Pass yCZl Book Mi '~ . r- C0TCRIG I rr DEPOSIT. / CU^y %Z$y Ww^ JUzx^ ^/foAM*" NEW WAEREN'S HOUSEHOLD PHYSICIAN, ENLARGED AND REVISED, BEING A BRIEF DESCRIPTION, IN PLAIN LANGUAGE, OF ALL THE Diseases of Men, Women and Children, WITH THE LATEST AND MOST APPROVED METHODS OF TREATMENT. ALLOPATHIC DEPARTMENT / BY LEA WARREN, A.M., M.D., Fellow of the Massachusetts Medical Society, etc. REVISED BT WILLIAM THOENDIKE, M.D., Fellow of Massachusetts Medical Society, and Member of Boston Society for the Improve- ment of Medicine, etc., and others. HOMOEOPATHIC DEPARTMENT BT A. E. SMALL, A.M., M.D., President of the Hahnemann Medical College, Chicago, 111. REVISED BY J. HEBEE SMITH, M.D., Professor of Materia Medica, Boston University School of Medicine, and late President of Mas- sachusetts Homoeopathic Society. And many others on special subjects. FULLY ILLUSTRATED. By 86 Figures on 16 Splendid Colored Lithograph Plates, 262 Engravings, and Two Full-Page Manikins. This book is published strictly as a Subscription Book, and to be sold only as such. A ny person or persons infringing tip on these rights ivillbe held liable. THE RIGHT OF TRANSLATION IS RESERVED. BOSTON: A. I. BEADLEY & COMPANY, 234 AND 236 CONGRESS STREET, 1898. j^ V^fik *i VED •^\\ ^ 3573 Entered according to Act of Congress, in the year 1859, by IRA WARREN, In the Clerk's Office of the District Court of the District of Mass. Entered according to Act of Congress, in the year 1863, by IRA WARREN, In the Clerk's Office of theDistrictCourt of the District of Mass. Entered according to Act of Congress, in the year 1870, by CHARLES ROBINSON, Jr., In the Office of the Librarian of Congress, at Washington. Entered according to Act of Congress, in the year 1885, by CHARLES ROBINSON, Jr., In the Office of the Librarian of Congress, at Washington. Entered according to Act of Congress, in the year 1889, by CHARLES ROBINSON, Jr.. In the Office of the Librarian of Congress, at Washington. Entered according to Act of Congress, in the year 1897, by GEO. A. BLANEY, Admstr. Estate of Ira Warren, In the Office of the Librarian of Congress, at Washington. RIGHT OF TRANSLATION IS RESERVED. This work is published strictly as a Subscription Book, and to be sold only as such. Any person or persons in- fringing upon these rights will be held liable. Plimpton Jpress PLIMPTON & CO., PRINTERS & BINDERS, NORWOOD, MASS., U S.A. PREFACE. This book is written for the people. It is based on the assump- tion that every man — the mechanic, the farmer, and the day laborer, as well as the professional man — has a right to all the knowledge he is capable of acquiring, on all subjects, — medicine not excepted. The book aims, therefore, to popularize and adapt to the many what has been claimed as belonging only to the few. I do not hesitate to avow that my sympathies, as a man, are with the great masses, who may be called the bone and muscle of the race. They are, in the main, more shrewd, more endowed with common sense, more simple and true in their natural instincts, and conse- quently less perverted, than those who claim more refinement and a higher place in the social scale. " All men," says Hippocrates, one of the great fathers of medicine, " ought to be acquainted with the medical art. I believe that knowl- edge of medicine is the sister and companion of wisdom." Such knowledge would shield the many from the impositions of quackery. No one, I venture to say, who reads this book thoroughly, will be often imposed upon thereafter by quack nostrums, or quack doctors. Every man's physical organization is his own ; and he is charged with the responsibility of taking care of it. To do this properly, he needs knowledge of it ; and to withhold this from him is another form of the old oppression, which decreed knowledge and power to the few, and ignorance and obedience to the many. In accordance with the design of the work, it has been written in plain, simple English, and brought within the comprehension of all who have medium powers of mind. In preparing this book, a great number of authors have been care- fully consulted, to whom I acknowledge large indebtedness ; yet the work is not a mere compilation. In dealing with each disease, I have aimed to sketch a brief pen-and-ink portrait, so like it that every reader shall know the original whenever he sees it ° 3 and then to give, in the fewest words, the best treatment. ■ No work of the sort has ever explained the reasons, or given the whys and wherefores of medicine to anything like the extent of this ; nor has any one been so extensively illustrated. The engravings have been, with few exceptions, done expressly for this work. The colored lithographs and manikins are inserted at great expense, and add much to the value of the book. I. W. SECOND PREFACE. The Household Physician was written in the belief that the people were ready and waiting for a popular medical work based on liberal principles ; and that one hundred and forty thousand copies have already been sold is a sufficient evidence that the belief was well-founded — many persons assuring the publishers that fifty or one hundred dollars would be no tempta- tion for them to part with the copy they have if they could not obtain another. Such an extensive sale of so large a book, with the demand constantly increasing, shows its value. For these evidences of public favor the Publishers are not ungrateful or unmindful of corresponding duties on their part. A chapter is now added, therefore, on "Old Age and its Diseases," — a subject never before intro- duced into any popular treatise on medicine, and very rarely, indeed, into any medical book. Great pains have been taken in preparing it, and we sincerely hope that many fathers and mothers will, in future years, be kindly remembered in consequence of the suggestions it contains. Also a chapter on new popular Gymnastics, illustrated with many cuts. The Publishers. THIRD PREFACE. The Household Physician, now so well known throughout the English and German-speaking world, again appears before the public, printed from entirely new plates, revised and improved in accordance with the progress of medical science of the present day. Old, obsolete matter has been discarded, and only those methods and remedies of olden times have been preserved to which, though numerous, recent discoveries have found nothing superior. Much new information has been added, including articles on Russian and Turkish baths at home, Drowning, and on Diseases of the Nervous System peculiar to modern times. The illustrations have been supple- mented by fine colored plates and manikins showing the arrangement of the various organs of the body, the muscles, arteries, veins, and nerves. New colored plates of medicinal herbs have also been added, thus giving a dis- tinct idea, not only of the pathological seat of many maladies, but of many of the sources from whence are derived their specific remedies. The prescription list has been most carefully revised, and the old heroic doses of opium in its various forms have been superseded by milder nar- cotics and sedatives. Mercury no longer shows its hideous features on these pages, except as it is to be given in syphilitic affections. The work now fairly competes in rich information with any newer system of popular medicine, and may be relied on, as ever before, for accuracy, best advice, and the most modern medical customs. The Publishers. TABLE OF CONTENTS. Page Preface % ....... . 3 General Introductory Remarks ........ 5 Anatomy 14 Physiological Laws of Life and Health — Hygiene .... 54 Temperaments, Constitution and Symptoms . . . . . 122 Skin Diseases ............ 134 Diseases of the Brain and Nerves ....... 164 Diseases of the Throat . 208 Diseases of the Chest 229 Heart Diseases ........... 274 Diseases of the Abdominal Cavity ....... 291 Venereal or Sexual Diseases 360 Female Diseases 379 Married Ladies' Perpetual Calendar ....... 443 Care of Children and their Diseases ....... 445 Diseases of the General System and Miscellaneous Diseases . . 469 Diseases Peculiar to Modern Times ...... \ . 493 Old Age and its Diseases ......... 496 Accidents 509 Surgical Diseases .......... 517 Homoeopathic Treatment of Diseases 608 A Treatise by A. E. Small, M.D. . . . . . . 608 Diseases of the Head . . . ...... 613 Diseases of the Brain and Nerves . . . • .' . 615 Diseases of the Eye and Lids 622 Diseases of the Ear . 625 Disorders of the Nose 62^ Diseases of the Respiratory Organs 628 Diseases of the Urinary Organs . 634 Diseases of the Organs of Generation . . . . . 638 Diseases of the Skin 642 Diseases of the,Organs of Circulation 651 Diseases involving the Various Organs ..... 653 Diseases of Various Organs and Regions . . . . . 665 Dropsies, Hydropsies 684 Insidious Diseases QS6 TABLE OF CONTENTS. Homoeopathic Treatment (continued). Paoe Miscellaneous Diseases 690 Affections of the Mind 692 Surgical Diseases 700 Diseases of Infants 706 Diseases of Women 713 Labor, Parturition 716 Specific Indications for Remedies in Fevers .... 720 Poisons and their Antidotes 726 Processes of the Hydropathic Treatment 732 Domestic Management of the Sick-Room 756 Cookery for the Sick-Room ......... 789 Dieting in regard to Health . 798 Dieting in Disease .......... 801 Bathing 803 Proofs of Death 807 Medicines and their Preparations — Materia Medica .... 808 Prescriptions — Recipes 920 Proprietary and Patent Medicines 944 Physical Culture — Gymnastics 950 Pronouncing Dictionary 961 General Index ........... 965 Index to Homoeopathic Department 982 LIST OF COLORED AND FULL-PAGE PLATES. Portrait of Dr Plate I. u II. u III. u IV. a v. a VI. u VII. u VIII. u IX. a X. it XI. u XII. « XIII. tt XIV. tt XV. tt XVI. tt XVII. tt XVIII. u XIX. . Ira Warren . Sectional Manikin of Human Head The Human Skeleton . Muscles of the Human Body Arteries and Veins of the Human Body Fig. 1, Measles ; Fig. 2, Scarlet Fever Small-Pox Erysipelas Sectional Manikin of Human Trunk Internal Organs of Human Body . Syphilitic Eruptions Syphilitic Affections of Throat Medicinal Plants (Aloes, etc.) " " (Bittersweet, etc.) " " (Dandelion, etc.) " " (Ground Ivy, etc.) " " (Hemlock, etc.) " " (Mullein, ete.) " " (Plantain, etc.) " " (Thorough wort, etc.) Frontispiece. Facing Preface. . . p. 19 Facing p. 27 37 136 140 142 164 291 362 368 814 820 836 840 844 856 864 882 Copyright, by Bradley & Woodruff, 1S92. GENERAL INTRODUCTORY REMARKS. Progress of Medicine. Medicine may be divided into a science and an art. It is a science as it presents facts and evolves principles ; an art as it consists of rules for practice. For its present attainments, it is indebted partly to researches scientifically conducted, and partly to empirical and haphazard discovery. As a science, medicine is chiefly indebted, and must ever be, to the members of what is called the " regular profession." This body of men, while it contains numerous persons whose talents and attain- ments do not raise them above the merest quacks, does yet embrace large numbers of men who are alike ornaments of the race, and lights of their profession. It is to the writings of this class that every stu- dent must go who would qualify himself for the proper discharge of the duties of a physician ; and he who attempts the practice of medi- cine without a knowledge of standard medical writings is either a fool or a knave — either without the brains to understand science, or destitute of the honesty to deal fairly with men. While this is said, however, it must be granted that a respectable portion of the facts which make up the science of medicine have been contributed by the industry of men who have not had what is called a regular standing in the profession. I am sorry to be obliged to add that the great body of this class have been quacks and charlatans, while only a few of them have had talents and acquirements. Nevertheless, they have been too indiscriminately condemned. Their labors have been useful in various ways, and have contributed to the advancement of medical knowledge. A regard for truth, not less than justice to these persons, requires this statement. One=Idea Men The " irregulars," as they have been called, have generally had their hobbies, which they have ridden with singular diligence, and often in little better than John Gilpin plight. Yet they have drawn attention to great truths, which the regular profession either did not see, or would not commend ; and they have done this by dwelling incessantly upon some single idea. The one-idea men, of every class, have been ridiculed in all ages ; and indeed have always exhibited some singular obliquities. Yet when they have been men of learning and talents, they have accom- plished great things, either for good or evil. b GENERAL INTRODUCTORY REMARKS. Martin Luther was strictly a one-idea man. The whole force of his extraordinary character was given to the propagation of the single doctrine of justification by faith ; and by the incessant efforts he made for this purpose, he sank the doctrine deeper into the heart of Europe than a hundred equally powerful men could have done by giving it only an ordinary share of attention. William Ellery Channing was a one-ideaist. Man, the noblest work of creation, to be developed, educated, adorned, loved, made like unto God, was the thought of his life, — a thought which he em- bellished and moulded into all the forms of beauty which our flexible language is capable of producing. Under the mild promptings of his genius, and the workings of this thought, philanthropy, quick- ened into a new life, spread out her arms, and embraced the world. Sir Isaac Newton was a one-ideaist. So entirely did he devote his great powers to astronomy and the higher mathematics, that he be- came unfitted for the duties of social and domestic life — so unfitted, that when induced by his friends to give a little attention to courtship, he fell into one of his abstractions, and detected himself in using his lady-love's fore-finger to poke down the ashes in his pipe ! But Sir Isaac advanced mathematical science to a point far beyond its previ- ous attainments, and laid it under such obligations as no general scholar could have done. It is in this way, though in a vastly less degree, and without the scientific method, that one-ideaists in medicine benefit the world. They seize upon some single remedy, — generally one which has been overlooked — and using it themselves to the exclusion of all others, they press it upon the world as the panacea for all its ills. With them disease is a unit, and they have found its one all-important remedy. Thus convinced, they press it upon others with the enthu- siasm of fanatics. Testing it in all cases, they develop all its virtues. Those who have the good sense to turn their attention to it have only to use it in those cases for which its adaptation is proved. It is in this way that these men become, incidentally, medical dis- coverers ; and not being burdened with modesty, they never with- hold their importunities till the world acknowledges whatever value there is in their discovery. And although they may do some mis- chief with the single-edged tool which they handle so industriously, I doubt if they do much more than many better workmen who use too many. At all events, wise and generous men thank them for their gift to the profession, small though it may be, and use it in the light of a clearer knowledge. Hydropathy. — As an illustration of what I have just been saying, I may refer to hydropathy, or the plan of treating all diseases by water. The singularly careful avoidance, by the whole medical faculty, for many ages, of the article of pure water as a medicinal, or, rather, health-imparting agent, was anything but creditable to the profession. It is now admitted by all sensible men that water, cold and warm. GENERAL INTRODUCTORY REMARKS. 7 used at proper times and to a reasonable extent, has great power over several diseases, and is a powerful promoter of health. No physicians, except those who are too indolent to know what is going on in the world, or too fast locked in old prejudices to. touch new things, now omit its use in many cases. How warm and, sincere my own approval of water as a remedy is, almost every page of this volume will attest. Indeed, it may honestly he allowed that the hydropathists have fairly drowned the almost criminal professional prejudice against water. They are in all the more need of this concession, since in their absurd zeal to cure all diseases by water, and make aquatic an- imals of men, they have also drowned their own common-sense. Homoeopathy. — This mode of practice is of comparatively recent origin ; but it has already sunk itself deep into the popular heart, and has drawn to its support many of the wealthy, the cultivated, and the intelligent, in our most refined communities. I do not pro- fess to comprehend and appreciate its principles, nor would it be honest in me to pretend to see how its infinitesimal doses can pro- duce the results which it often shows, and which it is fair to confess look like singular success ; and saying this, I can neither adopt nor approve the violent denunciations and censures which so many are induced (by fashion, I fear) to employ towards this generally well- cultivated class of practitioners. I hold them as useful members of the profession, and mean ever to cultivate towards them fraternal feelings. They give great attention to exercise, diet, the use of water, etc., — things which contribute very powerfully to preserve health, and to restore it when lost. In this thing, the old-school practitioners ought to learn a most important lesson from them. In truth, they are learning it, but very slowly and reluctantly, I am sorry to say. The central idea of the homoeopathist, that " like cures like," the "great law of cure," as he styles it, I do not feel called upon to dis- cuss — theories being of much less consequence than rules of prac- tice. The old-school men have certainly much to learn from him respecting the augmented power of medicine from the greatest possi- ble division by trituration. We have learned from him, too, — though many are too ungenerous to confess the source of the infor- mation, — that we may gain our purposes with much less medicine than we were once in the habit of giving. Eclectics. — There is a large and growing class of physicians, called, at first, after the founder of the school, Thomsonians. Subsequently, they were generally known as Botanic Physicians. Now they pass under the title of Eclectics. These men, directing their attention, at first, chiefly to cayenne and lobelia, have gradually extended their zealous researches over the vegetable kingdom, and have gathered much information worthy to be preserved. These researches have revealed a sadly neglected duty on the part of old-school practitioners. (S GENERAL INTRODUCTORY REMARKS. The education and talents of this class of practitioners have grad- ually risen, year by year, until they have several medical schools, where students are well instructed in the principles of medicine, by men of real ability. They have also a literature of no mean signi- ficance, especially in the department of materia medica. The list of remedies the) r have given to the world, drawn from our home plants, are a boon of no small value. I regard them as equal in value to all we were previously in possession of from the vegetable kingdom. The substitution of vegetable remedies, in most cases, for mercurials, can hardly be too highly prized. Physiologists. — Besides these various direct practitioners of medi- cine, there is the large and quite intelligent class of physiologists, including the phrenologists, who nearly discard medicine, and ap- pealing to the laws of life established by the Creator, urge temper- ance in eating and drinking ; exercise in the open air ; securing of pure air by ventilating dwellings, school-houses, and churches ; bath- ing in cold and warm water; cheerfulness of mind ; and the cultiva- tion of the Christian virtues, as the only rational modes of securing health and life. I confess myself inclined to forgive this class their error in ban- ishing medicine, in view of their zeal and success in disseminating hygienic information of the utmost value and importance to man- kind. Put man into harmony with nature, and establish over him the empire of reason, and their theory would be excellent; but as things are, medicines, like prisons, and alms-houses, and large cities, are " necessary evils." Other Practitioners. — Finally, we have Mesmerists, Pathetists, Electro-biologists, Spiritualists, Nutritivists, and what not, all pre- tending to cure disease by processes peculiar to themselves. They are all experimenters in different departments of nature, — now spreading over our eyes a large plaster of humbuggery, and now drawing a small curtain and giving .us a peep into the large and well-furnished rooms which nature has fitted up for our reception, by and by, when we are better instructed. All Useful in a Degree. — On the whole, I am disposed to regard all the operators in the different departments of medicine as useful in their degree ; excepting always those mercenary quacks, who lie about their remedies to make money. Each of all these (I mean all sincere and true men who believe what they teach) is aiding in some measure the general advancement. And though the truths, as they gather and present them, are but fragmentary, they are useful in the hands of those true Eclectics, who have the wisdom and independence to select the best things out of all systems. General Conclusion. — This brings me to remark that there is but one truly liberal and philosophical school of medicine. It is the Ec- lectic, — composed of those who have liberality enough to reject GENERAL INTRODUCTORY REMARKS. 9 every exclusive system, and to select out of all systems those things which are approved by experience and reason. I have already spoken of the school of practitioners called Eclectic. To a certain extent they are entitled to the name, but I think not entirely. They have formed a separate and exclusive school. They have turned some articles out of the materia medica possibly for no better reason than because their party is committed to their rejec- tion ; whereas they should have no party, but allow each man to act as if he were a citizen of the world only, and not a member of any restricted association. But I will not quarrel with them on this point. I think they are becoming eclectic. Progress of Medicine. — There have been long periods when the science and the art of medicine made scarcely any progress. They are now advancing, — in some departments quite rapidly. The Chemistry of Man, commonly called Animal Chemistry, is opening new sources of light. The writer was in the habit of asserting, many years ago, that most of the true progress in medicine must come through Animal Chemistry ; and the developments of the last few years have made good the assertion. Liebig, a diligent student in chemistry, has done much to open the way for inquirers in this department. Simon has, perhaps, done more. Mialhe is a yet later explorer, and has made valuable discoveries. The result is that students have now before their minds, and are endeavoring to solve and act upon as fast as possible, inquiries and propositions like these : — What is the chemical composition of the solids and fluids of the healthy human body ? What is the nature of the changes which occur in the composition of the solids and fluids during disease? What alterations in the chemical composition of the solids and fluids take place during the operation of , medicines ? Before it can exert any remote action on the animal economy, a remedy must be absorbed. Before it can be absorbed, it must be soluble in the fluids of the living body. Medicines are subject to chemical changes during their passage through the system. These changes are regulated by ordinary chemical laws, and may therefore, to some extent, be foretold and made available in the cure of disease. These chemical laws are disturbed and varied, to some extent, by the law of vitality, — just as the magnetic needle is made to vary by disturbing forces. What are those disturbances, and to what extent, and under what circumstances, do they occur ? With these and similar inquiries and propositions before his mind. 10 CENERAL INTRODUCTORY REMARKS. diligently studied, a man will in time learn to prescribe with some intelligent aim. Me will not know everything, to be sure, but what he does know, he will have a reason for knowing. If he give 1 a medicine, he will have in view the chemical changes of the solids and fluids of the body, known to be produced by the disease he is combating. He will also keep in mind the solution of the medicine in the fluids of the body, and the chemical reaction between its com- ponents and the acids, alkalies, etc., found in the alimentary tube and elsewhere. As the science of medicine advances, and becomes liberal and ec- lectic in its character, gathering from all systems the best attested facts, and using them to the exclusion of all mere theories, these facts must not themselves degenerate into mere petted theories, but must be held in subordination to future experience. Medical prac- titioners, who would meet the wants of the age, must be men of progress. The light of to-morrow, with them, must modify and im- prove the light of to-day. They must knock every hour for admis- sion into some new apartment of nature. Need of Liberality. — That medical progress may be real, physi- cians must be free from bigotry. They must have no narrow preju- dices against any man, or class of men ; but be ready to examine candidly an}- new thought or new remedy brought to their notice, from whatever source it may come. They should not hedge themselves about with such restrictive by- laws and societary rules as are calculated to fetter their thoughts, and turn their investigations, b}~ a sort of moral necessity, into the narrow channels of party conservatism; remembering that he who is once enclosed by such restrictions must hew a path for lus feet through bigotry, and even malevolence itself, before he can escape them, or be a free man in any noble sense. The members of medical societies do themselves no credit, in the nineteenth century, by putting on airs, and telling others to stand at a distance. This would do better, had medicine become an exact science ; but while the primary effects of even opium are not settled — some physicians considering it as primarily stimulant, others as sedative, others as stimulant to the nerves and sedative to the muscles, others as neither, and still others as alterative, — such ex- clusiveness seems neither wise nor modest. When the professors of the healing art can hoard medical knowledge as misers hoard gold, and can submit its purity to equally certain tests, it will appear in better taste for them to grow exclusive. Until then, the most be- coming badge they can wear is the Christian direction : " Let each esteem others better than himself/' Medical societies, with liberal by-laws, are fitted to do good ; but it would be hard to show that those with stringently restrictive rules can operate otherwise than as checks upon progress. In truth, they are apt to become mere catacombs in which to embalm dead ideas. GENERAL INTRODUCTORY REMARKS. 11 They are very liable to be made the instruments for accomplishing the ambitious purposes of a few leading men. They tend to suppress all sympathy with everything outside their organization ; and they beget a feeling like that which would forbid the fixed stars to drop their light into our atmosphere without first coming down and joining the solar system. Conservative Leaders. — There are no influences which hold so steady a check upon medical progress as the conservative leaders in many of our medical associations. Not that they are opposed to im- provement in the medical art, or would object to any amount of dis- covery, if it could come to the profession through channels which they have the honor of opening. But against all light from outside, or from obscure sources, they will draw down the curtains, and close the doors ; and, if it chance by any means, in spite of them, to get within the sacred enclosure, they will call it darkness, and, as priests of the temple, will attempt to atone for the indignity offered to the god of medicine, and fill the whole sky with murky clouds from their altars. These men have strong faith in caste, and in the right of the few to govern the many. In the low places of society, they look for nothing but ignorance and poverty. Notwithstanding that the light of every natural day breaks in the horizon, and ascends, they so far despise analogies as to insist that all medical light breaks at what they call the zenith of the profession, and comes down. With them the temples of Esculapius are all rebuilt, and they are the priests ; and to offer in sacrifice the smallest medicinal plant is a sacrilege, unless it be entrusted to their hands. Such persons measure and weigh a man by the amount of money he has. Property is their god, which gives laws to everything. With them, knowledge, like property, goes to posterity by will, — they being the principal testators. Like their money, too, it goes chiefly to their sons, and to certain favored institutions, by whom and in which it is to be hoarded, and whence it is to go out only in certain approved channels, weighed and stamped, like coin from the mint. These are the men who regard knowledge as a contraband article, unless regularly entered at the custom-house, with bills of lading properly certified by the conservative magnates at some other me- tropolis. With them, knowledge is not like the west wind, fanning the brow of the peasant as gently as that of the king — not like the light of heaven, entering the small, clean window of the hut, as readily as the larger one of the palace ; not a boon which comes alike freely to all, and which is to be everywhere amplified, changed as circumstances and conditions require, and especially adapted to the present hour. It is rather, as they too often view it, like litho- graphed letters of advice, printed upon stamped paper, and carefully sealed up and addressed to posterity. And then, if they can be made the mail-carriers, and be permitted to pass, unchallenged, with the precious bag, from post to post, and pass it over, carefully sealed, 12 GENERAL INTRODUCTORY REMARKS. to the next generation, they will think it has done its work, and that they have fulfilled their mission. I would not be unjust or severe, but I cannot but remark further, that these men present but one view of humanity. They are monot- onous objects of inspection. Look at them a thousand times, and you see only the same unaltered phase of life. To the mariner on life's ocean, they are not safe lights. If he approach them on the dark side they remain black as night to him, until he comes round to their shining front. They are not revolving lights. They have light : it may be bright and genial ; but it gleams out upon the waters only in one direction. It does not sweep round, and throw its rays upon every mariner's path. Such men are useful, but only to a certain class. They have in them no true omnilogy — they are not all-teaching. Their lives are ins ructive to their friends, their clique, their party, their school ; but a stumbling-block, a hindrance, an oppression, an offence to every- body else. They are like porcupines, with fronts smooth and easy of access ; but their backs bristle with quills to stick into those on the wrong side. They are not whole men. Humanity has infused into them only one or two of its elements. They have length, but no breadth. They are citizens of Boston, New York, Philadelphia, or Cincinnati, but not of the world. Within certain circles, they are genial friends, but cynics and haters outside of them. From their high places they come down to their humble followers with tokens of friendly recognition ; upon others they frown and lower like armed castles. The True Physician.— How different the character of the true man and physician! He is genial in his disposition. He has no dislikes and antipathies, and hates no men except tyrants. He accepts knowl- edge, though it come from the humblest source ; believing there is no experience but will repay a study of it, and no husbandman's plough- share but turns up a soil worth analyzing. He belongs exclusively to no party, and can be approached easily by respectable men of every stamp. Whether belonging to the same society with him or not, y ou may take hold of his nature and draw it out, without hav- ing it slip from your fingers, and spring back from your presence into a thousand kinks, like an overtwisted thread. He is a whole man. God made him for the world, and not for a party. By some strong influence you may possibly, for a time, draw him from the world into some narrower sphere, but not only will his reluctant nature, like a retiring tide, run back continually to embrace the continent, but will soon break from its confinement, and, like a full sea, come back, boil- ing and running over. What is now Wanted. — The foregoing remarks indicate one great leading want, in order that medical knowledge may increase. It is liberality in the true and full sense. We want true men in high places, who will not only let their own light shine everywhere, but will to hinder other n/>-,/'s light from shining. GENERAL INTRODUCTORY REMARKS. 13 Be}"ond this, and of nearly equal importance with it, we want med- ical knowledge diffused among the people. We want — what the world has never seen — a popular medical literature. We want the temples of Esculapius pulled down, and the priests turned into the streets to become teachers of the multitude, rather than worshippers in the inner sanctuary. I know this want will be stoutly denied, but not, I think, on well- considered grounds. We do not think it necessary to confine a knowledge of the soul to the ministers of religion. There is no branch of theology which we do not deem it proper for laymen to study; we even popularize it for our children. In the obscurest towns of New England, laymen who follow the plough or push the plane, become, in many cases, eminent theologians. Why should they not study the lower science which relates to the body? They have not been able to heretofore, because its mysteries have been purposely hidden under technicalities. These coverings should be torn off. It is said that those who begin to read upon medicine are very apt to imagine themselves afflicted with the various symptoms they find described. To some small extent this is true ; but it is also true that the light they obtain relieves them from many apprehensions which their previous ignorance allowed to prey upon them ; as boys lose their fears when the light of the morning changes to some familiar object the ghost of the preceding night. Physicians oppose the popularizing of this kind of knowledge too often, I fear, upon the sordid ground of self-interest. They think their own services will be less sought. We do not dispense with the services of ministers because the people study theology, neither shall we cease to employ teachers and practitioners of medicine when each man and woman is wise enough to study the healing art. The principal change we shall witness will be much larger attainments in knowledge among practitioners, — just as the ministers of religion now know, and are obliged to know, ten times as much as in those darker periods when the people re- ceived all spiritual knowledge from their mouths. The teachers of any art or science are obliged to keep in advance of their pupils. Let medicine become a popular study, and we shall have very few ignorant physicians, and quackery will become one of the impossi- bilities. Homceopathists, Eclectics, Hydropathists, and Physiolo- gists, believe in scattering medical books, stripped of their techni- calites, among the multitude, and their people purchase very few secret, advertised medicines ; — these being chiefly bought and con- sumed by the followers of those who believe this kind of reading- fosters quackery! ANATOMY. ANATOMY describes the structure and organization of living be- ings. Special Anatomy treats of the weight, size, shape, color, etc., of each organ separately. General Anatomy investigates the tissues or structures from which organs are formed. Surgical Anatomy or Regional Anatomy considers the relations of organs to one another. Physiological Anatomy treats of the uses or functions of organs in health. Pathological Anatomy describes the alterations made upon dif- ferent organs by disease. We shall here introduce a very brief compendium only of Special Anatomy. It is of great consequence that every person should have some knowledge of anatomy and physiology. Self-knowledge ought to extend to the body as well as the mind. To know one's self, physi- cally, is to gain a new insight into that wonderfully skilful adjust- ment of means to ends which is never absent from the works of God. Without this knowledge, one cannot know how to take care of the health ; and without health, life loses most of its value. Structure of the Body. The human body is composed of solids and fluids. The fluids are most abundant in children and youth. It is this which gives softness and pliancy to their flesh. In old age the fluids are less abundant, and the flesh is more hard and wrinkled. The fluids contain the whole body, as it were, in a state of solu- tion ; or rather, they hold the materials out of which it is manufac- tured. Chemical Properties of the Body. The four elements, oxygen, hydrogen, carbon, and nitrogen, make up nearly the whole bulk of the fluids and soft solids of the human body. A number of other elements, chiefly in a state of combina- tion, and in much smaller quantities, enter into several of the tissues. Binary Compounds. — Thus, we have carbonic acid in blood, urine and sweat; and we have water universally diffused through the sys- tem, -each of these substances being a binary compound, that is, composed of two elements. Compounds of more than two Elements are widely distributed over the body ; as, 14 ANATOMY. 15 Carbonate of Soda in serum, saliva, bile, mucus, sweat, and tears. Carbonate of Lime in cartilage, bone, and teeth. Phosphate of Lime in bones, teeth, and cartilage. Phosphate of Iron in blood, gastric juice, and urine. Chloride of Sodium in blood, brain, muscle, bone, cartilage and pigment. Chloride of Potassium in blood, gastric juice, milk, and saliva. Chloride of Calcium in gastric juice. Sulphate of Potassa in urine, gastric juice, and cartilage. Sulphate of Soda in sweat, bile, and cartilage. Sulphate of Lime in bile, hair, and scarf-skin. , Oxide of Iron in blood, black pigment, and hair. Organized Compounds. — Besides the above inorganic elements and compounds, several organized substances, or proximate elements, as they are called, exist largely in the body. The chief of these are albumen, fibrin, gelatin, mucus, fat, and casein. Others need not be named. Albumen is found in great abundance in the human body. It is the raw material out of which the flesh and other tissues are made. The white of an egg, which is nearly pure albumen, is a good speci- men of it. Fibrin, when removed from the human body, changes from a solu- ble to an insoluble state. In other words, it coagulates in a kind of net-work. Nearly the same thing takes place constantly in the living body, when the liquid fibrin leaves its soluble state, and is deposited as solid flesh. Fibrin bears the same relation to albumen that wool- len yarn does to wool ; it is spun from it in the busy wheel of or- ganic life. And the flesh or muscle is related to fibrin as the cloth is to yarn ; it is woven from it in the vital loom. Fibrin has been called liquid flesh. Gelatin exists largely in the ligaments, cartilages, bones, skin, and cellular tissue. When dissolved, five parts in one hundred of hot water, it forms a thick jelly. Isinglass is a form of gelatin obtained from the air-bladder of the sturgeon and the codfish. Glue is still another form of gelatin. It is extracted from the bones, and parings of hides, and the hoofs and ears of cattle, by boiling in water. Black silk, varnished over with a solution of gelatin, forms court-plaster: Mucus is a sticky fluid secreted by the gland-cells. It is spread over the surface of the mucous membranes, and serves to moisten and defend them from injury. Fat consists of cells held together by cellular tissue and vessels, and contains glycerin, stearic acid, margaric acid, and oleic acid. It has no nitrogen. If the stearic acid be in excess, the fat is hard ; if the oleic acid preponderate, it is soft. The stearine extracted from fat is used for making very hard candles. 16 ANATOMY. Casein is abundant in milk and constitutes its curd. It is held in solution in milk by a little soda. When dried, it is cheese. It is found in blood, saliva, bile, and the lens of the eye. It forms the chief nourishment of those young animals which live on milk. It is found in peas, beans, and lentils. Vegetable and animal casein are precisely alike in all their properties. Fibrin and albumen contain almost exactly the same amount of oxygen, hydrogen, carbon, nitro- gen, and sulphur, which is found in casein. This latter, when taken into the stomach, therefore, goes, without much change, to the forma- tion of the albumen and fibrin of the body. Physical Properties of the Body. The Tissues. — The solid organized substances of which the human body is composed, are called tissues. There are various kinds of tissues. The Cellular Tissue, commonly called areolar, is made up of small fibres and bands woven together into a sort of net-work, with numer- ous little spaces opening into each other. These spaces are filled with a watery fluid ; and when this is greatly increased by disease, so as to cause the parts to swell, and the skin to shine, the person has ana- sarca, or cell-dropsy. The uses of this tissue are to give parts and organs a kind of elastic cushion to rest upon, so that they may not be bruised and injured by the shocks of life ; to make a kind of safe highway for delicate vessels to pass from one part of the body to another ; and to furnish a beautifully arranged lodgment for the wa- tery fluid which gives such roundness, smoothness, and grace to the human form. The opening of the cells into each other explains the reason why feeble persons have swelled feet and ankles in the even- ing, and not in the morning — the fluid settling down from cell to cell, into the lowest parts, while they are up during the day, and running back to its proper place while they are lying down during the night. The Mucous Tissue, or mucous membrane, lines all the cavities which communicate with the air, as the mouth, stomach, bowels, lungs, etc. It is supplied with numerous small glands which secrete a sticky kind of fluid called mucus, to protect the surface from any injury which might be inflicted by air, or by irritating substances suspended in it. The Serous Tissue, or membrane, lines all the cavities which do not communicate with the air, that is, all those which are shut, and have no outward opening. The skull, the chest, and the belly are lined by this kind of membrane. The membrane itself forms a closed sac, — one layer of it being attached to the cavity it lines, while the other is folded back upon and around the contents of the cavity, which are left outside of the sac. A watery fluid oozes from the inner surface of the sac, to make its sides glide easily upon each other. When some disease causes this water to be poured out too freely, so as to fill or partly fill the cavity, we have dropsy of the brain, or chest, or abdomen, as the case may be. ANATOMY. 17 The Dermoid Tissue covers the whole outside of the body. We call it the skin, or cutis. It is similiar in structure to the mucous membranes, which are a mere continuation of it. It is harder than the mucous membrane, because more exposed to injury. In health, it never ceases to secrete and throw off a fluid which we call insen- sible perspiration while it is in the form of an invisible vapor, and perspiration, or sweat, when it is so increased as to be seen. So great is the sympathy between this dermoid covering of the body and the mucous membranes, that when it is chilled so as to stop the invisible perspiration, the internal membrane becomes affected, and we have a sore throat, or diarrhoea, or running at the nose ; that is to say, when the skin cannot sweat, the mucous membrane begins to sweat. The Fibrous Tissue consists of closely united fibres, and for what- ever purpose used, forms a fine, dense, and enduring body. In some cases it takes the form of a membrane, as the dura mater, which lines the interior of the skull and spinal column. The ligaments which hold the bones together, and the tendons or cords, which fasten the muscles to the bones, are fibrous bodies. It is this firm substance of which rheumatism frequently takes hold, and this is the reason why it lingers so much about the joints. It sometimes takes hold of the ligament which fastens the deltoid muscle to the bone of the upper arm, about two-thirds of the way from the elbow to the shoulder. This muscle lifts up the arm. In this form of rheumatism, therefore, the arm hangs helpless at the side. The Cartilaginous Tissue covers the ends of the bones where they come together to make a joint. It is well fitted to make the joint work easy, being smooth, hard, and elastic. The Osseous or Bony Tissue varies in its composition, density, and strength, according to the age of the person, and the uses of the bone. The Muscular Tissue, or muscle, being made for a great deal of pulling and lifting, is formed something like a rope, except that there is no twisting. Many small fibres or filaments unite to form fasciculi. A fasciculus is a bundle of fibres surrounded by a delicate layer of cell-tissue called sarcolemma, — just as a cord is a number of smaller threads of cotton or hemp bound together. A number of these fasciculi united together make a muscle, — just as several cords, called strands, twisted together, make a fig. i. rope. Figure 1 gives us a good view of the fibres and bundles, highly magnified. 18 ANATOMY. The Adipose Tissue is the material which the human body works up into pots and cells containing fat. It is found chiefly under the skin and muscles of the belly, and around the heart and kidneys. By the increase of this tissue, persons may become enormously en- larged without having their muscles at all increased in size. Such a condition is to be deplored, — the body having become merely the storehouse or depot of myriads of pots of fat. The Nervous Tissue is composed of two distinct kinds of matter, — the one gray and pulpy, called cineritious, the other white and fibrous, called medullary. The external part of the brain and the in- ternal portion of the spinal cord are composed of the gray or ash- colored tissue ; the nerves are made only of the white or fibrous matter, and are inclosed in a delicate sheath called neurilemma. Vital Properties of the Body. Bodies begin their growth with a simple cell, which is a delicate little bladder or shut sac. Cells take their rise in that portion of the blood which is capable of being organized, and which is called blastema. In animal bodies each cell generally begins as a minute point in the blastema, and grows until a transparent bladder or vesicle springs out from one side of it, and soon appears to enclose it. The bladder is then called the cell, and the point or dot is its nucleus. Within tins nucleus appears another dot, which is called the nucleolus. When fully ripened, the cell bursts and sets the nucleus free, and this, in its turn, matures and yields up its contents. Thus all cells have their origin in germs produced by previously existing parents cells. They are multiplied with great rapidity. Having grown to a certain extent, they lose their fluid contents, and their walls col- lapsing or coming together, they form simple membraneous discs. In this way, with some variations, the simple tissues of the body be- gin to be, and the foundation is laid for the noble structure of man. Anatomy of the Bones. The human skeleton is composed of two hundred .and eight bones, the teeth not included. When fastened together by natural ligaments, the bones are said to form a natural skeleton; when attached by wires, an artificial skele- ton. In Figure 2, — 1, 1, represent the spinal column; 2, the skull; 3. the lower jaw ; 4, the breast-bone (sternum) ; 6, the ribs ; 7, the col- lar-bone ; 8, the bone of the upper arm (humerus) ; 9, the shoulder- joint ; 10, the radius; 11, the ulna; 12, the elbow-joint; 13, the wrist; 14, the hand; 15, the haunch-bone; 16, the sacrum; 17, the hip-joint; 18, the thigh-bone; 19, the knee-cap (patella); 20, the knee-joint; 21, the fibula; 22, the tibia; 23, ankle-joint; 24, the foot ; 27, 28, 29, the ligaments of the shoulder, elbow, and wrist ; - 29 - — 30 28 1 15 29 31 32 - 34 33 36 20 ANATOMY. 30, tlie large artery of the arm; 31, the ligaments of the hip-joint; 32, the large blood-vessels of the thigh; 33, the artery of the leg; 34, 35, 36, the ligaments of the knee-cap, knee, and ankle. The protuberances or swellings in certain parts of the bones are called processes, and nit' the points to which muscles and ligaments are fastened. The bones are supplied with nutritive vessels, and, like other parts of the body, are formed from the blood. At first they are compara- tively soft and cartilaginous. After a time, in the young animal, they begin to change to bone at certain places, called points of ossifi- cation. They are covered with a strong, fibrous membrane called the periosteum. A somewhat similar covering upon the cartilages has the name of perichondrium, and that which covers the skull is the pericranium. The bones are compounded of earthy and animal matter. From the former — phosphate and carbonate of lime — they receive their strength; from the latter — cartilage — they derive their life. Put a bone for a few days into diluted muriatic acid, — one part of acid to six of water, — and the phosphate and carbonate of lime will all be removed, while the bone will remain the same in shape. It will now be comparatively soft, and may be bent, or even tied into a knot without break- ing. Place a similar bone in the fire for a few hours, and it w^ill also retain its shape, but the cartilaginous portion will be gone. It is now brittle, and may be picked in pieces with the fingers. The bones are divided into those of the head, thirty ; of the body, fifty-four; of the upper limbs, sixty-four ; and of the lower limbs, sixty. Bones of the Head. The bones of the head are divided 'into those of the shall, the ear, and the face. The skull has eight bones. They are composed of two plates, one above the other, with a porous partition between. These two plates are capable of giving the brain very powerful protection against in- jury, the outer one being fibrous and tough. — the inner one, hard and giass-iike, and hence called vitreous. The middle layer has the name of diploe. Its spongy nature deadens the jar from a blow inflicted upon the outer table. In early life, when the bones are tender and yielding, this porous layer is not needed, and is not found. ANATOMY. 21 Fig. 4. That the bones of the skull may not easily slip by each other, and get out of place, they are dovetailed together in curious lines called sutures. In advanced years, these gen- erally close up, the bones uniting firmly together. In early life they are quite open, the firm bones not covering the whole brain. The opening of the coronal suture in childhood is called a fontanelle. It presents a soft place upon the top of the head, where the finger could be pressed down into the brain. In Figure 4, — 1, 1, show the coronal suture on the front and upper part of the skull ; 2, the sagittal suture on the top of the skull ; and 3, 3, the lambdoidal suture, running down on each side of the back part of the skull. Figure 5 shows the skull-bones separated from each other at the sutures : 1, the frontal bone ; 2, the parietal ; 2, the occipital : 4, the temporal ; 5, the nasal ; 6, the malar ; 7, the superior maxillary ; 8, the unguis ; 9, the in- ferior maxillary. Ar- nott has demonstrated that the form of the skull is the best possible for sustaining weights, and resisting blows. The summit of the head is a complete arch, like that of a bridge. The ear has four small bones, which aid the sense of hearing. The bones of the face are fourteen in number. They hold the soft parts in place, and aid in FlG 5 grinding the food. Bones of the Trunk. In the trunk there are twenty-four ribs ; twenty-four pieces in the backbone or spinal column ; four bones in the pelvis and hips ; one breast-bone, called sternum ; and a bone at the base of the tongue, called os hyoides. They are so put together as to form two great cavities, namely, the thorax or chest, and the abdomen or belly. The ribs, connecting with the backbone behind and the breast-bone in front, form the thorax, which contains the lungs and heart. Fig. 22 ANATOMY. Fig. 6. 6 shows the natural form of the healthy chest : 1, is the spine ; 2, 2, ill.- collar-bones; 3, 3, the seven upper, or true ribs; 4, 4, the five lower or false ribs; 5, the breast-bone, to which the true ribs are united ; 6, the sword-shaped cartilage which constitutes the lower end of the breast-bone, called ensiform cartilage ; 7, 7, the upper part of two lungs ; 8, 8, the right lung, seen between the ribs ; 9, 9, the left lung ; 10, 10, the heart; 11, 11, the dia- phragm, or midriff; 12, 12, the liver ; 13, 13, the stomach, 14, 14, the second stomach, or duodenum ; 15, the transverse colon ; 16, the upper part of the colon on right side; 17, upper part of colon on left side. Each piece of the spinal col- umn is called a vertebra. Upon every one of these are seven projections, called processes — a part of which are for linking the bones together, and the rest to furnish attachments for the muscles of the back. The projections are linked together in such a way, that a continuous channel or opening runs down through the whole, in which is lodged the spinal cord, or medulla spinalis. This nervous cord is connected with the base of the brain, and is a kind of continuation of it. Between all the vertebrae are certain cartilaginous cushions, which, when com- pressed, spring back, like India rubber, and thus protect the brain from being injuriously jarred by running, leaping, or walking. The pelvis has four bones : the two nameless bones — in- nominate^ the sacrum, and the coccyx. In the side of each of the nameless bones is a deep, smooth cavity, called the ace- tabulum. Into this the round head of the thigh-bone is nicely fitted. When the bone is thrown out of this cavity, the hip is said to be out of joint. The sacrum took its name Fig. Fig. 8. ANATOMY. 23 from the fact that the heathens used to offer it in sacrifice. With them, it was the sacred bone. The coccyx is the lower termination of the backbone. These bones are represented in Fig. 8 : 1,1, being the innominata ; 2, the sacrum ; 3, the coccyx ; 4, 4, the acetabulum : a, a, the pubic portion of the nameless bones ; d, the arch of the pubes ; e, the union of the sacrum and the lower end of the spinal column. Bones of the Upper Extremities. The shoulder-Made (scapula), the collar-bone, (clavicle), the bone of the upper arm (humerus), the two bones of the forearm (ulna and ra- dius), the bones of the wrist (carpal bones), the bones of the palms of the hand (metacarpal bones), the bones of the thumb and fingers (phalanges), — these are the bones of the upper limbs. The collar-bone is fastened at one end to the breast-bone, at the other end to the shoulder-blade. It keeps the shoul- ders from dropping forward. Many persons allow it to fail of this end by getting very much bent in early life. This happens at school, when children are allowed to sit in a stooping posture. In the French, a race re- markable for a straight, upright figure, this bone is said to be longer than in any other people. The shoulder-blade lies upon the upper part of the back, forming the shoulder. It has a shallow cavity (glenoid cavity), into which is inserted the head of the upper arm-bone. Sev- eral strong muscles are attached to the eleva- tions of this bone, which keep it in its place, and move it about as circumstances require. The upper arm-bone has its round head fast- ened in the glenoid cavity, by the strong capsular liga- ment, forming a joint capable of a great number of move- ments. At the elbow it is united with the ulna of the fore-arm. It is a long, cylindrical bone, represented by Fig. 9 : 1, is the shaft of the bone ; 2, the large, round head which fits into the glenoid cavity ; 3, the surface i which unites with the ulna. FlG - 10 - Of the two bones of the fore-arm, the ulna is on the inner side, and unites with the humerus, making an excellent hinge-joint. The other bone of the fore-arm, the radius, lies on the outside of the arm, — on the same side with the thumb, — and unites, or articulates, as we say, with the bones of the wrist. In Fig. 10 : 1, is the body of the ulna ; 2, the shaft of the radius ; 4, the articulating surface, with which the lower end of the humerus unites ; 5, the upper extremity of the ulna, called the olecranon process, which forms the elbow- joint ; 6, the point where the ulna articulates with the wrist. Fig. 24 ANATOMY. The eight bones of the wrist or carpus are ranged in two rows, and being hound close together, do not admit of very tree motion. In Fig. 11 : S, is the scaphoid hone; L, the semilunar bone; C, the cuneiform bone ; P, the pisiform bone ; T, T, the trapezium and trapezoid bones ; M, the os magnum ; u, the cuneiform bone. The last four form the sec- ond row of carpal bones. 11, 11, are the meta- carpal bones of the hand ; 2, 2, the first range of the finger-bones ; 3, 3, the second range of finger-bones ; 4, 4, the third range of finger- bones ; 5, 6, the bones of the thumb. Of the five metacarpal bones, four are at- tached below to the first range of the finger- bones, and the other to the first bone of the thumb, while the whole are united to the second range of the carpal bones above. Bones of the Lower Extremities. These are the thigh-bone (femur), the knee-pan (patella), the shin- bone (tibia), the small bone of the leg (fibula), the bones of the instep (tarsal bones), the bones of the middle of the foot (meta- tarsal bones), and the bones of the toes (phalanges). The thigh-bone is the longest bone in the system. Its head, which is large and round, fits admirably into the cavity in the innominatum, called acetabulum, and forms what is called a ball-and-socket joint. In Fig. 12 : 1, is the shaft of the thigh-bone (femur) ; 2, is a projection called the trochanter minor, to which some strong mus- cles are attached; 3, is the head of the femur, which fits into the acetabulum ; 5, is the external projection of the femur, called the external condyle ; 6, the internal con- dyle ; 7, the surface which articulates with the tibia, and on which the patella slides. The knee-pan or knee-cap (patella) is placed on the front of the knee, and being attached tc the tendon of the extensor muscles above, and to the tibia by a strong ligament below, it acts as a pulley in lifting up the leg. The shin-bone (tibia) is the largest of the two in the lower leg, and is considerably enlarged at each end. The small bone of the leg (fibula) lies on the out- side, and is bound to the larger bone at both ends. Fig. 13 shows the two bones of the leg: 1, being the tibia;] 5, the fibula ; 8, the space between the two ; 6, the junction of the tibia and fibula at the upper extrem- ity ; 3, the internal ankle ; 4, the lower end of the tibia that unites Fig. 12. ANATOMY. 25 with one of the tarsal bones to form the ankle-joint ; 7, the upper end of the tibia, which unites with the femur. The instep (tarsus) has seven bones, which, like those of the wrist, are so firmly bound together as to allow but a limited motion. The metatarsal bones, corresponding with the palm of the hand, are five in number, and unite at one end with the tarsal bones, and at the other with the first range of the toe-bones. The tarsal and metatarsal bones are put together in the form of an arch, the spring of which, when the weight of the body descends upon it in walking, prevents injury to the organs above. (Fig. 14.) The phalanges have fourteen- bones. The great toe has two ranges FIG. 14. Fig. 13. of bones ; the other toes have three. Fig. 15 gives a view of the upper surface of the bones of the foot : 1, is the surface of the as- tragalus where it unites with the tibia ; 2, the body of the astragalus ; 3, the heel-bone (os calcis) ; 4, the scaphoid bone ; 5, 6, 7, the cune- iform bones ; 8, the cuboid ; 9, 9, 9, the metatarsal bones ; 10, the first bone of the great toe ; 11, the second bone ; 12, 13, 14, three ranges of bones forming the small toes. The Joints. That bones may be of any use, they must be jointed together. Joints are of the greatest importance. It is necessary they should be so constructed that there shall be no harsh grating of the bones upon each other, and no injurious jars in walking, etc. To prevent these things, a hard, smooth, and yet yielding, cushion-like substance is 26 ANATOMY. required between them in joints. Such are the cartilages. Fig. 16 gives a specimen of these intervening cartilages. I), is the body of a hone, at the end of which is a socket; C, the cartilage lining the socket, thin at the sides and thick in the centre ; B, the body of a bone, at fig- 16. the end of which is a round head ; C, the investing cartilage, thin at the sides and thick in the centre. Cartilage grows thinner, harder, and less elastic in old age. Hence old people are not quite as tall as in middle life, and a little stiffer in their joints. The synovial membrane is a thin layer covering the cartilage, and being bent back upon the inner surface of the ligaments, it forms a closed sac. From its inner surface a sticky fluid oozes out, which helps the joints to play easily. There are other smaller sacs connected with the joints, called bursa mucosae. They secrete a fluid similar to that from the syno- vial membrane. Fig. 17. Fig. 18. Fig. 19. The ligaments. To retain the bones in their places at the joints, some strong, flexible straps are required to stretch across from one to the other, and to firmly unite them. Such are the ligaments. They are the pearl-colored, lustrous, shining parts about the joints, in the form of straps and cords. There are a number of them so woven together as to form a complete covering of the joint, called a capsular ligament. In Fig. 17 : 1, 2, are ligaments extending from the hip-bone, 6, to the femur, 4. In Fig. 18: 1, is the socket of the hip-joint; 2, head of the femur, lodged in the socket; 3, the ligament within the socket. In Fig. 19: 1, is the tendon of the muscle which extends the leg ; 2, the knee-cap (patella) ; 3, the anterior ligament ANATOMY. 27 of the patella ; 6, the long external lateral ligament ; 4, 4, the syno- vial membrane ; 5, the internal lateral ligament ; 7, the anterior and superior ligament that unites the tibia with the fibula. Uses of the Bones. The bones are to the body what the frame is to the house. They hold up and retain the other parts in their proper places. They fur- nish points of attachment for the muscles, to hold the body together and to give it motion. They also furnish strong, bony cavities for the lodgment and protection of such delicate organs as the eye, the brain, and the heart. A single bone, examined by itself, might not seem to have much beauty or design about it; it might even look clumsy and misshapen. But when all the bones are inspected with reference to each other, we immediately discover a general plan upon which they are made, and are compelled to admire their beautiful harmony, and the sym- metrical grace with which they act. They show us that God can command our wonder, even in the bony frame of our bodies. The riuscles. That part of the animal's body which we call lean meat is com- posed of muscles. We have already explained that muscles are com- posed of threads, etc., put together in great numbers, forming bundles. So numerous are these threads and bundles in some cases, that the muscles which are composed of them have a strength truly wonderful. Toward the end of the muscle, the fibres cease, and the structure is so modified as to become a white cord of great density and strength. This cordy substance is fastened to the bone so strongly, that it is impossible, except in some rare cases, to detach it. Generally the bone will sooner break than this attachment will give way. Some- times this cord spreads out like a membrane. It is then called fascia or aponeurosis. The fibres of a muscle have the peculiar property of contracting under a nervous stimulus sent to them by the will. These contrac- tions cause them to act as pulleys, and to move the bones, and conse- quently the limbs and body, in such direction as the will commands. This is the special use of the muscles. All our movements are caused by them. They pull us about, not blindly and at a random, but under the direction of an intelligent will. The manner in which a muscle acts, with the cord attached, may be seen by examining the leg or " drum-stick " of a fowl. If the cord on one side be pulled, the claws are shut ; if that upon the other side be drawn, they will open. If both be pulled, they are held fast in one position, neither opening nor shutting. An examination of a piece of boiled lean meat will show the 28 ANATOMY. Fig. 20. threads of which it is composed. With proper instruments, these may- be unravelled, as it were, until fibres will be found not larger than a spider's web. These, covered with sheaths of great delicacy, extend beyond the fleshy fibre, and with the cell-substance connecting the fibres, are condensed into tendon. Millions of these sheathed fibres are gathered into a bundle, and covered with a sheath, and thus form what is called a fasciculus. A muscle is a number of these fascicula made into a bundle, and cov- ered with a sheath called a fascia (Fig. 1). The arm is a number of muscles bundled together, and covered, likewise, by a fascia. The fibres in a fasciculus being parallel, act together. But the fasciculous bundles which make up a muscle act in various ways. Shape of the Muscles. — Some muscles are fusiform or spindle- shaped, so that the attachment occupies but a small space (Fig. 20). Other muscles are radiate or fan-shaped fFig. 21). Such is the temporal muscle, the thin edge of which is attached to the side of the head, without producing an elevation or deformity. In some cases the fasciculi are arranged upon one or both sides of a tendon. In this way a great number may concentrate their action upon a single point. Such muscles are called penni- form, — being shaped like a feather (Fig. 22). In other instances, the fasciculi form circular muscles, — orbiculares, or sphincters, as These surround certain openings iirto the body, which they are designed to close, either in whole or in part. They surround the eyelids, the anus, the mouth of the womb, etc. (Fig. 23). In still other instances the fasciculi are ranged side by side in rings, forming muscular tubes. By the successive contraction of these rings, any substance is driven through the tube, — as food or drink through the gullet of a cow. Fig. 24 is a section of the gullet : a, 6, show the circular fibres ; 6', the longitudinal. Sometimes the fasciculi curve around in parallel layers or inter- lace with each other, forming a bag or pouch. By the contraction of these fasciculi, the contents of the bag will be turned from side to side as in the case of the stomach, or driven out, as in that of the heart. Fig. 25 shows the muscles of the stomach : L, represents the fibres running in one direction ; c, in another ; e, lower end of gullet ; o, pylorus ; D, beginning of duodenum, or second stomach. Fig 21 Fig. 22. they are called. Fig. 23. Fig. 24. PI. 8. MUSCLES OF THE HUMAN BODY. ANATOMY. 29 Number of Muscles. — The muscles of the body are as numerous as the ropes of a ship, — there being five hundred or more. Some anatomists reckon more, some less. The}' are divided into those of the head and neek, those of the trunk, those of the upper extremities, and those of the lower extremi- ties. They are too numerous to be named and individually described in this brief account of them. A part of them are voluntary, that is, under the control of the will; while another part are involun- tary, moving without reference to the will. The heart is of the latter kind, it being necessary for it to keep moving when the will and mind are asleep. On the back there are six layers of muscles, one above an- other. Such a number are neces- sary to perform the numerous movements of the back, neck, arms, etc. Every expression of the human face, as joy, sorrow, love, hate, hope, fear, etc., is produced by the gentle pulling of muscles, made expressly to indicate these emotions. The diaphragm is a large flat muscle, reaching across the great cavity of the body, and dividing the chest from the abdomen. It is penetrated by the gullet going to the stomach, and by the great blood-vessels leading to and from the heart. It is shaped like the cover of a dinner-dish, the convex surface being turned up. When the breath is drawn in, it sinks down towards a level, thus enlarging the chest at the expense of the belly. When the breath is thrown out, the reverse takes place. Mode of Action. — The eontractibility of a muscle, of which I have spoken, is simply its power of shortening itself. The hand is raised 5 by the shortening of a mus- cle in front, attached to the bone above the elbow, and to a bone below the elbow. The contraction of an an- tagonistic muscle behind, also attached above and be- low the elbow, brings the hand back to its place. Fig. 26 shows how all joints are moved : 1, is the bone of the arm above the elbow ; 2, one of the bones below the elbow; 3, the muscle which bends the elbow: 4. 5, attachments of muscles to bones ; 6, the muscle that extends the Fig. 26. 30 ANATOMY. elbow; 7, attachment to elbow; 8, weight in hand. The muscle, 3, contracts at the central part, and brings the hand up to 9, 10. The complication, variety, and swiftness of motion, executed by muscles, are past conception. Every movement which a human be- ing makes, from the heavier motions of the farmer in cultivating his fields, up to the magic touches of the painter's brush, and the method- ical frenzy with which the great master's fingers sweep the piano, are all made by muscles obeying an intelligent will. The Teeth. The teeth are not like other bones, either in composition, method of nutrition, or growth. When broken they do not unite, not being furnished with the necessary power of reproduction of lost parts. Both the upper and lower teeth are set into bony sockets, called alveolar processes. These, with the fibrous gums, give the teeth a very firm setting. Origin. — The teeth have their origin in little membranous pouches within the bone of the jaw, which, in their interior, have a fleshy bud. From the surface of this the bone or ivory exudes. The tooth and the bony socket are developed and rise up together, — the former, when sufficiently long, pushing itself through the gum. Number. — The first set of teeth are only temporary, and are called jnilk-teeth. There are but twenty of them. Between the age of six and fourteen, these become loose, and drop out, and the permanent teeth appear in their places. Of these there are thirty-two, sixteen in each jaw. Names. — The four front teeth in each jaw, a, b, Fig. 27, are the cutting teeth (incisors) ; the next one, c, is an eye-tooth (cuspid) ; the Fig. 27. next two, d, e, are small grinders (bicuspids) ; the last three, /, #, 7i, are grinders (molars). One appears late on each side, from the age of twenty to twenty-four, and is called wisdom tooth. ANATOMY. 31 Composition. — A tooth is composed of ivory and enamel. The internal part is ivory, which is harder than bone. The coating upon the surface is enamel, which is still harder than ivory. That part which rises above the jaw-bone is called the crown ; it is this only which is covered with enamel. The part within the jaw is called the root or fang ; this is composed of bony matter, through which small vessels pass in to nourish the tooth. Small white nerves also pass into the tooth, — of the presence of which we have terrible evidence in tooth-ache. Use of the Teeth. The incisors cut the food asunder; the molars break down its solid parts, and grind it to a fineness which fits it for the stomach. In masticating the food, the lower jaw has two movements, the up- and-down motion, like a pair of shears, and the lateral or grinding motion. These two movements are performed by different sets of muscles. Flesh-eating animals have only the up-and-down motion ; vegetable-eating animals have only the lateral or grinding motion ; while man has both the up-and-down and the lateral. This seems a pretty clear intimation that he is to eat both flesh and vegetables. The teeth aid us in articulating words, and they give a roundness and symmetry to the lower part of the face. When well formed, and kept in good condition, they add much to the beauty of the face, and their decay is an irreparable loss. Their proper care and treatment are spoken of in another place. The Digestive Organs. The alimentary organs are the mouth, the teeth, the salivary glands, the pharynx, the gullet (oesophagus), stomach, bowels (intestines), chyle vessels (lacteals), thoracic duct, liver and sweetbread (pan- creas). The preparatory process of digestion, the mastication of food, takes place in the mouth, where the food is mixed with saliva, a se- cretion of the salivary glands. Of these glands there are six, three on each side. The Parotid Gland lies in front of the external ear. It has a duct opening into the mouth opposite the second molar tooth of the upper jaw. This is the gland that swells in the disease called mumps. Hence the disease is also called parotitis. The Submaxillary Gland is inclosed within the lower jaw, in front of its angle. Its duct opens into the mouth by the side of the bridle of the tongue (frsenum linguae). On each side of this string or bridle, and under the mucous mem- brane of the floor of the mouth, lies the sublingual gland, which pours its saliva into the mouth, through seven or eight small ducts. 32 ANATOMY. Fig. 28. A disease called the frog consists in the swelling of this gland. Fig. 28 : 1, the parotid gland ; 2, its duct ; 3, the submaxillary ; 4, its duct ; 5, the sublin- gual. The Pharynx is a con- tinuation of the mouth, and is the cavity just below the soft palate. The two pas- sages going to the nose (posterior nares), the one going to the stomach (oesophagus), and the one going to the lungs (larynx and trachea ; all meet in this cavity. In Fig. 29: 1, is the trachea ; 2, the larynx ; 3, the oesophagus ; 4, 4, 4, muscles of pharynx ; 5, muscles of the cheek ; 6, the muscle which surrounds the mouth ; 7, the mus- cle forming the floor of the mouth. The Gullet or oesophagus is a long tube, descending behind the windpipe, the lungs, and the heart, through the dia- phragm into the stomach. It is composed of two membranes laid together, like two pieces of cloth. The inner one is mucous, the outer muscular. The two sets of fibres composing the muscular coat are arranged circularly and longitudinally (Fig. 25). The Stomach lies in the upper part of the belly, to the left, and directly under the diaphragm. It has an upper opening, where the stomach-pipe enters it, called the cardiac orifice. This is the larger end of the stomach, and lies on the left side ; the smaller end connects with the upper bowel, at which point it has an opening called the pyloric orifice. In addition to mucous and muscular coats, similar to those which compose the oesophagus, the stomach has still another over both, a serous coat, very strong and tough, to give this working organ additional en- durance. Within, it has many glands to secrete the gastric juice. The Intestines, or alimentary tube, or bowels, are divided into the small and large intestines. The small intestine has a length of about twenty-five feet, and is divided into three parts, — the duodenum, the jejunum, and the ileum. Of these three divisions, the duodenum is the largest, and is about fig. 29. ANATOMY. 33 a foot in length. It begins at the pyloric orifice of the stomach, and passes backward to the under surface of the liver, whence it drops down perpendicularly in front of the right kidney, and passes across the belly behind the colon, and ends in the jejunum. The Jejunum continues the above, and terminates in the ileum. The Ileum is a continuation of the jejunum, and opens, at an obtuse angle, near the haunch bone, into the colon. A valve is located here, to prevent the backward passage of substances from the colon into the ileum. At this point the large intestines begin, and here is situated the ccecum, a blind pouch, or cul-de-sac, attached to which is the appen- dix vermiformis, a worm-shaped tube, of the size of a goose-quill, and from one to six inches long. The Colon, or large intestine, is divided into the ascending colon, the transverse colon, and the descending colon. The Ascending Colon rises from the right haunch-bone to the under surface of the liver, whence it bends inward, and crosses the upper part of the belly, below the liver and stomach, to the left side. This portion which crosses over is the transverse colon. From this point, on the left side, it turns down to the left haunch, and has the name of the descending colon. Here it makes a curve like the letter S, which is called the sigmoid flexure. The Rectum is the lower portion of the large intestine, terminal ing at the anus. The Lacteals are small vessels which begin in the villi, upon the mucous membrane of the small bowels. From here they pass be- tween membranes of the mesentery to small glands, from which larger vessels run to another collection of glands; and after passing, for a space, from one collection of glands to another, at each stage of their progress increased in size and diminished in number, the lacteals pour their contents into the thoracic duct. This having passed up through the diaphragm, out of the belly, makes a sudden turn downward and forward, and empties its burden into a large vein which ends in the right heart. Fig. 30: 1, is the bowel; 2, 3, 4, the mesenteric glands through which the lac- Fl °- 30 - teals pass ; 5, the thoracic duct ; 7, the spinal column ; 8, the diaphragm. By the help of a magnifying glass, an infinite number of these small vessels may be seen starting from the rough, shaggy internal coat of the bowel. 34 ANATOMY. The mesentery is a thick sheet of membrane, formed of several folds of the peritoneum, and spread out from the vertebrae like a fan. The bowels are attached to its edge, and are held by it in their place, and at the same time have free motion. Between its layers are a great number of glands, which sometimes become diseased and swol- len in childhood, and prevent the chyle from passing along to the thoracic duct. Thus affected, children are not nourished, and waste away with a disease sometimes called mesenteric consumption. The Liver is a large gland, lying under the short ribs on the right side, below the diaphragm. It is convex on the upper surface and concave on the under, and is composed of several lobes. Its office is to secrete bile. It weighs about four pounds, being the largest organ in the body. Fig. 31 represents the liver: 1, being the right lobe; 2, left lobe ; 3,4, smaller lobes ; 10, gall-bladder ; 17, the notch into which the spinal column is fitted. The GalNBIadder lies on the under side of the liver, and receives, it is supposed, the surplus bile, which is reserved for special occasions. It opens into the gall- duct, which carries the bile along, and pours it into the duodenum. The Pancreas, Fig. 32, is a long, flat gland, something like the salivary glands. It lies transversely across the back wall of the ab- domen, behind the stomach. It secretes a colorless, al- kaline fluid called the pan- creatic juice, the office of which is to emulsify the different classes of food, so that the lacteals can ab- sorb it. This fluid is car- ried by a duct, and poured into the duodenum just where the bile- duct enters. Fig. 32 The Spleen has an oblong, flattened form. It lies on the left side, just under the diaphragm, and close to the stomach and pancreas. It is supposed to be a reservoir for holding the surplus blood of the liver. It was thought by the ancients to be the seat of melancholy. The blood in passing through it loses a portion of its red globules. The Omentum or caul is a doubling and extension of the perito- neum. It is a kind of fatty body, which lies upon the surface of the ANATOMY. 35 bowels and is attached to the stomach. Its use seems to be to lubri- cate the bowels, and especially to protect and keep them warm. Hence it is often called the apron. The Urinary System. The organs of this system are devoted to separating the urine from the blood, and carrying it out of the body. These organs are the kidneys, the ureters, the bladder, and the urethra. The Kidneys lie one on each side of the backbone, in the lumbar region, behind the peritoneum. They are four or five inches long, and two and a half broad. They are in shape like the kidney-bean, and weigh about half a pound each. In the centre there is a bag called the pelvis, which tapers like a funnel, and unites with the ureter which conveys the urine to the bladder. The texture of the kidney is dense, presenting in its interior two structures, an external or cortical, and an internal or medullary. The cortical portion has the blood-vessels, the medullary is composed of tubes which carry away the urine. The Ureters are membranous tubes of the size of a goose-quill, and eighteen inches long, which run down the back wall of the abdo- men, behind the peritoneum, to the bladder, into each side of which they empty their contents. The Bladder is located in the pelvis, in front of the rectum. It is composed of three coats ; the external is serous, the middle muscular, and the internal mucous. The external coat is strong and fibrous ; the internal is drawn into wrinkles, which makes it thick and shaggy; it secretes a mucus which prevents it from being injured by the cor- rosiveness of the urine. The urine is retained in the bladder by means of a circular muscle, called a sphincter, which draws the mouth of the organ together. When the quantity of urine is so increased as to give some uneasiness or pain, this muscle, by a sort of instinct, relaxes and lets it out. The bladder is attached to the rectum, to the hip-bones, to the peritoneum, and to the navel, by several ligaments. In the female the bladder has the womb between it and the rectum. This organ is wisely provided as a receptacle for the urine ; which, without it, would produce a great inconvenience by being constantly dribbling away. The Urethra is a membranous canal which leads from the neck of the bladder. It is composed of two layers, a mucous and an elas- tic fibrous. Through this channel, which is curved in its course, the urine passes out of the body. 36 ANATOMY. The Respiratory Organs. These organs consist of the windpipe (trachea) ; divisions and subdivisions of the windpipe (bronchia); air-cells; and the lungs or lights. The Windpipe (trachea) extends from the larynx — the seat of the voice — to the third dorsal vertebra, where it divides into two tubes, called bronchia. It runs down the front part of the throat, with the oesophagus behind and between it and the spinal column. It is com- posed mainly of rings of cartilage, one above another. The Bronchial Tubes are, at the division of the windpipe, two in number, but they divide and subdivide until they become very nu- merous. The Air-Cells or Vesicles are small, bladder-like expansions at the ends of the tubes. They are elastic and swell out when the air passes in. The Lungs fill the greater part of the chest, the heart being the only other organ which occupies much space in the cavity. The size of these organs is large or small, according to the capacity of the chest. Each lung — for there are two — is a kind of cone, with its base resting upon the diaphragm, and its apex behind the collar-bone. They are concave on the bottom, to fit the diaphragm, which is con- vex on its upper side. The right and left lungs are separated from each other by a parti- tion called the mediastinum, formed by two portions of the pleura, a smooth serous membrane coming off from the spine and closely en- veloping each lung ; the heart, covered by the pericardium, lies in the centre, between them. The right lung is divided into three lobes ; the left into two. Each lobe of the lungs is divided into a great many lobules, which are connected by cellular tissue. These lobules are again divided into very fine air-cells. Besides these, the substance of the lungs is composed likewise of blood-vessels and lymphatics, and is well sup- plied with nerves. In the foetal state, before the lungs have been filled with air, they are solid and heavy, something like other flesh, but after all their cells have been filled with air, and breathing has been established, they are exceedingly light and spongy, and float upon water. In cases where infanticide is suspected, and where it is desirable to know whether the child was still-born, or born alive and killed afterwards, the specific gravity of the lungs, compared with water, will often settle the question. ANATOMY. 37 The Organs of Circulation. The food having been digested, changed to chyle, absorbed by the lacteals, carried to the veins, poured into the right heart, sent up to the lungs, and prepared for nourishing the body, will still be useless, if not distributed to every part of the system. The organs for ef- fecting this distribution are the heart, the arteries, the veins, and the capillaries. The Heart is placed obliquely in the chest, with one lung on each side, and is enclosed between the two folds of the mediastinum Its form is something like a cone. Its base is turned upward and back- ward in the direction of the right shoulder; the apex forward and to the left, occupying the space between the fifth and sixth ribs, about three inches from the breast-bone. It is surrounded by a membranous case or sac, called the pericardium. The heart is a muscular body, and has its fibres so interwoven that it is endowed with great strength. It is a double organ, having two sides, a right and a left, which are divided from each other by a mus- cular partition, called a septum. The right heart sends the blood to the lungs ; the left heart distributes it to the general system. Each side is divided into two compartments, an auricle and a ventricle. The Auricles have thinner walls than the ventricles, being only reservoirs to hold the blood until the ventricles force it along to other The Ventricles have within them fleshy columns, called columnce cameos. The walls of the left ventricle are thicker than those of the right, being required to contract with more force. Each of the four cavities will contain from one and a half to two ounces of blood. The Tricuspid valves are situated between the auricle and ventricle on the right side, and consist of three folds of a thin, triangular membrane. The mitral valves occupy the same position on the left side. Small white cords, called chordce tendince, pass from the floating edge of these to the columnse carnese, to prevent the backward press- ure of the blood from carrying the valves into the auricles. The pulmonary artery is the outlet of the right ventricle ; the larger artery, called aorta, of the left ventricle. At the opening of these arteries are membranous folds, called semilunar valves. Fig. 33 gives a fine view of the heart : 1, is the right auricle ; 2, the left auricle; 3, the right ventricle; 4, the left ventricle; 5, 6, 7, 8, fig. 33. 9, 10, the vessels which bring the blood to and carry it away from the heart. 38 ANATOMY. The Arteries are the round tubes which carry the red blood from the left side of the heart to every part of the body. The sides of arteries are stiff and hard, and do not fall together when empty. They may often be seen open in a piece of boiled beef. The arteries have three coats, — an external, which is cellular, firm and strong ; a middle, which is fibrous and elastic ; and an internal, which is serous and smooth, being a continuation of the lining of the heart. They are surrounded by a cell vestment called a sheath, which separates them from surrounding organs. The Pulmonary Artery starts from the right ventricle in front of the opening of the aorta, and ascends to the under surface of the aortic arch, where it parts into two branches, sending one to the right, the other to the left lung. Having divided and subdivided to a great extent, they end in the capillary vessels, uniting, joining their mouths, and becoming continuous with the pulmonary veins just where they pass around the air-cells. The Aorta is the largest artery in the body. It takes a slight turn in the chest, called the arch of the aorta, from which are given off the arteries which carry the blood to the head, etc. ; thence it descends into the belly along the side of the backbone, and at the bottom of the abdomen it divides into two arteries, called the iliacs — one going to each of the lower limbs. The branches the aorta gives off a supply of red blood to every part of the body. The Veins carry the dark or purple blood. Being made red and vital by meeting atmospheric air in the lungs, and then conveyed to every part of the body in the arteries, the blood loses its redness in the capillaries, and comes back to the heart in the veins, dark and purple, and unfit to support life. The veins are more numerous and nearer the surface than the arteries. They have, likewise, thinner walls, and when empty, they collapse or fall together. They begin in the small capillaries, and running together, they grow larger and larger, and finally form the great trunks which pour the dark blood into the right auricle. The veins are composed of three coats, simi- lar to those of the arteries, with the exception of being thinner and more delicate. These vessels have valves all along their inner sur- face, to aid in circulating the blood. The large vein which receives all the dark blood from above r and pours it into the right auricle, is called the vena cava descendens ; the one which takes it from below, and disposes of it in the same manner, is the vena cava ascendens. The pulmonary veins bring the red blood from the lungs to the left auricle, and thus are exceptional in their use, — being the only veins which carry red blood. The Capillaries are the extremely fine network of vessels between the ends of the arteries on the one side, and of the veins on the other. PI. 4. THE ARTERIES AND VEINS OF THE HUMAN BODY ANATOMY. 39 They inosculate, or join their mouths to the very small arteries at one end, and to the equally small veins at the other. They are the industrious little builders of the human frame. Receiving the blood, red, and full of life, from the terminal extremities of the arteries, they take the living particles out of it, and apply them to the renewing and vitalizing of the body, and then pass it along into the hair-like beginnings of the veins, dark and bereft of vitality, to be carried up for another freight of chyle, and to be again vitalized by being touched in the lungs by the breath of heaven. In Fig. 34 we have a good ideal illustration of the whole circu- lation. From the right ventricle of the heart, 2, the dark blood is thrown into the pulmonary ar- tery, 3, and its branches, 4, 4, carry it to both lungs. In the capillary vessels, 6, 6, the blood comes in contact with the air, and becomes red and vitalized. Thence it is returned to the left auricle of the heart, 9, by the veins, 7, 8. Thence it passes into the left ventricle, 10. A forcible contraction of this sends it forward into the aorta, 11. Its branches, 12, 13, 13, distribute it to all parts of the body. The arteries terminate in the capillaries, 14, 14. Here the blood loses its redness, and goes back to the right auricle, 1, by the vena cava descendens, 15, and the vena cava ascend- ens, 16. The tricuspid valves, 17, prevent the reflow of the blood from the right ventricle to the right auricle. The semi- lunar valves, 18, prevent the blood from passing back from the pulmonary artery to the right ventricle. The mitral valves, 19, prevent its being forced back from the left ventricle to the left auricle. The semilunar valves, 20, pre- vent the backward flow from the aorta to the left ventricle. By a careful examination of this diagram, with these explanations, the reader may understand the circulation very well. The passage of the blood from the right heart, through the lungs, and back to the left heart, is called the lesser, or pulmonic circulation ; its passage from the left heart through all parts of the body, and back to the right heart, is the greater or systematic circulation. fig. 34. 40 ANATOMY. The Absorbent Vessels. The vessels which absorb the chyle from the small intestines, and convey it onward towards the blood, are the lacteals. They have been described. The veins are also supposed to have the power of absorption, particularly the small commencements of the veins. These have likewise been de- FIG - ^ scribed. The Lymphatic vessels resemble the lacteals. They abound in the skin, the mucous membranes, and the lungs. They are very small at their origin, and, like the veins, they in- ^KSB^ ,a crease in size, as they dimin- B>i7 ish in numbers. Like the veins, too, they travel to- wards the heart, and their Fig. 36. Fig. 37. contents are poured into it. Their walls are composed of two coats ; the external is cellular, and distensible ; the internal is folded into valves, like that of the veins. These vessels, on their way to the heart, pass through soft bodies, called lymphatic glands, which bear to them the relation that the mesenteric glands do to the ANATOMY. 41 lacteals. These glands are a collection of small vessels. The lymphatic glands are most numerous in the neck, chest, abdomen, arm-pits, and groins. They are also found, to some extent, in other parts of the body. Fig. 35 shows a single lymphatic vessel, much magnified; Fig. 36 exhibits the valves along one of the lymphatic trunks ; Fig. 37 shows a lymphatic gland with the vessels passing through it. Fig. 38 represents the lymphatic vessels and glands. 1, 2, 3, 4, 5, 6, show these vessels of the lower limbs ; 7, the inguinal glands ; 8, the commencement of the thoracic duct, into which the contents of lymphatic are poured ; 9, the lymphatics of the kidneys ; 10, those of the stomach; 11, those of the liver; 12, 12, those of the lungs ; 13, 14, 15, those of the arm; 16, 17, 18, those of the face and neck ; 19, 20, the large veins ; 21, the thoracic duct; 26, the lymphatics of the heart. A cold will* often cause lymphatic glands to swell. These swell- ings are called kernels. They often swell, also, without the irritation from cold, and become very much and permanently enlarged, particu- larly in scrofula. In scrofulous subjects they sometimes suppurate and break, forming bad sores upon the neck. The Organs of Secretion. The exhalants, the follicles, and the glands are the organs of secre- tion. The Exhalants are the sweat-glands. These have external termi- nations upon the skin, thus communicating with the air, and internal terminations upon the surfaces of organs not having an outward ex- posure. The Follicles are small sacs, located in the true skin and mucous membranes. The pores of the skin are the mouths or outlets of these little bags. Veins and organic nerves are sent to these vessels. Glands are soft organs, having a variety of structure, and perform ing many kinds of secretion. A gland is made up of several lobules, united in one mass, and each of these lobules has a small duct, communicating with a main duct which forms the outlet. Fig. 39 shows a gland ; 2, the small ducts spread through its body, and running together; 1, the large duct, through which the secreted substance is carried away. The mesenteric and lymphatic glands merely modify the fluids which pass through them ; others secrete from the blood either fluids to be used in the body, or such as are to be cast away. 42 ANATOMY. The Vocal Organs. No sounds touch the heart like those of the human voice, for no mechanic, however scientific and skilful, has ever been able to make an instrument which could produce sounds as beautiful, tones as varied, a timbre as melodious, and inflexions as manifold and agree- able. It has been compared to wind, reed and stringed instruments. In touching expression, it is most resembled by the concert-horn, the bassoon, and the hautboy. Vocal sounds, past all question, are produced in the larnyx, but these sounds are grouped, or formed into articulate speech, by the pharynx, the nasal cavities, the tongue, the teeth, etc. The Larynx is a kind of cavity or tube at the top of the windpipe, formed by the union of five cartilages, namely, the thyroid, the cricoid, the two arytenoid, and the epiglottis. Ligaments bind these together, and muscles move them. The Thyroid Cartilage is composed of two parts, and has a con- nection with the bone of the tongue above, and with the cricoid car- tilage below. The Cricoid Cartilage is shaped like a ring, and hence its Greek name. It is narrowest in front, and broadest behind. It connects with the thyroid cartilage above, and with the first ring of the trachea below. Fig. 40 gives a side view of the car- tilages of the larynx : 1, bone at the base of the tongue (os hyoides) : 2, the ligament con- necting hyoid bone and the thyroid cartilage ; 3, the front of the thyroid cartilage ; 4, the thyroid cartilage ; 6, the cri- coid cartilage ; 7, the wind- ^° ' Fig. 41 is a back view of the cartilages and ligaments of the larynx : 1, is the back surface of the epiglottis ; 3, 3, the os hyoides ; 4, 4, the lateral ligaments connecting the os hyoides and the thyroid cartilage ; 5, 5, the back face of the thyroid cartilage ; 6, 6, the arytenoid cartilages ; 7, the cricoid cartilage ; 8, the first ring of the windpipe. The Arytenoid Cartilages are upon the back part of the cricoid, and are connected with the thyroid cartilage by the vocal cords. The Epiglottis is a fibro-cartilaginous lid, shaped like a leaf, which covers the upper opening of the larynx. It is connected by a carti- FlG. 41. ANATOMY. 43 lage to the bone of the tongue (os hyoides) and to the thyroid carti- lage. Breathing opens and shuts it ; and in swallowing, it closes down upon the top of the larynx, to prevent food and drink from passing down the windpipe. The Vocal Cords are two ligaments, formed of elastic and parallel fibres, enclosed in a fold of mucous membrane. They are about two lines in width, and inserted behind into the anterior projection of the arytenoid car- tilages, and passing forward, are fixed to the anterior angle of the thyroid. There are four ligaments crossing the larynx, two superior and two inferior, — the lat- ter being called vocal cords. The interval between them is the glottis. The liga- ments themselves are sometimes called the lips of the glottis. The depression be- tween the superior and inferior ligaments is the ventricle of the larynx. Fig. 42 represents a view of the larynx from above : . a, 5, c, the thyroid cartilage, enclosing the ring of the cricoid ; A, A, e, e, the arytenoid cartilages connected by the trans- verse arytenoid muscle ; t, i, the vocal cords ; o, 0, the crico-arytenoid ligaments. The muscles which are attached to the cartilages have the power of pulling them about so as to change in various ways the shape of the laryngeal cavity ; to enlarge or diminish the size of the glottis • and to relax or tighten the vocal cords. By these means, and some others, the sounds of the voice receive their various modifications. Tightening the cords, for example, raises the pitch. The Skin. The skin is a membrane composed of two layers, covering the entire person. The outer layer is the scarf-skin or cuticle ; the inner is the true skin or cutis or corium. These layers differ in their struc- ture and uses. The Scarf-Skin, called also cuticle and epidermis, is a thin mem- brane, partially transparent, like a thin shaving of horn. Having no blood-vessels or nerves, and consequently no feeling, it appears to be a simple covering to protect the true skin from injury by external agents. It is thickest on those parts most exposed to friction. The scarf-skin is the production of the true skin, — an exudation from it in the shape of a fluid which is spread out as a thin layer, and dries up into flattened scales. The cuticle is composed chiefly of these scales, and is constantly being rubbed off as scurf, while new layers are forming underneath. 44 ANATOMY. The lower, softer layer of the scarf-skin, called the malpighian layer, or rete mucosum, is the seat of color. In this part the cells contain a pigment incorporated with the elementary granules, which gives to the various races their several shades of color. The depth of hue is dependent entirely on the amount of this coloring matter. The True Skin, which is called cutis, derma or corium, is a kind of web, woven of small fibres collected into strands. In the upper por- tion, the web is line and firm, but grows coarser below. Connected / / / wmmmmmm. Fig. 43. Fig. 44. with its under surface is a fibrous web in which the fat is deposited. Upon its upper surface is the sensitive or papillary layer, composed of blood-vessels and nerves, doubled into loops, which give little prominences called papillae. Fig. 43 gives an ideal view of these elevations, composed as they are, of a nerve, an artery, and a vein, lying side by side ; 1, 1, represent the true skin; 2, 2, the papillary layer; 3, 3, the arteries; 4, 4, the veins; and 5, 5, the nerves of the papillae. The arteries, veins, and nerves are spread over the true skin in great numbers, — so pro- fusely, that it is impossible to push the point of the finest needle into it, without piercing a blood-vessel and a nerve. Fig. 44 gives a view of the skin : a, a, the cuticle ; 6, 6, the colored layer of the cuticle ; c, . Great and unnatural boldness " Insanity or delirium. 6. Great and unusual languor " The beginning of an acute disease, or the progress of a chronic one. 7. Ability to lie only upon the back " Apoplexy. Organic disease of the brain or spinal marrow. Acute inflamma- tion of the lining of the abdomen. Rheumatism of the joints. 8. Lying upon the face " Several kinds of colics. 9. Lying upon one side " Pleurisy, or inflammation of the lungs. When one lung only is affected in consumption, the patient generally lies on the diseased side. TEMPEKAMENTS, CONSTITUTION, AND SYMPTOMS. 