate cases, in proper quantities, three to six times a day. The dose of brandy or whiskey should not, as a general rule, exceed one to two tablespoonfuls. If wine be used, about two ounces may be given. Alcoholic stimulants should not be continued longer than they are required as medicines, for the daily use of spirituous liquors, by persons in health, is very injurious, and tends to under- mine the constitution, and bring on serious and even fatal diseases of the brain, liver, and kidneys. No. 40. Wine Whey. Take of good milk, one half pint; heat to the boiling point; then add of sherry wine, one gill ; strain, and add of white sugar one ounce, and a little nutmeg. There are few mild stimulants more employed or more useful than wine whey. The dose must be regulated by the circumstances of the case. From one gill to a pint may be taken during the day. No. 41. Egg -Nog. Take of the White and Yolk of . . . .4 eggs. White Sugar, 1 ounce. Beat well together, then add, Sherry Wine, 2 ounces. Water, 4 ounces. Grated nutmeg to taste. The above is sufficient for about four doses. Stimulant and nu- tritious. No. 42. Millc Punch. Take of Good Brandy, 1 gill. Fresh Milk, \ pint. White Sugar 1 ounce. A little grated nutmeg. Mix. A tablespoonful or more may be taken every hour or two in low fevers, and other diseases characterized by great prostration. No. 43. Mixture of Carbonate of Ammonia. Take of Carbonate of Ammonia 2 drachms. White Sugar, 3 drachms. Powdered Gum Arabic, .... 3 drachms. Spearmint Water, \ pint. Mix. Give a tablespoonful every two hours. 340 MEDICAL AND SURGICAL COMPANION. . As carbonate of ammonia sustains the action of the heart, with- out stimulating the brain, it may be resorted to whenever the vital powers begin to fail, in diseases of nearly every type. 11. NARCOTICS. Narcotics are medicines which are used to procure sleep, allay pain or spasm, arrest inordinate secretion, and control inflammatory action or irritation. No. 44. Pills of Opium. Take of Powdered Opium, 12 grains. Powdered Castile Soap, .... 3 grains. Mix, and form into twelve pills. One is the ordinary dose for an adult to produce sleep, allay pain, &c. No. 45. Pills of Sulphate of Morphia. Take of Sulphate of Morphia, .... 2 grains. Confection of B-ose, . . . .24 grains. Mix, and divide into 12 pills. One may be taken for a dose to allay pain, procure sleep, or check vomiting. If relief is not obtained in one hour, give the second pill. Except in severe cases, they should not be repeated oftener than every three to six hours. They should never be taken unless actually required. No. 46. Pills of Camphor and Opium. Take of Powdered Camphor, .... 2 scruples. Extract of Opium, .... 8 grains. Add of mucilage of Tragacanth, a sufficient quantity to form a pill mass. Divide into sixteen pills. Take two pills every night at bedtime. Used for spasm of the urethra, and to prevent nocturnal erections, or chordee. No. 47. Dover's Powder. The ordinary dose for an adult is ten grains, to promote sleep, allay pain, &c. It may be mixed with molasses or sugar and water. No. 48. Pills of Camphor, Assafoztida,