127 10. Maintaining the sitting posture indicates only 11. The head thrown back " 12. Eestlessness and tossings 13. General enlargement of the body " Disease of the heart or lungs, which interferes with breathing. Severe diseases of the larynx and wind- pipe. The beginning of acute inflammation. Fevers. Delirium, and acute mania. Cell-dropsy. Emphysema from a wound of the chest. Head, Face, and Neck, 1. Head bent to one side 2. Head increased in size 3. Swollen scalp 4. Dull expression of face 5. Full, red face, with blood-vessels of eyes injected 6. Pinched, contracted countenance 7. Pinched nose, sunken eyes, hollow temples, skin of forehead tense and dry, complexion livid 8. Wrinkles across the forehead 9. Wrinkles from forehead, vertically to root of nose 10. A white line from inner angle of the eye to just below the cheek- bone 11. White line from the upper border of the wing of the nose (alanasi), curved to the outer margin of the orb of the eye 12. The white line in children from angle of mouth to lower part of face 13. A white line external to the last two, in a semicircular direction towards the chin 14. Swelling of the face and eyelids 15. Transient redness or flushing of face 16. Hectic flush 17. Paleness of face 18. Dingy, white, or greenish face 19. Yellow tint 20. A citron tint 21. A bluish tint 22. Perpetual motion of eyelids 23. Forcible closure of eyelids 24. Eyelids remaining open 25. Palsy of the upper lid 26. Flowing of tears over the cheek 27. Nostrils dilating forcibly and rap- idly 28. Itching of nostrils in children indicates Convulsions. Paralysis of one-half the body. Dislocation of bones of neck. Swelling of glands of neck. Chronic hydropholus. Enlarged brain. Erysipelas. Small-pox. Typhoid fever. Swelling of heart. Congestion of brain. Acute inflammation of peritoneum. Exposure to severe cold. Chronic disease just before death. Excessive pain arising externally. Distress, anxiety, and severe internal pain. In children, a brain or nervous affec- tion ; in adults, abuse of the genera- tive organs. In consumption and wasting of flesh. The lower part of the line indicates disease of stomach ; the upper part, some affection of upper part of bowel. When united with the white line named above, and with a drawing in of the cheek, fixed eyes, and a wan complexion, it implies worms. An affection of the chest, with diffi- culty of breathing. Chronic and obstinate chest or belly. disease in the Albumen in the urine. Suffering from the monthly irregular- ity. Consumption. Chronic affections. Cold stage of fever. Acute inflamma- tion. Chronic diseases, especially Bright's disease, during recovery. A low and deficient state of blood. Jaundice. Cancerous disease. Poor circulation in the veins. Cholera. Typhus fever. Blue disease. Mania and idiocy. Intolerance or dread of light. Orbicularis palpebrarum. Paralysis of the muscle which closes the eye. Injury of the third pair of nerves. Obstruction of the lachrymal duct. Difficulty of breathing. Worms in the bowels. The Tongue. Surface of tongue covered with a indicates layer of whitish, soft, mucous substance, which may partially be taken off with a scraper, — also, clammy mouth Derangement of stomach both. or bowels, or 128 TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 2. State of tongue as above, with clammy mouth, bitter taste, and fetid breath. 3. Great load on tongue as above, which peels off, leaving the tongue smooth, red and tender 4. Tougue slightly white from small white points, and sometimes cov- ered with fur, like the fibres of coarse velvet 5. Tongue pale, tumid, clean and very smooth 6. Tongue furred and dry 7. Tongue white and loaded, with much thirst 8. As above at first, — afterwards clean, red, and dry 9. Tongue white and loaded, with dry- ness 10. Tongue dry., parched, tender, and dark brown or black. Pushed out with great difficulty and tremb- ling 11. Tongue loaded with white, through which numerous elongated, very red papillae protrude their points indicates Acute dyspepsia. Asthma. 11 Severe cases of acute dyspepsia. Chronic dyspepsia. Some affection of the liver, if the fur be yellow. Chlorosis or green sickness. Violent local inflammation. Irritation in bowels. Inflammatory fever. Protracted inflammatory fever. Mild typhus fever. Severer forms of typhus fever. Scarlet fever. The Throat, 1. Throat enlarged 2. Violent pulsation of carotid arteries 3. Pulsation of the nameless artery (arteria innominata) above the breast bone, and to the right of the windpipe. 4. Circumscribed swelling about throat indicates The approach of puberty in females. " Acute mania. Inflammation of brain. Enlargement of heart, and dilation of right ventricle. Anemia. " Regurgitation from aorta. Enlargement of glands. 1. General enlargement of one side of chest 2. Bulging at the base of a lung 3. Bulging at front upper part of chest 4. Bulging right hypochondrium (See Fig. 95) 5. Bulging in region of heart 6. Tumor where the third rib joins the breast-bone 7. Tumor between the base of the shoulder blade and the spine 8. Depression or retraction of one side of chest 9. Breathing increased in rapidity. Generally, in health, about twenty breaths are taken in a minute 10. Breathing diminished in rapidity 11. Jerking respiration 12. Breathing with muscles of ribs only The Chest. indicates Large effusion of water from pleurisy. Water from pleurisy settling to the bottom. Emphysema. Enlargement of liver. Water in heart-case. Enlargement of heart. Aneurism of the ascending aorta. Aneurism of the descending aorta. Consumption. Absorption of fluid, effused by pleurisy. Spasmodic asthma. Pleurisy. Paralysis of respiratory mus- cles. Inflammation of lungs. Emphy- sema. Pneumothorax. Consumption. Spasmodic asthma. Obstruction in larynx and windpipe. Abdominal inflammation. Inflamma- tion of diaphragm. 1. Decreased size of belly The Belly. indicates Dropsy. Wind in bowels. Inflam- mation of peritoneum. Obstruction in bowels. Hysteria. TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 129 2. Enlargement in epigastrium (Fig. 93) indicates Hysteria. Cancer of stomach. 3. Enlargement in hypogastrium (Fig. 95) " Distension of bladder. Ovarian tu- mors. Accumulation of feces in bowels. 4. Belly diminished in size " Chronic dysentery. Lead colic. Also in most chronic diseases. 1. Enlarged penis in children 2. Drawing up of testicles 3. Enlargement of scrotum Private Organs. indicates Stone in bladder. Masturbation. Stone in kidneys. Hydrocele. Hematocele. Saroeele. 1. The limbs immovable 2. Limbs contracted and rigid 3. General swelling of limbs 4. Swelling of joints 5. Limbs diminished in size The Limbs. indicates Paralysis. " Softening of the brain. Defective circulation of blood. " Rheumatism. Water in the joints. White swelling. " Paralysis. The Nervous System, 1. Morbidly increased sensation 2. Tensive pain 3. Dull, heavy pain 4. Smarting pain 5. Shooting, tearing pains 6. Boring pains 7. Contusive pains. 8. Itching. Sensation as of ants creep- ing over the skin 9. Exaltation of vision 10. Black flecks floating before the eyes 11. Painfully acute hearing 12. Dull hearing 13. Increase of strength 14. Debility 15. Trembling 16. Rigidity of upper extremities 17. Cramp 18. Temporary spasm 19. Pain at extremity of penis 20. Pain in right shoulder 21. Pain in left shoulder 22. Exaltation of affections 23. Loss of moral sensibility 24. Exaltation of intellect indicates Acute inflammation of brain and spinal marrow. Fevers. Hysteria. Phlegmonous inflammation. " Enlarged internal organs. Internal tumor. Effusion of water into cavi- ties lined with serous membranes. Felt in the loins previous to dis- charge from menstruation, and from piles. Scarf-skin removed. Neuralgia. Cancer. Constitutional syphilis. Rheumatism. Gout. Inflammation of periosteum. " Bruises. Acute diseases. " Several diseases of the skin. Ophthalmia. Inflammation of brain. Some nervous diseases. Affections of the brain and optic nerve. Dyspepsia. Inflammation of brain. Hysteria. Typhus fever. Delirium. Inflammation of brain. Mania. Most diseases. Cold stage of fever. Nervous affec- tions. Old age. Action on the sys- tem of lead, mercury, strong coffee, alcoholic drink, tobacco, opium. Softening of the brain. Infiltration of blood into the brain. Hysteria. Pregnancy. Hysteria. Painters' colic. In convulsions of children. Some affections of the brain. Stone in bladder. Congestion of liver. Disordered stomach. Hypochondriasis. Mania. Typhus fever. Masturbation. Melancholy. Sometimes indicates close of life. 1. Stiffness of chest 2. Pressure upon parts The Breathing. indicates Cartilages turned to bone. Pleura hardened. Distortion from rickets. " Tumors. Dropsy of belly. 130 TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 3. Obstruction of air-tubes 4. Compression of lungs 5. Pain in parts moved in breathing 6. Paralysis of muscles of chest 7. Spasm of muscles of chest 8. Deficiency of red blood indicates Spasm of glottis. Spasm near the small ends of bronchial tubes. Mucus, etc., thrown out upon the inner surface. " Effusions in pleurisy. Water in chest. Air in substance of lungs. Aneurism and other tumors. " Pleurisy. Inflammation of perito- neum. " Injury of spinal marrow. " Locked jaw. Spasmodic asthma. " Anaemia. Chlorosis or green sickness. 1 . Hollow and barking cough 2. Sharp, ringing cough 3. Hoarse cough 4. Wheezing cough 5. Belching cough (i. Cough in paroxysms 7. Cough sounding harsh and concen- trated when listening with the stethoscope. 8. Cough sounding hollow, when lis- tening with the stethpscope, as though it came from a cavern. 9. Cough having a metallic or ringing sound when listening with the stethoscope. The Cough. indicates Last stage of consumption. Clironic bronchitis. Some nervous affections. ' ' Croup. Beginning of cold. Chronic laryn- gitis. " Asthma. " Some diseases of larynx. Hooping cough. Hysteria. " Consumption. Inflammation of the lungs. Pleurisy. Enlargement of bronchial tubes. " Tuberculous cavity. Enlarged bron- chial tubes. Large tuberculous cavity. The Expectoration. 1 . Scanty expectoration 2. Copious expectoration 3. Watery expectoration 4. Mucous expectoration 5. Expectoration of pus 6. Expectorated matter shaped like coin (nummular) 7. Muco-purulent, floculent expecto- ration 8. Tubular expectoration <». Whitish or greenish expectoration, that clings to the vessel 10. Yellow expectoration 11. Rusty expectoration 12. Putrid smell of expectoration 13. Faint and sweetish smell of expec- toration. 14. Expectoration smelling like garlic indicates First stage of acute diseases of the lungs. " Decline of acute diseases of air-passages and lungs. " Beginning of bronchitis. Congestion of lungs. Vesicular emphysema. " Bronchitis. Inflammation of lungs. " Consumption. Third stage of inflam- mation of lungs. " Tubercular consumption. Bronchitis of measles. " Consumption far advanced. Plastic bronchitis. Pneumonia. " Acute affections of lungs, particularly bronchitis " Chronic bronchitis. Other chronic af- fections of the lungs and throat. " Inflammation of the lungs. " Gangrene of the lungs. " Bronchitis. First stage of consumption. " Broncho-pleural fistula. Pain. 1. Dull, heavy, aching pain at the indicates Acute bronchitis. base of the chest 2. Soreness about the breast bone, and " Acute bronchitis. between the shoulders 3. Sharp, sudden, tearing pain below " Pleurisy. the nipple 4. Pain darting from front part of " Consumption. chest to between shoulder blades 5. Constant pain between the shoulders " Consumption. Green sickness. chronic diseases. Other TEMPERAMENTS. CONSTITUTION, AND SYMPTOMS. 131 The Pulse. 1. Strong pulse, resisting compression indicates by the finger 2. Weak pulse, easily pressed down " 3. Full pulse, as if the artery were in- creased in size 4. Small pulse, opposite of full 5. Hard, sharp, contracted pulse, — vi- brating like a cord under the finger 6. Soft pulse, yielding readily to pres- sure 7. Frequent pulse 8. Slow pulse Inflammatory affections, especially of the substance of large organs, as the liver, etc. Prostration from disease. Nervous and chronic affections. Fear. Diseases of women and children, and old per- sons. Congestion of brain. Apoplexy. Dis- ease of heart. Inflammation of stomach, bowels, bladder, etc. Hysteria, and other nervous affections. Inflammation of membranes. Active bleedings. Lead colic, etc. Affections characterized by debility. Inflammatory diseases. Hemorrhages. Apoplexy. Sometimes in disease of heart. Relating to Digestion. 1. Tongue trembling and dry, and di- minished in size 2. Voracious appetite 3. Diminished appetite 4. Increased thirst 5. Thirst gone 6. Vomiting 7. Pain increased by pressure 8. Pain relieved by pressure 9. Urgent desire to go to stool 10. "Watery stools 11. Mucous stools, like white of egg 12. Hard and lumpy stools 13. Clay-colored stools 14. Yellow or dark-brown stools 15. Dark-green stools 16. Stools red, and streaked with blood 17. Pitchy black stools 18. Stools pure blood, with no colic 19. Stools like rice-water 20. Black stools 21. Shreds of false membrane in stools 22. Fat with stools 23. Fetid stools indicates Typhoid and other low fevers. Pregnancy. Hysteria. Insanity. Some- times in dyspepsia. " In most acute diseases. ' ' Acute affections of stomach and bowels . " Cerebral disease, with coma. " Early pregnancy. Colic. Disease of brain. Inflammation of stomach. Hernia. Inflammation of internal organs. " Over-distension of bowels. Neuralgia. Colic. Dysentery. Sometimes in diarrhoea. Diarrhoea. Cholera. " Chronic inflammation of colon. " Constipation. Colic. Cancer of stom- ach. Deficiency of bile. " Too much bile. 4i Bile from children after taking cal- omel. " Dysentery. " Melaena. " Bleeding piles. - Asiatic cholera. Iron taken in medicine. " Dysentery. Diarrhoea. Worms. " Diabetes. Consumption. " Diseases attended by debility. The Urine. 1. Diminished secretion of urine 2. Retention of urine in the bladder 3. Urine increased in amount 4. Red or yellow sand deposits in urine (uric acid) 5. "White sediment in urine (earthy phosphates) 6. Oxalate of lime deposits in urine 7. Blood in urine 8. Albumen in urine 9. Mucus in urine 10. Sugar in urine indicates Dropsy. Inflammatory and febrile diseases. " Paralysis. Typhoid fever. Hysteria. " Diabetes. Cold stage of fevers. Hy- steria. Various passions of the mind. " Fevers. Acute Rheumatism. Con- sumption. Dyspepsia. Great indul- gence in animal food. " Depressed state of the nervous system, of serious import. " Derangement of digestion. " Bleeding of kidneys, etc. " Bright's disease. " Inflamed mucous membrane of ure- " thra, bladder, etc. " Diabetes. 132 TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 1 • Profuse perspiration 2. Diminished perspiration Night sweats Sour-smelling sweat Fetid smelling sweat Sweat with mouldy odor Smelling like ammonia Sweat having the odor of mice Sweat smelling like rottenstone The Perspiration. indicates Acute rheumatism. Decline of acute " inflammations and fevers, being sometimes critical. " Early stage of acute disease. Dropsy. Diabetes. " Consumption. " Rheumatism. Gout. Some debilitating fevers. " Measles. Scarlet fever. " Typhoid fever sometimes. " Insanity. " Miliary. The Temperature, 1. General heat of surface 2. External local heat 3. Hot forehead 4. Hot scalp f 5. Skin of chest hot I 6. Hands and feet hot. 7. Acrid heat, burning the hand when applied 8. Chills 9. Low temperature 10. Cold hands and feet indicates Fevers. " Inflammation. " Headache. " Disease of brain. " Inflammation in chest. " Consumption. " Typhus fever. " Beginning of fever. " Poor circulation. " Nervous diseases. Dyspepsia, state of the blood. Impure The Temperature of the Body. The use of the thermometer is an important addition to the means of making physical examination, and is one of the improvements in modern medicine. It is intended to measure the heat of the body. The best kind now in use is the self-registering. The bulb of the instrument is to be placed in the warmest part of the body, and should be allowed to remain there for eight to ten minutes. Some place it under the tongue ; some in the axilla. Sometimes it is necessary to introduce it into the rectum or vagina. In these parts the temperature is a degree higher than in other parts. The normal temperature of the body is from 98° to 99° Fahrenheit, in the great majority of persons. Exceptionally it may be half or a whole degree either above or be- low this range. The normal fluctuations are inconsiderable in comparison with the variations of disease. The natural variations in health are as follows : The temperature is at its minimum at five o'clock a. m. ; the maximum is reached in the latter part of the afternoon, and then decreases till five o'clock A. M. By means of the thermometer we are able to determine all differ- ences with precision. TEMPERAMENTS, CONSTITUTION, AND SYMPTOMS. 133 The increase of heat in different febrile diseases rarely exceeds 110° Fahrenheit, and as a rule the amount of increase is a criterion of its severity. An increase to 100° Fahrenheit or 101° is evidence of mildness of the disease. If the thermometer indicates steadily 105° Fahrenheit, it is certain that the disease is severe. A persisting temperature above 105° Fahrenheit denotes that there is great danger, and an increase to 108° to 110° Fahrenheit is usually a fatal sign. The abnormal changes of temperature consist of more or less in- crease. Diminution below the normal standard is comparatively rare ; yet it sometimes occurs and is of some importance. In the course of typhoid fever, a sudden decrease may indicate in- testinal hemorrhage. Sometimes the temperature falls without im- provement in the other symptoms. This is an unfavorable symptom. The value of thermometric changes depends in no small measure upon the symptoms with which they are associated. SKIN DISEASES. The skin is the soft and pliant membrane which covers the entire surface of the body. The interior, like the exterior is likewise covered by a skin, which, from its always being moist, is called a mucous membrane. At the various openings of the body, the outer and the inner skins are united, — forming one continuous skin, — like the same piece of silk turned over the border, and covering both the out- side and inside of a bonnet. From this continuity or oneness of the skin and mucous membrane springs an important medical law, namely, that a disease of the skin may spread to the mucous membrane, and a disease of the mucous membrane may spread to the skin. We see this illustrated by the breaking out around the lips which follow colds, and the itching of the nose of children when the mucous membrane of the bowel is irri- tated by worms. The Skin is Composed of Two Layers. — These are separated from each other by the action of a blister. The thin portion which is raised up by the fluid of a blister is called the scarf skin, the cuticle, or the epidermis ; that which remains in connection with the body is the sensitive skin, the cutis, the derma, or the true shin. The two skins have very different offices to perform. The scarf-skin is horny and insensible, and serves as a sheath to protect the more sensitive skin under it. Were the scarf-skin taken off, we could not bear to have anything touch us. The derma, or true shin, and its glands, etc., are the seat of all the cutaneous diseases. These maybe separated into four great divisions, — namely, diseases of the true shin, diseases of the sweat glands and tubes, diseases of the oil glands and tubes, and diseases of the hairs and hair glands. Then the diseases of the true skin are divided into Inflammation of the true shin ; Enlargement of the papilla* of the true shin ; Disorders of the vessels of the true shin; Disorders of the sensibility of the true shin ; Disorders of the color-producing function of the true shin. The inflammation of the true skin is conveniently divided into two groups, — namely, Such as are marked by inflammation of the derma and mucous membranes, with constitutional symptoms of a specific hind, and 134 ,0--.., J 1 ^«fc ¥£ i *f ' ^ ;vl **%■ 3 ;.#■ / \ / •xi SKIN DISEASES. 135 Such as are distinguished by inflammation of the derma, without constitutional symptoms of a specific kind. Congestive Inflammation of the True Skin. The First of these Groups, — those characterized by inflammation of the cutis, ivith constitutional symptoms of a specific kind, — embraces measles, scarlet fever, varioloid, and coiv-pox. Measles. — Rubeola. Measles is an acute inflammation of the entire skin, both external and internal, associated with an infectious and contagious fever. Symptoms. — The disease sets in with chills, succeeded by burning heat, listlessness, languor, drowsiness ; pains in the head, back, and limbs ; frequent pulse ; soreness of the throat ; thirst, nausea, vomit- ing, frequent dry cough and high-colored urine. These symptoms increase in violence for four days. On the third day the eyes become inflamed, cannot bear the light, and pour fourth a profusion of tears. This last symptom is called coryza. The nose likewise discharges a large quantity of watery secretion, and sneezing is frequent. The larynx, windpipe, and bronchial tubes become inflamed, and hoarse- ness, soreness of the breast, etc., are the result. The redness of the skin and breaking out appear about the fourth day, and produce heat and itching. This breaking out is character- ized by a patchy redness, which, on close inspection, is found to con- sist of numberless minute red points and pimples, collected into patches in the shape of a half or quarter moon. They appear first on the forehead and front of the neck, then upon the cheeks and around the nose and mouth. On the fifth day they reach their height in this region, and then appear upon the body and arms, and on the sixth day, upon the legs. The color of the skin, when the inflammation is at its height, is of a bright raspberry red. The decline of the rash takes place in the same order in which it comes out. The redness fades on the sixth day upon the face ; on the seventh, upon the body and limbs ; on the eighth, upon the back of the hands. The coryza, the hoarseness, and the cough, decline about the seventh day, while a diarrhoea comes on about the eighth or tenth, — showing that the in- flammation of the mucous membrane is subsiding. When the inflam- mation disappears, the whole scarf-skin peels off in the form of a scaly scurf. The artist has given a good picture of the disease in the beautifully colored lithograph, Plate I, Fig. 1. Treatment. — When the disease is mild and regular in its course, scarcely anything will be required, except mild diet, slightly acid drinks, with flax-seed tea, slippery elm, or some equivalent, to quiet the cough. Sponging with tepid water, if done with frequency, mod- erates the fever, and adds to the comfort of the patient. If the fever 136 ' SKIN DISEASES. runs high, take half an ounce of rochelle salt, and use recipe 125. Should the eruption "strike in," apply leeches or cups over the in- ternal organ affected, if any, and recall the rash by sweating. Those who have been exposed to the contagion, and are liable to have the disease, should avoid all unnecessary exposure to wet or co ld, — keeping the feet warm and dry, and the whole body well clad. With these precautions, and a mild, unstimulating diet, much of the force of the disease may be broken. During the first stages of the disease, bathing the feet once or twice a day with hot water, and freely using warm, sweating drinks, as saffron, summer-savory, pennyroyal, balm, and mullein tea, and put- ting mustard drafts to the feet, will hasten the coming out of the eruption. Should the breaking out be delayed by excessive fever, give full doses of tincture of veratrum viride, or nauseating doses of ipecac, antimony, lobelia, or hive-syrup, and teaspoonful doses of compound tincture of Virginia snake-root. Besides the milder forms of the disease, cases occur, chiefly in broken-down constitutions, in which the rash delays its coming out till the seventh day, and is then mingled with dark and livid spots, which remain, often, for ten or twelve days. The fever is of a low, typhoid kind, and the patient is extremely weak and languid. In this condition of things, the -patient must be supported by tonics (77 and 59), and whisky, and expectoration promoted by some appro- priate remedy, if required. If at any stage of the disease there should be fixed pain in any part of the chest, which is made worse by coughing, or by taking a full breath, we may conclude there is some inflammation of the chest ; and it must be treated as directed for pneumonia. Scarlet Fever. — Scarlatina. This is likewise an acute inflammation of the entire covering of the body, both external and internal, connected with fever which is infectious and contagious. Symptoms. — The fever comes on somewhere between the second and tenth day after exposure. On the second day of the fever, the eruption comes out in the form of very small points and pimples, which appear either in patches, or constitute a general redness, of a bright scarlet color. In Plate I, Fig. 2, the artist has given a fine picture of the disease. The disease begins with languor, pains in the head, back, and limbs, with drowsiness, nausea, and chills ; and these are followed by heat, thirst, etc. When the redness appears, the pulse is quick, and the patient is anxious, restless, and sometimes delirious. The eyes are red, the face swollen, the tongue covered in the middle with white mucus, and is studded with elevated points of extreme redness. The SKIN DISEASES. 137 tonsils are swelled, and the throat red. The greatest degree of red- ness is reached on the evening of the third or fourth day from its be- ginning, when a gentle moisture appears, the disease begins to decline, with itching, and the scarf-skin falls off in branny scales. A swelling or puffiness of the flesh, which spreads out the fingers in a singular manner, seems to be peculiar to scarlet fever. In the first stage of the complaint, the tongue, as stated above, is covered with a fur ; but as it advances, the tongue often becomes suddenly clean, and presents a glossy, fiery-red surface, which is sometimes, with the whole lining of the mouth, raw and tender. It is peculiar in this complaint, that the inflammation of the throat always runs into a state of ulceration. As far as can be seen, on pressing down the tongue, the throat is swollen and of a deep, florid red; and on the tonsils may be seen white or gray ulcers. This makes swallowing very difficult, and aggravates the sufferings of the patient. The great amount of mucus in these parts causes also a continual rattling in the throat. The eustachian tube, which extends up to the ear, is apt to get involved in the inflammation, and cause swelling and pain in that region. The glands under the ear and jaw sometimes inflame, and after a time they oc- casionally break. Abscesses formed in the ear frequently produce some deafness which is not easily cured. In the cell-dropsy, which sometimes appears after scarlet fever, the crystals of urate of ammonia may often be found in the urine with the microscope (Fig. 72). This disease resembes measles, but may fig. 72. be distinguished from it by the absence of cough ; by the eruption being finer, and of a more scarlet color (see plate) ; by the rash coining out on the second day instead of the fourth ; and by the ulceration in the throat. Treatment. — In ordinary cases, the treatment should be very simple. The apartment should be kept cool, and the bed-covering light. The whole body should be sponged with cool water as often as it is hot and dry, and the patient be permitted to take cooling drinks. Besides this, in many cases, very little is needed, except to give a few drops of the tincture of belladonna, night and morning. In some cases where there is a good deal of fever and soreness of throat, give tincture of veratrum (125) often enough to keep down the pulse. Give every half hour (an adult) till pulse reaches sixty. Aconite in drop doses to children every fifteen minutes. In addi- tion to this, the feet and hands should be soaked in hot water, with a little ground mustard, or pulverized cayenne, stirred in. This bath should be continued twenty minutes, twice a day, for two or three days. 138 SKIN DISEASES. The cold stage having passed, and the fever set in, warm water may be used without the mustard, etc. If the head be affected, put mustard drafts upon the feet. Should the bowels be costive, they may be gently opened by some very mild physic. No solid food should be allowed ; but after the first shock of the disease is passed, drinks, in reasonable quantities, Avill be advisable, — such as cold water, lemonade, barberry and tamarind water, rice water, balm or flax-seed tea, and some thin water-gruel. To promote the action of the skin, the spirits of nitre, with other articles (125), adapting the dose to a child, will be found useful. The nitrate of potash is useful, given in one to three-grain doses, dissolved in water, every three or four hours. Muriatic acid, forty-five drops in a tumbler filled with water, and sweetened, and given to a child in teaspoonful doses, is a good remedy. In very violent attacks, the system sometimes inclines to sink im- mediately ; typhoid symptoms show themselves ; there is great pros- tration ; the eruption strikes in ; the skin changes to a puiple or mahogany color ; the tongue is of a deep red, or has a dark-brown fur upon it, and the ulcers in the throat become putrid. This is called scarlatina maligna ; but it is only a severer form of the same disease. The treatment of this form must be different from that recom- mended above. It must be tonic. Quinia (§5^) must be freely given. Wine whey, mixed with toast-water, will be useful. Tincture of cayenne, in sweetened water, may be given often in small doses. Ammonia (135) may likewise be given as a stimulus. Gargles (245) (244) (243) are also required. A dropsical affection is one of the most frequent results of scarlet fever. It is believed that this seldom occurs, if the warm bath is daily used, as soon as the skin begins to peel off. After the dropsy has set in, give the warm bath twice a week, and encourage perspi- ration by the compound tincture of Virginia snake-root, and similar articles. The child should have a generous diet, at the same time, to bring up its strength. Anointing the skin with vaseline at night and washing off in the morning with suds removes the poisonous scales, and lessens the danger of contagion, as well as improves the activity of the skin. Nasal and aural catarrhal diseases are commonly observed to follow scarlet fever and need attention of a physician. Rheumatism like- wise is a frequent sequela, while nephritis or inflammation of the kidneys is often a sad reminder of the disease. These two compli- cations are to be treated as directed elsewhere. TABLE EXHIBITING THE DIFFEKENCE BETWEEN SMALL-POX, VARIO- LOID, SCARLET FEVER AND MEASLES. SMALL-POX. VARIOLOID. First. Period between exposure and when dis- First. Period of incubation more irregular ease first shows itself is from five to twenty days — than Small-Pox — from five to twenty days — av- usually shows itself in ten or twelve days. erages twelve days. SHALL POX PI. 2. ) %Q B ► 3 1 ) - & c 1 t V. . '"> > «■* «i 1 ^i 35 v ' & ,v- ■ Progress of h Small Pox. W 7?^. 2™£%. ^rffaay. 5^<%. #ft%. ffAfey. Mbday. Progress of Varioloid. lftdouj. Z^day. 3^day. 4$d*y. 8$douj. W^day. Progress of Vaccination . r > 4*day. 6*day. 8$ day. U^dccy. SKIN DISEASES. 139 Second. The fever and temperature is high, but is less after rash appears. Third. The rash appears on third or fourth day and is seen on the forehead or some part of face. Fourth. The eruption first consists of pimples, then watery blisters which become white and sink in the center. Fifth. The tongue is coated and swollen. Sixth. The eyes do not run, and bronchitis does not appear. Seventh. Sore throat is often present but not to as great an extent as in Scarlet Fever. Delirium and convulsions may occur. Eighth. Secondary fever appears after several days. Ninth. There are apt to be pocks and the eye- sight be weakened, but by modern treatment it can usually be avoided. SCARLET FEVER. First. Period between contagion and when dis- ease first shows itself is usually from three to six days, but may be much longer. Second. Fever greatly increased and continues without abatement after eruption appears. Third. Eruption makes its appearance on sec- ond day on the chest and neck and spreads over the body during the next twelve hours. Fourth. The eruption extends over the entire skin. Fifth, Eruption lasts from six to seven days when it begins to come off in large scales. Sixth. Tongue is covered with little red points. Seventh. There is little trouble with bronchitis or running of eyes. Eighth. Sore throat. Ninth. The mind is apt to be affected and there may be delirium. Tenth. Usually no secondary fever. Eleventh. In Scarlet Fever there is great dan- ger of the patient being left with kidney trouble, or the eyes, ears, or throat may be affected. Second. Fever high till rash is well developed and then a greater improvement than in Small- Pox. Third. Eruption appears on third or fourth day. Fourth. Rash consists of pimples, may go on to pustules and blisters, but usually subside be- fore advancing so far. Fifth. Tongue coated and swollen. Sixth. No nose or eye symptoms as a rule. Seventh. Sore throat mild. Delirium and sev- erity of disease often marked at beginning but quickly subside. Eighth. Secondary fever less marked than in Small-Pox. Ninth. Instead of rapidly convalescing, the patient often shows an amount of weakness and anasmia all out of proportion to preceding symp- toms. MEASLES. First. Period between exposure and when dis- ease first shows itself is from seven to fifteen days. Second. There is a moderate fever. It does not decrease but increases after eruption. Third. Eruption appears on fourth day on face and spreads over rest of body in about two days. Fourth. Eruption is crescent-Shaped, rest of skin healthy. Fifth. Eruption lasts about five days, then peels off in scales. Sixth. Tongue has red edges and is coated. Seventh. The nose and eyes run and bronchitis is usually apparent. Eighth. Usually throat is not sore. Ninth. The mind is not affected. Tenth. The fever subsides after the third day and there is no secondary fever. Eleventh. The patient's eyes may be inflamed and consumption or bronchitis follow. Small-Pox. — Variola. This is another disease characterized by acute inflammation of the entire skin, both external and internal, connected with infectious and contagious fever. The eruption has the form of red points, which soon become pimples, then vesicles, then flattened and scooped- out vesicles, then pustules, and finally hard brown scabs. These last fall off from the eleventh to the twenty-fifth day, and leave behind them small pits and scars. The fever is remittent, and precedes the eruption some three or four days, — ceasing when the eruption is developed, and returning when it has reached its height. The period between exposure and the attack of the disease, called incu- bation, is from five or six to twenty days, — being short in the severe cases, and longer in the milder ones. Symptoms. — The disease begins with languor and lassitude, with shivering, and pains in the head and loins ; with hot skin, and quick- ened pulse and breathing ; with thirst, loss of appetite, and furred tongue ; with nausea, vomiting, constipation, restlessness, and uni- versal prostration. To these symptoms sometimes succeed difficult breathing, cough, drowsiness, and even insensibility. The tongue. white at first, soon becomes red at the point, and over the whole 140 SKIN DISEASES. surface. The fever is highest during the night. The constitutional symptoms are more violent just before the eruption, but immediately subside, and soon disappear, when the breaking out is established. The eruption is at first in the shape of small red points, which are hard to the touch, and shaped like a cone, and are proportionate in number to the subsequent pustules. In Plate II the artist has well exhibited the developed disease, as well as the progress of the eruption from day to day. Treatment. — Like the two preceding diseases, the ordinary, un- complicated form of this requires only the most simple treatment. Not much is wanted, except confinement in bed, cooling drinks, cool and even temperature, frequent change of linen, and sponging the body with cool water. But when what is called the fever of inva- sion is past, and the eruption is fully developed, and has brought along with it the secondary fever, then some recipe, as (131), (355), (125) will be in place, and some gentle laxative to keep the bowels open (8), — also gentle injections (249), and opiates to relieve sleeplessness and nervous symptoms; (356) (357) may be used if very sleepless. Should the system, at this period, appear to be sinking, a more generous diet, and a little wine may be allowed. If the brain suffers, apply cold ice-cloths to head, or an ice-bag behind the ears, and put the feet in a mustard bath (242). If the breaking out appears with difficulty, put the patient into a warm bath, and give extract of jaborandi (358). Gargles will frequently be needed for the inflammation, and dryness of the mouth and throat (243). Cold sponging may be considered as highly beneficial, in both the primary and secondary fever. The belladonna likewise is a useful remedy, used in the same way as in scarlet fever. The plaster (288), applied to the face, will, it is said, arrest the formation of matter, and prevent the unsightly scars which so often cover the face of persons who have suffered from small-pox. Paint the face once or twice a day with glycerine, which will effectually prevent pitting. The use of collodion is still better. To avoid Pitting, and the occurrence of unsightly scars of the face, several methods of dressing have been used. The simplest consists in covering in the vesicle with iodoform-collodion, say, twenty grains of the former to one ounce of the latter. Having pricked the vesicle with an absolutely clean needle, one, for instance, that has been boiled in soda-water for five minutes, a layer of this collodion should be applied and allowed to dry on at once. Should pus form under this coating it must be released by washing off the collodion with alcohol. The wound is then to be thoroughly disin- fected with carbolic acid water (one teaspoonful to pint of water) and the collodion again applied. This process will avoid most of the pitting. SKIN DISEASES. 141 Varioloid. — Varicella. Varioloid, or modified small-pox, begins with symptoms similar to those of small-pox, but much milder in degree. These symptoms are feverishness, nausea, vomiting, pains in the loins and head, and a quickened pulse. The eruption comes out on the third or fourth day, and looks like that of small-pox. It reaches its height the fourth or fifth day, and then declines without any secondary fever. The pustules dry up and form brown scabs which fall off in a few days, and leave slight pits, and a few red or purple spots. Varicella appears under a variety of forms, called " hives," " swine- pox," " chicken-pox," " horn-pox," etc. But they all have a family likeness, and need not be described. The treatment of all these forms must be conducted on the same principles with small-pox. Sponging the skin in all these inflammatory conditions has the hap- piest effect, and should seldom be omitted. Cow- Pox. — Vaccina. This disease exists to some extent among lower animals, and is identical with small-pox in man. The immortal Jenner taught the world that the pus taken from the cow having this disease, and in- troduced under the skin of man, would produce an eruption similar to that of small-pox, and that this would protect the system from the latter disease. This was an immensely important discovery, and will render the name of Jenner famous through all time. It is a question of great importance how far vaccination, or inocu- lation with the matter of cow-pox, does, in fact, protect the system from small-pox. That it is a protection, to a certain extent, is doubted by none. That in some instances it protects through life, is likewise generally admitted. Is it a protection in all cases, and through the whole life ? Perhaps not, though this is a disputed point. Probably the mild form of the vaccine disease does not im- press the system powerfully enough to last more than a certain num- ber of years. Most thinking physicians now believe it is wise to revaccinate occasionally, to make sure of the protection. It is done with little trouble, and may save a terrible infliction. Plate II, Fig. 4, gives a good idea of the appearance and progress of the eruption. The Second Group of diseases, characterized by inflammation of the true skin, without constitutional symptoms of a specific kind, are Erysipelas, Nettle-Rash, False-Measles, and Inflammatory Blush. Erysipelas. — St. Anthony's Fire. Erysipelas is a diffused inflammation of the skin, affecting only a part of the surface of the body, and is accompanied by a fever, which is generally thought to be infectious and contagious. The 142 SKIN DISEASES. local inflammation is disposed to spread ; it extends deep, and is attended by swelling, a tingling, burning, and pungent heat, and by a redness, which disappears when the skin is pressed by the finger, and returns on remitting the pressure. Symptoms. — The constitutional symptoms are chilliness and shaking, succeeded by heat ; lowness of spirits, lassitude, pains in the back and limbs, pains in the head, quick and hard pulse, thirst, loss of appetite, white . and coated tongue, bitterness of mouth, nausea, vomiting, pain in stomach, and costiveness. These symptoms go before the local inflammation several days ; they increase with the redness of the skin, and disappear upon its decline. The nervous system is sometimes severely affected, and indicated by low, muttering delirium. At the close of the inflam- mation there is generally a relaxation of the bowels, and the scarf- skin peels off. Sometimes matter forms under the skin, and occa- sionally mortification occurs. The face is the most frequent seat of the disease. It commonly begins on one side of the nose, and soon spreads over one side of the face, closing up the eye, and changing the features in a shocking manner. See Plate III, Fig. 1. Somewhere about the third, fourth, or fifth day, very minute blis- ters appear on the inflamed parts, filled with water, which increases until the blisters break and let it out. The disease comes to a head on the eighth or ninth day, when the blistered parts dry, and the skin begins to peel off. Treatment. — In the treatment two things are to be done, — to subdue the fever, and the local inflammation. The fever is assuaged by rest, mild diet, gentle laxatives (26), (21), (125) ; and by the use of tincture of veratrum. For the local inflammation, various things have been advised, but nitrate of silver, on the whole, has the preference. First wash the inflamed part with soap and water to remove any oily substance, and wipe the skin dry. Then moisten the inflamed and surrounding skin, and pass over it a stick of nitrate of silver, touching not only the inflamed part, but going even an inch be}^ond it on all sides. Or, a solution of nitrate of silver and nitric acid (214) will in many cases, according to Dr. Higginbottom, do even better. A solution of copperas (215) is a good application. So is (303). In mild cases, flour may be dusted on the inflamed part from the dredging-box. Warm fomentations are also useful, and cloths wet with water, and laid on. A solution of perchloride of iron, applied to the inflamed skin, is much used now, or water as hot as can be borne. In erysipelas the powers of the system are generally reduced, and tonics, such as quinine, wine, etc., are generally required. Dr. Robert Williams, — high authority in these matters, — says he puts his patients upon milk diet, gently opens the bowels, and gives them, daily, from four to six ounces of port wine, together with sago, and that he seldom has to change this course, whatever the symptoms. ERYSIPELAS PL 3. W^B/mst^**^ Fig.l INrLAHMATORY BLUSH >fih I cV Fi 9 -- /') O Cj ■ i . ... ■ m o $B "" s ' SKIN DISEASES. 143 For the inflamed skin, a tea made of buckwheat meal is a good wash. Alcohol and water, or new rum, may be used for the same purpose. Nettle=Rash. — Urticaria. Nettle-bash begins with fever, which lasts two or three days, when wheals of various shapes, round, oval, and oblong, appear in the midst of red, slightly elevated patches, attended by great itching and tingling, as if the common nettle had been applied to the skin. The wheals go off during the day, and come again at night. The eruption is often a symptom of other diseases, or of mental anxiety. Sometimes it is the effect of articles of diet. Children have it occa- sionally while cutting teeth. A lighter form of the disease exists, in which the wheals appear and disappear at short intervals, according to the heat of the weather, the exercise, diet, etc. Treatment. — The treatment varies according to the cause of the disease. If this be anything offending the stomach, especially if it be putrid fish, an emetic (2), (4) will be required, followed by brisk physic (359). After which take a few doses of quinine (75). For external application, the lotion (216) or common vinegar and water (215) will be useful. Dr. Wilson recommends corrosive sublimate, etc. (217), as the best lotion to apply outwardly. Soda bath better. The diet should be simple and cooling, all stimulating food and condiments being avoided. Fruit, candies, and berries often the cause. Rose=Rash. — Roseola. — False Measles. Symptoms. — The summer rose-rash appears first on the arms, face, and neck, thence it spreads over the whole body, producing tingling and itching. It is usually preceded by the symptoms of fever-chills, succeeded by flushes of heat, languor, pains in the head, back, and limbs, restlessness, quick pulse, and thirst. The rash appears in small irregular patches, paler than those of measles, and of a more roseate hue. There is some hoarseness from inflammation of the throat. The rash never continues more than five days, unless it be merely partial, in which case it sometimes comes and goes at inter- vals for weeks. If it " strike in," it generally produces disturbance of the stomach, headache, and faintness, which are relieved by its re- appearance. The autumnal rose rash is in more distinct patches than the former, of a circular figure, slightly elevated, and of a dark damask-rose hue. Seldom any fever, or itching and tingling. Treatment. — For the first-described form of the disease, light diet, acid drinks, and gentle laxatives; for the second, recipe 59 or 51, ac- cording to convenience. 144 SKIN DISEASES. Inflammatory Blush. — Erythema. WHAT is called marginated inflammatory blush, is a mottled, red, smooth fullness of the skin, occurring on the extremities and loins, in irregular patches, bounded on one side by a hard, elevated, red border. This species of disease attacks old people, and indicates some inter- nal disorder, which is dangerous. Another form of the complaint appears on the arms, neck, and breast, in extensive, bright-red, irregular patches, slightly elevated. The redness, at its height, is very vivid, and continues about a fort- night, when it assumes a purplish hue in the centre. Treatment. — Light diet, gentle purgatives (21), soda bath to al- lay the tingling and secure sleep, and the mineral acids (63), with bitter tonics, comprise all that is required, except sponging with water, and friction. Watery Pimples. We now come to a class of diseases character.zed by watery pim- ples. Wilson says they are distinguished by " effusive inflammation of the derma," which means that there is inflammation of the true skin, which causes water to be poured out on top of the derma, and under- neath the scarf-skin, causing the latter to be lifted up in the form of small or large blisters, or vesicles. At first the fluid in these pimples is transparent, but in a short time becomes milky. Sometimes this fluid absorbs ; at other times, it dries up, and with the cuticle scales off as scurf. Eczema and Salt Rheum. Eczema is an inflammatory, acute or chronic, non-contagious skin disease characterized at first by redness, little pimples, vesicles or pustules and is attended by more or less burning itching. This pro- cess terminates either in the formation of crusts as the result of dried sticky serum, or else in the formation of fine scales. No skin disease has such a variety of aspects nor such grades of inflammation. There is generally more or less oozing of the blood- serum, which dries and thickens, forming crusts. There is usually more or less thickening of the skin, making it like leather ; there is generally some considerable scaling. Eczema may subside in a few weeks never to return, or, what is more probable, may lapse into a chronic state and continue for months and years, with bothersome symptoms, which are extremely annoying. Salt Rheum is a chronic eczema of this last variety. Treatment. — In the acute stage of eczema, soothing lotions, pow- ders, or ointments should be used, such as 372, 373, 374. Some are SKIN DISEASES. 145 better treated with powders, some by lotions ; the itching and heat are best relieved by 373. In the more chronic variety some stimulating ointments are needed, like 375. Carbolic acid, 10 or 15 grains to the ounce of oleate of zinc ointment, is an admirable remedy for the itching and burning. Salicylic acid, 10 grains to the ounce of benzoated zinc ointment is likewise very serviceable, while tarry preparations generally are the most satisfactory in this chronic stage. No skin disease, however, is often so stubborn to treatment as the different forms of eczema. The cure often will be slow and medi- cines frequently changed. The local varieties of eczema require spe- cial treatment. Eczema of Head in Children. — After oiling freely the crusts over night and washing off with suds in the morning, apply Salicylic acid, 1 part, tincture benzoin, 2 parts, vaseline, 50 parts. The very chronic, thick, and indurated skins require 360, and in many cases 219, espe- cially the chronic hand-cracks. The diet must be free from irritating articles of food, the bowels regulated and the hygiene of the skin at- tended to, while tonics and general systemic measures are often called for. Tetter — Shingles. — Herpes. After a slight feverish attack, lasting two or three days, clusters of small, transparent pimples, filled sometimes with a colorless, some- times with a brownish lymph, appear on the cheeks or forehead, or on the extremities, — and at times on the body. The pimples are a little larger than in eczema, — about the size of a pea. After a few days the vesicles break, pour out their fluid, and form brown or yel- low crusts, which fall off about the tenth day, leaving the surface red and irritable. The eruption is attended with heat, itching, tingling, fever and restlessness, especially at night. Ringworm is a curious form of herpes, in which the inflamed patches assume the form of a ring. Shingles usually attack the aged about the ribs of one side, and are evidences of impaired health and nutrition. They are very prostrating and require tonics from the start. Treatment. — Light diet, gentle laxatives. If the patient be ad- vanced in life, and feeble, a tonic (75) will be desirable. For exter- nal application, belladonna (173), or an ointment of sulphuret of lime, (174), or elder-flower ointment, etc. (175). Equal parts of chloral and camphor applied several times a day, especially later in the disease (361), give most relief. Itch. — Scabies. To this disease all classes are liable, though it is much less com- mon than in former years. It is found frequently among the poor, 146 SKIN DISEASES. whose condition in life does not give them the means to guard at all points against it ; but it is most common among such as neglect per- sonal cleanliness. Symptoms. — An eruption of distinct, cone-like, watery pimples, which are transparent at the summits, and are accompanied by an ex- cessive itching, which is made worse by high-seasoned food, by drink- ing liquor, and by the heat of the bed. When these pimples are scratched and torn, a sticky, watery fluid is poured out, which forms small scabs ; and, in time, if the disease is not cured, these scabs be- ing torn off, extensive sores are made. Cause. — It will excite the wonder of many readers to state that animals of so small a size as scarcely to be seen with the naked eye exist in the skin of man. Yet such is the fact; and it is the presence of these minute creatures, or the effect of their presence, which con- stitutes the disease called itch. The little creature (acarus scabiei, by name), a species of mite, is one seventy-seventh part of an inch in length ; and when closely inspected under the microscope, is really a beautiful, I may say an elegant, animal. Here are a front, a side, and a back view of him, well done by the artist. Fig. 73. Fig. 74. FIG. 75. His Method of Attack. — When placed upon the skin, the little fellow, like the squirrel and other ground-animals, sets himself to make a hole through the scarf-skin with his head and fore feet. Into this he pushes his whole body. He then begins to burrow himself in the derma or true skin — making a channel many times his own length, at the end excavating a chamber where he sleeps, and whence he goes out to do his day's work at mining, or boring for food. When tired of this sleeping apartment, he digs onward and scoops out an- other. This travelling, and boring, and turning about in an organ as sen- sitive as the true skin, must, of course, occasion a tickling and itch- ing ; and from this circumstance the disease took its name of itch. But this itching is not painful. James the First is said to have re- marked that the itch was fitted only for kings — so exquisite is the SKIN DISEASES. 147 enjoyment of scratching. Probably it is a royal luxury. Be that as it may, most persons would consent to have it all done by royal fin- gers. They have been used for meaner purposes. Treatment. — Whatever will kill the little animal described above, will cure the itch. Various agents have been employed for this pur- pose, but none have been found equal to sulphur. The compound sulphur ointment is a sovereign remedy for the disease. Four ounces of this should be well rubbed into the skin, before the fire, morning and evening, for three or four days. This will put an end to the whole colony of these sovereign squatters upon forbidden soil. Two ounces of sulphuret of potash, and the same amount of soft- soap, dissolved in a pint of water, and applied well to the skin, is used in many cases with good effect. Caustic potash, one part to twelve parts of water, applied in a sim- ilar way, is said to be a pretty sure remedy. A solution of the chloride of lime, used as a wash, will often effect a cure. The ointment of the American hellebore sometimes does well. Before applying any of these preparations, let the skin be washed with warm water and soap, and well dried. Be sure the parasite is killed before ceasing treatment. Best to continue, few days longer than what is apparently needed. Rupia. This is from a Greek word which means dirt, from the dirt-colored crusts which are formed after the breaking of the large watery pim- ples. The vesicles are like those of eczema and herpes, except that they are larger. This is distinguished from all other skin diseases by the formation of unhealthy, foul, and burrowing sores, which pour out a reddish matter in such quantities that it collects and dries upon the sore, and forms a crust of great thickness, — sometimes of the size of an oyster-shell. Rupia has its origin in a weakly and debili- tated constitution, and cannot be cured without renovating the whole system. It is a manifestation either of syphilis or lupus. Treatment, — Warm baths once or twice a week, with generous and nutritious diet. Tonic medicines (63) (51) (67) (61) (§&} will be required. For external treatment, dust the surface of the ulcers with cream of tartar, or apply nitrate of silver (214) (219) (220), white vitrol, etc. See syphilis. Pemphigus. — Pompholix. The first of these terms is from the Greek, and means a bubble : the second, pompholix, is from the same language, and means a water- bubble. This is still more applicable to the disease in hand, which consists, in fact, in the raising up of the scarf-skin in the shape of 148 SKIN DISEASES. bubbles, containing a watery fluid. These bubbles are just like com- mon blisters. They vary from the size of a split pea to that of a hen's egg. They rise up very rapidly, and break in two or three days, leaving a raw surface which soon becomes covered by a thin crust. Treatment. — Similar to that for Rupia, with the addition of iodide of potassium (140), and applying the stick nitrate of silver to the whole surface of the ulcer, and a short distance beyond it on all sides, or the ointment (176). See treatment for syphilis. Mattery Pimples. Another natural group of skin diseases are distinguished by an eruption of pimples, filled, not with water, like those just described, but with matter. The pimples of this class are not transparent, or whitish, but opaque and yellow from the first. The matter is poured out upon the true skin, and raises up the scarf-skin, in the same way as the watery pimples. As in the preceding diseases, too, the drying up of the matter forms crusts. But these pimples are never so small as those of eczema, nor so large as those of pemphigus. Crusted Tetter. — Impetigo. This eruption consists at first of slightly-elevated pustules or pim- ples, closely congregated, with an inflamed border. These break, and the surface becomes red, excoriated, shining and full of pores, through which a thin, unhealthy fluid is poured out, which gradually hardens into dark, yellowish-green scabs. These scabs sometimes look like a dab of honey dried upon the skin. This has given impetigo the name of "honey disease," or honey scab. This honeyed look is well repre- sented in the crusts which form on the lips and ears of children. Sometimes these scabs cover nearly the whole face, and are called the milk crust. This is putting the agreeable words milk and honey to rather questionable uses ! When this crusted tetter invades the head or scalp, it causes the hair to fall, and becomes what is called a scall. Impetigo may be simple, or contagious, or syphilitic. Treatment. — The vapor bath, and water dressing. The following ointments are useful : oxide of zinc, white precipitate, or diluted ni- trate of mercury (178). Hydrocyanic acid (221), applied externally, has a fine effect. The crusts should first be removed by a weak lye made from hard-wood ashes, or potash ; then, after applying one of the ointments above, or the lotion, cover the part with oil-skin. If the crusts are on the head, the hair should be cropped off before the remedies are applied. When of syphilitic origin, treat as for that disease. SKIN DISEASES. 149 Papulous Stall. — Ecthyma. The mattery pimple called ecthyma is developed on a highly in- flamed skin. The bladders are about the size of a split pea, and are surrounded by a broad ring of redness. They are generally separate, not clustered like impetigo. They are scattered over various parts of the body, and are followed either by a hard black crust, or by a sore. The disease is either acute or chronic. The latter attacks weakly children, and persons reduced by sickness or low living. Treatment. — For the acute form, give a generous diet, with oint- ment (176), and the cold sponge-bath on the sound parts. Use (176) (175) (214) (211) for external application. Hygienic treat- ment, tonics, and stimulants are called for ; iron, quinine, arsenic, and nux vomica. Scaly Eruptions. The scaiy eruption is called a dry tetter. It is an inflammation of the true skin, and is distinguished from the rashes and pimples by the alteration of the scarf-skin. The diseases forming this group are three in number, — lepra, psoriasis, and pityriasis. Leprosy. — Lepra. In this disease, the eruption makes its appearance as a small, sal- mon-red spot, raised a little above the surrounding skin, and consti- tuting, in fact, a flat pimple, almost as large at the top as at the bot- tom. On top of this pimple the scarf-skin becomes rough, and after a little while a thin scale is produced. New layers are added to its under surface, and it accordingly grows thicker. It has a bright, silvery lustre. These scaly spots multiply, and become the form of leprosy called lepra guttata, from the Latin gutta, a drop, the scales looking like drops of water on the skin. But the eruption more frequently spreads out into circular patches, of the size of a fifty-cent piece. These generally appear below the elbows and knees, and on the breast and shoulders, and back of the hands. Sometimes the entire hand is covered with scales of a pecu- liar silvery whiteness. These patches heal from the centre. Psoriasis. This differs from lepra in the eruption being more irregular. The spots sometimes come out in thick clusters, and blend in various ways. Instead of appearing in distinct circular forms, as in leprosy, the patches are irregular, and of every size. Instead of one well- formed and thick scale, there are many small and thin ones. And instead of a depressed centre with rising edges, the surface is level. While leprosy is a circular dry tetter, this is an irregular dry tetter. 150 SKIN DISEASES. Treatment. — Pyrogallic acid in ointment, 10 to 40 gr. to oz. Ap- ply daily ; it discolors the skin for a while. Chrysophanic acid in same strength is the best remedy known. It also discolors the skin and inflames the neighboring skin for a while. Recently the thyroid gland of the sheep has been nsed in five-grain tablets three times daily as an internal medicine with much success. Pityriasis. This is much like the two preceding, except that it gives rise to a copious production of very small bran-like scales. Indeed, its name is from the Greek, and means chaff or bran. It is a branny tetter. It may occur on any part of the body. Treatment. — When the skin is highly inflamed and stiff with heat, pain, and itching, the diet should be light, and the drinks of a cooling and unexciting kind. The warm bath and gentle friction of the skin are useful. Laxatives or tonics may be employed, according to the indications, — frequently laxatives first, and tonics afterwards. The specific remedies for curing the disease are unknown ; iodide of potas- sium (140), arseniate of iron (68), Fowler's solution, in two-drop doses, three times a day ; or Donovan's solution, in five-drop doses, three times a day. For external application, use a naphthaline oint- ment' (17 7), zinc ointment, white precipitate ointment, diluted nitrate of mercury ointment, or solution of corrosive sublimate (212). Dry Pimples. These are distinguished by the high degree of irritation of the skin winch they create. They are exceedingly troublesome, not only from the distress and itching they occasion, but because they are likely, in consequence of this, to be torn into painful and obstinate sores. When appearing in children, they are called red gum, and tooth- rash. In grown persons, one form is named lichen, and another, dis- tinguished by excessive itching, prurigo. In this form of pimples, the fluid is not poured out upon the sur- face of the true skin, — as in several of the preceding diseases, — but is collected within the tissue of this organ, and the pimples feel hard under the finger. The tooth-rash of infants is always accompanied with some fever- ishness, caused generally by irritation of the gums from growing teeth, occasionally by flannel worn next the skin. Lichen has a variety of forms. In one case the pimples are of a bright red, in another, bluish or livid. In one case they appear in circular groups, in another they produce great disorganization of the skin, and occasion terrible suffering. SKIN DISEASES. 151 Prurigo is a still more cruel disease than lichen. The pimples are not very manifest, but the skin is thickened or swollen, and con- densed. The suffering from it is terrible. It gives one no sleep, night or day. That form of it called ant-bite prurigo gives the sen- sation of millions of ants eating the flesh, or as many red-hot needles piercing it. This renders the existence of many elderly persons a terrible burden. Treatment. — Careful diet, and gentle aperients and tonics, accord- ing to the condition of the system. Externally, the cold salt-water sponge-bath, and glycerine, vinegar and water, applied with a soft sponge. Tar and sulphur are among the more successful remedies in fighting this rebellious disease (362). Iron, quinine, cod-liver oil. For relieving the terrible itching of the private parts, which females sometimes suffer, I have found morphine (223), for external use, very effectual. Lupus. This makes its appearance in the form of one or more circular elevations, of a dull red or salmon-color, and partially transparent. When pressed under the finger, these elevations are found to be soft, and when the finger is removed, they are flat and whitened. They generally appear on the face, and particularly the nose. In another and worse form of the disease, the tubercles are harder; and after a time, they become covered with thin brown scabs, which are scratched off, and followed by others, and these by others, until ulcers appear, which are sometimes slow and sometimes rapid in their progress. The whole nose has been destroyed by them in a month. (See Fig. 76.) This is one of the dis- eases which Erasmus Wilson thinks, and, in my judgment, correctly, to be, like scrofula, the result of the syphilitic poi- son, filtered through the blood of several generations. It is a disease which is the most destructive in the shortest time of all diseases. Treatment. — The internal remedies are iodide of arsenic (141), and iodide of potassium (140) ; the external, vine- gar of Spanish flies ; and to promote the healing of the ulcers, a weak solution of nitrate of silver (211) (214) is adapted. Hardly any disease has been treated by so many different remedies. At present the prospect of a cure is good, as certain anti-tubercular Fig. 76. 152 SKIN DISEASES. lymph injections have been found effective ; but no time should be lost in immediately consulting a surgeon, as its growth can be ar- rested, and the disease may be exterminated by early treatment. Warts and Corns, — Verruca — Tylosis — Clovus. In the derma or true-skin there are a great many small arteries, veins, and nerves, united together, and formed into loops (see Fig. 43), resembling, in shape, the peaks of miniature mountains. These are called papillce. These loops, frequently, without any apparent cause, take on a disposition to grow, and by extending themselves upward, they carry the scarf-skin along with them, which is thickened; and together they form what is called warts. Corns are formed by a somewhat similar growth of the papillae, brought about by the pres- sure and friction of tight boots and shoes. Treatment. — For warts, take a piece of diachylon plaster, cut a hole in the centre the size of the wart, and stick it on, the wart pro- jecting through. Then touch it daily with aqua fortis. Nitrate of silver sometimes answers well for touching it. They may be taken off very neatly, sometimes, by tying a string tight around them. Corns should be shaved down close, after being soaked in warm water and soap, and then covered with a piece of wash-leather, or buckskin, on which lead plaster is spread, a hole being cut in the leather the size of the corn. They may be softened, so as to be easily scooped out, by rubbing glycerine on them. Manganic acid destroys warts and corns rapidly. Bunions, which affect the joint of the great toe, must be treated with fomentations, and sugar of lead water (224), when there is considerable inflammation, with rest in a hor- izontal position. But the best cure for corns and bunions is to put away tight shoes. Wear a bunion-plaster for some time to take the pressure off of the corn or bunion. Mother's Marks. — Naevus. The small vessels of the skin, called capillaries, suffer certain al- terations of structure which pass under the name of mother's marks. These marks are simply a great dilatation of these minute blood-ves- sels. They vary in size from a mere point to a patch of several inches square. The smallest of all is the spider mark. It is a small red point, from which several little straggling vessels spread out on all sides. Sometimes this is of the size and appearance of a red currant ; at other times, of a strawberry or raspberry ; and occasionally it is even much larger, and is compared to a lobster. When the circulation is active through them, or the individual is excited by exercise, or by moral causes, these marks are of a bright red color. Some are naturally livid and dark-colored, and look like SKIN DISEASES. 153 blackberries, and black currants. The blueness of these is owing to the vessels being still more stretched and dilated, and to the conse- quent slower passage of the blood through them, which gives more time for its change from the arterial red to the venous blue. Treatment. — If the mark is not making progress, it had better be let alone, or only subjected to gentle pressure by putting a piece of soap-plaster over it. When its course is threatening mischief, it is sometimes cured by pencilling a small portion of its surface, from time to time, with nitric acid. They may be operated on with safety by electrolysis and other methods. Disordered State of the Nerves of the Skin. Itching. — Pruritus. This is supposed to be dependent on an al- tered condition of the nerves of the skin, and consists in a painful sensation of itching. There is no perceptible alteration in the ap- pearance or structure of the skin. This itching is thought, generally, to be a result of sympathy, through the nerves, with some diseased and excited condition of a distant part. The itching, is brought on by the most trifling causes, and for hours may deprive the sufferer of every particle of repose. It more frequently affects the fundament, or the private parts, particularly the scrotum. Treatment. — As this disease is only a symptom of several others, the constitutional treatment belongs under the heads of these other diseases. The local applications for relieving the itching are, a solu- tion of sugar of lead (224), hydrocyanic acid (363), of corrosive sub- limate (212), diluted nitrate of mercury ointment, and poppy fomen- tations. Also (223). Tonics are often of first importance. Weak solutions of carbolic acid or soda water at tim£s suffice. Disorders Affecting the Color of the Skin. Colored Patches. — Maculce. The depth of color in the skin de- pends on the amount of a certain coloring matter, called pigment, in- corporated with the deeper and softer portion of the scarf-skin. In the scarf-skin of the inhabitants of northern latitudes, there is but little of this pigment ; in that of the dwellers of Africa, there is a great deal ; among the inhabitants of Southern Europe, the quantity is intermediate between the two. The depth of color in the skin depends on the energy of its action. In the tropics, where light and heat are in excess, the skin is stimu- lated to great action, just as vegetation is, and the color is increased and intensified. This is illustrated every year before our eyes. In summer, under the heat of the sun and the flood of light, the pigment- forming power is increased, and the fairest skin is browned ; while the withdrawal of these forces leaves the winter's scarf without pig- ment, and blanched. 154 SKIN DISEASES. What the sun and light do, under natural circumstances, diseased action may effect. Hence we occasionally meet with alterations of color in the skin, from a disordered state of the system. We witness the formation of patches of dark color and irregular shape on various parts of the body. Sometimes they are raised above the level of the skin, and are called moles. At other times, they have no elevation, and spread over the whole body. Occasionally, from some peculiarity of constitution, the pigment is diminished, and white patches appear all over the body. At other times, a black person will become completely white. Such are called albinos. In many cases the coloring of the skin has varieties of tint, as when persons of light complexion, are, in the summer season, covered with yellow spots, like stains. These spots are known by the name of freckles, or, in learned language, lentigo. Treatment. — It is generally best not to meddle with a mole. If it be very unsightly, let it be removed by two incisions, taking out an elliptical portion of skin, and ft closing the wound with sticking plaster. In the case of bleached places, apply the shower bath, tonics, and a stimulating liniment (163) to the faded spots. For the change of color called sunburn, a liniment (191) of lime-water, etc., is the best preparation. For freckles, use recipe 360, or, perhaps, still better, 364. Disorders # of the Sweat=Glands. The perspiration is sometimes greatly increased above nature's de- sign. This is, technically, idrosis. In other instances there is too little sweating. This is called anidrosis. Sometimes the perspiration is so altered in its physical qualities as to have some peculiar smell. This is osmidrosis. In some rare instances, according to old writers, the sweat was changed in color. This was chromidrosis. And now and then a case occurs of bloody perspiration, of which the most memorable case on record is that of the Redeemer of men, who, in the garden, sweat great drops of blood. Several cases of this are re- corded in medical books. It is called hamiidrosis. The proper action of the skin being so vitally important to health, these changes often involve very serious consequences. Treatment. — Either too much or too little sweating can generally be corrected by the cold or warm bath, friction, tonics, and proper clothing. Small doses of jaborandi, also ergot and strychnine, are among the best internal medicines (365). Disorders of the Oil=Glands and Tubes. That the skin may be limber, healthy, and fit for use, it is neces- sary to have it oiled every day. For this object, the Creator has SKIN DISEASES. 155 wisely provided, by placing in the true skin a large number of very small glands and tubes, whose office it is to prepare and pour out upon the surface the proper amount of oil. The gland, regular little oil-pot, is in the true skin ; and from it a pfece of hose or tube runs up through the scarf-skin, through which the oily fluid is poured out. Some of these tubes are spiral, others are straight. On some parts these vessels do not exist ; on others they are quite abundant, — as on the face, nose, ears, head, eyelids, etc. They produce the wax of the ears ; and on the head, they open into the sheath of the hair, and fur- nish it with a hair-oil or pomatum better than the chemist can make. These little vessels are always at work, when the skin is healthy ; and no persons need be afraid to wash all over every day, lest, as the Boston Medical Journal taught, the skin will be injured by having the oil removed from it. You might as well be afraid to eat a meal of victuals, lest the saliva should all be swallowed with it, and none be left for future use. There is oil enough where that upon the skin comes from, and the vessels which produce it are not injured by work, any more than the muscles of the legs are by walking. Grubs or Worms. — But, unfortunately, the skin is not well taken care of in all cases, as in cities and towns where sedentary habits pre- vail. Here, the actions of the skin, instead of being regular and com- plete, are often sluggish and imperfect ; and the contents of the oil- cells and tubes, instead of flowing easily, become hard and impacted, and the vessels are not emptied. When this matter becomes station- ary, dry, and hard, it distends the tube, and fills it to the surface; and then coming in contact with the dust and smoke of the atmosphere, the ends become black, and look like the heads of worms. These spots are common on the nose and face of persons who have a sluggish skin. They may be squeezed out by pressing the nails on each side of them. These are called grubs and worms, or, technically, come- dones. When this matter produces in- flammation of the tube, there is then a black spot in the middle of a red pimple, and the disease is called spotted acne. Now and then the oily matter becomes very hard, producing spine- like growths, and even horns (Fig. 77) ; and again, it collects and forms soft tumors, as wens, etc. These are technically called encysted tumors. Sometimes the action of the glands is too great, and oil is poured out so profusely that the face shines with it. At other times there is so little that the skin is dry and harsh. In the hardened oily matter, which constitutes grubs, are found small animals, which Dr. Wilson calls the " animal of the oily product of the skin." On page 156 are three views of him. 156 SKIN DISEASES. Treatment. — For roughness and harshness 01 skin, wash with soap and water every night, and rub well into the skin after the bath, and in the morning, the ointment (362), and take a dose of sulphur, etc. (23), twice a »week. Or', rub the skin every morning with a damp Fig. 78. Fig. Fig. sponge dipped in fine oatmeal, and after drying the surface, the lini- ment (164) may be applied. The spinous variety, or porcupine dis- ease, requires washing with a quart of warm water, having a large teaspoonful of saleratus dissolved in it, and the use of the ointment (181) twice a day. For grubs, stimulate the skin by washing it with strong soapsuds, twice a day, and rubbing briskly with a coarse towel; and by using the corrosive sublimate (225) as a lotion. A spare diet will do much towards improving the skin in many cases; use tonics in others. Usually, destroy the old skin first (360) and apply after (352) to heal. Barbers' Itch. — Jackson's Itch. — Sycosis. This, is very much like acne, — only differing from it in its loca- tion. It appears chiefly on the hairy parts of the face, — the chin, the upper lip, the region of the whiskers, the eyebrows, and the nape of the neck. It consists in little conical elevations, which maturate at the top, and have the shaft of a hair passing through them. These pimples are of a pale yellowish color. In a few days they burst, and the matter running out, forms into hard, brownish crusts. These crusts fall off in one or two weeks, leaving purplish, sluggish pimples behind, which disappear very slowly. The eruption is preceded by a painful sensation of heat, and tight- ness of the skin. The disease is supposed to be brought on frequently by using a dull razor in shaving. It is very obstinate, — often lasting for man}' months, and even for years. SKIN DISEASES. 157 Treatment. — The most important part of the treatment is the re- moval of the cause. The beard must not be pulled with a dull razor; the shaving had better be discontinued altogether, and the beard be merely cropped off with scissors instead. All intemperance in eating and drinking, and exposure of the face to heat, must be avoided. A light, cool diet will do much towards curing the disease. The nitrate of mercury ointment, and a solution of oxalic acid, are the best applications. If one does not succeed, try the other. Black wash is to be used when the face is much inflamed. Disorders of the Hair and Hair=Tubes. The hair is an appendage of the scarf-skin, and is intended to be both useful and ornamental. It is subject to several disorders. It may grow too long, or too thick, or it may appear in an improper place. This last happens in the case of those little spots and patches which disfigure the face, and are called moles. The hair may be defective in its growth, or may fall off prematurely from various causes, or in the natural course of things from old age. This last is called calvities. It may change its color, too, under a great variety of circumstances, and at nearly every age. It is not very uncommon to find a single lock varying in color from that which surrounds it. Old age, the winter of life, nat- urally brings the frosted locks ; but they frequently appear also upon the heads of younger persons. Strong mental emotions, such as fear, grief, or sorrow, may bring a bleaching of the hair in a brief period, or even suddenly. Byron, in his " Prisoner of Chillon," beautifully refers to this fact : — " My hair is gray, but not with years, Nor grew it white In a single night, As men's have grown from sudden fears." PoTTigo. — There is a troublesome disease of the hair and hair-tubes called porrigo. It begins with the formation of a thin layer of scurf either around single hairs, or in patches which enclose several. These patches frequently have a circular form, which give to the affection the character of a ringworm. The hair-tubes are generally a little elevated, in the shape of papillae, which gives to the diseased scalp the appearance of " goose-flesh." These hairs, losing their proper nourishment and healthiness, break off at unequal distances from the skin, leaving their rough ends twisted and bent, and matted into thick grayish and yellow crusts. Upon the surface of these crusts may generally be seen the ends of a few hairs, looking like the fibres of hemp or tow. The scratching causes inflammation of the skin after a time, and matter is poured out, which still further mats the hair, and thickens the crusts. There are several varieties of this disease, differing slightly from each other ; but this general description will answer all practical purposes for this work. 158 SKIN DISEASES. The reader will often notice a disease of the hair-glands, character- ized by a yellowish and dirty-looking powder, covering the scalp and hairs. This matter is collected at the mouths of the follicles, and considerable of it is strung upon the hairs like beads. Pull out a hair, and the root will be found thin, dry, and starved in its appear- ance. In this disease, it is difficult to keep the hair cleansed, or to prevent its falling off. Favus. — Still another disease, called favus, is known by the collec- tion of a yellow substance, at first, around the cylinder of the hair. This substance, after a time, spreads out upon the scarf skin, and dries into yellow crusts, in the form of a cup, around the base of each hair. A number of these cups, collected together, look like the cells of a honey-comb. This disease is contagious, and is communicable by contact to any part of the skin. Treatment. — For removing the hair from particular parts of the scalp, it is common to resort to depilatories. Of these, the recipes 260, 261, 262, are frequently used, and are as good as those adver- tised ; indeed, they are the same. Forceps are the best means. To prevent loss of hair, and to restore it when lost, the circulation should be stimulated in the small vessels of the scalp. With this view, washing the head every morning with cold water, drying it by friction with a rough towel, and brushing it to redness with a stiff hair-brush, are excellent. To these should be added some stimulating ointment (183), or liniment (257), (258), (259). These last are about the best known preparations for causing the growth of the hair. Ringworm of the scalp requires attention to the diet, and such remedies as will improve the general health, with stimulating appli- cations externally (257), (258), (259). 366 is the newest and best mode. To color the hair, several preparations are used. Of these, 163 is about the best. It produces a beautiful black. A preparation of sul- phur and sugar of lead (264) is the famous compound recommended by General Twiggs, and extensively used. Preparations of nitrate of silver (265), (266), (311) are much in use in some quarters. They perhaps give a finer black to the hair, but they render it dry and crisp, and they will stain, the skin, if care is not used in applying them. Use care in the use of these remedies. In Favus, the two great objects to be gained are, to remove all lo- cal causes of irritation, and to excite the diseased hair-glands to healthy action. The first object is affected by cutting off the hair with the scissors, and removing the crusts by washing the scalp with castile soap and water. It may be well first to wet the crusts through witli corrosive sublimate (212), in weak solution. The washing with soap and water should be repeated every day, and be, followed by rubbing into the scalp a stimulating ointment (183). A very weak solution of the nitrate of mercury (226), applied every other day, with a earners hair brush, sometimes produces excellent effects. SKIN DISEASES. 159 Lice. Pediculosis or Lice is a contagious, animal, parasitic affection, characterized by the presence of pediculi in the skin and scratch- marks of the sufferer ensuing from the annoying itching. There are a number of varieties classified according to the peculiar parasite and its location. They all cause great discomfort and itching. The Pediculosis Capitis, or head-louse, is found in the scalp, and is a long, oval body with six legs furnished with nails ; it has an oval head with two prominent eyes and two horns. The ova or nits are small whitish bodies closely glued to the hair and look like small pieces of dandruff. One or two are deposited on a hair. They occur for the most part in poorly nour- ished children brought up under bad hygienic surroundings, and thence communicated to others. They cause extreme itching and scratch- ing, so that often the irritation is unbearable and the sticky serum of the blood mats together the hair, forming crusts. Sleep is often interfered with and ill health results. (See Fig. 81.) Fig. 81. head-louse. Pediculosis Corporis, or body-louse, is gen- erally the property of the clothing ; it is some- what larger than the head-louse and deposits its eggs in the seams of the clothing, remaining on the body only long enough to gain sustenance. The young are hatched in five or six days. The louse reproduces again in eighteen days. As the parasite crawls about it produces extreme itching and the scratching follows, resulting in long lines of excoriation. The chief locations for this parasite are the back, chest, abdo- men and thighs. The middle-aged and elderly are more apt to be attacked than the young. Here uncleanliness again is a prime factor in their occurrence. (Fig. 82.) Pediculosis Pubis, or crab-louse, is a smaller, shorter, stouter parasite than the two preceding, and attacks the pubes par- ticularly, but is also found in the axillae and over the eyelashes and beard of the male. They may be seen clinging closely to the skin with remarkable tenacity. They occur on adults and produce the same lesions as the other varieties. They are generally the result of promiscuous sexual intercourse. (Fig. 83.) Fig. 82. body-louse. 160 SKIN DISEASES. Treatment. — The main object in the treat- ment of these filthy diseases is the destruction of the parasite. The lesions they produce disappear with the disappearance of the ani- mal. It need hardly be said that strict clean- liness of person is a sine qua non. The rem- edies usually employed in their extermination are the mercurials, sulphur, carbolic acid, to- bacco, etc. crabTlouse. I n case °f tne head-louse the most effica- cious method of treatment consists in saturating the head over night with petroleum and washing off with soap in the morning. In young children the hair may be cut to get rid the more easily of the nits, but this is not necessary. The applications of petroleum may have to be repeated several times and the hair frequently washed with soft soap, soda washes, vinegar, etc., to get rid of the nits. If the louse be of the body variety the treatment must be directed to the clothing, which is to be changed often and either boiled or baked. This pro- cess is to be repeated until no more parasites are found. The itching of the body is best allayed by carbolic acid lotions (one teaspoonful to pint of water). The crab-louse is best treated by the well-known mercurial oint- ment, or blue ointment, and is to be washed off with soap and water each morning. It must be persisted in till no more crabs are found and no further itching is noticed. Bed-Bugs. The best preventives against these annoying bugs is corrosive sub- limate and pyrethrum powder. Purchase a small bottle of the corro- sive sublimate tablets, usually sold at the druggists for surgical pur- poses, and dissolve one in a quart of water. This solution is to be freely used about the cracks of the bed, after it has been taken apart, and also about any wooden furniture of the room as well as the wood- work of the room. The powder is then to be used freely. This pro- cess is to be repeated several times. The bites themselves are best relieved by carbolic lotions, vinegar and water, ammonia and water, etc. Freckles. This is a disease of the pigment layer of the skin and consists in a deposit of the coloring matter of the skin in irregular shapes, of the size of a pin-head or pea, and are yellowish, brown or even blackish, occurring for the most part on the face and back of the hands. They may be few and scattered or exceedingly abundant and cover a large area. All ages are subject to them except in very young children. The light-complexioned are more subject to them, SKIN DISEASES. 161 while the red-haired seldom escape them. Sunlight develops them so that many have them conspicuously only in summer. The possession of freckles is a matter greatly of idiosyncrasy, as many people never have them, no matter how much they may be subjected to the sun. Treatment. — One's aim in treatment should be toward destroying the pigment layer by some corrosive agent, like corrosive sublimate, which perhaps is the best remedy. Two grains to the ounce in water will in most cases prove suffi- ciently strong. The susceptibility of the skin to this remedy and the extent of the area involved have much to do with the strength of the remedy employed. This remedy is poisonous and is to be used with care. Do not get it near the lips, but to effect a cure it must be per- sisted in for quite a while. "Washing the face in buttermilk several times a day is excellent. Corns. Or all the minor ailments of the human body, few are more dis- tressing than the inflamed corn. They consist of a thickening of the outside or horny layer of the skin. As a secondary change, conse- quent on long irritation, the nerve and blood supply increase and an extreme tenderness is produced, amounting often to incapacity to walk or work. They are caused mechanically by the undue pressure of the boot against the joint or by one toe pressing against another. Too short a boot, which causes pushing out of the big toe joint, too narrow a boot, causing crowding of the large joints, are the more fre- quent causes of the corn. Bunion. The bunion is produced by wearing too short a boot, as a rule, and consists in the gradual displacement of the big-toe joint, so that fi- nally there is an actual deformity. The corn usually is added to this deformity. Treatment. — The outer layers of the corn should be softened and scraped off by a sharp, thin knife. The softening process may be ef- fected by soaking in a soda solution, or better still, by the following mixture : — Salicylic acid one-half ounce Extract cannabis indica ten grains Collodion one scruple This is to be applied each night. Care is to be exercised in not paring the corn too closely lest bleeding occur and poisoning ensue from the unclean knife that may be used. Pressure of the boot must be avoided by the substitution of another form of boot and also per- haps by wearing a plaster with a hole in the center, thus distributing the pressure over a greater area. When trimmed the corn is to be 162 SKIN DISEASES. likewise covered by a corn-plaster bound on the foot by strips of adhesive plaster. Painting with iodine often takes out the sore- ness and hardens the skin so that it may be more readily cut. In- flamed corns should be poulticed and treated like any pus wound. Spirits of turpentine will often take the soreness out of a corn. Ab- sorbent cotton, or better, wool, worn between the toes, will prevent or cure a corn between the toes. Dandruff. This is a disease of. the sebaceous glands of the scalp, characterized by a large secretion of the sebaceous matter and forming crusts or scales. The secretion may be so thick and oily as to mat together the hair, or so dry as to fall off the head in a shower when the head is combed. It is the most frequent cause of baldness. The crown of the head is the most frequent location of this disease. Treatment. — Inasmuch as those subject to this disease are often below par in health, such constitutional remedies as cod-liver oil and iron are valuable adjuncts in bringing about a cure. Should the amount of scales be considerable, especially if there are crusts, as in the case of little children, the best procedure consists in oiling the scalp over night with some bland oil, wearing a flannel cap, and wash- ing off the oil in the morning with soft-soap and water. The follow- ing blood tonic is an admirable one for adults : — Tincture of iron one ounce Dilute phosphoric acid . . . . . . . one ounce Syrup of lemon two ounces Take one-half teaspoonful in a wineglass of water three times daily. Use a glass tube to avoid staining the teeth. The scalp needs a shampoo once or twice a week ; the following will be found to be a suitable one:- — Green soap eight ounces Alcohol four ounces Put a little here and there over the scalp and then rub up with warm water. The scalp may then be stimulated night and morning with a little of the following lotion :[ — Tincture of cantharides three drachms Tincture of capsicum three drachms Castor oil two drachms Alcohol two ounces Spirits rosemary two ounces Another good remedy for daily use : — Hydrate of chloral two drachms Water four ounces SKIN DISEASES. 163 The yolk of two eggs well rubbed into the scalp and afterwards washed off with hot water is also a good cleansing agent and sham- poo. For very stubborn cases the following lotion applied night and morning will be found efficacious : — Corrosive sublimate . . . 12 grains Glycerine 4 drachms Alcohol 5 ounces Spirits rosemary 4 drachms Whatever method is pursued, the application must be persevered in and applied from twice daily to once every few days according to progress made and severity of case. Baldness. This disease is generally the outcome either of some constitutional weakness and requires general tonic treatment like iron and cod-oil, or is the result of some local lesion of the scalp proper. When due to syphilis, the hair falls out suddenly and quite extensively ; the eyebrows also suffer the same way. Its treatment is to be conducted on the same plans as directed under treatment of the syphilitic dis- ease. Eczema, scrofulous blood, etc., may also be the exciting cause of baldness. Baldness may ensue in areas only, and oftentimes is as complete as though no hair had ever grown there. This form is apt to be very stubborn and requires very irritating treatment, like blisters or the rubbing in of strong carbolic acid once a day for a number of days before ceasing treatment. The baldness of old age is of course irremediable, but may be ar- rested by attention to the general health and the employment of rem- edies mentioned under the consideration of dandruff. As has been mentioned, dandruff is the most fertile source of bald- ness. When once the scalp is clean and the dandruff is cured the following lotion will be found to be of great value in those cases of baldness characterized by the hair falling out in small patches : — Carbolic acid one drachm Alcohol one and a half ounces Castor oil . two drachms Oil bitter almonds ten drops Strong carbolic acid itself may be rubbed in the inveterate cases. The following lotion also contains desirable ingredients : — Tincture cantharides . . . one and a half ounces Tincture capsicum .... one and a half ounces Castor oil . two drachms Cologne one ounce DISEASES OF THE BRAIN AND NERVES. The brain and spinal column are the great centres of the nervous system. The brain produces sensation, thought, and voluntary motion. When this organ is diseased, therefore, we may expect one of these functions to be either disturbed or destroyed. Of Sensation there are various disturbances, perversions, and sus- pensions, caused by disease of the brain and nerves ; such as nausea, giddiness, specks floating before the eyes, ringing in the ears, decep- tive tastes and smells, intolerable itching, neuralgic pains, boisterously high spirits, depression without apparent cause, anxiety, and dread. Thought, in like manner, is disturbed and perverted in many ways. There is high delirium, dullness and confusion, loss of memory, weak- ened judgment, and every degree of stupor, down to entire loss of consciousness. Voluntary Motion is perverted and destroyed in muscular twitch- ings, trembling of the limbs, spasmodic stiffness, involuntary jerk- ings, convulsions, muscular debility, and palsy. The brain is composed of three parts, — the cerebrum, the cerebel- lum, and the medulla oblongata. These are all contained within the skull bones, and are immediately covered by three membranes, called the dura mater, the arachnoid, and the pia mater. The dura mater is a strong, fibrous membrane lying next to the skull-bones. The arach- noid is a serous membrane, lying next below, and the pia mater, which means pious mother, is a vascular membrane, lying next to the brain, dipping into it in places, and containing the vessels which bring to it all its nutrient materials. Hence its name. These membranes are all liable to be inflamed, — and so is the brain. Inflammation of the Dura Mater. The inflammation of this membrane does not often occur sponta- neously ; but it happens frequently from external injuries, as blows upon the head. After a blow upon the head which stuns him, a man may recover himself, and for some days remain in perfect health. Then he has 164 DISEASES OF THE BRAIN AND NERVES. 165 pain iii the head, is restless, cannot sleep, has a flushed face, red eyes, hot skin, hard pulse, rigor, nausea, vomiting, — ending with convul- sions and delirium. This disease is often caused by what is called otitis, or inflamma- tion of the internal ear. In such cases, inflammation will arise within the tympanum, causing intense earache ; matter comes at length from the external ear, but the pain does not stop ; the patient shivers, be- comes drowsy, perhaps delirious, and finally sinks into stupor. The dura mater is inflamed. Treatment. — When the disease arises from inflammation in the ear, leeches are to be applied behind the ear, and blisters and other irritants afterwards. Other modes of treatment will be mentioned after the next two forms of disease. Inflammation of the Arachnoid and Pia Mater. Arachnitis. These two membranes are generally inflamed together. They are so intimately connected that each involves the other in its own troubles. Generally this is divided into three stages : — The Irritative, characterized by wakefulness, irritable temper, re- pugnance to strong light, and contraction of the pupils. The Inflammatory Stage, known by transient pains in the head, alternating with similar ones in the bowels, increased restlessness and irritability, a quick and tense pulse, an expression of discontent on the face, the eye-brows knit and frowning, the eye-lids half closed, retching and vomiting, deep sighing, and torpid bowels. The Depressing Stage, in which the delirium is more continuous, the countenance has a look of surprise and stupor, the pupils are con- tracted or dilated, the white of the eyes injected and red, the pupils rolled up during sleep, constant sleepiness, inattention to surrounding objects, torpidity of mind, gradually increasing until complete coma closes all the senses. The disease does not always exhibit all these symptoms, or come on in the regular way described. Sometimes the first thing noticed is a long-continued paroxysm of general convulsions. Again these con- vulsions will come on after violent pains in the head, and are attended with screaming. Inflammation of the Brain. Brain Fever. Encephalitis. — Phrenitis. Acute and general inflammation of the brain and its membranes has two stages. The Stage of Excitement, in which there is intense and deep-seated pain in the head, extending over a large part of it, a feeling of tight- 166 DISEASES OF THE BRAIN AND NERVES. ness across the forehead, throbbing of the temporal arteries, a Hushed face, injected eyes, looking wild and brilliant, contraction of the pupils, great shrinking from light and violent sound, delirium, want of sleep, general convulsions, a parched and dry skin, a quick and hard pulse, a white tongue, thirst, nausea and vomiting, and constipation of the bowels. The Stage of Collapse, in which there are indistinct mutterings, dull and perverted hearing and vision, double vision, the pupil from being contracted expands largely and becomes motionless, Uvitchings of the muscles, tremors and palsy of some of the limbs, a ghastly and cadaverous countenance, cold sweats, profound coma, and death. The disease will not show all these symptoms in any one case. It runs a rapid course, causing death, sometimes, in twelve or twenty- four hours ; or it may run two or three weeks. Treatment. — This should be energetic, and administered early. The measures usually employed are hot foot-baths, and the ap]?lication of cold to the head, with occasional mustard poultice to legs. General Bloodletting. — This is much approved by many ; for myself, I do not like it. Wet cups and leeching are about the extent to which I would ever carry the abstraction of blood in these diseases. These may sometimes be applied with advantage to the neck, and be- hind the ears. Cold Applications. — These, applied to the head, are of great im- portance. First, shave the head, and put on cloths wetted in water as cold as it can be made, changing them often ; or, put powdered ice in a flexible bladder, and lay it upon the head, — taking care not to make it too heavy. Heat in a few cases is better borne. Cathartics. — These, while the inflammation is in the active stage, should be thorough and energetic. To effect it, many use calomel and other forms of mercury. They are not needed. Croton oil is one of the best articles (31), or colocynth, gamboge, etc. (32), without the oil, or the compound powder of jalap. In the stage of collapse, if there is pallor of the countenance, a feeble and flying pulse, great debility and tremors, coldness of the extremities, etc., give wine and other stimulants. See that the bladder is emptied every day. The feet, in the early stage of the complaint, should be bathed in warm water, or mustard and water (242). Mustard draughts must also be put upon the feet. The tincture of veratrum, given in full doses, to bring down the pulse, and produce sweating, must not be omitted. Give (351). Softening of the Brain. — Ramollissement. Inflammation of the brain, when it has run its course, sometimes leaves this organ, or portions of it, in a softened condition. The DISEASES OF THE BEAIN AND NERVES. 167 same mischief may happen to the brain from the blood-vessels which run to it being diseased, so as not to be able to carry blood for its proper nourishment. Symptoms. — The most remarkable symptom of this disease is the rigid contraction of the muscles which draw up the limbs ; the hand may be clenched and pressed against the shoulder, or the heel carried up to the hip. The other symptoms are various, — tingling and numbness in the ends of the fingers ; perverted vision, and sometimes blindness ; par- alysis of one limb, or half the body; difficulty of answering ques- tions ; forgetf ulness, making it difficult, at times, for the patient to remember his own name. General treatment is indicated. Suppuration and Abscess of the Brain. When a diseased brain is examined after death, sometimes matter is found mixed in with the softened portion. This shows that suppu- ration took place. At other times, the matter is found in a cavity, which shows that an abscess had formed during life. The symptoms of these mischiefs are convulsions in the earlier stages, and palsy in the latter. Surgical methods now often save life, and cause a cure in these cases. Induration of the Brain. Instead of softening the brain, inflammation sometimes does the very opposite, — it hardens it, — producing a change something like that which happens to white of egg when dipped in hot water. Convulsions appear as the result of this change, as in suppuration and abscess ; palsy much more seldom. Tumors of the Brain. Tumors infect the brain occasionally, — growing around it, on all sides, pressing themselves into its substance, and causing many dis- turbances. Cancers and hydatids are found there. The signs which these irritating bodies produce are like those of other diseases of the brain, and therefore cannot be distinguished during life. Syphilis is often the cause of them, and, when due to this, may be cured. Delirium Tremens. — Drunkard's Delirium. Mania a Potu. This is often mistaken for brain-fever ; but it is quite a different disease. It is not the result of inflammation of the brain, but of irri- tation. It is important to distinguish it from inflammation, because the remedies which are employed for that would be injurious if used for this. 168 DISEASES OF THE BRAIN AND NERVES. The Symptoms are incessant talking, fidgeting with the hands, trembling of the limbs, a rapid pulse, profuse sweating, utter sleep- lessness, and a mingling of the real with the imaginary in the busy talk. The patient is apt to think some one is about to do him a great injury, yet is unwilling to be alone. His face is pale and sal- low (sometimes red and flushed), his eye is rolling, quick and ex- pressive, his speech stuttering and inarticulate, — bodily and mentally, he is busy day and night, and can with difficulty be confined to his bed or room. As the disease advances, and he has been long without sleep, he imagines vermin to be crawling upon his scalp and body ; troops of rats run across his bed, or look at him out of the wall ; giant boxers confront him, and he squares off for a round at fisti- cuffs ; animals, figures of all shapes, and horrible monsters frighten his imagination; devils laugh at him, and dance before him. In long and sleepless hours, he talks and chatters with these spectral phan- toms, — now beckoning them, now shrinking from them, till he wears out and sinks from exhaustion. This is a disease of drunkards and opium eaters. The attack generally occurs in consequence of the withdrawal for three or four days of the accustomed stimulus. Treatment. — Opium and its preparations are the sovereign rem- edy. Give one-third of a grain of morphia ; if this does not quiet the patient, give thirty drops of laudanum every two hours, till sleep is produced. Sleep will cure him, and nothing else will. A draught or two of his accustomed drink, brandy, gin, or whatever it may be, will also generally dispose him to sleep, if he be not already in drink. Recently, a very effectual remedy has been found in the use of tepid baths, prolonged from four to ten hours, in connection with cold applications to the head. In connection with this, small doses of opium are required ; but the treatment may yet prove to be very valuable by enabling us to dispense with excessive doses of opium. Twenty grains of chloral may be given every hour till patient sleeps. Inebriety. In the beginning of the present century insanity was regarded as a visitation of God's displeasure and not as a disease subject to scientific investigation and amenable to treatment. Inebriety is regarded now as insanity was some hundred years ago, the disease being consid- ered irremediable. Alcohol is a poison, and like other poisons is cap- able of destroying life. In large doses it becomes a powerful irritant or a narcotic producing coma and death. It being constantly intro- duced into the system produces a general disease in the system. We believe inebriety can be cured like any other disease, but is subject to relapses like other diseases. The " alcohol habit," under the title Inebriety, oftentimes has the symptom or outward manifestation of diseased conditions, which an- tedate the alcoholic craving, and are its predisposing and exciting causes which retard, and sometimes even prevent a cure. DISEASES OF THE BRAIN AND NERVES. 169 In the popular, and too often in the professional mind, alcohol is regarded as the cause and root of the whole evil of inebriety. We desire to assert that inebriety is frequently dependent upon causes with which alcohol has nothing to do. There is a neurotic craving — it may be congenital, it may be developed as the result of disease or accident. This craving demands the various forms of narcotic stimulants, those that first excite, then produce narcosis more or less complete. Alcohol fulfills this condition, is easily accessible, reason- ably inexpensive, and is the one drug that meets a morbid craving that seems to be almost universal. We do not fail to recognize the deteriorating effects of alcohol manifested principally, at least, more pronouncedly upon the nervous system as seen in the various forms of insanity. We also note the degenerating effects of alcohol on lung, liver, kidney or other organs and tissues of the body ; or as a special poison in the same sense that lead, arsenic and tobacco produce their effects. We believe that the great majority of inebriates become so from he- redity, environment and disease, that produces physical degeneracy and pushes them over and plunges them into inebriety. The patient with fever craves and may drink water freely, exces- sively and injuriously. The diabetic is an aqua-maniac in a certain sense, but in neither case do we recognize the aqua-mania or water craving as the disease, but rather as proceeding from certain abnor- mal conditions which we readily recognize. So the liquor thirst is the result of morbid conditions that produce an abnormal desire, which alcohol seems, temporarily at least, to satisfy. The excessive use of alcohol, while it is oftentimes the cause of various diseases of the nervous system, and also a frequent cause of insanity, is also the precursor or initiatory symptom of certain diseases of the nervous system and also of insanity. The paretic will crave and use alcohol in the earlier stages of his malady. The victim of nervous syphilis is addicted to it, more es- pecially in the later stages, when the nervous system becomes in- volved. Any depressing, exhausting, or painful disease may produce the alcoholic craving, alcohol being sought for its stimulating properties. Alcohol, moreover, is second only to opium, ether, or chloroform as an anaesthetic ; indeed, has been used as a substitute for the latter. Hence, persons find experimentally that alcohol relieves pain, and its use is carried to a harmful extent, its deleterious effects produced, and inebriety established. It is possible that a healthy individual, with good personal and family history, may use alcohol sociably or as a matter of custom, un- til the habit becomes firmly established. The alcohol breaks down the constitution, invades and degenerates the nervous system, and thus develops inebriety, because the alcoho- lic degenerations, or even functional disturbances of the nervous sys- 170 DISEASES OF THE BRAIN AND NERVES. tern, are the very conditions under which inebriety is established. We say this is possible, but we assert again that behind the large majority of inebriates will be found a defective family or personal history, not only complicating but causing the inebriety ; retarding, oftentimes preventing a cure. It can be thus seen that inebriety is but a symptom — a flag of distress hung out by the nervous system. As some one has aptly said, " neuralgia is the cry of a diseased nerve," so the " drink-craze " is the cry of the neurasthenic for a stimulant, of the pain-tortured nerve for an anaesthetic, of the victim of insomnia for a hypnotic. Not any patient that applies for relief to the physician needs a more careful examination than does the inebriate. You may rest as- sured that there is some underlying cause, probably several that must be removed if we would restore the inebriate to his former habits of sobriety. If he is found suffering from the later manifestations of syphilis he will need special treatment for this condition, especially if the nervous system is involved ; a painful stricture of the urethra may require division. Chronic malarial poisoning with its complicating disorder of stom- ach, liver and spleen, will demand special treatment. In a case on record the irritation of a tape-worm produced a tendency to the ex- cessive use of alcohol, which tendency passed away when the worm was expelled. la a word, a large majority of inebriates are diseased persons, and that primarily and antecedent to their inebriety, which is appended to and aggravates their diseased condition. Special diseases, therefore, require special treatment, irrespective of the inebriety, if we would cure the inebriate. In this connection we may ask, are there an}^ drugs that we can substitute for alcohol that will take its place, and satisfy the inebriate, as a substitute for alcohol ? Opium and the salts of morphia will do so in a marked degree, al- though cocaine, chloral and the bromides have been so used. The use of opium or morphia is not uncommon among inebriates who desire to " leave off alcohol." The inebriate, as a rule, is a con- genital neurotic. From birth almost, he reaches out for some drug that will gratify or meet his neurotic craving. The alcohol and the opium habit to the inebriate are convertible habits, and the inebriate, like a pendulum, will swing from alcohol to opium ; not infrequently the two habits are combined, as in the form of tinct. opii, constitut- ing a mixed habit, in which the effects of both alcohol and opium have to be considered. Occasionally a case is presented in which morphia is used hypodermically, and the alcohol used in the usual manner. In cases where opium addiction is associated with the habi- tual use of alcohol, the opium habit is of paramount importance and the alcohol assumes a secondary place. The fact that opium can substitute alcohol is the keynote to many vaunted secret cures, in the so-called " narcotic treatment " for alco- DISEASES OF THE BRAIN AND NERVES. 171 hoi. It simply substitutes one habit for another, and as long as the victim is taking the so-called remedy he is reasonably comfortable. But I admit if the " narcotic treatment " was carefully practiced, in judicious hands it might, in conjunction with such other remedial measures as would best eradicate the primal causes of the inebriety, prove useful, if not curative, in cases of inebriety. Are there any drugs that are specifically beneficial for the treatment of inebriety as such ? We would state that drugs that act directly as a stimulant to the nervous system are of value. Strychnia is a type of this class of drugs, and one of the best of it class. Luton, of Rheims, Belgium, was the first to point out its value in alcoholism. Then the Russians used it largely and it was known as the " Russian treatment," and finally, the Americans adopted its use in such cases. Strychnia has proved serviceable as both abortive and curative in acute alcoholic delirium, as well as useful in the more chronic forms of alcoholism. It seems to be tolerated in such cases — in cases of alcoholic poisoning under normal conditions, we have no record of the value of strychnia as an antidote ; interesting experiments might be made on the lower animals with the view of determining this point. Strychnia is an excellent cardiac tonic, and one of the best respiratory stimulants, and might be used in general medicine in cases in which alcohol is oftentimes prescribed. Oxide of zinc, during the past twenty years, has been used with advantage in cases of chronic alcoholic intoxication. Quinine has been used more particularly in the later or convales- cent period of the treatment of alcoholism. The so-called "Red Cinchona Cure" for a time interested the pub- lic. Rational medicine does not recognize any special drug or speci- fic remedy as a universal cure for inebriety, nor does clinical experi- ence form any basis for such a claim. From the very nature of the case, such a remedy would be impossible. The aetiology of inebriety is dependent on such a variety of causes and its environments and complications so numerous that any one remedy could not fulfill all, or even meet the more important of these conditions. However val- uable drugs may be to meet certain indications in the various condi- tions incident to inebriety, we believe that so far as the curative treatment of inebriety is concerned, drugs must assume a secondary place, valuable as they may be in their respective spheres. In the treatment of the alcohol habit we place first: Restraint and seclusion in a special asylum for a definite period, and total* abstinence during this period. In a few words, concisely expressed, this statement includes the plan now adopted by the leading asylums of this country and of Europe for the recovery of the inebriate. It involves restraint, (legal, if need be), seclusion, a special institution, in which all the latest and best methods of dealing with the inebriate are procurable, a sufficient period in which to apply these measures, and we need 172 DISEASES OF THE BRAIN AND NERVES. hardly add, a long period of total abstinence from all alcoholic liquors. We need hardly add that diet, rest, recreation, hygienic surroundings, and the exhibition of appropriate drugs are all included in the above plan. The causes of degeneration being removed, the factors of regenera- tion being brought into action, new formation of nerve, muscle and tissue must supplant degenerated tissue, if haply organic disease has not resulted in irreparable injury. We have hinted at an hysterical element in the history of inebriety. The inebriate, whatever may be his condition, is largely influenced by his surroundings. In the light of such an hysterical element in the clinical history of inebriety, we can readily account for the apparent success of the so- called temperance movements that sweep over communities periodi- cally and effect many apparent cures, or rather, in the language of the day, reformations. Such an element will also explain why, after such a tidal wave of excitement, relapses take place oftentimes in large numbers, and the period of excitement is followed by a period of reaction. The occurrence of relapses is readily accounted for by the fact that the stimulus of the period of excitement buoys up the inebriate for the time being, during which strong mental emotion is a powerful factor. He is keyed up, as it were, for the time, and sustained by a moral stimulus. When this is withdrawn, reaction, followed by cor- responding depression, sets in, and the old method of stimulation is again imperatively demanded and yielded to. Why some inebriates go through such a period of excitement and do not relapse, and why others do, can be accounted for by the fact that the former are in a reasonable degree of physical health, and are not burdened, dragged down and handicapped, either by disease that is non-alcoholic, or that is the result of alcoholic degeneration. The inebriates so affected are not influenced, or if at all, only temporarily, by the so-called "temperance revivals" that appear and disappear with almost stated regularity in large and small communities, and we must add do good, but only in the channel indicated. It is also operating through this hysterical feature of inebriety that charlatanism may effect a temporary, possibly a permanent suc- cess in a certain class of cases. In cases where the hysterical element largely preponderates, we be- lieve psycho-therapeutical agencies, or even those that appeal to purely mental conditions, will be of service, but they will not cure a cirrhosed liver, lung, or kidney, or remove the physical causes upon which the inebriety may depend. In addition to those measures that appeal to the higher moral nature, there ought also to be combined such as meet certain intelligent wants. To this end all reasonable amusements, entertainments, and especially such occupations as will interest the person and keep him busy, should be encouraged, if not made compulsory. DISEASES OF THE BRAIN AND NERVES. 173 Incidentally I may mention hypnotism as having been used espe- cially by French physicians, with some benefit in cases of chronic al- coholism. I have no data to give, and have not had any personal experience with it. The Bi-Chloride of Gold cure, known as the Keeley cure, is in many cases successful, but not in all. Would advise its use as a last resort ; though we think its use sometimes leads to insanity and suicide. It cures at all events for the time being. If the temperance advocates would supply light, warm, cheerful places of resort with hot and temperance drinks, supplied with pool and billiard tables where the poor could spend their evenings and meet each other and amuse themselves at a reasonable expense, and establish cooking schools for the wives where they could learn how to cook nourishing and palatable food which would supply the body with the nourishment which it must have, and requires, we believe it would do more towards temperance than all the laws that could be passed. Enlargement of the Brain. — Hypertrophy. This is chiefly a disease of childhood. It consists in an unnatural growth of the brain. Sometimes the skull grows with it, and there may not be any, or only slight, symptoms of disease. The complaint is sometimes congenital, — the child being born with a head far above the natural standard of size. Sometimes a child's head, from this disease, will reach the size of an adult's by the time it is five or six years old. This is not necessarily a disease, though children that suffer from it are very apt to die finally of some affection of the brain. Symptoms, — Dullness of intellect, indifference to external objects great irritability of temper, inordinate appetite, giddiness, and an ha- bitual headache, which at times is very severe. In addition to these, there are, at times, convulsions, epileptic fits, and idiocy. There is a peculiar projection of the parietal bones, which serves well to distin- guish this disease from acute hydrocephalus. Treatment. — As far as possible, suspend and repress all exercise of the mind. Take the child from school as soon as the disease is discovered, and put it to the most active muscular exercise in the open air. The moment there is any excitement of the brain, or heat on the top of the head, apply cold water, ice, or cold evaporating lotions. If, as the child grows up, the signs of mischief increase, the diet must be simple, and carefully regulated. Bread and milk only is sometimes advisable. Shrinking of the Brain. — Atrophy. This is a disease in which the volume of the brain is diminished. There are' two forms of it; one is congenital, the brain not being 174 DISEASES OF THE BRAIN AND NERVES. properly developed at birth ; the other occurs in consequence of dis- ease either in the membranes or the arteries. The symptoms are not distinguishable during life from those of other brain affections, and therefore it can only be treated according to general principles. Water in the Head. — Acute Hydrocephalus. This, like enlargement of the brain, is likewise a disease of child- hood, and often attacks scrofulous children. Being an inflammatory disease, it is important to have early notice of its existence, and, if possible, to be aware of its approach ; which we may be, frequently, by observing the following premonitory Symptoms ; namely, a disturbance of the digestive functions, indi- cated by a capricious appetite, — the food at one time being disliked, at another devoured greedily; a foul tongue, offensive breath, enlarged and sometimes tender belly, torpid bowels, stools light-colored from having no bile, or dark from vitiated bile, fetid, sour-smelling, slimy and lumpy. The child loses its healthy look, and grows paler and thinner. Its customary spirit and activity are gone ; it is heavy, lan- guid, dejected ; it is fretful, irritable, uneasy ; and sometimes is a lit- tle tottering in its gait. After these warning symptoms, the disease may begin in one of three ways : — The pains in the head become more severe and frequent, and are sharp and shooting, causing the little patient to wake and shriek out. As the drowsy state advances, the shrieking gives place to moaning. Beside these symptoms, there are stiffness in the back of the neck, pain in the limbs, great tenderness of the scalp, vomiting, sighing, intolerance of light, knitting of the brows, increased disturbance of stomach and bowels. This stage may last ten to fourteen days, the child growing more weak and peevish. Another form of attack is marked by acute pain in the head and high fever, convulsions, flushed face, brilliant eyes, intolerance of light and sound, pain and tenderness in the belly, stupor, great irritability of stomach, causing retching and vomiting upon every attempt to sit up in bed. The third mode of attack is very insidious, — the early symptoms being mild and hardly noticeable, or not even occurring at all. In such case, the convulsions or palsy come suddenly, without notice, bringing swift and unexpected destruction. This has sometimes been called water-stroke. The First Stage is the period of increased sensibility and excite- ment, caused by inflammation, in which the pulse is quick and irreg- ular. * The Second Stage is one of diminished sensibility, or lethargy, dur- ing which water is effused upon the brain, and the pulse is slow. DISEASES OF THE BRAIN AND NERVES. 175 The Third Period is one of palsy and convulsions, with squinting of the eyes, rolling of the head, stupor, and a rapid, thread-like pulse. Treatment. — The first or inflammatory stage of the fever is very important, and must be controlled for five or six days. Scammony and croton oil (33) may be chosen for this purpose, Apply cold water, ice, etc., to the head. Use tinct. veratrum viride or (355). In the second stage, put blisters upon the back of the neck, and one upon the bowels if they are very tender. In the third stage, effusion having taken place, use the warm bath, or the vapor bath, — also digitalis, squills, and iodide of potassium, (144), (128), (302), (130). The effusion, if permanent, may be drawn off. Confine the child to a darkened room, of moderate temperature, — excluding all noise and causes of excitement, and let him lie upon a hair mattress, with his head somewhat elevated. Diet. — Gruel only during the stage of excitement, — during that of collapse, it should be nourishing, but mild and easy of digestion, as beef tea, plain chicken or mutton broth, and animal jellies. At the same time, support the patient by the cautious use of the aromatic spirit of ammonia, ten drops every four hours, valerian, wine whey, and infusion of gentian, columbo, or quassia, (64), (66). Dropsy of the Brain. — Chronic Hydrocephalus. Acute hydrocephalus is an inflammation; chronic hydrocephalus, now to be considered, is a dropsy. It often begins before birth. It consists in the accumulation of enormous quantities of water within the brain, sometimes within its ventricles, at other times upon its surface. When it occurs soon after birth, it advances slowly and imperceptibly, — the enlargement of the head being the first thing noticed. The skull being tender in infancy, it separates at the fontanelles, as the fluid accumulates, and the head, at times, attains an enormous size, — so great that the child cannot carry it upright, but lets it droop laterally upon the shoulder, or forward upon the breast. As the disease advances, the senses become blunted, the child is deaf or blind, the intellect is weakened, perhaps idiocy appears, the flesh and strength pass away, convulsions and paralysis come in their turn, and a stupor is apt to occur which ends in death. Treatment. — The remedies may be external, or internal, or both. Internal Remedies. — These should be purgatives (33), (31), or diuretics and alteratives (302), (145), (144). External Remedies. — Apply an ointment of the iodide of potas- sium to the scalp every night (185). A tight bandage applied over the whole head will sometimes have a favorable effect. Another ex- 176 DISEASES OF THE BRAIN AND NERVES. pedient is to puncture the skull and draw off the water. Tapping the brain has effected a cure in many cases, and perhaps promises the most relief of any remedy we have. In newly-born children with this affection, it is the best means. Diseases of the Spinal Cord. There are few diseases more interesting, as a study, than those which affect the nervous cord which runs 11 through the centre of the back-bone. This cord is a continuation, an appendage or tail of the brain. (See Figure 84.) It is the seat and centre of certain ner- vous functions, called reflex, by which so many move- ments take place which are not under the control of the will. In order that we may feel what takes place in any part of the body or limbs, and that the will may have power to move such part, it is necessary that nervous matter should be continuous and unbroken between the part in question and the brain. If the spinal cord be cut, broken, or crushed at any point, all those parts which receive nerves from below the injury, lose their power of motion and their feel- ing. When the injury is in the upper part of the cord, the breathing and the circulation will stop, and death is the immediate consequence. If the middle portion of the cord be the seat of the injury, the bowels and other organs may lose their motion and feeling ; if the lower portion, then the lower limbs only will be the sufferers. Disease or injury in the upper part of the cord is therefore much more dangerous than the same thing occurring in the lower. Inflammation of the Spinal Cord. The membranes which surround the cord may be inflamed just as those are which enclose the brain ; but as the cavity running through the spine is quite small, there cannot very well be inflammation of the membranes without its involving the cord at the same time. Symptoms. — Pains, often intense, running along the spine, extend- ing out into the limbs, and made worse by motion. They are similar, in some respects, to rheumatic pains. There is rigid contraction, and sometimes violent spasms of the muscles of the back and neck, — so great, at times, as to bend the body back into the shape of a hoop ; also a feeling of constriction in various parts, as if they were girt by a tight string ; a sense of suffocation ; retention of urine ; a most DISEASES OF THE BRAIN AND NERVES. 177 obstinate constipation and frequent chills or rigors. The pain which is felt along the cord is aggravated by rapping upon the spine, but not by pressure. The above symptoms are supposed to be the result of inflammation predominating in the membranes. When its seat is more particularly in the substance of the cord, the symptoms are, — convulsive affec- tions of the head and face, inarticulate speech, loss of voice, squint- ing, and difficulty of swallowing, if the extreme upper part of the cord is inflamed; if the disease be slightly lower, difficulty of breath- ing, irregular action of the heart, and tightness of the chest; if lower still, vomiting, pain in the belly, sensation of a cord tied round the abdomen, pain and heat in passing water, retention of the urine, ina- bility to retain the urine, desire to go to stool, or involuntary stools. Spasm and stiffness, then, are the results of inflammation of the membranes ; convulsions and palsy, of the same affection of the cord. Treatment, — When the inflammation is acute, apply a few leeches or wet cups along the sides of the spine. In chronic inflammation, powerful friction, or mustard draughts, stimulating liniments (190), or plasters, will generally answer the purpose. Apoplexy. Apoplexy is that condition in which all the functions of animal life are suddenly stopped, except the pulse and the breathing ; — in which there is neither thought, nor feeling, nor voluntary motion ; in which the person falls down suddenly, and lies as if in a deep sleep. Modes of Attack. — There are at least three ways in which this ter- rible disease may make its assault. The First form of attack is a sudden falling down into a state of insensibility and apparently profound sleep, — the face being gen- erally flushed, the breathing stertorous or snoring, the pulse full and not frequent, with occasional convulsions. From this mode of attack some die immediately, others get entirely well, and others get off with the exception of paralysis on one side, or the loss of speech, or some one of the senses. The Second form of attack begins with sudden pain in the head. The patient becomes pale, faint, sick, and vomits, — has a cold skin and feeble pulse, and occasionally some convulsions. He may fall down, or may be only a little confused, but will soon recover from all the symptoms, except the headache, — this will continue, and the pa- tient will sooner or later become heavy, forgetful, unable to connect ideas, and finally sink into insensibility, from which he never rises. This mode of invasion, though not appearing so frightful as the first, is of much more serious import. 178 DISEASES OF THE BRAIN AND NERVES. In the Third form of attack there is sudden loss of power on one side of the body, and also of speech, but not of consciousness. The patient retains his mind, and answers questions either by words or signs. This may be called paralytic apoplexy. The patient may either die soon, or get well, or live for years with imperfect speech, or a leg dragging after him, or an arm hanging useless at his side. The Persons Attacked are apt to have large heads, red faces, short and thick necks, and a short, stout, square build, though it occurs often among those who are thin, pale, and tall. The tendency to it increases in advanced life. The Forerunners of apoplexy are headache, vertigo, slight attacks of palsy, double vision or seeing two objects when there is but one, faltering speech, inability to remember certain words, sometimes a sudden forgetfulness of one's own name, a frequent losing of the thread of ideas attempted to be pursued, and occasionally an unac- countable dread, for which no reason can be given. Exciting Causes. — Whatever hurries the circulation of the blood, as strong bodily exercise, is an exciting cause. So are all those things which cause the blood to flow towards the head, as coughing, sneez- ing, laughing and crying, straining at stool when costive, lifting heavy weights, singing, and playing on wind instruments. To these may be added, exposure to the sun, the bad air of crowded rooms, holding the head down, or turning it around to look backward, tight cravats worn about the neck, and exposure to severe cold. Treatment. — If the patient have the appearance of suffering from fulness of blood in the head, as evinced by redness and turgescence of the face and throbbing of the temporal arteries, and if the pulse be full and hard, feeling like a tense vibrating rope under the finger, place him in a half -recumbent posture, with Ins head raised ; loosen his clothes, particularly his neck-cloth and shirt collar, and whatever may press upon the neck, and then as quickly as possible apply cold wet cloths to his head, changing them often. Ice is still better, if it may be had. Apply wet cups to the nape of the neck, and mustard draughts to the soles of the feet. — at the same time applying tight ligatures around the limbs, to prevent the blood from returning rapidly in the veins. The ligatures should be gradually removed when the patient recovers his consciousness.. Also administer a stimulating, purgative injection (246), and place two drops of croton oil, rubbed up with a little pulverized loaf sugar, far back upon the tongue. Repeat the injection every fifteen minutes, till the bowels are thoroughly moved. This is one of the few diseases suitable for bleeding:. If the patient be old, and the pulse small and feeble, with no ful- ness or beating of the temporal arteries, or swelling of the veins of the neck and forehead, the countenance being pinched, and the skin DISEASES OF THE BRAIN AND NERVES. 179 bloodless and cold, the cupping, purging, and applying the ligature must be omitted. In this case it will be better to apply warm flannels and hot bricks to the surface, and administer ammonia and camphor (283), (135) internally. To prevent future attacks, gentle tonics should be used, and the skin should be kept healthy by daily bathing and friction. The bowels mnst not be permitted to become costive. The diet should be light, chiefly vegetable, and almost entirely so in hot weather. The food should be well chewed. The mind should be kept cheer- ful and hopeful, and free from great excitement. The sexual passion should be restrained, and very rarely indulged. Intoxicating drinks should be abandoned, if used, and all tight cravats be dis- carded from the neck. Direct rays of the hot sun in summer should be carefully shunned. No food should be taken for three hours before retiring, and a mattress only, of some degree of hardness, should be slept upon, — the head being always well elevated. To these precautions, I would add dipping the feet every night before retiring in cold water; and, if any tendency to cold feet be ex- perienced, dusting pulverized cayenne in the bottoms of the stockings. Sunstroke. — Coup de Soldi. This is much like apoplexy; in fact, it is a kind of apoplexy. It occnrs in warm climates, or on very hot days in temperate regions, by exposure to the sun. It begins by headache, thirst, dizziness, and sometimes difficult breathing and bilious vomiting. The patient drops down senseless, as in apoplexy, and unless immediate relief is obtained, soon dies. Treatment. — Take the patient immediately into the shade, and employ about the same remedies as for apoplexy (351). Apply ice to the head. Palsy. — Paralysis. Palsy is a loss of the power of voluntary motion and feeling, one or both coming on, sometimes gradually, but more often suddenly, and extending at one time to a part, at another time to the whole body. It is a kind of station-house on the way to apoplexy, where passengers stop, not merely to stay over night, but to rest many days, or even years. A great injury inflicted upon the brain, either by pressure or other cause, will induce a complete loss of motion and feeling, and this ex- tending to the whole structure, brings likewise a loss of conscious- ness, which is apoplexy. A smaller degree of pressure, or a less injury upon the same brain, would occasion a loss of motion only, or, if a loss of feeling were experienced also, it would only extend to a part of the body, and consciousness would remain. This would be palsy. The disease is like apoplexy in kind, but stops short of it in degree. 180 DISEASES OF THE BRAIN AND NERVES. Hemiphlegia. When palsy affects an entire half of the body, dividing it through the centre of the face, neck, body, etc., from head to foot, it is called hemiphlegia. It is more nearly allied to apoplexy than any other form of the disease, and is generally ushered in by pretty well-marked apoplectic symptoms. Symptoms. — Sometimes there are no premonitory symptoms ; but often before the attack there are flushed face, swelling of the veins about the head and neck, vertigo, a sense of fullness, weight, and sometimes pain in the head, ringing in the ears, drowsiness, indistinct articulation of words, or even loss of speech, confusion of mind, loss of memory, and change of disposition, — amiable persons being made sullen and peevish, and irritable ones mild and simpering. After the attack, the countenance generally acquires a vague expression ; the mouth is drawn to one side ; the lower lip on the palsied side hangs down, and the spittle dribbles away. The speech is altered, and the mind is generally impaired. In some instances, the patient recovers in a longer or shorter time ; in others, little or no improvement takes place, and the patient, after remaining helpless, often for a long time, dies either from gradual exhaustion, or suddenly from apoplexy. Causes. — Hemiphlegia and paraphlegia are caused by pressure upon the brain, by the effusion upon it of blood or water, by a tumor, by mechanical injuries, by the striking in of eruptions, and by intem- perance in eating and drinking. Paraphlegia often results from dis- ease or injury of the spinal marrow. Paraphlegia. This form of palsy divides the body transversely, at the hips, and confines itself to the lower extremities, and to the parts about the pelvis. Symptoms. — When it arises from affections of the brain, it is at- tended by pain in the head, giddiness, drowsiness, dimness of sight, and impaired memory. Numbness is sometimes felt in the upper ex- tremities as a forerunner of this form of palsy. At first there is a slight stiffness and awkwardness of the motion of the legs, which continue to increase till a cane is needed to balance the body and make it steady. From a paralysis of the neck of the bladder, the stream of urine grows more feeble, and finally dribbles away involun- tarily. The bowels are for a time costive, but when the circular muscle which closes the fundament becomes palsied, the feces pass without consent of the will. When disease of the spinal cord is the cause of the complaint, it is apt to come on gradually ; languor and weakness are felt in the DISEASES OF THE BRAIN AND NERVES. 181 knees, the legs are not easily directed in walking, — being thrown across each other, causing tripping and stumbling. By degrees the loss of power increases in the thighs and legs, until at length the whole lower extremities become palsied and useless. Local Palsy. Palsy is called local when it is confined to a single limb, or muscle, or locality. One of these forms is called facial palsy. It affects one half the face only, and is a good specimen of these affections. It removes all power of expression from one half of the face, and leaves the features still, blank, and unmeaning. With the affected side of the face, the patient cannot laugh, or weep, or frown, or express any feeling or emotion, while the features of the other side are in full play. Among the ignorant, who do not comprehend the extent of the evil, the drollness of the expression excites laughter. Shaking Palsy. The nature of this form of palsy is well expressed by its name. Symptoms. — The first symptom of this complaint is a weakness and tremor of the head or hand. In about a year the other hand, or the lower extremities become affected ; and the patient begins to lose his balance in walking. Then the trembling becomes perpetual ; no limb or part remains still. Reading and writing are no longer possi- ble, and the hand cannot even carry the food to the mouth. The balance cannot be maintained in walking ; there is a tendency to fall forwards, and to avoid it, the patient is obliged to run or move quicker, and upon the toes. At a later period, the tremor continues during sleep ; there is in- creased weakness ; the body is bent forward, the speech becomes in- distinct, swallowing difficult, and the bowels torpid. At last the urine and feces pass involuntarily, and delirium and coma bring life to a close. Lead Palsy. In this disease the muscles of the forearm are palsied, so that the wrists " drop," as it is said, and the hands hang down when the arms are stretched out. It is caused by the gradual introduction of lead into the system. It is a disease, therefore, peculiar to painters, — particularly those who use carbonate of lead, or white lead, as it is called. It is generally the sequel of painter's colic. Treatment. — A sudden and severe attack of palsy requires the same treatment as apoplexy. When the bowels are obstinately con- stipated, they must be moved by scammony and croton oil (31), (32) and by injections (246). 182 DISEASES OF THE BRAIN AND NERVES. When all the symptoms of determination of blood to the head have disappeared, and the disease has become strictly chronic, exciting remedies must be employed, as frictions, stimulating liniments, blis- ters, stimulating baths, cold affusion, and electricity. Among the in- ternal remedies, strychnine has the best reputation (85), (86). The tincture of the poison oak is well recommended (284). An altera- tive (145) should likewise be used. Apply counter-irritants along the track of the spine, such as blis- ters, the moxa, the compound tar-plaster, and the pitch-plaster. At first the diet should be light ; but after the more active symp- toms have disappeared, it should be nutritious, and sometimes stimu- lating. Flannel underclothes should always be worn next the skin. For lead palsy, the best remedies are iodide of potassium, or sul- phuret of potassium . The dose of either of these is from three to ten grains, three times a day, dissolved in water, one ounce of the salt to six ounces of water, and taken in simple syrup. The affected limb should also be soaked an hour each day in a gallon of water, with half an ounce of sulphuret of potassium dissolved in it. Hydrophobia. — Rabies. The bite of the mad dog, or mad wolf, or other hydrophobic ani-, mal, is the most dangerous of all poisoned wounds, because it is apt to be followed by a disease for which there is no certain remedy. Fortunately, the human subject is not as susceptible to the effects of the poison as some of the lower animals ; for only about one-tenth of those bitten are attacked by hydrophobia. Symptoms. — The interval between the bite and the appearance of the disease varies from twelve days to two months. The wound heals like any other bite of a similar animal. After a time, the scar begins to have darting, lancinating pains, which, if it be a limb that was bitten, run up towards the body. Sometimes it feels cold, or stiff, or numb, or becomes red, swelled, or livid, and occasionally breaks open, and discharges matter. The patient feels a strange anx- iety, is depressed in spirit, has an occasional chill, and disturbed sleep, and spasmodic twitches. The pulse is above its natural state, both in quickness and strength, and the nervous system is very im- pressible. The senses are all more acute; trifling noises produce agitation, and the eyes are so disturbed by the light that the patient sometimes hides himself in a dark place. The appetite is lost. This is the first stage. Thirst now appears, and he attempts to drink. But the moment water approaches his mouth, a spasmodic shudder comes over him ; he pushes it back with horror ; the awful fact of his condition flashes upon him ; and he cries out, " What I have dreaded has come upon me." Thenceforward he can swallow no fluids ; complains of pain and DISEASES OF THE BRAIN AND NERVES. 183 stiffness about his neck ; is thrown into convulsions by the sight of water, or even the sound of liquids agitated in a vessel, or by a breath of air blowing upon him, by a bright light, or by the glare of a mirror. His throat is full of a viscid, glary matter, which he con- tinually tries to clear away. Thus, between convulsions, in which he struggles, and sometimes strives to bite his attendants, and com- parative stillness, during which he suffers great depression of spirits, he passes three or four days, and then dies either in a spasm, or from exhaustion. Treatment. — Cut off the bitten part, or apply dry cupping, or suction, at once. Also the caustic potash. The internal remedies heretofore employed have had little success. Perhaps nothing now known promises more than to have the patient vaccinated by the recently discovered virus. The tincture of scullcap, in two or three dram doses, will allay the nervous agitation, and is always worth using. It has been proposed to clear the throat of the tough mucus by cauterizing it with a strong solution of nitrate of silver (219), ap- plied with a shower syringe. The remedy is worthy of a trial. Some of the Western physicians declare the red chickweed, or scar- let pimpernell, to be an absolute remedy for this disease, and cite some quite remarkable cases of its success. Four ounces of this plant, in the dried state, are directed to be boiled in two quarts of strong beer or ale, until the liquid is reduced one half. The liquid is to be pressed out and strained, and two drams of laudanum added to it. The dose for a grown person is a wine-glassful every morning for three mornings. A larger dose is required if the disease have begun to show itself ; and if the case be fully developed, the whole may be taken in a day. The wound is to be bathed with the same decoction. The medicine, it is said, produces profuse sweating. It is worth a trial. Considerable has been said of late of a remedy used in some parts of Europe, and said to be effectual. It is the " golden cenotides " (cetonia aurata), or common rose-beetle, found in large quantities on all rose-trees. A similar insect is said to infest the geranium-plant. When collected, they are dried and powdered ; and given in this form, relieve excitement (so it is said) of the brain and nerves, and throw the patient into a sound sleep. Immediate suction and disin- fection of the wound is admirable, followed by caustics. Muscular and Nervous Derangements from Wounds. In some persons, a very small local injury will produce violent dis- turbance of the nervous system. Some will faint and be thrown into convulsions and vomiting from causes scarcely greater than the prick of a needle ; and, before Morton gave the world the boon of ether, it 184 DISEASES OF THE BRAIN AND NERVES. was not very uncommon for persons to die under the knife of the surgeon. One of the most serious disturbances from wounds, of a nervous and muscular character, is Locked Jaw. — Tetanus. This is spasmodic contraction, with rigidity, or stiffness, of the voluntary muscles. Sometimes this rigidity is partial, at other times universal throughout the system. Tetanus is produced by two causes, exposure to cold (idiopathic), and bodily injuries, particularly the injury of a nerve (traumatic te- tanus). This last is the most frequent, — perhaps the only form of the complaint. The Symptoms are long-continued, violent and painful contraction or cramp of the voluntary muscles. At first there is difficulty and uneasiness in turning the head, with inability to open the mouth easily, — then the jaws close gradually, but with great firmness ; swallowing now becomes difficult, and a pain, starting from the breastbone, pierces through to the back, — probably caused by cramp of the diaphragm or midriff. The cramps now extend to the muscles of the body, the limbs, the face, the tongue, etc., which continue in a state of rigid spasm, — being swelled and hard in the centre, — till the disease yields, or the patient dies. At times the abdominal muscles are so tense as to make the belly as hard as a board. Occa- sionally the patient is drawn backward into the shape of a hoop, so as to rest on his head and heels (episthotonos) ; at other times he is drawn forward in the shape of a ball (emprosthotonos) . All the con- tractions are attended with intense pain. It is the racking of the en- tire body with cramps like those which sometimes attack the calf of the leg. So violent are the contractions that the teeth are sometimes broken by them, and the tongue is often badly bitten. In the mean time, the appearance of the sufferer is frightful. The forehead is wrinkled, the brow knit, the eye-balls motionless and staring, the nostrils spread, the corners of the mouth drawn back, the set teeth exposed, and all the features fixed in a ghastly grin. Treatment The only known remedies for this disease are chlo- roform and ether, taken either into the stomach, or by inhalation, in quantities sufficient to control the spasm, and to be pursued as long as they continue to occur. The costiveness must be removed by one or two drops of croton oil, administered in a spoonful of gruel. Re- lieve the nerve or remove the foreign body from wound. Epilepsy.— Epileptic Fits. This disease has been sometimes called the falling sickness, but generally passes under the more vague title of fits. DISEASES OF THE BRAIN AND NERVES. 185 Symptoms. — The disease is characterized by a temporary loss of consciousness, strong spasms and intervals between the fits. The at- tack is sudden, generally without warning, and attended with a loud cry, when the patient falls down, is senseless and convulsed, struggles violently, breathes with embarrassment, has a turgid and livid face, foams at the mouth, bites his tongue, has a choking in the windpipe, and appears to be at the point of death. Presently, in from five minutes to half an hour, and by degrees, these symptoms diminish, and at length cease ; and the patient falls into an apparent sleep. In a short time more he recovers, and is apparently well. These attacks come again and again, and at irregular intervals. This is the worst form of the disease ; there is another class of cases in which the symptoms are much lighter, — there being no tur- gescence of the face, no foaming at the mouth, no cry, no convul- sions ; but merely a sudden and brief suspension of consciousness, a fixed gaze, a feeling of confusion, or a totter, from all of which the recovery is speedy. Causes. — These are numerous, — as worms, disturbance from indi- gestible food in the stomach and bowels, difficult teeth-cutting, ner- vous irritation, either direct or by sympathy, sexual excesses and masturbation, disease or injury of the brain or spinal marrow, gall stones in the excretory duct of the liver, stone or gravel in the kid- neys and bladder, fright, distress of mind, passion, great loss of blood, and many others. Treatment. — But little can be done during the fit, except to pro- tect the patient from being injured by the violence of the convulsions. To do this, place a piece of leather, cork, or other substance not too hard, between the back teeth to prevent the tongue from being bitten. Remove the neckcloth, and unbutton the shirt-collar. If the stomach and bowels are suspected to be overloaded, give an injection (246). The treatment during the intervals must depend on the cause of the disease. If worms be the cause, expel them ; if the attacks be excited by difficult teething, lance the gums ; if by uterine disturb- ances, search out the nature, and give the treatment recommended under the proper head ; if masturbation, command its entire discon- tinuance as the only hope of relief ; if the complaint arise from in- digestible food, great attention must be given to the diet and general health. In all cases, indeed, the diet should be carefully regulated, being- light, nutritious, and easy of digestion. The sleep should be taken at regular hours, and daily exercise in the open air be insisted upon. The bowels must be kept regular, by the food, if possible ; if not, by mild laxatives. Apply along the spinal column 195, once a day, rub- bing it well in ; also, now and then, mustard poultices. In addition to these remedies, give pills of iron and quinine (72). one after each meal, — also oxide of zinc (270), which is one of our 186 DISEASES OF THE BRAIN AND NERVES. very best remedies. Of the pills, one should be taken three times a day. Bromide of sodium, 1 dram in 24 hours, mostly at bedtime. We can seldom go amiss in giving medicine calculated to relieve nervous irritation, and to build up the general system. For this pur- pose, the valerianate of quinine, and the extract of black cohosh (79) are well adapted. Citrate of iron and strychnine (316), is a very val- uable remedy. It is said that a black silk handkerchief thrown over the face of a person in a fit, will immediately bring them out of it. It is an ex- periment easily tried ; and having seen it in a respectable medical journal, I give it for what it is worth. The bromides in large doses, long-continued, sometimes cure epilepsy (367). Catalepsy. — Trance. — Ecstasy. Cataleptic fits are simply what is known to all the world under the name of trance; and ecstasy is a modification of the same nervous disorder. It is a state in which the mind becomes so intensely ab- sorbed in something outside of its earthly tenement, that it withdraws all control over the body, and all apparent connection with it, leav- ing it as if dead. There is a very light ticking of the heart, just per- ceptible to a cultivated ear, but the breast does not rise and fall with breathing, the features are all inexpressive and still, the eyes are wide open and motionless, apparently staring after the departed intellect; and the body and limbs are entirely passive, — remaining unmoved where they are placed by others, however tiresome and uncomfortable the position. In a word, a person in catalepsy is, in appearance, like a marble statue, or like a human body suddenly turned to stone, or, like Lot's wife, to a pillar of salt. There is as little feeling, or thought, or consciousness, as if the bowl had been instantaneously broken at the cistern, and the apparent death were real. It is a peculiarity in this disease that the patient, on recovery from a fit, takes up the thread of conscious life just where it was broken by the attack. Thus, if she were lifting a cup of water to the mouth, she would hold it steadily, with the mouth open, till the return of consciousness, and then place it to the lips, as if no inter- ruption had occurred ; or, if conversing, and in the midst of a sen- tence, the unfinished words would be uttered at the end of the fit, even though it should last many days. Persons in a cataleptic fit have much the appearance of one in the mesmeric state ; and the statue-like position in winch an attack fixes a patient, reminds one of the manner in which the psychologists, so called, will arrest a man under their influence, and make him im- movable, with one foot raised in the act of stepping. The disease attacks females much more often than males. The premonitory symptoms are much like those of epilepsy, and the treatment should be about the same. DISEASES OF THE BRAIN AND NERVES. 187 Saint Vitus's Dance. — Chorea. This disease is chiefly confined to children and youth between the ages of eight and fourteen. But few cases occur after puberty. Symptoms — The complaint affects mostly the muscles and the limbs. It excites curious antics, — such as we should suppose would occur if a part of the muscles of voluntary motion had hatched a mimic rebellion, broken away from the control of the will, and in sheer mischief and wantonness, were tripping their fellow muscles, and playing tricks with the patient. A few of the muscles of the face or limbs begin their mischievous pranks by slight twitches, which, by degrees, become more energetic, and spread to other parts. The face is twisted into all kinds of ridiculous contortions, as if the patient were making mouths at somebody. The hands and arms do not remain in one position for a moment. In attempting to carry food to the mouth, the hand goes part way, and is jerked back, starts again, and darts to one side, then to the other, then mouthward again ; and each movement is so quick, and nervous, and darting, and diddling, that ten to one the food drops into the lap. If the at- tempt be made to run out the tongue, it is snatched back with the quickness of a serpent's, and the jaws snap together like a fly-trap. The lower limbs are in a state of perpetual diddle ; the feet shuffle with wonderful diligence upon the floor, as if inspired with a cease- less desire to dance. It is supposed by some that the disease consists in a partial palsy of a part of the muscles. The will in that case not being able to control the palsied muscles, when it commands the others to move, their action is not balanced, and they twitch the face and limbs into all the capricious and fantastic shapes we witness. Others, and probably with more truth, hold that the 'seat of the disease is in the cerebellum or little brain. It is supposed to be one of the functions of this organ to preside over and regulate the loco- motion, — that it holds the office of chief engineer, and that its duties are to keep the muscles in subjection to the will. The com- bined and consenting action of several muscles is needed for every movement. It is the business of the cerebellum to maintain this oneness of purpose and action — to see that no muscle flinches so as to disturb the harmony of the movement. When the cerebellum is diseased, all is confusion, — just as the locomotive runs from the track when the engineer is smitten with palsy. The disease is not dangerous, but when it continues for mam- years it is apt to weaken the mind, and it sometimes very nearly destroys it. Causes. — Whatever excites and weakens the nervous system, as powerful emotions of the mind, overworking the mind, reading ex- citing novels, eating too much meat, fright, striking in of eruptions, self -pollution, etc. 188 DISEASES OF THE BRAIN AND NERVES. Treatment. — In the first place, remove all causes of excitement. Take the patient from school, and require some sort of cheerful out- door exercise, daily. Take away all books, and be careful not to do anything to occasion anger or fear, or any kind of injurious excite- ment. Apply spinal ice-bags gradually and regularly. In the second place regulate the diet — making it more animal and stimulating if it has been to low, and more vegetable and cool- ing if it has been too high. In the third place, if the above changes have not been sufficient for the purpose, open and regulate the bowels with some gentle physic (30), (34) for a few days. In the last place, build up the nervous system with oxide of zinc pills (270), three a day ; or iron (63), (80), or black cohosh, scull- cap, etc. (79), or the compound valerian pill (81). Sulphate of zinc (82) will sometimes succeed when the oxide fails ; and where there is scrofula, the iodide of zinc is to be used. To these remedies should be added the shower-bath, beginning with tepid water, and making it a little colder every day. If the shower-bath frightens the patient, or is not otherwise well borne, take the sponge bath. " Fowler's Solution " has the most marked effect on the disease. Three drops gradually increased till coryza ensues ; stop and begin again. Chronic Chorea. This can hardly be said to amount to a disease. It consists rather in uncouth tricks, arising from some slight disorder of particular muscles, and grown into a fixed habit, such as shaking of the head every three to twenty seconds, repeated squinting of the eyes in con- nection with a peculiar knitting of the eyebrows, wrinkling of the nose, shrugging of the shoulders, lifting the ears up and down, or even moving the whole scalp back and forth. These movements are commonly made without a consciousness of it ; and generally there is no power to suspend them without a painful effort which cannot be easily continued. No medical treatment is of any avail. These tricks can only be corrected by great watchfulness and effort on the part of the person suffering from them, and in many cases, not even by such means. Cramps. Cramp is experienced .n the calves of the legs, the thighs, the stomach, the breast, the womb, etc. It is a very painful, sudden, and violent contraction of one or more muscles. The part is sometimes, as the phrase is, " drawn up into knots." When it attacks the stom- ach, it is a very dangerous affection. Women are subject to it about the third or fourth month of pregnancy. They occur more frequently at night as the result of over-fatigue DISEASES OF THE BRAIN AND NERVES. 189 and indigestion during the day. These spasmodic contractions often occur in the abdomen and are accompanied by diarrhoea due to indi- gestion. Abdominal cramps are also a symptom of locomotor ataxia and other spinal diseases. The cramp of swimming is often due to an over-straining of some one group of muscles not hitherto much used, the sudden fatigue causing cramp. They may be also of ner- vous origin. Rheumatism is not infrequently the sole cause of pain- ful muscular spasms. Causes. — Drinking cold water when very hot and perspiring, ex- posure to damp night air, debility, indigestible food, and excesses in eating and drinking, and particularly over-straining the muscles. Treatment. — Moderate the excessive labor and straining of the muscles which produce the cramps. When an attack occurs in the legs, tie a cord or handkerchief tight around the leg above the af- fected muscle. This will generally produce instant relief. Also briskly rub the parts with hot water, alcohol, ammonia, spirits of cam- phor, paregoric, or laudanum. When it occurs in the stomach, apply warm fomentations, or what is better, a mustard paste (165). Take hot Jamaica ginger or neuro- pathic drops. The bowels, if confined, should be opened with an in- jection. Cramps of the limbs which afflict women in the family way, can only be mitigated, not cured, till after confinement. As a palliative, high cranberry bark, scullcap, etc. (87), will be found useful. Pain of the Nerves. — Neuralgia, This disease affects one tissue only, — the nervous ; and has one symptom, — pain. In apoplexy, the nerves, rendered powerless and senseless by an ex- ternal force, are like a man under a bank of earth which has slid down upon him. In palsy, they are suddenly bereft of feeling and motion by a blasting scourge within, — as one is smitten down by a pervasive charge from a magnetic battery. In epilepsy, the nerves are grasped and for a time held senseless by an unseen power, in which they struggle, as a man strives in the folds of the anaconda. In catalepsy, they are suddenly stiffened into senseless strings, for such automatic use as the bystander may, for the time, choose to make of them. In chorea, they are set to dancing by an invisible ex- hilaration, as a man is suddenly crazed by brandy. In neuralgia, the nerves are neither crushed, nor collapsed, nor re- strained for a time, nor stiffened, nor exhilarated. They simply have their sense of feeling intensely exalted ; they are filled with pain. The pain is generally of a peculiarly darting, piercing character. The patient sometimes calls it tearing pain. It comes on in sudden par- oxysms, with intervals of freedom between. The attacks are some- 190 DISEASES OF THE BRAIN AND NERVES. times like an electric shock, and are so agonizing as to bring a tem- porary loss of reason. Occasionally there is great tenderness of the parts affected, and some fulness of the blood-vessels in the neighbor- hood ; but generally the signs of inflammation are all absent, except pain. Neuralgic pains occur in almost every part of the system. One of the most familiar forms of the disease is known under the name of Tic Douloureux. It occurs in those branches of the fifth pair of nerves which go to the face. (See Fig. 85.) Sometimes one, sometimes all of the three branches are affected, but more often the middle branch only. When the upper branch is the seat of the disease, the pain is in the forehead, the brow, the lid, and some- times the ball of the eye. The eye is generally closed during the pain, and the skin of the forehead is wrinkled. When the affection is in the middle nerve, the pain is preceded by a prick- ing sensation in the cheek, and twitch- ing of the lower eyelid. Soon it spreads in quick and piercing pangs over the cheek, reaching the lower eyelid, the sides of the nostrils, and the upper lip. If in the lower branch, it sends its light- ning shafts to the chin, the gums, the tongue and even up the cheek to the ear. Face-Ache. — There is a species of nervous pain called face-ache, which does not quite amount to tic douloureux, but is nevertheless very afflictive. It occurs principally in the jaw, which seems to be filled with pain. No one spot seems to be more affected than another. From the jaw the pain often goes to the whole head, but it has not the stabbing intensity which generally characterizes neuralgia. It often proceeds from defective teeth. Fig. 85. Hemicrania. This is a neuralgic pain, confined to one side of the head, — gen- erally the brow and forehead. Sickness of the stomach often attends it, and in many cases it is periodical, — coming on at a certain hour every day, and lasting a given time, and then passing away. . It may be caused by whatever debilitates the system, as hysterics, suckling an infant too long, or low diet. In fever and ague districts it is frequently produced by miasm. In many instances, the cause cannot be discovered. DISEASES OF THE BRAIN AND NERVES. 191 Sciatica. This is a pain beginning at the hip, and following the course of the sciatic nerve. Occasionally it is an inflammatory complaint ; sometimes is connected with an affection of the kidney; but fre- quently it is a purely neuralgic or nervous pain ; and I have there- fore thought it best to place it here, with nervous diseases. Besides the various forms of neuralgia now noticed, the disease occurs, — sometimes with great severity, — in the female breast, in the womb, in the stomach, in the bowels, in the thighs, in the knee, and even in the feet. In many of these cases the disease is not where the pain is felt, but in the brain or spinal marrow, and consequently the true source of the complaint very often escapes detection. An excellent Episcopal clergyman in Northern New York, the Rev. M. B , with whom I studied Latin and Greek preparatory to college, had a neuralgic pain in the knee so intense, persistent and exhausting, that the limb had to be cut off at the thigh to save his life. Treatment. — This must be as diversified as the causes of the dis- ease. For a general IJ use 368. For tic douloureux, and some other forms, give internally, valerian- ate of ammonia (88); also 89, 90, 91, 92, 93, 316, and 84, as tonics. For external use in tic douloureux, and other neuralgic affections, the prescriptions 188, 196, 197, 198. For the face-ache, above mentioned, muriate of ammonia (134), in half dram doses, is a very valuable remedy. When the disease is caused by miasm, and has a periodic character, like ague, it must be treated with quinine (67), (79), and if there be a low state of the blood, iron (72), (93) must be given at the same time. The galvanic battery often acts like magic in neuralgia. The shower-bath, exercise in the open air, and whatever else will build up the general health, must be used according to circumstances. Neuralgic pain of various kinds often yields readily to some one of the many coal-tar products like phenanthrene, antikamnia and ammo- nol: say 10 grains of either every two to four hours according to the intensity of the pain. The last named product is quite harmless and produces no numbness or faintness which is said to follow at times the use of some of the others. Avoid rich or fatty foods. Live on a plain nourishing diet. Take exercise out of doors as much as possible. Derangement of Mind. — Insanity. Most writers on this disease have attempted a definition of it. I have never seen one which suited me. Here is mine. Insanity is a wrench of maris nature, which sets his intellectual and moral faculties awry in their relations with the external ivorld. 192 DISEASES OF THE BRAIN AND NERVES. Iii a state of mental and moral health, he looks straight at the out- ward world, and sees it as it is ; insanity gives him an angular con- nection with it and he sees it as it is not; its objects have all changed their relative places ; objects at the right in the panorama of life have moved to the centre, or gone quite over to the left ; while things at the top have gone to the bottom, and those in the lowest places have taken the highest. With the thoroughly insane, the world has gone back to chaos. These persons have their sensibility very much altered and per- verted. Errors of the senses and illusions cheat them. In many cases, they cannot read because the letters are mingled in a confused mass. They often do not recognize their friends, and regard them as strangers or enemies. They become awkward in the mechanical use of their hands, and their touch loses the power to correct the errors of the other senses. Hence they are cheated in regard to the size, form, and thickness of bodies. They are haunted, at times, with smells which have no existence, and they hear voices distinctly speaking to them from clouds, or from trees ; and these voices have the familiar tones of a friend, relative, or enemy. The insane lose the power of comparing ideas. They associate things the most unlike, and often in a ridiculous way. They also lose the control of themselves, and come under the do- minion of their passions ; and then they will do acts which they them- selves disapprove. One of strict integrity, of unblemished morals, and of excellent standing, becomes insane, and immediately steals what he does not want, makes infamous proposals, and indecent gestures, and is in every respect the opposite of his past self. The insane often become averse to those who were previously among the most dear to them. For acts of kindness, they repay abuse. They fly from their best friends. This is the result of their fear and jealousy ; for they are very cowardly and jealous. This alien- ation from friends is almost a characteristic of insanity, and is one of its saddest features. The moral affections are always disordered, per- verted, or annihilated in insanity. So much is this a leading feature of the disease, that it is only when the insane begin to recover their moral affections, when they begin to wish to see their children and friends, to fold them once more in their arms, and to enter the family circle and renew its joys, that we can count upon any certain signs of a cure. The insane have a thousand strong fancies in regard to themselves. One thinks himself inspired of God, and charged with the conversion of the world ; while another, equally sincere, believes the devil has entered into him, and that the pains of hell are already taking hold of him, and he curses God, himself, and the universe. Still another is the " monarch of all he surveys," and much more ; he governs the DISEASES OF THE BRAIN AND NERVES. 193 world, and directs the stars. One has all knowledge, and affects to teach the wisest. Another is proud, and withdraws from his fellows, bidding them not to come into his presence without proper acts of homage, — calling himself, it may be, a king. There are five kinds of insanity. I will speak of each of them briefly. Melancholy. — Lypemania. This is characterized by moroseness, fear, and prolonged sadness. The melancholic person is lean and slender, with black hair, and a pale and sallow countenance. His skin is brown or blackish, and dry and scaly. His physiognomy has a fixed appearance, the muscles of the face are drawn tight, the eyes are motionless, and directed to one point, the look is askance and suspicious, and the general expres- sion is one of sadness, fear, and terror. He desires to pass his days in solitude and idleness. He walks as if aiming to shun some dan- ger. His eye and ear are on the watch for evil. These persons do not sleep much. They are kept awake by fear, jealousy, and hallucinations. If their eyes close, they see phantoms which terrify them. Their secretions are disordered. The urine is either abundant and clear, or scanty and muddy. They sometimes retain their urine for days. One patient did not dare to make water lest he should drown the world, but was finally persuaded to it by the assurance that he would extinguish a fire which was devouring a city. Insanity on One Subject. — Monomania. This is a chronic affection of the brain, not attended by fever, and characterized by a derangement of the intellect, the affections, or the will, upon one subject only. The patient seizes upon a false princi- ple, and draws from it injurious conclusions, which modify and change his whole life and character. In other cases the intellect is sound, but the affections and disposition being perverted, their acts are strange and inconsistent. These they attempt to justify by plausible reasoning. Mania. This is also a chronic affection of the brain, generally without fever. The countenance of the maniac is sometimes flushed, at other times pale. The hair is crisped ; the eyes injected, shining and hag- gard. Maniacs dislike the light, and certain colors horrify them. Their ears are sometimes very red, and are disturbed by a tingling, and a rumbling sound. Noise excites and disturbs them. They suf- fer from false sensations, illusions and hallucinations; and their ideas come with great rapidity, and are confused and without order. Their 194 DISEASES OF THE BRAIN AND NERVES. affections are in a state of turmoil, and their judgments are all erro- neous. Unlike the monomaniac, their delirium extends to all subjects. Their entire intellect, affections and will, are a chaotic wreck. Dementia. Here is another chronic affection of the brain, without fever, in which the sensibility, the intellect, and the will, are all weakened. Demented persons have not the power to concentrate their minds on anything, and can form no correct notions of objects. Their ideas float after each other without connection or meaning. They speak without any consciousness of what they are saying. Many of them have lost their memory, or, like old persons, they remember nothing recent, — forgetting in a moment what is just said or done. The demented have neither desires nor aversions ; neither hatred nor love. To those once most dear to them, they are totally indif- ferent. They meet friends long absent without emotion, and part from their dearest ones without a pang. The events of life passing around them awaken in them no interest, because they can connect themselves neither with the past nor the future; they have no remem- brances nor hopes. Their brain is inactive ; it furnishes no ideas or sensations. They are no longer active, but passive beings ; they de- termine nothing, but yield themselves to the will of others. They have a pale face, a dull eye, moistened with tears, an uncer- tain look, and a physiognomy without expression. They sleep pro- foundly, and for a long time, and have a voracious appetite. Idiocy. Idiocy is in the condition in which the intellectual faculties have never been manifested. We are not to infer disease from it, any more than we infer it in the lower animals from the absence of intellect. In idiocy there is no mind, because the brain is not large enough to be the organ of intelligence. It always dates back, therefore, to the beginning of life. Everything about the idiot betrays a defective organization. The demented person, the monomaniac, etc., once had intelligence ; the idiot, never. They, in many cases, may be cured ; he is hopelessly incurable. They had blessings which have been taken from them ; to him, none were ever given. They were once the pride and hope of their friends ; he, from his birth, was the smitten and blasted one of his family. He never reaches an advanced age, — rarely living beyond thirty years. These remarks are sufficient to show the difference between idiocy and other forms of mental derangement. In the other forms of in- sanity there are brains enough, but they are diseased ; in this there is no disease ; the smallness of the brain is the primal and fatal defect. DISEASES OF THE BRAIN AND NERVES. 195 This form of mental derangement is caused by a defective develop- ment of the brain. That the other forms are produced by disease of the brain, there can be no doubt. Some have supposed insanity to be a mental disorder merely, hav- ing nothing to do with the body. They might as well suppose the delirium of fever to be a disease of the mind only. Insanity is an unsoundness of the brain and nerves which proceed from it, in every instance. At first it is probably only excitement of the brain ; but this, long continued, becomes a chronic inflammation. The brain and nerves of an insane person are undoubtedly sore, and hence the painful thoughts and feelings which afflict them. When the soreness is much increased, they are violent and furious ; when it subsides, they are calm. In consequence of this inflammation and soreness of the brain, an insane person can no more think, or reason, or will, or feel correctly, than a person with an inflamed stomach can digest food well, or than one with inflamed eyes can see well. Causes of Insanity. — Hereditary predisposition ; painful subjects of thought or feeling long revolved in the mind ; injured feelings which cannot be resented, mortified pride, perplexity in business ; disappointed affection or ambition ; great political, religious, or social excitements ; sudden and heavy strokes of misfortune in the loss of property and friends ; and in general, whatever worries the mind for a long time, and creates a deep distress, may be a cause of insanity. But one of the most prolific causes, and worthy of special mention, is masturbation, or self-pollution, — a vice contracted by thousands of young people, both male and female. Besides the above, I may mention several physical causes, as con- vulsions of the mother during gestation, epilepsy, monthly disorders of women, blows upon the head, fevers, loss of sleep, syphilis, exces- sive use of mercury, worms in the bowels, and apoplexy. Chances of Cure. — Idiotism is never cured. Melancholy and monomania are cured when recent, and do not de- pend upon organic disease. Dementia is sometimes, though seldom, cured. Chronic insanity, of long standing, is not easily cured. Insanity which has been produced by moral causes, acting suddenly, is generally curable ; if the causes have acted slowly and long, the cure is more doubtful. Excessive study causes insanity which is hard to cure. If caused or continued by religious ideas, or by pride, it is not often cured. „ Insanity caused and maintained by masturbation is cured with great difficulty. Treatment. — The treatment of the insane is now almost confined, as it should be, to public hospitals. In these institutions, all the means are provided which humanity has been able to devise, to lift 196 DISEASES OF THE BRAIN AND NERVES'. from these unfortunate beings the terrible shadow which is upon them. Here they have safety, comfort, recreation, friendly guardians, rest, and medicine. They have safety from the annoyances which well-meaning but mistaken friends at home almost always commit in contradicting, and reasoning with, persuading, and threatening them ; for only in these humane institutions has it been well learned that to do so is no wiser than to persuade, scold, or threaten a neuralgic pain in the face, an inflammation in the stomach, or a felon upon the finger. They are safe, too, from the impertinent scrutiny of neighbors, the hootings of unthinking boys in the streets, and especially from the causes, what- ever they are, which have produced the disease. And so far, this is just the treatment they want, — no contradiction, no impertinent scrutiny from neighbors, no abuse in the streets, and a withdrawal of the causes which have produced the disease. In these institutions, too, they have comforts. They have clean rooms, galleries, lodges, bathing-rooms, yards and gardens for exer- cise and walking, safe, quiet, well-aired bed-rooms, and clean and comfortable beds ; cheerful dining rooms, and plain, wholesome, and nutritious food. And this, likewise, is the treatment they require. They have recreation, — dances, cards, back-gammon, chequers, chess, billiards, nine-pins, walking parties, riding parties, gardening, and an indulgence in those arts of painting, music, drawing and architecture for which they may have a taste. And such recreations are powerful instruments in the cure of all disorders of the nervous system. Here, too, they have friendly guardians, who have long studied their complaints, and have imbued their souls with a sympathy which goes down into the depths of their sufferings, and allies itself with all their sorrows ; — men and women who are willing to act the part of guardian angels ; to be their friends ; who know how to gain their confidence ; and who use the influence acquired by love, in leading them back towards health and happiness. And this, too, in curing the insane, is of great consequence, for none can do them good till they have their confidence, and this can be gained only by love and wisdom. In these insane asylums, they find rest. When the brain is hot from inflammation, and they are raving from delirium, they are here withdrawn from the noisy crowd, and shielded from the rude shocks of the world. If need be, they are placed in solitary rooms, where silence spreads its soothing stillness through their excited brains. And it is of the greatest importance that the sore and torn feelings should rest ; for rest allays excitement, and brings sleep ; and with- out a proper amount of sleep recovery is not possible. Finally, in these institutions, they receive the best medical treat- ment. They have warm and cold bathing, judiciously administered ; they have simple cathartics when the bowels are bound, as salts, cas- DISEASES OF THE BRAIN AND NERVES. 197 tor oil, and magnesia ; tonics for debility, such as quinine, iron, cas- sia, columbo, chamomile ; and quieting medicines for their excite- ment, such as opium, morphine, cicuta, hyoscyamus, belladonna, stra- monium, scullcap, and valerian. Prescription 74 is a combination much used. Here, too, broth, gruel, and milk, are administered by the forcing pump to such as take a fancy not to eat, — an expedient which has saved many lives. Fruits of all kinds, as strawberries, cherries, currants, plums, apples, peaches, and grapes, are allowed freely. Cold water, sweetened or otherwise, is the drink. To these things are added lively conversation, and whatever will divert the mind from reflection, and internal imaginings and revery. Thus I have indicated, very briefly, the treatment which the insane receive in public institutions. That the chances of recovery in these humane retreats is much greater than at home, does not admit of a doubt. When it is not convenient to send an insane person to a hos- pital, the treatment should be as near like the one here sketched as circumstances will permit. « Hypochondria. The common names of this disease are low spirits, spleen, vapors, aypo, and the blues. It produces constant fear, anxiety, and gloom. Business, pleasures, the acquisition of knowledge, and all the useful pursuits of life, become insipid, tasteless, and even irksome to the hy- pochondriac. His mind is full of the belief that something dreadful is about to befall him. He is either going to be sick, or to die, or lose his property or friends. He has no mind to engage in any busi- ness, nor does he wish to go anywhere, or to see anybody. Night and day his spirits are down to zero, and his heart has a load too heavy to bear. He is wholly occupied with his troubles and his feel- ings. He thinks he has various diseases, and wears out his friends by talking of his sufferings. He feels of his pulse often, looks at his tongue in the glass, and several times a day asks a friend if he does not look pale or sick. The external senses manifest symptoms of derangement as well as the thoughts, feelings, emotions, and passions. There are roarings in the ears, like a waterfall, or the noise of a distant carriage. Floating black specks, or bright sparks, are seen before the eyes. These indi- cate a slight fulness of the blood vessels, and perhaps, in some in- stances, sparks of electricity passing to or from the eye, and are in no proper sense subjects for the alarm they cause. At one time the per- son will feel as large as a barrel, at other times not larger than a whip-stock; the head will feel light or heavy, large or small. The skin will twitch in different parts, or feel numb, or have the sensation of spiders crawling on it. The smell and taste become perverted ; the hypochondriac will smell odors and flavors, at times, where there are none. 198 DISEASES OF THE BRAIN AND NERVES. These errors of the senses are all owing to some slight disorder of the organs of sense ; and they are no more wonderful than that the mind should perceive personal danger, poverty, and death itself, when none of these things are impending. These persons are subject to fainting turns, when the breathing will appear to stop, the body become cold, the face pale ; there will be distress in the region of the heart, which will apparently stop beat- ing, and the person will feel as if dying. At the same time the mind will remain clear. These nervous spells are alarming, but pass off without danger. These persons become changed in their moral dispositions. They are jealous, take a joke as an affront, and feel the greatest distress at any apparent lack of attention or neglect on the part of friends. They put the worst construction upon the actions of friends. They are irritable, fretful, peevish, and fickle. The complaint is distressing, but does not appear to shorten human life. The seat of the disease is in the brain and nerves. It is caused by anxiety, care, disappointment, working the brain too hard, diseases of the liver and stomach, costiveness, sedentary habits, excessive vene- real indulgence, and masturbation. Treatment. — This disease is more easily prevented than cured. It would be almost entirely prevented in this country if in childhood we were all taught to be contented with humble competence, to love ac- tive labor, and to think it honorable, instead of struggling after wealth, and falling into unhappiness when it does not come. Remedies. — Of all the remedies for this complaint, that which is most important is active employment out of doors. The human body was made for motion. Without it the blood cannot be distributed to the several organs. The senses, — the eye, the ear, the touch, — should be much in communion with nature. In this way they are strengthened. Nature is their great physician. Man is a creature of sensation; and if too much occupied with feelings, thoughts, and deep reflections, the nerves will be irritated, and begin to give deceptive sensations. A very nervous man should fly to some active occupa- tion, if he would be rid of suffering. The open, fresh air is very important to restore the system to soundness. Temperance, both in eating and drinking, will do much for this class of patients, yet they are the very persons who eat largely, and they often fly to the excessive use of stimulants to drive away their sorrow. By so doing, they aggravate the disease. Amusements are very important for hypochondriacs. Lively com- pany, cheerful and witty conversation, with mirth and laughter, lively songs and instrumental music, are all desirable ; and so are gunning, fishing, riding, billiard-playing, and travelling. DISEASES OF THE BRAIN AND NERVES. 199 Never allow these patients to be alone, and to have time to brood over their misery. See that they go early to bed, and rise betimes in the morning. The warm bath, the cold shower, or sponge bath, with brisk friction, are not on any account to be omitted. The diet should be light, nutritious, and generous ; but fats, acids, liquors, and coffee, must be forbidden. But little medicine will be required. If there be costiveness, let cracked wheat be eaten; if this does not answer, a little rhubarb and bicarbonate of potassa (85), or leptandrin, podophyllin, etc. (36), may be given as required by the symptoms. A teaspoonful of cal- cined magnesia once a day, or the infusion of thorough wort, drank cold, will often answer an excellent purpose. A bowl of warm motherwort tea, with a teaspoonful of spirits of camphor in it will do well in fits of fainting when there is a sensation of dying. A tea- spoonful of sulphuric ether may be given at the same time. If there be debility, tonics are sometimes useful (50), (49), (54), ^5^). Hiccough. — Singultus. This is a sudden, jerking spasm of the midriff, occurring every few moments in bad cases, causing the air to be driven out of the lungs with such suddenness as to produce a noise something like the invol- untary yelp of a puppy. It is generally caused by acidity of the stomach, which irritates the nerves distributed to its neighborhood, and is not difficult to remove ; but when it occurs towards the close of some acute and grave disease, it is sometimes a sign that dissolu- tion is at hand. Treatment. — Startle the person suffering, by exciting surprise, or fear, or anger ; or let a few small draughts of cold water be taken in quick succession ; or, let the breath be held as long as possible. If the stomach is sour, take a teaspoonful of bicarbonate of soda, dis- solved in half a tumblerful of cold water. To expel wind from the stomach, if it be present, take some warm aromatic essence of pep- permint, ether, or compound spirits of lavender. But one of the most effectual remedies is heavy pressure made upon the collar bones. It is simple, and very effectual. Cocaine, one-eighth grain every fif- teen minutes, is a very simple and often efficacious remedy. Fainting. — Syncope. Fainting is preceded by a distress about the heart, a swimming of the- head, sometimes sickness at the stomach, coldness of the hands and feet, and a loss of sight, or a sense of things growing dark. The breathing diminishes, the pulse becomes small, the face deadly pale, and the patient wilts down, and becomes more or less unconscious of what is passing around. Whatever causes debility, particularly of the nervous system, will 200 DISEASES OF THE BRAIN AND NERVES. predispose to fainting. Persons much weakened by disease, faint easily, especially when they attempt to stand still. When on their feet, such persons should keep moving. Fainting is sometimes in- duced by sudden surprises and emotions, by violent pains, by the sight of human blood, and by irritation of the coats of the stomach by indigestible food. Treatment. — Lay the patient upon the back,with the head low; let fresh air into the room instantly, and apply gentle friction. Sprinkle a little cold water upon the face, and hold spirits of camphor, ether, hartshorn, or vinegar to the nose, — rubbing a little of the spirits of camphor upon the forehead, and about the nostrils. As soon as the patient can swallow, give a teaspoonful of compound spirits of lav- ender, with ten drops of water of ammonia in it. Persons subject to fainting should not go into crowded assemblies where the air is bad ; neither should they wear tight dresses, or allow themselves to get excited. Cold bathing, a well-regulated diet, and vegetable tonics, will do much to break up the habit. Dizziness of the Head. — Vertigo. This affection makes objects which are stationary appear as if moving, or as the phrase is, " turning round." When seized with it, one will have a sensation as if falling, and objects about him will seem to be in motion. It is caused by irritation of the nerves of the stomach in dyspep- sia, by long application of the mind, by a weakened nervous system, by hysterics, and by a fulness of the blood-vessels of the head. When it proceeds from most of these causes, it is not dangerous ; but when caused by impending apoplexy, it is a symptom of very serious import. Treatment. — Find out the cause and remove that, and the dizzio ness will disappear. If it come from dyspepsia, eat lightly ; if from costiveness, open the bowels either by coarse food, by daily cold water injections, or by some gentle physic. Avoid coffee, ardent spirits and late suppers, and take much exercise. Keep the feet warm, and the head cool. See to the liver and heart. / Disturbed Sleep. — Nightmare. — Incubus. In this complaint the sleep is disturbed generally by some fright- ful image. Whatever of an alarming character is presented to the mind in sleep, causes fear, or some other painful emotion, the same as when awake. And when the attempt is made to resist, or to flee from the danger, it is ineffectual, because the muscles are locked fast in sleep. The fear being increased by the inability to escape, the sleeper makes all sorts of horrible noises, indicating distress of mind. The danger seen is as real to the sleeper as if he were awake, and he DISEASES OF THE BRAIN AND NERVES. 201 tries to do just what he would if awake. Sometimes the sensation is that some heavy weight, or perhaps some horrible monster, is upon the breast, nearly pressing the breath out of the body. At times, the power of motion 'is not absent, and then disturbed dreams may cause one to talk, or to rise and walk, or run. Children will laugh or cry, or scream, which shows that their minds are agi- tated by different passions. Persons who indulge gloomy and troub- lous thoughts in their waking hours are apt to be disturbed with sleep-walking, sleep-talking, and frightful dreams, as of falling down precipices, during the hours for repose. There is nothing very wonderful about these disturbances of sleep. It is only necessary that there should be an unusual sensitiveness of the brain, or that a hearty supper, eaten late, should irritate the nerves of the stomach, and that distressing thoughts should be dwelt upon during the day and evening, in order to produce all the walk- ing, talking, dreaming of hobgoblins, shipwrecks, fires and polar bears, which distress so many unfortunate sleepers. In night- walking there is simply a little more wakefulness than in night-talking, and in this latter, more than when one falls from a high place, and in this perhaps slightly more than in real incubus, when one is in the greatest peril, but cannot move at all. Treatment. — When sleeping persons groan, or make any noise indicating nightmare, shake them, and they will come out of it at once. As these troubles are often caused by a weakened state of the nerves, much out-door exercise should be taken. The diet should be simple, and well regulated. The suppers should be light, and never taken late. The evening should be spent in some pleasant amusement, which will drive away care ; and the last hours of wake- fulness be occupied with pleasant reflections. One afflicted with nightmare should not lie upon the back, nor with the hands over the head. Acidity of the stomach, and costiveness, if they exist, should be removed by neutralizing mixture. Headaches. These are not always caused by disorders of the brain and nerves, but they frequently are, and this seems the proper place to speak of them. It is unwise ever to neglect headaches. They are sources of great suffering, and often lead to serious derangements of the health. In childhood they have a more serious meaning than in adult life. They often indicate the approach of scarlet fever, or measles, or of other diseases. Headaches are more common among the civilized than the uncivil- ized ; more frequent among females than among males ; among those of sensitive feeling than among the more obtuse ; among those who think much than among those who think little ; among the sedentary than among the active. 202 DISEASES OF THE BRAIN AND NERVES. Causes of Headaches. — They are dependent on various causes, as derangement of the circulating system, of the digestive organs, of the nervous system, etc. Among those dependent on disturbance of the circulation, are Headaches from Eye Diseases. — Myopia, or near-sightedness ; Hypermetropia, or far-sightedness ; Astigmatism, or the inability to see equally well horizontal and vertical lines, as well as other irreg- ularities of vision, are frequent sources of headache. These head- aches are caused by overtaxing certain groups of muscles, or by fixing the eyes too long on one objective point, as experienced in prolonged study or reading, especially under unfavorable circumstances. These headaches are more or less similar in their symptomatology. The ache is generally dull, situated mostly in forehead and over eyes, but may also be spread from base of brain to the eyes ; oftentimes it is accompanied by nausea, especially after prolonged use of eyes under improper conditions. The treatment of these headaches consists in absolute rest of the eye, in case of overwork, and the fitting, by a competent oculist, of such glasses as will rectify the irregularity in the eye proper. Astigmatism is a common source of headaches, and often is so in- sidious in its development as to escape attention. A rough test may be made by drawing several horizontal and several vertical lines in close proximity, and then placing at some distance (15 to 20 feet) from the eye. If either set cannot be as clearly seen without blurring as the other, you have good cause to suspect Astigmatism, and should consult an oculist. Do not dally with these eye-head- aches, as you will be doing a permanent injury to your eyes. Tea and Coffee Headaches. — In the nervous, and oftentimes in the gouty and rheumatic person, the use of tea or coffee will cause violent headaches. Tobacco likewise after prolonged use shows a tendency to headaches. These luxuries of life should be discontin- ued at once for at least one month. An extra strong cup of black coffee, to be sure, will stop the headache for the time being, but only adds fuel to the fire in the long run. Bromo-caffeine, as ordinarily sold by the druggists, taken in teaspoonful doses every half hour, will relieve the malady. We would strongly advise any one that has constant or periodical headaches, if he uses either tea or coffee, and especially coffee, to leave them off entirely for three months. It may be the sole cause, and if caused by tea or coffee, there is no possi- bility of their cure by medicines while you continue their use. Plethoric Headaches These are dependent on a general fulness of blood. They are of two kinds. One is occasional, and lasts but a few hours. The other lasts for days or weeks. It occurs most often in the night or morning. Persons whose occupations require stooping have it most. A little dizziness is generally felt on rising up from a stooping posture. It is brought on by the bad air of DISEASES OF THE BRAIN AND NERVES. 203 crowded rooms, and is attended by costive bowels, short breath, and a white furred tongue. The persistent headache is accompanied by a sense of fulness, and sometimes of throbbing over the brows and temples, with a sensation of dizziness, and of mist before the eyes. The sufferer fears exertion and is constantly looking for a rush of blood to the head. Nature sometimes relieves this form of headache by a diarrhoea, or by bleed- ing from the nose. There is another form of plethoric headache, differing slightly from the above, in which there is too much blood, and it is made too fast, but it does not circulate so rapidly. The muscles are not very firm, and the heart does not propel the blood with much force. This form of headache is connected with congestion. Headaches of Indigestion. — These are caused either by taking improper articles of food, or by eating too much of those which are proper. The sensation in the head is not always a pain, but some- times only a dull weight, attended by languor and disinclination for exertion ; a tongue white in the centre, and pale red at the tip and edges ; cold and numb fingers ; slight nausea ; languid and feeble pulse ; dim and indistinct sight ; eyes aching when employed ; and difficulty in fixing the attention. Sick Headache. — This has received its name from the constant nausea or sickness at the stomach which attends the pain in the head. This headache is apt to begin in the morning, on waking from a deep sleep, or after sleeping in a close room, and when some irregu- larity of diet has been committed on the day before, or for several previous days. At first there is a distressingly oppressive feeling in the head, which gradually merges into a severe, heavy pain in the temples, frequently attended by a sense of fulness and tenderness in one eye, and extending across the forehead. There is a clammy, un- pleasant taste in the mouth, an offensive breath, and the tongue cov- ered with a yellowish-white fur. The sufferer desires to be alone, and in the dark. The hands and feet are cold and moist, and the pulse feeble. Accompanying these symptoms, there is a depressing sickness at the stomach, which is increased by sitting up, or moving about. After a time, vomiting comes, and relief is obtained. Bilious Headache. — This is most common in summer and au- tumn. It afflicts persons of dark complexion with black hair and melancholy dispositions. There are two kinds, one is due to an ac- cumulation of bile in the system ; the other, to a large secretion of bile. In the first variety the skin is dingy and sallow, the spirits de- pressed, the bowels costive, and there is wind in the stomach, with a dull, aching pain on the right shoulder. The pain is in the forehead, 204 DISEASES OF THE BRAIN AND NERVES. eyebrows and eyelids, and the " white of the eye " is a little yellow- ish. The tongue has a brown fur, and is cracked in the centre. There is a bitter taste in the mouth on waking in the morning, after restless nights, and frightful dreams. In the second variety, which is due to an " overflow of bile," the symptoms are much like those of the first kind, but the pain is not so continuous. In addition to the symptoms named, there is a throb- bing, rending pain in the head, the skin is hot and the face flushed, the limbs are sore, and there is a luminous halo or ring around ob- jects looked at, and a feeling of giddiness. Nervous Headaches. — These are more common among females than males. They occur most frequently among persons of high sus- ceptibility, who are easily elevated, and as easily depressed. They are often connected with indigestion. The pain is usually acute and darting, and is made worse by light, with a feeling as if the temples were, being " pressed together," and a " swimminess " in the head. There is sometimes a sense of sink- ing, with a dread of falling, and great despondency and restlessness. The bowels are generally costive, and the sight dim. The pain comes on most commonly in the morning, lasts through the day, and abates in the evening. Hysteric Headache. — There is a nervous headache dependent on the hysterical condition. It is generally confined to one small spot, frequently over the eyebrow, and is sometimes compared to a wedge or nail driven into the skull. Headache from Exhaustion. — Still another species of nervous headache arises from extreme exhaustion, produced by great loss of blood, by diarrhoea, or by over-suckling. The pain is generally on the top of the skull, and is often compared to the beating of a small hammer on the head. Brow Ague. — This is intermittent in its character, and is brought on by exposure to cold and moisture in damp and marshy districts ; and in this respect is much like ague. Megrims. — This is most frequent among females. It is often de- pendent on the same causes as Brow Ague, and is also produced by long and exhausting watching over sick children, distress of mind, and indigestion. In both the above forms, the pain is intermittent, seldom lasting long, but being of a sharp, piercing character like that of tic doulou- reux. Tin pain of Megrims usually begins at the inner angle of the eye, and extends towards the nose ; the parts being red and sore, and the eye-ball tender. In Brow Ague, pain and great tenderness cover an entire half of the head, compared by the patient, sometimes, to " an opening and shutting of the skull." It begins with a creeping sensation over the scalp. DISEASES OF THE BRAIN AND NERVES. 205 Rheumatic Headaches. — These generally affect persons who have been subject to rheumatism, and are often brought on by uncovering the head when sweating. The pain is usually in the brow, the tem- ples, or the back of the head, and is dull and aching, — rather an in- tense soreness than a real pain ; and the painful part is excessively tender upon pressure. The skin is moist, but not hotter than natural. Treatment. — In considering the treatment, I will take up the same order in which I have spoken of the different forms of headache. Plethoric Headaches. — Not much medicine should be taken for these, if it can be avoided. A diuretic (131) may be taken twice a day, and an occasional dose of gentle physic at night, followed by (7) in the morning. This will generally give great relief. Meat should be taken but once a day, and the whole diet should be spare, the appetite never being fully satisfied. All spirituous drinks, including distilled and fermented, should be let alone, and coffee like- wise. Much exercise should be taken in the open air. The hair should be kept short, and the head elevated during sleep. Bleeding at the nose, when it occurs, must not be too suddenly stopped. Two drops of the tincture of aconite root with three of the fluid extract of gel- semium repeated once a half hour for three or four times will be found to be of great value in the treatment of this form of headache. The hot-water bottle applied to that part of the spine between the head and shoulder blades will also give great relief. Congestive Headaches. — The exercise, diet, mode of sleeping, etc., should be the same as in plethoric headaches. In this complaint, there is too much blood in the head, and it inclines to stagnate. The feet and hands are cold ; and gloves and stockings of wool, and other bad conductors of heat from the body, must be worn. Occasionally a little gentle physic (319) is desirable to induce the bowels to act every day. If there is great debility, iron (71), (74), (75), (320), will be required. The ice bag applied to the last six or eight inches of the spine will call the blood to the extremities. The aconite and gelsemium recipe as given above is also very useful. Headache of Indigestion. — If the pain come immediately after a meal, and can be traced to something eaten, an emetic (2) may be taken, if the person be tolerably strong. If the pain come on some hours after eating, take rhubarb and magnesia (28), (14), or fluid magnesia. When the system is debilitated, take a warm draught (322) in the morning after a light breakfast, or twice a day, a bitter with an alkali (323). If the stomach be very irritable, bismuth, at meal times (324), (326). When it occurs after a debauch, take re- cipe (325). Sick Headache. — When it results from food taken, a draught of warm chamomile tea, or a little weak bran dy-and- water, will generally 206 DISEASES OF THE BRAIN AND NERVES. give relief. If the sickness continue, soda and water, with a little ginger may do well, or a mustard poultice upon the stomach (165) may be required. As soon as it can be kept on the stomach, a dose of physic (326) must be taken ; and if relief does not come after the operation of this, give a bitter and an aromatic (327). The patient must have perfect rest. If there be great lack of tone in the system, the mineral acids (328), (329) will be excellent. The diet must be carefully regulated, as in plethoric and conges- tive headaches. Cocaine, one-eighth grain every fifteen minutes till the nausea stops, and then a dose of physic is an excellent method of treatment. Ten grains of amenonol (ammonol) every hour will stop the pain, and very often the same amount of phenacetine will accomplish the same result. Bilious Headaches. — These are generally connected, more or less, with some affection of the liver. During an attack, if the suffering be great, attended by nausea, give an emetic (2). In milder cases, give recipe (321). If there be costiveness, give recipe (330) at night, and (7) in the morning. A few doses of podophyllin, leptandrin, etc. (34), (36), (39), to re- lieve the liver when the bile does not flow fast enough, will diminish the frequency and force of the attack. The fluid extract of dande- lion, taken for some time, often does good service. The diet should be light, and chiefly vegetable, and exercise in the open air must not be omitted. The daily sponge-bath, with friction, is excellent, Nervous Headaches. — The first thing to be done is to relieve the pain, and this may generally be accomplished either by preparation (331), or (332), or (333), or (88), or (93), or two or three drops of tincture of nux vomica in a spoonful of water, taken three times a day. 351 will be found usually to be of most service. In simple nervous headache, diet is of the greatest importance ; in hysterical cases, exercise ; in headaches from exhaustion, tonics (81), (79), (63), (73), (64), (61), (60). Of the simple remedies found on the druggists' counter bromide of caffein in effervescent form is very efficacious. Rheumatic Headaches. — Take a light diet, with but little animal food. Wear warm clothing, and avoid exposure to wet feet and damp- ness generally, and go to a mild climate, if convenient. When the local pain is great, apply hot fomentations, or a stimula- ting liniment (334), or a mustard poultice, to the back of the neck. In the beginning of the treatment, a little physic at night (335) is useful. 10 grs. potassium iodide, gradually increased, in water, is the best medicine. Before closing this chapter on headaches, let me enter a respectful protest against the indiscriminate use of the thousand and one reme- dies advertised to cure headaches ; for in a great majority of cases it DISEASES OF THE BRAIN AND NERVES. 207 is merely a symptom of some other disease ; for instance : Indigestion, Fever, B right's Disease, Softening of the Brain, Diseased Liver, etc. ; and the use of these remedies serves rather to increase than lessen the difficulty. Much has been written and much printed matter been given away by patent medicine venders vaunting their specific cures for headaches. These venders have grown in numbers of late, since the introduction into medicine of the coal-tar products, so that samples of headache cures may be found on one's doorsteps every little while. For the most part they are composed of what is known as acetanilide or antifebrin, because of its cheapness as compared with other coal-tar products. It is, however, the most harmful of them all, often causing blueness of the lips, fluttering of the heart dizziness, faintness, etc. Of other similar products not so much dan- ger may be expected, and yet no one ought to resort to these remedies without the consent and approval of the family physician. 8 grains of phenacetine for an adult, repeated in two to four hours, no doubt will cure more headaches of all descriptions than any other single drug. Lactophenin and ammonol are some of the newer remedies for headache which have the reputation of being efficient as coal-tar pro- ducts without any of their ill effects. Antikamnia, a proprietary medi- cine of the coal-tar group, enjoys a large sale, not only for headaches but for general neuralgic pain, and if employed in six-grain doses every two to four hours, according to the severity of the pain, will stop a large proportion of these aches. The various combinations of the bromides are always safe and often quite efficient in curing head- aches, especially if nerve-element is strong in their causation; bromo- cafTein, bromo-seltzer, bromo-soda, etc., are generally put up in small bottles in an effervescent and palatable form. DISEASES OF THE THROAT. The diseases which seat themselves in the throat, and in the great cavity of the chest, have occupied a large share of my attention for the last ten years. My practice in these complaints has been large, — being drawn from every part of the United States, and the British Provinces. No class of diseases from which men suffer are more nu- merous than these, and none have so generally baffled the skill of the profession. For this reason, I wish to present here a brief, practical, and common-sense view of these complaints, which shall be of real value to the thousands of families who consult these pages. Increase of Throat Diseases. — A striking increase in the number of throat diseases has been witnessed within the last few years. A person suffering from any of them will find, on speaking of his com- plaint, that a number of his neighbors are afflicted with troubles of a similar kind. I have thought that in some of their forms these dis- eases have fastened upon the throats of not less than half our popu- lation. And when it is considered that they are the natural, and if unmolested, the certain harbingers of lung disease, it is wise to make a note of the above fact. As I shall describe them in the nasal cavi- ties, the pharynx, the fauces, etc., they all have a natural proclivity downwards. From these upper cavities they pass, by one short step, into the larynx, — the cavity where the voice is formed, — and then, by another equally short and easy stage, into the body of the wind- pipe. It is a singular fact that their progress is always from the upper breathing passages downward, and never from the lower pas- sages upward. They afford a parallel to the order of progression in the moral world, in which evil tendencies are toward a lower depth. A Mistake Corrected. — Before describing the several diseases which belong to this family, I wish to correct the mistake which so generally classes them all under the term Bronchitis. They all consist in a simple inflammation, acute or chronic, either of the mucous membrane lining the several cavities to be spoken of, or of the small glands or follicles connected with that membrane ; and each disease takes its name from its particular location. Thus, the inflammation of the membrane lining the upper part of the throat, or pharynx, is called Pharyngitis. Inflammation in the top of the 208 DISEASES OF THE THROAT. 209 windpipe, or larynx, is Laryngitis. In the windpipe, or trachea, it is Trachitis. In the bronchial tubes, it is Bronchitis. As the bronchial tubes exist nowhere except in the lungs, below the division of the windpipe, there can be no Bronchitis in the throat. Nevertheless, it is the same disease with Laryngitis and Pharyngitis, and differs from them only in being in a more dangerous place. As the windpipe descends into the chest, it divides below the top of the breast-bone into two branches, one going into the right, the other into the left lung. These branches divide and subdivide very minutely, and send their ramifications into every part of the pulmon- ary tissue. Thus situated, Meckel has compared the windpipe to a Fig. 86. hollow tree with the top turned downward, — the larynx and trachea representing the trunk, and the bronchial tubes, with their innumera- ble subdivisions, the branches and twigs. (Fig. 86.) If the reader will now understand that the trunk and branches of this bronchial tree are hollow throughout, and lined with a delicate and smooth mucous membrane, and that the diseases to be described are inflammation either upon this membrane or the small glands con- nected with it, causing swelling,-redness, unhealthy discharges, rough- ness, etc., he will have a good general idea of them. Nasal Catarrh. I take these diseases in the order of their location. Nasal Catarrh consists in inflammation, which begins behind and a little above the 210 DISEASES OF THE THROAT. veil of the palate, and extends upward from thence into the nose. It is an exceedingly troublesome complaint, and afflicts great numbers. It passes under the name of Catarrh in the Head. The inflammation is not confined to the nasal cavities. It extends frequently to the air-cavities, called centrums and sinuses* which cover a considerable portion of the face, and extend to the lower part of the forehead. Persons sometimes feel as if their whole face were in- volved in the disease, and were almost in a state of rottenness, — so great is the amount of matter discharged from the head. Such free discharges cannot be wondered at when we reflect that all the air cavities in the face are lined with the same mucous membrane which lines the nose, and that they all communicate with the nasal cavities. The " horn ail," among cattle, is a similar inflammation of the inner surface of the horns ; and the " horse distemper " is an inflammation of the air cavities in the head of the horse, and is much the same disease with our catarrh in the head. The catarrh often creates a perpetual desire to swallow, and gives the feeling, as patients express it, " as if something were sticking in the upper part of the throat." When the inflammation has existed a long time, and ulceration has taken place, puriform matter is secreted, and drops down into the throat, much to the discomfort of the patient. Indeed, this is one of the most distressing features of the complaint, as this matter often descends into the stomach in large quantities, causing frequent vom- iting, and a general derangement of the health. Many times the suf- ferer can only breathe with the mouth open. Upon rising in the morning a great effort is required to clear the head and the extreme upper part of the throat. There is occasionally a feeling of pressure and tightness across the upper part of the nose ; and the base of the brain sometimes suffers in such a way as to induce headache, vertigo, and confusion. The smell is frequently destroyed, and sometimes the taste. The inflammation sometimes gets into the Eustachian tubes, the mouths of which are behind and a little above the veil of the palate, and extends up the lining membrane to the drum of the ear, causing pain or deafness, and occasionally both. In addition to this catalogue of evils, there is often added inflammation and elon- gation of the uvula or soft palate. Treatment. — The following is a fair illustration of my mode of treatment : — Mr. , of Boston, came under treatment for a bad case of ca- tarrh in the head, complicated with follicular disease of the pharynx, or upper part of the throat. In addition to nearly all the symptoms mentioned above, he had a stench from the nose exceedingly offen- sive to all about him. So much had the disease worn upon him that he had become bilious, sallow, dejected, and low in strength and flesh. When it is said that to all these were added a cough and loss of ap- petite, with insidious approaches of hectic, it will not be surprising DISEASES OF THE THROAT. ■ 211 that his friends saw the most serious results impending, even though assured by me that the disease had not yet taken a firm hold of his lungs. The first thing done for him was to cut off the uvula. Five days after, I began to bathe the whole nasal cavity, three times a week, with a shower syringe, by pushing the smooth bulb up behind the veil of the palate, and throwing instantaneously a most delicate shower of medicated fluid up both sides of the septum. The upper part of the throat was likewise bathed by the use of a shower syringe made expressly for that part, and the larynx, or place where the voice is formed, by a long, bent instrument made to reach this part of the throat. The solution used consisted of half a dram of crystals of ni- trate of silver dissolved in one ounce of soft water. The nitrate of silver powder was inhaled once a day with the pow- der inhaler. In this way the nasal cavities and throat were kept cleansed, and the articles used gradually subdued the inflammation, setting up a new and healthful action in place of the diseased one. The stomach was relieved of the offensive matter which had daily and nightly gone down into it, and the system of the poisonous ef- fects of its absorption. The great danger which threatened the lungs, and which would soon have been realized in their destruction, passed away. The skin gradually resumed its proper color ; the appetite, flesh, spirits, and strength came back, and Mr. B. has been since in the enjoyment of good health, pursuing his business cheerfully. When the above treatment fails, as it does occasionally, I am in the habit of changing the solution, using sometimes a weak solution of acid nitrate of mercury, twenty drops to an ounce of water. In other cases, a solution of sulphate of zinc serves a good purpose. A dilution of the tincture of arnica-flowers is a preparation of some value in these cases. There are other preparations, too numerous to mention, which I am in tHe habit of using. I will add, that the nitrate of silver powder, snuffed once a day, a pinch at a time, is far more successful than any other snuff ever made, but should be used only in severe cases> and with caution. Nasal catarrh is such a common affliction in the Eastern States, as to be a widespread curse. Douching the nose with salt and water (warmed) cleanses the nose of the foul mucus. The douche should be from a bag hanging only a little higher than the head, or it may be given by means of a common, blunt-pointed syringe, care being taken not to use too strong force, nor to point the syringe in the direction of the eyes. The stream of water should be directed straight ahead parallel with the floor ; the mouth must be open, and the patient as- sume the position of the countryman when gazing or gauking at the sights on his first visit to the city. The water then runs down the throat and also out of the other nostril. This process should be em- ployed on both sides till the head is clean. The tablets put up by all wholesale druggists, called "Carl Seller's alkaline tablets," is the best remedy for a nasal douche. The subsequent treatment is best ad- 212 DISEASES OF THE THROAT. vised by a physician, and usually consists in the use of some inhala- tion or spray. Inflammation of the Pharynx. — Pharyngitis. This is an inflammation of the upper and back part of the throat, or all that part which can be seen when the mouth is stretched open. It causes a redness of the mucous membrane lining the part, which is deep in proportion to the intensity of the inflammation. This complaint is generally connected with the one I am about to describe ; and since the treatment is the same the reader is referred to what next follows. Adenoid Growths. In young children a very disagreeable catarrhal affection often ex- ists in the naso-pharynx just behind and above the uvula. This is caused by continued catarrh till at last small growth's occur like proud-flesh, and not infrequently block up the passage from the nose to the mouth, to that extent that not only is loud snoring produced at night, but breathing becomes difficult by day. In severe cases the up- per jaw becomes angular, and the face assumes a peaked, pinched look. These growths are extremely common in children, and are produc- tive of much mischief. The inability, in severe cases, to properly breathe deprives the lungs of their proper amount of oxygen, so that the little one suffers in nutrition and growth. Treatment consists in scraping away with a scoop, or even with the finger, these soft, granulating masses. The effect is almost mar- vellous : the child breathes quietly, without snoring, the color re- turns to the cheeks, and the blood receives a new supply of food from the full supply of oxygen. In modern times, nothing has been in- augurated in the treatment of children's throat and nose diseases so beneficial and happy. Clergymen's Sore Throat. — Follicular Pharyngitis. This disorder made its appearance in this country in 1830, and the attention of the profession was first drawn to it, as a distinct disease, in 1832. Some have supposed its origin to have had a hidden con- nection with the epidemic influenza which spread over the civilized world in 1830, and affected all classes of persons ; but this is only conjecture. In its early developments it attracted notice chiefly by its visitations upon the throats of the clergy. Hence its popular name of Clergymen's Sore Throat. It was soon found, however, to at- tack all classes of persons indiscriminately, whether engaged in any calling which required a public exercise of the voice or otherwise. It was noticed more by public speakers and singers, on account of the greater inconvenience it gave them. The disease consists in a chronic inflammation of the mucous fol- DISEASES OF THE THROAT. 213 licles, or glands, connected with the mucous membrane which lines the throat and windpipe. The office of these little glands is to secrete a fluid to lubricate the air passages. When inflamed, they spread an acrid, irritating fluid over surrounding parts, which excites inflamma- tion in them. Hence a general inflammation of the upper part of the throat or pharyngitis usually attends the follicular disease, and I shall speak of the two together. This inflammation of the glands and the membrane, being neglected, as it generally is, lingers on from month to month, or from year to year, making in some cases slow progress, in others more rapid, — made a little worse and its step slightly quickened by every fresh cold, and finally results in ulcera- tion. The expectoration thenceforward becomes puriform, and finally undistinguishable from that of consumption, with all the symptoms of which the patient finally dies. Indeed, before its nature was un- derstood by the profession, it was considered the most fatal form 01 consumption, because it could be affected only in a very small de- gree, if at all, by medicines taken into the general system. For the milder cases one will find great comfort in the use of the troches of cubebs and ammonia, the inhalation of benzoin with steaming water, also from such throat-tablets as the Chloramine. Inflammation of Mucous Membrane and Glands of Larynx. — Follicular Laryngitis. A few strong and beautifully formed cartilages unite to form a curious and convenient box or cavity at the top of the windpipe, called the larynx. Across this enclosure are stretched two remark- able ligaments, called the vocal cords. They are from half to three quarters of an inch in length, and are rendered more or less tense by the small muscles with which they are connected. Just above these cords are two cavities, which, with the ligaments, act an important part in the formation of the voice. Here is produced the sound, which is modified and articulated by the tongue, the lips, and the nasal cavities. When disease reaches this cavity, and the fluid secreted to lubri- cate these cords becomes acrid, the voice, from this and other causes, is made hoarse ; and when, at length, these ligaments are altered in structure by inflammation and ulceration, the voice suffers a gradual extinction. I have treated a large number suffering entire loss of voice, and am happy to say it has been generally restored, where the lungs have not been involved in the disease. There is often also a little sensitiveness, or even soreness, in some cases, in the region of the larynx, which may be felt by pressing upon that prominence in front of the throat, called Adam's apple. 214 DISEASES OF THE THROAT. Inflammation in the Windpipe.— Tracheitis. This complaint and the one preceding it differ only in their local- ity from those described in the upper cavities ; and they are more alarming, because two removes nearer the citadel of life. Happily, we know that the seat of these diseases may be easily reached, and we have a shower syringe, so arranged as to pour the remedial agent directly upon them, without any lacerating disturbance of the parts. Symptoms. — The approach of these disorders is often so insidious as hardly to attract notice, — sometimes for. months, or even years, giving no other evidence of their presence than the annoyance of something in the throat to be swallowed or hawked up, — an increased secretion of mucus, and a sense of wearisomeness and loss of power in the throat, after public speaking, singing, or reading aloud. At length, upon the taking of a severe cold, the prevalence of an epi- demic influenza, or of an unexplained tendency of disease to the air- passages and lungs, the throat of the patient suddenly becomes sore, its secretions are increased and rendered more viscid, the voice grows hoarse, the difficulty of speaking is aggravated, and what was only an annoyance becomes an affliction, and a source of alarm and dan- ger. These diseases clearly belong to the family of consumption, and need early attention. Causes. — It is amusing to reflect upon the theories which writers were in the habit of constructing, a few years since, to account for the throat affection among the clergy. It was attributed by some to speaking too often, by others to speaking too loud. One class of writers thought it arose from muffling the neck; another, from a strain of voice on the Sabbath to which it was not accustomed on other days. The cause lies deeper than any of these trifling things. As it con- cerns ministers it may generally be expressed in two words, — labor, anxiety. The clerical order are placed just where they feel the force of the high-pressure movements of the age. They are the only class of recognized instructors of adult men, and are obliged to make great exertions to meet the wants of their position. The extremely trying circumstances in which they are often placed, too, in these exciting times, by questions which arise and threaten to rupture and destroy their parishes, weigh heavily upon their spirits, and greatly depress the vital powers. And when we add to this the fickle state of the public mind, and often the shifting, fugitive character of a clergy- man's dwelling place, and the consequent liability to poverty and want to which himself and family are exposed, we have a list of depressing causes powerfully predisposing to any form of disease which may prevail. DISEASES OF THE THROAT 215 It will be pardoned me, I think, if I suggest here, that the nature of a clergyman's calling is of so serious a character, that he some- times carries himself with too much sedateness, keeps himself too much braced up, and does not allow himself hours enough of that cheerful, light-hearted abandon, which is essential to the health of every sedentary man of mental habits. The hard-thiDking and hard- working minister, who will retain his health and save his throat, must have some moments, at least, when the weighty responsibilities of his office are lifted up from his soul, and he becomes, for the hour, the jocund, playful boy of earlier days. How far he can consistently re- lax and let himself down, or in my view of the matter, raise himself up to the simplicity and mirth of childhood, he alone can be the judge. As a physician, I prescribe ; as a minister, he must decide how far my prescription can be followed. Reading Sermons. — There is one practice, which, though it has not much to do with inducing this disease, does frequently aggravate it when once established ; I mean the habit of reading sermons from manuscripts, — especially when it is done in a sort of mechanical way. Every person who has suffered from throat-ail has doubtless noticed that to read aloud, for half an hour, from a book, occasions more fatigue and irritation in the throat than extemporaneous speak- ing, in the same tones, for one or two hours. The reason is, that in the latter case the mind conceives the thought in season for the or- gans of speech to fall into a natural attitude, and utter it with ease. The two work harmoniously together, — the instruments of articula- tion following the mind, and easily and naturally uttering its concep- tions. Whereas in the case of reading, the mind itself is, at least partially, ignorant of what is coming until it is just upon it, so that the organs of speech, being warned of what is to be done only at the moment their service is required, do their work under a perpetual surprise and constraint. The difference is, in some respects, like that between walking freely at large, without regard to where the feet are put down, and being obliged to step exactly in the footprints of some traveller who has gone before. In the latter case, the muscles tire much sooner, because they work in fetters. I have thus spoken particularly of the clergy, though it is not by any means they only, but all classes of people who are afflicted with this dangerous malady. These diseases often begin with a cold. But colds are seldom taken except when the nervous system is depressed, so that they are, in fact, to be traced back to the same cause which I have assigned to catar- rhal or throat complaints themselves. These Complaints Worse at Night. — It is worthy of note, that all these complaints, and many others, are worse during the night. This is easily explained when we remember that the atmosphere has the least amount of electricity in it at three o'clock in the morning, and that the first minimum atmospheric pressure, which happens twice a 216 DISEASES OF THE THROAT. day, occurs not far from the same hour. From three to four in the morning, therefore, the nerve-power si?iks to its lowest ebb; and those diseases which owe their existence to anxiety, overwork, etc., suffer, at this time, their greatest daily aggravation. Death occurs, too, more often during these hours, than in any other portion of the twenty- four. Treatment — Some years ago these diseases were thought to be incurable ; and by all the appliances of medical art then known, they were so. But time has brought a successful method of treatment, as well as a clearer knowledge of their nature. This treatment consists in what is called topical medication, or the applying of the medicine directly to the diseased part. The medici- nal agent more extensively used than any other is a solution of crys- tals of nitrate of silver. This substance is not, however, adapted to every case, — other articles succeeding better in some instances. Mod- ern chemistry has given us a variety of agents from which the skilful physician may select a substitute, should the nitrate of silver fail. The operation of applying this and other substances to the air pas- sages, is a delicate one, requiring tact and experience. Surgeons had supposed it an anatomical impossibility to introduce an instrument into the larynx ; but this has been practically demonstrated to be a great mistake. Instruments. — The instrument devised and used by Dr. Horace Green is a piece of whalebone, bent at one end, to which is attached a small, round piece of sponge. This, dipped in the solution, is dex- terously introduced into the laryngeal cavity, and applied directly to the diseased part. I formerly used this instrument myself, and am happy to know, that, notwithstanding its defects, it was generally successful. Yet where the larynx was highly inflamed, with a swollen and ulcerated condition of the epiglottis and lips of the glottis, I am sure I some- times had the singular powers of the nitrate of silver put at defiance by an irritation evidently produced by the sponge of the probang. Upon its introduction, in such cases, the parts contract upon and cling to it, and suffer aggravated irritation, almost laceration, upon its withdrawal, however carefully effected. Laryngeal Shower Syringe. — Such defects in the probang led me to contrive an instrument, which I call a Laryngeal Shower Syringe. It is in the form of a syringe, the barrel and piston of which are made of glass, silver, or gold, as may be desired. To this is attached a small tube, made of silver or gold, long enough to reach and enter the throat, and bent like a probang, with a globe or bulb at the end, from a quarter to a third of an inch in diameter, pierced with very minute holes, which cover a zone around the centre about one-third of an inch in breadth. This silver bulb I daily introduce into highly inflamed and ulcer- DISEASES OF THE THROAT. 217 ated larynges, generally without any knowledge of its presence on the part of the patient, until the contained solution is discharged. The instrument, being charged, is carried to the proper place, when a delicately quick pressure upon the piston causes very fine streams to flow through the holes in the form of a delicate shower, and all sides of the walls of the larynx are instantaneously bathed. How Introduced. — The introduction of this instrument into the larynx is easy. Upon the approach of any foreign substance, the epi- glottis instinctively drops down upon the entrance to the larynx, guarding it against improper intrusions. It has been found, however, that when the root of the tongue is firmly depressed, this cartilage cannot obey its instinct, but stands erect, its upper edge generally ris- ing into view. Availing himself of this, the surgeon has only to de- press the tongue with a spatula, bent at right angles, so that the left hand holding it may drop below the chin out of the way, and as the epiglottis rises to view, slip the ball of the instrument over its upper edge, and then with a quick yet gentle motion, carry it downward and forward, and the entrance is made. I have often admired the faith- fulness of this epiglottic sentinel, who, when overborne by superior force, stands bolt upright, and compels us to enter the sacred temple of speech directly over his head ! Pharyngeal Shower Syringe. — For washing the upper part of the throat, I construct the instrument with a straight tube, with holes over the outer end of the globe, and extending to the centre. This washes instantaneously the fauces and pharynx, but does not throw the solution back upon the tongue. Its main advantage over the probang is, that it bathes every part of the fauces and pharynx in- stantaneously, and does not subject the patient to the coughing and gagging which follow the slower and rougher process of drawing the sponge from side to side across the cavity of the throat. Nasal Shower Syringe. — Inflammations in the back passages to the nose, called catarrh in the head, have been almost inaccessible by any reliable healing agent, and consequently incurable. The probang could only reach a short distance, and occasioned great suffering. I have had a syringe constructed with the tube bent at an angle of forty-five degrees, and the globe, very small, pierced with a few fine holes at the upper end. Carrying this globe up behind the velum palati, with a single injection I wash both passages clear throu gh. I have had the pleasure of curing a large number of bad cases, of many years' standing, to the surprise and delight of the patients. About nineteen-twentieths of the physicians who have examined these instruments, and so far as my knowledge extends, all who have used them, think them much better than the probang. As to patients, I have yet to see one who will allow the sponge to be used after try- ing both. Have Superseded the Probang. — In my own practice the syringes 218 DISEASES OF THE THROAT. have superseded the probang altogether. My reasons may be briefly stated. I have already said there is less irritation produced. A piece of sponge drawn over an inflamed surface, especially when clung to by the irritated and quivering parts, must necessarily, in some cases at least, aggravate the symptoms of disease. To this consideration add the comfort of the patient during the operation. It is so quickly and delicately done with the syringe, that it is scarcely known when the act is performed. The straight syringe does not touch the throat at all. On touching the probang to the throat, the nitrate of silver unites with the mucus upon the surface, instantly covering the sponge with an albuminous pellicle, something like that which lines the shell of an egg^ preventing, in a degree, the further pressing out of the solution, and rendering its contacts with other parts of the surface comparatively powerless. For this reason, the sponge pushed down into an ulcerated bronchus, as Dr. Green recommended, must be ut- terly valueless as a remedial agent. Mopping, as it does in its whole course, a larynx and trachea, lined in some cases with puriform mat- ter, and generally with mucus, every inch of its descent doubles the gravity of this objection. Let it be considered, too, that in applying the remedy to an ulcerated larynx, the sponge cauterizes the healthy parts above, in its descent, and thus unfits itself for doing much for the diseased part ; whereas the syringe retains its solution till it reaches the affected place, and then pours a clean shower directly upon it, and upon no other part. Considering these manifest advantages of the syringes, I am sur- prised that any physician should still use the probang, — especially as one of these instruments, the Nasal Syringe, accomplishes an object which the probang cannot effect at all, not even in a rough way. I have wondered, too, how any parent can allow a child, suffering with croup, to be tormented by having a sponge pushed down its throat, when a syringe would give it so much less pain. I will mention briefly one or two cases of croup and diphtheria, se- lected from a great number treated by me for the last few years, where the syringes were successfully used, after several attempts to use the probang had been made, and failed, and where the pain caused by using was so small, and the relief so instantaneous and complete, that the patients were anxious for my return to use it again. I was called to see a little boy of Mr. R., five years old, who had had an attack of membranous croup some days previous ; and when I saw him the voice had sunk to a whisper, and the cough was en- tirely muffled, so that I had no doubt of the fatal termination of the case, and expressed my opinion to that effect to the astonished parents. The probang had been used by the physician in attendance, which had caused so much suffering that for the two days previous the par- ents had prohibited its use. It had no doubt increased the irritation, besides nearly causing strangulation. It was, therefore, with great reluctance that they consented to let DISEASES OF THE THROAT. 219 me use the syringe, which I did, to the great relief of the little suf- ferer, and to the entire satisfaction of the parents. The strength of the solution of the crystals of the nitrate of silver used was 20 grains to the ounce of water, which I injected freely, once in three hours for the first day, and then two or three times a day for two or three days. His recovery was rapid and complete. I will now mention the case of a young woman, with diphtheria, where the syringe was used with success. I was called to see a young lady, who had an attack of diphtheria the day previous. Found her in bed, very much prostrated, breath- ing with great difficulty, and uttering at every inspiration a croupal sound, which at times was followed by a short, convulsive cough. The face was flushed, pulse 124, small and feeble, and she complained constantly of a sense of suffocation and of great distress in the lar- yngeal region. On inspecting the throat, the fauces and the pharyngeal mem- brane, as far down as it could be seen, presented the appearance of a high degree of inflammation. One of the tonsils was nearly covered with the diphtheric membrane, and the upper and back part of the throat were thickly studded with small white or cream-colored spots. The physician in attendance had tried first a swab, or mop, as she termed it, and then the probang, which gave her so much pain that he was obliged to give it up. He then gave up the case as hopeless. At my earnest solicitation she consented to the use of the syringe. With a solution of the crystals of the nitrate of silver, of the strength of 60 grains to the ounce of water, I injected freely the fauces and the upper part of the cavity of the larynx. For a few moments the difficulty of breathing and feeling of strangulation was increased, but very soon a large amount of viscid, ropy mucus was discharged. In the course of half an hour after the use of the syringe, the symp- toms had improved, the respira- tion was less laborious, so that in a short time the patient ob- tained some sleep. I was after- ward called, as she thought her- self worse, but found that an application of the caustic with a syringe was all that was required. There was no further trouble with the case. These syringes or similar ones can now be bought of any large dealer in surgical instruments. Figure 87 represents the syringes as they lie in a case. Mode of Using. — The glass barrel and piston of my instruments are delicate, but they need not be broken. I handle them with the same ease that I do a spoon in feeding myself, and not in a very dis- similar way. The last three fingers are placed on the under side of the barrel, with the thumb on the upper side, — the index finger be- ing poised over the end of the piston, ready to drive it home at the 220 DISEASES OF THE THROAT. proper instant. The motion of the piston should be quick, so as to cause the streams to leap out in jets ; yet delicate, that they may not impinge with too much force upon the diseased surfaces. They should be rinsed with water immediately after being used. But even with this precaution, a small residuum of the nitrate re- mains and crystallizes, and after a time partially closes the holes. They must then be picked out with the point of a needle. When the silver tube becomes detached from the glass, it may be fastened on with common sealing wax ; first melting the wax and sticking it around the glass; then heating the silver over a lamp, and pressing it on. Amount of Solution to be Used. — The amount of solution to be used should be small. Half a dram is enough. The piston of the syringe need be drawn up only from an eighth to a third of an inch. Strangling is not often produced by these operations ; but to make its prevention still more sure, let the patient be directed to fill the lungs with a long inspiration while the operator is depressing the tongue. Strength of Solution. — The strength of the solution in ordinary cases of chronic folliculitis, etc., should generally be about forty grains of the crystals of the nitrate of silver to the ounce of water. But in all acute diseases of the air passages, it should be considerably stronger, — varying from one to two drams. A preparation of this strength is powerfully antiphlogistic and sedative. In those cases of chronic disease, where the inflammation is of a low grade, and the mucous membrane is in a relaxed, atonic condition, looking either sodden and pale, or of a dark color, like the cut surface of beef some days exposed to the air (as is often the case in throats of literary dys- peptics), then a solution of fifteen to thirty grains to the ounce is sufficient. This strength acts as a stimulant, and is well suited to throats in such condition, but would be injurious in high grades of inflammation. Catarrh in the head generally requires only about this strength. I am sorry to say, the topical mode of treating throat affec- tions has been in some places injured, in the public estimation, by a lack of knowledge and judgment on the part of the operator, in choosing the strength of his solution. To determine the proper frequency of the operation, also requires judgment and experience. In an ordinary case of chronic disease, the treatment may begin by showering the throat once a day for a week. Then the operation should be repeated three times a week, for a shorter or longer period ; then twice a week, and at last once a week. Attendant Diseases. — Among the persons I am treating for dis- eases of the air passages, many are dyspeptic and suffer with depres- sion of spirits. So often does this symptom present itself that I re- gard it as almost one of the peculiarities of throat disease. Persons thus depressed generally have the dark and dingy look of the face which indicates functional derangement of the liver. They are often DISEASES OF THE THROAT. 221 emaciated, nervous, hypochondriacal, irritable in temper, and are ex- hausted by an excessive secretion of urea. The urine of such per- sons is always acid, and loaded with crystals of oxalate of lime. An explanation of this fact has been attempted, by supposing that the oxydation of carbon (of which these persons have a superabun- dance), imperfectly accomplished in inflamed respiratory organs, is vicariously effected in the capillaries of the kidneys, — oxalic acid (C 2 2 ) instead of carbonic acid (C0 2 ) being the result. The crystals of oxalate of lime are octahedral in form, and, in the field of a good microscope, are beautiful objects for inspection. Lawyers, clerygmen, statesmen, and, in general, those who labor hard mentally, with but little bodily exercise, and who have a great weight of care resting on them, are the persons who suffer most from this complication. Generally the inflammation in the throat is of a low grade, and must not be treated with a very strong solution of ni- trate of silver. Of course when these attendant diseases exist, something more is needed than the local treatment. For the troubles just described, the treatment for hypochondria and dyspepsia will be proper. Elongation of the Uvula. The uvula is the small teat-like or pendulous organ which hangs down from the palatine arch, just over the root of the tongue. It is very apt to get inflamed, and its parts becoming re- laxed, it stretches out lengthwise, so that its lower extremity sometimes rests upon the tongue. (Fig. 88.) When this happens, it flaps about, backward and forward, and to the right and left, — touching the throat at various points, and by the tickling sensation produced, exciting a most incessant, uncontroll- able, and racking cough. Some of the most distressing coughs I have ever heard have been produced and kept up by this cause alone. Many a fatal con- sumption has begun in this way. When long inflamed, it often gets much out of shape, being sometimes bent nearly double. Treatment. — In some cases, the uvula, thus elongated, may be reduced back to its natural size, by an astrin- gent gargle, composed of an infusion of white-oak bark, with a little alum dis- FlG. 88. 222 DISEASES OF THE THROAT. solved in it (232) ; but it will generally stretch out again and again, upon the appearance of any fresh cold, and, therefore, the only certain cure is to cut it off. To do this, take hold of it with a pair of common forceps, and having stretched it down a little, clip it off above the forceps, with a pair of curved scissors. Nearly the whole of it should generally be removed. To take off a part only leaves a stump, which is often more objectionable than the whole organ. Its removal never injures the speech in the least. In many cases of nasal catarrh, this organ is a sort of diseased centre, from which inflammatory action spreads upward into the nasal cavities, and no medicine or power on earth can effect a cure until this offending member is snipped off. Acute Inflammation of the Tonsils. — Tonsilitis. The tonsils are chiefly a collection or mass of small mucous folli- cles or glands. They secrete a portion of the fluid which keeps the throat moist. There is a class of persons who suffer about every winter, some- times often er, with an attack of acute inflammation of these glands, which causes gieat suffering for several days. The trouble usually is ushered in by high fever, backache, headache and often by chills ; the temperature often reaches to 103° and 104° F. ; swallowing is difficult on account of the swollen glands, while pain in the ear is not infrequent. The tonsils are at first swollen, reddened and in- flamed ; later a whitish patch of secretion forms on the surface of the gland and is distinguished from that of diphtheria by being whiter and less tenacious ; if removed, the underlying surface does not bleed as in the case of diphtheria. It is, however, very difficult, at times, to distinguish between the two diseases at first. Another form of Tonsilitis occurs without patches, and is in reality an inflammation of the substance of the gland itself. This variety, often called Quinsy, goes on developing into an abscess, the anterior pillar of the fauces becomes intensely red, swollen and shiny. Treatment. — For the more common variety some antipyretic to reduce the fever and allay the intense aching of the head and bones is properly indicated. For this purpose 10 grains of Phenacetine (for an adult), repeated every two to four hours according to the effect produced, is quite efficacious. Ammonol in same dose may also be used. Some simple astringent and soothing gargle will next be found to render signal relief. Tannin, 30 gr., strong Carbolic Acid (95%), 30 drops, Glycerin, 1 oz., and peppermint water, 3 oz., is an admirable gargle for the average case : this should be used hourly. Equal parts of Glycerin, Alcohol and Water makes a very sooth- ing gargle, while equal parts of Peroxide of Hydrogen and Water is preferred by many. The diet should be limited in amount and con- sist only of liquids. DISEASES OF THE THROAT. 223 The second variety, tending to pus formation, is to be treated sur- gically by first applying a solution of cocaine and lancing. The relief resulting from evacuating the pus is immediate. It has been found that Tonsilitis is apt to be recurrent and that he who has suffered once is very prone to have one or more attacks annually thereafter. This class requires constitutional treatment in the intervals as outlined below. These inflammations are likewise found to be an expression often- times of rheumatism, and need corresponding treatment. But the only cure is to be found by cutting off the tonsils, after the inflam- mation has subsided. This will put an end to the attacks at once. Tonsils which are subject to these periodical attacks of acute in- flammation are always more difficult than others to operate upon, as they are almost invariably bound down very tight to the throat, and cannot be raised up for convenient excision. Chronic Inflammation of the Tonsils. Ik many of the follicular diseases of the throat, these glands are affected by a chronic inflammation, and are found enlarged, and sometimes very much hardened. In such cases they secrete a thin, unhealthy, irritating fluid, which is spread over the throat, increasing and perpetuating its disease. Much of this secretion finds its way into the stomach, and thence into the circulation. In the throats of many young persons and children, these glands are permanently so large as nearly to fill the fauces. The respiration of many children thus afflicted is difficult, and when asleep they can only breathe with the mouth open. The defective breathing of such children often occasions contractions of the chest, and thus lays the foundation for consumption. From these diseased parts, the inflam- mation often spreads upwards, into the posterior nares, and many times enters the eustachain tubes, causing deafness or pain in the ears. Such children often breathe as though they had a bad cold in the head. Their health and safety require an immediate attention to this state of things. Chronic inflammation of the tonsil, likewise the recurrent acute form, maybe dependent on poor blood or rheumatism. Those causes are met by blood-building medicines like Syrup of the Iodide of Iron in 10-drop doses three times daily, cod liver oil, and by some one of the many preparations of iron, arsenic, and strychnia combinations. It is found that generally the excision of the tonsil may be averted by visiting the surgeon, who will hunt out the little crypts or holes with which the gland is studded, and by gently cutting the narrow bridges which separate these holes, destroy these cavities. These little holes retain small particles of food and decomposed secretion, which after a while, if allowed to remain, set up a follicular tonsil- itis. The size of the gland is thus greatly diminished and the little 224 DISEASES OF THE THROAT. secreting follicle destroyed. Many a little sufferer can thus be spared the harsher method of excision, and bear with good grace, especially if cocaine be used, what otherwise might be a painful and bloody operation. But, as has been said, excision in many cases must be resorted to. Curability of Throat Diseases. — I have dwelt somewhat upon the preceding forms of throat disease, because they prevail to a fear- ful extent, and are, in thousands of cases, but the first stages of fatal disease of the lungs. If not connected with lung disease in the beginning, my experience in treating them enables me to say, emphatically, they are generally curable. But patients often put the question to me — " If cured, will I ever have the complaint again ? " My answer is — " Unless I can plant in your constitution a better protection than your Maker put there at your creation, you will of course be liable to a second attack." But then, where the lungs have been entirely free from disease, I have never yet seen a case of simple throat complaint relapse and become dangerous after proper treatment with the syringes. Let not those, therefore, who have been benefited, but not entirely cured by this treatment, undervalue what has been done for them. Even in such cases, the advantage derived to them amounts to just the value they attach to the continuance of life. Dangers of Delay. — In closing these remarks, let me warn the reader against the dangers of delay. Many of those who finally seek medical attendance in these complaints, first try all nostrums, and tamper with their disease till the case is either critical or hopeless. Too many wait till they are near enough to the engulfing whirlpool to hear it roar, before they seek in any practicable way to escape its dangers. Many persons neglect a slight inflammation of the pharynx, which might have been cured in a few days, but which, from long neglect, has gradually crept down the windpipe, spread over the widely dis- tributed mucous lining of the bronchial tubes, and thus become cur- able only in a partial degree, and after long and tedious treatment. Hundreds of persons are now suffering from slight attacks of this sort, who might be rid of the affliction in a week or a fortnight, but who will either carelessly give it no attention at all, or resort to use- less nostrums, until it has run through its primary stages and invaded the constitution, and will finally die of some of the forms of pulmo- nary disease. A Cold. — Influenza. A slight attack of the disease about to be described, affecting only here and there -a person, and lasting only for a few days, is called a cold. When it affects a large part of the community at the same DISEASES OF THE THROAT. 225 time, lasting many days, or even weeks, it is then an epidemic, and passes under the name of influenza. In this latter form, it sometimes spreads over a whole country, and has at times, as in 1832 and 1894, extended to nearly the whole civilized world. It often shows marked severity in its progress, and leaves serious results behind. Symptoms. — A tingling, with dryness, and a sense of fulness in the mucous membrane of the nose, are among the first indications of an attack of this complaint. Sneezing is a common symptom. Soon pain is felt in the forehead, and breathing through the nose becomes difficult. The eyes are red and watery, the throat is sore ; there is a dry cough, hoarseness, thirst, general lassitude, chills, and a desire to get near the fire. The mucous membrane of the nose, throat, windpipe, and breathing-tubes is inflamed, red, swollen, and some- times painful. In a short time, water begins to run from the nose and eyes, and the cough becomes a little more moist. There is also a slight dis- charge from the throat and tubes, which gradually increases, and, at length, as the disease declines, and becomes less acute, the expectora- tion is thick and yellow. Aching of the back and limbs, thirst, loss of appetite, flashes of heat, and chills whenever the patient is exposed to air a little cooler than he is accustomed to, are almost constant attendants upon the disease. Causes. — It is not always easy to say what the causes of this com- plaint are. Frequently, it can be traced to an improper exposure to cold or dampness ; but in a great majority of cases, especially when it takes the form of influenza, the causes are not obvious. They probably exist in some peculiar states of the atmosphere, and in a depression of the nervous system. The influence upon disease of the different degrees of density in the air which surrounds us, and of other circumstances affecting it, have not been much studied. Some valuable facts will be drawn from this source before many years. The putting upon the body, or taking from it, several tons of pressure every time the barometer rises or falls, must have, of itself, no small influence upon its health. The comparatively new science of Physical Geography, by spreading be- fore us its interesting facts in regard to temperature, storms, atmos- pheric currents, etc., is opening the way for the physician to learn a great deal more about the cftuses of disease than he now knows. Treatment. — In mild cases, only the most simple treatment is re- quired, — such as remaining in the house for a few days, soaking the feet in warm water, taking a gentle sweat, drinking warm infusions of flax-seed, mullein, slippery elm, or warm lemonade, and taking only a spare vegetable diet. If the bowels be costive, some gentle physic (34), (41) may be used. A laxative drink (132) will like- wise be useful. 226 DISEASES OF THE BRAIN AND NERVES. At the outset, especially when the nose runs water, a small dose of atropia, ^^ grain, taken every two hours till the throat is dry, will entirely arrest the disease at this point. The coryza pill found at the druggists' is a more valuable remedy still. When the attack is more severe, sweating must be induced by de- cisive measures. This may be affected by the spirit vapor-bath, or by putting the patient in bed, putting bottles of hot water to the feet and sides, and administering warm drinks, and the compound tinc- ture of Virginia snakeroot. Five drops every hour of the tincture of veratrum viride will often cause very free perspiration, and will reduce the inflammation upon the mucous surface. An emetic is sometimes very useful. To produce vomiting, use the powder of ipecac, ten to twenty grains, or the compound tincture of lobelia. It soothes the inflamed mucous surfaces very much to inhale the vapor from half a pint of hot water, with five drops of tincture of veratrum viride, or the same amount of the tincture of aconite root. If the cough is severe, use the preparations recommended under bronchitis and consumption. In the latter stages of the disease, if there be debility, — as there generally is, — quinia, iron, mix vomica, etc. (75), should be taken ; or, to support the nervous system, the extracts of scullcap, and bone- set, and the sulphate of quinia (81) will be found useful. At this stage of the complaint, the diet should be more liberal and nourishing. The patient should not venture into the open air until the unpleas- ant sense of chilliness, peculiar to the disease, ceases to be produced by exposure. La Grippe. This is a variety of influenza with which the world has become well acquainted within the last few years. Its history is interesting and its symptoms and results are severe and annoying. It is one of the most severe forms of catarrhal disease of the nose or throat with which we are acquainted. It owes its origin to a germ which found its birth in the filth and pollution of eastern Europe, and has visited the globe with terrible ravages on several occasions since the Middle Ages. It spreads by travelling the most frequented paths of com- merce, and attacks those in a depressed state of health. The varieties of la grippe are as numerous as that of any other disease. The catar- rhal form is much like that of ordinary head influenza, only it is more severe and prostrating ; the bronchial assumes the influenza type, at first, but soon attacks the lungs and sets up a severe, prolonged and harassing bronchitis ; the intestinal variety, besides producing the general symptoms of malaise, fever, cough, severe aches and pains, gives rise to a diarrhoea which lasts many days and is very debilita- ting; the most common variety, however, is the rheumatic, which is ushered in by chills, fever, muscular pains, coryza, cough and general DISEASES OF THE THROAT. 227 rheumatic pains. The characteristic feature of all of these forms is the great prostration which accompanies these symptoms and the ob- stinacy with which it clings to the patient. The sequelae of the disease, though much exaggerated, are numer- ous. The aged are often left infirm with heart weakness, the young with lessened resistance to disease, and the middle-aged with chronic coughs. Many an undiscovered disease has passed unnoticed under the dis- guise of " la grippe." It has no doubt served as a broad mantle to cover our ignorance of real disease and been made an easy refuge for the complaining; still its affects at times cannot be over-estimated, and death has not infrequently resulted. Treatment. — The onset is to be met with large doses of quinine, say 10 grains on retiring, by phenacetine and salol, 10 grains each, taken with some hot lemonade on retiring. This latter may be re- peated every three hours. The coryza is checked by small repeated doses of belladonna, camphor and quinine, as found in the coryza tablets bought at the druggist's — one taken every two hours till the throat is dry, then once in four to eight hours. The debility is to be met by tonics. Acute Inflammation of the Epiglottis. This is the disease by which our country lost its most loved and distinguished citizen, George Washington. This complaint was not understood at the time of his death, — the intelligent physicians who attended him supposing it to be inflammation of the windpipe. From their very clear description of the symptoms, we now know it to have been an acute inflammation of the epiglottis and glottis. From the rapid inflammation of the epiglottis, water is effused into this cartilage, so as to puff it up, and prevent it from shutting down in the act of swallowing. The lips of the glottis are swollen from the same cause, and brought so near to each other that air passes through to the lungs with great difficuly, and unless relief is soon obtained, the patient is strangled. Symptoms. — The disease begins with a severe chill, accompanied with some pain, and a sense of stricture or tightness in the upper and fore part of the throat. There is cough, with difficult and sometimes painful swallowing. These symptoms are soon followed by quick and laborious breathing. Speaking aloud is from the first difficult, and soon becomes impossible. As the complaint runs its rapid course, the breathing grows more difficult, and death soon results from com- plete strangulation. Treatment. — Apply immediately to the parts a strong solution of nitrate of silver. The solution should be of the strength of ninety to one hundred and twenty grains to the ounce of soft water. It 228 DISEASES OF THE THKOAT. should be applied every hour or two till the feeling of suffocation subsides, and should be done with the laryngeal shower syringe, though if this is not at hand the sponge probang may be used. While this local treatment is being employed, liberal doses, from five to twenty drops, of tincture of veratrum viride should be given every hour, watching the effect, and discontinuing when the pulse sinks too low. Hot fomentations applied externally, and filling the room with steam, as recommended in cases of croup, would be usef Mumps. — Parotitis. This disease appears most often among children ; but as it is not confined to them, I have not placed it among their complaints. Symptoms. — It begins with soreness and stiffness in the side of the neck. Soon a swelling of the parotid gland takes place, which is painful, and continues to increase for four or five days, sometimes becoming very large, and making it difficult to swallow, or open the mouth to receive food. After the fourth or fifth day the swelling subsides, and disappears in from seven to ten days. Both glands generally swell about the same time, but sometimes the swelling appears in one only after it has subsided in the other, and occasionally the swelling is wholly confined to one side. When the swelling is great, there is heat, and sometimes fever, with dry skin, quick pulse, furred tongue, constipated bowels, and scanty and high-colored urine. The affection is sometimes translated, as we say ; that is, in females, the breast swells, and in males, the testicles become swollen and pain- ful. This accident generally happens in consequence of taking cold from some imprudence. The disease is contagious ; that is, it is communicated from one person to another. Treatment. — In mild cases, very little treatment is required. Keeping the face and neck warm, avoiding exposure to cold and damp, drinking warm infusions of balm, spearmint, or sage, and ap- ply a poultice of flax-seed over the glands until the patient is fully relieved ; or the compound powder of jalap, if there be costiveness, is about all that is required. The diet should consist of rye hasty pudding, or brown bread and sweetened water. If the case be severe, and other glands swell, physic must be freely used, leeches must be applied, and cooling lotions, or poultices. Sweating must also be induced by the compound tincture of Vir- ginia snakeroot, or by a vapor bath. In young girls mumps often attack the ovaries and make the in- valid a great sufferer for a few days ; the testicle of the male is simi- larly affected at times. These complications call for soothing appli- cations and rest in bed. DISEASES OP THE CHEST. Consumption. — Phthisis. At the head of the diseases of our climate stands Consumption, — at their head both as it respects prevalence and fatality. Small-pox, yellow fever, and cholera are terrible in their visitations ; but what are all their aggregated slaughters compared with the ceaseless, silent march of this fell disease, which steals away in their fresh prime the brightest and the best ? Boston, from its population of 475,000, loses by consumption about twenty per week, eighty per month, or about nine hundred per annum. An equal mortality from any disease not often among us would send our citizens in terror to the country, and cause the stoutest hearts to feel that "in the midst of life we are in death." Massachusetts loses about seven thousand per annum ; New England, not less than twenty thousand ; and with the State of New York added, the victims of this single disease swell to forty thousand a year ! What an army ! Picked from the choicest ! All sundered from life untimely, and leaving more blight and sorrow behind than would perhaps twice or thrice the number whom any other pestilence would have selected. The magnitude of the evil places the question of the remedy before all others that pertain to the healing art. The greatest number of deaths occur in Massachusetts, being in the neighborhood of one in every two hundred and fifty. The smallest number is in Georgia, being about one in two thousand one hundred and fifty. New England is most unfavorable as a place of residence. The Northern Middle States, Western Central and Pacific Coast States are most favorable. The most healthful for consumptives, I would place in the following order : Georgia, New Mexico, Wiscon- sin, Colorado and California. A permanent residence in any of them will cure most cases if taken in first stages, and will greatly prolong life, unless in the last stages, in which case I would strongly advise the patient to remain at home among friends and home comforts. After a change of climate it is dangerous to return unless a perma- nent cure has taken place. Methods of Examining the Chest. — Before speaking further of consumption, I propose to do what has never been done, namely, to 229 230 DISEASES OF THE CHEST. instruct the general reader very briefly in the method of examining the chest to learn the existence of disease. Perhaps this will be considered a departure, in some slight degree, from my purpose to make this entire book intelligible to the general reader. If so, my reply is, that there are many school teachers, mechanics, masters of vessels, and farmers, who have inquiring minds, and sagacity enough to learn the physical signs of chest-disease, and to make them, in many cases, practically useful; and that even readers of little re- flection cannot fail to comprehend a portion of my explanations. Position of the Patient. — In performing percussion upon the front of the chest, the patient should be required to sit in a square position, with the arms hooked over the corners of the back of the chair, and the head thrown a little back. Instrument with which to Thump. — The index and middle fingers of the right hand are to be brought together, into a line, and used as the percussing instrument. The blow given with these is to be smart and quick, rather than heavy. Medium to Thump Upon. — Either the index or middle finger of the left hand is to be pressed firmly upon the surface of the chest to be percussed or struck, and thus used as a pleximeter. Auscultation. — Listening for the purpose of hearing within the chest the sounds produced by breathing, talking, coughing, etc., is called auscultation. Fig. 90. Fig. 91. Instruments with which to Listen. — The naked ear is generally considered best for hearing low and delicate sounds ; but for hearing loud and rough ones, it is not so good as the stethoscope, repre- sented by Fig. 90. A still better instrument is the double-eared stethoscope, Fig. 91. It magnifies the sounds very much, and is apt to confuse an examiner not accustomed to it ; but when the ear is once familiar with it, the aid it affords is very valuable. DISEASES OF THE CHEST. 231 The examiner should pass from side to side, continually comparing the sounds upon one side, with those upon the other. The patient must be calm, and the examiner in no hurry. Healthy Sounds. — To become skilful either in percussion or aus- cultation, the examiner's ear must first be trained to healthy sounds. These are best heard in the child, in whom they are louder than in the adult. In describing the healthy sounds in the different regions of the chest, I shall refer the reader constantly to Figs. 92 and 93. Clavicular Region. — This, in Fig. 92, is represented by 1, 1. Upon thumping upon the collar-bones, the sound given out at the breast-bone end should be very clear ; less clear in the middle ; and dull at the shoulder end. Subclavian Region. — This is represented by 2, 2, and lies be- tween the collar-bone and the fourth rib, on both sides. It covers a considerable portion of the upper lobe of the lungs. The sound upon striking this place should be very clear. Fig. 93. The Mammary Region, represented by 3, 3, extends from the fourth to' the seventh rib, on each side. In the upper part of this region, the healthy sound is clear ; but at the bottom of it, on the right, the sound is deadened by the liver ; on the left, by the heart. The Infra=Mammary Region, 4, 4, lies between the seventh rib and the edge of the cartilages of the false ribs. On the right side, the liver makes the sound dull ; but under the left side lies the stomach, which is hollow, and the sound is generally quite loud. 232 DISEASES OF THE CHEST. In the Sternal Region, 5, 6, 7, which covers the breast-bone, the sound is generally clear. The Axillary Region, 8, 8, is in the arm-pits. In this the sound should be clear. The Lateral Region, 9, 9, is immediately below the above, and yields, likewise, a clear sound. The Lower Lateral Region, gives a dull sound on the right side, and on the left a very hollow one. Fig. 93 represents the back part of the chest. In looking at this, we see the Acromial Region, represented by 11, 11. In this space the sound is dull, but it has not much meaning. The Scapular Region, 12, 12, covers the part occupied by the shoulder-blades. It gives rather a dead sound. The Intra=Scapular Region, 13, 13, lies between the shoulder- blades, on each side of the back bone. If the patient's arms are crossed, and the head bent forward, a clear sound will be obtained. The Dorsal Region, 14, 14, covers the base of the lungs, and, in health gives, a clear sound. Observation. — If, now, on thumping upon the chest, we find a dull, dead sound in any spot where a clear one ought to be yielded, we are to conclude that underneath there is not the usual quantity of air ; but we cannot tell merely, by percussing, whether tubercles are deposited there, "or the lung has become solid by inflammation, or water has been poured out into the cavity of the pleura. This point must be determined by auscultation, etc., to be explained gradually as we go along. Auscultation of Breathing. — On applying the ear or the stetho- scope to the chest, two sounds are heard which immediately succeed each other, — the louder is produced by the ingoing breath, or in- spiration ; the weaker by the outgoing breath, or expiration. These sounds will be further explained as we go along. Auscultation of the Voice and Cough. — The chest of a healthy person speaking communicates to the ear no distinct sound, but only a vibratory sensation, called, in technical language, the pectoral fre- mitus. Over the larynx and windpipe, the examiner may hear natural pectoriloquy ; between the shoulder blades, in the space correspond- ing to the roots of the lungs, natural bronchophony. Philosophy of Chest Sounds. — The fullness and clearness of sound upon percussion, depends upon the amount of air in the chest. The sounds called breathing murmurs, are caused by the expansion DISEASES OF THE CHEST. 233 and contraction of the air-cells or vesicles, as the air passes in and out ; hence they are called vesicular murmurs. The friction of the air against the sides of the windpipe and large bronchial tubes causes the blowing sound heard in those parts. In children a larger amount of air enters the lungs, and the air vesicles are expanded with more force ; hence their breathing has a louder sound, which is called puerile respiration. This kind of breathing, heard in the grown person, is a sign of disease. The lung tissue is a bad conductor of sound; and the voice is ac- cordingly heard only over those parts where large bronchial tubes are near the surface ; heard elsewhere, it indicates disease. Division of Consumption. — Consumption may be divided into two kinds, the tubercular and the bronchial. The former has a con- stitutional, the latter a local origin. First Stage of Tubercular Consumption. Physical Signs. - — Dullness of sound on and under the collar- bones. Inspiration shortened ; expiration augmented both in duration and intensity. This dullness often first perceived in armpits, or at base and back of lungs. Occasionally a pulmonary, crumpling sound. Dry, crackling rat- tles. The resounding of the voice increased at the top of the lungs. General Symptoms. — A sense of weariness and languor. Occasionally, slight, flying pains about the chest and shoulders. A peculiar sensitiveness to the effects of cold. Breathlessness on moving quick, or ascending a hill or stairs. In many cases a blue lividity of the lips and roots of the finger- nails, and coldness of the hands and feet. Occasionally, in females, even at this early stage, a cessation of the monthly turns. These usually stop later in the disease. Observations. — The formation of tubercles almost always begins at the top of the lungs. Laennec and others thought they appeared oftenest on the right side first; Louis, Andral Watson, Sir James Clarke, and others, believed they appeared more often on the Ze/^side. Recent investigations show that they were all mistaken. Tubercles appear first about as often upon one side as upon the other. The pulmonary crumpling sound is caused by a mechanical ob- struction to the expansion of the lungs. It is generally heard only during the drawing in of the breath. The sound is like that pro- duced by blowing upon very fine paper. 234 DISEASES OF THE CHEST. Second Stage. Physical Signs. — Marked dullness of sound on the collar bones, and extending below them. Inspiratory murmur diminished in duration and intensity ; expira- tory murmur augmented in both. In upper lobes of lungs, moist, crackling rattles, succeeded by mucous rattles. Also bronchial respiration, or tubular breathing. In lower lobes of lungs, puerile respiration. Sounds of the heart heard under the collar bones. Bronchophony heard in the same parts as bronchial respiration. General Symptoms. — A quickened pulse; slight fever towards evening, oftentimes amounting to quite high fever. Great susceptibility to the effects of cold, and liability to take cold easily. Bowels generally costive ; oftentimes seat of pain. The eye has a peculiar whiteness and lustre. The skin and mouth become dry in the afternoon ; chills occur about midday, followed by fever, during which the cheeks are flushed. As the second stage advances to its close, a dry, burning heat afflicts the palms of the hands and soles of the feet. Nio-ht-sweats occur at this time. Observations. — A hollow, elastic body, containing air, gives, when struck, a clear sound. The dullness of sound on percussing the chest, arises from the absence of air in the air-cells, — these having been pressed together, or obliterated by the deposit of a mass of tubercles. The destruction of these cells causes the cessation of the respiratory murmur. This stage of the disease is often accompanied by an inflammation of the mucous membrane lining the air-tubes. The air, pushing its way through the mucous secretions in these tubes, forms bubbles, the bursting of which causes the rattle. The crepitant rattle is produced by inflammation around the tubercles. The moist, crackling rattle is caused by the softening of the tubercles. The lungs, rendered more solid by the deposit of tubercles, become better conductors of sound ; and this causes the beating of the heart to be heard as far off as under the collar bones. Bronchial respiration gives the idea of air blown through a tube ; cavernous respiration, of air passing into a large enclosed cavity. Third Stage. Physical Signs. — In this stage cavities are formed. If the cavi- ties be small, and considerable tuberculated lung surrounds them, the sound, upon percussion, is still dull. DISEASES OF THE CHEST. 235 If the cavity be large, and near the surface, there is occasionally a tympanitic sound with musical tone. Sometimes a sound is heard like striking a cracked pot. Gurgling ; cavernous rattle ; cavernous breathing ; amphoric breath- ing; now and then, metallic tinkling; pectoriloquy; cavernous cough. General Symptoms. — Great loss of flesh, and weakness ; diarrhoea and night-sweats ; swelling of the feet and legs ; sore mouth ; and raising of matter with specks of tubercle in it like crumbs of cheese. Observations. — The gurgling rattle is caused by air displacing liquids, and the formation and bursting of bubbles. It resembles the sound produced by blowing through a tube immersed in soap-suds. Cavernous breathing is nothing more nor less than the sound pro- duced by air, breathed in and out, entering and retiring from a cavity. The air appears, sometimes, to one listening with the stetho- scope, as if it were sucked into his ear during inspiration, and blown back again during expiration. Amphoric respiration is simply an augmentation of cavernous breathing, and results, of course, from an increase of size in the cavity. In pectoriloquy, words uttered by the patient seem to pass through the stethoscope into the ear of the listener. The cavity should be empty, moderate in size, and have dense walls, in order to furnish the best specimen of this sound. Air suddenly driven backward through the windpipe, and out of the mouth and nose, by smart raps upon the chest over a cavity, gives the sound of the cracked pot. It is best heard when the pa- tient's mouth is partly open. The same sound is produced, on the same principle, by locking the fingers of the two hands, and joining the palms, so as to leave a small space or cavity between them, and then expelling the air from that cavity, by gently striking the back of one hand upon the knee. Causes of Consumption. — The human constitution, as shown by Liebig, in his profound work on Animal Chemistry, is governed by two forces, the nervous and the vegetative. The former disposes the particles composing the body to a state of motion ; the latter inclines them to a position of rest. In vegetative life there is motion in one direction only, so to speak ; that is, motion which tends to the opposite of motion, namely, rest. In vegetables, whose life is wholly under this power, there is no waste ; for here, all ultimate particles, having once taken a place of rest, remain undisturbed. In a tree, a layer of matter once deposited, always remains. Hence there is growth as long as the tree lives. There is no power to break up and destroy. But in the animal body there is motion in two directions, or a circuit of motion. Particles which under the vegetative force have been put to rest, are perpetually being displaced by the nervous energy, 236 DISEASES OF THE CHEST. and reduced to unorganized amorphous compounds, to be burned in warming the system, or cast out by the several excretory processes. So constant is the action of these two forces, that John Hunter compared the human system to a whirlpool, into which the particles of matter are perpetually poured, under the influence of the vegeta- tive power, and out of which they are as constantly whirled by the nervous force. By a little reflection upon these antagonisms, the reader will see that it is just when the vegetative force transcends the nervous, that the body increases in weight, and acquires that state in which the blood corpuscles abound, and the tendency, if to disease at all, is to that of the inflammatory kind. It is the tonic condition of the sys- tem. Nutrition is more rapid than destruction. New particles are laid down faster than old ones are taken up. The body grows. On the other hand, when the nervous force overmasters the vegeta- tive, when the outward or centrifugal motion of the whirlpool prevails, then it is that the body is attenuated, the blood thinned and made serous, and the consumptive or atonic condition is established. Now, there is too much motion. The nutritive particles, instead of tending to a state of deposit for the re-supply of waste matter, become fugi- tive in their habits, perpetually fleeing, like convicts escaped from prison. Introduce this power, in excess, into the vegetable kingdom, and the matter deposited upon the tree, instead of remaining to swell its bulk, would be driven off by the nervous force ; and the tree, in- stead of growing, would be annually lessened, become sickly, and die of consumption. In Tubercular Consumption, the system is like a field deluged by a flood ; nothing can take root. The repeated shocks of the nervous battery sent to the absorbents so quicken them in their work of re- moving waste matter, that they dislodge much which is not yet worn out, and assist in casting out of the system not a little designed to be used in its renewal. A healthy deposit is thus prevented, and nutri- tion is at an end. The nutritive arteries, those little builders of the human frame, are overmastered by the stimulated lymphatics ; the constructive material is wrested from them, and borne beyond their* reach, and the body wastes from want of nourishment. The blood becomes thin and watery; and from the increased serous portion, chiefly albumen, are deposited upon the lungs and other tissues the albuminous tumors called tubercles. Here is found the cause of _ that peculiar smallness of bone and muscle, and thinness and tallness of person, so peculiar to consump- tives. The absorbents, under the power of a very active nervous system, take down "the house we live in" faster than the nutritive arteries, confused by the motion around them, can effect its recon- struction. It is simply an unbalancing of the antagonistic forces, which build and pull down our earthly tenement. The men that de- molish are more numerous and better fed than the artisan builders. DISEASES OF THE CHEST. 237 It is this destructively nervous force which gives to consumptive persons their proverbial mental activity ; which causes them often to dazzle the world with the splendor of their gifts, and to bless their friends with the warmth of their affections. They are usually the choice spirits, the idols of their relatives, and the favorites of the com- munity in which they live. Their mental movements, and the exer- cise of their affections, are characterized by brilliancy and warmth. Of all persons, they are best fitted to enjoy life, and to impart happi- ness. Loving all, they are by all loved in return. They are speci- mens of partially etherealized humanity, stepping lightly across the earth, to whom friends passionately stretch out their arms, and em- brace — their shadows ! These views will appear the more reasonable, if we consider that in children the vegetative power is very active, while the nervous energy is comparatively weak. The preponderance of the former over the latter causes the rapid growth of children. The little arterial builders work faster than the lymphatic demolishers. This explains why so few children die of consumption. But from the age of seventeen to thirty-five, when the vegetative power is losing something of its extraordinary activity, and the nerv- ous force is showing its highest capabilities, — then it is, as this theory indicates, that tubercular consumption does its dreadful work, — then, that the outward world of this physiological Maelstrom casts upon the shores of mortality so many thinned, exhausted, and lifeless human forms. More than three-fourths of all who sink under this disorder die between the ages just named. The brain, between these points of time, acquires its full size and force. This disease prevails most, too, in those countries where an enlight- ened civilization gives to the nervous system its fullest development, as in Great Britain, France, and the United States, and in those where the nutritive process is most retarded by a relaxing climate ; and it is scarcely known among those people who are but little en- lightened and have small brains, and among those who live in high and invigorating latitudes. As the most enlightened, however, are generally found in temperate climates, and those with the least culti- vated brains in low latitudes, the rule is not perfectly explained by facts ; yet it shows itself sufficiently to establish its validity, and to afford another proof of my theory. Bronchial Consumption. The persons exposed to bronchial consumption are generally of an opposite habit to those described above, — having the nervous force, in health, well subordinated to the vegetative, the assimilation good, and the blood well supplied with red globules. They have usually a full habit and an active circulation. The absorbents, and other ves- sels in the lungs, working in the midst of a large amount of caloric 238 DISEASES OF THE CHEST. evolved by an energetic respiration, often take cold, which brings on Inn g-f ever and pleurisy, and these lay the foundation for the ultimate destruction of the lungs. For the same reason, the skin of this class of persons becomes diseased, and more often the inner skin, or mu- cous membrane, and most often that portion of mucous membrane which goes down into the lungs and lines the air-tubes. It is inflam- mation of this which constitutes bronchitis, and which lays the foun- dation for true bronchial consumption. As that class of persons who are exposed to the tubercular form of the disease suffer a general loss of carburetted hydrogen in its several forms, colliquative diarrhoea, sweats, increased breathing, and all con- ditions that carry fat out of the system, so those who suffer from attacks of the bronchial type of the disorder are generally afflicted with the opposite condition. They have too much carbon. It is well ascertained that carburetted hydrogen, accumulated in the system, acts as a poison. And that class of bilious persons who are subject to this disease often have their excretions badly performed. For this reason, carbonaceous compounds accumulate in the system, and give rise to the symptoms of morbid poison circulating in the blood. This led Dr. Madden to suspect the presence of such poison in the blood of all consumptive persons. He saw the evidence of it in numerous cases, and not distinguishing the one class from the other, he inferred its presence in all. Constitutional Difference. The constitutional difference between the two forms of consump- tion appears to be this : the tubercular type is usually attended, in its origin, by a tolerably good state of the digestive function, in connec- tion with bad assimilation ; while the bronchial form generally has its foundation laid in connection with bad digestion, accompanied with healthful assimilation. In the former case, the food is well di- gested, the pabulum is properly prepared, but the nutritive arteries do not use it for renewing the tissues. In the latter case, the digestion is bad, the pabulum poorly elaborated ; but the re-constructive vessels, under the control of a well-developed system of organic nerves, use it to the best advantage. In the one case there are good hiaidk-makers, and lazy brick-foyers ; in the other, the reverse. It happens, however, that before the fatal close of the disease, tu- bercular patients usually become afflicted, more or less, with bad digestion, and bronchial patients with defective assimilation ; so that, in the end, they present us with much the same class of symptoms. Starting from opposite poles in life's celestial sphere, they meet at the culminating point of death, and disappear under identical aspects of the heavens. DISEASES OF THE CHEST. 239 Exciting Causes of Tubercular Consumption. The preponderance of the nervous force being the state which pre- disposes to disease, whatever unduly excites the nervous energy in- vites an attack. These causes relate, mostly, to the prolonged exercise of the intellect, the passions, and the sentiments. Few are aware of the mischief done by excessive stimulation of the mind during the most active period of life, — especially if the muscular system be left half developed. Here is where ambitious students commit great errors. The constant plying of the mental powers, in the present modes of educating children, leads to a dreadful abridgment of human life. Better to train the bodily powers first, and let* the mental culture come in later time. He who would build a lasting structure must lay a solid foundation. The age in which we live abounds in the causes of excitement. The world is trembling with excess of mental life. The pine trees burned by the steam-engine are scarcely more numerous than the human constitutions consumed by the train of thought it has set on fire. Nor are the passions and sentiments less exercised, or less destruc- tive. Briefly, the causes of consumption embrace all those things which bring a destructive force against the digestive and assimilative func- tions, as insufficient and improper food, debaucheries, night-watches, sedentary habits, anxiety of mind, etc. ; and those which act injuri- ously upon the breathing organs, as impure air, inflammation of the lungs, pleurisy, measles, hooping cough, etc. ; and such as disturb the sweating process, as insufficient clothing, sudden changes of temper- ature, sleeping in damp sheets, etc. These exalt the nervous force, or depress the vegetative, or inflame the mucous lining of the air- tubes, or the substance of the lungs, or the membranous sack which encloses them, so as to induce one form or other of consumption on the principles I have explained. The immediate cause of consumption we know, now-a-days, to be due to a deposit of tubercles either in the neighborhood of the vocal cords, the upper parts of the lungs, or, not infrequently, at the bases of the same. These tubercles contain a germ called the Tubercle Bacillus, which can only be seen with a high power microscope, and then only after being stained with certain aniline colors which they absorb. These little germs are of the rod-shaped variety of bacilli, and appear under the microscope as little straight lines or rods about -^ inch in length. Their presence in the sputum of a person means tuberculosis of some part of the air-passages ; when they are associated with the presence of yellowish fibres (seen under the microscope) they are a proof of the deposit being in the lungs 240 DISEASES OF THE CHEST. proper. The examination of one's sputum, therefore, in the early part of any prolonged and suspicious cough, becomes an absolute ne- cessity, since thereby one is made aware, in the earliest stages, of this dreadful disease, and an opportunity offered of attacking it at once in its incipiency. This modern discovery has given rise to much experimentation in treatment with the aim in view of killing out the germ. Robert Koch of Berlin announced to the world, a short time ago, that he had discovered an agent, which he called Tuberculin, that would eradicate these death-producing germs, but time has shown his efforts to be unsuccessful as yet, although promising of great results in the future. These germs are contagious in character, so that we now can explain why many contract consumption in whose ancestral blood there never existed any tubercular taint. We know that husband may impart the disease to w^ife and mother to daughter if only the system is in a receptive state to offer a lodg- ment to the germs. These tiny but most enduring bacilli retain their life for an indefinite time in the midst of dust and other dried secretions, so that a practical point is that all persons suffering from tuberculous diseases should be exceedingly careful where they spit and with whom they sleep. To raise the sputum into small paper cups which may be burned is a common and very prudent custom. This discovery, while not disproving the old theory of heredity, nevertheless explains many a case of acquired Phthisis, and clears up many an old-fashioned theory. These are indisputable facts from which the medical profession at present hope to derive practical benefit by the discovery of some germicide which may be applicable and safe for internal administra- tion. Can Consumption be Cured ? — In many cases it can. It maybe cured, first, by the absorption of the tubercles. The celebrated John Hunter shows, in his work on the blood, that the absorbent vessels have a sort of elective affinity, by which they take up and remove " all adventitious new matter, as tumors" (tubercles are albuminous tu- mors), more easily « than those parts which were originally formed." Were this not so, an activity in these vessels equal to the removal of tubercles would cause them to waste all the tissues, and aggravate rather than cure consumption. Probably this does occur where proper hygienic means are not used to quicken the excretions. This hygienic treatment, to be spoken of hereafter, is not generally em- ployed, — certainly not as effectually as it should be. Here is the source of Laennec's fatal remark, so often quoted and so widely en- dorsed, that nature's efforts towards effecting a cure are injurious, and those of art are useless." Laennec's position cannot be true, if Hunter's statement is correct. If the absorbents, by an elective in- stinct, take up adventitious matter rather than the natural tissues, then the reason why they reverse this rule in consumption is, that by a weakened state of the constitution, the ultimate particles are not DISEASES OF THE CHEST. 241 well put together, and are more easily taken apart than those of the adventitious tubercular tumors ; and if we would restore these vessels to their natural activity, we must improve assimilation, and knit the unloving molecules into a firmer brotherhood. We must make the flesh hard, so that the absorbents cannot pick it to pieces. Do this, and "nature's efforts to effect a cure" will not "be injurious." A second form of cure is the reestablishment of the assimilative function, the building up of the general health, the arresting of the tubercular deposit, the reducing of tubercles already formed to an indolent state ; and then, by a strict observance of the laws of health, keeping them in that condition through life. A third mode of cure is the healing of the cavities after the tuber- cles have softened, broken down, and been expelled in the form of expectoration. A fourth method of cure is a change of tubercles to calcareous matter. These calcareous tubercles, Laennec says, "are consequent to tuberculous affections that have been cured" And Andral, at one time, hoped to learn how to effect cures by changing tubercles to " the calcareous phosphate." I have had several cases of cure by this last method, and have quite a collection of calcareous substances which my patients have coughed up, — one of which was raised in my presence by a lady who was a few years before in hopeless consumption, but is now in good health. Treatment. — This should be of two kinds, local and general. The local treatment of consumption is by the inhalation of vapors and powders into the lungs. It has been practised, more or less, by individuals, for many years, particularly in Europe ; but for some unaccountable reason, the profession generally have never used it, and do not know much about it. I had the honor, some years ago, to bring it freshly before the American public, in some articles writ- ten for popular reading, since which time it has been rapidly gaining public confidence, and is now attracting much attention. Conveying the remedy directly to the diseased parts, it strikes the common- sense mind as eminently reasonable and necessary. I shall speak of inhalation, therefore, very earnestly, not as a palliative of consumption only, but as far more, as a remedy. After long and patient use, my experience allows me to say, that I know it, in many cases, to be such ; and knowing this, I should be criminal not to press it upon the public ; for it is the great multitude of sufferers, pressing fast through the gate of death, who need to hear words of hope. Consumption a General Disease. — It is not denied that con- sumption is a general disease, needing constitutional treatment; but it has also a local development in the lungs, first in the form of al- buminous tumors, called tubercles, and then, after the softening, 242 DISEASES OF THE CHEST. breaking down, and discharge of these, in the more formidable shape of ulcerous cavities, which, beginning at the summit, devour the lungs down to the base. Can it be reasonable to apply no remedy directly to this local disease ? Not so does our profession deal with other local diseases. To an inflamed skin we apply poultices, cold compresses, solutions of acetate of lead, nitrate of silver, etc. ; to leprous or scaly affections, sulphuret of potash, bichloride of mer- cury, zinc ointment, nitrate of mercury ointment, sulphur, creosote, etc. ; to weak and inflamed eyes, sulphate of copper, sulphate of zinc, nitrate of silver, and opium ; to chronic ulcers upon the skin, tannin, pulverized rhubarb, opium, or cinchona ; and to an inflamed throat, nitrate of silver and other articles. These are but specimens of the thousand cases in which we use local remedies. Why, then, when the mucous membrane, which lines the air tubes, becomes in- flamed through all its branches, should we neglect, by the inhalation of medicated vapor, to apply a remedy directly upon the whole in- flamed surface ? Why, when tubercular matter is beginning to be deposited upon the surface of the air cells, and of the small bronchial tubes, should not the vapor go right to those parts, and cause, as it would, the immediate expulsion of this offending and dangerous matter ? Uneducated common sense sees the reasonableness of these sug- gestions at a glance. Many a person, with pulmonary disease, dies of suffocation, not because there is not muscular strength to expel the matter which is strangling him, but because the lungs below the large pellets of mucus, which plug up the bronchial tubes, cannot be inflated, and have therefore no means of driving out the offending substance. Yet a proper medicated vapor, drawn in with the breath, would either dissolve the mucus, or rouse up the expiring membrane to cast it off. If the reader were to place one end of a stethoscope directly over the disease upon the breast of a person in the third stage of consump- tion, and should then ask him to talk, the words spoken would seem to rise up through the instrument, and enter, well articulated, into his ear. This, in technical language, is called pectoriloquy, — a word signifying chest-talking. It implies a cavity in the lung. If now the patient be asked to cough, a gurgling and splashing sound will be heard. This denotes that the cavity is partly filled with fluid, which is dashed about by the air explosively driven through it by the portion of lung below. Here we have an excavated ulcer, with all its filthy contents, composed of pus, mucus, serum, and dissolved tubercles, lying in it day and night to aggravate its unhealthy condition. What more reasonable, what more necessary, than that a soothing, altera- tive, or astringent vapor should be drawn into this cavity, to cause its sides to heal, and its absorbents to remove this fluid ? A surgeon who should permit an ulcer upon the surface of the body to remain in that condition without a local dressing would be deemed unfit to practise his profession. DISEASES OF THE CHEST. 243 Both in tubercular disease and in simple bronchitis, the bronchial tubes almost always sutler some physical change. The mucous membrane lining these tubes is generally softened. At other times the tubes become enlarged through their whole length, so that many of them, from the size of a quill, reach the bigness of the finger of a glove. In still other cases, the straining produced by coughing causes a tube to belly out at some point, forming a sack, which is generally filled with mucus or purulent matter. At still other times, a tubercle will press against a tube so as to flatten it and convert it into a musical instrument, the air, as it is drawn laboriously through, producing a high or low note, according to the size of the pipe. These physical changes are all produced by causes which the inhala- tion of a suitable vapor, at the proper time, would almost infallibly remove. How strange that this remedy, — so simple, so effectual, so easily comprehended, — should have been so little used ! Right at this vital point in the lungs, where the blood runs in a ceaseless current, — where the whole of it goes every two minutes to renew its vitality by contact with atmospheric air, — we have, in thousands of cases daily occurring, inflammation with roughening or softening of membrane, with its consequent harsh breathing ; we have mucus, tough or glairy, to impede and interrupt respiration ; we have tubercles in the hard or soft state, adding to the general embarrass- ment, and not only lessening the vitality of the blood, but disturbing all the sympathies of the system ; — and yet the practice has been, and is, to attack these central disturbers of life only through the cir- cuitous path of the stomach, lacteals, etc. I have investigated faithfully the effects of the various substances proposed for inhalation by European physicians, and have explored a wide field of new remedies, not before used, several of which have proved to have qualities of great remedial power. The chief remedies I employ for inhalation are the following . Alterative Inhalant, composed of iodine, six grains ; iodide of potassium, twelve grains ; tincture of ipecac, one ounce ; tincture of balsam of tolu, six drams ; ethereal tincture of conium, one and a half drams ; alcohol, half a pint. These are to be mixed. The dose is one to two teaspoonfuls, to be inhaled ten or fifteen minutes, in about a gill of hot water. The ethereal tincture of conium is made by keeping a dram of powdered conium in one ounce of sulphuric ether a week. The above inhalant is used in the tubercular forms of consump- tion, particularly that of the scrofulous kind, and in many cases of bronchitis. Expectorant Inhalant. — Take pleurisy root, half an ounce ; squill, one ounce ; ipecac, two drams ; black cohosh, two ounces ; queen's root, one ounce and a half; American hellebore, two drams; diluted alcohol, one pint. Grind the roots, etc., and add the alcohol. 244 DISEASES OF THE CHEST. Let the whole stand one week, shaking or stirring daily. Draw off and filter through paper. Two teaspoonfuls make a dose, to be in- haled same as preceding. This is to be used when the cough is hard and dry, and the expec- toration difficult. It makes the raising easy, lessening the soreness of the chest, and the harshness of the cough. Soothing, Febrifuge Inhalant. — Take belladonna leaves, half an ounce ; black cohosh, two ounces ; American hellebore, half an ounce ; poke-root, two drams ; aconite root, one ounce ; diluted alcohol, one pint. Grind the roots, etc., add the alcohol. Let the whole stand one week, stirring daily. Pour off and filter through paper. Dose, one to two teaspoonfuls, to be inhaled as the preceding. This is excellent in all cases where the skin is hot, the pulse quick, the tongue and mouth parched, the chest sore, and the system suffering during the whole or a part of each day, from a general feverish condition. It is proper in all the forms of chest disease. Astringent Inhalant. — Take of wild indigo, one ounce ; catechu, half an ounce ; Peruvian bark, one ounce ; golden seal, one ounce ; diluted alcohol, one pint. Mix, and let the whole stand one week, stirring daily. Drain off, and filter through paper. Add two drams of creosote. One to two teaspoonfuls to be inhaled as preceding. This is to be used when the expectoration is profuse and easy, un- attended by fever, either in the latter stages of chronic bronchitis, when the mucous membrane of the tubes is in a relaxed condition, or, in the third stage of tubercular disease, for the purpose of con- stringing, cleansing, strengthening, and healing. Antiseptic Inhalant. — Take wild indigo, one ounce ; belladonna leaves, half an ounce ; diluted alcohol, one pint. Mix, and let the whole stand one week. Pour off, and filter through paper. Then add solution of chloride of soda two ounces. Dose, one to two tea- spoonfuls, to be inhaled as the preceding. This is used in cases of gangrene of the lungs,, generally distin- guished by considerable expectoration having a very fetid smell. Anti=Hemorrhagic Inhalant. — Take witch-hazel bark, two ounces ; black cohosh, four ounces. Grind, and add one pint of diluted alcohol. Let the mixture stand one week, stirring daily. Pour off, and filter through paper. Add to this two drams of creo- sote. Dose, one to three teaspoonfuls, to be inhaled as preceding. This is an excellent remedy for bleeding from the lungs. When there is a tendency to bleed, it should be used for a long time. It may frequently take the place of No. 4, as an astringent inhalant. For immediate relief give strong solution of salt water. Object of Inhalants. — Being vaporized and inhaled, these articles enter every air-cell throughout the lungs. Their object is to soothe and mollify inflamed mucous surfaces, to reduce enlarged bronchial DISEASES OF THE CHEST. 245 glands which press upon neighboring parts and cause bleeding, to stimulate the absorbents to take up and remove tubercles, to dissolve tubercles out of the pulmonary tissue, to cause ulcerous cavities to expel their mattery contents, and to stimulate their sides to take on a healing process. They should be used from three to six times a day, the inhalation continuing from ten to fifteen minutes. Other Inhalants. — Great numbers of other articles have been used, which I have not space to describe. I will mention, however, that the following are sometimes employed with advantage : — For an Expectorant Inhalant, take alcohol, four ounces ; tincture of camphor, half an ounce ; tincture of tolu, two drams ; naphtha, one dram ; benzoic acid, thirty grains ; oil of bitter almonds, four drops. Mix. For an Anodyne Inhalant, take alcohol, four ounces ; naphtha, one dram ; benzoic acid, thirty grains ; chloroform, twenty-five drops ; tincture of henbane, half an ounce. Mix. For an Astringent Inhalant, take alcohol, four ounces ; naphtha, one dram ; benzoic acid, thirty grains ; chloroform, one dram ; tannin, eight grains. Mix. Mode of Inhaling. — For inhaling these, a sponge is fitted into a glass cup, to which a flexible tube is attached. A small quantity of the mixture is poured upon the sponge, and the vapor arising is drawn into the lungs through the tube. To the expectorant inhalant may be added, occasionally, half a dram of nitric acid. These latter formulas are the principal ones used by those who practice what is called cold inhalation. A very common mode of inhaling volatile remedies is by saturat- ing a little cotton, contained in a wire basket, with the desired oil or fluid, and placing it over the mouth and nose. It is to be worn throughout the day. Oil of peppermint, creosote, menthol, oil of eucalyptus, etc., etc., are among the more common remedies thus used. A good inhaler can be bought of any dealer in surgical instruments. Constitutional Treatment. — The rapid breathing in consump- tion creates too much oxydation of the blood, — so much, that the muscles, especially the heart, are usually of a bright red. To prevent the patient from being literally burned up by oxygen, the blood must be de-oxydated as fast as possible. While there is too much of oxygen, there is, at the same time, a deficiency of carbon. Hence the cold hands and feet, and the gen- eral inability to bear frosty weather. The little nutritive arteries, in these thin-blooded persons, stand shivering and torpid with cold, un- able to perform their allotted function of nutrition. There is not fire enough, and fuel must be had in the form of carbon. Hence one of the advantages of cod-liver oil. This oil, too, as carbon, devours 246 DISEASES OF THE CHEST. the oxygen of the blood, and prevents its destroying the patient. This idea also explains the fact mentioned by Bennet and others, that in their post-mortems they found the evidences of healed ulcers in numerous persons who had been spirit-drinkers while living. And Liebig helps the explanation by saying that alcohol, taken into the system, circulates in a free state in the blood, and devours its oxygen. To which I beg to add, that the malaria of intermittent and bilious fever districts, has been pretty satisfactorily proved to be an instable organic body, consisting of sulphur, carbon, and Ir^drogen, all of Avhich have an affinity for oxygen, and devour it in the system. Consumption is not found in such districts. As I am here treating of the chemical effects of remedies (and to this test most remedies must finally come), I will mention that tar- trate of antimony and potassa arrests the circulation in the pulmonary arteries, — which fact gives a complete and luminous view of its power to prevent oxidation. But I am obliged to detract from its merits, by stating that it also retards the circulation in the capillaries of the system generally, and so hinders Je-oxidation. Phosphorus. — There is an article which has more recently pre- sented itself to the notice of the profession, to which I wish to invite special attention. I refer to phosphorus. This agent, for a time, challenged our notice in the shape of phosphate of lime ; but we could never feel sure that this article was dissolved in the fluids of the body. We now use, and with far more marked effect, the hypo- phosphites of lime, soda, potash, and iron. These are used in the form of the syrup of the hypophosphites. The dose is a teaspoonful before each meal. The effect ivoon tubercular disease is immediate and gratifying. Need of Phosphorus. — Cerebric acid contains nitrogen and phos- phorus, and is the peculiar component of the brain and nervous sys- tem. By combustion and the changes of oxidation in the brain, the phosphorus of cerebric acid is converted into phosphoric acid ; so that every act of the brain produces phosphoric acid. How rapid, then, must be the consumption of the phosphoric element of the cerebric acid, in that highly active and excitable state of the nervous system which I have described as peculiar to consumption. And how neces- sary, in order to save the brain from destruction, to meet this increased demand for phosphorus, by introducing it into the system. Mulder regards the fibrin of the blood as the carrier of oxygen; and by this oxidation, the fibrin becomes converted into the binoxide and trioxide of protein, — its phosphorus and sulphur (for it contains both) being converted into phosphoric and sulphuric acids. Adding phosphorus and sulphur, therefore, as medicinal agents, would seem to be the proper way to supply the fibrin with materials destructive of its freight of oxygen. It is well known that the salts of phosphoric acid are essential for DISEASES OF THE CHEST. 247 the formation of azotic compounds, — compounds which are neces- sary to sustain animal life. It should be remembered, too, as collat- erally illustrating this fact, that the tribasic phosphates of potash, soda, lime, and magnesia, play an important part in the growth and perfec- tion of plants. They are always found in the seeds of the cerelia, and no mature grains are produced where phosphates are absent from the soil. For the production of abundant grain-crops, it is necessary that these salts should exist in the soil, or be applied to it in manures. It is known, moreover, that in all chronic diseases distinguished by wasting of the tissues, a much larger quantity of phosphates is ex- creted by the kidneys than in the normal state. Hence there is no healthful growth ; and the human organism, like the soil, exhausted of its phosphates by successive croppings, brings nothing to perfec- tion, and needs to have its drained salts re-supplied. I cannot but call attention here to the inorganic substances found in healthy human blood. According to very careful analyses, by Schmidt : 1000 parts of blood-corpuscles, contain : Chlorine 1.686 Sulphuric Acid 0.066 Phosphoric Acid 1.134 Potassium 3.328 Sodium 1.052 Oxygen 0.667 Phosphate of Lime 0.114 Phosphate of Magnesia .... 0.073 1000 parts of liquor sanguinis (serum and fibrin), contain : Chlorine 3.664 Sulhuric Acid 0.115 Phosphoric Acid . .. . . . . 0.191 Potassium ........ 0.323 Sodium 3.341 Oxygen 0.403 Phosphate of Lime 0.311 Phosphate of Magnesia .... 0.222 Iron is omitted. Now, I venture the prediction, that out of these figures, mainly, in connection with those which represent the consti- tuents of the saliva, the bile, the gastric juice, the pancreatic secretion, and the organic compounds of the blood and tissues, are to be evolved within a few years a correct and partially demonstrative system of medication. In consumption, all the inorganic bodies represented by the above figures, with the exception of oxygen, are deficient in quan- tity. By reflecting upon the proportions of these several bodies, par- ticularly upon the large amount of chlorine and soda in the plasma, and of potassium in the corpuscles, the mind can hardly fail to obtain useful hints. I have not hesitated to make one of these hints the ground of a very free use of alkalies, — particularly in the form of bathing. Sugar of Milk. — There is one other medicinal article which I deem worthy to be mad prominent, and to be placed side by side with cod liver oil and the hypo-phosphites. I refer to sugar of milk. It belongs to that class of non-nitrogenized articles which Liebig has denomi- nated supporters of respiration. Its great affinity for oxygen is well worthy to be taken into the account, in considering its value in con- sumption. So great is this attraction, that, with ammonia and other alkalies, it has the power of reducing some of the metallic oxides. 248 DISEASES OF THE CHEST. When taken into the stomach, it is rapidly absorbed into the blood, which, being an alkaline fluid, augments its great de-oxidating power to a considerable degree. It unites rapidly with oxygen after enter- ing the blood, forming carbonic acid and water. A part of it, how- ever, does not enter the blood in an uncompounded state, but is changed in the stomach into lactic acid ; and this, in the blood, be- comes an alkaline lactate. But the portion thus changed appears also very useful ; for Lehmann says : " We know of no substance which could better act in the blood as food for the respiration, than the alkaline lactates." Corroborative of these views is the fact that all those kinds of milk, such as goat's, ass's, etc., which contain the largest amount of sugar of milk, have at different times, and in various countries, ob- tained a reputation for curing consumption. Goat's whey, in winch this article abounds, and from which it is largely manufactured, has been celebrated for its virtues in this line. Ancel speaks of it as an excellent remedy ; and Pereira says, " Sugar of milk, in consumptive cases and chronic 'diseases of the digestive organs, is a most valuable aliment." One of the best forms of taking sugar of milk is that of a gruel, which is quite palatable, and may be freely eaten by consumptive persons. Creosote, Guaicol, etc. — Modern researches having proved that consumption, as well as many throat and other diseases are propa- gated by germs or bacilli, as explained on page 239, medical investi- gators have for a long time been seeking some agent that would destroy these germs without at the same time injuriously affecting the human system. A few years ago Dr. Robert Koch, a celebrated German scientist, who had long been investigating the consumption, cholera, and other microbes, thought he had discovered a lymph that would destroy or at least counteract the consumption bacillus ; but unfortunately it proved a failure. Creosote, carbolic acid, guaicol and similar drugs kill the germ when outside the body, and for this reason most therapeutists of to-day use these remedies in as large a quantity, and for as long a time as the system will tolerate. At all events, whatever may be the outcome of thecustom at present in vogue, creosote certainly arrests the rapid proliferation of germ-life in the lungs, improves the appetite and digestion, lowers the temper- ature, and apparently helps the patient. The only offset to the use of this class of remedies lies in the fact that one cannot thoroughly disinfect the blood sufficiently to kill these germs completely. Creo- sote made from beechwood, taken in three-drop doses with a wine- glass of milk, after food, three times a day, is the usual form of administration. This dose should gradually be increased till ten and even twenty drops are taken at a time. The carbonate of creosote is a more elegant and perhaps more effective form of the drug. This medicine may also be procured in the form of capsules .and pills. DISEASES OF THE CHEST. 249 By Dr. Cyrus Edison's recently discovered product of carbolic acid, asepsin, it is claimed that seventy per cent of consumptive cases can be cured. It can only be administered as a hypodermic injection, however, at the hands of an experienced practitioner. The Cough. — The best article I have ever used for this is the "Pulmonic Cherry Cordial." I was five years in compounding this article to suit me, and I believe it to be the very best cough prepa- ration ever made. Dose, from one to two teaspoonfuls. Pulmonic Cherry Cordial. — Wild-cherry bark, ground, 10 pounds ipecac root, 20 ounces ; bloodroot, 24 ounces ; squill root, bruised, 12 ounces ; pulverized liquorice root, 5 ounces ; cochineal, bruised, 2 ounces ; anise seed, 32 ounces ; fennel seed, 8 ounces ; orange peel, 16 ounces ; acetate of morphine, 12 drams ; alcohol, 8 gallons ; water, 8 gallons ; pulverized white sugar, 40 pounds ; sulphuric acid, 1 ounce. Directions for making. — Grind all the articles to a coarse powder except those directed to be bruised or pulverized, and put them all to the alcohol except the wild-cherry bark, the water, the sugar, and the sulphuric acid. Let them stand one week, shaking or stirring thoroughly twice a day. Then, having kept the wild-cherry bark two days in a covered vessel, with water enough upon it to wet it through, place it in a percolator, and run eight gallons of water through it. Add this to the alcohol and other ingredients. Let the whole stand three days longer, stirring as before, twice a day. Draw off, and fil- ter through paper. Now add the sugar, and lastly the sulphuric acid. The acid is intended mainly to improve the color, by acting chemi- cally upon the cochineal. The color is a fine cherry red, tinged with orange. I have given the directions for making sixteen gallons — this being the smallest quantity in which I make it. Any person can easily make the calculation for reducing the quantity. The assertion pre- viously made that this is the " best cough preparation ever made," I see no cause to modify in the smallest degree. Were it kept in every apothecary shop, and were physicians to prescribe in pul- monary complaints, adding a little syrup of squills or wine of ipecac when a more expectorant effect is wanted, or a little morphine if greater narcotism is sought, it would save them much trouble in com- pounding cough syrups, and give them much more satisfactory re- sults. I have compared its effect, again and again, with the best other preparations in use, and I pledge my word that it will succeed in twice as many cases as any other compound that may be chosen. Let physicians try it; and I will be responsible for ever hair's breadth in which they find this proportion of successful results abridged. When a more quieting effect is needed, a little morphine may be added to this preparation ; if a more expectorant influence is required, add a few drops of the tincture of veratrum viride. For the great 250 DISEASES OF THE CHEST. majority of cases, it will be found to be right without any addition. When this is not at hand, any of the preparations (108), (112), (109), (113), (110), etc., may be used. Another good preparation is Dr. King's consumption cure. Night Sweats. — The very best preparation for these sweats is a compound of the oxide of zinc, one dram ; extract of conium, half a dram ; to be made into twenty pills, of which one or two are to be taken every night. The sponge bath also does much to check these sweats, and vinegar baths (369). Atropia, T £ 7 of a grain on retiring, and especially Agaricin, i grain, will cause the sweats to stop abso- lutely. Diarrhoea. — This is a most exhausting symptom in the latter stages of consumption. The only remedy which has much effect in controlling it is the tris-nitrate of bismuth. This should be given in doses of thirty grains immediately after, or at the time of each meal. These doses are much larger than used to be given ; but they will do no harm. Given to this extent, I find the bismuth very effectual. Iron. — This preparation, in some of its forms (316), (73), (159), (102), is almost always needed in consumption. If the scrofulous habit be strongly marked, give syrup of iodide of iron, in thirty-drop doses, three times a day. It should be taken in a glass of water. To the feeble administer Gude's pepto-mangan in teaspoonful doses three or four times daily. This is one of the simplest and most effica- cious forms of iron we have. External Irritants. — These are needed where there is much in- flammation and soreness of the chest. Blisters should very seldom be used. Croton oil, from two to half a dozen drops, rubbed over the sore part, generally answers very well. Sometimes the mustard paste, applied to the extent of producing redness, two or three times a week, is sufficient. Nitric acid, reduced with water to a strength a little above the strongest vinegar, answers a good purpose for keeping up an irritation. Atmospheric Inhalation. — It has been said by Laennec and others, that asthma has sometimes the effect of arresting tubercular consump- tion. Dr. Ramadge thought this was effected by an expansion of the vesicular structure of the lungs ; and he reasoned that the same expansion, by mechanical means, would secure a similar end. To ef- fect this, he made his patients take long breaths through a tube con- structed for the purpose. It is manifest that the philosophy of atmospheric inhalation was not understood by Dr. Ramadge, nor has it been by any of his fol- lowers in this country. Rokitansky thinks the tubercular habit depends upon the excess of fibrin in the blood ; and says that the reason of consumption being arrested by pregnancy is, that this condition offers a mechanical ob- DISEASES OF THE CHEST. 251 stacle to the transmission of blood through the lungs, — thus pre- venting its excessive oxidation, and keeping it in a venous state. This destroys the fibrinous condition, on which he thinks tuberculosis depends. Now this is precisely what is done by atmospheric inhalation. The trachea divides, on its entrance into the lungs, into two branches, which again divide and subdivide until the tubes become smaller than can be seen, each terminating in a minute air-cell. Over this entire surface the air is intended to be brought into communication with the blood for the purpose of oxidating it. By forcible inhala- tion, the air-vesicles are inflated to the extent of their capacity, by which means the extreme branches of the pulmonary arteries are so flattened between these extended cells, as to be able to convey but a small amount of blood, and but little is oxidated. This furnishes a mechanical obstruction to the transmission of the blood, and secures the defibrination of which Rokitansky speaks. This is my view of the philosophy of atmospheric inhalation. The benefit results, not from a larger amount of oxidation, as is generally supposed, but from a smaller. Asthma does the same thing by pro- ducing spasmodic contraction of the extreme bronchial tubes, and preventing air from entering the cells. The same end is gained in part by certain kinds of employment, as glass-blowing, playing upon wind instruments, and the like. Writers of distinction mention cases of recovery from incipient consumption by a vigorous use of the lungs in singing. Dentists subject their lungs to a similar process of expansion in the use of the blow-pipe ; the writer has known several instances in that profession, in which recoveries have taken place. The Conclusion to which I come is, that atmospheric inhalation may be used with great advantage in some cases, but should never be resorted to. except under the direction of a competent physician. In a congested state of the lungs, with hsemorrhagic tendencies, or with inflammation and soreness, it is well fitted to produce fatal bleeding and is of course dangerous. External Use of Water. — As a relaxation from severe exertions, the ancients had frequent recourse to bathing. Those who contended in the race, throwing the javelin, and wrestling, at Rome, plunged into the Tiber while warm and panting with their efforts. That this promoted prowess and physical endurance, none can doubt. Louis, the great French authority on pulmonary diseases, lays down several rules to be observed by consumptive patients, and par- ticularly mentions cold bathing. Few things give tone to the capillaries of the skin like cold water, systematically applied. It rallies the powers of the constitution, and improves assimilation. And by it another object is gained of scarcely less importance, — that of guarding the system against taking cold. 252 DISEASES OF THE CHEST. Those in the daily habit of applying cold water to the whole person seldom suffer from colds and catarrhs ; they generally become har- dened so as to endure the assaults of the elements. Consumptive persons should generally use the sponge bath, with cold water, if it can be endured, otherwise the tepid bath, to be fol- lowed, in all cases with brisk rubbing, with a coarse towel. If a sense of chilliness and discomfort follows the bath, a large portion of the water must be squeezed from the sponge, so as to use but very little, and the washing must be speedy, and the rubbing more lively than usual, — beginning with tepid water, and gradually lowering the temperature till it can be borne cold. A large teaspoonful of salera- tus to each quart of water should be used. Diet. The diet, like all other parts of the treatment, must have reference to the present condition of the patient. If the disease take the bron- chial form, and rapid breathing, and other conditions calculated to carry fat out of the system have not yet supervened ; or if the pa- tient have thirst and hectic, the diet must be spare and simple, — consisting chiefly of milk and farinaceous substances. But in all cases where the disease is tubercular, or, being bronchial, has reached the stage of emaciation, the very earliest moment at which the fever can be subdued should be improved to build up the patient with a generous diet. I have seen cases where the stuffing sometimes resorted to for fattening turkeys for Thanksgiving would seem to be almost justifiable. A good rule is to give the most gener- ous diet that can be taken without disturbing the stomach, or increas- ing the feverish symptoms. Animal food with a good quantity of salt should be freely taken. Fat meats, if well received by the stom- ach (and they generally are if taken cold), are particularly useful. The same is true of sweet butter and cream. Out=Door Exercise. — Without exercise, as a general thing, the consumptive patient will die. Exercise involves muscular exertion, which is attended by the tension, compression, and greater compact- ness of the muscles used. This compression of the muscles within the sheaths (fasciae) which enclose them sends out their blood, and pushes it forward towards the surface. Reaching the extremities of the arteries, the blood passes through capillary tubes, almost incon- ceivably fine, into the capillary veins of similar fineness, whence it flows through larger and larger veins back to the heart. At the mo- ment of its passage from the capillary arteries to the capillary veins, it ceases to be red or arterial, and becomes purple or venous blood. The oxygen in the arterial and the carbon in the venous blood unite, forming a literal combustion, just such as we produce in our stoves and grates by bringing together the carbon of the wood and the oxy- gen of the atmosphere. By this combustion our bodies are warmed, DISEASES OF THE CHEST. 253 and the little secreting, exhalant, and other vessels, are raised to a temperature that enables them to work. Every muscular contraction and compression helps push along the venous blood in larger quantities to the right auricle of the heart, which, receiving a fuller supply of its natural stimulus, contracts more energetically, forcing the fluid into the right ventricle. From thence it is expelled with increased energy likewise along its only pathway, the pulmonary artery, into the lungs. Rushing in here in greater volume than natural, a demand is made for deeper inspirations of air to vitalize and tit it for its descent by the pulmonary vein, to the left auricle. Coming here also as the natural stimulus, in larger quantities than usual, it gives increased energy to its own propulsion into the left ventricle, from whence it is driven out through the arte- ries to all parts of the system, by the powerful strokes of that strong muscle. Thus it goes its round, urged on by exercise, parting with its oxy- gen more and more freely in the capillaries, giving more activity to the vessels of the skin and other tissues, increasing the depth and strength of breathing by carrying more venous blood to the lungs ; improving the digestion, carrying a better elaborated pabulum to the nutrient arteries, and causing them to work it up more diligently in renewing the tissues. Nor is this all. Every wrench of a muscle forces some old, worn- out particles from their places, allowing none to remain except such as are firm, and able to bear the brunt of exertion. The flesh of those who exercise much becomes hard and enduring. I say then to the consumptive, if you would live and not die, exer- cise, exercise, exercise. It is the first, second, and third thing. If you ask for the modes of exercise, I say take it on foot, out of doors, every day, to the extent of a small amount of fatigue. Don't be frightened by a single cloud, or even by a cohort of them. You have as good a right to be out as the clouds ; and they will not look more angry, but rather more agreeable from finding you abroad in their company. The elements of nature are at war with organic life. Against them the vital principle has to maintain a perpetual struggle ; and he who loses the power to meet and gain the victory over them by out-door exercise, is beginning to die. Go abroad, therefore, often. Try it again and again. Extend your walk a little every day. Stretch it out to the distant fields. Gather flowers from the top of the hills and from the bosom of the valleys, and bring them home as trophies of your victory. If not able to begin with walking, ride as often as possible in a carriage. The jolting of a vehicle will jog the blood along much better than no exercise. Horseback riding is still better. It combines, in some measure, the passive exercise of carriage riding, with the active exertion of walking on foot. 254 DISEASES OF THE CHEST. Numerous other modes of exercise may be resorted to with advan- tage. Dumb-bells, adapted in size to the strength of the patient, and used with caution, are highly serviceable. The battledoor, the football, bicycle riding, pitching quoits, and the athletic sports of the gymnasium, all have their appropriate place. The greater the variety the better, as by it all parts of the system are brought into play, and both the mind and the muscles get the change winch they need. It is hard to impress patients with the importance of this subject. Say what you will, they somehow or other get the idea that a mod- erate amount of exercise, taken when they feel like it, is all that is required. Fatal mistake ! Whatever the physician may do, the pa- tient has a great deal to do for himself. He must strive to develop his physical powers to the utmost. He must train himself as runners and fighters do when preparing for their surprising feats ; for he is running against the swiftest disease (or the surest winner) of our cli- mate, and fighting with the elements. If he regards life as not worth this exertion, of course he will not make it ; but I beg him to consider that without it recovery will be uncertain, and in many cases, impossible. Do as I have directed, and if your medical attendant is skilful, the current of health will, in many cases, begin to flow back to you. Life will renew to you its policy of insurance, and multiply your days. Travelling: — Consumptive patients have generally been sent to a southern climate. But where the case involves dyspepsia and affec- tions of the liver, low latitudes are generally unfriendly. Liver com- plaints are the bane of a southern climate, and a sallow complexion is the inheritance of a southerner. Tubercular persons, chilled by our northern climate, are sometimes temporarily relieved by the warmer atmosphere of the south. But the relief is only temporary ; for, having lost the pow3r, as they im- agine, to bear the frowns of our northern sky, the}^ are dying, and will die anywhere unless they recover this power. And the way to retrieve a lost advantage over an enemy, is, not to retreat to a point where recovery will be harder, but to meet him at once. If the con- stitution cannot bear up against an enemy under the bracing of a northern atmosphere, it will be still harder to do so under the wilting of a southern. After all, the objects aimed at should be change and travelling. The exercise involved, the constant exertion required in getting from place to place, the agreeable sensations produced by the motion of cars and steamboats, the ever varying change of sights and sounds, and the constantly increasing stock of one's ideas of men and things, — these are what rally the constitution, and open anew the springs of life. Especially should all journeys for health be taken, if possible, with an object in view. Let the consumptive start with the view of see- ing the cave of Kentucky, the prairies of the West, the great lakes DISEASES OF THE CHEST. 255 of the North, the falls of Niagara, the fortress of Quebec, the Sague- nay river, the doctor, who he has reason to think will cure him, — anything which he is willing to make exertion to see, and that he is sure his eyes will rejoice in beholding. I have thus spoken of consumption more at large than of other complaints, because it is the great disease of the world, and is in- creasing with the advancement of civilization. Acute Bronchitis. This is an acute inflammation of the mucous membrane lining the air-tubes in the lungs. , It is generally quite a serious disease. Physical 5igns. — The sound upon percussion is generally good. If there be any dullness, it is commonly in the lower and back part of the chest. This occurs only in " Capillary Bronchitis." The breathing murmurs are sometimes more, sometimes less in- tense than natural. Occasionally they are almost extinct. In the early stage, sibilous and loud rattles. In the more advanced stage, mucous rattle. Now and then sub-crepitant rattle accompanies the inward-drawn breath. General Symptoms. — The disease begins with chills followed by fever ; tightness across the chest, difficulty of breathing, hoarseness, loss of strength, costive bowels, and a quick and hard pulse. Water runs from the eyes and nostrils, and there is a dry, harsh, croupy cough. After a few days, mucus begins to be raised. This expectoration gradually becomes more copious, and is opaque, yellowish, or green- ish, and occasionally streaked with blood. This mucus is very ropy and adheres to the vessel. There is more or less pain in the chest ; pain across the forehead, which is increased by coughing; and a pale and anxious countenance. In severe cases, the tightness across the chest is extreme, with a sense of suffocation, causing the patient to call for the opening of the windows. There is great difficulty of breathing ; a paleness and lividity of the cheeks and lips ; a loud wheezing and rattling in the throat, followed by cold sweat, insensibility and death. In children the disease comes on like a common cold, attended by a sore throat, a great desire to drink, but a disinclination to take food. But two or three swallows of drink can, be taken at a time for want of breath. The phlegm is frequently vomited up spon- taneously. Observations. — The loud and sibilous rattles are produced by similar causes, namely, the passage of air along tubes whose interior is dry and rough from inflammation, or whose calibre is contracted or altered in form by the swelling of the membrane, effusion upon its 256 DISEASES OF THE CHEST. inner surface of a tough, mucous substance, or a pressure upon its external surface of tubercles, swollen glands, aneurismal tumors, etc. The two sounds differ mainly in the key upon 'which they are pitched, — the sonorous, or low-keyed, coming from the larger tubes; the sibilous, or high-keyed, from the smaller, — just as the low notes of an organ come from the large pipes, and the high notes from the small ones. The sibilous rattle has been compared to the chirping of birds, the squeaking of puppies, the whistling of air passing through a key- hole, etc.; the sonorous, to the snoring of a sleeping person, the cooing of doves, and the sound of the bass-string of the violoncello rubbed with the ringer. Causes. — It is generally brought on by a sudden cold, by changes of the weather, and by inhaling irritating substances. It is a second- ary result, too, of scarlet fever, measles, small-pox, hooping cough, and the remittent fever of infants. Treatment, — In mild cases, give warm balm or flax-seed tea, hot lemonade, or other similar drinks, — at the same time soaking the feet in hot water, and, on retiring to bed, apply bottles of hot water to the feet and sides, to produce sweating. If the bowels be costive, some gentle physic, as rhubarb and magnesia, or salts and senna, may be taken. In the case of infants, an emetic of wine of ipecac, or compound tincture of lobelia, should be given, and followed with slippery elm and flax-seed tea. The compound tincture of lobelia, with tincture of veratrum viride, may be continued for a time as an expectorant. In more severe cases, both of adults and children, an active emetic is required, — perhaps the compound powder of lobelia is as good as any. This must be followed with tincture of veratrum viride, in full doses, so as to reduce the pulse at once, and keep it down to the natural standard. This is one of the very best articles in this com- plaint, and will generally very much lessen its violence and duration. If there is much difficulty of breathing, the air of the room must be kept moist, as recommended in croup. The room should also be kept warm, — decidedly warmer than in the case of other fevers. A gentle perspiration should be kept up by small doses of com- pound tincture of Virginia snake-root, and by frequently bathing the surface, or else by tincture of veratrum. Mustard should be applied to the chest, and to the soles of the feet. The cough may be managed by preparations (104), (106), (110), freely given. The diet should be confined to barley-water, toast-water, apple- water, rice-water, and a solution of gum-arabic, DISEASES OF THE CHEST. 257 Chronic Bronchitis. This is an inflammation of the mucous membrane of the air-tubes, which continues a great length of time, without any sudden or re- markable changes. Physical Signs. — The percussion-sounds are similar to those of acute bronchitis. When a bronchial tube is dilated, we sometimes have dullness around the dilated part. The breathing murmur is always accompanied by a mucous, sono- rous, or sibilant rattle, — sometimes by a subcrepitant. When dilatation of the tubes exists, the intensity and duration of the sound of the ingoing breath is decreased, — of the outgoing increased. In this state of the tubes, we also have cavernous breathing, bron- chophony, sometimes pectoriloquy, and bronchial or cavernous cough. General Symptoms. — A cough is generally present, which is in- creased in wet weather, and by every slight cold. This comes on in paroxysms ; is generally worse in the morning ; and is relieved by raising freely. The matter raised is generally yellowish, but some- times whitish and sticky; and in the latter stages is thick, and sometimes very much like that of consumption. Indeed, the disease often ends in bronchial consumption. • Remarks. — The breathing is bronchial or cavernous when the dilated portion of the tube is empty ; if it contain fluid, the mucous rattle will be heard. Dullness on percussion will exist if a dilated tube press upon the surrounding portion of lung so as to condense or make it solid. Dilatation of the tubes occurs only in chronic bronchitis of long standing. Its physical signs are much like those of a cavity in ad- vanced consumption. The examiner may learn to distinguish them by considering that in consumption, dullness precedes the cavity, while in bronchial dilatations, the cavity precedes dullness. The dilatation or swelling out at some point of a bronchial tube is caused by obstructions to the passage of air through it, — just as an India-rubber tube, partially closed up at a given point, will bulge out just in front of the obstructed place, when air is forcibly blown through it, and just as the left ventricle of the heart enlarges when the blood is obstructed in its passage through the aortic valve. Causes. — It often occurs as the result of acute bronchitis, and also of measles, hooping-cough, etc. But taking cold, and damp and changeable weather, are more frequently its causes. It most often follows chronic inflammations of the throat, which, being neglected, gradually creep down the windpipe into the tubes, and become very obstinate in their character. 258 DISEASES OF THE CHEST. Treatment. — Medicinal inhalation is one of the best remedies for this complaint. The inhaling powder has, in many cases, great efficiency. The dose is about what can lie on a ten-cent piece. It should be used once a day, in an instrument represented in the cut. This instrument I had constructed for my use. It consists mainly of a glass tube and a receiver, — the latter being something like a tube-vial, pierced with fine holes around the lower end. The pow- FlG 94 der is poured into the receiver, which is placed in the larger tube, and twirled between the thumb and finger while inhaling. When the powder cannot be easily got down into the tubes in the lungs, — as often happens, — the inhalation of medicated vapor will do better. If the expectoration be difficult, the expectorant inhalant, described under " consumption," should be used; if the expectoration be too profuse and free, the astringent inhalant must be taken. The cough preparations recommended for consumption, also (113), (112), will be the proper ones in this complaint. The daily alkaline bath, and brisk friction, are particularly service- able. Out-door exercise is almost as necessary in this disease as in con- sumption. Enlargement of the Air=Cells, — Emphysema. This disease consists in enlargement of the air-cells, the oblitera- tion of their vessels, and the wasting of their walls. Physical Signs. — Thumping upon the chest gives a clearer and louder sound than natural, — one which is tympanitic, or drum-head like. The murmur of the ingoing breath is diminished both in duration and intensity, — of the outgoing breath, it is increased. Dry, crepitant rattle attends the ingoing breath only; occasionally, sibilous rattle. General Symptoms. — Habitual shortness of breath, and very great difficulty of breathing, occurring in paroxysms, which cause the patient to rush to the open window for air. There is generally a cough, and the matter raised is frothy, liquid, and mucous, or watery. The face has a peculiar dusky color, and the countenance an anx- ious, melancholy expression. The nostrils are thick, and the lower lip full. The muscles of the neck are large, and the gait of the pa- tient is stooping. The strength is wasted in proportion to the diffi- culty of breathing. Emphysema tends to produce disease of the heart, Blight's disease, and venous congestions in the head. DISEASES OF THE CHEST. 259 Observations. — The tympanitic sound is caused by the increased amount of air in the cells. The air-cells have lost their elasticity, the air, in a great degree, remains in tliem, — not passing in and out, — hence the absence of the vesicular murmur. The crepitant rattle attends the ingoing breath only, and is sup- posed to arise from the expansion of the lungs which are in a drier state than natural. It has been compared to the sound producd by blowing into a dried bladder. Treatment. — To whatever extent the air-cells are destroyed, to that extent, of course, the disease is incurable. It may, however, be palliated and relieved to a great extent. Generally, bronchitis exists in connection with emphysema ; and when this is found to be the case, the remedies for that disease must be employed. (370) often is curative. The inhalation of tincture of stramonium, in one or two teaspoon- ful doses, the same as the alterative inhalant is used, will be useful. To be taken internally, an excellent preparation may be made by uniting one dram of etheral tincture of lobelia with two drams of tincture of ipecac, and two ounces of ammoniac mixture. The dose is one or two tablespoonfuls. Half-grain to grain doses of extract of cannabis indica are excellent to relieve the difficulty of breathing. The diet must be very carefully regulated, as overindulgence at the table aggravates the symptoms. Change of air is often highly beneficial ; but it is impossible to predict its effect beforehand in each individual case. Swelling of the Lungs. — Hypertrophy of the Lungs. This can hardty be regarded as a disease. It generally takes place in but one lung, and is the result of the inaction of the other. Thus, when one lung is diseased, the other has to do the work of both ; and being overworked, it enlarges, as the heart or an arm does when very much exercised. The only treatment required is to eat sparingly, and exercise with great moderation, so as not to increase the rapidity of the breathing. Pulmonary Apoplexy. This is generally the result of a disease of the heart, particularly of the mitral valve. Physical Signs. — Percussion yields a clear sound, except where the engorgement of blood is large, and near the surface, — in which case, it is dull. The sound of breathing is feeble or absent over a limited space. 260 DISEASES OF THE CHEST. Bronchial breathing is heard in some places, and bronchophony in part, in the same regions. Mucous rattle is also heard. Observations. — In this disease the small air-tubes and air-cells are the seat of bleeding ; and the blood becoming coagulated here, closes these vessels against the entrance of air. This explains the feeble- ness or absence of the breathing murmur. The fluidity of blood in the immediate vicinity gives rise to the mucous rattle. General Symptoms. — These are, difficulty of breathing, tightness,, and dull pain in the chest. The mucus raised is tinged or streaked with blood. The blood raised is darkish, and dirty-looking. This last symptom, the dirty look of the blood, is peculiar in this disease. Treatment. — The most important remedy is dry-cupping upon the chest. This will often arrest the disease at once. Counter-irritation by croton-oil is also useful. A free movement of the bowels by a preparation containing croton-oil, or elaterium (31), (33), has an ex- cellent effect. Air in the Chest. — Pneumothorax. This disease consists in the presence of air in the cavity of the pleura. Generally, there is also water in the pleural sac at the same time ; the water, being the heavier fluid, occupying the lower part of the cavity, and the air the upper part. Physical Signs. — Tympanitic or drum-like sound over the upper part of the side. Dull sound over the lower part. Breathing mur- mur diminished or suppressed. Amphoric breathing. Metallic tink- ling. General Symptoms. — Great oppression of the chest, and difficulty of breathing ; generally attended by palpitation of the heart, and fre- quently by severe pain under the breast-bone, on the affected side. The patient generally has to remain in the sitting posture, and can- not lie an instant on the sound side. If, on percussion, one side of the chest sounds louder than the other and the breathing murmur is heard distinctly on the side which gives only a moderate sound, and is not heard at all on the loud- sounding side, we may be sure it is a case of air in the chest. Observations. — The metallic tinkling is like the sound produced by dropping a pin's head into a metallic dish, or like the distant tink- ling of a sheep-bell, or the gentle pulling of the string of a violin. It is supposed that when the fluid in the cavity of the pleura hap- pens to be higher than the orifice, the air, when it enters at each in-drawn breath, forces its way up through the fluid, in the shape of DISEASES OF THE CHEST. 261 bubbles, and, bursting at the surface, gives the tinkling sound. This sound is sometimes produced, too, by the falling of drops of liquid from the upper part of the cavity, upon the surface of the fluid. The amphoric breathing is like the sound produced by blowing obliquely into an empty cask. One writer says he heard the same sound when out shooting on a rough day, produced by the wind blow- ing sideways into the gun-barrel. Treatment. — I would recommend the use, two or three times a day, of the antiseptic inhalant, mentioned under the head of con- sumption. To this should be added dry-cupping over the whole chest, which generally gives great relief. Blisters may also be used. Sweating must be encouraged in the manner recommended under acute bronchitis. For the difficulty of breathing, give half-grain doses of cannabis indica, or five-drop doses of tincture of aconite, or one-sixth of a grain doses of svapnia. Extract of belladonna, or of stramonium, is also worthy of trial. Water in the Chest. — Hydrothorax. This disease consists in a collection of water in the cavity of the pleura. Physical Signs. — There is a dull sound over the effusion. The breathing murmur is diminished, and gradually disappears altogether over the space occupied by the effusion. Bronchial breathing is heard in the same part. When the amount of fluid is small, egophony is heard in the mid- dle regions of the chest. Bronchophony is heard when the effusion is larger. General Symptoms. — Either upon lying down, or using active bodily exercise, the patient finds his difficulty of breathing increased. When in bed, he lies with his head and shoulders raised, which, by causing the fluid to settle at the bottom of the cavity, prevents, in a measure, its pressure upon the lungs, and gives him a little rest. His sleep is interrupted by sudden starts with alarm and terror. The pulse is hard, the thirst great, the urine scanty and high-colored, and has a sediment. After a time the feet swell, the face is pallid and livid, and the countenance expresses anxiety and alarm. There is a short, dry cough. When the quantity of fluid in the chest becomes large, the patient cannot lie down at all, and only gets short and disturbed naps in the sitting posture. Of all the symptoms, the starting in sleep is the most certain sign of the disease. 262 DISEASES OF THE CHEST. Causes. — In some rare cases, this may occur as a primary disease, — that is, as a disease not dependent upon any other as its cause. The greater number of cases, however, are secondary. They arise from organic disease of the heart, or liver, or stomach. Inflammation of the pleura is a very frequent cause. A plethoric, or full state of the system, predisposes to this com- plaint, — particularly in those persons who indulge freely at the table. It may arise, too, from the striking in of skin eruptions ; from the free use of liquors ; and from frequent excessive bleedings or purg- ings. Treatment. — Dry-cupping is a valuable remedy, and should al- ways be practised. The chest should be painted with the tincture of iodine, and a good degree of substantial soreness be kept up. The internal remedies are purges (31), (14), (30), and diuretics (123), (129), (130), (131) when the patient is not very weak. The iodide of potassium, in doses of five or six grains, once in three or four hours, is an excellent remedy. The following is a good form of taking it : iodide of potassium, one ounce ; fluid extract of pipsissewa, two ounces ; water, half a pint. Dose, one teaspoonful. The skin should be bathed and rubbed daily, three or four times, with much friction. Tapping the chest should be done when the fluid persists any length of time, otherwise a simple hydrothorax may become a doubly serious empyema or pus in the chest. Pleurisy. — Pleuritis. Pleurisy, or pleurisy fever, as it is sometimes called, is an in- flammation of the pleura, or the membrane which lines the chest, and, at the same time, is folded back so as to cover the outer surface of the lungs. The pleura, as is elsewhere explained, is a short sac or bag, whose inner sides are kept moist, so that they may slide easily upon each other as they are moved by the alternate contractions and expansions of the lungs in the act of breathing, and whose outer sides are made to grow, — one to the inside of the chest, and the other to the out- side of the lungs. Pleurisy and lung-fever, then, must be kindred diseases, and exist, more or less, together. In truth there is almost always some affec- tion of the pleura in lung-fever, and some affection of the lungs in pleurisy. The pain in lung-fever is owing to some inflammation of the pleura ; and the appearance of the rusty-colored phlegm in pleu- risy indicates that the lungs have been reached by the inflammation of the membrane which covers them. Physical Signs. — Flatness on percussion, at the lower part of the chest, which ascends as the effusion of water increases. DISEASES OF THE CHEST. ZbS If the effused fluid is not great, there is puerile breathing- at the top of the lung. Friction sound is heard occasionally in first stage of disease. Egophony is heard when the amount of fluid in the pleura is small. As the amount of water increases, bronchophony appears. General Symptoms. — This disease is most frequently introduced by shiverings, which are soon succeeded by high fever, with a pecu- liarly hard, resisting pulse; sharp, stabbing pain in the side, — gener- ally just below the nipple, but sometimes extending to the shoulder, arm-pit, and back ; hurried and interrupted breathing ; and a short, dry cough. The pain is greatly aggravated by motion, coughing, or an attempt to take a long breath. It holds the patient under constant and powerful restraint. We find him lying upon his back, or his well side ; his countenance full of anxiety, — fearing to move, cough, or even breathe needlessly ; and often crying out from the keen torture these necessary acts inflict in spite of all his caution. At a more advanced stage, when the tenderness has somewhat abated, he will prefer to lie on the diseased side, as this leaves the healthy lung more at liberty. Observations. — The first effect of the inflammation of the pleura is to dry up the moisture with.which its inner surfaces are lubricated, or made smooth and slippery. As a consequence, these surfaces be- come rough, and rub harshly upon each other, and produce a sound, in the early stages of pleurisy, like that of rubbing two pieces of wet leather together. It may be imitated by rubbing the finger back and forth upon a table. It is sometimes a creaking noise, like that of new shoes. As the disease advances an important change takes place in the state of things. Instead of an unnatural dryness, a watery fluid is poured out copiously from the inflamed surfaces of the pleural sac. This is called the period of effusion. This generally, though not al- ways, relieves the pain. But, by compressing the lung, causes dan- gerous difficulty of breathing. The air-cells are compressed by the effused fluid, and are not penetrated by air. Hence the absence of the breathing murmur. The pouring out of water between the layers of the pleura, com- presses the lung, and removes it from the walls of the chest. Hence the dullness or deadness of sound upon percussion. When listening with the stethoscope, the voice of the patient sounds feeble and interrupted, like the bleating of a goat, and is hence termed, egophony, or goat-voice. This peculiar voice is heard only when the effusion of water has been moderate in quantity, and only a thin layer of liquid lies be- tween the ribs and lung. It is caused by the voice passing over this 264 DISEASES OF THE CHEST. thin layer, which is thereby thrown into vibrations, or wavy, quivering motions. When thus agitated, the fluid reacts upon the voice, making it sharp and tremulous. When the effusion has become large, these effects cease ; but an- other sign then shows itself, and distinguishes pleuris}^ from the healthy state, and likewise from the solid, hepatized state of the lung in lung-fever. It may be discovered thus : If the hand be laid flat upon the chest of a healthy person, while he is speaking, a vibration or thrill will be left. If, in like manner, the hand be laid upon the chest of a person having lung-fever, with hepatized lung, this thrill will be found still more perceptible. But when the hand is placed over the place of watery effusion on the chest of a person having pleurisy, there will be discovered, when the person speaks, no thrill whatever. The absence of this thrill, then, is one of the very best signs of pleurisy ivith effusion. Persons recover from pleurisy sometimes very rapidly, before effu- sion has taken place. It is then said they have had an attack of dry pleurisy. When liquid has been poured out, even in considerable quantity, it is sometimes reabsorbed, and the patient recovers per- fectly. In other instances, it compresses the lungs, interferes seri- ously with breathing, reduces his strength, and he sinks rapidly. Treatment. — Pleurisy has been divided for description and treat- ment into three stages, following the natural events of the inflamma- tion. The first stage comprises the period from the first onset to the time when effusion commences. The second stage, or stage of effu- sion, extends to the time when the liquid begins to diminish ; and the third stage consists of the period occupied by the absorption of the liquid. Should the quantity remain stationary or diminish very slowly after the lapse of two or three weeks, the disease becomes chronic. The indication for treatment during the first stage is to arrest the progress of the disease, to diminish its intensity, to limit the amount of morbid products, and to relieve suffering. If the patient is robust, has a hard, frequent pulse, accompanied with extreme pain and fever, blood-letting is indicated. The abstrac- tion of ten to fifteen ounces of blood will give great relief and diminish the intensity of the attack ; but if the patient is not seen early, and is of a feeble constitution, some other measures should be substituted for it. The mass of blood may be lessened by saline cathartics, such as the sulphate of magnesia, or the bitartrate of potash in combination with jalap. The effect of a full dose of Epsom salts is equal to the abstraction of a pint of blood from the system. Depletion is obtained this way without the impoverishment of the blood. The frequency and force of the heart's action may also be affected by the nauseant sedatives, such as tartarized antimony and ipecacu- anha, and by the direct sedatives, such as the tincture of aconite and DISEASES OF THE CHEST. 265 of veratrum viride ; therefore, if blood-letting is contra-indicated, the first thing to be done is to give the sulphate of magnesia, and follow it with some diaphoretic like (130), to alleviate the painful stitch in the side and to tranquillize the system. It is well to administer salicylate of soda in 10-grain doses every three hours till a little ringing is heard in the ears, then once in four hours. This drug increases the action of the skin and kidneys and overcomes the rheumatic element present in most if not all pleurisies. The diet should be dry, all liquids being excluded, that the abstrac- tion of water from the chest may be favored. Nothing gives so much and such immediate relief to pain as a subcutaneous injection of morphine. Aconite also is a valuable sedative in this stage. It may be given in half or whole-drop doses every fifteen minutes for two hours ; then afterwards a drop, to be repeated hourly till some impression is made upon the heart's action. Smaller doses are to be given if the pulse becomes feeble. In the second stage, if the acute symptoms have yielded to treat- ment, as they usually do, the object of treatment is to promote the absorption of the fluid. This is done by the judicious use of saline cathartics and by diuretics, for the bowels and the kidneys are the natural pumps of the system. The application of counter-irritants is also of use for this purpose, such as the tincture of iodine, and small blisters, which are to be allowed to remain on till vesication, and then the blister is to be dried up and a new one applied. If at any time during this stage the effusion is rapid and excessive, so as to endanger life, it is to be drawn off by puncturing the chest between the fifth and sixth ribs on the side with a small trocar, and the fluid is to be drawn off by suction. Convalescence commences when the liquid begins to be absorbed ; and active medication should then cease, and that course should be pursued which will lead to the restoration of the general health. This is done by tonics, a nutritious diet, and other hygienic means. If the effusion ceases to be absorbed or the process takes place very slowly, then that state of things exists which is called chronic pleu- risy. Then the main objects of treatment are to effect the removal of the fluid, and to develop and sustain the powers of the system. Under these circumstances, it is better to discontinue remedies which act upon the bowels and kidneys, at least for a time, and try general treatment. This consists of tonics, stimulants, and general exercise in the open air, and with this the surgical removal of the fluids from the cavity of the chest. The operation is now so much improved, and is so safe and simple and attended with so little pain, that it has become an every-day practice, and an operation which was only resorted to as an extreme measure to save life, is now admissible whenever the pleural cavity remains filled with liquid, after only a brief trial of the remedies assigned to promote absorption. 266 DISEASES OF THE CHEST. Lung Fever. — Pneumonia. This disease, by common usage, has been called a fever ; but by physicians it is reckoned as one of the inflammations. It is inflamma- tion of the lungs or lights ; and whatever fever there may be results entirely from this local inflammation. Signs and Symptoms. — A patient suffering with lung fever is generally found lying upon his back, with some pain in the side ; more or less difficulty of breathing ; a cough, at first dry, but soon accompanied by raising a thick, sticky, rusty-colored matter, composed of a mixture of phlegm and blood. As the disease increases in severit}', this matter will become more sticky and tenacious, so that it will adhere to a spit-cup turned upside down. There will be more difficulty of breathing, greater prostration, and perhaps some delirium. For the purpose of more clearly describing this complaint, it is found convenient to divide it into three stages, or degrees of progress. First Stage. — This is called the stage of engorgement. The lungs during this stage are engorged or crowded with blood. If we could inspect them, we should find the inflamed portion redder, thicker, and heavier than usual. We should find them weaker, that is, more easily torn than in the natural state ; with less air in them, and con- sequently crackling less upon pressure, — yet not entirely destitute of air and crackling, and not so heavy as to sink in water. Rapping upon the chest at this period gives out a flatter, duller, or less hollow sound than usual. On applying the stethoscope, we hear less of the natural rustling sound of health ; and, either mingling with, or over- coming it, we hear a minute crackling sound, as the air passes in and out in breathing. This crackling has been compared to that produced by fine salt thrown upon red-hot coals ; or by that of rubbing a lock of fine hair between the thumb and finger near the ear. It is caused by small bubbles of air being forced along the moist and sticky sides of the small tubes and air-cells. It is heard only while the breath is being drawn in. Second Stage. — If the inflammation advances to the second stage, the swelling of the diseased lung increases so as to force out the air entirely, and it becomes solid, and wholly useless for the purpose of breathing. In solidity and general appearance, it resembles a piece of liver. Hence it is said to be hepatized, or liverized ; and this is called the stage of hepatization. As the lung grows more solid, its vitality and strength diminish ; it is not near as strong as a piece of healthy liver, though it looks like it ; it is soft and easily broken ; indeed it seems to be in a state of commencing decay or rottenness. Hence some writers, in order to be more precisely correct, call this the stage of red softening. DISEASES OF THE CHEST. 267 With increased solidity, there is of course increased dullness on percussion. When the stethoscope is applied to the chest, we hear no sound of air passing into and out of the diseased lung ; no natural rustling, or minute crackling ; but in their stead, we have a kind of whistling, produced by the air passing back and forth in the wind- pipe and its branches, but finding no entrance into the solidified air- cells. The breathing sometimes sounds like a sort of puff, — owing to the column of air rebounding when refused admission to the closed-up cells. The general symptoms now increase in severity. There is greater difficulty of breathing; the phlegm is more gluey; perhaps some delirium shows itself ; and the patient grows weaker. Third Stage. — At this period, the lung changes from red hepa- tization or red softening to gray hepatization or gray softening, and matter is now found diffused through its whole substance. The percussion sounds are much the same as in the second stage. On listening, we hear more of the rattling sound produced by disturbed phlegm. The matter raised is thinner, — more like liquid ; and looks like prune-juice. The symptoms generally indicate that the patient is sinking. Patients may recover from the first and second stages, but rarely from the third. Treatment. — Pneumonitis has been divided into three stages, corresponding to the inflammatory events of the disease: the first stage is that of active congestion, the second, that of solidification, and the third, that of resolution. The duration of the first stage is from twenty-four to forty-eight hours, of the second from two to four days, and the stage of resolution lasts from eight to ten days. Different cases vary, however, in these times. These different stages furnish different remedial indications. The objects of treatment in the first stage are to arrest the disease, to lessen its intensity, to relieve pain, and to promote toleration of the disease. When high fever, a hard pulse, and extreme pain are present in a robust constitution, the abstraction of blood from the arm is indi- cated. These cases are not frequent, for lung fever mostly occurs in patients with feeble constitutions, but when practised in the proper cases, the relief to pain and embarrassment of breathing is often immediate and marked. In those cases where blood-letting is contra-indicated, the same end can be secured, but more slowly, by saline cathartics and sedative remedies. After saline purgation, if the skin is hot and the pulse is frequent, tartar emetic may be given in small doses as a nauseant sedative ; but it must not be carried to the extent of distressing nausea. After this follows the use of vas- cular sedatives, such as the tincture of aconite and the tincture of veratrum viride, if not contra-indicated by the feebleness of the patient with a tendency to depression. 268 DISEASES OF THE CHEST. Sometimes the sulphate of quinine, in a full dose of from twenty to twenty-five grains at the onset, or within eight or ten hours, will arrest the disease. It may be well to try it, as it can be administered with perfect safety. Opium is of great importance also, to relieve pain and tranquillize the system. Cold or warm applications to the chest may be used according to the preferences of the patient. Warm applications act as revulsents ; the cold diminishes the determination of blood to the part, and re- lieves the pain by obtunding sensibility. Counter-irritants are not advisable in that stage. The treatment of the second stage aims at the promotion of reso- lution of the inflammation, the palliation of the symptoms, and the maintenance of the powers of life. The tinctures of veratrum viride and aconite may be continued in this stage, if there is considerable fever and there is no tendency to asthenia ; but the leading measure is to support the system. The rational use of veratrum viride, than which there is no better drug in Pneumonia, consists in giving five-drop doses hourly till the pulse reaches sixty per minute, then just often enough to keep the pulse in that neighborhood. This course embraces the use of tonics, stimulants, and nutritious diet. The use of alcohols is necessary in most cases, and sometimes very freely. The diet should consist of milk, farinaceous substances, and animal broths. Quinine in tonic doses is the best remedy in this stage. The preparations of opium are very useful, and only contra-indi- cated by the accumulation of mucus in the bronchial tubes. Digitalis is useful in five to ten grain doses three or four times a day, when it is necessary to increase the heart's action. The carbonate of ammonia is necessary in cases of extreme pros- tration. The external application of the tincture of iodine is the best counter-irritant in this stage. During the third stage, all those hygienic measures which improve the general health are to be pursued. Typhoid Lung Fever. — Typhoid Pneumonia. This is an inflammation of the lungs, differing from the preceding only in the character of the fever attending it, which is of a low, typhoid character. The disease, like typhoid fever, is characterized by great debility and prostration. Symptoms. — These are a combination of the symptoms of pneu- monia and of typhoid fever. The disease begins with great weari- ness, lassitude, dizziness, pain in the head, back, and limbs. Soon there is much difficulty of breathing, tightness across the chest, with a dry, short, hacking cough. DISEASES OF THE CHEST. 269 As the disease advances, the active symptoms pass away ; there is a dull pain across the chest ; drowsiness is very apt to come on, with the various symptoms of sinking peculiar to typhoid fever. The skin is harsh and dry, the temperature uneven, the tip and edge of the tongue red, and the middle covered with a yellow or brown fur. The bowels are tender, swollen, and drum-head like ; while there is often a diarrhoea, — the discharges having a dirty-yellow color. Treatment. — This should be like the treatment of pneumonia and typhoid fever united. Great care must be taken not to use reducing remedies. While active purging must not be used, yet, if there are symptoms of an inactive state of the bowels, podophyllin and leptandrin (34), (39), may be employed with advantage. When there are symptoms of great depression, use tonics (46), (48), (50), (53), (60), (64), (67), (73), taking care to keep the cough loose by flaxseed, slippery elm, and marshmallow tea, and by some external irritant. Broncho-Pneumonia. This is an infectious inflammation, characterized by an exudation from the blood-vessels, the formation of new connective tissue, and the growth of bacteria. The disease involves the walls of the bronchi and the air-spaces surrounding the inflamed tubes. It is frequently called capillary bronchitis and catarrhal pneumonia. It is the ordi- nary pneumonia of children, and is frequently seen in young people. It comes on primarily, but is often secondary to measles, whooping- cough, etc. Symptoms. — In the very young, the only symptoms are fever, prostration, and rapid breathing. There is no cough, no physical signs, but the disease is, almost always, fatal within a few days' time. There is a great difference in the invasion of the disease in dif- ferent cases, the severer cases being ushered in by one or more con- vulsions, by rapid rise of temperature, vomiting, difficulty in breathing, and delirium; the milder cases beginning with lower temperature, moderate prostration and shortness of breath. The height of the temperature is, as a rule, in proportion to the severity of the disease. Temperatures of 105° and over are usually fatal. The pulse reaches 150 to 170 in adults, and even higher in children, — so high, in fact, that it cannot be taken. The respiration varies from 40 to 80. Sleeplessness, restlessness, and even delirium are frequently present. The face is flushed, the tongue coated, and oftentimes diarrhoea and vomiting occur. Cough is usually present, and in the young the sputum is swallowed. The urine is frequently albuminous and contains casts. Between the second and fifth days the signs of consolidation and 270 DISEASES OF THE CHEST. ■r pleurisy appear, i. e., dullness on percussion, bronchial breathing and bronchophony with crepitant rattles. The duration of the disease in children varies : of the fatal cases the majority die within the first fortnight. The cases which recover vary from one to three weeks, though many persist for six and eight weeks. The softening and absorption which occurs in all pneumo- nias that recover occupy a much longer period in broncho-pneumo- nia than in lobar pneumonia. Many cases of broncho-pneumonia are complicated by cerebral symptoms of convulsions, delirium, stupor, vomiting, etc., even before any marked lesions in the lungs appear; as these subside the lung symptoms appear. Many cases are protracted for a long time, and though they may terminate favorably at last, yet they are apt to run into a chronic hardening of the lung which lasts for years ; or they recover with a permanent consolidation of the lung. Some die of exhaustion. Treatment. — The use of hot fomentations and poultices over the chest and the administration of small doses of ipecac and aconite at short intervals soothe the bronchitis and pain. For the cerebral symptoms, phenacetin and the bromides are very useful. Aconite and digitalis are usually employed when the pneu- monia stage comes on. As a rule stimulants are not required in children, in whom the disease most frequently occurs. In convalesence, iron, quinine, cod-liver oil, oxygen and a change of air are to be recommended. Other Forms of Lung Inflammation. Of the various other forms of lung inflammation which occur, mention may be made of pneumonia dependent on Heart Disease ; Interstitial Pneumonia, or the formation of new connective tissue and obliteration of the air-spaces ; Tubercular Pneumonia, which is caused by the presence of tubercle bacilli; Acute and Chronic Mi- liary Tuberculosis, characterized by the presence of numerous minute nodules called miliary tubercles ; Acute and Chronic Tubercular Consumption.; Gangrene of the Lung, where a portion of the lung has lost its vitality and the germs of putrefaction have entered. Asthma. Asthma may be defined to be great difficulty of drawing in the breath, — coming on suddenly, sometimes gradually, — accompanied with a sense of extreme suffocation, and a desire for fresh air ; con- tinuing for a longer or shorter period, and then passing away, and leaving the patient a period of comparatively easy respiration. Symptoms. — There are sometimes no premonitory symptoms, the attack coming on suddenly, and without warnings but more fre- DISEASES OF THE CHEST. 271 quently there are, for some days before the onset, loss of appetite, flatulence, belching of wind, irritability, languor, chilliness, oppres- sion, and drowsiness. The hard breathing generally makes its appearance in the night, — quite often at three or four o'clock in the morning, when the nervous system is at its lowest ebb. There is first a sense of tightness, or stricture, across the chest, which seems to expand with difficulty. The patient can no longer remain lying down ; he rises up, draws up his knees, and, leaning forward, puts his elbows upon them, and his head upon his hands, and then struggles hard to draw in his breath ; which, passing in slowly and laboriously, produces a loud wheezing sound. Sometimes he feels that he must have fresh air, and, rushing to a window, puts his head far out, to catch a stirring breeze. The hands and feet are cold, the face haggard and distressed, — sometimes a little red and swollen, but more generally pale and shrunk, — the body wet with perspira- tion, the pulse irregular, feeble, and small, though sometimes not disturbed. These symptoms continue for some hours, more or less, when the breathing becomes more easy, and there is a little phlegm raised, sometimes considerable. This cessation of difficult breathing may be complete, or only partial ; and lasts for a longer or shorter period, when the attack again recurs. Causes. — It is well known that Asthma has its cause mainly in the nervous system. The air-tubes are encircled with a series of little bundles of fibres, which are, in fact, muscles, and like all other muscles have the power of contracting or shortening themselves. These muscles, too, like all others, have nerves distributed to them ; and when these nerves become diseased or irritable, they will become disturbed on certain occasions, and cause these small, circu- lar puckering strings to contract and close up. the air-tubes near their terminations, very much as the puckeririg-string closes the mouth of the work-bag, so that very little air can pass into the air- cells, and that little with great difficulty and slowness. When these contractions take place, and the air is thus shut off, the result is a fit of asthma. This disease may be brought on by any of those states of the atmosphere which disturb or irritate the bronchial surfaces, or by any of the numerous causes which mysteriously unbalance the nervous system. A fit may be brought on by whatever disturbs the mind. Treatment. — The disease has been regarded as extremely diffi- cult of cure. There are certain remedies, however, which have a remarkable control over it, and, if skilfully used, will frequently bring it to a complete termination, and, even in the worst cases, to a state of very great mitigation and improvement. Inhalation. — The most important and certain remedy is the use of the Alterative Inhalant, described on page 243. I have with this article alone effected some surprising cures ; yet it is well to combine 272 DISEASES OF THE CHEST. other treatment with it. I have had several cases of a most distress- ing character, — the attacks continuing night and day, — in which the inhalation, judiciously administered, has caused the disappearance of the complaint within twenty-four hours, and in which no return of suffering has occurred for several weeks, and then only in a modified form. This remedy should be used four or five times a day. Iodide of potassium is a most valuable internal remedy in this complaint; indeed, in a certain sense, it is almost a specific. It should be used (prescriptions 101, 138, 140, 151) at the same time with the inhalation. The following preparation is a very good remedy for this disease : Ethereal tincture of lobelia, two ounces ; tincture of asafcetida, one ounce ; grindelia, one ounce ; iodide of potassium, two ounces ; simple syrup, four ounces. Mix. Dose, from a teaspoonful to a tablespoonful, every hour or two. Several other remedies are used for asthma, with more or less success, such as electro-magnetism, smoking stramonium leaves, burning paper dipped in a strong solution of nitrate of potash, and inhaling the smoke, etc., — but none of these, have as much value as the two remedies first named. In as grave a complaint as a severe case of asthma, it is always well to seek the aid of a physician. Hay- Asthma. — Hay = Fever. This is a very troublesome complaint, which seems to combine the peculiarities both of asthma and of influenza. Fortunately, it attacks but few persons, and those only at particular seasons of the year, — namely, while hay is in blossom, and during hay-making. Symptoms. — These are a combination of the symptoms of the two diseases above named. There is great irritation of the eyes, with sneezing, and a free discharge from the nose. There is tightness across the chest, difficulty of breathing, and a pricking sensation in the throat. These symptoms often appear in great severity, making the complaint a really distressing one. Cause. — This disorder appears to have but one cause, — namely, some sort of emanations from the grasses, flowers, etc., while in blossom ; which emanations come in contact with the mucous lining of the eyes, nose, and throat, producing very great and teasing irri- tation. Treatment. — One of the best remedies for this troublesome com- plaint is to avoid the cause, by removing, during the flowering and haying season, to some large city, or, still better, close down to the seashore, where flowers and hay do not grow. Of medicines, the tincture of lobelia, taken in moderate doses, is a very good remedy. Quinine and iron, given in combination (75), are valuable preparations. Strychnine and nux vomica, in connec- DISEASES OF THE CHEST. 273 tion with iron or otherwise (316), (83), (84), (85), (86), (95), are very useful. Iodide of potassium (101), (138), (140), is also worth a trial. Another very good remedy is the chloride of lime, or the chloride of soda, placed in saucers about the sleeping-room. Pieces of cotton cloth may also be dipped in one of these solutions, and hung about the apartments of the house. The hands and face may likewise be washed, once or twice a day, in a weak solution. The oxide of zinc and the extract of nux vomica, made into pills, two grains of the zinc to half a grain of the extract to each pill, and one pill taken morning and evening, should not be forgotten. Of late cocaine, painted by means of a camel's hair brush on the mucous membrane of the nose, has been used to check a paroxyism and mitigate the disease. The following formula is the most efficacious of this class of remedies and should be painted onto the nasal mucous membrane as high uj) as possible ; its use may be repeated several times till the membrane becomes numb. Cocaine 12 gr. Antif ebrin 25 gr. Alcohol 1 dr. Simple Elixir '. 3 dr. Mix and shake before using. HEAET DISEASES. Life rests upon a tripod, — the brain, the lungs, and the heart. These are equally important to its well-being and continuance. In substance, the human heart is a bundle of muscles, so put to- gether as to bear the greatest possible amount of work. In size, shape, and look, it is much like the heart of the hog. I wish it never had a likeness to it in its moral nature. The heart is enclosed in a case or sac, called the pericardium. It lies between the two lungs, a little to the left side of the chest. Its point is under the sixth rib on the left side, and its lower surface rests on the diaphragm, — a horizontal partition between the chest and belly. The heart is double. It has four cavities, — two for receiving the blood, which are called auricles, and two for driving it out, called ventricles. The venous, or dark blood, is brought from all parts below, and emptied into the right auricle through the ascending vena cava, and from all parts from above, and pour into the same cavity through the descending vena cava. From this it passes into the right ventri- cle, which contracts, and forces it through the pulmonary artery into the lungs, where it becomes red, and passes into the left auricle through the pulmonary vein, thence into the left ventricle, which contracts, and throws it out through the great aorta to all parts of the body. Fig. 95 gives a good idea of the circulation through the heart and lungs. The heart is divided into two sides, which are separated from each other by a muscular partition, — each side having an auricle and a ventricle. The auricles have comparatively thin walls, as they are only used for reservoirs. The walls of the ventricles are much thicker, being used, — particularly that of the left side, — for forcing the blood over a large surface. Between the auricle and ventricle on the right side, are three folds of triangular membrane, called the tricuspid valves. Between the auricle and ventricle on the left side, are three valves, called mitral. At the beginning of the pulmonary artery, and the aorta, are three half-moon shaped folds of membrane, called semilunar valves. 274 HEART DISEASES. 275 The office of all these valves is, to close after the blood has gone through, and prevent its flowing back while the cavity is being again filled. They do the same duty, in fact, as the valves of a pump. Through this heart, thus constructed, all the blood in the body, — about twenty-eight pounds, — passes once in about one minute and a half. This is rapid work; and when we consider that the heart works in this way through the whole life, resting not, day or night, we cannot wonder that it gets out of order. Fig. 95" The whole heart is seldom affectefl. to disease than the right. The left side is more liable Impulse of the Heart. The ear, when placed over the heart, feels, at each beat, a slight shock. This is felt at the same time the first sound is heard. This impulse is caused by the apex or point of the heart being thrown up against the ribs by the contraction of the ventricles. It is felt best between the cartilages of the fifth and sixth ribs on the left side. The Sounds of the Heart. On applying the ear to the chest just over the heart, two sounds are heard. The first one is dull and slightly prolonged ; the second is a shorter and smarter sound, having a sort of clack. These occur in pretty rapid succession, and then comes a brief interval. And this round of action, first a long and dull sound, then a short and smart one, and then an interval, — called the heart's rhythm, — is repeated continually. If the space of time occupied by the rhythm be divided 276 HEART DISEASES. into five parts, the first sound will take about two parts, the second one, and the interval of repose, the remaining two, The first sound is heard about the time of the contraction of the ventricles, and is therefore called the systolic sound ; the second is synchronous with the opening of the ventricles, and is called the diastolic sound. The syllables too-to — too-to, very fairly represent the two sounds of the heart. These sounds are heard over the largest space in lean persons. Percussion Sounds. If the ends of the fingers be struck upon the chest over the heart, a dull sound will be heard over a space from one and a half to two inches square, — beginning at the fourth rib on the left side, and ex- tending down nearly to the sixth. The dullness is diminished by lying upon the back, and increased by leaning forward, and by taking a full breath. The deadness of sound is caused by the heart being a partially solid body. The lungs which surround it yield a clear sound. If a solid substance, as large as the heart, were placed on the in- side of a drum, against the head, only a dead sound would be ob- tained by striking on that spot ; everywhere else, the sound would be louder. Altered Sounds of the Heart. These sounds are changed by disease in a variety of ways, both as to their character and duration. One or both sounds may be turned into a noise like the blowing of a pair of bellows. This is called the bellows sound. When this sound is very harsh, it may become like the noise of a rasp, or file, or saw. These altered sounds are all pro- duced by an altered condition of the valvular passages through which the blood passes. If you build an aqueduct of equal dimen- sions throughout, and smooth on the inside, you may send a certain volume of water through, at a given speed, without noise. But if you make sudden contractions in the aqueduct, or allow large stones to project into it, and then attempt to send through the same bod}^ of water, at the same rate of speed, you will hear all sorts of noises. Enlargement or Hypertrophy of the Ventricles. This is simply a thickening, or an increase of bulk, in the walls of the ventricles. The muscles composing the walls of one or both of these cavities grow thick and large. Physical Signs. — Impulse stronger than natural. When consid- erable, it is accompanied with a lifting and heaving of the parts. Dull sound on percussion over a larger space. First sound of heart prolonged; second sound feeble. The interval of silence, shorter than natural. In bad cases, the second sound is nearly extinguished. HEART DISEASES. 277 General Symptoms. — Hypertrophy of left ventricle gives a strong, prolonged, and tense pulse. Palpitation more constant than in any other disease of the heart. In advanced stages, the patient is easily ont of breath. There is a rush of blood to the head on making exer- tion or stooping, with more or less throbbing and lancinating head- aches, which are aggravated by suddenly lying down or rising up. There are vertigo, ringing in the ears, sparks of light and other illu- sions before the eyes ; also a purplish, violet or livid color upon the cheeks, nose, and lips. In many cases there is a dull, severe aching pain in the region of the heart, and extending towards the shoulder and the inside of the arm. When the right ventricle is enlarged, there is a swelling of the ex- ternal jugular veins. Causes. — The walls of the heart are thickened by overwork, in the same way that the blacksmith's arm is made muscular and large. All muscles grow in the same way. More action sends more blood to them, and this causes an increase of nutrition. Whatever interposes an obstacle to the passage of the blood through the valvular openings, will cause the ventricles which force it through to work harder. Hence, obstructions in the semilunar valves cause hypertrophy of the ventricles. Any excitement of the mind, or any great exertion, which causes the heart to beat harder and faster, if it be often repeated, will induce a thickening of the ventricles. Treatment. — First, remove, as far as possible, all causes of excite- ment which produce palpitation. If the head is much affected, apply wet cups to the back of the neck. The same may be applied over the heart. This will generally improve the symptoms at once. A blister placed over the heart will likewise make a favorable impres- sion. The meals should be taken at regular intervals, and should be very light. The food should be plain and simple, and composed much more of vegetable than of animal food. In fact, the diet should be so spare as slightly to reduce the strength. The patient should be careful never to take violent exercise, or, indeed to be in a hurry about anything. In bad cases, walking up hill, or against a strong wind, is often out of the question, and must in any case be attempted with great caution. Staircases are to be shunned as enemies. An attempt to run, even to avoid being left by the cars, might, in some cases, prove immediately fatal. Carriage- riding is not objectionable. The passions must be held in the most thorough subjection. Ex- citements of all sorts are dangerous, and must be avoided. For the first week or two of treatment, active purgatives will be useful. For this purpose, epsom salts and senna will answer a good purpose, and should be used so as to procure two or three watery stools a day. 278 HEART DISEASES. Iii addition to this, some sedative to lessen the force of the heart's action is generally needed, especially when there is considerable palpitation. For this purpose, tincture of black cohosh, and tincture of scullcap, or the former with tincture of digitalis (285), (94), are quite useful. Three to ten drops of tincture of the American helle- bore (veratrum viride) will reduce the action of the heart perhaps more effectually than any other medicine, for a few days or weeks. Dilatation of the Ventricles. The several cavities of the heart hold about one and a half ounces each. Dilatation is simply an enlargement of these cavities, so that they will hold more. And this increase in the size of the cavity in simple dilatation is generally at the cost of the walls, which are made thinner and weaker, — just as the walls of a bladder are made thinner by blowing into it and increasing its internal dimensions. Physical Signs. — Impulse more abrupt, and less marked than nat- ural. Dull sound on percussion commensurate in extent with the dilatation. The first beat of the heart, clearer, louder, and shorter than natural, and more nearly resembling the second. General Symptoms. — Difficulty of breathing; terrific dreams; starting from sleep ; swelling of the feet and legs ; purple, violet, or blue color of the cheeks, nose, lips, and especially around the eyes ; feeble and oppressed palpitation ; various disturbances in the head ; bleeding from the nose, stomach, bowels, and womb ; and frequently enlargement of the liver. Explanations. — The first sound of the heart is short and not well marked, in consequence of the muscular walls of the ventricles in this disease being thin and in a weakened condition, so that every stroke they make is short, quick, and spasmodic, instead of strong and lifting, as in hypertrophy. For the same reason, the impulse is a brief blow dealt the walls of the chest, which gives a slight shock, but has not power enough to lift the chest up. The blow is quick, because the muscle is thin and can contract quicker than a thick one. Dilatation, by thinning the walls of the cavities, enfeebles the heart, and shows us an obstructed circulation. Accordingly the blood is not transmitted by the left ventricle, and being retained in the lungs, it causes a crowded state of the vessels, and difficulty of breathing ; also congestion of the brain, with terrific dreams, etc. And this en- gorgement of the lungs, being propagated backwards to the right heart, great veins, and all their ramifications, produces dropsy of the feet and legs, discoloration of the face, passive hemorrhages, and con- gestion of the brain, liver and membranes. Fig. 95 gives an idea of how all this happens. Treatment. — As in many other diseases, search out the causes, and remove them. If it be obstruction of the circulation in the lungs by HEART DISEASES. 279 bronchitis or other complaint, that needs the first attention. If it be caused by violent exercise, by strong emotions of the mind habitually indulged, or by drunkenness, or any other irregularity of life, these habits must be corrected without delay. If it be caused by organic disease of the valves of the heart, relief cannot be so readily obtained ; but even in these cases, it is to be sought and expected. The circulation is to be kept as tranquil as possible by a strictly quiet and orderly life, and a plain, moderate, unstimulating diet. In this disease, however, it should be more nutritious, and composed to a larger extent of meats, than in hypertrophy. In some cases the general health and tone of the system will need to be improved by bitters (50), (67), (64), (69), (79), mineral acids (60), iron (269), (61), and aromatics (115). The compound mix- ture of iron is a good preparation when this mineral is called for by a low state of the blood. The stomach should be kept in the best possible condition, as a very small disturbance of it, even from acidity, will set the heart to beating very violently. If hysterical symptoms are present, the compound galbanum pill, and valerian (97), and other nervines will be called for. In attacks of great difficulty in breathing, immerse all the extremi- ties in warm water, and throw a blanket around the patient to pro- mote sweating, — at the same time admitting fresh air to satisfy the desire for breath. Give a draught, composed of ether, camphor, ammonia, etc. (135). This may be repeated two or three times, at intervals of half an hour, or an hour, according to the urgency of the case. Hypertrophy with Slight Dilatation. This is one of the most common complications of heart disease. It consists both in a thickening of the walls of the heart, and an en- largement of the cavities, — the former being more marked than the latter. Physical Signs. — Both sounds are louder than in any other dis- ease of the heart, and are heard sometimes over the whole chest. The impulse is strong and heaving, with an abrupt back-stroke. In bad cases, the whole person, and even the bed, is shaken by it. The dull sound on percussion covers a large space. General Symptoms. — The same as those of the two diseases of which it is composed, slightly modified by the action of each upon the other. Dilatation with Slight Hypertrophy. This is an enlargement of the cavities of the heart, with a slight thickening of its walls ; the dilatation being the predominant disease, or greater than hypertrophy. 280 HEART DISEASES. Physical Signs. — Percussion gives a dull sound in the region of the heart, in proportion to its size. The first beat resembles the sec- ond. The second beat is louder than natural. The impulse is a short, quick stroke, which contrasts strongly with the slower and heavier one of hypertrophy and dilatation. The general symptoms and the treatment are a modification of those of the two disease united in it. It is, however, to be kept in mind that the dilatation takes the lead ; and, furnishing the predomi- nant symptoms, is specially to be regarded in the treatment. Aneurismal Tumors of the Heart. When, from some obstruction in the valves, the blood cannot easily pass out of an auricle or a ventricle, its inner walls may become unable to bear the distending force, and giving way, let the blood through against the outer coats, which stretch, and swell out into the shape of a tumor, — the inside of the tumor becoming a regular sac. Such a state of things constitutes an aneurism of the heart. Of course it is a very grave disease. Softening of the Heart. In this disease the substance of the heart becomes soft, and easily broken. It is generally the result of some form of inflammation. Physical Signs. — The contractions of the heart being weakened by softening, the impulse is reduced in force, and both beats are weaker, and often they are intermittent. The first beat becomes short and flapping, like the second. General Symptoms. — A quick, feeble, small, and faltering pulse, great anxiety, and a disposition to faint. General languor ; a sallow, bloodless, withered complexion, with a purple, livid tint of the lips and cheeks, and frequently, general dropsy, from the inability of the heart to propel its contents. Treatment. — When accompanied by acute inflammation, softening is to be treated on the same principles as inflammation of the heart- case. If it be a result of chronic inflammation, it calls for iron, bitters, nutritious animal food, and good air. Induration of the Heart. The muscular substance of the heart sometimes undergoes a hard- ening process. It is occasionally so much hardened as to sound, when struck, like a hollow horn vessel. The disease is rare. It increases the heart's impulse, like hypertrophy ; and it requires about the same treatment as that disease. HEART DISEASES. 281 Fatty Degeneration of the Heart, The heart sometimes becomes overloaded with fat, which is depos- ited between the heart-case and the muscular substance, — covering the organ all over externally, and in some cases penetrating to some depth into its substance. The muscular walls themselves become thin and flabby. Symptoms. — The sounds of the heart are diminished, — especially the first. The pulse is irregular. Pain, and a feeling of oppression in the region of the heart, with general signs of retarded circulation, such as congestion of the brain and liver. There is occasionally gid- diness, loss of memory, and palpitation. Treatment. — Exercise, mental excitement, and stimulating drinks must be avoided ; and the patient must live for one or two years on a very light diet, taking but very little animal food. Bony and Cartilaginous Productions in the Heart. These productions in the heart are fortunately rare. Yet they occur; and the point of the heart, in its whole thickness, is some- times changed to cartilage. The ventricles are sometimes so ossified as to resemble the bones of the head. The symptoms of these degenerations are . obscure ; and as such cases are not curable, it is of less consequence that we should be able to know their precise nature during the life of the patient. The treatment can only afford temporary relief, and should be such as is prescribed in other heart-diseases with similar symptoms. Shrinking of the Heart. — Atrophy. The heart, like any other muscle, is liable to defective nutrition, and in consequence of it may become small. It shrinks, in some cases, to the size of an infant's heart. The complaint is generally caused by whatever reduces the general flesh, as consumption, diabetes, chronic dysentery, cancer, and exces- sive loss of blood. It can hardly be called a disease. Persons who have it are less subject to inflammatory diseases than others, though they faint from slight causes, and have nervous affections. Treatment. — If its causes can be discovered, trea't them; if not the treatment should be the same as for dilatation. Acute Inflammation of the Heart=Case. — Pericarditis. The pericardium, or heart-case, is a membranous sac, in which the heart is contained. It is composed of two layers. The outside 282 HEART DISEASES. one is fibrous, dense and white ; the inside one is serous. The serous layer forms the lining of the fibrous one, and then is reflected over the heart and the roots of the large blood-vessels. When the pericardium becomes acutely inflamed, it throws out both lymph and serum or water. The lymph often causes the two layers of the sac to grow together. Physical Signs. — The impulse is strong when the effusion of water is small, — feeble and unequal when it is large. Percussion yields a dull sound in proportion to the amount of fluid in the sac. When listening with the stethoscope, a rough noise is heard, resem- bling either the rasping of wood, the grating of a nutmeg, the rustling of silk, or the crackling of parchment. Sometimes it is softer, like the blowing of a pair of bellows. Occasionally it resembles the creaking of a new shoe-sole, or has a low creaking, like the tearing of linen cloth. When there is effusion, the ordinary beats of the heart sound dull and distant. General Symptoms. — Acute inflammatory fever, generally pre- ceded by chills, with pungent pain in the region of the heart, shooting to the left shoulder-blade, shoulder, and upper arm. Pain increased by taking a full breath, by stretching the left side, by percussion, and by pressure between the ribs over the heart. Sometimes the pain is in the epigastrium, or left hypochondrium. Inability to lie on the left side. Explanation. — The noises mentioned above are produced by the rubbing together of opposite surfaces of the heart-case, made rough by the exudation of lymph. The rasping is supposed to be caused by firm and rugged lymph ; the rustling and creaking, by soft and wet lymph; the bellows murmur, by soft and dry lymph; the creaking, croaking, and crackling, by dry, tough lymph. These sounds may all be imitated by rubbing a damp finger upon the back of the hand, while listening with the stethoscope applied to the palm. Chronic Inflammation of the Heart -Case. When acute pericarditis runs for more than ten days or a fortnight, it becomes chronic. It is chronic from the beginning, when it runs a slow, insidious course, without marked or violent symptoms. The symptoms are much the same in kind with those of the acute form, only less in degree. This low grade of the symptoms of the disease renders it more obscure than the acute. Treatment. — In the acute form of the disease, apply wet cups over the region of the heart, or apply from a dozen to forty leeches to the same parts. At the same time, move the bowels freely by an injection (247), or by a purgative pill (31). HEART DISEASES. 283 The strength and amount of the remedies employed in each case must be in proportion to the vigor of the patient's constitution. It is of great importance that the treatment should be active and prompt, and that the disease should be broken down early. Diluent, cooling drinks (132), (129), (298), (299), should be al- lowed as freely as the patient desires, in order to dilute the blood, and render it less stimulating to the heart. At the same time, five to fifteen-drop doses of tincture of veratrum viride should be given every hour, to bring down the action of the heart. Ten-drop doses of tincture of digitalis every four hours are good. Let the diet be wholly of barley-water, thin gruel, weak tea, or arrow-root. During recovery, the diet must be spare, and the greatest tranquil- lity of mind and body be preserved. In the treatment of chronic cases, when the cavity appears to con- tain fluid, counter-irritation is suitable. Blisters, croton-oil, the com- pound tar-plaster, and especially the tincture of iodine. The diet may be a little more nutritious than in the acute form of the disease, — embracing light animal food and broths. Inflammation of the Heart. — Carditis. This is an inflammation of the muscular substance of the heart. When existing alone, it is a very rare disease. Being mixed up with other forms of heart disease, it does not require any separate account of its symptoms or treatment. Acute Inflammation of the Lining of the Heart. Endocarditis. The heart is one of the citadels of life. Disease attacks it on all sides. In this complaint, it has entered the fort and taken possession. The inflammation is on the lining membrane. Physical Signs. — The impulse is violent, abrupt and regular, as long as the circulation through the heart is free, but when this is im- peded, it is at first a confused tumult (which generally happens when a fort is first taken), and gradually sinks to a feeble flutter. The dull sound upon percussion covers a space of from three to seven square inches. The beats of the heart are generally accompanied or marked by a bellows murmur, the loudness of which depends on the strength of the heart's action. General Symptoms. — Inflammatory fever. The action of the heart being generally violent and abrupt, the pulse corresponds with it, and is strong, full and hard. 284 HEART DISEASES. Explanation. — The bellows sound is supposed to depend on the inflamed and swollen condition of the valves. The dullness on percussion will be slight when the circulation through the heart is free; — more distinct and marked when it is obstructed. Dr. Hope says the disease may be anticipated, if a person be sud- denly attacked with these three signs : namely, fever, violent action of the heart, and a murmur which did not exist before. This disease, like inflammation of the heart-case, is often produced by, and is intimately connected with, acute rheumatism, and is then to be treated on same principles as rheumatic disorders. Chronic Inflammation of the Heart's Lining. Physical Signs. — The impulse more perceptible and diffused than natural. The dull sound upon percussion covers a space of from four to eight square inches. There is a sawing, rasping, or riling sound. This sound may cover one or both beats of the heart. Sometimes these unnatural sounds are double ; in which case, the first is caused by an obstruction to the natural flow of the blood forward ; the second, by the regurgitation or retrograde flow of the blood from some defect in the valve, — just as a pump-valve may get out of order, and allow the water which has gone through to flow back. Explanation. — A variety of organic changes occur in the valves, which give rise to the murmurs. Inflammation of the lining mem- brane of the heart reaches the valves, causing puckering, thickening, vegetative, cartilaginous, bony and fat-like degenerations, which ob- struct the blood in its onward flow, or prevent a closure of the valves, and allow it to flow back ; the former causing the first sound, the latter the second. If the unnatural noise be synchronous with the first beat of the heart, it implies disease in either set of the semilunar valves, or an impossibility of closing the auriculo-ventricular open- ings ; if it accompany the second beat, it signifies that either set of the semilunar valves may be open. A murmur attending the first beat of the heart must be caused by a current of blood from a ventricle ; one attending a second sound, by a like necessity, is produced by a current into a ventricle. Treatment. — The same as that for pericarditis. Tt should be equally prompt and vigorous. It must not be forgotten that this dis- ease leads to various organic diseases of the valves of a very grave character, and that such mischiefs can only be escaped by cutting the disease short in the very beginning. HEART DISEASES. 285 Disease of the Semilunar Valves. The inflammation of the lining of the heart makes sad work with the valves. The semilunars are subject to various changes in their structure. Physical Signs. — Obstructive Murmur. — In disease of the semi- lunars, the first beat of the heart is accompanied or obscured either by the bellows murmur, or a sawing, rasping, or filing sound. The unnatural murmur, whatever it is, appears superficial or near. The second beat is natural. When the opening into the aorta is contracted, or in any way ob- structed by unhealthy growths, so that the blood is subjected to more than a natural degree of friction in passing, this sound will be heard. It is called obstructive, because it arises from the obstruction of the blood in its forward course. Regurgitant Murmurs. — First beat of heart natural. Second beat accompanied or replaced by bellows murmur. There is some- times a musical murmur. Explanation. — The regurgitant murmurs arise from the valves being too small, or defective in some way, and allowing the blood to flow back through the orifice. This murmur is loudest opposite the semilunar valves, and is more audible above these valves than below them. When the aortic valves are contracted or shortened, and the open- ings are not guarded by them, so as to prevent the backward passage of the blood, there is a double bellows murmur, — one when it is driven through the orifice, and another when it flows back. Disease of the Mitral Valves. Physical Signs. — Obstructive Murmur. — First beat of heart natural. Second beat accompanied or replaced by bellows murmur. Regurgitant Murmurs. — The first beat of the heart accompanied by a loud and rough bellows murmur. This sound is like sawing or filing. It is loudest above or below the nipple, between the fourth and seventh ribs. There is occasionally a musical murmur. The second beat of the heart is natural. Sometimes there is a purring tremor. General Symptoms of Valvular Disease. — Cough, in many cases with watery expectoration ; difficulty of breathing ; frightful dreams and starting from sleep ; congestion of the lungs ; expectoration stained with dark and grumous blood ; swelling of the jugular veins ; a livid look of the face ; a feeling as if a cord were tied tight around the lower part of the chest ; general dropsy, of the legs and feet in 286 HEART DISEASES. particular ; passive hemorrhages from the mucous membranes ; en- gorgement of the liver and spleen ; congestion of the brain, with feel- ings of oppression. When the mitral valve is contracted, admitting regurgitation, the pulse is small, weak, irregular and intermittent. These are the worst symptoms of an advanced stage. Explanations. — The examiner will distinguish the various sounds thus: The murmurs generated at the origin of the arteries spread their sonorous currents upwards along these arteries. Those produced in the auricular orifices will be conducted into the auricles, and propagated downwards towards the apex of the heart. Which Set of Valves. — To learn in which set of valves it origi- nates, therefore, find its seat, and trace its direction. Finding the murmur to be in the aortic orifice, it is then known to be obstructive, if the first sound is morbid, and the second sound natu- ral ; and regurgitant, if the first sound is natural, and the second sound morbid. But if the murmur be in the mitral orifice, it is obstructive when the first beat of the heart is natural, and the second beat morbid ; and re- gurgitant when the first beat is morbid and the second beat natural. The Pitch or Key of a murmur depends on the distance of its seat from the ear of the listener, — nearness giving a high, and distance a low hey. Thus, a murmur seated in the orifice of the pulmonary artery, being nearer the surface, has a higher pitch than any other. It is on about the same key with a whispered s, — sometimes a little lower, and depending somewhat on the strength of the current of blood, a strong current elevating, and a weak current depressing the tone. The mitral orifice is situated opposite the junction of the cartilage of the third rib with the left side of the breast-bone. The aortic orifice is about half an inch to the right of this, and the same dis- tance lower. It is known by the key being lower, — about like a whispered r, which is the ordinary type of the sawing sound. Murmurs from pulmonic and aortic regurgitations are about two tones lower, in consequence of the currents of the blood being weaker. They are like whispering aive by inspiration and if the click of the valve be heard, the sound will be changed to paiv. Murmurs in the mitral valve, being more deeply seated, are about four tones lower, and are like a whispered who. The tricuspid murmurs are higher than the mitral, because nearer the surface. The musical murmur has been compared to whistling, the cooing of a dove, and the mewing of a kitten. It generally results from re- gurgitation. The purring tremor is caused, generally, by regurgitation through the mitral valve. HEART DISEASES. 287 Other Symptoms Explained. — The difficulty of breathing, fright- ful dreams, congestion of the lungs, hemorrhages, engorgements, etc., mentioned above, all proceed from such valvular stiffenings, pucker- ings, ossifications, enlargements, and contractions, as occasion a decid- edly obstructed circulation. The small, weak, irregular, and interrupted pulse, is caused by con- traction of the mitral valve, which occasions an insufficient or irregu- lar supply of blood to the ventricle, and causes the ventricle, by losing the resistance of the valve, to expend its force in a backward as well a forward direction, thus sending but little blood into the arteries. Treatment. — The tendency of valvular disease is to produce hyper- trophy and dilatation. The strong and ceaseless efforts of the ven- tricle to drive the blood through ah orifice obstructed by valvular disease, will of course make the walls grow thick, which is hypertro- phy ; and at the same time, the accumulation of blood which cannot be driven forward fast enough, must tend to swell and enlarge the cavity, — which is dilatation. The great object of treatment, therefore, is to diminish the force and activity of the circulation, — to induce the heart to cease striving to do what cannot be done. To accomplish this, give sedatives (285), (94), (124). The helle- bore and cohosh will be found particularly serviceable. The tincture of the American hellebore is about the best of all. Purgatives may be given according to the strength of the patient. When there is dropsy, and a scanty secretion of high-colored urine, diuretics, or medicines to increase the action of the kidneys, are very important. For this purpose, digitalis and acetate of potash (130) are excellent. Should this not succeed in reducing the dropsy, an active purgative (31) may accompany it. Diaphoretics, or medicines which promote perspiration, are also useful. This opening of the skin, however, is generally brought about by the hellebore, etc. (124), (358). The diet should be unstimulating, and yet should be sufficiently nourishing to prevent the patient from running too low. Animal food of the most digestible kind may be taken once a day ; though there are many cases requiring its entire rejection. The passions should be kept in the most perfect subjection, and the life should be as tranquil is possible. Nothing must be done in a hurry. Water in the Heart=Case. — Hydropericardium. This disease is common as an attendant of general dropsy. Physical Signs. — The impulse is undulatory, as if transmitted through a fluid, and it is not always of the same strength. The dullness extends upward in a conical form, in proportion to 288 HEART DISEASES. the amount of fluid, — sometimes rising as high as the second rib. The impulse does not coincide with the first beat of the heart. General Symptoms. — The patient has a sensation of the heart being in a floating state. The pulse is small, frequent, and intermit- tent. Explanation. — The reason that the impulse does not occur at the same time with the first beat of the heart is, that the apex does not i7nmediately strike the walls of the chest, — some time being re- quired to push it up through the fluid. The beats of the heart sound more distant than natural in conse- quence of the organ being pushed away from the walls of the chest by the fluid. Palpitation. — Nervous Palpitation. — Anaemic Palpitation. There is a great deal of palpitation of the heart dependent on dyspepsia, hypochondria, hysterics, mental agitation, excessive study with deficient sleep, venereal excesses, and masturbation. Palpitations likewise occur from what is called anosmia, or a low and deficient state of the blood. Physical Signs. — The impulse is weak, fluttering, or tumultuous, — generally increased by trifles. The beats of the heart are increased in frequency, and sometimes marked by intermission. Now and then they are accompanied by a bellows murmur. There are musical murmurs in the jugular veins, — loudest a little above the collar-bones. General Symptoms. — The complexion is generally pallid and bloodless ; the lips and the inside of the mouth partaking of the same paleness ; the pulse quick, small, weak, and jerking ; and during palpitation it sometimes has a thrill. Slight causes produce breath- lessness and faintness. A dislike of animal food, and a fondness for acids. The monthly discharge in females is deficient, and the whites take its place. Sometimes the menses are too profuse, lasting for several days, and consisting only of blood. In this state of things there is great feebleness both of mind and body, with rushing noises in the ears. Explanations. — The murmurs depend on a lack of blood. The conditions of their existence are, thinness of blood, a swift and spas- modic circulation, and particularly an unfilled condition of the blood- vessels. A brook is the more babbling in proportion as its water is more shallow. It is a law in physics, that heaviness of freight gives steadiness of motion ; and lightness of freight gives unsteady motion. The fireman's hose trembles and vibrates when only half full of water. In like manner the blood-vessels are agitated when imper- fectly filled. HEAKT DISEASES. 289 Treatment: — This is to be governed altogether by the cause of the trouble. If it be dyspepsia, hypochondria, hysterics, etc., these several diseases require their usual treatment ; when they are cured, the palpitation will stop. But when it is caused by a low state of the blood, then give for several weeks, iron, the compound mixture, and (316), (310). The food must likewise be nourishing, — tender meat, beef and mutton, with broths, etc. Gentle exercise will be required, and much exposure to a bracing out-door air. Neuralgia of the Heart. — Angina Pectoris. This is a strictly nervous disease. It begins with a sensation of pain and constriction in the region of the heart. This pain is accom- panied with more or less pain and numbness in the left arm. In females it is not uncommon for it to be attended by great sensitive- ness and pain of the breasts. When the attack is violent, the pain in the heart is excruciating, and even terrific. There is attending this a feeling of great oppression in the chest, amounting, in the worst cases, to a seiise of suffocation. The heart palpitates violently, the brain is oppressed, and fainting sometimes occurs. The disease is brought on, in nervous subjects, by over-excitement of the heart. Walking up hill, against a strong wind, may bring it on. If walking at the time of the attack, the patient is compelled to stop, and stand still till the pain subsides. The disease is often connected with organic changes in the heart's structure, such as ossifications and other alterations. Treatment. — When the complaint depends on organic disease of the heart, the treatment must be directed to the cure of these diseases. To relieve a severe attack, the patient should be instantly placed in a quiet position ; wind in the stomach, if present, should be ex- pelled by peppermint or anise water, or ether, or (115), or some other aromatic. If there is acidity or sourness of the stomach, it must be corrected by a teaspoonful of soda in half a tumbler of water ; and if the stomach be full of undigested food, let the patient take a table- spoonful of ground mustard, stirred up with a teacupful of warm water. This will cause almost instant vomiting. These things being done, give some quieting or antispasmodic medicines, or one of the following prescriptions : (285), (97), (135), (124). Inhale 5 drops of nitrite of amyl on a cloth frequently. Great relief is often obtained by sending a current of magnetism through the region of the heart, by applying one pole of the machine in front, and the other upon the back. During the intervals, the general health is to be improved b}^ a wholesome, nourishing diet, gentle out-door exercise, and a careful 290 HEART DISEASES. control of all the passions. T ± ^ of a grain of nitro-glycerine every hour, while in pain, steadies and slows the heart. Polypus of the Heart. A portion of the fibrin sometimes separates from the blood in the heart and large vessels, and becoming more or less organized, forms polypuses, which fill the cavities to which they are attached, and seriously obstruct the circulation. Physical Signs. — When the pulsations of the heart, previously regular, become suddenly anomalous, confused, and obscure, so that they cannot be analyzed, we may suspect a polypus. General Symptoms. — A sudden and great aggravation of the bad breathing, without any visible cause, — the patient being in agony from a sense of impending suffocation, and tossing about from side to side, struggling for breath. The pulse small, weak, irregular, in- termittent, and unequal ; the surface and extremities cold ; the face, livid, — to which there is generally added nausea and vomiting. Treatment. — When the polypus is once formed, the case is hope- less. The treatment, therefore, can only be preventive. The chief things to be done are, to keep the patient in a state of entire tranquillity, and to bring the circulation to the surface, by keep- ing the skin warm, and excited by friction. This will call the blood away from the heart and great vessels, and lessen the chances of the polypus. Displacements of the Heart. The heart may be misplaced from birth. I have seen a case in which it lay upon the right side, and had always been in that posi- tion. Its action was natural. A variety of causes may tend to push it out of its place, as water in the cavity of the pleura. In such cases, it will return to its place when the water is drawn off or absorbed. P1.7 THE INTERNAL ORGANS OF THE HUMAN BODY. DISEASES OF THE ABDOMINAL CAVITY. Under the above head I shall consider most of the diseases which occur in the great cavity below the diaphragm, called the abdomen or belly. These affections are quite important, and make up a con- siderable part of the ills we suffer from disease. Before speaking of these diseases, however, I will call the reader's attention to a profile view of the relative position of the several or- gans lodged in this cavity. In Fig. 96, L is the liver, S the stomach, C the colon, R the rectum B the bladder, P D the pancreas, and I the intestines. The double lines, folded back upon each other, and surrounding most of the or- gans, represent the peritoneum, a membrane winch lines the great cavity of which I am speaking. It will be well, too, before pro- ceeding further, to make the reader acquainted with the names of cer- tain regions of the abdomen which he will find constantly spoken of in medical books. I have not used these terms much in my book ; but it will be convenient to be acquainted with them. Phy- sicians who are careless in their readings are not always familiar with their exact locality. In Fig. 97, the abdomen is di- vided into nine different regions by the drawing of two parallel lines up and down, 2, 2, and 3, 3, and two lines across, 4, 4, and 1, 1. This gives three regions above, three in the middle, and three below. In the upper row, 6 is the epigastrium or epigastric region, in which are the left lobe of the liver, and a portion of the stomach ; 5, on the 291 292 DISEASES OF THE ABDOMINAL CAVITY. right side, is the right hypochondrium, in which is the right lobe of the liver ; and 5, on the left side, is the left hypochondrium, which contains the spleen, and a portion of the stomach and liver. In the middle row, 7 is the umbilical region, which contains the small intestines. On the right side, 8 is the right lumbar region, which holds the right kidney and the ascending colon ; and 8, on the left, is the left lumbar region, which contains the left kidney and the descending colon. In the lower row, 9 is the hypogastrium or hypogastric region, which contains a portion of the small intestines and bladder. On the right, 10 is the right iliac fossa, containing the coscum or caput coli ; and 10, on the left, is the left iliac fossa, con- taining the sigmoid flexure. And now I may as well present, in Fig. 98, a front view of many of the organs, both in the chest and abdomen: 1, 1, 1, 1, are the muscles of the chest ; 2, 2, 2, 2, the ribs; 3, 3, 3, the upper,] middle, and lower lobes! of the right lung; 4, 4,1 the lobes of the left lung;* 5, the right ventricle offF* the heart; 6, the left ven- tricle ; 7, the right auricle of the heart ; 8, the left auricle; 9, the pulmonary artery; 10, the aorta; 11, the vena cava descendens ; 12, the windpipe ; 13, oesophagus ; 14, 14, 14, 14, the pleura ; 15, 15, 15, the diaphragm; 16,16, the right and left lobes of the liver; 17, the gall- bladder ; 18, stomach; 26, the spleen ; 19, 19, the duodenum ; 20, the as- cending colon ; 24, the transverse colon; 25, the descending colon; 22, 22, 22, 22, the small intestines; 23, 23, the Fig DISEASES OF THE ABDOMINAL CAVITY. 293 walls of the belly turned down ; 24, the thoracic duct, opening into the left subclavian vein (27). Acute Inflammation of the Liver. — Hepatitis. The liver is the largest gland in the body. (See Fig. 31.) It lies in the right side, and at the top of the great abdominal cavity, di- rectly under the midriff, and lapping upon the stomach. Fig. 96 shows its relative position. Its office was supposed to be to take the superabundant carbon out of the blood. This carbon it unites with other elements and forms bile, the peculiar bitter substance which is poured into the upper bowel, and greatly aids digestion. The liver is liable to become inflamed from several causes, such as gravel-stones, external violence, suppressed secretions, hot climates, inflammation of the duodenum, etc. Symptoms. — These are sympathetic fever, with pain, and a sense of tension in the right side, inability to lie on the left side, difficulty of breathing, a dry cough, vomiting, and hiccup. The pain is acute and lancinating generally, though sometimes dull and tensive. When sharp, it is like the stitch of pleurisy, and it indicates that the peritoneum which covers the liver is inflamed. When dull, it is the body of the organ which is suffering. When the convex surface of the liver is the seat of the disease, the pain is apt to run up to the right collar-bone, and to the top of the right shoulder. Breathing, coughing, and lying on the left side, increase the pain. A soreness is felt by pressing over the liver. The pulse is full, hard, and strong, the bowels are costive, and the stools are clay-colored, owing to not being tinged with bile, — this having stopped flowing. The tongue is covered with a yellow, dark brown, or even black coat, and there is a bitter taste in the mouth. Explanation. — The bile, secreted by the liver, is poured into the upper bowel, and gives the brown or yellow color to the contents of the bowels. When the liver is inflamed, it cannot work, — it se- cretes little or no bile, and the discharges from the bowels lose their color. The bile is slightly laxative, and when it ceases to flow into the bowels, they become bound or costive. When the liver does not work, the bile has to be taken out of the blood by the kidneys, and the urine becomes of a deep yellow color. Much of it goes out through the skin, too, which is likewise yellow, and the sweat be- comes so yellow as to stain the linen. Treatment. — Flax-seed poultices applied over the liver are very good. Purgatives will also need to be used pretty freely at first. Those which produce watery stools (31), (247), (34), will be of the greatest service. After the cups and purgatives have been thoroughly used, blisters will be useful, and it will be better to apply several in succession, 294 DISEASES OF THE ABDOMINAL CAVITY. rather than to keep the first one open. Or, in the milder cases, a mustard poultice may be applied over tli" whole side, and even along the spine. Frictions over the stomach and liver with dilute nitro-muriatic acid, and a foot-bath of the same, will sometimes do well. The acid should be reduced with water to about the strength of sharp vinegar. Water a little soured with this same acid makes an excellent drink for the patient. Perspiration should be induced by the spirit vapor-bath, and kept up gently by the tincture of the American hellebore, from three to ten drops every hour. Or, the same thing may be done by prescrip- tions (126), (358). When the urine is small in quantity and red, give some diuretic, as infusion of marshmallow-root, pumpkin-seeds, or trailing arbutus. The diet should be rice-water, gruel, and toast-water. While getting up, it may gradually be improved, and some light tonics (49), (58), (64) be added to it. Chronic Inflammation of the Liver. — Chronic Hepatitis. There are few chronic diseases for which the physician is more often consulted than this. In the warm climate of the South, in the bilious districts of the West, and indeed even in the Middle and Eastern States, it meets us continually, and demands our attention. That it is difficult to cure must be admitted; but a constant famil- iarity with chronic diseases, for several years, has convinced me that it is generally curable. Symptoms. — A sense of fulness and weight in the right side with some enlargement, and shooting pains felt in the same region, particularly when it is pressed, with pains in one or both shoulders, and under the shoulder-blades ; uncomfortable sensations when lying on the left side; yellowness of the skin, eyes, and urine; bowels irregular, loose, or costive; appetite disturbed; sometimes a dry, hacking cough; shortness of breath; tongue whitish, and brown or yellow towards the root; a bitter and bad taste in the mouth in the morning. The urine deposits a sediment on standing. There is generally a low and desponding state of mind, with irritability and peevishness of temper. The skin is often covered with yellow spots and with a branny substance. The various symptoms of dyspepsia are often present. The nervous system is generally much disturbed, and there is a dis- inclination to apply the mind. There is frequently a great dread of imagined evil, supposed to be impending. Treatment. — This does not require to be as active as that for the acute form of the disease. DISEASES OF THE ABDOMINAL CAVITY. 295 If there be much tenderness of the liver, begin with mustard poultices, and the compound pills of podophyllin, or the compound pills of leptandrin, or (36). I have abandoned the use of mercury in this disease, as in most others ; but if any prefer to use it, the blue pill (52) will be found the most useful form. The compound tar-plaster placed over the liver, in bad cases, is often very serviceable. An alterative (138), (146) will be found useful. The daily alkaline sponge-bath must on no account be omitted. Vigorous friction must follow it. Vigorous constitutions will bear the shower-bath; in such cases it may, occasionally, take the place of the sponge-bath. The diet must be simple, yet nourishing and wholesome, and embracing but a small amount of fat, as this is composed largely of carbon, and the liver is unable to remove what is already in the blood. Especially and above all, out-door exercise must be taken to the full amount of the strength, and the thoughts be occupied with cheerful subjects. Let the hot sun be avoided, and the summer exercise be taken in the cool hours of the day. The recovery from this, as from all other chronic diseases, must necessarily be slow. Congestion of the Liver. This is not strictly a disease, but the result of gastro-intestinal disorders. There is an enlarged, congested liver, with a sense of fulness and weight in the right side under the ribs. The application of heat, and even leeches, to the side, and the ad- ministration of saline laxatives, afford relief. The diet must be light and farinaceous. Passive Congestion of the Liver Results from mechanical obtruction to the outflow of blood from the liver. When this condition has existed some time, there is a sense of weight and fullness in the liver region when sitting up or lying on the left side. The liver is enlarged and tender; the breath is shortened, and pain may be present, extending to the shoulder. Jaundice is usually present, but only to a slight degree. When the heart is the cause of the obstruction to the outflow of blood, there is often present an associated gastro-duodenal catarrh, in which case loss of appetite, nausea, vomiting, belching of gas, and pain, are also present. In the later stages of a prolonged case, ascites, or dropsy of the peritoneal cavity, is present. Prognosis. — The outcome of passive congestion of the liver is usually grave, since it is the result of some structural disease else- where, as of the heart, asthma, chronic pleurisy, tumors, etc. 296 DISEASES OF THE ABDOMINAL CAVITY. Treatment. — The indications for treatment are to strengthen the heart with digitalis, strophanthus, etc., increase the strength of the patient with strong, stimulating food, and to deplete the portal circu- lation by vegetable laxatives like podophyllin, rhubarb, aloes, etc. ; the salines also furnish an agreeable method of depletion, as for instance, Crab-orchard water, Hunjadi, etc. It occurs usually after middle life, and is more common in women than men. It is usually secondary to cancer elsewhere, as in the bowels or stomach, rectum and womb. The liver is increased in size, and is frequently studded with cancerous nodules, which in well-marked cases may be felt through the abdominal wall. The disease usually gives rise to loss of appetite, nausea, vomiting, constipation, emaciation and weakness. Pain over the liver is gen- erally present, while jaundice exists in about fifty per cent of cases. Dropsy of the bowels exists likewise in about the same proportion of cases. Hemorrhages from the nose, stomach and bowels occur in the later stages of the disease. The temperature is usually lower than normal, and the pulse slow, especially if jaundice be present ; the urine is diminished in amount and high colored. The disease progressively advances to a fatal termination inside of a year. No known treatment is of avail in arresting the terrible malady. Cirrhosis of the Liver. This is a disease characterized by an excessive increase of the fibrous tissue in the liver, whose later function is to contract and squeeze out, so to speak, the softer, glandular structure of the liver proper, thus causing its atrophy and diminution in size. The dis- ease is caused mainly by the introduction into the portal system of some irritant like alcohol. It is generally known as the gin-drinker's liver, but it does not result especially from gin any more than from any other spirit. It is, at all events, essentially a disease due to pro- longed though moderate use of spirits of one sort or another, and occurs between the ages of thirty and sixty, mostly in men. The symptoms of this disease are at first those of gastric and intes- tinal disorders due to alcohol, as nausea, flatulence, constipation and looseness, etc. Dropsy is finally the most pronounced symptom of the disease, but hemorrhages from the bowels not infrequently occur. The disten- sion of the abdomen by dropsy is sometimes enormous ; finally the feet and legs become swollen, emaciation and weakness progress, and the patient may finally die in coma or convulsions. The disease, when sufficiently advanced to be recognized, is incurable. Treatment. — The treatment is to be directed toward the removal of all irritating food and alcohol. The diet should consist largely of milk; green vegetables and fruit, beans, peas, eggs, lean meat, etc., may be taken if well borne. DISEASES OF THE ABDOMINAL CAVITY. 297 The stomach and bowels are to be kept in good condition, the dropsy drawn off or removed by means of loose evacuations from the bowels. Hydrochloric acid in three-drop doses, well diluted, after meals, may be of service, while bitter stomach-tonics are to be given before eating. Acute Inflammation of the Spleen. — Splenitis. The spleen is in the upper part of the belly, on the left side, opposite the liver. It is subject to acute inflammation, which is known by a pain just under the short ribs on the left side, also by swelling, soreness to the touch, and by more or less fever. The pain often shoots up through the midriff and to the left shoulder. There is a short, dry cough ; a feeling of tightness about the heart ; a sick- ness at the stomach, and vomiting ; and a discharge frequently of black blood from the bowels. The urine is scanty, is passed with some difficulty, and is high-colored. This disease appears most frequently in hot climates, and is often connected with intermittent fevers. Chronic Inflammation of the Spleen. This prevails most in fever-and-ague districts, and is a frequent result of chills and fever. It is generally very stubborn, often lasting many years. Symptoms. — A feeling of weight, tightness, and sometimes pain in the left side, the pain being increased by pressure, or an attempt to lie on the left side. The organ sometimes enlarges very much, so that it can be felt by the hand. This enlarged mass passes under the common name of " ague cake." There are sometimes numbness, weakness of the legs, difficulty of breathing, palpitation of the heart, inability to exercise much, obstinate constipation, vomiting of food, piles, dry skin, tongue coated white or red, low spirits, and occasion- ally dropsical affections. During the chill in fever and ague, the spleen becomes enormously loaded with blood. Surfeited and stretched in this way again and again, it is not strange that the organ should become diseased. Treatment. — This should be about the same as the treatment for acute and chronic inflammation of the liver. After the active symptoms of inflammation are subdued, the warm bath may be used one or twice a week. In the chronic form of the disease, counter-irritation with the compound tar-plaster, with mustard poultices, croton-oil, or tincture of iodine, will be particularly needed. Among medicines, muriate of ammonia (53), has a high reputation. 298 DISEASES OF THE ABDOMINAL CAVITY. To keep the. bowels open, podophyllin, quinine, and mix vomica (46), have a fine effect. Iron may be given (73) when the patient is bloodless and pale. Jaundice. — Icterus. The jaundice is a very common disease, and to be known needs only to be seen ; but inasmuch as it may be but a symptom rather than a disease per se, it behooves one to be careful that some hidden disorder be not preying upon the system. Among the more common affections which give rise to jaundice are gastro-duodenal catarrh, frequently affecting children, obstruction of the gall-ducts by thick bile or mucus, or by gall-stones ; cancer, chronic forms of liver com- plaints, and some forms of blood diseases. Symptoms. — The most prominent symptoms are, yellowness of the skin and whites of the eyes, saffron-colored urine, and whitish or clay-colored stools. So full is the urine of bile, that a piece of white linen dropped into it receives a bright yellow tinge. Besides these symptoms, there are impaired appetite, a loathing of food, the sense of a load at the pit of the stomach, sourness of stomach, sometimes sickness and vomiting, a bitter taste in the mouth, disinclination to move about, sleepiness, a dull pain in the right side, which is increased by pressure. The entire body of a person who has died of jaundice, including bones, muscles, and membranes, are found to be full of bile, and col- ored yellow. Explanation. — The bile flows into the upper bowel, a little below the stomach, through a duct or tube about as large as a goose-quill. This little tube or vessel receives the bile from a smaller tube, called the hepatic duct, and from another which goes to the gall-bladder, called the cystic duct. These little tubes sometimes get obstructed or plugged up by sticky, thickened, or hardened bile, or by gall-stones, formed in the liver ; and the bile, finding no outlet through, its natural channels, is taken up by the absorbents, distributed over the system, and produces the yellowness we witness. When these ducts and the gall-bladder are filled and stretched by this thickened and hardened bile, they be- come tender and sore. Hence the sore feeling in the side when pressure is made. There is another explanation of the way in which the yellowness of jaundice is produced, and it matters not whether it or the one just given be adopted. It is this : The bile is formed by the blood, and not by the liver. The office of the liver is to draw or strain off the bile from the blood. And when this organ is inflamed, or gets slug- gish and will not work, the blood is not relieved of its yellow freight. The bile accumulates, and in attempting to escape through other channels, it lodges in the various tissues, particularly in the skin. DISEASES OF THE ABDOMINAL CAVITY. 299 Treatment. — An infusion of thoroughwort, drunk freely every day, is a valuable remedy. The inner bark of the barberry steeped in eider, or this article compounded with others (286), (287), will be found excellent. The diet should be plain, wholesome, and nourishing, but com- posed mostly of vegetable articles, particularly green vegetables and berries when they are to be had. Cold water should be the principal drink ; or drink and medicine may be combined in the shape of three drops of muriatic acid, and two drops of nitric acid, dissolved in a tumbler of water slightly sweetened. This is generally a pleasant drink, and will assist very much in the cure. The warm bath once or twice a week, and the alkaline sponge-bath every day, with smart friction, must not be omitted. When jaundice is caused by the passage of gall-stones through the bile-duct, there is sometimes terrible pain and suffering, — the stone, occasionally, being as large as a nutmeg, and forcing its way through a quill-sized tube. So great is the distress that the patient sometimes rolls upon the floor in agony. To alleviate this pain, large doses of opium, laudanum, or morphine, are required. A large teaspoonful of bicarbonate of soda dissolved in a tumblerful of hot water is an ex- cellent remedy if drunk at a single draught. It relieves the acidity of the stomach, and acts as a fomentation to the internal seat of the pain. Mustard poultices, or warm fomentations, over the seat of the pain, are required. The warm bath is excellent. The acid bath, made by mixing three parts of muriatic acid with two parts of nitric acid, and adding as much of this mixture to water as will make it about as sour as weak vinegar, is valuable in jaundice. Only a quart of water need be taken ; and the solution should be applied with a sponge. It is of the right strength, if it produce a slight tingling of the skin. Gall=Stones. — Biliary Calculi. These are brownish, chocolate-colored concretions which form either in the gall-bladder itself, in the duct leading from the gall- bladder, or in the common duct which is formed by the ^^ union of the gall-duct and the hepatic duct which leads ^jf^ from the liver. They are solid, generally have bodies of flJllk irregular shape and size, and have facets caused by the y^^yilmlP stones being impacted against one another. Fig. 99 'WHB* shows their appearance. These concretions are formed FlG - "• of inspissated bile and organic salts. When they settle into the ducts their natural course is downward through the duct into the bowel, where they are naturally carried off with the faeces. Their passage through these ducts is accompanied often with extreme pain and colic, the pain being the severest of any to which the system is sub- jected, and generally requires an opiate. When once an attack of 300 DISEASES OF THE ABDOMINAL CAVITY. gall-stones has occurred, the patient is liable to more, as they seldom exist singly in the gall-bladder. These repeated attacks have been the subject of a great deal of thought among surgeons. Symptoms. — An almost constant uneasiness in the right hypo- chondriac region, with spasms of pain, coming on suddenly, and last- ing for a time with great severity, and then subsiding. The pain is caused by a stone being suddenly forced into the duct and moving forward in it, and it subsides when the stone either stops, or gets through the duct. When the stone reaches the bowels, it passes off with the stools. The patient generally has a pale, sallow complexion, a small, feeble pulse, and often suffers from nausea and vomiting, and from restless- ness and hurried breathing. Treatment. — To reduce the spasm, give svapnia powder in full doses, or chlorodine. Also, apply mustard over the right hypochon- drium and stomach, and follow it with hot fomentations with hops, or use wet cups. If the stomach is irritable, give the neutralizing mixture until it moves the bowels. To relieve the intense pain, morphine should be administered, together with hot baths and hot cloths over the abdo- men. Sweet oil was at one time advocated as a solvent of these bodies, but experience has not proven the validity of the claim. Many practitioners, however, still insist that oil in large doses hastens the passage of the stones. To remove the acidity on which the formation of these stones so often depends, a neutralizing preparation (338) may be given for a long time, the diet, in the mean time, being well regulated. The sponge-bath with saleratus and water, should be taken daily, followed by brisk rubbing ; and free exercise in the open air should on no account be omitted. Of late years it is customary to treat this complaint surgically, operating directly on the gall-bladder by incising it and removing the stones. If the ducts become obstructed, they too are incised and the stones dislodged, either by pushing them down into the bowel, or otherwise, as may be most convenient. The gall-bladder is either sutured to the abdominal wall, and a biliary fistula forms, discharg- ing the bile upon the abdominal wall; or it may be drained off into a bottle; or, as has been recently advocated, the bladder may be sewn up tightly and replaced. Sometimes communication is estab- lished between the gall-bladder, or the duct, and the duodenum, by means of an ingenious device called " Murphy's Button." This button, invented by Dr. Murphy of Chicago, is intended to draw to- gether the parts to be connected, retaining them in that position. After some days the walls slough away, and the button passes into the bowel, and is thus removed from the system. By this means DISEASES OF THE ABDOMINAL CAVITY 301 many stubborn cases of impacted gall-stone have been permanently cured. Abscess of the gall-bladder, inflammation of the surrounding tissue, and even death are not infrequent results of the presence of these foreign bodies. For preventing the formation of gall-stones, see the articles on Biliousness, Diet, etc. Acute Inflammation of the Stomach. — Gastritis. This is a rare disease. It is generally induced by irritating and corrosive substances taken into the stomach. Poisons, as arsenic, aquafortis, corrosive sublimate, and the like, are the most common causes of it. Blows, sudden stoppage of sweat, and excessive use of ardent spirits, may also excite it. Symptoms. — It is marked by burning pain in the stomach, thirst, restlessness, anxiety, constant vomiting, prostration of strength, a quick, hard, and small pulse, incessant retching, a sunken counte- nance, hiccough, cold hands and feet, and a damp skin. Treatment. — If the inflammation be excited by poison, the reme- dies named under antidotes for poisons must be first employed. The poison being neutralized or thrown off, the inflammatory con- dition must be combatted with the remedies usual for such states. Mustard poultices to the feet, along the spine, and particularly over the pit of the stomach, will be among the first things to be employed, and should be followed by hot fomentations of stramonium leaves or hops, — both the fomentations and the poultices to be repeated as occasion may require. Dry cupping over the region of the stomach is useful. Small and repeated doses of bismuth, or l-grain doses of cocaine, are generally very soothing to the stomach, and relieve the terrible vomiting. Drinks. — Cold water, bread-water, rice-water, arrow-root gruel, infusion of slippery-elm bark, and of marshmallow. These should be taken in very small quantities, — say a teaspoonful at a time, — about twenty drops of tincture of aconite-root being added to a half tumblerful. Lumps of ice may be held in the mouth, and occasion- ally swallowed. Injections. — Emetics and physic are not proper, but injections (248), (253), or simply soap-suds, will be required. The remedies must be pursued until all tenderness has disappeared from the pit of the stomach. While the patient is recovering, great care must be taken not to overload the stomach with food. Arrow-root, sago, and milk are among the first articles to be allowed. After these, will come grad- ually beef-tea, chicken-broth, soft-boiled eggs, and beef-steak, until the whole diet can be restored. 302 DISEASES OF THE ABDOMINAL CAVITY. Chronic Inflammation of the Stomach. This is a much more common disease that the preceding ; indeed it is very common. Though it does not put life in immediate danger, it perverts the feelings of the stomach, and causes many of the symp- toms of indigestion. Dyspepsia, however, is a different complaint, and not necessarily connected with inflammation. Symptoms. — There is generally pain in the stomach, which is in- creased by the presence of food, and by external pressure. The pain is sometimes felt only during digestion. The fermentation of the food in the stomach generates a gas, which is frequently belched up. This is what is meant in common language by having " wind in the stomach," and " belching wind." The meals are frequently vomited up ; the appetite is tickle, sometimes voracious, and again nearly ab- sent ; the thirst is likewise variant ; the tongue is white in the centre, and red at the sides and tip, — sometimes smooth and red all over, like a slice of raw beef. The urine is scanty and high-colored. The disease is very liable, if badly managed, to lead to ulceration of the coats of the stomach, and thence to a fatal end ; for an ulcer may penetrate the walls of the stomach, and let its contents into the abdominal cavity, which would excite an immediately fatal inflam- mation. Treatment. — If there be much tenderness, we may apply leeches over the stomach. With less tenderness, counter-irritation will an- swer,« — as blisters, croton-oil, mustard poultices, the compound tar- plasters, or dry cups. The skin of the whole surface should receive special attention. The warm or the cold bath should be used often, according to the strength of the patient. When the reaction is good, a cold compress bound upon the stomach every night, will do much to bring relief. The diet cannot be too carefully managed. While there is consid- erable tenderness, the nourishment must be of the most simple and unirritating kind, — consisting of little more than the most bland nutritive drinks ; and even these should be taken in small quantities at a time. Gum arabic water, rice-water, barley-water, arrow-root, gruel, tea, and toast without butter, will be amply sufficient to keep soul and body together, and will, in two or three weeks, generally starve the enemy out of his quarters. After this, a more nourishing diet may gradually be resumed. Many of the recent proprietary foods serve an admirable purpose in furnishing a large amount of nutriment in small bulk, which is easily digested. Among these may be mentioned proteinol, in teaspoonful to tablespoonful doses, liquid peptonoids, malted milk, koumiss, matzoon, etc. These latter are milk preparations with the cooling and refreshing taste of soda. DISEASES OF THE ABDOMINAL CAVITY. 303 Indigestion. — Dyspepsia. Dyspepsia is a disease of civilization. Savages know nothing of it. It is the costly price we pay for luxuries. All civilized nations suffer from it, more or less, but none so much as the people of the United States. It is here, in the new world, that the disease has become domesticated, and we, as a people, who have threatened to monopolize its miseries. Few disorders inflict upon their victims greater suffering ; yet it is not particularly dangerous, and it is even doubtful whether it tends very much to shorten life, unless the length of life be judged to con- sist in the sum of happiness enjoyed, — in which case few complaints shorten it more. Symptoms. — These vary very much in different stages of the dis- ease, and in different persons. In general the complaint begins with a sense of fullness, tightness, and weight in the stomach, sooner or later, after meals, and a changeable, diminished, or lost appetite. Occasionally, the appetite is craving, and when, in obedience to its promptings, a large meal is taken, there is pain in the stomach, with general distress and nervousness, and sometimes vomiting. Flatu- lency and acidity are common, with sour and offensive belching of wind ; and very often there is a water-brash, or vomiting of a clear, glairy fluid when the stomach is empty. Dizziness is a prominent symptom. There is a great deal of what patients call an " all-gone " feeling at the pit of the stomach, — a weakness so great at that par- ticular spot, that it is very hard to sit up straight. There is a bad taste in the mouth ; the tongue is covered with a whitish fur ; there is headache, heartburn, palpitation at times, high-colored urine, and tenderness, now and then, at the pit of the stomach. The bowels are generally irregular, sometimes very costive, at other times loose, when portions of food are passed off undigested. Nervous Complication. — Such are the symptoms in a case of simple disorder of the stomach, when no other part of the system is materially involved. This is indigestion, well-marked, and distressing enough ; but it is only a part of what is understood by a case of modern dyspepsia. In this, either the indigestion, in its course, dis- turbs and involves the nervous system, or the nerves become them- selves disordered, and produce the indigestion. Sometimes one hap- pens, sometimes the other, it matters not which ; both are present — the affection of the stomach and of the nerves — in a case of thorough dyspepsia. To make out a full case, in its tormenting completeness, we must add to the above symptoms, great depression of spirits, amounting at times to complete hopelessness and despondency ; a dread and fear of some impending evil ; a lack of interest in passing events ; unwillingness to see company or to move about ; an irritable and fretful temper ; a desire to talk of one's troubles, and nothing 304 DISEASES OF THE ABDOMINAL CAVITY. else ; a sallow, haggard, sunken, and sometimes wild expression of countenance ; a dry, wrinkled, and harsh skin, with unrefreshing sleep, disturbed by all sorts of annoyances and difficulties, such as shipwrecks, falls down precipices, and nightmare. The man who has all these symptoms, or any considerable portion of them, has dyspepsia, and is about as miserable as if all the sorrows of life were electrical currents, and were running through him con- tinually. Causes of Dyspepsia. — To healthy digestion, three conditions are especially necessary, — that the food should be well chewed and mixed with saliva before it is swallowed ; that the stomach should pour out and mix with it the right amount of healthy gastric juice ; and that it should be well churned while in the stomach. It is well known that the first of these conditions, a thorough chew- ing of food, is rare in this country. We eat too fast ; we do not masticate our food ; we bolt it whole. This is the first cause of dyspepsia, and it is the fruitful mother of causes. It furnishes the occasion for eating too much ; for when the food is swallowed with such rapidity, the stomach is taken by sur- prise, as it were ; it cannot secrete gastric juice fast enough to be diffused through the fast-growing mass ; and the appetite does not decline until a great deal too much is taken. The coats of the stomach, being stretched unnaturally, do not pour out the gastric juice at the right time, or as much of it as is wanted, and what there is, is altered in quality. Moreover, the stomach being overburdened, cannot turn over and churn it contents properly. To fast eating, we may add, high-seasoned dishes, too stimulating for the stomach ; eating between meals, and at unseasonable hours, — particularly at bed-time ; excessive use of strong drinks and tobacco ; habitually sitting up late at night ; inactive habits of body ; and excessive use of the mind. No causes of dyspepsia are more active than those which disturb and fret the mind. It is surprising how suddenly any mental agita- tion will put an end to the appetite, and suspend digestion. And when these mental disturbances are protracted, when care becomes a daily and hourly companion, dyspepsia is almost sure to show itself. Considering tjie numerous causes of unpleasant mental excitement which we have in the politics, the business, the ambition, the family jars, etc., of this country, it is a wonder that dyspepsia is not even more prevalent. It is hard for the sensitive to escape. These causes ma}' seem too simple to be the frequent origin of so much misery, and yet whole volumes might be written on this one subject. One cannot too forcibly nor too frequently remind the reader of the importance of these simple and brief remarks. No treatment will avail if they are not heeded. DISEASES OF THE ABDOMINAL CAVITY. 305 Urinary Deposits. — Before speaking of the treatment of dyspep- sia, it will be proper to take notice of certain deposits in the urine, to which persons suffering from this complaint are liable, and the discovery of which will, in many cases, indicate the treatment. Many dyspeptics have acid urine, which is loaded with crystals of oxalate of lime. These persons are much depressed in spirit, and look upon the dark side of everything. They are painfully disturbed by small annoyances, are irritable in temper, incapable of exerting themselves, look with dread upon the future, and generally have the dark and dingy look of the face which indicates functional derange- ment of the liver. The most of these crystals are octahedral in form, and in the field of a good microscope are beautiful objects for inspection. (Figs. 100 and 101.) To obtain them, take a portion of urine passed in the morning (urina sanguinis), and let it stand till a deposit takes place. Pour off the upper portion of the urine ; put a part of the remainder in a watch-glass, and gently heat it over a lamp. The heat will cause a deposit of the crystals. Fig. 100. Fig. 101. Fig. 102. The oxalate of lime is frequently found in urine, the crystals hav- ing the form of dumbells. When examined by polarized light, they appear beautifully colored and striated. (Fig. 102.) The urate of ammonia, and uric acid gravel, are likewise found in large quantities in the urine of many dyspeptics. Some are ex- hausted by them, and reduced almost to skeletons, and to a wretched state of health, — having boils, eruptions, etc. To find the urates, put a little of the urine containing the deposit in a test-tube, and warm it gently over a lamp. If the deposit readily dissolve, it is probably urate of ammonia (Figs. 103 and 104), and may then be examined under the microscope, to make the matter sure. To find uric or lithic acid, let morning urine stand until a solid deposit has sunk to the bottom ; then pour off the liquid, and place some of the solid portion upon a glass, and examine it with a micro- scope, and if this acid be present, its peculiar crystalline forms (Fig. 105) will be discovered, either alone, or mixed with urate of ammonia. 306 DISEASES OF THE ABDOMINAL CAVITY. In those cases in which there is a great prostration of the nervous system, with a loss of sexual power, bad feelings in the head, perhaps pain and weakness across the loins, and a tendency to consumption, Fig. 103. Fig. 104. we may suspect the presence of the triple phosphates in the urine. Phosphorus is one of the elements of the brain and nerves, and when there is a constant drain of this element through the kidneys, the nervous system is gradually exhausted. To find the triple phosphates, put some morning urine in a glass vessel, and let it stand till a sedi- ment has gone to the bottom. Put some of the sediment in a test-tube, and warm it gently over a lamp. If the warmth do not dissolve the deposit, add to it a little acetic acid ; if the deposit dissolve in the acetic acid, it probably consists of earthy phosphates. This is then to be exam- ined under the microscope to ascertain whether it is the phosphate of lime, the triple phosphate, or a mixture of both. Fig. 106 shows us the prismatic crys- tals of the triple phosphate. In a few rare cases, these are penniform (Fig. 107). Fig. 108 gives us an- other specimen of the crystals of the triple phosphates, as they Fig. 105. FlU. 106. Fig. 107. appear under the microscope, mixed with amorphous particles of phosphate of lime. If an excess of ammonia be added to the urine, the crystals become star-like and foliaceous, as in Fig. 109. DISEASES OF THE ABDOMINAL CAVITY. 307 Treatment of Dyspepsia. — As there are few complaints which distress the patient more than dyspepsia, so there are few which give the physician more trouble. Generally our art has failed upon it because too much has been required of us. We have not merely been asked to cure the disease, but to do it while the patient continues the indulgence of his appetite, or his excessive application to business or study. It has been expected of us, that with medicine we should contra- vene the laws of nature, and restore health while the causes of the disease are in full ac- tivity. This complaint is often brought on by not keeping the bowels open. To cure it, therefore, one of the first things to be done is to remove costiveness and regulate the bowels. One of the very best articles I know of to remove constipation is Mettauer's Aperient. I have placed it in the department of Phar- macy; it ought to be in the United States Dispensatory. Taken immediately after meals, in doses of a teaspoonful, it corrects acidity of the stomach, it gently opens the bowels, and when its action is over, will be found to have diminished the costiveness, rather than increased it, as most kinds of physic do. It is excellent in the bil- ious forms of dyspepsia, — acting finely upon the liver, — particularly if a few drops of aqua regia in water be taken before meals, — the aperient being taken after. If piles exist, this mixture will be objectionable on account of the aloes, and the fluid neutralizing extract may take its place. Sweet tincture of rhubarb and soda (37), is sometimes preferable to the aperient. Several other preparations (38), (289), (39), (290), will be found useful to remove costiveness and debility of the stomach. For acidity, besides the remedies already mentioned, prepared char- coal may be used, in teaspoonful doses, or carbonate of magnesia, or fluid magnesia, or trisnitrate of bismuth. A good remedy is pulver- ized guaiacum, rhubarb, prepared charcoal, and carbonate of mag- nesia, equal parts; also (28), (37), (38), (42). If crystals of oxa- late of lime be found in the urine, give a few drops of aqua regia, in water, three times a day. Hygienic Treatment. — The diet must be managed with great pru- dence. Food must be taken in such quantities only as the stomach can digest, however small that quantity may be ; and it must be taken slowly, and well chewed. No article should be touched, or thought of, which disagrees with the stomach. Costiveness may frequently be entirely removed by eating no bread except that made from un- bolted wheat-flour, commonly called Graham bread (that made from Franklin Mills flour), or by making one of the three daily meals of 308 DISEASES OF THE ABDOMINAL CAVITY. boiled cracked wheat, with milk or molasses. If the triple phosphates be found in the urine, there is a special reason why the unbolted flour, or the cracked wheat should be used. The wheat-grain abounds in phosphorus, the largest portion of which is in the bran, and this is much needed when the kidneys are robbing the brain of its phos- phoric element. Not too much Brain=work. — It is important that the brain and nervous system should be relieved of the burden of too much work, and that the thoughts should be turned into the most agreeable chan- nels. If the patient would get well, the disinclination to move about and see company must be resisted. In many cases, dyspeptics are like sea-sick persons, — feeling as though they would rather go over- board than move. In such instances, friends must not be harsh with them, and frown upon their listlessness as if it were a fault ; but rather treat them affectionately, and beguile them out by all sorts of pleasing enticements. Exercise must be had, every day, and be con- nected, if possible, with an object, so that it may be performed cheer- fully. It is important to engage the mind in the exercise ; and for this purpose, some contested game is very useful, as plajdng at billiards, rolling nine-pins, pitching quoits, or, where the strength will permit, playing ball or riding the bicycle. Cheerfulness. — Nothing does more to drive away dyspepsia than a cheerful, lively, and even mirthful state of mind. All the nervous influences sent from the brain to the stomach should be of the most agreeable kind. Some people think it vulgar to laugh. Let such stand with long faces in life's shadows, if they choose. As a general rule, the best men and women laugh the most. Good, round, hearty, side-shaking laughter, is health for everybody ; for the dyspeptic, it is life. Dyspeptics who have a taste for it, and can endure the expense, should travel. A voyage to Europe, and a year spent in seeing the wonders of the old world, will generally cure the most stubborn case of indigestion. This, however, depends upon circumstances. For those having the finer organizations and the higher natures, extensive travelling is sometimes indispensable. The narrow circle of thoughts, associations and things in their own neighborhood, do not fill the compass of their wants ; their many-sided faculties need to be drawn on by the large variety to be found only in travel. Their large and impressible natures want to be filled full in order to drive out disease, and it takes a world, or a considerable part of it, to fill them. The dyspepsia of such natures is not comprehended by the multitude, and even physicians are often amazed that their narrow prescriptions do not reach it. Heartburn. — Cardialgia. This is a gnawing and burning pain in the stomach, attended by disturbed appetite. It is generally caused by great acidit}^ of the DISEASES OF THE ABDOMINAL CAVITY. 309 stomach, and is a symptom of dyspepsia, and often afflicts pregnant women. Whenever too much food is taken, it is liable to ferment, and become extremely sour, — causing heartburn. In such cases, vomiting often occurs ; and what is thrown up is sour, and some- times bitter. Treatment. — Immediate temporary relief may be obtained by swallowing a teaspoonful of soda, magnesia, or chalk, in a tumbler of cold or warm water. Fluid magnesia, or lime-water, will answer the same purpose. If there is wind in the stomach, as well as acidity, a teaspoonful of the aromatic spirit of ammonia, or (135), will often still the uneasiness in a moment. To cure the complaint, the stomach must be strengthened by the remedies directed for dyspepsia. Spasm or Cramp in the Stomach. — Gastrodynia. Though generally of shorter duration, this is more violent than heartburn. It is attended by a sense of fullness, by anxiety, and by great restlessness. In females, hysterical symptoms are often coupled with it. Great quantities of air or gas are generally expelled, and the pain shoots through to the back and shoulders. Treatment.— A strong purgative injection (248) will often bring immediate relief. The sweet tincture of rhubarb and soda (37), with a few drops of tincture of cayenne mixed with it, will often bring speedy relief. So will a mustard poultice laid upon the stomach. The mustard poultice is a remedy of great excellence, in many cases. It deserves to be called the poor man's friend. Water-Brash. — Pyrosis. This consists in a discharge from the stomach, generally in the morning, of a thin, glairy, watery fluid, sometimes insipid, at other times sweetish, and at still others sour. A burning heat or pain in the stomach attends, and seems to be the immediate cause of the discharge. The discharge appears to be the natural mucus of the stomach, which is poured out in large quantities in consequence of a kind of catarrh of its mucous lining. The amount thrown up varies from a spoonful to a pint or more. The complaint is caused by a poor, innutritious diet, or by what- ever causes the blood to become thin and watery. Treatment. — Ten or fifteen drops of water of ammonia, in half a tumbler of water, will quiet the distress, and check the discharge. The most effectual remedy I am acquainted with for breaking up the discharge, is the trisnitrate of bismuth, taken at meal-times, in from twenty to thirty-grain doses, three times a day. The compound pow- der of kino is a valuable remedy. The compound tincture of senna and the tincture of balsam of tolu, in equal parts, and administered 310 DISEASES OF THE ABDOMINAL CAVITY. in tablespoonful doses, are sometimes useful. The tincture of nux vomica is a good remedy. To restore the blood, some of the various preparations of iron (74), (80), (73), (316), will be required. The diet should consist of easily-digested, nutritious food, — as soups, broths, fresh meat, and unbolted wheat-bread. Vomiting. This occurs under a great variety of circumstances. It may be induced by acidity of the stomach, by irritability of the stomach, by distress of mind, by injury of the brain, by offensive odors, and by all organic diseases of the stomach. Treatment. — Generally, it is cured by treating the disease which induces it. But in many cases it persists very obstinately, and may become the chief thing to be attended to. In such cases, it may re- quire a careful investigation of the cause to check it. But generally some aromatic, as ginger, spearmint, peppermint, or spice-tea, will put an end to it. Some cordial or stimulant, as brandy, champagne, tincture of ginger, paregoric, elixir solutis, or cherry brandy, will answer well. Strong coffee, without sugar or milk, will, in some cases, act like a charm. If it is dependent on acidity, the remedies are given under " dyspepsia." If caused by irritability of stomach, a pill of extract of belladonna and ipecac (339) will do well. While vomiting, the patient should lie still in bed, and in bad cases, a mustard poultice should be placed upon the stomach. The vomiting of children may sometimes be stopped by wetting a piece of cloth with laudanum, and laying it upon the pit of the stomach. Seasickness. This is the great terror of persons who, for the first time, cross the ocean. - It is said that dark-complexioned persons suffer more from it than others. If it cannot be entirely prevented, it may be mitigated by lying flat upon the back. To lie on deck, in the open air, is much better than lying in the close air of the cabin or stateroom. A wineglass of brandy, or iced champagne, sipped now and then, will relieve the sickness very much. For a child, it is sometimes sufficient to wet a cloth with mustard, and lay it upon the pit of the stomach. Creo- sote, one drop at a dose, made into a pill, is excellent. Ten drops of hartshorn, in half a tumbler of water, is good for some. But the best known remedy is chloroform, taken in doses of from forty to eighty drops, suspended in water by means of a little gum-arabic. Bromide of soda in large doses, daily, prevents it, or bromo-caffein when it first comes on. Cocaine in one-eighth grain doses every twenty minutes is usually very helpful. A spinal ice-bag placed DISEASES OF THE ABDOMINAL CAVITY. 311 opposite the stomach while the sufferer lies upon the back will do more toward curing sea-sickness than any other single remedy. These bags are about eight inches long, made of thin rubber, and are to be filled with small pieces of cracked ice. When the ice melts refill the bag. Milk Sickness. This disease prevails in the West, chiefly in the neighborhood of level, heavily-timbered, rather wet oak-land. The cattle, horses, and sheep, which range in this land, are fre- quently attacked by a disease which the people call the trembles. It is supposed to be produced by eating some plant growing upon those lands, as cattle which feed in the neighboring regions are free from it until they find their way into these low grounds. It has been sug- gested that the offending plant may be the poison ivy (rhus toxicoden- dron). Be this as it may, the calves, soon after sucking cows which have run in these grounds, are seized with trembling, and frequently die of the disease. Dogs which lap the milk are affected in a similar manner. Children drinking it leave the table and vomit. Upon grown persons the effects are more severe, but not so sudden. The eating of the beef, mutton, or veal, of affected animals, brings on the same disease. Symptoms. — The disease sets in with sickness at the stomach, which is preceded by general debility, more particularly of the legs. There is nausea, vomiting, and the breath is so offensive and peculiar that those acquainted with the complaint immediately recognize it from this smell. These existing for weeks, constitute, in some cases, the whole of the symptoms. In other cases they are more severe, being attended by chills and flushes, great oppression about the heart, anxiety, deep breathing, heat in the stomach compared to fire and boiling water, violent retching and vomiting, alarming beatings of the heart, and throbbings of the large vessels, and cold extremities, — producing, all together, extreme distress. In most cases, the vomiting returns every hour or two, attended by great burning at the pit of the stomach, the substance thrown up having a peculiar bluish-green color, and a sour smell. As soon as this discharge takes place, the patient falls back upon the pillow, and lies easy until another turn comes round. The tongue is covered with a whitish coat, the bowels are obstinately costive, and the pulse is small and quick. Treatment. — It is believed that the neutralizing mixture, given in tablespoonful doses every time the nausea and burning sensation are felt, is the most effectual remedy yet used. It relieves the acidity, and seems well adapted to allay the irritation. Some anti- bilious physic (40) to move the bowels should also be given. 312 DISEASES OF THE CHEST. Besides these remedies, a mustard poultice should be put upon the stomach, and hot bricks to the feet, and the patient be kept still for some hours. The diet should be very mild, — only toast-water, rice- water, or thin gruel. Acute Inflammation of the Peritoneum. — Peritonitis. This disease affects the extensive membrane which lines the whole inside of the belly, an extension of which forms the omentum or apron. It is an inflammation to which women are much exposed after confinement, and is known, in such cases, as child-bed or puer- pral fever. It is common among men also, and is a grave disease. The accepted notions of no disease have undergone so much of a revolution of late years as those relating to peritonitis. It was formerly considered to be generally of spontaneous or idiopathic origin, whereas now we know it to be the outcome of some one of several diseases, but lately understood, as for instance, appendicitis, septicaemia or blood-poisoning, inflammation of the fallopian tubes and ovaries, tuberculosis, abscess of gall-bladder, strangulated hernia, etc. Symptoms. — Like other forms of fever and inflammation, it is preceded by chills, with increased heat of surface, thirst, full, strong, and frequent pulse, flushed face, and red eyes, dry tongue with red edges, dry skin, restlessness, short, quick breathing, nausea and vomiting. The pain is increased by the patient sitting or standing up, — the bowels being thus pressed against the inflamed membrane. Lying upon either side is painful for the same reason. To lie flat upon the back, with the feet drawn up, is the only endurable position. The patient lies still, for all movements give pain. The pain in this disease is generally sharp, cutting, and pricking, but is not always equally intense. It is aggravated by the passage of wind along the bowel, by which the inflamed membrane is slightly stretched. When the disease is advancing towards a fatal termination, the belly becomes greatly swollen and tense, — having to the hand a peculiarly tight, drum-head feeling ; the pulse is rapid and feeble ; the countenance is full of anxiety, and is pinched and ghastly ; and a cold sweat breaks out. Treatment. — Small doses of antimony, lobelia, or ipecac, to pro- duce nausea and a moisture upon the skin, are generally among the first things given. The tincture of veratrum viride, in five to ten- drop doses, repeated every hour, will accomplish the same thing more effectually than any other known article. For such purposes, I give it the first place among medicines. A large poultice of white bread, rye-meal, or flax-seed, may be spread over the belly ; or cloths wet with cold water will be still better, if the patient be full-blooded, and naturally strong. The bowels should be moved at once by some DISEASES OF THE ABDOMINAL CAVITY. 313 active physic, as butternut, salts, magnesia, castor-oil, or cream of tartar (20), (IT), (18), (27), or by podophyllin, etc. (40), (41), (31). The two main indications in the treatment of peritonitis after having discovered and treated the causes, are the thorough draining of the bowels of their watery secretions by some gentle saline which will not stir them up ; and secondly to maintain them in a state of quiet and rest. The first is met by magnesia in the form of the solution of the citrate, say one-half bottle every four hours till copious watery move- ments occur. Tins drains the glands and causes a flow of the poi- sonous effete material into the bowels and rids the system of so much poison. The second indication is met by opium in some of its many forms. It is often, however, a serious problem for even the physician to decide, and should only be undertaken with his advice. The drinks should be lemonade, soda-water, tamarind-water, cur- rant-jelly dissolved in water, and preparations (298) and (299). Indian-meal gruel, toast-water, barley-gruel, and the like, are the only allowable diet. Chronic Inflammation of the Peritoneum. When the acute inflammation of the peritoneal membrane is not successfully treated, it may run on for a time, and then subside into a lower grade of inflammation, called chronic, and in this state remain for an indefinite time. But it often arises independently of the acute disease, and attacks persons of both sexes, and of all classes and ages. Scrofulous children have it, and, wasting away under it to mere skel etons, are said to have consumption of the bowels. Symptoms. — These are sometimes very obscure, and the advances of the disease stealthy. At first there may be only a little soreness of the belly, so slight as not to be noticed except after hard work, or upon some wrenching motion. Generally, there is a sense of fullness and tension of the belly, although it may not be increased in size. After a time, it enlarges a little, and its tension or tightness increases, especially towards evening. By pressing carefully with the hand, a deep-feeling tension may be detected, giving to the hand a sensa- tion as of a tight bandage underneath, with the skin and integu- ments sliding loosely over it. If water has been poured out into the abdominal cavity, its fluctuation may be frequently detected by press- ing upon one side of the belly with the palm of one hand, and strik- ing the other side with the ends of the fingers. As the disease goes on, the features become sharp and contracted, and the countenance grows pale and sallow. Costiveness comes on, sometimes chills and fever, with debility, loss of flesh, cough, difficult breathing, hectic, and swelling of the legs. Treatment. — Costiveness, if present, may be relieved by Mettauers aperient, or the neutralizing mixture, assisted by coarse bread, and boiled cracked wheat. 314 DISEASES OF THE ABDOMINAL CAVITY. Daily bathing is especially necessary, particularly the alkaline sponge bath, with vigorous friction over the bowels. The warm bath once or twice a week will be useful. In some cases, a wet towel laid upon the bowels over night, and well covered by flannels, will afford relief ; or the compound tar-plaster may occasionally be used. If there be dropsy of the belly, iodide of potassium (138) should be taken freely, and the skin made sore over the inflamed part, by tincture of iodine, well rubbed in, once a day. If the patient be pale and bloodless, give iron, quinine, etc. (74) (75), and let the diet be nourishing ; and if nervous symptoms be connected with the debility and paleness, add some nerve-tonic (93), (81), (316). When the disease is known to be the outcome of a deposit of tubercles on the peritoneum, it is now customary to open the abdomen under antiseptic methods and wash out the cavity. The effect of a mild salt-solution and the light and air oftentimes arrests the disease. Acute Inflammation of the Bowels. — Enteritis. By inflammation of the bowels is generally understood an inflamed condition of the mucous membrane which lines them ; but this, most commonly, is only a part of the disease ; it involves more or less, besides this mucous lining, the whole substance of the bowel. After an inflammation has existed some time, and even, in severe cases, at the start, certain poisonous substances are formed as the result of germ invasion, called toxines. These are genuine poisons, and often spread rapidly through the walls of the bowels by means of the numerous lymphatic vessels to the peritoneum itself, — that delicate membrane which we have seen covers all organs within the abdomi- nal cavity. When this membrane once becomes poisoned, an acute inflammation sets up, which masks all other symptoms, and is indeed a veritable blood-poison. We have then to deal with peritonitis. Symptoms. — The disease begins with a chill, and with uneasiness and slight griping pains, which increase in severity until they are in- tense and burning. Pressure aggravates the pain, which is most intense about the navel, but extends more or less over the whole bowels. From the beginning there is sickness at the stomach, and some- times vomiting ; there is loss of strength, costiveness, great anxiety, thirst, heat and fever, dry, furred, and red tongue, and but little urine, with pain in passing it. The matters passed from the bowels are dark and fetid ; and the whole belly is tender and sore to the touch. The pulse is quick, hard, and small. The stomach will be but little affected, comparatively, when the disease is at some distance from it in the lower portion of the bowels. Indeed, the nearness of the inflammation to the stomach, or its re- moteness from it, may be judged pretty correctly by the degree of DISEASES OF THE ABDOMINAL CAVITY. 315 disturbance in that organ. The length of time after drink and medi- cines are swallowed, before they are vomited up, is a pretty good measure, likewise of the distance of the disease from the stomach. How to Discriminate. — This disease is liable to be confounded with colic, and with inflammation of the peritoneum. It is important to distinguish it from colic, particularly, because the treatment for that would aggravate this. In this disease the pain is increased by pres- sure ; in colic, it is not, but is rather relieved. In enteritis, the pain remits, but never ceases wholly, as it does in colic. In enteritis, the knees are drawn up, and the breathing is short ; in colic it some- times gives relief to stretch the feet down, and the breathing is not- altered. To distinguish it from inflammation of the peritoneum, take notice that diarrhoea is much more common than in this latter complaint, while the pulse is not as quick, nor the pain as severe. Treatment. — This should be very much the same as that recom- mended for peritonitis. Perhaps in both diseases it might be well to begin with covering the belly all over with leeches. The tincture of veratrum viride, in full doses, so as to keep up a free perspiration, cold compresses, mustard poultices, hot fomentations, poultices, blisters, soothing and quieting injections, and demulcent drinks, as slippery elm, marshmallow, flax-seed, etc., if judiciously ap- plied, will do about all that we have it in our power to accomplish. In this disease it is well to inquire if the patient has a hernia, for if so, it is liable to become strangulated without his knowledge. A strangulation of the gut may be the cause of the disease. When this happens, the complaint is very unmanageable. The bowel may pos- sibly, in such case, be disentangled by applying a large dry cup ; or, what is better, a number of small ones ; but the tenderness of the belly makes the use of this remedy difficult. Here again magnesia may be of signal benefit unless the movements are already too copious and exhausting, in which case disinfectants or astringents must be re- sorted to. The possibility of tuberculosis must not be ignored. Chronic Inflammation of the Bowels. Like other chronic inflammations, this may follow the acute torm, but it also results from various other causes, as unripe fruit, taking cold, drastic physic, and improper treatment of other diseases. Symptoms. — Red end and borders of the tongue, dull pain in belly, increased by pressure and rough motion, abdomen either swelled or flat, skin dry and husky, feet and hands cold, small frequent pulse, thirst, loss of flesh, low spirits, urine scanty and high-colored, and dirty, slimy discharges from the bowels, from one to four times a day. Treatment. — To begin with, blisters, or croton-oil, or mustard 316 DISEASES OF THE ABDOMINAL CAVITY. poultices, or dry cups, if the tenderness is not great, or leeches if it is. If the bowels are hot and feverish, bind a cold compress upon the belly over night, covering it well with flannel. The warm bath should be used twice a week. Salol, ten grains every three hours, bismuth and opium, are in this case very valuable. Washing out the lower bowel with hot water by means of a syringe often soothes and heals. The diet must be of the most simple, unirritating kind, beginning with a solution of gum-arabic, rice-water, barley-water, arrow-root or sago-gruel, and gradually rising, as the symptoms improve, to beef- tea, mutton and chicken broth, tender beefsteak, etc. When the strength will permit, gentle exercise must be taken in the open air, but not on horseback, or in hard, jolting carriages. As soon as the inflammation is subdued, some mild laxative (35) may be given, in connection with an infusion of wild-cherry bark, geranium, and Solomon's seal, equal parts. Appendicitis. This is one of the so-called modern diseases, — not that it has not existed for a long time, but that not till lately has it been recognized as a distinct ailment. Formerly it fell under the general category of peritonitis or inflammation of the bowels. American physicians have done more toward discovering its characteristics than others. It is an inflammation of the appendix vermiformis, which is situated at the end of the large bowel, in the right flank, close to the junction of the colon with the small bowel (see Fig. 60). This organ is a small, round, tail-like body, about the size of a slate-pencil, and aver- ages some three inches in length. It is hollow, lined with mucous membrane, and covered like the bowel proper with a peritoneal mem- brane. It secretes mucus. Its use is as yet unknown, being thought by many to be a rudimentary organ like the uvula, without function, and possibly analogous to the herbivorous stomach. Whenever small seeds enter the cavity of this organ (which is in reality a rare occur- rence) or whenever, from any cause, a catarrhal inflammation is de- veloped in it, the secretion increases, and being confined, aggravates the trouble. This catarrhal inflammation is generally mild and the trouble often subsides either for good or to start up again sooner or later. The inflammation may, however, become purulent, the germs pen- etrating the walls of the appendix and causing a general inflammation of the peritoneal coat of the bowel. In these cases nature fights hard to resist the invasion of the germ and throws out a large amount of lymph and serum, which, when it hardens, often acts as a barrier to the further progress of the peritonitis which has begun about the appendix. These cases are characterized by a hard lump in the ap- pendicular region, the inside of which contains pus as a rule, which DISEASES OF THE ABDOMINAL CAVITY 317 has escaped from the bursting appendix. Cases of this class are ex- tremely dangerous and require the immediate aid of a surgeon, as they are bound to give trouble sooner or later, even if the first attack does not prove fatal. There is still a third class of cases, called fulminating, because from the very first they seem to be purulent, and spread rapidly into a general peritonitis, death occurring within a few days from the ap- pearance of the first symptoms. These cases are the most hopeless of all, and must be operated on without the slightest delay, since im- mediate evacuation of the pus, before a general infection of the ab- dominal cavity supervenes, is the only possible hope of saving the patient. Symptoms. — The disease, as generally observed, begins with lan- guor and pain in the abdomen, with special soreness on the right side, oftentimes nausea and vomiting, constipation, a slight rise of temperature, and headache. As the disease progresses the tenderness amounts to pain, a bunch may be felt by the medical attendant : the temperature gets a little higher and symptoms of pus formation set in. The case may hang in this initial stage (up to the point of pus formation) for several days and finally subside, it being a more or less catarrhal inflammation; but when pus has once formed the pa- tient cannot escape without an operation for the removal of the of- fending body. Many surgeons at the present day even take the ground that every inflamed appendix should be removed. Treatment. — The medical treatment consists in giving magnesia in form of the solution of the citrate, with a light diet, and keeping the patient in bed. Poultices may be of some benefit. Opium should not be used unless pain is extreme. The operation for appendicitis, when performed between the attacks, is a comparatively safe one in competent hands ; but it becomes a very grave one if pus forms rapidly and invades the general abdominal cavity. Between these two classes of cases there are all grades of difficulty and danger. Cancer of Intestine, This disease is much less frequent than cancer of the stomach, constituting about five per cent of all cases of cancer. It occurs usually about the middle period of life. We are in absolute igno- rance of its causation in this region. The rectum is the most favor- able part of the bowel for its development, the large intestine next, and then the small intestine. Symptoms. — Intestinal hemorrhage, pain; emaciation, irregular movements of the bowels, pain in the sacral region, radiating to the genitals and down the course of the sciatic nerves (in case of rectal cancer), are among some of the indefinite symptoms of cancer of the 318 DISEASES OF THE ABDOMINAL CAVITY. bowels. When well marked and when located favorably, a tumor may be discovered by palpation, but often this cannot be felt and the masses which at first seem to indicate cancer may afterward prove to be merely faecal accumulations. When the mass can be felt in the rectum the diagnosis becomes clearer. The prognosis of the disease is extremely unfavorable. Treatment. — As for treatment, only in rare cases is much aid ever procured. The formation of an artificial anus in the left flank may avert for a while the final end. The injection of the new cancer- serum is still of doubtful success. Opiates to relieve pain, nourishing food frequently repeated, and the use of antiseptic enemas, are, for the most part, the chief meas- ures that afford relief. Intestinal Obstruction. This is a mechanical interference with the movements of the fae- ces, and is caused either by intussusception or invagination, con- striction, twists, stricture or hernia. These conditions are frequently produced by irregular movements of the bowels as a whole, and by irregular movements in various parts of the same, there being an increased peristalsis in one part and constipation in an adjacent part. Many cases of intussuception occur at the ileo-caecal valve, the small bowel entering the large bowel and being driven downward. The circulation of the bowels is naturally interfered with, and intense congestion occurs, with swelling and final obstruction of the calibre of the gut. Pain becomes paroxysmal and peritonitis ensues. Pain increases, with vomiting and the discharge of mucoid stools ; finally the patient dies of exhaustion. Constriction of the bowel forms the larger proportion of cases and is not infrequently caused by fibrous bands which are the result of inflammation. Strangulation may be produced by a loop being held down by such bands or by being twisted about it. Intestinal ob- struction, ulceration, and even perforation are common results. A twist or volvulus is also a cause of obstruction, though less com- mon than the two causes just mentioned, and occurs generally near the sigmoid flexure. Stricture of the bowel usually occurs at the sigmoid flexure, or in the rectum, and is not usually complete, some small amount of faecal matter still escaping. Tumors, like cancer, not infrequently cause stricture by their compression. Functional obstruction occurs chiefly in hysterical females, but also in disease of the brain and spinal cord, as well as from peritonitis and blows on the abdomen. It is the result of a paralysis of the bowel. Impaction of fasces is still another frequent cause of obstruction. The contents of the bowels, especially in the rectum, become hard, DISEASES OF THE ABDOMINAL CAVITY. 319 blocking the passage till quite a perceptible bunch may be felt ex- ternally. The channel is not always blocked completely. Gall-stones may become impacted near the ileo-csecal valve in their passage downward, and form the starting point of the fsecal accumulation. These various causes produce either acute or chronic obstruction. Symptoms. — In the acute variety, pain, vomiting and constipa- tion are the prominent symptoms. There are at first some digestional disturbances, with moderate pain. Afterwards the pain becomes severe, even intense, and is usually located near the seat of the ob- struction. It is at first colicky and intermittent, but finally becomes continuous and severe over the whole abdomen. Vomiting sets in, first of food, then later of bile, and finally stercoraceous if the ob- struction becomes complete. Vomiting occurs whether the obstruc- tion is in the large or small bowel. Before the close of the scene this vomiting assumes a ricewater-like character, perhaps attended with hiccough. There is an absence of the passage of wind, although at first some small amount of fsecal matter may pass. In intussusception there are usually bloody discharges in addition to constipation. The ab- domen of course soon becomes tympanitic or swollen, and sounds of water and gas may be heard very distinctly. The general symptoms are those of a very grave disease, — restless- ness, cold extremities, pinched features, and cold, clammy skin. The pulse is small, the temperature generally subnormal, tongue dry, and thirst very pronounced. In the event of chronic obstruction, all these symptoms appear very much more gradually. Pain is less severe, vomiting often absent till the obstruction becomes complete. The fsecal matter may often be several feet long before the obstruction becomes severe. Long-stand- ing constipation which does not respond to proper laxatives should arouse suspicion. The stools themselves are often ribbon-like in shape and very small, not infrequently resembling the fseces of sheep. The prognosis of obstruction of the bowels is usually very grave, and the duration of life varies from a few hours to ten or twelve days. The higher up the obstruction, the worse the prognosis. Simple fsecal impaction perhaps offers the most hope ; next those cases amenable to surgical interference, Treatment. — Opium to relieve pain and to stop the exaggerated peristaltic movement in parts of the bowel above the obstruction is surely indicated ; it also relieves the vomiting. Continued, large enemas of suds and oil, and even the addition of turpentine, should be resorted to at once as soon as the trouble has been made out. These are best given with the hips elevated, and should consist of four to six quarts of water ; they are to be given slowly and without much force. Oftentimes an ansesthetic is needed. If the obstruction is from fsecal impaction, small, repeated doses 320 DISEASES OF THE ABDOMINAL CAVITY. of some saline should be used ; say two ounces of the solution of the citrate of magnesia every two hours. Castor-oil in teaspoonful doses hourly till movement occurs is also good. But if the obstruction is from intussusception, twist, stricture, etc., all laxatives must be strictly interdicted. Finally, these simple means failing and the case be suspected to be due to impaction by foreign bodies, fibrous bands, etc., the abdomen must be opened and the seat of the obstruction found and if possible removed. The operation in this class of cases is not attended with a great percentage of recoveries, and yet the fatal termination is much surer if left alone ; in many cases it is brilliantly successful. External methods of treatment by hot fomentations of turpentine, and even of massage, often add greatly to a favorable termination. The diet must be very light and nutritious, and in case of vomiting must be given by the rectum. After the obstruction has been re- lieved, one must be very careful about the diet and see that the bow- els are open daily. Wind Colic. — Flatulent Colic. — Interalgia. This is a severe and distressing pain in the bowels, — sometimes a stoppage, and a swelling about the pit of the stomach and the navel. What children call belly-ache is a mild form of it. The wind passing from one portion of the bowel to another causes a rumbling noise. The pain is not increased by pressure ; and this distinguishes it from the pain of inflammation. It moves about, too, from place to place, and is much relieved by the escape of wind up or down. The complaint may be caused by a weakness in the digestive or- gans, by eating indigestible food or unripe fruit, by costiveness, and by taking cold. Some persons always have the colic excited by eat- ing certain kinds of fruit. Treatment. — When the complaint is caused by an indigestible sub- stance taken into the stomach, the offending matter should be thrown off by an emetic as soon as possible. If this does not bring relief, let it be followed by a dose of salts, salts and senna, compound infu- sion of senna, elixir salutis, elixir pro., or sweet tincture of rhubarb. If there is no sickness of the stomach, a little essence of peppermint or spearmint in hot water, or brandy, gin, or whisky, in hot water, may prove sufficient to expel the wind, and relieve the pain. Ginger and hot water does well with some. If there be costiveness, and the pain is obstinate, let the bowels be unloaded by a stimulating injec- tion (248), (249), (250). Inject one dram of. ether in a little starch- water into the bowels, and relief will often be instant. It can be repeated every half-hour. The injection of a table-spoonful of tur- pentine in suds can also be tried and repeated every two hours. DISEASES OF THE ABDOMINAL CAVITY. 321 Air=Swellings. — Tympanites. It is quite common for persons in delicate health — particularly females — to have their stomach and bowels swell up, sometimes slowly, sometimes suddenly, so that they cannot bring their clothes together. They do not know what to make of it; it sometimes alarms them ; and they ask their medical adviser what it means. These swellings may occur from an accumulation of air within the bowels, and also within the abdominal cavity. This latter gives the belly a peculiarly hard feel, like the head of a drum, and when it is pressed upon with the finger no indentation remains. It usually is the result of a weakened sympathetic nervous system, brought about by some one of the many abdominal diseases. Treatment. — If the air be in the intestinal tube, a stimulating in- jection may bring away the wind. It may be composed of one pint of infusion of peppermint, one gill of tincture of prickly-ash berries, half a gill of tincture of castor, and a teaspoonful of ginger. The bowels of the patient should be rubbed for a long time ; and in all forms of the complaint, it would be well to do this every day. Some- times the wind may be drawn off by inserting into the rectum a long rubber tube. Treatment often resolves itself into a cure of some existing uterine or ovarian disease and the various phases of peri- tonitis, in which latter case there is fever and other well marked symptoms. The best constitutional remedies are tonics, — iron, quinine, mineral acids, and bitters, (48), (bh), (59), (60), (62), (63), (64), (71), (73). Exercise in the open air, and a careful regulation of the diet, will do much towards removing these troubles. Costiveness must be care- fully guarded against. Bilious Colic. This is a dangerous disease. There is pain of a griping, twisting, tearing kind, — what the ancients called atrocious pain. It is chiefly about the navel, but sometimes tortures the whole belly. It comes and goes in paroxysms. Sometimes the abdomen is drawn in, at other times it is swelled out, and stretched like a drum-head. At first the pain is relieved by pressure ; after a time the belly is tender to the touch. There is thirst and heat, and a discharge of bilious mat- ter from the stomach. In the worst cases, the pulse is small, the face pale, the features shrunk, and the whole body covered with cold sweat. While the head is hot the feet are cold. In advanced stages of the disease, the action of the bowels is sometimes reversed, and the fecal matter forced up through the mouth, owing to impaction of faeces or other obstructions of the bowel. 322 DISEASES OF THE ABDOMINAL CAVITY. Causes. — Costiveness, irritating substances in the bowels, thick, vitiated bile, long exposure to cold, torpidity of the liver and skin, great unnatural heat, with dampness, obstructed gall-duct, etc. These attacks are usually the result of indigestion in the upper bowel, near the bile-ducts, creating a thick mucus which obstructs the passage of bile from the ducts into the bowels. A regulation of the duct, small doses of podophyllin or the acids, with daily doses of some mild bilious laxative, will prevent their return. Crab-orchard water^ sal-muscatelle, and other simple medicines answer every pur- pose. Treatment. — Administer an active purgative injection immediately (251), (252). Internally, dioscorin, camphor, etc. (340), every fifteen minutes until relief is obtained, at the same time covering the whole belly with a large mustard-poultice. A strong decoction of the wild- yam root, drunk freely, is a medicine of some value, — so is a decoc- tion of sculleap and high-cranberry bark, equal parts. This latter article is excellent in spasmodic affections, on which account it has gained the name of cramp-bark. The sickness at the stomach may frequently be allayed by effervescing drafts, to which twenty-five or thirty drops of lavender are added. Croton-oil, given in one-drop doses, done up with crumb of bread, will sometimes succeed well as a purgative medicine ; or castor-oil and spirits of turpentine, equal parts, in two great spoonful doses, may be tried before the croton oil. The warm bath is worth remembering, and trying, too, if the means are at hand. Hot fomentations of the bowels with a decoc- tion of poppy-leaves, stramonium-leaves, hops, wormwood, boneset, or peppermint leaves, should not be overlooked. Bottles filled with hot water, or hot bricks rolled in flannel, should be placed at the back and feet to promote perspiration. Persons subject to this complaint may derive advantage from one pill composed of extract of high-cranberry bark, etc. (100), taken after each meal for some months. At the same time a reasonable amount of exercise should be taken out of doors, and a sponge bath, with friction, be employed daily. Care should be taken not to be often exposed to the hot sun. Painters' Colic. — Colica Pictorum. This form of colic is caused by the slow introduction of lead into the system, — generally the carbonate of lead. It passes under the different English names of painters' colic, Devonshire colic, and dry belly-ache. The first of these is the name by which it is most com- monly known, from its frequent occurrence among painters, who use white lead (carbonate of lead) a great deal in the preparation of their colors. Symptoms. — The disease generally comes on in a very gradual DISEASES OF THE ABDOMINAL CAVITY. 323 way. At first, the appetite is impaired, there is a slight nausea, belching of wind, languor, very obstinate costiveness, transient pains, with a feeling of weight and tightness in the belly, and a disinclina- tion to make any exertion. By degrees, the pain in the bowels, and particularly about the na- vel, becomes more severe, and has a twisting character. The belly becomes hard, drawn in, and a little tender to pressure, and the stom- ach very irritable. The pain occasionally slacks off a little ; but never, even in mild cases, entirely stops, as in other kinds of colic. In some severe cases, the pain runs up to the chest, and down the arms ; also down to the bladder, causing the urine to be passed with pain and difficulty, and giving a sense of weight and beaiing down in the lower belly. During the severest pains, the countenance is pale, contracted, and full of suffering ; cold sweats break out upon the face and limbs, and anxiety and agitation seize the patient. When the disease is not seasonably removed, it degenerates into the chronic form, the mental and physical energies become torpid, the circulation in the small vessels inactive, the skin dry, harsh, shriv- elled, pale, sallow, or of a leaden hue, the temper irritable, despond- ing and gloomy, and the body wasted. Besides all this, the muscles which lift up the lower arm become palsied, so that, when the arms are raised, the hands hang down in a helpless condition. In some cases, there is a blue line along the edges of the gums. Treatment. — For relieving the pain and opening the bowels, the treatment should be very much the same as that for bilious colic. There is one article, however, which is thought to have some special influence in curing this disease, after it has become chronic ; it is alum. Fifteen grains of alum, two of aloes, two of jalap, and four of ipecac powder, may be mixed, and taken for a dose two or three times a day. If the muscles of the arm be palsied, one thirtieth of a grain of strychnine may be added to the above. The aromatic sul- phuric acid, taken as a drink, fifteen drops to the tumblerful of water, is always worthy of trial. The use of the electromagnetic machine maybe tried for the palsy; or a splint applied to the arm and hand, with vigorous friction once or twice a day, will sometimes do much for recovering the use of the muscles. But the best remedy for the palsied muscles is iodide of potassium (146), taken freely. The sulphuret of potassa, one ounce dissolved in a quart of water, and taken in teaspoonful doses, three times a day, is also worth a trial. The affected arm should be soaked an hour, once or twice a day, in the same amount of this latter salt, dissolved in a gallon of water. Means of Prevention. — The numerous persons who work in lead should comb their hair with a fine comb, wash their hands and face, and rinse their mouth several times a day, and also wash the whole 324 DISEASES OF THE ABDOMINAL CAVITY. person with soap once or twice a week, and with clear water, or sal- eratus and water, once a day. Their working clothes should be of a kind to admit of being washed once or twice a week, and they should be put off for others when out of the workshop. A paper cap should be worn while at work. The food of the workmen should not be ex- posed to the vapors or floating particles of lead, and consequently should not be carried into the shop ; and when much of the poison is floating in the air of the workroom, it is a good plan to wear a mask to prevent its being drawn with the breath into the throat and lungs. It has been said that those who eat freely of fat meats, butter, and other oily substances, are not attacked by the disease, though exposed to the poison. I know not what protection this can give, unless the skin is in this way kept more oily, which prevents the absorption of the poison. This would seem to afford a hint in favor of anointing the whole person once or twice a week with sweet-oil. Costiveness. — Constipation. Few disorders are more common than costiveness. By this term I mean a sluggish state of the bowels, which causes them to retain the faeces longer than is warranted by health, hi this complaint, the discharges from the bowels are not always less frequent than they should be, but they are less in quantity, are compacted and hard, and are passed by hard straining, and sometimes with considerable pain. Symptoms. — Headache, dizziness, feverishness, bad feelings in the head not easily described, loss of appetite, sometimes nausea, but little desire to go to stool, a weight and heaviness about the lower part of the belly, and a sense of confinement over the whole body. Causes. — Sedentary habits, particularly when connected with close application of the mind ; astringent articles of medicine ; stimulating diet, composed chiefly of animal food ; various diseases, particularly those of a nervous character, and especially, a neglect to evacuate the bowels at proper periods. All these causes tend to weaken the bowels, and gradually to arrest that peculiar undulatory movement, or worm-like action, called the peristaltic motion of the bowels. It is this continual contraction of the muscular fibres of the intestines from above downward, which pushes the contents steadily along; and whatever weakens the force of this vermicular play of the intestinal walls, brings on constipation. Treatment. — One of the first things to be done is to establish the habit of attempting to evacuate the bowels at a particular hour every day. The best time for most persons is soon after breakfast in the morning. Whether successful or not, the attempt to procure an evac- uation should on no account be omitted. This regularity will often do much to break up the costive habit. Diet To this should be added a careful regulation of the diet. DISEASES OF THE ABDOMINAL CAVITY. 325 The quantity of food taken should be no greater than can be easily digested. Full meals which distend the stomach and cause it to press upon the bowels embarrass their movements. Bread made from fine wheat flour is an abomination in this disorder. Eat only that from unbolted flour. Cracked or rolled wheat, prepared as directed among dietetic preparations, is excellent for the cure of costiveness. Fresh vegetables, as peas, beans, potatoes, squashes, and ripe fruits, in their season, are all wholesome, and help to relieve costiveness. But rich pies, puddings, cakes, doughnuts, and all that sort of trash, increase the disorder. Water Injections, etc. — One of the best remedies is water, cold or tepid, according to the condition of the patient, injected into the bowels with the fountain syringe. Syringes for this purpose may be obtained in any drug-store, and one should be in every family. Water used externally, in the form of the sponge-bath, is also useful. Medicines. — All the above measures having failed to give relief, take Mettauer's aperient, or the neutralizing mixture. If these fail, podophyllin, etc. (36), may have a trial. A cold decoction of thorough- wort, drunk daily, sometimes has an excellent effect. It must be re- membered that medicines may make matters worse, and they should be used cautiously. Cascara Sagrada taken in small, repeated doses, say, half a grain once, twice or more times daily till the bowels move, for some weeks, then gradually decreased, often yields excellent re- sults. A glass of some aperient like Hunyadi Janos water, one-third glass with one-half glass of plain water on rising, will then take the place of the cascara ; and finally a glass of plain water will accom- plish all that previously required the use of the cascara. Daily knead- ing of the bowels, following the course of the large bowel, will add greatly to break up the sluggishness of the muscular atony of the bowel-walls. Piles. — Hemorrhoids. There are few complaints more common than the piles, and scarcely any which cause more trouble and misery. They consist in a fullness of blood, and languid circulation in the lower portion of the lower bowel or rectum. In consequence of this congestion, either the veins of the gut become enlarged or varicose, or the blood gets infil- trated into the cells beneath the mucous membrane, and collects, so as to form bloody tumors. These tumors, which are seldom absent, are the leading features of the piles. They sometimes appear externally, around the anus ; this is external piles. At other times they are within the bowel ; the com- plaint is then called internal piles. They are called bleeding piles when blood is discharged, and blind piles when it is not. Symptoms. — Usually there is a sense of weight and weakness in the lower part of the back and lions, with a painful itching about the ,/ 326 DISEASES OF THE ABDOMINAL CAVITY. anus. On going to stool, there is a burning, cutting pain experienced, which is followed by bearing down and tenesmus. If it be bleeding piles, the little tumors will bleed at every motion of the bowels. There are frequently disagreeable sensations in the head, general las- situde, an irritable state of mind, and a sense of fullness and anxiety in the stomach. The pains experienced range all the way from the slightest twinges up to the most terrible sufferings, which appear like tearing the body asunder. Causes. — Everything that irritates the lower bowel, and causes a determination of blood to the part. All drastic physic has this effect, — particularly aloes, which acts especially upon the rectum. Habit- ual costiveness, straining at stools, riding much on horseback, sitting a great deal, tight-lacing, high-seasoned food, and stimulation gener- ally, lifting and carrying heavy weights, and indurations of the liver, as well as a bilious indigestion. Females during pregnancy are much affected with piles, which are induced by the costiveness so peculiar to their condition, and by the pressure of the enlarged womb upon the veins of the pelvis. Treatment. — This should be medicinal and dietetic. Great care must be observed not to push medication too far. Ac- tive purging will do great mischief. Yet costiveness must in some way be corrected. For this purprse, no remedy that I have ever tried has done better in this complaint than an electuary composed of confection of senna, flowers of sulphur and cream of tartar (6), taken in doses just sufficient to procure one natural motion of the bowels each day. Pills made of extract of thoroughwort are said to do well. If the liver be in a congested state, take some of the arti- cles recommended in the chronic inflammation of that organ. For the local treatment, nothing is better than two ounces of lard and one dram of the flowers of sulphur mixed, and rubbed between two plates of lead until they are well blackened. This ointment is not only soothing but curative, both in the bleeding and blind piles. An ointment of almost equal excellence may be made from one hand- ful each of witch-hazel bark, white-oak bark, and sweet-apple tree bark, boiled together in one pint of water down to one-third of a pint. Then strain, and add two ounces of lard and simmer away the water, — stirring continually before and after removing from the fire, till it cools. Witch-hazel suppositories are excellent, as is also an oint- ment composed of 1 ounce stramonium ointment, 6 grains pulverized opium, and 5 grains tannin. If there is much inflammation and distress, an emollient and soothing poultice should be applied, composed of slippery-elm bark and stramonium or poke leaves. Steaming the parts is some- times useful, by sitting over a hot decoction of hops, stramonium, and poke. Piles may often be cured by the use of the domestic syringe. Daily DISEASES OF THE ABDOMINAL CAVITY. 327 injections of cool or cold water will do much to strengthen the bowel, and restore the dilated veins to their natural condition. The food should be of a laxative nature, corn-bread, rye-pudding, bread of unbolted wheat flour, mealy potatoes, ripe fruit, pudding and milk, buckwheat cakes, broths, and a little tender meat once a day. When the piles are very painful an ointment of cocaine, ten grains, vaseline, one-half ounce, smeared well over them, is exceed- ingly grateful. Five-grain iodoform suppositories are very effective in reducing piles ; its odor, however, is quite objectionable to many. Surgical treatment is often the only resource left for their cure. Looseness of the Bowels. — Diarrhoea. Looseness, or relax of the bowels, is manifested by frequent, copi- ous, and thin or unusually liquid discharges. The excessive dis- charge may be caused either by irritating and unwholesome food, by inflammation and ulceration of some portion of the bowels, or by de- bility. Symptoms. — Rumbling noise in the bowels, with more or less weight and bearing down and uneasiness in the lower part of the bowels. This pressing down and uneasiness are relieved as soon as the evacuation takes place, but returns when another is near at hand. Griping is generally present, the strength is reduced, and the skin is pale, dry, and, after a time, sallow. Treatment: — When the complaint is caused by irritating food, it will generally stup as soon as the offending substance is removed, and not much medicine will be required. To neutralize any acidity, to remove wind, allay irritation, and strengthen the stomach, the compound syrup of rhubarb and potassa is well adapted, given in teaspoonful doses, every hour, till it oper- ates. A little paragoric added to it occasionally, or essence of pep- permint, or spearmint, may aid its good effects. If nausea and vomiting are present, put a mustard poultice of one- third strength upon the stomach, and give one-tenth grain of cocaine in a teaspoonful of water every fifteen minutes. If there is much grip- ing, give an injection (248), with twenty drops of camphor in it. A common diarrhoea may generally be arrested at once by prescrip- tions 159 or 162, in teaspoonful doses, after each discharge. When there is inflammation and ulceration of the bowel, the treat- ment must be similar to that for dysentery, — fomentations exter- nally, and the occasional use of starch injections, mild cathartics (9), (10), and poultices externally. Chronic Diarrhoea. The acute form of diarrhoea, not being properly managed, often runs on, and becomes chronic, and is at times exceedingly difficult to cure. 328 DISEASES OF THE ABDOMINAL CAVITY. Symptoms. — Frequent discharges, generally with some pain and griping, restlessness, thirst, poor appetite, debility, loss of flesh, dry, rough, and somewhat sallow skin, and tongue dry and dark-colored. The food often passes through the bowels pretty much in the condi- tion in which it was swallowed. The liver is generally out of order, and the bowels are frequently afflicted with a low grade of inflam- mation. Treatment. — In this form of the disease, astringents and tonics will generally be required. Sometimes a teaspoonful of brandy, in a little sweetened water, or in clear water, several times a day, will effect a cure. Good cherry brandy is a valuable remedy ; so is black- berry brandy. Many of the worst cases have been cured by taking no nourishment, for a long time, except milk, with a little lime-water in it. When the liver is involved in the complaint, as evinced by light- colored stools, leptandrin, geranium, etc. (341), may be given with advantage. In some instances, when there is considerable debility, pills of quinine, catechu, etc. (342), will do well. A sponge-bath must be taken daily, and the skin be well rubbed after it. Cholera Morbus. The above name is given to a disease common in warm weather, and characterized by sudden attacks of bilious vomiting and purging, with severe pain in the belly, jcramps, and general fever and subse- quent prostration. The great amount of bile secreted and discharged has given it the name cholera, from cholos, bile. Symptoms. — The disease begins by sickness and distress at the stomach, which is succeeded by violent gripings, with vomiting of thin, dirty-yellowish, whitish, or greenish fluid, with discharges from the bowels similar to that vomited. The nausea and distress, with some few exceptions, continue between the vomiting and purging, and the pain, at times, is intense. The pulse is rapid, soon becoming small and feeble, the tongue dry, the urine high-colored, and there is much thirst, though no drink can be retained on the stomach. It is to be distinguished from diarrhoea by the bilious discharges. Treatment. — Apply a large mustard poultice over the stomach and liver, and give tablespoonful doses of compound powder of rhubarb and potassa, every half hour, until the vomiting and nausea are checked, adding to each dose five to ten drops of camphor, if neces- sary. Perhaps it would generally be best, however, to give liberal draughts of warm water, at first, or flax-seed tea, that all the solid contents of the stomach and bowels may be washed out. A teaspoonful of laudanum in a wine-glass of flax-seed tea, given as an injection, every two hours, will sometimes do excellently well ; DISEASES OF THE ABDOMINAL CAVITY. 329 or a tea made of chamomile flowers, or Colombo, and made sour by a few drops of nitric or sulphuric acid, and given internally, will some- times succeed better than most other things. One grain of svapnia and thirty grains of bicarbonate of soda dissolved in an ounce of sweet tincture of rhubarb, and given in teaspoonful doses, every half hour will often have a fine effect. The prescription 162 is also valuable. Hot-water bags should be applied to the feet, and warm flannels, or other kinds of dry heat, to the whole body. Asiatic Cholera. Besides the above name, this fearfnl disease has been called epi- demic cholera, malignant cholera, spasmodic cholera, and cholera asphyxia. It first attracted notice in Bengal in 1817, whence it spread westward through Europe, and in 1832 it reached Quebec, on this continent. It has since then visited Asia and Europe several times with great severity, and has even been present on our shores. But at the present day the strict vigilance of sanitary boards has done much to prevent its spread and mitigate its terrors. Through the investigations of Koch and others it is now known to be propa- gated by a microbe, called the comma bacillus, and the efforts of investigators is now being directed to the discovery of an agent that will destroy this germ and thus control the disease. Symptoms. — -First Stage. — The first, premonitory stage, is marked by derangement of the digestive organs, rumbling in the bowels, pain in the loins or knees, twitching of the calves of the legs, impaired appetite, thirst, and especially, a slight diarrhoea ; and these symptoms continue from a few hours to several days. I should add to these symptoms what is said to have been recently discovered, namely, that for several days before the attack, the pulse is down to forty or fifty beats in a minute. This, if it prove to be reliable, is a very valuable symptom. Second Stage. — This stage is marked by vomiting and purging a thin, colorless fluid, looking almost exactly like rice-water; by severe cramps in the calves of the legs, which soon attack the bowels and stomach. These cramps are excessively painful, and draw the mus- cles into knots. The tongue is pale and moist; the pulse feeble, though sometimes full and firm ; the breathing hurried, with distress about the heart ; great thirst ; a feeling of internal warmth, and the secretion of urine entirely stopped. These thin, colorless discharges by vomiting and purging, are the serum or watery portion of the blood, which oozes through the sides of the blood-vessels, and runs off rapidly, leaving the crassamentum, or red, solid part of the blood, stranded upon the inner surfaces of the arteries and veins. When so much of this is discharged that the blood cannot circulate freely, the patient sinks into the 330 DISEASES OF THE ABDOMINAL CAVITY. Third Stage, which is characterized by great prostration ; pulse hardly perceptible ; skin cold and clammy; face blue or purple, and eyes much sunken ; hands dark -colored and sodden, looking like a washerwoman's ; breathing short and laborious; a sense of great heat in the stomach ; and intense thirst. Recoveries from this stage sel- dom take place. Treatment. — In the first stage, the diarrhoea should receive the most prompt attention. From five to ten drops of laudanum, re- peated a few times, every three hours, will generally put a stop to it. Catechu (162) is also a suitable remedy. The compound syrup of rhubarb and potassa, with some other articles (343), in tablespoonful doses, every hour, till it operates gently, is worth a trial. The diet should of course be very carefully regulated at such a time, though not particularly changed, except to leave off any indigestible article which is known to be injurious, and to be made a little more sparing than in time of perfect health. When the second stage has set in, or the stage of vomiting, purg- ing, and cramps, the treatment must be energetic. The sinking pow- ers must be sustained by chloroform, opium, and ammonia (119), or by camphor, opium, and cayenne (344), giving one pill every hour. Brandy may also be given freely. The warmth of the surface must be promoted by all possible means, hot bricks and bottles, tincture of cayenne, friction, etc. In the third stage, the remedies recommended above are to be pur- sued with increased energy, particularly the stimulants, and the efforts to promote the warmth of the surface. Dysentery. — Bloody Flux. — Colitis. This is an inflammation of the mucous membrane lining the lower or large bowels. The small bowels begin at the stomach, and are eight or ten yards long ; being largest near the stomach, and dimin- ishing in size as they approach their termination in the caecum. The lower or large bowels are two or three times as large as the small ones, and from their junction with the latter, they extend about six feet to the outlet, or anus. The large bowels are composed of the caecum, the colon, and the rectum. The rectum is about one foot in length. In most cases of dysentery, the rectum, and about half the adjoin- ing portion of the colon, experience the chief force of the inflamma- tion. Sometimes the whole of the colon and caecum are affected. Sometimes the mucous membrane lining these is ulcerated, and, be- coming wholly disorganized, passes off in shreds. Symptoms. — The disease comes on with loss of appetite, costive- ness, lassitude, shivering, heat of skin, and quick pulse. These are followed by griping pains in the bowels, and a constant desire to pass DISEASES OF THE ABDOMINAL CAVITY. 331 their contents. In general the passages are small, composed of mucus mixed with blood. These passages are attended and followed by severe gripings and inclination to strain, learnedly called tormina, and tenesmus. They are sometimes, in the early stages, attended by nau- sea and vomiting. The natural feces, which do not pass off much, are small in quantity, and formed into round, campact balls, or irreg- ular, hardened lumps. This tenesmus, or great desire to strain, will continue, perhaps increase, for several days — the discharges being mostly blood in some cases, and chiefly mucus in others. Having generally but little odor at first, these discharges become, as the dis- ease advances, exceedingly offensive. Causes. — Dysentery is very frequently caused by sudden changes from hot to cold, by which sweating is suddenly checked, and the blood repelled from the surface. Hot climates, and dry, hot weather are predisposing causes. All green, unripe, and unwholesome food, and indigestible food of every sort, may induce it. Treatment. — In mild cases give a tablespoonf ul of castor-oil and two teaspoonfuls of paregoric, mixed, once a day. Sometimes, in place of the above, a dose of rochelle powder, dissolved in water, and eleven or twelve drops of camphor, may be taken. A moderate quan- tity of flax-seed or slippery-elm tea, may be taken as a drink, and the bowels be well emptied by an injection of starch. When there is much pain in the bowels a mustard poultice laid upon them will have a good effect. The starch injections should, in such case, have half a teaspoonful of laudanum mixed with it. The compound syrup of rhubarb and pdtassa will often act favorably, given in tablespoonful doses. If there is reason to suppose the liver is affected, give podophyllin, etc. (46). The patient should not be allowed to sit up, and must be kept very still, and be allowed only a very scant diet, as flour porridge, well boiled, rice water, etc. Chronic Dysentery. When dysentery " runs on " for some time, it is liable to become chronic. Symptoms. — Looseness of bowels, — the discharges being un- healthy, more or less bloody, attended by bearing down, or a desire to strain, and being in number from two to forty a day. There is great debility, the pulse is weak and quick, the tongue slightly furred, the appetite lost, the face pale and sallow, the skin dry and parched. Sometimes the relax alternates with costiveness. Treatment. — In this form of the complaint, astringents will be necessary (159), (161), (162), (345), (346), (347). Injections may be used, if necessary, composed of nitrate of sil- 332 DISEASES OF THE ABDOMINAL CAVITY. ver, fifteen grains to the ounce of water, or an infusion of golden seal, with a little tincture of prickly-ash berries added to it. The diet must be very light, easy of digestion, and nutritious. In some cases, it should be composed chiefly of wheat porridge, or boiled milk and boiled rice. In other cases, a little tender beef-steak should be taken once a day. Worms. — Vermes. The intestinal canal is subject to various disturbances from the presence of worms. Of these troublesome tenants, there are three principal varieties. The Ascaris, or phi-worm, called also maw or thread worm, is a small, white, thread-like worm from half an inch to an inch in length. These worms live, in great number, in the rectum, where they excite great irritation and itching. The Lumbricus, or ascaris lumbricoides, is a round worm, about an eighth of an inch in thickness, and from an eighth to a quarter of a yard in length. Its color varies from a milky whiteness to a deep red. It generally occupies the small bowels. The Tenia Solanum, or tape-worm, is a flat worm, with four suck- ers at the head, is from a few feet to some hundreds in length, and full of joints. It dwells in the small bowels, and feeds on the chyle as it comes along, before it is absorbed by the lacteals. In this way, it robs the body of nourishment, and produces great loss of flesh, and an enormous appetite. Symptoms. — In the grown person the symptoms of worms are quite obscure, except an intolerable itching within the anus, which generally indicates pin-worms. In children worms are indicated by paleness, itching of the nose, grinding of the teeth and starting in sleep, irregular appetite, bad breath, swelled upper lip, picking of the nose, hard swelled belly, and one cheek constantly flushed. Treatment. — For expelling worms various articles have been used. Among these spirits of turpentine (155) has a high reputation. The following preparation does well : Spirits of turpentine, half an ounce ; essence of anise, half an ounce ; castor-oil, one ounce ; worm-seed oil, one ounce. Mix. The dose for a child one or two years old is ten to twenty drops, every two or three hours. In two or three days, a brisk physic should be given. The worm-powder is quite success- ful. One of the most popular remedies is the pink-root. It should be united with a purgative. The following is a good preparation: Pink- root and senna, each half an ounce ; bitartrate of potassa, one dram ; pulverized jalap, half a dram ; cardamom seeds, half a dram ; extract of liquorice, two drams. Mix, and add half a pint of boiling water. Let the whole steep an hour. Give a tablespoonful or two, occasion- ally, till the worms are expelled. - DISEASES OF THE ABDOMINAL CAVITY. 333 An injection composed of quassia (66), or aloes (22), or of simple sweet-oil, is very effectual *in removing pin-worms from the lower bowel. So is an injection composed of the red iodide of mercury, one grain; iodide of potassium, half a grain; and two pints of water. Most of the above preparations are thought to be successful in ex- pelling all kinds of worms ; but for the tape-worm, no other remedy has yet shown itself as effectual as pumpkirirseeds. The seeds should be well bruised, and steeped in water. This should be drunk freely for several days, if need be. It is believed to be a sure remedy, even in cases of several years' standing. In all cases of worms, the diet should be carefully chosen, and be connected with proper exercise, pure air, frequent bathing, and all those measures which tend to improve the general health. After the expulsion of the worms, tonics should always be taken to strengthen the bowels, that the same evil may not return. Acute Inflammation of the Kidneys, — Nephritis. Before speaking of this disease, I wish to give the reader a general idea of a kidney, and shall do so by the use of two cuts. Fig. 110 presents the external surface of the right kidney, with its renal capsule mounted on top ; t, being its upper edge ; /, \ superior and inferior branches of the emulgent artery ; e, d, e, three branches of the emulgent vein ; a, the pelvis of the ureter ; 5, the ureter. Fig. Ill is the same kidney laid open ; 1, being the super-renal capsule ; 2, the vascular portion ; 3, 3, the tubercular portion, consisting Fig. 110. Fig. 111. of cones ; 4, 4, two of the calices receiving the apex of their corres- ponding cones ; 5, 5, 5, the three infundibula ; 6, the pelvis ; and 7, the ureter. The kidneys are glands, and their office is to draw or strain off 334 DISEASES OF THE ABDOMINAL CAVITY. from the body those effete or worn-out particles, or products of decay which contain nitrogen, while the liver takes away those carbonaceous matters which have no nitrogen. These useless substances which go out through the kidneys are generally in the form of urea. In carry- ing off these matters, the kidneys may have more to do than properly belongs to them ; and may be so stimulated, or irritated, or injured in some way, as to become inflamed. . Symptoms — Like most other inflammatory diseases, it begins with cold chills and rigors, especially in the back and loins, followed by fever and pain. The pain frequently extends to the bladder, the loins, and the thighs, and is of a severe, lancinating kind. — though some- times obtuse. Pressure, motion, straining, or taking a full breath, add to its pungency. The urine is scanty, high-colored, sometimes bloody, and can only be passed drop by drop. In the loins there is a sense of heat, gnawing, and constriction ; the bowels are either constipated, or relaxed by diarrhoea. A numbness of the thigh, and drawing up of the testicle on the affected side, are marked and peculiar symptoms. In some cases, there are nausea, vomiting, oppression of the stomach, faintness, hiccough, drum-head distention, and rumbling of the bowels. The skin is hot and dry, the pulse hard and frequent. Causes The use of cantharides, oil of turpentine, and other di- uretics, taking cold, violent exercise, mechanical injuries, the transla- tion of rheumatism or gout, the striking in of skin eruptions, and gravelly formations in the kidneys or ureters. Distinctions This disease is to be distinguished from colic by the pain being increased hj pressure, and by the frequent but difficult discharge of red urine ; from lumbago, from its being confined fre- quently to one side, and also by the urinary troubles, and by the nausea and vomiting; and from all other diseases, by the numbness >f the thigh, and the drawing up of the testicles. Terminations of the Disease It runs a rapid course, and may terminate by resolution, or by suppuration. When the latter happens, it is indicated by the decline of the more violent symptoms, a throb- bing and a sense of weight, with chills, followed by flushes of heat, and sweating. The matter formed, generally small in quantity, may pass into the cavity of the kidney, and thence through the bladder to a natural outlet with the urine. Treatment Either put the feet into a hot mustard-bath, or put mustard drafts upon them. At the same time apply a large mustard poultice upon the small of the back, and follow it up with hot fomen- tations of stramonium leaves and hops, or stramonium and wormwood or tansy. Let perspiration be induced as soon as possible by five to ten- drop doses of tincture of veratrum viride, repeated every hour, or by teaspoonful doses of the compound tincture of Virginia snake-root, given every half hour. DISEASES OF THE ABDOMINAL CAVITY. 335 If costiveness exist, the bowels must be opened by epsom salts, cream of tartar, or salts of tartar ; or by copious injections of warm water, containing a few drops of the tincture of arnica-leaves. Such injections not only unload the bowels, but act as a local bath, by lying in the bowel near the inflamed kidneys. The drinks must be mucilaginous and diuretic. The marshmal- low root and peach-leaves, slippery-elm bark, flax-seed, mullein, elder blows, hair-cap moss, and cleavers, are all valuable. If the disease is caused by gravel, twenty drops of liquor potassse, largely diluted with flax-seed and upland-cranberry tea, and taken freely as a drink, is excellent. We recommend Poland water in large quantities. Chronic Inflammation of the Kidneys. This is frequently the result of the acute form of the disease, but is also produced by injuries and other causes. Symptoms A weakness in the small of the back, and a dull, heavy pain in the kidneys. The urine is passed often and in small quantities. It is alkaline — sometimes white and milky — and has in it deposits of phosphate of lime, and triple phosphates. Treatment. — Infusions of pipsissewa, uva ursi, trailing arbutus, wild carrot, queen of the meadow, buchu-leaves, or foxglove are use- ful diuretics, and may be taken with advantage. The bowels must be kept open with some gentle physic (18), if they are costive ; and the alkaline sponge bath, with friction, be used daily. An eruption may be brought out upon the small of the back by rubbing on a few drops of croton-oil ; or, if the patient prefer it, a mustard poultice may be applied two or three times a week. The food should be nutritious, and easily digested, and a little ex- ercise be taken daily in the open air. Acute Inflammation of the Bladder. — Cystitis. This disease affects the lining membrane of the bladder, — some- times its muscular substance. It may attack the upper portion, the middle, or the neck of this organ. It runs a rapid course. Symptoms. — Burning, piercing, and throbbing pain in the region of the bladder. The pain extends to the perineum, and in some cases, to the testicles and thighs, and is much increased by pressure. The perineum, the space between the fundament and testicles, feels sore to the touch. The desire to pass urine is incessant, but the effort to do so is mainly ineffectual. The water passes off drop by drop, with great pain, or is entirely stopped, causing enlargement of the bladder, and great distress. Mucus from the inflamed lining of the bladder passes off with the water. Nausea, vomiting, and 336 DISEASES OF THE ABDOMINAL CAVITY. great anxiety are common. The bowels are bound, and when the disease is on the side next the lower bowel, there is a desire to empty the bowels ; and if the inflammation be in the neck, there is great pain in the perineum, and frequently an entire retention of the water. The pulse is full, hard, and frequent, the skin hot and dry, the thirst urgent, and the patient restless and dejected. Causes. — This disease may be produced by taking cantharides and turpentine ; by irritating substances forced into the bladder with a syringe, or by pushing bougies or catheters into it ; by gravel-stones in the bladder ; by retained urine ; by external injuries ; by gonor- rhoea ; and by cold applied to the feet, or to the lower portion of the abdomen. Treatment. — If the urine be retained, it is of the utmost impor- tance that it be earty drawn off with the catheter, lest a distention of the bladder bring on mortification. Great care is required not to pro- duce irritation by any roughness in introducing the instrument. Leeches should be applied upon the lower part of the bowels, the perineum, and around the anus. When these are removed, warm poultices should be applied. Cold compresses will often do as well. The bowels must be opened with epsom salts. Injections of warm water, with a few drops of tincture of arnica-leaves, will act finely as a local bath, — the water being retained as long as possible. The tincture of veratrum viride will be required in five to ten-drop doses, or the compound tincture of Virginia snake-root, to induce perspiration. Ex. jaborandi may sometimes be used for the same purpose. Drinks must be taken very sparingly. A small amount of cold in- fusion of slippery-elm bark, or marshmallow and peach-leaves, or cleavers. This mucilaginous drink must be the beginning and the end of the diet during the active stage of the disease. Alkalis are exceedingly useful in allaying the pain and smarting of urination, perhaps the best remedy being liq. potass, citratis, in tablespoonful doses every two hours. Suppositories of opium and belladonna in one-fourth grain doses by the rectum every two to four hours allay the frequent urination and pain and quiet the spasm of the neck of the bladder. Chronic Inflammation of the Bladder.— Cystirrhcea. This is much more common than the active form of the disease. It often arises from the same causes which produce acute inflamma- tion of the bladder. It often passes under the title of "catarrh of the bladder." It is a chronic inflammation of the mucous lining of that organ, and is a very common and troublesome affection among old people. Symptoms. — Slight lancinating pains, with a feeling of heat in the region of the bladder, and a sense of weight and tenderness in the DISEASES OF THE ABDOMINAL CAVITY. 337 perineum ; frequent and tormenting desire to pass water, with occa- sional spasmodic action of the bladder. The urine is loaded with tenacious mucus, just as the expectoration has large quantities of mucus in it when there is inflammation of the membrane lining the windpipe and bronchial tubes. When the water has stood a while, this mucus settles at the bottom of the vessel, leaving the fluid clear above. Great quantities of this are sometimes passed, — amounting even to pints in a day. The triple phosphates of magnesia and am- monia are often found in the water. Frequently there are derangements of the appetite and digestive functions, a white or brown fur upon the tongue, a harsh, dry skin, with thirst and general debility, — especially in the back and loins. Sometimes there is a little fever. Treatment. — To reduce the inflammation, apply leeches, or mus- tard, or croton-oil, or a cold compress every night. As a diuretic, give an infusion of buchu, uva ursi, trailing arbutus, queen of the meadow, etc. Tincture of veratrum viride and sweet spirits of nitre (125) is a good remedy. The compound infusion of trailing arbutus is well recommended. So is the compound balsam of sulphur. An infusion of the pods of beans has been well spoken of. An injection into the bladder, once a day, of a tepid infusion of golden-seal root, with much care, may be of great service ; or an infusion of equal parts of golden-seal, witch-hazel, and stramonium. It may be done with a gum-elastic catheter and a small syringe. The bowels must be kept open with the neutralizing mixture, or some other mild physic ; and the skin bathed with saleratus and water once a day, and rubbed well with a coarse towel. Should there be any scrofulous, or gouty, or rheumatic condition of the system, the remedies for those complaints may be used in addition to the above. Disease of the Supra=Renal Capsules. The supra-renal capsules are small bodies situated above the kid- neys. (Fig. Ill, 1.) Their office is not well understood. It has been found of late that they are subject to a disorder having peculiar symptoms. This is a comparatively new disease. Symptoms The most marked symptom is a peculiar change in the color of the skin, called " bronzing." This bronzing process be- gins in patches on those parts exposed to the sun, and to friction, as the neck, the backs of the hands, the fronts of the thighs, and the arms. These patches look, in color, like spots upon a bronze statue, deprived of their gloss. Another marked symptom is a general debility, which comes on without any apparent cause, — there being, generally, no evidence of organic disease, and no loss of flesh, — and is attended with faint- 338 DISEASES OF THE ABDOMINAL CAVITY. ings, loss of energy both of body and mind, a peculiar flabbiness of flesh, and an early death, apparently from sheer weakness. The blood becomes depraved, and loses its coloring matter, as shown by the paleness of the skin where there is no bronzing. The pulse is generally very soft and compressible. The stomach is irritable, the appetite is gone ; there is nausea and sometimes vomiting, with pain and a sense of sinking at the pit of the stomach. Fre- quently there is costiveness, sometimes diarrhoea, and pains in the back and loins. In some cases there are epileptic fits, failure of memory, change of temper, or a numbness of the fingers, legs, etc. Treatment. — Tins disease is a peculiarly fatal one. As no mode of treatment has yet proved successful, it is well to observe caution in prescribing. The treatment prescribed for chronic inflammation of the kidneys, would perhaps be as safe as any that could at present be proposed. Bright's Disease of the Kidneys. — Albuminuria. This peculiar disease was first explained to the profession in 1837, by Dr. Bright, of England, whose name it took. It consists of a dis- order of the kidneys, — probably a congestion and an obstructed cir- culation in them, from which arise two most important effects ; first, albumen, an essential alimentary constituent of the blood, is secreted and passed off, in larger or smaller quantities, in the urine ; and sec- ondly, urea, the worn-out matters of the blood which the kidneys are made expressly to carry off, is permitted to remain. If the urine of a person having Bright's disease be examined, therefore, albumen, which should not be there, will be found, and urea, a natural constitu- ent, will be absent. The presence of albumen, however, while ab- normal, is not necessarily indicative of Bright's disease, as it may proceed from indigestion and blood disorders. Method of Examination To discover albumen in urine suspected to contain it, place a little in a test tube, and boil it over a spirit- lamp. If albumen be present only in minute quantity, it may cause only a delicate opalescence ; if in larger quan- tity, it may separate in curdy flakes, and fall to the bottom as a more or less abundant white precipitate. If very abundant, the liquid may become nearly solid. The albumen is the same as the white of an egg, and the boiling has the same effect in whitening and hardening it, as upon that sub- stance. FlQ * 112 - Albumen is sometimes found in the urine in a coagulated state, and having the shape of tubes or worms (Fig. 112). This is quite common in Bright's disease. The deposit seems to be made up of fibrous casts of the uriniferous tubes of the kid- neys. mm DISEASES OF THE ABDOMINAL CAVITY. 339 Symptoms. — The two unnatural conditions mentioned above give rise to the symptoms of Bright's disease. One of them, how- ever, is itself the most constant and characteristic symptom of the disease, namely, the presence of albumen. This, too, being one of the nutritive constituents of the blood, its abstraction thins the serous portion of the blood, and causes it to filter out of its vessels into the cells, — causing dropsy of the cells, usually called cellular dropsy, or anasarca. This general dropsy begins frequently in the face, and spreads rapidly over the whole body and limbs. In addi- tion to this, there are pains in the back and loins, a gradual failing of strength, and a derangement of digestion. The skin becomes dry, with a pale and bloodless appearance, and there are frequently thirst, nausea and vomiting. The urine frequently has fat, blood, epithelial scales, mucus, blood-discs, fibrous casts of the uriniferous tubes, and saline sediments ; and is generally lighter by weight than in health, and less in quantity, and is apt to be red, brown, or dingy in color. The retention of urea in the blood acts as a poison, and causes, toward the latter end of the disease, when accumulated in large quan- tity, drowsiness, convulsions, and apoplexy. A frequent desire to make water, with a shifting back and forth of the bowels between costiveness and diarrhsea, are common symp- toms. Treatment. — The results of treatment in this disease are often un- satisfactory. Yet if taken in season, investigated with proper care, and treated with due diligence, much may be done for its cure. It is one of those harassing complaints, which physicians in family prac- tice seldom have the patience to investigate and manage with suffi- cient care. Let the healthy and active condition of all the vessels of the skin be the first object aimed at. This will relieve the laboring and falter- ing kidneys of a portion of their burden. The alkaline sponge-bath with vigorous friction every day will secure this object. In the next place, the skin being put in a working condition, should be made to work by some internal diaphoretic, — as the tincture of veratrum viride, in doses of from five to ten drops, or the compound tincture of Virginia snake-root, in teaspoonful doses. The kidneys may be still further relieved, especially when there is considerable tenderness and other signs of inflammation, by cupping, leeching, mustard-poultices and croton-oil. The bowels should be regulated by some gentle physic, as cream of tarter dissolved in flax-seed tea, rochelle powders, epsom salts, etc. In some cases, podophyllin and leptandrin (40), or the compound powder of jalap (41 ) , are useful. When there is dropsy of the cells, elaterium may be used as physic (31), or the kidneys may be jogged by digitalis (130), (129), its effects being carefully watched. Cider, freely drunk, has been found useful in some cases. 340 DISEASES OF THE ABDOMINAL CAVITY. To restore the blood, iron (73), (93), (74), (75), (72), (71) is the essential article. When there is considerable debility, some of the vegetable bitters, as quinine, quassia, gentian, Colombo, etc., may be used daily. Coffee, and all indigestible articles of food, as rich pastries, new bread, high-seasoned meat, and fats, must be avoided, — in a word, nothing must be taken, either in kind or quantity, which the stomach cannot easily digest. Diabetes. This disease is a kind of diarrhoea of the kidneys. The amount of urine secreted and discharged is large, sometimes enormous in quantity, amounting even to several gallons in twenty-four hours. Everything taken into the stomach seems to run off by the kidneys. The food and drink being mostly converted into urine, do but little good. The kidneys having got into an exalted state of action, do too much, — just as the mucous membrane of the air-tubes does in bronchitis. Nature of the Urine. — Not only is there too much urine discharged, but, instead of being lighter than healthy urine, as in Bright's disease, it is heavier, and instead of holding albumen in solution, it contains grape-sugar. To Detect Sugar. — Put a little of the suspected urine in a test- tube ; add to it a drop or two of solution of sulphate of copper, which will give the fluid a pale-blue tint. Now add liquor potassa in excess : if sugar be present, this will throw down a pale-blue precipi- tate (hydrated oxide of copper), which will immediately re-dissolve, forming a purplish-blue liquid. Boil this over a lamp; if there be sugar, a reddish or yellowish-brown precipitate (sub-oxide of copper) will be thrown down ; if no sugar, a black precipitate (common oxide of copper) will fall to the bottom. Another Test. — Place a little urine in a test-tube; add to it half its volume of liquid potassa, and boil five minutes. If there be sugar present, the liquid will take a brownish or bistre tint. G-roivth of Torula as a Test. — Place a portion of saccharine urine in a warm place, and a scum will soon rise, as if a little flour had been dusted on it. This, when examined under the microscope, proves to be minute oval bodies. These expand and dilate the vesicle containing them into the form of a tube. They still continue to enlarge, and pro- ject from the parent bladder, like buds. The whole then resembles a jointed fungoid growth (Fig. 113), which finally breaks up, and falls to the bottom, as a copious deposit of oval vesicles or spores. Fig. 113. DISEASES OF THE ABDOMINAL CAVITY. 341 Other Symptoms. — Great thirst, craving appetite, dry skin, a sense of weight and uneasiness in the stomach after eating, dry and parched mouth, white and foul or clean and red tongue, wasting of flesh, languor and aversion to exercise, debility, pain and weakness in the loins, costiveness, loss of the sexual feeling, and cold feet. As the disease draws towards a fatal end, the gums become spongy, the breath fetid, sometimes smelling like urine. Treatment. — The skin should have about the same treatment as that recommended in Bright's disease. Also, the same counter-irrita- tion over the kidneys. The bowels must be kept open by some gentle physic (13), (12), (15). Tonics. — These will be required to restore the tone of the system, particularly iron, — same preparations as recommended in Bright's disease. Astringents to check the flow of urine will be needed. Alum, in three-grain doses, three times a day, or sugar of lead, or white vitriol, or clear opium, will be serviceable. Creosote, in one or two-drop doses, and tincture of cantharides, have each cured cases. One scruple of Peruvian bark, one scruple of wild-cranberry leaves, powdered, and half a grain of opium, mixed and taken three times a day, is a good remedy. All articles which contain sugar and starch must be forbidden in the diet. Bread and potatoes contain a large amount of starch ; and beets, parsnips, and some other vegetables, have sugar. It is best to confine the patient almost entirely to tender, fresh meats ; and the drink, notwithstanding the great thirst, must be restricted to a very small quantity. Saccharin should be used to sweeten drinks instead of sugar. Bleeding from the Kidneys, etc. — Hematuria. By this I mean a discharge of blood from the urinary passage. It may come from the kidneys, the ureters, the bladder, or the urethra. Symptoms. — The passage of the blood is preceded by pain in the region of the bladder or kidneys, and accom- panied by faintness. There is generally heat and distress in the loins, and tenderness upon pressure in the region of the bladder or kid- neys, according to the place from which the blood comes. It is sometimes difficult to decide whether the coloring matter in the urine is really blood. In such cases, the microscope will generally detect the blood corpuscles, if present. They commonly appear as in Fig. 114, having a yellow color, and being pretty uniform in size. Fig. 114. 342 DISEASES OF THE ABDOMINAL CAVITY. Treatment. — This must of course vary according to the nature of the case, and the immediate cause producing it. Where active bleed- ing exists, the patient must have absolute rest in bed, with applica- tions of cold to the hips and loins. If the patient be strong and full of blood, wet cups or leeches may be applied over the kidneys, or the bladder. In such cases, too, the bowels must be freely moved with some preparation of salts (14), (18), (20), (25). Sugar of lead is a valuable remedy; but it should be given in large doses for a short time, rather than in small doses for a long time. It is best taken in form of solution (348), two great spoonfuls every two hours, until five or six doses are taken. But the best remedy is gallic acid. It seems to have extraordinary power in this complaint. It should be given in five-grain doses, mixed with a teaspoonful of mucilage of gum-arabic, and ten drops of tincture of henbane. Suppression of Urine. — Ischuria Renalis. This disease is, in one respect, just the opposite of diabetes. While immense quantities of urine are secreted in that, none is se- creted in this. In that, the kidneys do too much ; in this, they do nothing. This complaint is sometimes called paralysis of the kidneys. It usually occurs in old persons, and those inclined to corpulency. Symptoms. — The patient makes no water; and if the catheter be applied, none will be found in the bladder. The patient feels unwell, restless, anxious, with a slight pain in the loins and bowels, perhaps ; but on the whole not illness enough to give any very good account of it. After a little time, nausea comes on, and perhaps vomiting, and soon drowsiness, wanderings of mind, incoherent talk,' hiccough, stupefaction, and death. These head symptoms are caused by the shutting up, in the kidneys, the natural outlet of urea, of an excre- mentitious matter, which acts as a poison to the nervous system. Before death, the perspiration has a strong smell of urine. Treatment. — The cause of this complaint not being known, the treatment must necessarily be a little uncertain. We cannot go amiss, however, in placing the patient immediately in a warm bath for fifteen or twenty minutes. Then apply wet cups over the kidneys, and follow these either by mustard poultices or by hot fomentations. Let the bowels be opened by the compound powder of jalap, or by elaterium (31). Epsom salts or cream of tartar might in some cases be substituted for the above. A stimulating injection is also desira- ble (246). Diuretics, as sweet spirits of nitre, digitalis, queen of the meadow and peach-leaves, equal parts, and marshmallow, are of course called for. DISEASES OF THE ABDOMINAL CAVITY. 343 Much of the poisonous matter retained may be got out through the skin, by a free use of the compound tincture of Virginia snake-root or tincture of veratrum viride in full doses. Although the symptoms, in the earlier stages of this complaint, may not attract much attention, or be thought worthy of notice, yet the treatment should be prompt and energetic, as a fatal termination is sometimes reached in the brief space of forty-eight hours. Retention of Urine. This disorder is often confounded with suppression of the urine, but it is different in every respect. In suppression, the urine is not formed by the kidneys ; in retention, it is formed, and, in some cases, poured into the bladder, but is retained on account of some inability to pass it. Ischuria. — This is one of the forms of retention. In this com- plaint, the urine has passed from the kidneys to the bladder, but from some cause, generally palsy of the muscles of the bladder, it cannot be passed off. In this case, there is no pain, but the stream of water flows off with slower and slower pace, — the patient having to make tiresome efforts with the abdominal muscles to get the bladder emptied. As the quantity discharged diminishes, the desire to uri- nate grows more urgent. Pressure just above the pubes gives pain, and the bladder feels under the hand like a large, hard tumor. Dysuria. — In this form of the complaint, the water is passed to some extent, but with pain and heat along the water-pipe. This is generally caused by some inflammation along the urethra. Strangury. — In this the water is only passed drop by drop, and with great burning, scalding, and tenesmus in the neck of the bladder. When there is considerable inflammation, the skin becomes hot, the pulse hard and quick, and the tongue covered with a white fur. Causes. — These several forms of the complaint are caused by palsy of the bladder, gonorrhoea, inflammation in the neck of the bladder or the water-pipe, mechanical injuries of the bladder in child-bearing or otherwise, by tumors pressing upon it, by irritation from gravel or stone within its cavity, by stricture or partial closing up of the ure- thra, by disease of the prostate gland, by taking spirits of turpentine or cantharides, or by the absorption of this latter article when used as a blister. Treatment. — It is obviously necessary in this complaint, that treatment, in order to be of any avail, should be prompt ; for when the retention is complete, the bladder will burst in from two to five days, and cause the death of the patient. The treatment must vary according to the cause of the retention. If it be caused by palsy of the bladder, the common flexible cathe- 344 DISEASES OF THE ABDOMINAL CAVITY. ter must be used daily until the muscular fibres recover their lost power. When much irritation is caused by introducing it, it is better not to withdraw it, but to close its external orifice with a small plug, which the patient can remove as often as necessary to let off the urine. To remove the paralysis, the electro-magnetic machine is worth a trial, the current being passed through the bladder. At the same time let the patient take strychnia (85), (86), (83), (95). Cantharides, in the form of tincture, or in connection with strychnia (291), is often used. If the retention is caused by inflammation of the neck of the blad- der, leeches should be applied to the perineum, and three or four drops of croton-oil may be rubbed on just above the pubes to bring out an eruption. Warm fomentations will also be serviceable, and warm hip-baths. Cooling diuretics, as infusions of marshmallow, cleavers, pumpkin-seeds, buchu, sweet spirits of nitre, etc , must not be omitted. Inability to Hold the Urine. — Enuresis. This complaint, generally called incontinence of the urine, is quite common among children. In some cases the child has no ability to hold its water at any time ; but generally it is only passed off invol- untarily at night while in bed. In adult life it is less frequently met with, except among the old. Causes. — Irritation of the roots of the spinal nerves which go to the bladder, mechanical injuries of the bladder, palsy of the bladder, particularly in old people, debility of the neck of the bladder, a gen- eral weakness of the nervous system, worms in the bowels, piles, whites, gravel or stones in the bladder, long prepuce in boys, etc. Treatment. — As a general rule, the change of constitution which occurs at puberty cures this complaint. But as this does not always happen, it is important that parents do everything in their power to break it up early, lest it become an affliction for life. Children who suffer from this disorder are apt to drink largely. This habit should be restrained. But little drink should be allowed, whatever the desire for it. Care should be taken that the child make water before going to bed, — also that it be aroused at a late hour for the same purpose, and that the foot of the bed be elevated so as to draw the urine away from the neck of the bladder. The skin should be washed all over, every day, with cool or cold water, and vigorously rubbed with a coarse towel. This will cause the excess of fluids to pass off through the skin, and lessen the action of the kidneys. In some instances children urinate in bed through carelessness, being half conscious of what is occurring, but not caring enough to rouse themselves. In such cases, they are often cured by some de- cided correction, — the impending act of passing water connecting DISEASES OF THE ABDOMINAL CAVITY. 345 itself in their mind with the correction, and recalling them instantly to full consciousness. Of course this mode of relief should be resorted to with great judgment and caution. When the complaint proceeds from debility or relaxation of the neck of the bladder, the compound infusion of trailing arbutus and the isinglass custard found among dietetic preparations, may be used freely. The tincture of cantharides, from ten to forty drops to chil- dren, may be given, and increased gradually to a hundred, or until slight difficulty is felt in passing the water. Then stop, and give the articles mentioned above. Spirits of turpentine is useful to some extent, given also in small doses, and continued for some time. If the disorder be caused by irritation of the spinal nerves, cold water douched upon the back, or croton-oil rubbed along the spine, or a warm stimulating or irritating plaster upon the lower part of the back, will be required. The electro-magnetic machine may do well in some cases. Tincture of belladonna, given just as tincture of can- tharides above, afternoon and at bedtime, gives best results usually. Belladonna after a while troubles the eyes and must be stopped. Urinary Deposits. — Gravel. — Stone. Unnatural deposits in urine are to be regarded simply as evi- dences of changes which disease is making in the body. As such they are valuable, — more valuable, in many cases, than any or all other symptoms we can study, and most valuable from the ease with which they may be investigated. Yet but very few physicians, com- paratively, pay any special attention to them, or make any effort to acquire the small amount of knowledge needed for their detection. Sources of the Urine. — The urinary secretion has three sources. The largest bulk of it comes from the superabundance of drink taken into the stomach. This is shown from the free flow of pale urine after taking copious drafts of water or other fluids. Such quantities of water as are often drunk, would embarrass the functions of animal life, were it not pumped off by the kidneys. A second source of supply for the urinary secretion is to be found in the elements of imperfectly digested food, and also some abnormal elements arising from incomplete assimilation. Oxalic acid is a specimen of the latter, being sometimes largely excreted, in dyspep- sia, soon after a meal. The third source of urine is found in those old and worn-out atoms of the system, which can serve no further useful purpose in the ani- mal economy, and which cannot be got rid of by the lungs or skin. It is only, however, one portion of the dead tissue, namely, that which is rich in nitrogen, which goes out through the renal strainer ; an- other portion, which has a preponderance of inflammable elements — carbon, hydrogen, and perhaps sulphur — takes the outward channel through the liver, as bile. 346 DISEASES OF THE ABDOMINAL CAVITY. u Characteristics of Urine. — Healthy urine has a light amber color, is transparent, and lias different degrees of density, its specific gravity varying from 1.003 to 1.030. It has an aromatic, violet-like smell, and a bitter, disagreeble taste, like salts. That which is passed a little time after drinking largely, is pale, and has a low specific gravity, varying from 1.003 to 1.009, and is called urina potus. That passed soon after the digestion of a full meal, is called urina cliyli, or urina eibi ; it has a specific gravity f rom 1.020 to 1.030. That which is secreted from the blood, and is passed before eating or drinking in the morning, is called urina sanguinis; and has a specific gravity of from 1.015 to 1.025. This is the best specimen of the average density and nature of healthy urine. Healthy urine contains urea, uric acid, sulphuric acid, phosphoric acid, lime, magnesia, phosphate of soda, etc. It is only when these are discovered in excess, that they indicate disease. Examination of Urine. — Let a piece of blue litmus-paper be first dipped in the urine ; if it be acid, the color of the paper will be changed to red, or reddish-brown. Should the blue color remain un- changed, then use •yellow turmeric or reddened litmus paper; if the urine is alkaline, the turmeric will become brown, and the reddened litmus will be changed to blue. If the color in both cases remains unaltered, the urine is neutral; that is, neither acid nor alkaline. This being done, let the specific gravity be taken. This is easily done by the urinometer (Fig. 115). This instrument is known also by the names hydrometer, and gravimeter. It is generally made of glass. When placed in distilled water, it will sink to a certain point; and as all bodies immersed in fluid displace a bulk equal to themselves, it follows that in a fluid denser than water, the instrument will not sink so deep. The space above the large bulb is marked off into de- grees corresponding to different densities. When this instru- ment is immersed in urine, and has come to rest, the number on the graduated scale, which stands at the surface of the liquid, when added to 1.000, will represent the specific gravity of the fluid. If, for example, the surface of the liquid corresponds with 9 on the scale, the specific gravity of the urine will be 1.009 ; if at 25, it will be 1.025. By attending to the specific gravity of the urine, the physician may often gain important information respecting his patient, as it may be made to show him how much solid matter is daily carried out of the body through the kidneys. This, at the bed-side, may often give useful hints in regard to treatment. The following table, constructed by Dr. Golding Bird, shows at a glance the amount of solid matter in 1000 grains of urine of different densities : — Fig. 115. DISEASES OF THE ABDOMINAL CAVITY. 347 Specific Gravity. Solids. Water. Specific Gravity. Solids. Water. Specific Gravity- Solids. Water. Specific Gravity. Solids. Water. 1001 2.33 997.67 1011 25.63 974.37 1021 48.93 951.07 1031 72.23 927.77 1002 4.66 995.34 1012 27.96 972.04 1022 51.26 948.74 1032 74.56 925.44 1003 6.99 993.01 1013 30.29 969.71 1023 53.59 946.41 1033 76.89 923.11 1004 9.32 990.68 1014 32.62 967.38 1024 55.92 944.18 1034 79.22 920.78 1005 11.65 998.35 1015 34.95 965.05 1025 58.25 941.75 1035 81.55 918.45 1006 13.98 986.02 1016 37.23 962.72 1026 60.50 939.42 1035 83.88 916.12 1007 16.31 683.69 1017 39.61 960.39 1027 62.91 937.09 1037 86.21 913.79 1008 18.64 981.36 1018 41.94 958.06 1028 65.24 934.76 1038 88.54 911.46 1009 20.97 979.03 1019 44.27 955.73 1029 67.57 932.43 1039 91.87 909.13 1010 23.30 976.70 1020 46.60 953.40 1030 69.90 930.40 1040 93.20 906.80 The mode of using the above table is this. Having learned the density of the urine passed in twenty-four hours by means of the urinometer (Fig. 115), a glance at the table will show the proportion of solid matter and water in 1000 grains of the urine. Then, by weighing the whole quantity of urine passed in twenty-four hours, the weight of solids drained off by the kidneys may be determined by the simple rule of proportion. Symptoms of Gravel. — A sudden attack of pain in the region of the kidneys, so acute and severe, frequently, as to cause fainting and even convulsions. The pain runs down to the groin and thigh, caus- ing a numbness on the affected side, and a drawing up of the testicle. The pain is excessive at times, and then remits. Finally it stops suddenly. Leading from the kidneys to the bladder are two small tubes about the size of a goose-quill, called ureters, — being the appointed chan- nels of the urine. The pain, of which I have spoken, is caused, gen- erally, by the passage of a stone along one of these small tubes. If the stone happen to be a- little too large for the tube, or uneven or ragged upon its surface so as to bruise and tear the delicate lining of the ureter, severe pain is the result. The pain is intense when the stone moves along ; remits when it stops ; and suddenly ceases alto- gether, when it gets through, and drops into the bladder. Sometimes there is no pain, the gravel being so fine as to pass through the ureters very easily. It then passes through the urethra also, and is found as a sediment of the urine at the bottom of the vessel. These urinary deposits are various, and quite unlike each other in kind. They indicate different states of health, and require to be spoken of separately. Uric-Acid Gravel. This form of deposit passes indifferently under the name of uric acid gravel, or lithic acid gravel. The person who is in the habit of passing this kind of deposit largely, is said to have the lithic or uric acid diathesis or condition. The urine of persons in this state lets fall, after it has stood awhile, 348 DISEASES OF THE ABDOMINAL CAVITY. a reddish sediment, like brickdust. This consists chiefly of urate of ammonia (Figs. 116 and 117), tinged with certain coloring matters. This coloring substance may be more or less abundant, and give to the deposit various shades, as dirty-white, yellow, pink, and red. The Fig. 116. Fig. 117. pure uric acid sometimes appears as fine sand, or large crystals (Fig. 118). The urine is of a dark copper-color, about like brown sherry, and is more scanty than in health. It is also highly acid, giving to litmus paper a deeper shade of red. Persons who pass this kind of gravel largely are apt to be troubled with in- flammatory complaints; with acidity of the stomach and heartburn ; and some of them with gout and rheumatism. Placed under a blowpipe, uric acid is decomposed, and gives out an odor like that of burnt feathers, combined with the oil of bitter almonds. It is dissolved by liquor potassa, from which muriatic and nitric acids precipitate it ; and by sulphuric acid, from which it is precipi- tated by water. Acetic, nitric, and mu- riatic acids, alcohol, ether, and water, do not dissolve it. Fig. 118. Causes. — Uric acid is the form in which nitrogen and the effete compounds which contain it are got out of the body. It is the result of the decomposition of the tissues of the body. Its gravelly particles are the sands of life daily washed out of us, — reminding us always that we are wasting away. Whatever causes the body to waste rapidly, produces it in excess. We find it, therefore, in the urine of those who suffer from gout, rheumatism, dyspepsia, fevers, debility of the genital organs, straining of the loins, etc., which produce loss of flesh. Treatment. — The remedies for this uric-acid gravel are the alka- lies, bicarbonate of potash, bicarbonate of soda and magnesia. The DISEASES OF THE ABDOMINAL CAVITY. 349 first named is generally the best. It may be used in the form of the neutralizing extract, — especially if there be costiveness. If the bowels do not need physic, let the potash be taken in the shape of lye made from hard- wood ashes (300). Fluid magnesia is an excellent remedy; so is liquor potassa, taken in twenty or thirty-drop doses. The urine must be watched, and these remedies discontinued when it becomes alkaline. Black coffee drunk freely every day is an excellent remedy. At the same time the stomach should be supported by some bitter tonic, as the infusion of quassia, gentian, columbo, Peruvian bark, etc. Iron is, in many cases, not to be overlooked. If the patient be pale and bloodless, some of the preparations of this metal will be needed (61), (73), (74). Acid must be carefully avoided, both in food and drink. The diet must be plain, digestible and nourishing, and quite mod- erate in amount. The quality is of less consequence than the quan- tity. Exercise is of great consequence, and must be regular, and, if pos- sible, in the open air. The skin must receive daily attention in the shape of an alkaline sponge-bath, with friction. This will throw upon the skin much of the labor done by the kidneys. Poland Spring water used in large quantities is good. Phosphatic Deposits. These deposits are indicated by a state of the urine just the oppo- site of that which contains the uric-acid gravel. They are contained in urine which is either alkaline when passed, or becomes so very soon by standing. As the urine cools, a white sand falls to the bottom, and frequently a film forms upon the surface of the water. Looking at this film in different lights, you may see in it the several colors of the rainbow. Skim off this pellicle, place it upon paper, and let it dry ; and you may then see the little shining crystals. This urine quickly grows putrid and offensive. Sometimes it smells strongly of ammonia. The more phosphates it contains, the sooner it becomes alkaline. These deposits are generally the triple phosphates. Healthy urine contains the phosphate of magnesia in a state of solution. Under some circumstances, the urea of the urine is decomposed in the kid- neys, and ammonia is disengaged. This combines with the phosphate of magnesia, and forms the triple salt of the phosphate of ammonia and magnesia, which is not soluble. Symptoms. — A sallow complexion, a languid, spiritless state of mind, and an exhausted, debilitated condition of body. The urine is pale, rather copious, slightly turbid, has a low specific gravity, and smells unhealthy, having sometimes the faint odor of weak broth. There is generally derangement of the digestive organs, windy stom- ach and bowels, nausea, constipation, or diarrhoea, stools of various ooO ' DISEASES OF THE ABDOMINAL CAVITY. colors, and sometimes, in diarrhoea, resembling yeast, and an aching pain and weakness in the loins. Causes. — These deposits are produced by great debility of the constitution, by injuries of the spine, dyspepsia, defective assimila- tion of food, bad diet, irritation of the neck of the bladder, and or- ganic disease of the kidneys. But they are caused more especially by whatever wears and exhausts the nervous system, as heavy cares, de- pression of spirits, sedentary habits, great mental exertions, mastur- bation, and venereal excesses. Treatment. — These deposits being connected with great debility, care must be taken not to make the matter worse by taking active purgatives, by extreme fasting, or by any means which will increase the weakness. On the contrary, the strength must be supported by all the means that can be commanded. With this view, the citrate of iron (75) may be taken. Arsenic combined with iron (80), to allay irritability, and impart strength at the same time, may be used. The valerianate of iron (93) is excellent for the same purpose. Connected with a state of urine just the opposite to that which holds the uric-acid deposits, this form of gravel calls for the opposite remedies. Instead of the alkalies, the acids are wanted. The nitric and muriatic acids, with a vegetable tonic (76), may be used. Borax is spoken of in high terms, and is thought by some to have great power in turning alkaline urine acid. The compound balsam of sul- phur is highly spoken of, and the compound infusion of trailing arbu- tus is also mentioned with approbation. It is all-important to throw off care, and to give the mind a chance to rise up with all the elasticity it has. To bring this about, journeys and amusements are useful. The society of lively, laughing, witty friends will do a great deal to give the spirits a rebound, and the whole health an upward movement. Such persons are a blessing to the world ; and he who reckons a few of them among his friends will live the longer for it. The skin should have the benefit of the daily tonic effect of a sponge-bath, with water at first tepid, and afterwards cool ; and exer- cise, out of doors, should be habitual, and connected, as much as pos- sible, with objects of pleasure. The drinking of hard water is highly injurious ; and if none other can be had, it should be distilled, and then spread out to the atmos- phere, in shallow vessels, that it may recover its pleasant taste by reabsorbing air and carbonic acid. Oxalic Deposits. Oxalate of lime a\ the urine is the cause of this kind of gravel. It appears in the form of dumb-bells, and octahedral crystals. (Figs. 119, 120, and 121.) DISEASES OF THE ABDOMINAL CAVITY. 351 The urine has a specific gravity of 1.015 to 1.025, and is generally of a dark amber-color, and clear and bright ; it is generally acid, Fig. 119. Fig. 120. Fig. 121. Fig. 122. though occasionally alkaline or neutral. Urea is generally found in it, and epithelial cells (Fig. 122). Unlike the uric and phosphatic urines, it is quite free from sediments, except, as often happens, there is a large amount of urea in it, in connection with the oxalate of lime. When the urate of ammonia is combined with the oxalate of lime, it often happens that the latter has to be dissolved with a little liquor potassa, before the former can be seen with the microscope. Symptoms. — Great depression of spirits, excitable state of the ner- vous system, painful susceptibility to external impressions, dyspeptic symptoms, and disturbances of the liver, a fear and dread of consump- tion, emaciation, inability to make exertion, — the" smallest exertion causing fatigue ; in men, a deficient sexual power, a pain and weight across the loins, and some irritability of the bladder. Causes. — These deposits are supposed to result, like most other derangements connected with loss of flesh, in too great a degree of oxidation. Vegetables produce oxalic acid by just the opposite pro- cess, namely, deoxidation. Whatever depresses the vital powers, may generate this deposit, as mental depression, overwork of the brain, burdensome cares, idle- ness of mind or body, masturbation, debaucheries, intemperance, vene- real excesses, and injuries of the spine. This deposit may also be produced by certain articles of diet, which contain the oxalic acid. Among these may be named the rhubarb plant, which in summer is largely used for tarts ; and sorrel. Treatment. — The treatment for these deposits should be very much like that for the phosphatic. The stomach and liver should receive some special attention. A pill of leptandrin, podophyllin, etc. (39), may be used with advantage. The preparation of nitric and hydrochloric acids (76) must generally be taken for some time. In cases of great irritability, the sulphate of zinc (82) does well. 352 DISEASES OF THE ABDOMINAL CAVITY. The diet should be plain, digestible, and nourishing, — all articles containing oxalic acid being rejected, as the rhubarb plant, sorrel, tomatoes, onions, etc. For the rest, follow the directions for the treatment of phosphatic deposits. Urate of Ammonia Deposits. The urine which contains these deposits is generally pale, and of low specific gravity, about 1.012. It becomes opaque on cooling, from the deposition of a nearly white urate of ammonia. Instead of falling down readily, this forms ropy masses in the fluid, and looks like mucus or pus, or something between the two. Its real nature is discovered by applying a little heat, which quickly dissipates it. Microscopic Character. — Place a drop of this turbid urine be- tween two slips of glass, and examine it closely with a microscope ; you will see myriads of minute globules adhering together in linear masses. Now place a drop of the turbid urine in a watch-glass, and gently warm it ; as soon as it has become clear, add a drop of hydro- chloric acid to it, and when it is cold, examine it with the microscope. The muddiness will be gone, and you will now see lozenges, or thick cohering prisms of uric acid (Fig. 123). The explanation of this is, that the hydrochloric acid combines with the ammonia, forming muri- ate of ammonia in solution, and liberating the uric-acid crystals. Fig. 123. Fig. 124. Urate of soda (Fig. 124) is sometimes found in urine, which has similar chemical reactions with urate of ammonia. Causes. — These deposits are generally produced by some over- eating, or derangement of the skin. The treatment is the same as that for uric-acid gravel. Hippuric Acid Deposits. These deposits appear in the healthy urine of the cow and the horse ; and also in that of human beings, but in such small quanti- ties as to be scarcely appreciable. They sometimes, however, appear in unhealthy proportions : but they never show themselves as a sediment, until after the addition DISEASES OF THE ABDOMINAL CAVITY. 353 Fig. 125. Cause. of a stronger acid. The urine containing them is generally slightly acid or neutral, — sometimes alkaline, — having a low specific gravity, from 1.006 to 1.008. The triple phosphates are often found in it. To detect these deposits, fill a large watch- glass with urine, and evaporate it over a lamp to a few drops. Then add to it about half its bulk of hydrochloric acid, and set it aside. The addition of the acid produces a bright piak color, and an odor like new hay. After a few hours, if the hippuric acid be present, its peculiar crystals will be seen. (Fig. 125.) In man, this deposit is supposed to depend on the absence of food having a good share of nitrogen. The urine of vegetable-eaters contains it in largest quantities. Treatment. — The only treatment required is a diet composed in good proportion of animal food, a proper attention to the skin by bathing, etc., and when debility exists, tonic medicines, as iron and bitters, with out-door exercise enough to keep the muscles in working order. Cystine Deposits. These do not occur in healthy urine, and rarely as an element in diseased action. They contain twenty-six per cent of sulphur. Urine which contains cystine is of a pale yellow color, and has a low specific gravity. It frequently has an oily appearance, and its smell is peculiar, resembling that of sweet brier. Sometimes its odor is fetid, like putrid cabbage. On being kept for a short time, it has its surface covered with a pellicle which looks oily, and consists of a mixture of crystals of cystine and the phosphate of ammonia and magnesia. The cystine deposit appears to be diffused through the urine, which is always turbid when boiled. It is a white or fawn-colored powder, and falls to the bottom as a sediment. It undergoes no change by warming the urine, and this distinguishes it from white urate of ammonia. It is not soluble in diluted hydrochloric or strong acetic acid, which distinguishes it again from the earthy phosphates. To test this deposit, add liquor ammonia to a portion of it, and shake them. If the deposit be cystine, it will dissolve readily. Allow a few drops of the solution to evaporate on a slip of glass, and the six-sided tablets of cystine will remain, which may be examined under the microscope. (Fig. 126.) It is to be remembered that occasionally the chloride of sodium or common salt crystallizes in octahedral forms (Fig. 127), which, in some positions, may look very much like cystine. The ready solu- bility of the chloride in water, and the absence of all color when they are examined by polarized light, will prevent mistaking these crystals 354 DISEASES OF THE ABDOMINAL CAVITY. for cystine. If urine containing common salt be quickly evaporated on a slip of glass, and be then examined, instead of the octahedrons, we find crosslets and daggers. (Fig. 128.) Fig. 126. Fig. 127. Fig. 128. Causes. — An excess of sulphur in the tissues, a scrofulous consti- tution, and hereditary predisposition, with defective oxidation, and torpidity of the liver. It is often found in the urine of girls who have the green sickness. Treatment. — The great object is to improve the general health, which is to be done by attending to the skin, and the administration of iron and bitters, and also alteratives. The syrup of iodide of iron is a valuable remedy. Podophyllin and leptandrin (34) are wanted to regulate the liver. The nitro-muriatic acid (76) should be tried. The daily sponge-bath, and daily exercise, as in most chronic com- plaints, must on no account be neglected.- Stone. — Calculus. It often happens that the proper treatment for removing urinary deposits is not adopted in season. In such cases, gravelly particles, finding a lodgment for a time, in the kidneys or bladder, are apt to draw other particles to themselves, which become fastened to them, and form a layer quite around them. Over this, other layers form in succession, until a stone is produced so large that it cannot pass off. These grow to various sizes, — being sometimes so large as to fill the bladder. Uric-Acid Calculus. — The most common of these formations is the uric-acid calculus. It is generally smooth or slightly tuberculated on the surface, and varies in color from a pale yellowish-fawn to a red- dish-brown. When sawn through the centre, its layers will be found tolerably regular, but of different thickness. (Fig. 129.) To test it, place a small fragment upon platinum foil under the blow-pipe. If uric acid, it blackens, and gives out an odor like burnt feathers mixed with the oil of bitter almonds. Mixed Calculus. — These calculi are frequently composed of two or more different kinds of matter arranged in irregular layers. Fig. 130 is a mixed calculus, — the dark layers being oxalate of lime, the light ones uric acid. DISEASES OF THE ABDOMINAL CAVITY. 355 In testing such, fragments of each ingredient should be separately examined. Urate of Ammonia Calculus. — We occasionally meet with a cal- culus composed of the urate of ammonia. These calculi, when found, are generally small in size, smooth or slightly tuberculated upon the surface (Fig. 131), and of a pale slate or clay color. When heated before the blowpipe, it gradually disappears. Fig. 129. KlG. 130. Fig. 131. Phosphate of Lime Calculus. — This has a smooth polished sur- face, and quite regular layers, which separate easily when the calculus is cut asunder. It has a pale fawn or stone color. (Fig. 132.) It chars before the blowpipe, and gradually becomes white as the carbon burns away. Diluted nitric or hydrochloric acid dissolves it without effervescence. Oxalate of Lime Calculus. — This is frequently met with uncom- bined with others, but more generally its nucleus is uric acid or urate of lime. It commonly has a brown, dark-olive, or dirty-purple color. Its surface is irregular and somewhat rough. It looks like the fruit of the mulberry, and is known as the mulberry calculus. (Fig. 133.) It dissolves, without effervescence, in diluted nitric or hydrochloric acid. When thus dissolved, the addition of a little ammonia will cause it to fall to the bottom as a white precipitate. Fig. 132. Fig. 133. Fig. 134. Fusible Calculus. — This is a mixture of phosphate of lime and the phosphate of ammonia and magnesia. It is the most common of all the calculi, except the uric acid. It has an oval, irregular form (Fig. 134), and is white, soft, and friable, like chalk. Sometimes it is hard. * It may be known by the readiness with which it melts down before the blowpipe, without being consumed. Causes. — The causes of the different kinds of gravel have been already explained. Generally stones of the bladder are formed in the 356 DISEASES OF THE ABDOMINAL CAVITY. kidney, and descending through the ureters into the bladder, are pre- vented from passing out through the water-pipe by an enlarged pros- tate gland. Remaining in the bladder, they soon get encrusted over by other matters in the urine, and grow by accretion to be stones. Symptoms. — When a stone in the bladder reaches a certain size, especially if it is rough, it always produces suffering. A dull, annoy- ing pain is felt at the end of the penis. The desire to make water is frequent, and there is a sense of weight in the perineum. Sometimes the stream of urine is suddenly stopped by the stone falling on the orifice of the urethra. As the bladder becomes nearly emptied, it embraces the stone, and the pain is increased. Jolting in a carriage causes great pain. Mucus passes off with the urine, and sometimes blood. After a time, the appetite fails, hectic sets in, albumen ap- pears in the urine, and the patient sinks under inflammation of the bladder. These symptoms being found in diseases of the kidneys and blad- der, no one is authorized to pronounce upon the existence of stone, until the stone has been touched by a metallic sound introduced into the bladder. Treatment. — The only effectual treatment is a choice between three operations, — lithotrity, lithotomy, litholopaxy. The first consists in introducing an instrument, a kind of forceps, into the bladder, through the urethra, taking hold of the stone, and crushing it. The preparatory treatment consists in correcting the unhealthy state of the urine, and the frequent introduction of bougies or sounds to enlarge the water-pipe for the easy entrance of the crushing forceps. The after treatment consists in diluent drinks to increase the urine, injections of warm water to wash out the frag- ments, with hip-baths, soothing injections, and leeches or cupping upon the perineum. Lithotomy consists in making an incision into the bladder through the perineum, and taking out the stone or stones whole. Litholopaxy consists in crushing the stone in situ by means of the lithotrite and syphoning out the debris. Dropsy of the Belly. — Ascites. This is a collection of water in the cavity of the belly ; sometimes the fluid is outside of the peritoneum, and next to the muscles. Symptoms. — An enlargement 01 the belly, with a sense of disten- tion and weight, — particularly on the side on which the patient lies. When the collection of water is large, the breathing becomes short and difficult, and the swelling is uniform over the whole abdomen. In some instances the fluctuation of the water may be distinctly heard when the patient moves about, — just as we may hear the water in a half-filled barrel when it is rolled over. This sound of the fluid, when heard, distinguishes the complaint from pregnancy, DISEASES OF THE ABDOMINAL CAVITY. 357 and from the drum-head state of the bowels. This fluctuation may sometimes be produced by pressing upon one side of the belly while the patient is standing or sitting, and striking the other side with the ends of the fingers of the other hand. In some cases, there is loss of appetite, dry skin, costiveness, scanty urine, oppression of the chest, cough, colic pains, and variable pulse. Causes. — A frequent cause of this complaint is chronic inflamma- tion of the serous membrane which lines the abdomen, — I mean the peritoneum. It may also be produced by scarlet fever, fever and ague, disease of the heart, particularly dilation of the right cavities, and diseases of the liver, particularly the shrivelled, hobnail condition of the liver, — in short, whatever causes a pressure upon the portal veins, and obstructs the venous blood returning from the intestines. Treatment. — The remedies for this disease are mainly diuretics and purgatives. The bowels may sometimes be reduced in a few days from an enormous size, by medicines which excite the action of the kidneys. Digitalis combined with acetate of potash, etc. (130), forms an excellent preparation. The patient should have as a con- stant drink, a strong infusion made from two parts of hair-cap moss, and one each of juniper berries and dwarf-elder bark ; also an infu- sion of queen of the meadow. The purgatives used in this complaint are those which produce watery stools. One of the best of these is elaterium. It will some- times carry off the water with great rapidity ; combined with some active cathartics (31), it will have all its good effects without the griping it is apt to occasion alone. Cream of tartar, taken in large doses, every day, will sometimes do well. Epsom salts produces watery stools, and is a good remedy. For promoting absorption of the fluid, the iodide of potassium, taken in from three to ten-grain doses, three times a day, is a valua- ble medicine in many cases. The compound infusion of parsley is said to be still better. The skin must receive careful attention. The alkaline sponge bath, with friction, will increase the transpiration of fluid through that organ. Exercise does much to keep up an active circulation, and to lessen dropsical effusions. The strictest temperance, both in eating and drinking, must be observed. A light and nourishing diet, with water, tea, and the diuretics named above for drinks ; beyond these the patient must not go. A kneading and shampooing of the bowels once a day has an excellent effect ; it gives activity to the circulation in obstructed veins. A bandage tied close around the bowels, and tightened as the water diminishes, has an effect upon the sluggish vessels similar to that of the laced stocking in varicose veins of the legs. It lessens the liability of a return of the complaint. 358 DISEASES OF THE ABDOMINAL CAVITY. Dropsy of the Cells. — General Dropsy. — Anasarca. Just under the skin is a membrane composed chiefly of cells, called the cellular membrane. When a considerable part or the whole of these cells are filled with a watery fluid, we call the com- plaint anasarca, or cell-dropsy. If, besides this, there is a collection of water in the large cavities, we give it the name of general dropsy. Symptoms. — The disease generally begins with a swelling around the ankle and leg, which is more visible at night after standing and walking, and is less perceptible in the morning in consequence of the horizontal position of the night. To the touch of another person, dropsical feet and legs feel a little colder than natural ; and when hard pressed with the finger, a pit will be sunk in the flesh, which remains some time before it fills up. As the disease advances, the skin of the legs becomes smooth, shining, and sometimes even cracks open to let out the water. The limbs, and indeed the whole person, become stiff, heavy, and clumsy. As the disease advances, and ascends to the belly and chest, there is shortness of breath, a sense of suffocation on moving or lying down, a tightness and distress across the epigastrium, thirst, dryness of skin, wakefulness, loss of appetite, scanty and deep-colored urine, and a slow fever. Cause. — General dropsy is caused by whatever weakens the gen- eral system, and by such circumstances as obstruct the circulation in the veins. The most frequent causes, therefore, are certain diseases of the heart and kidneys. Explanation. — Modern physiology has demonstrated that the veins do a certain part of the work of absorption. The serous membranes which line the larger cavities of the body exhale watery fluid enough, and no more than enough, to keep them moist, and cause the organs within to play smoothly upon their surface. If the fluid were not taken away as fast as it is poured out, the cavity, being a shut sac, would become full, and we should have dropsy. It is the office of the veins to absorb this fluid and convey it away in the general cur- rent of the blood. This is the method of their doing it : The walls of the veins are so constructed as to permit watery fluids to pass through them, either in or out. When they are comparatively empty, or only moderately full, fluids on the outside pass in, and mingle with the contents. This is called endosmosis. When they are very full, the watery portion of the blood will filter through, and pass out. This is called exosmosis. Now, if the reader will think a little, he will easily see that if the veins are barely full enough not to allow any fluid to pass in, the natural exhalations of the shut sacs would bring on dropsy ; but if DISEASES OF THE ABDOMINAL CAVITY. 359 the veins are so full as to cause water to floiv out, then the dropsical accumulation will be still more rapid. Such being the office arid nature of the veins, the reader may learn how disease of the right side of the heart will cause dropsy. When the right ventricle is so dilated and weakened that it cannot send the blood forward to the lungs, of course the veins which bring it to the right side of the heart, will become full, and greatly distended. Exosmosis will then occur; the watery portion of the blood will begin to run out, either into the large cavities, or into the cells, and dropsy, either general or local, will be the result. Treatment. — This must be goverened very much by the cause of the disease. In dropsy from disease of the heart, we may use diuretics and such other methods as are recommended for dropsy of the belly. If the urine is strongly acid, depositing the brick-dust sediment, the alkaline diuretics will be the best, as the acetate and bicarbon- ate of potash combined, and dissolved in water. The bitartrate of potassa, to act upon the bowels, is a proper remedy. If the disease arise from general debility, the following powder will be useful: digitalin, three grains ; cinchonia, half a dram ; phosphate of iron, half a dram ; and white sugar, one dram. Mix, and triturate ; divide into sixteen powders, and give one, in pumpkin-seed tea, four times a day. VENEREAL OR SEXUAL DISEASES. Of all the diseases to which flesh is heir, none bring so much misery, moral and physical, as those called sexual or venereal. To the physician, they are the source of the greatest anxiety and per- plexity. They bring him into possession of the most delicate secrets, — secrets which involve the peace of families and neighborhoods, — secrets which his honor as a man, and his truth as a physician, compel him to lock fast in his own breast, and hold sacredly apart even from his nearest companions, — secrets which, if revealed would fill domes- tic circles with unutterable bitterness and heartburnings, and whole neighborhoods with scandal and immorality. These secrets are often a burden to him. They are in his breast like undigested food in the stomach, — disturbing the whole nature. The patient, if a man of sensibility, suffers even more, of course, than his physician. In many cases, he is a man of virtuous inten- tions, and perhaps of religious habits, who has fallen in a moment of temptation ; and he fears that the effect of his sin will spread itself through his whole system, and extend to the end of life ; or, still worse, that having poisoned the fountain of his life, it will go down as a heritage of misery to his offspring ; or, what he would deprecate as almost equally calamitous, that the partner of his bosom may be- come the innocent partaker of his disease. In this state of apprehension, he turns to his physician, not merely to keep his secret, but to cure his disease. How great a pity that, in such circumstances, he does not always fly immediately to an honor- able physician, instead of seeking the advice, as many do, of those miserable quacks, who lure him to their dens only to get Ins money, having no intention or ability to cure his complaint. These diseases are divided into two great branches, characterized, in part, by different symptoms, and generally held to be entirely dif- ferent complaints. The first to come under consideration is Pox. — Syphilis. This disease had a very early origin. It was known among the Jews, as we learn very clearly from the fifteenth chapter of Leviticus. Dr. Adam Clarke's Commentary upon this chapter, at least, makes it apparent. David, the king of Israel, has unconsciously left on record, in the thirty-eighth Psalm, a most graphic description of Tertiary 360 P1.5. Q VENEREAL OR SEXUAL DISEASES. 361 Syphilis, experienced in his own person. Dr. Clarke says : " It is most likely the Psalm was written in reference to some severe afflic- tion that David had, after his illicit commerce with Bathsheba ; but of what nature, we are left to conjecture from the third, fifth, and seventh verses." The Psalm is dated not quite a year after the act alluded to, — about the right time for the terrible symptoms David describes to make their appearance. The term syphilis is from a Greek word signifying filthy. There is one unvarying sign of this disease, — the existence of an ulcer or ulcers, usually upon the genital organs. The French call this ulcer a chancre. The common name is simply venereal sore, or ulcer. A pimple first appears ; on the summit of this a pustule forms ; then the rupture of the top of this brings to view the ulcer or sore. This ulcer is shallow, more or less circular or oval in form, bounded by a perpen- dicular and slightly jagged border, and furnished with a smooth, yel- low base, moistened by an unhealthy secretion. The skin around the sore is a little thickened and inflamed. This is a simple venereal ulcer. It generally lasts about five weeks, and then heals. But it is not always thus simple. It may be an inflammatory chancre, attended by excessive inflammation. It may be what is called a sloughing chancre, characterized by the perishing and falling off of large parts of flesh. It may be gangrenous, or marked by a ten- dency to mortification. It may be phagedenic, or eating, — being dis- tinguished by a rapid loss of substance, or eating away of flesh. Or, finally, it may be indurated, — being noted for the peculiar hardness of the base, and of the flesh immediately around it. A venereal sore is the result of impure connection with a person having the syphilitic disease. The poisonous secretion of a sore, applied to the skin of a healthy person, produces inoculation, and a new sore upon the previously healthy person is the result. This chancre appears in a few days after coition, — a certain time being required for it to produce its effect, as in the application of vaccine matter to the arm. Bubo. — The next symptom in the order of occurrence, which fre- quently follows the ulcer, is the bubo. It is named from a Greek word which means groin, from its usually appearing in that part. It is a painful swelling of the inguinal gland in the groin, and is caused by the absorption of virus or poisonous matter from the chancre. This gland is one of the lymphatics, a class of vessels as numerous, all over the system, as the veins and arteries. They are likewise called absorbents. Those that originate from the private parts absorb the poison from a venereal sore, and convey it to the glands in the groin, which being poisoned by it, inflame and swell. The bubo generally appears in from one to two weeks from the appearance of the ulcer. It is usually upon the same side which the chancre occupies upon the penis. When the bubo advances to sup- puration, and becomes an open sore, it is then a glandular chancre. 362 VENEREAL OR SEXUAL DISEASES. Vegetations. — These are peculiar growths appearing upon differ- ent parts of the skin, which resemble certain vegetables. They are found most frequently, in the male, on the head of the penis, and on the membrane lining the foreskin. In the female, they are found at the entrance to the vagina, and not infrequently in the vagina itself. They sometimes appear on the neck of the uterus. Primary Disease. — Thus far, the diseases noticed are what are Called primary. If properly treated, and cured in season, the consti- tution is not infected, and no subsequent troubles appear. But a result so fortunate as this is not common. Generally, the treatment is either too long delayed, or is too brief and superficial. The poison is, in consequence, absorbed into the circulation; the whole con- stitution becomes infected ; the fluids and solids are so acted on and altered, in fact, that a special constitution is created. For this reason the affections of the skin, the mucous membranes, the bones, etc., which follow, are called Constitutional. — These constitutional diseases never appear im- mediately, as the result of an impure connection, but only after those affections already noticed. The primary diseases are local ; the con- stitutional affections are general. The first thing which strikes the eye in these constitutional com- plaints is the color and appearance they give the skin. It has a red- dish, coppery tinge, and a peculiarly dirty appearance. The order in which the several parts are affected, are, first, the skin and mucous membranes ; second, the hard substance surrounding the bones, called periosteum, the tendons, and the bones themselves. Those affections which appear upon the skin and mucous membrane are usually called secondary, because they are the second to appear ; while those affecting the bones, etc., are denominated tertiary, be- cause, in the order of their appearance, they are in the third class. Eruptions of the Skin, and Ulcers. — Of the constitutional erup- tions, there is a great variety, — so great that I cannot, in small space, give a minute description of them. The breast and arms are not infrequently the first to be affected. Attending these eruptions there is little uneasiness, and no pain ; though there is sometimes a slight itching. The first breaking out is usually of a copper color, some- what paler than it subsequently is. The eruption is often in the form of blotches, elevated only a very little above the skin. They are composed of small pustules, with a little fluid in them, which soon dries away, and the whole may be rubbed off like bran. This may leave the skin looking tolerably sound, and inspire the belief that no further mischief is to be experienced. No hope can be more delusive. Parts afflicted with this complaint show no tendency to heal. The first crop of pimples is soon followed by a second, which pro- duces a thicker crust, and yields a larger amount of bran. This rubbed off, small ulcers appear underneath. VENEREAL OR SEXUAL DISEASES. 363 Vesicular Uruptions. — There is another syphilitic affection of the skin, which appears in the shape of vesicles, like small-pox. These dry and leave a scab. Scaly Eruptions There is still another affection, which is in the form of scales, and one scale will be piled upon another. It begins with an eruption of copper-colored blotches, which become covered with scales ; these are succeeded by scabs, and when these fall off, shallow ulcers are left with copper-colored edges. (Fig. 135.) This is a stubborn form. Fig. 135. Tubercular Eruptions In another variety of the disease, broad, red, copper-colored tubercles, or hard elevations appear, most com- monly about the sides of the nose, or on the cheeks. Gradually they suppurate, and are succeeded by deep ulcers, terminating in scars. This is an unfavorable form of the disease, and usually appears some considerable time after the primary symptoms, in persons whose con- stitution has been shattered. Plate V. This rather belongs to the tertiary form of the disease ; and in addi- tion to the above, patches of unhealthy inflammation are apt to form on the tongue, and after a time break, disclosing ragged, orange- colored ulcers. Plate VI. Fig. 2. Many other forms of eruption exist ; but in a popular work like this, it would be useless to make the nice distinctions which their description would require. Some of the worst forms of the secondary affections are found upon the mucous membrane of the mouth and throat. These corres- pond, in number and size, with the affections of the skin. They affect the lips, the internal sides of the cheeks, the tongue, the tonsils, the pharynx, the soft palate, the nasal cavities, etc. They are terribly destructive in their effects, forming gaping ulcers, and eating deeply into the parts. They often make shocking work in the whole mouth and throat; and, when attended with considerable inflammation, make it almost impossible to swallow anything, or even to open the mouth. I have often seen breaches through the palatine arch (Plate VI, Fig. 1), and even the whole arch destroyed (Plate VI, Fig. 2). Persons have often died from starvation, — not being able to swallow. The ulcers sometimes take hold of the tonsils, and "dig them out as if it were done with a punch." These ulcerations affect the mucous membranes of the genital organs. In the female, they often affect the vagina and the neck of the womb, and thus may exist for a long time, as the cause 364 VENEREAL OR SEXUAL DISEASES. of whites, without being suspected as such. They affect also the mucous lining of the fundament and the large bowel. They sometimes exist in the ear, and more often in the eye. This latter affection passes under the name of syphilitic iritis. In Plate V. the artist has well represented this form of constitutional disease in the eye. The disorder having, by frightful ulcers, run riot upon the delicate structures of the skin and mucous membranes, advances boldly on- wards, attacking the muscles, the tendons, the hard covering of the bones and the solid bones themselves. No part of the human frame- — not even the skeleton — can escape this devouring complaint. The bones of the nose and face are generally the first to be attacked. These perish slowly, — falling away piece by piece, — the nose, in the mean time, sinking down nearer to a level with the cheeks. From these parts the disease may spread to the bones of the whole system. These affections of the bones are attended by pains of almost every kind and degree. These pains are sometimes fixed in one place ; at other times wandering, the whole skeleton being painful. In these latter cases, they seem to the sufferer to reach the very mar- row. Sometimes when the pain is fixed in one place, the feeling is such as might be supposed to be experienced if the bone were being bored. These pains are most terrible during the night. Upon those parts where the skin is near the bone, as the forehead, or shin, syphilitic nodes or tumors often appear, which are hard, like cancerous tumors. Besides the above, there are the loss of the hair (alopecia), blindness, deafness, and various other mischiefs, resulting from syphilis, which need not be described. Is the Constitutional Disease Communicable ? — Many believe, — even among those who are eminent in the profession — that the constitutional forms of the disease are not communicable. A few years ago, indeed, this latter opinion was generally received. It is now quite extensively doubted, or rather disbelieved. Facts are con- stantly occurring under the eye of unprejudiced physicians, which make it very evident that the constitutional disease may be commu- nicated from one person to another. The Disease Hereditary It is no small amount of suffering, bodily and mental, which the individuals endure who contract this disease. But the inflictions visited upon them, severe as they are, are small compared with the aggregate of ills entailed by it upon the long line of their posterity. Whether it be the man or the woman whom the sphilitic virus has inoculated, if it be allowed to be absorbed, so as to affect the constitution, it Avill be very likely to be sent down to the children, and children's children. The divine law which links the sins of the father with the sufferings of even the third and fourth generation, is nowhere more painfully illustrated VENEREAL OR SEXUAL DISEASES. 365 than iii the scourging descent, through many generations, of this ter- rible disease. It may be passed down to posterity by either of the parents ; but if both be diseased, the transmission will be more cer- tain. If the mother be infected, she will infect the child while car- rying it. If the father's constitution be poisoned, the child will receive the infection from him, through the semen, and will be likely, while in the womb, to infect the mother. I recollect but one author of note (Ramsbotham) who has mentioned this mode of in- fection. I have myself seen two cases of it. This constitutional disease, whether it exist in the mother, or be communicated to the child, and thence to her, by an infected father, is a frequent cause of abortion. Throughout nature, blight is the re- sult of a diseased parentage. Mature fruit is seldom obtained from infected seed. Is the Constitutional Disease Curable ? — No question connected with the complaint possesses a greater interest than this. None is pressed more earnestly upon the physician. In a certain sense the disease is curable. Its outward manifestation may be wholly re- pressed. The health of the person suffering from it maybe restored, and become, in an important sense, good. But this cure is never brought about by nature ; it may be, and is often effected by medicine, I have never failed to effect such a cure in any case which has come under my treatment. Such results may properly, in general terms, be called cured. Yet there is a sense in which a cure never occurs. It is a well- attested fact, that a system once thoroughly pervaded by the poison is never completely purged of it. It may be shorn of all its active malignancies ; but it has too intimately permeated the tissues and solid bones to be wholly expelled. Pursue it as we will with the remedial forces of our art, it still takes refuge in the most subtle pro- cesses of animal life, — still infects the currents of being, and finds expression in the scrofula, in the lupus, and in the scaly affections of other generations. Dr. Erasmus Wilson, the great authority in skin diseases, says : " I feel convinced that a considerable proportion of those diseases which pass under the name of scrofula are the produce of the syphilitic poison, — are, in fact, not scrofulous, but syphilitic." Astruc thought the same, and suggested, what is doubtless true, that the transmission of syphilis must occur through several generations before it becomes scrofula. Bierchn, Camper, Stoll, Portal, Huf eland, and Alibert, have all advocated the same opinion. This is doubtless right, though there are many authorities on the other side. He must be a poor observer who cannot discover a prob- able filial relationship of scrofula to syphilis. A variety of facts, admitted by the whole profession, go far towards demonstrating this relationship. Scrofula is always hereditary. It is a disease of the parent, imparted to the offspring. But there is scarcely any disease so certainly sent down to posterity as syphilis. 366 VENEREAL OR SEXUAL DISEASES. Scrofula is like syphilis in many of its characteristics. It is like it in its power of propagating itself from parent to child. It is like it in affecting nearly all the children of diseased parents. It is like it in the variety of the structures it attacks,' — affecting the skin, the mucous membranes, the bones, etc. Like syphilis it produces hard tumors, ulcers of the skin, abscesses, and decaying of the bones. And finally, the great remedy for tertiary syphilis, iodide of potas- sium, is likewise the great remedy for scrofula ; and, indeed, almost every remedy which acts favorably upon one, is found useful for the other. This could hardly occur were not the diseases identical in nature. We can scarcely be surprised that a disease so widely diffused as scrofula should be the product of syphilis, when we reflect how fright- fully prevalent were the causes of this latter affection during the earlier and the middle ages of the world. To pass over the records of earlier times, with merely mentioning Abraham, and Lot, and Jacob, and Reuben, and Samson, and David, and Solomon, and numerous females, of whom some singular things are written in the older scriptures, and omitting all . mention of the incredible and almost universal debauchery and prostitution of Greece, and Rome, and Persia, and Media, and Egypt, I may say that Europe, in the middle ages, was well-nigh converted into a vast brothel. Foremost in the race of profligacy were those in authority, kings, and emperors. The licentiousness of Childeric knew no bounds. He carried off and violated the wives and daughters of his vassals, with- out regard to any right, human or divine. His successors were gen- erally a race of lecherous men, who spread debauchery on every hand. The French monarchs, from Pepin and Charlemagne, were a race of debauchees. Their courts were national brothels, in which the finest women in the land were trained in the arts of seduction and lust. Francis I, in 1515, endeavored to invest prostitution with elegance and chivalry, and even to ennoble it, by abandoning the public women of the palace to his subaltern officers, and substituting for them ladies of noble blood. In this movement, the nobles and the officers gave the king their support. ' ' ' They are all gone aside ; they are altogether become filthy; there is none that doeth good, no, not one." Brantome justifies Francis in his selection of girls of noble blood, on the ground that " they could not communicate the venereal dis- ease to the noblemen of the courts, like the common prostitutes." But the king, who was previously diseased, infected them; and these noble women, so called, passing from the arms of the prince to those of the courtiers, presented to them the fatal infection received from the king. The way in which Francis himself was infected illustrates, in a most shocking manner, the morals of the times. His illicit loves with VENEREAL OR SEXUAL DISEASES. 367 the Belle Ferroniere were not concealed from her husband, who, though obliged outwardly to regard the dalliance of his wife with the monarch as an honor, was inwardly indignant, and determined to become infected himself, and thus disease his wife, and revenge himself upon the king. This plan was suggested to him by a noble who had another motive, namely, that of punishing Francis for some personal spite. " How," said the husband, when the suggestion was made, " shall I give this disease to my wife, when we are both sound ? " " Go visit an infected girl," said the noble, " and to ren- der the matter certain, as I am infected, I will see your unfaithful wife." The result was such as the husband desired; and in 1547, Francis I, the gay and chivalric monarch, perished of the most foul and loathsome of all diseases. Debauchery did not die with him. It was cherished by his succes- sor, Charles IX, and his mother, Catherine de Medicis, and his grand- son, Henry III. The reigns of Henry IV, Louis XIII, Louis XIY, the Regency, and of Louis XV, were stained by the same licentious- ness and disregard of public decency, until the whirlwind of the revo- lution came to purify the moral atmosphere. The reader will now, I think, be in no mood to wonder that the men and women, and many of royal progeny, whether the dishonored occupants of thrones, or the more private recipients of the public bounty, are a scrofulous and degenerating race. Nor need it be much wondered at, that so large a portion of men and women every- where have more or less scrofula in their frames. Happy are those who can find no trace of this complaint in their constitution ! They should rise up and call their virtuous progenitors blessed. They should especially thank God that they have sprung from the loins of a race more noble and kingly in the eyes of Heaven than all the royal lines of the world. Treatment of Syphilis. — In the treatment of this disease, the first thing which requires attention is the pimple, pustule, or sore. This must be instantly touched with caustic. There should be no delay, for if the sore be not syphilitic, the caustic will do no harm ; and if it be, the most terrible results may be averted. The general belief is that poison remains in the sore for a time before it is absorbed into the constitution. It is of the utmost importance that it be destroyed before the absorption takes place. The caustics used are nitrate of silver (stick nitrate), nitric acid, chloride of zinc, potassa with lime, caustic potassa, and the painless caustic. The nitrate of silver is much used, but the best surgeons now re- gard it as useless. It does not prevent the absorption of the poison. The caustic potassa, the potassa with lime, and the painless caustic, are the sure remedies, — that is, if applied in season. But they must be employed with caution. It will not do to trust them in bungling hands. A little vinegar and Avater must be immediately used to neu- 368 VENEREAL OR SEXUAL DISEASES. tralize the caustic when it has accomplished what we desire. After the sore is cauterized, a piece of lint, dipped in a solution of watery extract of opium, one dram to four ounces, should be laid on it: and the organ enveloped in another piece of lint soaked in tepid water, and covered in oiled silk. The patient should remain at rest as much as possible, keeping the penis elevated, and repeating the opium dressing to the wound, and the water dressing to the whole organ, night and morning. In addition, the patient should take two pills (19), to be followed, night and morning, for three or four days, with a tablespoonful of (20). In some cases, a piece of lint, wet with the tincture of muriate of iron, diluted and kept upon the chancre, will cause it to heal kindly, and with safety to the patient. If this treatment be adopted early and properly, the patient is cured, and nothing further needed. But time is generally lost. The poison is absorbed before the patient is seen by the physician ; and the question then is, how it is to be driven out. To accomplish this, the diet should be regular and unstimulating; alcoholic drinks and tobacco should be forbidden ; the mind should be kept at rest ; a cold or tepid bath should be taken daily ; the ac- tion of the bowels and kidneys should be kept properly regulated. These things will put all the expelling agencies in proper condition for work ; and no single medicine will put them all into actio u like mercury. For this reason, no other single drug has enjoyed a repu- tation for curing pox so wide as this. But it must be used with judgment. No remedy is more safe, if judiciously employed, or more destructive, if abused. The profuse and ill-considered way in which it was used in former times, raised a prejudice against it which is unreasonably cherished at the present day. Abuse made mercury a curse ; judicious use makes it a blessing, — at least in this disease. The blue pill is one of the best forms of it (148), combined with extract of henbane. One pill at night is the usual amount to be taken. Some prefer the mercury with chalk (149) ; others, the corro- sive sublimate (150) ; others, the proto-iodide of mercury (136). Some one of these should be given about five days, in the doses named under the recipes, — being careful not to produce salivation. After the fourth or fifth day we can generally increase the frequency of the dose. Should salivation be accidentally induced, it should be arrested by a solution of chlorinated soda (205), one part to twelve of water. The mercurial treatment should continue for two years after the sore has disappeared; after this prolonged treatment iodide of potassium is used for another year in as large doses as the patient can take with- out producing ill effects. At the expiration of two years, if the patient has taken his medicine regularly, he may be considered cured, at all events, sufficiently so to marry and have children. Water should be taken freely, and various diluent drinks. They wash the poison out through the millions of avenues, called pores, just as we wash filth out of cities by pouring water into the sewers. P1.6. / ^% *s H CO > CO w CO A 3 <-p bo ,.3v 3? VENEREAL OR SEXUAL DISEASES. 369 I should mention that there are those who claim to cure the disease with other remedies, without mercury, and I am not disposed to be dogmatical, and say it cannot be done. For this purpose, perhaps as good a recipe as has been proposed is the compound syrup of stillin- gia, tincture of poke-root, tincture of sheep-laurel, each four ounces, mixed ; of which, from a teaspoonf ul to half a tablespoonf ul is to be taken three times a day. I think well of this remedy, especially if it be in connection with a small amount of mercury. If stillingia be used, obtain McDade's stillingia comp., 1 dram three times daily. The Bubo, if not attended with pain, may be treated with com- pression, by a piece of plaster of ammoniac with mercury, or by touching it with nitrate of silver. Should there be inflammation, and the formation of matter be inevitable, the bubo should be opened by touching it with the caustic potassa ; and the resulting sore must be treated with the solution of opium and water dressing. Should the sore need stimulating, it may be touched lightly with nitrate of silver. Eruptions upon the Skin. — In treating the disease after it appears upon the skin, etc., we shall derive great advantage from the use of either the warm or the vapor bath once a day. With this, if the case be not very old, we may employ (148) or (150) ; but if the disease be an old one, showing itself in the throat, or attacking the bones of the face, we must give iodide of potassium (138), combined with compound decoction of sarsaparilla. This is the great remedy for tertiary syphilis ; but when the case is obstinate, it may sometimes be discontinued, and the corrosive sublimate (139) be substituted for it. It is to be observed that the older the disease grows, and the more chronic its character, the more does mercury lose its control of it. In the first attack, the blue pill is the best ; in the second, as a general tiling, the iodide or the biniodide of mercury; in the third, the cor- rosive sublimate ; in the attacks subsequent to this, particularly in the tertiary form of the disease, the iodide of potassium. When the throat and nose are so ulcerated as to make a case absolutely terrible to contemplate, it is surprising to see how rapidly the recovery will often take place under the influence of this latter remedy. For syphilitic iritis, apply frictions twice a day on the eyelids and eyebrows with ointment (172), (173); and administer internally two pills of (136) daily. Clap. — Gonorrhoea. — Blenorrhagia. The reader is aware that the nose, mouth, and lungs are lined with a mucous membrane, which is liable to become inflamed from various causes. This inflammation we call a cold or catarrh. During its continuance, mucus and other matters, of different colors and degrees of consistency, are more or less freely discharged. 370 VENEREAL OR SEXUAL DISEASES. The mucous membrane of the private parts of both sexes is just like that of the mouth and throat, and subject to similar inflamma- tions and discharges. But these inflammations of the private parts, instead of being produced by change of weather, etc., generally result from the application of the specific poison or germ-microbe of gonorrhoea. When a woman abandons herself to unlimited inter- course with different men, the private parts become stimulated to so unnatural an extent, that the secretions of the parts, which are largely augmented, at length become altered in their nature, acrid, and finally poisonous, — so acrid and poisonous that they cause inflammation of the parts, and when brought in contact with the male organ, in the sexual act, they poison and inflame that. The specific germ of gonorrhoea is called the gonnococcus. This is the shortest and plainest explanation I can give of clap. From this explanation, one may learn why a man will sometimes take a disease from a woman who has never had any evidence of being diseased herself. If she have indulged her sexual propensities un- reasonably, though not enough to produce inflammation upon herself, her secretions may yet have become acrid enough to poison one whose organs are delicate and sensitive. And more than this, — the secre- tions of a female may become acrid and poisonous from other causes than excessive venery. The discharges in bad cases of whites will sometimes irritate and inflame the male organ, and induce a disease which has every appearance of gonorrhoea. A husband, in great distress of mind, sometimes submits a case of this sort to the phy- sician's inspection, and lays upon him the delicate and responsible duty of deciding whether the wife has been unfaithful. No act in a whole professional life can be more momentous than a decision of this sort. If a man be well skilled in his art, he may give an answer in such case, which shall dispel the most terrible apprehensions, and save the peace of a loving family. The poison, when communicated by a diseased person to the male or female organs, requires a certain time for the germs to produce their peculiar effect, — generally from three to eight days. Symptoms. — The first symptom of the disease is uneasiness in the end of the penis, accompanied, generally, with a little redness, and difficulty in passing water. The color of the first discharge may be white or straw-colored. There is tenderness where the parts are red. Scalding in passing water is sometimes, not always, present at first. This is the beginning, or first stage of clap. Now is the time to cure it easily. But, unfortunately, the physician seldom sees a case in this early stage. Before he is allowed to inspect it, the second stage has generally appeared, which is known by violent scalding when water is passed, by chordee, or painful erections of the penis, and by an increased discharge of greenish matter often tinged with blood, and coming from much farther down the urethra, or water- passage. The matter sometimes comes from as far down as opposite VENEREAL OR SEXUAL DISEASES. 371 the scrotum, or bag which holds the testicles. There is more or less pain the loins and back. The whole body of the penis may become affected, and abscesses form. A third and more terrible stage of the disease begins when the in- flammation has reached the lowest part of the water-passage, just where it enters the bladder. Around this part of the passage, and lying upon the bladder, is a gland in size and shape like the largest chestnut. It is called the prostate gland. On either side of it lie the receptacles of the semen, each of which sends its duct into the water- passage. When the inflammation extends through this gland, it irri- tates the neck of the bladder, and causes a distressing desire to pass water ; and from its proximity to the larger bowel, it sends its irrita- tion thither likewise, and impels a terrible effort to evacuate the bowels, called tenesmus. It is the same awful feeling experienced in dysentery. Few things can be more terrible than these two distress- ing feelings conjoined, — the desire to pass water and to empty the bowels. Racked with terrible pains and awful tenesmic distresses, and often with painful erections, the patient passes back and forth between the bed and stool, — often vowing in the sincerity of his heart, that if he can but recover from this, he will never be caught again. The enlargement of the prostate gland may become chronic and permanent, and be the affliction of a man's life. Stricture. — One of the most troublesome and persistent conse- quences of gonorrhoea is a partial closing up of the water-pipe, at- tended generally by quite a serious obstruction to the passage of the water. It is called stricture. The mucous membrane which lines this passage, being long inflamed, becomes thickened and less pliable or elastic. The tissues which lie underneath this membrane also become swollen and hardened, and, pressing upon the water-passage, lessen it still further, making the stricture more difficult of cure. In stricture, the stream of urine is altered in size, length, and force. Its course is changed, when the stricture is lateral. The stream is often flattened, like the blade of a pen-knife, or twisted like a gimlet, or forked, one stream reaching beyond the other. In consequence of obstruction, the bladder is not entirely emptied, and the desire to urinate immediately returns, and is very urgent. Gleet. — Another very troublesome result of gonorrhoea is gleet, — a thin, colorless discharge, which persists, in a chronic form, after all active inflammation has subsided. It is very annoying, and very ob- stinate. It is often dependent on the altered condition of the mucous membrane occasioned by stricture. Orchitis. — Another very severe result of clap is swelling of the testicles, called orchitis. . It begins frequently with chills and fever, with a feeling of weight in the scrotum, and pains in the loins. The swelling rapidly increases, and reaches its height in from three to five days. 372 VENEREAL OR SEXUAL DISEASES. Besides the above, there are still other mischiefs which follow this disease, such as inflammation of the prostate gland, already described, of the bladder, and of the kidneys. In the female gonorrhoeal inflammation affects the external geni- tals called the vulvae, the water-pipe, the vagina, and the neck of tKe womb, and often plays havoc with the ovaries and Fallopian tubes. In women the disease is often fatal by ascending the tubes and penetrat- ing to the abdomen, where an acute peritonitis is set up, with the formation of pus. There is a difference of opinion as to whether gonorrhoea ever pro- duces secondary or constitutional symptoms. Ricord, the great French authority on this subject, affirms, and with him a great num- ber of followers, including most of the profession in this country, that constitutional symptoms never follow clap ; that they never re- sult from anything but a syphilitic ulcer. Vidal, a French authority, safer, in my judgment, than Ricord, though not as renowned, says, on the contrary, that secondary and tertiary complaints do follow viru- lent gonorrhoea. Wilson, the highest English authority, and many others, agree with him. Unprejudiced observers feel well convinced that this latter opinion is right. I have myself seen not less than half a dozen cases of secondary and tertiary syphilis, which were preceded by gonorrhoea, and nothing more. Treatment. — In the first stage of the disease, there are two meth- ods of treatment, either of which may be adopted with success. The first, which has many advocates, is the local treatment. An injection, with a glass syringe, is immediately made, of a solution of nitrate of silver, of the strength of five to ten grains to the ounce of water. It should be retained from one to five minutes, by pressing the head of the penis between the thumb and finger. If done before the third day, this will generally cure the disease. The physician should have entire control of the patient, and com- pel him, if possible, to keep his room, and live for a few days on crackers and water, or something equally simple. All meats and stimulating drinks are to be excluded. The other mode of treatment, which is perhaps the more commonly adopted, is more general in its nature. It embraces the use of warm baths, warm sweating drinks, and rest. If the patient is full of blood, and strong, from five to fifteen leeches are applied to the space be- tween the scrotum and fundament. These things, with a low diet, will frequently reduce the disease in a few days. If the discharge should continue, after a fair trial of the above, then copaiba and cubebs (272) are to be used. Several articles are added in the above prescription, to make the copaiba acceptable to the stomach. This preparation can be taken by most persons, and generally produces very gratifying results. Vidal strongly recommends an electuary, or thick paste (273), of which a piece twice as large as a nutmeg is to be taken in the course of the day. The prescriptions which contain VENEREAL OR SEXUAL DISEASES. 373 copaiba and cubebs are numerous ; but the above two are as good as a hundred. With these articles, the baths, the leeches, and the re- pose, are to be united. Vidal says he never resorts to injections first, but employs the anti- inflammatory course first. If that fail, then he uses the injection (207), three or four times a day ; and if he employs the nitrate of silver at all, it is only as an astringent (208). Prescription (304) is a valuable injection. When the second stage sets in, and the symptoms become more violent, injections must not be used. For the very severe scalding in passing water, which is now felt, take thirty drops of a solution of potassa in half a tumblerful of water, twice or three times a day. Persons of full habit, may be benefited by dissolving a grain or two of tartar emetic in a tumbler of water, and taking to the extent of producing a little nausea. Relief is occasionally obtained by holding the penis for some time in warm water. For the painful chordee, or erections, camphor and opium (120) are required, — from one to three pills a day. Thirty drops of laudanum maybe given when the patient retires. Cold applications to the gen- ital organs, or walking barefooted upon the cold floor, will frequently give relief. When other things fail, three pills a day may be taken of extract of hyoscyamus, containing from one to four grains each. The quantity of drinks must be diminished, and cold lotions must be applied to the penis on going to bed, — the patient covering himself lightly. Gleet is generally very obstinate, and often requires a very pro- tracted treatment. If there be any tenderness along the under side of the penis, it is well to apply three or four leeches. Occasionally recipe (272) will have an excellent effect. But gleet is an unhealthy action, sustained by habit, and may often be cured by simply exciting a new action which shall break the old habit. It is always well, therefore, to resort to injections. Sugar of lead and sulphate of zinc (207) answer a good purpose ; or sulphate of zinc and tannin (209) may be tried. Chloride of zinc (210), does well in some obstinate cases. But gleet is often dependent on stricture, and when this is the case, we must learn the location of it by exploring the water-pipe with a bougie. When the instrument reaches the constricted part, the pa- tient feels pain, or the surgeon meets an obstruction, — often both. When the stricture is found, it is either to have the solid nitrate of silver applied to it with an instrument called the forte caustique, or a solution of nitrate of silver (211), or of acid nitrate of mercury (226), with a shower-syringe. When these means fail, we must pass a small bougie gently through the stricture ; then a larger, and then a still larger one, until the obstruction be removed. They should be used once or twice a day, and not be retained long in the passage. They frequently have to be used ten or twelve weeks, and should 374 VENEREAL OR SEXUAL DISEASES. not be discontinued till the cure is complete. Put no confidence in those quacks who promise to cure these old troubles in a few days. They want your money, but have no expectation or ability to cure you at all. For inflammation of the testicles, apply leeches at once. To this should be added warm fomentations and poultices. If these means fail, more serious measures are to be adopted, which it would be out of place to describe in this book. Inflammation of the prostate gland is also to be treated with leeches and poultices ; likewise a warm hip-bath. The water must be drawn off with a catheter until it can be passed in the natural way. Prevention of Sexual Diseases. — I have several times been in doubt as to the best method of presenting some of the topics which the wide scope of this book has brought before me ; but no one sub- ject has perplexed me like the one announced in the above head- ing, — not that it is not easy enough to furnish the rules for preventing venereal disease, but that it is a grave question in morals whether to instruct the world in the methods of such prevention is right. Is it proper to give any other advice than the simple direction to abstain from all liability to disease ? That is the question. If such advice would be heeded, of course no other should be given. But it would not. If the person disregarding it would alone suffer the penalty of the transgression, it might then be best to em- body the whole advice in the simple imperative word, abstain! But this cannot be. The infection will be imparted to a third person, and onward to thousands ; and many of these thousands will be innocent wives, who will perish of the disease, or send the infection down to the second, the third, the fourth, and to all generations ! While a strict morality might seem, therefore, at first view, to forbid the in- culcation of rules for avoiding infection, the good of the race would appear to justify and lequire it. The first requisite for prevention is cleanliness. Frequent washing is of prime importance. The precautions should not be the same before and after the vene- real act, when a person is about to expose himself to risk. Before the act, the parts should be carefully examined to see if there be any break in the skin. The least breach in this covering of the penis greatly promotes contagion. Before coition, there should be no wash- ing with soap, for this deprives the parts of the mucus and oil, = — thus rendering the naked and exposed skin liable to infection. On the contrary, to apply a solution of alum, tannin, or a decoction of oak-bark, or aromatic wine, constringes or hardens the covering of the organ, and renders contagion more difficult. An article called con- dom is often used to ward of! disease. It is a sack made of gold- beater's skin, and is drawn over the penis like a glove over the finger, and thus protects it from contact with poisonous matter. VENEREAL OR SEXUAL DISEASES. 375 Of still greater importance are prompt measures of prevention after the act. Lotions should be immediately applied to every part of the organ, and in the case of females, should be used as injections. These lotions should be acids or alkalies. A mixture of vinegar and water has been recommended as an excellent wash. Ricord recom- mends aromatic wine ; Malapert, corrosive sublimate (212), in the form of solution. Probably the best preventive is composed mainly of alcohol and soap (213), as recommended by Langlebert. An exposed person, using any one of these solutions, particularly the last, or, in the absence of all these, washing thoroughly with soap and water, will be likely to escape contagion. Medical Police. — What is called general prophylaxis, or preven- tion, or medical police, is not a subject of legislation in this country. The moral sense of the American people does not admit its necessity. In Europe, the authorities watch over prostitution. They even go so far as to regulate it. They appoint practitioners, whose duty it is to act as a sort of medical police, and particularly to visit houses of prostitution once or twice a week, and examine all the inmates. When a girl is found diseased, she is immediately removed to a hos- pital, and not permitted to return until she is well. Self -Pollution. — Masturbation. There is probably no vice to which so many boys and young men, and even girls and } r oung women, are addicted, and from which so many constitutions break down, as self -pollution. Small boys and girls learn the vile practice of the larger ones at school, and generally continue it up to maturity, without the least suspicion that they are inflicting upon themselves either a moral or a physical injury. This comes of the false modesty and bastard morality which with- holds from the young all knowledge of the proper functions of their sexual organs, and of the inconceivable mischief resulting from their abuse. A gentleman of distinction lately said to me: "I instruct my boys as faithfully on this subject as upon any other moral or physical question, and I tell my wife it is her duty to do the same with the girls." This is wise. Yet, how few parents ever speak to their boys or girls on the subject, to give them the least reason to suppose there is any better rule for their conduct than their own desires ! Symptoms. — These are very numerous. The principal are, head- ache, wakefulness, restless nights, indolence, indisposition to study, melancholy, despondency, forgetfulness, weakness in the back and private organs, a lack of confidence in one's own abilities, cowardice, inability to look another full in the face, and, among females, hyster- ics, whites, and a desire for seclusion from society and solitude. I have already spoken of the receptacles of semen, lying on each side of the prostate gland. From the fore part of these receptacles, the semen passes through two ducts, about a finger's breadth in 376 VENEREAL OR SEXUAL DISEASES. length, into the urethra or water-pipe, just in front of the prostate. From excessive self-pollution, these ducts become very irritable, and also debilitated and relaxed, — so much so that they will not retain the semen ; and during lascivious dreams, it flows off. These semi- nal losses are called "nocturnal emissions." So constant is the drain they keep up upon many young men who have abused themselves excessively, that *the whole man, mentally, morally, and physically, becomes a wreck. There are few objects more pitiable to behold than a young man in this condition, — his nervous system feeble, tremulous, and broken ; his memory weakened and fading out ; his eye unsteady and incapable of looking a friend in the face ; his loins and back weakened, giving him the feeble gait of old age ; his once erect form cowed and bent; his high sense of manliness all oozed out of him ; his mind taking up and dropping the simplest threads of thought, losing its way in the plainest paths of reflection, and often starting back affrighted at the glimpse of chaotic insanity opening before him, — turning here and there for relief, but finding little hope of recovery, except in marriage, and yet knowing himself unfitted to be the husband of an intelligent woman ! Treatment. — Every kind of treatment, no matter how judicious or well applied, will be unsuccessful, unless the vice which has produced the disease be absolutely and entirely abandoned. This is the first thing to be secured. It may be extremely difficult for the patient to do this, with his mental and moral nature all broken and in ruins, — with no heart to feel, nor will to execute ; and yet it must be done, or a cure cannot be effected. To bring this about, everything must be done by the physician to strengthen the moral nature of the patient, and to raise his self-respect and hope. The most careful directions must be given for restraining the imagination. The patient must be directed and encouraged to drive out from the mind, instantly, and upon all occasions, every lascivious thought; to cultivate the society of the most intellect- ual and virtuous females ; to make himself busy with useful and, if possible, agreeable employment; to avoid solitude; and to sleep with some friend. He should sleep on a mattress, and never on feathers ; always on the side, never on the back. Where there is considerable debility, tonics will be required, as the mineral acids (GO), (62), (78), and bitters (77), (67), (66), (59), and strychnine (83), (95), (85), and iron (80), (93), (72), (73), (71). In addition to some of the above preparations, the syrup of the hypophosphites should be taken for some time. The food should be nutritious and easy of digestion, and the cold alkaline sponge-bath should be taken once a day, with brisk rubbing; and the private parts should be washed daily with cold water, espe- cially just before retiring. In conclusion, I say emphatically to parents, do not let your sons and daughters remain ignorant on this subject. It is plainly your VENEREAL OR SEXUAL DISEASES. 377 duty to enlighten and to warn them. It is a matter in which young persons are generally disposed to do right, if rightly instructed. Avail yourself of your right to give counsel, and, if need be, to use authority. Says Ware : " The deleterious, the sometimes appalling conse- quences of this vice, upon the health, the constitution, the mind itself, are some of the common matters of medical observation. The vic- tims of it should know what these consequences are ; for, to be ac- quainted with the tremendous evils it entails, may assist them in the work of resistance. " To you, parents, on whose shoulders is carried the weighty re- sponsibility of rearing your children in a pure atmosphere, let me say that to shut your eyes against the probabilities of youth is an error and a sin. Let the mother learn to know the restlessness and ac- tivity of youth ; let the father recall his early ambitions, his longing for excitement, and his reaching out after life and activity in various ways. Do not repress these natural instincts, but learn to guide them into proper channels. Keep at home the attractions of public places ; have music and games, mirth and gayety; invent amusement and mirth, and banish dullness and apathy. Do not argue that your boy is better than other boys and your daughter superior to your neigh- bor's frivolous girls. The boys and girls guilty of this vice are somebody's children, and these somebody's children are nine to one your children. See that your children lead an active, physical life, that out-door games and gymnasium exercises enter largely into their lives ; keep them busy, give them something to do to occupy their attention beside their studies ; let them study with a will when they study, and play equally hard when they play. Do not be afraid to talk on, these matters with your children, and explain in a rational way what passion is, and how it is to be governed and how used. If you have that unfortunate amount of prudery and false shame so common to many people, and feel you cannot talk with your chil- dren about such matters, send them to your family physician and let him have a plain honest talk with the children. 4 Well stated in- formation never yet contributed to human inflammation.' Read them Storer, Ware and Wilder on 'What Young People should Know,' and make them realize that a 'healthy knowledge is the best preventive against an unhealthy ignorance.' Do not wait till the young have already grown up in the vice, — your admonitions may then be too late, — nor fancy your children have not been thrown in with influences which corrupt, and that by broaching the subject to them you are informing them of a subject they may never otherwise have heard of. Remember the statement : ' whether or not we ought to hide this subject from the young, if we could, the truth is, we cannot if we would."' To you, young men, in particular, let me warn you against a seem- ing propriety on your part to keep your silence. If 378 VENEREAL OR SEXUAL DISEASES to the habit, however slightly, go to your father, your mother, your family doctor. Confession will strengthen your will and purpose to overcome the temptation. Do not lie to the family physician in his inquiries : he is your friend and wishes you only success ; he is ac- quainted with these ailments and knows your temptations ; he ap- preciates and respects your noble desire to rid yourself of the evil. Do not, above all else, read the numerous pamphlets on Sexual Debility, Lost Manhood, etc., or be duped into answering advertise- ments in the public prints offering to send you literature on the sub- ject. No man can afford to send you free publications and postage- stamps unless he sees as an outcome a fee at the end of the book in the shape of medicines and other promised help. Steer religiously clear of these smoothly written books and these specialists in the art of restoring lost manhood. Your experience with them will be much like the countryman with bunco-steerers. Make every honest endeavor to conquer an unruly passion while it is young, and the more readily conquerable, but never despair of being helped by suitable aid, however long the passion may have been victorious over you. Do not ascribe your weakness in fighting temp- tation to the Almighty, the sins of your parents, or the example of your elders or associates, but go at the demon with a will and the fight is yours. Having conquered the enemy, the results of the past can be overcome by a pure life and the dictates of your physician ; nay, I may even add, Nature restores herself if only she can be as- sisted. In fact there is no specific for the troubles that arise from this vice. The only cure is to absolutely stop the habit and imme- diately thrust out all lascivious thoughts as soon as they enter the mind. Build up the strength and in time nature and marriage will do the rest. FEMALE DISEASES. In addition to the diseases common to both sexes, women are subject to a class of distressing complaints peculiar to themselves, and denominated, in general terms, female diseases. Involving con- siderations of a delicate nature, these complaints have too generally and too long been shut out from works intended for popular distribu- tion. Hence there is a general ignorance of a class of diseases which are fast unfitting woman for the high duty of continuing the race; and the subjects of these maladies are generally themselves so unin- formed of the true nature of their sufferings, that they are neither prepared to seek relief in the proper direction, nor to submit to the remedy if it chance to be proposed. It is intended here to speak of these disorders, as I have done of all others, in a plain and simple way, to describe them, so far as the present state of medicine permits, just as they are, and to make known the modes of treatment which have been found available for their cure. The sufferings of woman require this ; the interests of humanity require it ; and the writer is impelled to it, as he thinks, by a just sense of responsibility. Physicians, in my judgment, are chargeable with a great wrong in concealing within their own breasts information upon what are called delicate subjects, — information which the good of the world requires should be divulged, and which they ought to pour into the public mind, and make common, and which they would thus popularize, but for their stiff pride and conservatism. The idea that our knowledge cannot be imparted to the world without injuring the public morals, is simply absurd. We are more afraid of bringing the common people too near to us, of letting down our dignity, and of opening our profound secrets to popular eyes. The result is as it should be, that unsophisticated people are apt to give physicians a wide berth, and to have nothing to do with them unless necessity compels. Let doctors strip off their reserve, and while they remain gentlemen, become likewise companions, impart- ing their knowledge freely and familiarly to all, and the public con- fidence, now considerably shaken, will be frankly restored to the pro- fession. It should be the object of a good physician to know all he can, and 379 380 FEMALE DISEASES. to impart his knowledge to as many as possible. Knowledge is not merely power : it is happiness, it is wisdom, it is health, it is virtue ; yes, it is always virtue, except in some rare instances, where the worst natures pervert it. No physicians are so much loved as those who are frank, and have no concealments. The day for mysterious nods of the head, and rollings of the eyes, and shrugs of the shoulder, has gone by. Men, and women too (or those of them who are wise), wish to know distinctly what their diseases are, and what is neces- sary, not to palliate and prolong, but to cure them. Time when Female Diseases Begin Female complaints begin to make their appearance at the period of life called puberty, — the time when the girl passes from childhood to womanhood. This is the period when menstruation is established, which consists of a discharge from the genital organs, composed of blood and mucus, and which occurs, when regular, every four weeks. Up to this period, the system of reproduction has remained dormant. By the intervention of this mysterious function, the young female becomes a new being. The heart unfolds itself to new emotions; the mind assumes a solidity before unknown, and even the body acquires beauty from a sudden rotundity of form. This is the period when the great question of female health is very apt to be settled once for all, and for life. The girl who is well trained at this time, generally has a foundation laid for health and character, which is worth more to her than riches. At no time does the mother need so much wisdom and knowledge as now. To es- tablish the health and develop the affections of the daughter at this critical period, is a sacred trust which she can devolve upon no other being ; nor can she meet her responsibilities at this time, uuless better informed than most mothers are. The general apathy in regard to this maternal duty is deplorable. False Delicacy The refined delicacy which withdraws these subjects from the public gaze is commendable, for it casts a beauti- ful charm over society; but when carried so far as to cast a veil even over the eyes of mothers, it is quite unnatural, and leads to the worst results ; for in the bad management of girls at this critical period is laid the' foundation of so many of the diseases which shatter the con- stitution of so many women. For this bad management, it is not mothers alone who are to be blamed. The neglect of the medical profession to furnish the necessary information should come in for its full share of reproach. The Establishment of the Menses. — Nature always comes slowly and by degrees to the inauguration or establishment of any of her great functions. It is so in regard to menstruation, or, as it is va- riously called, " the menses," " the courses," " the change," etc. For some time before the flow begins, there are certain symptoms, or pre- monitions, which to the eye of the physician plainly enough foretell FEMALE DISEASES. 381 the impending change. To the mother these signs would be equal- ly intelligible, were she as well informed as she should be. It is plainly her duty to be intelligent enough to assist nature in the es- tablishment of this important function. But how often, either from ignorance or from false ideas of delicacy, does she fail to interfere, and allow the daughter to be taken by surprise, and perhans fright- ened and thrown into convulsions ! From inquiries made of about one thousand women, a distin- guished English physician found that about one-quarter were unpre- pared for the appearance of the menses. Some of the girls were frightened and went into hysterical fits; others thought they were wounded, and washed with cold water. The flow was stopped in several cases, and in some never restored ; while the health of all in whom it was interrupted was seriously impaired. Symptoms of the First Menstruation. — A variety of symptoms precede and foretell the first menstruation. Headache, dizziness, sluggishness of thought, and disposition to sleep ; these occurring in a girl, may be taken as hints that the " change "is at hand. If to these be added pains in the back and lower limbs, the intimations will be still more significant. At this time a girl loses a relish for the society of children ; she is apt to acquire a taste for solitude ; her temper becomes wayward and fretful ; her eyes acquire a peculiar lustre ; she becomes a sort of mystery to her friends and herself ; not her physical frame only, her whole character is changed. She is about stepping into a new life. Her emotions, thoughts, anticipations, retrospections, are all new to her, and her outward manifestations are new to her friends. An in- telligent mother will not fail now to prepare her mind for the impor- tant event close at hand. The age when this change takes place depends very much upon a variety of circumstances. It occurs much earlier in warm than in cold climates. It is hastened by high living ; by the whirl and bustle and excitement of city life ; by reading novels which are full of love- incidents ; by attending balls, theatres, and parties ; and by mingling much in the society of gentlemen. Early Menstruation not Desirable. — It is a law, both in animal and vegetable life, that the later the period at which maturity is reached, the greater the solidity of the body, and the longer it lives. Girls who menstruate early do so because the body is weakened by climate or luxury, and the nervous system unduly developed by ex- citement; while those who come late to womanhood have firmer constitutions, enjoy better health, and live longer. Those mothers, therefore, commit great errors, who are anxious and administer "forcing medicines," because their daughters do not menstruate at fourteen or fifteen. If girls are suffering from no special ill-health, no anxiety need be felt if " the custom of women " do not come to 382 FEMALE DISEASES. them till the age of eighteen, or even twenty. The delay should excite thankfulness rather than regret. It shows that the constitu- tion has not in it the seeds of early dissolution ; that it is fortifying itself against future disease. Girls who come thus tardily to maturity are much more " regular" in after life. They bear children with fewer accidents, and are af- flicted much less with female diseases. The duty of mothers is plain : it is to bring their daughters forward as late as possible, by refusing their early admission to society, by withdrawing from them all excit- ing reading, by prohibiting their early attendance at parties and theatrical entertainments, by prescribing for them the most unstimu- lating diet, and by requiring a large amount of exercise in the open air. A wide investigation has shown that the first menstruation occurs, in hot climates, at the average age of thirteen years and nineteen hundredths ; in temperate regions, at fourteen years and seventy-four hundredths ; in cold latitudes, at sixteen years and fifty-three hun- dredths. Under the hot-house culture of modern society, and espe- cially among the wealthy classes, where indolence, luxury, and excite- ment unite to weaken the constitution, this change is constantly oc- curring at a more tender age. How Female Diseases are Induced. — All living things have their origin in germs. The germ from which the higher animals spring, man included, is an ovum or egg. Every animal and every vegetable is provided with an organ for the production of germs. In woman, this organ is called an ovary. There are two ovaries, about half an inch in length, one lying on each side of the womb, to which they are attached by ligaments or cords. The ovarian bodies con- tain vast numbers of vesicles, or cells, or eggs, which are the true germs of human life, and the only sources from which, it can spring. Between the ages of fourteen and forty-five (speaking in general terms), every healthy woman matures and deposits an ovum once in twenty-eight days. This vesicle, some time before the monthly flow, begins to germinate and swell, and after a time, like a grain of wheat in the earth, it bursts its covering and springs forth. It then passes through what is called the Fallopian tube into the womb, whence it is cast off. During the swelling and bursting of this vesicle or germ, the ves- sels of the ovaries and womb, and particularly of the membrane lining the womb and its neck, are so crowded with blood as to pro- duce in the parts a state of congestion. If the parts be examined with a speculum at this time, they will be found red, sensitive, and almost inflamed. So great is this congestion, that the woman often complains of pain in the ovaries and the womb, and a general sense of heat, aching, and dragging down in the lower part of the bowels. The pain often extends to the back, the groins, and the thighs. FEMALE DISEASES. 383 This Condition Repeated Every Month. — When we consider that this state of things is repeated every four weeks, and that the congested or crowded state of the vessels begins some days before the monthly flow, and lasts, in all, some ten days, making about one- third part of every month, we need not wonder that inflammation so often supervenes, with all its attendant ill-health and suffering. Increased by Various Causes If we reflect, further, that this congestion is increased, among the wealthy, by high living, and among all classes, by over-stimulation of the nervous system, and by the lascivious morals of the age, we see stronger reasons for expect- ing — what is realty occurring — a continually increasing amount of suffering from female diseases. And when we know, still further, that American females are care- less of their health ; that they often attend balls and theatres at the very time of suffering from this monthly visitation; that they fre- quently wet their feet, and otherwise expose themselves to colds, we cannot feel surprise, even when we learn that from one-half to three- fourths of all women in cities, and quite a large proportion of them in the country, have inflammation of the ovaries, or of the womb, or of the neck of the womb, or suffer some of the forms of displace- ment of this latter organ. Child=Bearing. — The inflammatory state of the uterine organs is often induced by injuries received in child-bearing, and by excessive indulgence in sexual pleasures. Weakness of the Sexual System The womb, moreover, like any other organ, may be naturally frail, and easily affected by dis- ease. This weakness of the sexual system is indicated by the diffi- culty with which menstruation is established, and the presence of the whites, both before and after each monthly flow. Women in whom the generative organs are weak, are much more liable to inflamma- tion of the womb, and to all complaints peculiar to the sex. Description of the Sexual Organs Before describing the par- ticular diseases to which the female generative organs are liable, it is proper to give the reader a brief description of the chief of these organs. The Womb itself, in its healthy, natural state, is about two inches long, and one inch broad — weighing a little more than an ounce, and is in shape like a pear. It is lined with a mere rudimentary mucous membrane. The Neck of the Womb has a cavity distinct from that of the body of the organ, and is lined with a mucous membrane well sup- plied with follicles or glands. The Fallopian Tubes open, one from each side of the base, or largest end of the womb, and extend outward to the ovaries. 384 FEMALE DISEASES. The Ovaries are glandular bodies lying one on each side of the base of the womb. They are more particularly explained else- where. Fig. 136 gives some idea of these organs. A, is the body of the womb ; B, the neck of the womb ; C, C, the vagina ; D, one of the Fig. 136. ovaries ; F, F, the Fallopian tubes ; E, E, the fimbriated extremi- ties ; G, the small ligament attaching the fimbriated extremity to the ovary. Inflammation of the Neck of the Womb Inflammation of the body of the womb is a comparatively rare disease, but inflammation of the neck of this organ is so common that in nearly nineteen out of twenty cases, when females seek relief for whites, for painful men- struation, for stoppage of the menses, or even for what they suppose to be a falling of the womb, a careful examination will show that this pendant portion of the womb is in a state of marked inflamma- tion, or of absolute ulceration. The whites, if they continue with- out intermission from one menstrual flow to another, are almost al- ways the result of one of these conditions of the uterine neck. It would surprise most persons out of the medical profession, and many physicians, to know how large a proportion of the more grave diseases which inflict such terrible suffering upon woman, and so completely shatter her constitution, are dependent for their exist- ence upon a simple local inflammation, either in the neck of the uterus, or in one or both of the ovaries. Many a female has for years suffered agonies, greater than those of death itself, arising, as she supposed, from a complication of ills which invade every part of the system, while the whole of her troubles arose, in fact, from an in- flammation of the neck of the womb merely. Difficulties of Studying Uterine Diseases The social rela- tions of the sexes, and the great delicacy of the matters to be inves- tigated, for a long time prevented direct examination and investiga- tion, so that little knowledge was gained, and as little benefit con- ferred. FEMALE DISEASES. 385 Woman, always distinguished for her modesty, could not be ex- pected to invite investigations which were not proffered, whatever the extremity of her sufferings ; and man, scrupulously sensitive lest he should make himself an intruder by stepping within delicate enclos- ures, have both, in times past, mistaken their duty by misinterpreting the demands of the highest delicacy. Needful Examination not Indelicate. — Rightly viewed, no in- quiries or examinations are indelicate which are necessary to a full understanding of the nature of disease, and which are made with the sole purpose of rendering its cure possible. I agree with Dr. Meigs, the elder, that the delicacy or indelicacy of examining the persons of females for the purpose of exploring disease, depends on the motive with which it is done. To pure-minded persons, it is never, I think, a source of impurity. On the contrary, the self-restraint, the honor- able feeling, and the nice sense of delicacy which it calls into exercise, often heighten the tone of a man's virtue, and certainly increase a true woman's respect for it. Unfortunately, there is now and then a gross- minded man in the profession, who, in these investigations, will vio- late the most sacred of all trusts committed to his hands ; but such monsters — few in number — soon find their level, and are shunned as the most vile of the race. It is now so well understood that these investigations do not lead to immoralities, that the most highly educated, intelligent, refined, and virtuous females almost invariably raise the fewest objections to such examinations as a physician of character may propose. Methods of Investigating Female Diseases. — The symptoms of these complaints will be spoken of in their proper place, as the several diseases come under a brief review. I merely wish to allude here to the methods of physical exploration which modern practice has called to its aid. The Touch. — These methods consist, first, of what is called the touch, which is made either externally upon the bowels, or internally, with the index finger, through the vagina, or passage, from the external genital organs to the neck of the womb. The Speculum. — In the second place, of ocular in- spection of the vagina and neck of the uterus, through an instrument called the spec- ulum. By this instrument, the eye, as well as the finger, is made to assist in learning the real condition of the parts. The finger informs us whether there is any devia- fig. 137. Sims' speculum. 386 FEMALE DISEASES. tion from nature in the bulk, the firmness, the smoothness, or the sensibility of the parts ; while the sight, through the speculum, affords absolute certainty as to ^— -^ whether the parts are suf- fering from inflammation, ulceration, abrasion, or eruption. There are a variety of specula in use by modern physicians, but all are es- sentially of two kinds ; first, a so-called Sims' Speculum (Fig. 137), the end of which, when inserted into the vagina and pulled upon, allows the air to enter and balloons out the vagina so that the parts can be readily seen. This specu- lum necessitates what is known as Sims' posi- tion, i. e. the woman's hips resting on the edge of the bed or table, knees flexed, and chest rest- ing on bed with left arm out from behind her. The second variety of speculum is what is known as the duck-bill pattern (Fig. 138). By a separation of the two blades, the neck of the womb slips in between them. The speculum is then fastened with a thumb-screw, leaving the hands of the physician free. This speculum is used with the woman on her back, and feet resting on the bed or table, with knees flexed. We also give an illustration of an older kind, which is still used to some extent. The end is so shaped as to catch the neck of the Duck-bill Speculum. Fig. 139. womb, and then by drawing the instrument forward slightly, the diseased surface is presented for as perfect inspection as if located externally (Fig. 139). Inflammation, Ulceration, and Enlargement of the Neck of the Womb. Inflammation of the neck of the uterus is very common ; ulcera- tion and permanent enlargement (technically called hypertrophy), are its results, when it is not arrested in due time. These affections, in fact, and the same troubles as they affect the ovaries, make up the FEMALE DISEASES. 387 bulk of female diseases, — being the real causes of the most of those symptoms which have passed under the name of whites, suppression, painful menstruation, sterility, general debility, etc. The neck of the womb, when healthy, is soft and smooth. No hardness or condensation of tissue can be felt by the finger on press- ing over it. It is elastic, too, and feels unctuous to the touch. This latter sensation is communicated by the layer of mucus which covers it. Pressure upon it produces no pain. Inflammation, when found in this part, may begin in the mucous membrane which covers the neck, or in that which lines its cavity, or in the small glands in the body of the organ. Symptoms. — Inflammation of the mucous membrane covering the neck of the uterus destroys the unctuous feel which it has in health. It also causes the neck to swell, its vessels being crowded full of blood. If the body of the organ, as well as the surface, be reached by the inflammation, it will be hardened and enlarged; and in consequence of its increased weight, it is apt to drop down some- what into the cavity of the vagina. In married ladies, it is often, by physical pressure, pushed a little backward, or retroverted. Exami- nation with the speculum shows the inflamed neck to be of a vivid red, instead of a pale rose-color. It may be covered with red or white pimples, which are glands enlarged with muco-pus. In the healthy state, the mouth of the womb is so much closed as to be just perceptible when the finger passes over it. Inflammation causes it to be more or less open, and its lips to be parted. Inflammation followed by Ulceration. — In a majority of cases, inflammation of the neck of the womb and of its cavity is soon followed by ulceration, which generally appears first around the mouth, and just within the cavity of the neck. From thence it spreads both inward and outward. Various Degrees of Ulceration, etc. — Of course, these inflamma- tions and ulcerations mix and run into each other in all possible forms, — presenting excoriations, or raw places ; granulations, or pimply surfaces ; and indurations, or hardened parts. Sometimes these pimply patches will be red and hard, and again the whole sur- face will be spongy, and will bleed upon the slightest touch. In many cases, these ulcerations make wretched work with the mouth of the womb, eating deeply into the cavity, and giving it a ragged and unsightly appearance. Velvety Feel from Ulceration. — Ulceration generally gives to the surface on which it exists, a soft, velvety feel, which the finger gener- ally recognizes. This velvety sensation, with the open state of the mouth, are the most important evidences we can derive from the touch, of this form of disease. The Discharge from these Ulcers is always Pus, or, in common 388 FEMALE DISEASES. language, matter. It is sometimes poured out scantily, at other times very freely. It may be thick and yellow, or thin, and of a lighter color. The inflammatory and ulcerated condition of the neck of the womb often gives rise to pain ; and when the seat of the disease has not been examined, as it should be, this pain has frequently been called neuralgia. In this way, ignorance has compelled neuralgia to stand sponsor for a great many pains with which it has had nothing to do. These Ulcers Disturb Menstruation. — Menstruation is generally changed more or less in its character by the presence of inflamma- tion or ulceration in the neck of the womb. It usually becomes more painful. In some cases it is made more profuse, in others more scanty. It may come on more frequently, or it may be postponed, protracted, or abridged in its continuance. There is generally pain of a dull, aching kind, low down in the back. There is often a feeling of full- ness, pain, and a sense of bearing down in the lower part of the bowels ; sometimes the pain extends to the groins and thighs. Extensive Disturbances from these Inflammations, etc. — The nerves with which the womb is liberally supplied belong to those of the sympathetic system. Hence, the condition of the uterus influ- ences a wide circle of sympathies. By these nerves this organ is brought into close relationship with the organs of animal life. If the former suffer, the latter suffers also. The stomach, being intimately connected with the womb, physically, feels keenly these inflammations and ulcerations of the uterine neck. At times, the pain, debility, general disturbance, and dyspeptic state of the stomach are such as to cheat both the doctor and the patient into the belief that this organ is the seat of the disease. But in such cases, the symptoms of stom- ach disease will all disappear the moment the local affection is re- moved from the neck of the womb. The liver, too, often participates in these troubles, and becomes sadly deranged. It is sometimes even greatly enlarged and congested, and patients frequently have the various symptoms of what are called liver complaints. Severe pains are sometimes felt under the breast-bone, and over the chest generally, making the patient apprehensive of disease of the lungs ; and indeed consumption is not a very infrequent result of uterine diseases. Pains are often felt in the region of the heart, which organ is often harassed with palpitations. The flesh is apt to waste under the symptoms excited by these in- flammatory and ulcerative processes in the uterine neck ; and even the brain, though lying in some measure beyond the circle of influ- ences set in motion by the organic nerves, suffers disturbance and pain. FEMALE DISEASES. 389 Even the special senses of sight and hearing may be drawn into this general vortex, and both be much impaired. And to crown this catalogue of ills, it may be mentioned that those distressing things called hysterical fits proceed from the same local disorders. In brief, there is scarcely a point in the human body to which these inflammatory and ulcerative conditions of the uterine neck may not send their sympathetic pains and aches, and where they may not in time induce real disease. This is the reason why so many women suffering from these local complaints, tell the physician, when con- sulting him, that they are " diseased all over" If asked where the complaint is located, they will answer, " It is everywhere" In the most earnest manner the assurance will be given, "Doctor, there isn't any well part about me." Treatment. — It is just as unreasonable and useless to treat these inflammations and ulcerations through the stomach, as it is an in- flamed or ulcerated throat. They are local diseases, affecting a par- ticular part, and the remedy must be local. Like all other affections, these can only be managed intelligently after their nature is well understood. Nothing can really be done to- wards a cure until it is known what the matter is; and no competent physician will move a single step in the treatment of one of these cases until he has made a thorough examination. He owes this to himself and to his patient, the more so as the neck of the womb may be as easily examined as the upper part of the throat, and the local remedy may be almost as. readily applied in the former case as in the latter. If, upon the introduction of the speculum, the uterine neck be found simply inflamed and enlarged, the application of ichthyol and glycerin to the canal will reduce the swelling and inflammation; while a tampon of wool soaked in the same and placed behind the womb will reduce the entire swelling- of the womb by the watery discharges which are produced. The patient must learn to lie down most of the time. If this should not succeed (though it will in most cases) then introduce a speculum, and when the neck of the womb is fairly lodged in its extremity, drop in two or three leeches and al- low them to fill. One who is not accustomed to treat these affections in this simple way, will at first be surprised at the rapidity with which the local trouble will disappear, and with it the thousand and one aches and pains which torment the whole body. As the terrible pains in the whole face and head which are produced by a single tooth all in- stantly come to an end when* the tooth is extracted, so do the bad feelings all over the body subside as fast as the local ailments of the uterine neck are cured. There is no exception to this rule, except where the sympathetic affection has become fixed by long neglect of the primary uterine disease. It is, therefore, surprising that so many excellent women, whose lives are of the greatest value to them- 390 FEMALE DISEASES. selves and friends, should be permitted to perish of these ailments, when the cure is so simple, and many times so entirely within the reach of the most ordinary skill. It is a reproach to the profession which should be wiped away. If there are a hundred motives for gaining the mastery over other diseases, there are a thousand for learning to control these. More than any other disease, or all others, they make the homes of men desolate, by robbing them of women, their ornament and solace. The physician who neglects to make himself acquainted with all there is to be known of these complaints, shows himself not only unfit for his profession, but deficient in some of the prime elements which combine to make a true man. Hardening of the Uterine Neck. — In many cases the uterine neck is not only inflamed and enlarged, it is indurated and hardened. At times it is enlarged and hardened on one side, and not much on the other. In still other cases, there are enlarged spots, or nodes, giving the whole neck a knotty feel under the finger. These hardened conditions of the uterine neck proceed from vari- ous causes, and are more difficult to cure than the ordinary inflam- mation, or even ulceration. They sometimes indicate cancerous dis- ease, and then, of course, involve the most serious considerations. The glycerin tampon and the hot vaginal douche will do more for this hardening than all else combined. Uterine Syringe. — For applying the several remedies to the inter- nal cavity of the uterine neck, I have contrived a silver syringe, which is bent a little at the extremity, and pierced with fine holes all round. With this instrument, the remedy is carried directly to the diseased part, and applied instantaneously to every side of the cavity. Besides these local applications, it is frequently necessary to resort to soothing or astringent injections into the vagina, hip-baths, and injections into the bowels, some mild physic, and rest in a horizontal position. These matters will all be judiciously regulated by the at- tending physician, if he is master of his business. Inflammation, etc., of the Ovaries. — Ovaritis. The inflamed condition of the ovaries is indicated by increased heat, and pain upon pressure. The pain in the ovarian region is sometimes intermittent, sometimes constant, and occasionally passes down to the loins and thighs. There are acute and chronic inflammations of the organs; but it will be sufficiently accurate, in a work of this kind, to treat of them as essentially one. The effects of inflammation upon the ovaries, as upon other bodies, are various, sometimes enlarging and hardening, at other times col- lapsing and blasting them. This last effect, it is hardly necessary to say, cuts off all hope of bearing children. FEMALE DISEASES. 391 The Causes of ovarian inflammation are numerous. One of the most important causes has already been noticed, namely, the conges- tion of the parts, for several days, at every menstrual period. This, amounting as it does almost to inflammation, is often intensified by other causes, such as wetting the feet, taking sudden colds, excessive fatigue from dancing, and exciting drinks. Sexual indulgence often proves a cause of inflammation in these bodies. It is particulary apt to have this effect in the newly-married female, with whom it is a novel stimulus, and often applied with im- moderate excess. In late marriages, when the stimulus to the ovaries has long been denied, its sudden presentation is liable to make an in- flammatory impression. Its entire absence, too, in persons of strong passions, may result in ovarian disease. This inflammation may be produced by the new state of things existing at the critical period called the turn of life, when it reacts on the womb, producing the floodings which often bring menstruation to a close. The congestion, too, which has been present every month for many years, does not immediately cease at this change ; and not finding relief by the accustomed flow, the ovarian bodies are exposed to inflammation. In all large cities, the pest-houses of civilization, where the women are more numerous than the men, there are many females whose vir- ginity is a burden, and numerous others who give themselves up to sexual excesses ; to both these classes, the turn of life is very liable to promote these ovarian disorders. There is another class of causes, which, though not so easily re- cognized, are equally cogent in exciting this form of disease. I mean all those excitements which arise from unbridled thoughts, from books of questionable character, from music, social intercourse, and stimulating food and drinks, — all which promote and intensify burn- ing desires, which, though natural and proper in themselves, cannot lawfully be gratified in a community where the female sex greatly preponderates, numerically, over the male. When we consider how powerful within a woman's breast the conflict often is between the impulse of passion and the dictates of duty, and how strongly this conflict must react upon the sexual organs, and especially upon the ovaries, the centre of the sexual system, we can easily see in how many cases they may become inflamed. Another cause of this disease is suppression of the menses. The engorged and crowded state of the vessels of the womb, of the ute- rine neck, and oi the ovaries, not finding vent in the accustomed flow, inflammation in any one of these organs is a very natural result. The inflammation of these ovarian bodies is a frequent result, too, of a similar condition, previously existing in the neck of the womb. In passing from the uterine neck to the ovarian bodies, the inflamma- tory condition often fastens itself upon the broad ligament, the fallo- pian tubes, and their fimbriated extremities. The whole, it will be 392 FEMALE DISEASES. seen, presents an amount of disease which it is painful to contem- plate. The womb being turned over, and pressing against one of the ovaries, may cause it to inflame by mechanical irritation. Pessaries, injudiciously used, may do the same thing. Symptoms. — The first and most obvious symptom is a pain a little to the right or left of the womb. This pain is almost always increased by walking, riding, or by external pressure. It is especially aug- mented by straightening the thigh, by which the parts over the in- flammation are put upon the stretch. When standing up, ladies suffering from this disease are generally compelled to rest the foot on a stool, so as to bend the thigh, and relax the muscles. The pains radiate from the ovaries, and go down* to the loins and thighs, and sometimes to the fundament. They are of a dull, dragging, heavy nature. Sometimes the ovarian bodies become very much enlarged, and dropping down somewhat, press upon the lower bowel, causing con- stipation, or upon the neck of the bladder, creating a frequent desire to urinate, and an inability to pass the water freely. Treatment. — As inflammation of the ovaries is always increased during the menstrual flow, it is not proper to meddle with it at these monthly periods, lest the trouble be aggravated. Immediately after one of the turns has passed, from six to eight leeches should be ap- plied over the diseased ovary. When the bites are healed, a blister may be used in the same place. The scarf-skin should not be re- moved, and the irritated surface must be healed as soon as possible. The blister should be camphorated to prevent strangulation. The part should next be rubbed for a few minutes, night and morning, with an alterative and anodyne ointment (169). After the next menstruation, the same things should be repeated, and again after the next, and so on, for five or six months, or even longer, if need be. The already bloodless condition of the patient may require, however, that the leeches should not be applied more than once, or, at most, twice. The bowels should occasionally be opened by some simple cathartic, for the purpose of removing all hard substances which may press against and fret the inflamed ovaries. The purgatives employed should be of the most cooling kind, such as salts or oil ; while aloes, and all harsh cathartics must be avoided. Injections of tincture of belladonna and hyoscyamus are useful for quieting neighboring parts, and warding off external disturbances. They act like soft substances thrown upon the pavement in front of a sick man's house. A piece of flannel soaked in hot laudanum, laid over the ovary and covered with dry flannel, will give great relief and enable the patient to sleep. The patient should be kept, as much as possible, in the recumbent FEMALE DISEASES. 393 position, lying upon the bed or the lounge, and should only be per- mitted to move about to such extent as will not irritate the inflamed parts. Whites. — Leucorrhcea. — Fluor Albus. Leucorrhcea is from two greek words, Xefyog and psm, andfluor albus from two Latin words, albus and fluo, having precisely the same meaning as the Greek, namely, a white discharge. Hence, in popular language, the disease is called the " whites "; it is also called ^female iveakness." These terms are well enough, perhaps, if we have in mind that they conve} r to us only the idea of a symptom of disease. They all mean, with the exception of the last, a white discharge from the female genital organs. They are slightly inaccurate, as the discharge is sometimes yellow, or green, or otherwise variant from white. Any discharge from the female genital organs which is not bloody, comes under the term " whites." A Symptom Only. — As the name of a disease, the term whites has no specific meaning. It does not designate any particular complaint. It is a symptom, just as the matter expectorated and raised in lung diseases is a symptom ; and as such only should it be regarded. When persons cough and raise a great deal, they do not, on consult- ing a physician, say they have got the expectoration ; but they say they fear they have some disease of the lungs, because they expecto- rate. They look upon the expectoration as the sign or symptom of disease. So females, and physicians too, must learn to look upon the whites, not as a disease, but as the sign or symptom of disease, which sign they should become skilled in interpreting. There is no reason why the discharge from the genital organs should not be as well interpreted as the expectoration or discharge from the throat. The parts from which it comes may be about as easily and as well inspected. No Female Ailments so Common. — There are no female troubles to which the attention of the physician is so often called as these annoying and debilitating symptoms called whites ; and there is no department of medical practice in which the really able as well as conscientious and painstaking physician is so well tested. If, re- garding these discharges as they are, simply as signs, he searches faithfully for their cause, he will be led to a treatment which in a great majority of cases will be successful. And surely no success in life can be more prized by a right-minded physician. It procures health, the highest earthly boon, for suffering woman, and gratitude, the most prized of all rewards, for himself. There are Four Kinds of Discharges from the female genital or- gans, — mucus, pus, mucus and pus combined, and the watery. The 394 FEMALE DISEASES. first, mucus, does not in itself imply disease ; but when pus is dis- charged, we know that inflammation exists, because such a cause alone can produce it. Seat of the Disease. — The cause which produces the whites may have its seat either in the vagina, or in the neck of the womb ; and in practice it is of course quite important to know where its location is. The character of the discharge generally settles this point. If it be thin and watery, or thick and cream-like, it is from the vagina or passage which leads to the womb ; if ropy, gluey or albuminous, like white of egg, it is from the cavity of the uterine neck. Treatment. — Some physicians always prescribe the same remedy for the whites. They might as well have but one prescription for expectoration. The remedy must have reference to the cause of the discharge ; until the cause be searched out, every prescription is a mere trial at guessing, — a sort of practice well enough adapted to quacks, but not becoming scientific men. When a case of whites is brought before a physician who under- stands his business, he makes no prescription until he has discovered what the disease is. Having determined this point, his remedies have an intelligent bearing upon the case. If the discharge be of a ropy, tenacious character, one of the best remedies is a strong solution of nitrate of silver, used as an injection with a female syringe, once a day (254). Of this, not more than two teaspoonfuls should be used at a time ; and great care should be ob- served not to stain the underclothes with it. When the discharge is either yellow and thick, or lighter colored and watery, some one of the following: (200), (202), (203), (207), (209), (220), (230), (232), (243), (244), may be used with advantage as an injection, twice a day. An infusion of the white pond-lily, one ounce to the pint of water, makes a very excellent injection, which may be used twice a day. A very simple injection, and sometimes quite effectual, is a strong infusion of green tea. Some one of the above remedies will generally afford some relief ; but if whites exist in a somewhat aggravated form, they furnish evi- dence of some serious disease in the vagina or neck of the womb, and the case ought to be submitted to a competent physician. Absence of the Menses. — Amenorrhea. The absence of the menses is divided into two kinds, — retention and suppression. It is retention when the monthly flow has never appeared ; suppression, when, having been established, it is, by one cause or another, stopped. Retention Explained. — The ovaries, as we have before said, are the centre of the female sexual system. It is the swelling or ripening FEMALE DISEASES. 395 of an ovum or egg, every four weeks, which causes the large flow of blood to the parts, and the consequent menstrual discharge. But it sometimes happens that the ovaries are not developed at the usual time of life. The monthly evacuation does not then appear. There is retention. There may be retention, too, from other causes, after the ovaries are matured. Costiveness may sometimes occasion it ; so may a degenerated and low state of the blood. There may be mechanical causes of retention. The mouth of the womb may be entirely closed, or the neck may be so constricted as to close the passage through it, leaving no outlet for the monthly ac- cumulation. The hymen, also, may have no opening through it. When these mechanical obstructions exist, there are sometimes large collections of fluid in the womb, which cause enlargement of the body, and in some instances, painful suspicions that the sufferer has com- mitted imprudences, and is in the family way. Physicians should be on their guard against falling into such errors, and lending the sanc- tion of their name to these blasting mistakes. Suppression Explained. — Suppression — a stoppage after flow has been once established — may be caused by inflammation of the ovaries, the blood, in this diseased condition, being drawn so entirely to these swelling and germinating bodies, that the accustomed flow from the womb does not take place. Inflammation in the neck of the womb may also cause a stoppage. So may a fright, as from a fire occurring in the neighborhood, or a cold taken by being caught in a shower. Girls sometimes, in their utter thoughtlessness or ignorance, dip their feet in cold water, when their courses are upon them, and bring on a suppression of a most dangerous character. The most lovely and innocent girls have done this for the purpose of attending a party; and, in some instances, the stoppage induced has ended in death within a few hours. The pro- found ignorance of their own mechanism, and of the laws which gov- ern it, in which girls are kept who are just budding into life, is a serious reproach both to parents and physicians. Suppression may be induced by whatever reduces the quantity or quality of the blood, as consumption, or by great depression of spirits. With some rare exceptions, women have not their turns while in the family way. Treatment. — Before anything can be done in the way of treat- ment, the case must be thoroughly investigated, and the specific cause of the disease searched out. If it prove to be retention, and arises from a bloodless condition and an undeveloped state of the ovaries, iron is the proper remed} r (61), (73), (74), (75), with a generous diet and exercise out of doors. If caused by an inflammatory state of the uterine neck or ova- ries, the proper treatment has been already indicated. If from cos- tiveness, relief may generally be found from prescriptions (5), (9). 396 FEMALE DISEASES. The mechanical causes alluded to above, when found to exist, must be removed by gently dilating the mouth of the womb or the uterine neck, with bougies, beginning with the smallest, and increasing the size, or by puncturing the hymen, as the case may require. Per- manganate of potash, in capsules of 2 grains each, after meals, is one of the best remedies. In Treating Suppression, it should be borne in mind that at a cer- tain time each month nature makes an attempt to restore the lost function. Even when she is not successful, probably an ovum is ma- tured and in some way disposed of. The intelligent physician will of course avail himself of this favorable moment to try his skill in bring- ing about the desired regularity. When this time arrives, he should order three or four leeches applied to each groin at night. The next night, he should direct the use of a pungent foot-bath (242) ; also (16) as a cathartic. When suppression exists, it is not always proper to try in this direct way to bring on the turns. There may be no blood to spare ; and this may be the sole reason why the courses do not appear. When this is the case, nothing is to be done but to build up the health as rapidly as possible, and when this is sufficiently established, the courses will be all right. Profuse Menstruation. — Menorrhagia. Menstruation may. continue too long, or occur too often, or be too profuse while it lasts; or all these irregularities may be experienced by the same person. Any one of them will prove a serious irritation, and a drain upon the constitution ; the whole together, if not arrested, will undermine and destroy it. The Cause of this, like the source of all other female diseases, is, in a great majority of cases, overlooked. It is not to be attributed, as so many suppose, to a congested state of the womb ; but is rather the result, in a great many instances, of the inflammatory or ulcerated condition of the uterine neck. In still another large number of cases, it arises from a succession of ovarian abortions. When the blood has run low, and nutrition is defective, as in the consumptive habit, the ovarian vesicles fail to reach maturity. Like other products of the economy, they become blighted, and abort. And as these blights occur often, nature is busy every two or three weeks casting them off. Hence, the menses appear often. They come and go without order, because they spring from a process which is a contraversion of nature's laws. Profuse menstruation, like scanty menstruation, is a symptom of a variety of diseases. The quantity may be increased only on one or more days, or be so great as to cause death from hemorrhage. At all events, the amount of blood lost is often so great as to cause anaemia FEMALE DISEASES. 397 and impaired health for a long time. This is, however, usually the result of continued free bleeding extending through a number of months. The local causes of uterine hemorrhage are fibroid tumor of the womb ; inflammation of the womb, or metritis ; inflammation of the lining membrane, or endometritis ; uterine congestions from any source ; cancer of the womb in its early stages ; retroversion, or tip- ping over backward of the womb onto the rectum ; polypus ; enlarge- ment of the womb following labor or abortion ; the retention of pla- cental tissue, etc., etc. These also are among the local causes of hem- orrhage. But not infrequently the excess of flow is due to impaired general health. Wasting diseases like phthisis or consumption cause the blood to be so thin as to render it unable to form a clot, thus facilitating the easy or profuse hemorrhage often seen in young girls in the earlier stages of consumption ; later, amenorrhcea ensues from utter lack of blood. This flowing often attends acute fevers, pur- pura, Bright's disease, jaundice, heart-disease and debility. This last cause is often seen in the case of young girls who have grown rapidly since puberty and pursued a vigorous course of study with little or no out-door exercise. The strain on the nervous system in these girls is kept up constantly by sharp competition, and no heed is paid to nature's demand for rest and relaxation at the menstrual time. The claims of society on the young girl add no small share in the production of this evil. Explanation. — It is not easy to explain how inflammation and ulceration of the uterine neck should in one case produce suppression, and in another profuse menstruation. Yet it is a settled truth that such opposite results do come from one and the same apparent cause. Probably the explanation is to be found in the different degrees of inflammatory action, in the varieties of constitution, and in the variant degrees of tenacity with which the vessels hold the blood. Bleeding from the female genital or- gans may be produced by a variety of causes which have nothing to do with menstruation. Such bleedings are prop- erly uterine or vaginal hemorrhages, and not profuse menstruation. They are the result of inflammations, or tumors within the uterine neck (Fig. 140), or weak- ness. The womb may bleed for days, or even months, from pure debility. Treatment. — As profuse menstruation and uterine hemorrhage spring from a variety of causes, so the remedies are various. Here again we are confronted with the same absolute necessity to investi- 398 FEMALE DISEASES. gate accurately the true nature of the complaint before we venture a single prescription. All the cases present one general feature. There is too great a loss of blood ; and the first thought is that astringent medicines are necessary to arrest it. But if the bleeding be occasioned by a polypus, or by inflammatory ulceration, astringents would not arrest it, and might do great mischief. When the immoderate flowing is caused by a general breakdown of the nutritive powers, and by ovarian abortions, the great aim must be to rally the vital powers by iron, quinine, porter, wine, a generous diet, exercise on horseback and on foot, and warm and cold bathing. When produced by local diseases of the ovaries and neck of the womb, the treatment is to be local, — such as has been described. If a polypus or other tumor be the cause, the remedy must be sought for under the appropriate head. If the womb has become relaxed, and bleeds from pure debility, — as it may, — something must be found, if possible, which will condense its substance, making it harder, smaller, and more solid. For this purpose, cold bathing, as- tringent injections into the front passage, and acid drinks are useful. But one of the best remedies is the wine of spurred rye (267). One teaspoon ful should be taken three times a day. This article, by causing the womb to contract, solidifies and condenses it, thus arrest- ing the blood which oozes from its relaxed tissues. Of course, the object of all treatment is twofold : the one to stop the hemorrhage for the time being, the other to remove the cause. The physician may have to be called, and resort had to tampons in the vagina ; the uterus itself might have to be packed with gauze ; hot douches of 115° to 120° F. will frequently quiet a stubborn hemorrhage, espe- cially if rest in bed with the hips elevated be strictly enjoined. The hot douche should be repeated every three hours. Besides the giving of ergot, hydrastis, hamamelis and atropia are also quite useful, as, for instance : Fluid extract ergot, fluid extract hydrastis, fluid extract hamamelis, of each twenty drops, in water every three hours, with the addition of ^ grain of atropia at the same time. Sedatives, like the bromide of soda, in ten-grain doses every hour or two, will be of service if the hemorrhage be caused by fright, grief, or injury. The treatment of the intervals must depend on the cause, but generally some systemic tonics like iron or quinine are of great service ; rest in bed is, par excellence, the treatment in most cases at some stage of the flowing, generally during the flow itself ; but rest from excitement and freedom from overwork are equally important when the hemorrhage is due to this cause. Out-door exercise, fresh air and good food are none the less important for weary brains and tired nerves. Hemorrhage between the periods, or menorrhagia. — When hem- orrhage from the womb occurs between the periods, it is called Men- orrhagia, and is more apt to occur in women past thirty years of age, or, at all events, in married women. It is of more significance usually FEMALE DISEASES. 399 than profuse menstruation, and almost always proceeds from the womb itself. This bleeding comes on often after the menopause, or " change of life." The causes are quite similar to those just considered, but local causes are oftener found. Some sloughing surface, as from cancer, fibroid, erosion of the lining membrane, exists in half the cases. Abortion, and the retention of small pieces of afterbirth, are frequent causes of this kind of flowing. This trouble demands the immediate attention of the family phy- sician or the specialist, who will examine the uterus and ascertain the cause ; and, as not infrequently, the cause consists in something to be removed, a brief mention of the methods employed will not be out of place. The size, shape, position and firmness of the uterus and ovaries are made out by the examining fingers of the left hand being pressed into the abdominal walls above the bladder, while the fingers of the right hand, with the knees drawn well up, are introduced into the vagina and pressed against the neck of the womb. An endeavor is then made to bring the womb between the two sets of fingers, which maps out its locality, position, etc. The ovaries and ligaments are likewise located. Any erosion of the mouth of the womb, foreign growth there, malposition, excessive size, etc., can thus be readily detected. To explore the inside, one of the various specula before described are used, and the uterus dilated either with tents, so-called, or more commonly with a steel dilator. If, then, there is found aught to be removed, a sharp, spoon-like instrument, called a curette, is used to scrape away all diseased tissue or foreign growth, and the womb then washed out with some antiseptic solution. The womb is then often packed with gauze to still further disinfect its interior and afford a means of draining away all oozing blood or forming mucus. This operation called curetting is now frequently done as a regular means of treatment to do away with the causes of hemorrhage and to restore the normal bulk and character of the womb, instead of resort- ing to the slow, tedious, and less successful methods of former times. It is, to be sure, a regular operation; but when done under so-called aseptic methods, to be described later, is a perfectly safe and trust- worthy treatment, far in advance of old-fashioned methods, which seem less heroic. It necessitates rest in bed, nursing, and the disadvantages of sick- ness; but on the other hand, it saves lives, stops disease, and renders useful what otherwise might become useless and dangerous to life and health. Painful Menstruation. — Dysmenorrhea. Dysmenorrhea is from three Greek words Bv